Video-capsule endoscopy – current and future role
Video-capsule endoscopy is a non-invasive technology that directly visualizes  the mucosa of the gastrointestinal (GI) tract. Small bowel capsule endoscopy (SBCE) is a first-line test for investigating the small bowel. The most common indications for SBCE include suspected small bowel bleeding, iron deficiency anaemia, suspected Crohn disease (CD) and the assessment of esta blished CD. SBCE is safe and well tolerated by patients. The most common complication of SBCE is capsule retention, defined as retention of the capsule in the GI tract for>2  weeks after ingestion. (Source: Medicine)
Source: Medicine - March 27, 2024 Category: Internal Medicine Authors: Paul Collins Tags: New advances Source Type: research

Novel gastrointestinal procedures
Technological advancements have shaped the landscape of modern gastroenterology thanks to the accessibility of the gastrointestinal tract to endoscopic interventions. Over the last decade increasing research efforts have been dedicated to integrating artificial intelligence into endoscopy to allow the early detection of premalignant and early malignant lesions. Meanwhile, progress has been made in minimally invasive cell collection devices to reduce the burden of endoscopy in the context of preventive medicine. (Source: Medicine)
Source: Medicine - March 27, 2024 Category: Internal Medicine Authors: Juliana Serrazina, Massimiliano di Pietro Tags: New advances Source Type: research

Colorectal cancer: features and investigation
Colorectal cancer (CRC) is very common, affecting>40,000 people a year in the UK. The pathogenesis is mostly sporadic, but hereditary genes and inflammatory bowel disease are well-known causative factors. The symptoms can be very variable, are based on the location of the lesion and tend to be more obscure if they are right sided. Symptoms also overlap with benign conditions so luminal imaging, mainly colonoscopy as the gold standard, is needed. Bowel cancer screening programmes are designed to detect the earlier stages of CRC. (Source: Medicine)
Source: Medicine - March 27, 2024 Category: Internal Medicine Authors: Kris J Jourand, Justin Davies Tags: Colorectal cancer Source Type: research

Colorectal cancer: prevention and early diagnosis
This article reviews the aetiology and risk factors for CRC and focuses on strategies for prevention and early diagnosis. Prevention involves identifying and optimizing modifiable risk factors through  public health awareness. Population screening for CRC is well established in clinical practice and increasing data support it as an effective method for early cancer detection and prevention through polypectomy, although multiple different appropriate faecal tests and endoscopic approaches exi st and will be evaluated. (Source: Medicine)
Source: Medicine - March 26, 2024 Category: Internal Medicine Authors: Nicole Cianci, Giulia Cianci, James E East Tags: Colorectal cancer Source Type: research

Chronic pancreatitis and exocrine pancreatic insufficiency
Chronic pancreatitis is a fibro-inflammatory disease of the pancreas characterized by inflammation and fibrosis. It is associated with excessive alcohol consumption and smoking, although a number of other risk factors are increasingly recognized, including a genetic predisposition. Patients typically present with upper abdominal pain, weight loss and changes in bowel habits caused by exocrine pancreatic insufficiency. Additionally, chronic pancreatitis is frequently complicated by post-pancreatitis diabetes mellitus and a number of other conditions, including common bile duct stenosis and duodenal obstruction. (Source: Medicine)
Source: Medicine - March 26, 2024 Category: Internal Medicine Authors: S øren Schou Olesen Tags: Pancreas Source Type: research

Inherited gastrointestinal cancer syndromes
Inherited gastrointestinal (GI) cancer syndromes account for 5 –10% of cancers of the GI tract. Surveillance is tailored to prevent cancer or enable its early detection. Lynch syndrome accounts for 3% of colorectal cancers (CRCs). It is caused by a germline pathogenic variant that affects one of four mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. Individual s with a variant affecting MLH1 have the highest risk of developing CRC. Familial adenomatous polyposis (FAP) is an autosomal dominant syndrome caused by a truncating mutation of the APC gene. (Source: Medicine)
Source: Medicine - March 26, 2024 Category: Internal Medicine Authors: Paul Collins Tags: Colorectal cancer Source Type: research

Connective tissue disorders and the gut
Gastrointestinal (GI) symptoms are common in both inflammatory and non-inflammatory connective tissue disorders and can involve any part of the GI tract from mouth to anus. Dysphagia, gastro-oesophageal reflux, nausea, vomiting, abdominal pain and changes in bowel habit are common symptoms and usually arise from GI dysmotility and altered visceral sensitivity. In scleroderma, sensorimotor dysfunction is pronounced and can result in complications such as Barrett's oesophagus, gastroparesis, small intestinal bacterial overgrowth, malabsorption and malnutrition, with an associated reduction in survival. (Source: Medicine)
Source: Medicine - March 26, 2024 Category: Internal Medicine Authors: Asma Fikree Tags: New advances Source Type: research

Pancreatic cancer
The most common form of pancreatic cancer is pancreatic ductal adenocarcinoma. The long-term outcome of pancreatic cancer is extremely poor: overall median survival from diagnosis is 3 –6 months without treatment, increasing to around 23 months with resectional surgery and adjuvant treatment. Pancreatic cancer is usually diagnosed late and has a biological phenotype characterized by resistance to all cancer treatment modalities and early metastasis. Jaundice is the most commo n presenting symptom. (Source: Medicine)
Source: Medicine - March 26, 2024 Category: Internal Medicine Authors: Stella Dilke, Duncan Spalding Tags: Pancreas Source Type: research

Endoscopic ultrasonography
(EUS) is a high-frequency, high-resolution, real-time modality for imaging the gastrointestinal tract and surrounding extramural structures. Originally introduced as a diagnostic tool, EUS is  primarily used to stage luminal malignancies, including tissue acquisition, and to assess pancreatic and subepithelial lesions, particularly in individuals fit for surgery. In addition, therapeutic EUS has expanded into a range of indications for the treatment of gastrointestinal diseases. (Source: Medicine)
Source: Medicine - March 26, 2024 Category: Internal Medicine Authors: Ira Upadhye, Manu Nayar Tags: New advances Source Type: research

Diverticular disease
Colonic diverticula are formed by mucosal outpouching from the colonic wall. Their presence increases with increasing age, with most, white patients, being situated in the left colon. The aetiology of these outpouchings is not fully understood but dietary, lifestyle and genetic factors have all been implicated. Most patients with diverticula  are asymptomatic (diverticulosis); however, approximately 20% develop symptoms such as intermittent abdominal pain and change in bowel habit and are said to have symptomatic diverticular disease. (Source: Medicine)
Source: Medicine - March 26, 2024 Category: Internal Medicine Authors: David Humes, Christopher Lewis-Lloyd Tags: Diverticular disease Source Type: research

Colorectal cancer: management
Colorectal cancer is the fourth most common cause of cancer, contributing to 11% of all cancers, and the second most common cause of cancer death worldwide. The lifetime risk is greater in developed countries compared with lesser-developed countries, with survival influenced by stage of disease, socioeconomic factors and healthcare access. Early detection through bowel screening programmes in asymptomatic populations, risk stratification of symptomatic populations and surveillance of high-risk groups aim to identify early-stage disease. (Source: Medicine)
Source: Medicine - March 26, 2024 Category: Internal Medicine Authors: Farhat V.N. Din, Malcolm G. Dunlop Tags: Colorectal cancer Source Type: research

Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - March 25, 2024 Category: Internal Medicine Tags: Self-assessment/cpd answers Source Type: research

Irritable bowel syndrome
(IBS) is a disorder of brain –gut interaction (formerly known as a functional gastrointestinal disorder) typically characterized by at least weekly abdominal pain associated with a change in frequency and form of the stool. IBS is common, with a population prevalence of around 5%. It is associated with a marked reduction in q uality of life and significant healthcare expenditure. Its pathophysiology remains incompletely understood. IBS is subclassified according to the predominant bowel habit. (Source: Medicine)
Source: Medicine - March 4, 2024 Category: Internal Medicine Authors: Adam D. Farmer Tags: Motility and functional bowel disease Source Type: research

Crohn's disease
is a chronic, relapsing and remitting inflammatory disease  affecting any area of the gastrointestinal tract. It is becoming increasingly prevalent in western Europe, the USA and China, with the highest age-standardized prevalent rates in Norway. It is associated with modifiable risk factors such as smoking and diet, and non-modifiable risk factors includi ng gene variants; however, there is no specific method to prevent its onset or effect a cure. Patients often complain of diarrhoea and abdominal pain, but symptoms can occur intermittently for many years before diagnosis. (Source: Medicine)
Source: Medicine - March 4, 2024 Category: Internal Medicine Authors: Hannah Walton, Beatriz Gros, Shahida Din Tags: Inflammatory bowel disease Source Type: research

Anorectal function testing
Faecal incontinence and evacuation disorders are common conditions that cause significant morbidity. Patient-reported symptoms are poor predictors of underlying pathophysiology, so anorectal function testing is a key component of the clinical evaluation when initial management strategies fail. A number of investigations are available to assess anorectal structure (endoanal ultrasound, defaecography) and function (anorectal manometry, rectal sensory test, balloon expulsion test, defaecography). This review article outlines the usefulness and relevance of these investigations for investigating patients with faecal incontinen...
Source: Medicine - March 2, 2024 Category: Internal Medicine Authors: Emma V. Carrington, S. Mark Scott Tags: Motility and functional bowel disease Source Type: research