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Gastroenterology Clinics of North America
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ISSN (Print) 0889-8553
Published by Elsevier

[2589 journals]

Gastroparesis
- Abstract: Publication date: March 2015
  Source:Gastroenterology Clinics of North America, Volume 44, Issue 1
  Author(s): Henry P. Parkman , Pankaj Jay Pasricha
  
  PubDate: 2015-02-08T14:37:02Z
Gastroparesis
- Abstract: Publication date: March 2015
  Source:Gastroenterology Clinics of North America, Volume 44, Issue 1
  Author(s): Gary W. Falk
  
  PubDate: 2015-02-08T14:37:02Z
Diabetic Gastroparesis
- Abstract: Publication date: March 2015
  Source:Gastroenterology Clinics of North America, Volume 44, Issue 1
  Author(s): Kenneth L. Koch , Jorge Calles-Escandón
  
  Teaser Gastroparesis is a complication of long-standing type 1 and type 2 diabetes mellitus. Symptoms associated with gastroparesis include early satiety, prolonged postprandial fullness, bloating, nausea and vomiting, and abdominal pain. Mortality is increased in patients with diabetic gastroparesis. A subset of patients with diabetic gastroparesis have pylorospasm that results in obstructive gastroparesis. Current treatment approaches include improving glucose control with insulin and prescribing antinauseant drugs, prokinetic agents, and gastric electric stimulation. Future directions include improved diet counseling based on gastric emptying rate, continuous insulin delivery systems with glucose sensor-augmented monitoring, and drugs for correcting gastric neural and electric abnormalities.
  
  PubDate: 2015-02-08T14:37:02Z
Index
- Abstract: Publication date: March 2015
  Source:Gastroenterology Clinics of North America, Volume 44, Issue 1
  
  PubDate: 2015-02-08T14:37:02Z
Copyright
- Abstract: Publication date: March 2015
  Source:Gastroenterology Clinics of North America, Volume 44, Issue 1
  
  PubDate: 2015-02-08T14:37:02Z
Contributors
- Abstract: Publication date: March 2015
  Source:Gastroenterology Clinics of North America, Volume 44, Issue 1
  
  PubDate: 2015-02-08T14:37:02Z
Contents
- Abstract: Publication date: March 2015
  Source:Gastroenterology Clinics of North America, Volume 44, Issue 1
  
  PubDate: 2015-02-08T14:37:02Z
Forthcoming Issues
- Abstract: Publication date: March 2015
  Source:Gastroenterology Clinics of North America, Volume 44, Issue 1
  
  PubDate: 2015-02-08T14:37:02Z
Improving Our Understanding of Gastroparesis
- Abstract: Publication date: Available online 13 January 2015
  Source:Gastroenterology Clinics of North America
  Author(s): Henry P. Parkman , Pankaj Jay Pasricha
  
  PubDate: 2015-01-15T12:18:36Z
Pyloric Sphincter Therapy Botulinum Toxin, Stents, and Pyloromyotomy
- Abstract: Publication date: Available online 13 January 2015
  Source:Gastroenterology Clinics of North America
  Author(s): John O. Clarke , William J. Snape
  
  Teaser Gastroparesis is a syndrome characterized by delayed gastric emptying with associated symptoms. Gastric emptying is a complex process and pyloric dysfunction may play a key role in select subsets of patients with gastroparesis. Diagnostic tests to measure pyloric physiology are now available and have the potential to be more widely used in clinical practice. Targeted therapies including botulinum toxin, transpyloric stent placement, surgical pyloroplasty and endoscopic pyloromyotomy have been developed. Data are emerging regarding efficacy and durability, but these therapies may play a prominent role in select patients with gastroparesis and pyloric dysfunction.
  
  PubDate: 2015-01-15T12:18:36Z
Clinical Presentation and Pathophysiology of Gastroparesis
- Abstract: Publication date: Available online 5 January 2015
  Source:Gastroenterology Clinics of North America
  Author(s): Linda Anh Nguyen , William Snape Jr.
  
  Teaser Gastroparesis is a heterogeneous disorder defined by delay in gastric emptying. Symptoms of gastroparesis are nonspecific, including nausea, vomiting, early satiety, bloating, and/or abdominal pain. Normal gastric motor function and sensory function depend on a complex coordination between the enteric and central nervous system. This article discusses the pathophysiology of delayed gastric emptying and the symptoms of gastroparesis, including antropyloroduodenal dysmotility, impaired gastric accommodation, visceral hypersensitivity, and autonomic dysfunction. The underlying pathophysiology of gastroparesis is complex and multifactorial. The article discusses how a combination of these factors leads to symptoms of gastroparesis.
  
  PubDate: 2015-01-06T07:20:50Z
Gastric Arrhythmias in Gastroparesis Low- and High-Resolution Mapping of
Gastric Electrical Activity
- Abstract: Publication date: Available online 29 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Gregory O’Grady , Thomas L. Abell
  
  Teaser Gastric arrhythmias occur in gastroparesis but their significance is debated. An improved understanding is currently emerging, including newly-defined histopathologic abnormalities in gastroparesis. In particular, the observation that interstitial cells of Cajal are depleted and injured provides mechanisms for arrhythmogenesis in gastroparesis. Electrogastrography has been the dominant clinical method of arrhythmia analysis, but is limited by summative nature, low signal quality, and incomplete sensitivity and specificity. Recently, high-resolution (HR; multi-electrode) mapping has emerged, providing superior spatial data on arrhythmic patterns and mechanisms. However, HR mapping is invasive, and low-resolution approaches are being assessed as bridging techniques until endoscopic mapping is achieved.
  
  PubDate: 2015-01-01T04:41:25Z
Surgical Approaches to Treatment of Gastroparesis Gastric Electrical
Stimulation, Pyloroplasty, Total Gastrectomy and Enteral Feeding Tubes
- Abstract: Publication date: Available online 29 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Irene Sarosiek , Brian Davis , Evelin Eichler , Richard W. McCallum
  
  Teaser Gastric electrical stimulation (GES) is neurostimulation; its mechanism of action is affecting central control of nausea and vomiting and enhancing vagal function. GES is a powerful antiemetic available for patients with refractory symptoms of nausea and vomiting from gastroparesis of idiopathic and diabetic causes. GES is not indicated as a way of reducing abdominal pain in gastroparetic patients. The need for introducing a jejunal feeding tube means intensive medical therapies are failing, and is an indication for the implantation of the GES system, which should always be accompanied by a pyloroplasty to guarantee accelerated gastric emptying.
  
  PubDate: 2015-01-01T04:41:25Z
Complementary and Alternative Medicine for Gastroparesis
- Abstract: Publication date: Available online 29 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Linda A. Lee , Jiande Chen , Jieyun Yin
  
  Teaser Complementary and alternative medicine is of great interest to patients with gastrointestinal disorders and some will choose to ask their health care providers about those therapies for which some scientific evidence exists. This review focuses on those therapies most commonly used by patients, namely acupuncture/electroacupuncture and various herbal formulations that have been the focus of clinical and laboratory investigation. A discussion of their possible mechanisms of action and the results of clinical studies are summarized.
  
  PubDate: 2015-01-01T04:41:25Z
Gastroparesis Definitions and Diagnosis
- Abstract: Publication date: Available online 24 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Pankaj Jay Pasricha , Henry P. Parkman
  
  Teaser Gastroparesis is a chronic symptomatic disorder of the stomach characterized by delayed emptying without evidence of mechanical obstruction. Symptoms of gastroparesis include nausea, vomiting, early satiety, postprandial fullness, and upper abdominal pain. The 3 main causes are diabetic, postsurgical, and idiopathic. Diagnosis is confirmed by demonstrating delayed gastric emptying. Gastric emptying rates measured by gastric motor testing generally correlate poorly with symptoms and quality of life in patients with gastroparesis. It may be appropriate to reconsider the definition of gastroparesis, recognizing it as a broader spectrum of gastric neuromuscular dysfunction.
  
  PubDate: 2014-12-28T01:25:15Z
Prokinetics in Gastroparesis
- Abstract: Publication date: Available online 23 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Andres Acosta , Michael Camilleri
  
  Teaser Prokinetic agents are medications that enhance coordinated gastrointestinal motility and transit of content in the gastrointestinal tract, mainly by amplifying and coordinating the gastrointestinal muscular contractions. In addition to dietary therapy, prokinetic therapy should be considered as a means to improve gastric emptying and symptoms of gastroparesis, balancing benefits and risks of treatment. In the United States, metoclopramide remains the first-line prokinetic therapy, because it is the only approved medication for gastroparesis. Newer agents are being developed for the management of gastroparesis. This article provides detailed information about prokinetic agents for the treatment of gastroparesis.
  
  PubDate: 2014-12-28T01:25:15Z
Idiopathic Gastroparesis
- Abstract: Publication date: Available online 24 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Henry P. Parkman
  
  Teaser Gastroparesis is a chronic symptomatic disorder of the stomach characterized by delayed emptying without evidence of mechanical obstruction. Idiopathic gastroparesis refers to gastroparesis of unknown cause not from diabetes; not from prior gastric surgery; not related to other endocrine, neurologic, rheumatologic causes of gastroparesis; and not related to medications that can delay gastric emptying. There is overlap in the symptoms of idiopathic gastroparesis and functional dyspepsia. Patients with idiopathic gastroparesis often have a constellation of symptoms including nausea, vomiting, early satiety, postprandial fullness, and upper abdominal pain. Current treatment options of dietary management, prokinetics agents, antiemetic agents, and symptom modulators do not adequately address clinical need for idiopathic gastroparesis.
  
  PubDate: 2014-12-28T01:25:15Z
Symptomatic Management for Gastroparesis Antiemetics, Analgesics, and
Symptom Modulators
- Abstract: Publication date: Available online 26 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): William L. Hasler
  
  Teaser Although prokinetic agents typically are used for gastroparesis, antiemetic, analgesic, and neuromodulatory medications may help manage nausea, vomiting, pain, or discomfort. Antiemetic benefits are supported by few case reports. An open series reported symptom reductions with transdermal granisetron in gastroparesis. Opiates are not advocated in gastroparesis because they worsen nausea and delay emptying. Neuromodulators have theoretical utility, but the tricyclic agent nortriptyline showed no benefits over placebo in an idiopathic gastroparesis study raising doubts about this strategy. Neurologic and cardiac toxicities of these medications are recognized. Additional controlled study is warranted to define antiemetic, analgesic, and neuromodulator usefulness in gastroparesis.
  
  PubDate: 2014-12-28T01:25:15Z
Future Directions in the Treatment of Gastroparesis
- Abstract: Publication date: Available online 20 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Pankaj Jay Pasricha
  
  Teaser Understanding of gastroparesis is evolving, in part because of systematic studies on the pathology, pathophysiology, and outcomes. It is clear that simply accelerating gastric emptying may not effectively control symptoms in this syndrome and more creative approaches are required that address aberrant sensation (vagal and spinal) as well as regional disturbances in motility. Further, with the growing recognition of a possible inflammatory basis, the prospects of disease modifying now seem realistic.
  
  PubDate: 2014-12-22T22:42:45Z
Nutritional Considerations in the Patient with Gastroparesis
- Abstract: Publication date: Available online 19 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Carol Rees Parrish
  
  Teaser Gastroparesis, or delayed gastric emptying, has many origins and can wax and wane depending on the underlying cause. Not only do the symptoms significantly alter quality of life, but the clinical consequences can also be life threatening. Once a patient develops protracted nausea and vomiting, providing adequate nutrition, hydration, and access to therapeutics such as prokinetics and antiemetics can present an exceptional challenge to clinicians. This article reviews the limited evidence available for oral nutrition, as well as enteral and parenteral nutritional support therapies. Practical strategies are provided to improve the nutritional depletion that often accompanies this debilitating condition.
  
  PubDate: 2014-12-22T22:42:45Z
Histologic Changes in Diabetic Gastroparesis
- Abstract: Publication date: Available online 19 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Gianrico Farrugia
  
  Teaser The cellular abnormalities that lead to diabetic gastroparesis are increasingly being understood. Several key cell types are affected by diabetes, leading to gastroparesis. These changes include abnormalities in the extrinsic innervation to the stomach, loss of key neurotransmitters at the level of the enteric nervous system, smooth muscle abnormalities, loss of interstitial cells of Cajal, and changes in the macrophage population resident in the muscle wall. This article reviews the current understanding with a focus on data from human studies when available.
  
  PubDate: 2014-12-22T22:42:45Z
Epidemiology and Natural History of Gastroparesis
- Abstract: Publication date: Available online 18 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Adil E. Bharucha
  
  Teaser Gastroparesis is characterized by delayed gastric emptying and symptoms thereof in the absence of gastric outlet obstruction. Most studies on the epidemiology of gastroparesis have been conducted in selected case series rather than in the population at large. In the only community-based study of gastroparesis in diabetes mellitus (DM), the average cumulative incidence of symptoms and delayed gastric emptying over 10 years was higher in type 1 DM (5%) than in type 2 DM (1%) and controls (1%). In the United States, the incidence of hospitalizations related to gastroparesis increased substantially between 1995 and 2004, and particularly after 2000.
  
  PubDate: 2014-12-19T17:07:35Z
Other Forms of Gastroparesis Postsurgical, Parkinson, Other Neurologic
Diseases, Connective Tissue Disorders
- Abstract: Publication date: Available online 17 December 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Eamonn M.M. Quigley
  
  Teaser Although many surgical procedures originally associated with gastroparesis are less commonly performed nowadays, several more recently developed upper abdominal procedures may be complicated by the development of gastroparesis. Gastroparesis has been described in association with neurologic disorders ranging from Parkinson disease to muscular dystrophy, and its presence may have important implications for patient management and prognosis. Although scleroderma is most frequently linked with gastrointestinal motility disorder, gastroparesis has been linked to several other connective tissue disorders. The management of these patients presents several challenges, and is best conducted in the context of a dedicated and skilled multidisciplinary team.
  
  PubDate: 2014-12-19T17:07:35Z
Index
- Abstract: Publication date: December 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 4
  
  PubDate: 2014-10-31T00:30:37Z
Contents
- Abstract: Publication date: December 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 4
  
  PubDate: 2014-10-26T12:29:21Z
Contributors
- Abstract: Publication date: December 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 4
  
  PubDate: 2014-10-26T12:29:21Z
Emerging Endoscopic Therapies for Nonvariceal Upper Gastrointestinal
Bleeding
- Abstract: Publication date: December 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 4
  Author(s): Louis M. Wong Kee Song , Michael J. Levy
  
  Teaser Several new devices and innovative adaptations of existing modalities have emerged as primary, adjunctive, or rescue therapy in endoscopic hemostasis of gastrointestinal hemorrhage. These techniques include over-the-scope clip devices, hemostatic sprays, cryotherapy, radiofrequency ablation, endoscopic suturing, and endoscopic ultrasound–guided angiotherapy. This review highlights the technical aspects and clinical applications of these devices in the context of nonvariceal upper gastrointestinal bleeding.
  
  PubDate: 2014-10-26T12:29:21Z
What if Endoscopic Hemostasis Fails? Alternative Treatment Strategies:
Interventional Radiology
- Abstract: Publication date: December 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 4
  Author(s): Sujal M. Nanavati
  
  Teaser Since the 1960s, interventional radiology has played a role in the management of gastrointestinal bleeding. What began primarily as a diagnostic modality has evolved into much more of a therapeutic tool. And although the frequency of gastrointestinal bleeding has diminished thanks to management by pharmacologic and endoscopic methods, the need for additional invasive interventions still exists. Transcatheter angiography and intervention is a fundamental step in the algorithm for the treatment of gastrointestinal bleeding.
  
  PubDate: 2014-10-26T12:29:21Z
Forthcoming Issues
- Abstract: Publication date: December 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 4
  
  PubDate: 2014-10-26T12:29:21Z
Upper GI Bleeding
- Abstract: Publication date: December 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 4
  Author(s): Ian M. Gralnek
  
  PubDate: 2014-10-26T12:29:21Z
Upper Gastrointestinal Bleeding Patient Presentation, Risk Stratification,
and Early Management
- Abstract: Publication date: December 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 4
  Author(s): Andrew C. Meltzer , Joshua C. Klein
  
  Teaser The established quality indicators for early management of upper gastrointestinal (GI) hemorrhage are based on rapid diagnosis, risk stratification, and early management. Effective preendoscopic treatment may improve survivability of critically ill patients and improve resource allocation for all patients. Accurate risk stratification helps determine the need for hospital admission, hemodynamic monitoring, blood transfusion, and endoscopic hemostasis before esophagogastroduodenoscopy (EGD) via indirect measures such as laboratory studies, physiologic data, and comorbidities. Early management before the definitive EGD is essential to improving outcomes for patients with upper GI bleeding.
  
  PubDate: 2014-10-26T12:29:21Z
Upper GI Bleeding
- Abstract: Publication date: Available online 11 October 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Gary W. Falk
  
  PubDate: 2014-10-12T16:32:07Z
Epidemiology, Diagnosis and Early Patient Management of Esophagogastric
Hemorrhage
- Abstract: Publication date: Available online 3 October 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Sumit Kumar , Sumeet K. Asrani , Patrick S. Kamath
  
  Teaser Acute variceal bleeding (AVB) is a potentially life-threatening complication of cirrhosis and portal hypertension. Combination therapy with vasoactive drugs and endoscopic variceal ligation is the first-line treatment in the management of AVB after adequate hemodynamic resuscitation. Short-term antibiotic prophylaxis, early resuscitation, early use of lactulose for prevention of hepatic encephalopathy, targeting of conservative goals for blood transfusion, and application of early transjugular intrahepatic portosystemic shunts in patients with AVB have further improved the prognosis of AVB. This article discusses the epidemiology, diagnosis, and nonendoscopic management of AVB.
  
  PubDate: 2014-10-08T05:08:53Z
Endoscopic Hemostasis in Acute Esophageal Variceal Bleeding
- Abstract: Publication date: Available online 29 September 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Andrés Cárdenas , Anna Baiges , Virginia Hernandez-Gea , Juan Carlos Garcia-Pagan
  
  Teaser Acute variceal bleeding (AVB) is a milestone event for patients with portal hypertension. Esophageal varices bleed because of an increase in portal pressure that causes the variceal wall to rupture. AVB in a patient with cirrhosis and portal hypertension is associated with significant morbidity and mortality. The initial management of these patients includes proper resuscitation, antibiotic prophylaxis, pharmacologic therapy with vasoconstrictors, and endoscopic therapy. Intravascular fluid management, timing of endoscopy, and endoscopic technique are key in managing these patients. This article reviews the current endoscopic hemostatic strategies for patients with AVB.
  
  PubDate: 2014-10-03T20:04:18Z
Nonendoscopic Management Strategies for Acute Esophagogastric Variceal
Bleeding
- Abstract: Publication date: Available online 27 September 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Sanjaya K. Satapathy , Arun J. Sanyal
  
  Teaser Acute variceal bleeding is a potentially life-threatening complication of portal hypertension. Management consists of emergent hemostasis, therapy directed at hemodynamic resuscitation, protection of the airway, and prevention and treatment of complications including prophylactic use of antibiotics. Endoscopic treatment remains the mainstay in the management of acute variceal bleeding in combination with pharmacotherapy aimed at reducing portal pressure. This article intends to highlight only the current nonendoscopic treatment approaches for control of acute variceal bleeding.
  
  PubDate: 2014-09-28T02:03:18Z
Primary Prophylaxis of Variceal Bleeding
- Abstract: Publication date: Available online 22 September 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Jawad A. Ilyas , Fasiha Kanwal
  
  Teaser Gastroesophageal varices are present in almost half of patients with cirrhosis at the time of initial diagnosis. Variceal bleeding occurs in 25% to 35% of patients with cirrhosis. Effective and timely care can prevent variceal bleeding (primary prophylaxis). For example, clinical studies demonstrate that both beta-blockers and endoscopic variceal ligation are effective in preventing a first episode of variceal bleeding. The major challenge is to screen patients in a timely manner and institute a form of therapy that has the highest chance of success in terms of patient compliance and effectiveness.
  
  PubDate: 2014-09-24T21:21:06Z
Approach to the Management of Portal Hypertensive Gastropathy and Gastric
Antral Vascular Ectasia
- Abstract: Publication date: Available online 20 September 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Kamran Qureshi , Abdullah M.S. Al-Osaimi
  
  Teaser Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) are important causes of chronic gastrointestinal bleeding. These gastric mucosal lesions are mostly diagnosed on upper endoscopy and can be distinguished based on their appearance or location in the stomach. In some situations, especially in patients with liver cirrhosis and portal hypertension, a diffuse pattern and involvement of gastric mucosa are seen with both GAVE and severe PHG. The diagnosis in such cases is hard to determine on visual inspection, and thus, biopsy and histologic evaluation can be used to help differentiate GAVE from PHG.
  
  PubDate: 2014-09-21T05:11:07Z
Endoscopic Management of Acute Peptic Ulcer Bleeding
- Abstract: Publication date: Available online 16 September 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Yidan Lu , Yen-I Chen , Alan Barkun
  
  Teaser This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding.
  
  PubDate: 2014-09-21T05:11:07Z
Epidemiology and Diagnosis of Acute Nonvariceal Upper Gastrointestinal
Bleeding
- Abstract: Publication date: Available online 12 September 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Gianluca Rotondano
  
  Teaser Acute upper gastrointestinal bleeding (UGIB) is a common gastroenterological emergency. A vast majority of these bleeds have nonvariceal causes, in particular gastroduodenal peptic ulcers. Nonsteroidal antiinflammatory drugs, low-dose aspirin use, and Helicobacter pylori infection are the main risk factors for UGIB. Current epidemiologic data suggest that patients most affected are older with medical comorbidit. Widespread use of potentially gastroerosive medications underscores the importance of adopting gastroprotective pharamacologic strategies. Endoscopy is the mainstay for diagnosis and treatment of acute UGIB. It should be performed within 24 hours of presentation by skilled operators in adequately equipped settings, using a multidisciplinary team approach.
  
  PubDate: 2014-09-17T04:31:01Z
What If Endoscopic Hemostasis Fails' Alternative Treatment Strategies:
Surgery
- Abstract: Publication date: Available online 12 September 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Philip Wai Yan Chiu , James Yun Wong Lau
  
  Teaser Management of bleeding peptic ulcers is increasingly challenging in an aging population. Endoscopic therapy reduces the need for emergency surgery in bleeding peptic ulcers. Initial endoscopic control offers an opportunity for selecting high-risk ulcers for potential early preemptive surgery. However, such an approach has not been supported by evidence in the literature. Endoscopic retreatment can be an option to control ulcer rebleeding and reduce complications. The success of endoscopic retreatment largely depends on the severity of rebleeding and ulcer characteristics. Large chronic ulcers with urgent bleeding are less likely to respond to endoscopic retreatment. Expeditious surgery is advised.
  
  PubDate: 2014-09-17T04:31:01Z
Endoscopic Management of Nonvariceal, Nonulcer Upper Gastrointestinal
Bleeding
- Abstract: Publication date: Available online 12 September 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Eric T.T.L. Tjwa , I. Lisanne Holster , Ernst J. Kuipers
  
  Teaser Upper gastrointestinal bleeding (UGIB) is the most common emergency condition in gastroenterology. Although peptic ulcer and esophagogastric varices are the predominant causes, other conditions account for up to 50% of UGIBs. These conditions, among others, include angiodysplasia, Dieulafoy and Mallory-Weiss lesions, gastric antral vascular ectasia, and Cameron lesions. Upper GI cancer as well as lesions of the biliary tract and pancreas may also result in severe UGIB. This article provides an overview of the endoscopic management of these lesions, including the role of novel therapeutic modalities such as hemostatic powder and over-the-scope-clips.
  
  PubDate: 2014-09-17T04:31:01Z
Endoscopic Management of Gastric Variceal Bleeding
- Abstract: Publication date: Available online 12 September 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Frank Weilert , Kenneth F. Binmoeller
  
  Teaser Expert knowledge of endoscopic management of gastric varices is essential, as these occur in 20% of patients with portal hypertension. Bleeding is relatively uncommon, but carries significant mortality when this occurs. Inability to directly target intravascular injections and the potential complication related to glue embolization has resulted in the development of novel techniques. Direct visualization of the varix lumen using endoscopic ultrasound (EUS) allows targeted therapy of feeder vessels with real-time imaging. EUS-guided combination therapy with endovascular coiling and cyanoacrylate injections promise to provide reduced complication rates, increased obliteration of varices, and reduced long-term rebleeding rates.
  
  PubDate: 2014-09-17T04:31:01Z
Contributors
- Abstract: Publication date: September 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 3
  
  PubDate: 2014-08-12T16:29:30Z
Contents
- Abstract: Publication date: September 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 3
  
  PubDate: 2014-08-12T16:29:30Z
Forthcoming Issues
- Abstract: Publication date: September 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 3
  
  PubDate: 2014-08-12T16:29:30Z
Biologics of IBD
- Abstract: Publication date: September 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 3
  Author(s): Gary W. Falk
  
  PubDate: 2014-08-12T16:29:30Z
Biologic Therapy in Inflammatory Bowel Disease
- Abstract: Publication date: September 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 3
  Author(s): Edward V. Loftus Jr
  
  PubDate: 2014-08-12T16:29:30Z
Immunology of Inflammatory Bowel Disease and Molecular Targets for
Biologics
- Abstract: Publication date: September 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 3
  Author(s): Maneesh Dave , Konstantinos A. Papadakis , William A. Faubion Jr.
  
  Teaser Inflammatory bowel disease (IBD) is an immune-mediated disease and involves a complex interplay of host genetics and environmental influences. Recent advances in the field, including data from genome-wide association studies and microbiome analysis, have started to unravel the complex interaction between host genetics and environmental influences in the pathogenesis of IBD. A drawback of current clinical trials is inadequate or lack of immune phenotyping of patients. However, recent advances in high-throughput technologies provide an opportunity to monitor the dynamic and complex immune system, which may to lead to a more personalized treatment approach in IBD.
  
  PubDate: 2014-08-12T16:29:30Z
Who Should Receive Biologic Therapy for IBD' The Rationale for the
Application of a Personalized Approach
- Abstract: Publication date: September 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 3
  Author(s): Jennifer Jones , Juan Nicolás Peña-Sánchez
  
  Teaser The therapeutic approach in inflammatory bowel disease has evolved to target end-organ inflammation to heal intestinal mucosa and avoid structural damage. Objective therapeutic monitoring is required to achieve this goal. Earlier intervention with biologic therapy has been shown, indirectly, to be associated with higher clinical response and remission rates. A personalized approach to risk stratification with consideration of key clinical factors and inflammatory biomarker concentrations is recommended when deciding whether or not to start a patient on biologic therapy.
  
  PubDate: 2014-08-12T16:29:30Z
Anti–Tumor Necrosis Factor-α Monotherapy Versus Combination
Therapy with an Immunomodulator in IBD
- Abstract: Publication date: Available online 16 June 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Parambir S. Dulai , Corey A. Siegel , Laurent Peyrin-Biroulet
  
  Teaser Inflammatory bowel disease (IBD) treatment has progressed significantly over the past decade with the advent of biologics. Anti-tumor necrosis factor (anti-TNF) agents are the most widely available biologics, but the optimal approach when using them remains unclear. In this review, we highlight the currently available evidence regarding the use of anti-TNF monotherapy versus combination therapy with an immunomodulator. We focus on those patients at greatest risk for adverse events and outline the clinical approach when considering the use of combination therapy. We review the available tools through which providers may efficiently communicate these data to patients in the clinical setting.
  
  PubDate: 2014-07-26T04:25:36Z