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Gastroenterology Clinics of North America [4 followers] Follow
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ISSN (Print) 0889-8553
Published by Elsevier

[2556 journals] [SJR: 0.988] [H-I: 56]

Eosinophilic Esophagitis
- Abstract: Publication date: Available online 13 April 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Ikuo Hirano
  
  PubDate: 2014-04-15T16:24:05Z
Eosinophilic Esophagitis
- Abstract: Publication date: Available online 5 April 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Gary W. Falk
  
  PubDate: 2014-04-10T16:17:07Z
Clinical Presentation of Eosinophilic Esophagitis in Adults
- Abstract: Publication date: Available online 1 April 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Gary W. Falk
  
  Teaser Eosinophilic esophagitis (EoE) is an increasingly recognized immune antigen-mediated esophageal disease found in both children and adults. It is defined as a clinicopathologic disease characterized by symptoms of esophageal dysfunction accompanied by an eosinophil-predominant esophageal inflammation that occurs in the absence of other causes of esophageal eosinophilia. Classic symptoms in adults include dysphagia to solids and food bolus impaction but a variety of other symptoms are also encountered. Despite the increasing awareness of EoE among practicing physicians, a long delay from onset of symptoms to diagnosis remains a problem in this disease.
  
  PubDate: 2014-04-05T11:18:53Z
Steroids in Pediatric Eosinophilic Esophagitis
- Abstract: Publication date: Available online 29 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Emily M. Contreras , Sandeep K. Gupta
  
  Teaser Swallowed fluticasone and oral viscous budesonide are effective first-line therapies for eosinophilic esophagitis in children. Side effects are minimal without evidence of Cushing syndrome, as seen in treatment with systemic corticosteroids. New studies on alternative delivery systems and different corticosteroids (eg, ciclesonide) are encouraging. As knowledge of corticosteroids in eosinophilic esophagitis expands, newer questions continue to arise concerning dose, delivery, and choice of corticosteroids; long-term adverse effects; and maintenance therapies.
  
  PubDate: 2014-03-31T11:16:13Z
Dietary Treatment of Eosinophilic Esophagitis
- Abstract: Publication date: Available online 21 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Nirmala Gonsalves , Amir F. Kagalwalla
  
  Teaser Emerging evidence supports impaired epithelial barrier function as the key initial event in the development of eosinophilic esophagitis (EoE) and other allergic diseases. Symptom resolution, histologic remission, and prevention of both disease and treatment-related complications are the goals of treatment. Successful dietary treatments include elemental, empirical elimination and allergy test directed diets. Dietary therapy with exclusive elemental diet offers the best response. Cow's milk, wheat, egg, soy, peanut/tree nut, and fish/shellfish are the 6 food antigens most likely to induce esophageal inflammation.
  
  PubDate: 2014-03-26T12:16:13Z
Allergic Mechanisms in Eosinophilic Esophagitis
- Abstract: Publication date: Available online 22 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Joshua B. Wechsler , Paul J. Bryce
  
  Teaser Eosinophilic esophagitis is rapidly increasing in incidence. It is associated with food antigen–triggered, eosinophil-predominant inflammation, and the pathogenic mechanisms have many similarities to other chronic atopic diseases. Studies in animal models and from patients have suggested that allergic sensitization leads to food-specific IgE and T-helper lymphocyte type 2 cells, both of which seem to contribute to the pathogenesis along with basophils, mast cells, and antigen-presenting cells. In this review our current understandings of the allergic mechanisms that drive eosinophilic esophagitis are outlined, drawing from clinical and translational studies in humans as well as experimental animal models.
  
  PubDate: 2014-03-26T12:16:13Z
Eosinophilic Esophagitis Overview of Clinical Management
- Abstract: Publication date: Available online 21 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Alain M. Schoepfer , Ikuo Hirano , David A. Katzka
  
  Teaser A validated disease-specific symptom-assessment tool for eosinophilic esophagitis (EoE) has yet to be approved by regulatory authorities for use in clinical trials. Relevant end points for daily practice include EoE-related symptoms and esophageal eosinophilic inflammation. Endoscopic features should also be taken into account when establishing a therapy plan. A reasonable clinical goal is to achieve a reduction in EoE-related symptoms and esophageal eosinophilic inflammation. Evidence is increasing to support an anti-inflammatory maintenance therapy, as this can reduce esophageal remodeling. In EoE patients in clinical remission, annual disease monitoring with symptom, endoscopic, and histologic assessments of sustained treatment response is recommended.
  
  PubDate: 2014-03-26T12:16:13Z
Eosinophilic Esophagitis Interactions with Gastroesophageal Reflux Disease
- Abstract: Publication date: Available online 24 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Edaire Cheng , Rhonda F. Souza , Stuart Jon Spechler
  
  Teaser Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) are not mutually exclusive. The notion that GERD and EoE can be distinguished by the response to proton pump inhibitor (PPI) treatment is based on the mistaken assumption that gastric acid suppression is the only important therapeutic effect of PPIs, and therefore only GERD can respond to PPIs. We believe that a clinical or histologic response to PPIs does not rule in GERD or rule out EoE. We recommend a trial of PPI therapy for patients with symptomatic esophageal eosinophilia, even if the diagnosis of EoE seems clear-cut.
  
  PubDate: 2014-03-26T12:16:13Z
Genetic and Epigenetic Underpinnings of Eosinophilic Esophagitis
- Abstract: Publication date: Available online 24 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Joseph D. Sherrill , Marc E. Rothenberg
  
  Teaser Eosinophilic esophagitis (EoE) is a complex, polygenic disorder caused by genetic predisposition and environmental exposures. Because of the recent emergence of EoE as a bona fide global health concern, a paucity of available therapeutic and diagnostic options exists. However, rapid progress has been made in an effort to rectify this lack and to improve understanding of the factors that cause EoE. This article highlights key advances in elucidating the genetic (and epigenetic) components involved in EoE.
  
  PubDate: 2014-03-26T12:16:13Z
Eosinophilic Esophagitis Historical Perspective on an Evolving Disease
- Abstract: Publication date: Available online 24 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Stephen E. Attwood , Glenn T. Furuta
  
  Teaser Initial case series describing children and adults with symptoms related to esophageal dysfunction and dense esophageal eosinophilia lead to recognition of a “new” disease, eosinophilic esophagitis (EoE). Clinical, basic, and translational studies have provided a deeper understanding of this somewhat enigmatic disease that mechanistically is defined as an antigen-driven condition limited to the esophagus. This article summarizes many of the key historical features of EoE and provides a glimpse of potential future developments.
  
  PubDate: 2014-03-26T12:16:13Z
Steroid Treatment of Eosinophilic Esophagitis in Adults
- Abstract: Publication date: Available online 24 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Jeffrey A. Alexander
  
  Teaser Topical steroid therapy has been used to treat eosinophilic esophagitis (EoE) for more than 15 years. We review the treatment trials of topical steroid therapy in adult patients with EoE. Currently, there is no commercially available preparation designed to deliver the steroid to the esophagus. Current regimens consist of swallowing steroid preparations designed for inhalation treatment for asthma. In the short term, steroids are associated with an approximately 15% to 25% incidence of asymptomatic esophageal candidiasis, but otherwise appear to be well tolerated.
  
  PubDate: 2014-03-26T12:16:13Z
Histopathologic Features of Eosinophilic Esophagitis and Eosinophilic
Gastrointestinal Diseases
- Abstract: Publication date: Available online 19 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Margaret H. Collins
  
  Teaser Eosinophilic esophagitis (EoE) shows characteristic microscopic pathologic features in endoscopically obtained esophageal biopsies, including an eosinophil-rich inflammatory infiltrate in esophageal epithelium, but other inflammatory cells are also increased. Additional alterations are found in epithelium and lamina propria. Esophageal biopsy pathology is a sensitive but not specific marker for EoE related to antigen exposure. Several of the pathologic features of EoE correlate with dysregulated genes in the EoE transcriptome. Eosinophilic gastrointestinal diseases affecting the remainder of the gastrointestinal tract are less well characterized; this article discusses pathologic features in mucosal biopsies that could form the basis for diagnosis and future study.
  
  PubDate: 2014-03-21T12:16:16Z
Epidemiology of Eosinophilic Esophagitis
- Abstract: Publication date: Available online 19 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Evan S. Dellon
  
  Teaser In this article, the epidemiology of eosinophilic esophagitis (EoE) is reviewed. Demographic features and natural history are described, the prevalence and incidence of EoE are highlighted, and risk factors for EoE are discussed. EoE can occur at any age, there is a male predominance, it is more common in whites, and there is a strong association with atopic diseases. EoE is chronic, relapses are frequent, and persistent inflammation increases the risk of fibrostenotic complications. The prevalence is currently estimated at 0.5–1 in 1000, and EoE is now the most common cause of food impaction. The incidence of EoE is approximately 1/10,000 new cases per year, and the increase in incidence is outpacing increases in recognition and endoscopy volume, but the reasons for this evolving epidemiology are not yet fully delineated.
  
  PubDate: 2014-03-21T12:16:16Z
Eosinophilic Esophagitis Emerging Therapies and Future Perspectives
- Abstract: Publication date: Available online 14 March 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Alex Straumann
  
  Teaser Twenty years have passed since eosinophilic esophagitis was first recognized as a new and distinct entity. Current treatment modalities for eosinophilic esophagitis include the “3 Ds”: drugs, allergen avoidance with diet, and esophageal dilation. Drugs entail the limitation that only corticosteroids have a proven efficacy; most other compounds evoke only a minimal effect. Diets must be maintained continuously and they interfere markedly with the quality of life, possibly even involving some risk of malnutrition. A greater understanding of the immunopathogenesis, natural history, and disease spectrum will inevitably lead to improved therapeutic outcomes for this emerging entity.
  
  PubDate: 2014-03-16T12:16:27Z
Index
- Abstract: Publication date: March 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 1
  
  PubDate: 2014-02-05T07:19:24Z
Contributors
- Abstract: Publication date: March 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 1
  
  PubDate: 2014-02-05T07:19:24Z
Contents
- Abstract: Publication date: March 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 1
  
  PubDate: 2014-02-05T07:19:24Z
Forthcoming Issues
- Abstract: Publication date: March 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 1
  
  PubDate: 2014-02-05T07:19:24Z
Gastroesophageal Reflux Disease
- Abstract: Publication date: March 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 1
  Author(s): Gary W. Falk
  
  PubDate: 2014-02-05T07:19:24Z
Role of Endoscopy in GERD
- Abstract: Publication date: March 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 1
  Author(s): Virender K. Sharma
  
  Teaser Endoscopy is commonly performed for the diagnosis and management of gastroesophageal reflux disease (GERD). Endoscopy allows the physician to evaluate esophageal mucosa for evidence of esophagitis and Barrett esophagus, to obtain mucosal biopsies for evaluation of such conditions as eosinophilic esophagitis and diagnosis and grading of Barrett esophagus, and to apply various therapies. In a patient with suboptimal response to GERD therapy, endoscopy excludes other etiologies as a cause of patients’ symptoms. Newer endoscopic therapies for GERD are available or are in development. Advances in imaging techniques in development will improve the diagnostic yield of endoscopy and may replace the need for mucosal biopsies.
  
  PubDate: 2014-02-05T07:19:24Z
Gastroesophageal Reflux Disease and the Elderly
- Abstract: Publication date: March 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 1
  Author(s): Sami R. Achem , Kenneth R. DeVault
  
  Teaser Gastroesophageal reflux disease is a common disorder in all patients but a particular problem in the elderly, for whom the disease often presents with advanced mucosal damage and other complications. Symptoms are also not as reliable an indication of disease severity in older patients. Likewise, therapy is more difficult because of potential side effects and drug interactions.
  
  PubDate: 2014-02-05T07:19:24Z
Barium Esophagram Does It Have a Role in Gastroesophageal Reflux
Disease'
- Abstract: Publication date: Available online 7 January 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Mark E. Baker , David M. Einstein
  
  Teaser The barium esophagram is an integral part of the assessment and management of patients with gastroesophageal reflux disease (GERD) before, and especially after, antireflux procedures. While many of the findings on the examination can be identified with endosocopy, a gastric emptying study and an esophageal motility examination, the barium esophagram is better at demonstrating the anatomic findings after anti-reflux surgery, especially in symptomatic patients. These complementary examinations, when taken as a whole, fully evaluate a patient with suspected GERD as well as symptomatic patients after antireflux procedures.
  
  PubDate: 2014-01-07T22:17:51Z
What's New in Gastroesophageal Reflux Disease for 2014
- Abstract: Publication date: Available online 7 January 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Joel E. Richter
  
  PubDate: 2014-01-07T22:17:51Z
Surgical Treatment of GERD Where Have We Been and Where Are We Going'
- Abstract: Publication date: Available online 3 January 2014
  Source:Gastroenterology Clinics of North America
  Author(s): David Kim , Vic Velanovich
  
  Teaser Surgical management of gastroesophageal reflux disease has evolved from relatively invasive procedures requiring open laparotomy or thoracotomy to minimally invasive laparoscopic techniques. Although side effects may still occur, with careful patient selection and good technique, the overall symptomatic control leads to satisfaction rates in the 90% range. Unfortunately, the next evolution to endoluminal techniques has not been as successful. Reliable devices are still awaited that consistently produce long-term symptomatic relief with correction of pathologic reflux. However, newer laparoscopically placed devices hold promise in achieving equivalent symptomatic relief with fewer side effects. Clinical trials are still forthcoming.
  
  PubDate: 2014-01-04T07:16:27Z
Medical Treatments of GERD The Old and New
- Abstract: Publication date: Available online 31 December 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Marcelo F. Vela
  
  Teaser The mainstay of pharmacological therapy for GERD is gastric acid suppression with proton pump inhibitors (PPIs), which are superior to histamine-2 receptor antagonists for healing erosive esophagitis and achieving symptomatic relief. However, up to one-third of patients may not respond to PPI therapy, creating the need for alternative treatments. Potential approaches include transient lower esophageal sphincter relaxation inhibitors; augmentation esophageal defense mechanisms by improving esophageal clearance or enhancing epithelial repair, and modulation of sensory pathways responsible for GERD symptoms. This review discusses the effectiveness of acid suppression and the data on alternative pharmacological approaches for the treatment of GERD.
  
  PubDate: 2013-12-31T22:23:31Z
Acid and Nonacid Reflux Monitoring
- Abstract: Publication date: Available online 27 December 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Dustin A. Carlson , John E. Pandolfino
  
  Teaser Detection of acid and nonacid reflux using esophageal reflux monitoring, which includes conventional and wireless pH monitoring and pH impedance, can be a valuable diagnostic tool when used appropriately in the assessment of patients with gastroesophageal reflux disease. Reflux monitoring may be especially helpful if a management change is desired, such as when initial or empirical treatment is ineffective. However, each of these methods has its limitations, which need to be accounted for in their clinical use. Indications, test performance, interpretation, and clinical applications of esophageal reflux monitoring, as well as their limitations, are discussed in this review.
  
  PubDate: 2013-12-28T22:28:35Z
Obesity and GERD
- Abstract: Publication date: Available online 27 December 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Paul Chang , Frank Friedenberg
  
  Teaser Epidemiologic data have demonstrated that obesity is an important risk factor for the development of gastroesophageal reflux disease (GERD). There is also accumulating data that obesity is associated with complications related to longstanding reflux such as erosive esophagitis, Barrett esophagus, and esophageal adenocarcinoma. Central obesity, rather than body mass index, appears to be more closely associated with these complications. Surgical data are confounded by the concomitant repair of prevalent hiatal hernias in many patients.
  
  PubDate: 2013-12-28T22:28:35Z
Esophageal Manometry in Gastroesophageal Reflux Disease
- Abstract: Publication date: Available online 28 December 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Michael Mello , C. Prakash Gyawali
  
  Teaser High-resolution manometry (HRM) allows nuanced evaluation of esophageal motor function, and more accurate evaluation of lower esophageal sphincter (LES) function, in comparison with conventional manometry. Pathophysiologic correlates of gastroesophageal reflux disease (GERD) and esophageal peristaltic performance are well addressed by this technique. HRM may alter the surgical decision by assessment of esophageal peristaltic function and exclusion of esophageal outflow obstruction before antireflux surgery. Provocative testing during HRM may assess esophageal smooth muscle peristaltic reserve, and help predict the likelihood of transit symptoms following antireflux surgery. HRM represents a continuously evolving new technology that compliments the evaluation and management of GERD.
  
  PubDate: 2013-12-28T22:28:35Z
Pathophysiology of Gastroesophageal Reflux Disease
- Abstract: Publication date: Available online 27 December 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Guy E. Boeckxstaens , Wout O. Rohof
  
  Teaser Gastroesophageal reflux disease (GERD) is one of the most common digestive diseases in the Western world, with typical symptoms, such as heartburn, regurgitation, or retrosternal pain, reported by 15% to 20% of the general population. The pathophysiology of GERD is multifactorial. Our understanding of these factors has significantly improved in recent years, with increased understanding of the acid pocket and hiatal hernia and how these factors interact. Although our insight has significantly increased over the past years, more studies are required to better understand symptom generation in GERD, especially in patients with therapy-resistant symptoms.
  
  PubDate: 2013-12-28T22:28:35Z
Symptom Predictability in Gastroesophageal Reflux Disease and Role of
Proton Pump Inhibitor Test
- Abstract: Publication date: Available online 27 December 2013
  Source:Gastroenterology Clinics of North America
  Author(s): David S. Estores
  
  Teaser There are problems with the definition, assessment, and measurement of gastroesophageal reflux disease (GERD). The Reflux Disease Questionnaire and the GERD questionnaire are patient-reported outcome (PRO) measures for use in a primary care setting, which are easy to use and are validated. There is no widely accepted definition of a proton pump inhibitor test and performance of the test in the clinical setting is not standardized. The use of the PRO measures in primary care with predetermined cutoff values may help to reduce the cost of diagnosing GERD and increasing rates of response for evaluated patients to acid suppression.
  
  PubDate: 2013-12-28T22:28:35Z
Epidemiology of Gastroesophageal Reflux Disease
- Abstract: Publication date: Available online 27 December 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Joel H. Rubenstein , Joan W. Chen
  
  Teaser The prevalence of gastroesophageal reflux disease (GERD) symptoms increased approximately 50% until the mid-1990s, when it plateaued. The incidence of complications related to GERD including hospitalization, esophageal strictures, esophageal adenocarcinoma, and mortality also increased during that time period, but the increase in esophageal adenocarcinoma has since slowed, and the incidence of strictures has decreased since the mid-1990s. GERD is responsible for the greatest direct costs in the United States of any gastrointestinal disease, and most of those expenditures are for pharmacotherapy. Risk factors for GERD include obesity, poor diet, lack of physical activity, consumption of tobacco and alcohol, and respiratory diseases.
  
  PubDate: 2013-12-28T22:28:35Z
Extraesophageal Presentations of GERD Where is the Science'
- Abstract: Publication date: Available online 28 December 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Ryan D. Madanick
  
  Teaser This article reviews the evaluation and management of patients with suspected extraesophageal manifestations of gastroesophageal reflux disease, such as asthma, chronic cough, and laryngitis, which are commonly encountered in gastroenterology practices. Otolaryngologists and gastroenterologists commonly disagree upon the underlying cause for complaints in patients with one of the suspected extraesophageal reflux syndromes. The accuracy of diagnostic tests (laryngoscopy, endoscopy, and pH- or pH-impedance monitoring) for patients with suspected extraesophageal manifestations of gastroesophageal reflux disease is suboptimal. An empiric trial of proton pump inhibitors in patients without alarm features can help some patients, but the response to therapy is variable.
  
  PubDate: 2013-12-28T22:28:35Z
Dedication
- Abstract: Publication date: December 2013
  Source:Gastroenterology Clinics of North America, Volume 42, Issue 4
  Author(s): David J. Maron , Steven D. Wexner
  
  PubDate: 2013-11-28T03:01:41Z
Anal Squamous Intraepithelial Neoplasia
- Abstract: Publication date: December 2013
  Source:Gastroenterology Clinics of North America, Volume 42, Issue 4
  Author(s): Pablo A. Bejarano , Marylise Boutros , Mariana Berho
  
  Teaser Diagnosis, follow up, and treatment of anal intraepithelial neoplasia are complex and not standardized. This may be partly caused by poor communication of biopsy and cytology findings between pathologists and clinicians as a result of a disparate and confusing terminology used to classify these lesions. This article focuses on general aspects of epidemiology and on clarifying the current terminology of intraepithelial squamous neoplasia, its relationship with human papilloma virus infection, and the current methods that exist to diagnose and treat this condition.
  
  PubDate: 2013-11-28T03:01:41Z
Management of Radiation Proctitis
- Abstract: Publication date: December 2013
  Source:Gastroenterology Clinics of North America, Volume 42, Issue 4
  Author(s): Ankit Sarin , Bashar Safar
  
  Teaser Radiation damage to the rectum following radiotherapy for pelvic malignancies can range from acute dose-limiting side effects to major morbidity affecting health-related quality of life. No standard guidelines exist for diagnosis and management of radiation proctitis. This article reviews the definitions, staging, and clinical features of radiation proctitis, and summarizes the modalities available for the treatment of acute and chronic radiation proctitis. Because of the paucity of well-controlled, blinded, randomized studies, it is not possible to fully assess the comparative efficacy of the different approaches to management. However, the evidence and rationale for use of the different strategies are presented.
  
  PubDate: 2013-11-28T03:01:41Z
Contents
- Abstract: Publication date: December 2013
  Source:Gastroenterology Clinics of North America, Volume 42, Issue 4
  
  PubDate: 2013-11-28T03:01:41Z
Forthcoming Issues
- Abstract: Publication date: December 2013
  Source:Gastroenterology Clinics of North America, Volume 42, Issue 4
  
  PubDate: 2013-11-28T03:01:41Z
Disorders of the Anorectum and Pelvic Floor
- Abstract: Publication date: December 2013
  Source:Gastroenterology Clinics of North America, Volume 42, Issue 4
  Author(s): David J. Maron , Steven D. Wexner
  
  PubDate: 2013-11-28T03:01:41Z
Contributors
- Abstract: Publication date: December 2013
  Source:Gastroenterology Clinics of North America, Volume 42, Issue 4
  
  PubDate: 2013-11-28T03:01:41Z
Surgical Management of Fecal Incontinence
- Abstract: Publication date: Available online 6 November 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Joshua I.S. Bleier , Brian R. Kann
  
  Teaser The surgical approach to treating fecal incontinence is complex. After optimal medical management has failed, surgery remains the best option for restoring function. Patient factors, such as prior surgery, anatomic derangements, and degree of incontinence, help inform the astute surgeon regarding the most appropriate option. Many varied approaches to surgical management are available, ranging from more conservative approaches, such as anal canal bulking agents and neuromodulation, to more aggressive approaches, including sphincter repair, anal cerclage techniques, and muscle transposition. Efficacy and morbidity of these approaches also range widely, and this article presents the data and operative considerations for these approaches.
  
  PubDate: 2013-11-08T03:03:50Z
Anorectal Anatomy and Imaging Techniques
- Abstract: Publication date: Available online 6 November 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Patrick Solan , Bradley Davis
  
  Teaser The rectum and anus are two anatomically complex organs with diverse pathologies. This article reviews the basic anatomy of the rectum and anus. In addition, it addresses the current radiographic techniques used to evaluate these structures, specifically ultrasound, magnetic resonance imaging, and defecography.
  
  PubDate: 2013-11-08T03:03:50Z
Rectal Prolapse and Intussusception
- Abstract: Publication date: Available online 6 November 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Quinton Hatch , Scott R. Steele
  
  Teaser Rectal prolapse continues to be problematic for both patients and surgeons alike, in part because of increased recurrence rates despite several well-described operations. Patients should be aware that although the prolapse will resolve with operative therapy, functional results may continue to be problematic. This article describes the recommended evaluation, role of adjunctive testing, and outcomes associated with both perineal and abdominal approaches.
  
  PubDate: 2013-11-08T03:03:50Z
Pruritus Ani Diagnosis and Treatment
- Abstract: Publication date: Available online 6 November 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Yosef Y. Nasseri , Marc C. Osborne
  
  Teaser Pruritus ani is a common condition with multiple causes. Primary causes are thought to be fecal soiling or food irritants. Secondary causes include malignancy, infections including sexually transmitted diseases, benign anorectal diseases, systemic diseases, and inflammatory conditions. A broad differential diagnosis must be considered. A reassessment of the diagnosis is required if symptoms or findings are not responsive to therapy. The pathophysiology of itching, an overview of primary and secondary causes, and various treatment options are reviewed.
  
  PubDate: 2013-11-08T03:03:50Z
Anal Fissure and Stenosis
- Abstract: Publication date: Available online 6 November 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Sherief Shawki , Meagan Costedio
  
  Teaser Anal fissure is a common anorectal disorder resulting in anal pain and bleeding. Fissures can either heal spontaneously and be classified as acute, or persist for 6 or more weeks and be classified as chronic, ultimately necessitating treatment. Anal stenosis is a challenging problem most commonly resulting from trauma, such as excisional hemorrhoidectomy. This frustrating issue for the patient is equally as challenging to the surgeon. This article reviews these 2 anorectal disorders, covering their etiology, mechanism of disease, diagnosis, and algorithm of management.
  
  PubDate: 2013-11-08T03:03:50Z
Constipation and Pelvic Outlet Obstruction
- Abstract: Publication date: Available online 6 November 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Traci L. Hedrick , Charles M. Friel
  
  Teaser Caring for patients with constipation and pelvic outlet obstruction can be challenging, requiring skill, patience, and empathy on the part of the medical professional. The mainstay of treatment is behavioral with surgery reserved for a select group of patients. The evaluation, diagnostic, and treatment modalities of both constipation and pelvic outlet with a focus on current advancements and technology are explored in depth.
  
  PubDate: 2013-11-08T03:03:50Z
Chronic Pelvic Pain
- Abstract: Publication date: Available online 23 October 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Sharon L. Stein
  
  Teaser Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments.
  
  PubDate: 2013-10-27T04:30:09Z
Modern Management of Hemorrhoidal Disease
- Abstract: Publication date: Available online 23 October 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Jason F. Hall
  
  Teaser Complaints secondary to hemorrhoidal disease have been treated by health care providers for centuries. Most symptoms referable to hemorrhoidal disease can be managed nonoperatively. When symptoms do not respond to medical therapy, procedural intervention is recommended. Surgical hemorrhoidectomy is usually reserved for patients who are refractory to or unable to tolerate office procedures. This article reviews the pathophysiology of hemorrhoidal disease and the most commonly used techniques for the nonoperative and operative palliation of hemorrhoidal complaints.
  
  PubDate: 2013-10-27T04:30:09Z
Sexually Transmitted and Anorectal Infectious Diseases
- Abstract: Publication date: Available online 18 October 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Molly M. Cone , Charles B. Whitlow
  
  Teaser Sexually transmitted diseases (STDs) are common and they can involve the anus and rectum in both men and women. In this article, the main bacterial and viral STDs that affect the anus and rectum are discussed, including their prevalence, presentation, and treatment.
  
  PubDate: 2013-10-19T16:23:33Z
Anorectal Physiology and Testing
- Abstract: Publication date: Available online 10 October 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Julie Ann M. Van Koughnett , Giovanna da Silva
  
  Teaser A good understanding of anorectal physiology is essential for the diagnosis and appropriate treatment of various anorectal disorders, such as fecal incontinence, constipation, and pain. This article reviews the physiology of the anorectum and details the various investigations used to diagnose anorectal physiology disorders. These anatomic and functional tests include anal manometry, endoanal ultrasound, defecography, balloon expulsion test, magnetic resonance imaging, pudendal nerve terminal motor latency, electromyography, and colonic transit studies. Indications for investigations, steps in performing the tests, and interpretation of results are discussed.
  
  PubDate: 2013-10-12T06:15:02Z
Anal Abscess and Fistula
- Abstract: Publication date: Available online 4 October 2013
  Source:Gastroenterology Clinics of North America
  Author(s): Erica B. Sneider , Justin A. Maykel
  
  Teaser Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons, and colorectal surgeons. It is important to have a thorough understanding of the complexity of these 2 disease processes so as to provide appropriate and timely treatment. We review the pathophysiology, presentation, diagnosis, and treatment options for both anal abscesses and fistulas.
  
  PubDate: 2013-10-04T21:23:07Z