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

[2563 journals] [SJR: 0.988] [H-I: 56]

Miscellaneous Adverse Events with Biologic Agents (Excludes Infection and
Malignancy)
- Abstract: Publication date: Available online 5 July 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Joseph D. Feuerstein , Adam S. Cheifetz
  
  Teaser Anti-tumor necrosis factor-α (anti-TNF) agents are frequently used in the treatment of inflammatory bowel disease (IBD). Currently, there are 4 anti-TNF therapies that are Food and Drug Administration–approved for moderate to severe IBD: infliximab, adalimumab, golimumab, and certolizumab pegol. For most noninfectious, nonmalignant adverse events, cessation of anti-TNF therapy typically leads to improvement or resolution of drug-induced complications. In this article, the current knowledge regarding the noninfectious and nonmalignant toxicities associated with anti-TNF agents is summarized.
  
  PubDate: 2014-07-26T04:25:36Z
The Risk of Malignancy Associated with the Use of Biological Agents in
Patients with Inflammatory Bowel Disease
- Abstract: Publication date: Available online 13 June 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Parambir S. Dulai , Corey A. Siegel
  
  Teaser In this review, the available data regarding the risk of lymphoma, skin cancers, and other malignancies associated with biological agents that are approved and those under investigation for use in inflammatory bowel disease (IBD) are highlighted. How providers may approach the use of these agents in various clinical scenarios is discussed. This review may help providers better understand the true risk of malignancy associated with these agents, thereby leading to an enhanced communication process with patients with IBD when therapeutic decisions are being made.
  
  PubDate: 2014-07-26T04:25:36Z
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
Pharmacokinetics of Biologics and the Role of Therapeutic Monitoring
- Abstract: Publication date: Available online 24 June 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Kirk Lin , Uma Mahadevan
  
  Teaser Biologic therapies, including the anti–tumor necrosis factor-α and cell adhesion molecule inhibitor drugs, have revolutionized the treatment of moderate-to-severe inflammatory bowel disease. Since the introduction of anti–tumor necrosis factor therapies, the strategy of empiric dose-escalation, either increasing the dose or frequency of administration, has been used to recapture clinical response in inflammatory bowel disease. Disparate clinical outcomes have been linked to serum drug and antidrug antibody levels. Therapeutic drug monitoring has emerged as a framework for understanding and responding to the variability in clinical response and remission.
  
  PubDate: 2014-07-26T04:25:36Z
Update on Anti-Tumor Necrosis Factor Agents in Crohn Disease
- Abstract: Publication date: Available online 24 June 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Siddharth Singh , Darrell S. Pardi
  
  Teaser Anti-tumor necrosis factor-α (TNF) agents, including infliximab, adalimumab, and certolizumab pegol, are effective medications for the management of moderate to severe Crohn disease (CD). They are effective in inducing and maintaining clinical remission, inducing mucosal healing, improving quality of life, and reducing the risk of hospitalization and surgery in adult and pediatric patients with CD. Future research into comparative effectiveness of different agents, as well as better understanding of predictors of response, is warranted to allow optimization of therapeutic response.
  
  PubDate: 2014-07-26T04:25:36Z
Update on Janus Kinase Antagonists in Inflammatory Bowel Disease
- Abstract: Publication date: Available online 24 June 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Brigid S. Boland , William J. Sandborn , John T. Chang
  
  Teaser Janus kinase (JAK) inhibitors have emerged as a novel orally administered small-molecule therapy for the treatment of ulcerative colitis and possibly Crohn disease. These molecules are designed to selectively target the activity of specific JAKs and to offer a targeted mechanism of action without risk of immunogenicity. Based on data from clinical trials in rheumatoid arthritis and phase 2 studies in inflammatory bowel disease, tofacitinib and other JAK inhibitors are likely to become a new form of medical therapy for the treatment of inflammatory bowel disease.
  
  PubDate: 2014-07-26T04:25:36Z
Risk of Infections with Biological Agents
- Abstract: Publication date: Available online 16 June 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Uri Kopylov , Waqqas Afif
  
  Teaser An increasing proportion of patients with inflammatory bowel disease (IBD) are treated with biological medications. The risk of infectious complications remains a significant concern in patients treated with biologics. Treatment with biological agents in IBD is generally safe, but there may be an increased risk of certain opportunistic infections. Some of the infectious risks are class specific, whereas others are a common concern for all biologics. A careful screening, surveillance, and immunization program, in accordance with available guidelines, is important to minimize any risk of infectious complications.
  
  PubDate: 2014-07-26T04:25:36Z
Lymphocyte Homing Antagonists in the Treatment of Inflammatory Bowel
Diseases
- Abstract: Publication date: Available online 25 June 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Masayuki Saruta , Konstantinos A. Papadakis
  
  Teaser Lymphocyte homing antagonists represent promising therapeutic agents for the treatment of idiopathic inflammatory bowel disease (IBD). Several critical molecules involved in the recruitment of inflammatory cells in the intestine, including integrins and chemokine receptors, have been successfully targeted for the treatment of IBD. These agents have shown great promise for the induction and maintenance of remission for both Crohn disease and ulcerative colitis. This article discusses currently approved prototypic agents for the treatment of IBD (natalizumab, anti-α4 integrin; vedolizumab, anti-α4β7 integrin), and several other agents in the same class currently under development.
  
  PubDate: 2014-07-26T04:25:36Z
The Use of Biologic Agents in Pregnancy and Breastfeeding
- Abstract: Publication date: Available online 5 July 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Sara Horst , Sunanda Kane
  
  Teaser Biologic therapies, including anti–tumor necrosis factor antibody therapy and anti-integrin antibodies, are currently approved for the treatment of and are increasingly being used in patients with moderate to severe inflammatory bowel disease, including Crohn disease and ulcerative colitis. Because patients who require these medications are often in their child-bearing years, knowledge of the safety of these medications before and after pregnancy is imperative. This article summarizes the available data regarding the use of biologic therapy during and after pregnancy, highlighting such issues as safety for mother and newborn, length of medication use during pregnancy, and breastfeeding after pregnancy while on biologic therapy.
  
  PubDate: 2014-07-26T04:25:36Z
Eosinophilic Gastroenteritis and Related Eosinophilic Disorders
- Abstract: Publication date: June 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 2
  Author(s): Calman Prussin
  
  Teaser Eosinophilic gastroenteritis (EGE) represents one member within the spectrum of diseases collectively referred to as eosinophilic gastrointestinal disorders, which includes eosinophilic esophagitis (EoE), gastritis, enteritis, and colitis. EGE is less common than EoE and involves a different site of disease but otherwise shares many common features with EoE. The clinical manifestations of EGE are protean and can vary from nausea and vomiting to protein-losing enteropathy or even bowel obstruction requiring surgery. Although systemic corticosteroids are an effective treatment for EGE, their use results in substantial corticosteroid toxicity. Accordingly, there is a great need for improved therapies for these patients.
  
  PubDate: 2014-05-10T06:30:12Z
Index
- Abstract: Publication date: June 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 2
  
  PubDate: 2014-05-10T06:30:12Z
Contents
- Abstract: Publication date: June 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 2
  
  PubDate: 2014-05-10T06:30:12Z
Forthcoming Issues
- Abstract: Publication date: June 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 2
  
  PubDate: 2014-05-10T06:30:12Z
Eosinophilic Esophagitis Clinical Presentation in Children
- Abstract: Publication date: June 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 2
  Author(s): Chris A. Liacouras , Jonathan Spergel , Laura M. Gober
  
  Teaser Eosinophilic esophagitis (EoE) is increasing in western nations. Symptoms in infants and young children include feeding difficulties, failure to thrive, and gastroesophageal reflux. School-aged children may present with vomiting, abdominal pain, and regurgitation; adolescents and adults with dysphagia and food impaction. Delayed diagnosis increases risk of stricture formation. Children with untreated EoE have tissue changes resembling airway remodeling. Endoscopy does not always correlate. Management centers on food elimination. Approaches include skin prick and patch testing, removal of foods, or an amino acid formula diet. Long-term elimination diets can produce nutritional deficiencies and have poor adherence.
  
  PubDate: 2014-05-10T06:30:12Z
Contributors
- Abstract: Publication date: June 2014
  Source:Gastroenterology Clinics of North America, Volume 43, Issue 2
  
  PubDate: 2014-05-10T06:30:12Z
Clinical Implications and Pathogenesis of Esophageal Remodeling in
Eosinophilic Esophagitis
- Abstract: Publication date: Available online 16 April 2014
  Source:Gastroenterology Clinics of North America
  Author(s): Ikuo Hirano , Seema S. Aceves
  
  Teaser In eosinophilic esophagitis (EoE), remodeling changes are manifest histologically in the epithelium and subepithelium where lamina propria fibrosis, expansion of the muscularis propria, and increased vascularity occur. The clinical symptoms and complications of EoE are largely consequences of esophageal remodeling. Available therapies have demonstrated variable ability to reverse existing remodeling changes of the esophagus. Systemic therapies have the potential of addressing subepithelial remodeling. Esophageal dilation remains a useful, adjunctive therapeutic maneuver in symptomatic adults with esophageal stricture. As novel treatments emerge, it is essential that therapeutic end points account for the fundamental contributions of esophageal remodeling to overall disease activity.
  
  PubDate: 2014-04-20T11:15:26Z
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
Contents
- Abstract: Publication date: December 2013
  Source:Gastroenterology Clinics of North America, Volume 42, Issue 4
  
  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