Current Gastroenterology Reports最新文献_第7页

Precision Dosing of Anti-TNF Therapy in Pediatric Inflammatory Bowel Disease. 抗肿瘤坏死因子治疗在儿童炎症性肠病中的精确剂量

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-09-11 DOI: 10.1007/s11894-023-00895-4

Abigail Samuels, Kaitlin G Whaley, Phillip Minar

{"title":"Precision Dosing of Anti-TNF Therapy in Pediatric Inflammatory Bowel Disease.","authors":"Abigail Samuels, Kaitlin G Whaley, Phillip Minar","doi":"10.1007/s11894-023-00895-4","DOIUrl":"10.1007/s11894-023-00895-4","url":null,"abstract":"Purpose of the review: This review focuses on recent advancements in anti-TNF therapeutic drug monitoring (TDM), pharmacogenetics and personalized drug selection for children with inflammatory bowel disease (IBD).Recent findings: Several real-world studies and one clinical trial in children have demonstrated that proactive TDM, targeting higher exposure concentrations (> 5 µg/mL), can improve disease remission rates and enhance durability of the anti-TNF biologics. Recent data from both adult and pediatric IBD patients have revealed an association between a genetic polymorphism (HLA-DQA1*05) and the development of auto-drug antibodies. The impact of this association on clinical outcomes, considering more routine use proactive TDM and dose optimization in children, is still under investigation. Additionally, recent studies have identified potential inflammatory signatures and biomarkers that may serve as companion diagnostics for anti-TNF biologics. The effective management of anti-TNF therapies in children with IBD requires evidence-based precision dosing strategies, including routine TDM and proactive pharmacodynamic assessments.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"323-332"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10865142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10206506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgical Options for End-Stage Achalasia. 终末期失弛缓症的手术选择。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-08-30 DOI: 10.1007/s11894-023-00889-2

Melissa DeSouza

{"title":"Surgical Options for End-Stage Achalasia.","authors":"Melissa DeSouza","doi":"10.1007/s11894-023-00889-2","DOIUrl":"10.1007/s11894-023-00889-2","url":null,"abstract":"Purpose of review: Achalasia is one of the most commonly described primary esophageal motility disorders worldwide, but there is significant controversy regarding ideal management of end-stage disease. This article reviews the definition of end-stage achalasia and summarizes past and present surgical treatment.Recent findings: Myotomy of the lower esophageal sphincter remains the mainstay of treatment of achalasia, even in advanced disease. Esophagectomy may have benefit as a primary treatment modality in end-stage achalasia with sigmoid esophagus, but international guidelines recommend consideration of laparoscopic or endoscopic approaches initially in most patients. Novel peroral esophageal plication techniques may provide alternative treatment options in patients with significant esophageal dilation that fail myotomy or esophagectomy.Summary: End-stage achalasia is characterized by progressive tortuosity and dilation of the esophagus as a failure of primary peristalsis. Up to 20% of patients with achalasia will progress to end-stage disease. In most cases, laparoscopic or endoscopic myotomy is recommended as initial approach to surgical management.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"267-274"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10113014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Climate Change and the Esophagus: Speculations on Changing Disease Patterns as the World Warms. 气候变化与食道:随着全球变暖对疾病模式变化的推测。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-09-01 DOI: 10.1007/s11894-023-00888-3

Yeong Yeh Lee, Nur Sakinah Roslan, Vincent Tee, Thai Hau Koo, Yusof Shuaib Ibrahim

{"title":"Climate Change and the Esophagus: Speculations on Changing Disease Patterns as the World Warms.","authors":"Yeong Yeh Lee, Nur Sakinah Roslan, Vincent Tee, Thai Hau Koo, Yusof Shuaib Ibrahim","doi":"10.1007/s11894-023-00888-3","DOIUrl":"10.1007/s11894-023-00888-3","url":null,"abstract":"Purpose of review: Esophageal disorders, including gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), and esophageal cancer, may be affected by climate change. Our review describes the impact of climate change on risk factors associated with esophageal diseases and speculates how these climate-related factors impacted esophageal disorders and their management.Recent findings: Climate change is responsible for extreme weather conditions (shifts in rainfall, floods, droughts, and forest fires) and global warming. These consequences affect basic human needs of water and food, causing changes in population dynamics and pose significant threats to digestive health, including common esophageal disorders like GERD, EoE, and esophageal cancers. The changing patterns of esophageal diseases with climate change are likely mediated through risk factors, including nutrition, pollutants, microplastics, and the microbiota-gut-brain axis. The healthcare process itself, including GI endoscopy practices commonly employed in diagnosing and therapeutics of esophageal diseases, may, in turn, contribute to climate change through plastic wastage and greenhouse gas emissions, thus creating the climate change lifecycle. Breaking the cycle would involve changes at the individual level, community level, and national policy level. Prevention is key, with individuals identifying and remediating risk factors and reducing carbon footprints. The ABC (Advocacy, Broadcast, and Collaborate) activities would help enhance awareness at the community level. Higher-level programs such as the Bracing Resilience Against Climate Effects (BRACE) would lead to broader and larger-scale adoption of public health adaptation strategies at the national level. The impact of climate change on esophageal disorders is likely real, mediated by several risk factors, and creates a climate change lifecycle that may only break if changes are made at individual, community, and national levels.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"280-288"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10120835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Esophageal Cancer: Overview, Risk Factors, and Reasons for the Rise. 癌症食管癌：概述，危险因素和发病原因。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-10-09 DOI: 10.1007/s11894-023-00899-0

Steve Lander, Eric Lander, Michael K Gibson

{"title":"Esophageal Cancer: Overview, Risk Factors, and Reasons for the Rise.","authors":"Steve Lander, Eric Lander, Michael K Gibson","doi":"10.1007/s11894-023-00899-0","DOIUrl":"10.1007/s11894-023-00899-0","url":null,"abstract":"Purpose of review: Esophageal cancer (EC) is a common cancer affecting many regions of the world and carries significant morbidity and mortality. In this article, we review the key risk factors and their associated impact on the changing incidence and prevalence of EC subtypes within different global regions. We also highlight potential reasons for the ever-changing epidemiology of this prevalent cancer type.Recent findings: There has been a shift in incidence of Esophageal Adenocarcinoma (AC) and Squamous Cell Carcinoma (SCC) within certain populations primarily due to an increase prevalence of primary risk factors. In Western nations, more often the United States, there has been a shift from SCC predominance to the majority of new cases of EC being adenocarcinoma. This shift within the United States has largely correlated with a rise in obesity. The prevalence of AC in Asia is also starting to rise as more countries adopt a western diet. The pathophysiology, associated risk factors, and presentation of ESCC and AC are different. This difference is seen in varying lifestyles, population health, and certain genetic risks. With further development closer analysis of primary risk factors and implementation of policies and programs that promote public health literacy, there is a potential to decrease esophageal cancer's global disease burden.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"275-279"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41123023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment of Cholestasis in Infants and Young Children. 婴幼儿胆汁淤积症的治疗。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-08-31 DOI: 10.1007/s11894-023-00891-8

Nicole Heinz, Jennifer Vittorio

{"title":"Treatment of Cholestasis in Infants and Young Children.","authors":"Nicole Heinz, Jennifer Vittorio","doi":"10.1007/s11894-023-00891-8","DOIUrl":"10.1007/s11894-023-00891-8","url":null,"abstract":"Purpose of review: Cholestasis is characterized by a conjugated hyperbilirubinemia secondary to impaired bile synthesis, transport, or excretion from the liver. It is always pathologic and can be indicative of an underlying hepatobiliary, genetic, or metabolic disorder, several of which require timely diagnosis to ensure proper management and optimal outcomes. This review provides an overview of the evaluation of cholestasis with a focus on current and emerging treatment strategies.Recent findings: Increased accessibility of next generation sequencing (NGS) allows for utilization of genetic testing early in the diagnostic process. This may alter the clinical algorithm for diagnosis of cholestatic disorders. An enhanced understanding of the underlying pathophysiology may help guide future development of targeted therapies, such as ileal bile acid transporter (IBAT) inhibitors. These were recently approved for treatment of cholestatic pruritus in patients with Alagille syndrome and Progressive Familial Intrahepatic Cholestasis. Current management of cholestasis is aimed at the biochemical consequences of impaired bile flow, including malnutrition, pruritus, and progressive fibrosis. NGS has led to an enhanced understanding of biliary pathology and may guide development of future treatment modalities based on specific gene mutations. Rapid discernment of the underlying etiology is essential as new treatment modalities emerge.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"344-354"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10178040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clostridioides difficile Infection in Pediatric Inflammatory Bowel Disease. 儿童炎症性肠病中的艰难梭菌感染。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-08-30 DOI: 10.1007/s11894-023-00890-9

Seth A Reasoner, Maribeth R Nicholson

引用次数: 0

The Role of Endoscopy in the Management of Adolescent Bariatric Patients: A Primer For Pediatric Gastroenterologists. 内窥镜在青少年减肥患者治疗中的作用：儿科胃肠病学家的入门知识。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-10-03 DOI: 10.1007/s11894-023-00894-5

Robert E Kramer

{"title":"The Role of Endoscopy in the Management of Adolescent Bariatric Patients: A Primer For Pediatric Gastroenterologists.","authors":"Robert E Kramer","doi":"10.1007/s11894-023-00894-5","DOIUrl":"10.1007/s11894-023-00894-5","url":null,"abstract":"Purpose of review: The prevalence of childhood and adolescent obesity in the United States has reached alarming levels, necessitating effective interventions such as bariatric surgery. This article reviews the current state of bariatric surgery in the adolescent population, highlighting the common complications encountered in post-bariatric patients. Furthermore, it outlines the pivotal role of endoscopy in both the prevention and management of these bariatric complications.Recent findings: Though only a minority of eligible adolescent patients undergo bariatric surgery the number of cases continues to increase. Sleeve gastrectomy has emerged as the preferred type of surgery, with the best balance of safety and efficacy. However, only a small number of pediatric surgeons have additional bariatric training and a number of technical aspects of the surgery itself impact the risk for post-surgical complications. Gastric sleeve stenosis, anastomotic leaks and gastroesophageal reflux are the most common of these complications. Ability to perform dilation of sleeve stenosis, closure of anastomotic leaks and evaluation of reflux are critical tools in the endoscopic toolbox necessary for the management of these complicated patients. Bariatric surgery remains the most effective treatment available for management of morbid obesity in adolescents but has significant associated complications. Pediatric gastroenterologists must be familiar in the endoscopic management of these complications and are crucial in creating a high functioning adolescent bariatric program.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"299-307"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41143299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Treatment of Pediatric Eosinophilic Esophagitis: Traditional and Novel Therapies. 儿童嗜酸性粒细胞性食管炎的治疗:传统与新疗法。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-09-02 DOI: 10.1007/s11894-023-00893-6

Colby S Sharlin, Vincent A Mukkada, Philip E Putnam, Scott M Bolton

引用次数: 0

Update on Cystic Fibrosis in Pediatric Patients. 儿科患者囊性纤维化的最新进展。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-09-01 DOI: 10.1007/s11894-023-00896-3

Sarah Shrager Lusman

引用次数: 1

Promoting Research that Supports High-Quality Gastrointestinal Endoscopy in Children. 促进支持儿童高质量胃肠内窥镜检查的研究。

Current Gastroenterology Reports Pub Date : 2023-11-01 Epub Date: 2023-10-02 DOI: 10.1007/s11894-023-00897-2

Lisa B Mahoney, Catharine M Walsh, Jenifer R Lightdale

引用次数: 0