Current Gastroenterology Reports最新文献_第8页

Immune Checkpoint Inhibitor-Induced (Type 3) Autoimmune Pancreatitis. 免疫检查点抑制剂诱导的（3型）自身免疫性胰腺炎。

Current Gastroenterology Reports Pub Date : 2023-10-01 Epub Date: 2023-10-17 DOI: 10.1007/s11894-023-00885-6

Anusha Shirwaikar Thomas, Suresh T Chari

{"title":"Immune Checkpoint Inhibitor-Induced (Type 3) Autoimmune Pancreatitis.","authors":"Anusha Shirwaikar Thomas, Suresh T Chari","doi":"10.1007/s11894-023-00885-6","DOIUrl":"10.1007/s11894-023-00885-6","url":null,"abstract":"Purpose of review: Immune checkpoint inhibitors (ICI) have revolutionized cancer care and work primarily by blocking CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), and/or PD-1 (programmed cell death protein 1), and/or PD-L1 (programmed death-ligand 1), thereby providing highly efficacious anti-tumor activity. However, this unmitigated immune response can also trigger immune related adverse events (irAEs) in multiple organs, with pancreatic irAEs (now referred to as type 3 Autoimmune pancreatitis (AIP) being infrequent.Recent findings: Type 3 AIP is a drug-induced, immune mediated progressive inflammatory disease of the pancreas that may have variable clinical presentations viz., an asymptomatic pancreatic enzyme elevation, incidental imaging evidence of pancreatitis, painful pancreatitis, or any combination of these subtypes. Management is largely supportive with intravenous fluid hydration, pain control and holding the inciting medication. Steroids have not been shown to demonstrate a clear benefit in acute management. A rapid development pancreatic atrophy is observed on imaging as early as 1 year post initial injury. Type 3 AIP is a chronic inflammatory disease of the pancreas that though predominantly asymptomatic and mild in severity can lead to rapid organ volume loss regardless of type of clinical presentation and despite steroid therapy.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":" ","pages":"255-259"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41233012","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

Nutrition Considerations in Patients with Functional Diarrhea. 功能性腹泻患者的营养注意事项。

Current Gastroenterology Reports Pub Date : 2023-09-01 DOI: 10.1007/s11894-023-00878-5

Courtney Kay Ford

{"title":"Nutrition Considerations in Patients with Functional Diarrhea.","authors":"Courtney Kay Ford","doi":"10.1007/s11894-023-00878-5","DOIUrl":"https://doi.org/10.1007/s11894-023-00878-5","url":null,"abstract":"Purpose: Functional diarrhea (FD) is a functional gastrointestinal disorder that affects a great percentage of the population and has damaging nutritional and psychological effects. In this review, evidence has been assessed and analyzed to provide nutrition considerations and recommendations for patients with functional diarrhea.Recent findings: The traditional irritable bowel syndrome (IBS) diet, the low FODMAP diet, and general recommendations for diarrhea have been established as interventions for FD. Additionally, nutrition outcomes such as vitamin and mineral deficiencies, hydration levels, and mental health status should be at the forefront of assessment. The importance of medical management of FD and IBS-D is established, with many existing evidence-based recommendations and approved medications available. Nutrition management of FD from a registered dietitian/dietitian nutritionist, from symptom control to dietary advice, is imperative. There are no \"one-size-fits-all\" approaches to nutrition management of FD, but there is promising literature that can shape personalized nutrition interventions from a registered dietitian.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"25 9","pages":"198-203"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10380492","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

Providing Trauma Informed Care During Anorectal Evaluation. 在肛肠评估中提供创伤知情护理。

Current Gastroenterology Reports Pub Date : 2023-09-01 DOI: 10.1007/s11894-023-00879-4

Christina H Jagielski, Jessica P Naftaly, Megan E Riehl

引用次数: 0

Update on the Diagnosis and Management of Acute Colonic Pseudo-obstruction (ACPO). 急性结肠假性梗阻(ACPO)的诊断和治疗进展。

Current Gastroenterology Reports Pub Date : 2023-09-01 DOI: 10.1007/s11894-023-00881-w

Ahana Sen, Reena Chokshi

{"title":"Update on the Diagnosis and Management of Acute Colonic Pseudo-obstruction (ACPO).","authors":"Ahana Sen, Reena Chokshi","doi":"10.1007/s11894-023-00881-w","DOIUrl":"https://doi.org/10.1007/s11894-023-00881-w","url":null,"abstract":"Purpose of review: Acute Colonic Pseudo-obstruction (ACPO) is a cause of large intestinal dilation and obstruction without any physical transition point. It remains difficult to diagnose and treat. We review the recent updates on diagnosis and management of ACPO.Recent findings: Recent guidelines have posited that conservative management can be tried in most cases of ACPO, but that early decompression and surgery should be considered. Use of neostigmine is still a viable option but there is also promising data on pyridostigmine as well as prucalopride. Resolution of ACPO should be followed by daily use of polyethylene glycol (PEG) to help prevent recurrence. ACPO warrants early and accurate diagnosis with exclusion of alternate causes of large bowel dilation. Conservative management can be attempted for 48-72 h in those with cecal diameters < 12 cm and without signs of peritonitis and perforation. Early escalation of management should be attempted with neostigmine followed by endoscopy and/or surgery as needed, given that longer periods of dilation are associated with worse outcomes. There is promising new evidence for use of pyridostigmine and prucalopride, but further trials are needed prior to incorporating them into regular use. Finally, studies are lacking regarding prevention of ACPO after initial resolution.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"25 9","pages":"191-197"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10024456","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

Who Places Feeding Tubes and in What Scenario? 谁放置饲管，在什么情况下?

Current Gastroenterology Reports Pub Date : 2023-08-01 DOI: 10.1007/s11894-023-00880-x

Apeksha Shah, Rebecca A Busch, Erica Knavel Koepsel, Mohamed Eisa, Michael Woods, Sonali Palchaudhuri

引用次数: 0

The Use of Integrated Molecular Testing in the Assessment and Management of Pancreatic Cysts. 综合分子检测在胰腺囊肿评估和治疗中的应用。

Current Gastroenterology Reports Pub Date : 2023-08-01 DOI: 10.1007/s11894-023-00877-6

Joshua D Kirschenbaum, Tamas A Gonda

{"title":"The Use of Integrated Molecular Testing in the Assessment and Management of Pancreatic Cysts.","authors":"Joshua D Kirschenbaum, Tamas A Gonda","doi":"10.1007/s11894-023-00877-6","DOIUrl":"https://doi.org/10.1007/s11894-023-00877-6","url":null,"abstract":"Purpose of review: As abdominal imaging becomes more sensitive and regularly used, pancreatic cystic lesions (PCLs) are being diagnosed more frequently. A small but clinically significant minority of these lesions have a predisposition to either harbor malignancy or undergo malignant transformation. This review highlights the current state and performance of cystic fluid biomarkers and how they may be incorporated into management.Recent findings: Among the major domains of molecular testing for PCLs, DNA based analyses have demonstrated the highest accuracy in identifying cyst type and have the most data to support their clinical use. However, epigenetic and protein biomarker based molecular assessments have emerged with the potential to complement DNA based approaches. In addition, recent studies have increasingly demonstrated the value associated with combinations of mutations and other biomarkers in identifying higher grade mucinous cystic lesions. We present the performance of individual biomarkers in cyst fluid analysis with an emphasis on an algorithmic approach to improve the accurate identification of both cyst type and risk of malignant transformation.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"25 8","pages":"182-190"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922318","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

Anastomotic Ulcers: Current Understanding of the Pathogenesis and Management. 吻合口溃疡:目前对其发病机制和治疗的认识。

Current Gastroenterology Reports Pub Date : 2023-07-01 DOI: 10.1007/s11894-023-00873-w

Shaunte McKay, Valeria Cohran, Lee M Bass

引用次数: 0

Indications and safety of newer IBD treatments in the older patient. 老年患者新IBD治疗的适应症和安全性。

Current Gastroenterology Reports Pub Date : 2023-07-01 DOI: 10.1007/s11894-023-00874-9

Benjamin Clement, Kara De Felice, Anita Afzali

{"title":"Indications and safety of newer IBD treatments in the older patient.","authors":"Benjamin Clement, Kara De Felice, Anita Afzali","doi":"10.1007/s11894-023-00874-9","DOIUrl":"https://doi.org/10.1007/s11894-023-00874-9","url":null,"abstract":"Purpose of review: Treatment of inflammatory bowel disease (IBD) in the elderly requires special attention to treatment efficacy while considering drug safety, other medical comorbidities, and the patients' risk for treatment related adverse events. In this article, we reviewed the indications and safety of the newer IBD therapies in the older IBD patient beyond anti-TNF agents, thiopurines, and corticosteroids.Recent findings: Vedolizumab, ustekinumab, and risankizumab have favorable side effect profiles with regards to infections and malignancy. Ozanimod has a favorable side effect profile with regards to infection and malignancy, however cardiac events and macular edema are potential risks. Tofacitinib and upadacitinib are associated with an increased risk of serious infections, herpes zoster, malignancy, and have potential for an increased risk of cardiac events and thrombosis. From a safety profile perspective, vedolizumab, ustekinumab, and risankizumab should be considered first line treatment options for moderate-to-severe IBD in the elderly. Risk-benefit discussions are indicated for ozanimod, tofacitinib, and upadacitinib.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"25 7","pages":"160-168"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10209934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9735072","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

Evaluation of Esophageal Dysphagia in Elderly Patients. 评估老年患者的食道吞咽困难。

Current Gastroenterology Reports Pub Date : 2023-07-01 Epub Date: 2023-06-14 DOI: 10.1007/s11894-023-00876-7

Khanh Hoang Nicholas Le, Eric E Low, Rena Yadlapati

{"title":"Evaluation of Esophageal Dysphagia in Elderly Patients.","authors":"Khanh Hoang Nicholas Le, Eric E Low, Rena Yadlapati","doi":"10.1007/s11894-023-00876-7","DOIUrl":"10.1007/s11894-023-00876-7","url":null,"abstract":"Purpose of review: While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence.Recent findings: In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"25 7","pages":"146-159"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10726678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10094945","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

Colorectal Cancer Screening and Surveillance in the Geriatric Population. 老年群体中的结直肠癌筛查和监测。

Current Gastroenterology Reports Pub Date : 2023-07-01 Epub Date: 2023-05-23 DOI: 10.1007/s11894-023-00875-8

Janice Cheong, Adam Faye, Aasma Shaukat

引用次数: 0