Current Opinion in Gastroenterology最新文献_第9页

Fluid resuscitation in acute pancreatitis. 急性胰腺炎的液体复苏。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-09-01 Epub Date: 2023-07-05 DOI: 10.1097/MOG.0000000000000959

Allison L Yang, Santhi Swaroop Vege

引用次数: 0

Medical management of hypertriglyceridemia in pancreatitis. 胰腺炎患者高甘油三酯血症的药物治疗。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-09-01 Epub Date: 2023-07-05 DOI: 10.1097/MOG.0000000000000956

Nikola Gligorijevic, Maja Stefanovic-Racic, Erin E Kershaw

{"title":"Medical management of hypertriglyceridemia in pancreatitis.","authors":"Nikola Gligorijevic, Maja Stefanovic-Racic, Erin E Kershaw","doi":"10.1097/MOG.0000000000000956","DOIUrl":"10.1097/MOG.0000000000000956","url":null,"abstract":"Purpose of review: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) should be considered in all cases of acute pancreatitis and triglyceride levels measured early, so that appropriate early and long-term treatment can be initiated.Recent findings: In most cases of HTG-AP, conservative management (nothing by mouth, intravenous fluid resuscitation and analgesia) is sufficient to achieve triglyceride levels less than 500 mg/dl. Intravenous insulin and plasmapheresis are sometimes used, although prospective studies showing clinical benefits are lacking. Pharmacological management of hypertriglyceridemia (HTG) should start early and target triglyceride levels of less than 500 mg/dl to reduce the risk or recurrent acute pancreatitis. In addition to currently used fenofibrate and omega-3 fatty acids, several novel agents are being studied for long-term treatment of HTG. These emerging therapies focus mainly on modifying the action of lipoprotein lipase (LPL) through inhibition of apolipoprotein CIII and angiopoietin-like protein 3. Dietary modifications and avoidance of secondary factors that worsen triglyceride levels should also be pursued. In some cases of HTG-AP, genetic testing may help personalize management and improve outcomes.Summary: Patients with HTG-AP require acute and long-term management of HTG with the goal of reducing and maintaining triglyceride levels to less than 500 mg/dl.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"39 5","pages":"421-427"},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9985602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Interpretation of serum pancreatic enzymes in pancreatic and nonpancreatic conditions. 胰腺和非胰腺疾病中血清胰酶的解读。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-09-01 Epub Date: 2023-06-22 DOI: 10.1097/MOG.0000000000000961

Nikhil Bush, Venkata S Akshintala

{"title":"Interpretation of serum pancreatic enzymes in pancreatic and nonpancreatic conditions.","authors":"Nikhil Bush, Venkata S Akshintala","doi":"10.1097/MOG.0000000000000961","DOIUrl":"10.1097/MOG.0000000000000961","url":null,"abstract":"Purpose of review: Serum levels of amylase and lipase can be elevated in nonpancreatic conditions that may or may not be associated with abdominal pain. This leads to a large proportion of patients being falsely labeled as having acute pancreatitis. In this review, we aim to summarize the existing evidence on pancreatic enzyme elevation in various pancreatic and nonpancreatic conditions and its practical implications in clinical practice and healthcare.Recent findings: Serum amylase and lipase levels are not specific for pancreatitis. Attempts have been made to validate newer biomarkers including pancreatic elastase, serum trypsin, urinary trypsinogen-activated peptide, phospholipase A2, carboxypeptidase B, activated peptide of carboxypeptidase B, the trypsin 2 alpha 1 activation complex, and circulating cell-free DNA for the diagnosis of acute pancreatitis.Summary: Serum lipase levels can be elevated in many intra-abdominal inflammatory conditions. Although more sensitive and specific than amylase, serum lipase levels are not sufficient to diagnose acute pancreatitis in patients with abdominal pain. There is a need to increase stress on radiological evidence as well increase cut-off levels of enzyme elevation for a more accurate diagnosis of acute pancreatitis.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"39 5","pages":"403-410"},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thermal ablative therapies in the gastrointestinal tract. 胃肠道热烧蚀疗法。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-09-01 Epub Date: 2023-06-22 DOI: 10.1097/MOG.0000000000000954

Hendrik Manner

引用次数: 0

Therapeutic endoscopy pushing the boundaries: what boundaries? 突破界限的内窥镜治疗：什么界限？

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-09-01 DOI: 10.1097/MOG.0000000000000962

Anthony N Kalloo

引用次数: 0

Endoscopic approaches to the management of hemorrhoids. 用内窥镜治疗痔疮。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-09-01 Epub Date: 2023-06-21 DOI: 10.1097/MOG.0000000000000960

Syed Matthew Kodilinye, Anthony N Kalloo

{"title":"Endoscopic approaches to the management of hemorrhoids.","authors":"Syed Matthew Kodilinye, Anthony N Kalloo","doi":"10.1097/MOG.0000000000000960","DOIUrl":"10.1097/MOG.0000000000000960","url":null,"abstract":"Purpose of review: To review the literature within the last 5 years on the current status and future perspectives of the endoscopic management of internal hemorrhoids.Recent findings: Despite the large burden of hemorrhoidal diseases, research in this area, particularly on endoscopic approaches for treatment, has been slow. Within the last 5 years, data has been published on the novel cap-assisted endoscopic sclerotherapy (CAES), which will continue to gain attention in the future. Rubber band ligation has been adopted by the endoscopist as endoscopic rubber band ligation (ERBL), demonstrating satisfactory results in treating symptomatic hemorrhoids, although mild postprocedure complications are common. Data is needed on head-to-head comparisons between ERBL, endoscopic sclerotherapy, and CAES. Other methods, such as coagulation, are understudied and should be explored further in the endoscopic setting. Meaningful comparisons between treatment methods for internal hemorrhoids have been difficult because of variations in interventional techniques and methods, differences in the grading of hemorrhoids, and lack of standardization of clinical trials. The Goligher classification alone is inadequate for determining the management of symptomatic hemorrhoids and this warrants revision.Summary: Gastroenterologists are poised to assume a greater role in the management of internal hemorrhoids with flexible endoscopy. Current endoscopic treatment options require further study.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"39 5","pages":"375-380"},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9931316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy. 在胃肠道解剖结构改变的患者中使用腔隙贴合金属支架。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-09-01 Epub Date: 2023-07-20 DOI: 10.1097/MOG.0000000000000965

Yervant Ichkhanian, Manol Jovani

{"title":"Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy.","authors":"Yervant Ichkhanian, Manol Jovani","doi":"10.1097/MOG.0000000000000965","DOIUrl":"10.1097/MOG.0000000000000965","url":null,"abstract":"Purpose of review: Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions.Recent findings: Pancreatobiliary (PB) and non-PB interventions are challenging in patients with SAA. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and endoscopic ultrasound (EUS)-directed transenteric ERCP (EDEE) are effective procedures that are being increasingly utilized to perform ERCP in patient with Roux-en-Y gastric bypass (RYGB) and non-RYGB SAA, respectively. Furthermore, EUS-directed trans-gastric intervention (EDGI) is a collective term for the non-PB procedures that could be performed in patients with SAA. EDGE/EDEE/EDGI are considered relatively safe procedures, however, intra-procedural stent misdeployement, and long-term ramifications of persistent fistula and stent migration could require endoscopic or, in rare instances, surgical management.Summary: The advent of LAMS has revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. With the growing body of literature, it is expected that such techniques will be more commonly performed in the community, providing less invasive and more effective treatment options for patients with SAA.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"39 5","pages":"348-355"},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9935309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How to recognize and treat rumination syndrome. 如何识别和治疗反刍综合征。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-07-01 Epub Date: 2023-04-25 DOI: 10.1097/MOG.0000000000000937

Akinari Sawada, Daniel Sifrim

{"title":"How to recognize and treat rumination syndrome.","authors":"Akinari Sawada, Daniel Sifrim","doi":"10.1097/MOG.0000000000000937","DOIUrl":"10.1097/MOG.0000000000000937","url":null,"abstract":"Purpose of review: Rumination syndrome (RS) is a functional gastroduodenal disorder characterized by repeated effortless regurgitation or vomiting of recently ingested food without retching. RS generally has been considered a rare entity. However, it has been increasingly recognized that many RS patients are likely to be underdiagnosed. This review discusses how to recognize and manage RS patients in clinical practice.Recent findings: A recent epidemiological study that included over 50,000 individuals found that the prevalence of RS around the world is 3.1%. In patients with proton pump inhibitor (PPI)-refractory reflux symptoms, postprandial high-resolution manometry combined with impedance (HRM/Z) reveals that RS accounts for up to 20% of those cases. HRM/Z can be a gold standard for objective RS diagnosis. In addition, off-PPI 24-h impedance pH monitoring can suggest the possibility of RS when it reveals frequent postprandial, non-acid reflux with a high symptom index. Modulated cognitive behavioral therapy (CBT) targeting secondary psychological maintaining mechanisms almost eliminates regurgitation.Summary: The prevalence of RS is higher than generally thought. For patients suspected of RS, HRM/Z is useful to distinguish RS from gastroesophageal reflux disease. CBT can be a highly effective therapeutic option.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"39 4","pages":"340-346"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9663008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Managing the older adult with inflammatory bowel disease: is age just a number? 管理患有炎症性肠病的老年人：年龄只是一个数字吗？

IF 2.6 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-07-01 Epub Date: 2023-05-23 DOI: 10.1097/MOG.0000000000000943

Helen Bermudez, Adam S Faye, Bharati Kochar

{"title":"Managing the older adult with inflammatory bowel disease: is age just a number?","authors":"Helen Bermudez, Adam S Faye, Bharati Kochar","doi":"10.1097/MOG.0000000000000943","DOIUrl":"10.1097/MOG.0000000000000943","url":null,"abstract":"Purpose of review: This review summarizes the most recent literature on older adults with inflammatory bowel diseases (IBD). Additionally, we review geriatric syndromes that may be pertinent to the management of older adults with IBD.Recent findings: Traditionally chronological age has been used to risk stratify older adults with IBD, however physiologic status, including comorbidities, frailty, and sarcopenia, are more closely associated with clinical outcomes for older adults. Delaying care for and undertreating older adults with IBD based upon advanced chronologic age alone is associated with worse outcomes, including increased mortality. Treatment decisions should be made considering physiologic status, with an understanding of the differential risks associated with both ongoing disease and treatment. As such, there is an increasing recognition of the impact geriatric syndromes have on older adults with IBD, which need to be further explored.Summary: Older adults with IBD are less likely to receive advanced therapies and timely surgery. They are also more likely to have adverse outcomes despite having similar disease courses to younger adults with IBD. Focusing on biological age as opposed to chronological age can shift this trajectory and improve quality of care for this growing population of patients with IBD.","PeriodicalId":50607,"journal":{"name":"Current Opinion in Gastroenterology","volume":"39 4","pages":"268-273"},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10275506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9663562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying individuals at risk of esophageal adenocarcinoma: challenges, existing tools and future steps. 识别有食道腺癌风险的个体：挑战、现有工具和未来步骤。

IF 2.5 3区医学

Current Opinion in Gastroenterology Pub Date : 2023-07-01 Epub Date: 2023-05-23 DOI: 10.1097/MOG.0000000000000938

Andrew T Kunzmann, Joel H Rubenstein

引用次数: 0