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Gastroenterology Clinics of North America

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https://read.qxmd.com/read/30711215/new-developments-in-celiac-disease
#1
EDITORIAL
Benjamin Lebwohl, Peter H R Green
No abstract text is available yet for this article.
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711214/celiac-disease-gluten-free-and-today-s-fashionista
#2
EDITORIAL
Alan L Buchman
No abstract text is available yet for this article.
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711213/-outcome-measure-for-intervention-measures-a-guide-to-choosing-the-appropriate-noninvasive-clinical-outcome-measure-for-intervention-studies-in-celiac-disease
#3
REVIEW
Prashant Singh, Jocelyn A Silvester, Daniel Leffler
There is an unmet need for diagnostic and treatment interventions for celiac disease. Both clinical trials and real-world studies require careful selection of clinical outcome measures. Often, neither serology nor histology is an appropriate primary outcome. This article reviews various measures of intestinal function and nutrition, patient-reported outcome measures for symptoms and for health-related quality of life, and measures of sickness burden as they apply to intervention studies for celiac disease. A series of case studies is presented to illustrate key considerations in selecting outcome measures for dietary interventions, pharmacologic interventions, and real-world studies...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711212/capsule-endoscopy-and-enteroscopy-in-celiac-disease
#4
REVIEW
Suzanne K Lewis, Carol E Semrad
Celiac disease predominantly involves the proximal small bowel, but villus atrophy can be patchy, spare the duodenum, and be present more distally. Video capsule endoscopy is more sensitive than standard endoscopy to detect villus atrophy, and can define extent of disease, though it cannot obtain biopsies. Duodenal biopsy is the gold standard for diagnosis. Video capsule endoscopy assists in special circumstances when biopsy is not possible, and in equivocal diagnosis. Video capsule endoscopy and enteroscopy are recommended for evaluating complicated celiac disease, especially refractory celiac disease type II...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711211/nutritional-considerations-of-the-gluten-free-diet
#5
REVIEW
Melinda Dennis, Anne R Lee, Tara McCarthy
Celiac disease (CD) is an autoimmune-related disease causing inflammation in the small intestine triggered by the ingestion of gluten in the diet. The gluten-free diet (GFD) is the only treatment. Nutritional deficiencies of macronutrients and micronutrients are frequently found in untreated or newly diagnosed CD. A registered dietitian nutritionist is uniquely qualified to educate on the GFD and assess and support nutritional status at diagnosis and long term as well as helping patients with nonresponsive CD...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711210/biopsy-diagnosis-of-celiac-disease-the-pathologist-s-perspective-in-light-of-recent-advances
#6
REVIEW
Stephen M Lagana, Govind Bhagat
Celiac disease is a common immune-mediated disorder that occurs in individuals with permissive genetics (HLA-DQ2/DQ8 genotype) following exposure to certain wheat proteins. The histopathologic manifestations of small intestinal mucosal injury (villus atrophy, crypt hyperplasia, and intraepithelial lymphocytosis) are well recognized. However, these findings are not specific for celiac disease, because they are observed in other small intestinal disorders. These mimics include common and rare entities, the list of which continues to grow...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711209/celiac-disease-clinical-features-and-diagnosis
#7
REVIEW
Isabel A Hujoel, Norelle R Reilly, Alberto Rubio-Tapia
The presentation in celiac disease is shifting from the classical malabsorptive presentation to more nonclassical presentations, requiring clinicians to maintain a high level of suspicion for the disease and to be aware of the possible extraintestinal manifestations. The diagnosis of celiac disease is guided by initial screening with serology, followed by confirmation with an upper endoscopy and small intestinal biopsy. In some pediatric cases, biopsy may be avoided.
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711208/nonceliac-wheat-sensitivity-an-immune-mediated-condition-with-systemic-manifestations
#8
REVIEW
Umberto Volta, Roberto De Giorgio, Giacomo Caio, Melanie Uhde, Roberto Manfredini, Armin Alaedini
Non-celiac wheat sensitivity (NCWS) is characterized by gastrointestinal and extra-intestinal symptoms following the ingestion of gluten-containing cereals in subjects without celiac disease or wheat allergy. The identity of the molecular triggers in these cereals responsible for the symptoms of NCWS remains to be delineated. Recent research has identified a biological basis for the condition, with the observation of systemic immune activation in response to microbial translocation that appears to be linked to intestinal barrier defects...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711207/nondietary-therapies-for-celiac-disease
#9
REVIEW
Gloria Serena, Ciaran P Kelly, Alessio Fasano
Celiac disease (CD) is an autoimmune enteropathy triggered by gluten. Gluten-free diets can be challenging because of their restrictive nature, inadvertent cross-contaminations, and the high cost of gluten-free food. Novel nondietary therapies are at the preclinical stage, clinical trial phase, or have already been developed for other indications and are now being applied to CD. These therapies include enzymatic gluten degradation, binding and sequestration of gluten, restoration of epithelial tight junction barrier function, inhibition of tissue transglutaminase-mediated potentiation of gliadin oligopeptide immunogenicity or of human leukocyte antigen-mediated gliadin presentation, induction of tolerance to gluten, and antiinflammatory interventions...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711206/refractory-celiac-disease
#10
REVIEW
Georgia Malamut, Christophe Cellier
Refractory celiac disease (RCD) refers to persistence of malnutrition and intestinal villous atrophy for more than 1 to 2 years despite strict gluten-free diet in patients with celiac disease. Diagnosis remains difficult and impacts treatment and follow-up. RCD has been subdivided into 2 subgroups according to the normal (RCDI) or abnormal phenotype of intraepithelial lymphocytes (IELs) (RCDII). RCDII is considered as a low-grade intraepithelial lymphoma and has a poor prognosis due to gastrointestinal and extraintestinal dissemination of the abnormal IELs, and high risk of overt lymphoma...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711205/follow-up-of-celiac-disease
#11
REVIEW
Steffen Husby, Julio C Bai
Currently, the only effective treatment for celiac disease is complete removal of gluten from the diet. However, patients need to follow a strict gluten-free diet that results in symptomatic, serologic, and histologic remission in most patients. Histologic remission is usually complete in children, but recovery is slower and more frequently incomplete in adults. When remission has been achieved, yearly follow-up is recommended for adults, children, and adolescents. This article deals with conventional strategies used in order to follow-up patients on treatment and aiming to obtain the best clinical outcome...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711204/the-microbiome-in-celiac-disease
#12
REVIEW
Suneeta Krishnareddy
The healthy microbiome is necessary for normal immune development in the gut. Alterations in the microbial makeup after a critical window increase the risk of autoimmunity, including celiac disease. Although this dysbiosis has been described in adult and pediatric patients, factors leading to dysbiosis are still being elucidated. Genetics has some role in determining the microbiome makeup of the host, but other factors have yet to be determined. The microbiome remains an important therapeutic target in many autoimmune conditions, including celiac disease, however studies have yet to determine the ideal replacement therapy to correct the dysbiosis...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711203/celiac-disease-in-asia
#13
REVIEW
Govind K Makharia, Carlo Catassi
Celiac disease, once thought to be very uncommon in Asia, is now emerging in many Asian countries. Although the absolute number of patients with celiac disease at present is not very high, this number is expected to increase markedly over the next few years/decades owing to increasing awareness. It is now that the medical community across the Asia should define the extent of the problem and prepare to handle the impending epidemic of celiac disease in Asia.
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30711202/epidemiology-of-celiac-disease
#14
REVIEW
Jonas F Ludvigsson, Joseph A Murray
Celiac disease is a common, chronic inflammatory disorder of the small intestine triggered by exposure to gluten in individuals with certain genetic types. This disorder affects people of any age or gender. Although often thought to be European in origin, it is now global in extent. Presentations are variable, from asymptomatic patients to severe malnutrition. Initial detection usually relies on celiac-specific serology, and confirmation often requires intestinal biopsy. There have been substantial increases in prevalence and incidence over the last 2 decades for reasons that are almost certainly environmental but for which there is no clarity as to cause...
March 2019: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30337045/pediatric-gastroenterology
#15
EDITORIAL
Robert J Shulman
No abstract text is available yet for this article.
December 2018: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30337044/pediatric-gastroenterology-not-just-dealing-with-little-adults
#16
EDITORIAL
Alan L Buchman
No abstract text is available yet for this article.
December 2018: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30337043/advances-in-pediatric-fatty-liver-disease-pathogenesis-diagnosis-and-treatment
#17
REVIEW
Hayley A Braun, Sarah A Faasse, Miriam B Vos
Pediatric nonalcoholic fatty liver disease is an increasingly prevalent disease, but its pathophysiology is not fully elucidated, diagnosis is difficult and invasive, and therapeutic options are limited. This article addresses the recent advancements made in understanding the pathophysiology of nonalcoholic fatty liver disease, the development of less invasive diagnostic modalities, and emerging therapeutic options, including ongoing clinical trials in children.
December 2018: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30337042/assessment-and-treatment-of-nonadherence-in-transplant-recipients
#18
REVIEW
Caitlin Shneider, Claire Dunphy, Eyal Shemesh, Rachel A Annunziato
Stable intake of an immunosuppressant medication regimen is essential for posttransplant survival in the vast majority of cases. And yet, many patients are nonadherent (do not take their medications as prescribed), and suffer consequences ranging from rejection to morbidity and mortality. We review the evidence related to monitoring of adherence to medications, and intervention strategies. Our aim is to provide a baseline from which readers may approach behavioral aspects of posttransplant care. This review may also help readers in designing clinical programs for routine monitoring of adherence, and inform the choice of intervention when adherence falls below a certain threshold...
December 2018: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30337041/molecular-mechanisms-in-pediatric-cholestasis
#19
REVIEW
James E Squires, Patrick McKiernan
Pediatric cholestasis often results from mechanical obstruction of the biliary tract or dysfunction in the processes of forming and excreting bile. Various genetic defects with resulting molecular inaccuracies are increasingly being recognized, often with specific clinical characteristics. Identifying of the molecular abnormality can enable implementation of timely, appropriate treatment in some affected individuals and provide prognostic indicators for both families and care teams.
December 2018: Gastroenterology Clinics of North America
https://read.qxmd.com/read/30337040/improving-care-in-pediatric-inflammatory-bowel-disease
#20
REVIEW
Matthew D Egberg, Michael D Kappelman, Ajay S Gulati
Pediatric patients with inflammatory bowel disease (IBD) stand to benefit from quality improvement (QI) due to the chronic nature of the disease, frequent interaction with the health care system, and exposure to high-risk treatments. The use of QI in health care has led to significant improvements in quality and reliability of care. Despite these advances, significant deficits in providing high-quality pediatric IBD care persist. This article describes a brief history of health care QI, identifies gaps and challenges in delivery of quality pediatric IBD care, highlights several IBD QI initiatives, and concludes with future directions for improving pediatric IBD outcomes...
December 2018: Gastroenterology Clinics of North America
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