Tim Raine, Bram Verstockt, Uri Kopylov, Konstantinos Karmiris, Rima Goldberg, Raja Atreya, Johan Burisch, John Burke, Pierre Ellul, Charlotte Hedin, Stefan D Holubar, Konstantinos Katsanos, Triana Lobaton, Carsten Schmidt, Garret Cullen
Inflammatory bowel disease is a chronic disease with variable degrees of extent, severity, and activity. A proportion of patients will have disease that is refractory to licensed therapies, resulting in significant impairment in quality-of-life. The treatment of these patients involves a systematic approach by the entire multi-disciplinary team, with particular consideration given to medical options including unlicensed therapies, surgical interventions, and dietetic and psychological support. The purpose of this review is to guide clinicians through this process and provide an accurate summary of the available evidence for different strategies...
June 23, 2021: Journal of Crohn's & Colitis
Evan S Dellon, Margaret H Collins, David A Katzka, Vincent A Mukkada, Gary W Falk, Robin Morey, Bridgett Goodwin, Jessica D Eisner, Lan Lan, Nirav K Desai, James Williams, Ikuo Hirano
BACKGROUND AND AIMS: We evaluated treatment withdrawal, long-term outcomes and safety of budesonide oral suspension (BOS) 2.0 mg b.i.d. in patients with eosinophilic esophagitis who completed a 12-week induction study. METHODS: Induction full responders (≤6 eosinophils per high-power field [eos/hpf] and ≥30% reduction in Dysphagia Symptom Questionnaire [DSQ] score) to BOS 2.0 mg b.i.d. (ORBIT1/SHP621-301/NCT02605837) were randomized to continue BOS (BOS-BOS) or withdraw to placebo (BOS-PBO) for 36 weeks (ORBIT2/SHP621-302/NCT02736409)...
June 25, 2021: Clinical Gastroenterology and Hepatology
Jeffrey A Berinstein, Jessica L Sheehan, Michael Dias, Elliot M Berinstein, Calen A Steiner, Laura A Johnson, Randolph E Regal, John I Allen, Kelly C Cushing, Ryan W Stidham, Shrinivas Bishu, Jami A R Kinnucan, Shirley A Cohen-Mekelburg, Akbar K Waljee, Peter D R Higgins
BACKGROUND & AIMS: Despite rescue therapy, more than 30% of patients with acute severe ulcerative colitis (ASUC) require colectomy. Tofacitinib is a rapidly acting Janus kinase inhibitor with proven efficacy in ulcerative colitis. Tofacitinib may provide additional means for preventing colectomy in patients with ASUC. METHODS: A retrospective case-control study was performed evaluating the efficacy of tofacitinib induction in biologic-experienced patients admitted with ASUC requiring intravenous corticosteroids...
May 25, 2021: Clinical Gastroenterology and Hepatology
Manasi Agrawal, Elizabeth A Spencer, Jean-Frederic Colombel, Ryan C Ungaro
Inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis, are chronic, progressive, immune-mediated diseases of adults and children that have no cure. IBDs can cause significant morbidity and lead to complications such as strictures, fistulas, infections, and cancer. In children, IBDs can also result in growth impairment and pubertal delays. IBD is highly heterogenous, with severity ranging from mild to severe and symptoms ranging from mild to debilitating. Delay in IBD diagnosis, especially in Crohn's disease, is common and associated with adverse outcomes...
April 30, 2021: Gastroenterology
Neeraj Narula, Emily C L Wong, Parambir S Dulai, Neil K Sengupta, John K Marshall, Jean-Frederic Colombel, Walter Reinisch
BACKGROUND & AIMS: Comparative effectiveness has become increasingly important to help position therapies for inflammatory bowel disease. We compared the efficacy and rapidity of onset of action of infliximab vs ustekinumab induction therapy for moderate to severe biologic-naïve Crohn's disease (CD) using patient-level data from randomized controlled trials. METHODS: This was a post hoc analysis of 2 large CD clinical trial programs that included data on 420 biologic-naïve CD patients...
April 7, 2021: Clinical Gastroenterology and Hepatology
Elisabeth A Waldmann, Andreas A Kammerlander, Irina Gessl, Daniela Penz, Barbara Majcher, Anna Hinterberger, Michael Bretthauer, Michael H Trauner, Monika Ferlitsch
BACKGROUND & AIMS: The adenoma detection rate (ADR) and characteristics of previously resected adenomas are associated with colorectal cancer (CRC) incidence and mortality. However, the combined effect of both factors on CRC mortality is unknown. PATIENTS AND METHODS: Using data of the Austrian quality assurance program for screening colonoscopy, we evaluated the combined effect of ADR and lesion characteristics on subsequent risk for CRC mortality. We analyzed mortality rates for individuals with low risk adenomas (1-2 adenomas <10 mm), individuals with high risk adenomas (advanced adenomas or ≥3 adenomas), and after negative colonoscopy (negative colonoscopy or small hyperplastic polyps) performed by endoscopists with an ADR <25% compared with ≥25%...
April 17, 2021: Clinical Gastroenterology and Hepatology
Osman Ahmed, Jeffrey H Lee, Christopher C Thompson, Ashley Faulx
BACKGROUND & AIMS: The purpose of this expert review is to describe the current methodologies available to manage malignant alimentary tract obstructions as well the evidence behind the various methods (including their efficacy and safety), indications, and appropriate timing of interventions. METHODS: This is not a formal systematic review but is based on a review of the literature to provide best practice advice statements. No formal rating of the quality of evidence or strength of recommendation is carried out...
April 1, 2021: Clinical Gastroenterology and Hepatology
Robert Battat, William J Sandborn
Patients with postoperative Crohn's disease are difficult to manage because of their risk of experiencing a more severe course, multiple symptom confounders, and poor sensitivity of symptomatic remission to rule out intestinal inflammation. In this group, data are lacking on biologic therapeutic efficacy, and recommendations are lacking for those with multiple medication failures. Novel noninvasive testing can simultaneously exclude alternate causes of symptoms (serum C4, fecal fat, small intestinal bowel overgrowth breath testing) and assess intestinal inflammation (fecal calprotectin, endoscopic healing index)...
April 2, 2021: Clinical Gastroenterology and Hepatology
Vivek Kumbhari, David E Cummings, Anthony N Kalloo, Philip R Schauer
DESCRIPTION: Endoscopic techniques are paramount in the identification and management of complications after bariatric or metabolic surgery, though collaboration with other specialties is obligatory. Unfortunately, the evaluation and treatment algorithms are not standardized and there is a paucity of high-quality prospective studies to provide clarity regarding the best approach. The purpose of this clinical practice update is to apprise the clinician with respect to the endoscopic evaluation and management of patients with early (<90 days) complications after undergoing bariatric or metabolic surgery...
March 16, 2021: Clinical Gastroenterology and Hepatology
Louise China, Nick Freemantle, Ewan Forrest, Yiannis Kallis, Stephen D Ryder, Gavin Wright, Andrew J Portal, Natalia Becares Salles, Derek W Gilroy, Alastair O'Brien
BACKGROUND: Infection and increased systemic inflammation cause organ dysfunction and death in patients with decompensated cirrhosis. Preclinical studies provide support for an antiinflammatory role of albumin, but confirmatory large-scale clinical trials are lacking. Whether targeting a serum albumin level of 30 g per liter or greater in these patients with repeated daily infusions of 20% human albumin solution, as compared with standard care, would reduce the incidences of infection, kidney dysfunction, and death is unknown...
March 4, 2021: New England Journal of Medicine
Aasma Shaukat, Charles J Kahi, Carol A Burke, Linda Rabeneck, Bryan G Sauer, Douglas K Rex
Colorectal cancer (CRC) is the third most common cancer in men and women in the United States. CRC screening efforts are directed toward removal of adenomas and sessile serrated lesions and detection of early-stage CRC. The purpose of this article is to update the 2009 American College of Gastroenterology CRC screening guidelines. The guideline is framed around several key questions. We conducted a comprehensive literature search to include studies through October 2020. The inclusion criteria were studies of any design with men and women age 40 years and older...
March 1, 2021: American Journal of Gastroenterology
Stephan Miehlke, Danila Guagnozzi, Yamile Zabana, Gian E Tontini, Anne-Marie Kanstrup Fiehn, Signe Wildt, Johan Bohr, Ole Bonderup, Gerd Bouma, Mauro D'Amato, Peter J Heiberg Engel, Fernando Fernandez-Banares, Gilles Macaigne, Henrik Hjortswang, Elisabeth Hultgren-Hörnquist, Anastasios Koulaouzidis, Jouzas Kupcinskas, Stefania Landolfi, Giovanni Latella, Alfredo Lucendo, Ivan Lyutakov, Ahmed Madisch, Fernando Magro, Wojciech Marlicz, Emese Mihaly, Lars K Munck, Ann-Elisabeth Ostvik, Árpád V Patai, Plamen Penchev, Karolina Skonieczna-Żydecka, Bas Verhaegh, Andreas Münch
INTRODUCTION: Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, nonbloody diarrhoea and distinct histological abnormalities, which identify three histological subtypes, the collagenous colitis, the lymphocytic colitis and the incomplete microscopic colitis. With ongoing uncertainties and new developments in the clinical management of microscopic colitis, there is a need for evidence-based guidelines to improve the medical care of patients suffering from this disorder...
February 22, 2021: United European Gastroenterology Journal
Tonya Kaltenbach, Andrew Gawron, Craig S Meyer, Samir Gupta, Amandeep Shergill, Jason A Dominitz, Roy M Soetikno, Tiffany Nguyen-Vu, Mary A Whooley, Charles J Kahi
BACKGROUND & AIMS: Adenoma detection rate (ADR) is a key measure of colonoscopy quality. However, efficient measurement of ADR can be challenging because many colonoscopies are performed for non-screening purposes. Measuring ADR without being restricted to screening indication may likely facilitate more widespread implementation of quality monitoring. We hypothesized that the ADR for all colonoscopies, irrespective of the indication, would be equivalent to the ADR for screening colonoscopies...
February 19, 2021: Clinical Gastroenterology and Hepatology
Yong Lv, Wei Bai, Kai Li, Zhengyu Wang, Wengang Guo, Bohan Luo, Jianhong Wang, Qiuhe Wang, Enxin Wang, Dongdong Xia, Xiaomei Li, Jie Yuan, Na Han, Jing Niu, Zhanxin Yin, Daiming Fan, Guohong Han
INTRODUCTION: Current guidelines recommend anticoagulation as the mainstay of portal vein thrombosis (PVT) treatment in cirrhosis. However, because of the heterogeneity of PVT, anticoagulation alone does not always achieve satisfactory results. This study aimed to prospectively evaluate an individualized management algorithm using a wait-and-see strategy (i.e., no treatment), anticoagulation, and transjugular intrahepatic portosystemic shunt (TIPS) to treat PVT in cirrhosis. METHODS: Between February 2014 and June 2018, 396 consecutive patients with cirrhosis with nonmalignant PVT were prospectively included in a tertiary care center, of which 48 patients (12...
July 1, 2021: American Journal of Gastroenterology
Kara Wegermann
No abstract text is available yet for this article.
February 22, 2021: Clinical Gastroenterology and Hepatology
Peter S Liang, Aasma Shaukat, Seth D Crockett
DESCRIPTION: The purpose of this expert review is to describe the role of medications for the chemoprevention of colorectal neoplasia. Neoplasia is defined as precancerous lesions (e.g., adenoma and sessile serrated lesion) or cancer. The scope of this review excludes dietary factors and high-risk individuals with hereditary syndromes or inflammatory bowel disease. METHODS: The best practice advice statements are based on a review of the literature to provide practical advice...
February 10, 2021: Clinical Gastroenterology and Hepatology
Stacy A Markwell, Katherine S Garman, Iris L Vance, Ami Patel, Melissa Teitelman
BACKGROUND AND AIMS: The prevalence and burden of ergonomic related musculoskeletal injury is well established in the literature, though there is a paucity of data on techniques that can be used to avoid injury. This pilot study aimed to develop a new method of endoscopist wellness assessment. This technique presented here is an intervention by a physical therapist assessing ergonomic position and posturing during endoscopy to create an individualized wellness plan. METHODS: Volunteer endoscopists were identified in a single ambulatory surgical center...
February 6, 2021: Gastrointestinal Endoscopy
Shailja C Shah, Prasad G Iyer, Steven F Moss
The purpose of this CPU Expert Review is to provide clinicians with guidance on the management of H. pylori after an initial attempt at eradication therapy fails, including best practice advice on specific regimen selection, and consideration of patient and systems factors that contribute to treatment efficacy. This Expert Review is not a formal systematic review, but is based upon a review of the literature to provide practical advice. No formal rating of the strength or quality of the evidence was carried out...
January 29, 2021: Gastroenterology
Zachary Henry, Kalpesh Patel, Heather Patton, Wael Saad
Management of bleeding gastric varices (GV) presents a unique challenge for patients with portal hypertension. Despite over thirty years of diagnostic and treatment advances standardized practices for bleeding GV are lacking and unsupported by adequate evidence. There are no definitive natural history studies to help with risk assessment or prospective clinical trials to guide clinical decision making. Available literature on the natural history and management of gastric varices consists of case series, restricted cohort studies, and a few small randomized trials, all of which have significant selection biases...
June 2021: Clinical Gastroenterology and Hepatology
Lauren Deborah Feld
The American Board of Medical Specialties announced in July 2020 the adoption of a parental leave policy for residents and fellows allows for a minimum of 6 weeks of leave. This policy includes caveats: vacation and/or sick leave can be applied toward these 6 weeks, this leave can only be utilized once during training (whether for parental, caregiver, or medical leave), and this policy only applies to training programs of 2 or more years' duration. Although the new existence of a parental leave policy is a step in the right direction, trainees are in need of a more robust and evidence-based policy...
March 1, 2021: American Journal of Gastroenterology
2021-01-26 01:11:03
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