October 2018 Vol XLII Issue 10

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A SPECIAL ARTICLE

Chromoendoscopy in Community Practice

Mohd Amer Alsamman, Niren Jasutkar, Steven E. Reinert, Murray Resnick, Jude Fleming, Samir A. Shah

Early detection of dysplastic tissue during colonoscopy allows early intervention and may decrease colon cancer and improve survival. Studies from several academic centers have demonstrated chromoendoscopy increases diagnostic yield for intraepithelial neoplasia in inflammatory bowel disease (IBD) compared with white-light colonoscopy (WLE). The feasibility of this technique, however, has not been adequately studied in the community setting. Our study evaluates a single physician's experience with chromoendoscopy in patients with IBD.



DISPATCHES FROM THE GUILD CONFERENCE, SERIES #17

Managing Severe Ulcerative Colitis in the Hospitalized Patient

Edward V. Loftus

Studies tell us that the first year after diagnosis of ulcerative colitis (UC) is associated with the highest colectomy rate and it's severity can be defined by a combination of clinical and objective parameters. In this article we discuss the management of severe UC in the hospitalized patient.



FRONTIERS IN ENDOSCOPY, SERIES #46

A Review of Lithotripsy Applications in Gastroenterology

Praneeth Kudaravalli, Bilal Aslam, Moamen Gabr

Zenker's diverticulum (ZD) is a pharyngeoesophageal pulsion diverticulum which presents in the elderly and contributes to morbidity due to dysphagia and pulmonary aspiration. Open surgery and rigid endoscopy have previously been the primary modalities for therapy, however with a favorable safety profile and similar success rates, flexible endoscopy has become an emerging therapeutic modality in the treatment of ZD. This review seeks to highlight endoscopic techniques and tools in the management of ZD.



NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #180

Conventional, Complementary, and Controversial Approaches to Small Intestinal Bacterial Overgrowth

Amisha Ahuja, Nitin K. Ahuja

Small intestinal bacterial overgrowth (SIBO), classically understood as an excess of bacteria and their associated byproducts in the small bowel, has become in recent years a progressively credible explanation for a variety of gastrointestinal symptoms. At the same time, clinical presentations associated with this entity are wide-ranging and overlap substantially with other heterogeneous diagnoses like irritable bowel syndrome. This ambiguity is compounded by a lack of standardized testing and treatment modalities, which can be frustrating for providers and patients alike. Herein we outline a contemporary understanding of SIBO pathophysiology, diagnosis, and therapy, with particular attention to their interface with diet and nutrition.



THE MICROBIOME AND DISEASE, SERIES #6

Probiotics: What Do We Know So Far?

Skylar Steinberg, Sabine Hazan

Probiotic is a general term for live, nonpathogenic microorganisms, many of which exist in a symbiotic relationship within the normal human gut flora. Here we discuss their growth in popularity, their use in treating Gastrointestinal (GI) and non-GI medical conditions, and the data demonstrating their effectiveness.



LIVER DISORDERS, SERIES #8

Approach to Liver Disease in Pregnancy

Hamza Arif, Helen Lee, Christina Strahotin

Liver disease in pregnancy is a rare phenomenon, but its presence represents a challenging scenario as it can have harmful effects on both the mother and the fetus. Certain liver diseases are unique to pregnancy only, including hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, preeclampsia, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and acute fatty liver of pregnancy. In this article we discuss the management of these disorders as imperative to avoid development of maternal and fetal complications.



A CASE REPORT

Single Cause, Dual Presentation: Inferior Pancreatico-Duodenal Artery Pseudoaneurysm as a Cause of Acute Gastrointestinal Bleeding and Obstructive Jaundice

Mir Adil Shamim, Rupinder Mann, Steven Lichtenstein



Departments Section


From the Literature

Liver Stiffness Measurement After SVR for Hepatitis C

To investigate the degree of fibrosis regression (1 METAVIR stage decrease) after SVR and its associated factors in recurrent hepatitis C, as well as the diagnostic capacity of noninvasive methods in the assessment of liver fibrosis and portal hypertension (PH) after viral clearance, 112 hepatitis C virus-infected liver transplantation recipients who achieved SVR between 2001 and 2015 were evaluated. A liver biopsy was performed before treatment and 12 months post SVR. Hepatic venous pressure gradient (HVPG), liver stiffness measurement (LSM) and enhanced liver fibrosis (ELF) score were also determined at the same time points.



Diabetes and Hepatocellular Carcinoma

Type 2 diabetes (T2D) is a risk factor for hepatocellular carcinoma (HCC). To determine whether T2D duration or additional metabolic comorbidities further contribute to HCC risk, evaluation of the Nurses' Health Study (NHS) with 120,826 women enrolled in 1980, and from the Health Professionals Follow-Up Study (HPFS)



Bleeding Complications in Acute Liver Failure

In patients with acute liver failure (ALF), elevated prothrombin time and thrombocytopenia can fuel a perception of bleeding tendency. The incidence, site, risk factors and clinical significance of bleeding complications have not been quantified in a large cohort of patients with ALF. A total of 1770 adult patients were studied in the ALF Study Group Registry between 1998 and 2016. Bleeding complications and blood component transfusions were collected for 7 days after admission.



Surgical Intervention for Chronic Abdominal Pain Due to Adhesions

To evaluate results of a novel diagnostic and therapeutic approach for pain associated with adhesions, a prospective cohort study, including patients with a history of abdominal surgery referred to outpatient clinic of a tertiary referral center for the evaluation of chronic abdominal pain was carried out and subgroups were made, based on outcome of adhesion mapping with cine-MRI and shared decision-making.



AFP and Ultrasound Surveillance for HCC in Cirrhosis

To compare the performance of surveillance imaging with or without alpha-fetoprotein (AFP) for early detection of HCC in patients with cirrhosis, two reviewers searched MEDLINE and SCOPUS from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. Pooled estimates were calculated and compared using the DerSimonian and Laird method for random effects model. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines.



Portosystemic Shunts in Cirrhosis and Relationship to Mortality

To investigate the prevalence and characteristics of spontaneous portosystemic shunts (SPSS) in patients with cirrhosis and their outcomes, a retrospective study of 1729 patients who underwent CT scan or MRI from 2010 through 2015 at 14 centers in Canada and Europe was carried out. Data was collected on demographic features, etiology of liver disease, comorbidities, complications, treatment, laboratory and clinical parameters, MELD score and endoscopic findings.



Medical Bulletin Board

THE BRUCE AND CYNTHIA SHERMAN CHARITABLE FOUNDATION ANNOUNCES RECIPIENTS OF 2018 SHERMAN PRIZES, REWARDING OUTSTANDING ACHIEVEMENTS IN CROHN'S DISEASE AND ULCERATIVE COLITIS

Honorees Recognized for Pioneering Novel IBD Management Strategies and Surgical Approaches that Have Become Established Care Guidelines



INTERDISCIPLINARY AUTOIMMUNE SUMMIT 2019 AGENDA JUST ANNOUNCED

April 5-7, 2019. Join us in Chicago for IAS 2019, the most important cross-specialty meeting you will attend all year. If you are managing patients with immune-mediated inflammatory diseases (IMIDs) then this year's agenda will answer your most urgent questions surrounding the treatment of these complex diseases.



Meetings Calendar

December 13-15, 2018 Advances in Inflammatory Bowel Diseases - Multidisciplinary Approaches to IBD Patient-Centered Care
February 17-20, 2019 GUILD Conference 2019
April 5-7, 2019 Interdisciplinary Autoimmune Summit 2019