Entries Tagged as 'Curr Opin Gastroenterol'
Portal hypertension.
Curr Opin Gastroenterol. 2009 May;25(3):195-201
Authors: Cárdenas A, Ginès P
PURPOSE OF REVIEW: Portal hypertension is the most common complication of cirrhosis accounting for significant morbidity and mortality mainly because of variceal hemorrhage, ascites, bacterial infections, hepatic encephalopathy, and hepatorenal syndrome. Advances in the diagnosis and management of portal hypertension over the last year are reviewed. RECENT FINDINGS: The measurement of the hepatic venous pressure gradient provides important prognostic information in patients with portal hypertension. Noninvasive testing with transient elastography, capsule endoscopy, and computed tomography scanning for the diagnosis of esophageal varices is promising but more information is needed. Easily obtainable clinical data have been identified in patients with acute variceal bleeding that provides important information in determining initial response to therapy and prognosis. New therapies for patients with dilutional hyponatremia with vasopressin antagonists are promising and may improve the management of this condition. Terlipressin is the best medical therapy currently available for the management of hepatorenal syndrome as confirmed in recent studies. Patients with advanced liver disease benefit from the long-term administration of norfloxacin as it prevents the development of hepatorenal syndrome and improves survival. SUMMARY: The ongoing advances in the diagnosis and management of patients with cirrhosis and portal hypertension will improve the high morbidity and mortality of the complications of cirrhosis
PMID: 19396956 [PubMed - indexed for MEDLINE]
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Iron deficiency anemia: diagnosis and management.
Curr Opin Gastroenterol. 2009 Mar;25(2):122-8
Authors: Clark SF
PURPOSE OF REVIEW: Iron deficiency anemia (IDA) still remains universally problematic worldwide. The primary focus of this review is to critique articles published over the past 18 months that describe strategies for the diagnosis and management of this prevalent condition. RECENT FINDINGS: The medical community continues to lack consensus when identifying the optimal approach for the diagnosis and management of IDA. Current diagnostic recommendations revolve around the validity and practicality of current biomarkers such as soluble transferrin-receptor concentrations and others, and cause-based diagnostics that potentially include endoscopy. Management of IDA is based on supplementation combined with effective etiological treatment. Advances in oral and parenteral low-molecular-weight iron preparations has expanded and improved treatment modalities for IDA. Since the introduction of low versus high-molecular-weight intravenous iron administration, there have been fewer serious adverse events associated with parenteral iron preparations. SUMMARY: Best practice guidelines for diagnosing and managing IDA should include the design of an algorithm that is inclusive of multiple biomarkers and cause-based diagnostics, which will provide direction in managing IDA, and distinguish between IDA from the anemia of chronic disease.
PMID: 19262200 [PubMed - indexed for MEDLINE]
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Small bowel endoscopic enteral access.
Curr Opin Gastroenterol. 2009 Mar;25(2):155-9
Authors: Freeman C, Delegge MH
PURPOSE OF REVIEW: Small bowel endoscopic enteral access is perceived as difficult. However, small bowel access is necessary for patients who are unable to tolerate gastric feedings. This review discusses the successes and challenges involved with endoscopic small bowel tube placement in various populations using a variety of placement techniques. RECENT FINDINGS: In general, direct percutaneous endoscopic jejunostomy (DPEJ) is becoming a more common procedure performed to obtain small bowel enteral access. BMI may be a useful predictor of DPEJ tube placement success and complication rates. A retrospective review determined that DPEJ tube placement significantly decreased the incidence of aspiration pneumonia in patients with previous recurrent aspiration pneumonia episodes. DPEJ is an effective method of providing enteral nutrition for patients when percutaneous endoscopic gastrostomy is not indicated because of anatomical or gastric function abnormalities. However, there are known complications of DPEJ, including small bowel volvulus. Nasojejunal tubes also can provide enteral access to the small intestine. Endoscopic insertion of nasojejunal tubes promotes decreased length of hospital stay and early initiation of enteral feedings as compared with bedside self-migrating jejunal tubes in patients with severe acute pancreatitis. Endoscopically placed small bowel feeding tubes can safely deliver enteral nutrition to patients when gastric feedings are not indicated. SUMMARY: Continued evaluation of endoscopic jejunal tube placement methods and associated clinical outcomes in assorted populations is necessary to determine the safest and most effective technique.
PMID: 19528883 [PubMed - indexed for MEDLINE]
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Enteral feeding.
Curr Opin Gastroenterol. 2008 Mar;24(2):184-9
Authors: DeLegge MH
PURPOSE OF REVIEW: Enteral nutrition is a widely used therapy for nutritional treatment of patients with multiple pathologies. The present review selects important evidenced-based papers from 2006 and 2007 and critically reviews them for the reader. RECENT FINDINGS: Use of synbiotics and probiotics is gaining acceptance. Supplements such as glutamine may be important for wound healing. Enteral feeding in malnourished patients may result in rapid growth of gut mucosal protein. Antibiotics are important for reduction of postpercutaneous endoscopic gastrostomy infections. Early enteral nutrition in burn patients blunts the hypermetabolic response. Polymeric enteral formulations in vitro have a direct anti-inflammatory effect on enterocytes. Enteral nutrition, however, does not appear better than steroid use for induction of remission in Crohn’s disease. Long-term (12-week) infusion of immune-enhancing enteral formulas in a nonsurgical patient group is well tolerated and safe. Finally, large reviews of enteral nutrition and their efficacy for specific disease states continue to demonstrate the difficulty in interpreting multiple small clinical studies. SUMMARY: Enteral nutrition continues as a highly used medical therapy, usually as an adjuvant for other pharmacologic and supportive therapies. Multiple small clinical trials, observational studies and retrospective reviews must be analyzed to develop ‘best practice’ guidelines with enteral nutrition.
PMID: 18301269 [PubMed - indexed for MEDLINE]
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Parenteral nutrition and urban legends.
Curr Opin Gastroenterol. 2008 Mar;24(2):210-4
Authors: Koretz RL
PURPOSE OF REVIEW: To assess the recent literature regarding parenteral nutrition to identify publications that have purported to support various beliefs about the utility of parenteral nutrition, and then to critically evaluate the data presented in those (as well as prior) publications. RECENT FINDINGS: Artificial nutrition improves nutritional markers but not clinical outcomes, suggesting that malnutrition is not causatively associated with a poor outcome. There are no convincing data that parenteral nutrition is beneficial in severely malnourished surgical patients. Glutamine supplementation of parenteral nutrition solutions may reduce the infectious complication rate, but it is unknown if glutamine-supplemented parenteral nutrition is better than no parenteral nutrition. Most, but not all, systematic reviews have demonstrated that enteral nutrition produces fewer problems than parenteral nutrition; no data suggest that either modality is better than doing no artificial nutrition. Randomized trials have not uniformly been able to demonstrate that parenteral nutrition is efficacious in acute pancreatitis. There is some, but not convincing, data that a regimen of glutamine, growth hormone, and a specialized diet will reduce the need for parenteral nutrition in patients with short bowel syndrome. SUMMARY: It is important for clinicians to be able to critically evaluate the medical literature.
PMID: 18301273 [PubMed - indexed for MEDLINE]
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New advances in acute pancreatitis.
Curr Opin Gastroenterol. 2007 Sep;23(5):494-501
Authors: DiMagno MJ, DiMagno EP
PURPOSE OF REVIEW: We endeavor to review important new advances in acute pancreatitis made in the past year. We focused on clinical aspects of acute pancreatitis, which contained new observations or insights into new or old concepts. For experimental acute pancreatitis we refer readers to a recent comprehensive review. RECENT FINDINGS: Recently, case fatality rates of acute pancreatitis have stabilized; carbohydrate-deficient transferrin was shown to predict alcoholic acute pancreatitis; idiopathic chronic pancreatitis or occult cholelithiasis have been associated with ‘recurrent acute pancreatitis’ in most patients; and cystic fibrosis transmembrane conductance regulator genetic mutations were frequently found (10-50%) in patients with recurrent acute pancreatitis. In addition, alcohol was shown to increase the risk of pancreatic necrosis regardless of the cause of acute pancreatitis. Persistent organ failure and multiple organ dysfunction syndrome but not necessarily extent of necrosis were demonstrated to predict increased mortality in acute pancreatitis. Chemoprevention of post-endoscopic retrograde cholangiopancreatography acute pancreatitis remains unproven. Enteral feeding has been strongly recommended in severe acute pancreatitis. Finally, data are lacking for routine, prophylactic antibiotic administration to all patients with pancreatic necrosis. SUMMARY: We reviewed studies this past year that further characterize the epidemiology, etiology and risk stratification of acute pancreatitis. Evolving areas include chemoprevention of post-endoscopic retrograde cholangiopancreatography acute pancreatitis and enteral feeding and antibiotics in severe acute pancreatitis. We await translation of novel therapies from the bench to bedside.
PMID: 17762554 [PubMed - indexed for MEDLINE]
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Chronic pancreatitis.
Curr Opin Gastroenterol. 2007 Sep;23(5):502-7
Authors: Lankisch PG
PURPOSE OF REVIEW: As in previous reviews in this journal, this review is focused on the most important new observations in chronic pancreatitis made in the past year and the beginning of this year. RECENT FINDINGS: Important observations include the following: first, the natural history and course of chronic pancreatitis; second, that smoking enhances the risk of chronic pancreatitis; third, possible new function tests in combination with imaging procedures; fourth, the superiority of surgery compared with endotherapy for long-term pain relief; fifth, new insights in autoimmune pancreatitis. SUMMARY: All in all, little progress has recently been made in the field of diagnosis and therapy of chronic pancreatitis. There are some studies in the field of endotherapy and autoimmune pancreatitis that are promising however.
PMID: 17762555 [PubMed - indexed for MEDLINE]
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