Clin Gastroenterol Hepatol Research Articles

Will Virtual Colonoscopy Replace Optical Colonoscopy for Colorectal Cancer Screening?

Will Virtual Colonoscopy Replace Optical Colonoscopy for Colorectal Cancer Screening?

Laryngopharyngeal Reflux: Beauty is in The Eye of The Beholder

Laryngopharyngeal Reflux: Beauty is in The Eye of The Beholder

Crohn's disease: diagnostic and therapeutic potential of modern small-bowel endoscopy

Inflammatory bowel diseases collectively cause significant lifestyle sacrifices and suffering, and millions of dollars are spent in related health-care costs every year, partially due to a lack of effective diagnostic procedures and therapies. Approximately 40% of patients with Crohn's disease (CD) have disease involving both the small bowel and the colon. Another one third has disease confined to the small bowel, primarily the ileum. The small bowel is notoriously difficult to evaluate and is the intestinal site for which there is the most controversy regarding imaging. Early diagnosis, and, sometimes, reassessing disease extent or activity in inflammatory bowel disease of the small bowel can be challenging. Diagnosis of CD is achieved through a composite of clinical, endoscopic, radiographic, serologic, and histopathologic findings. Capsule endoscopy (CE) is a first-line test for visualizing the mucosa of the small intestine 1 American Society for Gastrointestinal Endoscopy ASGE technology status evaluation report: wireless capsule endoscopy. Gastrointest Endosc. 2006; 63: 539-545 Abstract Full Text Full Text PDF PubMed Scopus (228) Google Scholar ; however, there is significant uncertainty regarding its role in patients with CD. Although it is clearly more sensitive than conventional imaging techniques, the implications of lesions identified with CE are not fully understood. 2 Pennazio M. Capsule endoscopy: where are we after 6 years of clinical use?. Dig Liver Dis. 2006; 38: 867-878 Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar Double balloon endoscopy (DBE) is a new, specialized method for enteroscopy that has the potential to examine the entire length of the small bowel, providing biopsy and therapeutic capabilities. 3 Yamamoto H. Kita H. Sunada K. et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004; 2: 1010-1016 Abstract Full Text Full Text PDF PubMed Scopus (623) Google Scholar

Biologicals Move Into the Esophagus

Biologicals Move Into the Esophagus

Prevalence and Predictors of Esophageal Varices in Patients With Primary Biliary Cirrhosis

Esophageal varices and bleeding are among the most feared complications of primary biliary cirrhosis (PBC). We aimed to determine the prevalence of esophageal varices in patients with PBC, to evaluate noninvasive markers of esophageal varices in this population, and to validate the results in an independent set of patients. Data were collected on all patients with PBC seen for the first time at the University of Florida (study group) and at Case Western Reserve University hospitals (cross-validation group) during 7 consecutive years. Logistic regression analysis was used to identify independent predictors of esophageal varices. The best cut-off values were calculated based on receiver operating characteristic curves. The diagnostic accuracy of the independent predictors of esophageal varices identified in the study group were retested in the cross-validation group. Of 210 patients with PBC seen at the University of Florida, 113 had an endoscopy and 49.6% (56 of 113) were found to have esophageal varices. After excluding 22 patients with a history of variceal bleeding, data on 91 patients were analyzed. Thirty-four patients had esophageal varices (37%). Multivariate analysis revealed that a platelet count of less than 140,000 (odds ratio, 7.6; 95% confidence interval, 1.6-37) and a Mayo risk score of 4.5 or greater (odds ratio, 10.6; 95% confidence interval, 1.8-62) were independent predictors of esophageal varices. The diagnostic accuracy of these predictors was confirmed in an independent set of patients. Among patients with PBC, a platelet count of less than 140,000 and/or a Mayo risk score of 4.5 or greater appears to identify those patients more likely to benefit from a screening endoscopy.

Night Vision Goggles for Surveillance of Barrett’s Esophagus: A Paradigm Shift is Coming!

Night Vision Goggles for Surveillance of Barrett’s Esophagus: A Paradigm Shift is Coming!

Late-Onset Wilson’s Disease

The clinical symptoms and age at onset of Wilson's disease (WD) are highly variable. This study investigated patients who became symptomatic at >40 years of age. Clinical features, laboratory data, and mutation analysis were evaluated in 46 (3.8%) of 1223 patients who were investigated in a multinational study on genotype-phenotype correlations (1053 index patients, 170 siblings) who were >40 years of age at onset of symptoms and, in 2 asymptomatic siblings, diagnosed at >40 years of age. Thirty-one patients presented with neurologic symptoms (mean age, 44.5 years; range, 40-52; male/female, 14/17), 15 presented with liver disease (mean age, 47.1 years; range, 40-58; male/female, 6/9), and 2 were asymptomatic siblings. Hepatic copper content was measured in 17 patients and was above 250 microg/g dry weight in 13. One patient with hepatic presentation had "fulminant" WD, the remaining 14 abnormal liver function tests and/or hepatomegaly. Liver biopsy specimens were available in 13 patients presenting with liver disease (cirrhosis, 10; chronic hepatitis, 2; steatosis, 1; no abnormalities, 1) and in 14 neurologic patients (cirrhosis, 9; advanced fibrosis, 1; chronic hepatitis, 2; no abnormalities, 2). Twenty-seven of the 46 index cases had mutations on both chromosomes (including 13 H1069Q/H1069Q), 13 on just 1 chromosome. Late-onset WD is a frequently overlooked condition. The diagnostic features and the frequency of late-onset WD gene mutations were not different than in patients with an earlier onset of disease. Factors other than ATP7B mutations may modify the phenotypic presentation of WD.

Pneumatic dilation or myotomy for achalasia?

Pneumatic dilation or myotomy for achalasia?

Eosinophilic esophagitis: New insights into an emerging disease

Eosinophilic esophagitis: New insights into an emerging disease

Once-Daily, High-Concentration MMX Mesalamine in Active Ulcerative Colitis

SPD476 (LIALDA in the US; MEZAVANT in the EU; otherwise known as MMX mesalamine; Shire Pharmaceuticals Inc., Wayne, PA, under license from Giuliani SpA, Milan, Italy) is a novel, once-daily, high-strength (1.2 g/tablet) formulation of mesalamine, utilizing MMX Multi Matrix System (MMX) technology designed to deliver the active drug throughout the colon. We performed a double-blind, multicenter study, comparing MMX mesalamine vs placebo for the treatment of active ulcerative colitis. A delayed-release oral mesalamine (ASACOL; Procter & Gamble, Cincinnati, OH) reference arm was included. Three hundred forty-three patients with active, mild-to-moderate ulcerative colitis received MMX mesalamine 2.4 g/day or 4.8 g/day given once daily, ASACOL 2.4 g/day given in 3 divided doses, or placebo for 8 weeks. The primary end point was the proportion of patients in clinical and endoscopic remission (modified ulcerative colitis disease activity index of < or =1 with rectal bleeding and stool frequency scores of 0, no mucosal friability, and a > or =1-point reduction in sigmoidoscopy score from baseline). A significantly greater proportion of patients receiving MMX mesalamine 2.4 g/day given once daily (40.5%; P = .01) and 4.8 g/day given once daily (41.2%; P = .007) achieved clinical and endoscopic remission at week 8, vs placebo (22.1%). The clinical and endoscopic remission rate for ASACOL (32.6%; P = .124) was not significantly superior to placebo. All active treatments were well-tolerated. Once-daily MMX mesalamine was efficacious and well-tolerated for the induction of clinical and endoscopic remission. MMX mesalamine offers effective and convenient mesalamine therapy, potentially improving treatment compliance.

Double-balloon endoscopy: Extending the arm of the gastroenterologist

Double-balloon endoscopy: Extending the arm of the gastroenterologist

Cirrhosis-associated mortality: Frankly, Scarlet, do we really make a damn?

Cirrhosis-associated mortality: Frankly, Scarlet, do we really make a damn?

Chromoendoscopy: A new vision for colonoscopic surveillance in IBD

Chromoendoscopy: A new vision for colonoscopic surveillance in IBD

Should we bravo?

Should we bravo?

Lymphoma risk with azathioprine/6-MP therapy—read beyond the headlines

Lymphoma risk with azathioprine/6-MP therapy—read beyond the headlines

Is longer better?

Is longer better?

Can histopathology be the “Gold Standard” for diagnosing autoimmune pancreatitis?

Can histopathology be the “Gold Standard” for diagnosing autoimmune pancreatitis?

Obstructive sleep apnea: wreaking havoc with homeostasis

the phenotypic characterization of obstructive sleep apnea (OSA) continues to unfold. Recent studies provide evidence that this syndrome has the potential to disturb cardiovascular, neurological, and endocrine homeostatic processes ([1][1], [6][2], [8][3], [9][4]). Li et al. ([5][5]) present

Placebo Controlled Treatment Trials in Hepatic Encephalopathy Are Feasible and Ethical *

Abstract Gentile S, Guarino G, Romano M, Alagia IA, Fierro M, Annunziata S, Magliano PL, Gravina AG, Torella R. A randomized controlled trial of acarbose in hepatic encephalopathy. Clin Gastroenterol Hepatol 2005;3:184–191. (Reprinted with permission from Elsevier.) Background &amp; aims Hepatic encephalopathy in cirrhosis is contributed to by toxic products deriving from the proteolytic bacterial flora–related degradation of dietary nitrogen substances. Acarbose is a novel hypoglycemic agent acting through the inhibition of glucose absorption in the gut and the promotion of intestinal saccharolytic bacterial flora at the expense of proteolytic flora. We assessed whether acarbose exerts a beneficial effect on hepatic encephalopathy and on postprandial hyperglycemia in cirrhotic patients with low-grade hepatic encephalopathy and type 2 diabetes mellitus. Methods One hundred seven cirrhotic patients with grade 1–2 hepatic encephalopathy and type 2 diabetes mellitus were randomized to acarbose 100 mg 3 times daily or placebo for 8 weeks; after a 2-week washout period, treatments were switched, and patients were followed for 8 more weeks. Ammonia blood levels, Reitan's number connection test, intellectual function, fasting and postprandial glucose levels, glycated hemoglobin values, and C peptide values were determined 2 weeks before and 4, 8, 11, 14, and 18 weeks after treatment. Results (1) Acarbose significantly decreased ammonia blood levels and improved Reitan's test score and intellectual function score compared with placebo (P&lt; .01). (2) Acarbose caused a 33% decrease in fasting glucose level and an approximately 50% decrease in postprandial glucose level compared with placebo (P&lt; .01). (3) Acarbose significantly lowered glycated hemoglobin values and postprandial C peptide compared with baseline values, whereas placebo did not. (4) No change in biochemical parameters of liver function was observed after acarbose treatment. Conclusions Acarbose is a safe and effective drug in cirrhotic patients with low-grade hepatic encephalopathy and type 2 diabetes mellitus.

Feeding the injured pancreas

Feeding the injured pancreas