Severe gastrointestinal(GI) hemorrhage is a rare complication of Crohn's disease(CD). Although several surgical and non-surgical approaches have been described over the last 2 decades this complication still poses...Severe gastrointestinal(GI) hemorrhage is a rare complication of Crohn's disease(CD). Although several surgical and non-surgical approaches have been described over the last 2 decades this complication still poses significant diagnostic and therapeutic challenges. Given the relative infrequency of severe bleeding in CD, available medical literature on this topic is mostly in the form of retrospective case series and reports. In this article we review the risk factors, diagnostic modalities and treatment options for the management of CD presenting as GI hemorrhage.展开更多
Screening for colorectal cancer(CRC) has been associated with a decreased incidence and mortality from CRC.However,patient adherence to screening is less than desirable and resources are limited even indeveloped count...Screening for colorectal cancer(CRC) has been associated with a decreased incidence and mortality from CRC.However,patient adherence to screening is less than desirable and resources are limited even indeveloped countries.Better identification of individuals at a higher risk could result in improved screening efforts.Over the past few years,formulas have been developed to predict the likelihood of developing advanced colonic neoplasia in susceptible individuals but have yet to be utilized in mass screening practices.These models use a number of clinical factors that have been associated with colonic neoplasia including the body mass index(BMI).Advances in our understanding of the mechanisms by which obesity contributes to colonic neoplasia as well as clinical studies on this subject have proven the association between BMI and colonic neoplasia.However,there are still controversies on this subject as some studies have arrived at different conclusions on the influence of BMI by gender.Future studies should aim at resolving these discrepancies in order to improve the efficiency of screening strategies.展开更多
Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulin...Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A(BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences in results among them. Differences in patient selection, doses and method of administration of botox toxin in the prior studies may be the cause of conflicting results. The mechanism of action, indications, efficacy and side-effects of BT are reviewed. Finally, we recognize limited evidence to recommend BT in GP and calling attention for future research in this field since no advances in drug management had been made in the last two decades.展开更多
Viral infections affecting the liver have had an important impact on humanity,as they have led to significant morbidity and mortality in patients with acute and chronic infections.Once an unknown etiology,the discover...Viral infections affecting the liver have had an important impact on humanity,as they have led to significant morbidity and mortality in patients with acute and chronic infections.Once an unknown etiology,the discovery of the viral agents triggered interest of the scientific community to establish the pathogenesis and diagnostic modalities to identify the affected population.With the rapid scientific and technological advances in the last centuries,controlling and even curing the infections became a possibility,with a large focus on preventive medicine through vaccination.Hence,a comprehensive understanding of hepatitis A,B,C,D and E is required by primary care physicians and gastroenterologists to provide care to these patients.The review article describes the epidemiology,pathogenesis,clinical presentation,diagnostic tools and current medication regimens,with a focus on upcoming treatment options and the role of liver transplantation.展开更多
文摘Severe gastrointestinal(GI) hemorrhage is a rare complication of Crohn's disease(CD). Although several surgical and non-surgical approaches have been described over the last 2 decades this complication still poses significant diagnostic and therapeutic challenges. Given the relative infrequency of severe bleeding in CD, available medical literature on this topic is mostly in the form of retrospective case series and reports. In this article we review the risk factors, diagnostic modalities and treatment options for the management of CD presenting as GI hemorrhage.
文摘Screening for colorectal cancer(CRC) has been associated with a decreased incidence and mortality from CRC.However,patient adherence to screening is less than desirable and resources are limited even indeveloped countries.Better identification of individuals at a higher risk could result in improved screening efforts.Over the past few years,formulas have been developed to predict the likelihood of developing advanced colonic neoplasia in susceptible individuals but have yet to be utilized in mass screening practices.These models use a number of clinical factors that have been associated with colonic neoplasia including the body mass index(BMI).Advances in our understanding of the mechanisms by which obesity contributes to colonic neoplasia as well as clinical studies on this subject have proven the association between BMI and colonic neoplasia.However,there are still controversies on this subject as some studies have arrived at different conclusions on the influence of BMI by gender.Future studies should aim at resolving these discrepancies in order to improve the efficiency of screening strategies.
文摘Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A(BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences in results among them. Differences in patient selection, doses and method of administration of botox toxin in the prior studies may be the cause of conflicting results. The mechanism of action, indications, efficacy and side-effects of BT are reviewed. Finally, we recognize limited evidence to recommend BT in GP and calling attention for future research in this field since no advances in drug management had been made in the last two decades.
文摘Viral infections affecting the liver have had an important impact on humanity,as they have led to significant morbidity and mortality in patients with acute and chronic infections.Once an unknown etiology,the discovery of the viral agents triggered interest of the scientific community to establish the pathogenesis and diagnostic modalities to identify the affected population.With the rapid scientific and technological advances in the last centuries,controlling and even curing the infections became a possibility,with a large focus on preventive medicine through vaccination.Hence,a comprehensive understanding of hepatitis A,B,C,D and E is required by primary care physicians and gastroenterologists to provide care to these patients.The review article describes the epidemiology,pathogenesis,clinical presentation,diagnostic tools and current medication regimens,with a focus on upcoming treatment options and the role of liver transplantation.
