Expert review of gastroenterology & hepatology
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Expert Rev Gastroenterol Hepatol · Dec 2012
ReviewLINX(™) Reflux Management System: magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease.
Gastroesophageal reflux disease (GERD), commonly manifested by heartburn or regurgitation, is a chronic, progressive condition in which failed sphincter function allows the contents of the stomach to reflux into the esophagus, the airways and the mouth. Chronic GERD affects 10% of Western society. The majority of patients receive adequate relief from proton pump inhibitors, but up to 40% have incomplete relief of symptoms that cannot be addressed by increasing the dose of medications. ⋯ These factors have contributed to the propensity of patients to persist with medical therapy, even when inadequate to control symptoms and complications of the disease. Consequently, a significant gap in the treatment continuum for GERD remains evident in current clinical practice. The LINX(™) Reflux Management System (Torax Medical) is designed to provide a permanent solution to GERD by augmenting the physiologic function of the sphincter barrier with a simple and reproducible laparoscopic procedure that does not alter gastric anatomy and can be easily reversed if necessary.
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Expert Rev Gastroenterol Hepatol · Feb 2012
ReviewGluten sensitivity: problems of an emerging condition separate from celiac disease.
Gluten sensitivity appears to be emerging as a separate condition from celiac disease, yet no clear definition or diagnosis exists. As a result, patients with gluten sensitivity experience delayed diagnosis and continuing symptoms if they consume gluten. ⋯ The use of a gluten-free diet or an elimination diet is encouraged in assisting people to determine whether or not they are gluten sensitive. It is time to not only recognize, but to treat and further research gluten sensitivity, as unconfirmed environmental factors continue to spread this problem further into the general population.
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Expert Rev Gastroenterol Hepatol · Oct 2011
ReviewConstipation assessment scales in adults: a literature review including the new Bowel Function Index.
Constipation is a common clinical condition and patient and physician perception of the disorder can vary considerably. The assessment of a symptom-based condition such as constipation is challenging, in terms of making the diagnosis, assessing the severity of symptoms and their impact on a patient's quality of life, and assessing response to therapy or changes to symptoms over time. ⋯ During the course of a literature search, 16 studies were identified that reported assessment scales based on a selection of varied symptoms of constipation and that evaluated these scales in different groups of individuals; two studies presented stool form as being key to assessing transit time. In the present article, the characteristics and psychometric evaluation of these different constipation assessment scales, including the new Bowel Function Index, are reported with a view to discussing which assessment tool appears to be most robust and/or useful in daily clinical practice.
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Expert Rev Gastroenterol Hepatol · Jun 2011
ReviewRisk of lymph node metastasis in submucosal esophageal cancer: a review of surgically resected patients.
Endoscopic local procedures are increasingly applied in patients with superficial esophageal cancer as an alternative to radical oncologic resection. The objective of this article is to determine the risk of nodal metastases in submucosal (sm) esophageal cancer, comparing the two predominating histologic tumor types, squamous cell cancer (SCC) and adenocarcinoma (ADC). ⋯ While endoscopic therapy may be adequate in selected patients with 'low-risk' sm1 ADC, submucosal SCC necessitates esophageal resection and systematic lymphadenectomy because of its aggressive nature and tendency for early metastasis.
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Expert Rev Gastroenterol Hepatol · Jun 2011
ReviewLinaclotide, a synthetic guanylate cyclase C agonist, for the treatment of functional gastrointestinal disorders associated with constipation.
Chronic constipation (CC) and irritable bowel syndrome with constipation (IBS-C) are two functional gastrointestinal disorders that are associated with constipation. CC and IBS-C affect approximately 20% of the general population including the elderly, impairing quality of life. Patients not responding to over-the-counter treatments require effective and safe long-term therapies. ⋯ Linaclotide is a novel drug, with a unique mechanism of action, low bioavailability and local action in the intestinal epithelial cells. It is currently being developed for patients with CC and IBS-C. From animal studies to human pharmacodynamic Phase Ib trials, and a comprehensive program of Phase IIb and III trials in health and disease, linaclotide demonstrates long-term efficacy and safety in CC and IBS-C.