Current opinion in gastroenterology
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Curr. Opin. Gastroenterol. · Mar 2016
ReviewFrom coeliac disease to noncoeliac gluten sensitivity; should everyone be gluten free?
Gluten-free diets (GFDs) have seen a disproportional rise in use and popularity relative to the prevalence of established gluten-related disorders such as coeliac disease or immunoglobulin E wheat allergy. This entity has been termed noncoeliac gluten sensitivity (NCGS). This review aims to provide a current perspective on the emerging evidence for and against NCGS, along with the associated need for a GFD. ⋯ Despite the rising use of a GFD further studies are required to clearly establish the extent and exclusivity of gluten in NCGS.
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Curr. Opin. Gastroenterol. · Jul 2015
ReviewBiosimilars in inflammatory bowel disease: ready for prime time?
The goal is to review the most recent literature about biosimilars in inflammatory bowel disease (IBD), with emphasis on controversial regulatory issues. ⋯ Biosimilars in IBD are here to stay. New data are awaited to settle the controversy of extrapolation, but only the complex behavior of markets will show whether biosimilars fuel competition and extend access to biologics with significant cuts in drug costs.
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Acute liver failure (ALF) is a rare but life-threatening systemic disorder. Survival rates with or without emergency liver transplantation (ELT) are increasing. The benefit of ELT in some cases has been questioned and the potential for survival with medical management alone is changing our approach to the management of this disease. ⋯ ALF remains a life-threatening condition with a high mortality rate requiring prompt support of multiorgan failure. Historical listing criteria for ELT are being questioned and improvement in medical management offers the option of continued improvements in transplant-free survival.
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Renal dysfunction causes significant morbidity in cirrhotic patients. Diagnosis is challenging because it is based on serum creatinine, which is used to calculate estimated glomerular filtration rate, which itself is not an ideal measure of renal function in patients with cirrhosis. Finding the exact cause of renal injury in patients with cirrhosis remains problematic due to the limitations of the current diagnostic tests. The purpose of this review is to highlight studies used to diagnose renal dysfunction in patients with renal dysfunction and review current treatments. ⋯ Development of new biomarkers to differentiate the different types of AKI in cirrhosis holds promise. Early intervention in cirrhotic patients with renal dysfunction offers the best hope of improving outcomes.
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Continuing advances in pharmaceutical development are providing an expanding array of treatment approaches for patients with chronic constipation. More comprehensive characterization of pancolonic motility carries the promise of improved understanding of the pathophysiology of this common disorder. Chronic constipation which responds poorly to laxatives may result from the use of drugs such as opioids, or from defecation disorders and advanced colonic dysmotility. ⋯ The articles cited in this review inform the reader of new developments in the evaluation and treatment of patients with chronic constipation.