Gastroenterology clinics of North America
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Gastroenterol. Clin. North Am. · Jun 2015
ReviewThe Effect of Proton Pump Inhibitors on Barrett's Esophagus.
Proton pump inhibitors (PPIs) may protect against carcinogenesis in Barrett's esophagus because they eliminate the chronic esophageal inflammation of reflux esophagitis, and because they decrease esophageal exposure to acid, which can cause cancer-promoting DNA damage and increase proliferation in Barrett's metaplasia. Most clinical studies of PPIs and cancer development in Barrett's esophagus have found a cancer-protective effect for these drugs, although there are some contradictory data. Chemoprevention of dysplasia and cancer in Barrett's esophagus with PPIs appears to be cost-effective, and the indirect evidence supporting a cancer-protective role for PPIs is strong enough to warrant PPI treatment of virtually all patients with Barrett's esophagus.
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Gastroenterol. Clin. North Am. · Sep 2014
ReviewLymphocyte homing antagonists in the treatment of inflammatory bowel diseases.
Lymphocyte homing antagonists represent promising therapeutic agents for the treatment of idiopathic inflammatory bowel disease (IBD). Several critical molecules involved in the recruitment of inflammatory cells in the intestine, including integrins and chemokine receptors, have been successfully targeted for the treatment of IBD. These agents have shown great promise for the induction and maintenance of remission for both Crohn disease and ulcerative colitis. This article discusses currently approved prototypic agents for the treatment of IBD (natalizumab, anti-α4 integrin; vedolizumab, anti-α4β7 integrin), and several other agents in the same class currently under development.
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An increasing proportion of patients with inflammatory bowel disease (IBD) are treated with biological medications. The risk of infectious complications remains a significant concern in patients treated with biologics. ⋯ Some of the infectious risks are class specific, whereas others are a common concern for all biologics. A careful screening, surveillance, and immunization program, in accordance with available guidelines, is important to minimize any risk of infectious complications.
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Gastroenterol. Clin. North Am. · Sep 2014
ReviewAn update on anti-TNF agents in ulcerative colitis.
Anti-tumor necrosis factor-α agents are key therapeutic options for the treatment of ulcerative colitis. Their efficacy and safety have been shown in large randomized controlled trials. ⋯ Also reviewed are methods for optimizing their effectiveness, including therapeutic drug monitoring and treat-to-target strategies. Finally, remaining unresolved questions regarding their role and effectiveness are considered including how these may be addressed in future clinical trials.