Reviews in gastroenterological disorders
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Rev Gastroenterol Disord · Jan 2007
ReviewMedical therapy for gastroesophageal reflux disease in 2007.
Maximizing therapy for the patient with symptomatic gastroesophageal reflux disease (GERD) and optimizing efficacy of available agents in the difficult or refractory patient requires an understanding of antisecretory pharmacology and pharmacodynamics. Recent studies raise issues related to potential side effects of proton pump inhibitors (PPIs). Non-acid reflux and its potential association with symptoms must be considered in the management of refractory patients. Medical therapy of GERD is discussed, emphasizing optimizing antisecretory therapy, reviewing recent studies addressing potential side effects of PPIs and options for treatment of non-acid reflux.
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Rev Gastroenterol Disord · Jan 2006
ReviewTreatment of ulcerative colitis with oral mesalamine: advances in drug formulation, efficacy expectations and dose response, compliance, and chemoprevention.
Sulfasalazine, olsalazine, balsalazide, delayed-release mesalamine, controlled-release mesalamine, mesalamine pellets, and Multi-Matrix System mesalamine are effective first-line therapies for the treatment of mildly to moderately active ulcerative colitis and for subsequent maintenance of remission. For induction therapy it is unclear if there is a dose response above 1.5 g, and for maintenance therapy existing data do not support a dose response above 1.5 g. ⋯ Mesalamine >/= 1.2 g and sulfasalazine >/= 2 g reduce the risk of colorectal cancer in patients with ulcerative colitis. Drug formulations, efficacy expectations and dose response, toxicity expectations, compliance considerations, and chemoprevention considerations are reviewed.
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In the United States, African Americans have the highest incidence of colorectal cancer of any racial or ethnic group. Compared with whites, African Americans have a younger mean age at colorectal cancer diagnosis and a greater proportion have proximal cancers. ⋯ Currently, there are no established biological explanations for these differences in colorectal cancer between African Americans and whites. As leaders in the prevention and early diagnosis of colorectal cancer in the United States, clinical gastroenterologists can play an important role in promoting colorectal cancer awareness and the need for screening in African Americans.
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Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, bloating, and either constipation or diarrhea. Managing this chronic condition requires a coordinated effort between patient and physician. ⋯ In this article, medications commonly used to treat the individual symptoms of IBS are reviewed, based on evidence from the literature. In addition, new agents that affect the serotonin system and treat the global symptoms of IBS are described.