Current gastroenterology reports
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Curr Gastroenterol Rep · Dec 2010
ReviewMucosal healing in inflammatory bowel disease: where do we stand?
The definition of remission in Crohn's disease and ulcerative colitis has evolved to include mucosal healing as a measure of treatment efficacy. Randomized, controlled trials have demonstrated mucosal healing is attainable with the current arsenal of therapies available to treat inflammatory bowel disease. Mucosal healing has been shown to reduce the likelihood of clinical relapse, reduce the risk of future surgeries, and reduce hospitalizations. This review focuses on the latest studies addressing clinical outcomes of mucosal healing in the clinical trial and practice setting.
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Lung transplantation has become a valuable treatment for end-stage pulmonary disorders in an attempt to improve quality of life and extend survival. Development of chronic rejection, also known as bronchiolitis obliterans syndrome (BOS), is responsible for the vast majority of deaths after lung transplantation. ⋯ A high prevalence of gastroesophageal reflux and aspiration of gastric components has been described after lung transplantation. Reflux and aspiration have been implicated in the development of BOS and antireflux surgery has been proposed; however, the causal relationship with BOS and the impact of reflux in lung transplantation survival needs to be further elucidated.
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Colorectal cancer (CRC) remains the third most commonly diagnosed cancer and second leading cause of cancer death in the United States. Declines in CRC incidence and mortality over the past 20 years were attributed to CRC screening. Yet, only slightly more than half of the eligible at-risk population acknowledge being screened. ⋯ This article provides a focused assessment of effectiveness, limitations, and alternative available screening methods. New modalities endorsed in the updated guidelines (eg, fecal immunochemical tests, fecal DNA, and CT colonography) are reviewed. In addition, advances and updates in existing tests (eg, guaiac-based fecal occult blood tests and colonoscopy) are evaluated.
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Anorectal disorders affect men and women of all ages. Their management is not limited to the evaluation and treatment of hemorrhoids. Rather, a spectrum of anorectal disorders ranges from benign and irritating (pruritus ani) to potentially life-threatening (anorectal cancer). ⋯ In addition, treatment can be frustrating because clinicians are hamstrung by a lack of well-designed, prospective, clinical trials. Some of the most common anorectal disorders include fecal incontinence, pelvic floor dyssynergia, anal fissures, pruritus ani, proctalgia fugax, and solitary rectal ulcer syndrome. This article provides an update on the evaluation and treatment of common anorectal disorders.
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The prevalence of dyspepsia in the general population is as high as 40%, and its management represents a considerable financial burden to the health care system. Causes of dyspepsia amenable to medical therapy include peptic ulcer and functional dyspepsia, and testing for Helicobacter pylori and treating positive individuals is beneficial in both conditions. Individuals presenting for the first time with uninvestigated dyspepsia, age greater than 50 years, or alarm features require upper gastrointestinal (GI) endoscopy to exclude gastroesophageal malignancy. ⋯ Test and treat and empirical acid-suppression using a proton pump inhibitor (PPI) have similar costs and effects. Recent evidence suggests that empirical acid suppression commencing with antacids is as effective as PPI. Screening and treatment of H. pylori in PPI users and the community may reduce the costs of managing dyspepsia.