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The following reflects new findings and outcomes in medical research as presented at major medical meetings and published peer-reviewed medical journals. In this section members can view reports from important congresses as well as summaries of some recently published journal articles. Please let us know if you have a particular area of interest you would like to see covered. MEDICAL FRONTIERS - 46th Annual Meeting of the American Society of Clinical Oncology Update on Optimal Long-term Control of GIST with Targeted TherapiesChicago, Illinois / June 4-8, 2010 Chicago - The efficacy of imatinib, an oral small molecule inhibitor in the long-term control of metastatic or unresectable gastrointestinal stromal tumours (GIST), has provided an impressive demonstration of the potency of targeted therapy in malignant diseases. Recently, the indication for its use in GIST was expanded in Canada and elsewhere to include adjuvant treatment after primary resection. The new indication was based on results of a phase III study published in 2009 which (...) Read more... PRIORITY PRESS - 111th Annual Digestive Disease Week (DDW) Clinical Implications of Maximizing 5-ASA TherapyNew Orleans, Louisiana / May 1-5, 2010 New Orleans - New data have expanded the evidence that either twice-daily (b.i.d.) or once-daily mesalamine is highly effective for sustained healing and not just remission of ulcerative colitis. In a new analysis from a previously published phase III trial, both the b.i.d. and once-daily regimens of the extended-release formulation maintained mucosal healing in more than 80% of patients at the end of 12 months. In addition to reaffirming that mesalamine is effective when defining treatment (...) Read more... MEDICAL FRONTIERS - 111th Annual Digestive Disease Week (DDW) Toward Mucosal Healing in Ulcerative ColitisNew Orleans, Louisiana / May 1-5, 2010 New Orleans - The ability of complete rather than partial healing of ulcerative colitis (UC) to provide greater protection against relapse is a rational expectation now supported by several sets of data. These data have redirected the therapeutic target in both acute and maintenance treatment from symptom relief to a more rigorous definition of disease control at the mucosal level. The ability of the first-line therapy of UC, 5-aminosalicylic acid (5-ASA, mesalamine), to achieve mucosal (...) Read more... MEDICAL FRONTIERS - ESMO Conference on Sarcoma and GIST Advances in GIST Treatment: The Evolving Role of Tyrosine Kinase InhibitorsMilan, Italy / March 9-10, 2010 Milan - A series of major advances in the treatment of gastrointestinal stromal tumours (GIST) continues with progress in determining when to conduct mutational analyses to better target tyrosine kinase inhibitors (TKIs). Although surgery is the only curative treatment for GIST, TKIs have produced a revolution in the management of GIST by extending survival in those who are not surgical candidates and, more recently, demonstrating a steep reduction in the risk of recurrence when used as an (...) Read more... JOURNAL CLUB 2010 - Gastroenterology Optimizing Adherence and Potential Outcomes in Inflammatory Bowel DiseaseFebruary - 2010 Editorial overview
PRIORITY PRESS - Canadian Digestive Diseases Week Optimizing Adherence and Potential Outcomes in IBDToronto, Ontario / February 27- March 2, 2010 Toronto - Ulcerative colitis (UC) and Crohn’s disease are chronic conditions demanding lifelong care. In mild to moderate UC disease, 5-ASA formulations such as mesalamine are the mainstay of first-line therapy. In order to reduce the burden of multiple daily dosing and complex regimens, newer formulations offer the potential to safely administer mesalamine once daily. The problem of adherence also increases over time with symptom resolution. The large prospective QDIEM trial demonstrated (...) Read more... PRIORITY PRESS - 5th Congress of the European Crohn’s and Colitis Organisation (ECCO) Optimizing 5-ASA Therapy in the Management of Ulcerative ColitisPrague, Czech Republic / February 25-27, 2010 Prague - For several decades, 5-aminosalicylic acid (5-ASA) compounds have been used to treat patients with ulcerative colitis (UC), both during flares and as maintenance therapy. With proven efficacy and a well-established safety profile, guidelines still recommend oral 5-ASA agents as a first choice for maintenance of remission in patients with mild-to-moderate UC. A recurring theme at this year’s ECCO congress was implementing important measures to optimize 5-ASA therapy in the management (...) Read more... Journal of Pediatric Gastroenterology and Nutrition: February 2010 - Volume 50 - Issue - p S14–S34 Systematic Review of the Evidence Base for the Medical Treatment of Paediatric Inflammatory Bowel DiseaseWilson, DC; Thomas, AG; Croft, NM; Newby, E; Akobeng, AK; Sawczenko, A; Fell, JME; Murphy, MS; Beattie, RM; Sandhu, BK; Mitton, SG; and the IBD Working Group of the British Society of Paediatric Gastroenterology, Hepatology, and Nutrition Objective: To systematically review the evidence base for the medical (pharmaceutical and nutritional) treatment of paediatric inflammatory bowel disease. Methods: Key clinical questions were formulated regarding different treatment modalities used in the treatment of paediatric (not adult-onset) IBD, in particular the induction and maintenance of remission in Crohn disease and ulcerative colitis. Electronic searches were performed from January 1966 to December 2006, using the electronic (...) Read more... Clinical Radiology Volume 65, Issue 2, February 2010, Pages 126-132 CT colonography: accuracy of initial interpretation by radiographers in routine clinical practiceD. Burling , a, , P. Wyliea, A. Guptaa, R. Illangovana, J. Muckiana, R. Ahmada, M. Marshalla and S.A. Taylora a Intestinal Imaging Centre, St Mark’s Hospital, Harrow, Middlesex, UK Aim To investigate performance of computed-assisted detection (CAD)-assisted radiographers interpreting computed tomography colonography (CTC) in routine practice. Materials and methods Three hundred and three consecutive symptomatic patients underwent CTC. Examinations were double-read by trained radiographers using primary two-dimensional/three-dimensional (2D/3D) analysis supplemented by “second reader” CAD. Radiographers recorded colonic neoplasia, interpretation times, and patient (...) Read more... Alimentary Pharmacology & Therapeutics Volume 31 Issue 4, Pages 493 - 501 Impact of evidence-based medicine on the treatment of patients with unresectable hepatocellular carcinomaE. G. GIANNINI*, G. BODINI*, M. CORBO*, V. SAVARINO*, D. RISSO†, M. A. DI NOLFO‡, P. DEL POGGIO§, L. BENVEGNÙ, F. FARINATI**, M. ZOLI††, F. BORZIO‡‡, E. CATURELLI§§, M. CHIARAMONTE & F. TREVISANI†† FOR THE ITALIAN LIVER CANCER (ITA.LI.CA.) GROUP *Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università di Genova, Genova, Italy ; †Cattedra di Statistica Medica, Dipartimento di Scienze della Salute, Università di Genova, Genova, Italy ; ‡Divisione di Medicina, Ospedale Bolognini, Seriate, Italy ; §Divisione di Medicina, Ospedale Treviglio-Caravaggio, Treviglio, Italy ; Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Padova, Italy ; **Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova, Italy ; ††Dipartimento di Medicina Clinica, Alma Mater Studiorum-Università di Bologna, Bologna, Italy ; ‡‡Dipartimento di Medicina, Unità di Gastroenterologia, Ospedale Fatebenefratelli, Milano, Italy ; §§Unità di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy ; Cattedra di Gastroenterologia, Università dell’Aquila, L’Aquila, Italy ABSTRACT Background A randomized controlled trial performed by the Barcelona Clinic Liver Cancer (BCLC) published in 2002 demonstrated that transcatheter arterial chemoembolisation (TACE) is an effective treatment for well-selected patients with unresectable hepatocellular carcinoma (HCC). Aim To access whether this information has modified the use of TACE in clinical practice. Methods From 2042 HCC patients included in the Italian Liver Cancer database, we selected 336 cases diagnosed over (...) Read more... Alimentary Pharmacology & Therapeutics Volume 31 Issue 4, Pages 461 - 476 Review article: the management of hepatocellular carcinomaR. CABRERA & D. R. NELSON Section of Hepatobiliary Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA Correspondence to Dr R. Cabrera, Section of Hepatobiliary Diseases, Division of Gastroenterology, Hepatology and Nutrition, Department Of Medicine, University of Florida, PO Box 100277, Gainesville, FL 32610-0277, USA. ABSTRACT Background Hepatocellular carcinoma is the leading cause of death in cirrhosis. A majority of patients present at an advanced stage with poor prognosis. Aim To review the current screening, diagnosis and management strategies involved in hepatocellular carcinoma. Methods A literature search was performed using PubMed for publications with a predetermined search string to identify relevant studies. Results Hepatocellular carcinoma is dramatically increasing in incidence that is (...) Read more... Am J Gastroenterol 2010; 105:65–73 Empiric Quadruple vs. Triple Therapy for Primary Treatment of Helicobacter pylori Infection: Systematic Review and Meta-Analysis of Efficacy and TolerabilityJay Luther MD1, Peter D R Higgins MD, PhD1, Phillip S Schoenfeld MD1, Paul Moayyedi MB ChB, PhD2, Nimish Vakil MD3 and William D Chey MD, AGAF, FACG, FACP1 1Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA 2Gastroenterology Division, McMaster University, Hamilton, Ontario, Canada 3Division of Gastroenterology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA OBJECTIVES: Recent treatment guidelines recommend two first-line therapies for Helicobacter pylori infection: proton pump inhibitor (PPI), bismuth, tetracycline, and metronidazole (quadruple therapy) or PPI, clarithromycin, and amoxicillin (triple therapy). We performed a systematic review and meta-analysis to compare the efficacy and tolerability of these regimens as first-line treatment of H. pylori. METHODS: A search of MEDLINE, EMBASE, Google Scholar, the Cochrane Central Register (...) Read more... Am J Gastroenterol 2010; 105:34–41 Proton Pump Inhibitor and Clopidogrel Interaction: Fact or Fiction?Loren Laine MD1 and Charles Hennekens MD, DrPH2 1Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA 2Department of Clinical Science and Medical Education, Charles E. Schmidt College of Biomedical Science, Florida Atlantic University, Boca Raton, Florida, USA Current consensus recommendations state that patients prescribed clopidogrel plus aspirin should receive a proton pump inhibitor (PPI) to reduce gastrointestinal bleeding. Clopidogrel is converted to its active metabolite by cytochrome P450 (CYP) enzymes. Clopidogrel users with decreased CYP2C19 function have less inhibition of platelet aggregation and increased cardiovascular (CV) events. As PPI metabolism also involves CYP2C19, it was hypothesized that competition by PPIs might interfere (...) Read more... PHYSICIAN PERSPECTIVE - Viewpoint based on the following article: Gastroenterol Hepatol 2009;5(7):494-500 The Role of Long-term 5-ASA Maintenance in Preventing Relapse of Ulcerative ColitisNovember 2009 INTRODUCTION
FRONTLINE - Based on presentations from the Second Eastern Ontario Gastrointestinal Stromal Tumours (GIST) Consensus Meeting Second Eastern Ontario Conference on the Management of GISTOttawa, Ontario / November 6, 2009 Two years ago, the first eastern Ontario consensus conference on the detection, staging and treatment of gastrointestinal stromal tumours (GISTs) provided a summary of current management in the context of regional resources. A second conference was recently held to accommodate several advances important to the definition of optimal care that have occurred since that initial meeting. This summary, like the summary of the previous conference, is expected to be relevant to other regions of (...) Read more... PRIORITY PRESS - 74th Annual Scientific Meeting of the American College of Gastroenterology Ulcerative Colitis: Focus on Persistence with 5-ASA TherapySan Diego, California / October 23-28, 2009 San Diego - The ultimate goal of treatment for ulcerative colitis (UC) is mucosal healing. Although 5-aminosalicylic acid (5-ASA) agents have demonstrated efficacy in UC, as many as 60% of patients do not take the medication as prescribed, greatly reducing effectiveness. Patients with quiescent disease have especially poor adherence, possibly as a result of not understanding the need to continue medication after symptom resolution. Poor adherence to medication has been documented in several (...) Read more... Alimentary Pharmacology & Therapeutics Volume 29 Issue 5, Pages 481 - 496 Canadian consensus guidelines on long-term nonsteroidalBackground Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, but are not without risks. Aim To provide evidence-based management recommendations to help clinicians determine optimal long-term NSAID therapy and the need for gastroprotective strategies based on an assessment of both gastrointestinal (GI) and cardiovascular (CV) risks. Methods A multidisciplinary group of 21 voting participants revised and voted on the statements and the strength of evidence (assessed according to (...) Read more... Alimentary Pharmacology & Therapeutics Volume 29 Issue 6, Pages 635 - 642 Predictors of serious complications due to Clostridium difficile infectionD. GUJJA* & F. K. FRIEDENBERG† Background Identifying individuals with severe Clostridium difficile infection (CDI) at risk for major complications has become an important objective. Presence of clinical variables that predict complications from CDI would have the potential to strongly influence management. Aim To determine which clinical variables predict complications from CDI. Methods Cross-sectional study of all individuals admitted to Temple University Hospital between 12/1/03 and 7/1/08 with the primary discharge (...) Read more... Alimentary Pharmacology & Therapeutics Volume 29 Issue 6, Pages 626 - 634 Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital settingB. R. DALTON*, T. LYE-MACCANNELL†,‡, E. A. HENDERSON†,‡, D. R. MACCANNELL§ & T. J. LOUIE‡,§, Background Proton pump inhibitors (PPI) have been linked to higher risk of Clostridium difficile infection (CDI). The relevance of this association in hospitals with low disease activity, where an outbreak strain is nondominant, has been assessed in relatively few studies. Aim To assess the association of PPI and CDI in a setting of low disease activity. Methods A retrospective cohort study was conducted at two hospitals. Patients admitted for ≥7 days receiving antibiotics were included. (...) Read more... PRIORITY PRESS - 110th Annual Digestive Disease Week Examining the Role of 5-Aminosalicylates in the Treatment of Crohn’s DiseaseChicago, Illinois / May 30-June 4, 2009 Chicago - Crohn’s disease (CD) is characterized by periods of disease control or remission followed by flare-ups. Most affected patients have an uncomplicated clinical course characterized by remission or mild disease. As top-down therapy is being studied, those with uncomplicated disease have the potential for overtreatment. Although results of some clinical studies have questioned 5-aminosalicylic acid efficacy in this disease, other data from clinical practice suggest that many physicians (...) Read more... PRIORITY PRESS - American Transplant Congress 2009 Immunosuppression in Liver Transplant RecipientsBoston, Massachusetts / May 30-June 3, 2009 Boston - Patients with hepatitis C (HCV) who undergo liver transplantation typically experience less favourable patient and graft survival compared with non-HCV liver transplant recipients, primarily because HCV frequently recurs, damaging the new liver in the process. Achieving a sustained virological response to therapy significantly improves survival for HCV transplant recipients and measures that facilitate that response should be considered. As confirmed here at the ATC, new-onset (...) Read more... MEDICAL OPTIONS in Gastroenterology Proton Pump Inhibitor Treatment OptimizationReviews from published literature - March 2009 Towards Improved Treatment Outcomes: Revisiting GERD Symptomatology
PRIORITY PRESS Canadian Digestive Diseases Week (CDDW) 2009 Towards a Paradigm Shift in Ulcerative Colitis ManagementBanff, Alberta / February 27-March 2, 2009 Banff - Previously released phase III data demonstrated that extending the healing course of controlled-release mesalamine beyond eight weeks increases the proportion of ulcerative colitis (UC) patients who can avoid or delay the need for more aggressive therapy. New analyses of the same dataset have found that the median time to symptom resolution with this extension is 15 days. This new information permits physicians and patients to make informed decisions about the risks and benefits of (...) Read more... MEDICAL FRONTIERS Canadian Digestive Diseases Week (CDDW) 2009 A Step Forward in Gastroesophageal Disease Identification and ControlBanff, Alberta / February 27-March 2, 2009 Banff - A simple test has proven effective for rapidly identifying patients with gastroesophageal reflux disease (GERD) who are poorly controlled on their current therapy, including a proton pump inhibitor (PPI). Although PPIs are the most effective treatment for GERD, recent surveys have confirmed that a substantial proportion of patients on standard PPI dosages still experience symptoms sufficient to impair quality of life. The goal of a new method of rapid clinical evaluation, called the (...) Read more... FRONTLINE - Based on Sessions from the 64th Annual Meeting of the Canadian Rheumatology Association RheumatologyKananaskis, Alberta / February 18-21, 2009 Spondyloarthropathies and Comorbidities: Enhancing Patient Care by Increasing Interspecialty Awareness
Annals of Internal Medicine 20 January 2009 | Volume 150 Issue 2 Consensus Development Conference Statement: Management of Hepatitis B National Institutes of HealthMichael F. Sorrell, MD; Edward A. Belongia, MD; Jose Costa, MD; Ilana F. Gareen, PhD; Jean L. Grem, MD; John M. Inadomi, MD; Earl R. Kern, PhD; James A. McHugh, MD; Gloria M. Petersen, PhD; Michael F. Rein, MD; Doris B. Strader, MD; and Hartwell T. Trotter, MS* Hepatitis B is a major cause of liver disease worldwide, ranking as a substantial cause of cirrhosis and hepatocellular carcinoma. The development and use of a vaccine for hepatitis B virus (HBV) has resulted in a substantial decline in the number of new cases of acute hepatitis B among children, adolescents, and adults in the United States. However, this success has not yet been duplicated worldwide, and both acute and chronic HBV infection continue to represent important global health (...) Read more... Annals of Internal Medicine 20 January 2009 | Volume 150 Issue 2 Antiviral Therapy for Adults with Chronic Hepatitis B: A Systematic Review for a National Institutes of Health Consensus Development ConferenceTatyana A. Shamliyan, MD, MS; Roderick MacDonald, MS; Aasma Shaukat, MD, MPH; Brent C. Taylor, PhD, MPH; Jian-Min Yuan, MD, PhD; James R. Johnson, MD; James Tacklind, BS; Indulis Rutks, BS; Robert L. Kane, MD; and Timothy J. Wilt, MD, MPH Background: Chronic hepatitis B infection can lead to liver failure, hepatocellular carcinoma, and death. Purpose: To evaluate the effectiveness of antiviral therapy for adults with chronic hepatitis B infection. Data Sources: Randomized, controlled trials (RCTs) of interferon ( 2b and pegylated 2a), lamivudine, adefovir, entecavir, and telbivudine published from 1990 to 2008. Study Selection: Randomized, controlled clinical trials of adults with chronic hepatitis B published in English (...) Read more... Annals of Internal Medicine 6 January 2009 6 January 2009 | Volume 150 Issue 1 | Pages 1-8 Association of Colonoscopy and Death From Colorectal CancerNancy N. Baxter, MD, PhD; Meredith A. Goldwasser, ScD; Lawrence F. Paszat, MD, MS; Refik Saskin, MSc; David R. Urbach, MD, MSc; and Linda Rabeneck, MD, MPH Background: Colonoscopy is advocated for screening and prevention of colorectal cancer (CRC), but randomized trials supporting the benefit of this practice are not available. Objective: To evaluate the association between colonoscopy and CRC deaths. Design: Population-based, case–control study. Setting: Ontario, Canada. Patients: Persons age 52 to 90 years who received a CRC diagnosis from January 1996 to December 2001 and died of CRC by December 2003. Five controls matched by age, sex, (...) Read more... Therapeutic Advances in Gastroenterology 2009; 2; 11 Current status of therapy in autoimmune liverGideon M. Hirschfield, Nadya Al-Harthi and E. Jenny Heathcote Abstract: Therapeutic strategies for autoimmune liver diseases are increasingly established. Although proportionately uncommon, specialist centers have with time refined the best approaches for each disease, based on an improved understanding of the spectrum of presentation. The major treatment aims are to prevent end-stage liver disease and its associated complications. As a result of drugs such as ursodeoxycholic acid, predniso(lo)ne and azathioprine, both primary biliary cirrhosis and (...) Read more... Therapeutic Advances in Gastroenterology, Vol. 2, No. 1, 45-57 (2009) Review: Current status of therapy for hepatocellular carcinomaKathleen E. Corey Massachusetts General Hospital, GI Unit, Boston, MA, USA Daniel S. Pratt Massachusetts General Hospital, GI Unit, Boston, MA, USA, The incidence of hepatocellular carcinoma (HCC) is increasing worldwide. A multidisciplinary approach is required for its management. Screening high-risk patients allows for earlier diagnosis and the use of potentially curative therapies. Current recommendations for HCC screening for patients with cirrhosis are an abdominal ultrasound and serum alpha fetoprotein level every 6 to 12 months. Treatment choice depends on tumor stage, liver function and the patient’s overall functional status. (...) Read more... Therapeutic Advances in Gastroenterology, Vol. 2, No. 1, 29-43 (2009) Review: Current status of therapy in nonalcoholic fatty liver diseaseScott McNear Scott McNear Department of Medicine, Brooke Army Medical Center, San Antonio, TX, USA Stephen A. Harrison Scott McNear Department of Medicine, Brooke Army Medical Center, San Antonio, TX, USA, The obesity epidemic has now spread worldwide. With increase in weight, there is an increase in dysregulated energy metabolism ultimately leading to dysfunction of multiple organ systems recognized as the metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease worldwide, and is thought to be the hepatic manifestation of metabolic syndrome. It is a nondiscriminating disease affecting both children and adults and no socioeconomic class is (...) Read more... Progress in Lipid Research Volume 48, Issue 1, January 2009, Pages 1-26 Recent insights into hepatic lipid metabolism in non-alcoholic fatty liver disease (NAFLD)Giovanni Mussoa, , , Roberto Gambinob and Maurizio Cassaderb aGradenigo Hospital, C.so Regina Margherita 8, 10132 Turin, Italy bDepartment of Internal Medicine, University of Turin, Italy Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Western countries and is considered the hepatic manifestation of metabolic syndrome. The hallmark of NAFLD is hepatic neutral lipid accumulation, mainly triacylglycerol, in the absence of significant ethanol consumption, viral infection or other specific etiologies. Hepatic lipid accumulation results from an imbalance between lipid availability (from circulating lipid uptake or de novo lipogenesis) and (...) Read more... Alimentary Pharmacology & Therapeutics Volume 29 Issue 3, Pages 286 - 297 The safety profile of anti-tumour necrosis factor therapy in inflammatory bowel disease in clinical practice: analysis of 620 patient-years follow-upC. W. LEES*, A. I. ALI*, A. I. THOMPSON*, G.-T. HO*, R. O. FORSYTHE*, L. MARQUEZ*, C. J. COCHRANE*, S. AITKEN*, J. FENNELL*, P. ROGERS†, A. G. SHAND*, I. D. PENMAN*, K. R. PALMER*, D. C. WILSON†, I. D. R. ARNOTT* & J. SATSANGI* ABSTRACT Background Anti-TNF agents are now widely used in Crohn’s disease (CD), and in ulcerative colitis (UC). Aim To review the safety profile of anti-TNF agents in all patients treated with infliximab in Edinburgh from 1999 to 2007. Methods Complete data were available on 202/207 patients comprising 157 CD, 42 UC and three coeliac disease. Median follow-up was 2.4 years (1.0–4.9) with a total of 620 patient-years follow-up. About 19.1% of CD patients were subsequently treated with (...) Read more... Alimentary Pharmacology & Therapeutics Volume 29 Issue 3, Pages 247 - 257 Systematic review: impact of non-adherence to 5-aminosalicylic acid products on the frequency and cost of ulcerative colitis flaresP. D. R. HIGGINS*, D. T. RUBIN†, K. KAULBACK‡, P. S. SCHOENFIELD*,§ & S. V. KANE ABSTRACT Background Ulcerative colitis (UC) can be maintained in remission with 5-aminosalicylic acid (5-ASA) medications, but frequent non-adherence by patients who are feeling well has been associated with more frequent flares of colitis. Aim To perform a systematic review of the published literature and unpublished randomized clinical trials (RCTs) regarding the impact of non-adherence with 5-ASA medications on the incidence of UC flares and costs of care. Methods A search of MEDLINE, (...) Read more... Transplant International Volume 22 Issue 2, Pages 144 - 152 Autoimmune liver diseases and recurrence after orthotopic liver transplantation: what have we learned so far?Tim C. M. A. Schreuder 1,2 , Stefan G. Hübscher 3 and James Neuberger 1 1 Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK 2 Department of Gastroenterology and Hepatology, Liver Unit, VU Medical Centre, Amsterdam, the Netherlands ABSTRACT Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) may all recur after liver transplant. Diagnosis of rPBC is defined by histology; rAIH by serology, biochemistry and histology; rPSC by histology and/or imaging of the biliary tree and exclusion of other causes of nonanastomotic biliary strictures. Criteria for recurrent disease (RD) may differ from those used in similar disease in the native liver: frequent use of immunosuppressive (...) Read more... American Journal of Therapeutics. 15(6):536-542, November/December 2008. Is There a Dark Side to Long-term Proton Pump Inhibitor Therapy?Nealis, Thomas B MD; Howden, Colin W MD * Abstract: Proton pump inhibitors (PPIs) are among the most widely used of prescription drugs. They have revolutionized the management of gastroesophageal reflux disease and other acid-related disorders. Although generally safe, concerns about possible adverse effects continue to arise. Some of these, such as gastric neoplasms, are of theoretical concern only and are related to suppression of gastric acid secretion and consequent hypergastrinemia; these have not been encountered in clinical (...) Read more... 2008 Advances in Inflammatory Bowel Diseases Maintaining Long-term Response in the Patient with Complex Crohn’s DiseaseHollywood, Florida / December 4-7, 2008 Hollywood, Florida - Tumour necrosis factor alpha (TNF-a) inhibitors have demonstrated significant efficacy in chronic inflammatory diseases, including Crohn’s disease (CD). However, patients may lose their response to an anti-TNF agent and in many patients, the dose needs to be increased in order to restore a response. As well, patients might not respond to their anti-TNF agent due to stricture or open fistulas. With similar safety and efficacy data to other TNF-a agents, the first (...) Read more... Journal of Clinical Gastroenterology. 42 Supplement 3, Part 1:S116-S118, September 2008. Probiotics in Critically Ill Patients.Madsen, Karen PhD Abstract: Severe sepsis with associated multisystem organ dysfunction is a leading cause of death in patients hospitalized in intensive care units. The gastrointestinal system plays a key role in the pathogenesis of multisystem organ dysfunction owing to a breakdown of intestinal barrier function and increased translocation of bacteria and bacterial components into the systemic circulation. During critical illness, alterations occur in gut microflora owing to several factors, including (...) Read more... Journal of Clinical Gastroenterology. 42 Supplement 3, Part 1:S111-S115, September 2008. Understanding Why Probiotic Therapies Can be Effective in Treating IBD.Fedorak, Richard N. MD, FRCPC * + Abstract: Probiotics, for the treatment of inflammatory bowel disease, are a group of specific nonpathogenic bacteria that are functionally and genetically defined by their ability to reduce inflammation in the intestine. Although probiotics also seem to have broad beneficial effects in humans, both as a food and as a therapeutic agent, there are specific identified mechanisms in some, but not all, of these bacteria that are important relative to the pathogenesis of inflammatory bowel (...) Read more... Journal of Digestive Diseases Volume 9 Issue 3, Pages 129 - 139 Phytoceuticals: Mighty but ignored weapons against Helicobacter pylori infectionSun-Young LEE*, Yong Woon SHIN † & Ki-Baik HAHM †‡ ABSTRACT Helicobacter pylori (H. pylori) infection causes peptic ulcer disease, mucosa-associated lymphoid tissue (MALT) lymphomas and gastric adenocarcinomas, for which the pathogenesis of chronic gastric inflammation prevails and provides the pathogenic basis. Since the role of H. pylori infection is promoting carcinogenesis rather than acting as a direct carcinogen, as several publications show, eradication alone cannot be the right answer for preventing H. pylori-associated gastric (...) Read more... Therapeutic Advances in Gastroenterology, Vol. 1, No. 3, 173-189 (2008) Review: Treatment options for nonalcoholic fatty liver diseaseShivakumar Chitturi Australian National University Medical School, Gastroenterology and Hepatology Unit, Canberra Hospital, Australian Capital Territory, Australia, Nonalcoholic fatty liver disease comprises a range of disorders from steatosis and steatohepatitis through to cirrhosis. Nonalcoholic steatohepatitis can progress to cirrhosis and liver-related death. Therefore, managing this common disorder is becoming an important public health issue. Lifestyle measures are commonly suggested but robust data are lacking. Trials with antioxidants (vitamin E, betaine) as well as cytoprotectants (ursodeoxycholic acid) have been disappointing. While data for (...) Read more... 16th United European Gastroenterology Week (UEGW) Enhancing Treatment Success in Ulcerative Colitis: A PODIUM AnalysisVienna, Austria / October 19-22, 2008 Vienna - A series of new substudies from a landmark trial has identified several important variables that contribute to sustained remission of ulcerative colitis (UC) with 5-ASA therapy. The study itself, completed last year, confirmed that a once-daily, controlled-release formulation of mesalazine could maintain a greater proportion of UC patients on remission than a twice-daily regimen. The series of recent substudies may be at least as important because they define variables that (...) Read more... United European Gastroenterology Week (UEGW) SONIC: New Evidence-based Approach for Patients with Crohn’s DiseaseVienna, Austria / October 19-22, 2008 Vienna - Optimal drug selection in patients with Crohn’s disease who have failed steroids but who have not yet initiated an immunomodulator such as azathioprine has been redefined in a major multinational randomized controlled trial. The study compared a biologic, an immunomodulator, and the combination. Either regimen containing the biologic infliximab provided significantly greater steroid-free remission and complete mucosal healing than the immunomodulator alone at the end of six months. (...) Read more... United European Gastroenterology Week (UEGW) Attaining and Maintaining Mucosal Healing in Patients with Mild-to-Moderate Ulcerative ColitisVienna, Austria / October 18-22, 2008 Vienna - Due to a series of recent advances, a higher proportion of patients with mild to moderate ulcerative colitis are able to stay with first-line 5-aminosalicylates (5-ASA) for indefinite disease control. In acute treatment, mucosal healing rates have climbed above 60% with the most effective 5-ASA formulations. This rate of acute healing, which predicts a more benign disease course, is likely to be contributing to maintenance of clinical remission rates at one year that reached 90% in (...) Read more... 73rd Annual Meeting of the American College of Gastroenterology Staying the Course, Maintaining Remission in Patients with Ulcerative ColitisOrlando, Florida / October 3-8, 2008 Orlando - There are several advantages to initiating and maintaining ulcerative colitis patients on 5-aminosalicylic acid (5-ASA), but it has been unclear how long to pursue healing with this first-line agent before moving to an alternative. Although there are data that patients who do not heal at eight weeks will heal by 16 weeks, particularly if the dose is increased, patients and physicians are likely to be unwilling to accept persistent symptoms over this period of time. However, a new (...) Read more... Journal of Gastroenterology and Hepatology Volume 23 Issue 8pt2, Pages e340 - e347 Outcomes of bleeding peptic ulcers: A prospective studyNai-Jen Liu, Ching-Song Lee, Jui-Hsiang Tang, Hao-Tsai Cheng, Yin-Yi Chu, Kai-Feng Sung, Cheng-Hui Lin, Yung-Kuan Tsou, Jau-Min Lien, Pang-Chi Chen, Cheng-Tang Chiu and Chi-Liang Cheng Background and Aim: Bleeding peptic ulcers can be due to Helicobacter pylori (H. pylori) infection, use of non-steroidal anti-inflammatory drugs (NSAIDs), or idiopathic causes. The aim of this prospective study was to identify the clinical outcomes of bleeding peptic ulcers related to different causes. Methods: A total of 390 patients with bleeding ulcers were evaluated consecutively between June 2005 and August 2006. The diagnosis of H. pylori infection was made at index endoscopy, using (...) Read more... Transplantation Proceedings Volume 40, Issue 6, July-August 2008, Pages 1823-1826 Evidence of Liver Histological Alterations in Apparently Healthy Individuals Evaluated for Living Donor Liver TransplantationO. Cuomoa, A. Perrellaa, D. Pisanielloa, G. Marinob and G. Di Costanzoc aDepartment of Laparascopic, Hepatic Surgery and Liver Transplant Unit, AORN, A. Cardarelli Hospital, Naples, Italy bHistopathology Unit, AORN, A. Cardarelli Hospital, Naples, Italy cHepatology Unit, AORN, A. Cardarelli Hospital, Naples, Italy. Background Living donor liver transplantation (LDLT) represents an important therapeutic option for patients with end-stage liver disease (ESLD). It has been reported that steatosis may be a serious problem in patients who donate a part of their liver. Liver biopsy represents an accepted method to assess the rate of steatosis and the possible risk to the donor. Nonetheless, some histological abnormalities have been documented in the specimens from potential donors. The aim of this study was (...) Read more... Expert Opinion on Therapeutic Patents August 2008, Vol. 18, No. 8, Pages 841-859 Very late antigen-4 integrin antagonistsJefferson W Tilley Senior Research Director Hoffmann-La Roche, Inc., Roche Research Center, 340 Kingsland Street, Nutley, NJ 07110, USA +1 973 235 4660; +1 973 235 6084; Jefferson.tilley@roche.com Background: Together with β2 integrins and selectins, α4 integrins mediate lymphocyte arrest, extravasation and migration to sites of inflammation. They have been validated as therapeutic targets for inflammatory diseases and, in addition to the marketed anti-α4 antibody natalizumab, numerous small-molecule antagonists have been discovered as candidate drugs. Objective: The present review summarizes work establishing natalizumab as an agent for the treatment of multiple sclerosis and Crohn’s (...) Read more... Alimentary Pharmacology & Therapeutics Volume 28 Issue 3, Pages 334 - 343 Biliary events and an increased risk of new onset irritable bowel syndrome: a population-based cohort studyM. A. MCNALLY, G. R. LOCKE, A. R. ZINSMEISTER, C. D. SCHLECK, J. PETERSON & N. J. TALLEY ABSTRACT Background Prospective data are lacking to determine if irritable bowel syndrome (IBS) is a risk factor for cholecystectomy, or if biliary disease and cholecystectomy predisposes to the development of IBS. Aim To test the hypothesis that IBS and biliary tract disease are associated. Methods Validated symptom surveys sent to cohorts of Olmsted County, MN, (1988–1994) with follow-up in 2003. Medical histories were reviewed to determine any ’biliary events’ (defined by gallstones or (...) Read more... European Journal of Gastroenterology & Hepatology. 20(6):506-511, June 2008. An open-label randomized controlled trial of lactulose and probiotics in the treatment of minimal hepatic encephalopathy.Sharma, Praveen a; Sharma, Barjesh C. a; Puri, Vinod b; Sarin, Shiv Kumar a Background and aim: Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and increased work disability. Treatment with lactulose and probiotics has shown some benefit. We compared lactulose with probiotics and a combination of lactulose plus probiotics in the treatment of MHE. Patients and methods: One hundred and ninety cirrhotic patients without overt encephalopathy [Child’s A grade 71 patients (37.4%), Child’s B grade 72 patients (37.9%), Child’s C grade 47 (...) Read more... Based on an article in the journal Gastroenterology 2004;126:660-4. GERD in the Elderly: Current Strategies for Adequate Risk ManagementJuly 2008 INTRODUCTION
MEDICAL OPTIONS In Ulcerative Colitis Mucosal Healing, Adherence and Therapy: Qualifying Treatment Success in Ulcerative ColitisJune 2008 Endoscopic Healing as Treatment Goal in Ulcerative Colitis
Digestive Disease Week (DDW) 2008 Prolonged Endoscopic Healing in Patients with Mild-to-Moderate Ulcerative ColitisSan Diego, California / May 17-21, 2008 San Diego - Two studies conducted independently but with similar designs and objectives generated landmark evidence that a delayed-release, once-daily mesalamine formulation can reliably heal mild-to-moderate ulcerative colitis (UC). Although both studies are now published, each continues to yield additional data on the parameters of early and sustained disease control useful to patient counselling. In the most recent set of data, presented at the 2008 DDW, it was demonstrated that (...) Read more... Based on the following articles: Can J Gastroenterol 2007;21(12):827-34. Am J Gastroenterol 2005;100:2478-85. Rethinking Initial Management of Moderately Active Ulcerative ColitisMay 2008 Approximately 70% of patients who present with active ulcerative colitis (UC) have moderately active disease. Compounds containing 5-aminosalicylate (5-ASA) are recommended as first-line treatment for active UC but their optimal dosing based on disease severity and extent has been an issue for debate. Two studies of similar design have addressed part of this debate. Both ASCEND I and II showed that after six weeks of treatment, more moderately active UC patients receiving delayed-release (...) Read more... Journal of Digestive Diseases Volume 9 Issue 2 Page 63-67, May 2008 Impact of non-alcoholic fatty liver disease on accelerated metabolic complicationsJian Gao FAN; Insulin resistance is the basis of both non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS), the two conditions are often found in the same individual. The mortality of patients with NAFLD is significantly higher than that among the general population and cardiovascular risk may compete with liver-related risk in dictating the final outcome. Recent prospective studies have reported that NAFLD is associated with an increased incidence of MetS and type 2 diabetes mellitus, (...) Read more... European Journal of Gastroenterology & Hepatology. 20(5):436-440, May 2008. Effects of ginger on gastric emptying and motility in healthy humans.Wu, Keng-Liang a; Rayner, Christopher K. b; Chuah, Seng-Kee a; Changchien, Chi-Sin a; Lu, Sheng-Nan a; Chiu, Yi-Chun a; Chiu, King-Wah a; Lee, Chuan-Mo a Objective: Ginger has been reported to improve upper gastrointestinal symptoms. Little information about the effects of ginger on gastric motor function, exists, however. Our aim was to investigate the effects of ginger on gastric emptying, antral motility, proximal gastric dimensions, and postprandial symptoms. Methods: Twenty-four healthy volunteers were studied twice in a randomized double-blind manner. After an 8 h fast, the volunteers ingested three ginger capsules (total 1200 mg) or (...) Read more... European Journal of Gastroenterology & Hepatology. 20(5):450-464, May 2008. Proteomics in liver fibrosis is more than meets the eye.Cheung, Kin Jip a; Tilleman, Kelly b; Deforce, Dieter b; Colle, Isabelle a; Van Vlierberghe, Hans a Liver fibrosis is a serious health issue for many liver patients and is currently diagnosed using liver biopsy. The erroneous nature of this technique urges the search for better, noninvasive alternatives. In this regard, proteomics has been described as a useful biomarker discovery tool and has become increasingly applied in the study of liver fibrosis. Experimental and clinical studies have already provided deeper insights in the molecular pathways of liver fibrosis and even confirmed (...) Read more... The American Journal of Gastroenterology Volume 103 Issue 3 Page 734-743, March 2008 A Critical Review of Candidacy for Orthotopic Liver Transplantation in Alcoholic Liver DiseaseDavid S. Kotlyar, B.S.11University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, Anne Burke, M.D.22Division of Gastroenterology, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, The majority of candidates with end-stage alcoholic liver disease (ESALD) in the United States who are eligible for referral for liver transplantation (LT) are not being referred. There is a lack of firm consensus for the duration of abstinence from alcohol as well as what constitutes good psychosocial criteria for listing for LT. Evidence shows that the general public and the practicing physicians outside the transplant community perceive that patients with a history of alcohol abuse will (...) Read more... Oncology February 2008 • Volume 22 Number 2 New Therapeutic Options in Gastrointestinal Stromal TumorsEYTAN STEIN, MD; OLIVIA ARANHA, MD; MARK AGULNIK, MD Gastrointestinal stromal tumors have until recently had a uniformly poor prognosis with lack of effective drug therapies. These tumors usually have activating mutations in either KIT or PDGFR-α tyrosine kinase receptors. Over the past decade, imatinib (Gleevec), a selective tyrosine kinase inhibitor has become the standard of care for the first-line treatment of patients with unresectable and metastatic disease. For patients with imatinib-resistant disease or intolerant to the side effects (...) Read more... Current Opinion in Gastroenterology. 24(2):215-222, March 2008. Pharmaconutrition: a new emerging paradigm.Jones, Naomi E a,b; Heyland, Daren K a,b,c Purpose of review: This paper highlights recent studies of interest and provides rationale for why deficiencies with the current scientific paradigm of immunonutrition has produced studies with conflicting results, and why it should be replaced with a new paradigm termed ’pharmaconutrition’. Recent findings: Considering the overall treatment effect of immune-modulating nutrients, parenteral glutamine is recommended in patients receiving parenteral nutrition, while enteral glutamine should (...) Read more... European Journal of Gastroenterology & Hepatology. 20(3):217-223, March 2008. Refractory gastrooesophageal reflux disease.Bredenoord, Albert J. a; Smout, Andre J. b The introduction of proton pump inhibitors (PPIs) has facilitated the treatment of gastrooesophageal reflux disease (GORD) enormously; however, treatment of GORD still fails in a small proportion of patients. This small proportion of therapy-resistant patients encompasses a substantial part of the working load of physicians and has become a common clinical problem. A strong variability in acid-suppressive effect of PPI treatment exists depending on compliance, Helicobacter pylori status and (...) Read more... Canadian Digestive Diseases Week 2008 Long-term Endoscopic Healing in Mild-to-Moderate Ulcerative Colitis PatientsMontreal, Quebec / February 29-March 3, 2008 Montreal - In ulcerative colitis (UC), symptom relief is important but not sufficient for a chronic disease in which persistent lesions predict an increased frequency of relapses. Although 5-aminosalicylic acid (5-ASA) is widely regarded as the first-line therapy for mild-to-moderate disease due to its relative safety and symptomatic benefits, there was concern that UC patients sacrificed the potential for early and prolonged healing relative to the early addition or substitution of (...) Read more... 2008 Gastrointestinal Cancers Symposium Gastrointestinal Stromal Tumours and Tyrosine Kinase Inhibitors: New Strategies to Reduce the Risk of RecurrenceOrlando, Florida / January 25-27, 2008 Orlando - Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours in the GI tract. In 1998, Hirota et al. (Science 1998;279:577-80) were the first to identify gain-of-function mutations in the KIT receptor as the prime oncogenic transformation giving rise to GIST and this discovery is the basis upon which GISTs are treated today. Prior to the era of tyrosine kinase inhibitor (TKI) therapy, median overall survival (OS) in metastatic GIST was approximately 15 months (...) Read more... Colitis, Crohn’s and other Digestive Disorders.Helicobacter 12 (s2), 32–38. The Long-term Impact of Helicobacter pylori Eradication on Gastric Histology: a Systematic Review and Meta-analysisTheodoros Rokkas, Dimitios Pistiolas, Panos Sechopoulos, Ioannis Robotis and Georgios Margantinis Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece Background: Helicobacter pylori infection is a crucial factor in the multistep carcinogenic process of gastric cancer. In this process the gastric mucosa evolves through the stages of acute gastritis, chronic gastritis, gastric atrophy (GA), and intestinal metaplasia (IM) before developing gastric adenocarcinoma. Aims: The main aim of this study was to systematically review the long-term effects of H. pylori eradication on gastric histology (i.e. effects on GA and IM for both antrum and (...) Read more... FRONTLINE Based on presentations from the Eastern Ontario Gastrointestinal Stromal Tumours (GIST) Consensus Meeting The Management of GIST: Achieving Consensus for Improved CareOttawa, Ontario / November 29, 2007 Reviewed by
Alimentary Pharmacology & Therapeutics Volume 26 Issue 10 Page 1285-1292, November 2007 Review article: vaccination and viral hepatitis – current status and future prospectsleR. S. KOFF Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA Dr R. S. Koff, 234 Middlesex Road, Chestnut Hill, MA 02467, USA. E-mail: rkoff@comcast.net Background Viral hepatitis is the most common cause of liver disease in the world. In the past 25 years, vaccines have become available for two of the five hepatitis viruses, and, where implemented, vaccination has become a key component of hepatitis prevention. Aims To provide an update on recent advances in the use of current hepatitis vaccines and to examine progress in the development of vaccines for the remaining hepatitis viruses. Methods A Medline search was undertaken to identify (...) Read more... Journal of the American College of Cardiology Volume 50, Issue 16, 16 October 2007, Pages 1561-1569 Altered Intestinal Function in Patients With Chronic Heart FailureAnja Sandek MD†, Juergen Bauditz MD†, Alexander Swidsinski MD†, Sabine Buhner PhD†, Jutta Weber-Eibel MD†, Stephan von Haehling MD‡, Wieland Schroedl§, Tim Karhausen , Wolfram Doehner MD, PhD , Mathias Rauchhaus MD, PhD , Philip Poole-Wilson MD, FMedSci‡, Hans-Dieter Volk MD, PhD , Herbert Lochs MD, PhD† and Stefan D. Anker MD, PhD , ‡, , †Department of Gastroenterology, Charite, Campus Mitte, Berlin, Germany ‡Department of Clinical Cardiology, National Heart & Lung Institute, Imperial College London, London, United Kingdom Division of Applied Cachexia Research, Department of Cardiology, Charite, Campus Virchow-Klinikum, Berlin, Germany Department of Medical Immunology, Charite, Campus Mitte, Berlin, Germany. §Institute of Bacteriology and Mycology, Veterinary Faculty, Leipzig, Germany Objectives We evaluated morphology and function of the gut in patients with chronic heart failure (CHF). Background Intestinal translocation of bacterial endotoxin may contribute to the inflammatory state observed in patients with CHF. The morphology and function of the gut may be abnormal. Methods We studied 22 patients with CHF (age 67 ± 2 years, left ventricular ejection fraction [LVEF] 31 ± 1%, New York Heart Association functional class 2.3 ± 0.1, peak Vo2 15.0 ± 1.0 ml/kg/min) and 22 (...) Read more... Transplantation Proceedings Volume 39, Issue 8, October 2007, Pages 2516-2518 Donor Liver Dysfunction: Application of a New Scoring System to Identify the Marginal DonorB.H. Ferraz-Neto , a, , M.P.V.C. Zurstrassena, R. Hidalgoa, L.E.P. Fonsecaa, T.D.B. Mottaa, F.L. Pandulloa, M.B. Rezendea, S.P. Meira-Filhoa, J.R. Sáa and R.C. Afonsoa aAlbert Einstein Hospital, São Paulo, Brazil. Livers from marginal donors are increasingly used for transplantation due to the shortage of donor organs. The definition of a marginal donor remains unclear; prediction of organ function is a challenge. In the literature the use of steatotic livers has been associated with poor liver function or even primary dysfunction of the allograft. Tekin et al created a scoring system that classifies a donor as marginal or nonmarginal, using a mathematical model based on donor age and steatosis (...) Read more... 58th Annual Meeting of the American Association for the Study of Liver Diseases Hepatitis Viral Undetectability and Suppression Through Vigilance and ActionBoston, Massachusetts / November 2-6, 2007 Boston - Worldwide, hepatitis B infects 2 billion people, 350 million of them on a chronic basis, and only about half of all patients are treated successfully. It is the tenth leading cause of death worldwide, via chronic infection, cirrhosis and hepatocellular carcinoma. About 170 million people are chronically infected with hepatitis C, according to the World Health Organization; 75% to 85% will develop a chronic infection, as cited by the US Centers for Disease Control and Prevention. (...) Read more... 58th Annual Meeting of the American Association for the Study of Liver Diseases New Insights in Chronic Hepatitis C: Refining Treatment Protocols, Clarifying Genotype DifferencesBoston, Massachusetts / November 2-6, 2007 Boston - Chronic hepatitis C is the most common chronic blood-borne viral infection in North America. Around half of all patients fail to respond to treatment; a substantial fraction of them develop cirrhosis of the liver, and a smaller but still significant number develop hepatocellular carcinoma. Presenters here at the AASLD described final results from the POWeR study, which demonstrated that the currently used regimen of pegylated interferon alfa-2b/ribavirin has efficacy in the (...) Read more... 15th United European Gastroenterology Week Ulcerative Colitis: Maintenance of Remission and Prevention of Colorectal CancerParis, France / October 27-31, 2007 Paris - In ulcerative colitis (UC), a pooled analysis of studies has associated 5-aminosalicylate (5-ASA) maintenance therapy with an almost 50% reduction in the risk of colorectal cancer. At least some of the protection provided can be assumed to be independent of the anti-inflammatory effect because other anti-inflammatory agents do not offer similar protection. Agreement that 5-ASA should be considered a standard in maintenance was unanimous among experts participating in a symposium on (...) Read more... 15th United European Gastroenterology Week (UEGW) Treatment Goals in IBD Evolve with Increasing Evidence that Mucosal Healing Is Critical to Favourable Long-term OutcomeParis, France / October 27-31, 2007 Paris - The improvement in outcome associated with biologic therapies over other treatment options in inflammatory bowel disease (IBD) is being increasingly attributed to the greater likelihood of mucosal healing. In Crohn’s disease and ulcerative colitis, mucosal healing is associated with a greater likelihood of a sustained remission, a reduced likelihood of hospitalization, and a lower risk of surgery. A survey conducted among physicians in Europe who treat IBD found that more than 85% (...) Read more... 15th United European Gastroenterology Week (UEGW) Ulcerative Colitis: Promising New Findings for Rapid Symptom ReliefParis, France / October 27-31, 2007 Paris - The lack of compliance to maintenance therapies in ulcerative colitis, particularly once symptoms have been controlled, has long been regarded as a major cause of relapses and complications. The recent introduction of a q.d. formulation of 5-aminosalicylic acid (5-ASA), the standard first-line therapy for mild to moderate disease, is considered a significant step forward in addressing this issue. Data from phase III of two large multicentre studies are now being assessed for other (...) Read more... 15th United European Gastroenterology Week Maintaining Remission Without Increasing Treatment Burden: Expanding Therapeutic OptionsParis, France / October 27-31, 2007 Editorial Overview:
Internal Medicine Journal Volume 37 Issue 10 Page 705-712, October 2007 Hepatitis B virus reactivation following immunosuppressive therapy: guidelines for prevention and managementJ. S. Lubel,11Victorian Liver Transplant Unit, Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia A. G. Testro11Victorian Liver Transplant Unit, Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia and P. W. Angus11Victorian Liver Transplant Unit, Department of Gastroenterology, Austin Health, Heidelberg, Victoria, AustraliaPeter W. Angus, Victorian Liver Transplant Unit, Austin Health, Studley Road, Heildeberg, Vic. 3084, Australia. It is well known that immunosuppressive drugs or cancer chemotherapy can stimulate replication of hepatitis B virus (HBV) and precipitate severe flares of HBV infection. The risk of this syndrome of ‘reactivation hepatitis B’ is highest in haematopoietic stem cell or solid organ transplant recipients and in those undergoing chemotherapy for haematological malignancies; however, it has been described following almost any form of immunosuppressive treatment. Fortunately, it can be largely (...) Read more... Alimentary Pharmacology & Therapeutics Volume 26 Issue 7 Page 987-1003, October 2007 Medical management of mild to moderate Crohn’s disease: evidence-based treatment algorithms for induction and maintenance of remissionW. J. SANDBORN**Mayo Clinic, Rochester, MN, USA, B. G. FEAGAN††Robarts Research Institute, University of Western Ontario, London, Ontario, Canada & G. R. LICHTENSTEIN‡‡Hospital of the University of Pennsylvania, Philadelphia, PA, USA Background Patients with Crohn’s disease alternate between periods of active, symptomatic disease and periods of remission. The treatment goal for Crohn’s disease is to induce and then maintain remission of symptoms. Aim To review evidence from randomized, controlled, clinical trials on medical therapies for inducing and maintaining remission in patients with mild-to-moderate Crohn’s disease, and to suggest the best evidence-based approaches for induction and maintenance therapies. Methods (...) Read more... 72nd Annual Scientific Meeting of the American College of Gastroenterology Ulcerative Colitis: Strategies to Keep Patients on Maintenance Therapies to Reduce Risk of ColectomyPhiladelphia, Pennsylvania / October 14-17, 2007 Philadelphia - Even though the vast majority of ulcerative colitis patients have only mild-to-moderate disease at presentation, the lifetime risk of colectomy is nearly one in three. Progression in many cases is thought to be due to the frequent failure of patients to remain on maintenance therapies once symptoms have been controlled. New strategies, including simplified maintenance regimens, have the potential to break the cycle in which patients adhere to treatment only during symptomatic (...) Read more... Liver International Volume 27 Issue 7 Page 879-890, September 2007 Traditional Chinese herbal medicines for treatment of liver fibrosis and cancer: from laboratory discovery to clinical evaluationJohn M. Luk11 Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong*, Xiaoling Wang44 Department of Cell Biology, Shanghai University of Traditional Chinese Medicine, Shanghai, China*, Ping Liu44 Department of Cell Biology, Shanghai University of Traditional Chinese Medicine, Shanghai, China, Kwong-Fai Wong11 Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, Kwong-Leung Chan11 Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, Yao Tong33 School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong, Chi-Kin Hui22 Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, George K. Lau22 Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong and Sheung-Tat Fan11 Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong Liver disease afflicts over 10% of the world population. This includes chronic hepatitis, alcoholic steatosis, fibrosis, cirrhosis and hepatocellular carcinoma (HCC), which are the most health-threatening conditions drawing considerable attention from medical professionals and scientists. Patients with alcoholism or viral hepatitis are much more likely to have liver cell damage and cirrhosis, and some may eventually develop HCC, which is unfortunately, and very often, a fatal malignancy (...) Read more... Alimentary Pharmacology & Therapeutics Volume 26 Issue 4 Page 535-544, August 2007 Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndromeM. THABANE*,†*Division of Gastroenterology, Department of Medicine†Intestinal Diseases Research Program, McMaster University, Hamilton, ON, Canada, D. T. KOTTACHCHI**Division of Gastroenterology, Department of Medicine & J. K. MARSHALL*,†*Division of Gastroenterology, Department of Medicine†Intestinal Diseases Research Program, McMaster University, Hamilton, ON, Canada Summary Background Individual studies suggest that post-infectious irritable bowel syndrome is common, but symptoms gradually improve. Aim To review evidence for an association between intestinal infection and development of irritable bowel syndrome, assess the prognosis of post-infectious irritable bowel syndrome and explore factors that increase the risk. Methods MEDLINE (1966–2007) and EMBASE (1980–2007) databases were searched to identify the studies of post-infectious irritable bowel (...) Read more... Clinical Radiology Volume 62, Issue 9, September 2007, Pages 819-827 Optimization of CT colonography technique: a practical guideD.J.M. Tolana, E.M. Armstrongb, D. Burlingc and S.A. Taylord, , aDepartment of Clinical Radiology, St James’s University Hospital, Leeds, West Yorkshire, UK In this article we provide practical advice for optimizing computed tomography colonography (CTC) technique to help ensure that reproducible, high-quality examinations are achieved. Relevant literature is reviewed and specific attention is paid to patient information, bowel cleansing, insufflation, anti-spasmodics, patient positioning, CT technique, post-procedure care and complications, as well as practical problem-solving advice. There are many different approaches to performing CTC; our (...) Read more... Gastroenterology Volume 133, Issue 1, July 2007, Pages 288-308 Immunology of Helicobacter pylori: Insights Into the Failure of the Immune Response and Perspectives on Vaccine StudiesKeith T. Wilson , ‡, §, , and Jean E. Crabtree, , Helicobacter pylori infects the stomach of half of the human population worldwide and causes chronic active gastritis, which can lead to peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. The host immune response to the infection is ineffective, because the bacterium persists and the inflammation continues for decades. Bacterial activation of epithelial cells, dendritic cells, monocytes, macrophages, and neutrophils leads to a T helper cell 1 type (...) Read more... Journal of the American College of Cardiology Volume 50, Issue 5, 31 July 2007, Pages 409-418 Effect of the Magnitude of Lipid Lowering on Risk of Elevated Liver Enzymes, Rhabdomyolysis, and Cancer Insights From Large Randomized Statin TrialsAlawi A. Alsheikh-Ali MDa, Prasad V. Maddukuri MDa, Hui Han MDa and Richard H. Karas MD, PhD1, , a, Molecular Cardiology Research Institute and Division of Cardiology, Department of Medicine, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts. Objectives We sought to assess the relationship between the magnitude of low-density lipoprotein cholesterol (LDL-C) lowering and rates of elevated liver enzymes, rhabdomyolysis, and cancer. Background Although it is often assumed that statin-associated adverse events are proportional to LDL-C reduction, that assumption has not been validated. Methods Adverse events reported in large prospective randomized statin trials were evaluated. The relationship between LDL-C reduction and rates (...) Read more... BMJ 2007;334:1370-1371 (30 June), doi:10.1136/bmj.39231.633275.AD NICE guidelines: Management of faecal incontinence in adults: summary of NICE guidanceChristine Norton, Burdett professor of gastrointestinal nursing1, Louise Thomas, project lead2, Jennifer Hill, director2, for the Guideline Development Group1 Florence Nightingale School of Nursing and Midwifery, King’s College London, London , 2 National Collaborating Centre for Acute Care, Royal College of Surgeons of England, London WC2A 3PE The prevalence of faecal incontinence in adults living in the community is 1-10%, depending on the definition used.1 2 Faecal incontinence is a neglected problem that receives limited medical attention, and despite its profound negative impact most patients do not tell their doctor about it.3 4 Simple, low cost interventions will often improve or even cure symptoms. More sophisticated second line investigations and treatments are available, but referral for these is not common. This article (...) Read more... Journal of Clinical Gastroenterology. 41 Supplement 2:S59-S63, July 2007. Do Drugs or Bugs Cause GERD?McCarthy, Denis M. MD, PhD, FACP, FRCP * + Most gastroesophageal reflux disease (GERD) arises from disturbed esophageal motility that leads to the presence of injurious gastric juice in the esophagus and to a delay in its clearance. There remain questions, however, about the roles of medications and biologic agents in injuring the mucosa and in causing GERD. Suspect medications fall into 2 classes; those causing direct topical or systemic injury to the mucosa and those reducing lower esophageal sphincter pressure (LESP), thus (...) Read more... Journal of Clinical Gastroenterology. 41 Supplement 2:S51-S53, July 2007. GERD in Canada.Morgan, David G. MD As in most Western countries, management of gastroesophageal reflux disease (GERD) remains a considerable health challenge. The exact definition of GERD may differ from nation to nation and such differences in description may influence how patients are described and characterized. In Canada, symptoms of GERD are often considered as a component of dyspepsia, which can encompass a complex of upper gastrointestinal symptoms including not only reflux, but also belching, bloating, and early (...) Read more... Neuromodulation Therapy Page 155-164, July 2007 Functional Electrical Stimulation for Control of Internal Organ FunctionJonathan C. Jarvis**Department of Human Anatomy and Cell Biology, The University of Liverpool, New Medical School, Liverpool, UK, and Nico J. M. Rijkhoff††Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark.*Department of Human Anatomy and Cell Biology, The University of Liverpool, New Medical School, Liverpool, UK, and †Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark. Abstract This paper discusses the use of electrical stimulation for cardiac assist and control of bladder and bowel. It describes the state of the art, what progress there will be in the coming 10 years and what problems need to be solved in order to make that progress. The paper speculates that within 10 years, there will be patients whose cardiac function is augmented by the pumping function of skeletal muscle assist devices, and furthermore that within 10 years new implantable devices (...) Read more... Digestive and Liver Disease Volume 39, Issue 7, July 2007, Pages 601-609 Wilson disease—A practical approach to diagnosis, treatment and follow-upV. Medicia, b, L. Rossarob and G.C. Sturnioloa, , Abstract Wilson disease is an inherited, autosomal recessive, copper accumulation and toxicity disorder that affects about 30 individuals per million. This rare disease is caused by mutations in the gene encoding a copper-transporting P-type ATPase, which is important for copper excretion into bile, leading to copper accumulation in the liver. Toxic copper concentrations can also be found in the brain and kidney, and clinical phenotypes include hepatic, haemolytic, neurologic and (...) Read more... Journal of Gastroenterology and Hepatology Volume 22 Issue 6 Page 801Issue 6 - 808 - June 2007 How should we manage patients with non-alcoholic fatty liver disease in 2007?Henry L-Y Chan,**Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Professor Henry L-Y Chan, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9F Prince of Wales Hospital, Shatin, Hong Kong SAR, China. Email: hlychan@cuhk.edu.hk Medical School, The Canberra Hospital, Canberra, Australia Evidence-based management guidelines for non-alcoholic fatty liver disease (NAFLD) are lacking in the Asia–Pacific region or elsewhere. This review reports the results of a systematic literature search and expert opinions. The Asia–Pacific Working Party on NAFLD (APWP-NAFLD) has generated practical recommendations on management of NAFLD in this region. NAFLD should be suspected when there are metabolic risk factors and/or characteristic changes on hepatic ultrasonography. Diagnosis by (...) Read more... HIV Medicine Volume 8 Issue 5 Page 312Issue 5 - 321 - July 2007 The treatment of chronic hepatitis C in HIV-infected patients: a meta-analysisAI Kim11Division of Infectious Diseases, VA Greater Los Angeles Healthcare System, , A Dorn22University of California Los Angeles, , R Bouajram33Department of Medicine, VA Greater Los Angeles Healthcare System, and and S Saab44Departments of Medicine and Surgery, University of California Los Angeles, Los Angeles, CA, USA Objective Hepatitis C virus (HCV) disease progression appears to be accelerated in patients coinfected with HIV. The impact of HCV on coinfected patients is being realized as patients are now living longer. The objective of our study was to further elucidate incremental improvement and safety concerns with combinations of pegylated interferon (peginterferon), interferon and ribavirin based on data obtained from prospective randomized controlled trials. Methods A search of MEDLINE and the (...) Read more... Kidney and Blood Pressure Research 2007;30:156-161 Hepatitis C in Dialysed Patients - What Is the Current Optimal Treatment?Petar Kes, Nikolina Basic-Jukic Department of Dialysis, Zagreb University Hospital Centre, Zagreb, Croatia Abstract Hepatitis C virus (HCV) infection is an important cause of morbidity and mortality in the dialysis population. The problem is more pronounced after renal transplantation. It seems that immunosuppressive drugs facilitate HCV replication and accelerate hepatic lesions. Interferon is not recommended after renal transplantation because of the risk of acute rejection and graft dysfunction, and for this reason it is important to eradicate HCV RNA before transplantation. Prevention is the (...) Read more... Respiratory Medicine Volume 101, Issue 7, July 2007, Pages 1455-1461 The characteristics of different diagnostic tests in adult mild asthmatic patients: Comparison with patients with asthma-like symptoms by gastro-oesophageal refluxGabriele Di Lorenzoa, , , Pasquale Mansuetoa, Maria Esposito-Pellitteria, Vito Dittaa, Francesco Castelloa, Claudia Lo Biancoa, Maria Stefania Leto-Baronea, Gaetana Di Fedeb, Marcello Traversoa, Giuseppe Rotoloa, Sergio Vigneria and GiovamBattista Rinia aDipartimento di Medicina Clinica e delle Patologie Emergenti, Università degli Studi di Palermo, Via del Vespro no. 141, 90127 Palermo, Italy bDipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Italy Background Diagnosing asthma cannot be always easy. It is important to consider the validity of the diagnostic tests, and/or how much more commonly they are positive in patients with asthma compared to healthy subjects and, particularly, to patients with asthma-like symptoms. Objective To evaluate the validity of diagnostic tests for asthma, in terms of sensitivity, specificity, positive and negative predictive values, in patients with bronchial asthma compared to patients affected by (...) Read more... Clinical Radiology Volume 62, Issue 7, July 2007, Pages 645-650 CT colonography versus colonoscopy in the follow-up of patients after diverticulitis — A prospective, comparative studyF. Hjerna, , , E. Jonasa, B. Holmströma, T. Josephsonb, A. Mellgrena, c and C. Johanssona aDivision of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institut, Stockholm, Sweden bDivision of Radiology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden cDivision of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota, USA Aim To assess whether computed tomography colonography (CTC) is a viable alternative to colonoscopy or double contrast barium enema in the follow-up of patients after diverticulitis. Material and methods Fifty patients underwent CTC followed immediately by colonoscopy. Results were blinded to the examiners. Findings of diverticular disease and patient acceptance were evaluated. Results Bowel preparation and distension were good in the majority of CTC and colonoscopy examinations. (...) Read more... Scandinavian Journal of Gastroenterology, Volume 42, Issue 7 2007 , pages 867 - 877 Productivity improvements in hepatitis C treatment: Impact on efficacy, cost, cost-effectiveness and quality of lifeMathias Lidgren ab; Anna Hollander c; Ola Weiland c; Bengt Jönsson b a Medical Management Centre, Karolinska Institutet. Stockholm. Sweden b Centre for Health Economics, Stockholm School of Economics. Stockholm. Sweden c Division of Infectious Diseases, Karolinska University Hospital Huddinge. Stockholm. Sweden Objective. The treatment of chronic hepatitis C has advanced considerably during the past 15 years. The aim of this study was to evaluate the impact of different key developments from a health-economic perspective. Material and methods. Costs and health-related quality-of-life data from a follow-up of Swedish patients treated for hepatitis C in clinical practice were used together with clinical trial data and natural history data in order to create a mathematical model that could be used to (...) Read more... JAMA. 2007;297:2351-2359. Folic Acid for the Prevention of Colorectal AdenomasBernard F. Cole, PhD; John A. Baron, MD; Robert S. Sandler, MD; Robert W. Haile, DrPh; Dennis J. Ahnen, MD; Robert S. Bresalier, MD; Gail McKeown-Eyssen, PhD; Robert W. Summers, MD; Richard I. Rothstein, MD; Carol A. Burke, MD; Dale C. Snover, MD; Timothy R. Church, PhD; John I. Allen, MD; Douglas J. Robertson, MD; Gerald J. Beck, PhD; John H. Bond, MD; Tim Byers, MD, MPH; Jack S. Mandel, PhD, MPH; Leila A. Mott, MS; Loretta H. Pearson, MPhil; Elizabeth L. Barry, PhD; Judy R. Rees, BM, BCh, MPH, PhD; Norman Marcon, MD; Fred Saibil, MD; Per Magne Ueland, MD; E. Robert Greenberg, MD; for the Polyp Prevention Study Group Context Laboratory and epidemiological data suggest that folic acid may have an antineoplastic effect in the large intestine. Objective To assess the safety and efficacy of folic acid supplementation for preventing colorectal adenomas. Design, Setting, and Participants A double-blind, placebo-controlled, 2-factor, phase 3, randomized clinical trial conducted at 9 clinical centers between July 6, 1994, and October 1, 2004. Participants included 1021 men and women with a recent history (...) Read more... Alimentary Pharmacology & Therapeutics Volume 26 Issue 1 Page 79Issue 1 - 85 - July 2007 Long-term follow-up of patients with mild to moderate drug-induced liver injuryE. BJÖRNSSON, E. KALAITZAKIS, V. AV KLINTEBERG, N. ALEM & R. OLSSON Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden AimTo evaluate the long-term prognosis of patients diagnosed with drug-induced liver injury, and the nature of the liver injury. MethodsPatients with a diagnosis of drug-induced liver injury between 1994 and 2005 were identified in a university hospital clinic. Patients surviving drug-induced liver injury-associated liver failure were excluded. ResultsSeventy-seven cases were identified and those who were alive (69) were invited to attend follow-up. Of those patients who had died, none had (...) Read more... The Journal of Rheumatology Early online Pain Relief in Osteoarthritis: Patients’ Willingness to Risk Medication-Induced Gastrointestinal, Cardiovascular, and Cerebrovascular ComplicationsCHRIS G. RICHARDSON, ANDREW CHALMERS, HILARY A. LLEWELLYN-THOMAS, ALICE KLINKHOFF, ANNE CARSWELL, and JACEK A. KOPEC ABSTRACT.
Alimentary Pharmacology & Therapeutics 25 (12), 1451–1459. The Gastro-oesophageal Reflux Disease Impact Scale: a patient management tool for primary careR. JONES**Department of General Practice and Primary Care, King’s College London, London, UK, K. COYNE††United BioSource Corporation Center for Health Outcomes Research, Bethesda, MD, USA & I. WIKLUND‡‡AstraZeneca R&D Mölndal, Mölndal, Sweden *Department of General Practice and Primary Care, King’s College London, London, UK; †United BioSource Corporation Center for Health Outcomes Research, Bethesda, MD, USA; ‡AstraZeneca R&D Mölndal, Mölndal, Sweden Background Symptoms of gastro-oesophageal reflux disease have a substantial impact on patients’ everyday lives. Aim To develop and test a short questionnaire to aid patient–doctor communication. Methods The Gastro-oesophageal Reflux Disease Impact Scale was developed from a systematic literature review, focus groups of patients and primary care physicians, and patient cognitive interviews. A psychometric validation study was conducted based on two consultations in new (n = 100) or chronic (n (...) Read more... Alimentary Pharmacology & Therapeutics 25 (12), 1411–1421. The impact of eosinophilia and hepatic necrosis on prognosis in patients with drug-induced liver injuryE. BJÖRNSSON, E. KALAITZAKIS & R. OLSSON Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden Background Drug-induced liver injury may be immunologically mediated or metabolically induced. Peripheral eosinophilia and liver eosinophilia in suspected drug-induced liver injury generally supports the role of drug aetiology. Aim To assess the importance of eosinophilia and hepatic necrosis on outcome in patients with suspected drug-induced liver injury. Methods We performed search of MEDLINE for case reports on drug-induced liver injury associated with: amoxicillin/clavulanic acid, (...) Read more... Alimentary Pharmacology & Therapeutics 25 (12), 1389–1399 Systematic review: the potential influence of mesalazine formulation on maintenance of remission in Crohn’s diseaseA. H. STEINHART**Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, A. FORBES††Department of Gastroenterology and Nutrition, University College Hospital, London, UK, E. C. MILLS‡‡Acumen Healthcare Communications Ltd, Basingstoke, UK, B. S. RODGERS-GRAY‡‡Acumen Healthcare Communications Ltd, Basingstoke, UK & S. P. L. TRAVIS§§Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK *Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; †Department of Gastroenterology and Nutrition, University College Hospital, London, UK; ‡Acumen Healthcare Communications Ltd, Basingstoke, UK; §Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK Aim To evaluate the effectiveness of pH 6-/pH 7-dependent and controlled-release mesalazines in maintaining medically and surgically induced Crohn’s disease remission. Methods A systematic search identified 13 randomized controlled trials (RCTs). The rate of symptomatic relapse (Crohn’s disease activity index >150, or an increase in baseline by at least 60–100 points) was extracted from each randomized controlled trial. Pooled odds ratios (OR), the number needed to treat (NNT), and percentage (...) Read more... Alimentary Pharmacology and Therapeutics 2007;25:617-28 Gastroesophageal Reflux Disease: The Link Between Acid Control and HealingMay 2007 INTRODUCTION
The Society for Surgery of the Alimentary Tract, Inc.Society American Gastrointestinal Endoscopic SurgeonsNorth American Society for Pediatric Gastroenterology, Hepatology and NutritionInternational Liver Transplantation SocietyInternational Club of AscitesInternational Association for the Study of the LiverHepatitis B FoundationHepatitis Foundation InternationalEuropean Association for the Study of the LiverDigestive Disease WeekAsian Pacific Association for the Study of the LiverAmerican Society of TransplantationAmerican Society of Transplant SurgeonsAmerican Society of Gastrointestinal EndoscopyAmerican Liver FoundationAmerican Hepato-Pancreato-Biliary AssociationAmerican Gastroenterological AssociationAmerican College of GastroenterologyAmerican Liver SocietyAmerican Liver FoundationAmerican Association for the Study of Liver Diseases (AASLD)Ontario Association of GastroenterologyMcMaster University Intestinal Disease Research ProgramCanadian Society for Clinical NutritionGI Motility Education Centre (GIMEC), Queen’s UniversityQuebec Association of GastroenterologistsCanadian Association for the study of the Liver (CASL)Canadian Liver FoundationCanadian Association of GastroenterologyEuropean Journal of Gastroenterology & Hepatology. 19(6):479-485, June 2007. Photodynamic therapy of malignant biliary strictures using meso-tetrahydroxyphenylchlorin.Pereira, Stephen P. a b; Ayaru, Lakshmana a b; Rogowska, Agnieszka c; Mosse, Alexander c; Hatfield, Adrian R.W. a; Bown, Stephen G. c Objectives: The palliation of patients with malignant bile duct obstruction using metal or plastic biliary stents may be limited by stent occlusion. The aim of this study was to determine the safety and efficacy of endoscopically delivered meso-tetrahydroxyphenyl chlorin photodynamic therapy in the treatment of irresectable malignant biliary strictures and recurrent stent occlusion. Methods: Thirteen patients with malignant biliary obstruction owing to carcinoma of the biliary tract (n=9), (...) Read more... European Journal of Gastroenterology & Hepatology. 19(6):461-464, June 2007. Intravenous proton pump inhibitor use in hospital practice.Slattery, Eoin; Theyventhiran, Ruben; Cullen, Garret; Kennedy, Fionnula; Ridge, Carol; Nolan, Karen; Kidney, Rachel; O’Donoghue, Diarmuid P.; Mulcahy, Hugh E. Aim: North American studies suggest that intravenous proton pump inhibitors are used inappropriately in hospital practice, but little is known of prescribing patterns in Europe. Our aim was to examine intravenous proton pump inhibitors prescribing in a single university teaching hospital. Methods: Observational study of 101 consecutive hospital patients administered intravenous proton pump inhibitors over a 3-month period in a single hospital in Dublin, Ireland. Demographic, clinical, (...) Read more... European Journal of Gastroenterology & Hepatology. 19(6):441-447, June 2007. A comparative reappraisal of the Rome II and Rome III diagnostic criteria: are we getting closer to the ’true’ prevalence of irritable bowel syndrome?Sperber, Ami D. a b; Shvartzman, Pesach b d; Friger, Michael c; Fich, Alex a Objectives: Revisions of the diagnostic criteria for irritable bowel syndrome have led to varying prevalence estimates. The Rome III criteria require a lower symptom frequency than Rome II (at least 10% of the time for Rome III, compared with at least 25% of the time for Rome II). In an epidemiological survey of a representative sample of Israeli adults using Rome II, we reported the prevalence for irritable bowel syndrome as 2.9%. The official Rome II integrative questionnaire, used for (...) Read more... Gastroenterology Volume 132, Issue 6, May 2007, Pages 2191-2207 Abnormal Lipid and Glucose Metabolism in Obesity: Implications for Nonalcoholic Fatty Liver DiseaseSamir Parekha and Frank A. Anania, a, Nonalcoholic fatty liver disease represents a spectrum of histopathologic abnormalities, the prevalence of which may be as high as 24% of the population of the United States. Nonalcoholic fatty liver disease will play a major role in the science and practice of gastroenterology in the near future. The fundamental derangement in nonalcoholic fatty liver disease is insulin resistance, a key component of the metabolic syndrome, which includes type 2 diabetes mellitus, hypertriglyceridemia, (...) Read more... Gastroenterology Volume 132, Issue 6, May 2007, Pages 2169-2180 Obesity, Inflammation, and Insulin ResistanceSteven E. Shoelsona, , Laura Herreroa and Afia Naaza Weight gain and obesity are major risk factors for conditions and diseases ranging from insulin resistance and type 2 diabetes mellitus to atherosclerosis and the sequelae of nonalcoholic fatty liver disease. A chronic, subacute state of inflammation often accompanies the accumulation of excess lipid in adipose tissue and liver (hepatic steatosis), evidenced by changes in both inflammatory cells and biochemical markers of inflammation. These changes can be seen in the involved tissues and (...) Read more... Gastroenterology Volume 132, Issue 6, May 2007, Pages 2116-2130 Gut Hormones and Appetite ControlA.M. Wrena and S.R. Bloom Many peptides are synthesized and released from the gastrointestinal tract. Although their roles in the regulation of gastrointestinal function have been known for some time, it is now evident that they also physiologically influence eating behavior. Our understanding of how neurohormonal gut–brain signaling regulates energy homeostasis has advanced significantly in recent years. Ghrelin is an orexigenic peptide produced by the stomach, which appears to act as a meal initiator. Satiety (...) Read more... Gastroenterology Volume 132, Issue 6, May 2007, Pages 2087-2102 The Epidemiology of ObesityCynthia L. Ogden , , Susan Z. Yanovski‡, Margaret D. Carroll and Katherine M. Flegal In the United States, obesity among adults and overweight among children and adolescents have increased markedly since 1980. Among adults, obesity is defined as a body mass index of 30 or greater. Among children and adolescents, overweight is defined as a body mass index for age at or above the 95th percentile of a specified reference population. In 2003–2004, 32.9% of adults 20–74 years old were obese and more than 17% of teenagers (age, 12–19 y) were overweight. Obesity varies by age and (...) Read more... Digestive Disease Week 2007 Prolonging Control over Ulcerative ColitisWashington, DC / May 20-23, 2007 Washington, DC - New data generated from extension trials in ulcerative colitis (UC) have demonstrated long-term control with newer therapies. While one study tested a biologic agent reserved for use in patients with refractory disease, the other evaluated a formulation of 5-aminosalicylic acid (5-ASA) designed to improve delivery to the distal colon. The 5-ASA preparations have long been considered typical options for therapy; however, drug potency and high pill burdens have been (...) Read more... Obesity Management Apr 2007, Vol. 3, No. 2: 64-68. The Clinical Implications of Obesity for Cardiovascular DiseaseJarett D. Berry, MD and Donald M. Lloyd-Jones, MD, ScM The prevalence of obesity is increasing both in the U.S. and across the globe. Between 1960 and 1999, the prevalence of obesity in the U.S. increased from less than 15% to 30% of the population. Currently, national estimates suggest that only onethird of the U.S. population is of normal weight, which translates into a marked significant future burden of cardiovascular disease (CVD) and other diseases in the population through a variety of mechanisms. In addition to its independent effect on (...) Read more... 45th Annual Meeting of the Canadian Association of Gastroenterology Canadian Digestive Diseases Week 2007 The Importance of Mucosal Healing in Ulcerative Colitis PatientsBanff, Alberta / February 16-20, 2007 Banff - Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon of unknown etiology. It is characterized by mucosal ulceration, rectal bleeding, diarrhea and abdominal pain. Disease management of acute UC typically consists of 5-aminosalicylates, corticosteroids and immunosuppressants. The challenge for UC patients is achieving prolonged remission and improving quality of life. As such, findings from the SPD476-301 and -302 trials have demonstrated that a novel multimatrix (...) Read more... 14th United European Gastroenterology Week New Insights on Prevention of Colorectal Cancer in Patients with Inflammatory Bowel DiseaseBerlin, Germany / October 21-25, 2006 Berlin - There is mounting evidence that 5-aminosalicylic acid (5-ASA) can lower the risk of developing colorectal cancer (CRC) in both Crohn’s disease and ulcerative colitis among patients with inflammatory bowel disease (IBD), yet the explicit mechanisms by which that molecule inhibits carcinogenesis remain uncertain. New in vitro results presented here at the UEGW suggest those mechanisms may be the consequence of novel modes of 5-ASA action involving preservation of DNA integrity during (...) Read more... 14th United European Gastroenterology Week The Role of Biologics for Early and Sustained Control of Inflammatory Bowel DiseaseBerlin, Germany / October 21-25, 2006 Berlin - New data are increasing the support for a “top-down” strategy in the treatment of moderate to severe inflammatory bowel disease (IBD), particularly Crohn’s disease. In IBD, this strategy refers to the practice of employing a biological as first-line therapy rather than reserving this type of agent for use after other therapies fail. Although there is still concern about the risks and costs of their early use in patients with a low risk of complications, those with moderate to severe (...) Read more... 71st Annual Scientific Meeting of the American College of Gastroenterology Therapeutic Options for Patients with Ulcerative ColitisLas Vegas, Nevada / October 21-25, 2006 Las Vegas -The availability of improved conventional and biologic therapies offers physicians greater choice to enhance the care of patients with ulcerative colitis (UC). Oral 5-aminosalicylic acid (5-ASA) is generally regarded as the treatment of choice to induce and maintain remission in patients with mildly to moderately active disease. Current 5-ASA treatments, however, are complex, often leading to poor compliance; noncompliance with maintenance 5-ASA regimens increases the risk of UC (...) Read more... 14th United European Gastroenterology Week Interrelationship of Symptoms in Acid-related Gastrointestinal DiseasesBerlin, Germany / October 21-25, 2006 Berlin - New data suggest that acid-related disorders of the upper gastrointestinal (GI) tract have been defined too narrowly, impairing opportunities to provide complete symptom relief. Gastroesophageal reflux disease (GERD), for which therapeutic success is frequently defined as relief of heartburn, is a prominent example. Recently validated methods for evaluating symptoms reveal that GERD is poorly represented by heartburn alone. Other complaints, including sleep disturbances, (...) Read more... 14th United European Gastroenterology Week (UEGW) Updated Principles of Ulcerative Colitis Management: The Onus Is on ComplianceBerlin, Germany / October 21-25, 2006 Berlin - A more rigorous and proactive approach to maintaining long-term control of ulcerative colitis (UC) is being advocated for its broad array of advantages. Stable disease control not only provides an opportunity for a better quality of life, but it reduces costs by minimizing the need for hospitalizations, and it can improve outcome, not least by reducing the risk of cancer. The chief obstacle to preventing relapse appears to be compliance, judging from studies that demonstrate a (...) Read more... 31st Congress of the European Society of Medical Oncology Metastatic Colorectal Cancer: New Directions in Systemic TreatmentIstanbul, Turkey / September 29-October 3, 2006 Istanbul - Delegates here learned about promising new chemotherapy regimens and biologic combinations during the scientific sessions. An important development in the chemotherapy regimens themselves for the treatment of metastatic colorectal cancer is the confirmation of the efficacy of capecitabine, an oral prodrug that is preferentially converted into a cytotoxic agent in tumour cells. Results from a large, randomized clinical trial confirmed that the oral agent was just as effective as (...) Read more... 42nd Annual Meeting of the American Society of Clinical Oncology Update on New Strategies for the Treatment of Gastrointestinal CancersAtlanta, Georgia / June 2-5, 2006 Atlanta - When added to standard chemotherapy regimens for metastatic colorectal cancer, bevacizumab, a monoclonal antibody against vascular endothelial growth factor, demonstrated improved progression-free and overall patient survival. The safety profile of this anti-angiogenesis agent when used in real-life observational settings was also consistent with the known safety profile, with no new unexpected toxicities. This is reassuring, as patients with metastatic colorectal disease treated (...) Read more... Digestive Disease Week 2006 Compliance with Ulcerative Colitis Therapies: Key for Improved Long-term OutcomeLos Angeles, California / May 20-25, 2006 Los Angeles - Ulcerative colitis (UC) is often mistakenly perceived as a disease of persistently escalating severity that inevitably leads to increasing areas of involvement and need for resection. However, the clinical data indicate that only 9% of patients have severe disease at presentation and 80% of patients maintained on therapy have few or no symptoms one year after diagnosis. Although some UC patients eventually do progress rapidly to corticosteroids, infliximab or surgery, those (...) Read more... 44th Annual Meeting of the Canadian Association of Gastroenterology Enhancing Compliance and Inducing Remission in Ulcerative Colitis PatientsBanff, Alberta / February 24-27, 2006 Banff - Ulcerative colitis (UC) leads to ulcers and inflammation of the inner lining of the colon, typically resulting in abdominal pain, diarrhea and rectal bleeding, striking patients in their prime years and often requiring lifelong treatment regimens. One of the obstacles for patients to obtain remission is lack of therapeutic adherence, especially when patients become asymptomatic, thus triggering additional UC episodes. Until recently, traditional treatment regimens have required (...) Read more... |
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