2,048 results match your criteria Bailliere\'s clinical gastroenterology[Journal]


The interpretation of liver function tests in pregnancy.

Best Pract Res Clin Gastroenterol 2020 Feb - Apr;44-45:101667. Epub 2020 Feb 18.

Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy. Electronic address:

Abnormal liver tests occur in 3-5% of pregnancies and show many different causes. Although alterations of liver enzymes could be a physiological phenomenon, it may also reflect potential severe liver injury, necessitating further assessment and accurate management. The work-up has to consider liver diseases specific of pregnancy and non pregnancy-related liver damage (coincidental and pre-existing to pregnancy). Read More

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http://dx.doi.org/10.1016/j.bpg.2020.101667DOI Listing
February 2020

The immune system and microbiome in pregnancy.

Authors:
G M Fuhler

Best Pract Res Clin Gastroenterol 2020 Feb - Apr;44-45:101671. Epub 2020 Mar 6.

Erasmus MC University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Erasmus Medical Center, Gravendijkwal 230, 3015CE, Rotterdam, the Netherlands. Electronic address:

Hormonal changes during pregnancy instigate numerous physiological changes aimed at the growth and delivery of a healthy baby. A careful balance between immunological tolerance against fetal antigens and immunity against infectious agents needs to be maintained. A three-way interaction between pregnancy hormones, the immune system and our microbiota is now emerging. Read More

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http://dx.doi.org/10.1016/j.bpg.2020.101671DOI Listing

Non-obstetric surgery in pregnancy (including bowel surgery and gallbladder surgery).

Best Pract Res Clin Gastroenterol 2020 Feb - Apr;44-45:101669. Epub 2020 Mar 6.

Department of Gastroenterology and Hepatology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands. Electronic address:

Non-obstetric surgery during pregnancy is required in 0.75-2% of pregnancies. Physiologic changes during pregnancy, both hormonal and anatomic, can have interactions with surgery and anesthesia. Read More

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http://dx.doi.org/10.1016/j.bpg.2020.101669DOI Listing

Pre-existing liver disease in pregnancy: Cirrhosis, autoimmune hepatitis and liver transplantation.

Best Pract Res Clin Gastroenterol 2020 Feb - Apr;44-45:101668. Epub 2020 Mar 16.

School of Medicine, University of Rijeka, Rijeka, Croatia; Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia. Electronic address:

Liver disease during pregnancy is one of the least studied topics, but it links the interests of hepatologists, gynaecologists and family physicians. Approximately 3% of pregnant woman experience some type of liver disease. Liver disease can occur as a result of pregnancy, before pregnancy and coincidence-related during pregnancy. Read More

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http://dx.doi.org/10.1016/j.bpg.2020.101668DOI Listing

The impact of pregnancy on biologic therapies for the treatment of inflammatory bowel disease.

Best Pract Res Clin Gastroenterol 2020 Feb - Apr;44-45:101670. Epub 2020 Mar 13.

Inflammatory Bowel Disease Unit, Department of Gastroenterology, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada. Electronic address:

Active inflammatory bowel disease during conception and pregnancy has been associated with adverse materno-fetal outcomes. Patients are often unduly concerned about the adverse effects of biologic medications on the growing fetus, however, continuing therapy is advised, with potential risks of therapy outweighed by the risks of active maternal disease. A number of physiological changes associated with pregnancy can alter the absorption, distribution and elimination of these therapies, which may impact on their safety and efficacy. Read More

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http://dx.doi.org/10.1016/j.bpg.2020.101670DOI Listing

Preface: Pregnancy in GI-disorders.

Best Pract Res Clin Gastroenterol 2020 Feb - Apr;44-45:101672

Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands.

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http://dx.doi.org/10.1016/j.bpg.2020.101672DOI Listing

Preconception counseling of females with inflammatory bowel disease.

Best Pract Res Clin Gastroenterol 2020 Feb - Apr;44-45:101666. Epub 2020 Jan 16.

IBD MOM Unit, Digestive Diseases Institute, Shaare Zedek Medical Center, Affiliated with the Medical School, Hebrew University, Jerusalem, Israel. Electronic address:

Inflammatory bowel diseases (IBD) are commonly diagnosed in women of childbearing age. As such, pregnancy is often encountered in this subset of patients. Management of pregnancy in IBD patients poses numerous challenges as ensuring the safety of the mother and the fetus is required. Read More

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http://dx.doi.org/10.1016/j.bpg.2020.101666DOI Listing
January 2020

Effect of biologicals and JAK inhibitors during pregnancy on health-related outcomes in children of women with inflammatory bowel disease.

Best Pract Res Clin Gastroenterol 2020 Feb - Apr;44-45:101665. Epub 2019 Dec 28.

Department of Gastroenterology, Erasmus MC University Medical Center, 's Gravendijkwal 230, 3015, CE, Rotterdam, the Netherlands. Electronic address:

Current guidelines advise to maintain immunomodulators and biologicals in pregnant patients because relapse of inflammatory bowel is associated with unfavourable pregnancy outcome. With the exception of Methotrexate, IBD therapy seems not to be related to an increase of congenital malformations or infections requiring hospitalisation of the babies, although the effect the on the developing immune system of the exposed infants remains unknown. In this review we will focus on the effect of IBD drugs on health-related outcomes in children taking into account possible long-term effects of biologicals and immunomodulators, which are transferred across the placenta. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101665DOI Listing
December 2019

Abdominal Imaging in pregnancy (maternal and foetal risks).

Best Pract Res Clin Gastroenterol 2020 Feb - Apr;44-45:101664. Epub 2019 Dec 27.

Faculty of Medicine, Nursing and Health Sciences, Monash University, Director of Gastroenterology, Monash Health, 246 Clayton Rd., Clayton, VIC, 3168, Australia. Electronic address:

Imaging studies are useful in the diagnostic evaluation of inflammatory bowel diseases. However, concern often exists about the safety of imaging for pregnant and lactating women and their infants, leading to unwarranted avoidance of beneficial diagnostic tests or disruption of breastfeeding. Ultrasonography and magnetic resonance imaging (MRI) are not associated with ionizing radiation and are the imaging techniques of choice for pregnant patients. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101664DOI Listing
December 2019

Optimal management of the patient presenting with small bowel bleeding.

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101611. Epub 2019 Apr 17.

Division of Gastroenterology, London Health Sciences Centre, Canada; Schulich School of Medicine and Dentistry, Western University, Canada.

The management of small bowel bleeding, also known as obscure gastrointestinal bleeding, has changed substantially over the past two decades due to revolutionary technological advances in small intestinal endoscopy. This clinical review will summarize the evolving definition of small bowel bleeding, how to perform a detailed initial assessment of patients with the condition, the strengths and limitations of small bowel endoscopy, and the treatment of small bowel bleeding. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.04.004DOI Listing
February 2020

Risk stratification in upper and upper and lower GI bleeding: Which scores should we use?

Authors:
Kathryn Oakland

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101613. Epub 2019 Apr 17.

Digestive Diseases and Renal Department, HCA Healthcare UK, 242 Marylebone Road, London, NW1 6JL, United Kingdom. Electronic address:

Risk assessment is widely used in upper gastrointestinal bleeding (UGIB) however no score accurately predicts all important clinical outcomes. This review discusses the performance of the Rockall score, pre-endsocopy Rockall score, Glasgow-Blatchford score, AIMS-65 and newer scores such as Progetto Nazionale Emorragia Digestiva and CANUKA scores. The quality of external validation varies considerably for each score. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.04.006DOI Listing
February 2020

Changing epidemiology and etiology of upper and lower gastrointestinal bleeding.

Authors:
Kathryn Oakland

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101610. Epub 2019 Apr 17.

Digestive Diseases and Renal Department, HCA Healthcare UK, 242 Marylebone Road, London, NW16JL, United Kingdom. Electronic address:

Upper gastrointestinal bleeding (UGIB) develops in the oesophagus, stomach or duodenum and has an incidence of 47/100,000. Lower GIB (LGIB) develops in the small bowel, colon or anorectum and has an incidence of 33/100,000. Where the incidence of UGIB has fallen, driven by helicobacter pylori eradication and the use of proton pump inhibitors, the incidence of LGIB may be increasing. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.04.003DOI Listing
February 2020

The optimal use of blood components in the management of gastrointestinal bleeding.

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101600. Epub 2019 Feb 16.

Division of Gastroenterology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address:

Acute gastrointestinal bleeding accounts for 5,000 deaths per annum in the UK and is the second-most common indication for transfusion of blood components. Transfusion of blood components is integral to management of these patients. Recent years have seen an expansion in the evidence base for their use in this population and this review aims to provide up-to-date guidance on the use of red cells, plasma, platelets, sources of concentrated fibrinogen and adjuncts such as antifibrinolytic agents in patients with acute gastrointestinal haemorrhage. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.02.002DOI Listing
February 2020

Preface - Gastrointestinal bleeding.

Authors:
Vipul Jairath

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101632. Epub 2019 Jul 9.

Departments of Medicine, Epidemiology and Biostatistics, Division of Gastroenterology, Western University, London, Ontario, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.bpg.2019.101632DOI Listing

Is there still a role for the surgeon in the management of gastrointestinal bleeding ?

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101622. Epub 2019 Jun 14.

Dept of Surgery, Royal Surrey County Hospital, Guildford, Surrey, UK. Electronic address:

Modern investigation of gastrointestinal bleeds allows for reliable source identification in most cases. Current treatment algorithms utilise therapeutic endoscopy or interventional radiology and surgery now plays a limited role in the treatment of gastrointestinal bleeds. Approximately 2-4% of patients admitted with GI bleeds, however, require surgery to control their haemorrhage. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101622DOI Listing
February 2020

Endoscopic management of nonvariceal upper gastrointestinal bleeding.

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101608. Epub 2019 Apr 17.

Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Electronic address:

Endoscopic therapy is the mainstay of treatment for nonvariceal upper gastrointestinal bleeding (NVUGIB). Injection plus mechanical or thermal therapy continues to be the most widely used option. New endoscopic devices such as the use of an inert powder or a new class of over-the-scope clip system have demonstrated encouraging results as a rescue therapy for difficult hemostasis. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.04.001DOI Listing
February 2020

When all else fails - Radiological management of severe gastrointestinal bleeding.

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101612. Epub 2019 Apr 17.

Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France.

Although most cases of acute nonvariceal gastrointestinal bleeding (GIB) either spontaneously resolve or respond to medical management and endoscopic therapy, there are still a significant proportion of severe patients who require emergency angiography and endovascular treatment. Over the past three decades, transcatheter arterial embolization (TAE) has become the first-line therapy for the management of acute nonvariceal GIB that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer liquid embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the treatment of bleeding for a variety of indications. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.04.005DOI Listing
February 2020

Optimal timing of endoscopy in patients with acute upper gastrointestinal bleeding.

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101618. Epub 2019 Jun 3.

Gastrointestinal Unit, Glasgow Royal Infirmary, Glasgow, UK. Electronic address:

Endoscopy is the gold standard for evaluating and treating acute upper gastrointestinal bleeding (UGIB). The optimal timing of endoscopy is a very important consideration in the overall management of UGIB, but there is on going uncertainty regarding timing of the procedure, particularly in those with more severe bleeding. This is reflected by inconsistencies between current guidelines. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.05.005DOI Listing
February 2020

Proton pump inhibitors for upper gastrointestinal bleeding.

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101609. Epub 2019 Apr 17.

Division of Gastroenterology, McGill University, Montreal, Canada. Electronic address:

Acute upper gastrointestinal bleeding (UGIB) remains a public health burden with a persistent high mortality despite advances in modern day management. Proton pump inhibitors (PPI) as medical therapy is an attractive adjuvant to endoscopic treatment in UGIB but the method and dose of PPI therapy remains controversial. This chapter aims to describe the current evidence addressing acute PPI use in the management of UGIB. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.04.002DOI Listing
February 2020
3.478 Impact Factor

The role of colonoscopy and endotherapy in the management of lower gastrointestinal bleeding.

Authors:
Neil Sengupta

Best Pract Res Clin Gastroenterol 2019 Oct - Dec;42-43:101615. Epub 2019 May 29.

Section of Gastroenterology, University of Chicago Medical Center 5841 S Maryland Avenue, MC 4076, Chicago, IL, 60637, USA. Electronic address:

Colonoscopy is an integral diagnostic and therapeutic tool in the management of patients with lower gastrointestinal bleeding (LGIB). After resuscitation, reversal of coagulopathy, and exclusion of a proximal source of bleeding, colonoscopy should be performed in most patients with LGIB. Bowel preparation, typically with polyethylene glycol based solutions, is needed to closely inspect the colonic mucosa for bleeding sources. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.05.002DOI Listing
February 2020

Pseudo-obstruction, enteric dysmotility and irritable bowel syndrome.

Authors:
Greger Lindberg

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101635. Epub 2019 Jul 22.

Karolinska Institutet, Department of Medicine, Huddinge and Karolinska University Hospital Huddinge, Patient Area Gastroenterology, Dermatology, and Rheumatology, SE-14186, Stockholm, Sweden. Electronic address:

New diagnostic techniques have advanced our knowledge about the irritable bowel syndrome. The majority of patients that we believed to have a psychosomatic disorder have received other diagnoses explaining their symptoms. Endoscopy makes it possible to diagnose celiac disease before it leads to malnutrition and allows the detection of microscopic colitis as a cause of watery diarrhea. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101635DOI Listing
December 2019
1 Read

Utility of animal gastrointestinal motility and transit models in functional gastrointestinal disorders.

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101633. Epub 2019 Jul 26.

Area of Regulatory Biology, Division of Life Science, Graduate School of Science and Engineering, Saitama University, 255 Shimo-ohkubo, Sakuraku, Saitama, 338-8570, Japan; Area of Life-NanoBio, Division of Strategy Research, Graduate School of Science and Engineering, Saitama University, 255 Shimo-ohkubo, Sakuraku, Saitama, 338-8570, Japan. Electronic address:

Alteration in the gastrointestinal (GI) motility and transit comprises an important component of the functional gastrointestinal disorders (FGID). Available animal GI motility and transit models are to study symptoms (delayed gastric emptying, constipation, diarrhea) rather than biological markers to develop an effective treatment that targets the underlying mechanism of altered GI motility in patients. Animal data generated from commonly used methods in human like scintigraphy, breath test and wireless motility capsule may directly translate to the clinic. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101633DOI Listing
December 2019
1 Read

Reflux esophagitis, functional and non-functional.

Authors:
Serhat Bor

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101649. Epub 2019 Sep 17.

Professor in Gastroenterology, Ege University, School of Medicine, Division of Gastroenterology, Ege Reflux Group, Izmir, Turkey. Electronic address:

The pathogenesis of gastroesophageal reflux disease has been explained by acid-peptic model. However, related with the progress of the diagnostic modalities, another phenotypical group of patients were defined and called "functional disorders of the esophagus". These patients are important because diagnosis is particularly difficult, co-morbid disorders especially psychiatric diseases are common, proton pump inhibitor response is low, and surgical results are very poor. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101649DOI Listing
December 2019
1 Read

Preface - Functional gastrointestinal disorders.

Authors:
Per M Hellström

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101605. Epub 2019 May 16.

Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Electronic address:

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http://dx.doi.org/10.1016/j.bpg.2019.03.001DOI Listing

Pathophysiology of the irritable bowel syndrome - Reflections of today.

Authors:
Per M Hellström

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101620. Epub 2019 May 24.

Department of Medical Sciences, Gastroenterology Unit, Uppsala University, Bldg 40, 5th Floor, SE-75185, Uppsala, Sweden. Electronic address:

Irritable bowel syndrome (IBS) is a chronic gastrointestinal symptom complex defined by abdominal pain and disturbed bowel habits over 3 months within a period of 6 months, in absence of any identifiable organic pathology. Over the years, speculations of the pathophysiology of IBS has moved from elusive central nervous symptoms impinging on psychosomatic disease, to objective signs of intestinal fermentation with abdominal bloating and intestinal dysmotility. The specific subgroup of post-infectious IBS is of special interest since it opens the possibility of dysbiosis as the pivotal point for development of IBS in association with traveler's diarrhea or antibiotic treatment with ensuing dysbiosis and abdominal symptoms that may resolve over decades. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.05.007DOI Listing
December 2019
1 Read

The Rome IV: Irritable bowel syndrome - A functional disorder.

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101634. Epub 2019 Jul 18.

Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden.

Functional gastrointestinal disorders are the most common disorders encountered in the clinical gastroenterology setting. Over the years the Rome process has generated consensus definitions of functional gastrointestinal disorders, and given diagnostic criteria, based on various symptom patterns, that have evolved over the years. The latest Rome IV consensus was presented in May 2016. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101634DOI Listing
December 2019
1 Read

Helicobacter pylori eradication in dyspepsia: New evidence for symptomatic benefit.

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101637. Epub 2019 Jul 22.

Department of Medicine II, University Hospital, LMU Munich, Germany; Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Germany. Electronic address:

A causal relationship between Helicobacter pylori (H. pylori) infection and functional dyspepsia (FD) is well established in a subset of infected patients. In the Kyoto and Maastricht/Florence consensus reports H. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101637DOI Listing
December 2019

Tangible pathologies in functional dyspepsia.

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101650. Epub 2019 Aug 16.

Faculty of Health and Medicine, University of Newcastle, HMRI Building, Kookaburra Circuit, New Lambton Heights, 2305 NSW, Australia; Australian Gastrointestinal Research Alliance, University of Newcastle, NSW, Australia. Electronic address:

Functional dyspepsia (FD) is a common, costly and complex disease, currently defined by symptoms, directed by the Rome consensus on functional bowel disorders, which has evolved over the past two decades. Symptoms include abdominal pain, are often meal related and there are two major subtypes, postprandial distress syndrome and epigastric pain syndrome, not attributed to pathology. Increasingly it is recognised that tangible pathologies occur in FD, for example Helicobacter pylori and other pathophysiological changes, most notably duodenal pathology, namely duodenal eosinophilia, permeability alterations, structural neuronal changes and microbial duodenal dysbiosis. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101650DOI Listing
December 2019
1 Read

Therapeutic potential of an anaerobic cultured human intestinal microbiota, ACHIM, for treatment of IBS.

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101607. Epub 2019 Apr 29.

Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

By administering an anaerobic cultivated human intestinal microbiota (ACHIM) via upper gastrointestinal route using endoscopy we aimed to rectify intestinal dysbiosis and simultaneously achieve a treatment response in IBS patients. The study population fulfilled the Rome III IBS criteria and comprised 50 patients. During 10 days, patients recorded the irritable bowel syndrome symptom severity scale (IBS-SSS) along with the Bristol stool scale and number of stools/day. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.03.003DOI Listing
December 2019
6 Reads

The pros and cons of gastric bypass surgery - The role of the Roux-limb.

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101638. Epub 2019 Jul 23.

Institute of Clinical Sciences, Department of Gastrosurgical Research and Education, The Sahlgrenska Academy at the University of Gothenburg, Sweden. Electronic address:

The prevalence of overweight and obesity has exploded in the post-industrial era. Life style interventions like dieting and exercise can induce a marked weight loss, but the main problem for most patients is to maintain the reduced body weight over time. Gastric bypass surgery is a commonly performed and very effective method for achieving a pronounced and sustained weight loss including metabolic improvements in obese patients. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101638DOI Listing
December 2019
1 Read

Tests of intestinal mucosal hyperpermeability: Many diseases, many biomarkers and a bright future.

Authors:
Dominic-Luc Webb

Best Pract Res Clin Gastroenterol 2019 Jun - Aug;40-41:101636. Epub 2019 Jul 20.

Gastroenterology and Hepatology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Electronic address:

The number of disorders now linked to increased intestinal mucosal permeability implies that a substantial percent of the population is affected. Drug interventions targeting reduced tight junctional permeability are being pursued. Although hyper-permeability in itself is not a clinically recognized disease entity, its relationship to disease processes has driven interest in measuring, and even monitoring mucosal permeability in vivo. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.101636DOI Listing
December 2019

Evolution of treatment targets in Crohn's disease.

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101599. Epub 2019 Feb 16.

National Institute of Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, UK. Electronic address:

Crohn's disease is a chronic relapsing and remitting inflammatory disorder of the gastrointestinal tract, associated with significantly morbidity due to both symptoms and complications that have a considerable detrimental impact on a patient's quality of life. An early treat to target approach with disease modifying agents has been shown to significantly improve long term outcomes, demonstrated by a number of therapeutic targets in a number of modalities. This review will outline the current treatment targets and measures of disease burden in Crohn's disease. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.02.001DOI Listing
November 2019

Preface - Evolving approaches to the evaluation and management of Crohn's disease.

Authors:
Vipul Jairath

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101623. Epub 2019 Jun 19.

Departments of Medicine, Epidemiology and Biostatistics, Division of Gastroenterology, Western University, London, Ontario, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.bpg.2019.101623DOI Listing

In the absence of head-to-head trials, what do real world studies tell us about the comparative effectiveness of biologics in Crohn's disease.

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101619. Epub 2019 May 29.

University of California San Diego, Division of Gastroenterology and Hepatology, 9500, Gilman Drive, #0956, La Jolla, San Diego, CA, USA. Electronic address:

Head-to-head clinical trials are the highest quality of evidence to support comparative effectiveness. However, there are currently no head-to-head phase 3 clinical trials of biologics in Crohn's Disease. With a need for direct comparisons but lagging RCTs, Real World Data (RWD) can provide evidence on the comparative effectiveness of biologics for a diverse population that is more generalizable to routine practice. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.05.006DOI Listing
November 2019
3 Reads

"Can Magnetic Resonance Enterography (MRE) replace ileo-colonoscopy for evaluating disease activity in Crohn's disease?"

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101621. Epub 2019 May 31.

NIHR Nottingham Biomedical Medical Centre, Nottingham University Hospitals NHS trust, Nottingham, United Kingdom. Electronic address:

Crohn's disease is a form of chronic inflammatory bowel disease that can lead to structural bowel damage due to transmural inflammation. Ileo-colonosocopy is currently essential for initial diagnosis. Reassessment of disease burden is frequently needed during episodes of active disease and when evaluating treatment efficacy. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.05.008DOI Listing
November 2019
4 Reads

What is the role of histopathology in the evaluation of disease activity in Crohn's disease?

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101601. Epub 2019 Feb 15.

Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; Department of Medicine, University of Western Ontario, London, Ontario, Canada.

Assessment of disease activity is essential for developing and determining appropriate therapy in patients with Crohn's disease. Currently, clinical and endoscopic treatment targets have been proposed, whereas histologic assessment of disease activity is not recommended in expert guidelines. Histologic assessment of disease activity has emerged as an important tool in ulcerative colitis as persistent histological inflammation is associated with clinical relapse, corticosteroid use, hospitalisation, and development of dysplasia. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.02.003DOI Listing
November 2019
1 Read

Endoscopic scoring systems for the evaluation and monitoring of disease activity in Crohn's disease.

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101616. Epub 2019 May 28.

Division of Gastroenterology, Department of Medicine, McGill University Health Center (MUHC), Montreal General Hospital, 1650 Cedar Ave, C7-200, Montreal, QC, H3G 1A4, Canada. Electronic address:

Crohn's disease is a chronic relapsing idiopathic condition that can affect any part of the gastrointestinal tract. It has been shown that mucosal healing is associated with improved clinical outcomes such as reduced risk of surgery, hospitalization and complications. Nowadays mucosal healing is considered the optimal target of medical therapy. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.05.003DOI Listing
November 2019
1 Read

What is the role of C-reactive protein and fecal calprotectin in evaluating Crohn's disease activity?

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101602. Epub 2019 Feb 22.

Robarts Clinical Trials, Inc. London, Ontario, Canada; Division of Gastroenterology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address:

Historically, the evaluation of patients with Crohn's disease (CD) has centered on use of subjective symptom-based assessment. However, patients with CD experience a broad spectrum of non-specific symptoms that may not directly correlate with objective measures of inflammation. Endoscopy has been the gold standard for evaluating the burden and severity of mucosal disease. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.02.004DOI Listing
November 2019

Pharmacology, efficacy and safety of JAK inhibitors in Crohn's disease.

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101606. Epub 2019 Mar 6.

Robarts Clinical Trials, Inc, #200, 100 Dundas Street, London, Ontario, N6A 5B6, Canada; Department of Medicine, University of California San Diego, 9500 Gilman Drive, #0956, La Jolla, CA, 92093, United States. Electronic address:

Orally bioavailable inhibitors of the tyrosine kinases (TYKs), also referred to as Janus kinases (JAKs), are being evaluated for the treatment of patients with Crohn's disease (CD), ulcerative colitis (UC), and other chronic inflammatory disorders. To date, three JAK inhibitors have been tested in patients with moderate-to-severe CD: tofacitinib (pan-JAK inhibitor), filgotinib (JAK1 inhibitor) and upadacitinib (JAK1 inhibitor). Clinical development of tofacitinib was discontinued in CD because the primary endpoint of clinical remission in the phase II induction and maintenance trials was not met, although outcomes may have been influenced by trial design flaws and a high placebo rate was noted. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.03.002DOI Listing
November 2019
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IL12/23 or selective IL23 inhibition for the management of moderate-to-severe Crohn's disease?

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101604. Epub 2019 Feb 19.

Robarts Clinical Trials, Inc. London, Ontario, Canada; Division of Gastroenterology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address:

The interleukin (IL)-12 family of cytokines, including IL12 and IL 23, play an important role in driving aberrant Th1 and Th17 immune responses in patients with Crohn's disease (CD). Targeting this pathway has opened new avenues for therapeutic intervention. The approval of ustekinumab, a monoclonal antibody blocking the common p40 subunit of IL12 and IL23, marked an important evolution in medical management for CD: this novel class of biologic therapy demonstrated efficacy in both patients naïve to biologics as well as in patients experiencing inadequate response or loss of response to TNF antagonists. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.02.006DOI Listing
November 2019
4 Reads

Network meta-analysis to inform positioning of biologics in patients with Crohn's disease: Promise and perils.

Authors:
Siddharth Singh

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101614. Epub 2019 Jun 3.

Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA; Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA. Electronic address:

With availability of several different classes of biologic agents with variable efficacy and safety profiles for moderate-severe Crohn's disease (CD), positioning of different agents in treatment course is an important question for clinicians. Though in an ideal world, positioning would be personalized and driven by likelihood of response to different agents based on biomarkers in individual patients, that is still far from reality, and decisions are empiric. In the absence of head-to-head trials of different medications, decisions on treatment choice and positioning are primarily based on clinician experience, opinion-based treatment algorithms, patient preference and insurance reimbursement. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.05.001DOI Listing
November 2019

Targeting anti-fibrotic pathways in Crohn's disease - The final frontier?

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101603. Epub 2019 Feb 16.

Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, USA; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address:

Intestinal fibrosis with stricture formation affects up to half of patients with Crohn's disease (CD), resulting in impaired quality of life, increased risk of surgical intervention, and associated patient morbidity. The underlying pathophysiologic mechansisms responsible for initiating and perpetuating intestinal fibrosis are complex, dynamic, and implicate both inflammation-dependent and independent pathways. Previously thought to be an irreversible complication of long-standing inflammation unresponsive to medical therapy, fibrostenotic CD has been traditionally managed with endoscopic or surgical approaches. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.02.005DOI Listing
November 2019
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Interfering with leukocyte trafficking in Crohn's disease.

Best Pract Res Clin Gastroenterol 2019 Feb - Apr;38-39:101617. Epub 2019 May 28.

Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK. Electronic address:

The discovery of gut-specific leukocytes and the ability to modulate their function has been a groundbreaking development in the treatment of inflammatory bowel disease. Drugs target the interaction between lymphocytes and endothelial cells via integrins and their ligand cellular adhesion molecules. Safety, efficacy and sustainability of effect are key to this drug class, notwithstanding the association of natalizumab with fatal polyoma virus infection. Read More

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http://dx.doi.org/10.1016/j.bpg.2019.05.004DOI Listing
November 2019
10 Reads

Palliation of dysphagia.

Best Pract Res Clin Gastroenterol 2018 Oct - Dec;36-37:97-103. Epub 2018 Nov 22.

Department of Gastroenterology & Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. Electronic address:

Palliation of dysphagia is the cornerstone of palliative treatment in patients with incurable oesophageal cancer. Available palliative options for dysphagia are oesophageal stent placement and radiotherapy. In general, oesophageal stent placement is the preferred therapeutic option in patients with a relatively poor prognosis because of its rapid relief of dysphagia. Read More

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http://dx.doi.org/10.1016/j.bpg.2018.11.010DOI Listing
January 2019

The role of surgery in advanced disease for esophageal and junctional cancer.

Best Pract Res Clin Gastroenterol 2018 Oct - Dec;36-37:91-96. Epub 2018 Nov 24.

Department of Surgery, Erasmus MC - University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, the Netherlands. Electronic address:

The incidence of esophageal and junctional cancer has been increasing in western industrialized nations in the past 30 years. At the time of diagnosis, approximately 50% of patients with esophageal and junctional cancers have distant metastases and are considered incurable. In the recent ESMO guidelines and the German S3 guidelines, surgical therapy for metastatic disease is not recommended. Read More

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http://dx.doi.org/10.1016/j.bpg.2018.11.002DOI Listing
January 2019
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Molecular pathways in the development and treatment of oesophageal cancer.

Best Pract Res Clin Gastroenterol 2018 Oct - Dec;36-37:9-15. Epub 2018 Nov 23.

Cancer Research UK and Royal College of Surgeons of England Advanced Clinician Scientist Fellow, University of Southampton, UK. Electronic address:

The molecular pathways involved in the development and treatment of oesophageal cancer are complex. Recent large-scale genome sequencing studies have delivered novel insights into aetiology and possible targeted treatments. Oesophageal squamous cell carcinoma (OSCC) and adenocarcinoma (OAC) are distinct entities. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S15216918183012
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http://dx.doi.org/10.1016/j.bpg.2018.11.013DOI Listing
January 2019
39 Reads

The management of mid & proximal oesophageal squamous cell carcinoma.

Authors:
Ian Wong Simon Law

Best Pract Res Clin Gastroenterol 2018 Oct - Dec;36-37:85-90. Epub 2018 Nov 30.

Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong. Electronic address:

Despite the rise in incidence of adenocarcinoma, squamous cell cancer of the oesophagus remains the commonest cell type worldwide and is predominant in the East. Except for very early tumours where endoscopic therapy can be performed with curative intent, in more advanced but potentially curative cancers, treatment for mid and upper third tumours is primarily surgery with extended lymphadenectomy, together with multimodal therapies such as preoperative chemotherapy or chemoradiotherapy. Definitive chemoradiotherapy is utilized in those who decline surgery or in those who are unfit for major procedures. Read More

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http://dx.doi.org/10.1016/j.bpg.2018.11.012DOI Listing
January 2019
2 Reads
3.478 Impact Factor

Robot assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer.

Best Pract Res Clin Gastroenterol 2018 Oct - Dec;36-37:81-83. Epub 2018 Nov 29.

Department of Surgery, G04.228, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.

Worldwide, the standard treatment for locally advanced esophageal cancer with curative intent is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE) with gastric conduit reconstruction. Minimally invasive esophagectomy (MIE) was developed to improve the postoperative outcome by reducing the surgical trauma, with comparable short-term oncologic results. However, MIE is a highly complex procedure associated with a long learning curve. Read More

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http://dx.doi.org/10.1016/j.bpg.2018.11.004DOI Listing
January 2019
3 Reads

Oesophagectomy: The expanding role of minimally invasive surgery in oesophageal cancer.

Best Pract Res Clin Gastroenterol 2018 Oct - Dec;36-37:75-80. Epub 2018 Nov 21.

Department of Upper GI Surgery and General Surgery, Norfolk and Norwich University Hospital, Colney Lane, NR4 7UY, Norwich, United Kingdom. Electronic address:

Historically, open oesophagectomy was the gold standard for oesophageal cancer surgery. This was associated with a relatively higher morbidity. In the last two decades, we have seen significant improvements in short and long term outcomes due to centralisation of oesophagectomy, multidisciplinary approach, enhanced recovery after surgery programmes, neoadjuvant treatments and advances in minimally invasive oesophagectomy (MIO) techniques. Read More

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http://dx.doi.org/10.1016/j.bpg.2018.11.001DOI Listing
January 2019
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Peri-operative patient optimization for oesophageal cancer surgery - From prehabilitation to enhanced recovery.

Best Pract Res Clin Gastroenterol 2018 Oct - Dec;36-37:61-73. Epub 2018 Nov 30.

Department of Gastrointestinal Medicine and Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK; Division of Cancer Studies, King's College London, UK. Electronic address:

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http://dx.doi.org/10.1016/j.bpg.2018.11.006DOI Listing
November 2018
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