Current opinion in gastroenterology
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Enteral nutrition is a widely used therapy for nutritional treatment of patients with multiple pathologies. The present review selects important evidenced-based papers from 2006 and 2007 and critically reviews them for the reader. ⋯ Enteral nutrition continues as a highly used medical therapy, usually as an adjuvant for other pharmacologic and supportive therapies. Multiple small clinical trials, observational studies and retrospective reviews must be analyzed to develop 'best practice' guidelines with enteral nutrition.
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Curr. Opin. Gastroenterol. · Jan 2008
ReviewNutrition and colonic health: the critical role of the microbiota.
To highlight mechanisms whereby diet affects colonic function and disease patterns. ⋯ Our investigations have focused on a small number of bacterial species: characterization of microbiota and its metabolism can be expected to provide the key to colonic health and disease.
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Critical to realizing increasing benefits of enteral nutrition are techniques for feeding tube placement. Feeding tubes can be placed by bedside, endoscopic, fluoroscopic, and surgical methods. This review encompasses noteworthy studies on endoscopic approaches to enteral feeding published from January 2005 to the present. ⋯ Enteral nutrition access can be obtained by a variety of methods depending on local expertise and resources. Endoscopic approaches have equivalent or better outcomes than other methods; however, these methods may still have limitations and distinct complications.
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Primary sclerosing cholangitis is a chronic cholestatic liver disease characterized by strictures of the biliary tree complicated by cirrhosis and cholangiocarcinoma. It is immune mediated although the precise etiology remains unknown. ⋯ It is likely that a number of patients previously diagnosed with primary sclerosing cholangitis have autoimmune pancreatitis in association with primary sclerosing cholangitis, a syndrome with distinct clinicopathological features including steroid responsiveness. Primary sclerosing cholangitis-inflammatory bowel disease probably represents a distinct inflammatory bowel disease phenotype, which has implications for colonoscopic surveillance of these patients. CA19-9 plays no surveillance role for the early detection of cholangiocarcinoma. The best-studied drug in primary sclerosing cholangitis is ursodeoxycholic acid, which, despite a range of potentially valuable actions on the cholestatic liver, has not yet been proved to make a substantial impression on the course of the disease. Orthotopic liver transplantation remains the only established long-term treatment for primary sclerosing cholangitis.