Current opinion in gastroenterology
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Curr. Opin. Gastroenterol. · Jul 2012
ReviewHigh-grade dysplasia and intramucosal adenocarcinoma in Barrett's esophagus: the role of esophagectomy in the era of endoscopic eradication therapy.
The aim of this review is to evaluate the role of esophagectomy for high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC) in light of recent advances in endoscopic therapy for Barrett's esophagus. ⋯ A better understanding of the indications and limitations of endoscopic therapy for HGD and IMC permits a tailored approach to the management of patients with early esophageal adenocarcinoma. When indicated, the selection of a less morbid surgical technique has the potential to improve overall surgical and oncological outcomes.
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The major motor functions of the large bowel include storage, propulsion and defecation. New developments continue to expand our knowledge of this area and provide significant advances in the treatment of disorders of colorectal motility. ⋯ The articles referenced in this review inform the reader of new developments in understanding and treating disorders of colonic and anorectal motility and anticipate future advances.
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Curr. Opin. Gastroenterol. · Jan 2012
ReviewClostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options.
The incidence and severity of Clostridium difficile infection (CDI) around the world has increased over the past 20 years due to the emergence of hypervirulent strains, increased use and misuse of antibiotics, and the increase of susceptible at-risk populations. Treatments currently available for CDI are inadequate to impede the increasing spread and virulence of the infection, avoid recurrence in chronic patients or prevent infection in at-risk populations. ⋯ The review aims to summarize the most recent evidence available on the epidemiology, risk factors and treatment of CDI. New antibiotics with selected action on C. difficile and limited effect on microflora (fidaxomicin) and donor fecal transplantation seem to have a relevant efficacy in treating CDI and reducing its recurrence. The use of selected monoclonal antibodies directed against C. difficile toxins in addition to standard therapy is a new, promising approach for the treatment of recurrent cases. Vaccination could be an additional weapon against CDI. New robust data are needed before recommendations can be made to abandon current treatment based on vancomycin and metronidazole and move toward new frontiers.
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This review summarizes the recent progress in the epidemiology, pathophysiology and treatment of functional dyspepsia. ⋯ There is gradual progress in our understanding of the symptom pattern, impact and pathophysiology of functional dyspepsia. The areas of recent advances including the recognition of low-grade duodenal inflammation, central nervous system processing and the exploration of novel pharmacotherapeutic approaches are summarized in this review.
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Chronic liver disease (CLD) causes significant morbidity and mortality, mainly due to complications [hepatic encephalopathy, ascites, hepatorenal syndrome (HRS) and esophageal variceal hemorrhage (EVH)]. Studies of the complications, management and outcomes in patients with CLD over the last 18 months are reviewed. ⋯ Refinement in clinical management strategies for patients with cirrhosis and its complications appear to continue to contribute to improved patient outcomes.