Gastroenterology clinics of North America
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Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments.
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The concept of esophageal spastic disorders encompasses spastic achalasia, distal esophageal spasm, and jackhammer esophagus. These are conceptually distinct in that spastic achalasia and distal esophageal spasm are characterized by a loss of neural inhibition, whereas jackhammer esophagus is associated with hypercontractility. ⋯ The diagnosis of jackhammer esophagus as a primary motility disorder is based on the characteristic manometric findings after ruling out mechanical obstruction and eosinophilic esophagitis. Despite the differences in pathophysiology among the esophageal spastic disorders, their management is similar.
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Gastroenterol. Clin. North Am. · Dec 2012
ReviewThe role of probiotics in the prevention and treatment of antibiotic-associated diarrhea and Clostridium difficile colitis.
Clostridium difficile colitis is the most common gastrointestinal infection, exceeding all other gastrointestinal infections combined. There has been a dramatic increase in Clostridium difficile infection (CDI) worldwide during the past decade. ⋯ The antibiotic alters the protective, diverse bacteria allowing pathogenic bacteria to cause disease. Probiotics have been effective in reducing AAD and preventing CDI.
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Celiac disease is common, affecting approximately 1 in 100 people, yet it remains underdiagnosed. This article reviews our current understanding of celiac disease, diagnosis, and common pitfalls. Although the cornerstone of treatment is a gluten-free diet, some patients may still have persisting symptoms and warrant further investigations.
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Gastroenterol. Clin. North Am. · Mar 2012
ReviewThe role of endoscopic ultrasonography in the diagnosis and management of pancreatic cancer.
EUS with FNA is highly sensitive and specific for diagnosing pancreatic cancer. However, in certain situations, such as in patients with chronic pancreatitis, this high sensitivity and specificity can significantly diminish. ⋯ EUS has evolved from a diagnostic procedure to a therapeutic intervention in pancreatic cancer. EUS-guided fiducial insertion and EUS-guided delivery of antitumor agents, in addition to celiac plexus neurolysis, are the main therapeutic applications of EUS in pancreatic cancer.