The American journal of gastroenterology
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Am. J. Gastroenterol. · Jul 2019
ReviewThe Gut Microbiota in Causation, Detection, and Treatment of Cancer.
The gut microbiota has emerged as an important consideration in clinical oncology. The role of the microbiome in cancer extends beyond causation and cancer risk. It is now known that the microbiome not only acts at a local epithelial level in the gut but also modifies immune responses within intestinal and extraintestinal tumors. ⋯ The potential value of microbiome manipulation with live biotherapeutics or microbial transplantation has also become a realistic consideration. Maintenance of microbial diversity in patients with cancer is a variable challenge given the modifying influences of the tumor itself, chemotherapy, nutritional status, and sporadic antimicrobial therapy. Here, we address current evidence for the role of the microbiome in cancer therapy.
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Am. J. Gastroenterol. · Mar 2019
ReviewArtificial Intelligence-Assisted Gastroenterology- Promises and Pitfalls.
Technological advances in artificial intelligence (AI) represent an enticing opportunity to benefit gastroenterological practice. Moreover, AI, through machine or deep learning, permits the ability to develop predictive models from large datasets. Possibilities of predictive model development in machine learning are numerous dependent on the clinical question. ⋯ Furthermore, such analyses could predict the development of GI disease prior to the manifestation of symptoms, raising the possibility of prevention or pre-treatment. In addition, computer vision additionally provides an exciting opportunity in endoscopy to automatically detect lesions. In this review, we overview the recent developments in healthcare-based AI and machine learning and describe promises and pitfalls for its application to gastroenterology.
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Am. J. Gastroenterol. · Feb 2019
Meta AnalysisProkinetics for Functional Dyspepsia: A Systematic Review and Meta-Analysis of Randomized Control Trials.
Prokinetics are recommended for the treatment of functional dyspepsia (FD) but systematic reviews give conflicting results on the efficacy of these agents. We have therefore conducted an updated systematic review to support the 2017 joint ACG/CAG dyspepsia guidelines. ⋯ From the current evidence, prokinetics may be effective for the treatment in all subtypes of FD, with very low quality of evidence. There was no difference between prokinetics for dyspeptic symptom improvement. High-quality RCTs with large sample sizes of FD patients are needed to verify the efficacy of prokinetics.
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Am. J. Gastroenterol. · Sep 2018
Meta AnalysisA Systematic Review and Meta-Analysis Evaluating the Efficacy of a Gluten-Free Diet and a Low FODMAPs Diet in Treating Symptoms of Irritable Bowel Syndrome.
Dietary triggers such as gluten and highly fermentable oligo-, di- and monosaccharides and polyols (FODMAP)-containing foods have been associated with worsening irritable bowel syndrome (IBS) symptoms. However, the true impact of dietary restriction on IBS symptoms has remained unclear. The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the efficacy of exclusion diets (we focused on low FODMAP and gluten-free diets (GFD)) in IBS. ⋯ There is insufficient evidence to recommend a GFD to reduce IBS symptoms. There is very low quality evidence that a low FODMAP diet is effective in reducing symptoms in IBS patients.