Clinical Update最新文献

Commentary

In practice, dyspepsia is commonly used as an indication for endoscopy to exclude upper-gut mucosal abnormalities. However, in this review, Dr Nicholas J. Talley offers a much more pragmatic approach for the diagnosis and management of dyspepsia. By using several systematic reviews, meta-analyses, and recently proposed practice guidelines for dyspepsia, Dr Talley provides a convincing argument that upper endoscopy in subjects younger than 55 years with dyspepsia but without alarm symptoms is a low-yield diagnostic strategy. In contrast, subjects with dyspepsia and who are older than 55 years and/or with alarm symptoms would benefit from upper endoscopy as the initial evaluative strategy. An easy-to-follow (and remember) diagnostic algorithm for uninvestigated dyspepsia is offered at the end of the monograph.

– Ronnie Fass, MD, Editor

Commentary

In the last few years, we have seen a surge in referrals for colonoscopy because of an increase in public and physician awareness of the need for colorectal cancer (CRC) screening. Colonoscopy has become one of the most important screening tools for CRC, because it can provide diagnosis and treatment in 1 visit. In this review, Dr Rex presents the arguments for CRC screening and offers easy-to-follow guidelines for referral to a gastroenterologist. In addition, different CRC screening modalities are presented, and a compelling argument is provided for the usage of colonoscopy as the leading screening strategy. Most importantly, the limitations of screening tools commonly used by primary care physicians are discussed.

– Ronnie Fass, MD, Editor

Commentary

Upper GI bleeding is one of the most important therapeutic areas in gastroenterology. Many of the cases fall under the category of an emergency situation and thus require urgent endoscopic intervention. In this review, Dr Loren Laine provides updated information about the epidemiology, the clinical presentation, and therapeutic interventions in various GI bleeding scenarios. In addition, Dr Laine provides a critical review of some of the diagnostic and therapeutic approaches that are commonly pursued despite their very low yield. Lastly, Dr Laine emphasizes, in his review, the importance of combining endoscopic and medical therapeutic interventions in patients who present with upper-GI bleeding.

– Ronnie Fass, MD, Editor

Commentary

The study of eosinophilic esophagitis (EOE) is an emerging field in adult gastroenterology that has attracted increasing attention in recent years. This disorder is commonly underdiagnosed but is now being recognized in patients presenting with dysphagia and typical endoscopic findings. In this review, Dr David Johnson describes the epidemiology, various clinical presentations, diagnostic approaches, and therapeutic modalities of EOE. This review emphasizes the need for high suspicion; proper biopsy protocol; and, for most patients, the need for topical steroids for treatment.

– Ronnie Fass, MD, Editor

Commentary

Capsule endoscopy (CE) is an exciting new advance in GI-tract imaging. It has expanded our view to include the small bowel, which was historically inaccessible to traditional endoscopes. This unique technology has caught the interest of the public and the lay press. Although its best-defined role is in small-bowel imaging in patients with obscure GI bleeding, other indications are emerging. Dr Glenn Eisen has reviewed the current status of the small-bowel capsule and its newer relative, the esophageal capsule. Current and potential future indications for these exciting technologies are discussed.

– Grace H. Elta, MD, Editor

Commentary

Although large or malignant pancreatic cysts can present with symptoms, the vast majority of pancreatic cysts are incidental lesions discovered on abdominal imaging examinations. Pancreatic cysts occur in up to 25% of patients undergoing abdominal imaging. The increasing resolution of both CT and magnetic resonance imaging (MRI) allows detection of cysts less than 2 cm in size. Although a few of these cysts are premalignant, the majority will remain clinically insignificant; this has created controversy about how these cysts should be evaluated and when they should be surgically resected. Dr Brugge has reviewed the types of cyst pathology and their natural history. By depending on the cyst appearance and its location within the pancreas, he has indicated when a cyst fluid aspirate by EUS-guided FNA (EUS-FNA) is useful and when surgical resection should be entertained.

– Grace H. Elta, MD, Editor

Commentary

Colon-cancer screening has been endorsed by numerous medical professional societies, and several screening methods are reimbursable by most third-party payers. Of the screening methods, colonoscopy has the best sensitivity for polyps, with the added advantage of a therapeutic option during the initial examination, making it the currently favored method. There has been substantial press coverage of this important preventive health measure, and it has been incorporated into quality measures for primary care providers. Despite these facts, current compliance with any colon-cancer screening modality is only 30% to 40%. CT colonography (CTC) is a new, alternative method for imaging the colon. Drs Banerjee and Van Dam review the current methodology and the accuracy of CTC. They also review the cost and patient satisfaction issues that will help determine its ultimate role in colon imaging and colon cancer screening.

– Grace H. Elta, MD

Commentary

Screening and surveillance of Barrett's esophagus has been recommended by gastroenterology professional society guidelines in hopes of decreasing the mortality rate from esophageal adenocarcinoma. Although a large number of clinicians believe in the efficacy of both screening and surveillance for Barrett's esophagus, the evidence regarding their value is primarily inferential and based on relatively weak data. Dr. Kenneth Wang examines the current recommendations for screening and surveillance of Barrett's esophagus and reviews the most recent literature assessing their utility.

Grace H. Elta, MD

Editor