Reviews in gastroenterological disorders最新文献

The most effective colonoscopy misses polyps, and both barium enema and computed tomography colonography studies have identified hidden areas on the proximal sides of folds, flexures, and valves where colonoscopy can miss even substantially sized lesions. This article reviews the rationale, efficacy, and clinical challenges associated with one of the most promising devices for improvement of mucosal exposure during colonoscopy, the Third Eye Retroscope (Avantis Medical, Sunnyvale, CA).

Because of the limited therapeutic options, management of patients with functional dyspepsia can be remarkably difficult. This review considers the current state of the art for patients who present with unexplained dyspepsia, and outlines a practical management approach for clinicians.

There are several available diagnostic options to evaluate patients with suspected gastroesophageal reflux, whether acid, weakly acid, or nonacid. The appropriate application of these technologies is the subject of much discussion among experts. Thoughtful use of reflux monitoring is of great benefit in the evaluation of patients with endoscopy-negative disease reflux symptoms that are resistant, recurrent, or refractory to standard or double-dose antisecretory therapy; patients with distinct, atypical symptoms such as cough, laryngitis, chest pain, globus, or regurgitation in whom heartburn is infrequent or absent; patients who are seeking surgical or endoscopic corrective procedures to treat their symptoms; and those with recurrence of symptoms after undergoing surgical procedures. Reflux monitoring may be useful in avoiding an incorrect diagnosis of gastroesophageal reflux disease (GERD) and in management of patients with Barrett's esophagus. This article will review the current clinical applications of reflux monitoring in patients with GERD.

Antimicrobial resistance is a major cause for failed Helicobacter pylori eradication. This article discusses the prevalence and mechanisms of resistance in H pylori and presents a strategy for eradication in patients harboring resistant strains.

Constipation is a common problem associated with opiates and opioid compounds used for the treatment of pain and other medical conditions, and can influence patient quality of life. Methylnaltrexone appears effective in the therapy of opioid-induced constipation and will be useful for patients failing to respond to traditional laxative regimens.

To date, no alternative platform for colonoscopy seems prepared to substantially supplant the traditional colonoscopy platform. The Invendoscope and capsule colonoscopy are the most promising of the alternative platforms. With regard to colonoscope insertion, water immersion is quite noteworthy but requires additional study in broader populations. The benefits of cap-fitted colonoscopy for insertion are small. With regard to imaging, wide-angle colonoscopy may produce an operator-dependent improvement in efficiency, but there is no consistent evidence that it improves adenoma detection. Similarly, cap-fitted colonoscopy is not convincing as a method to improve adenoma detection. There is no method for seeing flat lesions that is both effective and practical for high-level white light adenoma detectors. Narrow-band imaging may have a learning effect on low-level adenoma detectors, and autofluorescence seems promising and deserves additional study. Several methods for determination of real-time histology are promising and seem to be methods by which the cost-effectiveness of colonoscopy could be improved through reduction in pathology charges for diminutive polyps.

The consequences of nocturnal gastroesophageal reflux disease (GERD) may be greater than daytime GERD in terms of clinical complications such as increased risk of esophageal lesions and respiratory conditions, as well as issues of health-related quality of life, sleep, work productivity, and economics. Proton pump inhibitors (PPIs) are the most effective therapy for patients with GERD; however, treatment success is greater in the improvement of daytime symptoms and acid control. Acid suppression of most PPIs, which are administered once daily before breakfast, wanes during the nighttime hours. Although nighttime heartburn improves with once-daily PPI treatment, PPIs are unable to eliminate nighttime heartburn completely. Increasing the dose of a PPI provides longer acid suppression, but the benefits have not been shown to be consistently greater than standard once-daily dosing. Twice-daily dosing, with a dose given before bedtime, would extend the duration of acid suppression into the nighttime hours; however, nocturnal acid breakthrough remains an issue. As a result, improved PPIs that will more reliably control nighttime symptoms and provide on-demand relief have been developed and studied. These newer PPI formulations offer significant hope for the advancement of treatment opportunities.