Reviews in gastroenterological disorders最新文献

Capsule endoscopy (CE) is now recognized as a significant technologic advancement in gastrointestinal endoscopy that provides noninvasive, high-resolution imaging of the small bowel and esophagus. There is also growing evidence that it may be useful in the colon. Since the introduction of CE to clinical practice, its diagnostic utility has become well established for evaluation of patients with obscure gastrointestinal bleeding. It seems also to be useful in evaluating small-bowel Crohn's disease, compared with other imaging modalities. With respect to esophageal diseases, CE shows promise in the screening of esophageal varices and possibly Barrett's esophagus. A colon capsule endoscope has also been developed, and its potential use in screening for colorectal neoplasia is currently being studied. The technology and software of CE is also rapidly expanding to allow the physician to read and evaluate the capsule videos in a more efficient manner. The Given Imaging system has progressed significantly over the past several years. In addition to Given Imaging, Olympus now offers a small-bowel capsule endoscope system. This new Olympus capsule technology and how it compares with the Given Imaging System is reviewed, in addition to the various clinical uses of CE.

Self-expanding metal stents (SEMS) have changed the management of malignant gastrointestinal obstruction. In malignant gastroduodenal obstruction for which curative surgical resection is not possible, endoscopic placement of SEMS is an ideal option. Endoscopic placement of SEMS has a high rate of technical and clinical success and a low rate of complications. Most studies have shown better outcomes as compared with surgical diversion procedures. Similar to the gastroduodenal stent, colonic SEMS have a role in colonic malignancy, both as a palliative modality and as a bridge to surgery. Placement of colonic SEMS has been highly technically and clinically successful. Published series have reported low complication rates for SEMS, with excellent outcomes in the context of palliation as well as a bridge to surgical resection.

Diagnosing the patient with chronic diarrhea can still be a major challenge despite modern testing. It is useful initially to consider what may be the likely underlying pathophysiologic explanation for diarrhea from the history (osmotic, secretory, inflammatory, or motility related) and let this information drive the management algorithm. However, gastroenterologists frequently ask how far the workup should go and when a confident diagnosis of functional diarrhea can be made. In contrast to diarrhea-predominant irritable bowel syndrome, the evidence that functional diarrhea exists as a real diagnostic entity is actually remarkably unconvincing.

Recent evidence suggests that there is a link between increased colonic inflammation and risk of colorectal cancer, stressing the importance of preventing relapse. The risk of relapse is associated with several factors, of which the foremost is patient nonadherence to prescribed medical therapy. Nonadherence may be affected by such factors as complicated dosing regimens, forgetfulness, male sex, and treatment delivery methods. Mesalamine is the standard, first-line therapy and the treatment of choice for inducing and maintaining clinical and endoscopic remission of inflammation in patients with mild-to-moderate ulcerative colitis. Novel formulations of mesalamine and newly devised, high-dose regimens offer additional therapeutic options and may lead to improved treatment adherence, longer-lasting periods of remission, and enhanced patient well-being.