Reviews in gastroenterological disorders最新文献

The use of sedation with peroral passage of conventionally sized endoscopes for upper endoscopy is the standard practice for most endoscopists in the United States. The administration of sedatives requires time-consuming and resource-intensive patient monitoring, has substantial cost, and can produce side effects and rare complications. Ultra-thin videoendoscopes (outer diameter less than 6 mm) have been developed, can easily be passed transorally or transnasally without sedation, and have been shown to be well tolerated and accurate. Unsedated upper endoscopy can provide an efficient, cost-effective alternative to standard endoscopy, should be useful for endoscopic screening, and can be offered as an option to conventional sedated examination.

A clinically important subset of patients with erosive esophagitis will not attain adequate symptom relief and healing on once-a-day proton pump inhibitor therapy. This is especially true in patients with frequent and nocturnal heartburn and in those with Los Angeles Grades C and D erosive esophagitis. The approach to evaluation and management of cases of refractory or difficult gastroesophageal reflux disease is the subject of this state-of-the-art review.

The use of sedation with peroral passage of conventionally sized endoscopes for upper endoscopy is the standard practice for most endoscopists in the United States. The administration of sedatives requires time-consuming and resource-intensive patient monitoring, has substantial cost, and can produce side effects and rare complications. Ultra-thin videoendoscopes (outer diameter less than 6 mm) have been developed, can easily be passed transorally or transnasally without sedation, and have been shown to be well tolerated and accurate. Unsedated upper endoscopy can provide an efficient, cost-effective alternative to standard endoscopy, should be useful for endoscopic screening, and can be offered as an option to conventional sedated examination.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is increasing, primarily due to arthritis in the aging population. This article reviews current data on the risk of gastrointestinal complications related to NSAIDs and strategies to manage risk in patients taking these agents. Risks of NSAID use include gastrointestinal ulceration, hemorrhage, or perforation; renal dysfunction; death; and dyspepsia. Alternate therapies include use of non-NSAID analgesics; low-dose NSAIDs; and concurrent administration of cytoprotective agents with NSAIDs, acid inhibitors, proton pump inhibitors, and COX-2 agents.

Most current drug delivery systems in the treatment of ulcerative colitis and Crohn's disease release the active drug at the least effective location for treatment. The pharmaceutical industry has been developing different delivery systems for Multi-Matrix System (MMX) mesalamine for the treatment of Crohn's disease and ulcerative colitis. The new oral mesalamine formulation is a once-daily MMX tablet that delivers the mesalamine to the colon, making it most useful in the treatment of ulcerative colitis. The MMX coating matrix and coating system begin dissolution in the final portion of the ileum. This type of oral formulation may make MMX a preferred agent over other oral mesalamine and mesalamine-prodrug formulations that release the drug proximally in the gastrointestinal tract. Unlike previous formulations, it can be administered once daily for the treatment of ulcerative colitis.

There has been a significant increase in the incidence and severity of Clostridium difficile-associated diarrhea (CDAD) in the past several years, including outbreaks in multiple states and provinces in the United States and Canada, as well as in the United Kingdom. A new, highly virulent strain of C. difficile has appeared that is less responsive to standard therapy and associated with a high rate of recurrence. Along with nosocomially acquired infections there has been a rise in the number of community-acquired cases of CDAD, even among those without prior antibiotic exposure. Many factors have contributed to this epidemic, including the development of resistance to the widely used fluoroquinolones class of antibiotics. Because this new strain is less responsive to standard therapy, particularly metronidazole, a number of new antibiotics and other therapies are actively being investigated for use in both primary and recurrent CDAD. A multifaceted approach to managing CDAD is called for, including active surveillance, antibiotic stewardship, and meticulous attention to contact precautions, including gloves, gowns, and hand washing.