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This issue of Gastroenterology Clinics of North America is all about acute upper GI bleeding and is divided into two distinct sections: section I is devoted to nonvariceal upper GI bleeding and section II is devoted to variceal upper GI bleeding. Acute nonvariceal upper GI bleeding may originate from the esophagus, stomach, or duodenum, essentially anywhere proximal to the Ligament of Treitz. In Section I, Dr Gianluca Rotondano, Hospital Maresca, Torre del Greco, Italy, begins with a review of the epidemiology and diagnosis of acute nonvariceal upper GI bleeding. We then turn to patient presentation, risk stratification, and how to initially medically manage these bleeding patients. I am pleased to have one of our emergency medicine colleagues, Dr Andrew Meltzer, Department of Emergency Medicine, George Washington University, contribute this important article and provide a unique viewpoint from the emergency department where most of these patients initially present. As we all know, endoscopic hemostasis is the accepted standard of care for patients with acute nonvariceal upper GI bleeding. Moreover, peptic ulcer bleeding is the most common nonvariceal cause of acute upper GI bleeding; thus, Drs Yidan Lu, Yen-I Chen, and Alan Barkun from McGill University, Montreal, Canada, provide an in-depth review of the endoscopic management of peptic ulcer bleeding. Drs Eric Tjwa, I. Lisanne Holster, and Ernst Kuipers from the Erasmus Medical Center University Hospital, Rotterdam, The Netherlands, review the endoscopic management of all other causes of acute nonvariceal upper GI bleeding, and in addition, Drs Louis Wong Kee Song and Michael Levy from the Mayo Clinic, Rochester, Minnesota discuss emerging endoscopic hemostasis treatments, such as topical sprays and over-the-scope clipping devices. Although endoscopic hemostasis is very highly effective, there are unfortunately cases where bleeding is unable to be controlled or when significant rebleeding occurs that is not amenable to endoscopic therapy. Therefore, I have included two articles that provide insight into the question...what if endoscopic hemostasis fails? The first article, written by Drs Philip Wai Yan Chiu and James Yun Wong Lau, from Prince of Wales Hospital, The Chinese University of Hong Kong, focuses on tried and true surgical treatment options. The second article, by Dr Sujal Nanavati, University of California at San Francisco, Department of Radiology and Biomedical Imaging, addresses the alternative treatment strategy of angiographic embolization, which has now emerged as the often preferred salvage treatment strategy.
With collaboration of Dr. Alan Buchman, Consulting Editor, Dr. Perry J. Pickhardt has created a comprehensive issue of Gastroenterology Clinics that looks at imaging techniques for gastrointestinal diseases. Experts in their respective fields have contributed clinical reviews in the following areas: Evaluation of Dysphagia: The Role of Barium Fluoroscopy; CT and MR Small Bowel Enterography: Current Status and Future Trends; Radiologic Assessment of Gastrointestinal Bleeding; CT Colonography: Implementation for Screening; Rectal MR for Cancer Staging and Surveillance; Defecography (fluoro vs MR); Noninvasive Imaging Techniques for Staging Liver Fibrosis; HCC Screening: Comparison of US, CT, and MR Approaches; Pancreatic Cystic Lesions; Overview of biliary imaging; Splenomegaly: Clinico-Radiologic Approach to the Differential Diagnosis; MR for Non-Traumatic Acute Abdominal Pain: Comparison with CT and US; and PET/MR: Current Clinical Status and Future Prospects. Gastroenterologists will come away with the knowledge they need to understand the latest imaging modalities for diagnosis and assessment of gastrointestinal diseases and disorders.
Upper gastrointestinal bleeding is the leading emergency leading to hospitalization and urgent endoscopy. The field of gastrointestinal bleeding is rapidly evolving. The epidemiology is changing with more complex older patients on anticoagulant and antithrombotic agents presenting with upper gastrointestinal bleeding. The initial management has rapidly evolved with new transfusion thresholds, the use of risk stratification scores and no more nasogastric tubes. There is new data and recommendations on optimal timing of endoscopy. Medical therapies have also evolved with changes in proton pump inhibitor administration and the use of prokinetics to improve endoscopic visualization. Many modifications in endoscopic therapy have recently been advanced including the use of endoscopic ultrasound guided angiotherapy, topical sprays (i.e. Hemospray) and over-the-scope clips. In order to give optimal care to patients, it is critical that practicing gastroenterologists are aware of the many recent advances in management of patients with upper gastrointestinal bleeding.
Leading experts in the fields of gastroenterology, surgery, and radiology comprehensively review the pathophysiology, diagnosis, management, and treatment of acute bleeding disorders of the GI tract. The authors break down acute bleeding into upper and lower GI tract sources and provide a differential diagnosis for each disease, evidence-based algorithms for clinical practice, treatment modalities for its management, and standards of care. The authors outline the many dilemmas faced by physicians in their approach to their patients, such as localization of the bleeding source (upper vs lower), the need and timing for emergency endoscopy, and the timing for radiologic intervention and/or surgery.
Ikuo Hirano, an international leader and pioneer in EoE, has assembled well-recognized experts in the field to provide a state-of-the-art, practical understanding of EoE for both children and adults in 2014. Topics you will find in this issue of Gastroenterology Clinics of North America include the epidemiology, clinical presentation, diagnosis, and management of EoE as well as a glimpse into what the future holds. In addition, articles dedicated to mechanisms of disease pathogenesis and complications complete this comprehensive assessment of the field at present.The Editors believe that this issue will enhance your understanding of EoE.
Helicobacter pylori (H. pylori) infection is a worldwide disease with a significant morbidity and mortality; it is the leading cause of non-ulcer dyspepsia, peptic ulcers and gastric tumors, including low-grade mucosa-associated lymphoid tissue-lymphoma and adenocarcinoma. In addition, it has also been recognized that the interaction between H. pylori and non-steroidal, anti-inflammatory drugs is damaging to the gastroduodenal mucosa. H. pylori treatment still remains a challenge for physicians, since no current first-line therapy is able to cure the infection in all treated patients. This issue will serve to update gastroenterologists on current therapies, evaluation and management of disease progression, and the future of management of H. pylori infection.
Gastroesophageal reflux disease and its complications effect 40 % of the US population. It is the most common reason for outpatient GI visits with treatment costs amounting to nearly $10 billion a year. Thisissue updates interested physicians on the new advance in GERD pathogenesis, diagnosis and medical/surgical treatment , especially over the last 5 years. Lots of advancements have been made in this time period and this will be a excellent reference book for the busy academic and community physician interested in GERD.
By the time this issue of Gastroenterology Clinics of North America is released, it will have been 16 years since infliximab was approved by the US Food and Drug Administration for the treatment of moderate to severe Crohn disease. Not only have we come a long way in understanding the efficacy and safety of infliximab, we are beginning to understand how and when to use the drug. Furthermore, as of this writing, we have five other biologic agents approved for either Crohn disease or ulcerative colitis, and there are many more molecules currently in drug development for these indications. In this issue,the Editors have assembled a collection of experts to provide the most cutting-edge information on the status of biologic therapy for inflammatory bowel disease.
In this issue of Gastroenterology Clinics, Guest Editors M. Nedim. N. Ince and David E. Elliott bring their considerable expertise to the topic of Gastrointestinal Infections. Top experts in the field cover key topics such as Candida esophagitis, Acute bacterial gastroenteritis, Clostridium difficile infection and antibiotic-associated diarrhea, and more. - Provides concise and comprehensive coverage of the issues physicians face every day. - Presents the latest information on a timely, focused topic under the leadership of experienced editors in the field. - Contains 14 relevant, practice-oriented topics including Helicobacter pylori infection; Viral gastroenteritis in special patient populations; Rare causes of hepatitis; Postinfectious irritable bowel syndrome; and more.
This issue will be an informative treatise on gastroparesis, a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Gastroparesis is an increasingly recognized and diagnosed disorder. Treatment can be challenging due to several mechanisms which play a role in causing the symptoms. Symptoms of gastroparesis are variable and include early satiety, nausea, vomiting, bloating, and upper abdominal discomfort. These symptoms can range from mild to severe leading to such complications as malnutrition, functional disability, and multiple hospitalizations. The three most common etiologies are diabetes, post-surgical, and idiopathic (unknown). Treatment consists of dietary manipulation, medical, and surgical therapy. The articles will provide a comprehensive review and in-depth information on gastroparesis. Each chapter will be written by an expert in the area. This issue will give the reader a better appreciation for the breadth of gastroparesis.