Curr. Opin. Gastroenterol. [JOURNAL]
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200 papers
Intestinal proteases.
Rao S, Grover M
Curr Opin Gastroenterol · 2023 Nov · PMID 37678185 · Full text
PURPOSE OF REVIEW: Proteases constitute a group of enzymes that hydrolyze peptide bonds. Intestinal proteases are an integral part of gut homeostasis and digestion. This review discusses the broader classification of pro...
PURPOSE OF REVIEW: Proteases constitute a group of enzymes that hydrolyze peptide bonds. Intestinal proteases are an integral part of gut homeostasis and digestion. This review discusses the broader classification of proteases, regulation of proteolytic activity (PA) in the intestinal tract, and how dysregulation of intestinal proteases contributes to the pathophysiology of conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease. We also discuss recent advancements in therapeutic modulation that directly or indirectly target intestinal proteases and can be utilized to treat these illnesses. RECENT FINDINGS: Host and microbiota derived proteases have been associated with symptoms in subsets of patients with IBS, IBD and celiac disease. Elevated PA mediates barrier dysfunction, visceral hypersensitivity as well as immune activation and inflammation. Recent mechanistic studies have revealed the nature of disease-associated proteases and mechanisms regulating their activity, particularly those driven by the microbiota. Advancements in activity-based probes have allowed novel ways of in vivo imaging of PA. Newer strategies targeting proteases include monoclonal antibodies, engineered microbiota as well as specific protease inhibitors. SUMMARY: Significant progresses made in the detection as well as regulation of PA is likely to provide therapeutic advancements for gastrointestinal diseases.
Population level screening for celiac disease: is now the time?
Shuler B, Liu E, Stahl MG
Curr Opin Gastroenterol · 2023 Nov · PMID 37678180 · Full text
PURPOSE OF REVIEW: As incidence and prevalence of celiac disease is increasing, subclinical and asymptomatic presentations are more commonly identified through celiac disease screening. However, the United States Prevent...
PURPOSE OF REVIEW: As incidence and prevalence of celiac disease is increasing, subclinical and asymptomatic presentations are more commonly identified through celiac disease screening. However, the United States Preventive Services Task Force released a statement in 2017 maintaining that there is insufficient evidence to recommend general population screening for celiac disease for asymptomatic individuals. This review summarizes the current available evidence on celiac disease screening. RECENT FINDINGS: Literature demonstrates that by limiting screening to individuals with recognized symptoms, celiac disease diagnosis is frequently delayed or missed entirely. Most individuals with screening-identified celiac disease have previously unrecognized symptoms that improve through treatment with a gluten-free diet. Screening-identified individuals also demonstrate signs of impaired nutrition, growth, bone health, and quality of life which improve with treatment. Overall, celiac disease screening is viewed favorably by those identified through celiac disease screening programs. SUMMARY: Individuals with screening-identified celiac disease may still incur complications from untreated disease and receive benefit from treatment with a gluten-free diet. More data is needed to determine the cost effectiveness of different mass screening approaches that incorporate the societal perspective towards screening.
Step on the accelerator: modern treatment of constipation.
Staursky D, Shimoga D, Sharma A
Curr Opin Gastroenterol · 2024 Jan · PMID 37678175 · Publisher ↗
PURPOSE OF REVIEW: This review aims to explore effective management of constipation, examine challenges in making a positive diagnosis, and highlights the significance of a positive patient-provider relationship and emer...
PURPOSE OF REVIEW: This review aims to explore effective management of constipation, examine challenges in making a positive diagnosis, and highlights the significance of a positive patient-provider relationship and emerging treatments. RECENT FINDINGS: Less than one-fifth of patients feel satisfied with treatment of their constipation. Sixty percent of patients with functional dyspepsia and gastroparesis have severe to very severe constipation that correlates with their upper gastrointestinal symptom severity. Two gold kiwifruits are noninferior to 10 g of psyllium in the treatment of constipation. More than 40% of patients undergoing lumbar fusion continue to fill opioid prescriptions 90 days after surgery, contributing to 80 000 chronic opioid users annually. Most patients are using over-the-counter (OTC) treatments for constipation with greater than 60% dissatisfied. Pharmacologic management involves the use of GCC agonists and emerging drug classes such as bile acid transport inhibitors and sodium hydrogen exchanger isoform 3 (NHE3) inhibitors. Nonpharmacologic treatments, including neuromodulation and FDA-approved vibrating capsule, show promise in improving symptoms and quality of life. SUMMARY: Constipation significantly impacts patients' quality of life and well being and the majority of patients are refractory to conservative measures and OTC treatments. Both pharmacologic and nonpharmacologic treatments hold promise for improving constipation and quality of life.
Gastroparesis: time for a paradigm change.
Lacy BE, Wise JL, Cangemi DJ
Curr Opin Gastroenterol · 2023 Nov · PMID 37678168 · Publisher ↗
PURPOSE OF REVIEW: Gastroparesis (GP) is a syndrome defined by symptoms and delayed gastric emptying in the absence of mechanical obstruction. Typical symptoms include nausea, vomiting, abdominal pain, and early satiety....
PURPOSE OF REVIEW: Gastroparesis (GP) is a syndrome defined by symptoms and delayed gastric emptying in the absence of mechanical obstruction. Typical symptoms include nausea, vomiting, abdominal pain, and early satiety. Only one medication is currently FDA-approved for the treatment of GP. This review highlights recent research findings pertaining to GP and provides evidence to support a change in the current GP diagnostic and treatment paradigm. RECENT FINDINGS: An analysis of GP trials over the past four decades demonstrates the power of placebo and the need to perform longer studies with clearly defined patient populations. Two studies highlight the need to evaluate patients with suspected GP carefully and to perform gastric emptying studies properly. The misdiagnosis of GP symptoms is reviewed, preceded by a discussion of whether GP should be considered a disorder of gut-brain interaction. Finally, new data on therapies that target the pylorus are highlighted. SUMMARY: Gastroparesis is frequently over-diagnosed and incorrectly diagnosed. Performing a proper gastric emptying study which adheres to standard protocol, and accurately interpreting the results in the context of the individual patient, are critical to making an accurate diagnosis of GP. The treatment paradigm needs to shift from simply aiming to accelerate gastric emptying to treating global symptoms of a chronic syndrome that may represent gut-brain dysfunction in many patients.
Evaluation and management of exocrine pancreatic insufficiency: pearls and pitfalls.
Ramsey ML, Hart PA, Forsmark CE
Curr Opin Gastroenterol · 2023 Sep · PMID 37530731 · Full text
PURPOSE OF REVIEW: The diagnosis and management of exocrine pancreatic dysfunction (EPD) can be challenging. EPD classically results from conditions that cause loss of pancreatic acinar cell function and decreased digest...
PURPOSE OF REVIEW: The diagnosis and management of exocrine pancreatic dysfunction (EPD) can be challenging. EPD classically results from conditions that cause loss of pancreatic acinar cell function and decreased digestive enzyme production. However, several conditions may contribute to signs or symptoms of EPD with otherwise normal pancreatic exocrine function. A thoughtful approach to considering these conditions, along with their specific therapies, can guide a tailored management approach. RECENT FINDINGS: An EPD severity classification schema has been proposed, which emphasizes a shift towards a more restrictive prescription of pancreas enzyme replacement therapy (PERT) for patients with milder EPD. In contrast, PERT use has been associated with a measurable survival benefit among individuals with EPD and pancreatic cancer, so the prescription of PERT may be more liberal in this population. Recent publications in the cystic fibrosis population offer pearls guiding the titration and optimization of PERT. SUMMARY: Among individuals with severe EPD, PERT is an effective therapy. Among individuals with milder EPD, although PERT is effective, there may be opportunities to provide additional and potentially more effective therapies.
Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy.
Ichkhanian Y, Jovani M
Curr Opin Gastroenterol · 2023 Sep · PMID 37530730 · Publisher ↗
PURPOSE OF REVIEW: Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via th...
PURPOSE OF REVIEW: Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions. RECENT FINDINGS: Pancreatobiliary (PB) and non-PB interventions are challenging in patients with SAA. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and endoscopic ultrasound (EUS)-directed transenteric ERCP (EDEE) are effective procedures that are being increasingly utilized to perform ERCP in patient with Roux-en-Y gastric bypass (RYGB) and non-RYGB SAA, respectively. Furthermore, EUS-directed trans-gastric intervention (EDGI) is a collective term for the non-PB procedures that could be performed in patients with SAA. EDGE/EDEE/EDGI are considered relatively safe procedures, however, intra-procedural stent misdeployement, and long-term ramifications of persistent fistula and stent migration could require endoscopic or, in rare instances, surgical management. SUMMARY: The advent of LAMS has revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. With the growing body of literature, it is expected that such techniques will be more commonly performed in the community, providing less invasive and more effective treatment options for patients with SAA.
Therapeutic endoscopy pushing the boundaries: what boundaries?
Kalloo AN
Curr Opin Gastroenterol · 2023 Sep · PMID 37530729 · Publisher ↗
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Endoscopic therapy for gastroesophageal reflux disease: where are we, where are we going?
Haseeb M, Thompson CC
Curr Opin Gastroenterol · 2023 Sep · PMID 37523156 · Full text
PURPOSE OF REVIEW: Gastroesophageal reflux disease (GERD) is the most common chronic condition with increasing prevalence in the Western world. Despite medical therapy, a considerable proportion of patients continue to e...
PURPOSE OF REVIEW: Gastroesophageal reflux disease (GERD) is the most common chronic condition with increasing prevalence in the Western world. Despite medical therapy, a considerable proportion of patients continue to experience symptoms, thus fueling the demand for minimally invasive GERD treatment options. This review will assess the currently available endoscopic approaches by analyzing their outcomes data, indication for use and limitations. RECENT FINDINGS: With increasing evidence of the safety and efficacy of endoscopic therapies, recent guidelines and consensus society documents have updated their recommendations for the endoscopic treatment of GERD. In this review, we have comprehensively assessed the current landscape of endoscopic approaches for the treatment of GERD and provided insight into future directions. SUMMARY: Endoscopic therapies for GERD show promise as new treatments emerge and existing therapies evolve into safer and more reproducible options. They are well positioned to cater to a large subset of the population suffering from chronic condition of GERD.
Endotherapy in pediatric pancreatitis.
Norris N, Troendle DM
Curr Opin Gastroenterol · 2023 Sep · PMID 37523027 · Publisher ↗
PURPOSE OF REVIEW: Some children with acute recurrent and chronic pancreatitis stand to benefit from therapeutic endoscopic interventions. The purpose of this review is to summarize specific endoscopic therapies used for...
PURPOSE OF REVIEW: Some children with acute recurrent and chronic pancreatitis stand to benefit from therapeutic endoscopic interventions. The purpose of this review is to summarize specific endoscopic therapies used for these conditions and highlight areas of future research. RECENT FINDINGS: Multicenter collaboration and consortium efforts have provided more data now than ever on the technical outcomes and safety of therapeutic endoscopic procedures for pancreatitis in children. Indications are growing but more research is needed to help guide patient selection. SUMMARY: Advanced endoscopic procedures including endoscopic retrograde cholangiopancreatography, endoscopic-ultrasound guided therapies, and single-operator pancreatoscopy may be used in patients with acute recurrent or chronic pancreatitis to manage pancreatic duct obstruction or local complications including pseudocysts and walled-off necrosis. Patient and procedural factors differ between adults and children. Access to these procedures for younger children is growing, and technical outcomes and adverse event rates appear similar between adults and children.
A review of deep learning and radiomics approaches for pancreatic cancer diagnosis from medical imaging.
Yao L, Zhang Z, Keles E … +3 more , Yazici C, Tirkes T, Bagci U
Curr Opin Gastroenterol · 2023 Sep · PMID 37523001 · Full text
PURPOSE OF REVIEW: Early and accurate diagnosis of pancreatic cancer is crucial for improving patient outcomes, and artificial intelligence (AI) algorithms have the potential to play a vital role in computer-aided diagno...
PURPOSE OF REVIEW: Early and accurate diagnosis of pancreatic cancer is crucial for improving patient outcomes, and artificial intelligence (AI) algorithms have the potential to play a vital role in computer-aided diagnosis of pancreatic cancer. In this review, we aim to provide the latest and relevant advances in AI, specifically deep learning (DL) and radiomics approaches, for pancreatic cancer diagnosis using cross-sectional imaging examinations such as computed tomography (CT) and magnetic resonance imaging (MRI). RECENT FINDINGS: This review highlights the recent developments in DL techniques applied to medical imaging, including convolutional neural networks (CNNs), transformer-based models, and novel deep learning architectures that focus on multitype pancreatic lesions, multiorgan and multitumor segmentation, as well as incorporating auxiliary information. We also discuss advancements in radiomics, such as improved imaging feature extraction, optimized machine learning classifiers and integration with clinical data. Furthermore, we explore implementing AI-based clinical decision support systems for pancreatic cancer diagnosis using medical imaging in practical settings. SUMMARY: Deep learning and radiomics with medical imaging have demonstrated strong potential to improve diagnostic accuracy of pancreatic cancer, facilitate personalized treatment planning, and identify prognostic and predictive biomarkers. However, challenges remain in translating research findings into clinical practice. More studies are required focusing on refining these methods, addressing significant limitations, and developing integrative approaches for data analysis to further advance the field of pancreatic cancer diagnosis.
Artificial intelligence in digestive endoscopy: recent advances.
Rey JF
Curr Opin Gastroenterol · 2023 Sep · PMID 37522929 · Publisher ↗
PURPOSE OF REVIEW: With the incessant advances in information technology and its implications in all domains of our life, artificial intelligence (AI) started to emerge as a need for better machine performance. How it ca...
PURPOSE OF REVIEW: With the incessant advances in information technology and its implications in all domains of our life, artificial intelligence (AI) started to emerge as a need for better machine performance. How it can help endoscopists and what are the areas of interest in improving both diagnostic and therapeutic endoscopy in each part of the gastrointestinal (GI) tract. What are the recent benefits and clinical usefulness of this new technology in daily endoscopic practice. RECENT FINDINGS: The two main AI systems categories are computer-assisted detection 'CADe' for lesion detection and computer-assisted diagnosis 'CADx' for optical biopsy and lesion characterization. Multiple softwares are now implemented in endoscopy practice. Other AI systems offer therapeutic assistance such as lesion delineation for complete endoscopic resection or prediction of possible lymphanode after endoscopic treatment. Quality assurance is the coming step with complete monitoring of high-quality colonoscopy. In all cases it is a computer-aid endoscopy as the overall result rely on the physician. Video capsule endoscopy is the unique example were the computer conduct the device, store multiple images, and perform accurate diagnosis. SUMMARY: AI is a breakthrough in digestive endoscopy. Screening gastric and colonic cancer detection should be improved especially outside of expert's centers. Prospective and multicenter trials are mandatory before introducing new software in clinical practice.
Endoluminal bariatric and metabolic therapies: state-of-the-art.
Bakheet N, Badurdeen D, Sartoretto A … +1 more , Kumbhari V
Curr Opin Gastroenterol · 2023 Sep · PMID 37522920 · Publisher ↗
PURPOSE OF REVIEW: The aim of this review is to present the current state of the field, highlight recent developments, and describe the clinical outcomes of these endoluminal bariatric and metabolic procedures. RECENT FI...
PURPOSE OF REVIEW: The aim of this review is to present the current state of the field, highlight recent developments, and describe the clinical outcomes of these endoluminal bariatric and metabolic procedures. RECENT FINDINGS: The landscape of endoluminal devices and techniques for treating obesity has expanded significantly, with FDA-approved therapies currently available to patients with a body mass index values as high as 50 kg/m 2 . Although notable advancements have been made in this area, there is a need for further emphasis to be placed on the metabolic improvements resulting from these therapies, in addition to the conventional focus on weight loss outcomes. Some of these procedures are now FDA approved for the treatment of metabolic disease as opposed to weight loss. To achieve the most favorable results, it is imperative that all endoluminal interventions are combined with a moderately intensive diet and lifestyle program lasting at least 12 months. SUMMARY: Endoluminal metabolic and bariatric therapy represents a bridge between lifestyle counseling, pharmaceutical interventions, and the most efficacious treatment for obesity, bariatric surgery. By virtue of its minimally invasive approach, this therapy may be an appealing option for patients who are ineligible for, or averse to, bariatric surgery and who have experienced suboptimal outcomes or unable to afford medical treatments. Furthermore, these interventions may be particularly beneficial in the early stages of obesity.
Fluid resuscitation in acute pancreatitis.
Yang AL, Vege SS
Curr Opin Gastroenterol · 2023 Sep · PMID 37421393 · Publisher ↗
PURPOSE OF REVIEW: The purpose of the review is to critically evaluate the evidence from the literature to establish the current perspective on fluid resuscitation (FR) in acute pancreatitis (AP). We will review the rati...
PURPOSE OF REVIEW: The purpose of the review is to critically evaluate the evidence from the literature to establish the current perspective on fluid resuscitation (FR) in acute pancreatitis (AP). We will review the rationale, type of fluid, rate of administration, total volume, duration, monitoring, ideal outcomes to be studied in clinical trials and recommendations for future studies. RECENT FINDINGS: FR remains the key component of supportive therapy in AP. The paradigm has shifted from administration of aggressive fluid resuscitation towards more moderate FR strategies. Lactated Ringer's remains the preferred fluid for resuscitation. There remain critical gaps in knowledge regarding the end point(s) to indicate adequate resuscitation, and accurate assessments of fluid sequestration and intravascular volume deficit in AP. SUMMARY: There is insufficient evidence to state that goal-directed therapy, using any of the parameters to guide fluid administration, reduces the risk of persistent organ failure, infected pancreatic necrosis, or mortality in AP, as well as the most appropriate method for the same.
Medical management of hypertriglyceridemia in pancreatitis.
Gligorijevic N, Stefanovic-Racic M, Kershaw EE
Curr Opin Gastroenterol · 2023 Sep · PMID 37421386 · Publisher ↗
PURPOSE OF REVIEW: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) should be considered in all cases of acute pancreatitis and triglyceride levels measured early, so that appropriate early and long-term treatmen...
PURPOSE OF REVIEW: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) should be considered in all cases of acute pancreatitis and triglyceride levels measured early, so that appropriate early and long-term treatment can be initiated. RECENT FINDINGS: In most cases of HTG-AP, conservative management (nothing by mouth, intravenous fluid resuscitation and analgesia) is sufficient to achieve triglyceride levels less than 500 mg/dl. Intravenous insulin and plasmapheresis are sometimes used, although prospective studies showing clinical benefits are lacking. Pharmacological management of hypertriglyceridemia (HTG) should start early and target triglyceride levels of less than 500 mg/dl to reduce the risk or recurrent acute pancreatitis. In addition to currently used fenofibrate and omega-3 fatty acids, several novel agents are being studied for long-term treatment of HTG. These emerging therapies focus mainly on modifying the action of lipoprotein lipase (LPL) through inhibition of apolipoprotein CIII and angiopoietin-like protein 3. Dietary modifications and avoidance of secondary factors that worsen triglyceride levels should also be pursued. In some cases of HTG-AP, genetic testing may help personalize management and improve outcomes. SUMMARY: Patients with HTG-AP require acute and long-term management of HTG with the goal of reducing and maintaining triglyceride levels to less than 500 mg/dl.
Thermal ablative therapies in the gastrointestinal tract.
Manner H
Curr Opin Gastroenterol · 2023 Sep · PMID 37389449 · Publisher ↗
PURPOSE OF REVIEW: Thermal ablatives therapies have seen an expanding role in gastrointestinal endoscopy during the last years. The aim of this review is to give an overview of the currently available techniques. RECENT...
PURPOSE OF REVIEW: Thermal ablatives therapies have seen an expanding role in gastrointestinal endoscopy during the last years. The aim of this review is to give an overview of the currently available techniques. RECENT FINDINGS: In the upper gastrointestinal tract, mainly in early Barrett's neoplasia, endoscopic ablation strategies ranging from RFA to Hybrid-APC are, together with resection strategies, the main part of the armamentarium. In the small intestine, argon plasma coagulation (APC) can be effectively used for the treatment of angiodysplasias. In the lower gastrointestinal tract, APC and RFA are mainly used. In tumour obstruction, thermal ablation is used to reopen the lumen. The selection of available techniques is still increasing. SUMMARY: The variety of ablation techniques enables the endoscopist to choose the appropriate ablation tool for each individual patient.
Endoscopic approaches to small intestinal strictures.
Ashat M, El-Abiad R, Khashab MA
Curr Opin Gastroenterol · 2023 Sep · PMID 37389433 · Publisher ↗
PURPOSE OF REVIEW: Gastric outlet obstruction (GOO) occurs from benign or malignant causes. Historically, the treatment of benign strictures revolved around endoscopic balloon dilation, whereas, in the case of malignant...
PURPOSE OF REVIEW: Gastric outlet obstruction (GOO) occurs from benign or malignant causes. Historically, the treatment of benign strictures revolved around endoscopic balloon dilation, whereas, in the case of malignant strictures, the placement of self-expandable metallic stents was the focus. The advent of lumen-apposing metal stent has opened new horizons in addressing shortcomings of enteral stenting and surgical gastroenterostomies. The purpose of the review is to discuss the endoscopic approaches to small bowel strictures and to examine the supporting data behind each practice. RECENT FINDINGS: Given the risk and futility of balloon dilation for malignant strictures, enteral stenting is pursued in patients who are poor surgical candidates and with life expectancy less than 6 months. For patients with longer survival, surgical gastroenterostomy (S-GE) should be considered. Recent data have shown comparable technical and clinical success rates between EUS-gastroenterostomy and S-GE but with lower adverse event rate and hospital length of stay. SUMMARY: In recurrent benign strictures and malignant GOO, EUS-GE has recently gained momentum in providing an effective and a well tolerated alternative. Individualized therapy centered around the patient's prognosis and preference while factoring in the local expertise for the specific indication is vital.
Endoscopic approaches to the management of hemorrhoids.
Kodilinye SM, Kalloo AN
Curr Opin Gastroenterol · 2023 Sep · PMID 37389425 · Publisher ↗
PURPOSE OF REVIEW: To review the literature within the last 5 years on the current status and future perspectives of the endoscopic management of internal hemorrhoids. RECENT FINDINGS: Despite the large burden of hemorrh...
PURPOSE OF REVIEW: To review the literature within the last 5 years on the current status and future perspectives of the endoscopic management of internal hemorrhoids. RECENT FINDINGS: Despite the large burden of hemorrhoidal diseases, research in this area, particularly on endoscopic approaches for treatment, has been slow. Within the last 5 years, data has been published on the novel cap-assisted endoscopic sclerotherapy (CAES), which will continue to gain attention in the future. Rubber band ligation has been adopted by the endoscopist as endoscopic rubber band ligation (ERBL), demonstrating satisfactory results in treating symptomatic hemorrhoids, although mild postprocedure complications are common. Data is needed on head-to-head comparisons between ERBL, endoscopic sclerotherapy, and CAES. Other methods, such as coagulation, are understudied and should be explored further in the endoscopic setting. Meaningful comparisons between treatment methods for internal hemorrhoids have been difficult because of variations in interventional techniques and methods, differences in the grading of hemorrhoids, and lack of standardization of clinical trials. The Goligher classification alone is inadequate for determining the management of symptomatic hemorrhoids and this warrants revision. SUMMARY: Gastroenterologists are poised to assume a greater role in the management of internal hemorrhoids with flexible endoscopy. Current endoscopic treatment options require further study.
Interpretation of serum pancreatic enzymes in pancreatic and nonpancreatic conditions.
Bush N, Akshintala VS
Curr Opin Gastroenterol · 2023 Sep · PMID 37389417 · Publisher ↗
PURPOSE OF REVIEW: Serum levels of amylase and lipase can be elevated in nonpancreatic conditions that may or may not be associated with abdominal pain. This leads to a large proportion of patients being falsely labeled...
PURPOSE OF REVIEW: Serum levels of amylase and lipase can be elevated in nonpancreatic conditions that may or may not be associated with abdominal pain. This leads to a large proportion of patients being falsely labeled as having acute pancreatitis. In this review, we aim to summarize the existing evidence on pancreatic enzyme elevation in various pancreatic and nonpancreatic conditions and its practical implications in clinical practice and healthcare. RECENT FINDINGS: Serum amylase and lipase levels are not specific for pancreatitis. Attempts have been made to validate newer biomarkers including pancreatic elastase, serum trypsin, urinary trypsinogen-activated peptide, phospholipase A2, carboxypeptidase B, activated peptide of carboxypeptidase B, the trypsin 2 alpha 1 activation complex, and circulating cell-free DNA for the diagnosis of acute pancreatitis. SUMMARY: Serum lipase levels can be elevated in many intra-abdominal inflammatory conditions. Although more sensitive and specific than amylase, serum lipase levels are not sufficient to diagnose acute pancreatitis in patients with abdominal pain. There is a need to increase stress on radiological evidence as well increase cut-off levels of enzyme elevation for a more accurate diagnosis of acute pancreatitis.
Modern approaches to treating Zenker's diverticulum.
Fair L, Ward MA
Curr Opin Gastroenterol · 2023 Jul · PMID 37278290 · Publisher ↗
PURPOSE OF REVIEW: Zenker's diverticulum is the most common hypopharyngeal diverticulum. Patients with Zenker's diverticulum may require surgical treatment, which can be performed via an open surgical or endoscopic appro...
PURPOSE OF REVIEW: Zenker's diverticulum is the most common hypopharyngeal diverticulum. Patients with Zenker's diverticulum may require surgical treatment, which can be performed via an open surgical or endoscopic approach. A new endoscopic technique that is now being used for Zenker's diverticulum is Zenker Per Oral Endoscopic Myotomy (ZPOEM). ZPOEM has demonstrated promising results, and may have certain advantages over the other endoscopic treatments. The purpose of this review article is to evaluate the various surgical and endoscopic treatment options for Zenker's diverticulum, while specifically focusing on ZPOEM. RECENT FINDINGS: Endoscopic approaches have become the first-line therapy for Zenker's diverticulum, replacing the traditional open approach, because of the less invasive nature of the endoscopic procedures, improved rates of morbidity, and quicker recovery times. Recent studies evaluating ZPOEM have demonstrated that it is technically feasible and highly efficacious. In addition, it has a low rate of clinical recurrence and adverse events. When compared with other endoscopic techniques for treating Zenker's diverticulum, ZPOEM appears to have improved outcomes. SUMMARY: ZPOEM has been recently implemented in the algorithm of Zenker's diverticulum management. Further comparative and prospective studies focusing on long-term follow-up are still needed; however, ZPOEM appears to be an excellent option for patients suffering from Zenker's diverticulum.
G-POEM for gastroparesis: past, present and future.
Vohra I, Gopakumar H, Adler DG
Curr Opin Gastroenterol · 2023 Sep · PMID 37265234 · Publisher ↗
PURPOSE OF REVIEW: Gastroparesis is a chronic debilitating condition with rising incidence and healthcare burden. As abdominal surgeries, diabetes, viral infections and autoimmune diseases become more prevalent, gastropa...
PURPOSE OF REVIEW: Gastroparesis is a chronic debilitating condition with rising incidence and healthcare burden. As abdominal surgeries, diabetes, viral infections and autoimmune diseases become more prevalent, gastroparesis will continue to upsurge. Conservative treatment options for gastroparesis are limited by their side effects and short-term efficacy. Gastric endoscopic pyloromyotomy (G-POEM) is a novel incisionless endosurgical technique with excellent long-term outcomes. This review is in time, as the demand for G-POEM will continue to escalate. RECENT FINDINGS: This review encompasses the conservative and nonconservative treatment options for gastroparesis. G-POEM is a nonconservative treatment option, and the aim of this review is to discuss the variations in technique of G-POEM, short-term and long-term clinical efficacy of G-POEM and adverse events associated with it. SUMMARY: G-POEM has high technical and clinical success with minimal adverse events. G-POEM outcomes are similar or superior when compared with other treatment options for refractory gastroparesis. G-POEM is being widely adopted and will become the preferred treatment choice in patients with refractory gastroparesis.
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