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Primary sclerosing cholangitis (PSC) is a progressive inflammatory and fibrosing condition, which can lead to chronic cholestasis and biliary cirrhosis. The pathogenesis of PSC is not clearly understood; therapies that impact disease progression are currently limited—liver transplantation is the only curative treatment modality. This Review provides an update on the current understanding and management of this condition and its associated complications.
Anemia is the most prevalent extraintestinal complication of IBD—it affects both quality of life and ability to work. Although the causes of anemia in IBD are multifactorial, iron deficiency anemia is the most common. In this Review, the authors provide an overview of iron homeostasis in health before discussing diagnostic and therapeutic strategies for iron deficiency anemia in patients with IBD.
The histopathological diagnosis of gastrointestinal cancers is usually unambiguous, but it does have its limitations. In the era of personalized medicine, molecular biomarkers are increasingly being explored, not only as viable diagnostic tools but also for predicting therapeutic response. In this Review, the authors discuss the most common clinically available biomarkers for cancers of the stomach, pancreas and colon, and the most promising molecular biomarkers for esophageal neoplasms.
In a prospective Chinese study in which bismuth was added to standard PPI-based triple therapy, the Helicobacter pylori eradication rate was above 90%. Increased treatment duration was also crucial—a therapeutic gain of 13% was achieved if the quadruple therapy was administered for 14 days instead of 7 days. Clarithromycin resistance was also overcome by the prolonged bismuth-containing quadruple therapy.
Despite steady improvement in survival after variceal bleeding in patients with cirrhosis, bleeding-related mortality remains high. Current treatment recommendations utilize a step-up strategy, in which only patients who rebleed despite drug and endoscopic therapy undergo TIPS (transjugular intrahepatic portosystemic shunt) implantation; however, in patients who are at high risk of rebleeding, early use of TIPS might greatly reduce mortality.
Endoscopic ultrasound (EUS) is the diagnostic modality of choice for various pancreatic pathologies. A recent study has suggested that EUS evaluation during diagnostic workup is a predictor of increased survival in patients with pancreatic cancer owing to improved pancreatic cancer staging and selection of suitable candidates for surgery.
Moderate sedation is typically used during lower gastrointestinal endoscopy procedures. Deep sedation with propofol is becoming widespread but carries the risk of cardiorespiratory depression. Nitrous oxide is an inhaled sedative administered routinely in dentistry that might prove to be a safe option for sedation during lower gastrointestinal endoscopy.
IBS is a common gastrointestinal condition characterized by abdominal pain associated with altered bowel habits. Limited and judicious use of diagnostic testing is recommended, particularly in patients with typical symptoms without alarm signs and symptoms. Management of IBS is multifaceted and is often driven by illness severity, predominant symptoms and patient and practitioner preferences. Sarah Khan and Lin Chang discuss the current evidence-based recommendations for the diagnosis and management of IBS.