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Endoscopy is the mainstay for diagnosis and therapy of upper gastrointestinal bleeding. Early risk assessment is crucial for effective timing of endoscopy and determination of the need for other measures to be taken—scoring systems should be used for this purpose. A new prospective study suggests that the Blatchford score can identify patients who do not need endoscopic intervention.
Hemochromatosis associated with HFE C282Y homozygosity affects persons of western European descent, and is the most common and well-characterized primary iron overload disorder worldwide. New clinical practice guidelines summarize current knowledge of the prevalence and penetrance of C282Y homozygosity and provide evidence-based recommendations for diagnosis and management of patients with HFE hemochromatosis.
A confident and efficient diagnosis of IBS is an important aspect of clinical gastroenterology. How far to investigate a patient with typical IBS symptoms has been the subject of a number of clinical guidelines. A recent study has recommended, somewhat provocatively, that investigation for pancreatic exocrine insufficiency should be added to the tests undertaken in patients with suspected diarrhea-predominant IBS who are referred to a gastroenterologist.
A 38-year-old female was evaluated for a 3 year history of postprandial abdominal pain, refractory nausea, vomiting and hematemesis. Her medical history was significant for juvenile polyposis syndrome and Crohn's disease resulting in a total colectomy. Juvenile polyposis syndrome with outlet obstruction of the stomach and excessive hypergastrinemia was diagnosed and treatment started with acid suppressive therapy, prokinetic therapy and total parenteral nutrition. Repetitive endoscopic polypectomy (also known as debulking) was performed twice followed by gastrectomy with duodeoesophageal anastomosis.
Tuberculosis is one of the most important infectious diseases worldwide. Hepatotoxic effects are a serious problem in patients who are undergoing treatment for tuberculosis, as they can cause morbidity and mortality as well interrupt their therapy and limit the efficacy of the antitubercular regimen. In this Review, Senousy and colleagues discuss the hepatotoxic effects of antituberculosis drugs and the management of these effects.
Bowel cleansing is necessary before a colonoscopy or colonic radiological examination, but the procedure is not without risks. This Review describes the safety issues related to the three major osmotically acting cathartics currently in use for bowel cleansing: sodium-phosphate-based products, polyethylene glycol and electrolyte lavage solutions, and magnesium-citrate-based agents. This Review also includes recommendations for the safe use of these agents in bowel cleansing, and discusses which patients are at risk of serious adverse events.
This article considers the case of a 72-year-old woman who presented with a 2-month history of right upper quadrant abdominal pain and a 15-day history of jaundice. The patient was diagnosed with bile duct duplication and coexistent cholangiocarcinoma. This Case Study explores the diagnosis and management of this patient and is believed to be the first reported case in the literature of this unique variant of bile duct duplication.
The etiology of acute biliary pancreatitis is complex and, as outlined in this Review, involves multiple factors including anatomy, genetics, gallstones, bile and pancreatic juice exclusion and ampullary obstruction. In this article, the authors also discuss the importance of establishing a biliary origin in acute pancreatitis and how both serum biochemistry and imaging investigations are vital to confirm a diagnosis of acute biliary pancreatitis.
Hepatic encephalopathy is an important neuropsychiatric complication of liver disease that in severe cases can lead to coma and death. This Review describes the pathogenesis of hepatic encephalopathy including the role of ammonia, inflammation, neurosteroids and manganese in the development of this disorder. The authors also discuss how best to clinically manage patients with hepatic encephalopathy by highlighting the clinical scales and tests used to grade the disorder and the different treatment strategies available.
