Gastroenterology

Expanding endoscopic interventions for pancreatic pseudocyst and walled-off necrosis
Recently, several endoscopists have described the usefulness of the endoscopic ultrasonography (EUS)-guided, single transluminal gateway technique (SGT) using transmural placement of single or multiple plastic stents or metal stents for a pancreatic pseudocyst (PC) and walled-off necrosis (WON). Moreover, the uses of the multiple transluminal gateway technique (MTGT) and single transluminal gat...


Autoimmune liver disease: Novelties in management
Autoimmune liver disease is the second commonest cause of chronic liver disease in teenagers. There are several forms including autoimmune hepatitis, autoimmune sclerosing cholangitis, primary sclerosing cholangitis and various overlap syndromes, classified on the basis of different serum antibody profiles, histological features and appearances on cholangiography. Treatment with immunosupressan...
Constrictive pericarditis caused by a pericardial-occupying tumor due to esophageal cancer
A 61-year-old female was admitted to our hospital for esophageal cancer treatment. Esophagectomy with 2-field lymphadenectomy was performed. Postoperative findings revealed the lesion was a poorly differentiated squamous cell carcinoma invading into the diaphragm and there were no carcinoma cells on the surgical margins. Eight months after surgery, a recurrence was suspected by the presence of ...


The role of pain modulators in esophageal disorders – no pain no gain
Pain modulators have been primarily used for the management of functional esophageal disorders. Recently, these drugs have also been used for the management of other esophageal disorders, such as non-erosive reflux disease, the hypersensitive esophagus, and heartburn that is not responsive to proton pump inhibitor treatment. Several etiologies have been identified in patients with functional es...
Parameters for quantifying bolus retention with high-resolution impedance manometry
This study aimed to develop a methodology for quantifying esophageal bolus retention using a high-resolution esophageal impedance topography (EIT) technique. The ability of impedance to quantify bolus retention was validated by comparison with concurrent fluoroscopic imaging (barium bolus) in 10 healthy subjects. High-resolution impedance manometry (HRIM) studies without fluoroscopy were perfor...


The Subspecialization of Surgery: A Paradigm Shift
General surgery has become increasingly fragmented into subspecialties and diseases previously treated by general surgeons are now managed by “specialists”. The Resident Education Committee of the Society for Surgery of the Alimentary Tract (SSAT) has reviewed the history of surgical training and factors that have contributed to this evolution to subsepcialization. As it is unlikely that th...
Directly Observed Care: Can Unannounced Standardized Patients Address a Gap in Performance Measurement?
There are three potential sources of information for evaluating a clinician’s performance: documentation, patient report, and directly observed care. Current measures draw on just two of these: data recorded in the medical record and surveys of patients. Neither captures an array of performance characteristics, including clinician attention to symptoms and signs while taking a history or cond...

Patterns of Surveillance Following Curative Intent Therapy for Gastroesophageal Cancer
Our aims were to examine surveillance strategies after curative treatment of early gastroesophageal (GE) cancer and to evaluate the impact of different approaches on outcomes. A total of 292 patients with non-metastatic GE cancer who were referred to the BC Cancer Agency from 2001 to 2010 for curative intent treatment were analyzed. Surveillance practices were classified into the following: coh...
The Impact of Capsaicin Intake on Risk of Developing Gastric Cancers: A Meta-Analysis
Reported associations of capsaicin with gastric cancer development have been conflicting. Here, we examine 10 published articles that explore these associations using 2,452 cases and 3,996 controls. We used multiple search strategies in MEDLINE through PubMed to seek for suitable articles that had case-control design with gastric cancer as outcome. The outcomes of our study shows protection (od...

Familial Pancreatic Cancer: Challenging Diagnostic Approach and Therapeutic Management
Familial predisposition characterizes up to 10 % of the patients with pancreatic cancer (PC). Although many syndromes have been associated with an increased risk for PC, familial pancreatic cancer (FPC) accounts for the majority of hereditary cases. FPC is defined by families with at least a pair of first-degree relatives (FDRs) who have been diagnosed with PC and do not fulfill the criteria o...
Diagnosis and treatment of narcotic bowel syndrome
Narcotic bowel syndrome (NBS) is characterized by incompletely controlled abdominal pain that cannot be explained by another known or previous diagnosis in patients receiving steady or increasing doses of opioids. In this Review, the authors summarize the literature on NBS including diagnosis, patient characteristics, mechanisms and treatment options.

A role for the gut microbiota in IBS
The gut microbiota is now acknowledged to have a profound effect on human health and disease. Here, Stephen Collins explores the role of the gut microbiota in the development of IBS, describing experimental evidence and clinical observational and trial data that implicates the gut microbiota in the manifestation of IBS.
Colorectal cancer: Serrated polyposis—should we screen first-degree relatives?
Serrated polyposis syndrome (SPS) is a condition characterized by multiple and/or proximal serrated polyps in the colorectum. Several features of SPS suggest there is an underlying genetic disorder that is yet to be identified. A new study provides insights on the diagnostic yield of screening colonoscopy in first-degree relatives of patients with SPS.
Drugs acting at 5-HT4, D2, motilin, and ghrelin receptors differ markedly in how they affect neuromuscular functions in human isolated stomach
Progress in identifying safer, effective drugs to increase gastric emptying is impeded by failed clinical trials. One potential reason for failure is lack of translation from animal models to the human condition. To make progress, the actions of existing drugs and new therapeutic candidates need to be understood in human isolated stomach. Neuromuscular activities were evoked in human gastric an...
A pilot study of the effects of the somatostatin analog pasireotide in postoperative dumping syndrome
Dumping syndrome is characterized by distinct pathophysiological features such as postprandial increase in hematocrit (HT) and pulse rate (PR) and delayed hypoglycemia (HG). Treatment is based on dietary measures and somatostatin analogs (SA), but current SAs have incomplete efficacy, possibly through limited affinity for various somatostatin receptor subtypes. We evaluated the effect of pasire...