April 2008 Vol XXXII Issue 4

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Introduction to a New Series

Muralidhar Jatla, Ritu Verma

Introduction to a New Series


Overview of Celiac Disease: Differences Between Children and Adults

Muralidhar Jatla, Patricia A. Bierly, Karen H. Hlywiak, Jennifer Autodore, Ritu Verma

Celiac Disease (CD) is an immune-mediated enteropathy caused by permanent sensitivity to gluten in genetically susceptable individuals. CD affects one percent of the general population in the United States, including children. This paper describes the epidemiology, pathophysiology, associated conditions and treatment of CD, with an emphasis on aspects to the pediatric population.


New Advances in Surgical Treatment of Crohn's Disease

Sharon L. Stein, Fabrizio Michelassi

Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract. Medical management may improve or even remit symptoms of Crohn's disease but there is no cure. Approximately 80 percent of patients diagnosed with Crohn's disease require operative procedures at some point in their life. This article reviews new technologies in the advancement of surgical treatment of Crohn's disease.


Nutrients and Constipation: Cause or Cure?

Lawrence R. Schiller

The basic evidence supporting low-fiber intake as a cause of constipation and other bowel problems dates back to the epidemiological observations in the 1960's. Most recent evidence suggests that low calorie intake and perhaps food sensitivities may play a role in the pathogenesis of constipation.


Preventive Approaches in Chronic Liver Disease, Part I

Mohammad R. Taheri, Thomas R. Riley III

Hepatitis C virus is the leading cause of chronic liver disease (CLD) worldwide. Preventive measures can significantly reduce the progress of liver disease to cirrhosis and liver cancer. This review will discuss preventive measures with proven benefits.


An Unusual Case of Profound Weight Loss in a Middle-aged Male: Case Report and Review

Sulaiman Azeez, Frank Nelson, Anita Soni, Balavenkatesh Kanna

An interesting case of profound weight loss due to herniation of the stomach through the foramen of Morgagni and review of the literature.


Muralidhar Jatla, Noelle A. Bates, Peter Mattei

A case for you to solve.

Departments Section

From the Literature


A prospective study of 47,363 male health professionals who were ages 40 to 75 years at enrollment in 1986 was conducted biannually.

Mucosal Atrophy in Celiac Disease

To study the macroscopic features in celiac disease by means of a magnified view of the intestinal mucosa utilizing wireless capsule endoscopy, evaluation of the following: (1) the distribution of atrophy in untreated celiac disease, (2) the correlation between extent of changes and clinical manifestations, (3) the accuracy and interobserver agreement of wireless capsule endoscopy assessment, and (4) the affect of gluten withdrawal.

Aspirin and Folic Acid in Recurrent Colorectal Adenomas

A multicenter, randomized, double-blind trial of aspirin (300 mg per day) and folate supplements (0.5 mg/day) to prevent colorectal adenoma recurrence was performed using a 22 factorial design.

Fundic Gland Polyp Dysplasia in FAP

Fundic gland polyps (FGPs) are common in familial adenomatous polyposis (FAP), but have been considered nonneoplastic. Gastric carcinoma rises from FGPs in FAP, presumably from a dysplasia/carcinoma pathway. To study the prevalence of FGPs and FGP dysplasia in FAP and identify endoscopic or demographic features associated with FGPs and dysplasia, a study was carried out.

Non-Polypoid Colorectal Neoplasms

Data are limited on the significance of nonpolypoid colorectal neoplasm (NP-CRNs) to determine the prevalence of NP-CRNs in a veteran hospital population and to characterize their association with colorectal cancer, a cross-sectional study was carried out with 1,819 patients undergoing elective colonoscopy from July, 2003 to June, 2004.

Narrow-Band Imaging Colonoscopy and Polyp Detection and Identification

To determine the detection rate of additional polyps by NBI after removal of polyps visualized by standard white light colonoscopy (WLC) and to correlate the surface mucosal and vascular patterns with polyp histologic diagnosis, a prospective pilot feasibility study was carried out among subjects referred for screening colonoscopy.

EUS in Suspected Choledocholithiasis

To more precisely estimate the diagnostic accuracy of EUS in suspected choledocholithiasis, proposal of a less invasive means of diagnosing that entity to decrease the need for ERCP with its associated risk, MEDLINE and EMBASE databases were used to identify prospective cohort studies in which the results of EUS were compared with the results of an acceptable criterion standard, including ERCP, intraoperative cholangiography, or surgical exploration.

Optimal Band Imaging System in Early Gastric Cancer

The endoscopic diagnosis of depressed-type early gastric cancers is difficult because they manifested subtle changes of color and shape. The newly developed, optimal band imaging (OBI system) can reconstruct the best spectral images derived from ordinary endoscopic images and enhances the mucosal surface without the use of dyes and is based on narrowing the band width of conventional images arithmetically by using spectral estimation technology.

Argon Plasma Coagulation in Treatment of Gastric Vascular Ectasia

GVE is an uncommon etiology of GI bleeding, affecting patients with cirrhosis and a variety of chronic diseases. In order to compare the clinical and endoscopic patient characteristics and responses to treatment by Argon Plasma Coagulation (APC) of bleeding GVE between patients with cirrhosis and noncirrhotic patients, a retrospective study of consecutive patients
between January 2001 and December 2005, including thirty patients treated with APC for bleeding GVE was carried out and clinical and endoscopic features of APC treatment success was compared between patients with cirrhosis (Group 1) and noncirrhotic patients (Group 2).

Narrow Band Imaging and Non-Neoplastic Gastric Pathology

In order to test the feasibility of Narrow Band Imaging (NBI), to predict gastric histologic diagnosis, a pilot feasibility study was carried out.

Certolizumab in Crohn's Disease

Certolizumab pegol is a pegylated humanized fab fragment that binds tumor necrosis Factor a. In a randomized, double-blind, placebo-controlled trial, the efficacy of CP in 662 adults with moderate to severe Crohn's disease was evaluated.

Medical Bulletin Board

New Scoring System Helps Predict Survival in Patients with Pancreatic Neuroendocrine Tumors

Researchers Analyze 20 Years of Data from National Cancer Database to Develop Reliable Predictions for This Tumor Type

Research Foundation for Tick-Borne Diseases to Fund Studies of Neurological and Immunological Mechanisms in Lyme Disease

The National Research Fund for Tick-Borne Diseases, Inc., the nation's only non-profit organization dedicated primarily to funding scientific research in the rapidly expanding field of tick-borne infections, has announced the award of four grants totaling $344,000 for basic and translational research in Lyme disease.

New Blood Marker May Predict Prostate Cancer Spread

Information Could Lead to More Accurate Prediction of Cancer Metastasis Thereby Improving Patient Management

IFFGD is Seeking Applications for 2008 Research Grants

IFFGD is seeking applications for research grants. Grant awards of $50,000 each are available to two investigators for research related to functional gastrointestinal and motility disorders, and neurogastroenterology.

From the Literature

Acute Pancreatitis in Children

The pathophysiology of acute pancreatitis in children is poorly understood, and a paucity of large studies is available. Treatment options are even less well studied with physicians relying on correlations from the adult medical literature. This study from the Children's Hospital of Pittsburgh evaluated the causes and outcomes of pancreatitis in young children (less than three years of age) over a 10-year period.

Endoluminal Gastroplication Results in Children

Gastroesophageal reflux disease (GERD) is a common gastrointestinal problem in children. Although pharmacologic therapy is available, surgical intervention is necessary for recalcitrant cases. Unfortunately, fundoplication can be associated with significant postoperative complications, and other options, including endoscopic endoluminal gastroplication, should be evaluated.