January 2012 Vol XXXVI Issue 1

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Hepatitis C: A New Era of Treatment, Series #3

The Future of Hepatitis C Beyond Protease Inhibitors?Will Hepatitis C be a Disease of the Past?

Melissa Palmer

It is truly an amazing time to be a hepatologist and witness the amount of clinical research being conducted in the area of new drug development for HCV. This article, the third in the HCV series, will present a preview of the medications now in clinical trials that may comprise the future treatment options for patients with HCV.

Nutrition Issues in Gastroenterology, Series #101

To Hold (Enteral Feeding) or Not to Hold: That IS the Question; A Commentary and Tutorial

Lingtak-Neander Chan

Enteral nutrition may interfere with drug absorption and lead to therapeutic failure. Here we present a tutorial guide to help clinicians determine when these concerns may be more clinically significant and what actions can be considered to optimize patient outcomes.

Fellows Corner

An Unusual Case of Intussusception

Luigino Bernabela, Debra Goldstein, Roland Liang

This report illustrates an unusual case of intussusception with the lead lesion being a gastrointestinal stromal tumor (GIST).

A Case Report

Not Just Another Case of Acute Abdomen

Raja Shekhar R. Sappati Biyyani, Amy Soloman, Brian S. Putka, Julia G. Thornton

We present a case of (PVG) portal venous gas associated with Familial Mediterranean fever (FMF) and our treatment experience.

Departments Section

Book Reviews

Gastroenterology: A Colour Handbook

Colour Handbook: Gastroenterology is an excellent handbook for practitioners who care for patients with gastrointestinal pathology, medical residents across subspecialties, gastrointestinal fellows in the early stages of training as well as mid-level providers.

Evidence-Based Gastroenterology & Hepatology

Evidence-Based Gastroenterology & Hepatology, now in its third edition, primarily aims to review and grade evidence for management of the major gastrointestinal and hepatic diseases encountered in clinical practice. There are few other texts that not only reference clinical trials and case series in the literature but also discuss the validity and clinical utility of the results to this extent.

Metabolic Basis of Obesity

The increasing prevalence of obesity verified globally has been creating a challenge to the various professionals involved in treating this disease. The focus of this book is to discuss the principal metabolic and physiopathologic mechanisms involved in the etiology of obesity and relate them with major diseases (in particular: insulin resistance, lipid metabolism and cardiovascular disease, and NAFLD).

Acing the Hepatology Questions on the GI Board Exam: The Ultimate Crunch-Time Resource

This 260-page book is the second book in the series by Dr. Spiegel and was written with a focus on hepatology related GI board exam questions. The book’s aims are to provide an emphasis on key concepts in liver disease.

Ascites, Hyponatremia And Hepato-Renal Syndrome: Progress In Treatment

This book includes 20 sections written in a digestible, easy to understand clinico-pathological format which makes it an indispensable reference in the subject for a wide range of health professions, including students of nursing and medicine as it fills the current gap in this complex field and providing up to date information in a wide range of issues under one cover.

From the Pediatric Literature

Islet Autotransplantation for Chronic Pancreatitis in Children

Chronic pancreatitis, although rare in children, can be a conundrum for the medical provider due to a lack of clinical trials for treatment. The authors of this study evaluated the efficacy of total pancreatectomy with islet autotransplantation (TP/IAT), to preserve beta cell function in pediatric patients with chronic pancreatiits.

Cardiac Function in Bilary Atresia

Biliary atresia is a leading cause of liver transplantation in children, and similar to adults with cirrhosis, it is expected that some degree of cardiac dysfunction may occur associated with liver disease. However, cardiomyopathy has not been fully studied in this specific pediatric population. The authors of this institution from a tertiary pediatric hospital with transplantation experience evaluated 40 pediatric patients with biliary atresia (median age 8 months) undergoing liver transplantation evaluation who subsequently underwent 2-dimensional echocardiography as part of standard procedure. Their echocardiogram results were compared with age and sex-matched controls.

Urotensin II as a Marker of Portal Hypertension

The use of biomarkers has the potential for establishing disease presence as well as monitoring for disease progression. Urotensin II is a powerful vasoconstrictor that is noted to be increased in the serum of adults with cirrhosis. The authors of this study evaluated Urotensin II levels in 3 patient groups, including healthy children with no liver disease, healthy adults with no liver disease, and children with both cirrhosis and portal hypertension.

Fluid Bolus is Associated with Mortality in Third-World Children

In sub-Saharan Africa, rapid intravenous fluid resuscitation is standard of care for children who present to intensive care facilities with shock. It is unknown if the effect of fluid resuscitation in children is beneficial when there are other associated morbidities, including starvation.

From the Literature

HBV DNA and ALT as Risk Factors for Hepatocellular Carcinoma

To determine whether risk for hepatocellular carcinoma (HCC) can be accurately determined from long-term changes in serum levels of HBV DNA or ALT, serum levels of each were determined at enrollment and during followup analysis of 3160 participants in the REVEALHBV study. Development of hepatocellular carcinoma was determined from followup examinations and computerized linkage with National Cancer Registry and National Death Certification profiles. Multivariateadjusted hazard ratios (HRs), and 95% confidence intervals (CIs) were estimated using Cox Regression Models.

Evaluation of Solid Pancreatic Lesions by EUS

To assess the false-positive (FP) rate of EUS-FNA (fine needle aspiration) with cytologic analysis in a retrospective study of a tertiary care referral center, a study was carried out, involving 367 patients with solid pancreatic lesions in whom EUS-FNA cytology reports were interpreted as positive or suspicious for malignancy and resulting in subsequent surgical resection.

Barrett’s Esophagus With Low-Grade Dysplasia

To investigate the incidence of high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC), and to compare progression in patients with different forms of LGD, the effects of consensus diagnosis of LGD on progression rates to HGD and EAC among expert pathologists were assessed.

Celiac Disease and Relationship to IBS

To evaluate the prevalence of CD antibodies and biopsyconfirmed CD among patients with nonconstipated IBS, (NC-IBS) in a large US population, the study was conducted at four sites from 2003 to 2008 and data was compared from 492 patients with symptoms of NCIBS to 458 asymptomatic individuals who underwent colonoscopic evaluations for cancer screening or polyp surveillance (controls).

Conservative Approach to Necrotizing Pancreatitis

Treatment of patients with necrotizing pancreatitis has become more conservative and less invasive. To evaluate data from prospective studies to support the efficacy of this change, a prospective multicenter study of treatment outcomes among necrotizing patients was carried out.

Improvement of Liver Fibrosis with Iron Chelation Therapy

To study the effects of the oral iron chelator Deferasirox on liver fibrosis and necroinflammation in a large population of patients with iron overload b-thalassemia, data from 219 patients with that disorder was collected from histologic analysis of biopsy samples taken at baseline and after at least three years of treatment. The treatment response was assessed from liver iron concentrations at the baseline and at the end of the study.

Medical Bulletin Board

Fifth Cycle of Probiotics & Microbiota Research Grant Announced

ALEXANDRIA, Va., The Global Probiotics Council (GPC), a committee formed by Danone and YAKULT HONSHA CO., LTD., announced the launch of the fifth annual Young Investigator Grant for Probiotics Research (YIGPRO). This grant provides two awards, each in the amount of $50,000, to promising young researchers. This year, the grant will continue to focus on the role of probiotics and gastrointestinal microbiota in health and wellness. Applications will be accepted until February 15, 2012.