| 1. |
- Ness-Jensen, Eivind, et al.
(författare)
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Tobacco smoking, alcohol consumption and gastro-oesophageal reflux disease
- 2017
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Ingår i: Best Practice and Research: Clinical Gastroenterology. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1521-6918 .- 1532-1916.
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Tidskriftsartikel (refereegranskat)abstract
- Gastro-oesophageal reflux disease (GORD) develops when reflux of gastric content causes troublesome symptoms or complications. The main symptoms are heartburn and acid regurgitation and complications include oesophagitis, strictures, Barrett's oesophagus and oesophageal adenocarcinoma. In addition to hereditary influence, GORD is associated with lifestyle factors, mainly obesity. Tobacco smoking is regarded as an aetiological factor of GORD, while alcohol consumption is considered a triggering factor of reflux episodes and not a causal factor. Yet, both tobacco smoking and alcohol consumption can reduce the lower oesophageal sphincter pressure, facilitating reflux. In addition, tobacco smoking reduces the production of saliva rich in bicarbonate, which is important for buffering and clearance of acid in the oesophagus. Alcohol also has a direct noxious effect on the oesophageal mucosa, which predisposes to acidic injury. Tobacco smoking cessation reduces the risk of GORD symptoms and avoidance of alcohol is encouraged in individuals where alcohol consumption triggers reflux.
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| 2. |
- Al-Saffar, Ahmad, et al.
(författare)
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Utility of animal gastrointestinal motility and transit models in functional gastrointestinal disorders
- 2019
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Ingår i: Baillière's Best Practice & Research. - : Elsevier. - 1521-6918 .- 1532-1916. ; 40-41
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Forskningsöversikt (refereegranskat)abstract
- Alteration in the gastrointestinal (GI) motility and transit comprises an important component of the functional gastrointestinal disorders (FGID). Available animal GI motility and transit models are to study symptoms (delayed gastric emptying, constipation, diarrhea) rather than biological markers to develop an effective treatment that targets the underlying mechanism of altered GI motility in patients. Animal data generated from commonly used methods in human like scintigraphy, breath test and wireless motility capsule may directly translate to the clinic. However, species differences in the control mechanism or pharmacological responses of GI motility may compromise the predictive and translational value of the preclinical data to human. In this review we aim to provide a summary on animal models used to mimic GI motility alteration in FGID, and the impact of the species differences in the physiological and pharmacological responses on the translation of animal GI motility and transit data to human.
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| 3. |
- Benno, P., et al.
(författare)
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Therapeutic potential of an anaerobic cultured human intestinal microbiota, ACHIM, for treatment of IBS
- 2019
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Ingår i: Baillière's Best Practice & Research. - : Elsevier. - 1521-6918 .- 1532-1916. ; 40-41
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Forskningsöversikt (refereegranskat)abstract
- By administering an anaerobic cultivated human intestinal microbiota (ACHIM) via upper gastrointestinal route using endoscopy we aimed to rectify intestinal dysbiosis and simultaneously achieve a treatment response in IBS patients. The study population fulfilled the Rome III IBS criteria and comprised 50 patients. During 10 days, patients recorded the irritable bowel syndrome symptom severity scale (IBS-SSS) along with the Bristol stool scale and number of stools/day. The enrolled patients were categorized as follows: 37 with diarrhea, 5 with constipation and 8 with mixed symptoms. The treatment response showed reduction in a majority of patients, 32 of which with 50-point reduction of IBS-SSS and 21 with a 100-point IBS-SSS reduction. The percentage improvement was 36 (23-49) and 28 (18-38) for women and men respectively. Short-chain fatty acids were not changed. We consider fecal microbiota transplantation in the form of ACHIM as an option for the future therapeutic armamentarium in IBS. (C) 2019 Published by Elsevier Ltd.
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| 4. |
- Bergquist, A, et al.
(författare)
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Epidemiology of cholangiocarcinoma
- 2015
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Ingår i: Best practice & research. Clinical gastroenterology. - : Elsevier BV. - 1532-1916 .- 1521-6918. ; 29:2, s. 221-232
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Tidskriftsartikel (refereegranskat)
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| 5. |
- Hagstrom, H
(författare)
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Alcohol, smoking and the liver disease patient
- 2017
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Ingår i: Best practice & research. Clinical gastroenterology. - : Elsevier BV. - 1532-1916 .- 1521-6918. ; 31:5, s. 537-543
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Tidskriftsartikel (refereegranskat)
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| 6. |
- Hedin, Charlotte, et al.
(författare)
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Should we use vedolizumab as mono or combo therapy in ulcerative colitis?
- 2018
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Ingår i: Baillière's Best Practice & Research. - : Elsevier. - 1521-6918 .- 1532-1916. ; 32-33, s. 27-34
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Tidskriftsartikel (refereegranskat)abstract
- Randomized controlled trials comparing the efficacy of vedolizumab monotherapy with combination therapy of vedolizumab and an immunomodulator in patients with ulcerative colitis (UC) are lacking. Emerging pharmacokinetic data indicate that vedolizumab concentrations correlate with clinical outcomes, although the correlation may be less strong for vedolizumab compared with an anti-TNF agents. Associations between concomitant use of immunomodulators and decreased immunogenicity of vedolizumab have been reported, but this does not appear to translate into enhanced therapeutic effect of combination therapy, at least not based on present data. However, data are sparse and often based on post-hoc analyses. Future comparative effectiveness studies of patients with UC, naive to vedolizumab as well as immunomodulators, are needed. This might be of specific relevance for subgroups of UC patients, such as young men and the elderly, in whom combination versus monotherapy therapy may have a different risk-benefit ratio, given the risk of malignancy associated with immunomodulators. (C) 2018 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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| 7. |
- Hellström, Per M., 1954-
(författare)
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Pathophysiology of the irritable bowel syndrome - Reflections of today
- 2019
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Ingår i: Baillière's Best Practice & Research. - : Elsevier. - 1521-6918 .- 1532-1916. ; 40-41
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Forskningsöversikt (refereegranskat)abstract
- Irritable bowel syndrome (IBS) is a chronic gastrointestinal symptom complex defined by abdominal pain and disturbed bowel habits over 3 months within a period of 6 months, in absence of any identifiable organic pathology. Over the years, speculations of the pathophysiology of IBS has moved from elusive central nervous symptoms impinging on psychosomatic disease, to objective signs of intestinal fermentation with abdominal bloating and intestinal dysmotility. The specific subgroup of post infectious IBS is of special interest since it opens the possibility of dysbiosis as the pivotal point for development of IBS in association with traveler's diarrhea or antibiotic treatment with ensuing dysbiosis and abdominal symptoms that may resolve over decades. The undefined disease mechanisms that take place within the gut seem responsible for the gut-brain signaling leading to activation of brain centers that drive the clinical picture of IBS, further modulated by the patient's social background and previous lifetime events. (C) 2019 Published by Elsevier Ltd.
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| 8. |
- Hellström, Per M., 1954-
(författare)
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Preface - Functional gastrointestinal disorders
- 2019
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Ingår i: Baillière's Best Practice & Research. - : Elsevier. - 1521-6918 .- 1532-1916. ; 40-41
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Hellström, Per M., 1954-, et al.
(författare)
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The Rome IV : Irritable bowel syndrome - A functional disorder
- 2019
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Ingår i: Baillière's Best Practice & Research. - : Elsevier. - 1521-6918 .- 1532-1916. ; 40-41
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Forskningsöversikt (refereegranskat)abstract
- Functional gastrointestinal disorders are the most common disorders encountered in the clinical gastroenterology setting. Over the years the Rome process has generated consensus definitions of functional gastrointestinal disorders, and given diagnostic criteria, based on various symptom patterns, that have evolved over the years. The latest Rome IV consensus was presented in May 2016. This summary points out some of the important changes made from the Rome III 2006 consensus including evaluation of symptoms from the stand-point of basal normative values and disorders of gut-brain interaction, as well as additions of the importance of the microflora. However, we are all aware of the fact that there are limitations, and the Rome consensus does not pick up all patients with functional gastrointestinal disorders. Out of those that seek medical help for their functional gastrointestinal symptoms additional outlines of disease have to be considered and judgements made on the patients' actual symptoms, or rather presentation of their symptoms. The Rome IV consensus is a robust standard for a clinical and research approach to functional gastrointestinal disorders, but might be improved by use of exclusion criteria and additional biochemical biomarkers in order to accurately diagnose those patients who may achieve relief by an extended treatment approach in the clinical setting of gastroenterology. A biopsychosocial approach to the patient is recommended to improve compliance and optimize treatment and outcomes. (C) 2019 Published by Elsevier Ltd.
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| 10. |
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| 11. |
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| 12. |
- Webb, Dominic-Luc
(författare)
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Tests of intestinal mucosal hyperpermeability : Many diseases, many biomarkers and a bright future
- 2019
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Ingår i: Baillière's Best Practice & Research. - : Elsevier. - 1521-6918 .- 1532-1916. ; 40-41
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Tidskriftsartikel (refereegranskat)abstract
- The number of disorders now linked to increased intestinal mucosal permeability implies that a substantial percent of the population is affected. Drug interventions targeting reduced tight junctional permeability are being pursued. Although hyper-permeability in itself is not a clinically recognized disease entity, its relationship to disease processes has driven interest in measuring, and even monitoring mucosal permeability in vivo. Along with improved knowledge of gut barrier physiology, advances have been made in tests and biomarkers of barrier function. Drawing from our experiences in the past decade, considerations and challenges faced in assessing in vivo intestinal permeability are discussed herein, along with indications of what the future might hold.
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| 13. |
- Xie, SH, et al.
(författare)
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Risk factors for oesophageal cancer
- 2018
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Ingår i: Best practice & research. Clinical gastroenterology. - : Elsevier BV. - 1532-1916 .- 1521-6918. ; 36-37, s. 3-8
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Tidskriftsartikel (refereegranskat)
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| 14. |
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| 15. |
- Björklund, Per, et al.
(författare)
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The pros and cons of gastric bypass surgery – The role of the Roux-limb
- 2019
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Ingår i: Best Practice and Research: Clinical Gastroenterology. - : Elsevier BV. - 1521-6918. ; 40-41
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Tidskriftsartikel (refereegranskat)abstract
- The prevalence of overweight and obesity has exploded in the post-industrial era. Life style interventions like dieting and exercise can induce a marked weight loss, but the main problem for most patients is to maintain the reduced body weight over time. Gastric bypass surgery is a commonly performed and very effective method for achieving a pronounced and sustained weight loss including metabolic improvements in obese patients. Despite the therapeutic successfulness there are known side-effects like chronic postprandial nausea and pain that in some patients become intractable. The pathophysiology is complex and partly unexplored. The physician or surgeon handling a patient with “post-bariatric symptoms” must be aware of the risk for symptom aggravations due to iatrogenic opioid-associated intestinal dysmotility. The present paper gives a brief overview of obesity surgery and its associated postsurgical conditions with a focus on the unexplored role of the Roux-limb following gastric bypass surgery. © 2019 Elsevier Ltd
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| 16. |
- Kärkkäinen, Jussi M., et al.
(författare)
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Acute mesenteric ischemia (part I) - Incidence, etiologies, and how to improve early diagnosis
- 2017
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Ingår i: Best Practice and Research in Clinical Gastroenterology. - : Elsevier BV. - 1521-6918. ; 31:1, s. 15-25
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Tidskriftsartikel (refereegranskat)abstract
- Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well. What can we do to improve diagnostic performance, so that more patients get proper treatment? The diagnosis is a collaborative effort of emergency department surgeons, gastrointestinal and vascular surgeons, and radiologists. The etiological categorization of AMI should be practical and guide the therapy. Furthermore, the limitations of the diagnostic examinations need to be understood with special emphasis on computed tomography findings on patients with slowly progressing "acute-on-chronic" mesenteric ischemia.
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| 17. |
- Kärkkäinen, Jussi M., et al.
(författare)
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Acute mesenteric ischemia (Part II) - Vascular and endovascular surgical approaches
- 2017
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Ingår i: Best Practice and Research in Clinical Gastroenterology. - : Elsevier BV. - 1521-6918. ; 31:1, s. 27-38
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Tidskriftsartikel (refereegranskat)abstract
- The modern treatment of acute mesenteric ischemia (AMI) requires seamless collaboration of gastrointestinal surgeons, vascular surgeons, and interventional radiologists. The treatment strategy is straightforward aiming at rapid restoration of blood flow to the intestine. Bowel resection is performed on demand. The first thing to consider is the patient's clinical condition at presentation, whether there are signs of peritonitis or not, and whether the patient is hemodynamically stable or not. Second, there are four etiologies of AMI that need to be distinguished as they differ in treatment: superior mesenteric artery embolism, mesenteric arterial occlusive disease, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia. In this review, we describe the basic vascular and endovascular treatment modalities accompanied by a simple algorithm for the various situations in AMI. Furthermore, the indications for damage control and primary definitive surgery are discussed.
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| 18. |
- Ohlsson, Bodil
(författare)
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The role of smoking and alcohol behaviour in management of functional gastrointestinal disorders
- 2017
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Ingår i: Best Practice and Research in Clinical Gastroenterology. - : Elsevier BV. - 1521-6918. ; 31:5, s. 545-552
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Forskningsöversikt (refereegranskat)abstract
- Functional gastrointestinal disorders (FGIDs) are common disorders in the population. Lifestyle habits have been suspected to influence the presence and degree of symptoms, and many studies have examined the role of food components and physical activity on the disease development. The role of smoking and alcohol intake on FGID has been less thoroughly examined. This systematic literature review, of a large amount of studies from different countries around the world with different design and application of FGID criteria, shows that smoking seems to be associated with a significant 50% increased risk of FD for current compared with never smokers. The associations between smoking and other FGIDs are weak, if present at all. A moderate alcohol intake is not associated with FGIDs. On the other hand, a high alcohol intake may lead to development and aggravation of FGID symptoms, especially functional dyspepsia.
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| 19. |
- Zarrouk, M., et al.
(författare)
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Testing for thrombophilia in mesenteric venous thrombosis - Retrospective original study and systematic review
- 2017
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Ingår i: Best Practice and Research in Clinical Gastroenterology. - : Elsevier BV. - 1521-6918. ; 31:1, s. 39-48
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Forskningsöversikt (refereegranskat)abstract
- The aim was to perform a local study of risk factors and thrombophilia in mesenteric venous thrombosis (MVT), and to review the literature concerning thrombophilia testing in MVT. Patients hospitalized for surgical or medical treatment of MVT at our center 2000-2015. A systematic review of observational studies was performed. In the local study, the most frequently identified risk factor was Factor V Leiden mutation. The systematic review included 14 original studies. The highest pooled percentage of any inherited thrombophilic factor were: Factor V Leiden mutation 9% (CI 2.9-16.1), prothrombin gene mutation 7% (CI 2.7-11.8). The highest pooled percentage of acquired thrombophilic factors were JAK2 V617F mutation 14% (CI -1.9-28.1). The wide range of frequency of inherited and acquired thrombophilic factors in different populations indicates the necessity to relate these factors to background population based data in order to estimate their overrepresentation in MVT. There is a need to develop guidelines for when and how thrombophilia testing should be performed in MVT.
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