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Volume 2, No 1 - Winter 2002

Volume 2, No 1 - Winter 2002

Table of Contents

Update on Gastrointestinal Imaging Technical Update
The current status of three gastrointestinal imaging techniques—positron emission tomography (PET) with 18 F-fluorodeoxyglucose (FDG), computed tomographic (CT) colonography, and magnetic resonance cholangiography (MRC)—are reviewed here. FDG-PET should not be used as an initial means to identify patients with primary colorectal malignancy; for the detection of colorectal carcinoma metastases and recurrence, contrast-enhanced CT should be used to monitor patients, with the use of PET reserved for equivocal cases. CT colonography is comparable to colonoscopy for the detection of patients with colorectal polyps = 1 cm, and its advantages include its capability of detecting extracolonic abnormalities. MRC is a relatively new application of MR imaging, with utility in multiple clinical settings, including patients with suspected obstructive disease, choledochal cysts, primary sclerosing cholangitis or AIDS cholangiopathy, biliary-enteric anastomoses, and patients with failed or inadequate endoscopic retrograde cholangiograms. [Rev Gastroenterol Disord. 2002;2(1):3–10]
Nonalcoholic Fatty Liver Disease Gastrointestinal Disorders
Nonalcoholic fatty liver disease (NAFLD) encompasses a broad clinicopathologic spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), which may advance to cirrhosis and end-stage liver disease. Steatosis alone does not appear to be progressive. The prevalence of NAFLD averages 20% and that of NASH, 2% to 3%, making these conditions the most common liver diseases in the United States. NAFLD is associated with insulin resistance, which may be evident clinically with obesity, type 2 diabetes mellitus, and hypertriglyceridemia. The pathogenesis of NAFLD consists of hepatic fat accumulation and oxidative stress with formation of free radicals. The clinical diagnosis is based on the presence of the insulin resistance syndrome and exclusion of alcohol abuse as well as viral, autoimmune, genetic, and druginduced liver diseases. Liver biopsy is essential for diagnosis but may not be necessary for clinical management. Treatment is aimed at correcting the risk factors for NAFLD and using potentially hepatoprotective agents. Ursodeoxycholic acid and betaine appear particularly promising in early trials. [Rev Gastroenterol Disord. 2002;2(1):11–19]
Alendronate and Risedronate: What You Need to Know About Their Upper Gastrointestinal Tract Toxicity New Drug Review
Adverse upper gastrointestinal (GI) tract events can occur with alendronate or risedronate therapy. Although the short-term, non–placebo-controlled comparisons of alendronate and risedronate indicated that risedronate therapy may be associated with a lower risk of upper GI toxicity than alendronate therapy, the placebo-controlled comparison shows no difference in the risk of upper GI toxicity between the two drugs. The risk of an adverse upper GI event increases when these drugs are used concurrently with nonsteroidal anti-inflammatory drug (NSAID) therapy, but this incidence is no more than that observed with concurrent placebo and NSAID therapy. Also, the risk of these adverse GI tract events can be decreased by following the dosing instructions (eg, avoid lying down for 30 minutes after taking the drug and take the drug with a full glass of water) and may be decreased with once-weekly dosing. [Rev Gastroenterol Disord. 2002;2(1):20–33]
Best of the AASLD 52 Annual Meeting of the American Association for the Study of Liver Diseases