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Volume 2, No 2 - Spring 2002

Volume 2, No 2 - Spring 2002

Table of Contents

Advances in Diabetic Gastroparesis Gastrointestinal Disorders
This review addresses the advances in our understanding of the epidemiology and mechanisms in diabetic gastroparesis and dyspepsia. The mechanisms discussed include: blood glucose levels at the time of presentation, “autovagotomy," and the intrinsic innervation (particularly the interstitial cells of Cajal and nitrergic nerves). In animal models of diabetic gastroparesis, there is evidence that homeostatic mechanisms are activated in the enteric nervous system to compensate for the loss of extrinsic innervation. Understanding these advances is key to the development of novel therapeutic strategies and for making rational choices in the management of diabetic gastroparesis and dyspepsia. [Rev Gastroenterol Disord. 2002;2(2):47–56]
A Clinician’s Perspective on Chronic Pancreatitis--2002 Gastroenterological Disorders
The diagnosis and management of chronic pancreatitis represents a significant challenge to clinicians. Progress is being made in our understanding of this disease, especially in the area of genetics and molecular biology. Despite these advances, diagnosis of early-stage disease depends on indirect tests, and management is limited to relief of obstruction if present. This review will concentrate on mild to moderate chronic pancreatitis and explore the current state of the diagnosis and management of this disease. [Rev Gastroenterol Disord. 2002;2(2):57–65]
Gastroesophageal Reflux Disease: New Treatments Treatment Update
The primary therapeutic endpoint for patients with gastroesophageal reflux disease is complete relief of symptoms and improvement in quality of life. The withdrawal of cisapride has created a vacuum in the prokinetic market, with few promising drugs in the pipeline. Reflux inhibitors are being considered for clinical trials, but as of yet are unavailable. Proton pump inhibitors (PPIs) continue to be the backbone of therapy for acid suppression, providing excellent relief of symptoms and healing of erosive esophagitis. Isomeric technology with esomeprazole as the prototype represents an advance in PPI pharmacology. Antireflux surgery is now more patient-friendly, with shorter hospitalization and less major morbidity compared to open fundoplication, but surgery is at best equal to medical therapy when optimal doses of antisecretory therapy are used. Two endoscopic procedures were recently approved by the U.S. Food and Drug Administration for treatment of gastroesophageal reflux disease: radiofrequency energy delivery to the gastroesophageal junction, and transoral flexible endoscopic suturing. These techniques should be used selectively until we have more data and until results are compared to the safe and highly effective medical therapies. [Rev Gastroenterol Disord. 2002;2(2):66-74]
Imatinib Mesylate New Drug Review
Imatinib is an example of a new group of drugs being developed using the principle of molecular targeting. Imatinib is able to kill the cancer cells and not the body’s healthy cells. Imatinib mesylate is indicated for the treatment of patients with Kit (CD117)-positive unresectable and/or metastatic malignant gastrointestinal stromal tumors and patients with Philadelphia chromosome– positive chronic myeloid leukemia in blast crisis, accelerated phase, or in chronic phase after failure of interferon-alfa. [Rev Gastroenterol Disord. 2002;2(2):75–86]