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Volume 4, No 2 - Spring 2004

Volume 4, No 2 - Spring 2004

Table of Contents

Management of the Patient With Barrett's Esophagus: A Continuing Dilemma for the Clinician Management Update
The primary controversy regarding Barrett’s esophagus (BE) relates to what form of therapy is “best” and, more importantly, whether any therapy results in the regression of abnormal epithelium or reduces the rate of progression to dysplasia and/or adenocarcinoma. The current standard of practice suggests that patients with BE should be treated in a similar fashion as patients with typical gastroesophageal reflux disease, that is, with antisecretory agents as needed to provide complete symptom relief. The most recent guidelines from the American College of Gastroenterology point out that there are no prospective studies that support any alternative approach to treatment (ie, neither high-dose acid suppression nor antireflux surgery has demonstrated reduced risk of dysplasia or esophageal adenocarcinoma). However, accumulating evidence suggests that simply controlling symptoms is inadequate. [Rev Gastroenterol Disord. 2004;4(2):49–59]
Colorectal Cancer in African Americans Management Update
In the United States, African Americans have the highest incidence of colorectal cancer of any racial or ethnic group. Compared with whites, African Americans have a younger mean age at colorectal cancer diagnosis and a greater proportion have proximal cancers. Survival in African Americans with colorectal cancer is lower than in whites. Currently, there are no established biological explanations for these differences in colorectal cancer between African Americans and whites. As leaders in the prevention and early diagnosis of colorectal cancer in the United States, clinical gastroenterologists can play an important role in promoting colorectal cancer awareness and the need for screening in African Americans. [Rev Gastroenterol Disord. 2004;4(2):60–65]
Emerging Biologic Therapies in Inflammatory Bowel Disease Treatment Update
Ulcerative colitis and Crohn’s disease, the idiopathic inflammatory bowel diseases (IBD), are thought to represent genetically determined, dysregulated immune responses to otherwise innocuous luminal antigens. Although progress in research has advanced our understanding of the immunopathogenesis and begun to elucidate genetic contributions toward susceptibility, limitations of current medical approaches continue to drive the search for better therapeutic agents. Most recently, the introduction of infliximab has heralded a new era of evolving biologically targeted treatments for IBD. Infliximab is currently the only biologic agent approved for the treatment of inflammatory and fistulizing Crohn’s disease, but ongoing research continues to generate new biologic agents targeted at specific pathogenic mechanisms involved in the inflammatory process. Undoubtedly, with the success of infliximab, the role of biologic therapy will continue to expand in the future treatment of IBD. [Rev Gastroenterol Disord. 2004;4(2):66-85]
The Short- and Long-Term Safety of 5-Aminosalicylate Products in the Treatment of Ulcerative Colitis Drug Review
5-aminosalicylic acid agents are effective in the treatment of ulcerative colitis. Balsalazide, mesalamine, and olsalazine are alternative formulations to sulfasalazine for the delivery of 5-aminosalicylic acid. The newer compounds might be better tolerated than sulfasalazine in some patients, as long as the intolerance is not due to hypersensitivity to 5-aminosalicylic acid. Adverse events requiring the withdrawal of therapy seem to occur less frequently with balsalazide, mesalamine, and olsalazine compared with sulfasalazine. If patients are unable to tolerate any one of these three 5-aminosalicylic acidreleasing preparations, they might be able to tolerate one of the others, as long as the intolerance is not due to hypersensitivity to 5-aminosalicylic acid. [Rev Gastroenterol Disord. 2004;4(2):86–91]