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Volume 7, No 2 - Spring 2007

Volume 7, No 2 - Spring 2007

Table of Contents

Chronic Hepatitis B With Advanced Fibrosis or Cirrhosis: Impact of Antiviral Therapy Treatment Review
Chronic hepatitis B virus (HBV) infection is a significant public health problem in the United States, with 1.25 million people infected with the virus. The long-term risks of chronic HBV infection include cirrhosis and hepatocellular carcinoma, which occur in 15% to 30% of those infected at birth or early in life and may lead to liver transplantation or death. During the past few years, the development and increased availability of oral antiviral agents have made treatment simpler, safer, and more tolerable for these patients. This article focuses on 3 of these drugs—lamivudine, adefovir, and entecavir—and their use in patients with chronic HBV infection and advanced hepatic fibrosis or cirrhosis. [Rev Gastroenterol Disord. 2007;7(2):63-73]
Use of Stents in Benign and Malignant Esophageal Disease Treatment Review
The currently available endoscopic treatment modalities for the palliation of malignant dysphagia outside of self-expandable stent placement are, as yet, not optimal for achieving rapid and sustained dysphagia relief with minimal morbidity and mortality. Self-expanding stents are effective in improving dysphagia; however, the number of re-interventions needed for management of recurrent dysphagia remains higher than initially anticipated. The introduction of newer-generation stents may reduce stent migration and nontumoral tissue overgrowth and result in a decrease in the need for re-intervention. The use of self-expandable stents for benign esophageal disease has shown promising results for the treatment of anastomotic leaks and perforations. However, the data on benign esophageal strictures have been mixed. Multicenter, prospective studies are needed to evaluate the late complication rate and long-term effectiveness in this difficult-to-treat patient population with refractory esophageal strictures. Future developments in stent design include biodegradable stents, stents with a radioactive coating, and drugeluting stents. [Rev Gastroenterol Disord. 2007;7(2):74-88]
Nuances in Treating Irritable Bowel Syndrome Treatment Review
Irritable bowel syndrome (IBS) is a difficult disease to treat because of its illdefined triggers, variable clinical course, and unpredictable myriad of symptoms of varying severity. Both doctors and patients are frustrated by the insidious nature of IBS—a nonlethal disorder that destroys lives, relationships, and careers. Traditional therapies are sometimes effective in mild disease but are often self-limiting because they focus primarily on individual symptoms. A combination of lifestyle and diet modifications, pharmacologic agents, and therapeutic interventions is usually necessary to address the multiple symptoms characteristic of IBS. One of the major advancements in the treatment of patients with IBS has been the development of US Food and Drug Administration– approved serotonergic therapeutics that specifically target the underlying causes of IBS and provide multisymptom relief by improving gastrointestinal function. Although they are controversial, alternative treatment approaches that target normalization of intestinal bacterial microflora may be helpful for some patients in whom intestinal bacterial overgrowth is present. Patients who have co-existing pelvic floor dysfunction may benefit from physical therapy. Overall, treatment approaches for IBS should address multisymptom relief and improvement of overall patient well-being. [Rev Gastroenterol Disord. 2007;7(2):89-96]
Functional Gastrointestinal Disorders in 2007 and Rome III: Something New, Something Borrowed, Something Objective Diagnosis Update
This review highlights the changes recommended by Rome III to the criteria for the functional gastrointestinal disorders and summarizes the practical implications for clinical practice. The committee retained functional dyspepsia as an umbrella term but emphasized its limited utility; they concluded that those with epigastric pain or burning probably constituted a set of patients very distinct from those who reported meal-related symptoms. Rome III added cyclic vomiting syndrome to the adult functional nausea and vomiting disorder category. The committee simplified clinical subtyping of irritable bowel syndrome. Problems remain with the Rome criteria for functional gallbladder and sphincter of Oddi disorders. Although these patients’ pain is probably genuine, the exact characteristics that identify true biliary-type pain remain poorly defined from a scientific perspective. The Rome criteria have been criticized for potentially over-splitting what are truly interdependent conditions. Nevertheless, the Rome criteria remain the best standard we have for guiding diagnosis and helping choose therapy. [Rev Gastroenterol Disord. 2007;7(2):97-105]