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Volume 8, No 1 - Winter 2008

Volume 8, No 1 - Winter 2008

Table of Contents

New Frontiers in Small-Bowel Imaging: The Expanding Technology of Capsule Endoscopy and Its Impact in Clinical Gastroenterology Technique Review
Capsule endoscopy (CE) is now recognized as a significant technologic advancement in gastrointestinal endoscopy that provides noninvasive, highresolution imaging of the small bowel and esophagus. There is also growing evidence that it may be useful in the colon. Since the introduction of CE to clinical practice, its diagnostic utility has become well established for evaluation of patients with obscure gastrointestinal bleeding. It seems also to be useful in evaluating small-bowel Crohn’s disease, compared with other imaging modalities. With respect to esophageal diseases, CE shows promise in the screening of esophageal varices and possibly Barrett’s esophagus. A colon capsule endoscope has also been developed, and its potential use in screening for colorectal neoplasia is currently being studied. The technology and software of CE is also rapidly expanding to allow the physician to read and evaluate the capsule videos in a more efficient manner. The Given Imaging system has progressed significantly over the past several years. In addition to Given Imaging, Olympus now offers a small-bowel capsule endoscope system. This new Olympus capsule technology and how it compares with the Given Imaging System is reviewed, in addition to the various clinical uses of CE. [Rev Gastroenterol Disord. 2008;8(1):1-14]
The Role of Loperamide in Gastrointestinal Disorders Treatment Review
Loperamide is an effective therapy for a variety of diarrheal syndromes, including acute, nonspecific (infectious) diarrhea; traveler’s diarrhea; and chemotherapy-related and protease inhibitor–associated diarrhea. Loperamide is effective for the “gut-directed” symptom of diarrhea in patients with painless diarrhea or diarrhea-predominant irritable bowel syndrome. Loperamide and diphenoxylate are commonly used to treat diarrhea in numerous settings of inflammatory bowel disease. Loperamide has also been observed to increase anal sphincter tone, which may lead to improvement of fecal continence in patients with and without diarrhea. Loperamide is generally well tolerated at recommended nonprescription doses, with the most common side effects related to the impact on bowel motility (abdominal pain, distention, bloating, nausea, vomiting, and constipation). [Rev Gastroenterol Disord. 2008;8(1):15-20]
Maximizing Patient Adherence and Clinical Outcomes With Mesalamine in Mildly-to-Moderately Active Ulcerative Colitis CME-Certified Review Article
Recent evidence suggests that there is a link between increased colonic inflammation and risk of colorectal cancer, stressing the importance of preventing relapse. The risk of relapse is associated with several factors, of which the foremost is patient nonadherence to prescribed medical therapy. Nonadherence may be affected by such factors as complicated dosing regimens, forgetfulness, male sex, and treatment delivery methods. Mesalamine is the standard, first-line therapy and the treatment of choice for inducing and maintaining clinical and endoscopic remission of inflammation in patients with mild-to-moderate ulcerative colitis. Novel formulations of mesalamine and newly devised, high-dose regimens offer additional therapeutic options and may lead to improved treatment adherence, longer-lasting periods of remission, and enhanced patient well-being. [Rev Gastroenterol Disord. 2008;8(1):21-32]
Pylera Plus Omeprazole: Quadruple Treatment for Helicobacter pylori New Drug Review
In 2007, the American College of Gastroenterology published updated treatment guidelines for the management of Helicobacter pylori infection, the leading cause of peptic ulcers. The recommended effective therapies are a triple drug regimen for 14 days or a quadruple bismuth therapy for 10 to 14 days, which includes a combination of a proton pump inhibitor such as omeprazole, bismuth, metronidazole, and tetracycline. These drug regimens all require strict adherence and several pills daily, but recent formulations have lessened the pill burden, which can improve patient compliance and outcomes. The pharmacology, product availability, efficacy, and potential adverse reactions of these regimens are discussed in this review. [Rev Gastroenterol Disord. 2008;8(1):33-41]
Report From the ACG Meeting Review
Highlights of the 72nd Annual Scientific Meeting of the American College of Gastroenterology, October 12-17, 2007, Philadelphia, PA [Rev Gastroenterol Disord. 2008;8(1):42-57]
Advances in Liver Disease Meeting Review
Highlights From the 58th Annual Meeting of the American Association for the Study of Liver Diseases, November 2-6, 2007, Boston, MA [Rev Gastroenterol Disord. 2008;8(1):58-70]