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Volume 9, No 2 - Spring 2009

Volume 9, No 2 - Spring 2009

Table of Contents

Screening and Diagnosis of Cholangiocarcinoma in Patients With Primary Sclerosing Cholangitis Diagnosis Update
Primary sclerosing cholangitis (PSC) is an idiopathic cholestatic liver disease which predisposes to the development of cholangiocarcinoma (CCA). Detection of CCA in PSC patients remains difficult and CCA is often found incidentally at autopsy or in explanted livers post-transplantation for PSC. In addition, considerable overlap exists between the symptoms of CCA and those of benign dominant strictures encountered commonly in PSC. Clinicians utilize a combination of serum tumor markers, cytology from bile duct brushings, and imaging in an attempt to screen for and detect CCA in patients with PSC, although the evidence for these modalities remains largely retrospective. Newer treatment options for early CCA such as resection and liver transplantation have shown promising results, making an effective screening regimen for the detection of CCA at a treatable stage in PSC patients a highly coveted goal.[Rev Gastroenterol Disord. 2009;9(2):E41-E47 doi: 10.3909/rigd.0335]
Functional (Non-Ulcer) Dyspepsia and Gastroparesis—Differentiating These Conditions and Practical Management Approaches State of the Art
Because of the limited therapeutic options, management of patients with functional dyspepsia can be remarkably difficult. This review considers the current state of the art for patients who present with unexplained dyspepsia, and outlines a practical management approach for clinicians.[Rev Gastroenterol Disord. 2009;9(2):E48-E53 doi: 10.3909/rigd.0345]
Reflux Monitoring State of the Art
There are several available diagnostic options to evaluate patients with suspected gastroesophageal reflux, whether acid, weakly acid, or nonacid. The appropriate application of these technologies is the subject of much discussion among experts. Thoughtful use of reflux monitoring is of great benefit in the evaluation of patients with endoscopy-negative disease reflux symptoms that are resistant, recurrent, or refractory to standard or double-dose antisecretory therapy; patients with distinct, atypical symptoms such as cough, laryngitis, chest pain, globus, or regurgitation in whom heartburn is infrequent or absent; patients who are seeking surgical or endoscopic corrective procedures to treat their symptoms; and those with recurrence of symptoms after undergoing surgical procedures. Reflux monitoring may be useful in avoiding an incorrect diagnosis of gastroesophageal reflux disease (GERD) and in management of patients with Barrett’s esophagus. This article will review the current clinical applications of reflux monitoring in patients with GERD.[Rev Gastroenterol Disord. 2009;9(2):E54-E62 doi: 10.3909/rigd.0351]
Diarrhea News and Views From the Literature
Helicobacter pylori News and Views From the Literature