Management and Treatment of Digestive Disorders

A special issue of Gastroenterology Insights (ISSN 2036-7422). This special issue belongs to the section "Gastrointestinal Disease".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 44015

Special Issue Editor


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Guest Editor
Department of Medicine, Division of Gastroenterology‐Hepatology, Albany Medical College, Albany, NY 12208, USA
Interests: gastroenterology; cholangioscopy; esophagogastric junction; biliary stones
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Special Issue Information

Dear Colleagues,

The goal of this Special Issue is to discuss the management and treatment of some of the most encountered gastrointestinal diseases. These are the bread and butter of gastroenterology, and every gastroenterologist should be proficient in them. Every day in clinical practice. we come across patients with GERD, PUD, cirrhosis, pancreatitis, biliary diseases, IBS, diverticular disease, and anorectal disorders. There have been enormous advances in technology and therapeutics. What we used to consider the standard of care 10 years ago has evolved. We hope with this Special Issue to shed the light on some of these advances to improve the practice of medicine and patients’ clinical outcomes.

Dr. Micheal Tadros
Guest Editor

Manuscript Submission Information

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Keywords

  • gastroesophageal reflux disease (GERD)
  • peptic ulcer disease (PUD)
  • cirrhosis
  • pancreatitis
  • cholelithiasis
  • irritable bowel syndrome (IBS)
  • diverticular disease
  • anorectal disorders

Published Papers (10 papers)

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Research

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12 pages, 962 KiB  
Article
Value of Some Scoring Systems for the Prognosis of Rebleeding and In-Hospital Mortality in Liver Cirrhosis with Acute Variceal Bleeding
by Duong Quang Huy, Nguyen Van Chung and Dinh Tien Dong
Gastroenterol. Insights 2023, 14(2), 144-155; https://doi.org/10.3390/gastroent14020011 - 28 Mar 2023
Viewed by 2294
Abstract
Background: Upper gastrointestinal (GI) hemorrhage, caused by acute esophageal variceal bleeding, is a common complication and a leading cause of death in patients with cirrhosis. Therefore, predicting the risk in order to employ an active management to prevent rebleeding and death is crucial. [...] Read more.
Background: Upper gastrointestinal (GI) hemorrhage, caused by acute esophageal variceal bleeding, is a common complication and a leading cause of death in patients with cirrhosis. Therefore, predicting the risk in order to employ an active management to prevent rebleeding and death is crucial. Currently, there are many prognostic scoring systems that have been proposed, but research is needed to find a valid score which can be applied in clinical practice in each country and population. Aims: To compare the value of ALBI (Albumin-Bilirubin), PALBI (Platelet Albumin-Bilirubin), AIMS65, model for end-stage liver disease (MELD), and Child–Pugh scores (CPS) approaches in predicting early rebleeding and in-hospital mortality of acute variceal bleeding in patients with cirrhosis. Subjects and methods: We performed a cross-sectional descriptive study on cirrhotic patients with acute variceal bleeding who were being treated at the Department of Gastroenterology, Intensive care unit—Military Hospital 103 and the Institute for Treatment of Digestive Diseases—108 Military Central Hospital from September 2020 to May 2022. We calculated ALBI, PALBI, AIMS65, MELD, Child–Pugh values and compared them with the rates of early rebleeding and in-hospital mortality. Then, determined and compared the prognostic value through an analysis of the area under the curve (AUC). Results: 222 patients with acute esophageal variceal bleeding were eligible for inclusion in the study. The rates of rebleeding and in-hospital mortality were 9.0% and 6.8%, respectively. Regarding the prognosis of early rebleeding, the ALBI and PALBI scores have good prognostic value (AUROC 0.74; 95% CI: 0.63–0.85 and AUROC 0.7; 95% CI: 0.59–0.81; p = 0.004, respectively), while the Child–Pugh, MELD, AIMS65 scores have little prognostic value, with AUROC < 0.70. Regarding prognosis of in-hospital mortality: the ALBI, PALBI, MELD and AIMS65 all have good value in predicting in-hospital mortality, with AUROC of 0.81 (95% CI: 0.68–0.93, respectively; p < 0.001); 0.8 (95% CI: 0.69–0.91; p <0.001); 0.83 (95% CI: 0.72–0.93; p < 0.001); and 0.82 (95% CI: 0.76–0.87, p < 0.001), respectively. While Child–Pugh score only has medium prognostic value, with AUROC 0.79 (95% CI: 0.66–0.92; p < 0.05). However, there was no significant difference between these prognostic scoring systems. Conclusion: the ALBI, PALBI, MELD and AIMS65 scores all had similar good value in predicting in-hospital mortality, but with early rebleeding prognosis, only ALBI and PALBI had good value. CPS does not show prognostic value like other scores, both in predicting early rebleeding and in-hospital mortality. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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12 pages, 1627 KiB  
Article
Evaluation of Therapeutic Effect of Buspirone in Improving Dysphagia in Patients with GERD and Ineffective Esophageal Motility: A Randomized Clinical Trial
by Foroogh Alborzi Avanaki, Elham Baghereslami, Hesam Aldin Varpaei, Narges Farhadi, Najmeh Aletaha, Farshad Allameh and Mohammad Taher
Gastroenterol. Insights 2023, 14(1), 1-12; https://doi.org/10.3390/gastroent14010001 - 21 Dec 2022
Viewed by 2892
Abstract
Background: Ineffective esophageal motility (IEM) is the most common esophageal motility disorder associated with low-to-moderate amplitude contractions in the distal esophagus in manometric evaluations. Despite recent new conceptions regarding the pathophysiology of esophageal motility and IEM, there are still no effective therapeutic interventions [...] Read more.
Background: Ineffective esophageal motility (IEM) is the most common esophageal motility disorder associated with low-to-moderate amplitude contractions in the distal esophagus in manometric evaluations. Despite recent new conceptions regarding the pathophysiology of esophageal motility and IEM, there are still no effective therapeutic interventions for the treatment of this disorder. This study aimed to investigate the effect of buspirone in the treatment of concomitant IEM and GERD. Methods and Materials: The present study was a randomized clinical trial conducted at the Imam Khomeini Hospital, Tehran. Patients with a history of gastroesophageal reflux disease and dysphagia underwent upper endoscopy to rule out any mechanical obstruction and were diagnosed with an ineffective esophageal motility disorder based on high-resolution manometry. They were given a package containing the desired medication(s); half of the packets contained 10 mg (for 30 days) of buspirone and 40 mg (for 30 days) of pantoprazole, and the other half contained only 40 mg (for 30 days) of pantoprazole. Dysphagia was scored based on the Mayo score, as well as a table of dysphagia severity. Manometric variables were recorded before and after the treatment. Results: Thirty patients (15 pantoprazole and 15 pantoprazole plus buspirone) were included. Females comprised 63.3% of the population, with a mean age of 46.33 ± 11.15. The MAYO score and resting LES pressure significantly changed after treatment. The MAYO and Swallowing Disorder Questionnaire scores significantly decreased after treatment in both groups of patients. Our results revealed that the post-intervention values of manometric variables differed significantly between the two groups after controlling for the baseline values of the variables. This analysis did not demonstrate the superiority of buspirone. Conclusion: Buspirone seems to have no superiority over PPI. Treatment with concomitant IEM and GERD using proton pump inhibitors improves the patient’s clinical condition and quality of life. However, adding buspirone to the treatment regimen did not appear to make a significant difference in patient treatment. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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12 pages, 583 KiB  
Article
Efficacy of Helicobacter pylori Eradication Based on Rabeprazole–Bismuth–Tetracycline–Tinidazole Regimen in Vietnamese Patients with Duodenal Ulcers
by Liem Thanh Nguyen, Vuong Ba Nguyen, Tu Viet Tran, Huy Quang Duong, Loan Thi Thuy Le, Mai Huynh Truc Phuong and Thang Nguyen
Gastroenterol. Insights 2022, 13(4), 365-376; https://doi.org/10.3390/gastroent13040036 - 22 Oct 2022
Cited by 3 | Viewed by 4249
Abstract
(1) Background: In Vietnam, H. pylori bacteria has a resistance rate of 63% to the antibiotic clarithromycin. The initial therapy of H. pylori eradication with a standard three-drug regimen has low efficacy. Objective: Assess the efficacy of H. pylori eradication therapy which uses [...] Read more.
(1) Background: In Vietnam, H. pylori bacteria has a resistance rate of 63% to the antibiotic clarithromycin. The initial therapy of H. pylori eradication with a standard three-drug regimen has low efficacy. Objective: Assess the efficacy of H. pylori eradication therapy which uses a four-drug regimen of rabeprazole–bismuth–tetracycline–tinidazole in patients with duodenal ulcers. (2) Methods: We performed gastrointestinal endoscopy on patients with a diagnosis of duodenal ulcers, gastric mucosa biopsy for a rapid urease test, and histopathology to diagnose H. pylori bacteria before and after treatment. Treatment for eradication of H. pylori bacteria using a rabeprazole–bismuth–tetracycline–tinidazole regimen was prescribed for 14 days. (3) Results: The rate of successful H. pylori eradication treatment according to per protocol (PP) and intention to treat (ITT) was 91.3% (95%CI: 84.8–96.7) and 82.4% (95%CI: 74.5–89.2) respectively. The success rate of H. pylori eradication therapy in males was 96.0% (95%CI: 92–100), higher than in females, which was 70.6% (95%CI: 47.1–88.2), p < 0.01. (4) Conclusions: Treatment of H. pylori with rabeprazole–bismuth–tetracycline–tinidazole regimen is highly effective. Men had higher H. pylori eradication results than women. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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10 pages, 603 KiB  
Article
Upper Gastrointestinal Tract Associated Lesions in Patients with Newly Diagnosed Celiac Disease
by Iulia Enache, Daniel Vasile Balaban, Florina Vasilescu, Ciprian Jurcut, Florentina Ionita-Radu, Alina Popp, Dumitru Matei and Mariana Jinga
Gastroenterol. Insights 2022, 13(1), 77-86; https://doi.org/10.3390/gastroent13010009 - 20 Feb 2022
Cited by 2 | Viewed by 3058
Abstract
(1) Background: Currently available guidelines require upper gastrointestinal (GI) endoscopy with biopsy sampling for adult celiac disease (CD) diagnosis. Based on the pediatric experience, there has been a growing interest if serology-based diagnosis would be possible for adult CD also. Our aim was [...] Read more.
(1) Background: Currently available guidelines require upper gastrointestinal (GI) endoscopy with biopsy sampling for adult celiac disease (CD) diagnosis. Based on the pediatric experience, there has been a growing interest if serology-based diagnosis would be possible for adult CD also. Our aim was to analyze the associated upper GI tract lesions in newly diagnosed CD patients, to see if significant associated pathology is detected during index endoscopy, which might impact patient management not related to CD. (2) Methods: We performed a retrospective analysis of newly diagnosed CD cases diagnosed over a period of 7 years (2014–2020). Demographic, clinical, laboratory, endoscopy and histopathology data were collected from the patients’ charts. Diagnosis was set according to ACG Guideline 2013. (3) Results: Altogether 79 patients were recruited for this study purpose, 75.9% female, median age 39 years. All patients had positive CD-specific serology and atrophic mucosal injury in duodenal biopsy samples. Besides villous atrophy, associated endoscopic findings were detected in 42/79 (53.16%) of patients. Most of the gastric lesions were minor endoscopic findings—small sliding hiatal hernias, non-specific chronic gastritis, but we also found two cases of peptic ulcers, one case of metaplastic gastritis, six cases of atrophic gastritis and one subepithelial lesion. Only one patient had changes in the duodenum except CD-related findings—an inflammatory polyp in the duodenal bulb. No malignancies were found. (4) Conclusions: In our cohort, there was a significant number of newly diagnosed CD patients who had associated lesions during the index upper GI endoscopy, but most of them were minor endoscopic findings. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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Review

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13 pages, 2046 KiB  
Review
Gastric Syphilis Presenting as a Nodal Inflammatory Pseudotumor Mimicking a Neoplasm: Don’t Forget the Treponema! Case Report and Scoping Review of the Literature of the Last 65 Years
by Emanuele Sinagra, Ina Macaione, Mario Stella, Endrit Shahini, Marcello Maida, Giancarlo Pompei, Francesca Rossi, Giuseppe Conoscenti, Rita Alloro, Simona Di Ganci, Calogero Ricotta, Sergio Testai, Marta Marasà, Giuseppe Scarpulla, Aroldo Gabriele Rizzo and Dario Raimondo
Gastroenterol. Insights 2023, 14(2), 178-190; https://doi.org/10.3390/gastroent14020014 - 4 Apr 2023
Cited by 2 | Viewed by 3044
Abstract
Despite the fact that gastric syphilis is considered rare, it is reported as a type of organic involvement that is present in a large proportion of secondary syphilis cases, even though gastritis presenting with symptoms is extremely rare. Clinical, radiological, and endoscopic findings [...] Read more.
Despite the fact that gastric syphilis is considered rare, it is reported as a type of organic involvement that is present in a large proportion of secondary syphilis cases, even though gastritis presenting with symptoms is extremely rare. Clinical, radiological, and endoscopic findings are non-specific and frequently mimic the symptoms of gastric adenocarcinoma or lymphoma, making diagnosis difficult. Immunostaining is required for this diagnosis. We would like to emphasize the importance of being suspicious of GS when a gastric mass exhibits the histologic features of an inflammatory pseudotumor (IPT), as previously reported for nodal IPT caused by luetic infection. We described a 56-year-old man who presented to the oncology department with a 3-month history of anorexia, epigastric pain, nausea, vomiting, and weight loss, as well as an initial radiological and endoscopic suspicion of gastric adenocarcinoma, in which immune staining allowed us to diagnose GS. In addition, we conducted an updated scoping review of the scientific literature to show the clinical, laboratory, and therapeutic findings in GS patients over the last 65 years. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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13 pages, 8300 KiB  
Review
Esophageal Food Impaction and Foreign Object Ingestion in Gastrointestinal Tract: A Review of Clinical and Endoscopic Management
by Livia Marieta Negoita, Catalin Stefan Ghenea, Gabriel Constantinescu, Vasile Sandru, Madalina Stan-Ilie, Oana-Mihaela Plotogea, Umar Shamim, Bogdan Florin Dumbrava and Mariana Mihaila
Gastroenterol. Insights 2023, 14(1), 131-143; https://doi.org/10.3390/gastroent14010010 - 17 Mar 2023
Cited by 2 | Viewed by 5612
Abstract
Foreign bodies in the digestive tract represent a frequent pathology for the emergency service. Foreign bodies are represented by impacted food bolus or voluntarily and involuntarily swallowed objects. Involuntary swallowing of objects occurs most frequently in children, especially between six months and three [...] Read more.
Foreign bodies in the digestive tract represent a frequent pathology for the emergency service. Foreign bodies are represented by impacted food bolus or voluntarily and involuntarily swallowed objects. Involuntary swallowing of objects occurs most frequently in children, especially between six months and three years of age. Food impaction is mostly encountered among adults with different pathologies. For the removal of swallowed foreign bodies, digestive endoscopy is the gold standard method, being successful in over 95% of cases without significant complications. For the endoscopic management of foreign bodies, it is crucial to be aware of the indications, devices, techniques and patient preparation in order to achieve successful and safe removal from the digestive tract. Recommendations in this article are based on a review of the literature and extensive personal experience. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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14 pages, 5865 KiB  
Review
Diverticular Disease—An Updated Management Review
by Sujata Kishnani, Kathryn Ottaviano, Lisa Rosenberg, Soe Htet Arker, Hwajeong Lee, Michael Schuster, Micheal Tadros and Brian Valerian
Gastroenterol. Insights 2022, 13(4), 326-339; https://doi.org/10.3390/gastroent13040033 - 30 Sep 2022
Cited by 3 | Viewed by 10654
Abstract
Diverticular disease is highly prevalent in the Western world, placing an increased burden on healthcare systems. This review clarifies the consensus in the literature on the disease’s classification, etiology, and management. Diverticular disease, caused by sac-like protrusions of colonic mucosa through the muscular [...] Read more.
Diverticular disease is highly prevalent in the Western world, placing an increased burden on healthcare systems. This review clarifies the consensus in the literature on the disease’s classification, etiology, and management. Diverticular disease, caused by sac-like protrusions of colonic mucosa through the muscular colonic wall, has a varied disease course. Multiple theories contribute to our understanding of the etiology of the disease, with pathogenesis affected by age, diet, environmental conditions, lifestyle, the microbiome, genetics, and motility. The subtypes of diverticular disease in this review include symptomatic uncomplicated diverticular disease, segmental colitis associated with diverticulosis, and uncomplicated and complicated diverticulitis. We discuss emerging treatments and outline management options, such as supportive care, conservative management with or without antibiotics, and surgical intervention. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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10 pages, 552 KiB  
Review
Applications of Artificial Intelligence to Eosinophilic Esophagitis
by Eric Reuben Smith and Jay Shah
Gastroenterol. Insights 2022, 13(3), 218-227; https://doi.org/10.3390/gastroent13030022 - 8 Jul 2022
Cited by 2 | Viewed by 3416
Abstract
Eosinophilic Esophagitis (EoE) is a chronic immune-related inflammation, and challenges to its diagnosis and treatment evaluation persist. This literature review evaluates all AI applications to EOE, including 15 studies using AI algorithms for counting eosinophils in biopsies, as well as newer diagnostics using [...] Read more.
Eosinophilic Esophagitis (EoE) is a chronic immune-related inflammation, and challenges to its diagnosis and treatment evaluation persist. This literature review evaluates all AI applications to EOE, including 15 studies using AI algorithms for counting eosinophils in biopsies, as well as newer diagnostics using mRNA transcripts in biopsies, endoscopic photos, blood and urine biomarkers, and an improved scoring system for disease classification. We also discuss the clinical impact of these models, challenges faced in applying AI to EoE, and future applications. In conclusion, AI has the potential to improve diagnostics and clinical evaluation in EoE, improving patient outcomes. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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11 pages, 972 KiB  
Review
High-Quality Colonoscopy: A Review of Quality Indicators and Best Practices
by Mason Soeder, Alla Turshudzhyan, Lisa Rosenberg and Micheal Tadros
Gastroenterol. Insights 2022, 13(2), 162-172; https://doi.org/10.3390/gastroent13020017 - 1 May 2022
Cited by 3 | Viewed by 3865
Abstract
Colorectal cancer (CRC) continues to be the third leading cause of cancer-related deaths in the US. Colonoscopy remains the best preventative tool against the development of CRC. As a result, high-quality colonoscopy is becoming increasingly important. Specifically, recent guidelines have highlighted pre-procedural, peri-procedural, [...] Read more.
Colorectal cancer (CRC) continues to be the third leading cause of cancer-related deaths in the US. Colonoscopy remains the best preventative tool against the development of CRC. As a result, high-quality colonoscopy is becoming increasingly important. Specifically, recent guidelines have highlighted pre-procedural, peri-procedural, and post-procedural practices, which promise to improve patient outcomes and reduce the mortality and interval cancer rates in patients undergoing colonoscopies. Despite the guidelines and advances in modern endoscopy, the procedure remains provider-dependent, which results in differences in outcomes. As a result, incorporating high-quality colonoscopy approaches early in training is key to improving patient outcomes. Additionally, ensuring that high-quality colonoscopy is practiced widely by endoscopists can lead to the most cost-effective care. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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Other

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7 pages, 488 KiB  
Perspective
First Therapeutic Approval for Eosinophilic Esophagitis
by Rami A. Al-Horani and Raquel Chiles
Gastroenterol. Insights 2022, 13(3), 238-244; https://doi.org/10.3390/gastroent13030024 - 30 Jul 2022
Cited by 15 | Viewed by 3512
Abstract
Eosinophilic esophagitis (EE) is a chronic, immune-mediated or antigen-mediated esophageal disease. Treatment for patients with EE can be challenging with no previously approved medications. Current management strategies follow the four D’s paradigm of drugs, dietary elimination, dilation, and disease anxiety and hypervigilance therapy. [...] Read more.
Eosinophilic esophagitis (EE) is a chronic, immune-mediated or antigen-mediated esophageal disease. Treatment for patients with EE can be challenging with no previously approved medications. Current management strategies follow the four D’s paradigm of drugs, dietary elimination, dilation, and disease anxiety and hypervigilance therapy. On 20 May 2022, dupilumab was approved by FDA for EE. A dose of 300 mg dupilumab weekly significantly improved signs and symptoms of EE compared to placebo in a phase 3 trial. The approval of dupilumab will fulfill an unmet need for the increasing number of patients with EE. Full article
(This article belongs to the Special Issue Management and Treatment of Digestive Disorders)
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