Gastroenterology & Hepatology

August 2017 - Volume Volume 13, Issue Issue 8

Letter From the Editor: Health Maintenance in Inflammatory Bowel Disease

Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Last month, our Advances in IBD column covered the importance of vaccination in patients with inflammatory bowel disease (IBD). Our coverage of health maintenance of IBD patients continues in this month’s issue of Gastroenterology & Hepatology. In our Advances in IBD column, Dr Sunanda V. Kane discusses the importance of assessing and screening IBD patients for conditions such as osteoporosis, melanoma and nonmelanoma skin cancers, cervical cancer, and depression and anxiety. Among other issues, she explains which patients with IBD are at risk for these conditions, how screening can be performed, why there are gaps between screening recommendations and the screening typically received, and what resources are available to increase screening.

One of our feature articles this month focuses on the importance of patient selection for ileal pouch–anal ana-stomosis (IPAA). Since the procedure was first reported several decades ago, IPAA has been the preferred operative treatment for many patients undergoing colectomy who do not wish to have a permanent ileostomy. According to Dr Shannon Chang, Dr Bo Shen, and Dr Feza Remzi, thoughtful consideration is needed before using IPAA in patients with obesity, anal sphincter dysfunction or damage, advanced age, radiation therapy, and indeterminate colitis or Crohn’s disease.

Incomplete colonoscopy is the focus of another feature article. As Dr Diana L. Franco, Dr Jonathan A. Leighton, and Dr Suryakanth R. Gurudu note, colonoscopy is the most common screening method for identifying and removing polyps in the colon and for preventing colorectal cancer. The authors examine factors that contribute to incomplete colonoscopy, strategies for prevention (such as adequate bowel preparation, app-ropriate sedation, abdominal pressure and position changes, and carbon dioxide), and current and emerging methods for management (such as repeat colonoscopy, overtube-assisted colonoscopy, spiral overtubes, colon capsule endoscopy, and robotic colonoscopes).

In our third feature article, Dr Liza Bronner Murrison and Dr Kenneth E. Sherman provide a thorough overview of hepatitis E virus (HEV). As the authors point out, this virus is the largest cause of acute viral hepatitis worldwide. Unfortunately, HEV is frequently missed or misdiagnosed, and it is poorly characterized. The authors explore HEV’s natural history (including its burden, clinical presentation, and disease severity and genotype), diagnosis, transmission, and epidemiology in developing as well as developed countries.

This month’s Advances in Hepatology column focuses on the management of autoimmune hepatitis in pregnant women. Among other issues, Dr Marion G. Peters discusses how pregnancy affects the disease course of autoimmune hepatitis (and vice versa), optimal management of these patients, whether there are any fetal and maternal risks associated with treatment for this disease, and how delivery affects disease activity.

In our Advances in Endoscopy column, Dr V. Raman Muthusamy examines endoscopic ultrasound–guided fine-needle aspiration and fine-needle biopsy. He discusses the differences between these techniques, their indications and contraindications, benefits and limitations, diagnostic accuracy and yield, and the number of passes required for diagnosis, as well as other related issues.

Our Advances in GERD column focuses on acetic acid chromoendoscopy in patients with neoplastic Barrett esophagus. In addition to other issues, Dr Pradeep Bhandari discusses how this form of chromoendoscopy compares to standard chromoendoscopy, its advantages and disadvantages, how effective it is in diagnosing neo-plastic Barrett esophagus, and how it compares to alternative surveillance and detection methods.

Our bimonthly HCC in Focus column returns with an interview with Dr Richard S. Finn on the recently approved agent regorafenib. He discusses the study design, important findings, and limitations of the RESORCE trial, which was conducted on regorafenib; how patients should be monitored while on this agent; and its safety and tolerability, among other issues.

I hope you find these articles interesting and useful.


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc