Gastroenterology & Hepatology

August 2019 - Volume 15, Issue 8

Letter from the Editor: Tools for the Screening of Colorectal Cancer

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

Colorectal cancer is one of the leading causes of cancer-related death in the United States. However, the effectiveness of screening for this condition still needs to be improved. This month’s issue of Gastroenterology & Hepatology examines the use of screening colonoscopy and stool-based tests, particularly the fecal immunochemical test and the multitarget stool DNA test, to screen for colorectal cancer. In our Advances in Endoscopy column, Dr David A. Ahlquist reviews the current colorectal cancer screening recommendations as well as how the different screening tests are performed, their advantages and disadvantages, possible adverse events, cost-effectiveness, and contraindications, among other issues.

One of our feature articles this month examines the utility of diagnostic testing in pediatric patients who have functional abdominal pain disorders. Dr Alejandro Llanos-Chea and Dr Miguel Saps examine issues such as the associated Rome diagnostic criteria, routine testing, stool biomarkers such as fecal calprotectin and stool lactoferrin, screening for celiac disease, endoscopic evaluation with esophagogastroduodenoscopy and colonoscopy, the use of video capsule endoscopy, and the expenses associated with evaluating and caring for these patients.

Our other feature article this month highlights the preventive management of compensated cirrhosis. Dr Akshay Shetty, Mr Jung Jun Yum, and Dr Sammy Saab describe key care aspects, such as the importance of diagnosing cirrhosis early; the management of gastroesophageal varices and hepatocellular carcinoma; the education of patients regarding nutrition, exercise, safe use of alcohol and medications (both prescription and over-the-counter), and immunizations; and the screening of related conditions.

High-resolution manometry in the setting of gastroesophageal reflux disease (GERD) is the focus of our Advances in GERD column. Among other issues, Dr C. Prakash Gyawali discusses how high-resolution manometry is performed in patients who have GERD and how it compares with conventional manometry, how reliable it is for differentiating patients with GERD from the general population, whether it can be used in children, and its main benefits and limitations.

Our Advances in Hepatology column, authored by Dr Jasmohan S. Bajaj, explores hepatic encephalopathy diagnosis and treatment. His discussion includes when hepatic encephalopathy should be suspected, the various types of diagnostic tests that can be used and their advantages and disadvantages, how both covert and overt hepatic encephalopathy are typically treated, the safety of the treatments, and whether fecal microbiota transplantation has a therapeutic role, among other issues.

Finally, our Advances in IBD column provides an overview of fecal diversion in Crohn’s disease. Dr Feza Remzi discusses the main reasons for using fecal diversion in this setting, how the procedure is usually performed, whether biologic therapy should be stopped beforehand, factors that might affect the decision to perform the procedure, predictors of success, and the main benefits and drawbacks, along with related issues.

I hope that you enjoy these articles and find them interesting and clinically useful.


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

Millennium Medical Publishing, Inc