Gastroenterology & Hepatology

January 2018 - Volume Volume 14, Issue Issue 1

Letter From the Editor: Pain Management

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

How should we manage our gastroenterology and hepatology patients who are in pain? This question has become particularly timely and increasingly important with the recent opioid epidemic in the United States. This issue of Gastroenterology & Hepatology includes an examination of pain management in patients with inflammatory bowel disease (IBD). In our Advances in IBD column, Dr Eva Szigethy discusses commonly used pain scales for IBD patients, risk factors for worse pain, sources of pain, numerous treatment options (including different types of antidepressants, mood stabilizers, opioids, cognitive behavioral therapy, medical hypnosis, and mindfulness meditation), and the possible role of medical marijuana, among other issues.

Our IBD coverage continues with a feature article on the effects of serrated colorectal lesions in IBD patients. As Dr Alyssa M. Parian and Dr Mark G. Lazarev note, the risk of colorectal cancer is increased in IBD patients; however, the role of serrated lesions in the development of colorectal cancer is not well understood. The authors examine the various categories of serrated colorectal lesions, the limited studies that have been conducted to date in this area, the concept of serrated epithelial change, and genetics of serrated lesions of the colon.

Another feature article this month focuses on hepatitis B virus (HBV) infection and various types of organ transplantation. Dr Walid S. Ayoub, Dr Paul Martin, and Dr Kalyan Ram Bhamidimarri discuss predictors of HBV recurrence following liver transplantation and measures for preventing recurrence, and examine hepatitis B core antibody positivity in liver, kidney, and thoracic organ transplantation as well as in patients receiving chemotherapy.

This issue also includes an article on the use of disaccharidase assays in patients with abdominal pain. Dr Stanley A. Cohen and Ms Hannah Oloyede note that although disaccharidase deficiency is often accompanied by abdominal discomfort and diarrhea, this deficiency is frequently overlooked when considering possible causes for these symptoms. The authors review endoscopic records from pediatric patients undergoing diagnostic esophagogastroduodenoscopy and disaccharidase analysis, and examine disaccharidase testing practices in this population.

Hepatitis delta virus (HDV) infection is the focus of our Advances in Hepatology column. Among other issues, Dr Jeffrey S. Glenn discusses the prevalence of HDV infection, potential consequences of this infection, current treatment, and emerging therapeutic targets that are being investigated, such as entry inhibitors, nucleic acid polymers, prenylation inhibitors, and pegylated interferon λ.

In our Advances in Endoscopy column, Dr Peter V. Draganov examines the use of endoscopic mucosal resection and endoscopic submucosal dissection for the removal of colon polyps. He describes how these techniques are performed as well as their advantages, dis-advantages, adverse events, and required training, along with related issues.

The association between gut-brain interactions and irritable bowel syndrome (IBS) symptoms is examined in our bimonthly Advances in IBS column. Among other issues, Dr Emeran A. Mayer discusses the role that the microbiome plays in the pathogenesis of IBS, the key parts of the brain and nervous system that are involved with IBS symptoms, whether the microbiome influences the brain or vice versa, whether there is a connection between childhood trauma and IBS, and whether probiotics can alter the effects of early-life trauma on IBS.

Finally, this issue includes an opinion piece by Dr Seymour Katz and Ms Eileen Petrilak on the effects of the 2017 coding update from the Centers for Medicare and Medicaid Services on relative value units and the cognitive physician visit.

As always, I hope you find these articles informative and relevant, and I wish you and your patients a happy, healthy, and prosperous new year.


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

Millennium Medical Publishing, Inc