This month’s issue of Gastroenterology & Hepatology includes several interesting articles involving endoscopy. One of our feature articles, authored by Dr Zaheer Nabi and Dr D. Nageshwar Reddy, highlights endoscopic treatment for gastroesophageal reflux disease (GERD). As the authors note, GERD is commonly encountered in outpatient clinics and typically treated with proton pump inhibitors (PPIs). However, endoscopic treatment may be an option in patients who do not respond to PPIs or who are unwilling to take them long term. In their article, the authors focus on endoscopic radiofrequency ablation (RFA) and endoscopic fundoplication devices (including transoral incisionless fundoplication, endoscopic full-thickness plication, and the Medigus Ultrasonic Surgical Endostapler). The authors also discuss indications, patient evaluation, and future directions for endoscopic treatment for GERD.
Endoscopy also plays a role in another feature article this month, which focuses on the management of patients with Barrett esophagus who have undergone RFA. Dr Craig C. Reed and Dr Nicholas J. Shaheen start by defining surveillance cohorts after RFA and examining different definitions that have been used to describe durable response to RFA after complete eradication of intestinal metaplasia (CEIM). They also discuss issues such as endoscopic surveillance intervals and techniques following CEIM, the management of recurrent Barrett esophagus after CEIM, chemopreventive measures to reduce the likelihood of relapse, and complications associated with endoscopic eradication therapy.
Our endoscopy coverage continues with our Advances in Endoscopy column, which centers on the management of obesity using endoscopic sleeve gastroplasty. Dr Reem Sharaiha examines the different endoscopic treatments for obesity and then discusses how endoscopic sleeve gastroplasty is performed, its learning curve, the ideal candidate for the procedure, how effective it is at achieving sustained weight loss, its advantages and disadvantages compared to other endoscopic inter-ventions, and its adverse events, among related issues.
This month’s third feature article focuses on nonalcoholic fatty liver disease (NAFLD) screening in the primary care setting. Dr Vijay Pandyarajan, Dr Robert G. Gish, Dr Naim Alkhouri, and Dr Mazen Noureddin examine the current society screening recommendations for NAFLD, the role of primary care providers for detecting NAFLD, and clinical prediction rules for the detection of advanced fibrosis (including the Nonalcoholic Fatty Liver Disease Fibrosis Score, Fibrosis-4 Score, and Enhanced Liver Fibrosis test). In addition, the authors provide a screening and treatment algorithm for NAFLD.
The role of fiber and fiber supplements in the management of irritable bowel syndrome (IBS) is the focus of our Advances in IBS column. Among other issues, Dr Jane Muir discusses the mechanism of action of dietary fiber in the gastrointestinal tract, the effects of fiber on IBS symptoms, possible adverse effects of supplemental fiber intake, and long-term use of these supplements.
Finally, idiopathic noncirrhotic portal hypertension is highlighted in our Advances in Hepatology column. Among other issues, Dr Harry L. A. Janssen discusses the etiology and pathophysiology of this condition, when it should be suspected in a patient, how it is typically diagnosed, the role of liver stiffness measurement, typical outcomes, the recommended therapeutic approach, follow-up care, and the next steps in research.
May this issue provide you with helpful information that you can put to good use in your clinical practice.
Gary R. Lichtenstein, MD, AGAF, FACP, FACG