Eosinophilic esophagitis, a chronic inflammatory disorder of the esophagus characterized by an esophageal eosinophilic infiltrate and other esophageal symptoms, is increasing in prevalence worldwide. This disorder is also one of the most common causes of dysphagia and food impactions globally. In a feature article in this month’s issue of Gastroenterology & Hepatology, Dr Anna M. Lipowska and Dr Robert T. Kavitt explore the diagnostic and treatment strategies currently available for this condition. The authors discuss endoscopic and histologic evaluation, the role of proton pump inhibitors, and the use of other diagnostic tools, as well as dietary therapies (including elemental diet, allergy testing–directed elimination diet, and empiric elimination diet), topical and systemic corticosteroids, endoscopic dilation, and various pharmacologic experimental therapies.
Another feature article examines the black box warning for potential reactivation of hepatitis B virus during the use of direct-acting antiviral therapy in patients with chronic hepatitis C virus infection. Dr Paul J. Pockros describes initial and recent reports of hepatitis B virus reactivation, the resulting effects on initiating and monitoring treatment (including the recent black box warning on all direct-acting antiviral drugs and combinations), and how society guidelines have been updated.
This month’s Advances in Endoscopy column focuses on endoscopic sleeve gastroplasty. Dr Reem Sharaiha discusses issues such as the procedure’s role in the management of obesity, how it is performed, its effectiveness in the long term, and its associated adverse events. She also describes the ideal candidate and compares the procedure to other endoscopic and surgical options for managing obesity.
In our Advances in IBS column, Dr Michael Camilleri examines medical treatments for patients with irritable bowel syndrome. Among other issues, he discusses the therapeutic agents currently available to treat this condition, why new therapies are still needed, the various agents presently being investigated, trial data on safety and adverse effects, the role of bile acids, and challenges associated with drug development.
Therapeutic drug monitoring of inflammatory bowel disease patients taking biologic therapy is the focus of our Advances in IBD column. Dr Adam Cheifetz discusses why therapeutic drug monitoring is important in this setting, when drug concentrations should be measured, study data on reactive therapeutic drug monitoring as well as on proactive therapeutic drug monitoring, and the challenges associated with these methods, among other issues.
Finally, in our Advances in Hepatology column, Dr Marcelo Kugelmas examines nonliver-related benefits associated with obtaining sustained virologic response in patients with hepatitis C virus infection. He discusses how, in addition to stopping inflammation and fibrosis, sustained virologic response can lead to improvements in quality of life, diabetes and insulin resistance, cryoglobulinemia, renal disease, lymphoma risk, cardiovascular disease, and cerebrovascular disease.
I hope you enjoy these articles and find them clinically useful.
Gary R. Lichtenstein, MD, AGAF, FACP, FACG