The Dyspepsia Alphabet: DU, GU, GERD, NERD, NUD/FD and UD

The care of patients with dyspepsia may be almost as confusing as the many terms that are used to describe this very common symptom. A symptom-based approach may prove to be ideal for the patient with undiagnosed dyspepsia. This brief overview describes some of the many terms used to describe dyspepsia. Clearly, new treatment algorithms are needed for the care of patients with undiagnosed dyspepsia seen in a primary care setting

A Gastroenterologist’s Perspective of The Medical Management of Patients with Crohn’s Disease and Ulcerative Colitis

Medical therapy in patients with inflammatory bowel disease (IBD) has specific objectives that need to be remembered when considering any form of intervention. These objectives include to improve the quality of life, to improve symptoms, to improve nutrition and reduce the risk of nutritional deficiencies, to reduce the frequency and severity of recurrences, to reduce complications, including the need for surgery, and to cure the disease. Medical therapy potentially helps to achieve all of these objectives for sufferers of IBD, except the last one – until the pathogenesis of the recurrent or continuous episodes of bowel inflammation is better understood, this last objective will remain "a riddle, wrapped in a mystery, inside an enigma"

Impact of PPIs on patient focused symptomatology in GERD

About half of patients with gastroesophageal reflux disease (GERD) have a normal endoscopy, so symptom assessment is the only appropriate outcome measure for these persons. Symptom assessment is also of great importance in persons with erosive esophagitis. There is currently no fully validated questionnaire to compare symptom response to treatment of patients with GERD. The aim of this review is to consider ReQuest™ assessment tool to evaluate esophageal, supra-esophageal, and infra-esophageal symptoms, as well as any modification of the patient’s quality of life. The ReQuest™ may be combined with the Los Angeles classification of esophagitis (LA A–D), to include the normal endoscopic finding in normal endoscopy reflux disease. The ReQuest™ score declines rapidly towards normal with patient treatment with a proton pump inhibitor. A proportion of patients need more than the usual 8 weeks of therapy. For example, in GERD patients with Los Angeles B–D, the ReQuest™ score falls more with pantoprazole 40 mg than with esomoprazole 40 mg after 12 weeks of therapy. Now that the simplified ReQuest in Practice™ is available, this validated brief questionnaire has potential as an instrument for use in GERD patients seen in everyday clinical practice

Small Bowel Review - Part II

Significant advances have been made in the study of the small bowel. Part II of this two-part review of the small bowel examines the early development and later ageing of the small bowel; the effect of diabetes, alcohol, radiation and HIV on the small bowel; enteral and parenteral nutrition; the brush border membrane and enterocyte proliferation; and peptide hormones (including transforming growth factors, motilin, peptide YY and cholecystokinin)

Basic Science for the Clinical Gastroenterologist: A Review of the Recent Literature on the Small Bowel – Part II

In small bowel science, as in all parts of medicine, there has been a recent explosion of information. This is the second of a two-part series in which the scientific basis of clinical gastroenterology practice and its future are considered. Advances in understanding the mechanisms of intestinal transport are examined, followed by a perspective of intestinal adaptation in health and disease. The author also discusses clinically important areas of motility and bloodflow

Therapeutic Options for Patients Bleeding with Peptic Ulcers

It is likely that the best outcome for the patient with an acute upper gastrointestinal bleed (GIB) includes early diagnosis: for a bleeding lesion with a high risk of rebleeding, in an older patient with systolic h.ypotension or in a person with multiple medical problems. Early therapeutic endoscopy with meticulous control of intragastric pH will Likely achieve the best outcome. The ideal pH criterion to stop bleeding or to prevent recurrence is unknown. An algorithm is presented to guide the clinical management of patients with GIB, and to focus on important questi.ons for future therapeutic studies