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Emergency Medicine Clinics of North... Feb 1996A systemic approach must be taken with both upper and lower gastrointestinal bleeding. The first priority is stabilization. Once this has been achieved, and in patients... (Review)
Review
A systemic approach must be taken with both upper and lower gastrointestinal bleeding. The first priority is stabilization. Once this has been achieved, and in patients who present with stable vital signs, a systematic approach to diagnosis and management must be followed. The urgency with which this is performed will be dictated by such aspects as risk factors and the clinical presentation. Some patients may need immediate diagnostic studies in the emergency department, some in the intensive care unit, some on a regular floor, and others may even be able to receive medical treatment followed by investigation on an outpatient basis.
Topics: Algorithms; Combined Modality Therapy; Critical Care; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Gastrointestinal Agents; Gastrointestinal Hemorrhage; Humans; Intestinal Diseases; Peptic Ulcer Hemorrhage; Sclerotherapy
PubMed: 8591778
DOI: 10.1016/s0733-8627(05)70243-1 -
Journal of Nippon Medical School =... 2021With advancements in the development of flexible endoscopes and endoscopic devices and the increased demand for minimally invasive treatments, the indications of... (Review)
Review
With advancements in the development of flexible endoscopes and endoscopic devices and the increased demand for minimally invasive treatments, the indications of therapeutic endoscopy have been expanded. Methods of endoscopic treatment used for tissue removal, hemostasis, and dilatation are as follows. Endoscopic submucosal dissection (ESD) is considered the gold standard curative method for removal of gastrointestinal node-negative neoplasms, regardless of their size or the presence of ulcer formation. Laparoscopic endoscopic cooperative surgery (LECS), which incorporates ESD, was introduced for removal of lesions in deeper layers. Another technique is endoscopic full-thickness resection, which is challenging without the assistance of laparoscopy. In terms of hemostasis, management of iatrogenic bleeding after endoscopic treatment is an important issue. Shielding methods and suturing techniques have been introduced for large mucosal defects after ESD, and their efficacy has been investigated clinically. Peroral endoscopic myotomy (POEM) is a new alternative surgical approach for minimally invasive treatment of esophageal achalasia. Furthermore, endoscopic fundoplication after POEM was devised to prevent post-POEM gastroesophageal reflux disease. Many endoscopic treatments, including ESD, LECS, and POEM, have been introduced in Japan. With the aging of the population, more attention will be directed toward therapeutic endoscopy for elderly patients, because it is less invasive. Development of endoscopic treatments with expanded indications is expected.
Topics: Endoscopes, Gastrointestinal; Endoscopy, Gastrointestinal; Esophageal Achalasia; Female; Fundoplication; Gastric Mucosa; Gastroesophageal Reflux; Gastrointestinal Neoplasms; Hemostasis, Endoscopic; Humans; Laparoscopy; Male; Myotomy; Postoperative Complications; Postoperative Hemorrhage
PubMed: 33692281
DOI: 10.1272/jnms.JNMS.2021_88-109 -
International Journal of Molecular... Jul 2016Studies in humans have shown that 3,3'-diindolylmethane (DIM), which is found in cruciferous vegetables, such as cabbage and broccoli, is effective in the attenuation of... (Review)
Review
Studies in humans have shown that 3,3'-diindolylmethane (DIM), which is found in cruciferous vegetables, such as cabbage and broccoli, is effective in the attenuation of gastrointestinal cancers. This review presents the latest findings on the use, targets, and modes of action of DIM for the treatment of human gastrointestinal cancers. DIM acts upon several cellular and molecular processes in gastrointestinal cancer cells, including apoptosis, autophagy, invasion, cell cycle regulation, metastasis, angiogenesis, and endoplasmic reticulum (ER) stress. In addition, DIM increases the efficacy of other drugs or therapeutic chemicals when used in combinatorial treatment for gastrointestinal cancer. The studies to date offer strong evidence to support the use of DIM as an anticancer and therapeutic agent for gastrointestinal cancer. Therefore, this review provides a comprehensive understanding of the preventive and therapeutic properties of DIM in addition to its different perspective on the safety of DIM in clinical applications for the treatment of gastrointestinal cancers.
Topics: Animals; Anticarcinogenic Agents; Apoptosis; Cell Proliferation; Gastrointestinal Neoplasms; Humans; Indoles
PubMed: 27447608
DOI: 10.3390/ijms17071155 -
Acta Gastro-enterologica Belgica 2016Cystic fibrosis (CF) is a life-limiting disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). This defective chloride channel,... (Review)
Review
Cystic fibrosis (CF) is a life-limiting disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). This defective chloride channel, present in different organ systems such as respiratory system, gastrointestinal tract, reproductive system and sweat glands, disturbs the ion and water transport over the membranes leading to the well known CF symptoms. CF has outgrown paediatric care, as half of CF patients are currently adults. The CF gastrointestinal tract has its own particularities. Some gastrointestinal manifestations are the direct consequence of the CFTR defect whilst others are secondary to treatment. The gastrointestinal diseases are classified according to the way they usually present in symptoms at diagnosis, acute and chronic abdominal pain and silently evolving conditions. (Acta gastroenterol. belg., 2016, 79, 481-486).
Topics: Adult; Child; Cystic Fibrosis; Disease Management; Gastrointestinal Diseases; Humans; Infant, Newborn; Symptom Assessment
PubMed: 28209107
DOI: No ID Found -
World Journal of Gastroenterology Apr 2016Severe gastrointestinal (GI) hemorrhage is a rare complication of Crohn's disease (CD). Although several surgical and non-surgical approaches have been described over... (Review)
Review
Severe gastrointestinal (GI) hemorrhage is a rare complication of Crohn's disease (CD). Although several surgical and non-surgical approaches have been described over the last 2 decades this complication still poses significant diagnostic and therapeutic challenges. Given the relative infrequency of severe bleeding in CD, available medical literature on this topic is mostly in the form of retrospective case series and reports. In this article we review the risk factors, diagnostic modalities and treatment options for the management of CD presenting as GI hemorrhage.
Topics: Crohn Disease; Gastrointestinal Agents; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Immunosuppressive Agents; Predictive Value of Tests; Recurrence; Risk Factors; Treatment Outcome
PubMed: 27122659
DOI: 10.3748/wjg.v22.i16.4073 -
Clinical and Translational... Mar 2020Current conventional endoscopes have restricted the accuracy of treatment delivery and monitoring. Over the past decade, there have been major developments in... (Review)
Review
Current conventional endoscopes have restricted the accuracy of treatment delivery and monitoring. Over the past decade, there have been major developments in nanotechnology and light triggered therapy, potentially allowing a better detection of challenging lesions and targeted treatment of malignancies in the gastrointestinal tract. Theranostics is a developing form of personalized medicine because it combines diagnosis and targeted treatment delivered in one step using advances in nanotechnology. This review describes the light-triggered therapies (including photodynamic, photothermal, and photoimmunotherapies), nanotechnological advances with nanopowder, nanostent, nanogels, and nanoparticles, enhancements brought to endoscopic ultrasound, in addition to experimental endoscopic techniques, combining both enhanced diagnoses and therapies, including a developed prototype of a "smart" multifunctional endoscope for localized colorectal cancer, near-infrared laser endoscope targeting the gastrointestinal stromal tumors, the concept of endocapsule for obscure gastrointestinal bleed, and a proof-of-concept therapeutic capsule using ultrasound-mediated targeted drug delivery. Hence, the following term has been proposed encompassing these technologies: "Theranostic gastrointestinal endoscopy." Future efforts for integration of these technologies into clinical practice would be directed toward translational and clinical trials translating into a more personalized and interdisciplinary diagnosis and treatment, shorter procedural time, higher precision, higher cost-effectiveness, and less need for repetitive procedures.
Topics: Cost-Benefit Analysis; Endoscopy, Gastrointestinal; Endosonography; Gastric Mucosa; Gastrointestinal Diseases; Humans; Intestinal Mucosa; Light; Nanostructures; Phototherapy; Theranostic Nanomedicine
PubMed: 32352709
DOI: 10.14309/ctg.0000000000000119 -
Gastroenterology Clinics of North... Jun 2013Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract. Soon after GIST was recognized as a tumor driven by a KIT or... (Review)
Review
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract. Soon after GIST was recognized as a tumor driven by a KIT or platelet-derived growth factor receptor mutation, it became the first solid tumor target for tyrosine kinase inhibitor therapies. More recently, alternative molecular mechanisms for GIST pathogenesis have been discovered. These are related to deficiencies in the succinate dehydrogenase complex, NF1-gene alterations in connection with neurofibromatosis type 1 tumor syndrome, and mutational activation of the BRAF oncogene in very rare cases.
Topics: Abdominal Pain; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Gastrointestinal Stromal Tumors; Humans; Neurofibromatosis 1; Platelet-Derived Growth Factor; Prognosis; Proto-Oncogene Proteins c-kit; Succinate Dehydrogenase
PubMed: 23639648
DOI: 10.1016/j.gtc.2013.01.001 -
Alimentary Pharmacology & Therapeutics Jun 2014Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal tract with an increasing incidence. (Review)
Review
BACKGROUND
Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal tract with an increasing incidence.
AIMS
To review the biology, diagnosis and treatment of gastrointestinal stromal tumours.
METHODS
A PubMed search using the phrases 'Gastrointestinal stromal tumor', 'imatinib', 'c-kit'.
RESULTS
The diagnosis of GIST is established by histology supplemented by the immunohistochemical marker CD117, which is positive in 95% of cases. The most common site of the tumour is the stomach. Most GIST are benign with 20-30% malignant. Five-year survival for malignant GIST ranges between 35% and 65% and depends primarily on tumour size, mitotic index and location. The malignant behaviour of GIST is best assessed by invasion of adjacent structures and distant metastases. The gold standard for treatment is surgical resection. Imatinib, a tyrosine kinase inhibitor, is the primary therapy for unresectable, recurrent or metastatic disease.
CONCLUSIONS
Gastrointestinal stromal tumours are rare tumours of the gastrointestinal tract and they vary in presentation. When surgical resection is not achievable, imatinib is the treatment of choice.
Topics: Antineoplastic Agents; Benzamides; Gastrointestinal Neoplasms; Gastrointestinal Stromal Tumors; Humans; Imatinib Mesylate; Piperazines; Protein Kinase Inhibitors; Pyrimidines
PubMed: 24749828
DOI: 10.1111/apt.12761 -
The AAPS Journal Nov 2014Physiologically based pharmacokinetic (PBPK) modeling holds great promise for anticipating the quantitative changes of pharmacokinetics in pediatric populations relative... (Review)
Review
Physiologically based pharmacokinetic (PBPK) modeling holds great promise for anticipating the quantitative changes of pharmacokinetics in pediatric populations relative to adults, which has served as a useful tool in regulatory reviews. Although the availability of specialized software for PBPK modeling has facilitated the widespread applications of this approach in regulatory submissions, challenges in the implementation and interpretation of pediatric PBPK models remain great, for which controversies and knowledge gaps remain regarding neonatal development of the gastrointestinal tract. The commentary highlights the similarities and differences in the gastrointestinal pH and transit time between neonates and adults from a PBPK modeling prospective. Understanding the similarities and differences in these physiological parameters governing oral absorption would promote good practice in the use of pediatric PBPK modeling to assess oral exposure and pharmacokinetics in neonates.
Topics: Adolescent; Adult; Aging; Child; Child, Preschool; Gastrointestinal Absorption; Gastrointestinal Tract; Gastrointestinal Transit; Humans; Hydrogen-Ion Concentration; Infant; Infant, Newborn; Models, Biological; Young Adult
PubMed: 25182208
DOI: 10.1208/s12248-014-9652-1 -
Digestive Diseases and Sciences Mar 2020The intestinal microbiome encodes vast metabolic potential, and multidisciplinary approaches are enabling a mechanistic understanding of how bacterial enzymes impact the... (Review)
Review
The intestinal microbiome encodes vast metabolic potential, and multidisciplinary approaches are enabling a mechanistic understanding of how bacterial enzymes impact the metabolism of diverse pharmaceutical compounds, including chemotherapeutics. Microbiota alter the activity of many drugs and chemotherapeutics via direct and indirect mechanisms; some of these alterations result in changes to the drug's bioactivity and bioavailability, causing toxic gastrointestinal side effects. Gastrointestinal toxicity is one of the leading complications of systemic chemotherapy, with symptoms including nausea, vomiting, diarrhea, and constipation. Patients undergo dose reductions or drug holidays to manage these adverse events, which can significantly harm prognosis, and can result in mortality. Selective and precise targeting of the gut microbiota may alleviate these toxicities. Understanding the composition and function of the microbiota may serve as a biomarker for prognosis, and predict treatment efficacy and potential adverse effects, thereby facilitating personalized medicine strategies for cancer patients.
Topics: Antineoplastic Agents; Gastrointestinal Diseases; Gastrointestinal Microbiome; Gastrointestinal Tract; Humans; Precision Medicine; Probiotics
PubMed: 32026181
DOI: 10.1007/s10620-020-06119-3