American Journal of Gastroenterology

Patients in Whom to Consider Genetic Evaluation and Testing for Hereditary Colorectal Cancer Syndromes No abstract available

Choosing a Prokinetic for Your Patient Beyond Metoclopramide No abstract available

Electronic Alerts as a Simple Method for Amplifying the Yield of Hepatitis C Virus Infection Screening and Diagnosis No abstract available

Esophagitis in Non-Small Cell Lung Carcinoma Treatment Caused by Pembrolizumab No abstract available

Primary Rectal Mucinous Cystic Neoplasm No abstract available

Endoscopic Loop String-Assisted Clip Suturing Closure of Large Mucosal Defects After Endoscopic Submucosal Dissection in the Sigmoid Colon No abstract available

Continuing Medical Education Questions: January 2020: ACG Clinical Guideline: Disorders of the Hepatic and Mesenteric Circulation No abstract available

Continuing Medical Education Questions: January 2020: Chronic Pancreatitis: Managing a Difficult Disease No abstract available

ACG Clinical Guideline: Disorders of the Hepatic and Mesenteric Circulation Disorders of the mesenteric, portal, and hepatic veins and mesenteric and hepatic arteries have important clinical consequences and may lead to acute liver failure, chronic liver disease, noncirrhotic portal hypertension, cirrhosis, and hepatocellular carcinoma. Although literature in the field of vascular liver disorders is scant, these disorders are common in clinical practice, and general practitioners, gastroenterologists, and hepatologists may benefit from expert guidance and recommendations for management of these conditions. These guidelines represent the official practice recommendations of the American College of Gastroenterology. Key concept statements based on author expert opinion and review of literature and specific recommendations based on PICO/GRADE analysis have been developed to aid in the management of vascular liver disorders. These recommendations and guidelines should be tailored to individual patients and circumstances in routine clinical practice.

What Causes Functional Gastrointestinal Disorders? A Proposed Disease Model Chronic unexplained gastrointestinal symptoms impact more than 1 in 5 Americans and their families; these disorders include the irritable bowel syndrome (IBS) and functional dyspepsia (FD), currently classified by Rome IV as functional gastrointestinal disorders. By definition, IBS and FD have no established pathology, but emerging evidence suggests this paradigm may need revision. Immune activation and, in subsets, subtle intestinal pathology have been identified in FD (most notably, postprandial distress syndrome) and IBS-diarrhea. A disease model is proposed that accounts for all of the intestinal and extraintestinal symptoms, relationship to food and infection, and the overlap with gastroesophageal reflux disease. It is speculated that antigen presentation to the mucosa (e.g., microbial antigens or food proteins after acute gastroenteritis) induces, in a genetically primed host, immune activation of the intestine with low-grade intestinal inflammation and subsequently neuronal structural and functional alterations, producing regional intestinal hypersensitivity and motor dysfunction. Immune activation may explain the female predominance and fluctuations in immune activity for symptom variability over time. In the future, as further evidence accumulates, the management paradigm may potentially shift to objective pathology-based subtyping based on serological, microbiological, and clinical assessments to identify when targeted therapies should be deployed in subsets. Potential targeted interventions may include therapies to dampen down immune activation or block release of key mediators such as histamine, specific microbial targeted treatments that may reverse disease, and dietary advice to eliminate relevant food antigens after objective in vivo testing. Only by identifying causation can we eventually anticipate cure, and as the true pathology unravels in subsets, this may become a reality.