GASTROENTEROLOGY (DIGESTIVE SYSTEM)

1. NEWS

Gastroenterology is a branch of medicine that is responsible for seeing the entire

digestive tract, from the esophagus, stomach, small intestine, coarse, colon, rectum
and thereby some pathologies of anorectal as well as digestive glands, liver and
pancreas .

In all these organs is where procedures for diagnosis, treatment and surgery are
performed. Gastrointestinal diseases have varied in recent years, previously they
were more acute diseases, infectious, it was more common to have ill-prepared
food diseases, gastroenteritis, came to seek care for these diseases, but currently
gastrointestinal diseases are increasingly more chronic.

He explains that a classic example is cirrhosis in patients who have liver failure and
that final complication. There is a wide variety of ailments such as varicose veins,
citis, which is the accumulation of fluid in the abdomen, hepatic encephalopathy,
neoplasias and metabolic diseases.

In addition, other diseases, including diarrhea, one of the high specialties that has
inflammatory bowel disease, includes two diseases known as CUSI (Chronic
Idiopathic Ulcerative Colitis), a condition that is confined to the large intestine, also
known as disease inflammatory bowel disease and Crohn's disease, which is
manifested by chronic inflammation of the intestinal tract that can affect the entire
digestive tract, from the mouth to the anus.

We can mention as important advances for bringing to comorbidities the

following:

COLORECTAL CANCER

Duration of benefit of one-time screening sigmoidoscopy (June 2017)

Sigmoidoscopy is one of several methods to screen for colorectal cancer in

average-risk persons.

Pembrolizumab for advanced colorectal cancer and other refractory solid

tumors with deficient DNA mismatch repair (May 2017)

Largely based upon these data, the US Food and Drug Administration granted
accelerated approval to pembrolizumab for the treatment of patients with
advanced microsatellite instability-high (MSI-H) or dMMR mCRC that has
progressed following conventional chemotherapy.

Interval to colonoscopy following a positive fecal immunochemical test (May

2017)
How soon follow-up colonoscopy should be done to evaluate a positive fecal
immunochemical test (FIT) is uncertain. Based on these findings, we encourage
follow-up colonoscopy as soon as possible (and definitely within a few months) for
patients who have a positive FIT.

ENDOSCOPY

Recurrence of acid reflux after laparoscopic anti-reflux surgery (October

2017)

Although over 90 percent of patients are satisfied with the results of their anti-
reflux surgery, criteria defining treatment success or failure vary among studies.
Risk factors for recurrence included female sex, older age, and comorbidity.

Four-food elimination diet for eosinophilic esophagitis (July 2017)

The traditional six-food (cow's milk, hen's egg, soy, wheat, peanut/tree nuts, and
fish/shellfish) elimination diet for eosinophilic esophagitis (EoE) results in
resolution of EoE in approximately three-quarters of children but is challenging
and can have negative nutritional consequences. Thus, we now suggest either the
four-food or six-food empiric elimination diet for most patients who opt for dietary
management of EoE. PPI use and mortality (July 2017)

It is unclear if proton pump inhibitor (PPI)

use is associated with an increase in risk of death, the risk of death increased with
the duration of PPI use. Limitations of the study include its generalizability as the
study cohort primarily consisted of older white males and lack of data on the cause
of mortality. The underlying basis for this apparent increased risk of death with
PPI use is not known, and further studies are needed to evaluate whether the
association is due to unmeasured confounding. However, we continue to
recommend that PPIs be prescribed at the lowest dose for the shortest duration
appropriate for the condition being treated.

Early refeeding in acute pancreatitis (August 2017)

The optimal timing of refeeding in acute pancreatitis is uncertain. In a systematic

review of 11 randomized trials that included 948 patients with acute pancreatitis,
early refeeding (48 hours after hospitalization) did not increase adverse effects
or exacerbate symptoms compared with delayed refeeding

ACG guidelines on the treatment of H. pylori (May 2017)

The American College of Gastroenterology has published updated guidelines on the
treatment of Helicobacter pylori [8]. According to these guidelines, the choice of
initial antibiotic regimen to treat H. pylori should be guided by risk factors for
macrolide resistance and penicillin allergy. Risk factors for macrolide resistance
include prior exposure to macrolides and local clarithromycin rates 15 percent
(assumed in the United States). In patients with risk factors for macrolide
resistance, bismuth quadruple therapy is a first-line treatment option.