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Antibiotic Prophylaxis for GI Endoscopy. Gastrointestinal Endoscopy. 67(6): 791-798. 2008.

This article presents a statement on the use of antibiotic prophylaxis for gastrointestinal (GI) endoscopy. The guideline is from a series of educational statements to assist endoscopists in providing care to patients. This guideline discusses infectious complications related to an endoscopy and makes recommendations for periprocedural antibiotic therapy. Topics include bacteremia associated with high-risk and low-risk procedures, bacteremia associated with routine daily activity, antibiotic prophylaxis for GI endoscopic procedures, the prevention of infective endocarditis (IE), the prevention of non-IE infections, cirrhosis with GI bleeding, synthetic vascular graft and other nonvalvular cardiovascular devices, orthopedic prosthesis, and natural orifice transluminal endoscopic surgery. The authors note that clinically significant IE infections associated with endoscopic procedures are extremely rare. They provide other rationales for not administering antibiotic prophylaxis for IE before endoscopic procedures. However, antibiotic prophylaxis may be useful for the prevention of infection related to some endoscopic procedures, before placement of prosthetic devices, and in specific clinical scenarios. The authors provide specific recommendations for these situations. 2 tables. 70 references.

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Appendix B: Some Tests Commonly Used in the Investigation of the Functional Gastrointestinal Disorders. IN: Drossman, D., ed. Understanding the Irritable Gut: The Functional Gastrointestinal Disorders. McLean, VA: Degnon Associates, Inc. 2008. pp 200-206.

This appendix is from a book that helps doctors and patients better understand functional gastrointestinal disorders (FGIDs), with text based on information developed by the Rome Foundation to identify, classify, and treat these disorders. This appendix describes some of the tests commonly used in the investigation of FGIDs. Tests covered include endoscopy, imaging procedures, esophageal motility tests, ambulatory 24-hour pH monitoring, and anorectal manometry. For each test, the author reviews the preparation, the reasons the test might be conducted, precautions, what to expect during the procedure, any sedation that might be used, and postprocedure patient care and complications.

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Barrett’s Esophagus. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 6 p.

This fact sheet describes Barrett’s esophagus, defined as a condition in which the tissue lining the esophagus—the muscular tube that connects the mouth to the stomach—is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia. No signs or symptoms are associated with Barrett’s esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD). A small number of people with Barrett’s esophagus develop a rare but often deadly type of cancer of the esophagus. The fact sheet answers common questions about the anatomy and function of the esophagus, the symptoms and treatment of GERD, the relationship between Barrett’s esophagus and GERD, diagnostic tests that may be used to confirm the presence of Barrett’s esophagus, the risk of esophageal cancer in people with Barrett’s esophagus, and treatment options, including endoscopic and surgical treatments. The authors note that improvement in GERD symptoms with acid-reducing drugs may decrease the risk of developing Barrett’s esophagus. Barrett’s esophagus is diagnosed through an upper gastrointestinal endoscopy and biopsies. People who have Barrett’s esophagus should have periodic surveillance endoscopies and biopsies. Endoscopic treatments are used to destroy Barrett’s tissue, with the aim of replacing Barrett’s tissue with normal esophageal tissue. However, removal of most of the esophagus is recommended if a person with Barrett’s esophagus is found to have severe dysplasia or cancer and can tolerate a surgical procedure. The fact sheet includes a brief description of current research in this area. Readers are referred to three resource organizations: the American Gastroenterological Association at 301–654–2055 or www.gastro.org, the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.org, and the National Cancer Institute at 1–800–422–6237 or www.cancer.gov. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 3 figures.

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Clinical Features of Malabsorptive Disorders, Small-Bowel Diseases, and Bacterial Overgrowth Syndromes. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 117-134. Price: $99.95.

This chapter on the clinical features of malabsorptive disorders, small-bowel diseases, and bacterial overgrowth syndromes is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The first section of the chapter covers malabsorptive disorders and diarrhea, including carbohydrate malabsorption, fat malabsorption, protein malabsorption, diarrhea, intestinal resections, and short bowel disorders. The next section focuses on small bowel diseases, including celiac disease, Whipple’s disease, tropical sprue, eosinophilic gastroenteritis, intestinal lymphangiectasia, and amyloidosis. The last section on bacterial overgrowth syndromes describes small intestinal bacterial overgrowth (SIBO) and its risk factors, complications, diagnosis, and treatment. Malabsorption is considered a defect in the mucosal absorption of nutrients, while maldigestion is a defect in the hydrolysis of nutrients. Both conditions imply disordered physiologic mechanisms in the gastrointestinal system. The chapter is illustrated with full-color drawings and photographs. 7 figures. 8 tables. 9 references.

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Colon: Questions and Answers. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 271-280.

This section of questions and answers is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. This section helps readers review seven chapters on the colon, including clinical aspects, therapy, extraintestinal manifestations and cancer, gastrointestinal infections, diverticular disease, colorectal neoplasms, irritable bowel syndrome (IBS), constipation, and disorders of the pelvic floor function. The section consists of 21 multiple choice questions, followed by annotated answers that explain each of the correct choices.

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Colonoscopy. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 6 p.

This fact sheet describes colonoscopy, a procedure used to see inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers, and abnormal growths. The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss. The fact sheet answers common questions about colonoscopy, including the anatomy and function of the colon and rectum, how to prepare for a colonoscopy, what to expect during and after the procedure, and recommendations for routine screening colonoscopy. Preparation will include the emptying of all solids from the gastrointestinal tract by following a clear liquid diet for 1 to 3 days before colonoscopy. During colonoscopy, a sedative, and possibly pain medication, helps keep patients relaxed. A doctor can remove polyps and biopsy abnormal-looking tissues during colonoscopy. Driving is not permitted for 12 hours after colonoscopy to allow the sedative time to wear off. The fact sheet includes a brief description of current research in this area. Readers are referred to online publications and three resource organizations: the American College of Gastroenterology at 301–263–9000 or www.acg.gi.org, the American Society for Gastrointestinal Endoscopy at 1–866–353–2743 or www.asge.org, and the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2 figures.

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Endoscopic Electronic Medical Record Systems. Gastrointestinal Endoscopy. 67(4): 590-594. 2008.

This review of endoscopic electronic medical record (EEMR) systems is from a series of scientific reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of gastrointestinal (GI) endoscopy. The authors note that the central role of the EEMR continues to be generation of the endoscopy procedure report. As information systems technology and practice demands have advanced, EEMR systems have evolved into sophisticated databases. The authors summarize the benefits and features of major EEMR systems available in the United States, including practice management tools, image and video clip management, nursing input, and readily searchable databases for research purposes. Newer functions include interfaces with hospital-wide electronic medical record systems (EMR) and pathology databases, improved communication with referring physicians through automated faxes or email, and Internet access to allow clinicians secure remote connections. The authors consider ease of use, outcomes and comparative data, safety, and financial considerations. One table summarizes the features for seven EEMR products: CORI version, gCare EMR, Endoworks 7.3, endoPRO, ProVation, Endoprose, and Endosoft. 1 table. 13 references.

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Flexible Sigmoidoscopy. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 6 p.

This fact sheet describes flexible sigmoidoscopy, a procedure used to see inside the sigmoid colon and rectum. Flexible sigmoidoscopy can detect inflamed tissue, abnormal growths, and ulcers. The procedure is used to look for early signs of cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss. The fact sheet answers common questions about flexible sigmoidoscopy, including the anatomy and function of the sigmoid colon and rectum, the differences between flexible sigmoidoscopy and colonoscopy, how to prepare for a flexible sigmoidoscopy procedure, and what to expect during and after the procedure. Preparations include one or more enemas that are performed about 2 hours before the procedure to remove all solids from the sigmoid colon. In some cases, the entire gastrointestinal tract must be emptied—similar to the preparation for colonoscopy. A sigmoidoscope transmits a video image from inside the colon to a computer screen. A doctor can biopsy abnormal-looking tissues during a flexible sigmoidoscopy. Polyps can be removed using special tools passed through the sigmoidoscope. If polyps or other abnormal tissues are found, the doctor may suggest examining the rest of the colon with a colonoscopy. A flexible sigmoidoscopy takes about 20 minutes. The fact sheet includes a brief description of current research in this area. Readers are referred to online publications and three resource organizations: the American College of Gastroenterology at 301–263–9000 or www.acg.gi.org, the American Society for Gastrointestinal Endoscopy at 1–866–353–2743 or www.asge.org, and the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1 figure.

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Vascular Disorders of the Gastrointestinal Tract. IN: Hauser, S.C. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 167-174.

This chapter on vascular disorders of the gastrointestinal (GI) tract is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The author cautions that mesenteric ischemia, or lack of blood flow, can occur from any of the many different conditions that decrease intestinal blood flow. The chapter covers patient history and examination, the recommended initial diagnostic evaluation, superior mesenteric artery embolus, superior mesenteric artery thrombus, nonocclusive mesenteric ischemia, mesenteric venous thrombosis, chronic mesenteric ischemia, ischemic colitis, and miscellaneous syndromes, including celiac artery compression, and vasculitis. The chapter is illustrated with black-and-white photographs. 3 figures. 3 tables. 17 references.

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Gastric Neoplasms and Gastroenteropancreatic Neuroendocrine Tumors. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 77-96.

This chapter on gastric neoplasms and gastroenteropancreatic neuroendocrine tumors is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. Of the various neoplasms that can affect the stomach, adenocarcinoma is the most common and accounts for up to 95 percent of all gastric neoplasms. Less common are gastric lymphomas, gastrointestinal stromal tumors, neuroendocrine tumors, and metastatic disease involving the stomach. The chapter covers epidemiology, pathogenesis, clinical presentation, risk factors, diagnostic evaluation, treatment, and prognosis of these neoplastic diseases. Risk factors discussed include diet, tobacco use, gastric surgery, infection, genetics, and gastric disorders such as pernicious anemia and Menetrier’s disease. The clinical features of gastric cancer are vague, but weight loss, nausea, and anorexia are common with advanced lesions. Surgery is the mainstay of treatment for gastric cancer. The prognosis for gastric adenocarcinoma remains grim for all but those who are candidates for surgical resection. Prognosis after surgical resection varies according to the pathologic extent of disease, staging and the population studied. The chapter is illustrated with full-color drawings and photographs and includes two patient care algorithms. 7 figures. 3 tables. 11 references.

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Gastrointestinal Infections, Clostridium Difficile- Associated Disease, and Diverticular Disease. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 223-240.

This chapter on gastrointestinal infections, Clostridium difficile-associated disease, and diverticular disease is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The authors focus on the more common infectious causes of diarrhea, food poisoning, and diverticulitis. The chapter first discusses viral infections, including rotavirus, caliciviruses, astrovirus, and enteric adenovirus. The chapter then considers bacterial causes of diarrhea, including Campylobacter, Salmonella, Shigella, Escherichia coli, Vibrio, and Yersinia. The next section considers parasitic infections, including those involving Giardia lamblia, Cryptosporidium, Entamoeba histolytica, and Blastocystic hominis. The chapter discusses traveler’s diarrhea, food poisoning, C. difficile-associated disease, and diverticular disease. C. difficile is described as a spore-forming toxigenic bacterium that causes diarrhea and colitis, typically after antibiotic therapy. Although in most cases the disease is mild and responds quickly to treatment, C. difficile colitis may be severe, especially if diagnosis and treatment are delayed. Symptoms of diverticulitis include lower abdominal pain, fever, and altered bowel habits––typically diarrhea. Treatment for diverticulitis is influenced by severity of the inflammation, ability to tolerate oral intake, previous history of diverticulitis or bleeding, and complications. 1 figure. 8 tables. 10 references.

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Gastrointestinal Manifestations of Human Immunodeficiency Virus Infection. IN: Hauser, S.C. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 149-158.

This chapter on the gastrointestinal (GI) manifestations of human immunodeficiency virus (HIV) infection is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The author of this chapter notes that successful antiretroviral drug therapy has diminished greatly the incidence of opportunistic infections in patients infected with HIV. However, side effects of antiretroviral therapy that may involve the GI tract and liver are common. These side effects may need to be considered in patients who have common complaints and disorders such as anorexia, nausea, vomiting, oral ulcers, abdominal pain, diarrhea, pancreatitis, or liver function test abnormalities. The chapter covers complications of the oral cavity, esophagus, stomach, small bowel, colon, and pancreas. In each section, a brief illustrative case study is presented. The chapter is illustrated with full-color drawings and photographs. 5 figures. 1 table. 12 references.

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Gastrointestinal Manifestations of Systemic Disease. IN: Hauser, S.C. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 175-182.

This chapter on gastrointestinal (GI) manifestations of systemic disease is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The author reviews the symptoms and signs that may be apparent in the GI system, including eating disorders, weight loss, obesity, nausea, vomiting, diarrhea, constipation, abdominal pain, jaundice, and abnormal results of liver function tests. The chapter covers systemic disorders by body system: dermatologic, immunologic, cardiovascular, pulmonary, renal, endocrine, hematologic, oncologic, neuromuscular, rheumatologic, pregnancy and gynecologic conditions, and miscellaneous topics. In each section, the author considers the typical symptoms and possible etiology, with a brief discussion of recommended diagnostic approaches. 13 references.

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Entendiendo la Manometria Esofagica [Understanding Esophageal Manometry]. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2007. 2 p.

This Spanish-language brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with esophageal manometry, a diagnostic test that measures the pressures and pattern of muscle contractions in the esophagus. Abnormalities in the contractions and strength of the muscle or in the sphincter at the lower end of the esophagus can result in pain, heartburn, and difficulty swallowing. After describing the test, the brochure reviews the basic anatomy of the esophagus, the preparations that a patient should undergo before the test, what to expect during the test, how long the test will last, what to expect after the test, and the possible complications. The brochure concludes with a brief description of the work of and contact information for the ASGE. The brochure is also available in English.

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Gastrointestinal Motility Disorders. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 97-110.

This chapter on gastrointestinal (GI) motility disorders is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The authors note that motility disorders result from impaired control of the neuromuscular apparatus of the gut. Associated symptoms include recurrent or chronic nausea, vomiting, bloating and abdominal discomfort, constipation, or diarrhea, which occur in the absence of intestinal obstruction. The chapter covers control of GI motor function, gastric and small-bowel motility, the pathogenesis of motility disorders, the management of gastroparesis and pseudo-obstruction, and treatment strategies, including the correction of hydration and nutritional deficiencies, medications, decompression, surgical treatment, and new therapies. An additional section considers functional dyspepsia. The authors conclude that understanding the mechanisms that control motility and the pathophysiologic mechanisms is the key to optimal management. Simple, quantitative measures of transit and an algorithmic approach to identifying the underlying cause may lead to correction of abnormal function. Patient education is essential to avoid aggravation of symptoms caused by dietary indiscretions. The chapter is illustrated with full-color drawings and photographs. 4 figures. 3 tables. 19 references.

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Guide to Eosinophilic Esophagitis in Children and Adults. Flourtown, PA: Children’s Digestive Health and Nutrition Foundation. 2008. 6 p.

This brochure describes eosinophilic esophagitis (EE), a disease characterized by an isolated inflammation of the esophagus by a specific white blood cell, the eosinophil. The brochure describes symptoms, incidence, diagnosis, and treatment of EE. Symptoms of EE can include difficulty swallowing, food becoming stuck in the esophagus, or symptoms of gastroesophageal reflux disease (GERD) such as vomiting, regurgitation, abdominal pain, or heartburn. EE is diagnosed by upper endoscopy and biopsy. Once EE is confirmed, patients are either treated with medications or referred to an allergist for dietary restriction. Children especially may be treated with dietary modifications. The brochure is illustrated with full-color photographs of adults and children, as well as endoscopic photographs of some of the esophageal changes seen in EE. The back cover of the brochure describes the work of the International Gastrointestinal Eosinophilic Researchers (TIGER), a group of pediatric and adult physicians and basic scientists interested in understanding the underlying science and clinical effects that eosinophils have on disease.

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Hemosuccus Pancreaticus: A Rare Complication in Patients with Chronic Pancreatitis. Practical Gastroenterology. 32(3): 42-47. April 2008.

This article presents a case of a patient with hemosuccus pancreaticus, a rare complication in patients with chronic pancreatitis. Hemosuccus pancreaticus is defined as pancreatic hemorrhage that passes via the pancreatic duct into the duodenum through the ampulla of Vater. The case was a 45-year-old male who presented with melena and complaints of intermittent epigastric pain. Upper endoscopy showed active bleeding from the ampulla of Vater. In addition, chronic calcific pancreatitis and a pseudoaneurysm within a pancreatic pseudocyst were seen on computerized tomography (CT) scan. The authors subsequently performed an angiogram that showed a large bilobed pseudoaneurysm that filled from the gastroduodenal artery and the inferior pancreaticoduodenal artery off the superior mesenteric artery. Extensive embolization was performed, with subsequent resolution of contrast opacification of the pseudoaneurysm. The patient had no further episodes of gastrointestinal bleeding and was discharged from the hospital in stable condition. The authors conclude with a brief discussion of treatment strategies. 3 figures. 33 references.

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Gastrointestinal Issues in the Assessment And Management Of the Obese Patient. Gastroenterology and Hepatology. 3(7): 559-569. July 2007.

This article outlines gastrointestinal issues in the assessment and management of the obese patient. The authors caution that as the obesity epidemic spreads, physicians of all specialties will be called on to participate in the management of obesity. Gastroenterologists should learn to recognize, prevent, and treat gastrointestinal disorders related to obesity, and they must have an understanding of the risks and benefits of various management strategies. They may also be called on to assist in the evaluation and management of liver and gastrointestinal problems that may develop after bariatric surgery. Specific topics include gastroesophageal reflux disease, obesity and esophageal adenocarcinoma, gallbladder disease, pancreatitis, liver disease, gastrointestinal cancer, the indications for bariatric surgery, the role of preoperative endoscopy, roux-en-Y gastric bypass, banded gastroplasty, the intragastric balloon, sleeve gastrectomy, biliopancreatic diversion, jejunoileal bypass, gallstones, vomiting, pulmonary embolism, wound infection, rhabdomyolysis, hemorrhage, weight gain, and cancer. The author notes that upper gastrointestinal endoscopy is an all-important tool in the assessment and therapy of the complications of obesity and related surgical techniques. 1 table. 149 references.

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How to Prepare for Tests. Digestive Health Matters. 16(2): 15-17. Summer 2007.

The diagnosis of a functional gastrointestinal disorder can often be made without the assistance of laboratory testing. However, a structural disease must often be excluded by tests that probe the gastrointestinal tract. This article helps readers prepare for gastrointestinal diagnostic tests. The author stresses that correct preparation for a test helps make that test itself easier and the results more useful; in addition, patients may feel some relief at understanding what to expect before, during, and after a particular test. The author first reviews general principles, including the use of sedation, local anesthesia, and informed consent. Specific tests are then described, including sigmoidoscopy, colonoscopy, other colonic procedures such as a barium enema, upper gastrointestinal endoscopy, and other upper gut examinations. When the gut interior is to be visualized by an endoscope or barium x ray, a clean and empty interior is required for a successful examination. In some tests of gut function, as little as possible should be done to interfere with the gut’s natural performance. Sometimes fasting is necessary, but during such tests, eating and activity should be normal and drugs that might alter gut performance should be withdrawn. 5 references.

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Indigestion. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 6 p.

This fact sheet familiarizes readers with indigestion, also known as dyspepsia, a term used to describe one or more symptoms including a feeling of fullness during a meal, uncomfortable fullness after a meal, and burning or pain in the upper abdomen. The fact sheet answers common questions about indigestion, including its causes, symptoms, diagnosis, and treatment. Indigestion can be caused by a condition in the digestive tract such as gastroesophageal reflux disease (GERD), peptic ulcer disease, cancer, or diseases of the pancreas or bile ducts. Sometimes a person has indigestion for which a cause cannot be found. This type of indigestion is called functional dyspepsia. Indigestion and heartburn are different conditions, but a person can have symptoms of both. The doctor may order x rays; blood, breath, and stool tests; and an upper endoscopy with biopsies to diagnose indigestion. Some people may experience relief from indigestion by making a few lifestyle changes and decreasing stress. The doctor may prescribe antacids, H2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), prokinetics, or antibiotics to treat the symptoms of indigestion. The fact sheet includes a brief description of current research in this area. Readers are referred to online publications and resource organizations, including the American Gastroenterological Association at 301–654–2055 or www.gastro.org and the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases. 1 figure.

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Infection Control During GI Endoscopy. Gastrointestinal Endoscopy. 67(6):781-790. 2008.

This article presents a clinical guideline on infection control during gastrointestinal (GI) endoscopy. The purpose of this document is to disseminate information and to promote understanding, with the goal of preventing infection as a result of a GI endoscopy. The authors focus on circumstances in which an endoscopy-related infection might occur, as well as measures to prevent such infection, including endoscope reprocessing, antibiotic prophylaxis, and protection of endoscopy personnel. Topics include patient-to-patient transmission of microorganisms; transmission of microorganisms by endoscopy itself; bacterial infections; chronic viral infections, notably hepatitis B and C; HIV infection; miscellaneous microbial transmission; the reprocessing of endoscopes; manual cleaning methods; high-level disinfection (HLD) with liquid chemical germicides; sterilization; rinsing and drying; storage of equipment and supplies; coping with endogenous infections; recommendations for antibiotic prophylaxis; general infection control measures; and the protection of health care personnel. The guidelines conclude that transmission of infection as a result of GI endoscopes is extremely rare. Endoscopes should undergo HLD as recommended by governmental agencies and pertinent professional organizations. Extensive training of staff involved in endoscopic reprocessing is mandatory for quality assurance and for effective infection control. 1 table. 109 references.

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Inflammatory Bowel Disease: Clinical Aspects. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 193-198.

This chapter on inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. Ulcerative colitis is an idiopathic chronic inflammatory disorder of the colonic mucosa, with the potential for extraintestinal inflammation. Crohn’s disease is an idiopathic chronic inflammatory disorder of the intestine, most commonly apparent in the ileum and the colon, but with the potential to involve the entire gastrointestinal tract from the mouth to the anus. The chapter covers epidemiology, genetics, diet, pregnancy, environmental influences, diagnosis, clinical presentations, endoscopy, and histology of IBD. In ulcerative colitis, the onset may be gradual or sudden, with an increase in bowel movements and bloody diarrhea, fecal urgency, cramping abdominal pain, and fever. The course is variable, with periods of exacerbation, improvement, and remission that may occur with or without specific medical therapy. Symptoms of Crohn’s disease depend on the anatomical location of the disease. With colonic disease, bloody bowel movements with diarrhea, weight loss, and low-grade fever are common. Patients with gastroduodenal Crohn’s disease often have burning epigastric pain and early satiety, and these symptoms usually overshadow the symptoms from coexisting ileal or colonic disease. The chapter includes full-color endoscopic photographs showing the intestinal mucosal changes that are typically found in ulcerative colitis and Crohn’s disease. 3 figures. 2 tables. 6 references.

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Many Manifestation of Gastroesophageal Reflux Disease: Presentation, Evaluation, and Treatment. Gastroenterology Clinics of North America. 36(3): 577-600. September 2007.

This article on the presentation, evaluation, and treatment of the various manifestations of gastroesophageal reflux disease (GERD) is from a special issue of Gastroenterology Clinics of North America that focuses on gastrointestinal (GI) motility. The author notes that GERD is a common problem that is expensive to diagnose and treat and that is increasing in prevalence in the Western world. Important risk factors for GERD are obesity and the eradication of Helicobacter pylori. Classic symptoms of GERD include heartburn and acid regurgitation, but using those symptoms alone to diagnosis GERD is not adequate. Ambulatory esophageal pH testing is the most sensitive test for GERD, whereas endoscopy is the most specific test. Medical treatment with proton pump inhibitors (PPIs) has revolutionized the treatment of GERD and its complications, but long-term side effects of these drugs can be a concern. Laparoscopic anti-reflux surgery and PPIs have been found to have similar levels of effectiveness in the long term. 8 figures. 2 tables. 94 references.

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Irritable Bowel Syndrome. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 251-256.

This chapter on irritable bowel syndrome (IBS) is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. IBS is a condition characterized by recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months, associated with two or more of the following symptoms: improvement with defecation, onset associated with a change in frequency of stool, or onset associated with a change in form or appearance of stool. The author notes that recent discoveries in the physiology of the enteric nervous system, the gut-brain axis, and the intestinal flora have led to the development of therapies targeted at potential pathophysiologic mechanisms of IBS. The chapter covers epidemiology, risk factors, pathogenesis, diagnosis, prognosis, management, and health care expenditures related to IBS. The author concludes that the traditional approach of reassurance and a high-fiber diet is no longer adequate for everyone diagnosed with IBS. Symptomatic care will likely remain the appropriate treatment for patients with mild symptoms. However, for patients with pronounced gastrointestinal symptoms, more aggressive approaches need to be used. One patient care algorithm is provided. 1 figure. 1 table. 14 references.

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Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. 520 p.

This comprehensive textbook provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The text is designed to assist physicians-in-training who are preparing for the gastroenterology board examination or preparing for recertification. Clinical knowledge related to diagnostic and therapeutic approaches to patient management is emphasized. The authors offer case-based presentations and multiple short board-examination-type, single best-answer questions, providing annotated answers for each. The book includes 38 chapters in seven sections: esophagus, stomach, small bowel and nutrition, miscellaneous disorders, colon, liver, pancreas and biliary tree. Specific topics covered include gastroesophageal reflux disease (GERD), Barrett’s esophagus and esophageal cancer, motility and motility disorders, peptic ulcer disease, gastritis, malabsorptive disorders, bacterial overgrowth syndromes, nutritional disorders, HIV and its impact on the gastrointestinal (GI) tract, GI bleeding, inflammatory bowel disease (IBD), GI infections, irritable bowel syndrome (IBS), constipation, disorders of pelvic floor function, hepatitis, fulminant liver failure, alcoholic liver disease, metabolic liver disease, liver transplantation, pancreatitis, and gallstones. Numerous color and black-and-white figures are used to illustrate the text.

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Miscellaneous Disorders: Questions and Answers. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 183-190.

This section of questions and answers is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. This section helps readers review four chapters on gastrointestinal (GI) manifestations of HIV infection, nonvariceal GI tract bleeding, vascular disorders of the GI tract, and GI manifestations of systemic disease. The section consists of 17 multiple choice questions, followed by annotated answers that explain each of the correct choices.

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Natural Office Transluminal Endoscopic Surgery (NOTES). Gastroenterology and Hepatology. 3(3): 183-184. March 2007.

This article answers questions physicians may have about natural orifice transluminal endoscopic surgery (NOTES), an experimental procedure where the peritoneal cavity, or abdominal cavity, is entered through the gastrointestinal tract using a natural orifice. This is in comparison with traditional surgery, which uses a large incision in the abdominal wall, or laparoscopic surgery, which uses a small incision in the abdominal wall. The author reviews the benefits and disadvantages of NOTES, which is currently in development. NOTES uses a standard endoscope, which is passed through the mouth to the stomach. Then, the stomach wall is punctured; through this hole or incision, the endoscope is advanced into the peritoneal cavity. The author addresses the need to rethink a puncture in the stomach wall as a positive, intentional happening, rather than a grave complication of endoscopy. Once the endoscope is in the peritoneal cavity, any intervention that a surgeon would do with a laparoscope or through open surgery could be performed. The author concludes that more work is required in the laboratory with animal subjects before patient trials are undertaken. 5 references.

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Neoplastic Precursor Lesions Related to the Development of Cancer in Inflammatory Bowel Disease. Gastroenterology Clinics of North America. 36(4): 901-926. December 2007.

This article on neoplastic precursor lesions related to the development of cancer in patients with inflammatory bowel disease (IBD) is from a special issue of Gastroenterology Clinics of North America that focuses on the pathology and clinical relevance of neoplastic precursor lesions of the gastrointestinal tract, liver, and pancreaticobiliary system. The author notes that dysplasia is an intermediate stage in the progression from inflammation to cancer in patients with IBD. Surveillance is currently the only credible alternative to prophylactic colectomy for high-risk patients. The author reviews steps that contribute to the success of surveillance strategies, including adherence of gastroenterologists to recommended procedural guidelines, adherence of pathologists to standardized histological criteria and nomenclature, and a joint commitment to close clinical–pathological communication. The chapter covers some technical enhancements to conventional endoscopy that hold promise of improved efficiency and accuracy. In addition, molecular-based testing may have a future role for risk stratification and early detection of neoplasia in IBD. 9 figures. 1 table. 117 references.

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Modifications in Endoscopic Practice for Pediatric Patients. Gastrointestinal Endoscopy. 67(1): 1-9. 2008.

This article about the modifications in endoscopic practice for pediatric patients is one in a series of statements discussing the use of gastrointestinal (GI) endoscopy in common clinical situations. The guideline was prepared by the Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) and is based on a literature search and review. The document covers indications and contraindications, the preprocedure preparation, sedation and analgesia, patient monitoring during the procedure, postprocedure monitoring and discharge, and equipment. The document concludes with a bulleted list of items summarizing the use of GI endoscopy in children. The guideline supports the use of endoscopic procedures in the pediatric population but recommends that endoscopy in children be performed by pediatric-trained gastroenterologists whenever possible. Endoscopy is indicated for symptomatic pediatric patients with known or suspected ingestion of caustic substances and should be considered even in the absence of symptoms. Preprocedure preparation should be individualized according to the patient’s age, size, clinical state, and planned procedure. Indications for antibiotic prophylaxis in children mirror that for adults. General anesthesia is commonly used for pediatric endoscopy. All sedated pediatric patients should receive routine oxygen administration and should be monitored with a minimum of pulse oximetry and heart rate monitoring. 4 tables. 72 references.

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Nonvariceal Gastrointestinal Tract Bleeding. IN: Alexander, J.A. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 159-174.

This chapter on nonvariceal gastrointestinal (GI) tract bleeding is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The first section reviews upper GI bleeding, which constitutes 75 to 80 percent of all cases of acute GI bleeding. Peptic ulcers are the most common source of upper GI bleeding; other major causes are gastric erosions, bleeding varices, and Mallory-Weiss tears. Most cases of acute bleeding involve the use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). This section discusses the initial approach to patients with upper GI bleeding, prognostic factors, diagnosis, peptic ulcers, Mallory-Weiss tears, portal hypertensive gastropathy, aortoenteric fistula, hematobilia and hemosuccus pancreaticus, neoplasms, and vascular anomalies. The remainder of the chapter considers nonupper gastrointestinal (non-UGI) bleeding, covering diverticular bleeding, vascular ectasia, neoplasm, ischemic colitis, Meckel’s diverticulum, inflammatory bowel disease, benign rectoanal disease, infection, and NSAID enteropathy and colopathy. Patients who are being evaluated because of positive findings on fecal occult blood testing require colonic imaging for diagnosis. 16 references.

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Nutritional Disorders: Vitamins and Minerals. IN: Hauser, S.C. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 135-138.

This chapter on nutritional disorders is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The author of this chapter stresses that vitamins and minerals are critical to normal health because they are essential to a vast assortment of metabolic functions. The chapter focuses on selected important vitamins and minerals and their relationships with gastrointestinal disorders. The first section covers water-soluble vitamins, including vitamin B12, folic acid, vitamin C, thiamine, riboflavin, niacin, and pyridoxine. The next section briefly reviews fat-soluble vitamins, including vitamins A, D, E, and K. The chapter concludes with a discussion of minerals, including iron, zinc, copper, and miscellaneous minerals that may have an impact on nutrition. 10 references.

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Pregnancy in Gastrointestinal Disorders. 2nd ed. Bethesda, MD: American College of Gastroenterology. 2007. 79 p.

This monograph presents updated information about pregnancy in women with gastrointestinal disorders. The monograph offers eight chapters, covering constipation, diarrhea, hemorrhoids, and fecal incontinence; the use of endoscopy in pregnancy; heartburn, nausea, and vomiting during pregnancy; hyperemesis gravidarum and nutritional support, including nutritional requirements, venous access, and monitoring of pregnant patients on total parenteral nutrition (TPN); liver diseases in pregnancy, including the use of imaging studies, the safety of drugs in pregnancy, liver disorders unique to pregnancy, and pregnancy in liver transplant patients; surgical problems in the pregnant patient; and pregnancy in women with inflammatory bowel disease (IBD). The chapter about surgical problems reviews appendicitis, biliary tract diseases, pancreatitis, trauma, intestinal obstruction, splenic artery aneurysms, hepatic lesions, hemorrhoids, inflammatory bowel disease, and colorectal malignancy. Each chapter focuses on bringing readers up to date on the research in the area covered, the recommended treatments, and patient management concerns, notably issues of maternal and fetal safety. Each chapter concludes with a list of references.

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Provocation Of Bleeding During Endoscopy in Patients With Recurrent Acute Lower Gastrointestinal Bleeding. Gastroenterology and Hepatology. 3(7): 570-573. July 2007.

This brief article considers the problem of provocation of bleeding during endoscopy in people with recurrent acute lower gastrointestinal bleeding (GIB). The authors caution that management of this problem is difficult because the bleeding tends to be intermittent and often ceases by the time of diagnostic or therapeutic intervention. They use a case report to illustrate the recommended patient approach. The case report features a 65-year-old man with two prior episodes of left-sided diverticular bleeding who was eventually diagnosed with a distal ileal carcinoid that was found as the source of his bleeding. The authors discuss the patient’s care and offer generalized recommendations for managing patients with recurrent acute GIB. The authors conclude that provocative testing should not be avoided for fear of causing uncontrollable hemorrhage because the anticoagulative effects of heparin are short-lived and are easily reversible with protamine. However, the optimal dosage for anticoagulation with heparin is not known and most likely will need to be individualized for each patient. Appended to the case report is a commentary by Steven B. Ingle and Jeffrey A. Alexander, who summarize some of the guidelines for managing recurrent obscure gastrointestinal bleeding. 22 references.

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Peptic Ulcer Disease. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 55-66.

This chapter on peptic ulcer disease (PUD) is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. A peptic ulcer is defined as a break in the gastric or duodenal mucosa that penetrates down to the muscularis mucosae. The chapter covers epidemiology, pathophysiology, Helicobacter pylori infection, nonsteroidal antiinflammatory drugs (NSAIDs), hypersecretion of gastric acid, viral causes of upper gastrointestinal tract ulceration, risk factors, the clinical features of PUD, noninvasive and invasive diagnostic tests used to confirm PUD, treatment options, the use of antisecretory treatments, lifestyle modifications, follow-up and maintenance therapy, and prevention of PUD and its complications. The authors note that PUD is usually caused by H. pylori infection or the use of NSAIDs. Thus, the cornerstones of treatment for PUD include testing for and, if appropriate, eradicating H. pylori infection, discontinuing treatment with NSAIDs if possible, and providing aggressive acid suppression with proton pump inhibitors (PPIs). For appropriately selected patients, the prophylactic use of PPIs can be a useful and cost-effective measure. The chapter is illustrated with full-color drawings. 4 figures. 2 tables. 11 references.

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Portal Hypertension-Related Bleeding. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 345-350.

This chapter on portal hypertension-related bleeding is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The author describes portal hypertensive bleeding as encompassing a spectrum of conditions, including esophageal, gastric, and ectopic varices, and portal hypertensive gastrointestinal enteropathy. The chapter covers the pathogenesis of portal hypertension, esophageal varices, and portal hypertensive lesions in the stomach. Esophageal variceal hemorrhage occurs through a combination of increased portal pressure and local factors. Management of esophageal varices includes primary prevention of variceal hemorrhage, treatment of actively bleeding varices, and prevention of variceal rebleeding. Primary prophylaxis is usually drug therapy with beta blockers or variceal band ligation. Active bleeding is best treated endoscopically. Surgical shunts or transjugular intrahepatic portosystemic shunts (TIPS) are second-line therapy. Therapy for gastric sources of portal hypertensive bleeding is often based on an empiric approach, as no evidence-based management strategies are available. 1 figure. 1 table. 9 references.

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Propofol Use for Sedation during Endoscopy in Adults: A Canadian Association of Gastroenterology Position Statement. Canadian Journal of Gastroenterology. 22(5): 457-459. May 2008.

This article presents a position statement of the Clinical Affairs Committee of the Canadian Association of Gastroenterology on the use of propofol sedation for endoscopy in adult patients. Propofol is an intravenously administered, hypnotic drug initially developed for the induction and maintenance of general anesthesia. Research over the past decade has demonstrated that the use of propofol sedation for gastrointestinal endoscopy by gastroenterologist and trained endoscopy nurses is safe and effective in appropriately selected patients. The benefits of propofol sedation include rapid onset of action, improved patient comfort and rapid clearance, as well as prompt recovery and discharge from the endoscopy unit. The authors note that this document is not intended to mandate a wholesale switch to propofol, but is rather a statement regarding the option and appropriateness of propofol as an alternative to standard agents for conscious sedation. 22 references.

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Understanding Colonoscopy. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2008. 2 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with colonoscopy, a diagnostic test that examines the lining of the colon for abnormalities. After defining the test, the brochure reviews the preparations that a person should undergo before the test, whether current medications can be continued, what to expect during the test, how long the test will last, what to expect after the test, the possible complications, and the use of biopsy in conjunction with colonoscopy. An additional section describes colonic polyps, why they need to be removed, and how they are usually removed. The brochure reminds readers of the importance of colonoscopy and the fact that most people tolerate colonoscopy without pain or complications. The brochure concludes with a brief description of the work of and contact information for the ASGE.

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Vascular Diseases of the Liver. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 337-344.

This chapter on vascular diseases of the liver is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The author divides vascular diseases into disorders of hepatic inflow, which are diseases of the portal venous and hepatic arterial inflow, and disorders of hepatic venous outflow. The chapter reviews the anatomy of the splanchnic circulation, which comprises the arterial blood supply and venous drainage of the entire gastrointestinal tract from the distal esophagus to the mid-rectum and includes the spleen, pancreas, gallbladder, and liver. Specific disorders are discussed: chronic mesenteric venous thrombosis, hepatic artery thrombosis, hepatic artery aneurysm, hepatic artery-portal vein fistulas, ischemic hepatitis, hereditary hemorrhagic telangiectasia, and veno-occlusive disease. A final section covers Budd-Chiari syndrome, a heterogeneous group of disorders characterized by obstruction of hepatic venous outflow and often related to hematologic abnormalities, particularly myeloproliferative disorders. 1 figure. 3 tables. 11 references.

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What I Need to Know About Colon Polyps. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 10 p.

This brochure describes colon polyps, which are growths on the surface of the colon, also called the large intestine. Colon polyps can be raised or flat and a person can have more than one colon polyp. Written in nontechnical language, with a pronunciation guide, the brochure answers common questions about colon polyps, including the risk of polyps being cancerous, who gets colon polyps, the symptoms of colon polyps, diagnostic testing for colon polyps, treatment options, and how to prevent colon polyps. Some types of polyps may already be cancerous or can become cancerous. Flat polyps can be smaller and harder to detect and are more likely to be cancerous than raised polyps. Most people with colon polyps do not have symptoms. However, symptoms may include constipation or diarrhea for more than a week or blood on the underwear, on toilet paper, or in stool. Doctors remove most polyps and test them for cancer. Readers are encouraged to speak with their health care provider about getting tested for colon polyps if they are 50 years of age or older, or earlier when symptoms are present or someone in their family has had polyps or colon cancer. Readers are referred to four resource organizations for more information: the American College of Gastroenterology (www.acg.gi.org or 301–263–9000), the American Gastroenterological Association (www.gastro.org or 301–654–2055), the American Society for Gastrointestinal Endoscopy (www.asge.org or 1–866–353–2743), and the National Cancer Institute (www.nci.nih.gov or 1–800–422–6237). The brochure is illustrated with line drawings of some of the concepts discussed. The inside back cover briefly describes the work of the National Digestive Diseases Information Clearinghouse, which provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. 8 figures.

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American Gastroenterological Association (AGA) Institute Medical Position Statement on Obscure Gastrointestinal Bleeding. Gastroenterology. 133: 1694-1696. November 2007.

This article presents the official recommendations of the American Gastroenterological Association (AGA) Institute, approved in 2007, about the evaluation and management of occult and obscure gastrointestinal (GI) bleeding. These recommendations update the prior technical review on obscure GI bleeding, which was published in 2000. The authors define obscure GI bleeding as bleeding from the GI tract that persists or recurs without an obvious cause after esophagogastroduodenoscopy (EGD), colonoscopy, and radiologic evaluation of the small bowel. Determining the cause of some GI bleeding is difficult, particularly when it is due to bleeding lesions that are overlooked in the esophagus, stomach, and colon during initial workup or to lesions in the small intestine that are difficult to visualize with conventional endoscopy or radiologic imaging. The guidelines review etiology and definitions, along with patient evaluation and management. The authors focus on specific steps to determining the cause of occult GI bleeding, starting with a comprehensive workup, a repeat of the endoscopic examinations, and then the use of capsule endoscopy. The authors conclude that endoscopic or surgical therapy should be considered due to its ease, relatively good long-term results, and the lack of a clearly effective, well-tolerated medical therapy. They propose that the earlier use of capsule endoscopy may allow more rapid diagnosis and thus improved patient care, as well as reduce costs for managing occult bleeding. 1 reference.

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Canadian Credentialing Guidelines for Endoscopic Privileges: An Overview. Canadian Journal of Gastroenterology. 21(12): 797-801. December 2007.

This article reviews the Canadian credentialing guidelines for upper gastrointestinal (GI) endoscopy, flexible sigmoidoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS), with reference to diagnostic procedures as well as interventional or therapeutic maneuvers such as polypectomy, dilation, hemostasis, and endoscopic mucosal resection. The authors focus on the issues that are common to all types of endoscopic procedures. The authors note that the credentialing guidelines, set up by the Canadian Association of Gastroenterology (CAG), are designed as general reference documents that should be considered during both endoscopic training and when individuals are applying for endoscopic privileges at an institution. The article includes a definition of terms, the Canadian credentialing process, appropriate training, proctoring, medicolegal issues, and the responsibilities of the institution. The guidelines are similar to those developed by other national professional bodies and, as such, are based primarily on the application of expert opinion regarding the numbers of procedures required to achieve competence. The authors conclude by reminding readers that the guidelines are not all-encompassing and that some deficiencies in the current process still exist. However, these guidelines may help lead to a greater degree of uniformity in evaluating credentials and granting privileges. 15 references.

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Capsule Endoscopy in the Evaluation of Obscure Gastrointestinal Bleeding: A Comprehensive Review. Gastroenterology and Hepatology. 3(10): 777-784. September 2007.

This article provides information about the use of capsule endoscopy in the evaluation of obscure gastrointestinal bleeding (OGIB). The authors note that capsule-based technology has enabled a more rapid and accurate diagnosis of many small bowel disorders through the noninvasive visualization of the complete small bowel. Topics include the development of capsule endoscopy (CE); the equipment used; the different types of CE available in Europe and the United States; causes of OGIB; the differential diagnosis of small bowel OGIB; the findings from CE compared with other diagnostic tests; complimentary imaging and endoscopic techniques; the role of bowel preparation, prokinetics, and simethicone in improving the diagnostic yield of CE; the role of repeat CE in OGIB; and contraindications and complications associated with CE. The authors conclude that CE is safe and well-tolerated and should be the first-line diagnostic modality used for patients with OGIB. 10 figures. 2 tables. 63 references.

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Capsule Endoscopy: Impact on Patient Management. Gastroenterology and Hepatology. 3(2): 124-126. February 2007.

This article describes capsule endoscopy (CE), an emerging technology for the diagnosis of a variety of gastrointestinal (GI) disorders. The authors focus on the impact of CE on patient management, noting that in order for CE to play a significant role in the care of GI disease, changes in patient management and positive patient outcomes must be seen. The authors report on a study undertaken to determine the impact of CE findings in the subsequent management of patients referred for CE. The authors undertook a retrospective chart review of all patients (n = 210) who underwent CE at the University of South Alabama College of Medicine from April 2002 to May 2005. Overall, CE findings would lead to a change in patient management in 81 of 210 patients (38.6 percent). When the sample was restricted to the 93 patients with obscure-occult bleeding, 34 patients (36.6 percent) would have a change in patient management. Of the 79 obscure-overt bleeding patients, 33 patients (41.8 percent) would experience a change in patient management. Of the 36 patients who underwent CE for known or suspected inflammatory bowel disease (IBD), 13 patients (36 percent) would have a patient management change based on capsule findings. The authors conclude that their study supports CE as meeting a reasonable criteria for clinical utility in its ability to provide information to change patient management. Also of importance is the ability of CE to provide information that reassures patients and eliminates the need for further testing. 1 table. 12 references.

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Emerging Diagnostic Methods in Inflammatory Bowel Disease. Gastroenterology and Hepatology. 3(4): 284-286. April 2007.

This article answers common questions physicians may have about emerging diagnostic methods in inflammatory bowel disease (IBD). The author notes that the primary concern when patients first present with gastrointestinal (GI) symptoms is to differentiate between irritable bowel syndrome (IBS), IBD, a GI malignancy, or some other GI problem. Once the diagnosis of IBD is established, the next need is to assess disease activity to effectively treat the condition. The author notes that no one test can be used to secure a diagnosis for either Crohn’s disease or ulcerative colitis, the two primary types of IBD. The author reviews current advances in serologic testing for the diagnosis and evaluation of IBD and then describes the new endoscopic techniques that are being used in IBD diagnostics, including capsule endoscopy. A final section considers the role of computerized tomography (CT) and magnetic resonance imaging (MRI) in detecting small bowel abnormalities. 5 references.

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Endoscopy in Pregnancy. IN: Pregnancy in Gastrointestinal Disorders. 2nd ed. Bethesda, MD: American College of Gastroenterology. 2007. pp 10-17.

This chapter about endoscopy in pregnancy is from a monograph that presents updated information about pregnancy in women with gastrointestinal disorders. The authors stress that the spectrum of gastrointestinal diseases in the pregnant patient is virtually identical to that in nonpregnant women. However, options for evaluating pregnant patients are somewhat limited because barium studies and other radiographic techniques subject the fetus to the risks of radiation. However, endoscopy can play a crucial role in the diagnosis and treatment of various disorders in the pregnant patient. The chapter focuses on bringing readers up to date on the research in the area covered, the recommended treatments, and patient management concerns, notably issues of maternal and fetal safety. Topics include the use of upper endoscopy for diagnosing nausea, vomiting, esophagitis, ulcers, and gastritis; the use of lower endoscopy to evaluate rectal bleeding and inflammatory bowel disease (IBD); sigmoidoscopy and colonoscopy; endoscopic retrograde cholangiopancreatography (ERCP) used to evaluate gallstones; percutaneous endoscopic gastrostomy (PEG) placement to assist patients who cannot sustain adequate nutritional intake; and the use of sedation for endoscopic tests in women who are pregnant. The authors conclude that endoscopy appears to be safe in pregnancy. They recommend that procedures be performed after the first trimester if possible, following guidelines to minimize radiation and excessive sedation. Endoscopists are encouraged to consult with an obstetrician in challenging, complicated cases. 1 table. 17 references.

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Entendiendo el Sangrado Rectal Leve [Understanding Minor Rectal Bleeding]. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2007. 2 p.

This Spanish-language brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with minor rectal bleeding, a term that refers to the passage of a few drops of bright red, fresh, blood from the rectum, which may appear on the stool, on the toilet paper, or in the toilet bowl. The brochure reviews several possible causes for minor rectal bleeding, including hemorrhoids, anal fissures, proctitis, polyps, colon or anal cancer, and rectal ulcers. The brochure describes each of these conditions, their symptoms, and treatment options. For hemorrhoids, the treatments of rubber band ligation, laser or infrared coagulation, sclerotherapy, and surgery might be used. The brochure also discusses the procedures used to evaluate and diagnose the cause of minor rectal bleeding, as well as practical approaches to prevent further episodes of rectal bleeding. Readers are cautioned that a complete evaluation and early diagnosis of any episodes of rectal bleeding is important. The brochure concludes with a brief description of the activities of and contact information for the ASGE. The brochure is also available in English.

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Entendiendo La Diverticulosis [Understanding Diverticulosis]. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2007. 2 p.

This Spanish-language brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with diverticulosis, a condition in which there are small pouches or pockets in the wall or lining of any portion of the digestive tract. The pouches associated with diverticulosis are most often located in the lower part of the large intestine, also called the colon. The brochure describes the risk factors for diverticulosis, the causes of the condition, the symptoms of diverticulosis, diagnostic tests used to confirm a diagnosis, treatment options, and complications from diverticulosis, notably diverticulitis. The brochure notes that most people do not have symptoms of diverticulosis, so the condition is found incidentally during a screening exam for another problem such as polyps. When diverticulosis is accompanied by abdominal pain, bloating, or constipation, patients may be advised to follow a high-fiber diet to help make stools softer and easier to pass. Diverticulitis occurs when the pouches become infected or inflamed; minor cases can be treated with oral antibiotics. The brochure concludes with a brief description of the activities of and contact information for the ASGE. The brochure is also available in English.

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Small-Bowel Adenocarcinoma: Case Report and Review of Literature on Diagnosis of Small-Bowel Tumors. Gastroenterology and Hepatology. 3(2): 129-136. February 2007.

This article presents a case report and review of the literature on the diagnosis of small-bowel tumors. Although the small bowel makes up nearly 75 percent of the total length of the gastrointestinal (GI) tract, small-bowel tumors are uncommon and thought to account for only 1 to 2 percent of GI tumors. However, the use of capsule endoscopy (CE) has increased the diagnosis of small-bowel tumors. The authors report a case of proximal primary jejunal adenocarcinoma as a cause of obscure GI bleeding and discuss the various methods that can be used to diagnose small-bowel tumors, including barium studies, push enteroscopy, CE, and double-balloon erthroscopy. Appended to the article is a peer review by Decker and Leighton. 4 figures. 4 tables. 55 references.

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Understanding Diverticulosis. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2007. 2 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with diverticulosis, a condition in which there are small pouches or pockets in the wall or lining of any portion of the digestive tract. The pouches associated with diverticulosis are most often located in the lower part of the large intestine, also called the colon. The brochure describes the risk factors for diverticulosis, the causes of the condition, the symptoms of diverticulosis, diagnostic tests used to confirm a diagnosis, treatment options, and complications from diverticulosis, notably diverticulitis. The brochure notes that most people do not have symptoms of diverticulosis, so the condition is found incidentally during a screening exam for another problem such as polyps. When diverticulosis is accompanied by abdominal pain, bloating, or constipation, patients may be advised to follow a high-fiber diet to help make stools softer and easier to pass. Diverticulitis occurs when the pouches become infected or inflamed; minor cases can be treated with oral antibiotics. The brochure concludes with a brief description of the activities of and contact information for the ASGE. The brochure is also available in Spanish.

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Understanding Esophageal Manometry. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2007. 6 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with esophageal manometry, a diagnostic test that measures the pressures and pattern of muscle contractions in the esophagus. Abnormalities in the contractions and strength of the muscle or in the sphincter at the lower end of the esophagus can result in pain, heartburn, and difficulty swallowing. After describing the test, the brochure reviews the basic anatomy of the esophagus, the preparations that a patient should undergo before the test, what to expect during the test, how long the test will last, what to expect after the test, and the possible complications. The brochure concludes with a brief description of the work of and contact information for the ASGE. The brochure is also available in Spanish.

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Understanding Minor Rectal Bleeding. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2007. 4 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with minor rectal bleeding, a term that refers to the passage of a few drops of bright red, fresh, blood from the rectum, which may appear on the stool, on the toilet paper, or in the toilet bowl. The brochure reviews several possible causes for minor rectal bleeding, including hemorrhoids, anal fissures, proctitis, polyps, colon or anal cancer, and rectal ulcers. The brochure describes each of these conditions, their symptoms, and treatment options. For hemorrhoids, the treatments of rubber band ligation, laser or infrared coagulation, sclerotherapy, and surgery might be used. The brochure also discusses the procedures used to evaluate and diagnose the cause of minor rectal bleeding, as well as practical approaches to prevent further episodes of rectal bleeding. Readers are cautioned that a complete evaluation and early diagnosis of any episodes of rectal bleeding is important. The brochure concludes with a brief description of the activities of and contact information for the ASGE. The brochure is also available in Spanish.

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Gastroesophageal Reflux in Children and Adolescents. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2006. 4 p.

Gastroesophageal reflux (GER) occurs when stomach contents come back up into the esophagus during or after a meal. A ring of muscle at the bottom of the esophagus—the lower esophageal sphincter, or LES—opens and closes to allow food to enter the stomach. This fact sheet describes GER in children and adolescents, along with symptoms, diagnosis, and treatment issues. GER may begin in infancy, but most children grow out of it. GER may cause vomiting, coughing, hoarseness, or painful swallowing. Diagnostic tests to confirm the condition include an upper gastrointestinal (GI) series of x rays or endoscopy. Treatment depends on the child’s symptoms and age, and may include changes in eating habits and medications. Surgery may be the best option for children who have severe symptoms that do not respond to any treatment. Readers are referred to two organizations for additional information: the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) at www.NASPGHAN.org and NASPGHAN’s Children’s Digestive Health and Nutrition Foundation (CDHNF) at www.CDHNF.org. A final section offers a brief description of the National Digestive Diseases Information Clearinghouse (NDDIC), a Federal Government agency that provides information about digestive diseases to people with digestive disorders and their families, health care professionals, and the public. 1 figure.

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Simulators for Training in Endoscopy. Gastroenterology and Hepatology. 2(1): 13-14. January 2006.

This article, written in a question-and-answer format, addresses the use of simulators for training in endoscopy. Beginning in the mid-1990s, computer simulators were able to create a realistic, visual representation of the colonoscopy, esophagogastroduodenoscopy, or other technique being performed. The simulators are designed to provide not only a visually realistic simulation of the lumen of the gastrointestinal tract, but also the feel and resistance of inserting and advancing a scope, loop formation, etc. The author describes current research studies on the effectiveness of simulation training, the goals of using this kind of training to accelerate skill acquisition, the need for achieving competence quickly, the use of simulators to assess competence, the recommended stages of training that are most appropriate for simulator program use, and advances in simulator training that would be useful. A final section considers the costs of simulator training. 5 references.

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Gastrointestinal Complications of Bariatric Surgery. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 621-628.

This chapter about gastrointestinal (GI) complications of bariatric surgery is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders that affect the GI tract. The authors describe bariatric surgery as a collective term for operations that involve reducing the size of the gastric reservoir, with or without associated induced malabsorption. Although most patients achieve successful outcomes, many patients develop postoperative GI symptoms. The authors describe the role of the gastroenterologist in the management of the various GI complications that may occur. Adverse events covered include nausea and vomiting, dumping syndrome, diarrhea, nutrient deficiency, early postoperative complications such as anastomatic leak and distention, anastomotic complications, gastric ulcers, jejunal ulcers, anastomotic stenosis, obstructive complications in vertical banded gastroplasty (VBG) and laparoscopic adjustable banding system (lap-band), weight gain, internal hernia, and cholelithiasis. Another section of the chapter reviews endoscopic management issues, including the indications for upper endoscopy and cancer screening. The authors conclude that, for the gastroenterologist, successful management of these patients requires communication with the bariatric surgeon, knowledge of postoperative anatomy, an understanding of the potential complications, and implementation of appropriate treatment. A multidisciplinary team is essential to a patient’s success in maintaining long-term weight loss after surgery. 3 figures. 52 references.

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Imaging of the Pancreatobiliary System Using Endoscopic Ultrasound. IN: Lichtenstein, G.; Ginsberg, G.; Ahmad, N., eds. The Clinician’s Guide to Pancreaticobiliary Disorders. Thorofare, NJ: Slack Incorporated. 2006. pp 311-326.

This chapter about endoscopic ultrasound imaging of the pancreatobiliary system is from a comprehensive text that covers the epidemiology, pathophysiology, diagnosis, and management of disorders of the pancreatic and biliary systems. The authors of this chapter note that endoscopic ultrasound (EUS) is an imaging technique that combines endoscopy and ultrasonography; an ultrasound transducer is mounted on the tip of the endoscope, allowing accurate imaging of lesions located within and adjacent to the gastrointestinal wall. The chapter covers instruments used in this technique, including echoendoscopes and intraductal probes; endosonography of the biliary system, including that done for choledocholithiasis and bile duct strictures; endosonography of the pancreas, including chronic pancreatitis and pancreatic endocrine tumors; endosonography of the gallbladder, finding microlithiasis or sludge, gallbladder polyps, and for gallbladder cancer staging; endosonography in ampullary carcinoma; endoscopic ultrasound-guided fine-needle aspiration; endosonography-guided celiac plexus neurolysis; and complications that may be encountered in EUS. The authors conclude by reiterating the strengths of EUS in obtaining high-resolution images of small lesions and to access those areas for tissue acquisition and potential therapeutic uses with a minimally invasive technique. The chapter is illustrated with black-and-white photographs of EUS studies. 8 figures. 9 references.

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Anxiety, Depression and Psychotropic Medication Use in Patients with Persistent Upper and Lower Gastrointestinal Symptoms. Alimentary Pharmacology and Therapeutics. 21(8): 1001-1006. April 2005.

This article reports on a study undertaken to determine anxiety and depression and related endoscopic findings in patients presenting with persistent gastrointestinal symptoms prior to endoscopy. Subjects were referred for endoscopy between February 2002 and February 2004 (n = 1298). All subjects completed a questionnaire on anxiety and depression 2 weeks prior to endoscopy in order to participate. Subjects referred for upper gastrointestinal endoscopy (n = 600) used the most psychotropic agents (24 percent), especially patients with an organic abnormality (42 percent) relative to patients without an organic abnormality (8 percent). Patients with colonic polyps were more anxious and depressed than subjects referred for lower gastrointestinal endoscopy (n = 698). 1 figure. 2 tables. 24 references.

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Como Comprender la Dilatacion Esofagica [Understanding Esophageal Dilation]. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2005. 2 p.

This Spanish-language brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with esophageal dilation, a procedure that dilates, or stretches, a narrowed area of the esophagus. After describing the procedure, the brochure reviews why the procedure might be needed, recommended patient preparation for this procedure, what to expect during and after the procedure, the possible complications of esophageal dilation, and the indications for repeat dilations. The brochure concludes with a brief description of the activities of and contact information for the ASGE. The brochure is also available in English.

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Como Comprender la Endoscopia Capsular [Understanding Capsule Endoscopy]. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2005. 2 p.

This Spanish-language brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with capsule endoscopy, a test that uses a pill-sized video capsule to view the middle part of the gastrointestinal tract, including the duodenum, jejunum, and ileum. After describing the test, the brochure reviews why the test might be ordered, the preparations that a patient should undergo before the test, what to expect during the test, how long the test will last, what to expect after the test, and the possible complications. Readers are cautioned that, as with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. The brochure concludes with a brief description of the work and contact information for the ASGE. The brochure is also available in English.

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Como Comprender la ESCRP Terapeutica [Understanding GERD, Barrett's Esophagus and the Risk for Esophageal Cancer]. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2005. 2 p.

This Spanish-language brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with the interplay of gastroesophageal reflux disease (GERD), esophageal cancer, and Barrett’s esophagus. In a small percentage of people with GERD, a change in the esophageal lining develops; this condition is called Barrett’s esophagus. Evidence exists that most cases of adenocarcinoma of the esophagus begin in Barrett’s tissue. The brochure defines Barrett’s esophagus and describes the diagnostic and monitoring tests done in people with GERD, screening recommendations for Barrett’s esophagus, risk factors for the condition, treatment options for Barrett’s and for GERD, and dysplasia, a precancerous condition that is diagnosed by biopsy. In people with Barrett’s esophagus whose initial biopsies do not show dysplasia, endoscopy with biopsy is recommended to be repeated every 1 to 3 years. The brochure concludes with a brief description of the activities of and contact information for the ASGE. The brochure is also available in English.

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Esophagus. IN: Digestive Disorders 2005. Palm Coast, FL: Medletter Associated. pp 1-18. 2005.

This chapter on the esophagus is from a White Paper on digestive disorders, including conditions that affect the esophagus, stomach, gallbladder, bile ducts, small intestine, and large intestine. This chapter covers normal anatomy of the esophagus; examination of the upper gastrointestinal tract, including upper endoscopy, capsule endoscopy, and the upper GI series; and the causes, symptoms, diagnosis, and treatment of dysphagia (swallowing disorders), hiatal hernia, gastroesophageal reflux disease (including heartburn), esophageal spasms and achalasia (disorders of motility), esophageal stricture, and Barrett's esophagus. The chapter includes a lengthy, detailed chart that summarizes the drugs used for the treatment of gastroesophageal reflux disease (GERD). One sidebar describes gastroparesis (delayed emptying of the stomach), another lists heartburn symptoms that need to be evaluated by a health care provider, and a third summarizes new research into the prediction of heartburn-associated esophageal damage. The author stresses that appropriate medication, lifestyle changes (including dietary changes, increased exercise, weight loss, and stress reduction), or surgery can alleviate or eliminate the symptoms of many digestive disorders. 1 figure. 1 table.

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Helicobacter Pylori: Findings in Native American Population. IHS Primary Care Provider. 30(3): 1-5. March 2005.

This article reports on a retrospective study of Native American patients who received care at a community hospital over the course of 38 months for symptoms suggesting upper gastrointestinal (GI) pathology. The patients were assessed for Helicobacter pylori infection by one or more of three methods: serologic testing, esophagogastroduodenoscopy (EGD) with biopsy followed by a rapid urease test (RUT), or biopsy with histological examination. The study included a total of 154 consecutive EGDs in 145 patients. Ninety-two patients were female (63.44 percent) and 53 patients were male (36.55 percent); the age range was 15 to 95 years. The authors note that with the prevalence of H. pylori infection being strongly correlated with the socioeconomic environment and given that the local conditions have been compared to those of a third-world country, H. pylori might be expected to be found in 80 percent of more of the community members. The 72 percent rate found in this study may reflect the fact that some patients undergoing endoscopy have had treatment with histamine receptor blockers and proton pump inhibitors, or in some cases antibiotics, unrelated to dyspepsia in the weeks and months prior to endoscopy. The authors found no correlation between the presence of H. pylori and the presence of running water in the home. The lack of association between H. pylori positivity and blood group O, or H. pylori and anemia is similar to earlier studies. Of the patients in this study, about 12 percent were found to have intestinal metaplasia, and one patient was diagnosed with in situ adenocarcinoma. The authors stress that endoscopy with histology cannot be replaced by other tests in detecting the most serious pathology related to H. pylori. 4 tables. 33 references.

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Understanding Capsule Endoscopy. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2005. 2 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with capsule endoscopy, a test that uses a pill-sized video capsule to view the middle part of the gastrointestinal tract, including the duodenum, jejunum, and ileum. After describing the test, the brochure reviews why the test might be ordered, the preparations that a patient should undergo before the test, what to expect during the test, how long the test will last, what to expect after the test, and the possible complications. Readers are cautioned that, as with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. The brochure concludes with a brief description of the work and contact information for the ASGE. The brochure is also available in Spanish.

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Understanding Esophageal Dilation. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2005. 2 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with esophageal dilation, a procedure that dilates, or stretches, a narrowed area of the esophagus. After describing the procedure, the brochure reviews why the procedure might be needed, recommended patient preparation for this procedure, what to expect during and after the procedure, the possible complications of esophageal dilation, and the indications for repeat dilations. The brochure concludes with a brief description of the activities of and contact information for the ASGE. The brochure is also available in Spanish.

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Understanding EUS Endoscopic Ultrasonography. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2005. 4 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with endoscopic ultrasonography (EUS), a diagnostic test that examines the stomach lining as well as the walls of the upper and lower gastrointestinal tract. The upper tract is the esophagus, stomach and duodenum; the lower tract includes the colon and rectum. After describing the test, the brochure reviews the preparations that a patient should undergo before the test, whether current medications can be continued, what to expect during the test, how long the test will last, what to expect after the test, why the test may be used in people with cancer, the possible complications, the use of antibiotics before or after EUS examinations, and the use of deep needle biopsy in conjunction with the EUS examination. The brochure concludes with a brief description of the work of and contact information for the ASGE.

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Understanding Flexible Sigmoidoscopy. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2005. 6 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with flexible sigmoidoscopy, a diagnostic test that examines the lining of the rectum and a portion of the colon for abnormalities. After first describing the test itself, the brochure reviews the preparations that a patient should undergo before the test, whether current medications can be continued, what to expect during the test, how long the test will last, what to expect after the test, possible complications, and the use of biopsy in conjunction with the test. One section lists the different types of endoscopy procedures and refers readers to the ASGE website for more information. The brochure concludes with a brief description of the work and contact information for the ASGE.

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Understanding GERD, Barrett's Esophagus And the Risk for Esophageal Cancer. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2005. 2 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with the interplay of gastroesophageal reflux disease (GERD), esophageal cancer, and Barrett’s esophagus. In a small percentage of people with GERD, a change in the esophageal lining develops; this condition is called Barrett’s esophagus. Evidence exists that most cases of adenocarcinoma of the esophagus begin in Barrett’s tissue. The brochure defines Barrett’s esophagus and describes the diagnostic and monitoring tests done in people with GERD, screening recommendations for Barrett’s esophagus, risk factors for the condition, treatment options for Barrett’s and for GERD, and dysplasia, a precancerous condition that is diagnosed by biopsy. In people with Barrett’s esophagus whose initial biopsies do not show dysplasia, endoscopy with biopsy is recommended to be repeated every 1 to 3 years. The brochure concludes with a brief description of the activities of and contact information for the ASGE. The brochure is also available in Spanish.

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Understanding Percutaneous Endoscopic Gastrostomy (PEG). Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2005. 2 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with percutaneous endoscopic gastrostomy (PEG), a procedure through which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG is used to allow nutrition, fluids, and medications to be introduced directly into the stomach, bypassing the mouth and esophagus. After describing the procedure, the brochure reviews why the procedure might be needed, how PEG is performed, who can benefit from this procedure, how to care for the PEG tube, how feedings are given, limitations to oral feeding during PEG feedings, the possible complications, and how long PEG tubes can be used. The brochure concludes with a brief description of the activities of and contact information for the ASGE.

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Capsule Endoscopy. Practical Gastroenterology. 17(3): 13-14, 16, 18, 21, 25-26, 28, 31-33. March 2004.

The lack of a safe and reliable method for investigation of suspected small bowel diseases has fueled a tremendous amount of interest and growth in research for wireless capsule endoscopy. This article reports on the advances in this area. The wireless system consists of an ingestible 11 centimeter by 26 centimeter capsule, a sensor array to assist in localization of lesions, and a workstation to view the thousands of images of the small intestines. The procedure does not require administration of pro-motility agents or a bowel preparation, and is painless and safe. Data suggests that the diagnostic yield of capsule endoscopy for patients with obscure gastrointestinal bleeding and suspected Crohn's disease is several folds higher than that of small bowel enteroscopy and other radiographic studies, with vascular lesions and ulcerations being the most common findings. Over 65,000 studies have been performed worldwide, and capsule endoscopy is quickly gaining acceptance as the gold standard for evaluation of the small bowel. 5 figures. 1 table. 86 references.

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Role of Endoscopy in Dyspepsia. Clinical Update. 15(1): 1-4. July 2007.

This article provides a practical approach to the diagnosis and management of dyspepsia. The author cautions that even the term itself can be confusing because different clinicians and patients use it to mean different symptoms. Gastroenterologists use the term dyspepsia to refer to patients who have epigastric pain or meal-related symptoms such as postprandial fullness or an inability to finish a normal meal. The author uses several systematic reviews, meta-analyses, and recently proposed practice guidelines for dyspepsia to support the argument that upper endoscopy in patients younger than 55 years, with dyspepsia but without alarm symptoms, is a low-yield diagnostic strategy. These patients may benefit from a trial of acid-suppression therapy. However, in patients who are older than 55 years, who have dyspepsia, or who have alarm symptoms, upper endoscopy is an appropriate initial diagnostic approach. The article concludes with a patient care algorithm for uninvestigated dyspepsia. 1 figure. 27 references.

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Gastric Adenocarcinoma. In: Kelly, K.A.; Sarr, M.G.; Hinder, R.A., eds. Mayo Clinic Gastrointestinal Surgery. St. Louis, MO: Elsevier Science. 2004. p. 75-90.

This chapter on cancer of the stomach (gastric adenocarcinoma) is from a book that focuses on the major diseases treated by gastrointestinal surgeons, from the esophagus to the anal canal. The presentation has a definite clinical orientation and a major emphasis on practical applications as they are applied at the Mayo Clinic. The author of this chapter notes that even though the incidence of gastric cancer has declined, several controversies and challenges confront the surgeon. Because the symptoms of gastric carcinoma are usually insidious, diagnosis is often made only at late stage. The 5 year survival rate is highly stage-dependent and ranges from 7 percent to 78 percent. Topics covered include epidemiology and risk factors, pathology, diagnosis and preoperative evaluation, surgical management, the operative approach used at the Mayo Clinic, adjuvant and neoadjuvant therapy, and long-term follow up. Liberal use of endoscopy in patients with dyspepsia may increase the number of patients in whom gastric cancer is diagnosed early. Even though the extent of operation is still controversial, a curative resection is essential for long-term survival. The gastric resection needs to include the tumor and a negative margin of tumor-free tissue. Postoperatively, all patients should be referred to an oncologist for consideration of adjuvant therapy. The chapter is illustrated with line drawings. 5 figures. 3 tables. 112 references.

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