This volume provides a comprehensive, state-of-the art review of inflammatory bowel disease and its management through the use of telemedicine applications. The book reviews barriers to successful outcomes in patients with IBD and offers a rationale for how self-management and telemedicine approaches can improve care in chronic illnesses such as IBD. This volume also includes a summary of the burden of telephone encounters in patients with IBD, characteristics of frequent callers to the office, outcomes associated with high telephone use, and strategies to provide education via telephone to patients with IBD. Prior literature on implementation of teleconsultation in research and clinical practice, as well as mobile applications used to track symptoms, quality of life, diet, and medication use in IBD are also explored in the book. Written by experts in the field, Telemanagement of Inflammatory Bowel Disease is a valuable resource for gastroenterologists, surgeons, a nd other clinicians dealing with, and interested in, this novel adjunct to routine care for inflammatory bowel disease.

This Recent Results in Cancer Research volume contains the majority of the invited expert contributions from the First St. Gallen EORTC Gastrointestinal Cancer Conference, held on 22-24 March 2012 in St. Gallen, Switzerland. Written by some of the world's leading experts in the field, the volume constitutes a comprehensive update on recent developments in the imaging, molecular biology, pathology, and multidisciplinary management of early cancer of the gastrointestinal tract. The latest recommendations regarding diagnosis and treatment are provided, and areas of consensus and controversy, identified. While the principal focus is on esophageal and gastric cancer, advances in the treatment of colorectal and pancreatic cancer are also discussed in some detail. This book will be of interest to every clinician involved in the care of patients with gastrointestinal malignancies.

Squamous cell carcinoma of the esophagus has a lower incidence than other gastrointestinal tract cancer; however, there are many difficult issued related to the choice of appropriate therapy for these patients. In recent years, the use of multimodal treatment has greatly improved the prognosis of patients affected by this disease but several aspects of the oncological and surgical management are still controversial. This book aims to give a homogeneous approach to esophageal cancer treatment, based on the author's lifetime experience in conjunction with exhaustive review of recent literature. In each chapter surgeons and oncologists will find appropriate tools for correct management of the diagnosis and therapy of this difficult disease. The book analyzes all the aspects of staging and treatment, such as modern diagnostic and staging techniques (MRI or PET-CT), endoscopic treatment of early cancer, new minimally invasive and open surgical techniques, and combined treatment. In addition, there are chapters dedicated to the postoperative course of these patients, as well as their quality of life, with indications for the correct follow-up and treatment of relapses.

The aim of this book is to present a unique compilation of lectures given by international speakers at the Hammersmith Hospital during the recent Meetings in Hepato-Pancreato-Biliary and Transplantation. New therapeutical approaches, advances in oncology and in diagnostic imaging, which reduce the need for invasive techniques and reach an improvement in survival and quality of life in cancer, are considered in this book. Modern literature has been reviewed with special reference to articles of general interest. In the clinical management of patients with liver, bile duct and pancreas diseases, it is important to assess the degree of disturbance and to diagnose the causative insult, and therefore clinical and laboratory methods of assessing each of these pathologies are of high interest. This version is an up-to-date account of diseases of the liver, biliary tract and pancreas, including transplantation, which we trust will be of value for surgeons, physicians and pathologists and also a reference book for medical students.

Identification of cancer risk factors and potential prevention strategies have been some of the most important medical and research contributions to the improvement of public health in the past half-century (Steele 2003). Und- standing the role of lifestyle, exposure to endogenous factors and exogenous environmental factors, and individual genetic and epigenetic variability have contributed significantly to this effort. Cancer prevention strategies have been developed based on results of epidemiologic, preclinical, and clinical studies that have generated clues for identifying risk factors that may be modulated by changes in lifestyle, such as smoking cessation or dietary modification (Greenwald 2002a). In addition, significant progress in medical interventions involving chemoprevention-a pharmacological approach to intervention that aims to prevent, arrest, or reverse either the initiation phase of carcinogenesis or the progression of premalignant cells-is beg- ning to pay dividends in reducing risks associated with cancer. Emerging technologies, identification of biomarkers of risk, and advances in genetics research also are finding applications in chemoprevention research that p- mise to speed the acquisition of knowledge on the molecular and cellular - fects of chemopreventive agents. 2 Lifestyle Approaches Population studies from the 1950s through the early 1980s provided c- pelling evidence that modifiable lifestyle choices can either increase or - crease cancer risk. For example, several landmark epidemiologic studies in the 1950s showed a clear association between smoking and lung cancer (Wynder and Graham 1950; Levin et al. 1950). In 1964, the U. S.

This book investigates intraperitoneal chemotherapy in a variety of complex and interesting ways. The volume details major clinical trails to date. Authors also examine regional approaches to therapy, systemic therapy, and the use of carboplatin and paclitaxel as the standard treatment for women with stages III and IV ovarian cancer. The future direction of intraperitoneal chemotherapy both normothermic and hyperthermic is also covered.

The obesity epidemic has generated immense interest in recent years due to the wide-ranging and significant adverse health and economic consequences that surround the problem. Much attention has been focused on behaviors that lead to obesity, in particular to over consumption of energy-dense food and to sedentary lifestyle. However, obesity is an extremely complex condition with poorly defined pathogenesis. Thanks to greatly enhanced research in the area, the discovery of pathways in the brain and peripheral organs that mediate energy homeostasis has provided a framework for understanding the biological basis of obesity. Metabolic Basis of Obesity adds an important new dimension to the growing literature on obesity by offering a comprehensive review of specifically how metabolic imbalance culminates in obesity. Developed by a team of expert authors, this important title discusses the principles of energy balance, genetics of body weight regulation, hormones and adipokines, and metabolic pathways in the brain, liver, muscle and fat, to name just several of the areas covered. The book also examines the connection between obesity and diabetes, cardiovascular disease and other complications. Current and future diagnostic and treatment strategies are also reviewed. Comprehensive and timely, Metabolic Basis of Obesity is an essential reference for understanding the burgeoning problem of obesity.

In recent years there have been a number of significant developments of natural products for the treatment of rheumatic diseases, pain and gastro-intestinal ulcers and inflammation. The volume covers some of these novel developments of natural products which are of current and future interest as therapies for the above-mentioned conditions. Most available volumes cover a wide range of biological and technicological aspects of natural products and their discovery, some involving synthesis and properties of chemical compounds. The difference in this volume is that the natural products have a focus on their therapeutic effects on pain, arthritic and gastrointestinal diseases. Some of the natural products covered are either at the experimental stage of development while others are well-established clinically-used products. Each has its own unique place in therapy.

This volume presents the most recent developments in diagnosis and treatment of patients with gastroesophageal reflux disease (GERD) and those who continue to be refractory to conventional GERD therapies. The book delineates the role of newly developed endoscopic therapies in GERD and outlines the best candidates for surgical fundoplication. Topics as the risks associated with GERD, lifestyle modification in GERD and the role of H2RA and proton pump inhibitor therapy in treating reflux disease are also explored. Written by authorities in the field, Diagnosis and Treatment of Gastroesophageal Reflux Disease is a concise yet comprehensive resource that is useful for primary care providers, gastroenterologists, pulmonologists, surgeons and ENT specialists.

This handbook discusses developments and the future of gout treatment, which looks promising. Gout has been a well-known disease for over 2000 years, and is the most common cause of joint inflammation in adult males. It has become apparent that no therapeutic target based on hyperuricemia outcome had been defined. Very few controlled trials were available to test the efficacy and safety of treatments, and no research on diagnosis and management had been done despite data showing that patients with gout were generally improperly treated even in the hands of specialists. In the last 10 years, good-quality evidence on gout impact and management has grown exponentially, renal transporters have been recently identified, and a number of new drugs have been approved or are under current development.

The prevention of colorectal cancer is a subject of increasing medical importance, and there have been a number of promising recent developments. This book examines in detail important aspects of the current status and future prospects for chemoprevention of colorectal tumors. Research into the mechanisms that lead from early colorectal adenoma to colorectal cancer is discussed. The role and modes of action of available drugs such as celecoxib and sulindac are described, and recent data from aspirin trials are analyzed. In addition, the possible impact of nutritional agents with anti-inflammatory properties is considered, and strategies applicable in those with a high level of genetic risk are evaluated. An important feature of the book is its holistic perspective, making it relevant for gastroenterologists, internists, general practitioners, oncologists, colorectal and gastroenterological surgeons, and public health practitioners.

As the population ages, clinicians are facing an increasing number of elderly patients with colorectal cancer. These patients pose unique challenges as they have more comorbidities and lower functional reserves. In addition, the treatment goals may differ from those in younger patients. This book discusses in depth the different aspects of management of colorectal cancer in the elderly. After the provision of pertinent background information on the normal physiology of aging, screening and diagnosis are discussed. Subsequent chapters focus on a range of issues associated with the surgical and perioperative care of these patients and with adjuvant treatment and palliative care. Each chapter provides helpful take-home messages in bullet point form, and numerous informative figures and tables are also included. The authors are surgeons, physicians, anesthetists, geriatricians, oncologists, and allied health professionals with extensive experience in the field.

General Section. Progress in laparoscopy (new instruments, technical innovations, integration between laparoscopy and sonography). Special Section. Traditional and present indications for laparoscopy. Laparoscopy inliver diseases. Oncological lapaoscopy (diagnosis, staging and follow-up for malignant tumors). Emergency laparoscopy.

Hepatocellular carcinoma is one of the most common fatal malignan cies of mankind. Up to a few decades ago it was looked upon as a cancer which aroused mainly academic concern but relatively little clinical interest, because its therapy and prognosis had a most un favorable outlook. Indeed, it was mostly recognized only at autopsy. Recently this pessimism has radically changed and is disappearing to a rapidly accelerating degree. Many of the scientific contributions at this change in outlook are the result of research in the Far East, first, Japan and then gradually extending to its neighbors. The introduction of experimental hepatocarcinogens by Yoshida more than 50 years ago may have been one of the first important steps. Hepatocellular car cinoma shows a characteristic geographical distribution. With the highest incidence in China, Taiwan, Southeast Asia and sub-Saharan Africa, followed by southern and eastern Europe, while generally the incidence is rather low in western and northern Europe and North and South America.

Since the success in chemical induction of cancer in rabbit's ear skin by K. Yamagiwa in 1915, oncologists of the world have come to believe that they can only solve their problems by means of animal experimen tation. The importance of environmental factors became moreevident in 1935 when T. Yoshida and T. Sasaki introduced azodye hepatocarcino genesis in rats. In the domain of the gastrointestinal tract, T. Sugimura has more recently accumulated enough evidence to indicate that locally active chemical mutagens are carcinogenic. In contrast, principal approaches to colorectal tumors have been quite different: emphasis has been placed on gene identification. Long before cancer of the large bowel was recognized, importance of the roles of adenomatosis coli and its familial occurrence attracted the attention of epidemiologists and geneticists. Morphological characteri zation and analysis of hereditary trends of human material have already bad a long history, and recently detailed analysis of genetic material has become feasible in the wake of rapid development in our knowledge of the oncoviruses, oncogenes, suppressor genes, chromosomal and DNA mapping, molecular mutation and so on. lt is true that in colorectal pathology, and in no other field, these areas of research have been explored more extensively and decisively. The identification of previ ously ill-defined lesions such as precancers and benign neoplasms have been improved because sequential changes can be observed in multiple samples spread over a wide area and followed up in due course.

Over the past 10 years there has been a veritable explosion of knowledge in working in this area are fortunate to meet their bile acid research. Those colleagues from time to time at International Meetings which are often held in attractive parts of the world. The 7th International Symposium on bile acids 'Bile Acids in Gastroenterology' was no exception. It took place in Cortina d'Ampezzo in the heart of the Italian Dolomites, from 17th-20th March 1982. This meeting was organised by a Scientific Committee, with representatives from Italy, the United States and Great Britain, in collaboration with the Italian Society of Gastroenterology. The format of the meeting was somewhat different from that of previous years. In addition to the free communications (verbal and poster presentations) which characte rise many scientific meetings, there was also an Advanced Postgraduate Course on bile acids given by a distinguished international panel of experts. Their contributions form the basis for this timely volume which should be of interest both to basic scientists and to clinical investigators alike. The editors are indebted to Dr Gian Germano Giuliani, Gipharmex SpA, Milano, whose generous support made the meeting possible. They also thank Mr P. M. Lister, Managing Editor, MTP Press Limited and Mrs Veronica Cesari, Italian Society of Gastroenterology for help with the publication of these proceedings. R. Herman Dowling ix 1 Liquid-solid extraction, lipophilic gel chromatography and capillary column gas chromatography in the analysis of bile acids from biological samples K. D. R.

There is a tradition behind the current radiologic examination of the small bowel. Many of the great names in gastrointestinal radiology have established their reputations on the basis of their work in the small bowel. This is an area which is assuming ever greater importance for radiologists as its mucosal surface continues to elude the endos copist. Moreover, it is an aspect of radiology which calls for the greatest technical and interpretative skill. It is a great pleasure to welcome the English language version of this beautiful work on Radiology of the Small Intestine. English speaking physicians are frequently not as familiar with the large body of work published in French as they should be. Tant pis ! Dr. Bret and his co-workers have been pioneers in the pursuit of excellence in gastrointestinal radiology. During all the years that I have been involved in this field, I have admired their work.

Gastrointestinal bleeding is an age-old problem. The original description of g- trointestinalbleedingmayhavebeenfromGalenandhisworkconnectingdyspepsia andmelanoticstool. Thechangesinourmanagementofgastrointestinalbleeding overthecenturieshavebeendrivenbynaturalalterationsinthespectrumofdiseases, expanding our understanding of these diseases and the never ending advances in technologyandpharmacologythathaveoccurredrelativetoGIdiseases. Academic interestingastrointestinalbleedingpeakedinthelasthalfofthetwentiethcentury withtheexpandingroleofsurgery,thediscoveryofacid-basedpepticulcerthe- pies,andtheriseof?exibleendoscopyandculminatedinthedescriptionofh. pylori as a causative agent for ulcer disease. More recently there has been a decrease incidenceinbleedingdiseasesofthegutandthereforeadecreasinginterestinthe scholarlywritingaboutthesediseases. Therehasnotbeenamajortextbookwritten aboutgutbleedinginover10yearsandthereforetheintentionofthistextbookisto ?llthatvoidbyprovidingareviewofacomprehensiveapproachtouppergut,mid, andlowergutbleeding. CliniciansatDukeUniversitywhohaveacommoninterestinthegastrointes- naltracthavecollaboratedintheconstructionofthistext. Thisefforthasbrought together surgeons, gastroenterologists, and radiologists, to carefully chronicle the presentation, diagnosis, and management of modern day causes of gastrointes- nal bleeding. These co-authors concentrate on some of the latest innovations in the endoluminal and minimally invasive techniques that characterize the current approaches to these diseases. Emphasis has been placed on capsule endoscopy, double-balloon endoscopy, laparoscopic peptic ulcer surgery, and angiographic diagnosis and management techniques. The text has been written in such a way thatthereadercanquicklyreviewaspeci?ccauseofGIbleedingpriortomanaging ofsuchapatient. Weexpectthistextwillbeusedwiththesameimmediacyasthe diseasespresent. Wehopethatthistextprovidesafoundationforlearningformedicalstudents, interns,residents,andpractitionerswhoencounterthesecriticallyillanddif?cultto managepatients. Durham,NC,USA AuroraD. Pryor Durham,NC,USA TheodoreN. Pappas Durham,NC,USA MalcolmStanleyBranch v Acknowledgment TheeditorswouldliketothankMs. VirginiaCashforherhelpinthepreparation andcoordinationofthetext. vii Contents Part I Upper GI Bleeding Stabilization of Patients Presenting with Upper Gastrointestinal Bleeding. ..3 ErrolL. BushandMarkL. Shapiro Urgent Workup for Upper Gastrointestinal Bleeding...13 LorettaErhunmwunseeandSandhyaA. Lagoo-Deenadayalan Management of Esophageal Variceal Bleeding ...23 KekiBalsaraandLisaPickett Management of Dieulafoy's Lesions ...31 SerainaK. Faes,BrianR. Untch,ClaireEdwards,JohnTurner, MartinPoleski,andDouglasS. Tyler Management of Bleeding Peptic Ulcer Disease ...39 JamesC. PadussisandTheodoreN. Pappas Management of Unusual Sources of Upper GI Bleeding...65 ElisabethTracyandJanetTuttle-Newhall Mallory-Weiss Syndrome...79 JacobN. SchroderandMalcolmS. Branch Management of Bleeding Small Bowel Tumors...85 KeriE. LunsfordandAuroraD. Pryor Management of Bleeding from the Bile Duct ...103 CarlosE. MarroquinandBridgetM. Marroquin Management of Bleeding from the Pancreas...

Primary Liver Cancer: Surveillance, Diagnosis and Treatment focuses on the many therapies rapidly evolving to assist with controlling hepatocellular carcinoma as well as emerging technologies to assist in early diagnosis as well as prevention. All chapters are written by experts in their fields and include the most up to date information for diagnosis, treatment, surveillance, epidemiology, staging, recurrence and prevention. This volume will serve as a useful resource for clinical gastroenterologists, hepatologists, oncologists, pathologists, and physicians who treat patients with chronic liver disease and hepatocellular carcinoma.

This volume covers the myriad of functional and motility gastrointestinal disorders in a comprehensive manner. The book is divided into seven major sections, with each section beginning with a brief case presentation highlighting the specific disorder to be reviewed. Appropriate criteria is highlighted, followed by a brief review on the epidemiology, etiology, pathophysiology, diagnosis and treatment of each specific disorder. 2-3 key teaching "pearls", test questions and key references are also provided for each chapter. The book is organized so that each chapter can stand on its own and be used as a quick reference source in the clinic. Alternatively, it can be read cover to cover as an authoritative textbook on gastrointestinal functional and motility disorders. Written by international experts in the field of motility disorders, Functional and Motility Disorders of the Gastrointestinal Tract: A Case Study Approach is an invaluable resource for experienced physicians, students, residents, fellows, nurse practitioners and physician assistants.

The work describes a new method of sphincter salvage in surgery of rectal cancer. Low tumors of the rectum are traditionally treated with amputation of the rectum. However, this operation is not well-received by patients, since it results in a permanent colostomy. By contrast, intersphincteric resection allows sphincter salvage even in low tumors and is now widely accepted among experts in the field of colorectal surgery. The book will describe the basics (pathology,physiology, radiology) as well as the surgical technique and its different modifications.

Because of the increasing burden of hepatitis C and fatty liver disease, there is an explosion in the prevalence of chronic liver failure and hence its complications. The onset of Hepatic Encephalopathy (HE) in these patients has a significant impact on the quality of life, morbidity and mortality. Unfortunately, the approach observed by most clinicians to this complex disorder is minimalistic. This book provides a comprehensive review on pathophysiology and clinically important aspects in HE. Topics in basic physiology, nitrogen metabolism, new insights into pathogenesis and brain edema are covered in great detail. The authors have made a special effort by simplifying the complex aspects of pathogenesis and diagnosis so that it can be easily understood and applied clinically. This volume also focuses on recent developments regarding diagnoses of subtle forms of HE, also known as minimal or covert HE as well as on new treatments. Hepatic Encephalopathy will be of great value to gastroenterologists, hepatologists, pathologists, medical residents, fellows, internists and general practitioners who treat patients with hepatic encephalopathy.

The Yale Swallow Protocol is an evidence-based protocol that is the only screening instrument that both identifies aspiration risk and, when passed, is able to recommend specific oral diets without the need for further instrumental dysphagia testing. Based upon research by Drs. Steven B. Leder and Debra M. Suiter, an easily administered, reliable and validated swallow screening protocol was developed and can be used by speech-language pathologists, nurses, otolaryngologists, oncologists, neurologists, intensivists and physicians assistants. In addition, the protocol can be used in a variety of environments, including acute care, rehabilitation and nursing homes. The Yale Swallow Protocol meets all of the criteria necessary for a successful screening test, including being simple to administer, cross-disciplinary, cost effective, acceptable to patients and able to identify the target attribute by giving a positive finding when aspiration risk is present and a negative finding when aspiration risk is absent. Additionally, early and accurate identification of aspiration risk can significantly reduce health-care costs associated with recognized prandial aspiration.

The Second International Symposium on Inflammatory Bowel Diseases was held in Jerusalem from September 8-11, 1985, under the auspices of the Israel Academy of Sciences, the Israel Gastroenterological Society and the Hebrew University-Hadassah Medical School. Five hundred physicians and researchers from 26 countries attended. The symposium was organized into six panels devoted to state of the art reviews and presentations of the latest findings and approaches on etiology, pathogenesis, medical and surgical management of IBD and clini cal assessment of disease. In addition, 89 abstracts were presented as posters during the symposium, all of which were published in the book of abstracts. The concluding panel outlined new directions for future re search on IBD. The organizing committee gratefully acknowledges all the contributors who presented their work in a clear and concise manner, and to all the participants whose active role in the discussions contributed to the suc cess of the meeting. In view of the great interest in the symposium and the tradition es tablished following the first, in 1981, it was decided to convene a third international symposium on IBD in Jerusalem in September 1989."