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.

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.

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.

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...

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.

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.

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.

Advocate For Your Care It's expected that you will have questions about biliary cancer upon diagnosis. Whether it's your own diagnosis or a diagnosis of a loved one, this easy-to-read guide provides invaluable practical knowledge such as help for preparing to meet with an oncologist, seeking a second opinion, and understanding clinical trials. 100 Questions & Answers About Cholangiocarcinoma, Gallbladder, and Bile Duct Cancers is a resource that empowers patients and caregivers with the information needed to navigate their treatment with realistic goals for a good quality of life and targeted long-term survivorship. The perspective of patients and doctors is provided in this book with comprehensive answers to the most asked questions with added guidance for support and access to support services. You are the best solution to your cancer care.

The Third International Symposium on Inflammatory Bowel Diseases was held in Jerusalem during September 10-13, 1989. Four hundred physicians and scientists from 25 countries attended the meeting. The symposium was organized into five panels devoted to state of the art reviews of the latest findings and approaches on the etiology, pathogenesis, metabolic implications, clinical assessment of disease activity and the medical management of IBD. Several issues were discussed in debate form. The last panel was dedicated to discussion of three patients with computer assisted active participation of all the attendants. In addition, 03 abstracts were presented as posters, all of which were published in the Book of Abstracts. The organizing committee gratefully acknowledges the contributors who presented their work in clear and concise manner and the participants, whose active part in the discussions contributed to the success of the meeting. The Jerusalem International symposium on Inflammatory Bowel Diseases has become a tradition that will continue with the Fourth Symposium to be convened in September 1993. Joseph Zimmerman, M.D. Daniel Rachmi1ewitz, M.D. LIST OF FIRST AUTHORS Theodore M. Bayless, Michael J. Langman, Johns Hopkins University Department of Medicine, School of Medicine, Queen Elizabeth Hospital, Baltimore, Maryland. Birmingham, England. Michael D. Blackstone, J.E. Lennard-Jones, University of Chicago, St. Mark's Hospital, Chicago, Illinois. City Road, London, England. Charles O. Elson, Division of Gastroenterology, James Lee Madara, The University of Alabama Department of Pathology, at Birmingham, Brigham and Women's Hospital, Birmingham, Alabama. Boston, Massachusetts.

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."

This is a carefully illustrated volume of surgical procedures. Well-known standard as well as alternative procedures in surgery of the stomach and the proximal duodenum are depicted with anatomical exactness. Possible complications, errors, and dangers and how to avoid them are discussed in detail. Each operative step is illustrated superbly and accompanied by a short, precise text. Both illustrations and text stem from the practical experience in the operating theater of the many renowned surgeons who have contributed to this volume. The book serves as an indispensable reference for surgeons; likewise, gastroenterologists, radiologists, pathologists, and anatomists will find this volume of immeasurable value in their daily work.

The gastrointestinal track provides one of the distinct systems where multiple malignancies, including adenocarcinoma of the pancreas, esophagus and colon are each associated with obesity. This unique association is covered in this volume of Energy Balance and Cancer from the epidemiologic, biologic and potential etiologic viewpoint. The focus on possible dietary contribution as well as the role of exercise in prevention and therapy is presented in both animal model and patient based studies. Special focus is provided also on the role of genetic mutations and inflammatory pathways as drivers of these obesity related gastrointestinal malignancies. Overall, this volume on Energy Balance and Gastrointestinal Malignancies should be valuable to Epidemiologists, Gastroenterologists and Oncologists, as well as to students and researchers from multiple disciplines interested in understanding and disrupting the association between obesity and cancer.

Whereas during the past decade endoscopy has become established as the leading means of diagnosis and management of diseases affecting the esophagus, starnach and large bowel, radiology has retained its pre-eminence for the clinical study and evaluation of the small bowel. This book provides unique coverage of all current radiological techniques used to study the small bowel, including not only barium studies and angiography but also cross-sectional methods such as uhrasound and computer tomography as well as nuclear medicine. Ernerging techniques such as magnetic resonance imaging are given close consideration, and interventional procedures are dealt with fully. Following an introduction on anatomy, physiology, and pathology pertinent to radiol ogy, the book describes in great detail common and less common congenital and development anomalies, trauma, infectious and infl.ammatory conditions, and tumors. The radiological accounts are illustrated by unique color photographs of pathological specimens. It is important for all professionals involved in the management of patients with small-bowel disease tobe critically informed about the specific advantages as well as the limitations of the various modern imaging techniques now employed for the in vivo morphological evaluation of the small bowel. This comprehensive book provides a timely update of our knowledge in this field and is a welcome addition to our series "Medical Radiology;' which aims to provide exhaustive coverage of modern diagnostic radiology. It will be of great interest for general and abdominal radiologists, gastroen terologists, and abdominal surgeons.

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.

This book embarks on a journey never taken before, approaching the imaging of the disease of achalasia with new pathophysiological assumptions in mind, coming from the Chicago Classification of Manometric diagnosis. Using state-of-the-art, modern x-ray technology, the authors have developed a schematic and simple approach to detection, diagnosis, and patient stadiation and prognostic stratification, for radiologists, clinicians, and students. Key Features: 1. Serves as a useful guide to structured and comprehensive reporting of barium swallows, both in achalasia and other oesophageal motility disorders. 2. Allows radiologists, both specialists, and trainees, to comprehensively understand achalasia from anatomic, pathophysiologic, therapeutic points of view, allowing for exact comprehension, detection, and reporting of the radiologic hallmarks of the disease. 3. Empowers readers to diagnose and define the exact achalasia subtype in each patient, due to the specifically developed FBF score.

Gastroparesis is an increasingly recognized disorder. Treatment can be difficult due to the several mechanisms for symptom production. Gastroparesis: Pathophysiology, Presentation and Treatment serves as a concise reference on this disorder that allows clinicians to quickly access and evaluate the necessary information for treating and managing patients with gastroparesis. Each chapter is written byexperts in their respective area. The volume will enable the reader to better understand all aspects of this disorder. The book presents current concepts in a variety of areas opening with the epidemiology, clinical presentation and pathophysiology of gastroparesis. The natural history of patients is explored as well as evaluation of patients with suspected gastroparesis. This section includes chapters on Wireless Capsule Motility, Electrogastrography and Antroduodenal Manometry. This important resource concludes with a full section on treatment including dietary, prokinetic, antiemetic, sensory, electric stimulation, and surgical methods. New developments include the use of gastric electric stimulation for treatment, the use of SmartPill for diagnosis, and a number of new agents in development for this disorder. Gastroparesis: Pathophysiology, Presentation and Treatment is the ideal reference for gastroenterologists, and also for surgeons, endocrinologists, primary care physicians and nutritionists looking to keep pace with the latest information treatment options for their patients. "

Dietary fibre is now recognized as a vital component of good daily nutrition, yet its properties and specific role in the digestive system are still being investigated. The involvement of government agencies, the food industry and health professionals - as well as public interest - make this global overview, Dietary Fibre - A Component of Food, an important contribution to the literature on the subject. The cooperation of experts from different research centers and their peer review of each other's papers enhance the value of the book, since it presents consolidated views and objective assessments on such key issues as fibre analysis and mineral bioavailability. The seventeen chapters are grouped into three sections. The background papers deal with biochemical and analytical characteristics: e.g. the physico-chemical properties of food polysaccharides and bacterial fermentation in the colon. The papers on physiological effects deal with the physiological function of dietary fibre throughout the gastrointestinal tract: its influence on protein, lipid and carbohydrate digestion and absorption and its role in bile acid metabolism and faecal bulking. The third section of papers focuses on the prevention and treatment of disease: gastrointestinal disorders, obesity, diabetes mellitus, and hyperlipidemias.

This first reference to comprehensively address both the medical and surgical management of diseases affecting the colon, this source spans the wide array of colorectal disorders including rectal prolapse, irritable bowel syndrome, benign and malignant colonic tumors, fissures and ulcers, and Crohn's colitis, among other ailments. With chapters by world leaders in the field, this guide analyzes diagnostic and imaging techniques for disease evaluation and management including advances in colonoscopy, radiology, and surgery.

Colorectal Cancer Screening provides a complete overview of colorectal cancer screening, from epidemiology and molecular abnormalities, to the latest screening techniques such as stool DNA and FIT, Computerized Tomography (CT) Colonography, High Definition Colonoscopes and Narrow Band Imaging. As the text is devoted entirely to CRC screening, it features many facts, principles, guidelines and figures related to screening in an easy access format. This volume provides a complete guide to colorectal cancer screening which will be informative to the subspecialist as well as the primary care practitioner. It represents the only text that provides this up to date information about a subject that is continually changing. For the primary practitioner, information on the guidelines for screening as well as increasing patient participation is presentedd. For the subspecialist, information regarding the latest imaging techniques as well as flat adenomas and chromoendoscopy are covered. The section on the molecular changes in CRC will appeal to both groups. The text includes up to date information about colorectal screening that encompasses the entire spectrum of the topic and features photographs of polyps as well as diagrams of the morphology of polyps as well as photographs of CT colonography images. Algorithms are presented for all the suggested guidelines. Chapters are devoted to patient participation in screening and risk factors as well as new imaging technology. This useful volume explains the rationale behind screening for CRC. In addition, it covers the different screening options as well as the performance characteristics, when available in the literature, for each test. This volume will be used by the sub specialists who perform screening tests as well as primary care practitioners who refer patients to be screened for colorectal cancer.

Diseases of the gastrointestinal tract are common. There is increasing appreciation of the importance of the immune system in the pathogenesis of a number of these diseases. This book covers basic aspects of innate and adaptive immunity in the gastrointestinal tract, oral tolerance, and cellular and molecular mechanisms of acute and chronic inflammation. Specific disease covered include bacterial infections, human immunodeficiency virus (HIV) infection, coeliac disease, and inflammatory bowel disease. Other topics include mucosal immunisation and intestinal transplantation immunology. The readership of this book includes clinicians, scientists, and students interested in the gastrointestinal tract.

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.

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 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.