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Irritable bowel syndrome (IBS) is a complex, multifactorial disorder characterized by chronic or recurrent abdominal pain associated with altered bowel habits. My general approach is to identify the predominant or most bothersome symptoms and the most likely pathophysiologic mechanisms underlying these symptoms. Then I target treatment toward these predominant symptoms and mechanisms. Validating symptoms, building […]

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In 2018, there is substantial evidence that hepatitis C virus (HCV) infection is a systemic disease associated with adverse clinical, economic, and patient-reported outcomes (PROs). Specifically, the clinical consequences of HCV infection can lead to both hepatic and extrahepatic manifestations. In this context, HCV infection increases the risk of liver-related and overall mortality. Additionally, HCV […]

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By now, most of us have learned that human beings have co-existed with bugs since the beginning of time and that we bear trillions of microbes in our body (the “microbiome”) — mostly located in the gut. There, they appear to act as a digestive organ, a training tool for the immune system, and a guardian of dangerous infections — key roles in […]

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Making the diagnosis of eosinophilic esophagitis (EoE), a clinicopathologic disease, requires the integration of patient symptoms, histology and clinical data. As gastroenterologists, we are obliged to do the same when monitoring for a therapeutic response. Although there are several axes on which EoE treatments may be assessed, no single measure has been shown to be sufficient. Therefore, considering the subjective experience together […]

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What’s new in the management of gastroparesis? First, there is increased recognition that the symptoms of gastroparesis may result not only from delayed gastric emptying, but also from several motor or sensory disorders of the upper gut, particularly the stomach. Hence, getting the right diagnosis for the patient’s symptoms is an essential first step. The classical diagnosis of gastroparesis is based on the […]

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I read the debate articles by Dr. Luke John Day and Dr. Louis Korman regarding training of non-physicians to perform endoscopy with great interest. I appreciate that both sides of the argument were presented to balance the debate. Debate is important, but some positions may not deserve equal time. It is unwise and unnecessary as […]

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The success of standard treatment for H.pylori has steadily declined. Increased use of antibiotics in foods and medical therapy may have contributed to increasing H. pylori antibiotic resistance.1 While there are some benefits of gastric colonization by H. pylori infection, it is still recognized as a carcinogen by the World Health Organization (WHO) and most […]

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Over the last 25 years of managing the care of patients and families with hereditary colorectal cancer syndromes (HCCS), I have witnessed many changes affecting both patients and practitioners. In particular, the discovery of new HCCS genes affords more patients and families a definitive cause for their disease. New technology for mutational analysis with next […]

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Chronic hepatitis C infection (HCV) is a major public health problem affecting more than 71 million patients worldwide including more than 3.5 million patients in the United States.1 With the introduction of direct acting antiviral agents (DAAs), it is now possible to cure hepatitis C infection even in patients with advanced fibrosis, cirrhosis and HCV […]