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Encoded by the Orphan Drug Act (ODA) in 1983, rare diseases are those that afflict less than 200,000 persons in the U.S. from infancy through adulthood. While “rare” may connote qualities separate from “common,” this should not marginalize rare diseases. In fact, rare gastrointestinal and hepatobiliary diseases are advancing our field in an ever-expanding manner […]

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Despite nearly 15 years of clinical availability, computed tomography colonography (CTC) remains an infrequently utilized method of colorectal cancer (CRC) screening. High-quality trials and meta-analyses demonstrate comparable test performance between CTC and colonoscopy to detect colorectal polyps in average-risk individuals, especially for polyps 1 cm or greater. Variation in insurance coverage, limited endorsement by gastroenterology […]

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It is both an exciting and challenging time for diagnostic endoscopy. The latest endoscopy platforms provide sharp, high-resolution images of the gastrointestinal tract that help us distinguish subtle mucosal and vascular patterns. By itself, this represents a significant improvement in performance compared to standard-definition endoscopy. In parallel, several advanced imaging modalities have emerged that provide […]

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Ever find yourself getting off your highway exit, not remembering most of the trip?  Chances are you were in a hypnotic trance — a state of intense mental focus, reduced awareness of the environment around you and a heightened ability to receive suggestions that would normally seem unbelievable. Luckily, without the occurrence of the latter, […]

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Worldwide, idiosyncratic drug-induced liver injury (DILI) is an uncommon but important cause of acute and chronic liver disease. In general, the susceptibility of DILI is not related to the dose or duration of suspect medication use but rather has been attributed to novel host factors that may involve the individual patients’ microbiome, genome, or transcriptome.1 […]

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Walled-off pancreatic necrosis (WON) is a defined entity that occurs following an episode of acute necrotizing pancreatitis. Direct endoscopic necrosectomy (DEN) is performed by advancing an endoscope transmurally into WON and has become an accepted modality. However, clinicians have many questions about endoscopic necrosectomy. Some of these questions will be addressed. 1. Is DEN required […]

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Over the years there have been attempts at standardizing care for the patient with inflammatory bowel disease (IBD). I was the director of AGA’s initiative to establish quality metrics for the care of patients with IBD in 2011. Subramanian and Triadafilopoulos published a review in 2016,1 and Berry and Melmed published an excellent review this […]

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I cannot think of many areas in medicine where there are more divergent opinions than in extraesophageal manifestations (EEMs) of gastroesophageal reflux disease (GERD). There are fervent believers and deniers, with frequent swings of the pendulum depending on the latest proposed mechanism and the tests used to support them. Furthermore, the long list of purported […]

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Although there is a downward trend of patients with Crohn’s disease undergoing surgical management, surgery remains an important treatment option for Crohn’s disease. In fact, no guidelines or specific evidence base exists that directs the optimal timing of surgery for Crohn’s disease. It is the experience of the gastroenterologist that guides him or her on […]