Table of Contents
Authors ix
Preface xv
Section I General Concerns
2 Acute Abdominal Pain: Basic Principles & Current Challenges Molly L. Perencevich, MD Frederick L. Makrauer, MD 1
Evaluation of the Acute Abdomen 4
Acute Appendicitis 8
Unique Presentations of Appendicitis 11
2 Inflammatory Bowel Disease: Immunologic Considerations & Therapeutic Implications Vanessa Mitsialis, MD Scott B. Snapper, MD, PhD Richard S. Blumberg, MD 13
General Principles of Gut-Associated Lymphoid Tissues and the Mucosal Immune Response 14
Pathogenesis of Inflammatory Bowel Disease 17
Mucosal Inflammatory Signatures of IBD 20
Cytokines in IBD and Therapeutic Implications 23
Additional Therapeutic Targets in IBD 26
3 Inflammatory Bowel Disease: Medical Considerations Rachel W. Winter, MD, MPH Sonia Friedman, MD 29
General Considerations 29
Epidemiology 29
Etiology 29
Clinical Findings 30
Radiographic Findings 31
Endoscopic Examination 32
Extraintestinal Manifestations 32
Complications 33
Differential Diagnosis of IBD 34
Medical Therapy of Crohn's Disease and Ulcerative Colitis 35
Treatment of Acute Inflammation 37
Cyclosporine and Tacrolimus 37
Surgical Management of IBD 38
4 Inflammatory Bowel Disease: Surgical Considerations Jennifer L. Irani, MD Ronald Bleddy, MD 40
Ulcerative Colitis 40
Crohn's Disease 45
5 Acute Diarrheal Disorders Rahul S. Dalal, MD, MPH Jerry S. Trier, MD Jessica R. Allegretti, MD, MPH 52
Acute Diarrhea 52
Acute Diarrheal Disease Caused by Specific Infections 57
6 Mesenteric Vascular Disease Navin L. Kumar, MD Kunal Jajoo, MD 75
Mesenteric Ischemia 75
Acute Mesenteric Ischemia 76
Chronic Mesenteric Ischemia 80
Acute Colonic Ischemia 82
7 Gastrointestinal & Biliary Complications of Pregnancy Punyanganie S. de Silva, MBBS, MPH 86
Gastroesophageal Reflux Disease 86
Nausea & Vomiting 89
Hyperemesis Gravidarum 92
Constipation 93
Diarrhea 94
Hemorrhoids 96
Irritable Bowel Syndrome 97
Fecal Incontinence 98
Inflammatory Bowel Disease 99
Abdominal Pain 107
Peptic Ulcer Disease 109
Biliary Disease 110
Pancreatitis 110
Appendicitis 111
Intestinal Obstruction, Pseudo-Obstruction, & Gastrointestinal Cancer 112
Endoscopy In Pregnancy 113
8 Liver Disease in Pregnancy Rachel Placzek, PA-C Anna Rutherford, MD, MPH 120
Interpretation of Liver Biochemical Tests During Pregnancy 120
Hepatic Conditions Unique to Pregnancy 121
Conditions Not Unique to Pregnancy 124
9 State-of-the-Art Imaging of the Gastrointestinal System Francesco Alessandrino, MD Alan J. Cubre, MD 128
Gastrointestinal Tract Imaging 129
Liver Imaging 146
Biliary Imaging 153
Pancreatic Imaging 158
Summary of Current Recommendations 163
10 Acute and Chronic Gastrointestinal Toxicities of Oncologic Therapy Lawrence Kogan, MD Shilpa Grover, MD, MPH 165
Acute Complications 165
Chronic Gastrointestinal Complications 174
11 Mast Cell Disorders Matthew J. Hamilton, MD Mariana Castells, MD, PhD 175
General Considerations 175
Classifications of Mast Cell Disorders 176
Pathogenesis of Mast Cell Disorders 177
Clinical Findings 178
Differential Diagnosis 179
Treatment 180
Clinical Course & Prognosis 181
Unresolved Issues 181
Section II Esophageal Diseases 182
12 Gastroesophageal Reflux Disease Walter W. Chan, MD, MPH 182
General Considerations 182
Clinical Findings 183
Complications 187
Treatment 188
Course & Prognosis 191
13 Barrett Esophagus Kunal Jajoo, MD 193
General Considerations 193
Clinical Findings 194
Treatment 196
Course & Prognosis 199
14 Oropharyngeal & Esophageal Motility Disorders Hiroshi Mashimo, MD, PhD 200
Oropharyngeal Dysphagia 200
Impaired Ues Relaxation, Cricopharyngeal Spasms, & Cricopharyngeal Bar 203
Zenker Diverticulum 205
Globus Pharyngeus 205
Esophageal Motility Disorders 206
Esophageal Motor Dysphagia 207
Gastroesophageal Reflux Disease 209
Esophageal Chest Pain 211
Disorders of Inhibitory Innervation 214
Disorders of Excitatory Nerves and Smooth Muscles 219
15 Eosinophilic Esophagitis Wai-Kit Lo, MD Matthew J. Hamilton, MD 222
General Considerations 222
Epidemiology 222
Pathogenesis 222
Clinical Findings 223
Differential Diagnosis 224
Treatment 224
Course & Prognosis 225
Unresolved Issues 226
Section III Diseases of the Stomach
16 Peptic Ulcer Disease Edward Lew, MD, MPH 227
General Considerations 227
Pathogenesis 228
Clinical Findings 230
Differential Diagnosis 232
Complications 232
Treatment 234
17 Zollinger-Ellison Syndrome (Gastrinoma) Edward Lew, MD, MPH 240
General Considerations 240
Pathogenesis 240
Classification 240
Clinical Findings 241
Treatment 245
Prognosis 246
18 Functional Dyspepsia Molly L. Perencevich, MD 247
General Considerations 247
Pathogenesis 248
Clinical Findings 250
Differential Diagnosis 252
Treatment 253
Course & Prognosis 256
19 Disorders of Gastric & Small Bowel Motility Jennifer X. Cai, MD, MPH Walter W. Chan, MD, MPH 257
Gastroparesis & Chronic Intestinal Pseudo-Obstruction 258
Dumping Syndrome & Accelerated Gastric Emptying 267
Rapid Transit Dysmotility of the Small Bowel 267
20 Acute Upper Gastrointestinal Bleeding John R. Saltzman, MD 268
Nonvariceal Bleeding 277
Less Common Causes of Nonvariceal Bleeding 283
Variceal Bleeding 285
Section IV Small Bowel Diseases
21 Intestinal Malabsorption & Nutrition Walter M. Kim, MD, PhD Joshua R. Korzenik, MD 289
Diseases Associated with Intraluminal Maldigestion 297
Diseases Associated with Impaired Mucosal Digestion & Absorption 298
Diseases Caused by Impairment of both Intraluminal Digestion & Mucosal Digestion/Absorption 309
Diseases Caused by Impaired Postmucosal Transport 311
Section V Colorectal Diseases
22 Chronic Constipation & Fecal Incontinence Nayna A. Lodhia, MD Walter W. Chan, MD, MPH 313
Chronic Constipation 313
Fecal Incontinence 322
23 Diverticular Disease of the Colon Navin L. Kumar, MD Benjamin N. Smith, MD 326
Diverticulosis 326
Acute Diverticulitis 330
Diverticular Hemorrhage 334
24 Colorectal Cancer Screening Nicolette J. Rodriguez, MD, MPH Ramona Lim, MD Sapna Syngal, MD, MPH 338
Risk Stratification 339
Screening & Surveillance Recommendations 340
Screening Modalities 346
Additional Screening Modalities 349
Summary of Recommendations 350
25 Hereditary Gastrointestinal Cancer Syndromes Nicolette J. Rodriguez, MD, MPH Sapna Syngal, MD, MPH Elena M. Stoffel, MD, MPH 351
Hereditary Colorectal Cancer Syndromes 351
Hamartomatous Polyposis Syndromes 358
Serrated Polyposis Syndrome 360
Colorectal Polyposis Not Otherwise Specified 360
Other Gastrointestinal Cancer Syndromes 361
26 Irritable Bowel Syndrome Anne F. Liu, MD Sonia Friedman, MD 364
General Considerations 364
Pathogenesis 365
Clinical Findings 367
Differential Diagnosis 369
Complications 373
Treatment 373
27 Acute Lower Gastrointestinal Bleeding John R. Saltzman, MD 377
Evaluation of Lower GI Bleeding 377
Specific Causes of Acute Lower GI Bleeding 382
Section VI Pancreatic Diseases
28 Acute Pancreatitis David X. Jin, MD, MPH Darwin Conwell, MD Peter A. Banks, MD 386
General Considerations 386
Pathogenesis 387
Clinical Findings 387
Differential Diagnosis 391
Treatment 391
Prognosis 392
29 Chronic Pancreatitis Julia McNabb-Baltar, MD, MPH Peter A. Banks, MD 394
General Considerations 394
Pathogenesis 394
Clinical Findings 395
Differential Diagnosis 399
Complications 399
Treatment 400
Course & Prognosis 402
30 Autoimmune Pancreatitis Alice A. Lee, MD David X. Jin, MD, MPH 403
General Considerations 403
Type 1 Autoimmune Pancreatitis 403
Epidemiology 403
Clinical Findings 403
Type 2 Autoimmune Pancreatitis 406
Diagnosis & Differential Diagnoses 406
Treatment 407
Course & Prognosis 408
31 Tumors of the Pancreas Julia McNabb-Baltar, MD, MPH 409
Pancreatic Cancer 409
Cystic Neoplasms of the Pancreas 416
Pancreatic Lymphoma 420
Section VII Therapeutic Endoscopy & Diagnostic Techniques
32 Polypectomy Sanchit Gupta, MD, MS Kunal Jajoo, MD 421
Equipment 421
Polypectomy for Sessile Polyps 422
Polypectomy for Pedunculated Polyps 423
Endoscopic Mucosal Resection 423
Endoscopic Submucosal Dissection 424
Endoscopic Full-Thickness Resection 424
33 Endoscopic Management of Acute Biliary & Pancreatic Conditions Russell D. Dolan, MD Andrew C. Storm, MD Christopher C. Thompson, MD 426
Acute Cholangitis 426
Gallstone Pancreatitis 428
Bile Duct Injuries 430
Pancreatic Duct Injuries 432
Hemorrhagic Biliary & Pancreatic Conditions 433
34 Endoscopic Retrograde Cholangiopancreatography (ERCP) Russell D. Dolan, MD David L. Carr-Locke, MA, MD Christopher C. Thompson, MD 436
Disorders of the Major Duodenal Papilla 436
Biliary System 438
Pancreas 443
35 Video Capsule Endoscopy & Deep Small Bowel Enteroscopy Daniel J. Stein, MD, MPH Ramona M. Lim, MD 449
Video Capsule Endoscopy 449
Deep Small Bowel Enteroscopy 458
36 Gastrointestinal Foreign Bodies Russell D. Dolan, MD Andrew C. Storm, MD Christopher C. Thompson, MD 462
General Considerations 462
Clinical Findings 462
Treatment 464
37 Endoscopic Ultrasound Russell D. Dolan, MD Linda Lee, MD 469
Cancer Staging 471
Nonmalignant Lesions 475
Therapeutic Endoscopic Ultrasound 480
Future Directions 482
38 Endoscopic & Surgical Treatment of Obesity Pichamol Jirapinyo, MD, MPH Colston Edgerton, MD Malcolm K. Robinson, MD 486
Treatment of Obesity 487
Endoscopic Bariatric & Metabolic Therapies 489
Metabolic Surgery 490
Metabolic Surgical Procedures 493
Postoperative Care & Complications 496
Gastroenterology Evaluation & Treatment 498
Long-Term Outcomes of Metabolic Surgery 501
Weight Regain 503
Recommendations & Caveats 503
Section VIII Liver Diseases
39 Approach to Abnormal Liver Tests Jordan Sack, MD, MPH Gyorgy Baffy, MD, PhD 504
General Considerations 504
Pathogenesis 505
Prevention 505
Clinical Findings 505
Differential Diagnosis 508
Complications 510
Treatment 510
Prognosis 510
When to Refer & Admit 510
40 Acute Liver Failure Anna Rutherford, MD, MPH 512
Specific Causes of Acute Liver Failure 518
41 Viral Hepatitis Anne F. Liu, MD Stephen D. Zucker, MD 523
Hepatitis A 526
Hepatitis B 527
Hepatitis C 534
Hepatitis D 537
Hepatitis E 538
42 Autoimmune Liver Disorders Michael Li, MD, MPH Stephen D. Zucker, MD 541
Autoimmune Hepatitis 541
Primary Biliary Cholangitis 545
43 Metabolic Liver Diseases Alexander S. Vogel, MD Benjamin Smith, MD 548
Hemochromatosis 548
Wilson Disease 555
α1-Antitrypsin Deficiency 558
44 Alcohol-Associated Liver Disease Alexander S. Vogel, MD Gyorgy Baffy, MD, PhD 561
General Considerations 561
Pathogenesis 562
Clinical Findings 563
Differential Diagnosis 564
Treatment 565
Alcohol-associated Hepatitis 566
45 Nonalcoholic Fatty Liver Disease Anne F. Liu, MD Kathleen Viveiros, MD 569
General Considerations: Definitions 569
Pathogenesis 571
Clinical Findings 572
Treatment 573
Course & Prognosis 575
46 Complications of Cirrhosis: Ascites & Hepatic Encephalopathy Jordan Sack, MD, MPH Kathleen Viveiros, MD 577
Introduction 577
General Considerations 577
Ascites 578
Hepatic Encephalopathy 582
47 Portal Hypertension & Esophageal Variceal Hemorrhage Kathleen Viveiros, MD Marvin Ryou, MD 585
Gastric Varices 595
Portal Hypertensive Gastropathy 596
Idiopathic Portal Hypertension 597
Future Treatment Trends 597
48 Drug-Induced Liver Injury Michael Li, MD, MPH Gyorgy Baffy, MD, PhD 598
Drugs of Special Interest 602
49 Liver Neoplasms Nikroo Hashemi, MD, MPH 606
Benign Liver Tumors 606
Hepatocellular Carcinoma 611
Cholangiocarcinoma 617
Metastatic Liver Disease 618
50 Liver Transplantation Jordan Sack, MD, MPH Nikroo Hashemi, MD, MPH 619
Indications for Transplantation 620
Pretransplant Evaluation 621
Contraindications 622
Listing & Donor Liver Options 623
Transplantation Procedures 623
Complications 624
Infection after Liver Transplantation 626
Long-Term Medical Care After Liver Transplantation 626
Prognosis & Disease Recurrence 628
Section IX Biliary Tract Diseases
51 Primary Sclerosing Cholangitis & Congenital Disorders of the Biliary System Marvin Ryou, MD Stephen D. Zucker, MD 631
General Considerations: Primary Sclerosing Cholangitis 631
Pathogenesis 631
Clinical Findings 632
Differential Diagnosis 633
Treatment 634
Course & Prognosis 634
General Considerations: Congenital Cystic Diseases of the Biliary System 635
Pathogenesis 637
Classification 637
Clinical Findings 637
52 Gallstone Disease Stephen D. Zucker, MD 638
General Considerations 638
Pathogenesis 638
Clinical Features 642
Differential Diagnosis 643
Complications 643
Treatment 645
Index 649
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