Introduction

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THIS WEEK'S TOPIC

When the liver is not the cause

Journal Articles

All journal articles are available via CIAP, or by request from the Clinical Library via our online request form.

Gioia, S., et al. (2020). "Causes and Management of Non-cirrhotic Portal Hypertension." Curr Gastroenterol Rep 22(12): 56 1534-312x

Curr Gastroenterol Rep. 2020 Sep 17;22(12):56. doi: 10.1007/s11894-020-00792-0.

file:///C:/Users/25133492/Downloads/s11894-020-00792-0%20(1).pdf PDF AVAILABLE AT LINK

PURPOSE OF THE REVIEW: Non-cirrhotic portal hypertension (NCPH) includes a heterogeneous group of conditions. The aim of this paper is to make an overview on the denominations, diagnostical features and management of porto-sinusoidal vascular disease (PSVD) and chronic portal vein thrombosis (PVT) being the main causes of NCPH in the Western world. RECENT FINDINGS: The management of NCPH consists in the treatment of associated diseases and of portal hypertension (PH). PH due to PSVD or PVT is managed similarly to PH due to cirrhosis. TIPS placement and liver transplantation are considerable options in patients with refractory variceal bleeding/ascites and with progressive liver failure. Anticoagulation is a cornerstone both in the treatment of thrombosis in PSVD and in the prevention of thrombosis recurrence in patients with portal cavernoma. Physicians should be aware of the existence of PSVD and chronic PVT and actively search them in particular settings. To now, the management of portal hypertension-related complications in NCPH is the same of those of cirrhosis. Large cooperative studies on the natural history of NCPH are necessary to better define its management.

Giri, S., et al. (2023). "Prevalence of hepatic encephalopathy in patients with non-cirrhotic portal hypertension: A systematic review and meta-analysis." Indian Journal of Gastroenterology 42(5): 642-650 https://doi.org/10.1007/s12664-023-01412-1 https://link.springer.com/article/10.1007/s12664-023-01412-1 PDF AVAILABLE AT LINK

Hepatic encephalopathy, (HE) although commonly associated with cirrhosis, has also been reported in non-cirrhotic portal hypertension (NCPH). The importance of identifying and treating HE in NCPH lies in the fact that many patients may be wrongly diagnosed as having psychiatric or neurologic disorders. Hence, we aimed to systematically review the prevalence of HE in NCPH.

Kmeid, M., et al. (2021). "Idiopathic Non-Cirrhotic Portal Hypertension and Porto-Sinusoidal Vascular Disease: Review of Current Data." Gastroenterology Res 14(2): 49-65 1918-2813

Gastroenterology Res. 2021 Apr;14(2):49-65. doi: 10.14740/gr1376. Epub 2021 Apr 21. https://pmc.ncbi.nlm.nih.gov/articles/PMC8110235/ PDF AVAILABLE AT LINK

Idiopathic non-cirrhotic portal hypertension (INCPH) is a clinicopathologic disease entity characterized by the presence of clinical signs and symptoms of portal hypertension (PH) in the absence of liver cirrhosis or known risk factors accountable for PH. Multiple hematologic, immune-related, infectious, hereditary and metabolic risk factors have been associated with this disorder. Still, the exact etiopathogenesis is largely unknown. The recently proposed porto-sinusoidal vascular disease (PSVD) scheme broadens the spectrum of the disease by also including patients without clinical PH who are found to have similar histopathologic findings on core liver biopsies. Three histomorphologic lesions have been identified as specific for PSVD to include obliterative portal venopathy, nodular regenerative hyperplasia and incomplete septal cirrhosis/fibrosis. However, these findings are often subtle, under-recognized and subjective with low interobserver agreement among pathologists. Additionally, the natural history of the subclinical forms of the disease remains unexplored. The clinical course is more favorable compared to cirrhosis patients, especially in the absence of clinical PH or liver dysfunction. There are no universally accepted guidelines in regard to diagnosis and treatment of INCPH/PSVD. Hence, this review emphasizes the need to raise awareness of this entity by highlighting its complex pathophysiology and clinicopathologic associations. Lastly, formulation of standardized diagnostic criteria with clinical validation is necessary to avoid misclassifying vascular diseases of the liver and to develop and implement targeted therapeutic strategies.

Sarma, M. S. and J. Seetharaman (2021). "Pediatric non-cirrhotic portal hypertension: Endoscopic outcome and perspectives from developing nations." World J Hepatol 13(10): 1269-1288 1948-5182 World J Hepatol. 2021 Oct 27;13(10):1269-1288. doi: 10.4254/wjh.v13.i10.1269

https://pmc.ncbi.nlm.nih.gov/articles/PMC8568571/ PDF AVAILABLE AT LINK

Non-cirrhotic portal hypertension (NCPH) forms an important subset of portal hypertension in children. Variceal bleed and splenomegaly are their predominant presentation. Laboratory features show cytopenias (hypersplenism) and preserved hepatic synthetic functions. Repeated sessions of endoscopic variceal ligation or endoscopic sclerotherapy eradicate esophageal varices in almost all cases. After variceal eradication, there is an increased risk of other complications like secondary gastric varices, cholangiopathy, colopathy, growth failure, especially in extra-hepatic portal vein obstruction (EHPVO). Massive splenomegaly-related pain and early satiety cause poor quality of life (QoL). Meso-Rex bypass is the definitive therapy when the procedure is anatomically feasible in EHPVO. Other portosystemic shunt surgeries with splenectomy are indicated when patients present late and spleen-related issues predominate. Shunt surgeries prevent rebleed, improve growth and QoL. Non-cirrhotic portal fibrosis (NCPF) is a less common cause of portal hypertension in children in developing nations. Presentation in the second decade, massive splenomegaly and patent portal vein are discriminating features of NCPF. Shunt surgery is required in severe cases when endotherapy is insufficient for the varices. Congenital hepatic fibrosis (CHF) presents with firm palpable liver and splenomegaly. Ductal plate malformation forms the histological hallmark of CHF. CHF is commonly associated with Caroli's disease, renal cysts, and syndromes associated with neurological defects. Isolated CHF has a favourable prognosis requiring endotherapy. Liver transplantation is required when there is decompensation or recurrent cholangitis, especially in Caroli's syndrome. Combined liver-kidney transplantation is indicated when both liver and renal issues are present.

Books

Cotton and Williams' Practical Gastrointestinal Endoscopy by Catharine M. Walsh; Ahmir Ahmad; Brian P. Saunders; Jonathan Cohen; Peter B. Cotton; Christopher B. Williams
Call Number: CAMPBELLTOWN Clinical Library WI 141/4a

ISBN: 9781119525202

Publication Date: 2024

The fundamental guide to gastrointestinal endoscopy returns in a fully updated new edition For over forty years, Cotton and Williams' Practical Gastrointestinal Endoscopy has offered a clear, accessible introduction to the fundamentals of endoscopy, from patient positioning to the range of available procedures.
Greenberger's CURRENT Diagnosis & Treatment Gastroenterology, Hepatology, & Endoscopy, Fourth Edition by Richard Blumberg (Editor); Norton Greenberger; Sonia Friedman; John Saltzman
Call Number: BANKSTOWN Medical Library WI 140/GRE/4

ISBN: 9781260473438

Publication Date: 2022

The peerless guide to clinical management of digestive and liver diseases--updated to reflect the latest research and treatments Authoritative coverage of the entire spectrum of gastroenterology and hepatology conditions, including therapeutic advances in Barrett's esophagus, eosinophilic esophagitis, acute diarrheal disorders, peptic ulcer disease, hereditary gastrointestinal cancer syndromes, upper and lower gastrointestinal bleeding Written by expert faculty physicians at Harvard Medical School and Brigham and Women's Hospital Presented in a streamlined style that makes learning and retaining key information effortless More than 90 full-color endoscopic and radiographic images enhance clinical decision-making and clarify imaging techniques Logical organization begins with a section on general concerns such as acute abdominal pain, then progresses to specific disease categories "Essentials of Diagnosis" bulleted lists deliver instant guidance on identifying both common and rare digestive disorders Updated references to recently-published clinically relevant articles Key information from related fields, including gastrointestinal surgery, and subspecialties such as liver transplantation, advanced endoscopy, bariatric surgery, inflammatory bowel disease, mast cell disease, toxicities of oncologic therapy, intestinal malabsorption, nutrition, and state of the art imaging High-yield overview of effective treatment approaches for both acute and chronic viral hepatitis provides key perspectives on improving patient outcomes

E-books

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Handbook of Gastroenterologic Procedures by Todd Huntley Baron; Ryan Law
Call Number: ProQuest E-Book Central database (login required)

ISBN: 9781975111656

Publication Date: 2020

The only handbook to cover both endoscopic and non-endoscopic GI procedures, Handbook of Gastroenterologic Procedures, 5th Edition, has been extensively revised and reorganized to be even more useful as a quick reference in your practice. New editors, 20 new chapters, and a concise, pocket-sized format make it a must-have resource for clinicians involved in any aspect of gastroenterologic procedures. Comprehensive yet succinct coverage of all diagnostic and therapeutic GI procedures--both endoscopic and non-endoscopic--in current use for adult and pediatric patients. A concise, logically structured format includes indications, contraindications, patient preparation, equipment, technique, post-procedure care, and adverse events. New chapters include balloon-assisted enteroscopy, placement of colonic self-expandable metal stents, endoscopic ultrasound-guided biopsies and drainage, endoscopic submucosal dissection, peroral endoscopic myotomy, and management of post-surgical adverse events. More than 100 drawings guide you through key steps. Appendices provide information on organizing a procedure unit, handling specimens, doses of GI drugs, guidelines for endoscopic screening and surveillance, CPT codes, and more.
The Washington Manual Gastroenterology Subspecialty Consult by Chandra Gyawali
Call Number: ProQuest E-Book Central database (login required)

ISBN: 9781975113308

Publication Date: 2020

The Washington Manual® Gastroenterology Subspecialty Consult, Fourth Edition, provides essential information on inpatient and outpatient management of common gastrointestinal diseases and disorders. This edition offers state-of-the-art content on disease pathophysiology, diagnostic tools, and management options. Ideal for residents, fellows, and practicing physicians who need quick access to current scientific and clinical information in gastroenterology, the manual is also useful as a first-line resource for internists and other primary care providers.
Non-Alcoholic Fatty Liver Disease : Insights into Alcohol Consumption, Genetics, and Proteomics by Blomdahl. Julia
Call Number: E-Book

ISBN: 9789180752923

Publication Date: 2023