Abstract:
:Successful treatment of unresectable and metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs) requires the thoughtful choice of systemic therapy as a component of a multidisciplinary therapeutic approach. The role of somatostatin analogues is established in symptom relief, but the efficacy of interferon and radiopeptide targeted therapy is not clear. The utility of a variety of tyrosine kinase and antiangiogenic agents is variable and under investigation, whereas the role of cytotoxic chemotherapy in poorly differentiated GEP-NETs is accepted. Overall, the ideal treatment of more indolent tumors is less certain. Reassessments of the GEP-NET pathology classification has provided improved logic for the role of a variety of agents, whereas the precise positioning of many new agents that target molecular pathways of angiogenesis and proliferation is under examination. This article describes the current options for systemic therapy for GEP-NETs within the framework of the current World Health Organization classification system.
journal_name
Gastroenterol Clin North Amjournal_title
Gastroenterology clinics of North Americaauthors
Lawrence B,Gustafsson BI,Kidd M,Modlin Idoi
10.1016/j.gtc.2010.08.013subject
Has Abstractpub_date
2010-09-01 00:00:00pages
615-28issue
3eissn
0889-8553issn
1558-1942pii
S0889-8553(10)00055-5journal_volume
39pub_type
杂志文章,评审abstract::Irritable bowel syndrome (IBS) is a complex clinical process with multiple pathophysiologic mechanisms. There has recently been a shift in the treatment of patients with severe IBS symptoms to disease-modifying therapies as opposed to symptomatic treatment. Because pathophysiologic differences exist between men and wo...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2011.03.012
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abstract::Anal cancer is rare and this helps to explain why anal pre-neoplastic conditions are poorly understood, especially with regard to their natural history and management. Anal intraepithelial neoplasia is closely linked to human papillomavirus infection and is particularly common in homosexuals and in immunosuppressed pa...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2007.08.001
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abstract::In most patients presenting with acute pancreatitis, the cause can be established on the basis of initial history, physical examination, laboratory studies, and abdominal sonography. Patients with unexplained pancreatitis at that point are often considered to have idiopathic disease. However, a cause and, often, effec...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1990-12-01 00:00:00
abstract::Although many mechanisms remain unclear, a large body of evidence indicates that several dietary and lifestyle factors are likely to have a major influence on the risk of colon cancer. Physical inactivity, excess body weight, and a central deposition of adiposity are consistent risk factors. Overconsumption of energy ...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0889-8553(02)00057-2
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abstract::Endoscopic approaches have revolutionized the palliation of advanced pancreatic cancer. The ideal management consists of a multidisciplinary approach involving surgeons, endoscopists, radiologists, and oncologists. Concurrent advances in the fields of interventional radiology and laparoscopic surgical oncology should ...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2007.04.001
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abstract::Ischemic injury to the gastrointestinal tract can threaten bowel viability with potential catastrophic consequences, including intestinal necrosis and gangrene. The presenting symptoms and signs are relatively nonspecific and diagnosis requires a high index of clinical suspicion. AMI often results from an embolus or t...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0889-8553(03)00093-1
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abstract::Choosing NSAID therapy remains confusing and controversial-the challenge for the clinician is to sum all the risks as well as analgesic and anti-inflammatory efficacy. COX-2 inhibitors are an important scientific advance in pain therapy, and using them in a safe and cost-effective manner is possible when all the compe...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2009.03.006
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abstract::Probiotics have been studied in a variety of GI infections, and are an appealing concept given their favorable safety profiles. Several placebo-controlled trials indicated that lactobacilli have a suppressive effect on H pylori infection. Although some studies reported improvement in H pylori eradication, others faile...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2006.03.005
更新日期:2006-06-01 00:00:00
abstract::Endoscopy plays an important role in the diagnosis and treatment of acute and chronic pancreatitis as well as pancreatic cancer. Sphincterotomy and stone removal in biliary pancreatitis, stone extraction and drainage in chronic pancreatitis, and stent implantation in pancreatic cancer are the predominant procedures. W...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0889-8553(05)70087-x
更新日期:1999-09-01 00:00:00
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journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2015.05.006
更新日期:2015-09-01 00:00:00
abstract::Individuals with a genetic predisposition to Crohn's disease develop aberrant immune responses to environmental triggers. The gastrointestinal microbiota is increasingly recognized to play an important role in the development of Crohn's disease. Decrease in global gut microbial diversity and specific bacterial alterat...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2017.05.004
更新日期:2017-09-01 00:00:00
abstract::Living donor intestinal transplantation (LDIT) has been improved leading to results comparable to those obtained with deceased donors. LDIT should be limited to specific indications and patient selection. The best indication is combined living donor intestinal/liver transplantation in pediatric recipients with intesti...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2018.01.008
更新日期:2018-06-01 00:00:00
abstract::In this article, the epidemiology of eosinophilic esophagitis (EoE) is reviewed. Demographic features and natural history are described, the prevalence and incidence of EoE are highlighted, and risk factors for EoE are discussed. EoE can occur at any age, there is a male predominance, it is more common in whites, and ...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章
doi:10.1016/j.gtc.2014.02.002
更新日期:2014-06-01 00:00:00
abstract::Autoimmune pancreatitis is the pancreatic manifestation of a systemic disorder that affects various organs, including the bile duct, retroperitoneum, kidney, and parotid and lacrimal glands. It represents a recently described subset of chronic pancreatitis that is immune mediated and has unique histologic, morphologic...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章
doi:10.1016/j.gtc.2008.02.004
更新日期:2008-06-01 00:00:00
abstract::As the AIDS epidemic continues to grow, it becomes increasingly important that physicians are aware of the gastrointestinal and abdominal diseases specific to this group of patients. Most AIDS patients exhibit gastrointestinal symptoms at some time during the course of their disease. Clinical AIDS is often determined ...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1995-06-01 00:00:00
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journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章
doi:
更新日期:1987-09-01 00:00:00
abstract::It is shortsighted to consider only the esophageal manifestations and complications of esophageal reflux. That such reflux can directly affect not only the lung but also the oropharynx and larynx, both by direct acid contact and reflex neurologic mechanisms, has been demonstrated repeatedly. The task of the future wil...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1990-09-01 00:00:00
abstract::Diagnostic angiography still plays an essential role in the diagnosis of patients,particularly those with acute lower GI bleeding. Transcatheter therapy appears to be a viable treatment alternative in selected patients with GI bleeding. Many interventionists today believe embolotherapy to be more effective initially a...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章
doi:10.1016/j.gtc.2005.09.001
更新日期:2005-12-01 00:00:00
abstract::Gastric cancer (GC) is third leading cause of cancer-related death. Only 28.3% of new GC cases survive more than 5 years. Although incidence has declined in the United States, an increase is estimated for 2016. Risk factors include sex (risk is higher in men), Helicobacter pylori infection, heredity, and lifestyle. GC...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2016.04.002
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abstract::Corticosteroids are a nonspecific immune modulator used in the treatment of ulcerative colitis. Topical and systemic forms of corticosteroids have been shown to be effective in induction of clinical remission and remain first-line therapy for acute severe ulcerative colitis. A large proportion of patients experience a...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2020.08.001
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abstract::The role of the aminosalicylates for induction therapy of mild moderate ulcerative colitis and as maintenance treatment has been substantiated by a large series of controlled clinical trials and confirmatory meta-analyses. Both sulfasalazine and newer derivatives are effective in preventing relapses. It remains to be ...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2004.02.010
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abstract::A wide spectrum of gastrointestinal illnesses impairs bone health and can result in bone pain, demineralization, and fracture. This article summarizes current knowledge of the skeletal pathology exhibited in patients with diseases of the liver, biliary tree, pancreas, and bowel. Mechanisms responsible for these syndro...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0889-8553(05)70016-9
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journal_title:Gastroenterology clinics of North America
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doi:10.1016/j.gtc.2019.04.007
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abstract::Dramatic refinements in CT technology are resulting in improved evaluation of the liver, pancreas, and gastrointestinal tract. Further clinical trials are necessary to compare the relative merits of CT versus MR imaging and endoscopic ultrasonography in a wide variety of gastrointestinal diseases. ...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1995-06-01 00:00:00
abstract::Bile supersaturation is necessary for cholesterol gallstones to form. Not all people with supersaturated bile form gallstones, however, and additional factors must be present. The role of pronucleating substances has been extensively studied. Of these, proteins, especially mucin, are best understood. Mucin is secreted...
journal_title:Gastroenterology clinics of North America
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doi:10.1016/s0889-8553(05)70045-5
更新日期:1999-03-01 00:00:00
abstract::Biologics are a primary focus for research and development of new treatments for IBD and other immune disorders. CDER, which is a branch of the FDA, oversees most of the biologics that are being used or tested for IBD, and it regulates nonbiologic medications for IBD. The approval process for most biologics for IBD is...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2006.09.010
更新日期:2006-12-01 00:00:00
abstract::Obesity-related disorders derive from a combination of genetic susceptibility and environmental factors. Recent evidence supports the role of gut microbiota in the pathogenesis of obesity, type 2 diabetes mellitus, and insulin resistance by increasing energy harvest from diet and by inducing chronic, low-grade inflamm...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.gtc.2012.08.009
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abstract::The view of surgical treatment of esophageal carcinoma is pessimistic. This is so because (1) most patients present late in the disease and are beyond the benefits of surgical therapy for cure, (2) resection is associated with a high operative mortality, and (3) the poor 5-year survival rates for surgical resection ci...
journal_title:Gastroenterology clinics of North America
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doi:
更新日期:1991-12-01 00:00:00
abstract::Therapeutic gastrointestinal endoscopy has a much greater risk of inducing gastrointestinal hemorrhage than diagnostic endoscopy. For example, colonoscopic polypectomy has a risk of approximately 1.6% of inducing bleeding, compared with a risk of approximately 0.02% for diagnostic colonoscopy. Higher-risk procedures i...
journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0889-8553(05)70110-2
更新日期:2000-03-01 00:00:00
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journal_title:Gastroenterology clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1993-12-01 00:00:00