|Year : 2021 | Volume
| Issue : 4 | Page : 222-223
Mahesh Kumar Goenka
Director and Head, Institute of Gastrosciences and Liver Transplant and Director of Medical Education, Apollo Multispecialty Hospitals, Kolkata, West Bengal; Convenor, Speciality Board (Medical Gastroenterology), National Board of Examination, Delhi; Governor (Indian Region), American College of Gastroenterology, USA; President-Elect, Indian Society of Gastroenterology; Editor-in-Chief, Journal of Digestive Endoscopy, India
|Date of Submission||26-Nov-2021|
|Date of Acceptance||26-Nov-2021|
|Date of Web Publication||23-Dec-2021|
Mahesh Kumar Goenka
58, Canal Circular Road, Kolkata, West Bengal, 700 054
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goenka MK. Guest Editorial. Apollo Med 2021;18:222-3
Gastroenterology like many other branches of medicine is rapidly advancing. What may be true and standard of care today may become obsolete and outdated tomorrow. Epidemiology of various gastrointestinal (GI) diseases and liver also is changing over a period of time. For example, fatty liver disease, considered uncommon and “benign” till a few years back, is now known to be almost endemic and is also known to progress in a sinister way, at least in a small subset of patients. I am happy to know that the current issue of journal is dedicated to subspecialty of gastroenterology. We have seven articles related to the field.
De and Duseja have address to the need of exercise and consistent weight loss as a part of holistic approach to patients with fatty liver diseases. They have also summarized the medical therapy, namely Vitamin E, pioglitazone, and saroglitazar. However, as mentioned by the author, ideal drug therapy is still not available. In a related article, Gajanan et al. have highlighted the availability of noninvasive test for diagnosis and assessment of fatty liver disease. Since liver biopsy is not always consented by patients, clinicians have to depend on biochemical markers and noninvasive tests such as transient elastography, acoustic radiation force impulse, and Magnetic Resonance Imaging Proton Density Fat Fraction (MRI-PDFF). These tests not only are easily acceptable but also have the advantage of allowing repeated evaluation of disease because of their noninvasive nature. Need for liver biopsy therefore is now limited to borderline cases only.
Tandon and Mahiboob have large personal experience of managing patients with chronic pancreatitis. They have rightly emphasized a step-up approach with lifestyle changes and pancreatic enzyme replacement therapy in the initial stage. Patients with ductal abnormality with stricture and/or stones may be selected for endotherapy or surgery as per the anatomy. Extracorporeal shock wave lithotripsy has been shown to be very useful both in short term and long term for the management of pain due to large pancreatic stones.
GI bleeding from small intestine has been a challenging issue for gastroenterologist because of difficulty in direct visualization of small intestinal mucosa. Over the last two decades, capsule endoscopy, balloon-assisted enteroscopy, and more recently, power spiral enteroscopy have changed the paradigm completely. Power spiral is an interesting tool which allows fast and safe progress of enteroscope through convoluted small bowel by merely pressing a foot paddle. Afzalpurkar and Goenka. have given a current and appropriate appraisal of these devices.
Endoscopic ultrasonography (EUS) has become an essential element of any GI facility. It allows accurate assessment of luminal, mural, and extraluminal lesions since it performs an ultrasound examination from a very close view without interference due to gas or other organs. It has really advanced our diagnosis of submucosal tumors and pancreatobiliary diseases. EUS also has great therapeutic potential with emerging role in management of obstructive jaundice, peripancreatic collections, gastric varices, pain relief (celiac axis block). Sonthalia has very aptly reviewed the subject.
Prakash has eluded the topic of acute liver failure, which is still responsible for significant emergency admissions. The disease has high mortality and a significant proportion of patients require consideration of liver transplant. The article also addresses various nontransplant modalities found to be useful in acute liver failure.
Parallel to advancement in pharmacotherapy and endoscopic techniques, radiological interventions have also become more sophisticated. Biliary stenting, both external and internal even today, has a role both as primary therapy in advanced malignant biliary obstruction and as a salvage therapy when endoscopic procedures fail or are not possible. Article by Goenka et al. addresses the role of interventional radiology in these difficult scenarios.
These seven articles in the present issue do reflect some of the refinement we have been able to achieve in the field of GI and hepatology. But as mentioned earlier, the field is dynamic and paradigm for approach to these diseases is likely to change over the next decades, if not years.
| References|| |
De A, Duseja A. Fatty liver – Current and future treatment: A narrative review. Apollo Med J 2021;18:239-44.
Rodge GA, Goenka MK. Noninvasive assessment of nonalcoholic fatty liver disease. Apollo Med 2021;18:266-70.
Tandon M, Mahiboob S. Management of chronic pancreatitis (CP). Apollo Med J 2021;18:245-50.
Afzalpurkar S, Goenka MK. Obscure gastrointestinal bleeding. Apollo Med J 2021;18:251-55.
Sonthalia N. Interventional Endoscopic Ultrasound: An update. Apollo Med J 2021;18:271-77.
Prakash V. Acute liver failure. Apollo Med J 2021;18:262-5.
Goenka U, Jajodia S, Rodge G. Percutaneous biliary interventions. Apollo Med J 2021;18:256-61.