Acquisitions Editor: Sonya Seigafuse Product Manager: Kerry Barrett Vendor Manager: Bridgett Dougherty Marketing Manager: Kimberly Schonberger Manufacturing Manager: Ben Rivera Design Coordinator: Stephen Druding Editorial Coordinator: Katie Sharp Production Service: Aptara, Inc © 2012 by Department of Medicine, Washington University School of Medicine Printed in China All rights reserved This book is protected by copyright No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright Library of Congress Cataloging-in-Publication Data The Washington manual gastroenterology subspecialty consult / editor, C Prakash Gyawali — 3rd ed p ; cm — (Washington manual subspecialty consult series) Includes bibliographical references and index ISBN 978-1-4511-1410-2 (alk paper) — ISBN 1-4511-1410-9 (alk paper) I Gyawali, C Prakash II Series: Washington manual subspecialty consult series [DNLM: Digestive System Diseases—diagnosis—Handbooks Digestive System Diseases— Therapy—Handbooks WI 39] 616.3′3—dc23 2011052164 The Washington Manual™ is an intent-to-use mark belonging to Washington University in St Louis to which international legal protection applies The mark is used in this publication by LWW under license from Washington University Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care providers to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to pm, EST 10 5 Anupam Aditi, MD Resident Department of Internal Medicine Washington University School of Medicine St Louis, Missouri Akwi W Asombang, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Riad Azar, MD Associate Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Elizabeth Blaney, MD Resident Department of Internal Medicine Washington University School of Medicine St Louis, Missouri Benjamin E Cassell, MD Resident Department of Internal Medicine Washington University School of Medicine St Louis, Missouri Chien-Huan Chen, MD Assistant Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Reena V Chokshi, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Matthew A Ciorba, MD Assistant Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Jeffrey S Crippin, MD Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Dayna S Early, MD Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Darrell M Gray, II, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri C Prakash Gyawali, MD, MRCP Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Heba Iskandar, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri John M Iskander, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Sreenivasa Jonnalagadda, MD Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Thomas A Kerr, MD Assistant Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Kevin M Korenblat, MD Associate Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Gowri Kularatna, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Mridula V Kumar, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Vladimir Kushnir, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Alexander Lee, MD Resident Department of Internal Medicine Washington University School of Medicine St Louis, Missouri Mauricio Lisker-Melman, MD Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Faiz Mirza, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Daniel Mullady, MD Associate Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Amit Patel, MD Resident Department of Internal Medicine Washington University School of Medicine St Louis, Missouri Nishant J Patel, MD Resident Department of Internal Medicine Washington University School of Medicine St Louis, Missouri Andrew Reinink, MD Resident Department of Internal Medicine Washington University School of Medicine St Louis, Missouri Gregory S Sayuk Assistant Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri 10 NSAID-associated, 130, 132t pathophysiology of, 131, 131t recurrent, 137 risk factors, 131, 131t treatment for, 135–137, 136t Zollinger–Ellison syndrome and, 130–131 Gastric erosions, 50 Gastroesophageal reflux disease (GERD), 108–112 complications from, 112 definition, 108 diagnosis, 109–110 PPIs (proton pump inhibitor), 110, 111–112 risk factors, 108 symptoms, 109 treatment, 110–111 Zollinger–Ellison syndrome and, 108 Gastrointestinal bleeding (GIB) See also Gastrointestinal bleeding, acute; Gastrointestinal bleeding, obscure; Gastrointestinal bleeding, occult acute, 49–60 LGIB (lower gastrointestinal bleeding), 49, 52–53, 52t resuscitation after, 56–57 treatment, 56–60 UGIB (upper gastrointestinal bleeding), 49–52 Gastrointestinal bleeding (GIB) (continued ) from cirrhosis, 256–257 obscure, 64–67 occult, 62–67 FOBT (fecal occult blood test), 63 IDA (iron-deficiency anemia), 62 symptoms of, 62 LGIB (lower gastrointestinal bleeding), 49, 52–53 physical examination, 54 resuscitation, 56–57 treatment, 56–60, 57t nonvariceal bleeding, 56–57 variceal bleeding, 57–60 UGIB (upper gastrointestinal bleeding), 49–52 536 from vascular ectasias, 51 Gastrointestinal bleeding (LGIB), lower, 49, 52–53 lesions from, 52t Gastrointestinal bleeding (GIB), obscure, 64–67 See also Enteroscopy causes, 64, 65t definition, 62 diagnosis, 64–66 evaluation, 64–66 symptoms, 64 treatment, 66–67 Gastrointestinal bleeding (GIB), occult, 62–67 Gastrointestinal bleeding (UGIB), upper, 49–52 Gastrointestinal diseases, genetics and, 315, 316–317t Gastrointestinal endoscopy, 327–328 Gastrointestinal stromal tumors (GISTs), 139–140 GERD See Gastroesophageal reflux disease (GERD) GGT See Gamma-glutamyltransferase GIB See Gastrointestinal bleeding, acute GISTs See Gastrointestinal stromal tumors Globus, Hemobilia, 51 Hemosuccus pancreaticus, 52 Hepatic iminodiacetic acid (HIDA) scan, for jaundice, 77 Hepatic vein thrombosis, 214 Hepatitis, 197–206, 212–214 autoimmune, 212–213 chronic viral, 220 HAV (hepatitis A virus), 197–199 HBV (hepatitis B virus), 199–202, 220–228 HCV (hepatitis C virus), 202–203, 228–231 HDV (hepatitis D virus), 203–204 herpes simplex virus, 205–206 HEV (hepatitis E virus), 204–205 ischemic, 213–214 treatment, 225–227 with IFN (interferon) therapy, 225, 230 with liver transplants, 227 537 Hepatocellular cancer, 268 Hepatopulmonary syndrome, 262 Hepatorenal syndrome, 93, 261 diagnosis, 261 treatment, 261 Type I, 93 Type II, 93 Hereditary diffuse gastric cancer (HDGC), 315–318 Hereditary hemochromatosis (HH), 243–245, 323–324 Hereditary nonpolyposis colorectal cancer (HNPCC), 319 Amsterdam criteria for, 320t Hereditary pancreatitis, 324–325 Herpes simplex virus, 115, 117 hepatitis, 205–206 HH See Hereditary hemochromatosis HIDA scan See Hepatic iminodiacetic acid scan High-resolution manometry, Hirschsprung’s disease, 36t HIV/AIDS See Human immunodeficiency virus/Acquired immune deficiency syndrome HNPCC See Hereditary nonpolyposis colorectal cancer Human immunodeficiency virus/Acquired immune deficiency syndrome, esophagitis and, 114, 115 Hydrogen breath tests, 143 Hyperbilirubinemia, 70–72, 74 conjugated, 70–71, 75 mixed, 71–72 diagnosis, 73–78 unconjugated, 70, 73 Hyperglycemia, 105 Hypertriglyceridemia, 276 Hypoglycemia, 255 IBDs See Inflammatory bowel diseases IBS See Irritable bowel syndrome IDA See Iron-deficiency anemia Idiopathic esophageal ulcerations, 115, 118 IFN therapy See Interferon therapy 538 IgG4-associated sclerosing cholangitis, 237 Immunomodulator therapy, 179–180 Infections acute pancreatitis, 276 ascites, 92 bacterial endocarditis, 335–336 Infectious colitis See Colitis, infectious Inflammatory bowel diseases (IBDs), 165, 167–186 causes, 167 CRC (colorectal cancer) and, 165, 185 Crohn’s disease, 168–169 diagnosis, 170–172 Montreal classification, 169t pathologic features, 168–169 symptoms, 170 treatment, 176–183 ulcerative colitis v., 174t definition, 167 diagnosis, 170–176, 174t extraintestinal manifestations, 169, 173t microscopic colitis, 167, 183–184 osteoporosis, 184–185 pathophysiology, 167–169 pregnancy and, 183 risk factors for, 170 thiopurine S-methyltransferase (TPMT), 325–326 treatment, 176–183 ulcerative colitis, 169–186 Crohn’s disease v., 174t diagnosis, 173 pathologic features, 169 symptoms, 173 treatment, 182–183 Inflammatory diarrhea, 21 Interferon (IFN) therapy, 225, 230 Intussusception, 53 Involuntary guarding, 41 539 Iron-deficiency anemia (IDA), occult GIB and, 62 Irritable bowel syndrome (IBS), 34, 188–195 classification, 188 Rome criteria in, 189t constipation, 34 definition, 188 as FGID (functional gastrointestinal disorder), 188, 189t symptoms, 190t treatment, 192–196, 193t centrally acting agents, 195 with cognitive and behavioral therapy, 195 peripherally acting agents, 193–195 Ischemic colitis, 52–53 Ischemic hepatitis, 213–214 Jaundice, 69–80 See also Hyperbilirubinemia acute v chronic, 73 causes of, 70–72 bilirubin metabolism, 69, 72f combination hyperbilirubinemia, 70, 71–72 conjugated bilirubin, 69–71 in critically ill patients, 79 diagnosis, 73–78 imaging procedures, 76–77 intrahepatic, 69 management, 78 pancreatic cancer, 292 pathophysiology, 72–73 posthepatic, 69 pregnancy and, 78–79 prehepatic, 69 primary biliary cirrhosis, 240 unconjugated bilirubin, 69, 70 Lamivudine, 227 Large volume paracentesis (LVP), 96 Laryngoscopy, Laxatives as constipation treatment, 37 540 emollient, 38 saline, 38 stimulant, 38 in stool studies, for chronic diarrhea, 26 LBM See Lean body mass Lean body mass (LBM), 99 Leiomyomas, 152 LGIB See Gastrointestinal bleeding, lower Liver biopsy, 333–334 Liver disease(s) See also Cirrhosis, of liver; Hepatitis; Liver disease, acute; Primary sclerosing cholangitis acute, 197–219 ALF (acute liver failure), 197, 216–219 King’s College criteria for, 218t 1-antitrypsin deficiency, 245–247 autoimmune, 233–236 biopsies, 89 causes, 82t diagnosis, 85–89 excretory products as markers for, 81–85 fatty liver disease, 241–243, 266–267 Liver disease(s) (continued ) HH (hereditary hemochromatosis), 243–245 jaundice, 79 MELD (Model for End-Stage Liver Failure) scores for, 262 metabolic, 243 nonalcoholic fatty (NASH), 89, 241–243 PBC (primary biliary cirrhosis), 239–241 pregnancy and, 79 PSC (primary sclerosing cholangitis), 173, 237–239, 307–309 serum enzymes as markers for, 81–85 symptoms, 85 synthetic function measures, 85 albumin, 85 clotting factors, 85 Wilson’s disease, 215–216, 247–249 Liver disease, acute, 197–219 See also Hepatitis 541 causes acetaminophen toxicity, 206–207, 208f alcohol use, 207–210 autoimmune disease, 212–213 Budd-Chiari syndrome, 214–215 DILI (drug-induced liver injury), 210–211 “shock liver”, 213 viral hepatitis, 197, 220 encephalopathy, 218t Liver function tests, 81 Liver toxicity induced by alcohol (ETOH), 231–233 Liver transplantation for alcohol-related liver disease, 266 after ALF (acute liver failure), 218 complications, 272–273, 272t evaluation, 270 fulminant hepatic failure, 268–269 hepatitis HBV (hepatitis B virus), 201, 267 from HCV (hepatitis C virus), 203, 230, 266 hepatocellular carcinoma, 268 immunosuppression, 271–272 indications, 264–268, 265t living donor, 271 MELD (Model for End-Stage Liver Failure) for, 264, 269 for metabolic liver diseases, 268 for nonalcoholic fatty liver disease, 266–267 organ allocation, 269 orthotopic, 264 patient evaluation, 269–270 for primary biliary cirrhosis, 267 for primary sclerosing cholangitis, 267–268 split, 271 Lubiprostone, 38 LVP See Large volume paracentesis Lymphomas gastric, 140 542 Lynch syndrome, 319–321 See also Hereditary nonpolyposis colorectal cancer Magnetic resonance cholangiopancreatography (MRCP), 238 for chronic pancreatitis, 287 Magnetic resonance imaging (MRI) for abdominal pain, 47 for jaundice, 77 for pancreatic cancer, 294 Malabsorption, 140–144 causes, 140, 141t diagnosis, 141–144 symptoms, 142 Mallory-Weiss tears UGIB (upper gastrointestinal bleeding) from, 18, 51 vomiting, 51 Malnutrition, 99–106 MBS study See Modified barium swallow study Meckel’s diverticulum, 53 Medications See Drugs MELD score See Model for End-Stage Liver Disease score Methylnaltrexone, 38 Microscopic colitis, 167, 183–184 Model for End-Stage Liver Disease (MELD) score, 262 Modified barium swallow (MBS) study, MRCP See Magnetic resonance cholangiopancreatography MRI See Magnetic resonance imaging Nausea and vomiting, 9–18 See also Vomiting pregnancy, 10–11 CNS disorders, 11 differential diagnoses, 10t endocrine disorders, 10–11 management, 12–14 metabolic disorders, 10–11 medications as cause of, 9–10 nausea, refractory, 16 viral infections, 10 543 vomiting, 9–18 Neoadjuvant therapy, 297 Neoplasms from acute GIB (gastrointestinal bleeding), 66 in colon, 155–165 in small bowel, 151–154 adenocarcinomas, 152 adenomas, 152 FAP (familial adenomatous polyposis), 152 hereditary conditions for, 151 leiomyomas, 152 lymphomas, 152 Peutz–Jeghers syndrome, 151 Nephrotic syndrome, 92 Nonalcoholic fatty liver disease (NASH), 89, 241–243 Nonsteroidal anti-inflammatory drugs (NSAIDs) for acute GIB (gastrointestinal bleeding), 49–50 IBDs (inflammatory bowel disease), from use of, 170 nausea and vomiting from use of, PUD (peptic ulcer disease) and, 49–51, 130, 131t, 132 Nonvariceal UGIB (upper gastrointestinal bleeding), treatment for, 56–57 NSAIDs See Nonsteroidal anti-inflammatory drugs Nutcracker esophagus, 125 Nutrition, of patients, 99–106 assessment of, 100 BMI (body mass index), 101–102, 101t enteral, 102–103 formula choice, 103 postpyloric or small bowel feeding, 103 evaluation, 101–102 fat mass, 99 LBM (lean body mass) and, 99, 102 management, 101–104 calculation of requirements, 101–102 nutritional support, 102 parenteral, 103–104 administration, 103–104 544 complications, 105 refeeding syndrome, 106 Odynophagia, Oropharyngeal dysphagia, 1–7 Osmotic diarrhea, 20 Osteoporosis, 185–186 Pain See Abdominal pain p-ANCA See Perinuclear antineutrophil cytoclasmic antibody Pancreatic cancer, 291–297 causes, 292 diagnosis, 292–295 risk factors, 292 staging laparoscopy, 295 symptoms, 292–293 treatment, 295–297 Pancreatic disorders, 274–297 See also Pancreatic cancer; Pancreatitis, acute; Pancreatitis, chronic acute pancreatitis, 274–283 chronic pancreatitis, 283–291 causes of, 284 pancreatic cancer, 291–297 Pancreatitis, acute, 71, 274–283 causes, 275–276 alcohol use as, 275 diagnosis, 277–280 pseudocysts, 281–283 severity, 277, 278t symptoms, 277 treatment, 280–281 Pancreatitis, chronic, 283–291 causes, 284 diagnosis, 285–287 exocrine insufficiency, 288 incidence rates, 284 pseudocysts, 290 symptoms, 285 Tigar-O classification, 284t 545 treatment, 287–289 Parenteral nutrition, 103–104 administration, 103–104 complications, 105 hyperglycemia, 105 for SBS (short bowel syndrome), 151 Peptic strictures, 122–123 Peptic ulcer disease (PUD), 49, 128–138 causes of, 128–131, 129t Helicobacter pylori infection, 129–130, 136–137 NSAID-associated, 49, 128, 130, 132t, 137 Zollinger–Ellison syndrome, 130–131 complications, 138 diagnosis, 131–135, 131t pathophysiology, 131 recurrent, 137 risk factors, 131t symptoms, 131–132 treatment, 135–137 Heliobacter pylori infection, 136–137, 136t NSAID-associated PUD, 137 Percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ), 334–338 Percutaneous transhepatic cholangiography, 77–78 Perinuclear antineutrophil cytoclasmic antibody (p-ANCA), 238 Peutz–Jeghers syndrome, 151, 318–319 Phlebotomy, 245 Plummer–Vinson syndrome, 122 Portal hypertensive gastropathy, 51 PPIs See Proton pump inhibitors Pregnancy jaundice, 78–79 Dubin-Johnson syndrome and, 79 intrahepatic cholestasis with, 79 liver diseases, 79 acute fatty, 79 nausea and vomiting, 10–11 Primary biliary cirrhosis, 239–241 546 Primary sclerosing cholangitis (PSC), 173, 237–239, 307–309 Prokinetics, in UGIB, 60 Prophylaxis American Society of Gastrointestinal Endoscopy guidelines for, 337t for endocarditis, 336–37 for hepatitis, 198–199, 201, 221–222 Proton pump inhibitors (PPIs), 57, 110 Pruritus, 240 PSC See Primary sclerosing cholangitis Pseudocysts, 281–283 in chronic pancreatitis, 290 PUD See Peptic ulcer disease Radiography, for abdominal pain, 46 Refeeding syndrome, 106 Regurgitation, 13 Resuscitation, after acute GIB (gastrointestinal bleeding), 56–57 Rumination, 13 SAAG See Serum-ascites albumin gradient SBBO See Small bowel bacterial overgrowth SBS See Short bowel syndrome Schatzki’s rings, 122, 124 Scleroderma, 126 Secondary sclerosing cholangitis, 237 Secretory diarrhea, 20–21 Sedation, conscious, 335 ASA assessment for, 335 Serum-ascites albumin gradient (SAAG), 92 “Shock liver,” 213 Short bowel syndrome (SBS), 149–151 Sigmoidoscopy See Flexible sigmoidoscopy Small intestinal bacterial overgrowth (SIBO), 147–149 Small bowel disorders, 140–154 See also Celiac sprue; Malabsorption celiac sprue, 144–147 malabsorption, 140–144 neoplasms, 151–154 SIBO (small intestinal bacterial overgrowth), 147–149 SBS (short bowel syndrome), 149–151 547 SmartPill®, 14 Spontaneous bacterial peritonitis, 260–261 as complication of ascites, 93, 97 Squamous cell carcinomas esophageal disorders, 113–115 management, 114 prognosis, 114 risk factors, 113 treatment, 114 evaluation, 113 Staging systems, for CRC (colorectal cancer), 161, 162t Steatorrhea, 21 Stomach cancers See Gastric adenocarcinomas; Gastric lymphomas; Gastrointestinal stromal tumors Stool studies, for chronic diarrhea, 26 cultures, 26 fat measurements, 26 fecal leukocytes, 26 laxative screening and, 26 osmotic gap, 26 for parasites, 26 pH levels, 26 Stress ulcers, 50 Surgery, conventional for acute GIB (gastrointestinal bleeding), 60 for cholangiocarcinomas, 311 for chronic pancreatitis, 289 for constipation, 39 for CRC (colorectal cancer), 162–163 for GERD (gastroesophageal reflux disease), 111 for IBDs (inflammatory bowel disease), 182–183 for pancreatic cancer, 295–297 pancreatic cancer as result of, 292 for SIBO (small intestinal bacterial overgrowth), 149 for SBS (short bowel syndrome), 150 Sustained virologic response (SVR), 229 SVR See Sustained virologic response 548 Syndromes See Budd-Chiari syndrome; Dubin-Johnson syndrome; Gardner’s syndrome; Hepatopulmonary syndrome; Hepatorenal syndrome; Irritable bowel syndrome; Nephrotic syndrome; Peutz– Jeghers syndrome; Plummer–Vinson syndrome; Refeeding syndrome; Short bowel syndrome; Turcot’s syndrome; Zollinger–Ellison syndrome Technetium-99-m-labeled erythrocyte scans, 55, 66 Telbivudine, 227 TIPS See Transjugular intrahepatic portosystemic shunt TNF antagonists See Tumor necrosis factor antagonists Tobacco use IBD, 170 pancreatic cancer, 292 Transjugular intrahepatic portosystemic shunt (TIPS), 96 for acute GIB (gastrointestinal bleeding), 58 for ascites, 96 Transplants See Liver transplants Tube feeding See Enteral nutrition Tumor necrosis factor (TNF) antagonists, 180 Turcot’s syndrome, 323 UC See Ulcerative colitis UGIB See Gastrointestinal bleeding, upper Ulcerative colitis (UC), 167–186 Ultrasound for abdominal pain, 46 for chronic pancreatitis, 283 for jaundice, 76–77 EUS (endoscopic ultrasound), 77 for pancreatic cancer, 293–294 for pancreatitis, 279, 286 acute, 279 chronic, 286 Upper endoscopy, Variceal bleeding, 50–51 liver cirrhosis and, 50 UGIB (upper gastrointestinal bleeding), treatment, 58–60, 59t angiotherapy, 60 antibiotic prophylaxis, 58 549 balloon tamponade, 58 colonoscopy, 59 endoscopic variceal ligation, 58 sclerotherapy, 58 surgical shunts, 60 transjugular intrahepatic portosystemic shunt, 58 upper endoscopy, 59 vasoconstrictors, 57–58 Varicella zoster virus, 115, 116 Vascular ectasias, 51 Viral esophagitis, 115 Viral hepatitis, 89, 197 Vomiting, 9–18 acute, 12 chronic, 12 management, 12–14 medications as cause of, 9–10 refractory, 16 symptoms, 12 treatment, 14–16 viral infections, 10 Wilson’s disease, 215–216, 247–249 Xerostomia, Xylose absorption test, 142 Zollinger-Ellison syndrome, 131 PUD (peptic ulcer disease), 128 550 [...]... Department of Internal Medicine Washington University School of Medicine St Louis, Missouri Anil B Seetharam, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Anisa Shaker, MD Assistant Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Noura M Sharabash, MD Fellow Division of Gastroenterology Washington. .. School of Medicine St Louis, Missouri Jennifer Shroff, MD Resident Department of Internal Medicine Washington University School of Medicine St Louis, Missouri A Samad Soudagar, MD Resident Department of Internal Medicine 11 Washington University School of Medicine St Louis, Missouri Shelby A Sullivan, MD Assistant Professor of Medicine Division of Gastroenterology Washington University School of Medicine... Hongha (Susan) T Vu, MD Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Sachin Wani, MD Advanced Fellow Division of Gastroenterology Washington University School of Medicine St Louis, Missouri 12 t is a pleasure to present the new edition of The Washington Manual Subspecialty Consult Series: Gastroenterology Subspecialty Consult This pocketsize book continues... of the Division of Medical Education, Department at of Medicine, Washington University School of Medicine, for his advice and guidance I believe this Manual will meet its desired goal of providing practical knowledge that can be directly applied at the bedside and in outpatient settings to improve patient care Victoria J Fraser, MD Dr J William Campbell Professor Interim Chairman of Medicine Codirector,... education is unsurpassed, and their efforts and skill in compiling this manual are evident in the quality of the final product In particular, I would like to acknowledge our editor Dr C Prakash Gyawali and the series editors Drs Katherine Henderson and Tom De Fer, who have worked tirelessly to produce another outstanding edition of this manual I would also like to thank Dr Melvin Blanchard, Chief of. .. utilized in clinical gastroenterology Given these advances, it is clear that there is ongoing need for easy access of concise diagnostic and management direction for the novice and intermediate trainee, a need that this manual fulfills The unique aspect of this manual is that it is conceived and written by trainees for trainees, with extensive mentoring and editing from academic faculty experts The manual. .. been updated, and in some cases, entire chapters have been rewritten by current Washington University internal medicine residents aspiring to become gastroenterologists and gastroenterology fellows currently enrolled in fellowship traini ng, all under the watchful eyes of faculty experts The third edition of the manual therefore represents an up-to-date yet concise treatise on current knowledge of common... mentors who worked tirelessly to ensure that their chapters were updated and that they conformed 14 to the revised formats For our trainee authors entering the field of gastroenterology, seeing their contributions in print will hopefully provide them renewed enthusiasm and vigor for continued scholarship and education, and ultimately the opportunity to return the favor by furthering education of future trainees... that are encountered most often in clinical units, both ambulatory and inpatient The manual strives to provide a succinct yet descriptive synopsis of each condition, presenting the reader with disease characteristics, clinical features, investigation, and management With the widespread distribution and review of the second edition of the manual, it became evident that certain areas needed additional emphasis... outcomes The Washington Manual Subspecialty Consult Series addresses this challenge by concisely and practically providing current scientific information for clinicians to aid them in the diagnosis, investigation, and treatment of common medical conditions I want to personally thank the authors, which include house officers, fellows, and attendings at Washington U niversity School of Medicine and Barnes ... Assistant Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Jeffrey S Crippin, MD Professor of Medicine Division of Gastroenterology Washington. .. Assistant Professor of Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri Kevin M Korenblat, MD Associate Professor of Medicine Division of Gastroenterology. .. Division of Gastroenterology Washington University School of Medicine St Louis, Missouri C Prakash Gyawali, MD, MRCP Professor of Medicine Division of Gastroenterology Washington University School of