Management of irritable bowel syndrome: a narrative review.

Background and Objective: As our understanding of the pathophysiology of irritable bowel syndrome (IBS) has advanced, so too has the therapeutic landscape, offering a myriad of approaches to alleviate symptoms and enhance the well-being of patients. This review paper is dedicated to a comprehensive exploration of the diverse therapeutic modalities available for managing IBS. By delving into the complexities of IBS therapeutics, our aim is to contribute to the enhancement of patient care and the overall quality of life for patients grappling with this complex condition. Methods: This review utilized information from PubMed/MEDLINE using the key search term "irritable bowel syndrome" as well as the 2020 American College of Gastroenterology (ACG) and 2022 American Gastroenterological Association (AGA) society guidelines on IBS. The search was restricted to articles in the English language only and included peer-reviewed observational studies and randomized controlled trials (RCTs) in adult patients from April 22, 2020 to October 16, 2023. Key Content and Findings: This review will start with an overview of the current guidelines for pharmacologic therapies for IBS as recommended by the ACG and the AGA, with an emphasis on clinical trials published after the most recent guidelines. It will then delve into the literature on dietary modifications, probiotics, fecal microbiota transplant, behavioral therapy, and complementary and alternative medicine approaches to IBS. Conclusions: It is evident that the management of IBS has transcended a one-size-fits-all approach. As the field of IBS management continues to evolve, it is imperative for physicians to stay informed and receptive to the array of therapeutic options available, ultimately providing patients with the most effective and personalized care.

Identifying and Screening At-Risk Patients for Hepatitis Delta Virus: A Case Report.

Hepatitis Delta Virus (HDV) is associated with one of the most severe forms of viral hepatitis, with rapid progression to cirrhosis and hepatocellular carcinoma. While HDV was thought to be uncommon in the United States, recent data shows that its prevalence may be significantly higher than formerly acknowledged. Early identification of HDV is critical since approved therapeutic options are only available for compensated patients. All patients with a reactive hepatitis B virus surface antigen should undergo HDV screening, especially those with additional risk factors, including migration from an endemic area, immunosuppressed patients, hemodialysis patients, gay and bisexual men, persons who inject drugs, and persons employed in healthcare or public safety professions.

Progression From Antral G-Cell Hyperplasia to Gastric Neuroendocrine Tumor in a Patient With Autoimmune Gastritis.

Autoimmune metaplastic atrophic gastritis is caused by immune-mediated destruction of gastric parietal cells. This leads to the absence of gastric acid production, which causes compensatory hyperplasia of gastric antral G-cells leading to hypergastrinemia. The excess gastrin binds to enterochromaffin-like cells causing hyperplasia, which may progress to dysplasia and rarely to gastric neuroendocrine tumors. We present a rare case of autoimmune metaplastic atrophic gastritis associated with G-cell hyperplasia showing the full developmental spectrum of enterochromaffin-like cell proliferation from hyperplasia to dysplasia to neuroendocrine tumor.

An Atypical Presentation of Cystic Echinococcosis.

Cystic echinococcosis (CE) is an infection caused by the Echinococcus granulosus tapeworm. CE generally manifests in the liver, but it may present in any organ. These patients often first present to the emergency department. Mortality over 10 years is significant for those who go undiagnosed. We report the case of a 34-year-old patient who immigrated from Yemen six years earlier. She presented with acute onset dysuria, suprapubic pain, and fever. Imaging revealed a primary multicystic mass on the right renal pole with a secondary lesion in the right hepatic lobe. On further investigation, the patient's serum was positive for echinococcus antibodies.

Popular over-the-counter cosmeceutical ingredients and their clinical efficacy.

The cosmeceutical market is a vast and rapidly growing global industry with hundreds of new products introduced each year. Patients often turn to cosmeceuticals to address their skin problems since these products are more accessible and affordable than prescription products. Unlike most drugs, cosmeceuticals do not undergo strict safety or efficacy testing by the FDA since they are classified as cosmetics. While the marketed properties of some ingredients are thoroughly researched and supported by clinical studies, not all ingredients have been tested to this standard, with some having only molecular or in vitro evidence and hardly any clinical authentication to support their use. Given these characteristics of the industry, dermatologists need to be familiar with cosmeceuticals in order to provide appropriate recommendations to their patients. The goal of this review was to explain the mechanism of action and evaluate the efficacy of popular cosmeceutical ingredients.