Fecal incontinence (FI) in community-dwelling men affects quality of life and increases the risk of institutionalization. Observational studies and randomized, controlled trials (RCTs) on epidemiology and prevention of FI published in English from 1990 to November 2007 were identified in several databases to abstract rates and adjusted odds ratios (ORs) of incontinence and to synthesize evidence with random effects models. Twenty-one observational studies and 4 RCTs were eligible for analysis. Pooled prevalence of FI in elderly men increased with age to 5% to 6%. Men over age 85 years (OR 2.5; 95% confidence interval [CI], 1.3-5) and with kidney diseases (OR 1.9; 95% CI, 1.2-3.3) had higher odds of incident FI. Significantly impaired cognitive status and general health were associated with FI. Men had increased risk of incontinence after radical prostatectomy or radiation for prostate cancer. Lower doses of radiation caused inconsistent reduction in FI across 2 RCTs. The prevalence of incontinence increased with age and functional dependency. Cognitive impairment, poor general health, surgery, and radiation for prostate cancer were associated with incontinence in community-dwelling men. No effective interventions are known at the present time.

Intravenous (IV) administration of the esomeprazole is a faster way to achieve gastric acid suppression than oral administration of the same agent. Peak suppression following IV administration occurs within hours compared with several days following oral administration. Thus, the IV administration route offers a faster onset of gastric suppression, achievement of intragastric pH closer to target levels, and better bioavailability. Treatment of peptic ulcer bleeding is the newest indication for the IV formulation of esomeprazole. The drug is effective in preventing rebleeds following endoscopic treatment when administered within 24 hours of the procedure as an 80-mg bolus followed by an IV infusion for 72 hours. What remains to be seen is whether oral therapy can be substituted for all, or part, of the 72-hour IV infusion and whether the patient can be discharged from the hospital sooner with similar outcomes.

Constipation is a common problem associated with opiates and opioid compounds used for the treatment of pain and other medical conditions, and can influence patient quality of life. Methylnaltrexone appears effective in the therapy of opioid-induced constipation and will be useful for patients failing to respond to traditional laxative regimens.

Antimicrobial resistance is a major cause for failed Helicobacter pylori eradication. This article discusses the prevalence and mechanisms of resistance in H pylori and presents a strategy for eradication in patients harboring resistant strains.

This article summarizes the David Sun Lecture at the American College of Gastroenterology in Orlando, Florida, that was delivered on October 4, 2008. The lecture, entitled "The Future Direction of IBD Care," reviewed the future use of current drugs (such as 5-aminosalicylate, steroids, immunosuppressive medications, and biologic agents) and upcoming drugs in the treatment of IBD.

There are several available diagnostic options to evaluate patients with suspected gastroesophageal reflux, whether acid, weakly acid, or nonacid. The appropriate application of these technologies is the subject of much discussion among experts. Thoughtful use of reflux monitoring is of great benefit in the evaluation of patients with endoscopy-negative disease reflux symptoms that are resistant, recurrent, or refractory to standard or double-dose antisecretory therapy; patients with distinct, atypical symptoms such as cough, laryngitis, chest pain, globus, or regurgitation in whom heartburn is infrequent or absent; patients who are seeking surgical or endoscopic corrective procedures to treat their symptoms; and those with recurrence of symptoms after undergoing surgical procedures. Reflux monitoring may be useful in avoiding an incorrect diagnosis of gastroesophageal reflux disease (GERD) and in management of patients with Barrett's esophagus. This article will review the current clinical applications of reflux monitoring in patients with GERD.

Because of the limited therapeutic options, management of patients with functional dyspepsia can be remarkably difficult. This review considers the current state of the art for patients who present with unexplained dyspepsia, and outlines a practical management approach for clinicians.

Primary sclerosing cholangitis (PSC) is an idiopathic cholestatic liver disease which predisposes to the development of cholangiocarcinoma (CCA). Detection of CCA in PSC patients remains difficult and CCA is often found incidentally at autopsy or in explanted livers post-transplantation for PSC. In addition, considerable overlap exists between the symptoms of CCA and those of benign dominant strictures encountered commonly in PSC. Clinicians utilize a combination of serum tumor markers, cytology from bile duct brushings, and imaging in an attempt to screen for and detect CCA in patients with PSC, although the evidence for these modalities remains largely retrospective. Newer treatment options for early CCA such as resection and liver transplantation have shown promising results, making an effective screening regimen for the detection of CCA at a treatable stage in PSC patients a highly coveted goal.

Hemorrhoids are common in Western societies. Appropriate assessment and treatment of symptomatic hemorrhoids can substantially reduce morbidity and improve patient well-being. In this article, the clinical presentation, differential diagnoses, and current treatment options, including the CRH-O'Regan banding device, an emerging technology for the anoscopic treatment of symptomatic internal hemorrhoids, are reviewed.