Yamada’s Handbook of Gastroenterology Yamada’s Handbook of Gastroenterology EDITOR Tadataka Yamada, MD Board Member Chief Medical and Scientific Officer Executive Vice-President Takeda Pharmaceutical Corporation Tokyo, Japan Adjunct Professor Department of Internal Medicine Division of Gastroenterology University of Michigan Medical School Ann Arbor, MI, USA ASSOCIATE EDITOR John M. Inadomi, MD Cyrus E. Rubin Professor of Medicine Head, Division of Gastroenterology University of Washington Seattle, WA, USA CONTRIBUTING AUTHORS Renuka Bhattacharya, MD Clinical Associate Professor, Division of Gastroenterology Chief of Clinical Hepatology Medical Director for Liver Transplantation University of Washington Seattle, WA, USA Jason A. Dominitz, MD, MHS National Program Director, Gastroenterology Veterans Health Administration Professor, Division of Gastroenterology University of Washington Seattle, WA, USA Joo Ha Hwang, MD, PhD Associate Professor, Division of Gastroenterology Director of Endoscopic Research University of Washington Seattle, WA, USA THIRD EDITION A John Wiley & Sons, Ltd., Publication This edition first published 2013 © 2013 by John Wiley & Sons, Ltd Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. 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Cover design by Sarah Dickinson Set in 9.5/13pt Meridien by SPi Publisher Services, Pondicherry, India 1 2013 Contents Foreword, vii Preface, viii List of Abbreviations, ix Part 1 Approach to Patients with Gastrointestinal Symptoms 1 Approach to the Patient with Dysphagia or Odynophagia, 3 2 Approach to the Patient with Chest Pain, 11 3 Approach to the Patient with Gastrointestinal Bleeding, 18 4 Approach to the Patient with Unexplained Weight Loss, 40 5 Approach to the Patient with Nausea and Vomiting, 48 6 Approach to the Patient with Abdominal Pain, 58 7 Approach to the Patient with Gas and Bloating, 70 8 Approach to the Patient with Ileus or Obstruction, 78 9 Approach to the Patient with Constipation, 89 10 Approach to the Patient with Diarrhea, 99 11 Approach to the Patient with an Abdominal Mass, 112 12 Approach to the Patient with Jaundice, 121 13 Approach to the Patient with Abnormal Liver Biochemical Tests, 135 14 Approach to the Patient with Ascites, 148 15 Approach to the Patient Requiring Nutritional Support, 163 16 Approach to the Patient Requiring Endoscopic Procedures, 178 Part 2 Specific Gastrointestinal Diseases 17 Motor Disorders of the Esophagus, 195 18 Gastroesophageal Reflux Disease, 204 19 Esophageal Tumors, 212 20 Disorders of Gastric Emptying, 221 v vi Contents 21 Acid Peptic Disorders, 232 22 Functional Dyspepsia, 241 23 Tumors of the Stomach, 247 24 Celiac Disease, 256 25 Short Bowel Syndrome, 263 26 Tumors and Other Neoplastic Diseases of the Small Intestine, 270 27 Diverticular Disease of the Colon, 278 28 Irritable Bowel Syndrome, 285 29 Inflammatory Bowel Disease, 291 30 Colonic Neoplasia, 306 31 Anorectal Diseases, 323 32 Pancreatitis, 335 33 Pancreatic Adenocarcinoma, 349 34 Structural Anomalies, Tumors, and Diseases of the Biliary Tract, 358 35 Biliary Tract Stones and Postcholecystectomy Syndrome, 366 36 Diseases of the Abdominal Cavity, 377 37 Viral Hepatitis, 391 38 Nonviral Hepatitis, 405 39 Cholestatic Syndromes, 412 40 Alcoholic Liver Disease, 420 41 Autoimmune Liver Disease, 427 42 End-stage Liver Disease, 432 43 Hepatocellular Carcinoma, 443 44 Infections of the Gastrointestinal Tract, 451 45 Vascular Lesions: Ectasias, Tumors, and Malformations, 471 46 Multiple Choice Questions, 479 Index, 523 Foreword From its inception, the Textbook of Gastroenterology was intended to provide an encyclopedic reference to the rapidly evolving science and practice of gastroenterology to practitioners who encountered patients with digestive and liver diseases and to researchers in the field. Recognizing the need to provide access to the essential elements of the Textbook in a more concise format that was optimized to provide information of particular usefulness to medical students, house officers and fellows, we undertook the editing of Yamada’s Handbook of Gastroenterology. The success of the first two editions of the Handbook has provided evidence of its utility not only as a guide to those in training but also as a resource for practicing physicians. Dr. John Inadomi, the Associate Editor, has carried forward the best elements of past editions and improved on them in the third edition of Yamada’s Handbook of Gastroenterology, with important additions such as key practice points, case studies, management algorithms and questions and answers, all within fewer pages. Moreover, this edition is available in electronic format to make it more compatible with the needs of practicing physicians. I am indebted to Dr. Inadomi and his contributing authors Drs. Renuka Bhattacharya, Jason Dominitz and Joo Ha Hwang for the enormous time and effort they put into making this edition so clear and complete and hope that these qualities provided to the reader will help them to deliver the best possible care to their patients. Tadataka Yamada 2013 vii Preface On behalf of my co-authors, Drs. Bhattacharya, Dominitz and Hwang, I am pleased to introduce the third edition of Yamada’s Handbook of Gastroenterology. Yamada’s Handbook is based on the Textbook of Gastroenterology and Principles of Clinical Gastroenterology by Tadataka Yamada, and is divided into two major sections: symptom-based evaluation chapters and disease-based management chapters. In addition to updating the content for this version of Yamada’s Handbook, Dr. Yamada challenged us to change the format for this version by incorporating pedagogical features that would enhance the learning experience for the reader. For this reason this version differs from previous editions of Yamada’s Handbook by providing Key Practice Points, easily identified in “call-out boxes” in each chapter, which highlight the most important factors that guide clinical care. The case scenarios created for each chapter in Part 1: “Approach to Patients with Gastrointestinal Symptoms” are accompanied by discussions that we hope will provide the context necessary to translate medical knowledge to clinical practice. Finally, we have written a series of questions, with detailed answers located in the back of Yamada’s Handbook, that should provide a means to test and solidify the reader’s knowledge base. We hope Yamada’s Handbook of Gastroenterology is a useful companion to the Yamada Textbook of Gastroenterology and Principles of Clinical Gastroenterology, especially for readers interested in a condensed reference guiding the care of patients with gastrointestinal and liver diseases. In addition, we expect that trainees of all levels will benefit from Yamada’s Handbook by providing a solid foundation upon which they may build a comprehensive understanding of this exciting and rapidly evolving field of medicine. John M. Inadomi 2013 viii List of Abbreviations 5-ASA 5-aminosalicylate 6-MMP 6-methylmercaptopurine 6-MP 6-mercaptopurine 6-TG 6-thioguanine ACCR amylase-to-creatinine clearance ratio ACE angiotensin-converting enzyme ADH alcohol dehydrogenase AFP α-fetoprotein (AFP AIDS acquired immunodeficiency syndrome AIH autoimmune hepatitis ALD alcoholic liver disease ALDH acetaldehyde dehydrogenase ALT alanine aminotransferase AMA antimitochondrial antibody ANA antinuclear antibody APC adenomatous polyposis coli; argon plasma coagulation ASCA anti-Saccharomyces cerevisiae antibody ASMA anti-smooth muscle antibody AST aspartate aminotransferase BRIC benign recurrent intrahepatic cholestasis BUN blood urea nitrogen CBC complete blood count CC chronic constipation CCK cholecystokinin CDC Centers for Disease Control and Prevention CEA carcinoembryonic antigen CHRPE congenital hypertrophy of the retinal pigment epithelium CREST calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia CRP C-reactive protein CT computed tomography CTC computed tomography colonography DES diffuse esophageal spasm DS double strength ix x List of Abbreviations EAC esophageal adenocarcinoma ECG electrocardiogram EGD esophagogastroduodenoscopy EGG electrogastrography EHEC enterohemorrhagic Escherichia coli EIEC enteroinvasive Escherichia coli ELISA enzyme-linked immunosorbent assay EMR endoscopic mucosal resection EPEC enteropathogenic Escherichia coli ERCP endoscopic retrograde cholangiopancreatography ERP endoscopic retrograde pancreatography ESD endoscopic submucosal dissection ESR erythrocyte sedimentation rate ETEC enterotoxigenic Escherichia coli EUS endoscopic ultrasound FAP familial adenomatous polyposis FIT fecal immunochemical test FNA fine needle aspiration FOBT fecal occult blood test GABA γ-aminobutyric acid GAVE gastric arteriovenous ectasia, gastric antral vascular ectasia GERD gastroesophageal reflux disease GGT γ-glutamyl-transferase GI gastrointestinal GIST gastrointestinal stromal tumor HAART highly active antiretroviral therapy HAV hepatitis A virus HBIG hepatitis B immune globulin HBV hepatitis B virus HCC hepatocellular carcinoma HCT hematocrit HCV hepatitis C virus HDV hepatitis D virus HE hepatic encephalopathy HEV hepatitis E virus HGD high-grade dysplasia HHC hereditary hemochromatosis HIAA hydroxyindoleacetic acid HII hepatic iron index HIV human immunodeficiency virus HNPCC hereditary nonpolyposis colorectal cancer HPF high-power field HVPG hepatic venous pressure gradient List of Abbreviations xi IBD inflammatory bowel disease IBS irritable bowel syndrome IBS-C irritable bowel syndrome – constipation predominant ICU intensive care unit Ig immunoglobulin IGF insulin-like growth factor IHC immunohistochemistry IL interleukin IM intramuscular I-MIBG I-labeled metaiodobenzylguanidine INR international normalized ratio IPMN intraductal papillary mucinous neoplasm IPSID immunoproliferative small intestinal disease IU international unit IV intravenous LAP leucine aminopeptidase LDH lactate dehydrogenase LES lower esophageal sphincter MALT mucosa-associated lymphoid tissue MCV mean corpuscular volume MELD Model for End-Stage Liver Disease MEN multiple endocrine neoplasia MRCP magnetic resonance cholangiopancreatography MRI magnetic resonance imaging NADH nicotinamide adenine dinucleotide NAFLD nonalcoholic fatty liver disease NASH nonalcoholic steatohepatitis NCCN National Comprehensive Cancer Network NG nasogastric NSAID nonsteroidal anti-inflammatory drug OLT orthotopic liver transplantation pANCA perinuclear antineutrophil cytoplasmic antibody PAS periodic acid-Schiff PBC primary biliary cirrhosis PCNA proliferating cell nuclear antigen PCR polymerase chain reaction PDGFR platelet-derived growth factor receptor PEG polyethylene glycol PEI percutaneous ethanol injection PET positron emission tomography PFIC progressive familial intrahepatic cholestasis PICC peripherally inserted central catheter PJS Peutz–Jeghers syndrome