This issue provides important updates on the management of disorders of the anorectum and pelvic floor. Expert authors provide information on hemorrhoidal issues, anorectal anatomy and imaging techniques, fissure and anal stenosis, rectal prolapse, and anal abscess and fistula. Other articles are devoted to sexually transmitted and infectious diseases, treatment of radiation proctitis, and pruiritis ani. Readers will come away with a full understanding of the current strategies for diagnosis and management of these disorders.

In this issue, guest editors bring their considerable expertise to this important topic.Provides in-depth reviews on the latest updates in the field, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.

As aging trends in the United States and Europe in particular are strongly suggestive of increasingly older society, it would be prudent for health care providers to better prepare for such changes. By including physiology, disease, nutrition, pharmacology, pathology, radiology and other relevant associated topics, Geriatric Gastroenterology fills the void in the literature for a volume devoted specifically to gastrointestinal illness in the elderly. This unique volume includes provision of training for current and future generations of physicians to deal with the health problems of older adults. It will also serve as a comprehensive guide to practicing physicians for ease of reference. Relevant to the geriatric age group, the volume covers epidemiology, physiology of aging, gastrointestinal physiology, pharmacology, radiology, pathology, motility disorders, luminal disorders, hepato-biliary disease, systemic manifestations, neoplastic disorders, gastrointestinal bleeding, cancer and medication related interactions and adverse events, all extremely common in older adults; these are often hard to evaluate and judge, especially considering the complex aging physiology. All have become important components of modern medicine. Special emphasis is be given to nutrition and related disorders. Capsule endoscopy and its utility in the geriatric population is also covered. Presented in simple, easy to read style, the volume includes numerous tables, figures and key points enabling ease of understanding. Chapters on imaging and pathology are profusely illustrated. All chapters are written by specialists and include up to date scientific information. Geriatric Gastroenterology is of great utility to residents in internal medicine, fellows in gastroenterology and geriatric medicine as well as gastroenterologists, geriatricians and practicing physicians including primary care physicians caring for older adults.

Three-dimensional endoanal ultrasonography with emphasis on the anatomy of the pelvic floor and diagnosis of anorectal benign diseases. Numerous schematic representations coupled with ultrasonographic and radiologic images provide a didactic approach. Readers gain a clear understanding of the fundamental principles and techniques of ultrasonography as well as of the normal anatomy of the pelvic floor and its modification in various benign anorectal diseases. Both general and specialist clinical practices will benefit from this book.

Some Chapter Topics Include:

Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.

Many gastroenterologists are presented with patients complaining of one or more of several anorectal symptoms. Patients expect that a gastroenterologist can treat their symptomatic hemorrhoids or anal fissures or diagnose accurately their rectal bleeding. Today the evaluation and treatment of these common ailments is not included within the core curriculum of most gastrointestinal fellowship training programs, and therefore has not been incorporated into a typical GI practice. Diagnosis and Management Guide for Anorectal Disease: A Clinical Reference looks to fill that void. Dr. Waqar Ahmed Qureshi states that most of these perianal and anorectal problems can be successfully treated non-surgically. Diagnosis and Management Guide for Anorectal Disease: A Clinical Reference reviews a number of diseases that gastroenterologists should be able to effectively manage in their office, which eliminates extra cost, inconvenience, and frustration for their patients. A few of the topics that can be found inside: Anatomy and Examination Anatomy and Physiology of the Pelvic Floor Benign Anorectal Conditions Hemorrhoids, Anal Fissures, and Anal Pruritus Benign Soft Tissue, Perianal, Perineal, and Complicated Conditions Pilonidal Disease, Aanorectal IBD Management, and Defecation Disorders Neoplasms Anal Carcinoma and screening high-risk groups The gastroenterologist occupies a unique position between conservative treatment offered by primary care physicians and the more invasive procedures offered by the surgeon. Diagnosis and Management Guide for Anorectal Disease: A Clinical Reference is designed to provide a comprehensive understanding of anorectal diseases that they can manage and, therefore, improve the care of their patients in one comprehensive volume.

This text includes sections on anatomy, normal and abnormal physiology, investigation techniques, inflammatory conditions and treatment options. The international panel of contributors is at the forefront of research in the field; the editors have assembled these contributors and topics that span the entire range of pelvic floor disorders in women. Throughout, the emphasis is on an evidence-based approach to the treatment of pelvic floor problems. Indispensable for gynecologists and urologists.

With collaboration of Dr. Alan Buchman, Consulting Editor, Dr. Perry J. Pickhardt has created a comprehensive issue of Gastroenterology Clinics that looks at imaging techniques for gastrointestinal diseases. Experts in their respective fields have contributed clinical reviews in the following areas: Evaluation of Dysphagia: The Role of Barium Fluoroscopy; CT and MR Small Bowel Enterography: Current Status and Future Trends; Radiologic Assessment of Gastrointestinal Bleeding; CT Colonography: Implementation for Screening; Rectal MR for Cancer Staging and Surveillance; Defecography (fluoro vs MR); Noninvasive Imaging Techniques for Staging Liver Fibrosis; HCC Screening: Comparison of US, CT, and MR Approaches; Pancreatic Cystic Lesions; Overview of biliary imaging; Splenomegaly: Clinico-Radiologic Approach to the Differential Diagnosis; MR for Non-Traumatic Acute Abdominal Pain: Comparison with CT and US; and PET/MR: Current Clinical Status and Future Prospects. Gastroenterologists will come away with the knowledge they need to understand the latest imaging modalities for diagnosis and assessment of gastrointestinal diseases and disorders.

Together with Consulting Editor, Dr. Alan Buchman, Dr. Parkman has created as state-of-the-art issue devoted to the modern technology and approaches for evaluation and treatment of GI motility. He has provided coverage for the esophagus, colon, small intestine, and gut. Leaders in the field have contributed the detailed clinical review articles on the following topics: Enhancing High Resolution Esophageal Manometry: Use of Impedance, multiple rapid swallows, Position change, Solid food boluses, and other techniques; EndoFLIP in the esophagus: Assessing sphincter function, wall stiffness, motility to guide treatments; Evaluation and Treatment of patients with persistent reflux symptoms despite PPI treatment; Esophageal Evaluation for Patients undergoing Lung Transplant Evaluation: What should we do for evaluation and management; Tailoring Endoscopic and Surgical Treatments for GERD; Endoscopic and Surgical Treatments for Achalasia: Who to treat and how; Enhancing Scintigraphy for evaluation of gastric, small bowel, colonic motility; Targeting treatment for gastroparesis: Use of clinical tests to guide treatments; Endoscopic and Surgical Treatments for Gastroparesis: What to do and Whom to treat; Gastric Biopsies in Gastroparesis: Insights to Gastric Neuromuscular Disorders to Help with treatment; SIBO: How to diagnose and treat (and then treat again); Assessing anorectal function in constipation and fecal incontinence; Treating chronic abdominal pain in patients with Chronic Recurrent Abdominal Pain and IBS; and Refractory Chronic Constipation: How to evaluate and treat. Gastroenterologists will come away with the technical information they need to improve outcomes in their patients.