Gastrointestinal and Liver Diseases

b. Refractory Sprue

c. Tropical Sprue

• Han PD, Burke A, Baldassano RN, Rombeau JL, Lichtenstein GR. Nutrition and Inflammatory Bowel Disease. Gastroenterol Clin N Am 28(2):423-443,1999. This comprehensive review covers the development of malnutrition and specific nutrient deficiencies in inflammatory bowel disease. The nutritional assessment of these patients, their macro- and micro-nutrient requirements are discussed. The role of parenteral and enteral nutritional support as either primary or supportive therapeutic interventions is described. Investigations nutritional therapies such as short chain fatty acids, fish oils, and glutamine are briefly discussed.

• Crohns and Colitis Foundation www.ccfa.org

a. Whipple’s Disease

b. Giardia

c. Bacterial Overgrowth

• Saltzman JR, Russell RM. Nutritional Consequences of Intestinal Bacterial Overgrowth. Compr Ther 20(9):523-530,1994. This review discusses the pathophysiology and clinical signs and symptoms of intestinal bacterial overgrowth. The diagnostic modalities for bacterial overgrowth and the anatomic abnormalties that may predispose an individual are discussed along with therapeutic options.

d. HIV

• Turtel PS, Shike M. Diseases of the Small Bowel. In Modern Nutrition in Health and Disease, 9^th ME Shils, JA Olson, M Shike, AC Ross, eds., 1999, 1151-1161.

• Scolopio JS, Fleming CR. Short Bowel Syndrome. Gastroenterol Clin N Am 27(2):467-479,1998. This comprehensive review defines short bowel syndrome and lists its etiology. Prognostic factors for dependence on parenteral nutrition are discussed. Nutritional complications, including specific nutrient deficiencies, gastric acid hypersecretion, D-lactic acidosis, cholelithiasis, and nephrolithiasis described. Treatment recommendations are provided.
• Christi SU, Scheppach W. Metabolic Consequences of Total Colectomy. Scand J Gastroenterol Suppl 222:20-24,1997. This review discusses the nutritional importance of the colon, especially as it functions in short bowel syndrome. Nutritional issues involving pouchitis and diversion colitis are also briefly discussed.

a. Water-Soluble Vitamins

• Snow CF. Laboratory Diagnosis of Vitamin B12 and Folate Deficiency: A Guide for the Primary Care Physician. Arch Intern Med 159(12):1289-1298,1999. This comprehensive review describes the clinical manifestations of folate and vitamin B12 deficiency including historical complaints, physical signs, hematologic and biochemical abnormalities. Absorption and transport of these vitamins is discussed. The laboratory diagnosis and treatment of deficiency and the approach to the determination for the etiology of the deficiency is described.

b. Steatorrhea and Fat Soluble Vitamin Deficiencies

c. Zinc and Selenium Deficiency

a. Chemotherapy and Radiation-Associated Malabsorption

b. Malnutrition and TPN-Associated Changes

c. Dumping Syndrome

• Lieber CS. Nutrition in Liver Disorders. In Modern Nutrition in Health and Disease, 9^th ME Shils, JA Olson, M Shike, AC Ross, eds., 1999, pp1177-1178. This textbook chapter discusses the role of the liver in protein synthesis and assimilation in the normal state. /li>

• Mizock BA. Nutritional Support in Hepatic Encephalopathy. Nutrition 15(3):220-228,1999

Cabre E, Gassull MA. Nutrition in Chronic Liver Disease and Liver Transplantation. Curr Opin Nutr Metab 423-430, 1998. This comprehensive review discusses the diagnosis and classification, and pathogenesis of hepatic encephalopathy. The metabolic alterations, including malnutrition, that occur in acute and chronic hepatic failure, as well as in hepatic failure are described. Recommendations on the route of feeding during hepatic encephalopathy and the therapeutic use of specific nutrients including branched chain amino acids in acute and chronic hepatic encephalopathy are provided.

• Nanji AA, Fakim D. In Hepatology: A Textbook of Liver Disease. Philadelphia: WB Saunders, 1996, pp891-962.This textbook chapter describes the physiologic and biochemical aspects of alcoholic liver disease, the nutritional status of such patients and potential nutritional therapy.

• Cabre E, Gassull MA. Nutrition in Chronic Liver Disease and Liver Transplantation. Curr Opin Clin Nutr Metabol Care 423-430,1998. This comprehensive review describes the metabolic alterations that occur in the liver during cirrhosis, including the development of malnutrition. Specific nutrient deficiencies are discussed. The nutritional evaluation of the patient with chronic hepatic insufficiency and the role of nutritional support and the nutritional management of the pre-and post-transplant patient are reviewed.

a. Wilson’s Disease

• Zucker SD, Gollan JL. Wilson’s Disease and Hepatic Copper Toxicosis. In Hepatology: A Textbook of Liver Disease. Philadelphia: WB Saunders, 1996, pp1405-1439 This textbook chapter discusses the diagnosis of, genetics, pathophysiology, clinical features, and management of copper overload.

• Wilson’s Disease Association www.wilsonsdisease.org

b. Hemochromatosis

• Bacon BR, Tavill AS. Hemochromatosis and the Iron Overload Syndromes. In Hepatology: A Textbook of Liver Disease. Philadelphia: WB Saunders, 1996, pp1439-1472 This textbook chapter discusses the diagnosis of, genetics, pathophysiology, clinical features, and management of iron overload.

• American Hemochromatosis Society http://www.americanhs.org/

c. TPN-Associated Liver Disease

• Buchman AL, Ament ME. Liver Disease and Total Parenteral Nutrition.In Hepatology: A Textbook of Liver Disease. Philadelphia: WB Saunders, 1996, pp1810-1820.  This textbook chapter discusses the pathophysiology and management of TPN-associated steatosis, steatohepatitis, and cholestasis.

d. Inborn Errors of Metabolism

• Ghishan FK. Inborn Errors of Metabolism. In Hepatology: A Textbook of Liver Disease. Philadelphia: WB Saunders, 1996, pp1574-1605.  This textbook chapter discusses disorders of carbohydrate metabolism, including their pathophysiology and treatment, glycogen storage diseases, disorders of amino acid metabolism, and disorders of lipid metabolism.