GI LEARN - GI News Feed

Lab Notes: Wall Street Success Genetic

Fri, 03 Feb 2012 22:00:00 EST

(MedPage Today) -- A look at why some stockbrokers are successful, a study that brings oncologists' worst nightmare to life, and a timely Eureka moment in the war against parasites highlight this week's collection of Lab Notes.

Predictors of fecal impaction in hospital

Fri, 03 Feb 2012 22:00:00 EST

A study in the most recent issue of Colorectal Disease investigates predictors of fecal impaction and in-hospital complications.

Participation in trials does not influence surgery outcomes for GERD

Fri, 03 Feb 2012 22:00:00 EST

The latest issue of the British Journal of Surgery investigates the impact of participation in randomized trials on outcome following surgery for gastro?esophageal reflux.

New generation colonoscopes increase adenoma detection rate

Fri, 03 Feb 2012 22:00:00 EST

This month's Clinical Gastroenterology Hepatology investigates the latest generation, wide-angle, high-definition colonoscopes and adenoma detection rate.

Gleevec Wins Regular Approval as GIST Adjuvant

Thu, 02 Feb 2012 22:00:00 EST

WASHINGTON (MedPage Today) -- The provisional approval of imatinib (Gleevec) as adjuvant therapy for a certain form of gastrointestinal stromal tumor has been made permanent, the FDA announced.

Cancer Survivors Do Better With Exercise (CME/CE)

Thu, 02 Feb 2012 22:00:00 EST

(MedPage Today) -- Another large study has confirmed that cancer survivors have better physical function and quality of life when they are physically active after their treatment ends, researchers found.

Patients With IBD Fare Well on Their Travels

Thu, 02 Feb 2012 22:00:00 EST

Travelers with IBD visiting developed countries had a higher rate of illness vs control patients, but their absolute increased risk was small, and most episodes of illness were mild. Medscape Medical News

What Is Killing People With Hepatitis C Virus Infection?

Thu, 02 Feb 2012 22:00:00 EST

What is it about hepatitis C that makes it such a potentially deadly disease? This new study takes a close look at the disease. Seminars in Liver Disease

Smoking cessation recommended for BE patients

Thu, 02 Feb 2012 22:00:00 EST

Patients with Barrett�s esophagus should be encouraged to give up smoking, say researchers who found the habit doubles the risk for progression to esophageal cancer.

H pylori treatment does not increase GERD

Thu, 02 Feb 2012 22:00:00 EST

The latest issue of the Scandanavian Journal of Gastroenterology investigates the effect of Helicobacter pylori treatment on gastroesophageal reflux disease.

High-fiber diets do not protect against asymptomatic diverticulosis

Thu, 02 Feb 2012 22:00:00 EST

This month's issue of Gastroenterology investigates various diets and the risk of asymptomatic diverticulosis.

Obesity and body mass index trends in the USA

Thu, 02 Feb 2012 22:00:00 EST

This week's issue of the Journal of the American Medical Association investigates the prevalence of obesity and trends in the distribution of body mass index among US adults.

ACIP Issues 2012 Adult Immunization Schedule

Wed, 01 Feb 2012 22:00:00 EST

The CDC's Advisory Committee on Immunization Practices has issued the 2012 adult immunization schedule, which has broadened the recommendations for HPV and HBV vaccination. Medscape Medical News

Anal sphincter training benefits colorectal cancer surgery patients

Wed, 01 Feb 2012 22:00:00 EST

French researchers have demonstrated the benefits of anal sphincter rehabilitation for patients who undergo extensive rectal surgery for cancer.

Low prevalence of H pylori infection in IBD

Wed, 01 Feb 2012 22:00:00 EST

A study in February's issue of Alimentary Pharmacology Therapeutics investigates the prevalence of H pylori infection among patients with IBD.

Exercise can improve the health and wellbeing of cancer patients

Wed, 01 Feb 2012 22:00:00 EST

Exercise can improve the health of cancer patients who have completed their main cancer-related treatment, finds a study published on bmj.com.

Women taking indigestion drugs at increased risk of hip fracture after menopause

Wed, 01 Feb 2012 22:00:00 EST

Post-menopausal women are more at risk to suffer hip fracture if they take indigestion drugs, which increases further with smoking status, suggests a study published today by the British Medical Journal.

Proton Pump Inhibitors Raise Hip Fracture Risk Over Time

Tue, 31 Jan 2012 22:00:00 EST

PPI-associated hip fracture risk increases with duration of use, smoking history. Medscape Medical News

GERD Drugs Raise Hip Fracture Risk (CME/CE)

Tue, 31 Jan 2012 22:00:00 EST

(MedPage Today) -- Postmenopausal women who use proton pump inhibitors regularly are at increased risk for hip fracture, particularly if they have ever smoked, a prospective cohort study has confirmed.

Second Sigmoid Study Ups Early Cancer Detection (CME/CE)

Tue, 31 Jan 2012 22:00:00 EST

(MedPage Today) -- Repeat flexible sigmoidoscopy increased detection of colorectal cancer or advanced adenoma by one-fourth in women and one-third in men, a major screening trial found.

Factors related to fatigue in cirrhosis before and after liver transplant

Tue, 31 Jan 2012 22:00:00 EST

February's issue of Clinical Gastroenterology Hepatology identifies factors related to fatigue in patients with cirrhosis before and after liver transplant.

Next-generation stool DNA test accurately detects colorectal cancer

Tue, 31 Jan 2012 22:00:00 EST

The latest issue of Gastroenterology investigates technical advances to stool DNA tests that detect colorectal cancer and large adenomas.

Capecitabine with oxaliplatin for gastric cancer after gastrectomy

Tue, 31 Jan 2012 22:00:00 EST

This week's issue of Lancet investigates the issue of adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy.

Risk of death among live liver donors

Mon, 30 Jan 2012 22:00:00 EST

A study in February's issue of Gastroenterology estimates early death, acute liver failure, and long-term mortality among live liver donors.

Travel-associated health risks for patients with IBD

Mon, 30 Jan 2012 22:00:00 EST

A study in the latest issue of Clinical Gastroenterology Hepatology assessed rates of illness while traveling among patients with IBD.

Diagnostic accuracy of tests of lactose digestion to predict genotype

Mon, 30 Jan 2012 22:00:00 EST

February's issue of the Alimentary Pharmacology Therapeutics investigates the diagnostic accuracy of lactose breath hydrogen or lactose tolerance tests for predicting the North European lactase polymorphism C/T-13910.

Mutant Colon Ca May Respond to BRAF-EGFR Inhibition (CME/CE)

Sun, 29 Jan 2012 22:00:00 EST

(MedPage Today) -- An unexpected feedback mechanism in cell signaling pathways may explain why some mutated colorectal cancers don't respond to a BRAF inhibitor that theoretically should work, researchers reported.

Lab Notes: Steak and Surgery May Not Mix

Fri, 27 Jan 2012 22:00:00 EST

(MedPage Today) -- Tops in this week's edition, research in mice suggests that taking protein out of patients' diets a few days before surgery could reduce the risk of complications.

Cancer Screening Falls Short, CDC Says (CME/CE)

Thu, 26 Jan 2012 22:00:00 EST

(MedPage Today) -- Large numbers of Americans who should have screening exams for breast, colon, and cervical cancer are not getting them, government researchers said.

Chromosome gain linked to CRC hepatic metastases development

Thu, 26 Jan 2012 22:00:00 EST

Dutch scientists have discovered a chromosomal marker linked to the development of liver metastases in patients with colorectal cancer, and identified a candidate gene at this site.

�Significant minority� of patients continue smoking after cancer diagnosis

Thu, 26 Jan 2012 22:00:00 EST

US researchers report that a �significant minority� of patients diagnosed with lung or colorectal cancer are still smoking 5 months after they received their diagnosis.

Anorectal function tests poor predictors for fecal incontinence

Wed, 25 Jan 2012 22:00:00 EST

Anal manometry and endosonography do not accurately differentiate between patients with and without fecal incontinence, study findings show.

Reflux Drugs No Help for Children With Asthma (CME/CE, with video)

Tue, 24 Jan 2012 22:00:00 EST

(MedPage Today) -- Proton pump inhibitor treatment doesn't ease asthma for children without gastroesophageal reflux symptoms, even for those with a positive pH test, a randomized trial determined.

ER Presentation Not the End for Colon Cancer Patients

Tue, 24 Jan 2012 22:00:00 EST

SAN FRANCISCO (MedPage Today) -- Curative therapy is still a possibility, even if a colon cancer patient is seen for the first time in the emergency department with acute symptoms, researchers said here.

Extended Lymph Node Excision Feasible in Gastric Cancer

Tue, 24 Jan 2012 22:00:00 EST

SAN FRANCISCO (MedPage Today) -- In patients with gastric cancer, laparoscopic gastrectomy that includes removal of lymph nodes outside the immediate area around the stomach offered 'excellent' margin status and node retrieval, researchers reported here.

Time in ER Sends Infection Back to Nursing Home (CME/CE)

Tue, 24 Jan 2012 22:00:00 EST

(MedPage Today) -- An emergency department visit may triple the risk of respiratory and GI infections for nursing home residents, researchers found.

High-Fiber Diet No Help for Diverticulosis (CME/CE)

Mon, 23 Jan 2012 22:00:00 EST

(MedPage Today) -- A high-fiber diet afforded no protection against asymptomatic diverticulosis, findings from more than 2,000 colonoscopy exams showed.

Skipping Surgery in Early Esophageal Cancer May Be OK (CME/CE)

Mon, 23 Jan 2012 22:00:00 EST

SAN FRANCISCO (MedPage Today) -- Non-surgical therapies for stage 0-IA squamous esophageal cancer may be a viable alternative treatment that also provides a chance for organ preservation, according to a Japanese study.

Cardiac Risk Higher for Women Getting Radiation

Mon, 23 Jan 2012 22:00:00 EST

SAN FRANCISCO (MedPage Today) -- Women undergoing radiation therapy for esophageal cancer appear to be at greater risk of cardiac complications than men, researchers reported here at the Multidisciplinary Gastrointestinal Cancers Symposium.

Inflammatory bowel disease rates lower in sunnier regions

Fri, 20 Jan 2012 22:00:00 EST

Women living in southern regions of the USA have a significantly lower risk for Crohn�s disease and ulcerative colitis than those living in northern regions, study findings indicates.

Corticosteroid use raises colorectal anastomotic leak risk

Thu, 19 Jan 2012 22:00:00 EST

Anastomotic leakage after colorectal resection is significantly more common in patients who use corticosteroids than nonusers, Dutch researchers have found.

Investigational drug improves colorectal cancer survival

Thu, 19 Jan 2012 22:00:00 EST

The investigational multikinase inhibitor regorafenib significantly prolongs survival among patients with metastatic colorectal cancer who have exhausted all other standard therapy options, show results of a phase III, randomized, placebo-controlled trial.

Probiotic enema may help pediatric UC patients

Wed, 18 Jan 2012 22:00:00 EST

Children with ulcerative colitis may benefit from intestinal microbiota manipulation, suggest the results of a study of Lactobacillus reuteri enema.

Elderly cirrhosis patients� healthcare �poses significant burden�

Fri, 13 Jan 2012 22:00:00 EST

Older patients with cirrhosis have high levels of comorbidity and functional disability, highlights research published in the journal Hepatology.

Endoscopic Stent-in-Stent Placement for the Palliation of Malignant Duodenal Obstruction

Wed, 21 Dec 2011 22:00:00 EST

Jonathan Buscaglia, MD, Stony Brook University Medical Center Parantap Gupta, MD, Stony Brook University Medical Center A 56 year old man with malignant duodenal obstruction presents with recurrent nausea and vomiting. The endoscope is not able to be passed through the existing duodenal stent. Both the duodenal stent and the previously placed biliary stent can be seen. A standard biliary extraction balloon is passed through the narrowed lumen of the previously place [...]

Clip-aided biliary cannulation

Thu, 15 Dec 2011 22:00:00 EST

Shyam Menon, MRCP, University Hospital Aintree Richard Sturgess, MD, University Hospital Aintree An 81-year old male presented to his local hospital with multiple episodes of biliary colic and two episodes of cholangitis. Cross-sectional imaging revealed a 20mm common bile duct stone with dilated extra and intra-hepatic bile ducts. Attempted ERCP failed twice due to the presence of a large duodenal diverticulum. At ERCP, we found a large per [...]

Pancreatic Rests

Mon, 12 Dec 2011 22:00:00 EST

Andrew J. Bain, MD, University of California San Diego Suresh Pola, MD, University of California San Diego, Veterans Affairs San Diego Medical Center Thomas Savides, MD, University of California San Diego A 54 year old female underwent upper endoscopy at an outside facility for evaluation of dyspepsia showing a subepithelial gastric mass. Mucosal biopsies were non-diagnostic. The patient was referred to our center for endoscopic ultrasound and further tissue sampling. Upper endoscopy showed a 1 cm subepithelial mass in the gastric antrum locate [...]

Biliary IPMN (Intraductal Papillary Mucinous Neoplasm) Diagnosed with Cholangioscopy

Tue, 06 Dec 2011 22:00:00 EST

Raymond Tang, MD, University of California San Diego Thomas Savides, MD, University of California San Diego A 62 year-old man was referred for recurrent obstructive jaundice. Cross-sectional imaging revealed dilated biliary system without obvious obstructing lesion. ERCP at an outside facility demonstrated filling defects in a markedly dilated common bile duct. Bile duct balloon sweeps removed large amount of gelatinous and purulent material but no sto [...]

Diagnosis of Acute Appendicitis with granulomatous disease during colonoscopy

Mon, 05 Dec 2011 22:00:00 EST

Truptesh H. Kothari, MD, Lenox Hill Hospital David H. Robbins, MD, Lenox Hill Hospital Patient is a 27 year old female presents to endoscopy suite for colonoscopy for evaluation of rectal bleeding. Patient denies abdominal pain, fever, chills, nausea, vomiting, bowel #8211; bladder complaints.Patient denies history of surgery and family history of GI cancers or polyps. On physical examination, found to be normal with normal vital s [...]

Metastatic Somatostatinoma

Wed, 21 Sep 2011 22:00:00 EST

Prashant Kedia, MD, Mount Sinai Medical Center Ron Lee, MD, Mount Sinai Medical Center Kalpesh Patel, MD, Mount Sinai Medical Center Michelle Kim, MD, Mount Sinai Medical Center A 41 year old surgeon presented with several months of epigastric pain. A CT scan was performed which revealed multiple masses in the liver, the largest of which measured approximately 7.4 cm in diameter. Some of these lesions demonstrated high peripheral density suggestive of calcification; no obvious pancreatic mass was noted. A CT guided biop [...]

Intraductal Papillary Mucinous Neoplasm (IPMN) with Malignant Biliary Invasion

Tue, 20 Sep 2011 22:00:00 EST

Patrick Yachimski, MD, Vanderbilt University Medical Center The patient is an 84 year old male who had previously been diagnosed with a main duct IPMN involving the pancreatic head. The patient had opted for expectant management in lieu of surgical resection, and had been relatively asymptomatic for 2 years, until presenting with jaundice, cholangitis, and gram negative sepsis. An abdominal CT demonst [...]

Colon Cancer Prevention: EMR of Flat Lesion � SSA

Wed, 15 Jun 2011 22:00:00 EST

Gottumukkala S. Raju, MD, MD Anderson Cancer Center Liben Mahometano, MD Anderson Cancer Center Asif Rashid, MD, PhD, MD Anderson Cancer Center Patrick Lynch, MD, MD Anderson Cancer Center Colon cancer prevention series: we would like to share with you endoscopic mucosal resection of a flat lesion in the cecum. Here is a 62 year old man who was recently diagnosed with prostrate cancer. He was referred to us for colonoscopy. He had two large sessile serrated adenomas removed earlier. He came in for removal of additional lesions. In th [...]

Colon Cancer Prevention: Flat Lesion and Endoscopic Mucosal Resection

Fri, 10 Jun 2011 22:00:00 EST

Gottumukkala S. Raju, MD, MD Anderson Cancer Center Liben Mahometano , MD Anderson Cancer Center Asif Rashid, MD, PhD, MD Anderson Cancer Center Patrick Lynch, MD, MD Anderson Cancer Center In this colon cancer prevention series, we would like to show you a flat lesion and its removal using endoscopic mucosal resection technique. A 70-year-old man with prior colon cancer resection and negative colonoscopies on several occasions came in for surveillance examination. As you can see here, there is a flat lesion evidenced by a red patch a [...]

How to record and edit endoscopy videos: Equipment set-up

Thu, 09 Jun 2011 22:00:00 EST

Evan S. Dellon, MD, MPH, University of North Carolina Overview and objectives This video will review the equipment and set-up needed to record high-quality endoscopic video. At the end of this presentation, you will know the specific equipment needed, how to set-up this equipment for use during a procedure, and how to capture video footage. A schematic of the set-up is shown here. The vid [...]

Management of Complications of Weight Loss Surgery

Mon, 06 Jun 2011 22:00:00 EST

W. Scott Butsch, MD, Massachusetts General Hospital Dr W. Scott Butsch, physician in the MGH Weight Center, presented at the clinical fellows#039; conference at the MGH GI Unit. The topic of was management of complications following weight loss surgery. The presentation was recorded 31 May 2011. [...]

Insulinoma

Thu, 02 Jun 2011 22:00:00 EST

Charles Chaya, MD, Kaiser Permanente Riverside Medical Center Albert Ko, MD, Kaiser Permanente Riverside Medical Center Mark Taira, MD, Kaiser Permanente Riverside Medical Center Jane Tongson-Ignacio, MD, Southern California Permanente Medical Group Regional Laboratory Brian S. Lim, MD, Kaiser Permanente Riverside Medical Center 60 year old female presented with episodes of hypoglycemia with glucose in the range of 55 to 63. Her symptoms included night sweats and confusion during the day time for which patient would eat peanut butter with improvement. Symptoms were worse with exercise. Patient was found to have high insulin level of 20 (normal 3 - 11 mU/L). C-peptide [...]

Autoimmune Hepatitis

Wed, 01 Jun 2011 22:00:00 EST

Lawrence S. Friedman, M.D., Newton-Wellesley Hospital Dr Lawrence Friedman, Chair of the Department of Medicine at Newton-Wellesley Hospital and Assistant Chief of Medicine at Massachusetts General Hospital presented grand rounds at the MGH GI Unit. The topic was autoimmune hepatitis. The presentation was recorded 31 May 2011. [...]

Precut papillotomy in distal bile duct obstruction

Thu, 26 May 2011 22:00:00 EST

Shyam Menon, MRCP, University Hospital Aintree Richard Sturgess, MD, University Hospital Aintree A 91-year old woman was admitted with painless jaundice, weight loss and Cholestatic symptoms. Imaging revealed dilated intra and extra-hepatic bile ducts down to the level of the ampulla. We were unable to initially obtain selective deep cannulation of the bile duct using a sphincterotome and wire in a standard technique as the ampulla was very fl [...]

Cholangioscopic evaluation of a biliary stricture

Thu, 26 May 2011 22:00:00 EST

Shyam Menon, MRCP, University Hospital Aintree Monica Terlizzo, MD, University Hospital Aintree Richard Sturgess, MD, University Hospital Aintree A 68-year old man was admitted with weight loss, deep jaundice and Cholestatic liver function tests (LFTs). Cross-sectional imaging revealed dilatation of the intrahepatic ducts. Close inspection revealed a sharp cut-off at the level of the hilum suggestive of a hilar infiltrative process. Moreover, the intrahepatic ducts were not significantly dil [...]

Population-Based Screening and Cascade Testing for Lynch Syndrome: Are We There Yet?

Fri, 06 May 2011 22:00:00 EST

Vincent W. Yang, MD, PhD, Emory University School of Medicine Dr Vincent Yang, Director of the Division of Digestive Diseases at Emory University School of Medicine, presented clinical grand rounds at the MGH GI Unit. The topic was screening for Lynch Syndrome (HNPCC). The presentation was recorded 19 April 2011. [...]

EUS Learning Series: Gastric cancer EUS staging

Wed, 27 Apr 2011 22:00:00 EST

Gottumukkala S. Raju, MD, MD Anderson Cancer Center Muslim Atiq, MD, MD Anderson Cancer Center Jeffrey H. Lee, MD, MD Anderson Cancer Center Staging of gastric cancer. A 73 year old man underwent EGD for gastroesophageal reflux disease. It revealed a 3 cm antral mass; biopsies were positive for cancer. He was referred to our center for tumor staging. It consisted of a CT scan to rule out metastasis and an EUS for locoregional staging. Let us look at the CT scan first. As you can see her [...]

Budesonide Is Effective in Adolescent and Adult Patients With Active Eosinophilic Esophagitis

Tue, 26 Apr 2011 22:00:00 EST

Sophia Jagroop, MD, Stony Brook University Medical Center Dr Sophia Jagroop, GI Fellow at Stony Brook University Medical Center, reviewed the recent article from the journal Gastroenterology titled 'Budesonide Is Effective in Adolescent and Adult Patients With Active Eosinophilic Esophagitis'. The presentation was recorded in April 2011. [...]

Indeterminate Biliary Strictures: Gadgets and Molecular Analysis to Improve Diagnosis

Mon, 25 Apr 2011 22:00:00 EST

Susana Gonzalez, MD, Columbia University Medical Center Dr Susana Gonzalez, Interventional Endoscopy Fellow at Columbia University Medical Center, delivered clinical grand rounds at the Massachusetts General Hospital GI unit. The topic was improving diagnosis of indeterminate biliary strictures. The presentation was recorded in March 2011. [...]

Endoscopic Ampullectomy with twin-wire technique

Thu, 21 Apr 2011 22:00:00 EST

Dr. Quan Wai Leong, Tan Tock Seng Hospital, Singapore Endoscopic ampullectomy has been considered a high risk procedure associated with a higher complication rate of bleeding, perforation and pancreatitis compared to conventional ERCP. Much effort has been spent on using different technique, equipment and different power settings of the electrosurgical unit in an attempt to minimize complications. T [...]

Disease Extension in UC and UP

Thu, 26 Jun 2008 22:00:00 EST

The inflammation in ulcerative colitis (UC) and ulcerative proctitis (UP) is dynamic and the extent of the colon involved can change over time. UC and UP uniformly affect the rectum (the lowest part of the colon) and the inflammation extends for a variable length upwards through the colon. Studies of UP patients suggest that the disease moves further up to involve more of the colon in about 25% of patients after diagnosis. The probability of disease extension appears to increase over time, with cumulative probabilities of extension estimated to be 20% and 55% at 5 and 10 years, respectively. Why the amount of colon involved remains stable in some patients and extends over time in others is not known. Risk factors for extension of disease include severe, and poorly controlled UP and UC. It is noteworthy that extension of disease can occur even in patients who are asymptomatic. Understanding the anatomic location of inflammation in the colon is important because we know that segments that have been inflamed are at greater risk of developing cancer than uninflammed segments. As such, taking medications as prescribed and staying on schedule for colon cancer screening are important for UP and UC patients.

Avoiding NSAIDs in IBD

Wed, 25 Jun 2008 22:00:00 EST

A common question from patients is: 'Why is it recommended that non-steroidal anti-inflammatory medications (NSAIDS), such as ibuprofen, be avoided in IBD?' While NSAIDs can serve as potent anti-inflammatory medications to treat things such as joint pains and backaches, they can have a paradoxical pro-inflammatory effect on the GI tract. The reason this happens is that the GI tract needs multiple lines of defense to protect its inner lining (think of all things the GI tract must be able to withstand - food, stomach acid, bile, medications, alcohol). One of the defense mechanisms our body uses to protect the GI tract is the secretion of hormone-like chemicals called prostaglandins. Prostaglandins help protect the intestinal lining against ulcer formation and aid in healing the GI tract when the protective barrier is broken. NSAID medications inhibit the production of prostaglandins throughout the body, and therefore leave the lining of the GI tract vulnerable to various insults. Furthermore, studies have demonstrated an association between NSAID use and increased risk of IBD flares. It is thought that a reduction in prostaglandin levels in the GI tract may account for this observation. As such, IBD patients are counseled to avoid products pain relievers and cold medicines that contain ibuprofen. Alternative pain medications that are safe for most IBD patients include acetaminophen and tramadol. Patients with questions about which pain medication is best for them should consult with their physician

Probiotics: A Patient's Experience

Wed, 25 Jun 2008 22:00:00 EST

Kevin wrote into the blog recently to share his experience with probiotics in UC: 'Just wanted to mention something that really has worked for me. I have pancolitis (entire colon affected). I seem to flare up every two years and need a round of steroids to get back in remission. This last time, I flared again when I had tapered down off the prednisone a bit. For me, what finally got me off the steroids was a probiotic (live bacteria and other helpful 'bugs') called Primal defense. I have been almost as colitis free as before I was diagnosed. Primal defense is soil organisms, similar to what you would ingest if you ate fresh vegetables out of a garden. Apparently they crowd out the unhealthy bugs that tend to accumulate in the guts of IBD sufferers. I can't guarantee it will work for anyone else, but it sure did the trick for me. Of course, check with your GI Doc before trying anything. Most will say stuff like 'well, at least it won't harm you.' As discussed in a prior blog, probiotics have been studied for use in UC and Crohn's disease. Thus far, probiotics have only shown definitive benefit for treatment of pouchitis. Results from studies evaluating the utility of probiotics for UC and Crohn's have shown equivocal results. That being said, certainly there are some individuals such as Kevin who have noted improvement which they attribute to the probiotic. For the most part, probiotics are felt to be safe and the majority of physicians are not opposed to patients using them. As not all formulations are the same, however, it is wise discuss probiotics with one's physician before selecting one to take.

Getting Facts about UC

Fri, 20 Jun 2008 22:00:00 EST

One of my patients recently diagnosed with UC became quite tearful during her last office visit. When I inquired what had upset her, she replied that she had been seeking information about UC on the internet and was frightened by some of the stories she read. She encountered uncensored websites with postings that did not contain medically accurate information, as well as patient stories that seemed to indicate to her that a surgery was inevitable so she should start planning now. We had a long discussion about the wide spectrum of disease severity in UC and how 'you should not believe everything you read,' particularly on the internet. While the World Wide Web has opened new avenues to obtaining information about almost everything you could want to know at any given time, it is important to review medical information from the internet with your doctor to verify its validity. Below are a few internet sites that contain reliable information and resources for patients regarding UC and Crohn's: General Resources The Crohn's and Colitis Foundation of America http://www.ccfa.org/ The American Gastroenterology Association http://www.gastro.org The American College of Gastroenterology http://www.acg.gi.org National Institutes of Health http://www.nlm.nih.gov/medlineplus/ulcerativecolitis.html#cat10 Living with UC http://www.livingwithuc.com/livingwithuc/home.html Pediatric IBD Resources Boston Children's Hospital http://www.experiencejournal.com/ibd/ American Pediatric Surgical Association http://www.eapsa.org/parents/resources/ulcer_coli.cfm Ostomy Resources United Ostomy Associations of America http://www.uoaa.org/

Managing Problems with Bowel Preps

Tue, 17 Jun 2008 22:00:00 EST

One of the more unpleasant tasks for patients undergoing colonoscopy is having to take a bowel preparation to cleanse the colon. Among the most common complaints with bowel preps are nausea, vomiting, and feeling dehydrated (fatigued, lightheaded, dizzy). Some tips on how to minimize or eliminate these problems include the following: 1) Stay well hydrated before you begin your bowel preparation. Two days before your colonoscopy, be mindful of your fluid intake and losses. The 48 hours before your test, the average adult consume at least eight 8oz glasses of fluid. The day before the procedure, it is recommended that an individual drinks 8 oz of fluid every 1-2 hours before taking the bowel prep. Drinks that contain electrolytes (ie; sodium, potassium) such as Gatorade or Propel are helpful in maintaining a balance of electrolytes during the prep. Patients with heart, lung, or fluid balance problems should speak with their doctor regarding how they should modify their fluid intake before a test. The key point to remember is to stay well hydrated. 2) Many bowel preparations instruct individuals to take a morning laxative the day before the test, followed by a stronger bowel preparation beginning that evening. Much of the nausea and vomiting associated with bowel preps is precipitated by rapid consumption of the prep. As such, individuals taking a bowel prep may want to consider starting the prep earlier in the afternoon and consuming at a slower pace to mitigate these symptoms. 3) A variety of bowel preparations exist that vary in volume and type (pill vs. liquid). Patients who have difficulty consuming large amounts of liquid preps, may want to speak with their physicians regarding alternative preps that come in a different formulation or smaller volume. Some preparations are not appropriate for patients with heart or kidney problems. Patients with such conditions should discuss this with their doctor before taking a bowel prep. 4) Individuals who have had problematic nausea and vomiting with bowel preps in the past may want to discuss with their doctor obtaining a prescription for anti-nausea medicine to take before the prep.

What is "Irritable Pouch Syndrome"?

Sun, 15 Jun 2008 22:00:00 EST

While ileal pouch-anal anastomosis surgery after colectomy provides individuals with a way to maintain continuity of the GI tract for defecation, pouches are not without problems. In a previous blog, the issue of pouchitis, or inflammation of the pouch was discussed. Another pouch problem encountered by some individuals is a recently recognized condition called 'irritable pouch syndrome' or IPS for short. IPS is a condition of the pouch that is akin to irritable bowel syndrome (IBS) of the intestine. Symptoms of IPS are similar to pouchitis and include: change in stool consistency, abdominal pain or cramping, and perianal or pelvic discomfort. A diagnosis of IPS is considered when pouch patients with such symptoms are found to have normal intestinal lining on endoscopic exam but remain symptomatic. As opposed to pouchitis which is due to inflammation of the pouch, IPS is believed to be secondary to changes in nerve sensation to the pouch after surgery. Symptoms may be relieved by dietary changes, such as low fat and low carbohydrate diets. Avoidance of diary products or excessive caffeine and alcohol may also be of benefit. Treatment with antidiarrheals (diphenoxylate, loperamide, cholestyramine), anti-spasm medication (dicyclomine, hyoscyamine), or medication for chronic abdominal pain (amitriptyline) may help alleviate symptoms that do not respond to dietary changes.

UC and Stress Management

Fri, 06 Jun 2008 22:00:00 EST

Many individuals with UC identify stress as a trigger for colitis flares. While the mind-body connection remains somewhat elusive, there is strong evidence to suggest that stress contributes to physiologic changes in hormones and the immune system. As such, stress reduction is beneficial for maintaining an overall healthy balance in life. Some tips and ideas for management of stress from Helpguide.org include the following: 1) Learn how to adapt to stress - Many things that happen in life are out of our control. Instead stressing out over things you cannot control, try to focus on how you can adapt and react to situations. - Reach out to others and share your feelings. - Focus on the positive. While it is difficult to see the positive aspects of stressful situations, many people skilled at dealing with stress are able to use such situations as opportunities for personal growth. 2. Adopt a healthy lifestyle - Regular exercise has been shown to be beneficial for stress management. In general, there are no exercise restrictions placed on UC patients outside of serious flares or recent surgeries. - Eat a balanced diet and reduce caffeine and sugar. The swings that come with caffeine and sugar ingestion may leave you feeling fatigued when the effects wear off. - Obtain adequate and restful sleep. The restorative properties of sleep help provide both physical and mental rest for our bodies. 3) Nurture yourself - Set aside time for relaxation. Whether you enjoy massage, acupuncture, exercise, or simply going for a walk, it is important to set aside time for yourself to relax. - Connect with others. Having a strong support network provides a buffer in stressful times. - Do something you enjoy everyday.

Dietary Recommendations for UC

Tue, 03 Jun 2008 22:00:00 EST

A common question asked by patients is whether they need to change their diet after being diagnosed with UC. As discussed in previous blogs, there is no evidence that specific foods contribute to inflammation in IBD. While there is not a 'colitis diet' that individuals need to adhere to, certain foods or their components may produce symptoms of loose stools or gas. Some general considerations regarding diet for UC patients: 1) Eating smaller more frequent meals may help alleviate cramping and gas associated with larger meals. 2) Dietary fiber intake may have differential effects depending on the segment of the colon involved with colitis. Some patients with colitis limited to the rectosigmoid region find that fiber helps to bulk stool and aid with passage of bowel movements. Others with more extensive colitis, may develop discomfort with higher amounts of fiber as these products pass through inflamed segments. 3) It is possible to have lactose intolerance in addition to UC. Lactose intolerance is caused by gradual loss over time of the enzyme that digests lactose in dairy products. Symptoms of gas, bloating, and or/diarrhea after dairy products could suggest a diagnosis of lactose intolerance. Simple elimination of these foods from the diet or ingestion of a tablet containing a lactase enzyme usually results in symptom improvement. 4) Eating a balanced diet is more important restricting specific foods. 5) Alcohol will not affect inflammation in the gut related to UC, but can result in flatulence and diarrhea. Alcohol can be consumed in moderation in IBD. 6) In general, consumption of a daily multivitamin is a good idea. Patients with a history of steroid use or osteopenia/osteoporosis should also take 1500mg of calcium daily and 400-800 IU of vitamin D daily. Take note that an excess of vitamins can result in toxicity. Consult your physician or pharmacist if you are unsure regarding the dosage of vitamins and minerals that should be taken daily. 7) While fish oil has a theoretical anti-inflammatory effect, research studies regarding fish oil in UC have shown only a mild improvement in symptoms if any. Although fish oil is not harmful, there is insufficient evidence that it produces any significant benefit in UC at this time.

A Diabetes Drug to Treat UC?

Tue, 03 Jun 2008 22:00:00 EST

Researchers are always on the hunt for novel therapies to treat UC and Crohn's. A recent study examined the effect of rosiglitazone, a drug used for management of type II diabetes mellitus, in mild to moderately active UC. How can a diabetes drug be useful for treating UC? The receptor that the drug affects is present both in fat cells and colon cells. It is hypothesized that the drug may act on the receptors on colon cells and send signals to decrease inflammation. In this study, 105 patients with mild to moderately active UC despite current medical therapy were randomized to take rosiglitazone 4mg twice a day or placebo. At the end of 12 weeks of treatment, 44% of those treated with rosiglitazone had a clinical response as compared to 23% of those receiving placebo. Improvement in symptoms was noted as early as 4 weeks into the study; and patients who had a good response reported an improved quality of life by 2 months. It should be noted, however, that while many patients reported feeling better, colonoscopies performed after treatment continued to show some degree of inflammation. As the study was only 12 weeks in duration, the long-term effects of such a treatment remain unknown. With regard to side effects there has been some concern raised regarding an increased risk of bone fractures and heart attacks in diabetics using rosiglitazone. In the UC study, no patients reported having fractures or heart attacks. The most common side effects were headache and swelling of the extremities. While the use of such a medication in mainstream UC treatment is a ways off, it is reassuring to see potential progress on the horizon.

UC Relapses

Mon, 12 May 2008 22:00:00 EST

UC is a chronic gastrointestinal illness that follows a course of relapsing and remitting disease. Perhaps one of the most frustrating aspects of UC for patients is the abrupt onset and unpredictability of disease flares. A recent study suggested that the risk of relapse in UC is 40%, 57%, and 67%, at 2, 5, and 10 years, respectively. While there is no crystal ball to forewarn individuals when the next flare may arise, investigators have identified some factors which may be associated with a greater risk of relapse: 1) Relapse within the first year of diagnosis. Early relapse, defined as a disease flare within the first year of diagnosis, has been associated with having a greater number flares in the future. It is thought that early disease recurrence may suggest a more severe form of disease that requires aggressive treatment. 2) Younger age at diagnosis. Individuals diagnosed with UC under the age of 30 years may be at risk for earlier and more frequent flares. The reason for this is unknown, but may be related to genetic predisposition or constitution of the immune system. 3) Cessation of cigarette smoking. In a subset of patients with UC who are smokers, stopping smoking is associated with disease onset. Similarly, there is evidence to suggest that cessation of smoking in this group may increase disease flares. Such individuals also appear to have a higher risk of disease relapse then never smokers. 4) Not taking medication as prescribed. Studies have shown that up to 60% of UC patients admit to not taking their medication regularly (taking < 70% of prescribed medication). These individuals are 5 times more likely to have a disease flare than someone who is adherent to their prescription instructions.

Making the Most of Your Colonoscopy

Mon, 07 Apr 2008 22:00:00 EST

Once you have had ulcerative colitis for several years it is necessary to have colonoscopies every couple of years in order to identify and prevent colon polyps and cancer. There are a few things that you can do to make sure that your colonoscopy is as productive and pleasant as possible: 1) By far the most important thing is to make sure that you have a clean colon. If the colon is not clean then the gastroenterologist will not have optimal viewing conditions to identify small polyps or masses. If the preparation is inadequate then the procedure will take longer than normal and may need to be repeated at another time, putting the patient through two procedures instead of one. Different physicians prefer different purgative regimens, but you will always need to avoid solid food for at least 36 hours before the procedure. Clear liquids can be taken up until several hours before the colonopscopy. Clear liquids are foods which are liquid at room temperature and transparent to light such as apple juice, tea, popsicles, broth and jello. Milk is not a clear liquid, but coffee is as long as no milk is added. Make sure that you read the preparation instructions carefully and contact the doctor�s office if there is any confusion. It is far better to call ahead of time with a question than to have a poor preparation for the colonoscopy. 2) You should continue to take most medications as usual with a couple of exceptions. If you are diabetic then medications may need to be decreased for a couple of days before the colonoscopy to balance the decreased caloric intake. If you take blood thinners such as warfarin, injectable heparin, or even aspirin then you should discuss with your doctor whether or not to stop these medications. 3) Ask your doctor for a copy of the full procedure report including pictures. It is useful to have a hard copy of the report findings and future plans in case you cannot remember the details of the procedure. Furthermore, it is important to have these for your records if you ever have to switch doctors.

Coping with the Diagnosis of UC

Tue, 25 Mar 2008 22:00:00 EST

Accepting and managing a diagnosis of chronic illness can be an overwhelming prospect. As the peak incidence of IBD occurs between the ages of 20 and 40, many individuals who have otherwise enjoyed a life of good health are blindsided by the seemingly abrupt diagnosis. Given that people manage stress in different ways, there is no single coping mechanism that is applicable to everyone. In general, however, most practitioners would agree that a proactive, hopeful outlook aids patients as they navigate through a new diagnosis. Below is a recent article from the New York Times regarding coping with the diagnosis of UC that I found honest and insightful and wanted to share with others: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Cases - New York Times 'When the Body Decides to Stop Following the Rules' By LOREN BERLIN Published: February 26, 2008 'Every day over breakfast, I fill three pillboxes. Fifteen pills in the morning, 3 at lunch and 8 before bed, for a total of 26. To my surprise, I find pleasure in the sorting, as it is one of the few moments when I can pretend I have some control over the bizarre war raging in my colon. When I learned 11 months ago at age 29 that I had a chronic illness, I understood that my life was going to change. I knew I would stop eating certain foods, limit stress and think more strategically about when to have children. What I didn't anticipate was the loss of control over my life that I thought I had, until the gastroenterologist uttered the words 'ulcerative colitis.' He explained that for reasons unknown, my immune system was ravaging the walls of my large intestine, mistakenly trying to fight off a nonexistent foreign invader. Short of removing the colon, he said, there was no cure - leaving me to contend with unpredictable bouts of abdominal pain, bloody diarrhea, fatigue, weight loss, dehydration and night sweats. Forever. Before my illness, I didn't realize I had been operating on the assumption that there was an equation to explain how things played out. It was almost like physics. If I followed certain rules, I would get the desired outcomes. I wanted to lose 10 pounds. So I quit eating after 8 p.m. and watched my waist shrink. I wanted to find a good man. So I treated strangers with respect and am now engaged to my best friend. It didn't always work. But generally, if I made the investment, I got the return. But incurable illness doesn't operate that way. Dealing with it is not about studying harder or developing a regimented routine. Nor is it about karma, becoming a better person or learning to like leafy greens. Rather, it is about hope, about believing that things will work out even if I don't know how. It's hard. Not only am I adjusting to a chronic illness, but I'm also accepting that I am vulnerable to countless things beyond my control-that great haze that is the unknown. With ulcerative colitis, the unknown is exploding around me like cannon balls. I could end up in the hospital with liver failure induced by my medicine. I could experience a vicious flare-up that results in the complete removal of my colon. These are only two of many possibilities, all of them frightening. When I get scared, I focus on a definition of fate provided to me by a professor in college. Describing an ancient Greek perspective, he explained that fate could be imagined as a plot of fenced land. The individual cannot control where the fence stakes are placed. But every person determines for herself how she maneuvers within the enclosed space. That I have ulcerative colitis is a fence post hammered into the ground at a very unfortunate angle. How I live my life with the disease is my decision. And my decision is to be hopeful. There is evidence to support that hope. For starters, those 26 pills, which represent the achievements of a host of scientists and the sustained investments of pharmaceutical companies. With so many resources invested in my disease, it is likely that medical advances will generate improved therapies. I feel hopeful, too, when I consider the immense creativity of the natural environment. In a world with the imagination to invent emeralds and giraffes, Spanish moss, hound dogs and icicles, it's not quite so hard to believe that my life will evolve nicely, with or without the benefit of organizational tendencies. Trusting in something outside myself is difficult. But I can say that I am learning to believe that things will work out well, just because they will. In one form or another, my life will continue, and it will continue to include the man I am marrying, family, friends, helpful strangers, gregarious toddlers. At least, it will for now. And that's a start.' Loren Berlin lives in North Carolina and works at Self-Help, a group that aids low-income families.

If I have surgery for UC, can I have only part of my colon taken out?

Sun, 16 Mar 2008 22:00:00 EST

YS wrote into the blog asking about the surgical options for UC: 'My wife is suffering from ulcerative colitis since 1990 and has been taking sulfasalazine and steroid treatment with local enema but now she is not responding to the treatment and relapses are very early and frequent with daily motions exceed 30 to 35 per day with bleeding per rectum and abdominal pain. What are the prospects of surgery like left hemicolectomy with colorectal anastomosis?' Indications for surgery in UC include: 1) Failure of maximal medical therapy to control disease 2) Colon malignancy 3) Fulminant colitis with complications (ie; diseased colon wall that breaks open) 4) Massive gastrointestinal bleeding With regard to surgical procedures, the preferred surgery at the current time is total abdominal proctocolectomy (removal entire colon and rectum) with either an ileostomy (external ostomy bag) or ileoanal pouch (internal pouch made from small bowel). The decision to have a permanent ostomy versus a pouch depends on patient age, weight, and technical factors. Y.S. queried about the possibility of only removing only the diseased portion or part of the colon. This entails surgeries called subtotal colectomies or an ileorectal anastomosis (connection of the small bowel to the rectum). Surgical experience has shown that removal of only part of the colon is unsuccessful because the rectum is almost uniformly involved in UC. Diseased rectum is not distensable and difficult to connect surgically to additional segments of colon and bowel. Also, the natural history of UC has shown that disease inevitably returns post-operatively to the unresected portion of the colon. Lastly, leaving in even a small portion of the colon does not reduce the future of risk of colon cancer in UC. As such, total proctocolectomy remains the favored surgical option at this time. For more information about surgical options for UC, these websites may be of interest: CCFA website - http://www.ccfa.org/info/surgery/surgeryuc Up To Date - http://patients.uptodate.com/topic.asp?file=digestiv/10295

What Causes UC?

Thu, 13 Mar 2008 22:00:00 EST

Barbara wrote into the blog this week regarding her diagnosis of ulcerative proctitis/colitis and queried what causes colorectal inflammation in UC: 'I had a routine colonoscopy in Sept of 2006 and all of just fine....I never had problems in that area.....in May of 2007 I was struck with a terrible intestinal virus which caused me to vomit and have diarrhea at the same time for 5 days....it was the worst illness I have ever had....when it was over I started to bleed from the rectum with my bowel movements and shortly afterwards I was given a sigmoidoscopy and it was determined through biopsies that I had UC of the rectum or Proctitis....I am still in shock with this diagnosis since I never had a problem in this area.....what could have caused this to happen to me?' Barbara's story of feeling completely fine and even having a normal colonoscopy prior to the onset of UC is not uncommon. The onset of UC is most often abrupt and seems to occur out of the blue. Barbara's question about why this happened to her is one of the most frequently asked questions by patients. While an exact cause for UC is not known, current theory suggests that it is likely due to a combination of genetics and environmental triggers. When a genetically predisposed individual comes in contact with a causal environmental agent, he/she may develop an inflammatory state that results in colitis. There is a lot of ongoing research regarding the genetics of IBD and what the potential environmental triggers could be. At the present time, the search for genes suspected to cause IBD has been more fruitful for Crohn's disease than UC. Advances in new genetic and molecular techniques, however, may help in the identification of genetic markers in UC. Much research has focused on environmental agents that may be associated with the onset or exacerbation of IBD. Some postulated risk factors for IBD include: 1) Cigarette smoking - protective factor for UC; flares often occur after smoking cessation 2) Prior appendectomy - protective factor for UC, risk factor for Crohn's 3) Antibiotics - may alter bowel flora 4) Oral contraceptives - weak association if any 5) High fat or sugar diet - no conclusive evidence for dietary causes 6) Lack of breastfeeding as an infant 7) Infections (both GI and otherwise) 8) Vaccinations - no conclusive evidence vaccinations cause IBD 9) Alterations in bowel bacteria Barbara relates that she had a significant gastrointestinal infection which preceded the onset of her UC. Many patients describe such an event which seems to incite an inflammatory cascade that results in UC. As discussed in a previous blog, patients with UC have a predilection for GI infections cause by a bug called C. diff. Thus, in Barbara's case it may be that she possesses a genetic predisposition to IBD and her gastrointestinal infection was the inciting event for her UC. For more information on the genetics and causes of IBD, please see our blogs from July 17 and 19, 2007 in the archives.

Long-standing UC and Ileoanal Pouch Surgery

Fri, 07 Mar 2008 22:00:00 EST

Angie recently wrote into the blog and shared her own experience with UC through multiple medications and surgery: 1986 - diagnosed UC as a 'tween', began sulfasalazine prednisone. 2 hospital episodes 1986 and 1988. early 1990s: off sulfa, changed to Asacol. Still on preds but lower dosage (10 mg/every other day??) 1996: flareup of joints, increased preds for two months, gradual taper to 5 mg every other day late 1990s: finally off steroids after 10+ years. 2004: no more Asacol, due to IAPT successful surgery Angie's story highlights the chronic nature of UC and the difficulty many patients experience tapering off of steroids completely. Angie relates she was on steroids for more than 10 years to control her colitis and joint symptoms and is now doing well off medications after a successful colectomy with ileoanal pull through (same as ileoanal pouch surgery). As discussed in prior blogs, the decision to have elective surgery for UC weighs the risks and benefits of chronic medications and potential side effects with removal of the diseased colon and future reduction of colon cancer risks. For elective situations, it is ultimately a question of quality of life, control of disease activity, and maintenance of future health. With regard to quality of life issues, it is important for patients considering ileoanal pouch surgery to understand possible outcomes post-operatively. In general, individuals with ileoanal pouches pass on average 5-7 bowel movements per day. The bowel movements are typically liquid in nature because the colon which normally reabsorbs fluid is gone. As such, maintaining good hydration during sports and outdoor activities is important. Studies suggest 10-30% of people may experience a small amount of stool seepage at night while sleeping. Fewer are affected by episodes of daytime incontinence. About 30-60% of patients will have a single episode of 'pouchitis' or inflammation of the pouch requiring a course of antibiotics for treatment. A small proportion, approximately, 8-10% may experience chronic symptoms of pouchitis requiring long-term courses of antibiotics and probiotics. As discussed in prior blogs, young women should be advised of the reduction of fecundity with childbearing associated with pouch surgeries. While fertility issues have not been associated with pouch surgeries for young men, reports of impotence or retrograde ejaculation are along the lines of 1%. The vast majority of individuals, however, report improved sexual functioning after pouch surgery to overall improved wellbeing.