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Articles matching the ‘Patient care’ Category

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March 14th, 2014

Dysphagia and Normal Endoscopy – Should We Biopsy Everyone?

The “discovery” of eosinophilic esophagitis (EoE) has added immensely to our understanding of many patients with dysphagia, and when endoscopic signs are present (furrowing, rings, white nodules, etc.), we should always confirm the diagnosis with endoscopic biopsies. However, many patients with EoE have a normal-appearing esophageal mucosa, and EoE would remain undetected if biopsies were [...]


January 28th, 2014

What Bowel Prep for the Sensitive Stomach?

Although it is clear that split-dose polyethylene glycol (PEG), our first-line bowel prep, provides the optimal bowel cleansing for colonoscopy, many of my patients find it difficult or even impossible to tolerate this solution (i.e., due to vomiting). Although alternatives such as Gatorade/Miralax, with or without magnesium citrate and Dulcolax, are used by many endoscopy [...]


November 6th, 2013

Iron Deficiency Anemia: When Do We Stop Scoping?

It is standard practice to perform endoscopy in patients with iron deficiency anemia who have evidence of gastrointestinal bleeding or other symptoms. Even in the absence of symptoms, in patients aged 50 years or older, who are at increased risk for colorectal cancer, age alone would indicate that at least a colonoscopy is in order. [...]


August 8th, 2013

Probiotics: Which one, and in whom?

I continue to be intrigued by the burgeoning use of probiotics  — by both patients and practitioners, including myself — to treat patients’ symptoms of digestive diseases. The problem I run into when considering their use in patients, or when answering patients’ questions about them, is in determining which patients are good candidates for probiotics, [...]


July 16th, 2013

Follow-up after Barrett esophagus ablation: How do you do it, and when do you stop (if ever)?

We have shifted the paradigm of treating neoplastic Barrett esophagus (BE) away from a choice between intensive surveillance or surgery and towards endoscopic ablation. In the last 5 years, I have done hundreds of BE ablations using radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR), and many thousands have been performed worldwide. However, on post-ablation [...]


June 28th, 2013

Colonoscopy Preps: Patient Marketing vs. Patient Quality

There are innumerable bowel preps on the market as well as “home brewed” ones (e.g. Miralax™ and Gatorade™). In my community, many gastroenterology practices appear to choose their colonoscopy prep based on patient acceptability and/or taste preference. I find this choice of bowel prep based on “marketing” to patients troublesome. Although I absolutely understand the [...]


June 4th, 2013

Suspected Lower GI Bleeding: When do you do an Upper Scope?

Most gastroenterologists I know seem pretty confident that they can differentiate bright red blood from a lower GI (e.g., colonic) source and massive upper GI bleeding presenting as bright red blood in the lower GI tract. The location of bleeding is critical from a treatment and prognosis perspective. Lower GI bleeding usually ceases spontaneously, requires [...]


April 10th, 2013

Barrett esophagus with dysplasia: Endoscopic resection or endoscopic burning?

The effectiveness of endoscopic ablation of neoplastic (dysplastic) Barrett esophagus (BE) has made it the new standard of care in many communities; referrals to surgeons have largely disappeared. However, the procedure is still evolving — from thermal ablation by laser in the 1980s and early 1990s to BICAP probes and Argon Plasma Catheter (APC) in [...]


December 30th, 2012

Quality Colonoscopy: How do you let your patients know you meet the mark?

Colonoscopy prevents most colorectal cancers, but only when it is performed as part of a high-quality examination. The quality measures most often discussed include cecal intubation rate, cecal withdrawal time, documentation of bowel prep quality in endoscopy reports, adenoma detection rate  (ADR), and appropriate recommendation of subsequent screening or surveillance intervals after colonoscopy. While third-party payers [...]


November 11th, 2012

C. difficile: How many stool samples do you send for a diagnosis?

The diagnosis of this increasing and now epidemic infection has been evolving as well. When I first started testing for this infection, a cytotoxin assay was used that delayed the diagnosis and was very operator-dependent. Enzyme immunoassays came next, and more recently PCR testing of stool has become available. Despite the increased accuracy and more [...]


Gastroenterology Research: Author M. Brian Fennerty, M.D.

M. Brian Fennerty, MD

Editor-in-Chief

NEJM Journal Watch Gastroenterology

Biography | Disclosures | Summaries

Learn more about Gut Check on Gastroenterology.