M. Brian Fennerty, MD, is the editor of Journal Watch Gastroenterology and Professor of Medicine and Section Chief of Gastroenterology in the Department of Internal Medicine at Oregon Health & Science University.
Learn more about Gut Check on Gastroenterology.
(8 votes, average: 3.38 out of 5)In treating patients with constipation, we have several options for first-line agents: bulking agents/fiber, osmotic laxatives, or stimulant laxatives. When a patient has a suboptimal result, we commonly add or move to another class of laxative agents. Fortunately, most patients respond to these interventions, but we all have patients whose condition is “refractory” to these [...]
(3 votes, average: 2.00 out of 5)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 [...]
(1 votes, average: 5.00 out of 5)I am amazed at the variation I have seen in the use of endoscopic ultrasound (EUS) in staging Barrett esophagus (BE). Some of us use EUS universally, and others (myself included) never use it to stage intramucosal carcinoma or high-grade dysplasia. So, let me propose a case and ask what you would do: The patient [...]
(3 votes, average: 3.00 out of 5)I have been using PPIs to manage GERD and acid-sensitive dyspepsia since omeprazole first became available in 1989. Although no drug class is absolutely safe, there is, as yet, not a single case report of a death related to this drug class, despite hundreds of millions of patient-years of exposure. Despite this remarkable safety profile, [...]
(1 votes, average: 5.00 out of 5)All gastroenterologists are very familiar with celiac disease, including its characteristic findings on small bowel biopsy and the treatment with a gluten-free diet. But I have noticed that we as gastroenterologists approach the possibility of sprue, or those suspected of having gluten sensitivity without sprue, with extraordinary variability. For instance, a negative screening tissue transglutaminase [...]
(4 votes, average: 4.25 out of 5)I remember clearly when “pain” became a vital sign. As I suspect most medical professionals felt, chronic pain was a serious and disabling symptom that was poorly treated for the most part. The last decade of expanding research into mechanisms and treatments of chronic pain has brought enormous relief to the millions that suffer from [...]
(2 votes, average: 5.00 out of 5)Well it seems you can teach an old dog a new trick after all! About 18 months ago I was exposed to the concept of infusing warm water into the colon during the initial part of the colonoscopy exam (100-150ml injected through the biopsy port when at the recto-sigmoid junction up through the sigmoid colon) [...]
(2 votes, average: 4.50 out of 5)I have been doing manometry for a long time and felt there really wasn’t much more to learn or see related to this field. That is until we got a high-resolution system. Now I realize I wasn’t seeing as much as I thought I was with the old perfusion systems and the physiology is incredible [...]
(3 votes, average: 3.33 out of 5)Eosinophilic esophagitis has been around for a long time but we only recently have recognized it and begun to try and treat it. My dilemma has been how and for how long should I treat this patient. Part of the decision difficulty lies in the extreme variation of clinical presentation that I see in this [...]
(3 votes, average: 4.00 out of 5)I admit it. I’m frustrated. I do not know how to manage a substantial portion of my IBS patients because so few of them get relief from traditional therapies (bulking agents, antidiarrheals, tricyclic antidepressants, etc.). Recently, I noticed that many of my colleagues are using Align probiotics, Iberogast herbal supplements, and other alternative/complementary therapies for [...]
