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Articles matching the ‘Uncategorized’ Category

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November 25th, 2013

Does Suppressing Gastric Acid Cause Community-Acquired Pneumonia?

Ever since early observational studies documented an association between acid suppression and pneumonia, many clinicians have assumed this association meant causation. This intrigues me because results of numerous prospective trials that have controlled for underlying patient comorbidities have refuted any causative effect. Moreover, acid suppression does not result in a gastric environment conducive to bacterial [...]


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. [...]


September 23rd, 2013

Making Bowel Preps Palatable

We know that split-dose, polyethylene glycol (PEG)–based bowel preparation solutions provide the best cleansing before colonoscopy. However, many patients are not compliant with the bowel prep procedure because of the poor taste of the PEG solution. Results of a recent trial suggest a practical approach to overcoming this problem: Use candy. In the trial, use [...]


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 [...]


February 10th, 2013

What is your best treatment for “refractory” constipation?

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 [...]


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 [...]


October 10th, 2012

Barrett esophagus with high-grade dysplasia: How should it be staged?

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 [...]


August 5th, 2012

PPIs: Are the risk issues being overplayed?

 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, [...]


July 8th, 2012

Gluten: How often is it the culprit?

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 [...]


October 1st, 2010

The New Epidemic: Narcotic Bowel and Abdominal Pain

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 [...]


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.