Gut Check on Gastroenterology Archive

March 25th, 2011

H. pylori: Is it time to change our first-line treatment?

H. pylori dominated the GI news in the 1990s, and despite it disappearing from the front pages, it remains a common and important clinical problem. The dominant recommended initial treatment strategy has been a clarithromycin-based PPI triple therapy, with either amoxicillin or metronidazole as the third drug. This approach was based on clinical studies, ease […]

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January 24th, 2011

A new way to treat IBS?

The more we look into the normal gut bacteria flora the more complex it becomes. We know these bugs that reside in our small and large intestines affect immunology, motor, sensory and a myriad of other gut functions. The ability to modulate this diverse population of bugs does seem to help some patients with IBS […]

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October 1st, 2010

Esophageal food impaction: Are you a secret pusher?

I, like most endoscopists, remember being told that you should never push an esophageal food impaction into the stomach but instead all food should be removed first, then the cause of the impaction determined and treated. Well I suspect that most endoscopists do what I do and that is try and safely push the impaction into […]

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March 1st, 2010

When Should We Stop Surveillance of Barrett’s Patients?

Some of my patients who have undergone successful ablation therapy for Barrett’s esophagus ask a really good question: If I haven’t had Barrett’s for years, why do I need to keep having endoscopies?”  I admit, I do not have a uniform answer for that, nor do GI society guidelines. I would say that for patients […]

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April 7th, 2009

Our Love-Hate Relationship with Bowel Preps: It’s Time to Split Up!

For the past couple years, my colleagues and I have been bemoaning the state of bowel preps, especially for colonoscopies done in the afternoon. As many as one third of those preps were so poor that we had to tell patients to resume screening at intervals sooner than 7 to 10 years, for fear of […]

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March 14th, 2009

Sedating HIV-Infected Endoscopy Patients

In a recent blog post, ID expert Paul Sax raised the question of which sedatives should be used when scoping HIV-infected patients on ritonavir or efavirenz. Both antiretrovirals inhibit the CYP3A enzyme, which metabolizes one of our most commonly used sedatives, midazolam. Use of midazolam with either antiretroviral is technically contraindicated because of significant increases […]

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February 26th, 2009

Should Nurses Be Performing Endoscopy?

Two provocative articles recently appeared in BMJ (here and here) showing that experienced, well-trained nurses are as clinically effective — but not as cost-effective — as physicians in performing diagnostic upper endoscopy and sigmoidoscopy. This randomized trial definitively answers the question of whether nurses can deliver high-quality endoscopy, but the larger question is whether they should […]

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February 18th, 2009

Sedation-Free Colonoscopy: Why Isn’t It the Standard?

This Saturday’s Wall Street Journal featured an intriguing article on sedation-free colonoscopy, which is standard in Europe and Asia but rarely done in the U.S. One could argue that Americans are just “weenies,” but I think the blame rests solely with us doctors. Sedation-free colonoscopy is successful in most who try it (I did!), but it […]

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