Gut Check on Gastroenterology Archive

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, […]

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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 […]

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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 […]

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August 31st, 2010

Drown out that pain! Warm water infusions lead to better colonoscopy tolerance.

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) […]

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July 19th, 2010

Esophageal manometry: Time to teach old dogs new tricks!

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 […]

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July 12th, 2010

I’m back! So how do you treat eosinophilic esophagitis?

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 […]

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January 11th, 2010

How Do You Spell Relief for Irritable Bowel Syndrome?

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 their […]

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December 17th, 2009

Ulcer Bleeding: Tricks of the Trade!

One of the difficulties we face when performing urgent endoscopy on a patient with upper GI bleeding is to visualize the mucosa and the lesion when blood is still present in the stomach. IV erythromycin can help by evacuating blood from the stomach, but it has become increasingly scarce; we haven’t had any available at […]

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December 11th, 2009

Should Propofol Be Used for Routine Endoscopy?

Propofol is a remarkable drug that has revolutionized sedation for patients undergoing endoscopic procedures. It can produce rapid and, when necessary, deep sedation, and its effects can be reversed within seconds to minutes. Because it has proven to be more effective than hypnotics (such as versed) and narcotics (such as fentanyl), an estimated 40% of […]

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December 7th, 2009

Gatorade and Miralax: A Better Bowel Prep?

Only about half of U.S. adults have undergone colonoscopy screening for colorectal neoplasia. To reach our goal of screening 100% of the adult population, we must find ways not only to make the procedure more accessible and affordable for patients, but also more tolerable, especially in terms of bowel preparation.  Intolerance of the gold-standard bowel […]

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