Gut Check on Gastroenterology Archive

July 6th, 2009

The real issue in PPI-induced acid rebound: Why are PPIs used in the first place?

A great deal of alarm has been voiced over a recent report that some patients with no previous acid-related dyspepsia or GERD developed acid symptoms after stopping PPI therapy in a month-long trial. Should we really be surprised by this finding? Not really. PPI use is known to cause acid rebound, and the effect is thought […]

---

June 9th, 2009

Fennerty’s Top 10: Endoscopy News from DDW 2009

Here are ten key findings about endoscopy that were reported at Digestive Disease Week 2009, held May 30 – June 4, 2009 in Chicago: #10. We need to drop Bisacodyl from the new Gatorade prep. #9. Wire-guided cannulation during ERCP results in less pancreatitis. #8. Looking carefully during endoscopy finds lesions, enhanced imaging is not what does […]

---

June 9th, 2009

Can We Justify Performing Upper and Lower Endoscopies on Consecutive Days?

I recently saw a patient who was referred after upper and lower endoscopies had not revealed the cause of his abdominal discomfort. What struck me was that the patient had these two exams on consecutive days. That meant two days lost from work, two days with altered diet, two trips to the endoscopy center, two days […]

---

April 16th, 2009

Asthma, Cough, and Hoarseness: GERD or the Great Hoax?

For at least a decade, people suggested that GERD was more than just heartburn and regurgitation, that it might also account for all the wheezing, coughing, and throat clearing we were encountering in the clinic. This idea led to the notion that we should try high-dose acid-suppression therapy in these other “GERD” patients. What has recently become clear, however, is that most of […]

---

February 5th, 2009

PPIs and Plavix: There Are No Simple Answers but Maybe a Simple Solution!

In response to my earlier post on PPIs and upper GI bleeding, Bahman N Shokouhi writes: A recent article in the Canadian Medical Association Journal (published online Jan 28, 2009), suggests that this is not a class effect and that Pantoprazole does not seem to have an effect. It has been suggested that the cause of […]

---

January 23rd, 2009

Ambulatory Endoscopy Centers: No Seniors Allowed!

Ambulatory endoscopy centers (AECs) have proven so successful in providing convenient, efficient, low-cost, high-quality endoscopy services to outpatients that they are now ubiquitous around the country. Given this success, you might assume that payers would steer business their way. However, that’s not the case with the Centers for Medicare & Medicaid Services (CMS). In fact, […]

---

January 16th, 2009

Beware of Plavix: Your Next On-Call Nightmare

I love being a gastroenterologist, but I hate being on call. If I could avoid “call,” I probably would never even contemplate retiring. Alas, call may be about to get worse for gastroenterologists, especially in light of new evidence that could curtail the common use of PPIs to prevent GI bleeding in patients taking clopidogrel (Plavix). […]

---

December 29th, 2008

What Should We Do with Barrett’s: Ignore It or Fry it?

The answer to the question “What to do with Barrett’s: Ignore it or fry it” is simple: It depends on whether we are talking about Barrett’s with or without dysplasia! We now have ample evidence that  endoscopic interventions for dysplastic Barrett’s are effective in decreasing the incidence of cancer. As a matter of fact, the success of […]

---

December 22nd, 2008

Telling the Truth About Colonoscopy, Take II

This article in Annals of Internal Medicine neatly drives home the argument that I made below about colonoscopies missing some cancers. Glad to see that in its coverage, the Times at least correctly identified that the problem is with who does the procedure, not with the procedure itself.

---

November 4th, 2008

Whither Gastroenterology?

What does it mean to be a gastroenterologist in 2008? Is our field moving in the right direction? I suspect that most gastroenterologists were and are attracted to the specialty because it offered the opportunity to deal with multiple organs and diseases. My generation of gastroenterologists came of age along with the exciting and emerging ability to diagnose–and […]

---