Moderate-to-severe inflammation of the ileum is typical of Crohn's disease. The trend in management of the disease is to prescribe biologic agents earlier in the course of disease, since evidence suggests that this can help prevent strictures and the need for surgery.Read More
Patients who have chronic constipation may be at increased risk for colorectal cancer and benign neoplasms, according to researchers. Newly issued screening guidelines recommend colonoscopy as a “preferred” colorectal cancer prevention strategy beginning at age 50 years.Read More
Several classes of drugs seem to have positive effects for patients with GI disorders--including NSAIDs, anticonvulsants, alpha-adrenergic agents, neuromuscular agents, and antidepressants. Details here. Read more
Extensive diverticulosis was found throughout the length of the colon of an 84-year-old woman, who depended on a weekly dose of magnesium citrate to have a bowel movement.Read More
Also known as congenital aganglionic megacolon (A), this condition is characterized by a congenital absence of ganglion
cells in the submucosal (Meissner) plexus and the
myenteric (Auerbach) plexus in one or more segments of
the colon. This is attributable to a failure of migration of
nerve cell elements from the neural crest in a cephalocaudal
direction along the GI tract. The absence of parasympathetic
innervation causes failure of relaxation of the internal
anal sphincter. An aganglionic colon does not permit
normal peristalsis to occur and thus results in a
functional obstruction.
A 44-year-old man with type 2 diabetes was recently hospitalized for an acute
exacerbation of pancreatitis. This was his seventh admission for the condition
within the past several years. Although imaging studies revealed no calcifications,
the hospitalist suspected that acute relapsing pancreatitis was evolving
into chronic pancreatitis.
Fourteen months of intermittent, foul-smelling, perianal discharge prompted a 45-year-old man to seek medical evaluation. He also complained of occasional bright red rectal bleeding and soreness of the perianal region; he denied fever.
A 53-year-old man presents 3 days after a brief episode of abdominal pain.
The pain was followed by significant blood in his stool at his next bowel movement,
which occurred 2 hours later. There has been no visible blood in the
stool at subsequent bowel movements. The patient has had no nausea, vomiting,
or diarrhea and denies trauma, fever, and recent travel to a foreign country.
Medical history is noncontributory.
A 44-year-old man presents with sharp, severe abdominal discomfort
that began suddenly while he was driving to your office for a routine
physical examination. The patient reports that several days earlier he had
lifted a refrigerator. He experienced intermittent umbilical discomfort for several
days afterwards.
A 72-year-old man is brought to the emergency department by his wife. He
complains of nausea, vomiting, and severe abdominal pain that makes it difficult
for him to walk. The pain began the previous afternoon and has worsened steadily.
The patient denies trauma and recent foreign travel. His history includes an appendectomy
performed many years earlier but is otherwise noncontributory.
For 2 days, a 68-year-old woman had watery, yellowish diarrhea with mucus and left lower quadrant pain. Her medical history included hypertension, diabetes mellitus, and congestive heart failure (CHF); she had left the hospital 5 days earlier following treatment of an exacerbation of CHF with intravenous furosemide and sodium and fluid restriction. The patient was taking furosemide, lisinopril, and glipizide; she denied any recent antibiotic therapy.
For many years, a 71-year-old multiparous woman had a painless swelling around her umbilicus that intermittently and spontaneously decreased in size. Progressive, dull pain at the site that had lasted for 7 days prompted her to seek medical evaluation. The patient also noticed recent maceration of the skin on the surface of the affected area.
Christopher Pleyer, MD, from the Mayo Clinic, Rochester, MN, summarizes his part in the plenary session "Observer Bias in the Diagnosis of Gastroesophageal Reflux Disease and Functional Dyspepsia" at ACG 2011. Distinguishing GERD from other upper GI problems is crucial, he explains.
Is obesity really leading to an increase in GERD? Or, has GERD just become a catch-all phrase for all sorts of upper GI distress? Has GERD become the new "dyspepsia"? G. Richard Locke, MD, FACG, from the Mayo Clinic, Rochester, MN, discusses his findings as presented at the ACG 2011 program.
Commentary on: QuachC, McArthur M, McGeer A, et al.. Risk of infection following a visit to the emergency department: a cohort study. <I>CMAJ</I>2012;184:E232–9.
Implications for practice and research
Further evaluation is needed of the consistency of application of Stand
Postoperative surgical-site infections are a major source of morbidity and cost. This study aimed to identify and present all randomized controlled trial evidence evaluating the effects of dressings on surgical-site infection rates in surgical wounds healing by primary intention; the secondary outcomes included comparisons of pain, scar and acceptability between dressings.|Randomized controlled trials comparing alternative wound dressings, or wound dressings with leaving wounds exposed for postoperative management of surgical wounds were included in the review regardless of their language. Databases searched included the Cochrane Wounds Group Specialised Register and Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase and EBSCO CINAHL from inception to May 2011. Two authors performed study selection, risk of bias assessment and data extraction, including an assessment of surgical contamination according to the surgical procedure. Where levels of clinical and statistical
To evaluate the relationship between age and clinicopathological characteristics in gastric carcinoma patients, we performed the meta-analysis based on nine retrospective clinical trials. Comparing elderly patients with young patients it showed lower male/female ratio, more diffuse GC, more Borrmann type IV, more poorly differentiated carcinoma, more peritoneal metastasis, less vascular invasion, fewer partial resections, and better 5-year survival rate. These particular age-related characteristics need to be further investigated.
This study aimed to validate two prognostic biomarkers, pfetin and adenosine triphosphate-dependent RNA helicase DDX39 (DDX39), in gastrointestinal stromal tumour. Prognostic biomarkers have long been required for the optimal use of kinase inhibitors in gastrointestinal stromal tumour.|The expression level of pfetin was immunohistochemically examined in 72 gastrointestinal stromal tumour cases, being correlated with the clinicopathological parameters. Meta-analysis of the prognostic value of pfetin was performed in a total of 371 cases. The prognostic utility of the combination of pfetin and DDX39 was examined in the 72 gastrointestinal stromal tumour cases.|Immunohistochemical study demonstrated the disease-free survival rate to be 94.7% for pfetin-positive patients and 20.0% for pfetin-negative patients among the 72 gastrointestinal stromal tumour cases (P < 0.0001). In the 371 cases, the disease-free survival rate was 93.8% for pfetin-positive patients and 40.6% for pfetin-negative
To determine the effect of allogeneic blood transfusion (ABT) on clinical outcomes in patients with colorectal cancer undergoing surgery.|Perioperative ABTs may be associated with adverse clinical outcomes.|Systematic review of the literature with odds ratio (OR) and incidence rate ratio (IRR) meta-analyses of predefined clinical outcomes based on a MEDLINE search.|In total, 20,795 colorectal cancer (CRC) patients observed for more than 59.2 26.1 months (108,838 patient years) were included, of which 58.8% were transfused. ABT was associated with increased all-cause mortality OR = 1.72 (95% confidence interval [CI] 1.55-1.91, P < 0.001); I(2) = 23.3% (0-51.1) and IRR = 1.31 (1.23-1.39, P < 0.001), I(2) = 0.0% (0-37.0). ABT was also associated with increased ORs (95% CI, P) for cancer-related mortality of 1.71 (1.43-2.05, P <0.001), combined recurrence-metastasis-death 1.66 (1.41-1.97, P < 0.001), postoperative infection 3.27 (2.05-5.20, P < 0.001), and surgical reintervention 4.08
We studied marginal zone B-cell lymphomas of the gastrointestinal tract including seven small cell lymphomas, eight large cell areas of composite lymphomas and 13 large cell variants using SNP array profiling. We found an increase of genomic complexity with lymphoma progression from small to large cytology, and identified gains of prominent (proto) oncogenes such as REL, BCL11A, ETS1, PTPN1, PTEN and KRAS which were found exclusively in the large cell variants. Copy numbers of ADAM3A, SCAPER and SIRPB1 were varying between the three different modes of presentation, hence suggestive for aberrations associated with progression from small to large cell lymphoma. The number of aberrations was slightly higher in the large cell part of composite lymphomas than in large cell lymphomas, suggesting that clonal selection takes place and that composite lymphomas are in a transition state. To further investigate this, we comparatively analyzed samples of two morphologically different regions of
Until now, only imatinib and sunitinib have proven clinical benefit in patients with gastrointestinal stromal tumours (GIST), but almost all metastatic GIST eventually develop resistance to these agents, resulting in fatal disease progression. We aimed to assess efficacy and safety of regorafenib in patients with metastatic or unresectable GIST progressing after failure of at least imatinib and sunitinib.|We did this phase 3 trial at 57 hospitals in 17 countries. Patients with histologically confirmed, metastatic or unresectable GIST, with failure of at least previous imatinib and sunitinib were randomised in a 2:1 ratio (by computer-generated randomisation list and interactive voice response system; preallocated block design (block size 12); stratified by treatment line and geographical region) to receive either oral regorafenib 160 mg daily or placebo, plus best supportive care in both groups, for the first 3 weeks of each 4 week cycle. The study sponsor, participants, and
Celiac disease is an inflammatory condition of the small intestinal mucosa induced by gluten consumption in genetically susceptible individuals, leading to a spectrum of gastrointestinal presentation. A number of autoimmune and other disorders are highly associated with celiac disease. Cardiomyopathy associated with celiac disease has been rarely reported in the literature.|We present a case of a 27-year-old male with one month history of diarrhea, weight loss, fatigue, dyspeptic symptoms, peripheral edema, and cardiac palpitations. After positive serological screening with immunoglobulin A anti-tissue transglutaminase antibody test, the diagnosis of celiac disease was confirmed with histopathology examination of duodenal biopsy specimen. Echocardiographic findings were consistent with acute myocarditis. After common causes of myocarditis had been excluded, probable celiac disease-associated autoimmune myocarditis was diagnosed. The patient was recommended to undergo a strict
23281980 2013 01 03 2013 01 17 1533-4406 368 1 Jan 3 N. Engl. J. Med. 75-6 10.1056/NEJMe1212009 Laine Loren L eng Comment Editorial United States N Engl J Med 0255562 0028-4793 0 Hemoglobins AIM IM N Engl J Med. 2013 Jan 3; 368( 1): 11-21 23281973
The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy.|We enrolled 921 patients with severe acute upper gastrointestinal bleeding and randomly assigned 461 of them to a restrictive strategy (transfusion when the hemoglobin level fell below 7 g per deciliter) and 460 to a liberal strategy (transfusion when the hemoglobin fell below 9 g per deciliter). Randomization was stratified according to the presence or absence of liver cirrhosis.|A total of 225 patients assigned to the restrictive strategy (51%), as compared with 65 assigned to the liberal strategy (15%), did not receive transfusions (P<0.001). The probability of survival at 6 weeks was higher in the restrictive-strategy group than in the liberal-strategy group (95% vs. 91%; hazard ratio for death with restrictive strategy, 0.55; 95% confidence
Reviews the evidence for and against hundreds of preventive health services, recommending tests, and counseling interventions when evidence exists that it is effective.
Reviews the evidence for and against hundreds of preventive health services, recommending tests, and counseling interventions when evidence exists that it is effective.
Reviews the evidence for and against hundreds of preventive health services, recommending tests, and counseling interventions when evidence exists that it is effective.
Primary Care Can't Thrive Without Nurse Practitioners Courtney H. Lyder, ND, May 17, 2013 With a projected shortfall of primary-care physicians, it's time for alternate solutions to patient care. Nurse practitioners are one logical remedy.
Fourteen months of intermittent, foul-smelling, perianal discharge prompted a 45-year-old man to seek medical evaluation. He also complained of occasional bright red rectal bleeding and soreness of the perianal region; he denied fever.
For 3 days, a 30-year-old man had had bilateral flank pain that radiated to the lower abdomen; gross hematuria had accompanied the pain for 1 day.
For 2 days, a 68-year-old woman had watery, yellowish diarrhea with mucus and left lower quadrant pain. Her medical history included hypertension, diabetes mellitus, and congestive heart failure (CHF); she had left the hospital 5 days earlier following treatment of an exacerbation of CHF with intravenous furosemide and sodium and fluid restriction. The patient was taking furosemide, lisinopril, and glipizide; she denied any recent antibiotic therapy.
For many years, a 71-year-old multiparous woman had a painless swelling around her umbilicus that intermittently and spontaneously decreased in size. Progressive, dull pain at the site that had lasted for 7 days prompted her to seek medical evaluation. The patient also noticed recent maceration of the skin on the surface of the affected area.