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
This condition is characterized by
a localized narrowing of the jejunum
without a disruption of continuity
or defect in the mesentery. At the
stenotic site, there is often a short,
narrow segment with a minute lumen
where the muscularis is irregular
and the submucosa is thickened.
The resultant intestinal obstruction
is incomplete.
This condition involves the invagination of a proximal
segment of bowel (the intussusceptum) into a more distal
segment (the intussuscipiens) (A). It occurs most
frequently in infants between the ages of 5 and 12
months and is a leading cause of intestinal obstruction
in children aged 2 months to 5 years. Intrauterine intussusception
is associated with the development of intestinal
atresia. The male to female ratio is approximately
3:2. Intussusception is slightly more common in white
than in black children and is often seen in children
with cystic fibrosis.
This obstruction is caused by a failure of intestinal peristalsis;
there is no evidence of mechanical obstruction.
Paralytic ileus is common after abdominal surgery, especially
if anticholinergic drugs are given preoperatively
and/or narcotics are used postoperatively. It usually lasts
2 to 3 days. Paralytic ileus may also be caused by peritonitis;
ischemia or surgical manipulation of the bowel; retroperitoneal
hemorrhage; spinal fracture; systemic sepsis;
shock; hypokalemia; uremia; pharmacologic agents (eg,
vincristine, loperamide, and calcium channel blockers);
diabetic ketoacidosis; and myxedema.
Persistent bloating, epigastric discomfort, and increased gastric acidity prompted a 47-year-old woman to seek medical care. Gastroesophageal reflux disease was diagnosed; antacids and H2-blockers were prescribed but provided no relief.
This obstruction results from hypertrophy
of the circular and longitudinal
muscularis of the pylorus and the distal
antrum of the stomach. It occurs
in approximately 3 of every 1000 live
births and is 4 times more common
in boys. Pyloric stenosis (PS) is relatively
uncommon in African American
and Asian infants. The observation
that it occurs primarily in first-born
infants has been disputed.
This disorder occurs in fetal development,
when the midgut supplied by
the superior mesenteric artery grows
too rapidly to be accommodated in
the abdominal cavity. Prolapse into
the umbilical cord occurs around the
sixth week of gestation. Between the
tenth and eleventh weeks, the midgut
retracts from its location at the exocelomic
umbilical stalk back into the
abdominal cavity. During this return,
the midgut undergoes a 270-degree
counterclockwise rotation about the
axis of the superior mesenteric artery,
followed by fixation to the posterior
abdominal wall. Malrotation
results from failure of the midgut to
properly rotate and affix itself to this
wall. This disorder occurs approximately
once in 500 live births.
Adhesions (A) can form within the
peritoneal cavity after abdominal
surgery, especially if there is an underlying
inflammatory condition such
as appendicitis (B) or inflammatory
bowel disease. The incidence of adhesive
intestinal obstruction following a
laparotomy is approximately 2%. Most
adhesive obstructions occur within 3
months of the laparotomy, and 80%
occur within 2 years. Adhesive obstructions
tend to be more common
in children than in adults.
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.
Key Differences between FQHCs and RHCs Chastity Werner, RHIT, June 13, 2013 FQHCs and RHCs take up a unique niche among physician practices. And that affects compensation and billing.
Improving Care Coordination in Your Practice Susanne Madden, June 12, 2013 Practices are feverishly working to control the rising costs of healthcare - effective care coordination can help.
Refunding Overpayments: Two Options for Medical Practices Ericka L. Adler, June 12, 2013 Medicare and Medicaid providers must return overpayments once identified. Here are two different refund approaches for practices to consider when necessary.
iPad Alternatives for Mobile Physicians Marisa Torrieri, June 11, 2013 As more physicians are seeing the merits of media tablets, the market is expanding, too.
A 72-year-old man presented after several months of dyspepsia and 1 day of hematemesis. He was not taking NSAIDs.
Persistent bloating, epigastric discomfort, and increased gastric acidity prompted a 47-year-old woman to seek medical care. Gastroesophageal reflux disease was diagnosed; antacids and H2-blockers were prescribed but provided no relief.
A 75-year-old woman had a 1-year history of an anal protrusion, bloodstained mucus discharge, and anal incontinence of flatus and loose stools.
24-year-old woman had experienced perianal itching and a small amount of rectal bleeding for 6 months. She also complained of a perianal protrusion.