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By Jeff Bank Internal Medicine R2 at the University of Utah
Douglas J Robertson, Jeffrey K Lee, C Richard Boland, Jason A Dominitz, Francis M Giardiello, David A Johnson, Tonya Kaltenbach, David Lieberman, Theodore R Levin, Douglas K Rex
The use of the fecal occult blood test (FOBT) for colorectal cancer (CRC) screening is supported by randomized trials demonstrating effectiveness in cancer prevention and widely recommended by guidelines for this purpose. The fecal immunochemical test (FIT), as a direct measure of human hemoglobin in stool has a number of advantages relative to conventional FOBT and is increasingly used relative to that test. This review summarizes current evidence for FIT in colorectal neoplasia detection and the comparative effectiveness of FIT relative to other commonly used CRC screening modalities...
October 18, 2016: American Journal of Gastroenterology
Elliot B Tapper, Sameer D Saini, Neil Sengupta
BACKGROUND: Many patients have elevated serum aminotransferases reflecting many underlying conditions, both common and rare. Clinicians generally apply one of two evaluative strategies: testing for all diseases at once (non-directed) or just common diseases first (directed). METHODS: We simulated the evaluation of 10,000 adult outpatients with elevated with alanine aminotransferase to compare both testing strategies. Model inputs employed population-based data from the US (National Health and Nutrition Examination Survey) and Britain (Birmingham and Lambeth Liver Evaluation Testing Strategies)...
October 4, 2016: Journal of Hepatology
Laura Valle
The development of genome-wide massively parallel sequencing, i.e. whole-genome and whole-exome sequencing, and copy number approaches had raised high expectations for the identification of novel hereditary colorectal cancer genes. Although relatively successful for genes causing adenomatous polyposis syndromes, both autosomal dominant and recessive, the identification of genes associated with hereditary non-polyposis colorectal cancer has proven extremely challenging, mainly due to the absence of major high penetrance genes and the difficulty in demonstrating the functional impact of the identified variants and their causal association with tumor development...
October 3, 2016: Clinical Gastroenterology and Hepatology
Julien Tap, Muriel Derrien, Hans Törnblom, Rémi Brazeilles, Stéphanie Cools-Portier, Joël Doré, Stine Störsrud, Boris Le Nevé, Lena Öhman, Magnus Simrén
BACKGROUND AND AIMS: We have limited knowledge about the association between the composition of the intestinal microbiota and clinical features of irritable bowel syndrome (IBS). We collected information on the fecal and mucosa-associated microbiota of patients with IBS and evaluated whether these were associated with symptoms. METHODS: We collected fecal and mucosal samples from adult patients who met the Rome III criteria for IBS at secondary or tertiary care outpatient clinics in Sweden, as well as from healthy subjects...
October 7, 2016: Gastroenterology
Shanti L Eswaran, William D Chey, Theresa Han-Markey, Sarah Ball, Kenya Jackson
OBJECTIVES: There has been an increasing interest in the role of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) in irritable bowel syndrome (IBS). We report results from the first randomized controlled trial of the low FODMAP diet in US adults with IBS and diarrhea (IBS-D). The objectives were to compare the efficacy of the low FODMAP diet vs. a diet based upon modified National Institute for Health and Care Excellence guidelines (mNICE) on overall and individual symptoms in IBS-D patients...
October 11, 2016: American Journal of Gastroenterology
Qi Chen, Wei Zhang, Qingyan Fu, Xiao Liang, Wenzhong Liu, Shudong Xiao, Hong Lu
OBJECTIVES: To compare the efficacy and safety of bismuth-containing quadruple therapy with tetracycline or amoxicillin for rescue treatment of Helicobacter pylori. METHODS: The study was a non-inferiority trial of H. pylori eradication with at least two previous treatment failures. Subjects were randomized to receive 14-day therapy with b.i.d. lansoprazole 30 mg and bismuth 220 mg, plus metronidazole 400 mg q.i.d and amoxicillin 1 g t.i.d (amoxicillin group) or tetracycline 500 mg q...
September 27, 2016: American Journal of Gastroenterology
Christophe Bureau, Dominique Thabut, Frédéric Oberti, Sébastien Dharancy, Nicolas Carbonell, Antoine Bouvier, Philippe Mathurin, Philippe Otal, Pauline Cabarrou, Jean Marie Péron, Jean Pierre Vinel
BACKGROUND & AIMS: There is controversy over the ability of transjugular intrahepatic portosystemic shunts (TIPS) to increase survival times of patients with cirrhosis and refractory ascites. The high rate of shunt dysfunction with the use of uncovered stents counteracts the benefits of TIPS. We performed a randomized controlled trial to determine the effects of TIPS with stents covered with polytetrafluoroethylene in these patients. METHODS: We performed a prospective study of 62 patients with cirrhosis and at least 2 large volume paracenteses within a period of at least 3 weeks; the study was performed at 4 tertiary care centers in France from August 2005 through December 2012...
September 20, 2016: Gastroenterology
Sumant Inamdar, Dennis Han, Monica Passi, Divyesh V Sejpal, Arvind J Trindade
BACKGROUND AND AIMS: Rectal indomethacin is a popular chemopreventive agent to help prevent post-ERCP pancreatitis (PEP). Prior meta-analyses have shown an overall protective effect for PEP in average-risk and high-risk patients. However these meta-analyses are limited by a small number of studies. Recently, more trials have been published addressing this issue. The aim is to determine if rectal indomethacin prevents PEP in average-risk and high-risk groups, after incorporating this new data...
September 6, 2016: Gastrointestinal Endoscopy
Thierry Thévenot, Charline Briot, Vincent Macé, Hortensia Lison, Laure Elkrief, Alexandra Heurgué-Berlot, Christophe Bureau, Caroline Jézéquel, Ghassan Riachi, Alexandre Louvet, Arnaud Pauwels, Isabelle Ollivier-Hourmand, Rodolphe Anty, Nicolas Carbonell, Hélène Labadie, Karim Aziz, Denis Grasset, Eric Nguyen-Khac, Mehdi Kaassis, Sofia Hermann, Florence Tanné, Thomas Mouillot, Olivier Roux, Aurélie Le Thuaut, Jean-Paul Cervoni, Jean-François Cadranel, Matthieu Schnee
OBJECTIVES: We aimed to assess the performance of a new strip (Periscreen) for the rapid diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: Ascitic fluid (AF) of cirrhotic patients hospitalized between March 2014 and August 2015 was independently tested by two readers using the new strip, which has four colorimetric graduations (negative, trace, small, and large). SBP was diagnosed on neutrophils in ascites>250/mm(3). Ascites not related to portal hypertension were excluded...
October 2016: American Journal of Gastroenterology
Manon C W Spaander, Todd H Baron, Peter D Siersema, Lorenzo Fuccio, Brigitte Schumacher, Àngels Escorsell, Juan-Carlos Garcia-Pagán, Jean-Marc Dumonceau, Massimo Conio, Antonella de Ceglie, Janusz Skowronek, Marianne Nordsmark, Thomas Seufferlein, André Van Gossum, Cesare Hassan, Alessandro Repici, Marco J Bruno
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations for malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliative treatment of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass (strong recommendation, high quality evidence)...
October 2016: Endoscopy
Amy E Thompson
No abstract text is available yet for this article.
September 13, 2016: JAMA: the Journal of the American Medical Association
Francis K L Chan, Moe Kyaw, Tetsuya Tanigawa, Kazuhide Higuchi, Kazuma Fujimoto, Pui Kuan Cheong, Vivian Lee, Yoshikazu Kinoshita, Yuji Naito, Toshio Watanabe, Jessica Y L Ching, Kelvin Lam, Angeline Lo, Heyson Chan, Rashid Lui, Raymond S Y Tang, Yasuhisa Sakata, Yee Kit Tse, Toshihisa Takeuchi, Osamu Handa, Hiroko Nebiki, Justin C Y Wu, Takashi Abe, Tsuyoshi Mishiro, Siew C Ng, Tetsuo Arakawa
BACKGROUND & AIMS: It is not clear whether H2-receptor antagonists (H2RAs) reduce the risk of gastrointestinal (GI) bleeding in aspirin users at high risk. We performed a double-blind randomized trial to compare the effects of a proton pump inhibitor (PPI) vs a H2RA antagonist in preventing recurrent upper gastrointestinal (GI) bleeding and ulcers in high-risk aspirin users. METHODS: We studied 270 users of low-dose aspirin (325 mg or less per day) with a history of endoscopically confirmed ulcer bleeding at 8 sites in Hong Kong and Japan...
September 15, 2016: Gastroenterology
Edoardo Savarino, Manuele Furnari, Andrea Ottonello, Vincenzo Savarino
No abstract text is available yet for this article.
September 2016: American Journal of Gastroenterology
Douglas G Adler, Linda Jo Taylor, Tyler McVay, Madeleine Birch, Gloria Francis, Andrew Zabolotsky, Sobia N Laique, Umar Hayat, Tingting Zhan, Ali A Siddiqui
INTRODUCTION: Postsurgical or traumatic bile duct leaks (BDLs) can be safely and effectively managed by endoscopic therapy via ERCP. The early diagnosis of BDL is important because unrecognized leaks can lead to serious adverse events. Our aim was to evaluate the relationship between timing of endotherapy after BDL and the clinical outcomes, adverse events, and long-term results of endoscopic therapy. METHODS: We conducted a multicenter, retrospective study on patients with BDLs who underwent ERCP between 2006 and 2014...
August 25, 2016: Gastrointestinal Endoscopy
Sang G Kim, Tae Y Kim, Joo H Sohn, Soon H Um, Yeon S Seo, Soon K Baik, Moon Y Kim, Jae Y Jang, Soung W Jeong, Bora Lee, Young S Kim, Ki T Suk, Dong J Kim
OBJECTIVES: Propranolol has been used as prophylaxis for variceal bleeding in patients with cirrhosis. More recent data suggest that carvedilol may be more effective for reducing the hepatic venous pressure gradient (HVPG) than propranolol. The primary aim of this study was to evaluate the hemodynamic response to carvedilol compared with propranolol. METHODS: A total of 110 patients with a baseline HVPG value >12 mm Hg were allocated randomly to receive either carvedilol or propranolol...
August 30, 2016: American Journal of Gastroenterology
David M Faleck, Hojjat Salmasian, E Yoko Furuya, Elaine L Larson, Julian A Abrams, Daniel E Freedberg
OBJECTIVES: Patients in the intensive care unit (ICU) frequently receive proton pump inhibitors (PPIs) and have high rates of Clostridium difficile infection (CDI). PPIs have been associated with CDI in hospitalized patients, but ICU patients differ fundamentally from non-ICU patients and few studies have focused on PPI use exclusively in the critical care setting. We performed a retrospective cohort study to determine the associations between PPIs and health-care facility-onset CDI in the ICU...
August 30, 2016: American Journal of Gastroenterology
Anthony Lembo, Mark Pimentel, Satish S Rao, Philip Schoenfeld, Brooks Cash, Leonard B Weinstock, Craig Paterson, Enoch Bortey, William P Forbes
BACKGROUND AND AIMS: Few treatments have demonstrated efficacy and safety for diarrhea-predominant irritable bowel syndrome (IBS-D). A phase 3, randomized, double-blind, placebo-controlled trial was performed to evaluate the safety and efficacy of repeat treatment with the nonsystemic antibiotic rifaximin. METHODS: The trial included adults with IBS-D, mean abdominal pain and bloating scores of 3 or more, and loose stool, located at 270 centers in the United States and Europe from February 2012 through June 2014...
August 12, 2016: Gastroenterology
Alexandra Feldman, Sebastian K Eder, Thomas K Felder, Lyudmyla Kedenko, Bernhard Paulweber, Andreas Stadlmayr, Ursula Huber-Schönauer, David Niederseer, Felix Stickel, Simon Auer, Elisabeth Haschke-Becher, Wolfgang Patsch, Christian Datz, Elmar Aigner
OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is closely linked to obesity; however, 5-8% of lean subjects also have evidence of NAFLD. We aimed to investigate clinical, genetic, metabolic and lifestyle characteristics in lean Caucasian subjects with NAFLD. METHODS: Data from 187 subjects allocated to one of the three groups according to body mass index (BMI) and hepatic steatosis on ultrasound were obtained: lean healthy (BMI≤25 kg/m(2), no steatosis, N=71), lean NAFLD (BMI≤25 kg/m(2), steatosis, N=55), obese NAFLD (BMI≥30 kg/m(2), steatosis; N=61)...
August 16, 2016: American Journal of Gastroenterology
Joseph Mermelstein, Alanna Chait Mermelstein, Maxwell M Chait
Gastroesophageal reflux disease is the most common upper gastroenterology disorder in the US. It is associated with a variety of complications and significantly impacts quality of life. Proton pump inhibitors are the most effective treatment. Dexlansoprazole modified release (MR) is a proton pump inhibitor that employs a novel release formulation that prolongs its absorption and allows for more flexibility in dosing. Dexlansoprazole MR can be dosed without regard to food intake or time of day, and once-daily dosing may replace twice-daily dosing of other agents...
2016: Clinical and Experimental Gastroenterology
Gitte Dam, Hendrik Vilstrup, Hugh Watson, Peter Jepsen
UNLABELLED: Proton pump inhibitors (PPIs) may be a risk factor for hepatic encephalopathy (HE) in patients with cirrhosis, possibly through translocation of gut bacteria, which can also lead to spontaneous bacterial peritonitis (SBP). We examined the associations between PPIs and development of HE or SBP in patients with cirrhosis with ascites. We used data from three 1-year trials of satavaptan for ascites control. We used Cox regression to compare HE and SBP rates between users and nonusers of PPIs...
October 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
2016-08-13 00:24:08
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