Gastroenterology

C. difficile on the rise in outpatient settings

March 03, 2010

A patient's diarrhea or abdominal cramps could be the result of infection with Clostridium difficile. Researchers report that infection with this bacterium is increasing in incidence and severity, particularly in...
 

Irritable bowel syndrome made simple

Carl Sherman February 08, 2010

The authors place particular emphasis on IBS's status as a true disease, as opposed to a figment of the patient's imagination.
 

Guidelines for GERD: A practical approach

By Carl Sherman December 03, 2009

Start with antisecretory drugs, i.e., proton-pump inhibitors, then make medication, dosage, and lifestyle changes to suit the individual patient.
 

Colorectal cancer rising among younger patients

By Myra Dembrow July 13, 2009

New data support current screening recommendations, but family and other history will help you identify which patients need colonoscopy regardless of age.
 

Flu shot creates opportunity for colorectal screening

March 18, 2009

If one group of practitioners has its way, clinicians may find themselves handing out colorectal cancer screening kits along with immunizations next flu season.
 

Diet tips for heart failure, COPD updated

March 11, 2009

Registered dietitians have some new advice for your patients with heart failure or chronic obstructive pulmonary disease, now that the American Dietetic Association has published evidence-based guidelines for providing nutrition treatment to patients with these conditions.
 

Overactive bladder reduced in obese women who lose weight

March 04, 2009

You can add incontinence relief to the list of benefits obese patients gain when they shed pounds, according to a recent NIH-funded clinical trial.
 

Hepatitis C treatment different for Hispanics

March 02, 2009

A new study has found evidence that ethnicity may determine how patients respond to treatment for hepatitis C. In an open-label, nonrandomized trial, Hispanic whites did not fare as well as white patients who were not Hispanic.
 

Iron deficiency anemia in a vegetarian

Question by Cecelia Madrid, MD, Los Angeles; response by Michael Flamm, MD February 25, 2009

What is the best way to treat true iron deficiency anemia in a vegetarian without inducing constipation or epigastric discomfort? I usually recommend that my patients take iron 325 mg with vitamin C 500 mg on an empty stomach, but this is difficult for most people to digest.
 

Positive spin pushes cancer screenings

February 13, 2009

If you want to effectively encourage African American patients to be screened for colon cancer, accentuate the positive. According to new research, emphasizing the risks of late detection can actually make these patients less likely to have the test.
 

More colonoscopies in your future?

By Myra Dembrow January 15, 2009

Primary-care physicians are performing colonoscopies as safely and effectively as specialists, a meta-analysis found. The American College of Gastroenterology disagrees.
 

Colonoscopy less useful in right-side cancer

By Delicia Yard December 17, 2008

A large Canadian study has found that complete colonoscopy is strongly associated with fewer deaths from colorectal cancer that develops on the left side, but the same can't be said when the cancer is located on the right.
 

Antibiotic-induced diarrhea

Submitted by Patricia L. Kress, MD, Eau Claire, Wis. November 21, 2008

To reduce the risk of antibiotic-associated diarrhea, I recommend yogurt with live cultures. The yogurt also helps settle diarrhea after a bout of gastroenteritis....
 

Differences in PPIs

Question asked by Steven Schwartz, MD, Bronx, N.Y., and answered by Christopher Ruser, MD November 21, 2008

Over many years, the difference in cost between omeprazole and some of the other proton-pump inhibitors (PPIs) can add up to thousands of dollars. There seems to be a widespread belief that other PPIs work better. Do they?
 

Recognizing celiac disease when there is no malabsorption

By Carl Sherman November 17, 2008

In more and more cases, celiac disease doesn't look the way you might expect.
 

Unusual epigastric pain and retching

CASE AND ANALYSIS BY EVERETT W. SCHLAM, MD September 30, 2008

Vague symptoms brought this patient to the ED three times before physicians made a rare diagnosis.
 

Colorectal cancer screening: Prevention over detection

By Carl Sherman September 30, 2008

Primary-care physicians play a crucial role in helping patients choose the right test for them.
 

Who should be screened for celiac disease?

Question asked by Nathan W. Keever, DO, and answered by Laura G. Kehoe, MD July 22, 2008

It seems that I am seeing celiac disease diagnosed more frequently. I suspect this is because the antigliadin serology is available, but I worry that this is going to become an attention deficit disorder/fibromyalgia "diagnosis du jour." How good are these tests?
 

Rationale for DRE

Question by Daniel Konold, DO, Canal Winchester, Ohio May 30, 2008

If DRE is not recommended to screen for prostate or colon cancer, why do we do it?
 

Atypical GI symptoms with zoster

Question raised by Frank S. Sutton, MD, Encinitas, Calif. and answered by Cedric W. Spak, MD, MPH May 15, 2008

An 81-year-old man experienced five days of prodromic GI symptoms (distension, hyperactive peristalsis but no diarrhea, no emesis) prior to the onset of left lower-quadrant herpes zoster. The pain, which was unrelated to food intake, appeared to be the result of distension and was relieved by....
 

Colonoscopy for a healthy patient?

Question raised by Joseph R. Arulandu, MD and answered by Michael Flamm, MD April 17, 2008

Does a 50-year-old patient with parents in their 90s, no family history of cancer, and no bowel problems need a colonoscopy?
 

Appendicitis: Toward better diagnosis

By Christina M. Surawicz, MD March 14, 2008

It's a delicate balance: A missed diagnosis can lead to rupture and peritonitis, but 12%-18% of appendectomies are unnecessary.
 

Easing esopageal spasms

Submitted made by Yanina M. Benikova, MD, Portland, Ore. and answered by Daniel G. Tobin, MD May 22, 2007

In most cases, drinking fluid (tea, water, etc.) as hot as possible without burning yourself will relieve painful esophageal spasms in seconds....
 

Thyroid-interferon interaction

Question raised by Butch Tubera, MD, Fort Worth, Tex., and answered by Susan Kashaf, MD, MPH March 14, 2007

A hepatitis C patient being treated with pegylated interferon alfa-2b and ribavirin has a low TSH and free thyroxine of 3.7 ng/dL.
 

High lipids, high liver enzymes

Question raised by Tony Pham, DO, Dallas and answered by Peter F. Cohn, MD February 21, 2007

How should I manage a 62-year-old Hispanic man who has hyperlipidemia and abnormal liver enzymes?
 

A better hemorrhoid treatment?

Question raised by Susan M. Muller, MD, Saratoga Springs, N.Y. and rasied by Daniel G. Tobin, MD September 14, 2006

I have found that anal fissures and inflamed (not thrombosed) external hemorrhoids heal faster with a combination of triamcinolone and nystatin (Mycolog) cream b.i.d. for five days than with hydrocortisone cream, Tucks pads, or sitz baths.
 

CLINICAL PEARL: Another use for fish oil

Topic raised by Craig A. Freyer, MD, Ft. Worth, Tex. and answered by Susan Kashaf, MD, MPH April 18, 2006

 

Effective B12 administration

Question by Robert E. Lowenstein, MD, PhD, Clinton, N.Y.; answer by Susan Kashaf, MD, MPH February 15, 2006

Can oral vitamin B12 supplementation substitute for parenteral administration?
 

Acute diarrhea: When and how to treat

Christina M. Surawicz, MD February 15, 2006

If a bacterium or parasite is involved, you could have a very sick patient on your hands. The earlier treatment begins, the better.
 

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