- Treatment with Biologic Agents has not Reduced Surgeries among Patients with Crohn’s Disease with Short Bowel Syndrome – CGH
- Risk of colorectal cancer in chronic liver diseases: a systematic review and meta-analysis – GIE
- Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection among Metabolically Healthy Obese Adults – JAMA Internal Medicine
- Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis – GIE
- Mobile phone in the stomach:call the emergency endoscopist! – GIE
- Impact of gum chewing on the quality of bowel preparation for colonoscopy: an endoscopist-blinded, randomized controlled trial – GIE
- Hepatitis B reactivation in Hepatitis B and C coinfected Patients treated with Antiviral Agents: A systematic Review and Meta-analysis. – Hepatology
- Gastostomies Preserve But Do Not Increease Quality of Life for Patients and Caregivers – CGH
- “Errare Humanum Est, Perseverare Autem Diabolicum” – Gastro
- Association of Changes in Diet Quality with Total and Cause-Specific Mortality – NEJM
- Association Between Proton Pump Inhibitor Use and Cognitive Function in Women – Gastro
- Increased Rate of Adenoma Detection Associates with Reduced Risk of Colorectal Cancer and Death – Gastro
- Risk Factors for 30-day Hospital Readmission for Diverticular Hemorrhage. – J of Clinical Gastro
- Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis – CGH
- Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010 – CGH
- Fecal Immunochemical Test Detects Sessile Serrated Adenomas and Polyps With a Low Level of Sensitivity – CGH
- Comparison of Two Intensive Bowel Cleansing Regimens in Patients With Previous Poor Bowel Preparation: A Randomized Controlled Study. – GIE
- Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management – ACG
- Disentangling the Association between Statins, Cholesterol, and Colorectal Cancer: A Nested Case-Control Study – PLOS Medicine
- Association of Gastric Acid Suppression With Recurrent Clostridium difficile InfectionA Systematic Review and Meta-analysis – JAMA Internal Med
- Amanita phalloides Mushroom Poisonings — Northern California, December 2016 – MMWR June 2017
- Wild Mushrooms: An Exclusive Delicacy or Last Meal – ACG
- Treatment of NASH: What Helps Beyond Weight Loss? – ACG
- Small intestinal bacterial overgrowth and Celiac disease: A systematic review with pooled-data analysis – Neurogastro & Motility
This one is a bit noisy. Not the Best Microphone. Sorry.
List of articles cited
- Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis NEJM
- Thiazolidinediones and Advanced Liver Fibrosis in Nonalcoholic Steatohepatitis – Jama Internal Medicine
- Tenapanor Treatment of Patients With Constipation-Predominant Irritable Bowel Syndrome: A Phase 2, Randomized, Placebo-Controlled Efficacy and Safety Trial The AmJ of Gastro
Medication Management in the Pregnant IBD Patient The AmJ of Gastro
Central Neuromodulators for Treating Functional GI Disorders: A Primer The AmJ of Gastro
I have read this article back in July, and immediately found it interesting. One reason is that it is (albeit a poor one) an example of the use of “Big Data” type analysis where a large database of patient biopsy specimens can be searched.
Second reason – is the actual clinical finding – less polyps than expected in those with microscopic colitis – prevalence of ALL types of polyps was reduced.
Summary: 130,000 patients with symptoms of diarrhea had a colonoscopy with biopsies. Compared with 97,000 control cases. So, in this CASE-CONTROL study for patients with workup of diarrhea – less polyps (Odds ratios = 0.46 for hyperplastic, 0.24for serrated adenomas, and 0.35 for tubular adenomas).
Criticism: It would have been nice if the authors have age-matched the cases one for one from the beginning, even though these were adjusted for. There is no duration of disease, so the mechanism would remain elusive. Although it would be interesting to have someone do a database review of patients whose clinical history is known. It can even be compared to the current study, if the data is available, i.e. authors had 14% of colons have polyps in normals, and 8.3% in microscopic colitis, is there an influence of disease duration or is this an all or none phenomenon?
I don’t know about you, but during my fellowship thus far, I’ve only done one or two cases where the patient was positioned on the right side. Both were ICU/CCU cases, and both times we’ve reached the cecum without an issue. Positioning in those cases was difficult secondary to all the cardiac/ICU hardware the patient was hooked up to.
This study, which is amazing to see, since it actually examines a commonly held practice, something arose more from tradition/long held beliefs, rather than evidence. There aren’t that many studies that actually go and do that.
The authors have found that right-sided positioning at the start of the colonoscopy results in a better, quicker, more comfortable procedure. N was about 80 for both arms, and about 75 cases were analyzed in post. Primary outcome was time to reach cecum.
Conclusion – 3 min and 33 seconds (30%) shorter if starter on the right side. Benefit stems largely from improved negotiation of the sigmoid.
Of note, there is a figure in the text, Figure 5, which shows how terrible fellows like me are at doing endoscopy in terms of time to cecal intubation. Also, shows that the dramatic reduction in time to cecum happens not after 500 colonoscopies, but after 5000 colonoscopies!
We need more of these kinds of studies. The types that test “tried and true” practices, simple design, simple conclusions.