2017 · CGH · Podcast

GI Pearls – September 15-30 2017 – Episode 10

Show Notes for September 15-30, 2017  Episode 010
  1. Global Burden of Disease Study 2016 – Lancet
  2. Proton Pump Inhibitors Decrease Phlebotomy Need in HFE Hemochromatosis: Double-Blind Randomized Placebo-Controlled Trial – Gastro
  3. Influence of Age and Eosinophilic Esophagits on Esophageal Distensibility in a Pediatric cohort – Am J Gastro
  4. Long-Term CRC Incidence After Negative Colonoscopy in the State of Utah: Teh effect of Family History. – Am J Gastro
  5. Fecal Incontinence Is associated with Mortality Among Older Adults with Complex Needs – Am J Gastro
  6. Screening for Occult Cancer in Patients with Unprovoked Venous Thromboembolism – Annals of IM
  7. The Durability of Antireflux Surgery – JAMA
  8. Association of prophylactic endotracheal intubation in critically ill patients with upper GI bleeds and cardiopulmonary unplanned events – GIE
  9. Age of red cells for transfusion and outcomes in critically ill adults. – NEJM
  10. The Natural History of Sever Acute Liver Injury – Am J Gastro
  11. Esophageal Dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis – GIE
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2017 · Podcast

GI Pearls – September 1-15 2017 – Episode 9

Show Notes for September 1-15 2017  Episode 009
  1. Asthma Is Associated With Subsequent Development of Inflammatory Bowel Disease: A Population-based Case–Control Study  – CGH
  2. Laboratory predictors of bleeding and the effect of platelet and RBC transfusions on bleeding outcomes in the PLADO trial – Blood
  3. Therapeutic endoscopy-related GI bleeding and thromboembolic events in patients using warfarin or direct oral anticoagulants: results from a large nationwide database analysis – Gut
  4. Major Bleeding Risk During Anticoagulation with Warfarin, Dabigatran, Apixaban, or Rivaroxaban in Patients with Nonvalvular Atrial Fibrillation. – J of Managed Care & Spec Pharm
  5. Oral administration of conditioned medium obtained from mesenchymal stem cell culture prevents subsequent stricture formation after esophageal submucosal dissection in pigs. – GIE
  6. High Dietary Intake of Specific Fatty Acids Increases Risk of Flares in Patients With Ulcerative Colitis in Remission During Treatment With Aminosalicylates – CGH
  7. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Inherited Polyposis Syndromes – Dis of Col and Rectum.
  8. Measurement Bias of Polyp Size at Colonoscopy – Dis of Col and Rectum.
  9. Chronic Pancreatitis and Pancreatic Cancer Risk: A Systematic Review and Meta-analysis – Am J Gastro.
  10. Rural and Urban Residence During Early Life is Associated with Risk of Inflammatory Bowel Disease – AmJGastro
  11. What’s new in Rome IV – Neurogastro & Motility
  12. Fecal Calprotectin Levels Predict Histological Healing in Ulcerative Colitis – IBD Journal
  13. Weight and Metabolic Outcomes 12 Years after Gastric Bypass – NEJM
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Uncategorized

GI Pearls Episode 6 – First two weeks of July 2017 Gastroenterology Literature Review

Show Notes for 2017 First two weeks of July 006
  1. Treatment with Biologic Agents has not Reduced Surgeries among Patients with Crohn’s Disease with Short Bowel Syndrome – CGH
  2. Risk of colorectal cancer in chronic liver diseases: a systematic review and meta-analysis – GIE
  3. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection among Metabolically Healthy Obese Adults – JAMA Internal Medicine
  4. Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis – GIE
  5. Mobile phone in the stomach:call the emergency endoscopist! – GIE
  6. Impact of gum chewing on the quality of bowel preparation for colonoscopy: an endoscopist-blinded, randomized controlled trial – GIE
  7. Hepatitis B reactivation in Hepatitis B and C coinfected Patients treated with Antiviral Agents: A systematic Review and Meta-analysis. – Hepatology
  8. Gastostomies Preserve But Do Not Increease Quality of Life for Patients and Caregivers – CGH
  9. “Errare Humanum Est, Perseverare Autem Diabolicum” – Gastro
  10. Association of Changes in Diet Quality with Total and Cause-Specific Mortality – NEJM
  11. Association Between Proton Pump Inhibitor Use and Cognitive Function in Women – Gastro
  12. Increased Rate of Adenoma Detection Associates with Reduced Risk of Colorectal Cancer and Death – Gastro
  13. Risk Factors for 30-day Hospital Readmission for Diverticular Hemorrhage. – J of Clinical Gastro
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2017 · CGH · Podcast · Study

GI Pearls Episode 5 – Last two weeks of June 2017

Show Notes for 2017 Second two weeks of June 005
  1. Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis – CGH
  2. Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010 – CGH
  3. Fecal Immunochemical Test Detects Sessile Serrated Adenomas and Polyps With a Low Level of Sensitivity – CGH
  4. Comparison of Two Intensive Bowel Cleansing Regimens in Patients With Previous Poor Bowel Preparation: A Randomized Controlled Study. – GIE
  5. Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management – ACG
  6. Disentangling the Association between Statins, Cholesterol, and Colorectal Cancer: A Nested Case-Control Study – PLOS Medicine
  7. Association of Gastric Acid Suppression With Recurrent Clostridium difficile InfectionA Systematic Review and Meta-analysis – JAMA Internal Med
  8. Amanita phalloides Mushroom Poisonings — Northern California, December 2016 – MMWR June 2017
  9. Wild Mushrooms: An Exclusive Delicacy or Last Meal – ACG
  10. Treatment of NASH: What Helps Beyond Weight Loss? – ACG
  11. Small intestinal bacterial overgrowth and Celiac disease: A systematic review with pooled-data analysis – Neurogastro & Motility
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2017 · CGH · Podcast

GI Pearls Episode 2 – First two weeks of May 2017

Show Notes for 2017 May 1- 15 002

 This one is a bit noisy. Not the Best Microphone. Sorry. 

List of articles cited

  1. Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis NEJM
  2. Thiazolidinediones and Advanced Liver Fibrosis in Nonalcoholic Steatohepatitis  – Jama Internal Medicine
  3. Tenapanor Treatment of Patients With Constipation-Predominant Irritable Bowel Syndrome: A Phase 2, Randomized, Placebo-Controlled Efficacy and Safety Trial  The AmJ of Gastro
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2015 · Article · Case-Control

Unexpected reduction in polyp numbers in Chronic Inflammatory conditions of the Colon

Tubular_adenoma_4_low_magI 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?

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Study

ROLCOL – Right or Left-sided starting position in colonoscopy

110405-N-KA543-028 SAN DIEGO (April 5, 2011) Hospitalman Urian D. Thompson, left, Lt. Cmdr. Eric A. Lavery and Registered Nurse Steven Cherry review the monitor while Lavery uses a colonoscope on a patient during a colonoscopy at Naval Medical Center San Diego. (U.S. Navy photo by Mass Communication Specialist 2nd Class Chad A. Bascom/Released) 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.

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