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
Uncategorized

Right-sided colonic ischemia with and without acute mesenteric ischemia

One of the most frustrating calls that I remember getting from ED was related to general confusion between colonic ischemia and acute mesenteric ischemia. It would be a resident calling stating that the Lactate is normal, but “all signs point to mesenteric ischemia” even though there is no abdominal pain, stable vitals, and more often than not no co-morbidities, and reassuring imaging. Which drew my attention to this article, which examined patients with biopsy-proven Right-sided Colonic Ischemia alone or in combination with Acute Mesenteric Ischemia(confirmed by imaging or surgical evaluation of small bowel).

Summary:

  1. IRCI + AMI = disaster. Mortality of ~90%.
  2. BUN and WBC count can be used to differentiate those with acute mesenteric ischemia to those without ( BUN would be high – above 35, and WBCs will be high as well  – above 20). Nothing new here, but nice to see this in another study. We already know that CT alone can be used as well.
  3. 15% of cases of Right-sided Colon ischemia will have Acute Mesenteric Ischemia as well – so look for it, since it is such a disaster, with almost all patients undergoing surgical resection of some sort.
  4.  COPD  may be associated with development of AMI, and poor outcomes in Colonic Ischemia in general.

The article is written by the folks from Connecticut as well as Montefiore Hospital, which bailed out my Medical School recently.