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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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2015 · Article · Study · Uncategorized

Gastroparesis patient outcomes after 48 weeks

This Article in December issue of Gastroenterology summarizes the findings from the Gastroparesis Clinical Research Consortium (7 tertiary care centers). Out of 262 patients- only 28% had a reduction in symptoms that was significant.

They also tabulated factors that are associated with reduction in symptoms – male sex, older age, infect196681.jpgious prodrome, antidepressant use, and 4-hr retention greater than 20%.

This is bad news for those with gastroparesis. Most importantly there was no difference in those with and without diabetes.

Most notably there is no post-treatment gastric emptying, which would be interesting to see who actually improved, and who just “felt” better, and whether there is a correlation between these.

 

 

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New Approaches to Controlling Health Care Costs

A Commentary in JAMA:Internal Medicine

David Lieberman and John Allen discuss what is probably going to happen to the colonoscopy payment system: – bundling: fixed fee for the anesthesia, pathological analysis, and repeated procedures due to poor bowel preparation.

Currently Centers for Medicare and Medicaid Services waive patient costs associated with anesthesia services (i.e. propofol for all). Some think it is not a great idea from a cost perspective. The authors point out that given focus on quality and patient satisfaction, anesthesia for all cases may not be a bad idea, especially if we enter the bundled payment system.

These are good points, but from a clinical perspective, the quality and patient satisfaction are not exactly two major parameters that enter my mind when it comes to what’s best for patient. Quality is slowly becoming a nebulous term which includes anything from access, cost, etc, and the contribution of clinical indication is rapidly declining in that formula.

And bundled payments may in the end not be so bad, as long as we all share in the costs of this, from primary care to the specialist.

One more thing -“…costly, cost-effective, and well accepted. In some areas, however, charges can vary more than 10-fold for the same services, from approximately $500 to more than $8000.” $8000 for a colonoscopy?  – Where? What kind of a colonoscopy does one get for that much money?

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