Latest Findings Archives

2011

December 2011

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Featured Articles:

  • The Impact of the Quality of Colon Preparation on Follow-Up Colonoscopy Recommendations | Abstract
  • Association Between the Use of Antibiotics and New Diagnoses of Crohn’s Disease and
    Ulcerative Colitis | Abstract
  • Incidence, Prevalence, and Survival of Chronic Pancreatitis: A Population-Based Study | Abstract

November 2011

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Featured Articles:

  • Gastroesophageal Reflux Symptoms and Comorbid Asthma and Posttraumatic Stress Disorder Following the 9/11 Terrorist Attacks on World Trade Center in New York City | Abstract
  • Increased Screening Colonoscopy Rates and Reduced Racial Disparities in the New York Citywide Campaign: An Urban Model | Abstract
  • Is Diabetes Mellitus an Independent Risk Factor for Colon Cancer and Rectal Cancer? | Abstract

October 2011

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Featured Articles:

  • Severity in Irritable Bowel Syndrome: A Rome Foundation Working Team Report | Abstract
  • A Novel Method for the Nonradiological Assessment of Ineffective Swallowing | Abstract
  • A Randomized Placebo-Controlled Phase IIb Trial of A3309, A Bile Acid Transporter Inhibitor, for Chronic Idiopathic Constipation | Abstract

Special Supplement:

Abstracts Submitted for the 76th Annual Scientific Meeting of the American College of Gastroenterology
Washington, DC, October 28–November 2, 2011

Full Table of Contents

September 2011

Full Table of Contents

Featured Articles:

  • Mindfulness Training Reduces the Severity of Irritable Bowel Syndrome in Women: Results of a Randomized Controlled Trial | Abstract
  • High-Dose Ursodeoxycholic Acid Is Associated With the Development of Colorectal Neoplasia in Patients With Ulcerative Colitis and Primary Sclerosing Cholangitis | Abstract
  • The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD With the European Crohn’s and Colitis Organisation: Safety | Abstract

August 2011

Full Table of Contents

Featured Articles:

  • Queue Position in the Endoscopic Schedule Impacts Effectiveness of Colonoscopy | Abstract
  • Adenoma Detection Rate Is Not Influenced by the Timing of Colonoscopy When Performed in Half-Day Blocks | Abstract
  • Internet-Delivered Exposure-Based Treatment vs. Stress Management for Irritable Bowel Syndrome: A Randomized Trial | Abstract

July 2011

Table of Contents

Colorectal Cancer Screening and Surveillance in the Elderly Patient
Lukejohn W. Day, MD, University of California, San Francisco
Abstract
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Summary: Older age is associated with a rise in colorectal cancer and adenomas, necessitating the need for CRC screening in older patients. But decisions about CRC screening and surveillance in older adults are often difficult and challenging. This review addresses the factors unique to colorectal cancer and performing colonoscopy in older adults that are relevant in weighing the risks and benefits of screening and surveillance in this population.

The review found that after a screening colonoscopy, the detection of recurrent CRC and adenomas is unaffected by age highlighting that current guidelines for surveillance do not need alteration based on age. At certain ages it appears that the risks and increased resources used outweigh the potential benefits to the older patient. Furthermore, comorbid medical conditions, of which older patients have a higher burden of, have an important role in CRC screening as patients with more severe and a greater number of comorbidities have less benefit from screening.

The review concluded that the decision to screen elderly patients requires an individualized assessment that incorporates factors unique to performing colonoscopy in older adults in order to weigh the risks and benefits for each patient according to their overall health and preferences. Factoring into the decision-making process about whether to purse colonoscopy in older patients include the associated complication with the procedure, as older patients are at greater risk especially with respect to perforation, bleeding and cardiovascular/pulmonary complications. Other factors include technical ones associated with colonoscopy, such as the patient’s ability to achieve a successful bowel prep and completion rates—which vary widely in older patients.

Non-Steroidal Anti-Inflammatory Drugs and Colorectal Cancer Risk in a Large, Prospective Cohort
Elizabeth H. Ruder, PhD, MPH, National Cancer Institute, Rockville, Maryland
Abstract
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Summary: Use of non-steroidal anti-inflammatory drugs (NSAIDs) has been inversely associated with colorectal cancer; however, the association within colorectal subsites or among higher risk individuals is understudied. In this study, researchers investigated NSAID use and colorectal adenocarcinoma by subsite, and among individuals with a family history of colon cancer in the National Institutes of Health-AARP Diet and Health Study.

In this large prospective study with 2,605,35 people over a 10-year follow-up, use of any NSAIDS was associated with a 20% reduced risk of colorectal cancer. Furthermore, increased frequency of use of both classes of NSAIDS was associated with lower risks across anatomic subsites of the colorectum. Within individuals with a first-degree relative with a history of colon cancer, daily aspirin use was associated with a 40% reduction in rectal cancer risk, and weekly (defined as 1-2 times per week to 5-6 times per week) or daily use of non-aspirin NSAIDS reduced the risk of proximal colon cancer by 46 and 56% respectively.

The results of the study suggest weekly or daily use of NSAIDS is associated with colorectal cancer protection in the general population, as well as in individuals with a first-degree relative with colon cancer. The strength of the association varies by drug class, but generally a dose-response relationship is observed between frequency of use and cancer protection. The potential harms associated with NSAID use must be considered before translating these results into clinical practice.

Characteristics of Acute Pain Attacks in Patients With Irritable Bowel Syndrome Meeting Rome III Criteria
Per M. Hellström, MD, PhD, Uppsala University, Sweden
Yuri A. Saito, MD, MPH, Mayo Clinic, Rochester, Minnesota
Abstract
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Summary: An international multicenter, prospective, non-interventional, 2-month study characterized acute pain attacks in patients with irritable bowel syndrome (IBS). This study is the first longitudinal study that has assessed characteristics of pain attacks in IBS patients, according to the study authors. Specifically, researchers aimed to characterize the frequency, duration and intensity of acute pain attacks; to determine patient behaviors during pain attacks; to assess how attacks interfere with daily activities in patients from Western countries and; and to compare characteristics across IBS subtypes.

This observational study supports that pain attacks are frequently reported by patients and are a significant cause of disruption of daily activities. Current available treatments for IBS pain are not effective in treating acute pain attacks as so few patients in this study manage their pain attacks with medication despite the prolonged duration of these attacks, according to the findings. Researchers concluded that given the incidence, duration, and intensity of acute pain attacks regardless of IBS subtype, and lack of effective medication use, pain attack treatment is an unmet need and should be a major focus of IBS management.

June 2011

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Association Between Visual Gaze Patterns and Adenoma Detection Rate During Colonoscopy
Abstract
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Summary: Eye gaze tracking (EGT) technology follows a person’s gaze and records the resulting visual gaze pattern (VGP). Adenoma detection rate (ADR) is a validated measure of colonoscopy quality. Higher ADRs are associated with prolonged withdrawal times and other endoscopic maneuvers that allow a better visualization of the mucosa; however, the influence of VGP has yet to be explored. This study aimed to quantify the VGP for endoscopists observing colonoscopy videos and describe the association between VGP and ADR. The study also evaluated the relationship between VGP and the endoscopists’ years of experience.The results show a positive correlation between ADR and central VGP. High adenoma detectors tended to focus on the central portion of the screen, whereas low adenoma detectors moved their gaze more broadly across the screen. The study also found that the more experienced endoscopists spent a lower percentage of time focusing on the central VGP.

Researchers said that if the results of this pilot study are confirmed in a larger sample, these data can be used to retrain low ADR endoscopists and test whether this improves colonoscopy quality.

Small Bowel Homing T Cells Are Associated With Symptoms and Delayed Gastric Emptying in Functional Dyspepsia
Abstract
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Summary: Immune activation may have an important pathogenic role in irritable bowel syndrome (IBS). While little is known about immunologic function in functional dyspepsia (FD), researchers have observed an association between cytokine secretion by peripheral blood mononuclear cells (PBMCs) and symptoms in IBS. Upper gastrointestinal inflammatory diseases are characterized by enhanced small bowel homing ?4-, ?7-integrin, chemokine receptor 9 (CCR9) positive T lymphocytes. In this study, researchers aimed to (i) compare cytokine release in FD and healthy controls (HCs), (ii) quantify “gut homing” T cells in FD compared with HC and patients with IBS, and (iii) correlate the findings to symptom severity and gastric emptying. This study found an association of systemic cellular immune activation with symptom manifestation in patients with functional dyspepsia. Overall delayed gastric emptying and higher intensity of pain, cramps, nausea, and vomiting but not fullness or satiety were associated with increased cytokine levels and CD4+?4?7+CCR9+ small bowel homing T lymphocytes. Researchers also said that these observations may help identify biomarkers and have treatment implications in functional dyspepsia.

Methylation of NEUROG1 in Serum Is a Sensitive Marker for the Detection of Early Colorectal Cancer
Abstract
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Summary: Colorectal cancer is the third most common cancer and a major cause of cancer-related deaths. Early detection of colonic lesions can reduce the incidence and mortality of colorectal cancer. Colonoscopy is the screening test for colorectal cancer with the highest efficacy, but its acceptance in the general public is rather low. To identify suitable tumor-derived markers that could detect colorectal cancer in blood samples, researchers analyzed the methylation status of a panel of genes in sera of affected patients.Researchers found that NEUROG1 DNA methylation represents a suitable diagnostic serum marker that discriminates between healthy individuals and individuals with colorectal cancer at early stages. Healthy persons have very low levels of methylated NEUROG1 DNA in their sear; however, there is a significant increase in methylated NEUROG1 in serum of patients with colorectal cancer. This change in the NEUROG1 methylation status can be used to identify patients with early-stage colorectal cancers that would otherwise remain undetected.

May 2011

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Development and Validation of a Novel Patient Educational Booklet to Enhance Colonoscopy Preparation
Abstract
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Summary: The success of colonoscopy depends on high-quality bowel preparation by patients; yet inadequate preparation is common. In this study, researchers developed and tested an educational booklet aimed at addressing patient knowledge, attitude, and belief barriers to colonoscopy preparation and improve bowel preparation quality. A total of 436 patients were randomized between arms. In an intention-to-treat analysis of the primary outcome, mean Ottawa scores were superior in patients allocated to booklet vs. controls (P = 0.03). An intention-to-treat analysis of the secondary outcome revealed a “good” preparation in 68 vs. 46 % of booklet and control patients, respectively ( P = 0.054). In a per-protocol analysis limited to patients who actually received the booklet, preparation was good in 76 vs. 46 % patients, respectively ( P < 0.00001). Regression analysis revealed that booklet receipt increased the odds of good preparation by 3.7 times (95 % confidence interval = 2.3 – 5.8). Researchers found that patients receiving the booklet in a randomized controlled trial of single-dose purgatives achieved better bowel preparation quality vs. controls independent of the specific purgative prescribed.

Statin Use and the Risk of Liver Cancer: A Population-Based Case–Control Study
Abstract
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Summary: In this population-based case – control study, researchers found that statin use below 215.4 DDD in cumulative dose is associated with a 38% risk reduction in liver cancer as compared with individuals who did not use statins after controlling for potential confounders. The risk reduction observed in this study is of similar magnitude to those observed in the study by El-Serag et al., which reported a risk reduction with statin use that ranged between 25 and 40 %. Given the widespread use of statins, this magnitude of risk reduction would have a substantial public health impact. This study suggests that statins have a potential role in the hemoprevention of liver cancer.

Opioid-Induced Constipation Challenges and Therapeutic Opportunities
Abstract
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Summary: There has been an alarming increase in the prescription and chronic use of opiates and opioids for chronic non-cancer pain in the past 15 years. It is estimated that opiate-induced constipation (OIC) is experienced by 40 % of these patients, and that constipation and other gastrointestinal symptoms may dissuade patients from using the required analgesic dose to achieve effective pain relief. Opiates have several effects on gastrointestinal functions, and the inhibition of colonic transit and intestinal and colonic secretion results in constipation. In this clinical review, Dr. Michael Camilleri, concluded that although there are recommendations for treatment, there continues to be unmet clinical need in the management of patients with OIC, an increasingly relevant problem with the extensive use of opioids for the relief of chronic pain, often associated with benign conditions. He said that an evidence-based management approach for OIC will be more feasible after the new generation of drugs is formally and thoroughly studied in large, high-quality clinical trials.

April 2011

Special IBD-Themed Issue AJG April 2011
The April issue of The American Journal of Gastroenterology is devoted to modern management of Inflammatory Bowel Disease. A large variety of topics that span the care of pediatric and adult patients with Crohn’s disease and ulcerative colitis are explored. Advances in medical therapy are examined, including management of patients who do not respond or lose response to biological agents. Chemoprevention against cancer and patient-based outcomes of surgical therapy are assessed. Included among the articles is a joint effort between the European Crohn’s and Colitis Organization (ECCO) and the Pediatric Inflammatory Bowel Disease (IBD) Porto group on behalf of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) to develop consensus guidelines for managing acute severe ulcerative colitis in children.

Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Pediatric IBD Porto Group
A group of 19 experts in pediatric IBD participated in an iterative consensus process including two face-to-face meetings. Seventeen predefined questions were addressed by working subgroups based on a systematic review of the literature. Recommendations were endorsed with a consensus rate of at least 95% and covered issues including definitions, initial evaluation, standard therapy, timing of second line therapy, the role of endoscopic evaluation and heparin prophylaxis, how to administer second line medical therapy and how to assess response, surgical considerations, and discharge recommendations. This document includes a management flowchart that guides the management of acute severe ulcerative colitis in children.

Efficacy of Biological Therapies in Inflammatory Bowel Disease: Systematic Review and Meta-analysis
Multiple studies of biological therapy for Crohn’s disease (CD) and ulcerative colitis (UC) exist, but no meta-analysis has examined this issue in its entirety. Dichotomous symptom data were pooled to obtain relative risk (RR) of failure to achieve remission in active disease, and RR of relapse of activity in quiescent disease once remission had occurred, with a 95% confidence interval (CI). The search strategy identified 3061 citations, 27 of which were eligible for inclusion. Anti-TNFa antibodies and natalizumab were superior to placebo in inducing remission of luminal CD (RR of no remission = 0.87; 95% CI 0.80-0.94 and RR = 0.88; 95% CI 0.83-0.94 respectively). Anti-TNFa antibodies were also superior to placebo in preventing relapse of luminal CD (RR of relapse = 0.71; 95% CI 0.65-0.76). Infliximab was superior to placebo in inducing remission of moderate to severely active UC (RR = 0.72; 95% CI 0.57-0.91). This meta-analysis illustrates the magnitude of benefit provided by biological therapies in inducing remission of active CD and UC, and in preventing relapse of quiescent CD.

Review the entire April issue of The American Journal of Gastroenterology.

March 2011

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Meat Consumption and Risk of Esophageal and Gastric Cancer in a Large Prospective Study
Abstract
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Summary: Red and processed meat are positively associated with colorectal cancer, but researchers from the National Cancer Institute investigated whether there was an effect on other GI malignancies. Using the National Institutes of Health (NIH)–AARP Diet and Health study (a cohort of approximately half a million men and women who had completed a detailed meat intake questionnaire), researchers found a clear link between red meat consumption and esophagus cancer. Investigators looked at meat and meat-related variables, including cooking methods and doneness levels, for their role in cancer etiology. The study found heterocyclic amines formed in meat cooked at high temperature are positively associated with stomach cancer and suggestive positive association for esophageal squamous cell carcinoma.  Additionally, researchers found that heme iron intake may also be associated with esophageal cancer risk.

Physical Activity Recommendations, Exercise Intensity, and Histological Severity of Nonalcoholic Fatty Liver Disease
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Summary: Nonalcoholic fatty liver disease (NAFLD) is a significant public health problem and constitutes the most common chronic liver disease in the United States, affecting an estimated 30 percent of the U.S. population. Exercise is a recommended treatment. Researchers evaluated the association between physical activity intensity and the severity of biopsy-proven NAFLD. This large multicenter study of U.S. patients found no significant difference in the adjusted odds of having definite NASH between those subjects who met recommendations for moderate activity and those who were inactive. However, they did conclude that meeting minimum guidelines for vigorous physical activity was associated with a significant reduction in the adjusted odds of having steatohepatitis (NASH) and lower odds of advanced fibrosis.

2010

 

August 2010

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Hormone Replacement Therapy, Oral Contraceptive Use, and Distal Large Bowel Cancer: A Population-Based Case – Control Study
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Summary: Women who use hormone replacement therapy (HRT) are at a reduced risk of developing distal large bowel cancer, regardless of race. Longer duration of use of HRT is associated with an increased reduction of distal large bowel cancer incidence. As a result, it is possible that widespread use of HRT Oral contraceptives, when modern day formulations are included, do not reduce the risk of distal large bowel cancer, regardless of race.

Alcoholic Liver Disease-Related Mortality in the United States: 1980-2003
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Summary: Alcohol-related liver disease (ALD) is a significant burden on health, with alcohol consumption accounting for an estimated 3.8% of global mortality. Over 24 years, ALD-related mortality decreased, whereas hepatitis C virus (HCV)-related mortality increased; however, ALD continues to be a significant cause of mortality. In 2003, the age-and-sex adjusted mortality rate was 4.4/100,000 for ALD and 2.9/100,000 for HCV.

Newly Developed Antibiotic Combination Therapy for Ulcerative Colitis: A Double-Blind Placebo-Controlled Multicenter Trial
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Summary: A two-week antibiotic combination therapy consisting of amoxicillin 500 mg t.i.d., tetracycline 500 mg t.i.d, and metronidazole 250mg t.i.d. producved improvement, remission, and steroid withdrawal in active ulcerative colitis patients more effectively than a placebo. As a result, this combination therapy should be considered alongside conventional therapy in patients with relapsing ulcerative colitis as an alternative to undertaking surgery.

A Decision-Analytic Evaluation of the Cost-Effectiveness of Family History-Based Colorectal Cancer Screening Programs
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Summary: Using a validated microsimulation model, we found that family history screening (FHS) at age 40, followed by colonoscopy schedules following current guidelines, has moderate-to-poor cost-effectiveness when compared with population-wide screening at age 50. For persons identified as having higher risk based on family history, 5-year screening schedules appear to have superior cost-effectiveness to 10-year schedules.

Irritable Bowel Syndrome – Type Symptoms in Patients with Inflammatory Bowel Disease: A Real Association or Reflection of Occult Inflammation?
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Summary: IBS-like symptoms are common in patients with IBD who are thought to be in clinical remission, but abnormal calprotectin levels suggest that the mechanism in most cases is likely to be occult inflammation rather than coexistent IBS.

July 2010

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Association Between Colonoscopy Rates and Colorectal Cancer Mortality
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Summary: In men and women 50 – 90 years of age in Ontario, living in a region with a higher colonoscopy rate was associated with a decreased risk of death from CRC, after taking into account age, sex, income, and location of residence (urban / rural). 3 For every 1 % increase in colonoscopy rate, the risk of death from CRC decreased by 3 %.  Increased colonoscopy use was associated with mortality reduction from CRC at the population level.

Hepatoxicity Due to Hydroxycut: A Case Series
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Summary: Hydroxycut has been clearly implicated as a cause for severe liver injury that may lead to acute liver failure and death. The responsible toxic ingredient is not entirely certain, but may be the consequence of the presence of Camellia sinensis in the product. Weight loss supplements represent a class of dietary supplements that should be regarded as capable of causing severe hepatic toxicity when the usual causes of identified liver injury cannot be otherwise elucidated.

The New Health Care law and What It Means for Clinical GI
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Summary: ACG President Philip O. Katz, MD, FACG, Division of Gastroenterology, Albert Einstein Medical, explains how the health care reform law will impact physicians—specifically gastroenterologists. He outlines key-health reform provisions including provider reimbursement and discusses the key impacts on GI patients, especially related to colorectal cancer screening.