GI

PTH versus PTHrP — Small Differences, Big Implications

March 3, 2016
PTH versus PTHrP — Small Differences, Big Implications

Samantha Kass Newman, MD

Peer Reviewed 

A 48-year-old depressed male smoker with a bit of an alcohol problem presents to the emergency department with worsening fatigue, severe lower back pain, constipation, abdominal pain, and 4 days of coffee ground emesis.

This could be anything. Viral gastroenteritis? Perhaps. Food poisoning? Probably not. Upper GI bleed? Likely, given his alcohol use. You send off routine labs, and then are called for a critical value: his calcium is 13.8 mg/dL. The albumin is normal. Next, you check the …

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Are We Overusing Proton Pump Inhibitors?

November 13, 2015
Are We Overusing Proton Pump Inhibitors?

By Shimwoo Lee
Peer Reviewed
Case: A 31-year-old man with poorly controlled type 2 diabetes was hospitalized for community-acquired pneumonia. His home medications included esomeprazole. When asked why he was receiving this medication, the patient said it was first started during his prior hospitalization for “ulcer prevention” eight months ago and that he had continued to take it since. He denied any history of upper gastrointestinal symptoms. Esomeprazole was tapered off during this admission. When being discharged after successful treatment of his pneumonia, he was …

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Proton Pump Inhibitors: Acid Suppression with a Nutritional Cost

June 13, 2014
Proton Pump Inhibitors: Acid Suppression with a Nutritional Cost

By Dana Zalkin

Peer Reviewed

In the late 1970s evidence began to emerge that a newly discovered pump, a H+/K+ ATPase in the gastric mucosa, was the final step in the process of acid secretion . With this discovery, further research demonstrated the ability to reduce gastric acid secretion by inhibiting these proton pumps . We now have drugs that do just that: the proton pump inhibitors (PPIs). Proton pump inhibitors have been used since 1989 to treat acid-related gastrointestinal disorders as well as in …

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Proton Pump Inhibitors and Clostridium Difficile Infection

March 20, 2014
Proton Pump Inhibitors and Clostridium Difficile Infection

By Aaron Smith, MD

Peer Reviewed

First introduced in the late 1980s, proton pump inhibitors (PPIs) have revolutionized the treatment of gastric acid-related disorders and have been described as a miracle drug by patients and physicians alike. As is often the case with miracle drugs, however, long-term use of PPIs has led to unforeseen adverse effects. Chief among the purported side effects of PPI use is an association with Clostridium difficile infection (CDI). CDI, an enterocolitis that leads to voluminous and potentially fatal diarrhea, was …

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Can Young Patients Get Diverticular Disease?

January 23, 2014
Can Young Patients Get Diverticular Disease?

By Aaron Smith, MD

Peer Reviewed

Case: A 35 year-old, overweight female presents to the emergency room with five days of left lower quadrant abdominal pain. The pain is 10/10 in severity and accompanied by nausea, bloating, and loss of appetite.

Diverticulosis, the presence of small colonic outpouchings thought to occur secondary to high pressure within the colon, is an extremely common condition in elderly patients. Recent data suggests that up to 50% of people over the age of 60 have colonic diverticula. When a …

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The Prevention of Post-ERCP Pancreatitis

January 10, 2014
The Prevention of Post-ERCP Pancreatitis

By Shivani K Patel, MD

Peer reviewed

A 61-year old male with chronic epigastric discomfort presented to the emergency room with severe abdominal pain radiating to his back. He had similarly presented and been hospitalized two weeks prior to this admission at an outside hospital, where he underwent endoscopic retrograde cholangiopancreatography (ERCP) with placement of a pancreatic duct stent. His pain initially improved, but quickly recurred after discharge. Admission labs showed only mild leukocytosis with slight elevation in serum lipase. Computed tomography (CT) of the …

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Who Should We Screen for Hepatitis C: By Risk Or Birth Cohort?

January 8, 2014
Who Should We Screen for Hepatitis C: By Risk Or Birth Cohort?

By Jung-Eun Ha

Peer Reviewed

Over the last few years major changes have occurred in the diagnosis and treatment of hepatitis C. In 2011 the U.S. Food and Drug Administration (FDA) approved a rapid finger stick antibody test for hepatitis C virus (HCV) infection . The FDA also approved the protease inhibitors telapravir (Incivek; Vertex Pharmaceuticals, Cambridge, Massachusetts; Johnson & Johnson, New Brunswick, New Jersey) and boceprevir (Victrelis; Merck, Whitehouse Station, New Jersey), for the treatment of genotype 1 hepatitis C . In August 2012, …

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Is there a Non-Invasive Method to Diagnose Cirrhosis/Hepatic Fibrosis?

October 11, 2013
Is there a Non-Invasive Method to Diagnose Cirrhosis/Hepatic Fibrosis?

By Becky Naoulou, MD

Faculty Peer Reviewed

Clinical Question:

You are asked to see a 45 year-old male with a medical history significant for untreated hepatitis C (HCV RNA 5,000,000 copies/mL, genotype 1a). He presents complaining of worsening fatigue and weakness for several months. Labs are remarkable for mildly elevated transaminases, low albumin, and an elevated INR. The patient is very worried because he has heard that hepatitis C can cause liver cancer and asks you if there is a non-invasive screening test for liver …

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From The Archives: Does Heyde Syndrome Exist?

August 8, 2013
From The Archives: Does Heyde Syndrome Exist?

Please enjoy this post from the Archives dated September 29, 2010

By Lara Dunn, MD

Faculty Peer Reviewed

In 1958, EC Heyde published 10 cases of aortic stenosis (AS) and arteriovenous malformations (AVMs) of the gastrointestinal tract in the New England Journal of Medicine . Thus, the association between aortic stenosis and intestinal angiodysplasia became known as Heyde Syndrome. Yet the existence of this syndrome has been controversial.

Contrasting conclusions have been obtained by studies conducted to evaluate this association. In a prospective study, Bhutani …

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Have a Cow? How Recent Studies on Red Meat Consumption Apply to Clinical Practice

April 12, 2013
Have a Cow? How Recent Studies on Red Meat Consumption Apply to Clinical Practice

By Tyler R. McClintock

Faculty Peer Reviewed

“Red Meat Kills.” “Red Meat a Ticket to Early Grave.” “A Hot Dog a Day Raises Risk of Dying.” Such were the headlines circulating in popular press last year when the Annals of Internal Medicine released details of an upcoming article out of Frank Hu’s research group at the Harvard School of Public Health . Analyzing long-term prospective data from two large cohort studies, researchers found that individuals who ate a serving of unprocessed red meat each day …

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The Effect of Bariatric Surgery on Incretin Hormones and Glucose Homeostasis

April 4, 2013
The Effect of Bariatric Surgery on Incretin Hormones and Glucose Homeostasis

By Michael Crist

Faculty Peer Reviewed

Until recently, little thought was given to the important role played by the duodenum, jejunum, and ileum in glucose homeostasis. The involvement of the gut in glucose regulation is mediated by the enteroinsular axis, which refers to the neural and hormonal signaling pathways that connect the gastrointestinal (GI) tract with pancreatic beta cells. These pathways are largely responsible for the increase in insulin that occurs during the postprandial period. In 1964 McIntyre and colleagues first reported the phenomenon of …

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Anal cancer screening – A case for screening anal paps

January 24, 2013
Anal cancer screening – A case for screening anal paps

By Nelson Sanchez, MD

Faculty Peer Reviewed

Case:

A 56 year-old homosexual male presents to your clinic to ask whether or not he should have an anal Pap smear. The patient is HIV positive, has been on HAART for five years, and has no history of opportunistic infections. He denies any anal pain, bleeding or masses.

While efforts to improve knowledge about colorectal cancer in various communities continues to grow, awareness of and misconceptions about anal cancer remain. Over the past couple of years there …

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