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How Do You Approach a Patient with Arthritis and Hepatitis C?

August 7, 2008

Commentary by Peter Izmirly MD, NYU Division of Rheumatology

A 54 year old male with a past medical history significant for hepatitis C genotype 1a s/p ifn/ribavarin 2003-2004 with HCV Qual negative in 2005 presents with 3 weeks of bilateral wrist pain. The pain is worst with extension. His exam is notable for diffuse tenderness when pressure is applied to his wrists. He has no obvious swelling, erythema, deformity or subcutaneous nodules. The remainder of his musculoskeletal exam in unremarkable. In addition, he has no stigmata…

Dietary Issues after Bariatric Surgery

July 18, 2008

Commentary by Melissa Freeman MD, Endocrinology Section Editor

A new outpatient Bariatric Surgery Clinic recently opened at Bellevue Hospital Center. This clinic offers laparoscopic adjustable gastric banding to patients 18 years of age or older who meet specific BMI and medical criteria. This life-altering surgery is now covered by Medicaid and those who are uninsured can work with financial counselors to obtain funding through special HHC programs. While the surgeons diligently educate their patients on their dietary transitions and requirements after surgery, primary…

Should H. pylori Eradication Be Confirmed?

June 12, 2008

Commentary by Fritz Francois, MD, MS, NYU Division of Gastroenterology

Humans are essentially the only reservoir for Helicobacter pylori, which is estimated to colonize the stomach of about half the world’s population (1). Although the bacteria generally do not invade the mucosa, attachment to the epithelium leads to an inflammatory reaction with neutrophils, lymphocytes, plasma cells, and macrophages. Over time, the persistent inflammation leads to changes in the gastric mucosa that may predispose to the development of dysplasia(2).

Class Act: Is there clinical evidence for use of probiotics in the treatment of IBS?

March 12, 2008

Class act is a feature of Clinical Correlations written by NYU 3rd and 4th year medical students. These posts focus on evidenced based answers to clinical questions related to patients seen by our students in the clinics or on the wards. Prior to publication, each commentary is thoroughly reviewed for content by a faculty member.

Commentary by Alexander Jow, MSIII

Irritable bowel syndrome (IBS) is a poorly understood disorder, commonly encountered in clinical practice; IBS accounts for more than one-third of…

Meeting Perspectives: American Association for the Study of Liver Diseases

February 27, 2008

Last November, thousands of eager hepatologists descended on Boston to attend the AASLD Liver Meeting. While there was an enormous amount of hepatology information presented, one intrepid GI fellow, Ponni Perumalswami MD, has compiled a few of the most interesting presentations.

In a late-breaking abstract, major results were presented by Dr. Di Bisceglie from the HALT-C trial. This study is designed to examine the effect of prolonged antiviral therapy with peginterferon in prevention of the complications of advanced liver disease associated with hepatitis C.…

Treatment of obesity with bariatric surgery: evidence and implications

November 15, 2007

Commentary by Jatin Roper MD PGY-3 and Christine Ren MD Associate Professor, Department of Surgery

Bariatric procedures to treat obesity involve the restriction of the gastric reservoir, bypass of part of the gastrointestinal tract, or both. Worldwide, an estimated 300 million people are obese, and in the United States, the percentage of adults who are obese increased from 15% in 1995 to 24% in 2005. (Obesity is defined as a Body Mass Index or BMI of 30 or more, measured…

Why Does Hypertriglyceridemia Lead to Pancreatitis?

October 4, 2007

Commentary by Daniel Frenkel, PGY-2

Case: A 46 year old male with diabetes on oral hypoglycemic medications is admitted to the hospital with one day of constant epigastric pain, nausea, vomiting, and an inability to tolerate oral intake. You are concerned about pancreatitis but laboratory analysis reveals amylase levels that are within the normal reference range. You notice that his glucose level is 410mg/dL and that the specimen is described as lactescent. Should you still be concerned about acute pancreatitis?

Lactescent or…

Are beta blockers indicated in cirrhotics with small varices?

August 1, 2007

Commentary by Bani Chander MD, PGY-2

Esophageal varices are a common complication of cirrhosis and approximately one-third of all cirrhotic patients with varices will develop a variceal bleed . Each episode of variceal hemorrhage is associated with a 15 to 20 percent risk of mortality in patients with severe liver dysfunction. The risk of bleeding is related to the location, size, and appearance of the varix, presence of red wale markings, variceal pressure, prior history of variceal bleeding, as well as the severity…

A Case of Celiac Disease and Diagnostic Clues

July 12, 2007

Commentary by Josh Olstein MD, Chief Resident NYU Internal Medicine

Mr. J is a 56 year old Caucasian gentleman who presented with complaints of “I just can’t do what I used to be able to do. I just don’t have the energy.” He describes himself as a hearty fellow who had never had a problem with his energy level until around a year ago. Though he has not noticed any weight loss, he denied any weight gain despite the lumberjack-like portions he eats…

Should All Patients with Hepatitis C Be Screened for Hepatocelluar Carcinoma?

July 3, 2007

Should patients with Hepatitis C (HCV) with no evidence of cirrhosis undergo screening for hepatocellular carcinoma (HCC)? Is there any reason to check for HCC when the liver associated enzymes (LAEs) are normal?

-Sandeep Mangalmurti, PGY-2

Commentary by Mike Poles MD, Associate Editor Clinical Correlations and Assistant Professor, Division of Gastroenterology

HCC continues to be one of the most common solid malignancies worldwide. Further, almost all cases of HCC occur in the background of a histologically-abnormal liver; approximately 90% of cases…

Meeting Perspectives: Digestive Disease Week (DDW) 2007

June 20, 2007

Commentary by Milini Sahu, MD Fellow, Division of Gastrotenterology, Gina Sam-DeRiggs, Fellow, Division of Gastroenterology, and Michael Poles MD, Assistant Professor, NYU Division of Gastroenterology and Associate Editor, Clinical Correlations

Close to 17,000 gastroenterologists attended Digestive Disease Week (DDW) from May 19-24 in Washington DC. While I stayed behind (someone has to help with emergency endoscopies), the majority of NYU’s gastroenterology fellows and attendings were there for a week of learning, presenting, and making NYU proud. Two of our fellows, Malini…

Morning Report-How Do You Approach a Patient with a Significant Transaminitis?

March 23, 2007

Consultant: Robert Raicht, MD Professor of Medicine, Chief Division of Gastroenterology

Clinical Vignette:
The patient is a 50 year old male with a past medical history notable for type II diabetes, hypertension and recently treated right foot cellulitis and c.difficile colitis who presented to the emergency room with the complaint of fevers and malaise for 1 week. His labs were notable for a significant transaminitis (AST 1997, ALT 1620, alkaline phosphatase 365, total bilirubin 3.1), INR wnl. An abdominal ultrasound was ordered with…

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