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GI and Nutrition (2013-16) Newsworthy Scientific Literature and Medical Reports

PPIs and Kidney Cancer?  "In a prospective, community-based study involving more than 10,000 adults followed for a median of 14 years, baseline use of a proton pump inhibitor (PPI) was independently associated with a 20% to 50% higher risk for incident chronic kidney disease (CKD)."  

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New IBS/diarrhea medicine.  Better treatments are needed for irritable bowel syndrome (IBS) patients that may also have diarrhea. In an

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, a new medicine for this condition is reported, Eluxadoline.  Those taking this new drug  reduced symptoms of IBS with diarrhea in two phase 3 trials, with sustained efficacy over 6 months. 

Coffee Prevents Colon Cancer Relapse?  A

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study suggests a large positive impact of coffee on colon cancer relapse.  
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Detecting Ulcerative Colitis  A new study indicates that "pairing of high-definition white light endoscopy with chromoendoscopy can detect significantly more dysplastic lesions than high-definition endoscopy alone in patients with long-standing ulcerative colitis", - See more at: 

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 Barrett’s Esophagus Rising Sharply in Younger Adults -  "A new study of 50 million unique patient records between 2008 and 2013 showed that while the absolute incidence remains low among people younger than age 55 years, the share of cases in that group climbed sharply over the five-year period.... The reason(s) for the increasing incidence of BE in younger people is unknown, but the growing prevalence of obesity is one potential explanation. Obesity is a well-established risk factor for both GERD and BE." -Read the story from 

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.  Washington, D.C.,  07/15

Diarrhea Breakthrough.  "Study of the diarrhea-causing pathogen Cryptosporidium has been hindered by a lack of genetic-modification and culture tools. A description of genome editing using Crisper-Cas9 and new propagation methods  for the parasite changes this picture" in a recent study in Nature.  

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  7/15/15.  Figure (click to expand) Legend: "The strong-walled oocyst form of Cryptosporidium parasites can be isolated from the feces of infected calves. Oocysts can be induced to excyst to release the sporozoite form, which will infect cultured mammalian epithelial cells, but the sporozoites undergo only one or two rounds of replication before they die. Vinayak et al.1 have improved on this limited in vitro system in two ways. They have developed techniques for genetically modifying the sporozoite form — using electroporation to introduce foreign DNA in the form of a plasmid bearing the sequences required for CRISPR-based genome editing. And they show that these modified sporozoites will replicate when directly transplanted into the intestines of mice, and can be recovered as modified oocysts, which can be collected from mouse feces for analysis in culture, or used to inoculate new mice to maintain the line indefinitely." 

  

Chances of GI cancer being hereditary is greater in younger patients.  A new

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  finds that of 193 adolescent and young adult patients with colorectal cancer (CRC), 35% had an identifiable hereditary cancer syndrome.  The study recommends that patients with CRC in this age range should get genetic counseling.  
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Gupta Guide 7/21/15

White House war on GI Superbugs.  "The White House has  published an extensive plan to slow the emergence and spread of antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile."  Medpage Today 4/1/15.

Redirecting food poison bacteria to target GI cancer.  Scientists are trying to genetically engineer wildtype infectious food borne bacteria that normally colonize tumors to destroy them.  See the

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paper and
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 (5/26/15, Germany)

 

Acute Appendicitis — Appendectomy or the “Antibiotics First” Strategy.  Appendectomy is still recommended for most people with uncomplicated appendicitis, but patients should be informed about options, and an antibiotics-first strategy may be considered in those who have strong preferences for avoiding an operation or who have contraindications to surgery 

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 and 
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Racial Disparities.  Efforts to decrease racial disparities in GI cancer screening/care is credited for changing Delaware from the state with the highest incidence of colorectal cancer to #15.  See the story at 

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Broad spectrum antibiotic, meropenem, approved by the U. S. Food and Drug Administration for treating abdominal infections in children less than 3 months of age, Bethesda, MD  (

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, May 2015). 

Study in Gut suggests that a breath test may be useful for detecting gastric cancer.  (Haifa, Israel, April 2015) See the story at this URL:

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More than 100 sickened by NOROVIRUS during cruise  SAN DIEGO (AP, April 2015) - "Federal health officials say 106 passengers and six crewmembers aboard the Celebrity Infinity cruise ship were sickened by the gastrointestinal illness norovirus."  Read the

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.  
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Which new hepatitis C treatments is most cost effective?  Exciting developments, dizzying in number have occurred in the last decade leading to new improvements for the treatment of Hep C and cures.  A number of options are now available, so researchers  in a March 2015 study in 

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asked which was most cost effective.  According to a  
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 summary: "The researchers discovered that sofobuvir-ledipasvir was the optimal strategy for genotype 1 and would be cost-effective if the drug cost less than $5500.  For genotype 2, sofosbuvir-ribavirin-PEG would be cost-efficient if sofobuvir cost less than $2250 every week, and sofosbuvir-ledipasvir-ribavirin would be the most cost-saving for genotype 3 if sofosbuvir cost less than $1500 per week.  

Drug-resistant Shigellosis spreading. April 2015.  CDC is warning of the spread of multidrug-resistant shigellosis (see above image).  Read the news story at 

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 and the  
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Are you a PWAG (person without celiac disease avoiding gluten) and why is that? April 2015.  

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 in Amer J Gastroenterol explores "Trends and Racial/Ethnic Disparities in Gluten-Sensitive Problems in the United States".  Listen to the co-author's 
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.

New non-radioactive breath test approved by FDA for gastroparesis. April 6, 2015  Current tests used to diagnose gastroparesis typically involve the use of a small amount of radioactive material or imaging equipment, so testing must be conducted in specialized outpatient centers.  The new Gastric Emptying Breath Test (GEBT) uses stable (non-radioactive) isotopes that can be detected by mass spectrometry of the breath.  

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.  

Blog at KevinMD explains why people chose to become gastroenterologists,   See the piece by 

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Growing evidence of microbiome's role in health and disease- Arlington, VA Feb 4 2015 – A patient has rapid and unexpected weight gain after fecal transplant. 

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Deadly food borne outbreak of Listerosis in those eating infected carmel apples  As of mid December 2014, the CDC says that 28 people in the U.S. have been infected with outbreak strains of Listeria monocytogenes believed to be derived from the consumption of otherwise yummy carmel coated Apples.  Cases have been reported in 10 states, and 26 of those infected have been admitted to hospital.  "The agency has reported three other listeriosis outbreaks this year -- in soy and cheese products -- but the caramel apple outbreak is the largest.  It is also the largest since a listeriosis outbreak in 2011 traced to contaminated cantaloupes." -
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.  According to the CDC, "a person with listeriosis usually has fever and muscle aches, sometimes preceded by diarrhea or other gastrointestinal symptoms.  Almost everyone who is diagnosed with listeriosis has "invasive" infection, in which the bacteria spread beyond the gastrointestinal tract". -Source CDC 
 
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Norovirus closes down a North Andover Middle School.  
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 - 
More than 200 North Andover Middle School (Massachusetts) students came down with a stomach bug consistent with Norovirus, by the end of the school day, at least 240 students had come down with the virus, according to Superintendent Dr. Kevin Hutchinson. The seventh-grade was hit the hardest by the bug, with 142 students confirmed sick, close to half of the entire grade.  
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President Obama is diagnosed with Acid Reflux Disease, some feel release of this diagnosis will help others get proper treatment.  See story in 
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Ebola Updates and Recent Review of Virus Life Cycle and Immune Avoidance Mechanisms.  While Ebola virus is considered a type of Viral Hemorrhagic Fever, it nevertheless can cause severe diarrhea, nausea and vomiting...so we mention it here. Another Ebola outbreak began in March of 2014 in Western Africa.  At this writing there have been more than 8000 deaths (~50% fatality) For latest figures see 
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  A review article on the molecular aspects of the Ebola Virus and how it evades the immune system is found in the October 2014 edition of the journal Cell: 
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Celiac Sprue  (Chicago IL, July 2014) -  According to 
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  Gastroenterology and Endoscopy News , new data suggest that " fewer than half of the people who should be screened for celiac disease according to current guidelines are being evaluated for the condition".

Social Media in GI Medicine  (Boston MA, July 2014)

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Gastroenterology and Endoscopy News describes a "session on the emergence of social media in medicine at the 2014 GI Roundtable, a conference dedicated to exploring challenges and their solutions for gastroenterology and the field’s future."  Moderator, Dr Duffy is quoted as saying, "As physicians, we can no longer ignore [social media]; we have to understand how patients are wanting to connect with us.”

Nutrition News  "A position statement from the American Society of Nutrition has sparked controversy due to its stance that processed foods are an integral part of the American diet."  Read the story in a July 28 2014 post from MedPage Today

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Gut Microbiota News  "New virus' discovered in human gut.  Scientists say they have stumbled upon a common virus that has never been described before" that by virtue of being a bacteriophage may influence the gut microbiome.  Cited from

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about a peer-reviewed paper in Nature Communications.   July 2014

Orchestrating weight loss  (June 2014) An FDA advisory committee voted that use of the MAESTRO Rechargeable System for the treatment of obesity outweighed the risks. There was broad agreement about safety but less certainty about efficacy for this 

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Asian Fusion...Clinical scientists are studying the "pairing of traditional Chinese acupuncture  with modern micro-electrode technology to help patients get through endoscopic ultrasound diagnostic treatments with less pain and anxiety"...see the 

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Baseball Hall of Famer Tony Gwynn died at the age of 54, following a long battle with salivary gland cancer; smokeless tobacco is implicated (

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)

New Obesity commentaries and findings in JAMA and NEJM.  

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 (JAMA, May 2014) and then in a May 2014 issue of NEJM a nice (recent) historical perspective 
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  dovetails with a new metabolic syndrome gene discovery 
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Gut Microbiota News  Currently gut microbiomes are examined from stool samples.  However few studies focus on the flora of jejunum or ileum which apparently is somewhat distinct and may be in a better position to affect nutrient and GI signaling according to a recent (May 2014)

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.  In this same vein, a new
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(May 2014) has emerged that suggest some of the positve effects of GI microbiota are brought about by changing the chemical structure of bile acids which signal to both cell surface and nuclear receptors (FXR) during their travel through the enterocytes and back to the liver. 

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.   See the April 2014 JAMA paper "
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"

Liver Transplant Stops Rare Metabolic Disorder  A girl with lathosterolosis, a rare and historically incurable metabolic disease, appeared to be saved with a liver transplant, researchers said.

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PPIs under fire from Watchdog group  Citing fracture risk, Public Citizen's group sues FDA to force GERD drug warnings today (May 5 2014).  Evidence has shown PPIs increase the risk of severe side-effects such as hip fractures, life-threatening cardiac arrhythmias, and C. difficile infections. The FDA revised labeling requirements in 2010 to include the fracture risk. But Public Citizen claims current warnings for all the risks are not displayed prominently.

Constipation relief from vibrating pills An oral capsule that vibrates as it moves through the digestive tract has shown notable promise as a non-pharmacological treatment for constipation, according to new research presented today at

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, May 2014. 

New GI Cancer treatment approved.  "FDA has approved the angiogenesis inhibitor

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 for treatment of advanced gastric cancer or adenocarcinoma of the gastroesophageal junction (GEJ)." April 2014

Gastric Bypass Surgery News.  More results of STAMPEDE trial

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.  Obese pts with uncontrolled type 2 diabetes -> 3 years of intensive medical therapy plus bariatric surgery vs medical therapy alone.  Bariatric surgery showed favorable results at 3 years in the surgical groups, as compared with the group receiving medical therapy alone for body weight, use of glucose-lowering medications, and quality of life.  Mar 2014

New Treatment for Giardia found?  An OTC weight loss drug (Orlistat) that inhibits gastric lipases was more potent in vitro killing Giardia in culture compared to the standard treatment, metronidazole (MTZ).  This included an MTZ resistant strain.  See the

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 paper. 

Health Disparities Research  Black children do not fare as well as whites with liver transplants.  

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 Dec 2013

FDA approves first drug intended to be part of hepatitis C (HCV) treatment that -- at least for some patients -- does not also use pegylated interferon. "Sofosbuvir (Sovaldi) is the second new drug approved by the agency in the past 2 weeks to treat chronic HCV infection."  

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 Dec 2013

WHO issues new guidance for treating children with severe acute malnutrition:  "children with severe acute malnutrition who do not have health complications that require hospitalization, receive special, high-energy food and antibiotics to treat infection. This allows them to recover at home with their families. They also give guidance on how to treat them for HIV and, if necessary make recommendations on how to treat severely malnourished infants under six months"  

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 Dec 2013

Weight Loss Surgery- STAMPEDE trial results: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy similarly reduced body fat.  However, RYGB had greater suppression of active Ghrelin, lower visceral fat and improved pancreatic beta cell function.  See 

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, Nov 2013.

Colon Cancer News- New Guidelines for Follow-up of Colorectal Cancer Patients including followup surviellance schedule was published in the Nov 12 2013 issue of the Journal of Clinical Oncology.  See the perspective at  

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   (free login may be required)

NASH News -Patients with nonalcoholic fatty liver disease (NAFLD, NASH) are recommended to maintain a healthy lifestyle with diet and exercise, however a new study in Gastroenterology could not justify recommending a low-fructose or low-glycemic diet to prevent NAFLD. 

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Gastric Bypass Surgery News - According to a paper in

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, bariatric surgery boosted sexual functioning and health.  See perspective at
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  #doyoufindmesexy

Gut Microbiome- New study shows that the "gut microbiota of patients recently diagnosed with rheumatoid arthritis is enriched in microbes belonging to the Prevotella genus." - See more at: http://elife.elifesciences.org/content/2/e01608#sthash.nRe9yD8y.dpuf  Nov 2013

40 Key trends may shape the future of medicine, see the white paper at

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New Euro recommendations for Clostridium difficile infection (CDI), published online October 5 in Clinical Microbiology and Infection, advise antibiotic treatment for all but very mild cases of CD after reviewing evidence based alternatives including toxin-binding resins and polymers, immunotherapy, probiotics, and fecal or bacterial intestinal transplantation.  From  

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Health Disparities - Conference news - Many Liver Transplant Recipients cannot afford their medications,

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.  "One in 6 liver transplant recipients say they make trade-offs between buying food and their medication or they space out doses because they cannot afford them and try to make them last longer, a new study finds."

Business of Medicine - 

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.   "The Affordable Care Act (ACA) will affect all medical specialties, including gastroenterology. Here are 8 ways that the ACA creates new problems and new opportunities specifically for GI medicine practices." from Medscape Business of Medicine Oct 28 2013
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Diarrhea is the second leading cause of death in children worldwide but out of ~40 organisms that can possibly cause it only about 4 appear to be largely responsible, "rotavirus, Cryptosporidium, a toxic type of Escherichia coli, and Shigella". 

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Meeting Proceedings IDWEEK - In a randomized phase II trial, a 3-drug combination of so-called "direct-acting agents (without interferon and Ribavirin in treatment-naive hepatitis C genotype 1 patients.) completely knocked out the Hepatitis C virus in 89%-94% of patients 12 weeks after the end of therapy. 

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Gastroenterology Research News- "a rising incidence of metabolic syndrome over the past few decades seems to correlate with an increase in esophageal cancer and Barrett's esophagus" according to researchers at Cleveland Clinic.  

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Health Disparities Research - "Certain racial and ethnic inequities were found to be common in the management of children presenting to hospital emergency departments with abdominal pain, according to researchers.  Non-Hispanic white children and teens were more likely to receive analgesics than non-Hispanic blacks, and that black and Hispanic children and adolescents were also more likely to have a prolonged stay in the emergency department than white patients."  

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Oct 2013

Hospital borne infections - Dogma about the source of Clostridium difficile transmission has been challenged in a new study in the NEJM.  Genetic analysis of Clostridium difficile from hospitalized patients in Oxfordshire, England, suggests that the majority of C. diff transmission may not arise from symptomatic hospitalized patients.

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(Oct 2013 -NEJM)

Nutrition/Taste Receptors - "Recently, in addition to the gustatory processing of the 5 basic tastes (sweet, salty, sour, bitter, and umami, characterized by the taste of monosodium glutamate), the taste of carbonation, its cellular and molecular substrates, and the modulation of CO2 of sweet perception, has been the focus of investigation".  In the Sept 2013 issue "of Gastroenterology (

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),
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examine, the interference between CO2, perception of sweetness, the differential effects of CO2, sucrose and the artificial sweetener commonly used in diet beverages by functional magnetic resonance imaging. Their findings demonstrate that carbonation reduces the neural processing of sucrose more than of artificial sweeteners and suggest that the combination of CO2 and sucrose leads to increased consumption of sucrose. "  (Sept 2013- source Covering the Cover , Gastroenterology)

Nutrition/Therapeutics -  Addition of niacin (Niaspan) to statin therapy increased beneficial HDL cholesterol, BUT had no effect on cholesterol efflux capacity or a surrogate measure of the lipid particle's antioxidant function, according to Daniel Rader, MD, coauthor of the study in

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  See accompanying story at
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Therapeutics -

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is associated with a significantly lower incidence of adenocarcinoma according to a new systematic review of the literature.

Food Safety - Beef Recall -

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is a potentially deadly Shiga toxin producing bacterium that can cause bloody diarrhea, dehydration, and in the most severe cases, kidney failure. The very young, seniors and persons with weak immune systems are the most susceptible to foodborne illness. (July 31, 2013 - Source USDA, CDC)

New Screening Guidelines for HVC being codified- USPSTF  "

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certainty that screening for HCV infection in adults at increased risk for infection and 1-time screening in adults in the 1945–1965 birth cohort is moderately beneficial."  The American Association for the Study of Liver Diseases (17), the Infectious Diseases Society of America (18), and the American College of Gastroenterology (19) recommend screening in higher-risk patients. The CDC now recommends screening in high-risk patients and age cohort–based screening for HCV in all persons born between 1945 and 1965 (5). Previous recommendations on screening for hepatitis C by the American Academy of Family Physicians, which is currently updating its recommendations, have been consistent with those of the USPSTF (20)." (June 2013 - uspreventiveservicestaskforce.org)

Epidemiology Infectious Disease- By close to the end of July 2013, "CDC had been notified of 372 cases of Cyclospora infection from the following 16 health departments: IA, TX, NE, FA, WI, IL, NYC, GA, MI, AR, CT, KS, MN, NJ, NY, OH."

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    "Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis.  Infected shed unsporulated (non-infective; immature) Cyclospora cayetanensis oocysts in their stool; immature oocysts usually require at least 1 week under favorable laboratory conditions to sporulate (become infective). An unsporulated oocyst, with undifferentiated cytoplasm, is shown (far left), next to a sporulating oocyst that contains two immature sporocysts (A). An oocyst that was mechanically ruptured has released one of its two sporocysts (B). One free sporocyst is shown as well as two free sporozoites, the infective stage of the parasite (C)." Image/text Credit: CDC/DPDM.

Transplant News - Japanese researchers created human liver buds complete with blood vessels that performed normal metabolic activities when implanted in mice. 

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Therapeutics-

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Medpage Today 2013,  Abbott Molecular's "RealTime HCV Genotype II" test identifies the specific viral genotype -- classified as 1, 1a, 1b, 2, 3, 4, or 5 -- present in clinical samples. This information is vital for treatment planning, as available treatments for HCV infection vary in effectiveness according to genotype.

Nutrition -

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 Medpage Today 2013, "Women who took iron supplements during pregnancy had a significantly lower risk of anemia and low-birth-weight babies, according to a large meta-analysis."

Therapeutics- 

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 Medpage Today 2013    "Simponi is an important new treatment option for patients with moderate to severe ulcerative colitis," said Andrew E. Mulberg, MD, deputy director of the Division of Gastroenterology and Inborn Errors Products in the FDA's Center for Drug Evaluation and Research, in a statement.

Epidemiology Infectious Disease - "In 2012, a new strain of Norovirus was detected in Australia called GII.4 Sydney.  By now, people in the U.S. and other countries have also been infected with the new strain.  In the U.S., GII.4 Sydney is currently the leading cause of norovirus outbreaks." CDC 2013

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Health Disparities - 

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 -NEJM 2013   "...not everyone who would qualify for therapy has been tested and identified, referred for appropriate care, and offered or given the best therapy available..."

Therapeutics/IRONic - Small neo magnets recalled as 

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 and a 
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, but these are now being re-purposed to 
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 - Medpage Today 2013

Translational -

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  Swedish study of European women with various levels of glycemia. ScienceDaily Summary and Nature 2013. 

Health Policy - AMA adopted policy that recognizes

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requiring a range of medical interventions to advance obesity treatment and prevention. This decision overrode AMA committees' recommendations that it was not a disease and that better measurement metrics and research are needed. It is widely felt that BMI is a imperfect measure of adiposity. NBC News,
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and AMA
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2013

Therapeutics - 

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   "Infants and young children awaiting liver transplantation have the highest waitlist mortality of all liver transplant candidates, and deceased donor partial liver transplantation has become less risky over time, and now has comparable outcomes to whole liver transplantation in infants and young children"  according to Medpage Today 2013

Nutrition -

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-Medpage Today 2013   Action points: "Low 25(OH)D3 serum levels are associated with high levels of HBV replication in patients with chronic hepatitis B.   Serum 25(OH)D3 and HBV DNA levels showed inverse seasonal fluctuations."

Law - In two recent unrelated cases, fentanyl-addicted health workers with active infections have pled guilty to infecting patients with hepatitis C by first injecting themselves with some or all of the patients' pain medication and then injecting the rest or saline into the patient with the same contaminated pre-filled fentanyl syringe.  

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: (3/2013)
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,
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: (2012).

Nutrition -

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-The Cochrane Library, 2013  Vitamin B12 deficiency can cause anaemia and neurological complications. Vitamin B12 is rarely prescribed in the oral form in most countries except Sweden and Canada. Injections can increase healthcare worker time and cost. Two randomised controlled studies were included in this review. The trials recruited a total of 108 participants and followed up 93 of these from 90 days to four months. The evidence derived from these limited studies suggests that high oral doses of B12 (1000 mcg and 2000 mcg) could be as effective as intramuscular administration in achieving haematological and neurological responses.

Therapeutics -

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-Medpage Today 2013  "Researchers who have been reporting
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now may need an OK from the FDA to continue that treatment (an FDA OK = an
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= Investigational New Drug application)." UPDATE JULY - FDA Backs Down on Fecal Transplant Rules: 
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Nutrition -

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  -The Cochrane Library, 2013   "Antibiotics are widely prescribed; however they can cause disturbances in gastrointestinal flora which may lead to reduced resistance to pathogens such as Clostridium difficile (C. difficile). Probiotics are live organisms thought to balance the gastrointestinal flora....Based on this systematic review and meta-analysis of 23 randomized controlled trials including 4213 patients, moderate quality evidence suggests that probiotics are both safe and effective for preventing Clostridium difficile-associated diarrhea."

Therapeutics new review-
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  -GUT 2013    "The epidemiology, pathogenesis, diagnosis and treatment of diabetic gastroparesis are reviewed, focusing on the areas that are still controversial and those that require more studies"

Therapeutics/Nutrition - 

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  -Drug Safety 2013   "Nonjudicious use of PPIs creates both preventable financial as well as medical concerns. PPIs have been associated with an increased risk of vitamin and mineral deficiencies impacting vitamin B12, vitamin C, calcium, iron and magnesium metabolism"

Preclinical Research-

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-Nature 2013    "Scientists at the National Institutes of Health, and their colleagues, have discovered that a gene called BACH2 may play a central role in the development of diverse allergic and autoimmune diseases, such as multiple sclerosis, asthma, Crohn's disease, celiac disease, and type-1 diabetes"

 Nutrition -

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-Gastroenterology, 2013 " Based on a study of 10 pediatric patients, genetic defects that disrupt bile acid amidation cause fat-soluble vitamin deficiency and growth failure, indicating the importance of bile acid conjugation in lipid absorption. Some patients developed liver disease with features of a cholangiopathy. These findings indicate that patients with idiopathic neonatal cholestasis or later onset of unexplained fat-soluble vitamin deficiency should be screened for defects in bile acid conjugation."

Physiology/Nutrition Review -

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-Current Biology 2013  "One reason for the success of bariatric approaches to obesity may be related to its actions on multiple pathways in the periphery. Roux-en-y gastric bypass profoundly increases prandial CCK [92], Apo A-IV [93], GLP-1 92, 94 and 95, PYY 92 and 95, amylin [96], insulin 94 and 95, glucagon [92] and other factors as part of an integrated response to surgically induced changes in nutrient handling. These changes may incur and maintain weight loss independent of the gastric restriction that is also produced by this surgery. Total weight loss after Roux-en-y gastric bypass can be in excess of 25% of pre-operative values [1]. Thus, targeting multiple pathways may be one way to overcome the 5% ceiling effect seen in traditional weight-loss approaches."


 Nutrition - Minerals news -FDA advisory -FDA advisory health care professionals should stop "using magnesium sulfate injection for more than 5-7 days to stop pre-term labor in pregnant women.  Administration of magnesium sulfate injection to pregnant women longer than 5-7 days may lead to low calcium levels and bone problems in the developing baby or fetus, including thin bones (osteopenia), and fractures."  -Medpage Today 2013 and -FDA, 2013

Surgical Residents Bemoan Work Hour Limits  Medpage Today 2013  Efforts to reduce residents' sleep deprivation and stress with mandatory reductions in work hours have not been popular with hospital attending staff, and now a new survey suggests that the rules are equally unpopular among the residents themselves.

Nutrition - Mediterranean diet shown to reduce heart disease, landmark study finds    Boston Globe 2013   "A Mediterranean diet supplemented with extra-virgin olive oil or mixed nuts can significantly reduce heart attacks, strokes, and deaths from heart problems, according to a study that is the first to demonstrate its benefits in a type of clinical trial considered the most reliable."

Genes Influence H. Pylori Infection Medpage Today 2013    Genetic susceptibility appears to play a role in Helicobacter pylori infection, according to genome-wide association found in two large studies.  Point out that genetic testing would be premature given the need for replication, especially in more diverse populations.

Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus  plus a podcast  GUT 2013

Geographical variability and environmental risk factors in inflammatory bowel disease  GUT 2013

Functional (Non-Ulcer) Dyspepsia and Gastroesophageal Reflux Disease: One Not Two Diseases?  AGJ 2013    "Functional dyspepsia is a very common, distressful, and costly condition. New data indicate that heartburn and regurgitation occur frequently in functional dyspepsia, even after objective gastroesophageal reflux disease has been exhaustively excluded by appropriate testing. Arbitrarily excluding heartburn in functional dyspepsia studies appears misguided.

A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children NEJM 2012  Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children.

EB-PBL, Literature Presentation Ideas by Topic Areas - More Topics than PBL cases

We are hoping to raise your interest in literature rather than making it a negative.  So for EB-PBL it is important to us that you find a paper that interest's you!  You can choose among some of the papers here or find your own using a search engine like those found in Endnote, Ovid, Pubmed or Highwire Press (link is → Highwire press - push the "include Pubmed" button and narrow the dates to recent years ).  Feel free to contact our GI resource Librarian Faculty for help with that.   To schedule individual or small group appointments for literature searching instruction contact librarian Amy Knehans, MLIS, AHIP, Clinical Outreach, Liaison & Instruction Librarian -  aknehans@hmc.psu.edu  

U.S. = Gastroesophageal Reflux Disease (GERD),  U.K. =Gastro-oesophageal Reflux Disease (GORD)

  GERD or GORD 

Efficacy and safety of lesogaberan in gastro-oesophageal reflux disease: a randomised controlled trial

Quantitative analysis of tooth surface loss associated with gastroesophageal reflux disease A longitudinal clinical study

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Treating silent reflux disease does not improve poorly controlled asthma

Impaired ghrelin signaling is associated with gastrointestinal dysmotility in rats with gastroesophageal reflux disease

Esophageal Sphincter Device for Gastroesophageal Reflux Disease

Clinical, but not oesophageal pH-impedance, profiles predict response to proton pump inhibitors in gastro-oesophageal reflux disease

Here is a Perspective for a Science paper.  The perspective is entitled Esophageal Stem Cells, Where Art Thou?.  You could then use that perspective to help you present this Science paper:  A Single Progenitor Population Switches Behavior to Maintain and Repair Esophageal Epithelium

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  Terrific content but advertisements appear before content is shown

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Achalasia

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Gastric Cancer

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Gastroparesis

 Tetrahydrobiopterin deficiency induces gastroparesis in newborn mice

Intragastric pH in diabetic vs. idiopathic gastroparesisCarbon monoxide reverses diabetic gastroparesis in NOD mice

The Added Diagnostic Value of Liquid Gastric Emptying Compared with Solid Emptying Alone

Specific food structures supress appetite through reduced gastric emptying rate

Human chorionic gonadotropin regulates gastric emptying in ovariectomized rats

TRPV2 ion channels expressed in inhibitory motor neurons of gastric myenteric plexus contribute to gastric adaptive relaxation and gastric emptying in mice

Gastric emptying, mouth-to-cecum transit, and glycemic, insulin, incretin, and energy intake responses to a mixed-nutrient liquid in lean, overweight, and obese males

Nerve activity recordings in routine human intestinal biopsies

Peptic Ulcer

Association Between Peptic Ulcer and Personality Disorders in a Nationally Representative US Sample

Fall in peptic ulcer mortality associated with increased consultant input, prompt surgery and use of high dependency care identified through peer-review audit

Changing trends in peptic ulcer disease: the rise of NSAID-induced and fall of H pylori-induced ulcers

Use of non-steroidal anti-inflammatory drugs and proton pump inhibitors in correlation with incidence, recurrence and death of peptic ulcer bleeding: an ecological study

Anti-Helicobacter pylori Potential of Artemisinin and Its Derivatives

The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention

Birth cohort patterns of gastric cancer and peptic ulcer among non-whites in the USA

Prevention of peptic ulcers with esomeprazole in patients at risk of ulcer development treated with low-dose acetylsalicylic acid: a randomised, controlled trial (OBERON)

Helicobacter pylori VacA Induces Programmed Necrosis in Gastric Epithelial Cells ▿

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Gastric Bypass Surgery


 

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Controversy-  

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Celiac Sprue, Celiac Disease  (British = coeliac disease)

Structural basis for gluten intolerance in Celiac Sprue

Probe-Based Confocal Laser Microscopy Identifies Criteria Predictive of Active Celiac Sprue

Protein engineering of improved prolyl endopeptidases for celiac sprue therapy

Multiphoton Tomographic Imaging: A Potential Optical Biopsy Tool for Detecting Gastrointestinal Inflammation and Neoplasia

Targeted modification of wheat grain protein to reduce the content of celiac causing epitopes

A functional candidate screen for coeliac disease genes

Anti-Tissue Transglutaminase Antibodies in Patients with Abnormal Liver Tests: Is It Always Coeliac Disease?

BACH2 represses effector programs to stabilize Treg-mediated immune homeostasis

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Pancreatitis

 Balthazar's scoring system for severity of acute pancreatitis Balthazar scoring based on CT : Grade A: Normal CT - 0 points  Grade B: Focal or diffuse enlargement of the pancreas - 1 point   Grade C: Pancreatic gland abnormalities and peripancreatic inflammation - 2 points   Grade D: Fluid collection in a single location - 3 points   Grade E: Two or more fluid collections and / or gas bubbles in or adjacent to pancreas - 4 points  Necrosis Score based on percentage of necrosis on CT  No necrosis: 0 points,  0 to 30% necrosis: 2 points, 30 to 50% necrosis: 4 points, Over 50% necrosis :6 points.    CT severity index = CT grade point + points for necrosis

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Abstinence after First Acute Alcohol-Associated Pancreatitis Protects Against Recurrent Pancreatitis and Minimizes the Risk of Pancreatic Dysfunction

Transient Receptor Potential Ankyrin 1 (TRPA1) Mediates Chronic Pancreatitis Pain In Mice

CCR2 knockout exacerbates cerulein-induced chronic pancreatitis with hyperglycemia via decreased GLP-1 receptor expression and insulin secretion

Early Jejunal Feeding Initiation and Clinical Outcomes in Patients with Severe Acute Pancreatitis

Patients with non-diagnostic hyperamylasaemia must be investigated and managed as per acute pancreatitis

Tobacco carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone initiates and enhances pancreatitis responses

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Gallstones, Cholelithiasis, Cholangitis, Cholecystitis, and Choledocholithiasis

Duodenoscopy image of pus extruding from Ampulla of Vater, indicative of cholangitis

Emergency endoscopic retrograde cholangiopancreatography in critically ill patients is a safe and effective procedure

Pediatric obesity and gallstone disease

Are liver function tests, pancreatitis and cholecystitis predictors of common bile duct stones? Results of a prospective, population-based, cohort study of 1171 patients undergoing cholecystectomy

Role of antibiotic therapy in mild acute calculus cholecystitis: a prospective randomized controlled trial 

Health disparities- Choledocholithiasis Management in Rural America: Health Disparity or Health Opportunity?

Abdominal and Total Adiposity and The Risk of Acute Pancreatitis: A Population-Based Prospective Cohort Study

Inflammatory Bowel Disease 

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Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS)

Anti-inflammatory effects of freeze-dried black raspberry powder in ulcerative colitis

Ulcerative Colitis–Associated Colorectal Cancer Arises in a Field of Short Telomeres, Senescence, and Inflammation

The mucosal addressin cell adhesion molecule antibody PF-00547,659 in ulcerative colitis: a randomised study

Anti-inflammatory effects of Saccharomyces boulardii mediated by myeloid dendritic cells from patients with Crohn's disease and ulcerative colitis

Health disparities - Colorectal Cancer Screening Disparities for Rural Minorities in the United States  

Health disparities -  Identifying Barriers to Colonoscopy Screening for Nonadherent African American Participants in a Patient Navigation Intervention                

Health disparities -  Spiritually Based Intervention to Increase Colorectal Cancer Screening Among African Americans Screening and Theory-Based Outcomes From a Randomized Trial

Health disparities - Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study

Evidence based medicine and health disparities - Impact of gastroenterologist care on health outcomes of hospitalised ulcerative colitis patients

Ustekinumab Induction and Maintenance Therapy in Refractory Crohn's Disease

BACH2 represses effector programs to stabilize Treg-mediated immune homeostasis

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Diverticulitis 

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Colon Cancer



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Diarrhea (British = diarrhoea)

 

 

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 - LANCET

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Constipation


Comparative Effectiveness - 

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Hepatitis

Alcoholic hepatitis evident by fatty change, cell necrosisMallory bodies

Health disparities -  Integrating theory into community interventions to reduce liver cancer disparities: The Health Behavior Framework

Perspective on An Interferon Paradox describes original Science papers, choose one: Persistent LCMV Infection Is Controlled by Blockade of Type I Interferon Signaling or  Blockade of Chronic Type I Interferon Signaling to Control Persistent LCMV Infection

Sofosbuvir for Previously Untreated Chronic Hepatitis C Infection

Perspective for this NEJM potential PILLs paper: Treatment of HCV Infection by Targeting MicroRNA

Association Between Sustained Virological Response and All-Cause Mortality Among Patients With Chronic Hepatitis C and Advanced Hepatic Fibrosis

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Alcoholic Cirrhosis-Hepatitis-Liver Transplant

Epidemiology-based risk assessment using the benchmark dose/margin of exposure approach: the example of ethanol and liver cirrhosis

Health disparities - Alcohol-Related and Viral Hepatitis C-Related Cirrhosis Mortality among Hispanic Subgroups in the United States, 2000–2004

Detection of alcohol consumption in patients with alcoholic liver cirrhosis during the evaluation process for liver transplantation

Increased serum activin-A differentiates alcoholic from cirrhosis of other aetiologies

The prevalence of cirrhosis and hepatocellular carcinoma in patients with human immunodeficiency virus infection

Potential Therapeutic Application of Intravenous Autologous Bone Marrow Infusion in Patients with Alcoholic Liver Cirrhosis

Anatomical cardiac alterations in liver cirrhosis: an autopsy study.

Viusid, a nutritional supplement, increases survival and reduces disease progression in HCV-related decompensated cirrhosis: a randomised and controlled trial

Dynamic Adaptation of Liver Mitochondria to Chronic Alcohol Feeding in Mice

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