September 2008 Vol XXXII Issue 9

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Biliary Diseases in the Elderly

Bhavesh B. Shah, Rad M. Agrawal, Brian Goldwasser, Katie F. Farah

As the United States population ages it is important for gastroenterologists to understand the various biliary diseases in the elderly and to have knowledge of the variety of clinical presentations that may inflict this population. This article reviews the possible biliary diseases and their management.


Hidden Sources of Gluten

Karen H. Hlywiak

The goal of this article is to help guide health care providers, and celiac patients along with their families, in identifying sources of gluten, both obvious and hidden. The author cautions, "read the labels", and offers many information sources where patients and their families may seek help.


Celiac Disease and the Colon

William Dickey

Celiac disease is an autoimmune enteropathy of the small intestine triggered by dietary exposure to gluten. There are well described associations between celiac disease and both inflammatory bowel disease and microscopic colitis. Dr. Dickey’s article suggests that colonoscopy should be performed on all patients over 40 years of age who present with altered bowel habits or iron deficiency anemia.


Water Intoxication-Considerations for Patients, Athletes and Physicians

Timothy D. Noakes

Before 1969 athletes were advised to avoid any fluids during exercise. Beginning in the 1970's athletes were advised to "drink beyond hirst." In 1981 came the first reported case of exercise-associated hyponatremic encephalopathy. This article reviews exercise-associated hyponatremia (EAH) and exercise-associated hyponatremic encephalopathy (EAHE) and provides safe guidelines for hydration during exercise.


Submassive Hepatic Necrosis in a Patient with AIDS

Mujtaba I. Butt, Kidada Gilbert-Lewis, Cherif El-Younis, Nora V. Bergasa

An unusual case of a patient with AIDS and Hepatitis C who presented to the hospital with fever, chills and rash. Liver biopsy revealed hepatic necrosis and proved to be an adverse drug reaction.


A case for you to solve.

Ami K. Naik, Claudio R. Tombazzi


This cases demonstrates the earliest gastrointestinal symptoms following habitual marijuana use.

Vikram Budhraja, Tarun Narang, Sulaiman Azeez

Departments Section

From the Pediatric Gastroenterology Literature

Increased Awareness of Nutritional Needs in Cystic Fibrosis

Patients with cystic fibrosis (CF) have an increased energy requirement in order to preserve lung function over time. In particular, the resting energy expenditure (REE) of CF patients is especially pronounced in girls. This Australian study looked at CF patients from five-to-18-years of age over a five-year study period with testing points at study entry, one year, and two years.

Chronic Hepatitis C Infection in Children

Hepatitis C virus (HCV) infection occurs in children throughout the world although the disease course is not clear. It is thought that the HCV in children is a relatively mild disease, but clinical trials are lacking. In this study, a multi-center evaluation of pediatric patients in Italy determined the clinical features of HCV over a 15-year period. Patients were studied using the "Observatory for HCV Infection and Hepatitis C in Children" which studies HCV infection in Italian children.

From the Literature

Metabolic Syndrome and Chronic Hepatitis C Infection

In order to estimate the prevalence of metabolic syndrome (MS) in HCV patients undergoing antiviral therapy and to assess its predictive value and treatment outcome, all HCV treatment-na?ve patients who met the inclusion/exclusion criteria were studied.

Chronic Hepatitis B and Mildly Elevated ALT

A retrospective study was conducted to investigate the prevalence of significant histology in a patient population with mildly elevated serum ALT levels.

Eosinophilic Esophagitis and Atopy

To identify the spectrum of specific allergic sensitivities to environmental and food allergens within a series of adult patients with eosinophilic esophagitis (EE), 23 adult patients with biopsy-proven EE referred for allergy evaluation at an Academic clinic were evaluated.

Insulin Resistance and Diabetes Effects on Fibrosis in Genotype 1A HCV Infection

In order to assess whether increase in degrees of insulin resistance (IR) up to overt diabetes are linked to steatosis and higher stages of fibrosis in patients with CHC (chronic hepatitis C), resulting from genotype I HCV (G1-HCV), two hundred one consecutive patients with G1-HCV infection were evaluated by liver biopsy and anthropometric and metabolic measurements, including IR, by the HOMA (homeostasis model assessment).

Small Intestinal Bacterial Overgrowth and Scleroderma

To investigate the orocecal transit time (OCTT) and the presence of small intestinal bacterial overgrowth (SIBO) in systemic sclerosis (SSC), as a cause of intestinal symptoms, 55 SSC patients and 60 healthy controls entered the study. Enrolled subjects completed a questionnaire for intestinal symptoms and a global symptomatic score (GSS) was calculated.

PEG Interferon Plus Ribavirin in Treatment of Hepatitis C Genotype 6

Infection with HCV genotype 6 is common in patients from parts of China and Southeast Asia. In order to examine the treatment response to PEG IFN plus RBV in Genotype 6 patients, and the effects of treatment duration on SVR rates, a retrospective study of 190 consecutive Asian-American patients who were diagnosed with HCV Genotype 6 at a gastroenterology clinic in Northern California between 2001 and 2004 was performed.

Symptoms of GERD on Acid Reflux Therapy

To compare physical and chemical characteristics of gastroesophageal reflux (GER) episodes associated with symptoms in patients on acid suppressive therapy, patients with those symptoms on therapy underwent combined impedance/pH monitoring.

Abdominal Bloating and Functional Gastrointestinal Tract Disease

Bloating is common, but its significance as a marker of underlying disease has not been defined. A cross-sectional population-based study of 1,069 employees of the Veteran's Affairs Black Hills Health Care System was carried out.

Hormone Replacement Therapy in Menopausal Women with IBD

To characterize the effect of menopause on disease activity and identify possible modifiers of disease activity and IBD, a retrospective study of women followed at the University of Chicago IBD Clinic was carried out.

Medical Bulletin Board

Studies Show USGI Medical's EndoSurgical Operating SystemTM Enables Incisionless Surgery to Reduce Gastric Pouch and Stoma After Gastric Bypass

Studies Presented at American Society for Metabolic and Bariatric Surgery Meeting

Vertex Announces Positive Interim Results with Telaprevir-based Therapy in Genotype 1 Chronic Hepatitis C Patients who Failed to Achieve SVR with Previous Pegylated Interferon and Ribavirin Treatment

Interim results were presented in a late-breaker poster presentation at EASL on April 24?Significant early on-treatment viral response from patients who previously failed therapy

Precancerous Esophagus Disease Eliminated in 98.4% of Patients Treated with HALO Ablation System

Long-term study confirms treatment could help 3.3 million U.S. sufferers

ASGE Issues Guidelines on the Role of Endoscopy in the Bariatric Surgery Patient

The American Society for Gastrointestinal Endoscopy (ASGE) has issued guidelines on the role of endoscopy in the bariatric surgery patient.

Epocrates Introduces Online Disease Resource

Free, point-of-care reference provides fast answers to clinical questions