June 2012 Vol XXXVI Issue 6

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Nutrition Issues in Gastroenterology, series #106

Nutritional Care in Adult Inflammatory Bowel Disease

Amar S. Naik, Nanda Venu

Identification and treatment of specific nutritional deficiencies are an integral part in the therapy of inflammatory bowel disease. This article addresses the assessment and management of the nutritional state of adult IBD patients.

Practical Approaches to the Diagnosis and Treatment of Colorectal Cancer, Series #4

Genetics and Individualized Treatment for Colorectal Cancer

William P. Hendricks, Daniel L. Edelstein

Genomic data and tools are beginning to be translated from the laboratory to the clinic where physicians and patients can use them to assess risk, predict outcomes, and individualize treatment. Although this transition is still in its infancy, its early fruits are particularly striking in colorectal cancer (CRC). Here, we discuss genetic tests available as standard of care for prognosis and prediction of treatment response and the emerging technologies promising to significantly improve patient care in the near future.

A Special Article

Feeding Options in Dementia

Nehal Ghevariya, Vishal Ghevariya, Sury Anand

Dementia, a syndrome that affects numerous complex functions of the brain, affects more than 4 million Americans. Inability to recognize hunger and fulfill the desire of eating commonly results in weight loss in dementia. Our simple algorithm will be useful for primary care physicians to approach various physiologic and artificial means of feeding for patients withthis condition.

a Case Report

Diffuse Hepatic Cavernous Hemangiomatosis Presenting with Portal Hypertension, Esophagogastric Varices, and GI Bleed

Anthony Yu, Andrew D Lerner, Vaibhav Mehendiratta, Steven Herrine

Fellows’ Corner

Case Presentation

Mickey B. Sachdeva, Kong Peng Yap

Departments Section

From the Pediatric Literature

GER and Dental Erosions in Children: True, True, Unrelated?

There has long been a proposed association between gastroesophageal reflux (GER) and dental enamel loss. However, dietary history, drinking habits, and salivary fluid bacteria may be more likely to lead to dental erosions in children. A group of 59 children ages 9 to 17 years with symptomatic GER and 20 control children of similar age underwent 24-hour pH probe testing, blinded dental assessment for erosion, food and oral hygiene questionnaires, measurement of stimulated salivary volume, and quantification of bacteria in the saliva (specifically, Streptococcus mutans and Lactobacillus species).

How Many Colon Biopsies are too Many?

Diagnostic endoscopy in children is increasing in utility throughout the world. Due to different disease processes in the pediatric population compared to adults, intestinal biopsies of normal tissue often are obtained in children due to the possible presence of microscopic disease (eosinophilic infiltration, microscopic colitis, celiac disease, etc.). As a result, large numbers of forcep biopsies are often obtained which can become expensive and problematic as many of these biopsies are often normal.

Intrapyloric Injection of Botulinum Toxin A in Children

Intrapyloric injection of botulinum toxin A for treatment of gastroparesis has had mixed results in adult studies. However, younger adults may have a better clinical response to this medication. The authors of this study retrospectively evaluated the clinical outcomes of all children who had received intrapyloric botulinum toxin A for treatment of gastroparesis over a 6-year period at a tertiary children’s hospital.

Can Treatment of Infant Feeding Problems be Improved?

Feeding difficulties are a common problem of premature infants and such infants often are referred for consultation by pediatric gastroenterologists. Such patients require extensive work with speech therapy or occupational therapy and can have significant associated health care costs.

Influenzae, IBD, and Children

Due to the nature of immunosuppression medication used in inflammatory bowel disease (IBD), patients with IBD have an increased risk of serious infections, including influenza. This study evaluated the immunogenic response of the influenza vaccine given to children with IBD

Hepatitis A Immunization and United States Adolescents

Hepatitis A virus (HAV) infection often is asymptomatic in children, but mortality from this infection can be quite high in adults older than 50 years of age. The two-dose HAV vaccination has been recommended for children living in high-risk states (defined as infection rates twice the national average) since 1999 and is recommended for all United States children at 12 months of age or older since 2006.

Book Reviews

The ASCRS Textbook of Colon and Rectal Surgery, Second Edition

The ASCRS Textbook of Colon and Rectal Surgery fulfills its goal in providing an up to the minute, comprehensive guide to colorectal surgery. It is sponsored by the American Society of Colon and Rectal Surgeons and edited by a group of experts chosen by the ASCRS Executive Committee.

Vascular Liver Disease: Mechanisms and Management

The functions of the liver are highly dependent on the vascular connections. These connections not only allow the liver to process and store nutrients but also permit removal of bacteria that come from the gut before they enter into the systemic circulation. It follows that the abnormalities that directly or indirectly affect the hepatic vasculature will lead to significant disease. Although many textbooks have been written on the consequences of the cirrhosis on the liver vasculature this is one of the few books that focuses on liver vasculature as a separate entity.

Managing the Complications of Cirrhosis: A Practical Approach

Managing the Complications of Cirrhosis: A Practical Approach is a concise review of commonly encountered clinical scenarios in patients with liver disease. The book is nicely divided into ten sections, including preventative health in cirrhosis (important for the primary care provider), nutrition, varices, ascites and renal issues, hepatic encephalopathy, hepatocellular carcinoma (HCC), pulmonary issues, preoperative risk assessment, and timing of referral for liver transplant.

Medical Bulletin Board

Mauna Kea Technologies Reports New Data Demonstrating Cellvizio(R)’s Potential as a Tool for the Characterization of Pancreatic Cysts

Adding Cellvizio’s AQ-Flex(TM) 19 Confocal Miniprobe Could Improve Care of Patients With Suspected Pancreatic Cancer

Product Release: Revital-Ox™ Family of Endoscopy Cleaning Solutions

The Revital-Ox™ one-stop shop of oxidative chemistry based solutions provides an effective, efficient and environmentally thoughtful approach to cleaning valuable endoscopic equipment.

New Data Show That Avantis Medical Systems’ Third Eye(R) Retroscope(R) Device Significantly Increases Adenoma Detection Rate in Patients at Higher Risk for Colorectal Cancer

Studies Presented at Digestive Disease Week(R) 2012 Confirm That Third Eye Retroscope Helps Address Limitations of Standard Colonoscopy, Including Missed Adenomas