September 2012 Vol XXXVI Issue 9

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Inflammatory Bowel Disease: A Practical Approach, Series #77

Metabolic Bone Disease in Inflammatory Bowel Disease

Fayez K. Ghishan, Pawel R. K

Chronic inflammatory bowel diseases (IBD) affect bone metabolism and are frequently associated with decreased bone mineral density (BMD) and increased risk of fractures. New studies continue to unravel a complex network of interactions leading to the inflammationassociated loss of BMD, and may help direct treatment of IBD toward more bone-sparing strategies. Understanding the pathophysiology of osteopenia and osteoporosis in Crohn?s disease and ulcerative colitis are critical for the correct choice of available treatments or the development of new targeted therapies.

Nutrition Issues in Gastroenterology, Series #109

Nutrition and Nutraceuticals for Muscle Maintenance and Recovery: Hero or Hokum?

Joe Krenitsky

Muscle loss during hospitalization, especially during intensive care unit admissions, contributes to muscle weakness, functional limitations and the need for extended rehabilitation services. This review will evaluate the data investigating the potential of nutraceuticals and nutrition strategies to minimize muscle loss and accelerate rehabilitation of muscle mass and strength.

Practical Approaches to the Diagnosis and Treatment of Colorectal Cancer, Series #7

Flat Polyps: Endoscopic Detection and Treatment

Susan G. Coe, Michael B. Wallace

Flat and serrated polyps are a particular challenge to detect and may explain why some of these cancers occur. When performed by appropriately trained endoscopists in carefully selected patients, endoscopic resection can reduce the risk and morbidity of resection. In this review we define the types of difficult to detect polyps, methods to increase their detection,and describe available endoscopic resection techniques.

A Case Report

Mesenteric Pannicultis Presenting as Recurrent Small Bowel Obstruction in an Elderly Male

Ashish Kataria, Sanjaya K. Satapathy, Richard Straus, Silvat Sheikh-Fayyaz, Ronald Greenberg

A Case Series

Endoscopic Clip Closure of Benign Esophagopleural Fistulas

Kimberly Salaycik Kolkhorst, Eric Hill, Patrick Brady

Fellows Corner

Arieda Gjkopulli, Ritu Walia, Gia Bradley, Kalpana Murthy, David Tuchman

Departments Section

Book Reviews

Self-Expanding Stents in Gastrointestinal Endoscopy

Self-Expanding Stents in Gastrointestinal Endoscopy is a multi-authored text on evidence- based use of selfexpanding stents (SES) in adult gastrointestinal (GI) endoscopy. This comprehensive text is divided into fourteen chapters including lists of references. The first thirteen chapters, organized by anatomical area of stenting, address the FDA-approved uses of various types of stents in benign and malignant pathology of the luminal GI tract (esophagus, stomach/duodenum, and colon) as well as the pancreaticobiliary tree. These include plastic, uncovered, partially covered, and fully covered self-expanding metal stents. Intra- and post procedural complications of stent insertion and their management are also reviewed. The final chapter focuses on the future of SES in GI endoscopy specifically drugeluting, biodegradable, and radioactive stents. Multiple tables are included which summarize studies, scoring systems, and features of most stents available in the US. The fluoroscopic and full color endoscopic images are of high quality and add visual appeal and depth to the text.

Autoimmune Hepatitis: A Guide for Practicing Clinicians

This 243 page book, with 236 pages of text, images, figures, tables, and references, was written by an international collection of authors and experts as a clinical reference for providers caring for patients with autoimmune hepatitis. The structure of the book covers the major areas of concern in caring for patients with autoimmune hepatitis and each chapter concludes with a "chapter summary", in addition to a section of "useful tips" and "common pitfalls" for practitioners, which reinforce key clinical issues.

A Practical Guide to Reflux: Causes, Consequences, and Care

This is a short well-referenced book that reads like a tome on the topic of esophageal reflux. In other words, this little book (81 pages including references) requires close attentiveness and possibly a great amount of caffeine to completely read through. In the end, it offers little over what many other better written books and more up to date articles already offer on the subject.

Clinical Gastroinestinal Endoscopy

This book provides a comprehensive review of endoscopy as it applies to clinical gastroenterology. The concise overview of clinical conditions in the introductory part of each chapter serves as a nice prelude to the endoscopy-centered portion of the text and makes for easy reading and assimilation. Brief tables and easy-to-follow figures, illustrations and diagrams enhance the text. The stature of the authors in the field of gastrointestinal endoscopy contributes to its strength. A main attraction of the book is its focus on descriptive endoscopic content, which is hard to find in other standard and traditional textbooks of gastroenterology. This aspect makes it a particularly helpful reference for gastroenterologists and endoscopists who seek answers to endoscopic "how to" as well as "why" questions.

Iron Physiology and Pathophysiology in Humans

My friends are always asking me why I find iron fun to study. One reason is that perhaps more than other field, iron physiology spans so many different spheres. Iron deficiency may be understood through the medical, nutritional and even public or global health context; improved iron therapies and fortification remain an important goal. Iron overload may result from inherited genetic disorders or long-term transfusions for acquired or congenital hematologic conditions; improved strategies for iron removal remain an important need. The interaction between iron and inflammation and infection positions it as a key immunologic player. Measurement of iron status utilizes rapidly evolving biochemical, hematologic, and radiologic studies. Pathways of regulation of mediators of iron metabolism have been understood through the prism of cell biology, forward genetics, and genetic epidemiology. The richness and diversity in this field are synthesized in Anderson and McLaren’s Iron Physiology and Pathophysiology in Humans.

Gut Instincts: A Clinician's Handbook of Digestive and Liver Diseases

There are few quick reference books focused on gastroenterology and hepatology. Gut Instincts is a pocket guide that has an ambitious goal to become an efficient quick reference for topics frequently encountered in gastroenterology and hepatology. The book’s authors combine evidence from clinical trials with expert opinions throughout the book. The book is an information-dense read spanning 324 pages. The level and depth of information would best benefit learners in gastroenterology or would be a quick reference for a busy practitioner

From the Pediatric Gastroenterology Literature

Lymphoma Risk in Children with Inflammatory Bowel Disease

Due to the early age of immune suppression exposure in children with inflammatory bowel disease (IBD), there is concern that such medication may lead to an increased risk of malignancy. This possibility is especially concerning as there is an increased risk of hepatosplenic T-cell lymphoma in children with IBD in young males who are receiving thiopurines with or without the addition of anti-tumor necrosis factor (TNF) antibodies.

Another Antibiotic as a Motility Agent in Children?

Antibiotics, such as erythromycin, are used as gastric motility agents. Minimal therapies are available to enhance small bowel motility. Amoxicillin / clavulanate (A/C) is known to cause diarrhea as a side effect, and it may be a potential therapy to induce small bowel motility. The authors of this study attempted to study the effect ofA/C on small bowel motility in children.

Gastroparesis in Children

Gastroparesis is known to occur in children. However, its prevalence in the pediatric population and its etiology are poorly defined. The authors of this study identified all cases of pediatric gastroparesis over a 6-year period at a tertiary academic children?s hospital. All patients were diagnosed with gastroparesis by gastric scintigraphy, and the causes of gastroparesis as well as the response to medications were reviewed.

From the Literature

Changes in Risk For Colorectal Cancer in IBD

nationwide cohort of 47,374 Danish patients with IBD, study was carried out over a 30-year period. Poisson Regression-Derived Incidence Rate Ratios of CRC from one year after IBD diagnosis, adjusted for age, sex, and calendar time was determined.

Seroprevalence of HBV DNA with Mutation After Complete Vaccination

Despite the success of a universal vaccination program against HBV in Taiwan, a small, but substantial proportion of individuals remain infected by mutant viruses that escape the vaccine. To investigate the seroepidemiology, HBsAg, antibody to hepatitis B core antigen (anti-HBC), and antibody to hepatitis B surface antigen (anti-HBS), in 1214 serum samples collected throughout Taiwan from individuals 0.6 to 87 years old were measured.

Albumin Infusion in Large-Volume Abdominal Paracentesis

To determine whether morbidity and mortality differ between patients receiving albumin versus alternative treatment, a meta-analysis was carried out, including randomized trials, evaluating albumin infusion in patients with tense ascites. Primary end points were post paracentesis circulatory dysfunction, hyponatremia, and mortality.

C. Difficile and Relationship to PPI Use

To perform a systematic review of incident and recurrent Clostridium difficile infection (CDI) in proton pump users (PPI), and to evaluate the relative impact of concurrent antibiotic use or switching acid suppression to histamine-2 receptor antagonists (H2RAs), a metaanalysis was carried out through December 2011 with reports on the risk of CDI, with and without PPI use.

Hypertriglyceridemia/Pancreatitis, Statins, and Fibrate Therapy

To investigate associations between statins or fibrate therapy and incident pancreatitis in large, randomized trials, literature searches of MEDLINE EMBASE and Web of Science were carried out from January 1, 1994 and January 1, 1972 for statin and fibrate trials, respectively,through June 9, 2012.

Serum Ferritin Elevations in Chronic Hepatitis C

A comprehensive analysis of the role of serum ferritin and its genetic determinants was carried out in the pathogenesis and treatment of chronic hepatitis C (CHC). Serum ferritin levels at baseline of therapy with PEG Interferon and Ribavirin on or before biopsy were correlated with clinical and histologic features of HCV infection, including necroinflammatory activity (N = 970), fibrosis (N = 980), steatosis (N = 886), and response to treatment (N = 876).

Complications Associated with Treatment of Inflammatory Bowel Disease

To analyze the safety of long-term Infliximab treatment with/without concomitant immunomodulators across Crohn?s disease (CD), and ulcerative colitis (UC), clinical trials, primary safety data was pooled across 10 CD or UC trials, including 5 randomized control trials, contributing data from patients who received intravenous Infliximab 5 or 10 mg/kg (N = 1713); azathioprine or placebo (N = 406), with or without azathioprine. Pooled incidences and 95% confidence intervals (CI) were determined for mortality, infection, and malignancy.

PEG Interferon-Associated Retinopathy in HCV With Hypertension

To investigate the frequency and clinical significance of retinopathy during therapy with Peg-Ifna and ribavirin in 97 consecutive HCV patients, in all, 54 (55.7%) and 43 (44.3%) with PEG-Interferon 2A and 2B, respectively, ophthalmologic examination was performed before therapy (baseline), at 3 and 6 months of therapy and 3 months after the end of therapy. Overall, 30.9% of patients developed retinopathy as defined by the presence of cotton wool spots and/or retinal hemorrhages.

Colorectal Carcinoma With IBD From 1998 to 2010

To calculate the incidence and standardizing mortality ratios of CRC among adult individuals with intact colons using Kaiser Permanente of Northern California’s database of members with IBD and general membership data for the period of 1998 to June 2010, and to include trends in medication use and rates of cancer detection over time, 29 cancers were identified among patients with CD and 53 with UC.

HCV Reinfection and Superinfection

To evaluate reinfection and superinfection during treatment for recent HCV, the Australian Trial in Acute Hepatitis C (ATAHC), that was a prospective study of the natural history and treatment of recent HCV, defined superinfection by detection of infection with an HCV strain distinct from the primary strain in the setting of spontaneous or treatment-induced viral suppression.

Medical Bulletin Board

FDA Approves Ferring’s PREPOPIK™ (sodium picosulfate, magnesium oxide, and anhydrous citric acid) For Colonoscopy Prep

New Low-Volume Regimen With 10 Ounces of Prep Solution


Swiss study shows that colonoscopy with polypectomy significantly reduces colorectal cancer incidence and mortality in the general population

Prometheus Launches New Monitoring Test To Help Guide Inflammatory Bowel Disease Management

PROMETHEUS ® Anser ™ IFX designed to help identify potential causes for loss of treatment response among IBD patients using infliximab