January 2013 Vol XXXVII Issue 1

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Nutrition Issues in Gastroenterology, Series #113

Nutritional Management of the Adult with Cystic Fibrosis ? Part I

Christie L. Rogers

This is part I of a two part series which serves to present the nutritional challenges of adults with cystic fibrosis and to provide tools to prevent or manage these major nutritional concerns. Part I will address weight maintenance, pancreatic insufficiency and sufficiency, vitamin supplementation, gastrointestinal issues beyond the pancreas, and bone disease. Part II willcover cystic fibrosis related diabetes, fertility, and pregnancy with cystic fibrosis.

Hepatitis C: a New era of Treatment, Series #5

Ribavirin Prescribing Practices Among HCPs and the Future of Ribavirin in the Treatment of Chronic Hepatitis C

Melissa Palmer

This article discusses the history, the proposed mechanism of action (MOA), the pharmacokinetics and the hemolytic anemia associated with ribavirin (RBV). In addition, the RBV prescribing practices among health-care practitioners who treat a high-volume of hepatitis C (HCV) patients will be revealed. Finally, this article will address the possible role of RBV in the treatment of HCV in the upcoming era of all-oral, interferon-free therapies.

A Case Report

Primary Sclerosing Cholangitis Complicating Ulcerative Colitis, Two Liver Transplants and Colorectal Carcinoma:

Michelle Maciag, Osamuyimen Igbinosa

A Case Report Spanning 25 Years

Fellows’ Corner

Duvy Tran, Ritu Walia

Pulmonary Nodules in Pediatric Patients with IBD

Departments Section

Book Reviews

Physiology of the Gastrointestinal Tract; 5th Edition

There is little doubt that the fifth edition of Physiology of the Gastrointestinal Tract is an impressive collection. At 82 chapters and over 2200 pages, this two volume set is not only physically substantial but is equally as remarkable in its expansive coverage of gastrointestinal physiology.

From the Pediatric Literature

Biomarkers for Biliary Atresia

Biliary atresia (BA) is a common cause of liver transplantation in children and a palliative procedure, the hepaticoportoenterostomy (Kasai procedure), needs to be performed very early in an infant?s life to allow for a delay before liver transplantation is considered. It would be useful to have serum biomarkers to aid in the diagnosis of BA and to help facilitate an early Kasai procedure.

Determining Cow?s Milk Protein Allergy Resolution

Cow’s milk protein allergy (CMPA) is a common IgEmediated food allergy in children, especially in infants. The lack of standardized criteria for diagnosis of CMPA in infants makes it difficult to determine which children will have long-term medical issues associated with this allergy as most infants with CMPA seem to have resolution of this allergy. The authors of this study from Israel tried to determine which infants were at risk of long-term.

From the Literature

PPI Therapy and Osteoporosis

PPI use has been identified as a risk factor for hip and vertebral fractures. To evaluate whether PPIs are associated with accelerated DMV loss that might increase fracture risk, a Canadian multicentre osteoporosis study that enrolled a population-based sample of Canadians who underwent DMV testing of the femoral neck, total hip, and lumbar spine at baseline and then again at 5 and 10years.

Evaluation of Acute Overt Obscure Gastrointestinal Bleeding

Both capsule endoscopy (CE) and angiography have been recommended as first investigation for patients with acute overt obscure gastrointestinal bleeding (OGI bleed). No studies have directly compared the two modalities and in order to compare the diagnostic longterm outcomes of patients with same, randomization to CE or angiogram were carried out in consecutive patients who presented with acute melena or hematochezia, but nondiagnostic upper and lower GI endoscopy.

Approach to Treatment of Idiopathic Recurrent Acute Pancreatitis

To evaluate the therapeutic effects of endoscopic sphincterotomy in patients with recurrent acute pancreatitis (RAP), and the prognostic significance of pancreatic sphincter dysfunction (SOD), a randomized trial of ERCP with SOM for patients with idiopathic RAP was carried out.

Additional Treatment for Short Bowel Syndrome With Intestinal Failure

Teduglutide, a glucagon-like peptide to analogue, might restore intestinal structure and functional integrity by promoting growth of the mucosa and reducing gastric emptying and secretion, increasing fluid and nutrient absorption in patients with short bowel syndrome with intestinal failure (SBS-IF).

Treatment of Intrahepatic Cholestasis of Pregnancy

A meta-analysis to evaluate the effects of ursodeoxycholic acid (UDCA) on pruritus, liver test results, and outcomes of babies born to women with intrahepatic cholestasis of pregnancy (ICP), was carried out with a systemic review of nine published, randomized, controlled trials of which three were double-blinded, that compared the effects of UDCA to other drugs, placebo, and controls in patients with ICP.

Hip Fracture Risk and Chronic HCV

HCV infection has been associated with reduced bone mineral density. To determine whether persons with HCV infection alone are at increased risk for hip fracture, compared to uninfected individuals, and whether HIV coinfected persons compared to those with HCV alone and HIV alone, and those uninfected, a cohort study in 36,950 HCV/HIV coinfected, 276,901 HCV-monoinfected, 95,807 HIV monoinfected, and 3,110,904 uninfected persons within the US Medicaid populations of five states was carried out.

HCV SVR and Insulin Resistance

HCV infection is associated with insulin resistance (IR), that influences the progression of liver fibrosis and response to PEG Interferon/ribavirin therapy (PEG-IFN and RBV, respectively). To assess whether an SVR after SVR after antiviral therapy prevents the development of IR in the long term, members of the Milan Safety Tolerability Study Cohort who received PEG-IFN-RBV therapy, underwent a homeostasis model assessment (HOMA) at the baseline at 24 months after treatment completion.

Treatment of Hypersensitive Esophagus

A total of 252 patients with normal endoscopic findings and typical reflux symptoms (heartburn, chest pain, and regurgitation), despite proton pump inhibitor therapy twice daily, underwent 24 hour pH impedance sign monitoring. Distal esophageal acid exposure (percentage time pH less than 4), was measured and reflux episodes were classified into acid or non-acid. A positive symptom index (SI) was declared if at least half of the symptom events were preceded by reflux episodes.

Linaclotide For IBS With Constipation

A phase 3, double-blind, parallel group, placebocontrolled trial of randomized IBS-C patients to placebo on 290 ug of oral linaclotide once daily for a 26-week period was carried out. The primary and secondary efficacy assessments were evaluated over the first 12 weeks oftreatment.

Medical Bulletin Board

First Patient Enrolled in Boston Scientific Randomized Study of Removable WallFlex® Biliary RX Fully Covered Stent for Patients Suffering From Chronic Pancreatitis

Study to Compare Clinical Outcomes of Self-Expanding Metal Stents (SEMS) Versus Plastic Stents for the Treatment of Biliary Strictures Caused by Chronic Pancreatitis

Data from Viral Kinetic Study Showed Rapid Reduction of HCV RNA with ALS-2200 (VX-135), Vertex’s Oral Nucleotide Analogue in Development for the Treatment of Hepatitis C

4.54 log10 median reduction in HCV RNA after 7 days of dosing; ALS-2200 was well-tolerated with no serious adverse events and no discontinuations due to adverse events
Vertex moving forward with multiple Phase 2 trials in early 2013 exploring all-oral combinations, including VX-135 with GSK2336805 and with simeprevir (TMC435)

St. Joseph’s Healthcare System

Lap band surgery is one of the safest weight loss surgeries available, but in 2?14 percent of patients, the device can erode into the stomach and cause pain and requires surgical removal. Sohail N. Shaikh, MD, at St. Joseph’s Healthcare System, is the first physician in New Jersey to remove an eroded lap band using endoscopic technology, a nonsurgical intervention.