September 2013 Vol XXXVII Issue 9

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Epidemiology of Gastrointestinal Cancers

Introduction To A New Series: Epidemiology of Gastrointestinal Cancers

C.S. Pitchumoni

Epidemiology of Gastrointestinal Cancers, #1

Battle of the Bulge and the Burden of Gastrointestinal Cancers

Arun Chockalingam, C.S. Pitchumoni

In many countries, cancer rates are increasing in parallel with obesity. It is estimated that 15-20% of all cancer deaths in the United States can be related to overweight and obesity, demonstrating that this health burden may exceed that of cigarette smoking. The aim of this review is to demonstrate the relationship of obesity as a major risk factor in gastrointestinal cancers.

A Special Article

Colon Cancer Screening in HIV-Infected Patients Age 50 and Older: Data from an Outpatient HIV Clinic

Robert D. Kung, Ashley L. Reid, Matthew M. McMahon, Ying Guo, Ryan M. Ford

Here we present a retrospective cohort study conducted to determine colon cancer screening results. Our study aims to better define prevalence and modality of colorectal cancer (CRC) screening in an HIV-infected population. We also aim to define the risk of polyps, advanced neoplasia and cancer in an age appropriate population of HIV-infected patients undergoing colonoscopy.

Nutrition Issues in Gastroenterology, Series #121

Nutritional Management for Head and Neck Cancer Patients

Stephen S. Schoeff, Dane M. Barrett, Carla DeLassus Gress, Mark J. Jameson

Nutrition management is an essential part of the care of patients with head and neck cancer. Both the disease and the treatments, especially surgery and radiation therapy, have significant negative impact on upper digestive tract function. Here we discuss the importance of continued progress in dysphagia prevention and treatment as a key factor in quality of life and the need for a diverse and experienced patient care team to produce the best outcomes.

A Case Report

Unusually Elevated CA 19-9 in Choledocholithiasis

Eiad Nasser, Ali Abbas, Dany Raad, Paula Burkard

A Case Report

Stricture Associated with "Inlet Patch"

Zeeshan Afzal, Mahwish Nasir, Nisar Ahmed

Departments Section

Book Reviews

Molecular Pathology of Neoplastic Gastrointestinal Diseases

This is a well written book that examines the molecular basis of gastrointestinal (GI) tract neoplasms. The book addresses the basic molecular mechanisms of all aspects of GI cancer development and focuses on the following types of cancers: esophagus, stomach, small intestine, colon and rectum, neuroendocrine tumors, and gastrointestinal stromal tumors. The book also serves as a practical guide by describing currently available molecular tests that exist for some types of cancers, the rationale for the testing, and the clinical implications of the test results for treatment.

GI and Liver Disease During Pregnancy: A Practical Approach

Few patient encounters generate the anxiety and uncertainty in gastroenterologists and internists such as the pregnant patient. Drs. Issacs and Long, with the help of several contributors, very eloquently and concisely address the care of the pregnant patient with GI and liver diseases in this very readable and easy to follow pocket guide—GI and Liver Disease During Pregnancy: A Practical Approach.

Atlas of Dermatological Manifestations of Gastrointestinal Disease

The relationship between gastrointestinal maladies and cutaneous manifestations has been recognized for thousands of years. The Atlas of Dermatological Manifestations of Gastrointestinal Disease is a 196- page hardcover text with a stated purpose “to produce an atlas that will provide a comprehensive compendium of digestive tract diseases with dermatological manifestations.”

Extraesophageal Manifestations of GERD

Numerous studies and manuscripts have dealt with the common manifestations of gastroesophageal reflux disease (GERD), primarily esophagitis. More recently, many human ailments have been attributed to GERD, ranging from halitosis and asthma in adults to

From the Literature

Pruritus in Cholestatic Disease: A Difficult Dilemma

Alagille syndrome is associated with extremely problematic pruritus as a result of chronic cholestasis. Medical management is usually initiated, although pharmaceutical intervention is associated with variable response. Surgical management may be necessary, in extreme cases, including partial external biliary diversion or liver transplantation. All children with Alagille syndrome that were followed using a database at the Paediatric Liver Centre at King’s College Hospital were evaluated for clinical response to pruritus using medical or surgical management.

Hepatopulmonary Syndrome For Transplantation

HPS (hepatopulmonary syndrome) independently increases mortality regardless of the cause or severity of liver disease. To evaluate the long-term survival with the use of liver transplantation (LT), a large consecutive series of HPS patients specifically addressing survival related to the degree of hypoxemia and the era in which LT was conducted was evaluated from 106 HPS patients at the Mayo Clinic from 1986 through 2010. Survival was assessed using Kaplan-Meier methodology.

Refractory Hepatic Encephalopathy/Spontaneous Portosystemic Shunts

Large spontaneous portosystemic shunts (SPSSs), had been suggested to sustain HE in cirrhotic patients to retrospectively assess the efficacy and safety of patients treated with embolization of large SPSSs for the treatment of chronic therapy refractory HE in a European multicentric working group and to identify patients who may benefit from this procedure.

Autoimmune Hepatitis: Predictors of Poor Outcome

AIH can lead to cirrhosis, hepatic failure, and death. To identify the predictors of advanced liver fibrosis at presentation, predictors of incomplete response to initial immunosuppression, and predictors of poor liver-related outcomes in the population-based AIH cohort from Canterbury, New Zealand were reviewed.

Treatment of Combined HCV and HBV

The durability of hepatitis B and C clearance in coin- fected patients was investigated in a 5-year follow-up study. Patients with active HCV genotype 1, both HBV-coinfected (N = 97), and HBV-monoinfected (N = 110), underwent 48 week combination therapy with PEG Interferon Alfa-2A plus ribavirin. In patients with HCV genotype 2 or 3, both HBV-coinfected (N = 64) and monoinfected (N = 50) patients underwent 24-week combination therapy. A total of 295 (91.9%) patients completed treatment and 24 weeks post treat- ment follow-up, 264 (89.5% of patients) agreed to receive additional follow-up for up to five years after the end of treatment.

Tattooing and HCV

A large, multi-center, case-controlled study was carried out, analyzing demographic and HCV risk factor exposure history data from 3871 patients, including 1930 with chronic HCV infection and 1941 HCV-negative controls. Crude and fully-adjusted odds ratios (ORs) of tattoo exposure by multivariate logistic regression in HCV-infected versus controls were determined.

Medical Bulletin Board

Q&A on Gastrocolic Reflex:

By Dr. Ellen Gutkin from New York Hospital Queens, New York- Presbyterian Healthcare System