March 2014 Vol XXXVIII Issue 3

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Nutrition Issues in Gastroenterology, Series #127

Clogged Feeding Tubes: A Clinician’s Thorn

Charles Fisher, Bethany Blalock

Clogged feeding tubes are responsible for significant lost delivery of enteral feeding. They also increase risks and costs to patients in the event that they must be replaced. This article will present evidence-based guidelines to clinicians for feeding tube clog prevention and declogging. The current products and techniques for declogging feeding tubes will be discussed with emphasis on practical declogging methods.

Inflammatory Bowel Disease: A Practical Approach, Series #88

Hepatobiliary Disease and Inflammatory Bowel Disease

Emily Schonfeld, James S. Park, Seymour Katz

Ten to twenty percent of patients with inflammatory bowel disease (IBD) have liver disease. This article will encompass important inflammatory conditions, such as primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), drug-induced liver injury, cholelithiasis, steatosis and rare liver diseases associated with IBD, such as amyloidosis and granulomatous hepatitis.

Unusual Causes of Abdominal Pain, #2

Unusual Causes of Abdominal Pain

George W. Meyer

A Case Report

Hepatic Abscesses Caused by a Rare Fistulous Tract

Neha Sahni, Dhiraj Gulati, Kamran Heydarpour

Fellows’ Corner

Giant Paraumbilical Veins/Caput Medusae

Amulya Belagavi, Lisa Meringer

Departments Section

Book Reviews

Overcoming Challenges in IBD Management

The book “Overcoming Challenges in IBD Management” by Panes, Ghosh, Gomollon, and Louis (editors) from Karger Press is a collection of up-to- date clinical and basic science topics in inflammatory bowel disease (IBD) that were presented at the 187th Falk Symposium in Barcelona, Spain. This book is a reprint of the articles found in the journal, Digestive Diseases in 2013 (volume 31, issue 2). This 263-page book is divided into six major topics: understanding mechanisms of disease, advanced techniques for diagnosis of IBD, optimal use of available drugs in IBD, best surgical approaches for IBD, managing IBD outside the gut, and cancer in IBD.

Probiotic Bacteria and Their Effect on Human Health and Well-Being

As the study of host-microbiome interaction has in recent years become one of the hottest fields in life science, the resulting advances in methodology and research have generated an explosion of knowledge on the topic, which in turn has opened fertile new areas for inquiry. Appropriately, this review of “Probiotic Bacteria and their Effect on Human Health and Well- Being” is not a comprehensive textbook, but is rather a concise, high-level snapshot of the progress to date in both (1) mechanistic understanding and (2) practical use of probiotics.

Falk Symposium 186: Challenges of Liver Cirrhosis and Tumors: Prevent It, Treat It, Manage Consequences

For over 40 years, the The Falk Foundation e.V. has supported educational symposia and workshops to promote heatlh and review the most current understanding of disease states. The goal of the 186th Falk Symposium in October 2012 in Mainz, Germany was to address cirrhosis and its consequences, with the particular focus of this meeting concentrating on hepatocellular carcinoma (HCC). A broad range of hepatology topics were presented including varied subjects of liver transplantation, liver tumors including hepatocellular carcinoma and cholangiocarcinoma, cholestatic liver disease, and hepatitis B in its relation to HCC.

From the Pediatric Gastroenterology Literature

Intraesophageal Pressure in Relation to Pediatric Cough

Multichannel intraluminal impedance with pH monitoring (MII-pH) has become a commonly used test for detection of gastroesophageal reflux (GER) in children. One indication MII-pH is for GER-associated cough, although there is a question of reliability of patients or parents recording symptoms in relation to GER. Recently, the addition of intraesophageal pressure recoding (IEPR) to MII-pH has been proposed as a more accurate method of correlating cough with GER, and this prospective study evaluated the sensitivity of IEPR with cough correlation in pediatric patients with GER.

Probiotics, NEC, and Sepsis

It is known that premature infants are at risk of late- onset sepsis (defined as sepsis occurring more than 48 hours after birth) due to gastrointestinal pathogenic bacteria entering the blood stream. Complications from such pathogenic bacteria include sepsis and necrotizing enterocolitis (NEC). Probiotics may be a potential preventative therapy for both sepsis and NEC in premature infants. The authors of this study evaluated the ability of probiotics to reduce the incidence of late- onset sepsis in a prospective, multi-centered, double- blinded, placebo-controlled trial.

From the Literature

Clinical Course of Primary Sclerosing Cholangitis

To obtain population-based prevalence and incidence figures, insight and disease course with regards to survival, liver transplantation (LT) and occurrence of malignancies, as well as risk factors thereof, four independent hospital databases were searched in 44 hospitals in a large geographically-defined area of the Netherlands, comprising 50% of the population.

Adalimumab and Risk of Hospitalization in Treatment of UC

To assess whether adalimumab in addition to standard UC therapy, reduced the risk for hospitalization (from all causes from complications of UC, or of the drugs used to treat it), and colectomy in patients with moderate to severe UC compared with placebo, data was combined from patients who received induction therapy or placebo in two trials (ULTRA-1 and ULTRA-2), N = 963.

Prophylaxis for Gastrointestinal Bleeding in Hepatocellular Carcinoma

To compare outcomes after variceal bleeding (VB), with and without hepatocellular carcinoma (HCC), all patients with HCC and esophageal VB admitted between 2007 and 2010 were evaluated. Followup was continued until death, transplantation, or June 2011. For each patient with HCC, a patient without HCC matched by age and Child-Pugh class was selected. A total of 292 patients were included, 146 with HCC and 146 patients without HCC.

Simeprevir Regimen in Treatment-Naïve Hepatitis C

A phase IIB, double-blind, placebo-controlled PILLAR Trial investigated the efficacy and safety of two different simeprevir (SMV) doses administered once daily with PEG IFN-a2a and RBV in treatment-naïve patients with HCV genotype 1 infection. Patients were randomized to one of five treatments (SMV 75 or 150 mg q.d.) for 12 or 24 weeks or placebo plus PEG, IFN, and RBV. Patients in the SMV arms stopped all treatment at week 24. If response-guided therapy (RGT) criteria were met, patients not meeting RGT continued with PEG Interferon and RBV until week 48, as did patients in the placebo control group. SVR rates measured 24 weeks after the planned end of treatment (SVR 24) were 74.7 to 86.1% in the SMA groups vs. 64.9% in the control group for all comparisons, except SMV 75 mg for 24 weeks.

Eosinophilic Esophagitis and Responsiveness to PPI

To determine the prevalence of proton pump responsive eosinophilic esophagitis in patients undergoing upper endoscopy and to determine features that distinguish the two groups (responsive and nonresponsive), a prospective study was conducted at University of North Carolina from 2009 to 2011. A total of 223 subjects were enrolled, 173 had dysphagia and 50 did not.

Medical Bulletin Board


Breakthrough supplements for celiacs target body, bones and blood
PORTLAND, Maine - February 2014 - Gluten Free Therapeutics announced recently the launch of Celi•Vites (, a line of scientifically formulated supplements designed specifically for those suffering from the debilitating effects of celiac disease or gluten intolerance. Committed to producing the highest quality nutritional supplements on the market, company founders worked with highly respected formulators to develop Body Heath and Blood Health supplements with the safest and most efficacious gluten-free ingredients available. The company plans to introduce its third product, a Bone Health supplement, in the first quarter of 2014.


Collaboration will provide Cernostics with access to one of the largest Barrett’s Esophagus patient registries in the world
PITTSBURGH, Pa. - January 7, 2013 - Cernostics, a diagnostics company focused on delivering next generation cancer diagnostics through a unique approach to tissue analysis, announced that it is collaborating with the Academic Medical Center in The Netherlands (AMC). As part of the collaboration, AMC will be providing Cernostics with access to one of the largest Barrett’s Esophagus patient registries in the world, which Cernostics will use, along with other data, to complete clinical validation studies of its lead product TissueCypher: Barrett’s.