December 2016 Vol XL Issue 12

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Colonic Capsule as a Screening Test for Colorectal Cancer: We are Improving

Cesera Hassan, Nadir Arber

In an effort to improve patientsí willingness to cooperate in improving their colon health, non-invasive testing of the colon has been trialed over the past few decades. Colonoscopy with colon-capsule is an endoscopic technique developed for a non-invasive, painless exploration of the colon without the need of sedation and injection of air. Its major obstacle is the need for meticulous colonic cleaning. Here we discuss the Check Cap imaging system, a device that may overcome the hurdle of pre-procedure bowel preparation. This capsule emits radiological data for constructing three-dimensional images of the colonic mucosa without the need for colonic cleansing. Since the system is safe, easy-to-use, painless, patient-friendly and private, this imaging system may significantly increase participation rates in a CRC screening programs.


Medicare Coverage for Home Parenteral Nutrition - An Oxymoron? Part I

Penny Allen

Physicians and healthcare providers charged with caring for patients requiring home parenteral nutrition (HPN) face increasing pressure to discharge patients earlier from the acute care setting. This article provides the clinician with a review of the very dated Medicare policy for HPN, the criteria and objective documentation still required by law today, as well as strategies for attempting to provide home infusion therapy when Medicare will not cover patients who appropriately need HPN.


Introducing POEM in Your Institution: The Blueprint for Launching a New Program in the Endoscopy Suite

Dennis Yang, Peter V. Draganov

Per-oral endoscopic myotomy (POEM) is a prime example of a hybrid technique derived from NOTES and endoscopic submucosal dissection (ESD). POEM is an endoscopic therapeutic procedure aimed at treating achalasia and spastic esophageal disorders. While POEM was introduced and traditionally performed in the operating room (OR) setting, its well-documented safety and efficacy over the past 8 years has led to its natural acceptance by therapeutic endoscopists worldwide and consequently a growing interest in performing this procedure in the endoscopy suite. This review aims to provide a practical guide of introducing POEM in the endoscopy suite from a gastroenterologist's perspective.


Primary Malignant Fibrous Histiocytoma of the Cecum

Patrick C Bonasso, Jared Feyko, Nezar Jrebi

Departments Section

From the Literature

PPI and Decompensated Cirrhosis

Considering that proton pump inhibitors (PPIs) may be a risk factor for hepatic encephalopathy (HE) in patients with cirrhosis, possibly through translocation of gut bacteria which can also lead to spontaneous bacterial peritonitis (SBP), the association between PPI and development of HE or SBP in patients with cirrhosis with ascites was examined.

Avulsion in EMR for Residual Neoplasia

EMR used widely for treatment of nonpedunculated colorectal adenomas greater than 2 cm presented recurrence at the resection site in 10% to 30% of cases. To compare/contrast the effects of avulsion therapy vs. Argon plasma coagulation (APC) to treat all visible residual neoplasia after exhaustive attempts at snare resection during EMR, the effects of change from APC to avulsion approach were analyzed.

Mercaptopurine in Treatment of Crohn's Disease After Surgical Resection

To investigate whether mercaptopurine can prevent or delay postoperative clinical recurrence of Crohn's disease, a randomized, placebo-controlled, doubleblind trial at 29 UK secondary and tertiary hospitals of patients who had a confirmed diagnosis of Crohn's disease and had undergone intestinal resection was carried out.

Oropharyngeal pH Testing for Response to PPI Therapy for Laryngeal Symptoms

To investigate the prognostic potential of oropharyngeal pH monitoring to predict responsiveness to PPI therapy in patients with laryngeal symptoms, the Restech Dx-pH probe was used transnasally to measure oropharyngeal pH.

NSAID Effects in Barrett's Esophagus

Regular use of NSAIDs is associated with a reduced risk of esophageal adenocarcinoma. To determine whether NSAIDs prevent or decrease the risk of the precursor lesion, Barrett's esophagus, pooled individual-level participant data from six case-controlled studies of Barrett's esophagus in the Barrett's and esophageal adenocarcinoma consortium (BACON), were analyzed.

Diabetes Mellitus and Relationship to HCC in Cirrhosis

To investigate whether diabetes increases the risk of HCC in patients with cirrhosis and whether the etiology of liver disease modifies the association between diabetes and HCC, all liver cirrhosis patients who had repeated radiographic evaluation of the liver at Mayo Clinic Rochester between January 2006 and December 2011 were included in a study. The Cox Proportional Hazard Regression Analysis was used to investigate the effects of diabetes on the risk of HCC.

Oral Contraceptive Use and Ulcerative Colitis Progression

Oral contraceptive (OC) use has been consistently linked to increased risk of IBD. A specific role of OC in the natural history of ulcerative colitis (UC) requires study and 6104 incident female UC cases aged 16 to 51 years at diagnosis from the Swedish National Patient Register were identified starting in January 2003.Information on current OC use was obtained from the prescribed drug register starting in July 2005. Cases were followed through December of 2014 for primaryoutcome defined as first UC-related surgery and thesecondary outcome was defined by recipient of the first prescription of oral steroids or anti-tumor necrosis factor (anti-TNF) use.

Entecavir and HCC in Chronic Hepatitis B Patients

To determine whether treatment with Entecavir (ETV) is associated with a reduced HCC risk, study was carried out by calculating the expected HCC incidence based on the risk estimation for HCC and chronic hepatitis B (REACH-B Model), and comparing it with the observed HCC incidence.

Metabolic Syndrome, Transient Elastography and Prognosis in Chronic Hepatitis B

To determine whether metabolic syndrome affects the long-term prognosis of chronic hepatitis B (CHB) patients in terms of hepatic events, cardiovascular events, and death, determination of the incidence of hepatic events, cardiovascular events and death in those patients with or without metabolic syndrome were evaluated from 2006 to 2008.

Long-Term Outcome of Endoscopic Resection of Rectal Neuroendocrine Tumors

To determine the long-term clinical outcomes of endoscopically resected rectal neuroendocrine tumors (NETs), according to the pathologic status after initial resection, a large, multicenter, retrospective cohort study was carried out, analyzing the medical records of patients who underwent endoscopic resection of rectal NETs and were followed for greater than 24 months at 16 university hospitals. The outcomes of interest were local or distant recurrence and metachronous lesions.

HCV Viral Persistence Post Treatment

To assess the presence of HCV RNA in liver explants from 39 patients awaiting liver transplantation who were treated with an interferon-free regimen and had undetectable serum HCV RNA at the time of liver transplantation, 39 patients were evaluated and HCV RNA was detected in most liver explants (67%).

From the Pediatric Literature

Molecular Testing to Diagnose Infectious Gastroenteritis in Children

Acute gastroenteritis (AGE) in children is extremely common, but many children develop AGE with no identifiable infectious source. The authors of this study evaluated the efficacy of a new technique for diagnosing infectious causes of AGE using pediatric stool samples from Tennessee. Specifically, the study utilized the Gastrointestinal Pathogen Panel (Luminex Molecular Diagnostics,Toronto, Ontario, Canada) which provides for the capability of nucleic acid extraction and identification of common bacteria, viruses, and parasites associated with AGE. Additionally, multiplex reverse-transcription real-time PCR on stool specimens was performed to identify sapovirus and astrovirus.

Do Antibiotics Change the Intestinal Microbiome in Breastfed Infants?

Breastfeeding is beneficial for infants as it decreases the risk of infections, and the protective effect is likely due to the composition of the gut microbiota influenced by the infant's diet. However, antibiotic use may change the gut flora so this protective effect is lost, and the authors of this study evaluated the effect of antibiotics use and health outcomes on children that had been breast fed.

Medical Bulletin Board


SAN DIEGO, CA - Prometheus Laboratories Inc. announced the successful completion of the validation of the new PROMETHEUS Anser VDZ test for use in adult patients treated with vedolizumab in the management of moderate to severe active ulcerative colitis and Crohn's disease.


Awards presented at the 2016 Crohn's & Colitis Foundation of America's Advances in Inflammatory Bowel Diseases Clinical and Research Conference

Meetings Calendar

January 28, 2017 - 5th Annual Advances in Gastroenterology and Hepatology Conference
February 19-22, 2017 - The GUILD Conference
October 13-18, 2017 World Congress of Gastroenterology (WCOG) at ACG 2017