Fergus Shanahan, MD, FACG, summarizes his session at ACG 2011, "Probiotics: Are They Ready for Prime Time?"
Christopher Pleyer, MD, from the Mayo Clinic, Rochester, MN, summarizes his part in the plenary session "Observer Bias in the Diagnosis of Gastroesophageal Reflux Disease and Functional Dyspepsia" at ACG 2011. Distinguishing GERD from other upper GI problems is crucial, he explains.
Is obesity really leading to an increase in GERD? Or, has GERD just become a catch-all phrase for all sorts of upper GI distress? Has GERD become the new "dyspepsia"? G. Richard Locke, MD, FACG, from the Mayo Clinic, Rochester, MN, discusses his findings as presented at the ACG 2011 program.
Long-Term Follow-up of Colonoscopic Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection
Clostridium difficile infection is a serious, life-threatening nosocomial infection that can follow on the heels of broad-spectrum antibiotic use. It affects over 500,000 Americans annually, with 15,000 deaths. Infection recurs in 15% to 25% of those initially treated successfully; infection subsequently redevelops in 40% to 50% of those an initial recurrence.
If ACG 2011 had a recurrent theme, it was nicely summed up in this lecture: probiotic treatments are coming. Scientific evidence is accumulating for this approach, and patients will likely embrace it as a “natural” remedy. Primary care physicians should carefully follow this emerging trend—it holds promise for some of our most challenging patients with chronic disease.
Like other chronic inflammatory conditions, inflammatory bowel disease (IBD) has been revolutionized by the advent of biologic agents that fundamentally alter the inappropriate inflammatory response. The most potent of these are the biologic agents, infliximab, adalimumab, certolizumab pegol, and natalizumab. They also have the most dangerous side-effect profile.
Following on the heels of the obesity epidemic, a second epidemic has become apparent—sleep-disordered breathing and its effect on esophageal conditions, primarily gastroesophageal reflux disease (GERD). Many, many primary care providers have heard the following complaint: “I gained 10 pounds and now I have heartburn/cough/worsening asthma” (take your pick). What’s going on?
Prevalence for overweight (BMI 24.9 to 29.9) and obesity (BMI > 30) have been steadily rising for the past 30 years—two-thirds of Americans now qualify as overweight or heavier. Hypertension, hyperlipidemia, coronary artery disease, type 2 diabetes, sleep apnea, and GERD prevalence are following this epidemic. Obesity is now the second most common preventable cause of death, exceeded only by smoking.
For better or worse, primary care physicians are encountering increasing numbers of patients who are using complementary and alternative medicines (CAMs) for gastrointestinal syndromes. The use of these agents has exploded over the last decade. Dr. Keshavarzian quoted the 2007 National Health Interview Study from CDC, which revealed that nearly 4 in 10 adults had used a CAM treatment within the past year.
Mention GERD and most of patients probably think of heartburn. But the GERD story does not begin and end with the esophagus. The connection between GERD and laryngeal, pharyngeal, and pulmonary symptoms is the focus of a seminar, “An Eye and Nose Opening Experience—Chronic Complications of GERD,” at the upcoming American College of Gastroenterology Annual Scientific Meeting, October 31 to November 2 in Washington, DC.