Jeffrey Hertzberg, MD, MS

A new analysis supports a strategy of aggressive adalimumab treatment in moderately ill patients with Crohn disease who have a CRP of 10 ml/L or greater.

Crohn disease-its development, flares, progression, need for drug therapy, and need for surgery-is affected by cigarette use.

A multinational panel took issue with a key element of the criteria, the centrality of pain or discomfort as a diagnostic criterion.

Patients with mild Crohn disease could avoid expensive and potentially harmful treatment if they are identified early.

IDA is commonly seen in IBD as a result of iron malabsorption and, ironically, chronic blood loss through disrupted mucosal surfaces.

GI specialists call for more systematically developed criteria for IBS diagnosis and often rely, like their primary care colleagues, on a process of exclusion.

A new study validates online delivery as an effective means of promoting dietary adherence in celiac disease, and this method may prove effective across diets for patients with obesity, metabolic syndrome, and diabetes.

The American College of Gastroenterology's last update to their gastroesophageal reflux disease guideline was published in 2005, so this February's new synthesis of more current treatment standards is welcome.

This study confirmed the usefulness of testing on the basis of a decreased long-term incidence of ulcer bleeding.

Patients with UC who also have celiac disease may be at higher risk for pancolitis as opposed to more limited forms of inflammatory bowel disease.

The mechanisms and effectiveness of probiotics in treatment of irritable bowel syndrome and inflammatory bowel disease are emerging.

Results suggest that wheat sensitivity is a true clinical entity worthy of further study, and that it is a heterogeneous condition with at least 2 distinct subtypes. How this will translate into clinical practice will be an evolving research area, but clinicians should not expect gluten avoidance to disappear as yet another food fad.

Despite limitations, this study lends some reassurance that risk of osteoporosis is not likely to overshadow the benefit of proton pump inhibitors in preventing recurrent peptic ulcer, esophageal reflux symptoms, and esophageal cancer risk.

This study ought to put concerns about handling and administration of donor feces to rest: the cure rate in this study of fecal microbiota transplant for recurrent C difficile approached 95%.

New drugs are needed because a significant fraction of patients reach the end of the line with existing therapies.

All patients with IBD should receive aggressive ongoing assessment of their inflammatory state and its response to immunomodulators, anti-TNF drugs, and other agents.

A purely dichotomous understanding of whether to start treatment for patients who have IBD with anti-TNF agents is becoming an outdated view.

Even the most experienced and skilled gastroenterologists in the country are struggling to make science-based decisions in this area.

These agents remain the mainstay of therapy for the majority of patients with the disease.

A straightforward discussion drove toward attendees toward the more current understanding of the clinical and genetic overlap between the 2 major forms of IBD.

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.

A panel of experts presented a general strategy for evaluating patients with refractory hypertension, but ultimately cautioned the audience to assume non-compliance until proven otherwise.

The panel presented three challenging cases of heart failure with preserved ejection fraction (HFPEF) (see Update on Diastolic Heart Failure). In an innovative twist, the panel solicited feedback from a standing-room-only audience through SmartPhone technology-attendees voted for their favored diagnostic approach, therapy, or final diagnosis, with voting results instantly integrated into the presenter’s Powerpoint display.

Diastolic heart failure (or HFPEF-heart failure with preserved ejection fraction) is characterized by inadequate myocardial relaxation and diastolic filling ("stiff ventricle"), with heart failure signs and symptoms despite normal ejection fraction. The most common cause is long-standing hypertension.

Systemic inflammation has been identified as a risk factor for the development of heart failure in population studies. In the 5-year prospective MESA study, researchers from Johns Hopkins Hospital in Baltimore recorded a baseline nonspecific marker of systemic inflammation, C-reactive protein (CRP).