March 21st 2023
Constipation, bloating, and abdominal pain worsening over 1 week bring a woman in her mid-70s to the ED. Labs are normal. What do you see on the CT scan?
January 10th 2023
Your daily dose of clinical news you may have missed.
January 9th 2023
Findings elaborate on the pathophysiological differences in autoimmunity and atrial fibrillation risk between men and women.
January 6th 2023
Direct-acting antiviral treatment was independently associated with a lower risk of mortality and liver and nonliver outcomes in a large study of adults with chronic hepatitis C.
Dyspepsia vs GERD: Epigastric Locus Helps Make Distinction
Chronic or recurrent pain or discomfort centered in the upper abdomen distinguishes dyspepsia from GERD, with a dominant symptom of heartburn.
Screening and Rx in Barrett Esophagus
Societal recommendations include surveillance esophagogastroduodenoscopy every 3 to 5 years for patients with Barrett esophagus, and proton pump inhibitor therapy for symptom control.
Differential Diagnosis of Liver Disease in Pregnancy
Because pregnancy can alter results of standard liver tests, use of the gestational age of the pregnancy is the best guide to the differential diagnosis.
Chronic GERD and Intestinal Metaplasia: What Next?
Upper endoscopy demonstrates salmon-colored tongues that extend 2 cm above the squamocolumnar junction in a 42-year-old man with chronic GERD. Biopsies reveal intestinal metaplasia with no dysplasia. What now?
Overt Upper GI Bleeding: What to Do First?
What do the American College of Gastroenterology recommendations for initial assessment and risk stratification for patients with ulcer bleeding include?
Next Test to Rule Out Celiac Disease?
A 31-year-old woman had intermittent abdominal cramping for years. Which test should be ordered next to rule out celiac disease?
Eosinophilic Esophagitis Presenting With Food Impaction
Eosinophilic esophagitis is a chronic inflammatory condition believed to be secondary to an allergic trigger. Endoscopic findings of concentric rings and longitudinal furrows in the esophagus suggest this diagnosis.
Recurrent Nausea and Vomiting: What Cause?
A 21-year-old college student has presented multiple times with nausea and vomiting during the last 4 years. Upper endoscopy showed residual food in the stomach. Cyclical vomiting syndrome? Something else?
Recurrent Nausea and Vomiting: Gastroparesis Is the Cause
A gastroparesis diagnosis is based on the cardinal symptoms of nausea, vomiting, abdominal pain, and early satiety.
Probiotic Therapy: Level I Evidence for Which Condition?
Probiotic therapy has level 1 evidence for only one condition-acute infectious diarrhea.
Probiotic Therapy: Level I Evidence for Acute Infectious Diarrhea Only
Probiotics have only been shown to be effective in well-conducted, well-controlled studies in treatment of acute infectious diarrhea.
HLA DQ2/DQ8 to Rule Out Celiac Disease
The optimal test used for primary detection of celiac disease is an IgA anti-tissue transglutaminase test.
Lots of Lesions, Hematemesis, Vaccinations
This week’s questions cover a range of disorders-from infectious disease to GI problems, to HIV/AIDS. See how well you do . . .
Which Laxatives Linked With Melanosis Coli?
The finding of pigmented mucosa-melanosis coli-on colonoscopy is associated with which of the following laxatives?
Laxatives With Antraquinones Associated With Melanosis Coli
Laxatives that contain antraquinones can induce a dark pigmentation in the colonic mucosa.
What Test for Worsened Constipation?
A 65-year-old multiparous woman presents complaining of having to spend up to 30 minutes on the commode with difficulty evacuating stool. Which of the following tests should be performed next?
Most Beneficial Test for Worsened Constipation
Anorectal manometry would be most beneficial in testing the patient's internal and external anal sphincter function.
Conditions Associated With Proton Pump Inhibitor Use
Proton pump inhibitors have been associated with magnesium deficiency, pneumonia, and Clostridium difficile infection.
What’s Associated With Proton Pump Inhibitor Use?
All of the following have been associated with long-term proton pump inhibitor use except . . . ?
Not a Risk Factor for Clostridium difficile Infection?
Previous antibiotic use and hospitalization are well known risk factors for C difficile infection. Are age, PPI use, immunosuppression, and BMI all also risk factors?
Risk Factors for Clostridium difficile Infection?
Age; proton pump inhibitor us; immunosuppression; BMI: which of these is not a risk factor for Clostridium difficile infection?
Postprandial Food and Drooling in a Young Man: What Dx?
Food impaction, uncontrollable secretions, progressive dysphagia, and endoscopic findings of concentric rings and longitudinal furrows in the esophagus. The likely diagnosis?
In Non-Dysplastic Barrett Esophagus, What PPI Regimen?
In patients with non-dysplastic Barrett esophagus, what regimen of proton pump inhibitors should be initially prescribed for management?
PPI Dosing in Non-Dysplastic Barrett Esophagus
Most patients respond to once-daily dosing of a proton pump inhibitor. If symptoms persist, increasing to twice daily or titrating dosage based on pH studies are both options.
Weight Loss and Abdominal Pain in Diabetic Man: What Test?
What study would you order to determine the cause of progressively worsening crampy abdominal pain and unintentional weight loss in an older patient with diabetes?
Sitophobia and Chronic Mesenteric Ischemia in Older Diabetic Man
The clinical presentation-crampy abdominal pain after meals, weight loss, and loose stools-is consistent with chronic mesenteric ischemia given this patient's history of diabetes.
Eosinophilic Esophagitis: What Works, What Doesn't?
Several treatment options improve symptoms. Which one doesn't?
Eosinophilic Esophagitis: Which Treatments Work-Which Don't?
Topical corticosteroids, special diets that eliminate the 6 most common food allergens, endoscopic dilation, and medical therapy effectively control symptoms. Mast cell inhibitors are not a recommended treatment.
In Cholelithiasis, What Role for Ursodeoxycholic Acid Rx?
In patients in whom cholelithiasis with numerous stones is incidentally noted on imaging, should ursodeoxycholic acid be considered to help dissolve the stones and reduce the risk of biliary disease?
No Role for Ursodiol in Asymptomatic Cholelithiasis
Ursodiol has not been demonstrated to be very effective in stone dissolution.
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