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.

When it comes to treating ulcerative colitis, it’s a jungle out there. This is because the gut is the largest and most complex immune environment in the human body. To successfully treat intestinal tract disorders, therapeutic agents must be delivered at the right time, in the right amount, to the right location.

Colorectal cancer is the third leading cause of cancer-related deaths in the United States. However, it is also one of the most manageable. A plenary session on colorectal cancer prevention will be among the highlights of the upcoming American College of Gastroenterology Annual Scientific Meeting, October 31 to November 2 in Washington, DC.

Once you've decided that an opioid analgesic is indicated, what can you do to ensure that your patient uses the medication safely?

When counting sheep fails as first line therapy, what measures can you recommend to help your patient get some sleep?

Dr Margaret Fisher- who helped write the (Red) book on immunizations for youngsters- succinctly summarizes the latest guidelines here.

Marc B. Garnic, MD, addresses these questions in this short video. Dr Garnic, who spoke on this topic at the 2011 American College of Physicians meeting in San Diego

Psychiatrist Sidney Zisook, MD-a guest speaker at the recent American College of Physicians meeting in San Diego

Exercising at least 4 times a week can increase left ventricular mass and preserve elasticity, thereby reducing the risk of diastolic heart failure. Researchers from Texas presented their study results at the American College of Cardiology’s 60th Annual Scientific Session.

Measurement of pulse pressure may help identify patients with "white coat" hypertension, according to data presented by Korean researchers at the American College of Cardiology’s 60th Annual Scientific Session.

What is the optimal duration for antiplatelet therapy after placement of drug-eluting stents? Initial results of the EXCELLENT study show that 6 months of antiplatelet therapy is as effective as the 12-month regimen recommended by current guidelines.

A Danish study found no clinical benefit from using NT-proBNP (b-type natriuretic peptide) to identify and monitor high-risk patients with chronic heart failure, according to research from the NorthStar study presented at the American College of Cardiology’s 60th Annual Scientific Session in New Orleans.

Compared with medical therapy alone, coronary artery bypass grafting (CABG) significantly reduced cardiovascular deaths and the composite end point of all-cause deaths and cardiovascular-related hospitalizations, reported investigators from the Surgical Treatment of Ischemic Heart Failure (STICH) trial. However, the effect of the two management strategies on overall survival in patients with ischemic heart failure was similar.

Recently, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a focused update to the 2007 guidelines for the management of patients with unstable angina (UA)/non-ST-elevation myocardial infarction (non-STEMI).

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.