ABSTRACT: Only a small number of patients with celiac disease exhibit the textbook symptoms of malabsorptive diarrhea with steatorrhea, weight loss, and nutritional deficiencies. Others may present with a subclinical enteropathy, GI complaints without constitutional symptoms, persistent travelers' diarrhea, or extraintestinal manifestations alone. Be alert for suggestive signs, such as weight loss, skin lesions, oral aphthae, muscle atrophy, de-enamelization of the teeth, and vague GI symptoms, such as bloating. Helpful serologic tests include IgG and IgA antigliadin antibodies, enzyme tissue transglutaminase antibodies, antiendomysial antibodies, and total IgA. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. In addition to a gluten-free diet, management encompasses repletion of vitamins and minerals, including iron, folate, calcium, and vitamin D; screening for thyroid disease and diabetes mellitus; bone densitometry and age-appropriate cancer screening; and pneumococcal vaccination.

A trip to the supermarket or a meal in a restaurant can be a challenge for patients who have celiac disease. Treatment of the disease consists of strict adherence to a gluten-free diet. This regimen can be difficult to follow because gluten is found not only in such obvious sources as wheat-based cereals and pasta but also in many processed foods (eg, salad dressings and gravies).

An 84-year-old man with a history of stable angina, type 2 diabetes, hyperlipidemia, and hypertension presents to the emergency department with worsening dyspnea and peripheral edema.

ABSTRACT: Risk factors for oral cancer include tobacco use and alcohol intake (especially in conjunction with tobacco use). Many benign conditions may be confused with squamous cell carcinoma, the most common type of intraoral neoplasm. Any red and/or white lesion that has surface corrugation, stippling, or induration is considered dysplastic or neoplastic until proved otherwise. Even without these clinical signs, white plaques of any size that persist for several months may represent dysplasia. These lesions should be assessed by biopsy. Risk factors for lichen planus include stress, exposure to certain foods and medications, and systemic illness. Erosive lichen planus may cause significant pain and oral dysfunction.

ABSTRACT: Only a small number of patients with celiac disease exhibit the textbook symptoms of malabsorptive diarrhea with steatorrhea, weight loss, and nutritional deficiencies. Others may present with a subclinical enteropathy, GI complaints without constitutional symptoms, persistent travelers' diarrhea, or extraintestinal manifestations alone. Be alert for suggestive signs, such as weight loss, skin lesions, oral aphthae, muscle atrophy, de-enamelization of the teeth, and vague GI symptoms, such as bloating. Helpful serologic tests include IgG and IgA antigliadin antibodies, enzyme tissue transglutaminase antibodies, antiendomysial antibodies, and total IgA. Typical endoscopic findings are mucosal atrophy, fissuring, and scalloping. In addition to a gluten-free diet, management encompasses repletion of vitamins and minerals, including iron, folate, calcium, and vitamin D; screening for thyroid disease and diabetes mellitus; bone densitometry and age-appropriate cancer screening; and pneumococcal vaccination.

When a patient with a history of severe anaphylactic reactions needs an epinephrine auto-injector, prescribe two rather than just one. An injector at home does a patient no good if he or she is at the office or out backpacking when a reaction occurs.

Inflamed hemorrhoids are traditionally treated with hemorrhoidal pads impregnated with witch hazel. I have found that ordinary baby wipes work just as well and in addition are readily available, less expensive, and less painful to use.

To simplify knee aspiration (after a standard knee prep), use a regular vacuum tube with an adapter and a 21-gauge needle supplied by your laboratory.

After shooting himself in the finger during target practice in his backyard, a 37-year-old man presented with a traumatic injury to the left second digit. The patient said he was looking through the scope at the target when he released the trigger. However, he failed to realize that his finger was still at the base of the barrel of his 22-caliber pistol. He reported no significant medical history, routine medication use, or drug allergies, and denied smoking. The patient, a social drinker, admitted to having 2 to 3 beers that day.

BOSTON -- The brain of babies who die of sudden infant death syndrome (SIDS) have multiple serotonin system defects, and this appears to pin down an underlying fatal susceptibility in these children, according to researchers here.

LAS VEGAS -- Pill-sized cameras, self-navigating endoscopes, and other high-tech gadgetry may one day supplant or augment colonoscopy for colon cancer detection, according to a technology review presented here.

LAS VEGAS -- For treating patients with chronic constipation, a recently approved chloride channel activator compares well with other medications in efficacy and tolerability, according to a review of published data presented here.

LAS VEGAS -- Drugs that activate cannabinoid receptors in the colon might help treat lower GI conditions such as diarrhea or certain types of fecal incontinence, according to a proof-of-concept study presented here.

LAS VEGAS -- Chronic constipation may signal a 20% rise in the 10-year risk of mortality, researchers reported here.

BOSTON -- High liver enzyme levels are predictive of a greater risk of death within a decade for anyone in the community at large, researchers reported here.

TUCSON, Ariz. -- Joints affected by the inflammation of rheumatoid arthritis may be soothed by dietary supplements containing extracts of the curry ingredient turmeric, researchers here studying rats reported.

CHICAGO -- The combination of two targeted therapies appears to be a more effective, but less toxic, alternative to chemotherapy for second line treatment of unresectable non-small-cell lung cancer.

SAN DIEGO -- Preliminary results of a small ongoing study of vitamin B12 injections for children with autism showed no signs of significant benefit, researchers reported here, but they remained hopeful.

SAN DIEGO -- Although anorexia nervosa patients commonly have obsessions and compulsions, that doesn't necessarily translate into full-blown obsessive-compulsive disorder, according to a Polish team.

SAN DIEGO -- The black box warnings ordered by the FDA on the risk of suicidality with pediatric antidepressant use cut overall prescriptions for children and adolescents by some 10%, researchers said here.