Posted by: John
on Mar 24, 2011
In the March issue of Gastroenterology, the AGA came out with a position statement on the treatment of Barrett's esophagus. Barrett's esophagus is defined as the presence of columnar epithelium above the normal border between the stomach and the tubular esophagus. The risk of cancer in patients with Barrett's esophagus is reported to be .5% per year. Risk factors for development of cancer include age greater than 50, male sex, white race, chronic heartburn, increased BMI, hiatal hernia and increased abdominal fat. Patients at risk for adenocarcinoma of the esophagus tend to progress from Barrett's without dysplasia to low grade dysplasia and then to high grade dysplasia. Patients with dysplasia should be screened more frequently. Every 6-12 months for patients with low grade dysplasia and every 3 months for patients with high grade dysplasia. Treatment with PPI's does not protect the patient from developing carcinoma but should be used to prevent symptoms of heartburn. High grade dysplasia should be treated with endoscopic treatment ie radio frequency ablation or Barrx, endoscopic mucosal resection or photodynamic therapy. Barrx seems to be the safest mode of treatment and leads to eradication of Barrett's epithelium in over 90% of patients. Treatment of patients with low grade dysplasia remains controversial with no evidence that eradication is any better than surveillance. Eradication of non dysplastic epithelium is not recommended at this time.
Gastroenterology
Volume 140, Issue 3 , Pages 1084-1091, March 2011
Posted by: John
on Mar 16, 2011
A new study published in the journal BMC Medicine http://www.biomedcentral.com/1741-7015/9/23 looked at the difference between true celiac disease and gluten sensitivity. Celiac disease is an autoimmune enteropathy where the exposure of gluten in the diet sets off an autoimmune reaction in the intestinal tract manifested by the development of antibodies and a flattening of the intestinal lining. This results in various GI symptoms and signs of malabsorption. There are a subset of patients who are deemed sensitive to gluten but do not manifest the autoimmune nature of the disease. These patients develop symptoms suggestive of celiac disease but not the intestinal damage. Their symptoms improved when gluten was withdrawn.
In everyday gastroenterology practice, a large number of patients present with vague symptoms that are ultimately lumped into the irritable bowel syndrome when no organic cause can be delineated. This entity can be frustrating for both the patient and the physician. The American Gastroenterology Association has recommended testing for celiac disease in all IBS patients. If the serologies come back negative, maybe a trial of a gluten free diet would be helpful.
Posted by: John
on Feb 19, 2011
Your pet pooch already lowers your blood pressure and provides emotional support. What if it could also identify your early-stage colon cancer?
In a new study, a Labrador retriever that was trained to sniff out cancer was able to detect colon cancer nearly as accurately as a colonoscopy. The dog was given breath and stool samples of 306 patients, collected right before they received colonoscopies; 48 patients had recently been diagnosed with bowel cancer, and the other 258 were either suffering from another colorectal ailment or had survived cancer, or were healthy.
When smelling breath samples, the dog was at least 95% as accurate at identifying cancer as colonoscopy, and 98% correct when sniffing stool samples, the researchers found. Most impressively, the dog was especially good at spotting early stage cancer, and could discern polyps from malignancies, which colonoscopies can't do.
"Detection of early-stage cancers is the real holy grail in bowel cancer diagnosis because surgery can cure up to 90% of patients who present with early-stage disease," Trevor Lockett, a bowel cancer researcher with the Commonwealth Scientific and Industrial Research Organization in Australia, told Bloomberg News.
Although there's not much hope for the routine use of scent dogs in cancer screening — they're too expensive, for one thing — the current findings suggest that other noninvasive screening measures could be developed to pick up the same scent. ("This study shows that a specific cancer smell does indeed exist," the researchers wrote in the study, published today in the medical journal Gut. "These odor materials may become effective tools in screening."