Crohn’s Disease and Ulcerative Colitis Show Unique Cytokine Profiles

Both CD and UC specimens display upregulated transcript levels of IL-12, IL-18, Il-21 and IL-27 in both inflamed and non-inflamed intestinal areas when compared to non-IBD.

More than 15 Million Americans at Risk of Significant Kidney Damage

  • Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide.
  • H2 blockers are equally effective for acid control and pose significantly less risk.
  • Long-term PPI exposure is linked to significantly increased risk of chronic kidney disease (CKD), CKD progression, and end-stage renal disease.
  • The risk of developing these diseases correlated directly with the duration of therapy.
  • PPI use was associated with CKD in all analyses, including a time-varying new-user design.
  • Twice-daily PPI dosing was associated with a higher risk than once-daily dosing.

Aspirin Significantly Prolongs Survival in Patients with Colorectal Cancer

  • Colorectal cancer patients who used aspirin post-diagnosis were 15% less likely to die vs those who did not use aspirin.
  • Regular use of aspirin is associated with reduced incidence and mortality of colorectal cancer.
  • Trial included 23,162 patients diagnosed with CRC in Norway.
  • Exposure to aspirin was defined as receipt of aspirin prescriptions for more than 6 months after the diagnosis of colorectal cancer.

Three Biologic Drugs Superior to Placebo, Colectomy for Ulcerative Colitis

  • Study conducted by the National Health Service in Britain.
  • Cost of biologics was seen as prohibitive.
  • Initial treatment failed in patients with moderately to severely active ulcerative colitis.
  • Infliximab, adalimumab and golimumab were superior to placebo for second-line therapy.
  • Systematic review and network meta-analysis included 10 randomized, controlled trials (RCTs).
  • Highly sophisticated statistical analysis included nearly 5000 patients.
  • Cost effectiveness ratio modeling suggests that treatment with 1 of 3 monoclonal antibodies costs US$40,000 to nearly US$55,000 per quality-adjusted life-year (QALY) gained vs. colectomy.

Metabolic Disease: Candidates for Surgery Versus Drug Therapy

Philip R. Schauer, MD, is a leading authority on the use of bariatric surgery to control obesity and type 2 diabetes. View our video of him discussing the differential diagnosis for patients who need bariatric surgery versus those who would benefit from pharmacologic therapy.

Alcohol, Processed Meat, High BMI Linked to Significantly Higher Stomach Cancer Risk

  • Alcohol, processed meats, and high BMI tied to increased risk of stomach cancers.
  • Risk relationship is linear; Higher rates of consumption of alcohol, processed meats, and higher BMI lead to still higher risk of stomach cancer.
  • Approximately 1 in 7 cases of stomach cancer could be prevented by consumption of <3 drinks per day, abstinence from processed meat, and maintenance of a healthy weight.
  • These dietary habits could be responsible for as many as 4,000 stomach cancer cases per year in the U.S.

Comprehensive Self-Management Strategies Are Effective for IBS

  • Strategies resulted in long-lasting improvements in both GI symptoms and quality of life (QOL).
  • The multicomponent comprehensive self-management (CSM) program allowed patients to select the most effective and feasible strategies to self-manage symptoms.
  • Strategies included variations in diet, relaxation techniques, and tools for identifying thought distortions, and challenging underlying beliefs, among others.
  • At 12 months’ follow-up after the CSM program, 94% of the participants (76/81) were still using ≥6 strategies and adherence was >79% for all subthemes of CMS strategies.

Fewer Complications, Similar Analgesia with Paravertebral vs. Thoracic Epidural Block for Thoracotomy

  • Paravertebral blockade was associated with fewer short-term complications compared to thoracic epidural blockade for thoracotomy.
  • Reduced pain was presumably associated with higher patient satisfaction.
  • Reduced short-term complications were presumably associated with reduced short-term hospital costs.
  • No differences were found in 30-day mortality, major complications, or length of hospital stay.
  • The reviewers found insufficient data on chronic pain and costs.

Conservative Management of Borderline Cholelethiasis is Cost Effective, Recommended

  • Endoscopic retrograde cholangiopancreatography (ERCP) is not cost effective for treatment of borderline common bile duct stones (CBDS).
  • Conservative management of CBDS is associated with decreased length of hospital stay, fewer complications, and reduced cost.
  • Conservative management of CBDS obviates the surgical challenges associated with ERCP for borderline cholelethiasis.
  • Conservative management is equally effective as ERCP for removal of borderline common bile duct stones.
  • Post-ERCP pancreatitis occurred significantly more frequently in patients in the ERCP group.

Home Colon Cancer Screening Saves Lives, Cuts Costs

  • Initial patient compliance with fecal immunochemical testing (FIT) was high at 48.2%.
  • Follow-up screening remained high at 75.3% to 86.1% for 4 years.
  • Previous studies have found FIT to be sensitive for occult blood in stool, as well as for polyps.
  • FIT has higher compliance and similar sensitivity as fecal occult blood testing (FOBT).
  • Positive result on FIT screening should prompt the more invasive CT colonoscopy or the fully invasive colonoscopy for conclusive results.

New Data Show Coffee Reduces Hepatic Fibrosis in Patients with Liver Disease

  • Coffee consumption has been associated with reduced frequency of liver disease.
  • Total caffeine intake was not associated with prevalence or hepatic fibrosis of nonalcoholic fatty liver disease.
  • Regular coffee caffeine consumption may significantly reduce hepatic fibrosis in patients with nonalcoholic fatty liver disease.
  • Coffee consumption can reduce the severity of fibrosis and may contribute to the repair of liver tissue.
  • Coffee caffeine is associated with a significant reduction in risk of fibrosis among patients with nonalcoholic steatohepatitis.

Safely Evaluating a Cocaine Smuggler

This 3D reconstruction demonstrates the 63 packets of cocaine this body packer smuggled. Patients can be asymptomatic or may present with symptoms related to complications such as bowel obstruction, perforation, or packet rupture. The majority of patients are treated conservatively using laxatives. In complex or symptomatic cases, surgical intervention may be required.

Visit Figure 1 for more images. Click here for more on this image.

Large Study Finds PPIs May Increase Risk of Kidney Disease

  • Evidence of risks associated with proton pump inhibitors continues to accumulate.
  • Proton pump inhibitors may be overprescribed in place of lifestyle modifications.
  • Risk of chronic kidney disease is added to risk of gastrointestinal tract hemorrhage and infectious complications in the intensive care unit potentially attributable to PPI use.
  • No causal mechanisms of potential PPI injury have been identified.

New Antivirals Revolutionize HCV Treatment Value Proposition

  • In 2015, 80% of all Medicare spending will be on new, frequently curative treatments of hepatitis C (HCV) infection.
  • Medicare spent about $7 million/y on older HCV drugs; will spend about $9 billion on new DAAs in 2015.
  • Newer HCV drugs will be accompanied by high cost in the first few years of their use. A precipitous drop in spending is expected once the HCV epidemic is stemmed.
  • HCV-related costs will drop sharply in the coming years, to below $2 billion by 2020, and to just $14 million by 2030.
  • New DAAs are one of the greatest value propositions in the history of medicine; a fantastic value at a high up-front cost.