“PPIs are the most effective agents in preventing CIB, but they may increase the risk of pneumonia”.
Original article: Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies – PLOS One (free)
Commentaries: Comparison of Fecal Transplant Using Capsule vs Colonoscopy to Prevent Clostridium Difficile Infection – The JAMA Network (free) AND New evidence suggests there’s a much easier way to get a fecal transplant – Quartz (free) AND Fecal transplant by capsule may match colonoscopy for C diff – CIDRAP (free)
Adherence to a Healthy Lifestyle is Associated With a Lower Risk of Diverticulitis among Men – American Journal of Gastroenterology (link to abstract – $ for full-text)
Commentary: Unhealthy lifestyle may cause half of diverticulitis cases – Reuters (free)
Original article: Systematic review with meta-analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection – Alimentary Pharmacology and Therapeutics (link to abstract – $ for full-text)
Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention – Annals of Internal Medicine (free)
Commentaries: Is Eating Fiber After Colorectal Cancer Diagnosis Associated with Lower Death Risk? – The JAMA Network (free) AND Higher Fiber Intake After Colorectal Cancer Diagnosis Tied to Improved Survival – Physician’s First Watch (free)
Original article: Glucocorticosteroids for people with alcoholic hepatitis – Cochrane Library (link to abstract – $ for full-text)
“We found no evidence of a difference between glucocorticosteroids and placebo or no intervention on all-cause mortality, health-related quality of life, and serious adverse events during treatment”.
Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study – Gut (link to abstract – $ for full-text)
Commentaries: Acid reflux drug linked to more than doubled risk of stomach cancer – study – The Guardian (free) AND Gastric Cancer Risk Doubled With Long-term PPI Use – Medscape (free registration required) AND PPI Use After H. pylori Eradication Therapy Tied to Increased Risk for Gastric Cancer – Physician’s First Watch (free)
“Among 797 067 individuals on maintenance PPI therapy, the SIR of gastric cancer was over threefold increased (SIR=3.38, 95% CI 3.23 to 3.53)”.
25th UEG (United European Gastroenterology) Week: Long-term aspirin use reduces the incidence of digestive cancers by up to 47% (free)
Incidence, Demographics, and Clinical Characteristics of Diabetes of the Exocrine Pancreas (Type 3c): A Retrospective Cohort Study – Diabetes Care (link to abstract – $ for full-text)
“Diabetes of the exocrine pancreas is frequently labeled type 2 diabetes but has worse glycemic control and a markedly greater requirement for insulin”.
Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course Versus Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score–Matched Cohort – Clinical Infectious Diseases (link to abstract – $ for full-text)
Antibiotic-associated diarrhea ocurred in 8.0% of the probiotic group compared to 17.7% in the control group. The number needed to treat (NNT) to prevent one case of diarrhea was 11 (95% CI 6 to 13).
Commentaries: Proton pump inhibitors linked to liver disease, researchers find – The Pharmaceutical Journal (free) AND Liver disease risk may be heightened by gastric acid drugs – Medical News Today (free) AND Common acid reflux medications promote chronic liver disease – EurekAlert (free)
Percutaneous cholecystostomy in the management of high-risk patients presenting with acute cholecystitis: Timing and outcome at a single institution – American Journal of Surgery (link to abstract – $ for full-text)
Commentary: Percutaneous Cholecystostomy: An Alternative to Urgent Surgery for Cholecystitis? – Medscape (free registration required)
Medical News & Perspectives: Study Questions Use of Acid Suppressors To Curb Mild Infant Reflux – JAMA (free) (RT @DeeMangin see Tweet)
Study abstract presented at the Pediatric Academic Societies meeting: Infants prescribed antacids for reflux have increased risk of bone fractures (free)
News release: WHO recommends large-scale deworming to improve children’s health and nutrition (free)
Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) – Gut (free)
Commentary: Standards for Upper GI Endoscopy Released – Medscape (free registration required)
Original article: Strategies for detecting colon cancer in patients with inflammatory bowel disease – Cochrane Library (link to abstract – $ for full-text)
Editorial: Increased risk of cancer in children with inflammatory bowel disease (free)
Commentaries: Inflammatory Bowel Disease in Childhood Tied to Higher Cancer Risk Later – Physician’s First Watch (free) AND IBD in Childhood Raises Cancer Risk – Medscape (free registration required)
Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis – British Journal of Surgery (link to abstract – $ for full-text)
See also a related meta-analysis suggesting the safety of nonoperative treatment for uncomplicated cases (free) and a recent guideline that incorporates the possibility of non-operative treatment for uncomplicated disease (free)
Efficacy of Thalidomide in Preventing Delayed Nausea and Vomiting Induced by Highly Emetogenic Chemotherapy: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Phase III Trial (CLOG1302 study) – Journal of Clinical Oncology (link to abstract – $ for full-text)
Commentaries: Thalidomide Improves Prevention of Delayed Nausea and Vomiting Induced by Highly Emetogenic Chemotherapy – PracticeUpdate (free registration required) AND Adding Thalidomide to Palonosetron, Dexamethasone Reduces CINV – Oncology Nurse Advisor (free)
Incidence, Demographics, and Clinical Characteristics of Diabetes of the Exocrine Pancreas (Type 3c): A Retrospective Cohort Study – Diabetes Care (link to abstract – $ for full-text)
Commentary: Glycemic control poor, insulin use high in diabetes after pancreatic disease – Haelio (free registration required)
Infographic: Preventing Colorectal Cancer (free)
Almost half cases of colorectal cancer can be prevented by staying lean, eating healthy, and moving more.
Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux – JAMA (link to abstract – $ for full-text)
Commentaries: Laparoscopic Antireflux Surgery Associated With High Rate of Recurrence of GERD – The JAMA Network (free) AND GERD Recurrence Fairly Common Following Laparoscopic Antireflux Surgery – Physician’s First Watch (free) AND High recurrence of gastroesophageal reflux disease in patients treated with laparoscopic antireflux surgery – 2 Minute Medicine (free)
The Low FODMAP Diet: Recent Advances in Understanding Its Mechanisms and Efficacy in IBS – Gut, via Medscape (free registration required)
Commentaries: AGA releases recommendations on therapeutic drug monitoring in IBD – ACP Gastroenterology (free) AND New Guideline for Therapeutic Drug Monitoring in Inflammatory Bowel Disease – Journal Watch (free)
Commentaries: Dietary Approach Found as Effective as Medications for Treating Type of Reflux Disease – The JAMA Network (free) AND Treating Reflux With Diet – The New York Times (10 articles per month are free)
A small retrospective cohort study suggests a plant-based, Mediterranean-style diet may be as effective as medication.
Efficacy of a 4-Food Elimination Diet for Children With Eosinophilic Esophagitis – Clinical Gastroenterology and Hepatology (link to abstract – $ for full-text)
Commentaries: Elimination Diet for Eosinophilic Esophagitis — Are Four Foods as Good as Six? – Journal Watch (free) Four-Food Elimination Diet Can Treat Eosinophilic Esophagitis in Children – NewsWise (free)
Full Review: Chemotherapy for advanced gastric cancer – Cochrane Library (link to abstract – $ for full-text)
Related: Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (free) AND Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Summary (free) AND Locally Advanced Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Summary (free)
Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)
Commentary: Which NOACS are riskiest for gastrointestinal bleeding? – Pharmacy News (free)
Source: ACP Journal Club ($)
Observational study suggests Apixaban may be associated with a more favorable gastrointestinal safety profile. Further randomized trials are needed to confirm these findings.
National Estimates of Reductions in Acute Gastroenteritis–Related Hospitalizations and Associated Costs in US Children After Implementation of Rotavirus Vaccines – Journal of the Pediatric Infectious Diseases Society (free)
Commentary: Rotavirus vaccines continue to reduce diarrhea hospitalizations, medical costs in US kids – Medical News Today (free) AND Study: Rotavirus vaccine cuts healthcare costs in US children – CIDRAP (free)
Gastrointestinal safety of celecoxib versus naproxen in patients with cardiothrombotic diseases and arthritis after upper gastrointestinal bleeding (CONCERN): an industry-independent, double-blind, double-dummy, randomised trial – The Lancet (link to abstract – $ for full-text)
Source: ACP Journal Club
In this study, patients at high risk of both cardiovascular and gastrointestinal events who required concomitant aspirin and NSAID, celecoxib associated with a proton pump inhibitor led to less recurrent gastrointestinal bleeding when compared to naproxen associated with a proton pump inhibitor (5.6% vs 12.3%).
Related: UK clinical practice guidelines for the management of gastrointestinal stromal tumours (GIST) – Clinical Sarcoma Research (free) AND SEOM Clinical Guideline for gastrointestinal sarcomas (GIST) – Clinical and Translational Oncology (free)
Commentaries: Flexible Sigmoidoscopy Tied to Lower Mortality Risk – Physician’s First Watch (free) AND Flexible Sigmoidoscopy Reduces All-Cause Mortality – Medscape (free registration required)
Starts Today! Free Online Course: Anatomy of the Abdomen and Pelvis; a journey from basis to clinic – Leiden University Medical Center and Coursera
Commentaries: At Last, a Big, Successful Trial of Probiotics – The Atlantic (free) AND Probiotic Bacteria Could Protect Newborns From Deadly Infection – NPR Goats and Soda (free) AND Seeding the Gut Microbiome Prevents Sepsis in Infants – The Scientist (free)
See also: FDA News Release
Standard treatment length was previously 12 weeks or more.
Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial – Gastrointestinal Endoscopy (link to abstract – $ for full-text)
“A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopy in terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood”
Commentaries: Yemen’s cholera outbreak passes 500,000 cases – CIDRAP (free) AND More Than 500,000 Infected With Cholera in Yemen – The New York Times (10 articles per month are free)
Related guidelines: United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (free) AND Guidelines for the understanding and management of pain in chronic pancreatitis – Pancreatology (free)
Diet and Risk of Cholecystectomy: A Prospective Study Based on the French E3N Cohort – American Journal of Gastroenterology (link to abstract – $ for full-text)
Commentary: Fewer gallbladder surgeries with Mediterranean diets – Reuters (free)
Expansion of Treatment for Hepatitis C Virus Infection by Task Shifting to Community-Based Nonspecialist Providers: A Nonrandomized Clinical Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Nonspecialists Could Safely Provide Hepatitis C Care – Physician’s First Watch (free) AND HCV treatment by NPs, PCPs appears safe, effective as that provided by subspecialists – ACP Internist (free)
Related guideline: NCCN Guidelines Insights: Antiemesis, Version 2.2017 (free)
Commentaries: Antipsychotic Added to ASCO Antiemetic Guide – MedPage Today (free registration required) AND New Antiemetic Guidelines Issued by ASCO – Medscape (free registration required)
A Diet Low in Fermentable Oligo-, Di-, and Mono-saccharides and Polyols Improves Quality of Life and Reduces Activity Impairment in Patients with Irritable Bowel Syndrome and Diarrhea – Clinical Gastroenterology and Hepatology (link to abstract – $ for full-text)
Commentary: Low-FODMAP Diet Improves Life of Patients With Irritable Bowel Syndrome and Diarrhea – PracticeUpdate (free registration required)
Commentary: Food Allergy: Consensus Report Stresses Diagnostic Accuracy – Medscape (free registration required)
Commentary and perspectives on graft-versus-host disease.
Source: Guidelines: 2017 Midyear Review – Medscape (free registration required)
What carcinoembryonic antigen level should trigger further investigation during colorectal cancer follow-up? A systematic review and secondary analysis of a randomised controlled trial – Health Technology Assessment (free)
Source: ACP Journal Wise ($)
“The results suggest that (1) CEA testing should not be used alone as a triage test; (2) in year 1, testing frequency should be increased (to monthly for 3 months and then every 2 months); (3) the threshold for investigating a single test result should be raised to 10 µg/l; (4) after the second CEA test, decisions to investigate further should be made on the basis of the trend in CEA levels; (5) the optimal threshold for investigating the CEA trend falls over time; and (6) continuing smokers should not be monitored with CEA testing”.
Molecular Biomarkers for the Evaluation of Colorectal Cancer: Guideline From the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and the American Society of Clinical Oncology (free)
Commentaries: ASCP/CAP/AMP/ASCO Guideline on Molecular Biomarkers in Colorectal Cancer – ASCO Post (free) AND ASCP/CAP/AMP/ASCO Clinical Practice Guideline Focuses on Molecular Biomarker Testing for Patients With Colorectal Cancer – ASCO Post (free) AND Clinical Practice Guideline Focuses on Molecular Biomarker Testing for Patients with Colorectal Cancer – College of American Pathologists (CAP), via NewsWise (free)
Source: Oncology Research Review Newsletter (free registration required)
New available guidelines are:
Clinical Review: Optimal diagnosis and disease activity monitoring of intestinal Behçet’s disease (free)
Clinical Review: Treatment and outcomes: medical and surgical treatment for intestinal Behçet’s disease (free)
Clinical Review: Prevalence, Pathogenesis, Diagnosis, and Management of Microscopic Colitis – Gut and Liver (free PDF)
Head To Head: Should we screen for cirrhosis? – The BMJ (free)
Pros and cons of screening high risk patients for liver cirrhosis.
Practical review of this common problem in the emergency department.
An analysis of a large database of de-identified electronic medical records (EMRs) with over 40.000.000 patients found no association.
Commentaries: Cases of recurrent Clostridium difficile infection are soaring – University of Pennsylvania School of Medicine, via EurekAlert (free) AND Multiply Recurrent C difficile Infection Rates Sharply Rise – Medscape (free registration required) AND Demand for FMT likely to increase with rise in multiply recurrent C. difficile cases – 2 Minute Medicine (free) AND Marked increase seen in multiply recurrent C diff – CIDRAP (free)
Commentaries: Proton pump inhibitors associated with raised mortality – OnMedica (free) AND Longtime use of heartburn drugs linked to increased risk of death – NewsMedical (free) AND People taking heartburn drugs could have higher risk of death, study claims – The Guardian (free) AND Some heartburn drugs linked with higher risk of death – CBS News (free) AND PPIs Linked to Higher Risk for Death – Medscape (free registration required)
In a large observational study, PPI use was associated with increased mortality (HR 1.25; CI 1.23 to 1.28). PPIs were also associated with increased risk compared to H2 blockers (HR 1.24; CI 1.21 to 1.27). See more on the trade-offs of PPI therapy in our July 3rd issue (see #10)
Commentary: Diagnosis and Treatment of Functional Dyspepsia – PracticeUpdate (free registration required)
Commentary: Complications of Proton Pump Inhibitor Therapy – PracticeUpdate (free registration required)
Related: Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline – Canadian Family Physician (free) AND Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD – Journal of the American Society of Nephrology (link to abstract – registration required for full text) AND Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis – Jama Neurology (link to abstract – subscription required for full text)
The authors of this review argue that the observational studies that brought up the safety issues associated with PPIs (above studies, for example) are insufficient to establish causation and suggest a more balanced approach to PPI prescribing.
Source: EvidenceAlerts (free resource to find articles of interest)
In this meta-analysis including 19 randomized trials, probiotics given within 2 days of the first antibiotic dose (more effective than if started later) reduced the risk of Clostridium difficile infection (CDI) by >50% in hospitalized adults. 1 case of CDI would be prevented for every 23−144 patients treated with probiotics when antibiotics are started. “There was no convincing evidence of superior efficacy for any of the tested probiotic formulations, delivery methods (drink or capsule), or probiotic doses”.
Original article 1: The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS – Gut (link to abstract – $ for full-text)
Original article 2: Diet Low in FODMAPs Reduces Symptoms in Patients with Irritable Bowel Syndrome and Probiotic Restores Bifidobacterium Species: a Randomized Controlled Trial – Gastroenterology (link to abstract – $ for full-text)
Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk for Colorectal Cancer: A Meta-analysis – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentaries: Fecal immunochemical testing demonstrates good diagnostic accuracy for high-risk individuals – 2 minute medicine (free) AND Mixed Results with FIT Screen for High-Risk Colon Cancer – MedPage Today (free registration required)
Interview with the author: Fecal Testing Better At Detecting Colon Cancer Than Advanced Atypical Changes – MedicalResearch.com (free)