A 32-year-old woman recently came to see me for an opinion on stomach pain.  Why would I refuse to see her again?  Abdominal pain is an everyday occurrence for a gastroenterologist.  She was accompanied by her mother.  I had never met this woman previously. She had suffered abdominal pains for as long as she could remember.  She recalled frequent visits with the school nurse when she was a young girl. She has abdominal distress ...

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The world is asunder.  Iraq is sinking into a sectarian abyss.  ISIS, a terrorist group, now controls a larger territory than many actual countries.  Russia has swallowed Crimea and has her paw prints all over eastern Ukraine.  China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines.  The Israeli-Palestinian peace process is in another deep freeze.  Terrorists in Sudan and Nigeria are kidnapping ...

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In 2011, Food and Drug Administration Commissioner Margaret Hamburg remarked upon a “new direction in the treatment of hepatitis C,” as a success rate of approximately 70% marked a significant improvement over the previous rate of approximately 50%, and suggested a cure was in sight. Today, that cure has been realized as Sovaldi (sofosbuvir), a novel agent, has shown a success rate of 95% in clinical trials.  Sofosbuvir comes without the ...

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One of the frustrating aspects of medical practice is trying to decide if the medication I am prescribing is covered by the patient’s insurance company. Even with the advent of electronic medical records, which should be able to determine this, we are often left to hope and pray. Here’s how it works. Individual insurance companies have formularies -- lists of approved drugs -- that they encourage patients and their physicians to use. ...

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If you pay close attention to medical education and training, you have surely read something like this as an goal or learning objective: “Manage inflammatory bowel disease and its complications.” However, this is not exactly what our goals should be. One push in the patient-centered care community has been changing the focus from managing the disease to managing the patient who has (or might have) the disease. The difference in wording is subtle, but it gets more ...

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As a resident of San Francisco (and with Los Angeles just a drive away), I cannot escape the food hate.  Whether it be a campaign against cooked provisions, farmed products or anything of solid consistency, I cannot help but wonder if any possible benefit of these diets outweigh the risk of missing out on amazing grub. But what about gluten-free diets? Gluten sensitivity Gluten, a protein found in foodstuffs such as wheat, barley ...

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The New York Times recently published two articles in a series about inflammatory bowel disease, or IBD, in hopes to destigmatize the disease, and to broadcast medical and surgical advancements that have worked to change how we conceptualize IBD. I applauded the Times for highlighting what can be a debilitating disease for the 1.4 million Americans who are afflicted with it, and thought: Finally! IBD is getting the attention it deserves. Albeit ...

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Cancer screening in those with metastatic disease“Your cancer has come back.” These are words no one treated for cancer wants to hear, yet they are words I have said far too often in my own career. In this case, I had said this to a patient I had cared for ever since her initial diagnosis. At that time, she had stage III breast cancer. After her surgery, ...

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The incidence of esophageal adenocarcinoma has increased more than five-fold over the past four decades in the U.S. While the rate of rise in incidence of esophageal cancer has slowed somewhat in recent years, this malignancy is still associated with a dismal prognosis. Barrett’s esophagus, the precursor lesion to esophageal cancer, is easily identifiable on routine upper endoscopy and can be monitored for the development of precancerous changes. We generally ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 51-year-old woman is evaluated for a 6-month history of diarrhea and bloating. She reports four to six loose stools per day, with occasional nocturnal stools. She has had a few episodes of incontinence secondary to urgency. She has not had melena or hematochezia but notes an occasional oily appearance to the ...

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