I was glad she never asked if I had done this before. My first nasogastric tube was placed on an elderly woman with chronic liver disease. As her illness worsened, it gradually turned her skin yellow, her abdomen swollen, and her mind foggy. One day, we realized that she was at too high a choking risk to swallow her medications herself. She would need a plastic tube to do it for ...

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Fecal microbiota transplantation (FMT) has emerged as an increasingly common treatment for patients with refractory Clostridium difficile infection (CDI). Unlike standard antibiotic approaches, which only exacerbate dysbiosis and may perpetuate CDI recurrence, FMT restores normal gut microbial community structure and function of the gastrointestinal tract. However, a number of challenges need to be overcome before this procedure is widely accepted in mainstream clinical practice.

Before I jump into highlighting ...

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Whenever I am asked this question, I can't help but think of the punchline to a joke that was once supposed to be funny but would now be considered beyond the pale in all respects, so I won't repeat it. The punch line is: “Just lucky, I guess.” That's the short answer to why we gastroenterologists work in our field. Despite the distasteful aspect of human waste and the perverse ...

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Millions of people are diagnosed with irritable bowel syndrome (IBS) every year making it one of the most common gastrointestinal (GI) conditions. Despite its prevalence, there remain many misconceptions about IBS among both patients and doctors. Here we review some basic concepts in hopes of demystifying this nebulous syndrome. What is IBS? Irritable bowel syndrome is defined by a constellation of symptoms including abdominal pain and altered bowel habits (diarrhea or constipation) ...

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It’s been a long day, and you just want to decompress. My boyfriend tells me about his day. I get to hear about the insane amount of reading he has to do for graduate school, or about the occasional annoying customer he’s had to deal with at his part-time job as a bank teller. When it’s my turn to decompress, I usually gripe about a patient or two from the ...

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Parents are appropriately expressing concern about the safety of Miralax®, a commonly used stool softener in kids, after a recent New York Times article exposed a potential association with long-term use of the drug and undesired behavioral side effects. As the article explains, the FDA has awarded a research grant to a team at the Children’s Hospital of Philadelphia (CHOP) to directly address these concerns. Miralax® has been used ...

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The really incredible advances in the treatment of hepatitis C bring to life several relevant questions as we move forward into 2015. First, who should be treating hepatitis C patients (primary care providers, gastroenterologists, infectious disease specialists)? Second, can we really afford to use these new treatments? I recently discussed this topic with my GI and hepatology colleagues in AGA Perspectives, the bi-monthly opinion magazine of the
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I see patients with abdominal pain every day. Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable. I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion. With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal ...

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medpagetodayFrom MedPage Today:

  1. NSAIDs Linked to Leaks After GI Surgery. Postoperative nonsteroidal anti-inflammatory drug (NSAID) use was associated with anastomotic leak after nonelective colorectal surgery.
  2. More Nurses May Mean Fewer Deaths in ICU. A high nurse to patient ratio in intensive care units was independently associated with a lower risk of in-hospital ...

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Last year, I underwent a colectomy, a surgery that removed my entire colon. Afterwards, I had to wear a temporary waste-collecting pouch attached to my abdomen known as an ostomy. Until my next surgery, I was now an “ostomate.” One of the early side-effects of the surgery was that I was prone to bouts of severe dehydration that left me hospitalized for a few days. During one of my dehydration-related ...

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