The over-the-counter sale of probiotics is a huge industry. They are heavily promoted on social media as a cure-all for a wide variety of ills. Probiotics are live cultures of what are often called “good bacteria,” and there are solid physiological reasons for recommending them. But, and this is a huge but, actual clinical data demonstrating their usefulness behind some well-defined disorders is pretty scant. Their potential usefulness in many ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated in the emergency department for a 2-day history of mild nausea and dyspepsia that is worse with fasting and improved with eating. He has also had a 24-hour history of frequent black stools and fatigue. He has no history of gastrointestinal bleeding, alcoholism, chronic ...

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Recently, news broke about a disturbing act of medical battery carried out by doctors at St. Joe’s Medical Center in Syracuse, New York. The case began when police officers conducted a pretext stop and elected to harass their victim about a small amount of marijuana.

As the situation escalated, the cops took the man to St. Joe’s Medical Center for him to be searched for ...

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I prescribe heartburn medicines every day. There’s a gaggle of them now -- Prilosec, Nexium, Prevacid, Protonix -- to name a few. As far as experts know, their primary effect is to reduce the production of stomach acid. This is why they are so effective at putting out your heartburn fire. In simple terms: no acid, no heartburn. I am quite sure that well-meaning physicians like myself do not understand or ...

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The intestinal microbiota, also commonly known as the ‘‘gut microbiome’’ is integral to human physiology and has wide-ranging effects on the development and function of the immune system, energy metabolism and even nervous system activity. There is a lot of excitement around the potential of targeting the microbiome therapeutically to promote health and to prevent or treat medical conditions. Further, as DNA sequencing technologies and computational methods ...

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Recently, a physician asked my opinion if a patient needed a colonoscopy. My partner was already on the case and I was covering over the weekend. The facts suggested that a colonoscopy was warranted. The patient had a low blood count and had received blood transfusions. Certainly, a bleeding site in the colon, such as a cancer, might be responsible. We do colonoscopies to address similar circumstances on a regular ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old woman is evaluated in the emergency department for a 2-day history of left lower abdominal discomfort. The pain began insidiously and has gradually progressed. She has felt warm but has not had shaking chills, urinary symptoms such as dysuria or urgency, change in bowel habits, or apparent ...

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A 30-year old male patient was recently admitted to my service via the emergency department. He came in complaining of abdominal pain and dark tarry stools. He mentioned a recent fall resulting in knee pain for which he had been taking 400 mg ibuprofen four times daily. He underwent upper GI endoscopy and was diagnosed with a bleeding gastric ulcer from his self-prescribed misuse/overuse of ibuprofen. Fortunately, he recovered, but this ...

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Well, they are calling it the golden age of rectums! The trends are simple and straightforward. First, Baby Boomers and beyond are aging and staying alive longer. The gut, a hidden culprit behind many ailments, requires continuous maintenance. Colonoscopies, EGDs and ERCPs. These require services of gastroenterologists (GIs) who are always in short supply (14,000 in the U.S.).4 Second, gastroenterology practices are fragmented like hotels were before the Hilton. Regulatory, technological and ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old man is evaluated in follow-up after recent abnormal findings on intraoperative liver biopsy. Two days ago he underwent right colon resection for a large villous adenoma with high-grade dysplasia. At the time of surgery, an abnormal-appearing liver was noted and biopsy was performed. His medical history is ...

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