Dr. Snow's Gastro Blog
monday, january 14, 2013
Clostridium difficile is an infection that can occur after antibiotic administration and can result in severe diarrhea. It can often be acquired in patient's while in the hospital. It occurs when the normal bacteria of the gut are eliminated by broad-spectrum antibiotics. This allows the Clostridium difficile to grow, and secrete toxins which lead to the diarrhea. There is no sure way to prevent this infection, but recent studies suggested taking probiotics while on antibiotics may reduce the incidence. There are also novel ways to treat this infection, in addition to using specific antibiotics. These include metronidazole and vancomycin. Recent studies show value in fecal microbiology transplants. This is where normal stool is inserted into the colon, which repopulate the colon with normal bacteria.
The following 2 articles discuss this infection. The first is from the Toronto Star describing and artificial colon in which many scientific studies can be done. The second is from the Annals of internal medicine, and describes a review of multiple studies of probiotics in the prevention of Clostridium difficile in hospitalized patients. This study says that there is moderate evidence of probiotics, should be used to prevent Clostridium difficile in hospitalized patients. If you are hospitalized, you should ask you Dr. if you should be on probiotics.
Sugar, Fructose vs Glucose, and
Obesity, does it actually increase your life span.
tuesday, january 8, 2013
If you have been a reader of previous blogs, I hope I have had the chance to discover some of the effects of sugar on the liver. Attached is a summary of a study of fructose on the brain from Dr Kathleen Page at Yale University, showing that fructose ingestion does not stimulate satiety, and therefore people continue eating. This was published in JAMA Following that, is an article on obesity.
In that same issue of JAMA, another study suggested that being overweight (defined as having a body mass index of 25 or more), did not lead to increase mortality, and that people who were heavier, would actually live longer. The article was a meta-analysis, which means it pooled together many other previous studies to come to this conclusion. Attached is an article which presents many reasons why this meta-analysis is likely wrong, and likely harmful. We will await future studies.
monday, october 01, 2012
Obesity is a serious issue in this country. In the US, the rate of obesity exceeds 30 %, and is 29% in Virginia, and 32 % in West Virginia. Obesity is associated with multiple health problems, including heart disease, diabetes, and some cancers. As a gastroenterologist, we also see a lot of liver disease from excess fat in the liver, which can lead to cirrhosis. There are a lot of health benefits from intervention in this disorder, and because of this, the United States Preventative Services Task Force recently updated there recommendations for the screening and management of obesity. They recommend screening everybody for obesity with a measurement of body mass index (BMI). If the BMI exceeds thirty, the definition of obesity, then they recommend intensive multi-component behavioral interventions. Attached is a link to these guidelines for patients.
monday, october 08, 2012
Colon cancer is the second leading cause of death in this country, with more than 50,000 deaths per year. Not all of these deaths are preventable, but we are getting better at detection and treatment. Over the past couple years, we have reduced the incidence of colon cancer. Recent studies show that even one colonoscopy reduces your chance of getting colon cancer, and increases the chance of finding colon cancer for people who have undergone colon cancer screening. A study just released from Gastrointestinal Endocsopy by Dr. Mancer concluded that a singel screeing colonoscopy led to a marked reduction in colon cancer incidence and mortality in an asymptomatic population. In addition to colonscopy, there are other ways to screeen for colon cancer, though colonscopy renmains the gold standard. If you are over 50, and have not discussed colon cancer screening with you physician it is important to do so. I have attached a link to a recent American Cancer Society pamphelt on colon cancer, and the recent CDC guidelines.
Hepatits C Screening
monday, september 24, 2012
The Centers of Disease Control recently recommended that people born between the years of 1945 to 1965 get screened for hepatitis C. More than half of individuals with Hepatitis C do not know they have it, and this group of people born in those years account fot the majority of people who will get sick from this.
They said the following;
The following recommendations for HCV testing are intended to augment the Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease issued by CDC in 1998 (8). In addition to testing adults of all ages at risk for HCV infection, CDC recommends that:
- Adults born during 1945–1965 should receive one-time testing for HCV without prior ascertainment of HCV risk (Strong Recommendation, Moderate Quality of Evidence), and
- All persons identified with HCV infection should receive a brief alcohol screening and intervention as clinically indicated, followed by referral to appropriate care and treatment services for HCV infection and related conditions (Strong Recommendation, Moderate Quality of Evidence).
Providers and patients can discuss HCV testing as part of an individual's preventive health care. For persons identified with HCV infection, CDC recommends that they receive appropriate care, including HCV-directed clinical preventive services (e.g., screening for alcohol use, hepatitis A and hepatitis B vaccination as appropriate, and medical monitoring of disease). Recommendations are available to guide treatment decisions (31). Treatment decisions should be made by the patient and provider after several factors are considered, including stage of disease, hepatitis C genotype, comorbidities, therapy-related adverse events, and benefits of treatment.
You can see your family doctor to discuss this new recommendation, and who can diagnosis this infection with a simple blood test.
For a more complete report, see the following link: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm