Monthly Archives: November 2017

Kaminski et al1 used feedback and quality benchmark indicators to improve colonoscopy performance and happily they succeeded. They confirmed that increasing the rate of adenoma detection (RAD) is associated with a reduced risk of colorectal cancer and death.2 Nevertheless, their findings may not be generalizable to other settings. First, they should provide the rationale how they divided ADR into quintiles of ≤11.21%, 11.22% to 15.10%, 15.11% to 19.17%, 19.18% to 24.56%, and >24.56%; these divisions seem arbitrary and very different from their previous reports. Continue reading →

Direct acting antiviral agents have revolutionized the treatment of chronic infection with hepatitis C virus (HCV), but further improvements are needed to meet the public health goal of controlling HCV worldwide. Shortened courses of therapy might redu… Continue reading →

Question: A 74-year-old vegetarian woman with a medical history significant for severe nonischemic dilated cardiomyopathy, chronic obstructive pulmonary disease, stage IV chronic kidney disease, hypertension, atrial fibrillation on chronic warfarin, and right-sided breast cancer treated with mastectomy >20 years ago, presented for evaluation of fatigue and a 16-year history of iron deficiency anemia. History was notable for an absence of melena, hematemesis, and bright red blood per rectum. Six years prior, she had undergone an upper endoscopy, which identified a Dieulafoy lesion that was treated with cauterization. Continue reading →

Question: A 50-year-old woman was referred for screening colonoscopy during small bowel transplant evaluation. One year ago, she developed acute mesenteric ischemia from superior mesenteric artery thrombosis. She required resection of a major portion o… Continue reading →

Question: A 65-year-old man with a significant past medical history of peripheral vascular disease requiring aortofemoral bypass graft placement in 2009 owing to severe symptoms. Since the surgery in 2009 there had not been any complications involving … Continue reading →

Question: A 58-year-old woman with a history of ulcerative colitis in clinical remission was referred for endosonographic evaluation of a periduodenal mass. She developed abdominal pain in the right upper quadrant and lost 15 lbs over the preceding 3 months. She denied jaundice. Laboratory studies were remarkable for an elevated alkaline phosphatase (ALP) of >1000 U/L (normal range, 38–126) without elevation of aminotransferases or bilirubin. She had no history of cholelithiasis or pancreatitis, and no family history of pancreatic cancer. Continue reading →

Non-celiac gluten sensitivity is characterized by symptom improvement after gluten withdrawal in absence of celiac disease. The mechanisms of non-celiac gluten sensitivity are unclear, and there are no biomarkers for this disorder. Foods with gluten of… Continue reading →

Diagnosis of inflammatory bowel diseases (IBD) is increasing among elderly persons (60 years or older). We performed a nationwide population-based study to estimate incidence and treatment. Continue reading →