The Association of Age and Race and the Risk of Large Bowel Polyps

Blacks have a higher incidence of colorectal cancer (CRC) and a younger age at diagnosis compared to Whites. Few studies have investigated racial differences in risk of metachronous adenomas and serrated polyps whether this risk differs by polyp characteristics or age of patient

The Celiac Disease and Diabetes-Dietary Intervention and Evaluation Trial (CD-DIET) protocol: A randomised controlled study to evaluate treatment of asymptomatic coeliac disease in type 1 diabetes

Introduction: Coeliac disease (CD) is an autoimmune condition characterised by gluten-induced intestinal inflammation, and observed at a 5-10 fold greater prevalence in type 1 diabetes. While universal screening for CD in patients with diabetes is frequently advocated, objective data is limited as to benefits on diabetes control, bone health or quality of life related to the adoption of a gluten-free diet (GFD) in the large proportion of patients with diabetes with asymptomatic CD. The Celiac Disease and Diabetes-Dietary Intervention and Evaluation Trial (CD-DIET) study is a multicenter, randomised controlled trial to evaluate the efficacy and safety of a GFD in patients with type 1 diabetes with asymptomatic CD. Methods and analysis: Children and adults (8-45 years) with type 1 diabetes will be screened for asymptomatic CD. Eligible patients with biopsy-proven CD will be randomly assigned in a 1:1 ratio to treatment with a GFD for 1 year, or continue with a gluten-containing diet. The primary outcome will evaluate the impact of the GFD on change in glycated haemoglobin. Secondary outcomes will evaluate changes in bone mineral density, blood glucose variability and health-related quality of life between GFD-treated and the regular diet group over a 1-year period. The study was initiated in 2012 and has subsequently expanded to multiple paediatric and adult centres in Ontario, Canada. Ethics and dissemination: The findings from this study will provide high-quality evidence as to the impact of GFD treatment on glycaemic control and complications in asymptomatic children and adults with CD and type 1 diabetes. Trial registration number: NCT01566110

Cyclooxygenase-2 Polymorphisms, Aspirin Treatment, and Risk for Colorectal Adenoma Recurrence--Data from a Randomized Clinical Trial

Cyclooxygenase-2 (COX-2) catalyzes the rate-limiting step in the production of prostaglandins, potent mediators of inflammation. Chronic inflammation plays an important role in the development and progression of colorectal cancer. Aspirin inhibits COX-2 activity and lowers the risk of colorectal adenomas and cancer. We investigated whether common genetic variation in COX-2 influenced risk of colorectal adenoma recurrence among 979 participants in the Aspirin/Folate Polyp Prevention Study who were randomly assigned to placebo or aspirin and followed for 3 years for the occurrence of new adenomas. Of these participants, 44.2% developed at least one new adenoma during follow-up. Adjusted relative risks (RRs) and 95% confidence intervals (CIs) were calculated to test the association between genetic variation at six COX-2 single nucleotide polymorphisms (SNPs) and adenoma occurrence and interaction with aspirin treatment. Two SNPs were significantly associated with increased adenoma recurrence: for rs5277 homozygous carriers of the minor C allele had a 51% increased risk compared to GG homozygotes (RR=1.51, 95% CI=1.01–2.25), and for rs4648310 heterozygous carriers of the minor G allele had a 37% increased risk compared to AA homozygotes (RR=1.37, 95% CI=1.05–1.79). (There were no minor allele homozygotes.) In stratified analyses, there was suggestive evidence that rs4648319 modified the effect of aspirin. These results support the hypothesis that that COX-2 plays a role in the etiology of colon cancer and may be a target for aspirin chemoprevention and warrant further investigation in other colorectal adenoma and cancer populations

Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study.

OBJECTIVE: To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD. RESEARCH DESIGN AND METHODS: Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA RESULTS: Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9-8.2%, CONCLUSIONS: CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD

Audit of IV Pantoprazole: Patterns of Use and Compliance with Guidelines

ABSTRACT Background: Institutional guidelines were developed to promote appropriate use of the IV proton pump inhibitor pantoprazole. The guidelines restricted use of this drug to patients with upper gastrointestinal bleeding who were hemodynamically unstable or at high risk of rebleeding and patients requiring a proton pump inhibitor but designated NPO (unable to receive enteral medication or feeding).Objective: To describe patterns of use of pantoprazole and to determine compliance with the guidelines at a tertiary-care, university-affiliated institution.Methods: Drug utilization and compliance with guidelines were audited retrospectively. The medical records of all patients who received IV pantoprazole during the initial 6 months of use of this drug at the institution (February to July 2000) were reviewed.Results: Fifty-seven patients received IV pantoprazole during the study period: 46 for upper gastrointestinal bleeding and 11 because they were NPO. In the group with upper gastrointestinal bleeding, 30 (65%) of the orders were recommended by the gastroenterology service; however, only 16 (35%) of the cases clearly met the eligibility criteria of hemodynamic instability or high risk of rebleeding. Adherence to the dosing regimen in this group was 70% (32 cases), and mean duration of therapy was acceptable, at 73.0 h. In the NPO group, 6 (55%) of the treatment courses met the criteria set out in the guidelines. Continuous infusion was prescribed inappropriately for 4 (36%) of these patients. Mean duration of therapy was much longer, at over 200 h. Total expenditures for IV pantoprazole were approximately $13 000 over the 6-month audit period.Conclusions: Despite guidelines and prescribing restrictions, this criteria-based audit found that IV pantoprazole was used inappropriately in a substantial proportion of treatment courses. Prospective monitoring and intervention by pharmacists are recommended to ensure cost-effective use of this new therapeutic modality.RÉSUMÉ Historique : Des lignes directrices pour l’établissement de santé ont été élaborées afin de favoriser l’utilisation adéquate de l’inhibiteur de la pompe à protons par voie intraveineuse, le pantoprazole. Les lignes directrices limitaient l’administration de ce médicament aux patients souffrant d’hémorragies digestives hautes et présentant une instabilité hémodynamique ou un risque élevé de récidive hémorragique, et aux patients nécessitant un inhibiteur de la pompe à protons qui ne pouvaient rien prendre par voie orale (chez qui l’alimentation ou la médication entérales étaient impossibles).Objectif : Décrire les habitudes d’utilisation du pantoprazole et déterminer le degré d’observance des lignes directrices dans un établissement de soins tertiaires affilié à une université.Méthodes : L’utilisation du médicament et l’observance des lignes directrices ont été évaluées à posteriori. Les dossiers médicaux de tous les patients qui ont reçu du pantoprazole I.V. au cours des premiers six mois de l’utilisation de ce médicament à l’établissement de santé (de février à juillet 2000) ont été passés en revue.Résultats : Au total, 57 patients ont reçu du pantoprazole I.V., dont 46 pour des hémorragies digestives hautes et 11 parce que l’administration entérale de médicaments était impossible. Dans le groupe hémorragies digestives hautes, 30 (65$ au cours de la période d’étude de six mois.Conclusions : Malgré les lignes directrices et les restrictions d’ordonnance, cette vérification fondée sur les critères a révélé que le pantoprazole I.V. était utilisé de façon non appropriée dans un nombre considérable de schémas thérapeutiques. La surveillance prospective et l’intervention par les pharmaciens sont recommandées pour assurer l’utilisation rentable de cette nouvelle modalité thérapeutique

Cloxacillin: A New Cause of Pill-Induced Esophagitis

A large variety of medications can cause pill-induced esophagitis. Herein we present a case of cloxacillin-induced esophagitis. A 66-year-old male presented with an acute onset of epigastric and retrosternal pain on the 5th day of a course of oral cloxacillin prescribed for erysipelas. Initial clinical and imaging assessment was negative and he was sent home. A few days later, he returned with persistent severe retrosternal pain; endoscopy at the same day revealed a normal upper esophagus, several small stellate erosions in the midesophagus, and a normal squamocolumnar junction with a small hiatus hernia. Treatment with esomeprazole 40 mg bid and MucaineR suspension resulted in complete resolution of his symptoms. Pill-induced esophagitis may be underreported by patients, when symptoms are mild and unrecognized and/or underdiagnosed by the clinicians as a cause of retrosternal pain, odynophagia, or dysphagia. Failure of early recognition may result in unnecessary diagnostic investigations and prolongation of the patient’s discomfort. This case signifies the importance of enhancing clinician awareness for drug-associated esophageal injury when assessing patients with retrosternal pain, as well as the value of prophylaxis against this unpleasant condition by universally recommending drinking enough water in an upright position during ingestion of any oral medication

E-mail Communication in the Management of Gastroenterology Patients: A Review

E-mail correspondence between physicians and patients can be a useful tool to improve communication efficiency, provide economic and ecological benefits, improve therapeutic interventions and adherence, and enhance self-management. The model of self-management in chronic disease has become an integral component of North American and British medicine. From a practical standpoint, the use of e-mail between physicians and patients can complement the self-management model