Articles related to Gastroenterology

The adenoviral vector–based gene therapy contains the gene for interferon alfa-2b. It is administered by catheter into the bladder once every three months. The virus penetrates the bladder endothelial cells and releases the gene, which is incorporated by the cells. As a result, the cells begin secreting high levels of the cancer-fighting interferon.

In an analysis of 19 studies across 12 countries involving more than 25,000 participants, individuals in highest 20% bracket for omega 3 levels had 13% less risk for developing CKD compared with participants in the lowest 20% bracket. Results were consistent and independent of subgroup variables of age, GFR, hypertension, CAD, and diabetes.

Updated recommendations include EGD with multiple duodenal biopsies, setting intestinal healing as the goal for gluten-free diet, and use of gluten-free oats in some populations. There wasn’t evidence to support routine use of probiotics or use of gluten detection devices.

The American Journal of Gastroenterology published the ACG clinical guideline on the management of IBS in January 2021. Lead author gastroenterologist Brian E. Lacy, MD, PhD, says that to diagnose IBS, clinicians should take a careful history, perform a careful physical exam, use Rome IV criteria, and perform limited diagnostic testing (complete blood count, C-reactive protein, and possibly celiac serologies and fecal calprotectin, depending on symptoms). Regardless of whether a patient has constipation-predominant symptoms, diarrhea-predominant symptoms, or a combination of constipation and diarrhea, the first step is to classify the patient into a mild, moderate, or severe IBS category.

A layered approach to care is described with lifestyle interventions being a key feature of the updated recommendations. The recommendations now include therapies proven to improve cardiovascular and kidney outcomes in patients with diabetes and CKD.

She has been treating her IBS with bismuth subsalicylate. Her symptoms include shortness of breath, nausea, and vomiting. On exam, the patient is confused. Laboratory testing showed primary anion-gap metabolic acidosis, primary respiratory alkalosis, and a salicylate level 25x greater than the normal upper limit.