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The following appeared in the July 1999 issue of American Journal of Gastroenterology....

colonoscopy

 

Dr. Minocha  is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies"

1. There is a growing trend towards surgical treatment of gastroesophageal reflux disease (GERD), especially with the advent of laproscopic ("mini") surgery. El-Serag et al. Report that fundoplication (commonest surgery for GERD) improves outcome in patients who have complications like ulcers or narrowing in esophagus but not in patients without complications. More importantly, surgery did not reduce overall health care costs. This study was done in patients undergoing open surgery and not by laproscopic technique.

In another report on same topic, Rantanen report that long-term results of open fundoplication surgery done in non-specialized centers is worse than the results previously reported for specialized surgical centers.

2. Havulund report that acid blocking treatment with potent prescription only acid blocking drugs improves quality of life in heartburn population and restores it comparable to healthy controls.

3. Wu et al., confirming several such earlier studies report that Helicobacter pylori infection in stomach appears to protect against GERD (heartburn). In another journal, July 1999 issue of Gastroenterology , Holtmann et al. from Germany report that when acid blockers are used, the presence of H. Pylori infection in stomach facilitates healing of acid reflux related inflammation of esophagus.

4. Helicobacter has been closely linked to duodenal ulcer in as many as 95% cases. More recent studies suggests that it may be an overestimation. Ciociola et al. From North Carolina confirm the somewhat lower association to be around 73% in their study. This emphasizes that there are other significant causative factors involved in ulcers and should be looked for, especially NSAIDs (aspirin, motrin like arthritis drugs).

5. Some recent studies have suggested that colonoscopy can be done without sedation in most patients. But will patients accept that? Early et al. From Columbia, MO addressed this hot issue.  They found that only one-fifth of their patient population was willing to undergo colonoscopy without sedatives. Patient acceptance, thus, is a major issue!

6. Food "allergy" and intolerance is a controversial topic in IBS, but a not frequent complaint among patients with Irritable Bowel Syndrome (IBS). Dainese et al. from Italy found that over half of the IBS patients were "sensitized" to some food or inhaled substance. However, not only did they not have any typical symptoms related to that, but they also could not identify the particular food or inhalant. This lack of correlation makes their role in mechanisms of IBS a suspect, but more studies are needed.

7. Fibromyalgia and Irritable bowel syndrome are common especially among women. The causes have not been fully established. Barton et al. from Britain report that over a quarter of patients with IBS have concomitant fibromaylgia. This and other literature on these topics suggests that some common mechanisms may be involved in causation of these diseases.

8. Use of antibiotics can lead to killing some bacteria while overwhelming of gut by the "bad" bags and leading to Clostridium dificille diarrhea which can be silent or life-threatening. Usually it occurs when antibiotic is taken by mouth or injection. Vikenes et al. From Norway report a case of C. dificille diarrhea after 3-day treatment using intra-vaginal clindamycin.

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