Gut Makeover -A New Years’ Resolution?

Posted on January 3, 2017 by gutsandgrowth

A recent NY Times article reviews a recent study which shows that changes in diet that incorporate more fruits and vegetables appears to create a ‘healthier’ microbiome.

Link: A Gut Makeover for the New Year?

An excerpt:

Related article: VJ Martin, MM Leonare, L Fiecntner, A Fasano. J Pediatr 2016; 179: 240-48.This review provides more specific information regarding the microbiome in health and disease. Specifically, the authors provide data on the relationship of the microbiome to five common pediatric chronic inflammatory conditions: allergic diseases, celiac disease, inflammatory bowel disease, necrotizing enterocolitis, and obesity.

Liver Briefs 2017

Posted on January 2, 2017 by gutsandgrowth

Briefly noted:

RJ Fontana et al. Hepatology 2016; 64: 1870-80. In this study of 681 adults with acute liver failure in U.S., only 3 had detectable anti-HEV IgM and all three were negative for HEV-RNA. In addition, other putative causes of acute liver failure were present in all three. My take: Hepatitis E is very rare explanation for acute liver failure in the U.S.

RA Rosencrantz et al. Hepatology 2016; 64: 2253-6. Case report of 2.5 yr old with autoimmune sclerosing cholangitis with Kawasaki disease. This was a well-described case with MRCP and liver histology. My take: In patients with Kawasaki with protracted liver disease, another etiology to consider.

NEJM Critique of the HHS Pick: Forsakes Tradition of Looking Out for Vulnerable

Posted on January 1, 2017 by gutsandgrowth

A recent NEJM commentary reviews Dr. Tom Price’s congressional record and the implications for his impending appointment to head HHS.

Full Text: Care for the Vulnerable vs Cash for the Powerful –Trump’s Pick for HHS

Here’s an excerpt:

Ostensibly, he emphasizes the importance of making our health care system “more responsive and affordable to meet the needs of America’s patients and those who care for them.”4 But as compared with his predecessors’ actions, Price’s record demonstrates less concern for the sick, the poor, and the health of the public and much greater concern for the economic well-being of their physician caregivers…

Price has sponsored legislation that supports making armor-piercing bullets more accessible and opposing regulations on cigars, and he has voted against regulating tobacco as a drug. His voting record shows long-standing opposition to policies aimed at improving access to care for the most vulnerable Americans. In 2007–2008, during the presidency of George W. Bush, he was one of only 47 representatives to vote against the Domenici–Wellstone Mental Health Parity and Addiction Equity Act, which improved coverage for mental health care in private insurance plans. He also voted against funding for combating AIDS, malaria, and tuberculosis; against expansion of the State Children’s Health Insurance Program; and in favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments.

Price favors converting Medicare to a premium-support system and changing the structure of Medicaid to a block grant — policy options that shift financial risk from the federal government to vulnerable populations.

My take: I’m worried that patients who need even basic care may not receive it if the affordable care act is repealed without a backup plan in place.

Related NY Times article discusses Dr. Price: Trump’s Health Secretary Pick Leaves Nation’s Doctors Divided The article discusses the AMA’s endorsement of Dr. Price and how many physicians have countered that the AMA does not speak for them.

AGA 2017 Guidelines for Postoperative Crohn’s Disease

Posted on December 31, 2016 by gutsandgrowth

Link to article: American Gastroenterological Association Institute Guideline on the Management of Crohn’s Disease After Surgical Resection (Full Text)

C Geoffrey et. Gastroenterol DOI: http://dx.doi.org/10.1053/j.gastro.2016.10.038

Bad Combination? Lansoprazole and Ceftriaxone

Posted on December 29, 2016 by gutsandgrowth

From Gastroenterology & Endoscopy News Nov 2016: Giving PPIs and Antibiotics Together May Disrupt Heart Rhythm

An excerpt:

Taking two common drugs—an over-the-counter proton pump inhibitor (PPI) and an antibiotic—together was associated with an increased risk for life-threatening arrhythmia (J Am Coll Cardiol 2016 Oct 10. [Epub ahead of print]).

New York researchers scanned data from two independent databases to investigate possible QT interval–prolonging drug–drug interactions: 1.8 million adverse event reports from the FDA’s Adverse Event Reporting System and 1.6 million ECGs from 382,221 patients treated at NewYork-Presbyterian Hospital/Columbia University Medical Center, in New York City, between 1996 and 2014…

In the study, patients taking ceftriaxone, a cephalosporin antibiotic, and the PPI lansoprazole were 40% more likely to have a QT interval above 500 milliseconds, the current FDA-stated threshold of clinical concern. Among men taking the two drugs, QT intervals were 12 milliseconds longer than men who took either drug alone…

The interaction identified in the data analysis was specific to lansoprazole and ceftriaxone, but not other cephalosporins.

My take: The magnitude of this risk is very low for a single individual but is important when one considers how many patients could be taking this combination of medications.