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Guideline Issued for Treatment of Mild, Moderate Ulcerative Colitis

Guideline Issued for Treatment of Mild, Moderate Ulcerative Colitis

Guideline Issued for Treatment of Mild, Moderate Ulcerative
Colitis
 
A new clinical guideline from the American Gastroenterological
Association (AGA) published Dec 18 in Gastroenterology focuses
on the medical management of patients with mild-to-
moderate ulcerative colitis (UC).

To inform the guideline, Siddharth Singh, MD, from the University of California in San Diego, and colleagues compiled the clinical evidence in accordance with the Grading of Recommendations

Assessment, Development, and Evaluation framework.
In the guideline, Cynthia W. Ko, MD, from the University of
Washington in Seattle, and colleagues note that most UC patients
have a mild-to-moderate course characterized by periods of
activity or remission. For patients with extensive mild-to-moderate UC, using standard-dose mesalamine or diazo-bonded 5-ASA is recommended rather than low-dose mesalamine, sulfasalazine, or no treatment. Rectal mesalamine should be added to oral 5-ASA for patients with extensive or left-sided mild-to-moderate UC.

High-dose mesalamine with rectal mesalamine is recommended
for patients with mild-to-moderate UC with suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA. Once-daily
dosing is recommended rather than multiple-daily dosing for
patients with mild-to-moderate UC being treated with oral
mesalamine. For induction of remission, standard-dose oral
mesalamine or diazo-bonded 5-ASA is recommended rather than
budesonide MMX or controlled ileal-release budesonide.

“We identified several knowledge gaps and areas for future research in this patient population,” Ko and colleagues write. “Due to evidence gaps, the AGA makes no recommendation for use of probiotics, curcumin, or fecal microbiota transplantation in patients with mild-to- moderate UC.”

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Endoscopy Overview

Endoscopy Overview

ENDOSCOPY OVERVIEW — An upper endoscopy, often referred to as endoscopy, EGD, or esophago-gastro-duodenoscopy, is a procedure that allows a physician to directly examine the upper part of the gastrointestinal (GI) tract, which includes the esophagus, the stomach, and the duodenum (the first section of the small intestine)
The physician who performs the procedure, known as an endoscopist, has special training in using an endoscope to examine the upper GI system, looking for inflammation (redness, irritation), bleeding, ulcers, or tumors.
REASONS FOR UPPER ENDOSCOPY — The most common reasons for upper endoscopy include:

●Unexplained discomfort or pain in the upper abdomen.
●GERD or gastroesophageal reflux disease (often called heartburn.)
●Persistent nausea and vomiting.
●Upper gastrointestinal (GI) bleeding (vomiting blood or blood found in the stool that originated from the upper part of the GI tract). Bleeding can be treated during the endoscopy.
●Iron deficiency anemia (low blood count associated with a low iron level in the blood) in someone who has had no visible bleeding.
●Difficulty swallowing; food/liquids getting stuck in the esophagus during swallowing. This may be caused by a narrowing (stricture) or tumor or because the esophagus is not contracting properly. If there is a stricture, it can often be dilated with special balloons or dilation tubes during the endoscopy.
●Abnormal or unclear findings on an upper GI x-ray, CT scan, or MRI.
●Removal of a foreign body (a swallowed object).
●To check healing or progress on previously found polyps (growths), tumors, or ulcers.

ENDOSCOPY PREPARATION — You will be given specific instructions regarding how to prepare for the examination before the procedure. These instructions are designed to maximize your safety during and after the examination and to minimize possible complications. It is important to read the instructions ahead of time and follow them carefully. Do not hesitate to call the physician’s office or the endoscopy facility if there are questions.
You may be asked not to eat or drink anything for up to eight hours before the test. It is important for your stomach to be empty to allow the endoscopist to visualize the entire area and to decrease the possibility of food or fluid being vomited into the lungs while under sedation (called aspiration).
You may be asked to adjust the dose of your medications (such as insulin) or to stop specific medications (such as blood thinning medications) temporarily before the examination. You should discuss your medications with your physician before your appointment for the endoscopy.
You should arrange for a friend or family member to escort you home after the examination. Although you will be awake by the time you are discharged, the medications used for sedation may cause temporary changes in the reflexes and judgment and interfere with your ability to drive or make decisions (similar to the effects of alcohol). Patients who receive sedation are often required to be accompanied home after the procedure.

WHAT TO EXPECT DURING ENDOSCOPY — Prior to the endoscopy, the staff will review your medical and surgical history, including current medications. A physician will explain the procedure and ask you to sign consent. Before signing consent, you should understand the benefits and risks of the procedure, alternatives to the procedure, and all of your questions should be answered.

If you are going to receive sedation for the procedure, an intravenous line (a needle inserted into a vein in the hand or arm) will be inserted to deliver medications. You may be given a combination of a sedative (to help you relax) and a narcotic (to prevent discomfort), or other medications that are commonly used for sedation.
Your vital signs (blood pressure, heart rate, and blood oxygen level) will be monitored before, during, and after the examination. The monitoring is not painful. Oxygen is often given during the procedure through a small tube that sits under the nose and is fitted around the ears. For safety reasons, dentures should be removed before the procedure.

Although most patients are sedated for the examination, many tolerate the procedure well without any medication. Usually, these patients are given a medication to numb the back of their throats (either a gargle or a spray) just prior to the endoscopy to prevent gagging during the passage of the instrument. This may be offered to patients felt to be at higher risk for receiving sedation. Otherwise, if you are interested in having your endoscopy in this sedation-free manner, you should discuss this with the doctor beforehand to see if this is a possibility for you.

THE ENDOSCOPY PROCEDURE — The procedure typically takes between 10 and 20 minutes to complete. The endoscopy is performed while you lie on your left side. A plastic mouth guard is placed between the teeth to prevent damage to the teeth and endoscope.

The endoscope (also called a Gastroscope) is a flexible tube that is about the size of a finger. The endoscope has a lens and a light source that allows the endoscopist to see the inner lining of the upper gastrointestinal (GI) tract, usually on a TV monitor. Most people have no difficulty swallowing the flexible Gastroscope because of the sedating medications. Many people sleep during the test; others are very relaxed and generally not aware of the examination.
An alternative procedure called trans nasal endoscopy may be available in some facilities. This involves passing a very thin scope (about the size of a drinking straw) through the nose. You are not sedated but a medication is applied to the nose to prevent discomfort. A full examination can be performed with this instrument.
The endoscopist may take tissue samples called biopsies. Obtaining biopsies is not painful. The endoscopist may also perform specific treatments (such as dilation, removal of polyps, treatment of bleeding), depending upon what is found during the examination. Air or carbon dioxide gas is gently introduced through the endoscope to open the esophagus, stomach, and intestine, allowing the endoscope to be passed through these areas and improving the endoscopist’ s ability to see completely. You may experience mild discomfort as air is pushed into the stomach and intestinal tract. This is not harmful; belching may relieve the sensation. The endoscope does not interfere with breathing. Taking slow, deep breaths just before and during the procedure may help you to relax.

RECOVERY FROM ENDOSCOPY — After the endoscopy, you will be observed for a period of time, generally less than one hour, while the sedative medication wears off. Some of the medicines commonly used cause some people to temporarily feel tired or have difficulty concentrating. You typically will be instructed not to drive and not to return to work for the balance of the day of the procedure.

The most common discomfort after the examination is a feeling of bloating as a result of the air introduced during the examination. This usually resolves quickly. Some patients also have a mild sore throat. Most patients are able to eat shortly after the examination.

ENDOSCOPY COMPLICATIONS — Upper endoscopy is a safe procedure and complications are rare. The following is a list of some possible complications:
●Aspiration (inhaling) of food or fluids into the lungs, the risk of which can be minimized by not eating or drinking for the recommended period of time before the examination.
●Reactions to the sedative medications are possible; the endoscopy team (doctors and nurses) will ask about previous medication allergies or reactions and about health problems such as heart, lung, kidney, or liver disease. Providing this information to the team ensures a safer examination.
●The medications may produce irritation in the vein at the site of the intravenous catheter. If redness, swelling, or discomfort occurs, you should call your endoscopist or primary care provider, or the number given to you at discharge.
●Bleeding can occur from biopsies or the removal of polyps, although if bleeding occurs, it is usually minimal and stops quickly on its own or can be easily controlled.
●The endoscope can cause a tear or hole in the area being examined. This is a serious complication but fortunately occurs extremely rarely.
The following signs and symptoms should be reported immediately:
●Severe abdominal pain (more than gas cramps)
●A firm, distended abdomen
●Vomiting
●Any temperature elevation
●Difficulty swallowing or severe throat pain
●A crunching feeling under the skin of the neck

AFTER UPPER ENDOSCOPY — Most patients tolerate endoscopy very well and feel fine afterwards. Some fatigue is common after the examination, and you should plan to take it easy and relax the rest of the day.
The endoscopist can describe the result of the examination before you leave the endoscopy facility. If biopsies have been taken or polyps removed, you should call for results at a time specified by the endoscopist, typically within one week.

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Colonoscopy Overview

Colonoscopy Overview

COLONOSCOPY OVERVIEW — A colonoscopy is an exam of the lower part of the gastrointestinal tract, which is called the colon or large intestine (bowel). Colonoscopy is a safe procedure that provides information other tests may not be able to give. Patients who require colonoscopy often have questions and concerns about the procedure.
Colonoscopy is performed by inserting a device called a colonoscope into the anus and advancing through the entire colon. The procedure generally takes between 20 minutes and one hour.
Other tests that are sometimes used to screen for colon cancer, like virtual colonoscopy (also called CT colonography),

More detailed information about colonoscopy is available by subscription..
REASONS FOR COLONOSCOPY — The most common reasons for colonoscopy are:

●To screen for colon polyps (growths of tissue in the colon) or colon cancer
●Rectal bleeding
●A change in bowel habits, like persistent diarrhea
●Iron deficiency anemia (a decrease in blood count due to loss of iron)
●A family history of colon cancer
●A personal history of colon polyps or colon cancer
●Chronic, unexplained abdominal or rectal pain
●An abnormal x-ray exam, like a barium enema or CT scan

COLONOSCOPY PREPARATION — Before colonoscopy, your colon must be completely cleaned out so that the doctor can see any abnormal areas. This is vitally important to increase the chances that your doctor will identify abnormalities in your colon. If your colon is not completely cleaned out, the chances your doctor will miss abnormalities increases. Your doctor’s office will provide specific instructions about how you should prepare for your colonoscopy. Be sure to read these instructions as soon as you get them so you will know how to take the preparation and whether you need to make any changes to your medications or diet. If you have questions, call the doctor’s office in advance.

You will need to avoid solid food for at least one day before the test. You should also drink plenty of clear fluids on the day before the test. You can drink clear liquids (a liquid you can hold up to the light and see through) up to several hours before your procedure, including:

●Water
●Clear broth (beef, chicken, or vegetable)
●Coffee or tea (without milk)
●Ices
●Gelatin such as Jell-O (avoid red gelatin)

Avoid drinking red liquids. Your doctor may also ask you to avoid high fiber foods including seeds and nuts for the week before the procedure.

To clean the colon, you will take a strong laxative and empty your bowels. You may be asked to take the entire preparation the night before the test, or you may be asked to take it in two doses, with the second dose taken four to six hours prior to the colonoscopy. Taking the preparation in two “split” doses may help get the colon even cleaner. This may require you to wake up early in the morning to complete the preparation. The instructions you are given will tell you how you should take the preparation.

A commonly used preparation is a 4-liter (1 gallon) solution that is purchased at the pharmacy with a prescription. There are several low-volume (2- to 3-liter) preparations on the market as well. Some doctors prefer citrate of magnesia (also called magnesium citrate), a 300 mL (10 ounce) bottle that requires no mixing and is over-the-counter. Packets of powdered laxative are available that are mixed with a smaller volume of water. Sodium phosphate-based preparations are now usually avoided due to concerns over safety.

Refrigerating the solution can make it easier to drink, but do not put ice in the solution since it will melt and you will have to drink even more fluid. Drinking the solution through a straw, adding sugar-free powdered flavor packets (ex. Crystal Light), and taking half the preparation the night before and the other half later (four to six hours before your colonoscopy) may also make it easier to drink. Drinking this solution may be the most unpleasant part of the exam. Watery diarrhea is the desired result. This may occur shortly after drinking the solution or may be delayed for several hours. The result should be diarrhea that looks like urine. If you become nauseated or vomit while drinking the solution, call your doctor or nurse for instructions. Tips that can help with nausea and vomiting include temporarily stopping drinking the solution, walking around, and resuming drinking at a slower pace.
Medicines — You can take most prescription and nonprescription medicines right up to the day of the colonoscopy. Your doctor should tell you what medicines to stop. You should also tell the doctor if you are allergic to any medicines.

Some medicines increase the risk of heavy bleeding if you have a polyp removed during the colonoscopy. Ask your doctor how and when to stop these medicines, including warfarin/Coumadin, Clopidogrel/Plavix, or any other anticoagulant (blood thinning) medicine. Do not stop these medications without first talking with your doctor.
Transportation home — Most patients are given a sedative (a medicine to help you relax) during the colonoscopy, so you will need someone to take you home after your test. Your doctor may prefer that an anesthesiologist administer the sedative and monitor you during the colonoscopy. Although you will be awake by the time you go home, the sedative/anesthetic medicines cause changes in reflexes and judgment that can interfere with your ability to make decisions, similar to the effect of alcohol. You will not be able to drive home or go back to work after the examination if you received sedation for the procedure. You should be able to return to work the next day.

WHAT TO EXPECT — Before the test, a doctor will review the procedure with you, including possible complications, and ask you to sign a consent form.

An IV line will be inserted in your hand or arm. Your blood pressure, heart rate, and breathing will be monitored during the test.

THE COLONOSCOPY PROCEDURE — You will be given fluid and medicines through the IV line. With sedation/analgesia provided during the colonoscopy, many people sleep during the test, while others are very relaxed, comfortable, and generally not aware. Your doctor may request an anesthesiologist give you an anesthetic agent (for example, Propofol), which is a stronger sedative and will put you to sleep while you are being closely monitored.

The colonoscope is a long black flexible tube, approximately the diameter of the index finger. The doctor will gently pump air or carbon dioxide and sterile water or saline through the scope into the colon to inflate it and allow the doctor to see the entire lining. You might feel bloating or gas cramps as the air opens the colon. Try not to be embarrassed about passing this gas (it is just air), and let your doctor know if you are uncomfortable. You may feel like you have to go to the bathroom, which is a normal feeling during the procedure.
During the procedure, the doctor might take a biopsy (small pieces of tissue) or remove polyps. Polyps are growths of tissue that can range in size from the tip of a pen to several inches. Most polyps are benign (not cancerous). However, some polyps can become cancerous if allowed to grow for a long time. Having a polyp removed does not hurt.

RECOVERY FROM COLONOSCOPY — After the colonoscopy, you will be observed in a recovery area, usually for about 30 to 60 minutes until the effects of the sedative medication wear off. The most common complaint after colonoscopy is a feeling of bloating and gas cramps. You should pass gas and not feel embarrassed doing this either during or after the procedure. This will relieve your feelings of bloating and cramping. You may also feel groggy from the sedation medications. You should not return to work, drive, or drink alcohol that day. Most people are able to eat normally after the test. Ask your doctor when it is safe to restart aspirin and other blood-thinning medications.

COLONOSCOPY COMPLICATIONS — Colonoscopy is a safe procedure, and complications are rare but can occur:
●Bleeding can occur from biopsies or the removal of polyps, but it is usually minimal and can be controlled.
●The colonoscope can cause a tear or hole in the colon. This is a serious problem that sometimes requires surgery to repair, but it does not happen commonly.
●It is possible to have side effects from the sedative medicines like nausea or vomiting.
●Although colonoscopy is the best test to examine the colon, it is possible for even the most skilled doctors to miss or overlook an abnormal area in the colon.
You should call your doctor immediately if you have any of the following:
●Severe abdominal pain (not just gas cramps)
●A firm, bloated abdomen
●Vomiting
●Fever
●Rectal bleeding (greater than a couple of tablespoons [30 mL])

AFTER COLONOSCOPY — Although many people worry about being uncomfortable during a colonoscopy, most people tolerate it very well and feel fine afterward. It is normal to feel tired afterward. Plan to take it easy and relax the rest of the day.
Your doctor can describe the results of the colonoscopy as soon as it is over. If s/he took biopsies or removed polyps, you should call for results within one to two weeks if your doctor has not already contacted you.

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Updated Guidelines From GI Societies

Updated Guidelines From GI Societies

Updated ACS guidelines on colorectal cancer screening (May 2018)

The American Cancer Society (ACS) has updated its colorectal cancer (CRC) screening guidelines [2]. On the basis of an apparent increase in the incidence of CRC in younger adults, the ACS guidelines now make a “qualified” recommendation to begin screening persons at average risk for CRC at age 45 years, with a strong recommendation to screen at age 50 years and above. The guidelines also now offer six testing options to select among: colonoscopy every 10 years, computed tomographic colonography (CTC) every five years, sigmoidoscopy every five years, take-home high-sensitivity guaiac-based fecal occult blood testing yearly, take-home fecal immunochemical testing (FIT) yearly, and multitargeted stool-DNA test every three years, noting that any positive result on a non-colonoscopy test should be followed up with timely colonoscopy. In including more tests, rather than prioritizing tests that could detect both polyps and cancer, the ACS notes that screening with a test acceptable to the patient is preferable to the patient declining screening. For average-risk patients, and in keeping with most guidelines, we continue to initiate screening starting at age 50 years. We prefer colonoscopy when possible, and FIT or CTC if the patient cannot or will not have colonoscopy.

Hemostatic nanopowder approved for use in gastrointestinal bleeding (July 2018)

Hemostatic nanopowder can be used to treat bleeding in the gastrointestinal tract due to lesions such as ulcers and tumors. It is sprayed onto a bleeding site under endoscopic guidance and forms a stable mechanical barrier at the site of bleeding. In prior reports, success rates for achieving initial hemostasis in patients with nonvariceal upper gastrointestinal bleeding are 75 to 100 percent, with rebleeding rates of 10 to 49 percent. In May 2018, Hemospray, a hemostatic nanopowder, was approved as a device by the US Food and Drug Administration (FDA) [5]. The data submitted to the FDA showed hemostasis on index endoscopy in 97.8 percent of 750 patients, with an overall rebleeding rate of 10.2 percent [6]. In patients with bleeding peptic ulcers, hemostatic sprays may be particularly helpful when a temporizing measure is needed to stabilize a patient pending definitive therapy or when traditional endoscopic techniques fail to control massive bleeding.

Revised diagnostic criteria for eosinophilic esophagitis (July 2018)

The 2018 Appraisal of Guidelines for Research and Evaluation (AGREE) conference has published new consensus criteria for the diagnosis of eosinophilic esophagitis [7]. The diagnosis of eosinophilic esophagitis requires symptoms of esophageal dysfunction, at least 15 eosinophils per high-power field on esophageal biopsy, and exclusion of other causes that may be responsible for or contributing to symptoms and esophageal eosinophilia. In contrast to prior guidelines, persistence of mucosal eosinophilia in the esophagus after two months of treatment with a proton pump inhibitor (PPI) is no longer a diagnostic criterion for eosinophilic esophagitis. The rationale for exclusion of a PPI trial is that patients with eosinophilic esophagitis who are PPI-responsive do not appear to be clinically distinct from patients who are not PPI-responsive, and their management should not differ.

AGA guidelines on acute pancreatitis (April 2018)

The American Gastroenterological Association (AGA) updated its guidelines on the management of acute pancreatitis [14]. They recommend goal-directed therapy for fluid management and advise against the use of hydroxyethyl starch-containing fluids. Prophylactic antibiotics should also be avoided. The guidelines also recommend early oral feeding and the use of enteral feeding rather than parenteral nutrition in patients who are unable to tolerate an oral diet.

 

 

 

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Clinical Updates

Clinical Updates

CLINICAL UPDATES

 

Obesity, type 2 diabetes tied to jump in NAFLD cases

At the annual meeting of the American College of Physicians. Younossi and other researchers conducted a meta-analysis of studies in 20 countries, which was published in Hepatology Communications and found that the global prevalence of NAFLD is 24%, but nearly 75% of patients with the disease are obese, and 58% of people with diabetes also have NAFLD.

Study: Insect consumption may improve gut inflammation

Research suggests that eating crickets may improve inflammation in the gut and its overall health, according to a study led by Valerie Stull, a postdoctoral research fellow at the University of Wisconsin-Madison. The investigators looked at whether cricket consumption was tolerable and safe and changed markers of inflammation or lipid metabolism, and they assessed whether insect fibers such as chitin — the chief component of a cricket’s exoskeleton — could work as prebiotics.

Report: Medicaid could save over $4.8B with fully electronic transactions

Medicaid could save over $4.8 billion per year if all of the program’s claims processes were to become fully electronic, according to a report from the Council for Affordable Quality Healthcare. The move could save payers $6.84 per transaction, the report estimates.

 

CDC looks at patient health data exchanged by physicians

CDC researchers found that referrals, laboratory results and medication lists were the most common types of patient health information sent by office-based physicians, while they most often received lab results, imaging reports and medication lists. The findings in National Health Statistics Reports, based on 2015 National Electronic Health Records Survey data, also showed that lab results were the most commonly electronically integrated data, while medication lists were the most commonly searched data in the EHR.

 

Using analytics to incentivize value-based health care

Value-based care encourages medical professionals to prioritize outcomes and efficiency with preventative health care, but the strategy can be difficult to incentivize for health professionals. Analytics could help solve this problem by collecting patient data, indicating where there are gaps in the patient’s care and creating priority and outreach lists, says Jennifer Carney of Beth Israel Deaconess Care Organization.

 

Health data access remains a challenge for patients

Patient access to health records remains a challenge, with a survey finding that 63% of Americans are unaware of where their health care data is stored or who has access to it. The CMS has launched the MyHealthEData Initiative for Medicaid and Medicare’s EHR programs, and the agency has started using Medicare Blue Button 2.0, a new software protocol for developers.

 

Compiled By Tarun Kothari MD

8.22.18

 

 

 

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IBS and 5 Things to Know

IBS and 5 Things to Know

IBS—From Symptom to Disease: Five Things to Know

In a recent Healio Gastronenterology article, Dr. William Chey, of the University of Michigan, explained the challenges of IBS and why we need to create a future in which we can identify an effective solution for some IBS patients that is based on a more personalized medicine approach.

Dr. Chey points out that IBS is a symptom-based condition defined by the presence of abdominal pain and altered bowel habits.

“The clinical phenotype can be quite diverse so while all patients have pain, some patients can have problems with diarrhea, others can have problems with constipation, and still others can have a mixture of both constipation- and diarrhea-related features,” he said in the article.

IBS—being a symptom-based condition—isn’t one disease, according to Dr. Chey. “It’s likely several different diseases that happen to present with the same symptoms. Yet, given our current understanding and a lack of validated biomarkers, we cannot parse IBS patients on the basis of pathophysiological abnormalities. Instead, we rely upon symptoms to establish a diagnosis and choose a treatment.

Dr. Chey’s Five Things to Know about IBS:

  1. IBS is currently a condition defined by characteristic symptoms of pain and abnormal bowel habits.
  2. There are many potential causes for IBS symptoms—IBS isn’t one disease—it’s likely a number of diseases which happen to present with the same symptoms.
  3. Most tests are done to RULE OUT diseases like colon cancer, inflammatory bowel disease and celiac disease that can mimic the symptoms of IBS.
  4. Researchers are developing tests to RULE IN IBS, but they are in their infancy at the present.
  5. The future will pair symptom based criteria like the Rome IV criteria with tests that help a doctor to understand the cause for a patient’s IBS symptoms and, in that way, choose the right therapy for a specific patient.

More about IBS

Irritable bowel syndrome (IBS) is a disorder of bowel function (as opposed to being due to an anatomic abnormality). Patients who suffer from irritable bowel syndrome have changes in bowel habits such as constipation or diarrhea, and abdominal pain along with other symptoms including abdominal bloating, and rectal urgency with diarrhea. In addition, IBS may be associated with a number of non-intestinal (“extra intestinal symptoms”), such as difficulty with sexual function (pain on intercourse or lack of libido), muscle aches and pains, fatigue, fibromyalgia syndrome, headaches, back pain, and sometimes urinary symptoms including urinary urgency, urinary hesitation or a feeling of spasm in the bladder.

In the United States, it is estimated that 10-15 percent of the adult population suffers from IBS symptoms, yet only 5 to 7 percent of adults have been diagnosed with the condition. IBS is the most common condition diagnosed by gastroenterologists and one of the most common disorders seen by primary care physicians.

The exact cause of irritable bowel syndrome is not known. However, tremendous advances in our understanding of this common and disabling disorder have been made in the last 10 years. Abnormal motility in terms of the bowel moving too fast (which causes diarrhea) or too slow (which causes constipation) is certainly part of this syndrome. However, this represents only one part of a complicated disorder. The symptoms of pain, incomplete emptying of the bowels, and bloating cannot be explained only by abnormal gut GI motility. Over the last 20 years a number of very well done scientific studies have demonstrated that individuals with IBS tend to have higher levels of sensitivity in the intestines compared to individuals who do not have IBS.

Source: The American College of Gastroenterology

 

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Public Health Survey

Public Health Survey

Public health survey:

 From: Common Ground Health <communications@commongroundhealth.org>
Sent: Wednesday, June 20, 2018 10:05 AM
Subject: Please participate to improve community health

Dear Friend,

Common Ground Health, working in partnership with the public health directors in each of our nine Finger Lakes counties,* is conducting an important health survey. I am writing to ask for your help.

We are gathering health stories from as many residents of our region as possible in order to learn more about our region’s health-related needs and help our county health departments develop strategies for addressing public health priorities. Please tell us your story through the survey below and then share the link with family, friends and colleagues. The survey will take 15 to 20 minutes of your time.

You can complete the survey anonymously, or enter your name and email for a chance to win a $500 gift card to a local supermarket or gas station. **

To begin the survey in English, click here: MyHealthStory2018.com. For Spanish, follow this link: MiHistoriadeSalud2018.com.

I can’t thank you enough,

 

Trilby

 

Trilby de Jung

CEO

 

Feel free to re post or forward this to your friends.

 

 

 

 

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Low Vitamin D Levels May Raise Bowel Cancer Risk

Low Vitamin D Levels May Raise Bowel Cancer Risk

Low Vitamin D Levels May Raise Bowel Cancer Risk

In the largest study of its kind, low levels of vitamin D are linked with a significant increase in colorectal cancer risk. Conversely, higher levels appear to offer protection.

Vitamin D is produced in the skin after contact with sunlight, as well as absorbed in our guts from several dietary sources — including fortified foods and fatty fish.

Its primary role was long considered to be bone maintenance. But, as researchers dig deeper, vitamin D’s sphere of influence widens.

For instance, vitamin D deficiency has now been linked to Parkinson’s, cardiovascular disease, and obesity, among many other conditions.
Scientists have also investigated its influence on the progression of cancer.

Vitamin D and Bowel Cancer

Recently, researchers from a host of organizations, including the American Cancer Society (ACS) in Atlanta, GA, the Harvard T.H. Chan School of Public Health in Boston, MA, and the United States National Cancer Institute in Rockville, MD, combined forces to investigate vitamin D’s role in colorectal cancer risk.
Aside from skin cancers, colorectal cancer — which is also called bowel cancer — is the third most common cancer in the U.S. It is expected to claim more than 50,000 lives in 2018.

Understanding what factors play a role in its development is crucial. And, if vitamin D is involved, it might form the basis of a simple and cost-effective intervention.

Some previous studies have found a link between vitamin D deficiency and colorectal cancer, but others have not. This new, large-scale effort was designed to iron out the creases and present more concrete evidence.

The researchers’ findings were published recently in the Journal of the National Cancer Institute.

Co-senior study author Stephanie Smith-Warner, Ph.D. — an epidemiologist at the Harvard T.H. Chan School of Public Health — says, “To address inconsistencies in prior studies on vitamin D and to investigate associations in population subgroups, we analyzed participant-level data, collected before colorectal cancer diagnosis, from 17 prospective cohorts and used standardized criteria across the studies.”
In all, the team used data from studies conducted on three continents that included 5,700 cases of colorectal cancer and 7,100 controls.

Previously, researchers found it difficult to pool data from different studies because of the variety of ways that vitamin D was measured. These researchers calibrated the existing measurements so that a direct comparison could be made between multiple trials in a meaningful way.

Vitamin D’s influence on cancer

The researchers compared each individual’s vitamin D levels with the current National Academy of Medicine recommendations for bone health.
People who had vitamin D levels below the current guidelines had a 31 percent increased risk of colorectal cancer during the follow-up — an average of 5.5 years. Those with vitamin D above the recommended levels had a 22 percent reduction in risk. The link was stronger in women than in men.

These relationships remained significant even once the team had adjusted the data to account for other factors that are known to increase colorectal cancer risk.
But, it is worth noting that the reduced risk did not become more pronounced in the people with the highest levels of vitamin D in their system.
“Currently,” notes co-first study author Marji L. McCullough, “health agencies do not recommend vitamin D for the prevention of colorectal cancer.”

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