Gi Insights

Host: Jay Goldstein, MD Guest: Christian Stone, MD, MPH Incidents of Clostridium difficile, or C.diff, are increasing in the US. Are patients with ulcerative colitis or Crohn's disease more at risk for developing C. difficile infection than other patients? Is this due to an increased use of antibiotics in hospitals, or are other factors playing a role? Join host Dr. Jay Goldstein as he welcomes Dr. Christian Stone, associate professor of medicine at Washington University School of Medicine in St. Louis, to discuss the recent trends of C. difficile infections among inflammatory bowel disease patients.

Guest: Andrew Chan, MD, MPH Host: Mark DeLegge, MD Guest: David Lieberman, MD It's currently recommended that patients at average risk for colorectal cancer repeat a colonoscopy every 10 years. Is the 10-year interval appropriate for average-risk patients, or would patients benefit from more frequent colonoscopies? What evidence do we have to support the idea that more frequent colonoscopies would provide more accurate screening? Or, would a shorter intervals between colonoscopies unnecessarily increase cost and inconvenience, without much added benefit? Dr. Mark DeLegge hosts a point-counterpoint discussion. Dr. David Lieberman, professor of medicine at Oregon Health and Science University, supports the standard interval, while Dr. Andrew Chan, assistant professor of medicine at Harvard Medical School, challenges the idea that a screening every 10 years is appropriate for most average-risk patients.

Guest: T. Karl Byrne, MD Host: Mark DeLegge, MD What are the advantages to each of the two main types of obesity surgeries— gastric bypass and lap band surgery? How do the recovery times, efficacy and potential complications compare? Host Dr. Mark DeLegge welcomes Dr. T. Karl Byrne, professor of surgery and medical director of the Bariatric Surgery Center at the Medical University of South Carolina, to discuss the role of the gastric bypass and lap band procedures in treating obesity. Are some patients clear candidates for one procedure over the other? And how is a third procedure — the sleeve gastrectomy — becoming another attractive option for treating obesity?

Guest: Douglas Rex, MD Host: Mark DeLegge, MD Fecal immunochemical testing (or FIT testing) replaces the older stool guaiac test in the recent colorectal cancer screening guidelines. What's the advantage to FIT testing? Is there a place for fecal DNA testing in the realm of colorectal cancer screening methods right now, or does this procedure need further revision? Host Dr. Mark DeLegge discusses the newest developments in colorectal cancer screening technologies with Dr. Douglas Rex, distinguished professor of medicine at Indiana University School of Medicine. Is CT colonography also a viable screening option?

Guest: Lisa Boardman, MD Host: Mark DeLegge, MD Early detection through screening for colorectal cancer (CRC) can make a huge impact in preventing the development or progression of CRC. What screening methods are most recommended? Dr. Lisa Boardman, assistant professor of medicine at the Mayo Clinic, reviews details of the CRC screening guidelines from both the Joint Effort Panel, as well as the United States Preventive Services Task Force. Will these guidelines be dramatically revised in the near future, and if so, will we shift towards widespread use of the newer CRC screening technologies? Dr. Mark DeLegge hosts.

Guest: Robert Bresalier, MD Host: Jay Goldstein, MD What are some common gastrointestinal complications from oncologic therapies? How can physicians differentiate a side effect from a condition that requires further evaluation? Host Dr. Jay Goldstein welcomes Dr. Robert Bresalier, professor of medicine in the department of gastrointestinal medicine and nutrition at the M.D. Anderson Cancer Center, to discuss the role of the gastroenterologist in treating cancer and complications from oncologic therapies. Is there a way to prevent gastroenterologic complications?

Guest: J. Randolph Hecht, MD Host: Jay Goldstein, MD How have treatments for colorectal and pancreatic cancers advanced in recent years, and are novel treatments reducing the mortality rate of patients with these cancers? Dr. J. Randolph Hecht, director of the GI Oncology Program at the UCLA Health System and clinical professor of medicine in the hematology-oncology division at the UCLA David Geffen School of Medicine, looks at some of the newer pharmacological agents and methods being used to treat these gastrointestinal cancers. Dr. Jay Goldstein hosts.

Guest: Michael Camilleri, MD Host: Mark DeLegge, MD What are some of the newer bariatric endoscopic procedures, and when are these procedures preferred over traditional gastric bypass surgery? Dr. Michael Camilleri, professor of medicine and physiology at the Mayo Clinic Medical School in Rochester, Minnesota, reviews the most common gastric bypass procedures, such as the Roux-en-Y, laproscopic banding and duodenal switch procedures, and explains the advantages to some of the newer surgeries, including the sleeve gastrectomy and transoral gastroplasty. Dr. Mark DeLegge hosts.  

Guest: Timothy Rubin, MD Host: Mark DeLegge, MD The micro-organism Clostridium difficile, or C. diff, can cause serious infection and is often resistant to antibiotic therapy. A less traditional approach to treatment — the stool transplant — has emerged as a very successful therapy for patients suffering from C. diff. What does the procedure involve, and which patients might be candidates? Host Dr. Mark DeLegge explores this unconventional therapy with Dr. Timothy Rubin, gastroenterologist at Saint Mary's Duluth Clinic Health System in Minnesota.  

Guest: Emmet Keeffe, MD Host: Jay Goldstein, MD What do recent measures recommend to primary care physicians and gastroenterologists who care for patients with hepatitis C? Dr. Emmet Keeffe, professor of medicine emeritus at Stanford University Medical Center, joins host Dr. Jay Goldstein to outline the 10 measures for diagnosing and treating patients with hepatitis C.

Guest: John Inadomi, MD Host: Jay Goldstein, MD Non-cardiac chest pain and chronic cough are just two of the extraesophageal manifestations of gastroesophageal reflux disease, or GERD. What other symptoms should we look for? If a patient displays characteristics of GERD, such as esophogeal regurgitation, is that patient also likely to experience extraesophogeal manifestations of GERD? Dr. John Inadomi, the Dean M. Craig Endowed Chair in Gastrointestinal Medicine at the University of California, San Francisco, explains what distinguishes extraesophogeal manifestations of GERD from GERD symptoms. Do proton pump inhibitors treat both GERD and its extraesophogeal symptoms? Dr. Jay Goldstein hosts.

Guest: David Peura, MD Host: Mark DeLegge, MD Constipation is a common symptom that presents more often in women and as patients get older. What are the primary and secondary causes of chronic constipation? What are some of the differentiating factors between chronic constipation and IBS-C? Dr. David Peura, professor of medicine at the University of Virginia School of Medicine, joins host Dr. Mark DeLegge to discuss algorithms for diagnosing chronic constipation. When are lifestyle changes not enough for treating chronic constipation, and what are the most effective alternatives?

Guest: Rowen Zetterman, MD Host: Mark DeLegge, MD Acetaminophen, vitamin supplements and antibiotics are just a few of the medications that can cause liver injury. What are the signs of drug-induced liver injury? Are the effects immediate, or do the effects become noticeable after an extended period of time? Dr. Rowen Zetterman, professor of internal medicine at the University of Nebraska Medical Center, provides an overview of factors that might lead to drug-induced liver injury. Dr. Mark DeLegge hosts.

Guest: Mark Donowitz, MD Host: Mark DeLegge, MD Are there fewer physician-scientists today than there were a few decades ago? What does the future landscape look like for medical research? Dr. Mark Donowitz, LeBoff Professor of Medicine and director of the Center for Epithelial Disorders at the Johns Hopkins University School of Medicine, as well as immediate past-president of the American Gastroenterological Association, discusses some of the barriers and challenges physician-scientists face, and how we can ensure a sound future for research. Dr. Mark DeLegge hosts.    

Guest: Donald Castell, MD Host: Mark DeLegge, MD How common is Barrett's esophagus in patients with chronic gastroesophageal reflux disease (GERD) or asymptomatic reflux? What risk factors might predict a diagnosis of Barrett's esophagus? Dr. Donald Castell, professor of medicine and director of the esophageal disorder program at the Medical University of South Carolina, joins host Dr. Mark DeLegge to discuss this potentially pre-cancerous condition.

Guest: Glenn Eisen, MD, MPH Host: Jay Goldstein, MD What does outcomes research measure, and how does it differ from clinical trials? Is evidence-based medicine related to outcomes research? Host Dr. Jay Goldstein evaluates outcomes research with Dr. Glenn Eisen, professor in the department of medicine and the division of gastroenterology at Oregon Health and Science University. How will outcomes research impact clinical practices?

Guest: Scott Cotler, MD Host: Jay Goldstein, MD Untreated hepatitis B can lead to cirrhosis and liver cancer. What methods are available for physicians to treat hepatitis B patients? Host Dr. Jay Goldstein reviews available treatments for reducing liver damage from hepatitis B with Dr. Scott Cotler, chief of hepatology at the University of Illinois at Chicago. How can the virus be suppressed while reducing the progression of liver disease?

Host: Mark DeLegge, MD Guest: William J. Sandborn, MD The current treatment paradigm for Crohn's disease is a pyramid approach, where patients are given the safest medications before pursuing more aggressive strategies. New evidence suggests that Crohn's disease should be treated with the most effective medications first, such as anti-TNF therapies. But is a top-down strategy safe enough for most patients? Dr. William Sandborn, professor of medicine and gastrointestinal research at Mayo Clinic College of Medicine, describes the results of new Crohn's disease trials and research. Is using steroids to treat Crohn's disease an idea of the past, or are steroids still effective for certain patients? Dr. Mark DeLegge hosts.

Guest: Prateek Sharma, MD Host: Mark DeLegge, MD Esophageal cancer survival rates greatly decline when the cancer has reached its late stages, so detecting neoplasia in a Barrett's esophagus patient early is a crucial tool in cancer management. What are some emerging endoscopic techniques that can be used for a Barrett's esophageal patient? Dr. Prateek Sharma, professor of medicine in the division of gastroenterology and hepatology at the University of Kansas School of Medicine, discusses the best ways to manage esophageal cancer and Barrett's esophagus patients with host Dr. Mark DeLegge.

Guest: Brennan Spiegel, MD, MSHS Host: Jay Goldstein, MD In its 1948 charter constitution, the World Health Organization defined health as "a state of complete physical, mental and social well-being." Today, to measure this totality of well-being, we measure quality of life. Host Dr. Jay Goldstein discusses how quality of life measurements can be incorporated into everyday practice, with Dr. Brennan Spiegel, assistant professor of medicine in the division of digestive diseases at the David Geffen School of Medicine at UCLA. How is health-related quality of life measured objectively in clinical trials? To what degree do quality of life endpoints trump physiological endpoints?