Edith Y. Ho

Continuing Medical Education Questions: January 2018: Prophylactic Therapy of Cyclic Vomiting Syndrome in Children: Comparison of Amitriptyline and Cyproheptadine: A Randomized Clinical Trial

Continuing Medical Education Questions: January 2018: Prophylactic Therapy of Cyclic Vomiting Syndrome in Children: Comparison of Amitriptyline and Cyproheptadine: A Randomized Clinical Trial

Continuing Medical Education Questions: September 2017: Fecal Incontinence Is Associated With Mortality Among Older Adults With Complex Needs: An Observational Cohort Study

Continuing Medical Education Questions: September 2017: Fecal Incontinence Is Associated With Mortality Among Older Adults With Complex Needs: An Observational Cohort Study

Continuing Medical Education Questions: April 2016.

QUESTIONS: 1. A 30-year-old man is admitted for 1 week of hematochezia, abdominal pain, and fever. He has a history of ulcerative colitis and has been in clinical remission on azathioprine until 1 week ago, when he began to have 8–10 bloody bowel movements per day along with signifi cant abdominal pain and fever. He has not had any recent illnesses or sick contacts. He does not smoke, drink alcohol, or use recreational drugs. On physical exam, he appears ill and uncomfortable. Vital signs are temperature 101 ° F, heart rate 110 bpm, blood pressure 102/70 mm Hg, and respiratory rate 15 bpm. His abdomen is tender on palpation in the lower quadrants without rebound or guarding. Bowel sounds are slightly active. No joint swelling, skin rashes, or oral ulcerations are noted. Laboratory testing demonstrates hemoglobin of 10.2 g/dL, white blood cell 14.9 x 10 9 /L, platelets 172 x 10 9 /L, albumin 3.3 g/L, INR 1.1, and creatinine 1.4 mg/dL. Th e patient undergoes a colono scopy, which reveals active infl ammation throughout the colon, interpreted as severe ulcerative colitis. He receives 1 week of intravenous steroids but his symptoms persist.

Continuing Medical Education Questions: December 2016: Biomarkers in Search of Precision Medicine in IBD

Continuing Medical Education Questions: December 2016: Biomarkers in Search of Precision Medicine in IBD

Continuing Medical Education Questions: October 2016

1. A 70-year-old with history of hypertension and Crohn’s disease presents to your clinic for follow-up. He was diagnosed with Crohn’s disease 1 year ago when he presented with abdominal pain and weight loss. Remission was successfully induced with a course of steroids and he remains asymptomatic on azathioprine 200 mg daily. Th e patient does not smoke, drink alcohol, or use recreational drugs. On physical exam, the patient appears comfortable and well-nourished. His vital signs, cardiopulmonary exam, physical exam, and laboratory testing is normal. He asks you if he is at increased risk of malignancy because of his Crohn’s disease.

Continuing Medical Education Questions: July 2016.

1. A 62-year-old man is admitted to the hospital for 1 week of nausea, diarrhea, and lower abdominal pain. His past medical history is signifi cant for hypertension, diabetes, stroke, and recurrent sinusitis. He recently took antibiotics for a dental procedure. Th e patient does not smoke, drink alcohol, or use recreational drugs. On physical exam, the patient appears slightly uncomfortable. His vital signs are temperature 100 ° F, heart rate 110 bpm, blood pressure 100/60 mm Hg, 96% oxygen saturation on room air, and respiratory rate 15 bpm. His cardiopulmonary exam is unremarkable. His abdomen is tender on deep palpation of the lower quadrants with no rebound or guarding. Bowel sounds are present. Laboratory testing shows hemoglobin of 12 g/dL, white blood cells 20.9 x 10 9 /L, platelets 350 x 10 9 /L, albumin 3.2 g/L, INR 1.1, and creatinine 1.3 mg/dL. C. diffi cile toxin test is positive. Fecal microbiota transplantation (FMT) is considered as the next step of management.

Ulcerative Colitis: What is the Optimal Treatment Goal and How Do We Achieve It?

Opinion statementThe treatment paradigms and therapeutic options for ulcerative colitis (UC) have rapidly evolved during the past decade. Traditionally, the treatment target has focused on achieving successful induction and maintenance of steroid-free clinical remission. This has been shown to provide a better quality of life and a reduction in complications, hospitalizations, and surgery. Recent studies, however, suggest that achieving “mucosal healing” or endoscopic remission may be the optimal treatment endpoint. In this review, we will examine the treatment goals for UC and the efficacy of each therapy to reach these targets. We will also review the therapeutic options available for UC: mesalamines, steroids, immunomodulators, and biologics, including the first anti-integrin inhibitor, approved in May 2014, for the treatment of UC. Therapeutic drug monitoring, which measures serum drug level and anti-drug antibody concentrations, is emerging as an important clinical decision tool in patients on tumor necrosis factor (TNF)-antagonists. These evolving treatment strategies allow gastroenterologists to optimize control of the disease and offer patients a better quality of life.

Functional abdominal pain causing Scurvy, Pellagra, and Hypovitaminosis A

Severe vitamin deficiency disease is rarely seen in developed countries. We present an atypical case of a young man with scurvy, pellagra, and hypovitaminosis A, caused by longstanding functional abdominal pain that severely limited his ability to eat.

A 13 year-old boy with post-transplantation lymphoproliferative disorder presenting with obscure gastrointestinal bleeding: a case report

One well recognized and potentially serious complication of chronic immunosuppression in organ transplant recipients is post-transplantation lymphoproliferative disorders (PTLD). This accounts for 20% of all malignancies in transplant recipients, which is four times higher than the general population 1,2. The diagnosis of PTLD is often difficult, due to various manifestations resulting in late diagnosis. We report an unusual presentation of PTLD in a pediatric patient where the diagnosis was achieved only after extensive investigation.