Molly Perencevich

Use of antibiotics in the treatment of inflammatory bowel disease.

&NA; An increasing amount of evidence suggests that enteric flora may have a role in the pathogenesis of inflammatory bowel disease (IBD). Patients with IBD appear to have an altered composition of luminal bacteria that may providethe stimulus for the chronic inflammation characterizing IBD. The suspected role of bacteria in the pathogenesis of IBD provides the rationale for using agents, such as antibiotics, that alter the intestinal flora. However, there remains much uncertainty about the optimal use of antibiotics in the treatment of Crohns disease, ulcerative colitis, and pouchitis. This article reviews the literature and presents a clinical model for the use of antibiotics in IBD.

Blood-based biomarkers can differentiate ulcerative colitis from Crohn's disease and noninflammatory diarrhea.

Background: Blood gene expression profiling has been used in several studies to identify patients with a number of conditions and diseases. A blood test with the ability to differentiate Crohns disease (CD) from ulcerative colitis (UC) and noninflammatory diarrhea would be useful in the clinical management of these diseases. Methods: Affymetrix U133Plus 2.0 GeneChip oligonucleotide arrays were used to generate whole blood gene expression profiles for 21 patients with UC, 24 patients with CD, and 10 control patients with diarrhea, but without colonic pathology. Results: A supervised learning method (logistic regression) was used to identify specific panels of probe sets which were able to discriminate between UC and CD and from controls. The UC panel consisted of the four genes, CD300A, KPNA4, IL1R2, and ELAVL1; the CD panel comprised the four genes CAP1, BID, NIT2, and NPL. These panels clearly differentiated between CD and UC. Conclusions: Gene expression profiles from blood can differentiate patients with CD from those with UC and from noninflammatory diarrheal disorders. (Inflamm Bowel Dis 2011;)

Racial and ethnic variations in the effects of family history of colorectal cancer on screening compliance.

BACKGROUND & AIMS Individuals with a family history of colorectal cancer (CRC) have a higher risk of developing CRC than the general population, and studies have shown that they are more likely to undergo CRC screening. We assessed the overall and race- and ethnicity-specific effects of a family history of CRC on screening. METHODS We analyzed data from the 2009 California Health Interview Survey to estimate overall and race- and ethnicity-specific odds ratios (ORs) for the association between family history of CRC and CRC screening. RESULTS The unweighted and weighted sample sizes were 23,837 and 8,851,003, respectively. Individuals with a family history of CRC were more likely to participate in any form of screening (OR, 2.3; 95% confidence limit [CL], 1.7, 3.1) and in colonoscopy screening (OR, 2.7; 95% CL, 2.2, 3.4) than those without a family history, but this association varied among racial and ethnic groups. The magnitude of the association between family history and colonoscopy screening was highest among Asians (OR, 6.1; 95% CL, 3.1, 11.9), lowest among Hispanics (OR, 1.4; 95% CL, 0.67, 2.8), and comparable between non-Hispanic whites (OR, 3.1; 95% CL, 2.6, 3.8) and non-Hispanic blacks (OR 2.6; 95% CL, 1.2, 5.7) (P for interaction < .001). CONCLUSIONS The effects of family history of CRC on participation in screening vary among racial and ethnic groups, and have the lowest effects on Hispanics, compared with other groups. Consequently, interventions to promote CRC screening among Hispanics with a family history should be considered.

Incidence and predictors of microbiology results returning postdischarge and requiring follow‐up

BACKGROUND Failure to follow up microbiology results pending at discharge can delay appropriate treatment, increasing the risk of patient harm and litigation. Limited data describe the frequency of postdischarge microbiology results requiring a treatment change. OBJECTIVE To determine the incidence and predictors of postdischarge microbiology results requiring follow-up. DESIGN Cross-sectional. SETTING Large academic hospital during 2007. MEASUREMENTS We evaluated blood, urine, sputum, and cerebrospinal fluid (CSF) cultures ordered for hospitalized patients. We identified cultures that returned postdischarge and determined which were clinically important and not treated by an antibiotic to which they were susceptible. We reviewed a random subset to assess the potential need for antibiotic change. Using logistic regression, we identified significant predictors of results requiring follow-up. RESULTS Of 77,349 inpatient culture results, 8668 (11%) returned postdischarge. Of these, 385 (4%) were clinically important and untreated at discharge. Among 94 manually reviewed cases, 53% potentially required a change in therapy. Urine cultures were more likely to potentially require therapy change than non-urine cultures (OR 2.8, 95% CI 1.1-7.2; P = 0.03). Also, 76% of 25 results from surgical services potentially required a therapy change, compared with 59% of 29 results from general medicine, 38% of 16 results from oncology, and 33% of 24 results from medical subspecialties. Overall, 2.4% of postdischarge cultures potentially necessitated an antibiotic change. CONCLUSIONS Many microbiology results return postdischarge and some necessitate a change in treatment. These results arise from many specialties, suggesting the need for a hospital-wide system to ensure effective communication of these results.

The Search Is On

An 81-year-old man presented to the emergency department with hematochezia and hematemesis, which began after he was awakened by an urgent need to move his bowels. He did not have abdominal pain, black stools, dysphagia, or odynophagia.

How to Create an Unfunded Teaching Fellowship During the Gastroenterology Fellowship That Positively Impacts Subsequent Teaching Activities and Career Path

The gastrointestinal (GI) pathophysiology course is a 2.5-week required preclinical course at the end of medical school’s second-year pathophysiology organ system blocks. In 1993, I was appointed co-course director of this course. teaching using the Case-Based Method. In October 2002, I went for the first of numerous times to Harvard Business School to observe and learn from Professor Garvin. Here the professors consistently use the Case Method with question, listen, and respond as the prime teaching strategy. In addition, each professor summarizes with high-yield, takehome points at the end of class. Learning these 3 key teaching strategies made all the difference in my individual ratings, overall course ratings, and how I taught the current teaching and academic fellows to teach.

Mo1964 Alkaline Phosphatase Reduction Is Associated With Decreased Mortality and Risk of Colorectal Cancer or Dysplasia in Primary Sclerosing Cholangitis and Inflammatory Bowel Disease

G A A b st ra ct s statistics, the predictive accuracy of calprotectin in identifying patients with ineffective surveillance was 0.92 (area under the curve). A cutoff value of 545 μg/g indicated patients with ineffective surveillance with 86% sensitivity and 89% specificity, positive predictive value 52% and negative predictive value 98%). CONCLUSION: Fecal calprotectin testing prior to a scheduled surveillance colonoscopy can be used to identify IBD patients with active endoscopic inflammation in whom surveillance will probably be ineffective. Routine use of this test might prevent useless colonoscopies and can therefore be cost effective.