Stephanie M. Moleski

Special Considerations for Women with IBD

Inflammatory bowel diseases (IBD), namely Crohn disease (CD) and ulcerative colitis (UC), are common in Western society. Because at least half of the patients suffering from these diseases are women, it is important that physicians are aware of their gender-specific needs. There are multiple important concerns for women with UC and CD including issues of body image and sexuality, menstruation, contraception, screening for cervical cancer, matters related to menopause and hormone replacement therapy, osteoporosis, and the overlap seen between IBS and IBD. In this article, we have addressed these important, non-pregnancy-related issues faced by women with IBD.

The Man Who Swallowed a Table Knife: A Case Report

A 31-year-old male presented with acute foreign-body ingestion. He reported swallowing a table knife 2 h prior to his arrival. He had a history of post-traumatic stress disorder and multiple prior foreign-body ingestions requiring endoscopic and surgical extraction. Previous ingestions included pens and a mechanical pencil. He appeared in no acute distress. His physical exam was unremarkable other than for multiple well-healed abdominal incisions. A rectal exam was performed, and the patient’s stool found to be heme-occult negative. Chest X-ray (Figs 1 and 2) revealed a metallic knife at the gastroesophageal junction with the handle oriented inferiorly. Emergent esophagogastroduodenoscopy was performed under general anesthesia with overtube insertion. A table knife was identified in the mid-esophagus. It was grasped with a snare and then drawn into the overtube. The scope and overtube were then carefully withdrawn. The snare slipped off the knife, leaving the knife partially in the proximal esophagus and posterior pharynx. The anesthetists removed the knife with a laryngoscope and McGill forceps. After removal of the knife, the endoscope was reintroduced for careful examination. There was minimal trauma to the esophagus in the location where the knife was removed. There was no active bleeding at any time throughout the procedure. Post-extraction, the table knife was measured to be 21 cm in length.

Mo1073 Nutritional Knowledge of Gastroenterology Fellows in the United States

Introduction: The aim of this study is to determine current nutritional knowledge and identify the perceived effectiveness of nutrition education among gastroenterology (GI) fellows. Methods: A survey was created to collect demographic data, perceived nutritional knowledge, and a 20 question multiple choice examination (MCE) testing components of nutrition specific to GI. Adult GI fellowship coordinators at the 162 U.S. accredited adult fellowship programs were sent an email asking them to forward an internet link to their 1 st through 3 rd year GI Fellows where fellows could anonymously complete the survey. Results: The survey was attempted by 137 fellows with 119 fellows fully completing it. The majority of fellows (86.6%) wanted more nutrition focused education. Fellows perceived themselves as having the least knowledge in micro/macronutrients and providing nutritional support to patients. Fellows perceived themselves as having the strongest knowledge in technical skills to manage nutritional issues. The mean total score for MCE was 39.45% (standard deviation (SD) = 15.56). Fellows had the highest mean score in the questions related to nutritional support (50.67%, SD = 21.55). The lowest mean score was on the subset of questions related to obesity (26.08%, SD = 13.01). Mean scores in other areas of nutrition included: nutrition assessment 46.45% (SD = 14.18), micro/macronutrients 34.07 % (SD = 18.92), and nutrition in GI diseases 43.35% (SD = 23.88). Discussion: GI fellows believe their knowledge of nutrition is suboptimal and objective evaluation of nutrition knowledge confirms this belief. Formal nutrition education should be developed in the context of GI fellowship education.