Common Bowel Disorders
Dr. Samita Garg is a board certified , fellowship trained gastroenterologist. She received her medical degree at the St. Louis University School of Medicine, and completed her residency in internal medicine at the University of Colorado Hospital. Dr. Garg’s fellowship training in gastroenterology was done at the University Hospitals Case Medical Center in Cleveland, Ohio. She then practiced as a staff gastroenterologist at Cleveland Clinic Foundation. She is currently on Staff at Porter Adventist Hospital in Denver, CO. Her philosophy of care is to provide high-quality patient focused care with an emphasis on improving patient outcomes and achieving patient satisfaction.
Peanut Gastro-Intestinal Delivery Oral Immunotherapy in Adolescents
Oral immunotherapy to peanut is effective in desensitizing patients but has significant side effects including anaphylaxis and gastro?intestinal symptoms. In most protocols peanut is administered in a vehicle food.
In an exclusively adolescent population, we tested a new approach using sealed capsules of peanut (Gastro-Intestinal Delivery Oral Immunotherapy or GIDOIT) in order to bypass the upper gastro-intestinal tract. The primary aim was to assess the efficacy of the oral build?up phase of GIDOIT and the secondary aim to analyse its safety.
Adolescents with a history of a clinical allergic reaction after peanut ingestion were included in a two-armed, parallel-design, individually randomised, double-blind, placebo-controlled, multicentre trial after a positive double-blind placebo-controlled oral food challenge (DBPCFC1). A central randomisation centre used computer generated tables to allocate treatments. Peanut (or placebo) capsules were ingested daily over a period of 24 weeks with increments every 2 weeks from 2 to 400 mg of peanut protein. Primary outcome was tolerance of 400 mg of peanut protein at DBPCFC2.
Thirty patients were included between September 2013 and May 2014. At DBPCFC2, unresponsiveness to 400 mg of peanut protein was achieved in 17/21 peanut?group patients (2 withdrawn patients) and 1/9 in the placebo group (Intention-to-treat analysis, p < 0.001, absolute difference=0.7, 95%CI; 0.43; 0.96). Oropharyngeal symptoms were equally frequent in both groups. No dysphagia or other signs of eosinophilic oesophagitis occurred. Digestive adverse events were more frequent in the treated group (p=0.02), but mild and without compliance issues. Only one severe advent event led to withdrawal in a patient who ingested twice the investigated treatment. Peanut specific humoral immune responses were modulated.
The GIDOIT protocol demonstrated clinical and immunological efficacy and had an acceptable level of safety with weak oropharyngeal symptoms, no dysphagia, mild digestive events and few severe systemic adverse events.
ORLANDO — The use of artificial intelligence during colonoscopy appears to boost the accuracy and sensitivity of adenoma detection, even for lesions as small as 5 mm, according to recent studies.
The goal of integrating this technology into routine colonoscopy is to get the adenoma detection rate closer to the 50% reported in studies of screening-age populations, said William Karnes, MD, from the University of California, Irvine.
"Adenoma detection rates among different colonoscopists vary between 7% and 53%. The adenoma detection rate should equal prevalence," he told Medscape Medical News.
Convolutional neural network technology was able to distinguish between images with and without polyps with 96% accuracy in a study of 9000 screening colonoscopy images, he reported at the World Congress of Gastroenterology 2017.
The machine-learning system can read up to 170 images per second, making it "easily applied to live video," said Dr Karnes when he presented the research, which won the 2017 Presidential Poster Award for Colorectal Cancer Prevention.
"Artificial intelligence for polyp detection has the potential to help all colonoscopists achieve detection rates closer to true prevalence, and to further reduce the risk of interval colorectal cancers," he added.
The adenoma detection rate should equal prevalence.
Another computer-aided system, known as EndoBRAIN artificial intelligence, is easy to use and provides an automatic diagnosis at the push of a button, reported Yuichi Mori, MD, from Showa University in Shinagawa-ku, Japan.
"Recognizing a lesion as neoplastic is very useful information during a colonoscopy," Dr Mori emphasized at the recent United European Gastroenterology (UEG) Week 2017. With EndoBRAIN, lesions identified as neoplastic can be considered as such "with very high confidence."
Gut bacteria and the rise in IBD incidence in Canadian children
The overall incidence of Inflammatory Bowel Disease IBD in children in Canada is one of the highest in the world and is on the rise. It has increased from 7.9 per 100,000 children in 1999, to 10.6 per 100,000 in 2009.
As reported by Eric Benchimol, MD, and colleagues, the incidence of IBD has stabilized in children over the age of 5 years. However, the incidence is rising rapidly in children under 5-years-old. These are important findings, since these children will live longer with the disease.Data came from five provinces -- Alberta, Manitoba, Nova Scotia, Ontario, Quebec -- and comprised 79.2% of the Canadian population.
Out of the total of 5,214 new cases, 3,462 were diagnosed with Crohn's disease, 1,382 ulcerative colitis, and 279 unclassifiable.
Prevalence at the end of the study period in Canada was 38.25 per 100,000 children, with an increase of 4.56% per year over time.
The cause of the increase in IBD cases was not identified. However, one possibility is that a change in gut bacterial flora related to early life exposure to antibiotics, diet, or lower levels of vitamin D in Canadians may be responsible.
Benchimol E, et al "Trends in epidemiology of pediatric inflammatory bowel disease in Canada: distributed network analysis of multiple population-based provincial health administrative databases" Am J Gastroenterol 2017; DOI: 10.1038/ajg.2017.97.