Digestive Health Associates

Southwest Endoscopy Center

Gastroenterology News




Professional-Level GI News Summaries

Gastroenterology News on MedPage Today

 

Weekly Patient-Level News Summary with Press Links

Digestive Health SmartBrief from the American College of gastroenterology is a free electronic newsletter (view sample) published every Wednesday, which is available to all Digestive Health patients.  Subscribe to receive a copy by e-mail by registering here or by clicking the graphic to the right.  Enter either Dr. Steven Christensen or Dr. Patrick Gerstenberger as your Digestive Health physician on the registration form.

Digestive Health SmartBrief Privacy Policy

 


 
Digestive Health SmartBrief
 


For Immediate Release

-March 14, 2014

The region's endoscopy technology leader

Southwest Endoscopy is pleased to announce our implementation of Olympus' state-of-the-art EVIS EXERA III Endoscopy System.


For Immediate Release
-November 25, 2011
Southwest Endoscopy is recognized by leading gastrointestinal medical society for quality and safety.

For Immediate Release
-May 26, 2010
The FDA issued a Drug Safety Communication on May 25, 2010 discussing a possible increased risk of fractures of the hip, wrist and spine with the use of proton pump inhibitors (PPI), and issued these consumer recommendations:

-Proton pump inhibitors are effective in treating a variety of gastrointestinal disorders. Do not stop taking your proton pump inhibitor unless told to do so by your healthcare professional.
-Be aware that an increased risk of fractures of the hip, wrist, and spine has been reported in some studies of patients using proton pump inhibitors. The greatest increased risk for these fractures was seen in patients who receive high doses of these medications or use them longer (a year or more).
-Read and follow the directions on the OTC Drug Facts label, when considering use of OTC proton pump inhibitors.
-Be aware that the OTC proton pump inhibitors should only be used as directed for 14 days for the treatment of frequent heartburn. If your heartburn continues, talk to your healthcare professional. No more than three 14-day treatment courses should be used in one year.
-Talk to your healthcare professional about any concerns you may have about using proton pump inhibitors.

Read Medscape summary

Read the FDA Drug Safety Communication


For Immediate Release
-October 18, 2009
Thiopurine drugs, such as azathioprine (Imuran®) and 6-mercaptopurine (6-MP or Purinethol®), are suspected to potentially increase the risk of lymphoma when used to treat inflammatory bowel diseases.  A French study published in the Lancet of 19,486 patients with Crohn's disease or ulcerative colitis examined the occurrence of lymphoma associated with thiopurine therapy and found a five-fold increased risk of lymphoproliferative disorders in patients treated with these drugs.  The reported incidence rates of lymphoproliferative disorders were 0.90 per 1,000 patient-years among those on the drugs, 0.20 per 1,000 in those who had discontinued the drugs, and 0.26 per 1,000 in those who had never received thiopurines.  The authors, in extrapolating their data, noted that the absolute cumulative risk of lymphoproliferative disorder in young patients receiving a 10-year course of thiopurines is low (<1%) and="" does="" not="" undermine="" the="" positive="" risk-benefit="" ratio="" of="" these="" drugs="" br="">
Read Medscape® summary

Editor's note:  While this study raises concern about potential adverse effects of thiopurine therapy it must be considered in the context of the benefits of treatment, which in addition to affording many patients long term remission of their disease, may actually include a reduction of the risk for colon cancer and high grade dysplasia in patients with long-term extensive inflammatory bowel disease.  A French study presented at Digestive Disease Week in May 2009 Dr. Philippe Seksik of Saint-Antoine Hospital, Paris reported data from a cohort of 19,500 patients showing a reduction in the risk of new neoplasia by 72% (5.5-fold) in thiopurine treated individuals with extensive long-standing colitis compared to similar patients who had never been treated with thiopurines.



For Immediate Release
-August 31, 2009
A new analysis of the TRITON-TIMI 38 and PRINCIPLE-TIMI 44 trials shows that the use of proton pump inhibitors does not reduce the clinical effectiveness of antiplatelet therapy with clopidogrel (Plavix®) or prasugrel (Effient®).  While PPIs do reduce measurable antiplatelet activity of these agents in the test tube, this does not appear to increase the risk of myocardial infarction, stroke or death in patients undergoing coronary stent placement.
Read more in Principalities Today.
Read more in the
Lancet.


For Immediate Release
-May 12, 2009
Centers for Medicare and Medicaid Services (CMS) Determines There is Insufficient Evidence on Computed Tomography Colonography (CTC)
 

The CMS finding concluded that "The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under §1861(pp)(1) of the Social Security Act. CT colonography for colorectal cancer screening remains noncovered."  Read the CMS decision memo.


For Immediate Release
-February 12, 2009

Aspirin May Help Prevent Colorectal Cancer
While there is little question that aspirin can reduce the formation of colorectal adenomas, and by extension, colon cancer, the risks of aspirin therapy, the most effective dose of treatment, and types of patients for whom the benefits outweigh the risks, remain uncertain.  This study, a meta-analysis of four randomized placebo-controlled studies, is helpful in furthering our understanding.  Currently, the U.S. Preventive Services Task Force recommends against the routine use of aspirin for the prevention of colon cancer (see USPST Guidelines).


For Immediate Release
-January 9, 2009
Gastroenterologist Shortage Is Forecast
from the New York Times



For Immediate Release

-December 30, 2008
Experienced nurses lead to higher polyp detection rate
"Colonoscopy procedures staffed with inexperienced nurses have lower polyp detection rates, according to U.S. researchers who analyzed 3,631 screening colonoscopies. The study found a polyp was detected in 40.3% of procedures that involved nurses with six months or less of experience, compared with a polyp detection rate of 46% in colonoscopies done with more experienced nurses."
-from ACG SmartBrief  


For Immediate Release

-December 19, 2008
Colonoscopy effectiveness in the news


For Immediate Release
-December 11, 2008
FDA to add black-box warnings to bowel-cleansing drugs

On December 11 the Food and Drug Administration (FDA) reported that it will add the sternest safety warnings available, black-box warnings, to nonprescription and prescription drugs used to cleanse the bowel before colonoscopies.

Digestive Health's physicians discontinued the routine use of these oral sodium phosphate products in November 2005 because of our concerns over the potential risk of kidney injury related to the use of these products for colon cleansing prior to colonoscopy.  This warning applies to the nonprescription agents Fleet® Phospho-Soda, generic phospho-soda and the prescription tablet preps Visicol® and OsmoPrep®.  Read the
FDA Alert.

Editor's note:  In response to the FDA's alert, the C.B. Fleet company voluntarily recalled its nonprescription Fleet Phospho-Soda products from the market in the United States:

C.B. Fleet Voluntarily Recalls its Fleet Phospho-soda Product after FDA Safety Alert

"LYNCHBURG, Va (December 11, 2008) ? Following the issuance of FDA's Safety Alert on Thursday stating that oral sodium phosphates bowel cleansing solutions should be available by prescription only, C.B. Fleet Company immediately announced a voluntary recall of their over the-counter products Fleet® Phospho-soda® and Fleet® Phospho-soda® EZ-Prep® Bowel Cleansing System. The voluntary recall is directed to retailers and wholesalers.  The recall decision was made to address FDA's determination that oral sodium phosphate solutions used for bowel preparation prior to medical procedures such as colonoscopy should only be available by prescription, and consumers should not be using over-the-counter products for bowel cleansing. Since Fleet's Phospho-soda products are currently labeled and sold as over-the-counter products, Fleet decided voluntarily to remove them from the market as expeditiously as possible to address the FDA's decision that the products be available by prescription only."

As FDA has recommended that doctors not direct their patients to use these over-the-counter products for bowel cleansing, C.B. Fleet requests that consumers not purchase these products for bowel cleansing and contact their physician for alternatives if their physician has recommended their use for this purpose.


For Immediate Release

-November 13, 2008
PPI medications (omeprazole, Prilosec®, Prevacid®, Protonix®, Aciphex®, Nexium®) in patients treated with Plavix® (clopidogrel)

Please read the August 31, 2009 update above to put the information below in the context of our current understanding of this issue.

Digestive Health's gastroenterologists concur with the American College of Gastroenterology (ACG), American College of Cardiology and the American Heart Association, in advising that patients who are currently taking these medications should not change their medication regimen unless advised by their health care provider.

The ACG published the following statement in the November 12, 2008 ACG SmartBrief:

Previous research shows that combining a PPI with clopidogrel lessens the risk of GI bleeding. However, recent studies have suggested that adding a PPI could blunt clopidogrel's anti-platelet effect. This interaction has not been studied in large numbers of patients, so there is no definitive evidence that the use of PPIs will keep clopidogrel from working to prevent cardiac events. The Medco study provides insufficient evidence to change clinical practice. In the interest of patient safety, the ACG along with the American College of Cardiology and the American Heart Association, advise that patients who are currently taking these medications should not change their medication regimen unless advised by their health care provider, according to a statement released Tuesday at the AHA Meeting in New Orleans. The Medco study is a retrospective analysis so the importance of balance of all significant other relative risks for patients is evident. According to ACG's Dr. David Johnson, a member of the joint ACG/ACC/AHA writing group for a recent consensus guideline on NSAIDs and anti-thrombotics, "this patient population could have been prescribed PPIs because they were thought to have more co-morbid risks and hence were sicker patients. Clearly to date, it has by no means been standard practice for cardiologists to routinely put patients on PPIs when they begin Plavix and it would be unlikely that these patients were receiving this as Plavix co-therapy. As such, there are many questions that arise with any retrospective analysis."

Additional information about PPI medication is available on our PPI page.



Digestive Health's Recent Contributions to Published Clinical Research


Endoscopist-Directed Administration of Propofol: A Worldwide Safety Experience
Douglas K. Rex, Viju P. Deenadayalu, Emely Eid, Thomas F. Imperiale, John A. Walker, Kuldip Sandhu, Anthony C. Clarke, Lybus C. Hillman, Akira Horiuchi, Lawrence B. Cohen, Ludwig T. Heuss, Shajan Peter, Christoph Beglinger, James A. Sinnott, Thomas Welton, Magdy Rofail, Iyad Subei, Rodger Sleven, Paul Jordan, John Goff, Patrick D. Gerstenberger, Harold Munnings, Martin Tagle, Brian W. Sipe, Till Wehrmann, Jack A. Di Palma, Kaitlin E. Occhipinti, Egidio Barbi, Andrea Riphaus, Stephen T. Amann, Gen Tohda, Timothy McClellan, Charles Thueson, John Morse, Nizam Meah
Gastroenterology, October 2009


Background & Aims:

Endoscopist directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation.

Methods:

We reviewed all published work utilizing EDP. We contacted all endoscopists performing EDP for endoscopy that we were aware of to obtain their safety experience. These complications were available in all patients: endotracheal intubations, permanent neurologic injuries, and death.

Results:

A total of 646,080 (223,656 published and 422,424 unpublished) EDP cases were identified. Endotracheal intubations, permanent neurologic injuries, and deaths were 11, 0, and 4, respectively. Deaths occurred in two patients with pancreatic cancer, a severely handicapped patient with mental retardation, and a patient with severe cardiomyopathy. The overall number of cases requiring mask ventilation was 489 out of 569,220 (0.1%) cases with data available. For sites specifying mask ventilation risk by procedure type, 185 of 185,245 (0.1%) patients and 20 of 142,863 (0.01%) patients required mask ventilation during their EGD or colonoscopy, respectively (p <0.001). The estimated cost per life year saved to substitute anesthesia specialists in these cases, assuming they would have prevented all deaths, was 5.3 million dollars.

Conclusions:

EDP thus far has a lower mortality rate than that in published data on endoscopist delivered benzodiazepines and opioids and a comparable rate to that in published data on general anesthesia by anesthesiologists. In the cases described here, utilization of anesthesia specialists to deliver propofol would have had very high costs relative to any potential benefit.

Digestive Health endoscopy case data from the Southwest Endoscopy Center and Mercy Regional Medical Center is incorporated in this review of our current sedation techniques.