The Year in Gastroenterology: 10 Practice-Changing, Must-Read Studies

David A. Johnson, MD


December 20, 2017

Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death

Kaminski MF, Wieszczy P, Rupinski M, et al
Gastroenterology. 2017;153:98-105

The adenoma detection rate (ADR) is a recognized validated measure for assessing quality of colonoscopy and the related risk reduction for interval postcolonoscopy colorectal cancer (CRC). This prospective study showed that improvement in the ADR reduced both interval CRC and related death.

Clearly, even colonoscopists who are "good" can get better and save lives by further improving their ADR. Clinicians should not be satisfied by meeting the current minimum national benchmark targets for ADR.


Drug Safety and Risk of Adverse Outcomes for Pregnant Patients With Inflammatory Bowel Disease

Mahadevan U, McConnell RA, Chambers CD
Gastroenterology. 2017;152:451-462

This article provides guidance on the use of medications in the treatment and maintenance of IBD, focusing on the most current data regarding safety in pregnancy and lactation. This is a must-read for providers treating and counseling patients who are pregnant or contemplating pregnancy.


Colorectal Cancer Screening: Recommendations for Physicians and Patients From the US Multi-Society Task Force on Colorectal Cancer

Rex DK, Boland CR, Dominitz JA, et al
Am J Gastroenterol. 2017;112:1016-1030

This article updates information and recommendations contained within the Task Force's earlier 2008 guidelines.

As part of these updated recommendations, the Task Force has divided the screening tests into three tiers based upon their effectiveness. The timing of the initial screening and the intervals for different risk populations are also suggested, as well as the time to discontinue screening. Key questions for patients to ask the colonoscopist have been included.


Changing Concepts of Cirrhotic Coagulopathy

Tripodi A, Primignani M, Mannucci PM, Caldwell SH
Am J Gastroenterol. 2017;112:274-281

This report highlights evidence that patients with cirrhosis may be not only hypocoagulable with high international normalized ratio but also hypercoagulable due to reduced protein C levels. As a result, they are at an increased risk for venous thrombosis; in particular, portal vein and pulmonary embolus. The lack of value of fresh frozen plasma for acute bleeding or prevention of bleeding is discussed. The new paradigm is to measure fibrinogen levels, which are where we can make a meaningful intervention if they fall below defined thresholds. The appropriate use for venous thrombosis in patients with cirrhosis who are at risk, as well as identifying and minimizing bleeding risks in patients undergoing therapeutic interventions, are key points. A change in the approach to these patients is clearly warranted.



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