Read Like Gastroenterologists

What Did Gastroenterologists Learn in the Past 12 Months That PCPs Should Know?

Lauri R. Graham; Laurie Scudder, DNP, NP; Joanna M. Pangilinan, PharmD

Disclosures

June 04, 2018

Primary care clinicians, by necessity, are jacks of all trades. Keeping up with changes in virtually every specialty and translating that new knowledge into a busy primary care practice is a gargantuan task. This likely helps explain why, on average, it takes 17 years for medical advances to be widely implemented.[1]

This series aims to bring primary care clinicians a one-page crib sheet of five topics that our subspecialist members—across all specialties—found to be most important, as evidenced by what they chose to read in the last 12 months.

This issue: gastroenterology. Here's what gastroenterologists focused on.

IBS? Yogurt to the Rescue!

Irritable bowel syndrome (IBS) is common, estimated to affect 10%-20% of the population, and can be frustrating for both physicians and patients. Diet is a mainstay of treatment, and one recent, small, randomized, controlled study found that patients on individualized diets that eliminated trigger foods felt significantly better overall and had reduced symptom severity. But constructing those diets required use of a leukocyte activation test that has not been rigorously studied.

Could ingestion of a diet high in homemade yogurt (recipe below!) be an alternative option? A nonrandomized, nonblinded, open-label, pilot study of 189 adults, some of whom had experienced IBS symptoms for as long as 9-10 years, suggests yes. Patients were instructed to consume 2-3 cups of yogurt every day and record their symptoms in a chart, which were assessed every 2 months over the 6-month study period.

Complete remission—defined as the relief of pre-existing IBS symptoms and one or two normal bowel movements daily—was achieved by 89% of the participants.

The many qualifiers used to describe this study point to the preliminary nature of these results and the need for further research. However, this finding is of particular interest given that dairy is often a food group avoided by patients with IBS. For patients who can tolerate dairy without any worsening of their symptoms, yogurt may be worth a try.

Unmasking Celiac Disease

An analysis of data from the Explorys database, which aggregates electronic health record data from over 35 million people enrolled in 26 major integrated healthcare systems in the United States, reported some surprising findings about celiac disease. The report, presented at the World Congress of Gastroenterology, revealed that the incidence of celiac disease was calculated at 0.22%, lower than the 1%-2% range previously estimated, a finding that the researchers attribute to underdiagnosis. They also found a significant association between celiac disease and 13 other autoimmune disorders. In fact, of the autoimmune conditions they looked at, with the exception of primary biliary cholangitis, all were found to be associated with celiac disease to some degree. A table in the article lists the prevalence of diagnoses in people with and without celiac disease.

 

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