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Category Archives: GI
Cdiff 9th leading cause of GI death
This large database analysis found that Cdiff is now the 9th leading cause of GI death in the US, and that hospitalizations and mortality from Cdiff have more than doubled in the last decade (abstract).
Guidelines on endoscopy
The ACP has published guidelines on the appropriate use of EGD, which is indicated for patients with heartburn with “alarm symptoms”, to assess healing of esophagitis or Barretts, for recurrent dysphagia/stricture, to assess GERD that has failed PPI therapy, and … Continue reading
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Zofran 32mg IV dose removed from the market
The FDA is warning providers to discontinue use of high dose zofran (32mg IV) due to acute QT prolongation (FDA site)
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Careful with acetaminophen dosing in inpatients
In this large retrospective analysis from 2 tertiary care academic medical centers, 7% of patients were exposed to >4 grams/day of acetaminophen; of those >age 65 or with chronic liver disease, 18% exceeded the recommended dose of 3 grams/day. Hospitalists … Continue reading
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Probiotics for Cdiff prevention
This large meta-analysis of 20 randomized trials found that probiotics reduced the risk of Cdiff by 66% in patients on antibiotics, with fewer adverse events (compared to placebo). Probiotics should be considered for any patient on antibiotics to reduce the … Continue reading
Feeding tubes in dementia patients
In this prospective cohort of >35,000 nursing home patients, 5% had a feeding tube inserted within 1 year of eating problems. Neither the timing nor the insertion of the feeding tube affected mortality. There is no survival advantage of placing … Continue reading
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Vaptins should not be used in hyponatremia in cirrhosis
This systematic review of clinical trials of the use of vaptans (tolvaptan, satavaptan, and lixivaptan) in patients with cirrhosis and hyponatremia found no difference in mortality, variceal bleeding, hepatic encephalopathy, SBP, hepatorenal syndrome, or renal failure, compared to placebo. The … Continue reading
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Resuming warfarin after GI bleed
This large cohort of patients on warfarin who experienced a GI bleed found 59% resumed warfarin within 90 days. Those that resumed were significantly less likely to experience thrombosis (hazard ratio 0.05, CI 0.01-0.58) or death (hazard ratio 0.31, CI … Continue reading
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Probiotics for hepatic encephalopathy
In this open label trial, 235 patients with a history of hepatic encephalopathy were randomized to placebo, lactulose tid, or probiotics tid. Within 12 months of follow up, hepatic encephalopathy developed in 38 placebo patients, 22 probiotic patients, and 18 … Continue reading
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Capsule endoscopy for acute GI bleeding?
In this small trial, patients with acute GI bleeding without a source despite upper and lower endoscopy were randomized to capsule endoscopy or angiography; the diagnostic yield was 53% for capsule endoscopy and 20% for angiography, and there was no … Continue reading
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