Debates

Most Crohn’s disease patients who undergo an intestinal resection will have postoperative recurrence. The most effective way to prevent recurrence is to initiate an anti-TNF within four weeks of surgery. It has been my practice that patients at high risk for postoperative Crohn’s disease recurrence initiate anti-TNF shortly after they are discharged from the hospital. […]

Debates

A surgical resection for a patient with Crohn’s disease is a major milestone in the natural history of their condition. It is without a doubt that patients who require surgery will make avoiding further surgery a priority and accordingly many patients will consider any possible preventive measure. I explain to patients that surgery is usually […]

Debates

Gastroesophageal reflux disease (GERD) testing has evolved ever since the initial introduction of the catheter-based pH test more than half a century ago. More accurate pH measurements and improved patient tolerability were achieved by reducing the catheter’s diameter and stiffness, and the catheter-based pH test has continued to improve over the years.1 Introduction of the […]

Debates

Prolonged pH or reflux monitoring is neither essential to the primary evaluation or treatment of patients with suspected gastroesophageal reflux disease (GERD) who respond to therapy nor needed for patients who have endoscopydocumented erosive esophagitis that responds to antisecretory therapy. The history, endoscopic findings and clinical response to therapy provide adequate support for the diagnosis of GERD in […]

Debates

As a card-carrying gastroenterologist, I enjoy performing screening colonoscopy just like most of my society brethren. However, I feel strongly that the fecal immunochemical test (FIT) is a fully acceptable alternative for colorectal cancer (CRC) screening. Perhaps the easiest defense for those of us who are enthusiastic about stool-based screening is the quality of evidence supporting it. […]

Debates

In Australia and some European countries, colorectal cancer (CRC) screening occurs in an organized or programmatic setting, usually funded by the national government. Organized screening commonly relies on fecal occult blood testing (FOBT) as the primary means of screening, and usually the fecal immunochemical test (FIT). FIT is a good option for these programs as […]

Debates

F or patients found to have low-grade dysplasia (LGD) in Barrett’s esophagus, two recent studies suggest that the decision between treating with radiofrequency ablation (RFA) or simply continuing endoscopic surveillance is a slam dunk for RFA.1,2 In a European, randomized trial of surveillance versus radio frequency ablation (SURF) for 136 patients who had LGD confirmed […]

Debates

The primary goal of ablation in Barrett’s esophagus is to reduce progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). The decision to perform endoscopic therapy (with the goal to eliminate intestinal metaplasia), is based on the principles of: 1. documenting an elevated risk of progression, 2. demonstrating reduction in risk of progression using robust […]

Debates

Celiac disease is diagnosed by small intestinal biopsy. As the popularity of the gluten-free diet has surged in the past decade, histology has largely remained intact as the arbiter between celiac disease and non-celiac gluten sensitivity, a condition whose etiology, pathogenesis and natural history remain incompletely understood. Though a pathway for a biopsy-free diagnosis of […]

Debates

Broadly, my celiac patients suffer from two main problems. The first is poorly controlled celiac disease, with some combination of ongoing symptoms, enteropathy and laboratory abnormalities. This group, collectively referred to as nonresponsive celiac disease, is significant and although all current data on this issue comes from a few tertiary referral centers, it is likely […]