The opinion magazine of the American Gastroenterological Association
This is half of a two-part debate — read the opposing argument. The opinions expressed here are that of the author and do not represent the position of AGA. The use of non-physicians to provide clinical services is widespread. Mid-level providers can act both independently without supervision, i.e. nurse practitioner, or act as surgical assistants, […]
This is half of a two-part debate — read the opposing argument. The opinions expressed here are that of the author and do not represent the position of AGA. Over the last 30 years there has been a dramatic rise in the demand for endoscopic procedures across the world and in the United States. This […]
The last decade has witnessed significant expansion in our understanding of inflammatory bowel disease (IBD) therapies and their pharmacological characteristics. This improved knowledge, along with the paradigm shift in IBD management — evolving from merely symptom control to blocking disease progression and preventing bowel damage — has resulted in the emergence of several treatment concepts […]
In almost all areas of medicine, we accept a role for therapeutic drug monitoring. Whether we consider digoxin levels or vancomycin and cyclosporine troughs, the principles remain the same — there is a range wherein the drug is effective and also one in which there is toxicity. For the purposes of this treatise, we posit […]
As physicians, we have grown accustomed to the concept of screening for and surveillance of those found to have premalignant conditions with the expectation that by doing so we can prevent cancer and do little if any harm. In reality this concept has rarely been demonstrated to be true and indeed we often do great […]
Roughly one-fifth of all human cancers arise in the gastrointestinal tract. Worldwide, over 3.5 million patients are newly diagnosed with GI tract cancer each year, of whom 310,000 are in the U.S. alone. These malignancies show marked gender, racial and socioeconomic differences in incidence. For instance, esophageal and gastric adenocarcinomas occur more frequently in U.S. […]
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. […]
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 […]
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 […]
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 […]
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