Gut Check: 10 GI Issues in the News

1. Best Strategies to Prevent NSAID-associated GI Toxicity:

In analyses based on 82 trials that included 125,053 participants, the combination of selective cyclooxygenase (COX)-2 inhibitors plus proton pump inhibitors (PPIs) provided the best protection to prevent NSAID-associated GI toxicity. Second best were selective COX-2 inhibitors, followed by nonselective NSAIDs plus PPIs.

2. Women With GERD Can Tolerate Step-down:

Female patients with gastroesophageal reflux disease (GERD) who are receiving long-term proton pump inhibitor (PPI) therapy were 3 times more likely to tolerate half of their prior dose. Female gender was the strongest predictor for successful step-down. Women with GERD might manage with lower doses of PPIs than men.

3. Win Uphill Kidney Stone Battle With NSAIDs:

Intramuscular NSAIDs offer the most effective sustained analgesia for the pain of patients with renal colic in the ED and may have fewer adverse effects. Diclofenac was significantly more effective than morphine in achieving the primary outcome, a 50% reduction in initial pain score at 30 min after analgesia.

4. Physical Activity Trims GI Cancer Risk:

Greater levels of leisure-time physical activity are linked with a lower risk of 13 types of cancer, including several GI cancers: colon cancer, esophageal adenocarcinoma, liver cancer, cancer of the gastric cardia, and kidney cancer. A possible link between physical activity and colon cancer risk is a reduction in the time it takes for waste to pass through the GI tract.

5. Gluten-Free Diet Not Risk-Free:

The gluten-free diet (GFD) provides treatment for patients with celiac disease, but there are no data to support health benefits for the growing number of gluten-free food consumers who do not have the disease. A GFD actually may do more harm than good. Gluten-free foods often contain a greater density of fat and sugar. Also, obesity, overweight, and new-onset insulin resistance and metabolic syndrome have been identified after the start of a GFD.

6. Probiotics Provide Irritable Bowel Syndrome Treatment:

Dual-coating layers of probiotic supplement may offer effective treatment for patients with diarrhea-predominant IBS. Significant improvement in overall discomfort in the dual-coating group was seen in responses to the adequate relief questionnaire, and the ratio of normal stools to hard or watery stools had a better effect from dual-coated probiotics than from noncoated probiotics.

7. An Apple-Juice-a-Day Keeps Gastroenteritis Away:

Initial oral hydration with dilute apple juice followed by a child’s preferred fluids resulted in fewer treatment failures than electrolyte maintenance solution in children with mild gastroenteritis and minimal dehydration. Dilute apple juice and preferred fluids may offer an appropriate treatment and prevention alternative in many high-income countries.

8. Ozanimod Better Than Placebo for Ulcerative Colitis:

The oral S1P1/S1P5 agonist ozanimod taken at a daily dose of 1 mg resulted in a slightly higher rate of clinical remission of ulcerative colitis than placebo. Ozanimod induces peripheral lymphocyte sequestration, potentially decreasing the number of activated lymphocytes circulating to the GI tract.

9. Aspirin Therapy Eases GI, Colorectal Cancer Risks:

In a Harvard study, regular aspirin use-a 325-mg or 81-mg tablet taken 2 or more times per week-was associated with a 3% overall reduction in cancers. Risk reductions for GI cancer and for colorectal cancer were 15% and 19%, respectively. The researchers suggested aspirin use to complement colorectal cancer screenings.

10. For IBD Care, There’s No Place Like a Medical Home:

A specialty medical home for patients with Crohn disease and ulcerative colitis shows promise as a new approach to patient-centered, cost-effective care, according to a paper in Inflammatory Bowel Diseases. In such a model, expert medical care could be coordinated with attention to social support and mental health to improve the patient experience, enhance health care quality, and decrease cost.