Colons and Polyps and Preps, Oh My!

Not a pretty picture. The googled-eyed pink blob is a colon polyp. The tall thin green thing is an enema. And the woman to my left is Anka, a former internal medicine doctor turned medical journalist. She's great, by the way and worked hard to keep up with all the news coming out of Digestive Disease Week 2007. I think she has nearly fifty articles to write! See, I told you there was so much news and information coming out of that conference--I know I have an endless stream of topics to share with you here over the next several weeks, perhaps months!

Anyway, back to the topic of colons and polyps.

Here's what you need to know.

Did you know that colorectal cancer is the second leading cause of cancer death in the United States? Yikes. But when colorectal cancer is detected early, it has one of the highest cure rates. Now that's good news! But IT HAS TO BE DETECTED EARLY!

That's one reason why we need innovative and improved ways to screen for and detect this disease.

When I was at Digestive Disease Week® 2007 (DDW®), there was new research presented there that highlighted several technological and research advances that are helping to decrease both the number of deaths and the number of new cases of colorectal cancer diagnosed in the United States.

This is great news! But remember, early detection is the key to prevention! Colorectal cancer in its early stages usually doesn't cause any symptoms. If you don't get screened, you won't know and frankly, by the time you do decide to get screened, it may be too late. Now, I'm not trying to alarm you here.

In fact, I need to have a colonscopy soon too. Ok. I'll put it out here right now and say, yes, my doctor, a lovely woman (to whom I complained to about my chronic abdominal pain and bouts of constipation and it's counterpart) who urged me have a colonscopy as a precaution. That was back in February and I still haven't made the appointment. Shame on me!

Does my failure to make an appointment for a colonscopy make me a hypocrite? Well, maybe a little. But it also makes me human and highlights the hesitation most of us have about dealing with our health matters. Am I afraid? You bet. Not so much about the end-result and what they may find--more so about the procedure. Basically, fear of the unknown. Anticipatory anxiety. Even a Gastro Girl is a bit scared.

I met with some reps from Ez-Prep at DDW--they said their product is one used by docs to prepare their patient's (read cleaning out their colons) before the colonscopy. They mentioned it wasn't as bad as we might think.

For me, my time at DDW, listening, learning, asking questions. etc. about all things digestive, including colorectal cancer--which was a major topic at the conference--made a huge impact on me.

Gastro Girl Colonoscopy Challenge

What am I going to do about my fear? I don't even know what I'm afraid about really--what's the worst that could happen? The doc has to zap a polyp or two?

I'm gonna schedule a colonscopy. I tell you what--watch this space for the Gastro Girl Colonoscopy Challenge. Yea. That's it. We'll make a pact to get screened all over the world around the same time! How cool would that be! You can write in with your appointment time and day and location and we can all feel the huge outpouring of support--there is power in numbers!

Stay tuned.

Get the scoop from the Revolution Health community
Colonscopy: What can I expect?

Scoping Out Endscopy: Getting My Gastro On

It's not everyday I get to don blue gloves, white lab coat and do a little endoscoping. But I sure looked like a real Gastro yesterday, when the hoopla down at the zillion square foot exhibitor hall at Digestive Disease Week 2007 was evaporating into the glorious air outside as the 19,000 or so Gastro docs and other Gastro groupies from all over the world made their way back home, went sightseeing or shopping (hey Dr.Mark hope you found Best Buy!.)

And while the Gastros were probably relieved to have some time away from doing endoscopies, I was in heaven--yet again! Let me tell you this was one of the best Gastro weeks I've had in a long time!

Ok. Here I am--do I look, like way, Gastro or what? Ok, maybe not WAY Gastro, but sort of, right? Yea, that strange look on my face is one of sheer amazement and intense concentration--I took this demo seriously and I was in true awe!


The representatives from U.S. Endoscopy were oh so kind to indulge my request to try this endoscopy demo out. Dean Secrest. executive VP of Research and New Product Development (he's in the photo later on in this post)was particularly helpful! Thanks again, Dean! I mean, what better way to understand what endoscopy is all about than to try it--no not an actual patient! But I think they were a bit perplexed at my enthusiasm for experiencing this first hand. What you see here is an actually training model that U.S. Endoscopy makes to train physicians on the use of the endoscopy devices/accessories, which they also make.

Physicians Do Practice Before They Scope

This is good news for us, as patients--docs don't just use this equipment without proper training. So I was relieved to discover the use of these "models" which are designed with pig intestinal linings and stomach. And it looks real!(a cranberry saucy concoction was used to emulate blood.) By the way, prominent gastroenterologists who are leaders in the field of endoscopy used these models to showcase the latest and most innovative endoscopic procedures to their peers from around the world during special sessions this week.

Back to my "learning"session

What I found interesting was the gadget that I was controlling with my hands. To move through the upper GI tract, I rotated a dial-like control with my right hand. I held the device in my left hand (and there is a certain way to hold it so that you have easy control to two button-one to add water and the other to add air/suction.) Why are these buttons key? well, for one the water enables a clear view and cleans the lens, the suction dries the passageway up a bit, and the air inflates the area. Of course,I played around, rather I experimented with the controls, adding air when I was in the stomach so I could have a closer view of the stomach lining. So cool!

Anyway, as I explored the "patient's" upper GI tract I wondered what a doctor would do if they found an abnormality. I know that doctors could remove polyps and take tissue samples. But I asked Dean anyway and he said a doctor would do a biopsy. I asked how--(see I really wanted to do this procedure as well.) By now I'm so excited I'm thinking: Maybe I should have gone to Med school? Maybe I was a gastroenterologist in a previous life?

Anyway, I was given a flexible needle constrained within a plastic catheter(it looked like a long thin green tube--and I think tube actually protects the patient since you wouldn't want to stick a needle, unprotected down the esophagus. Yikes!) I passed through the endoscopic that was already in place in the patient and I watched the monitor until the tube reached the stomach. Then Dean showed me how the needle was pushed through the tube (which we controlled by a syringe attached to the endoscope)and as I watched the monitor, the needle reached the stomach wall where we could complete the biopsy. Very cool!

You can see the stomach on the monitor in this picture. This was my view when I was doing my thing as seen above. From what I could tell, a long lighted tube was placed down the patient's esophagus and into the stomach. I asked Dean if I was seeing anything "abnormal" in the stomach. Unfortunately (for me since I wanted to see what a tumor or lesion or whatever else would be a red flag to a doc) but everything in this stomach was ok.)

Here is what the physician would see (and what I saw during my demo) The gentleman in the photo is Dean by the way:


The procedure I learned about here was upper endoscopy.

So what exactly is an upper endoscopy?

Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy (eh-SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee. Source: Revolution Health.

Now, this endoscopic device does many things--not just provide a view or the GI tract. From what I learned about U.S. Endoscopy, this company designs all sorts of innovative and very helpful accessories for the scope, which allow the doctor to take tissue samples, treat tumors that are found in the intestinal tract, clean-out specific areas and even suture,among a lot of other things I'm sure I've missed.

You can see some of the devices and learn about what they do on the U.S. Endoscopy site.

Endoscopy: Should I have one? What can I expect?

Wondering if you need an endoscopy or if it's the right thing for you? Dr. Micheal Brian Fennerty provides insight in his blog post, "Is an endoscopy always the right answer for what ails the gut?"

Have you had an endoscopy? Or do you have any questions about the procedure? Join a discussion on Revolution Health.

You've Got the Power: Choose Wisely for A Healthy GI

When I arrived early this morning in the press room for Digestive Disease Week 2007 (DDW), I claimed my spot at one of the long tables alongside journalists from all over the world (ah, brings back memories of my former life as a newspaper reporter), set up my laptop and made my way to the coffee station.
I was pleasantly surpised when I spotted a breakfast buffet of scrambled eggs, bacon, potatoes, fresh fruit, danish, crossiants and a variety of cereal. After arranging a colorful plate of melon and berries I came to a (plastic) fork in the road. Lemon-filled danish or raisin bran? Well, I did what any gastro-logical girl would do and confidently and unapologetically placed a lemon-filled danish next to my fresh fruit. Good choice? Of course not! But I take full responsibity for my irregularity today. See, it's past 3 p.m. and nothing's moving yet.

Guess, I should've gone for the raisin bran.

So what's the point you ask?

Well, I had the good fortune of attending an insightful press conference yesterday where gastro experts presented research that all stressed the same conclusion: that lifestyle choices when it comes to things like diet, for instance, have a huge impact on our overall gastrointestinal health.

While we can't choose our genetic make-up or whether it rains on our parade, we can make certain lifestyle choices like choosing what we eat your or ordering an appetizer for dinner. And you know what is so key: these choices, while they may seem small may have a significant impact on our gastrointestinal (GI) system, and affect our risk for certain diseases,our weight and our general GI-related activity, which is basically everything that happens from our mouth, down our espophagus, inside our stomach, throught our intestines and out.

“Many factors come into play when managing a healthy lifestyle. While some factors may be difficult for patients to change, other simple adjustments, such as adopting a vegetarian diet early in life or ordering the appropriate soup while eating out, may result in decreased risk for obesity and colon cancer," said Alan Buchman, M.D., MSPH, AGAF, Feinberg School of Medicine of Northwestern University School of Medicine. “The studies presented today further demonstrate how researchers are beginning to understand the links between digestive diseases and lifestyle – most notably, diet.”

You go Dr. Buchman! I'm forever grateful for your statement!

See,these findings are so important and I finally feel vindicated for what some may call "my annoying pronouncements" about the importance of our digestive health in relation to our overall health and well-being. In fact, much of what has been discussed at this conference showcases the relationships between digestive health (digestive diseases) and other health conditions/diseases such as cancer, diabetes, obesity, heart disease, asthma, reproductive health, nutritional deficiances, and mental health.

By the way, my gastro-friend and co-worker Jennifer Randall scribes her daily choices in her blog, "Jennifer Randall is Having her Cake and eating It Too" Check it out for inspiration!

Here's a summary of what was presented and what you need to know:

Source: DDW 2007.

Life Long Vegetarian Diet Reduces the Risk of Colorectal Cancer

In case you weren't aware: The average person’s lifetime risk of developing colorectal cancer (CRC) is about seven percent. The role of diet in preventing colorectal cancer is still under debate. Most of all, previous studies foucused on middle-aged people, which suggested that colorectal cancer development could start before common interventions.

These facts prompted sesearchers from Tata Memorial Hospital (TMH) in Mumbai, India, to determine whether a vegetarian diet helps reduce the risk of colorectal cancer if started very early in life.

In this study, researchers used a prospectively created database of 8,877 Indian patients managed in a clinical nutrition service from January 1, 2000 through December 31, 2005, to examine the association of life-long vegetarianism with incidence of CRC. During the evaluation for nutrition support, a history of life-long vegetarianism (due to religious reasons) was obtained from all patients to plan an appropriate diet. Twenty-seven percent of subjects (2,092 patients) from the control cohort were life-long vegetarians and 22.4 percent (178 patients) of subjects with colon cancer were vegetarians.

Bottom line:
“A well-planned vegetarian diet is a healthy way to meet your nutritional needs,” said Yogesh M. Shastri, M.D., of Johann Wolfgang Goethe University Hospital, Frankfurt, Germany and previously a co-author of this study at TMH, Mumbai, India. “The exact mechanism by which life long vegetarianism may reduce the risk of sporadic CRC needs further investigation. Prolonged vegetarianism starting in early life may be a viable lifestyle option for those at risk of developing the disease.”


Interesting....


Dinner plans? Have a "Fatty Soup" as an Appetizer And You'll Eat Less


Many people believe that ordering an appetizer can actually make you hungrier and that you tend to eat more of your entrée as a result. But, researchers from the University of Texas Medical Branch in Galveston, Texas, feel that what you order as a starter determines your overall appetite, as absorption of fat in the small intestine induces the feeling of being full and slows down gastric emptying. The aim of this study was to investigate whether a fatty soup consumed before a meal might reduce food intake in both lean and obese subjects and whether this possible inhibitory effect would be related to changes in gastric functions.

Here's what they did:

For the study, investigators recruited 12 lean and 12 obese healthy subjects and invited each group to the lab for two sessions (eating both fatty soup and protein soup with the same number of calories and volume). Each session consisted of a 30-minute baseline of soup consumption, a 20-minute post-soup period, an “all you can eat” pizza meal, and a 60-minute post-meal period. Electrogastrogram (a test recording the electrical activity of the stomach, EGG) and electrocardiogram (a similar test recording electrical activity of the heart, ECG) were recorded during each session. Food intake was assessed by the caloric count of the consumed pizza. Several symptoms, including satiety, appetite and nausea, were rated at different times of the study. In a second study, subjects were given the soup appetizer and then taken to an “all-you-can-eat” pizza buffet together in a social setting.

When compared with the protein soup (in this case it was a two-egg soup), the fatty soup (Campbell's Cream of Chicken) significantly reduced the amount of caloric intake with the following meal in both lean (962.0 vs. 1,188.5 calories) and obese (1,331.9 vs. 1,544.6 calories) subjects. A similar reduction in caloric intake was noted in lean subjects eating in the social setting (1,555 vs. 1,825 calories), except that significantly more food was consumed in social sessions compared with the lab setting.

Bottom line:

“In this study, we found that fatty soup as an appetizer reduces food intake by about 20 percent in both lean and obese subjects and may have a therapeutic potential for obesity,” said Jiande Chen, Ph.D., of the University of Texas Medical Branch and senior author of the study. “Our hope is that further studies with similar outcomes may curb those myths and that people will think about what certain foods often thought to be off-limits may be able to achieve for their overall health and weight.”

Feel the Flow: IBS With Constipation? Lubiprostone May Help!

I'll tell you one thing, constipation isn't a problem here at Digestive Disease Week 2007, which is by the way the largest annual international meeting of digestive disease specialists. Whoa, That's a lot of Gastros and their groupies (like me) in one place!

And yes, a steady, sometimes quick stream of news and information is flowing like you wouldn't believe. No bowel obstructions of any kind.
And this perfect regularity has nothing to do with my taste-testing Benefiber down at the Novartis booth. Way better tasting than Metamucil (and no lumpy, choke-hold swallowing problems getting this stuff down, either). Suzanne, the kind demo-lady was taking her Benefiber in a cup of Cappuccino. Oh, la, la. Is this the beginning of it's hip, cool and wow to get your fiber on along with your foam? I bet we'll soon see girlie girls ordering grande-decaf-non-fat-extra-hot-fiber-filled-sugar-free vanilla lattes! Just remember, you heard it here first!

Anway, when I asked Suzanne for a sample of a fiber-filled cappuccino, she laughingly said, "OH, no you better wait until tomorrow." She was looking out for Gastro soundness since I already guzzled the Benefiber in a nice cup of Spring Water. Nothing's moved yet, in case you're wondering.

Anyway, back to the reason for the post. Oh, yea, the new study that shows the active ingredient in AMITIZA® (lubiprostone), given 8 mcg twice a day, may improve symptom relief rates in adults with irritable bowel syndrome with constipation (IBS-C).

"In this study, patients receiving lubiprostone were nearly twice as likely to achieve an overall response from symptoms of IBS-C compared to those receiving placebo," said Douglas A. Drossman, M.D., primary investigator, UNC Center for Functional GI and Motility Disorders, University of North Carolina, and the Chair of the Rome Committee. "As a result, lubiprostone may represent an important treatment for IBS-C sufferers."

In case you didn't know, IBS affects about 58 million Americans and accounts for 25-50 percent of referrals to gastroenterologists. IBS-C symptoms include abdominal pain or discomfort associated with defecation or a change in bowel habits with features of disordered defecation. Not fun!


Join A Discussion on this IBS drug in Revolution Health's Community Forum

Have You Tried Amitiza (Lubiprostone) for IBS-C?

If you were taking Zelnorm, read what others are saying about Amitiza

Lubiprostone is marketed in the U.S. as AMITIZA, a 24-mcg gelcap that was approved for use for chronic idiopathic constipation in adults on January 31, 2006.

Sucampo Pharmaceuticals expects to submit a supplemental New Drug Application for IBS-C to the U.S. Food and Drug Administration by July 2007.

The following is from the DDW 2007 press release (wanted you to have this info quickly so I've posted it here:)About the Study for IBS-C (lubiprostone 8 mcg)

"In two phase III, multi-center, double-blind, randomized, placebo-controlled trials, 1,171 adults diagnosed with IBS-C (Rome II Criteria) were enrolled and received lubiprostone 8 mcg taken twice daily (783 adults) or placebo (388 adults) over a 12-week period.

Primary efficacy was determined by a unique question: "How would you rate your relief of IBS symptoms (abdominal discomfort/pain, bowel habits and other IBS symptoms) over the past week compared to how you felt before you entered the study"" A 7-point balanced scale with a strict evaluation using the two highest scale points to qualify as a responder was used. Patients were considered monthly responders if they reported at least moderate relief four out of four weeks or significant relief two out of four weeks. To qualify as an overall responder (the measure used in the primary endpoint), patients had to be a monthly responder for at least two out of three months. During the evaluation period, patients discontinuing for any reason or reporting an increase in rescue medication use, lack of efficacy or moderately or significantly worse relief were deemed non-responders. These responder rates may not be comparable to those in other studies since the new scale was more restrictive than those used in previous reports.

The findings demonstrated that patients receiving lubiprostone 8 mcg twice daily were nearly twice as likely to achieve overall response compared to those receiving placebo (lubiprostone 17.9 percent vs. placebo 10.1 percent, P=0.001). There was a similar incidence of serious adverse events (1 percent in each group) and related adverse events (lubiprostone 22 percent vs. placebo 21 percent) compared to placebo. The most common treatment-related adverse events (>5% of patients) were nausea (8 percent vs. 4 percent, respectively), diarrhea (6 percent vs. 4 percent, respectively) and abdominal pain (4 percent vs. 5 percent, respectively)."

Digestive Disease Week 2007: A Gastro Girl's Dream Extravaganza

It's finally here. DDW 2007. (Digestive Disease Week 2007). I'm in heaven. See, it's all information, all the time. I'm reporting live from the press room at the Washington,D.C. Convention Center and man is this place buzzing. Just got my purple bag filled with all sorts of yep, INFORMATION. In my hand now is the Scientific Session Handout--a nearly 2 inch thick book filled with all the latest and greatest research. Actually, it's a guide to where all this latest and greatest research is being presented. SO much to learn...so little time...I need a team of Gastro Girls to help me cover all this great stuff. But I'll do the best I can to bring you what you need to know...and if I can't cover it all to the extent I want to...I'll summarize the highlights and point you to more information. Most importantly, I promise to follow-up with all this great stuff (ok how many times have I used the word "great" so far?

Quickly, before I run off to a Press Conferences:

Two things of major note based on new studies from this morning's early sessions:

Hypnotherapy Helps Children With IBS

Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome is "highly superior" (which I take this to mean it works much better)than conventional therapies. Stay tuned for more info. This is great news for kids who are unfortunatley trying to cope with IBS and/or functional abdominal pain. Want more? Read my post about hypnotherapy and IBS. What are people saying about hypnotherapy?

Diverticular Disease? You Can Watch Your Movie and Eat Your Popcorn Too

Diverticular disease? Well, a new study is saying that popcorn, seeds, corn and nuts may not be bad. In fact, frequent popcorn consumption was associated with a reduced risk of diverticulitis. This is great news for those who were told to avoid nuts, seeds and the beloved movie munchie--popcorn. The study found that eating corn and nuts doesn't increase the risk of diverticular disease. Wonder if movie ticket sales and Popcorn Combo sales will go up with this news? Let the munching begin...

Read the Medical News Today article on this study


Stay tuned for more updates...