Faculty Bibliography

Purpose: Racial disparities in the presentation of colorectal cancer (CRC) have been well documented. African Americans (AA) have a higher incidence of CRC, are diagnosed at a later stage, and have a decreased survival when compared to Caucasians. One suggested reason for these differences is decreased utilization of the diagnostic modalities currently available. Computed Tomographic Colonography (CTC) has been suggested as a potential non-invasive tool for CRC screening. To date no studies have examined the utility of CTC in average risk CRC screening in AA patients. We aimed to examine the utility of CTC for average risk CRC screening in AA patients as well as rates of follow-up colonoscopy, After an abnormal exam. Methods: Data from 229 consecutive AA patients presenting from February 2007 until August 2012 for average risk CRC screening with CTC at a large city hospital, in Brooklyn, NY, was collected in a prospective study design. The data was analyzed for reason for referral, polyp detection rate (PDR), follow-up colonoscopy, and pathology. In addition to the overall PDR, particular rates for segments of the colon not previously visualized during prior incomplete colonoscopies were calculated to account for possible decreased PDR due to prior polypectomies. Results: The most common reason for referral for CTC was incomplete colonoscopy. The overall PDR for all patients was 8.7%. However, the verified adenoma detection rate, determined by subsequent colonoscopy with biopsy or polypectomy was much lower at 2.2%, as many of the patients failed to follow up with further workup (45% of those with polyps), or follow-up endoscopy failed to detect adenomas (30%). Median time to follow-up colonoscopy was 188 days. By segment of previously unvisualized colon, there were 169 segments of ascending colon/cecum in which 5 polyps (3.0%) were noted, 115 segments of transverse colon in which no polyps were noted, 89 segments of descending colon in which 1 polyp (1.1%) was noted, 74 segments of sigmoid col!

OBJECTIVES: The Gastroenterology (GI) Core Curriculum is a culmination of efforts from the American Association for the Study of Liver Diseases, the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy to develop a review of knowledge and skills for those training in a gastrointestinal subspecialty. Fellows are expected to conduct scholarly activity, attend seminars, and read textbooks and syllabus materials. While efforts to standardize education across the nation are welcomed, we sought to ascertain the learning preferences of GI fellows and attending physicians. METHODS: A national online survey was e-mailed to directors of US adult GI programs, who were also asked to invite their colleagues and fellows to participate. RESULTS: While majorities of both fellows and attendings affirmed regular attendance at national conferences, more attendings affirmed that their knowledge was improved by their participation. Asked how they acquire knowledge best, 45 fellows and 67 attendings responded; 42% of attendings favored journal articles, and 40% of fellows favored conferences. More attendings than fellows felt that writing a manuscript and belonging to a GI society improved knowledge. CONCLUSIONS: We believe the Gastroenterology Core Curriculum provides trainees with essential tools for becoming an autonomous gastroenterologist who can appreciate various learning modalities.

BACKGROUND: Stress ulcer prophylaxis (SUP) has been increasingly prescribed for patients admitted to medical wards. The knowledge, attitudes, and practices of those in the healthcare profession regarding use of SUP in medical wards are understudied. METHODS: A survey consisting of closed-ended questions and multiple-choice queries was handed out during grand rounds. RESULTS: One hundred people (39 attending physicians, 61 residents) completed the survey. More attending physicians (41 vs. 30 %) believed SUP was indicated for patients treated in a non-intensive-care medical ward (P = 0.2357). All residents preferred a proton-pump inhibitor (PPI) for SUP compared with 85 % of attending physicians (P < 0.05). Despite equal agreement that PPIs were not harmless, more attending physicians than residents agreed that using PPIs increased the risk of community-acquired pneumonia (P < 0.05). More residents than attending physicians agreed on the use of SUP for patients suffering from major burns and for those with liver failure. In situations of respiratory distress not requiring intubation and in cases of steroid treatment for a chronic obstructive pulmonary disease flare, more attending physicians than residents felt SUP was required. Approaching a statistically significant difference, more attending physicians than residents felt that being too busy to question SUP indication and the perception of PPIs as harmless affected decision making. CONCLUSION: Despite the publication of guidelines, misuse of gastric acid suppressants continues to occur, even by attending physicians. More complete understanding of the need and occasion for SUP use should result in more cautious use.

Many cancer-prevention interventions have demonstrated effectiveness in diverse populations, but these evidenced-based findings slowly disseminate into practice. The current study describes the process of disseminating and replicating research (i.e., peer patient navigation for colonoscopy screening) in real-world settings. Two large metropolitan hospitals collaborated to replicate a peer patient navigation model within their existing navigation systems. Six African-American peer volunteers were recruited and trained to navigate patients through colonoscopy scheduling and completion. Major challenges included: (1) operating within multiple institutional settings; (2) operating within nonacademic/research infrastructures; (3) integrating into an established navigation system; (4) obtaining support of hospital staff without overburdening; and (5) competing priorities and time commitments. Bridging the gap between evidence-based research and practice is critical to eliminating many cancer health disparities; therefore, it is crucial that researchers and practitioners continue to work to achieve both diffusion and fusion of evidence-based findings. Recommendations for addressing these challenges are discussed.

INTRODUCTION: Bone demineralization has been increasingly recognized as a disease process concurrent with inflammatory bowel disease (IBD). Racial variation in osteoporosis in IBD patients has been poorly described. We sought to identify the risk factors for demineralization in Afro-Caribbeans (AC) with IBD. METHODS: A retrospective chart review was performed from a 10-year prospectively collected database of IBD patients seen at an urban medical center. Data on dual-energy X-ray absorptiometry (DXA) scanning, use of steroids, bisphosphonates, calcium, and vitamin D, as well as blood chemistries were collected. RESULTS: One hundred and fifteen charts of AC IBD patients were reviewed, of which 24 patients had undergone DXA scanning. Fourteen patients with a T-score of less than -1 were compared with 10 patients with DXA scores of more than -1. Two patients with T-scores of less than -1 had fractures, whereas none were observed in the comparison group (P=0.5). The mean BMI for those with T-scores of less than -1 was 23.9 kg/m compared with 31.5 kg/m in those with T-scores of more than -1 (P=0.0034). CONCLUSION: Screening for bone demineralization in ethnic populations with IBD is lacking as only 21% of AC IBD patients seen in our institution had undergone a DXA scan. Of those who were scanned, more than half of the patients had T-scores suggestive of bone demineralization. Although those who were obese did not have demineralization, our sample sizes were small and the results from this study should prompt further investigation to determine the prevalence and significance of bone demineralization in minority populations with IBD.

Pain resulting from chronic pancreatitis is often debilitating and difficult to manage. Many approaches have been used to treat these patients, including narcotic analgesia, antidepressants, pancreatic enzymes, octreotide, denervation procedures, such as celiac plexus block, and various palliative, decompression, or drainage procedures. Many of these procedures can be performed endoscopically, while others require a more invasive, surgical approach. The effectiveness of these therapies is not only highly variable but also often controversial. This review will discuss the endoscopic options for pain management in patients with chronic pancreatitis and their utility in treating this difficult disease.