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VIDEO: Hidradenitis suppurativa in pediatrics similar to that in adults
WASHINGTON– Hidradenitis suppurativa (HS) can present early in adolescence, and the approach to treatment in pediatric patients is similar to treatment in adults, “with a few caveats,” A. Yasmine Kirkorian, MD, said in a video interview at an educational session held by George Washington University.
While the literature often states that HS starts in a person’s 20s, it primarily starts in adolescence, sometimes earlier, with a presentation that is similar to that seen in adults and appearing at the same sites, such as the armpits and groin, said Dr. Kirkorian a pediatric dermatologist at Children’s National Health System and George Washington University, Washington.
“As dermatologists, we know this. Kids are getting this disease, but we need to characterize that better in the literature so that we can start to apply the adult style therapeutics in clinical trials ... to children,” she added.
In the interview, Dr. Kirkorian discussed treatment strategies, as well as familial cases of HS and the links between HS and Down syndrome and inflammatory bowel disease in children.
The meeting was sponsored by AbbVie. Dr. Kirkorian had no financial conflicts to disclose.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
WASHINGTON– Hidradenitis suppurativa (HS) can present early in adolescence, and the approach to treatment in pediatric patients is similar to treatment in adults, “with a few caveats,” A. Yasmine Kirkorian, MD, said in a video interview at an educational session held by George Washington University.
While the literature often states that HS starts in a person’s 20s, it primarily starts in adolescence, sometimes earlier, with a presentation that is similar to that seen in adults and appearing at the same sites, such as the armpits and groin, said Dr. Kirkorian a pediatric dermatologist at Children’s National Health System and George Washington University, Washington.
“As dermatologists, we know this. Kids are getting this disease, but we need to characterize that better in the literature so that we can start to apply the adult style therapeutics in clinical trials ... to children,” she added.
In the interview, Dr. Kirkorian discussed treatment strategies, as well as familial cases of HS and the links between HS and Down syndrome and inflammatory bowel disease in children.
The meeting was sponsored by AbbVie. Dr. Kirkorian had no financial conflicts to disclose.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
WASHINGTON– Hidradenitis suppurativa (HS) can present early in adolescence, and the approach to treatment in pediatric patients is similar to treatment in adults, “with a few caveats,” A. Yasmine Kirkorian, MD, said in a video interview at an educational session held by George Washington University.
While the literature often states that HS starts in a person’s 20s, it primarily starts in adolescence, sometimes earlier, with a presentation that is similar to that seen in adults and appearing at the same sites, such as the armpits and groin, said Dr. Kirkorian a pediatric dermatologist at Children’s National Health System and George Washington University, Washington.
“As dermatologists, we know this. Kids are getting this disease, but we need to characterize that better in the literature so that we can start to apply the adult style therapeutics in clinical trials ... to children,” she added.
In the interview, Dr. Kirkorian discussed treatment strategies, as well as familial cases of HS and the links between HS and Down syndrome and inflammatory bowel disease in children.
The meeting was sponsored by AbbVie. Dr. Kirkorian had no financial conflicts to disclose.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
After the epidemic, Ebola’s destructive power still haunts survivors
VIENNA – The Ebola crisis may be over in Sierra Leone, but the suffering is not.
The last patient from the epidemic was discharged in February 2016, but 78% of survivors now appear to have one or more sequelae of the infection. Some problems are mild, but some are so debilitating that life may never be the same.
Janet Scott, MD, of the University of Liverpool (England), heads a task force studying Ebola’s lingering aftereffects. These fall into four categories, Dr. Scott said at the European Society of Clinical Microbiology and Infectious Diseases annual congress: musculoskeletal pain, headache, eye problems, and psychological disorders.
They add up to an enormous risk of disability – survivors are more than 200 times more likely than controls to express at least moderate disability.
Dr. Scott and her team of researchers are partnering with clinicians and data managers in the Ebola treatment unit in the 34th Regimental Military Hospital (MH34) in Freetown, Sierra Leone. In Sierra Leone alone, she said, there were nearly 9,000 cases and 3,500 deaths from the virus; about 5,000 patients survived. So far, Dr. Scott and her team have collected data on about 500 patients for whom they also provide free health care.
The project has six arms, each headed by an expert: clinical care, data collection, disability, neurology, ophthalmology, and psychiatry.
The team sees patients in a large tent sectioned by a plywood wall*. Wireless Internet access, which she said is “enormously expensive” in Sierra Leone, has been donated by Omline Business Communications*. It’s the team’s lifeline, allowing them to transmit data between Freetown and participating units around the world. Members also Skype regularly, talking with patients and with each other.
All patients who come into the clinic have an initial visit that includes collection of demographics, their Ebola and clinical history (including an exploration of comorbidities), a maternal health screening for women, vital signs and symptom assessment, medication dispensing, and a treatment plan.
Then they visit the specialists, either onsite or through local referral*. These specialist modules include joints, eyes, headache, ears, neurology, cardiac, respiratory, gastrointestinal, renal and urologic, reproductive health for both genders, and psychiatry.
Last year, Dr. Scott published initial data on 44 patients. At ECCMID 2017, she expanded that report to include 203 survivors. They spanned all ages, but about 67% were in their most productive adult years, aged 20-39 years.
Her findings are striking: About 78% report musculoskeletal pain, with many saying they have trouble walking even short distances, climbing stairs, or picking up their children.
Headache was the next most common problem, reported by nearly 40%. About 15% report ocular problems, which include anterior uveitis, cataracts – even in very young children – and retinal lesions. Abdominal and chest pain affect about 10% of the survivors.
Although she didn’t present specific numbers, Dr. Scott also said that many of the survivors experience psychological sequelae, including insomnia, anxiety, and depression. Whether this is related to viral pathology isn’t clear; it could be a not-unexpected response to the trauma of living through the epidemic.
“Many of these people have lost their entire family, and those that are left now shun them,” she said in a live video interview on Facebook. “It’s almost like a post-traumatic stress reaction.”
The other symptoms probably are related to the disease pathology, she observed. “Unfortunately, we don’t have all the clinical details of the acute phase for everyone, but for those for whom we do have details, we are seeing correlation between some of the problems with viral loads at admission, and even episodes of becoming unconscious during the acute illness.”
Patrick Howlett, MD, of the King’s Sierra Leone Partnership, Freetown, leads the neurology study. So far, the researchers have collected data on 19 patients with severe neurological consequences. Of those, 12 (63%) experienced a period of unconsciousness during their acute Ebola episode. In a comparator group of 21 with nonsevere neurologic sequelae, 33% had experienced unconsciousness.
Headache was present in nine (47%) of the patients. Migraine was the most common diagnosis. “We don’t have money for migraine medications, but fortunately, most of our migraine patients seem to be doing well on beta blockers,” Dr. Scott said.
CT scans were performed on 17 patients: three showed cerebral or cerebellar atrophy and two had confirmed stroke.
The brain injuries were severe in two, including a 42-year-old with extensive gliosis in the left middle cerebral artery region and a dilated left ventricle secondary to loss of volume in that hemisphere. A 12-year-old girl showed extensive parietal and temporal lobe atrophy. She is now so disabled that her family can’t care for her at home.
Other neurological problems include peripheral neuropathy, brachial plexus neuropathy, and asymmetric lower limb muscular atrophy.
Paul Steptoe, MD, an ophthalmic registrar from St. Paul’s Eye Unit at the Royal Liverpool Hospital, heads the eye study. He has observed dense cataracts, even in children, and anterior uveitis that has blinded some patients. There is concern about live virus persisting in vitreal fluid, but two eye taps have been negative, Dr. Scott said.
The most exciting recent finding, however, was made possible by the donation of a digital retinal camera, which “enabled us to get dozens of amazing images,” Dr. Scott said. With it, Dr. Steptoe conducted a case-control study of 81 Ebola survivors and 106 community controls. The findings of this study are potentially very, very important, Dr. Scott said.
“The first thing we found out is that retinal scarring is pervasive in our control patients,” she said. “There is just a lot of it out here in the community. But more interesting is that Dr. Steptoe seems to have identified a characteristic retinal lesion seen only in our survivors. It could be evidence of neurotropic aspects of the Ebola virus.”
The lesions occurred in 12 (15%) of the survivors and none of the controls. They are of a striking and consistent shape: straight-edged and sharply angulated. The lesions are only on the surface of the retina and do not penetrate into deeper levels. Nor do they interfere with vision. Dr. Steptoe has proposed that they take their angular shape from the retina’s underlying structures. His paper documenting this finding has been accepted and will be published shortly in the journal Emerging Infectious Diseases.
All of the post-Ebola sequelae add up to general disability for survivors, Dr. Scott said. Soushieta Jagadesh, of the* Liverpool School of Tropical Medicine, is conducting a disability survey. The comparison between 27 survivors and 54 community controls employed the Washington Group extended disability questionnaire. “We noted major limitations 1 year after discharge in mobility, vision, cognition, and affect,” Dr. Scott said.
The hazard ratios for these issues are enormous: Overall, compared with controls, survivors were 23 times more likely to have some level of disability. They were 94 times more likely to have walking limitations and 65 times more likely to have problems with stairs. Survivors were over 200 times more likely to have moderate disability than were their unaffected neighbors.
If funding for the project is renewed – and Dr. Scott admitted this is an “if,” not a “when” – caring for and studying these survivors will continue. Just in this one city, she said, the need is huge.
According to data from the U.S. Centers for Disease Control and Prevention, more than 17,000 patients in Sierra Leone, Liberia, and Guinea survived the 2014 Ebola outbreak.
If the assessments of Freetown survivors hold true across this population, thousands of survivors face life-limiting sequelae of the disease.
“We still have patients walk in every day with musculoskeletal pain, headaches, and ocular issues,” Dr. Scott said. “At the beginning of the epidemic, we were just focusing on containing it and reducing transmission. Now, we are faced with the long-term consequences.”
The Wellcome Trust supported the study. The authors have been awarded a grant from the Enhancing Research Activity in Epidemic Situations (ERAES) program, funded by the Wellcome Trust to support further research into the sequelae of Ebola virus disease.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
msullivan@frontlinemedcom.com
On Twitter @Alz_gal
*This story was updated May 2, 2017.
VIENNA – The Ebola crisis may be over in Sierra Leone, but the suffering is not.
The last patient from the epidemic was discharged in February 2016, but 78% of survivors now appear to have one or more sequelae of the infection. Some problems are mild, but some are so debilitating that life may never be the same.
Janet Scott, MD, of the University of Liverpool (England), heads a task force studying Ebola’s lingering aftereffects. These fall into four categories, Dr. Scott said at the European Society of Clinical Microbiology and Infectious Diseases annual congress: musculoskeletal pain, headache, eye problems, and psychological disorders.
They add up to an enormous risk of disability – survivors are more than 200 times more likely than controls to express at least moderate disability.
Dr. Scott and her team of researchers are partnering with clinicians and data managers in the Ebola treatment unit in the 34th Regimental Military Hospital (MH34) in Freetown, Sierra Leone. In Sierra Leone alone, she said, there were nearly 9,000 cases and 3,500 deaths from the virus; about 5,000 patients survived. So far, Dr. Scott and her team have collected data on about 500 patients for whom they also provide free health care.
The project has six arms, each headed by an expert: clinical care, data collection, disability, neurology, ophthalmology, and psychiatry.
The team sees patients in a large tent sectioned by a plywood wall*. Wireless Internet access, which she said is “enormously expensive” in Sierra Leone, has been donated by Omline Business Communications*. It’s the team’s lifeline, allowing them to transmit data between Freetown and participating units around the world. Members also Skype regularly, talking with patients and with each other.
All patients who come into the clinic have an initial visit that includes collection of demographics, their Ebola and clinical history (including an exploration of comorbidities), a maternal health screening for women, vital signs and symptom assessment, medication dispensing, and a treatment plan.
Then they visit the specialists, either onsite or through local referral*. These specialist modules include joints, eyes, headache, ears, neurology, cardiac, respiratory, gastrointestinal, renal and urologic, reproductive health for both genders, and psychiatry.
Last year, Dr. Scott published initial data on 44 patients. At ECCMID 2017, she expanded that report to include 203 survivors. They spanned all ages, but about 67% were in their most productive adult years, aged 20-39 years.
Her findings are striking: About 78% report musculoskeletal pain, with many saying they have trouble walking even short distances, climbing stairs, or picking up their children.
Headache was the next most common problem, reported by nearly 40%. About 15% report ocular problems, which include anterior uveitis, cataracts – even in very young children – and retinal lesions. Abdominal and chest pain affect about 10% of the survivors.
Although she didn’t present specific numbers, Dr. Scott also said that many of the survivors experience psychological sequelae, including insomnia, anxiety, and depression. Whether this is related to viral pathology isn’t clear; it could be a not-unexpected response to the trauma of living through the epidemic.
“Many of these people have lost their entire family, and those that are left now shun them,” she said in a live video interview on Facebook. “It’s almost like a post-traumatic stress reaction.”
The other symptoms probably are related to the disease pathology, she observed. “Unfortunately, we don’t have all the clinical details of the acute phase for everyone, but for those for whom we do have details, we are seeing correlation between some of the problems with viral loads at admission, and even episodes of becoming unconscious during the acute illness.”
Patrick Howlett, MD, of the King’s Sierra Leone Partnership, Freetown, leads the neurology study. So far, the researchers have collected data on 19 patients with severe neurological consequences. Of those, 12 (63%) experienced a period of unconsciousness during their acute Ebola episode. In a comparator group of 21 with nonsevere neurologic sequelae, 33% had experienced unconsciousness.
Headache was present in nine (47%) of the patients. Migraine was the most common diagnosis. “We don’t have money for migraine medications, but fortunately, most of our migraine patients seem to be doing well on beta blockers,” Dr. Scott said.
CT scans were performed on 17 patients: three showed cerebral or cerebellar atrophy and two had confirmed stroke.
The brain injuries were severe in two, including a 42-year-old with extensive gliosis in the left middle cerebral artery region and a dilated left ventricle secondary to loss of volume in that hemisphere. A 12-year-old girl showed extensive parietal and temporal lobe atrophy. She is now so disabled that her family can’t care for her at home.
Other neurological problems include peripheral neuropathy, brachial plexus neuropathy, and asymmetric lower limb muscular atrophy.
Paul Steptoe, MD, an ophthalmic registrar from St. Paul’s Eye Unit at the Royal Liverpool Hospital, heads the eye study. He has observed dense cataracts, even in children, and anterior uveitis that has blinded some patients. There is concern about live virus persisting in vitreal fluid, but two eye taps have been negative, Dr. Scott said.
The most exciting recent finding, however, was made possible by the donation of a digital retinal camera, which “enabled us to get dozens of amazing images,” Dr. Scott said. With it, Dr. Steptoe conducted a case-control study of 81 Ebola survivors and 106 community controls. The findings of this study are potentially very, very important, Dr. Scott said.
“The first thing we found out is that retinal scarring is pervasive in our control patients,” she said. “There is just a lot of it out here in the community. But more interesting is that Dr. Steptoe seems to have identified a characteristic retinal lesion seen only in our survivors. It could be evidence of neurotropic aspects of the Ebola virus.”
The lesions occurred in 12 (15%) of the survivors and none of the controls. They are of a striking and consistent shape: straight-edged and sharply angulated. The lesions are only on the surface of the retina and do not penetrate into deeper levels. Nor do they interfere with vision. Dr. Steptoe has proposed that they take their angular shape from the retina’s underlying structures. His paper documenting this finding has been accepted and will be published shortly in the journal Emerging Infectious Diseases.
All of the post-Ebola sequelae add up to general disability for survivors, Dr. Scott said. Soushieta Jagadesh, of the* Liverpool School of Tropical Medicine, is conducting a disability survey. The comparison between 27 survivors and 54 community controls employed the Washington Group extended disability questionnaire. “We noted major limitations 1 year after discharge in mobility, vision, cognition, and affect,” Dr. Scott said.
The hazard ratios for these issues are enormous: Overall, compared with controls, survivors were 23 times more likely to have some level of disability. They were 94 times more likely to have walking limitations and 65 times more likely to have problems with stairs. Survivors were over 200 times more likely to have moderate disability than were their unaffected neighbors.
If funding for the project is renewed – and Dr. Scott admitted this is an “if,” not a “when” – caring for and studying these survivors will continue. Just in this one city, she said, the need is huge.
According to data from the U.S. Centers for Disease Control and Prevention, more than 17,000 patients in Sierra Leone, Liberia, and Guinea survived the 2014 Ebola outbreak.
If the assessments of Freetown survivors hold true across this population, thousands of survivors face life-limiting sequelae of the disease.
“We still have patients walk in every day with musculoskeletal pain, headaches, and ocular issues,” Dr. Scott said. “At the beginning of the epidemic, we were just focusing on containing it and reducing transmission. Now, we are faced with the long-term consequences.”
The Wellcome Trust supported the study. The authors have been awarded a grant from the Enhancing Research Activity in Epidemic Situations (ERAES) program, funded by the Wellcome Trust to support further research into the sequelae of Ebola virus disease.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
msullivan@frontlinemedcom.com
On Twitter @Alz_gal
*This story was updated May 2, 2017.
VIENNA – The Ebola crisis may be over in Sierra Leone, but the suffering is not.
The last patient from the epidemic was discharged in February 2016, but 78% of survivors now appear to have one or more sequelae of the infection. Some problems are mild, but some are so debilitating that life may never be the same.
Janet Scott, MD, of the University of Liverpool (England), heads a task force studying Ebola’s lingering aftereffects. These fall into four categories, Dr. Scott said at the European Society of Clinical Microbiology and Infectious Diseases annual congress: musculoskeletal pain, headache, eye problems, and psychological disorders.
They add up to an enormous risk of disability – survivors are more than 200 times more likely than controls to express at least moderate disability.
Dr. Scott and her team of researchers are partnering with clinicians and data managers in the Ebola treatment unit in the 34th Regimental Military Hospital (MH34) in Freetown, Sierra Leone. In Sierra Leone alone, she said, there were nearly 9,000 cases and 3,500 deaths from the virus; about 5,000 patients survived. So far, Dr. Scott and her team have collected data on about 500 patients for whom they also provide free health care.
The project has six arms, each headed by an expert: clinical care, data collection, disability, neurology, ophthalmology, and psychiatry.
The team sees patients in a large tent sectioned by a plywood wall*. Wireless Internet access, which she said is “enormously expensive” in Sierra Leone, has been donated by Omline Business Communications*. It’s the team’s lifeline, allowing them to transmit data between Freetown and participating units around the world. Members also Skype regularly, talking with patients and with each other.
All patients who come into the clinic have an initial visit that includes collection of demographics, their Ebola and clinical history (including an exploration of comorbidities), a maternal health screening for women, vital signs and symptom assessment, medication dispensing, and a treatment plan.
Then they visit the specialists, either onsite or through local referral*. These specialist modules include joints, eyes, headache, ears, neurology, cardiac, respiratory, gastrointestinal, renal and urologic, reproductive health for both genders, and psychiatry.
Last year, Dr. Scott published initial data on 44 patients. At ECCMID 2017, she expanded that report to include 203 survivors. They spanned all ages, but about 67% were in their most productive adult years, aged 20-39 years.
Her findings are striking: About 78% report musculoskeletal pain, with many saying they have trouble walking even short distances, climbing stairs, or picking up their children.
Headache was the next most common problem, reported by nearly 40%. About 15% report ocular problems, which include anterior uveitis, cataracts – even in very young children – and retinal lesions. Abdominal and chest pain affect about 10% of the survivors.
Although she didn’t present specific numbers, Dr. Scott also said that many of the survivors experience psychological sequelae, including insomnia, anxiety, and depression. Whether this is related to viral pathology isn’t clear; it could be a not-unexpected response to the trauma of living through the epidemic.
“Many of these people have lost their entire family, and those that are left now shun them,” she said in a live video interview on Facebook. “It’s almost like a post-traumatic stress reaction.”
The other symptoms probably are related to the disease pathology, she observed. “Unfortunately, we don’t have all the clinical details of the acute phase for everyone, but for those for whom we do have details, we are seeing correlation between some of the problems with viral loads at admission, and even episodes of becoming unconscious during the acute illness.”
Patrick Howlett, MD, of the King’s Sierra Leone Partnership, Freetown, leads the neurology study. So far, the researchers have collected data on 19 patients with severe neurological consequences. Of those, 12 (63%) experienced a period of unconsciousness during their acute Ebola episode. In a comparator group of 21 with nonsevere neurologic sequelae, 33% had experienced unconsciousness.
Headache was present in nine (47%) of the patients. Migraine was the most common diagnosis. “We don’t have money for migraine medications, but fortunately, most of our migraine patients seem to be doing well on beta blockers,” Dr. Scott said.
CT scans were performed on 17 patients: three showed cerebral or cerebellar atrophy and two had confirmed stroke.
The brain injuries were severe in two, including a 42-year-old with extensive gliosis in the left middle cerebral artery region and a dilated left ventricle secondary to loss of volume in that hemisphere. A 12-year-old girl showed extensive parietal and temporal lobe atrophy. She is now so disabled that her family can’t care for her at home.
Other neurological problems include peripheral neuropathy, brachial plexus neuropathy, and asymmetric lower limb muscular atrophy.
Paul Steptoe, MD, an ophthalmic registrar from St. Paul’s Eye Unit at the Royal Liverpool Hospital, heads the eye study. He has observed dense cataracts, even in children, and anterior uveitis that has blinded some patients. There is concern about live virus persisting in vitreal fluid, but two eye taps have been negative, Dr. Scott said.
The most exciting recent finding, however, was made possible by the donation of a digital retinal camera, which “enabled us to get dozens of amazing images,” Dr. Scott said. With it, Dr. Steptoe conducted a case-control study of 81 Ebola survivors and 106 community controls. The findings of this study are potentially very, very important, Dr. Scott said.
“The first thing we found out is that retinal scarring is pervasive in our control patients,” she said. “There is just a lot of it out here in the community. But more interesting is that Dr. Steptoe seems to have identified a characteristic retinal lesion seen only in our survivors. It could be evidence of neurotropic aspects of the Ebola virus.”
The lesions occurred in 12 (15%) of the survivors and none of the controls. They are of a striking and consistent shape: straight-edged and sharply angulated. The lesions are only on the surface of the retina and do not penetrate into deeper levels. Nor do they interfere with vision. Dr. Steptoe has proposed that they take their angular shape from the retina’s underlying structures. His paper documenting this finding has been accepted and will be published shortly in the journal Emerging Infectious Diseases.
All of the post-Ebola sequelae add up to general disability for survivors, Dr. Scott said. Soushieta Jagadesh, of the* Liverpool School of Tropical Medicine, is conducting a disability survey. The comparison between 27 survivors and 54 community controls employed the Washington Group extended disability questionnaire. “We noted major limitations 1 year after discharge in mobility, vision, cognition, and affect,” Dr. Scott said.
The hazard ratios for these issues are enormous: Overall, compared with controls, survivors were 23 times more likely to have some level of disability. They were 94 times more likely to have walking limitations and 65 times more likely to have problems with stairs. Survivors were over 200 times more likely to have moderate disability than were their unaffected neighbors.
If funding for the project is renewed – and Dr. Scott admitted this is an “if,” not a “when” – caring for and studying these survivors will continue. Just in this one city, she said, the need is huge.
According to data from the U.S. Centers for Disease Control and Prevention, more than 17,000 patients in Sierra Leone, Liberia, and Guinea survived the 2014 Ebola outbreak.
If the assessments of Freetown survivors hold true across this population, thousands of survivors face life-limiting sequelae of the disease.
“We still have patients walk in every day with musculoskeletal pain, headaches, and ocular issues,” Dr. Scott said. “At the beginning of the epidemic, we were just focusing on containing it and reducing transmission. Now, we are faced with the long-term consequences.”
The Wellcome Trust supported the study. The authors have been awarded a grant from the Enhancing Research Activity in Epidemic Situations (ERAES) program, funded by the Wellcome Trust to support further research into the sequelae of Ebola virus disease.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
msullivan@frontlinemedcom.com
On Twitter @Alz_gal
*This story was updated May 2, 2017.
AT ECCMID 2017
VIDEO: Geeks brave rain to March for Science
WASHINGTON – Peaceful protesters in hundreds of cities around the globe gathered on Earth Day, April 22, to voice their support for evidence-based policies and funding for scientific research at the March for Science.
In Washington, thousands of participants gathered on the rainy National Mall for teach-ins and speeches, then marched from the Washington Monument to Capitol Hill. A key concern for marchers here was cuts in science agency funding in the Trump administration’s budget proposal for fiscal year 2018.
Organizers now are calling on supporters to participate in a week of action to continue to demonstrate widespread support for their positions.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
dfulton@frontlinemedcom.com
On Twitter @denisefulton
WASHINGTON – Peaceful protesters in hundreds of cities around the globe gathered on Earth Day, April 22, to voice their support for evidence-based policies and funding for scientific research at the March for Science.
In Washington, thousands of participants gathered on the rainy National Mall for teach-ins and speeches, then marched from the Washington Monument to Capitol Hill. A key concern for marchers here was cuts in science agency funding in the Trump administration’s budget proposal for fiscal year 2018.
Organizers now are calling on supporters to participate in a week of action to continue to demonstrate widespread support for their positions.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
dfulton@frontlinemedcom.com
On Twitter @denisefulton
WASHINGTON – Peaceful protesters in hundreds of cities around the globe gathered on Earth Day, April 22, to voice their support for evidence-based policies and funding for scientific research at the March for Science.
In Washington, thousands of participants gathered on the rainy National Mall for teach-ins and speeches, then marched from the Washington Monument to Capitol Hill. A key concern for marchers here was cuts in science agency funding in the Trump administration’s budget proposal for fiscal year 2018.
Organizers now are calling on supporters to participate in a week of action to continue to demonstrate widespread support for their positions.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
dfulton@frontlinemedcom.com
On Twitter @denisefulton
VIDEO: Surgery succeeds with select hidradenitis suppurativa patients
WASHINGTON – Medication has its limits for some patients with more severe hidradenitis suppurativa, and these patients can often benefit from surgical treatment, Chris Sayed, MD, said at an educational session held by George Washington University.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
“Especially if patients have relatively limited areas of sinus, being able to do some local procedures [is] what will get the patient a lot better,” Dr. Sayed of the department of dermatology at the University of North Carolina, Chapel Hill, said in a video interview. “Whereas the medicines would never have made that sinus go away.”
The meeting was supported by AbbVie. Dr. Sayed disclosed financial relationships with the company.
WASHINGTON – Medication has its limits for some patients with more severe hidradenitis suppurativa, and these patients can often benefit from surgical treatment, Chris Sayed, MD, said at an educational session held by George Washington University.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
“Especially if patients have relatively limited areas of sinus, being able to do some local procedures [is] what will get the patient a lot better,” Dr. Sayed of the department of dermatology at the University of North Carolina, Chapel Hill, said in a video interview. “Whereas the medicines would never have made that sinus go away.”
The meeting was supported by AbbVie. Dr. Sayed disclosed financial relationships with the company.
WASHINGTON – Medication has its limits for some patients with more severe hidradenitis suppurativa, and these patients can often benefit from surgical treatment, Chris Sayed, MD, said at an educational session held by George Washington University.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
“Especially if patients have relatively limited areas of sinus, being able to do some local procedures [is] what will get the patient a lot better,” Dr. Sayed of the department of dermatology at the University of North Carolina, Chapel Hill, said in a video interview. “Whereas the medicines would never have made that sinus go away.”
The meeting was supported by AbbVie. Dr. Sayed disclosed financial relationships with the company.
Medial Patellofemoral Ligament Repair
Video, Part 1. Femoral Attachment
1. Ultrasound is used to identify femoral and patellar attachments of medial patellofemoral ligament (MPFL).
2. MPFL is followed from patella to its attachment near adductor tubercle.
3. In-plane ultrasound guidance is used to place needle anterior and distal to tubercle.
4. Percutaneous incision is made down to needle tip. Spear is placed at needle tip for anatomical placement of socket.
5. Socket is drilled.
6. 3.0-mm suture anchor (BioComposite Knotless SutureTak; Arthrex) is placed.
7. Leading edge of torn MPFL is identified.
8. Suture passer (Labral FastPass Scorpion; Arthrex) is used to pass sutures through leading edge of torn MPFL to create horizontal mattress.
9. Sutures are tied.
10. Repair is complete.
Video, Part 2. Patellar Attachment
1. Ultrasound is used to scan patella to identify ideal or exact location of tear. In-plane ultrasound guidance is used to place spinal needle at desired socket location.
2. After spinal needle is positioned, in-line percutaneous incision is made, and needle is palpated at patella.
3. Spear is then placed at spinal needle tip for anatomical positioning of socket.
4. Socket is drilled.
5. 3.0-mm suture anchor (BioComposite Knotless SutureTak; Arthrex) is placed in socket.
6. Leading edge of torn medial patellofemoral ligament (MPFL) is identified.
7. Suture passer (Labral Past Pass Scorpion; Arthrex) is used to pass suture from anchor in horizontal mattress fashion through leading edge of torn MPFL.
8. Wire with loop (FiberSnare; Arthrex) is used as part of knotless technology to pull suture back through anchor to create knotless fixation.
9. Suture is pulled for appropriate tensioning of tissue.
10. Ultrasound is used to visualize construct to confirm that MPFL tissue abuts anchor and that repair is complete.
Video, Part 1. Femoral Attachment
1. Ultrasound is used to identify femoral and patellar attachments of medial patellofemoral ligament (MPFL).
2. MPFL is followed from patella to its attachment near adductor tubercle.
3. In-plane ultrasound guidance is used to place needle anterior and distal to tubercle.
4. Percutaneous incision is made down to needle tip. Spear is placed at needle tip for anatomical placement of socket.
5. Socket is drilled.
6. 3.0-mm suture anchor (BioComposite Knotless SutureTak; Arthrex) is placed.
7. Leading edge of torn MPFL is identified.
8. Suture passer (Labral FastPass Scorpion; Arthrex) is used to pass sutures through leading edge of torn MPFL to create horizontal mattress.
9. Sutures are tied.
10. Repair is complete.
Video, Part 2. Patellar Attachment
1. Ultrasound is used to scan patella to identify ideal or exact location of tear. In-plane ultrasound guidance is used to place spinal needle at desired socket location.
2. After spinal needle is positioned, in-line percutaneous incision is made, and needle is palpated at patella.
3. Spear is then placed at spinal needle tip for anatomical positioning of socket.
4. Socket is drilled.
5. 3.0-mm suture anchor (BioComposite Knotless SutureTak; Arthrex) is placed in socket.
6. Leading edge of torn medial patellofemoral ligament (MPFL) is identified.
7. Suture passer (Labral Past Pass Scorpion; Arthrex) is used to pass suture from anchor in horizontal mattress fashion through leading edge of torn MPFL.
8. Wire with loop (FiberSnare; Arthrex) is used as part of knotless technology to pull suture back through anchor to create knotless fixation.
9. Suture is pulled for appropriate tensioning of tissue.
10. Ultrasound is used to visualize construct to confirm that MPFL tissue abuts anchor and that repair is complete.
Video, Part 1. Femoral Attachment
1. Ultrasound is used to identify femoral and patellar attachments of medial patellofemoral ligament (MPFL).
2. MPFL is followed from patella to its attachment near adductor tubercle.
3. In-plane ultrasound guidance is used to place needle anterior and distal to tubercle.
4. Percutaneous incision is made down to needle tip. Spear is placed at needle tip for anatomical placement of socket.
5. Socket is drilled.
6. 3.0-mm suture anchor (BioComposite Knotless SutureTak; Arthrex) is placed.
7. Leading edge of torn MPFL is identified.
8. Suture passer (Labral FastPass Scorpion; Arthrex) is used to pass sutures through leading edge of torn MPFL to create horizontal mattress.
9. Sutures are tied.
10. Repair is complete.
Video, Part 2. Patellar Attachment
1. Ultrasound is used to scan patella to identify ideal or exact location of tear. In-plane ultrasound guidance is used to place spinal needle at desired socket location.
2. After spinal needle is positioned, in-line percutaneous incision is made, and needle is palpated at patella.
3. Spear is then placed at spinal needle tip for anatomical positioning of socket.
4. Socket is drilled.
5. 3.0-mm suture anchor (BioComposite Knotless SutureTak; Arthrex) is placed in socket.
6. Leading edge of torn medial patellofemoral ligament (MPFL) is identified.
7. Suture passer (Labral Past Pass Scorpion; Arthrex) is used to pass suture from anchor in horizontal mattress fashion through leading edge of torn MPFL.
8. Wire with loop (FiberSnare; Arthrex) is used as part of knotless technology to pull suture back through anchor to create knotless fixation.
9. Suture is pulled for appropriate tensioning of tissue.
10. Ultrasound is used to visualize construct to confirm that MPFL tissue abuts anchor and that repair is complete.
VIDEO: Awardee's work targets mucosal stem cells in Crohn’s, ulcerative colitis
BOSTON – A series of important technological advances in cloning stem cells of the gastrointestinal tract is rewriting the basic concepts surrounding these cells and has the potential to advance understanding of GI conditions such as Barrett’s esophagus and Crohn’s disease, according to the winner of the 2016 AGA-Medtronic Research and Development Pilot Award in Technology.
The award is sponsored by Medtronic and administered through the AGA Research Foundation. “Medtronic is pleased to partner with the AGA Research Foundation in supporting research to improve patient outcomes,” said Vafa Jamali, president of Early Technologies’ business with Medtronic. “We are dedicated to support patient-friendly innovations enabling the early detection and treatment of chronic GI diseases and cancers.”
“The enabling technology we developed is the means of cloning and propagating single mucosal stem cells from discrete regions of the gastrointestinal tract in their most immature form. What we have shown is that these stem cells from normal individuals are essentially immortal, are genetically stable, and, critically, are rigorously regiospecific,” Dr. Xian of the Institute of Molecular Medicine for the Prevention of Human Diseases, University of Texas Health Science Center, Houston, said in an interview.
“This regiospecificity – duodenum stem cells always yield duodenum epithelia, ascending colon stem cells produce ascending colon epithelia – has important implications for both regenerative medicine and drug discovery,” she added.
With regard to the dominant stem cell technologies in use today, including induced pluripotent stem cells and organoid cultures of the gastrointestinal tract, Dr. Xian’s technology represents a paradigm shift.
Dr. Xian’s system generates pure “ground state” stem cells that differentiate in 3-D culture to an epithelium indistinguishable from textbook images of in situ epithelia, at rates 250 times faster than intestinal organoid systems.
This system is being applied in major investigations into Barrett’s esophagus and inflammatory bowel disease in collaboration with investigators at multiple centers in the United States and Singapore.
For Barrett’s, Dr. Xian has developed patient-matched stem cells from endoscopic biopsies of esophageal, Barrett’s, and gastric cardia to show that each arises from distinct lineages, and that the Barrett’s stem cells accumulate genetic alterations not found in those of the matched normal epithelia. These stem cells have been adapted to a drug-screening platform to identify leads that specifically eliminate Barrett’s with an eye on preemptive therapies.
Her work on mucosal stem cells in patients with Crohn’s and ulcerative colitis is revealing a coexistence of normal and pathogenic stem cells in these patients that may alter concepts of both the etiology and treatment of these conditions.
Dr. Xian suggests that treatment of Crohn’s may become analogous to treatment of cancer – emphasizing preservation of healthy cells while eliminating diseased cells – and move therapy from the current effort to induce a quiescent inflammatory state to one in which the goal is cure.
“These findings appear to indicate that some of the chronic inflammatory conditions so prevalent in gastroenterology, as well as the cancers arising from them, may have as their basis profound alterations in mucosal stem cell biology,” she added.
Though it’s still early days with this technology, its single-cell resolution naturally melds with other emerging genomic and genome editing technologies into a powerful means of dissecting the molecular basis of disease and realizing the potential of autologous regenerative medicine, according to Dr. Xian.
Following Dr. Xian’s presentation, Michael L. Kochman, MD, who is executive committee chair of the AGA Center for GI Innovation and Technology, announced the winner of the 2017 AGA-Medtronic Research and Development Pilot Award in Technology. The award was presented to Bani Chander Roland, MD, of Lenox Hill Hospital & Northwell Health System, New York. Her research will involve assessment of the ileocecal valve.
“She has several aims in this proposal to really understand better the causes of ileosphincter dysfunction using a novel method of measuring ileocecal junction pressures,” reported Dr. Kochman. He explained that other parts of the proposal included ileocecal evaluation with wireless capsule endoscopy as well as an evaluation of flora across the GI tract.
A new award to foster innovation in GI medtech is also planned. In partnership with Boston Scientific, the AGA has established the AGA-Boston Scientific Technology and Innovation Pilot Award. This $30,000 research grant will support investigators at any career stage who are developing and testing new medical devices and technologies with applications in gastroenterology and hepatology. The details of the award will be available on the AGA’s website in May. Applications for the award will be accepted beginning in the fall.
BOSTON – A series of important technological advances in cloning stem cells of the gastrointestinal tract is rewriting the basic concepts surrounding these cells and has the potential to advance understanding of GI conditions such as Barrett’s esophagus and Crohn’s disease, according to the winner of the 2016 AGA-Medtronic Research and Development Pilot Award in Technology.
The award is sponsored by Medtronic and administered through the AGA Research Foundation. “Medtronic is pleased to partner with the AGA Research Foundation in supporting research to improve patient outcomes,” said Vafa Jamali, president of Early Technologies’ business with Medtronic. “We are dedicated to support patient-friendly innovations enabling the early detection and treatment of chronic GI diseases and cancers.”
“The enabling technology we developed is the means of cloning and propagating single mucosal stem cells from discrete regions of the gastrointestinal tract in their most immature form. What we have shown is that these stem cells from normal individuals are essentially immortal, are genetically stable, and, critically, are rigorously regiospecific,” Dr. Xian of the Institute of Molecular Medicine for the Prevention of Human Diseases, University of Texas Health Science Center, Houston, said in an interview.
“This regiospecificity – duodenum stem cells always yield duodenum epithelia, ascending colon stem cells produce ascending colon epithelia – has important implications for both regenerative medicine and drug discovery,” she added.
With regard to the dominant stem cell technologies in use today, including induced pluripotent stem cells and organoid cultures of the gastrointestinal tract, Dr. Xian’s technology represents a paradigm shift.
Dr. Xian’s system generates pure “ground state” stem cells that differentiate in 3-D culture to an epithelium indistinguishable from textbook images of in situ epithelia, at rates 250 times faster than intestinal organoid systems.
This system is being applied in major investigations into Barrett’s esophagus and inflammatory bowel disease in collaboration with investigators at multiple centers in the United States and Singapore.
For Barrett’s, Dr. Xian has developed patient-matched stem cells from endoscopic biopsies of esophageal, Barrett’s, and gastric cardia to show that each arises from distinct lineages, and that the Barrett’s stem cells accumulate genetic alterations not found in those of the matched normal epithelia. These stem cells have been adapted to a drug-screening platform to identify leads that specifically eliminate Barrett’s with an eye on preemptive therapies.
Her work on mucosal stem cells in patients with Crohn’s and ulcerative colitis is revealing a coexistence of normal and pathogenic stem cells in these patients that may alter concepts of both the etiology and treatment of these conditions.
Dr. Xian suggests that treatment of Crohn’s may become analogous to treatment of cancer – emphasizing preservation of healthy cells while eliminating diseased cells – and move therapy from the current effort to induce a quiescent inflammatory state to one in which the goal is cure.
“These findings appear to indicate that some of the chronic inflammatory conditions so prevalent in gastroenterology, as well as the cancers arising from them, may have as their basis profound alterations in mucosal stem cell biology,” she added.
Though it’s still early days with this technology, its single-cell resolution naturally melds with other emerging genomic and genome editing technologies into a powerful means of dissecting the molecular basis of disease and realizing the potential of autologous regenerative medicine, according to Dr. Xian.
Following Dr. Xian’s presentation, Michael L. Kochman, MD, who is executive committee chair of the AGA Center for GI Innovation and Technology, announced the winner of the 2017 AGA-Medtronic Research and Development Pilot Award in Technology. The award was presented to Bani Chander Roland, MD, of Lenox Hill Hospital & Northwell Health System, New York. Her research will involve assessment of the ileocecal valve.
“She has several aims in this proposal to really understand better the causes of ileosphincter dysfunction using a novel method of measuring ileocecal junction pressures,” reported Dr. Kochman. He explained that other parts of the proposal included ileocecal evaluation with wireless capsule endoscopy as well as an evaluation of flora across the GI tract.
A new award to foster innovation in GI medtech is also planned. In partnership with Boston Scientific, the AGA has established the AGA-Boston Scientific Technology and Innovation Pilot Award. This $30,000 research grant will support investigators at any career stage who are developing and testing new medical devices and technologies with applications in gastroenterology and hepatology. The details of the award will be available on the AGA’s website in May. Applications for the award will be accepted beginning in the fall.
BOSTON – A series of important technological advances in cloning stem cells of the gastrointestinal tract is rewriting the basic concepts surrounding these cells and has the potential to advance understanding of GI conditions such as Barrett’s esophagus and Crohn’s disease, according to the winner of the 2016 AGA-Medtronic Research and Development Pilot Award in Technology.
The award is sponsored by Medtronic and administered through the AGA Research Foundation. “Medtronic is pleased to partner with the AGA Research Foundation in supporting research to improve patient outcomes,” said Vafa Jamali, president of Early Technologies’ business with Medtronic. “We are dedicated to support patient-friendly innovations enabling the early detection and treatment of chronic GI diseases and cancers.”
“The enabling technology we developed is the means of cloning and propagating single mucosal stem cells from discrete regions of the gastrointestinal tract in their most immature form. What we have shown is that these stem cells from normal individuals are essentially immortal, are genetically stable, and, critically, are rigorously regiospecific,” Dr. Xian of the Institute of Molecular Medicine for the Prevention of Human Diseases, University of Texas Health Science Center, Houston, said in an interview.
“This regiospecificity – duodenum stem cells always yield duodenum epithelia, ascending colon stem cells produce ascending colon epithelia – has important implications for both regenerative medicine and drug discovery,” she added.
With regard to the dominant stem cell technologies in use today, including induced pluripotent stem cells and organoid cultures of the gastrointestinal tract, Dr. Xian’s technology represents a paradigm shift.
Dr. Xian’s system generates pure “ground state” stem cells that differentiate in 3-D culture to an epithelium indistinguishable from textbook images of in situ epithelia, at rates 250 times faster than intestinal organoid systems.
This system is being applied in major investigations into Barrett’s esophagus and inflammatory bowel disease in collaboration with investigators at multiple centers in the United States and Singapore.
For Barrett’s, Dr. Xian has developed patient-matched stem cells from endoscopic biopsies of esophageal, Barrett’s, and gastric cardia to show that each arises from distinct lineages, and that the Barrett’s stem cells accumulate genetic alterations not found in those of the matched normal epithelia. These stem cells have been adapted to a drug-screening platform to identify leads that specifically eliminate Barrett’s with an eye on preemptive therapies.
Her work on mucosal stem cells in patients with Crohn’s and ulcerative colitis is revealing a coexistence of normal and pathogenic stem cells in these patients that may alter concepts of both the etiology and treatment of these conditions.
Dr. Xian suggests that treatment of Crohn’s may become analogous to treatment of cancer – emphasizing preservation of healthy cells while eliminating diseased cells – and move therapy from the current effort to induce a quiescent inflammatory state to one in which the goal is cure.
“These findings appear to indicate that some of the chronic inflammatory conditions so prevalent in gastroenterology, as well as the cancers arising from them, may have as their basis profound alterations in mucosal stem cell biology,” she added.
Though it’s still early days with this technology, its single-cell resolution naturally melds with other emerging genomic and genome editing technologies into a powerful means of dissecting the molecular basis of disease and realizing the potential of autologous regenerative medicine, according to Dr. Xian.
Following Dr. Xian’s presentation, Michael L. Kochman, MD, who is executive committee chair of the AGA Center for GI Innovation and Technology, announced the winner of the 2017 AGA-Medtronic Research and Development Pilot Award in Technology. The award was presented to Bani Chander Roland, MD, of Lenox Hill Hospital & Northwell Health System, New York. Her research will involve assessment of the ileocecal valve.
“She has several aims in this proposal to really understand better the causes of ileosphincter dysfunction using a novel method of measuring ileocecal junction pressures,” reported Dr. Kochman. He explained that other parts of the proposal included ileocecal evaluation with wireless capsule endoscopy as well as an evaluation of flora across the GI tract.
A new award to foster innovation in GI medtech is also planned. In partnership with Boston Scientific, the AGA has established the AGA-Boston Scientific Technology and Innovation Pilot Award. This $30,000 research grant will support investigators at any career stage who are developing and testing new medical devices and technologies with applications in gastroenterology and hepatology. The details of the award will be available on the AGA’s website in May. Applications for the award will be accepted beginning in the fall.
FROM THE AGA 2017 TECH SUMMIT
VIDEO: Study estimates prevalence of pediatric celiac disease, autoimmunity
By age 15 years, 3.1% of adolescents in Denver developed celiac disease, and another 2% developed a lesser degree of celiac disease autoimmunity, according to a 20-year prospective longitudinal study.
“Although more than 5% of children may experience a period of celiac disease autoimmunity [CDA], not all develop celiac disease [CD] or require gluten-free diets,” Edwin Liu, MD, of University of Colorado School of Medicine and Children’s Hospital Colorado (Aurora, Colo.), wrote with his associates in the May issue of Gastroenterology (doi: 10.1053/j.gastro.2017.02.002). Most celiac autoimmunity probably develops before age 10, “which informs future efforts for universal screening,” they added.
Source: American Gastroenterological Association
About 40% of the general population has the HLA-DQ2 or DQ8 risk genotypes for celiac disease [CD], but little is known about rates of celiac disease among children in the United States, the researchers said. To help fill this gap, they analyzed celiac-risk HLA genotypes for 31,766 infants born between 1993 and 2004 from the Diabetes Autoimmunity Study in the Young. The 1,339 children with HLA risk genotypes were followed for up to 20 years.
By age 15 years, 66 of these children (4.9%) had developed tissue transglutaminase autoantibodies (tTGA) consistent with CDA, and also met criteria for CD, the researchers said. Another 46 (3.4%) children developed only CDA, of whom 46% experienced spontaneous resolution of tTGA seropositivity without treatment. By using genotype-specific risk weighting for population frequencies of HLA, the researchers estimated that 2.4% of the general population of Denver had CDA by age 5 years, 4.3% had CDA by age 10 years, and 5.1% had CDA by age 15 years. Estimated rates of CD were 1.6%, 2.8%, and 3.1%, respectively.
These findings suggest a significant rise in the incidence of CD compared with historical estimates in the United States, and reflect recent studies “using different approaches in North America,” the researchers said. Reasons for the “dramatic increase” are unknown, but environmental causes seem likely, especially given the absence of identified genetic differences and marked changes in the prevalence of CD during the past 2 decades, they added.
Several other reports have documented fluctuating and transient tTGA antibodies in children, the researchers noted. Awareness of transient CD autoantibodies might limit public acceptance of universal screening programs for CD, they said. “Continued long-term follow-up will identify whether the autoimmunity in these subjects truly abates and tolerance develops, or if CDA will recur in time, possibly in response to additional stimulating events,” they added. “At present, low positive tTGA results should be interpreted with caution, and do not necessarily indicate need for biopsy or for treatment.”
The study did not include the DR5/DR7 risk genotype, which accounts for less than 5% of CD cases. The study also did not account for the estimated 2.5% of the general population that has DR3/DR7, which can be considered high risk, the researchers said. Thus, the study is conservative and might underestimate the real incidence of CD or CDA, they added.
The National Institutes of Health provided funding. The investigators reported having no conflicts of interest.
This study calls into question the incidence of celiac disease in the modern pediatric population and, by extension, future prevalence in adults. This is a unique prospective cohort study that followed children over a decade and a half and estimated a cumulative incidence of celiac disease of 3.1% by age 15. In sharp contrast, previous retrospective population-based studies estimated a prevalence of approximately 0.75%-1% in adult and pediatric populations. A recent publication by the United States Preventive Services Task Force used the previously accepted prevalence estimates to recommend against routine screening for celiac disease in the asymptomatic general population as well as targeted screening in those at higher risk. Increases in disease incidence as reported by the current study may call these recommendations into question, particularly in young children where cumulative incidence was high and potential for treatment benefit is substantial.
Dawn Wiese Adams, MD, MS, is assistant professor, director of celiac clinic, in the department of gastroenterology, hepatology, and nutrition, Vanderbilt University Medical Center, Nashville, Tenn. She has no conflicts of interest.
This study calls into question the incidence of celiac disease in the modern pediatric population and, by extension, future prevalence in adults. This is a unique prospective cohort study that followed children over a decade and a half and estimated a cumulative incidence of celiac disease of 3.1% by age 15. In sharp contrast, previous retrospective population-based studies estimated a prevalence of approximately 0.75%-1% in adult and pediatric populations. A recent publication by the United States Preventive Services Task Force used the previously accepted prevalence estimates to recommend against routine screening for celiac disease in the asymptomatic general population as well as targeted screening in those at higher risk. Increases in disease incidence as reported by the current study may call these recommendations into question, particularly in young children where cumulative incidence was high and potential for treatment benefit is substantial.
Dawn Wiese Adams, MD, MS, is assistant professor, director of celiac clinic, in the department of gastroenterology, hepatology, and nutrition, Vanderbilt University Medical Center, Nashville, Tenn. She has no conflicts of interest.
This study calls into question the incidence of celiac disease in the modern pediatric population and, by extension, future prevalence in adults. This is a unique prospective cohort study that followed children over a decade and a half and estimated a cumulative incidence of celiac disease of 3.1% by age 15. In sharp contrast, previous retrospective population-based studies estimated a prevalence of approximately 0.75%-1% in adult and pediatric populations. A recent publication by the United States Preventive Services Task Force used the previously accepted prevalence estimates to recommend against routine screening for celiac disease in the asymptomatic general population as well as targeted screening in those at higher risk. Increases in disease incidence as reported by the current study may call these recommendations into question, particularly in young children where cumulative incidence was high and potential for treatment benefit is substantial.
Dawn Wiese Adams, MD, MS, is assistant professor, director of celiac clinic, in the department of gastroenterology, hepatology, and nutrition, Vanderbilt University Medical Center, Nashville, Tenn. She has no conflicts of interest.
By age 15 years, 3.1% of adolescents in Denver developed celiac disease, and another 2% developed a lesser degree of celiac disease autoimmunity, according to a 20-year prospective longitudinal study.
“Although more than 5% of children may experience a period of celiac disease autoimmunity [CDA], not all develop celiac disease [CD] or require gluten-free diets,” Edwin Liu, MD, of University of Colorado School of Medicine and Children’s Hospital Colorado (Aurora, Colo.), wrote with his associates in the May issue of Gastroenterology (doi: 10.1053/j.gastro.2017.02.002). Most celiac autoimmunity probably develops before age 10, “which informs future efforts for universal screening,” they added.
Source: American Gastroenterological Association
About 40% of the general population has the HLA-DQ2 or DQ8 risk genotypes for celiac disease [CD], but little is known about rates of celiac disease among children in the United States, the researchers said. To help fill this gap, they analyzed celiac-risk HLA genotypes for 31,766 infants born between 1993 and 2004 from the Diabetes Autoimmunity Study in the Young. The 1,339 children with HLA risk genotypes were followed for up to 20 years.
By age 15 years, 66 of these children (4.9%) had developed tissue transglutaminase autoantibodies (tTGA) consistent with CDA, and also met criteria for CD, the researchers said. Another 46 (3.4%) children developed only CDA, of whom 46% experienced spontaneous resolution of tTGA seropositivity without treatment. By using genotype-specific risk weighting for population frequencies of HLA, the researchers estimated that 2.4% of the general population of Denver had CDA by age 5 years, 4.3% had CDA by age 10 years, and 5.1% had CDA by age 15 years. Estimated rates of CD were 1.6%, 2.8%, and 3.1%, respectively.
These findings suggest a significant rise in the incidence of CD compared with historical estimates in the United States, and reflect recent studies “using different approaches in North America,” the researchers said. Reasons for the “dramatic increase” are unknown, but environmental causes seem likely, especially given the absence of identified genetic differences and marked changes in the prevalence of CD during the past 2 decades, they added.
Several other reports have documented fluctuating and transient tTGA antibodies in children, the researchers noted. Awareness of transient CD autoantibodies might limit public acceptance of universal screening programs for CD, they said. “Continued long-term follow-up will identify whether the autoimmunity in these subjects truly abates and tolerance develops, or if CDA will recur in time, possibly in response to additional stimulating events,” they added. “At present, low positive tTGA results should be interpreted with caution, and do not necessarily indicate need for biopsy or for treatment.”
The study did not include the DR5/DR7 risk genotype, which accounts for less than 5% of CD cases. The study also did not account for the estimated 2.5% of the general population that has DR3/DR7, which can be considered high risk, the researchers said. Thus, the study is conservative and might underestimate the real incidence of CD or CDA, they added.
The National Institutes of Health provided funding. The investigators reported having no conflicts of interest.
By age 15 years, 3.1% of adolescents in Denver developed celiac disease, and another 2% developed a lesser degree of celiac disease autoimmunity, according to a 20-year prospective longitudinal study.
“Although more than 5% of children may experience a period of celiac disease autoimmunity [CDA], not all develop celiac disease [CD] or require gluten-free diets,” Edwin Liu, MD, of University of Colorado School of Medicine and Children’s Hospital Colorado (Aurora, Colo.), wrote with his associates in the May issue of Gastroenterology (doi: 10.1053/j.gastro.2017.02.002). Most celiac autoimmunity probably develops before age 10, “which informs future efforts for universal screening,” they added.
Source: American Gastroenterological Association
About 40% of the general population has the HLA-DQ2 or DQ8 risk genotypes for celiac disease [CD], but little is known about rates of celiac disease among children in the United States, the researchers said. To help fill this gap, they analyzed celiac-risk HLA genotypes for 31,766 infants born between 1993 and 2004 from the Diabetes Autoimmunity Study in the Young. The 1,339 children with HLA risk genotypes were followed for up to 20 years.
By age 15 years, 66 of these children (4.9%) had developed tissue transglutaminase autoantibodies (tTGA) consistent with CDA, and also met criteria for CD, the researchers said. Another 46 (3.4%) children developed only CDA, of whom 46% experienced spontaneous resolution of tTGA seropositivity without treatment. By using genotype-specific risk weighting for population frequencies of HLA, the researchers estimated that 2.4% of the general population of Denver had CDA by age 5 years, 4.3% had CDA by age 10 years, and 5.1% had CDA by age 15 years. Estimated rates of CD were 1.6%, 2.8%, and 3.1%, respectively.
These findings suggest a significant rise in the incidence of CD compared with historical estimates in the United States, and reflect recent studies “using different approaches in North America,” the researchers said. Reasons for the “dramatic increase” are unknown, but environmental causes seem likely, especially given the absence of identified genetic differences and marked changes in the prevalence of CD during the past 2 decades, they added.
Several other reports have documented fluctuating and transient tTGA antibodies in children, the researchers noted. Awareness of transient CD autoantibodies might limit public acceptance of universal screening programs for CD, they said. “Continued long-term follow-up will identify whether the autoimmunity in these subjects truly abates and tolerance develops, or if CDA will recur in time, possibly in response to additional stimulating events,” they added. “At present, low positive tTGA results should be interpreted with caution, and do not necessarily indicate need for biopsy or for treatment.”
The study did not include the DR5/DR7 risk genotype, which accounts for less than 5% of CD cases. The study also did not account for the estimated 2.5% of the general population that has DR3/DR7, which can be considered high risk, the researchers said. Thus, the study is conservative and might underestimate the real incidence of CD or CDA, they added.
The National Institutes of Health provided funding. The investigators reported having no conflicts of interest.
Key clinical point: The presence of celiac disease autoimmunity does not predict universal progression to celiac disease.
Major finding: By age 15 years, an estimated 3.1% of children in Denver developed celiac disease, and another 2% developed a lesser degree of celiac disease autoimmunity that often resolved spontaneously without treatment.
Data source: A 20-year prospective study of 1,339 children with genetic risk factors for celiac disease, with extrapolation based on the prevalence of human leukocyte antigen genotypes in the general population.
Disclosures: The National Institutes of Health provided funding. The investigators reported having no conflicts of interest.
VIDEO: Occult cancers contribute to GI bleeding in anticoagulated patients
Occult cancers accounted for one in about every 12 major gastrointestinal bleeding events among patients taking warfarin or dabigatran for atrial fibrillation, according to a retrospective analysis of data from a randomized prospective trial reported in the May issue of Clinical Gastroenterology and Hepatology (2017. doi: org/10.1016/j.cgh.2016.10.011).
These bleeding events caused similarly significant morbidity among patients taking either drug, Kathryn F. Flack, MD, of Icahn School of Medicine at Mount Sinai in New York and her associates wrote. “Patients bleeding from cancer required a mean of approximately 10 nights in the hospital, and approximately one-fourth required intensive care, but 0 of 44 died as a direct result of the bleeding,” the researchers reported. They hoped the specific dabigatran reversal agent, idarucizumab (Praxbind), will improve bleeding outcomes in patients receiving dabigatran.
Source: American Gastroenterological Association
Major gastrointestinal bleeding (MGIB) is the first sign of occult malignancy in certain patients receiving anticoagulation therapy. Starting an anticoagulant is a type of “stress test” that can reveal an occult cancer, the researchers said. Although dabigatran etexilate (Pradaxa) is generally safe and effective, a twice-daily, 150-mg dose of this direct oral anticoagulant slightly increased MGIB, compared with a lower dose in the international, multicenter RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy) trial (N Engl J Med. 2009;361:1139-51). Furthermore, unlike warfarin, dabigatran therapy places active anticoagulant within the luminal gastrointestinal tract, which “might promote bleeding from friable gastrointestinal cancers,” the investigators noted. To explore this possibility, they evaluated 546 unique MGIB events among RE-LY patients.
Medical chart reviews identified 44 (8.1%) MGIB events resulting from occult gastrointestinal cancers. Cancer accounted for similar proportions of MGIB among warfarin and dabigatran recipients (8.5% and 6.8%; P = .6). Nearly all cancers were colorectal or gastric, except for one case each of ampullary cancer, renal cell carcinoma, and melanoma that had metastasized to the luminal gastrointestinal tract. Colorectal cancer accounted for 80% of cancer-related MGIB overall, including 88% in the dabigatran group and 50% in the warfarin group (P = .02). Conversely, warfarin recipients had more MGIB associated with gastric cancer (50%) than did dabigatran recipients (2.9%; P = .001).
Short-term outcomes of MGIB associated with cancer did not vary by anticoagulant, the investigators said. There were no deaths, but two (4.5%) MGIB events required emergency endoscopic treatment, one (2.3%) required emergency surgery, and 33 (75%) required at least one red blood cell transfusion. Compared with patients whose MGIB was unrelated to cancer, those with cancer were more likely to bleed for more than 7 days (27.3% vs. 63.6%; P less than .001). Patients with occult cancer also developed MGIB sooner after starting anticoagulation (223 vs. 343 days; P = .003), but time to bleeding did not significantly vary by type of anticoagulant.
“Most prior studies on cancer bleeding have been case reports and case series in patients receiving warfarin,” the investigators wrote. “Our study is relevant because of the increasing prevalence of atrial fibrillation and anticoagulation in the aging global population, the increasing prescription of direct oral anticoagulants, and the morbidity, mortality, and complex decision making associated with MGIB and especially cancer-related MGIB in patients receiving anticoagulation therapy.”
The RE-LY trial was sponsored by Boehringer Ingelheim . Dr. Flack reported no conflicts of interest. Senior author James Aisenberg, MD, disclosed advisory board and consulting relationships with Boehringer Ingelheim and Portola Pharmaceuticals. Five other coinvestigators disclosed ties to several pharmaceutical companies, and two coinvestigators reported employment with Boehringer Ingelheim. The other coinvestigators had no conflicts.
Dr. Flack and her colleagues should be congratulated for providing important data as they reviewed 546 major GI bleeding events from a large randomized prospective trial of long-term anticoagulation in subjects with AF. They found that 1 in every 12 major GI bleeding events in patients on warfarin or dabigatran was associated with an occult cancer; colorectal cancer being the most common.
How will these results help us in clinical practice? First, when faced with GI bleeding in AF subjects on anticoagulants, a proactive diagnostic approach is needed for the search for a potential luminal GI malignancy; whether screening for GI malignancy before initiating anticoagulants is beneficial requires prospective studies with cost analysis. Second, cancer-related GI bleeding in dabigatran users occurs earlier than noncancer-related bleeding. Given that a fraction of GI bleeding events were not investigated, one cannot exclude the possibility of undiagnosed luminal GI cancers in the comparator group. Third, cancer-related bleeding is associated with prolonged hospital stay. We should seize the opportunity to study the effects of this double-edged sword; anticoagulants may help us reveal occult malignancy, but more importantly, we need to determine whether dabigatranreversal agent idarucizumab can improve bleeding outcomes in patients on dabigatran presenting with cancer-related bleeding.
Siew C. Ng, MD, PhD, AGAF, is professor at the department of medicine and therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong. She has no conflicts of interest.
Dr. Flack and her colleagues should be congratulated for providing important data as they reviewed 546 major GI bleeding events from a large randomized prospective trial of long-term anticoagulation in subjects with AF. They found that 1 in every 12 major GI bleeding events in patients on warfarin or dabigatran was associated with an occult cancer; colorectal cancer being the most common.
How will these results help us in clinical practice? First, when faced with GI bleeding in AF subjects on anticoagulants, a proactive diagnostic approach is needed for the search for a potential luminal GI malignancy; whether screening for GI malignancy before initiating anticoagulants is beneficial requires prospective studies with cost analysis. Second, cancer-related GI bleeding in dabigatran users occurs earlier than noncancer-related bleeding. Given that a fraction of GI bleeding events were not investigated, one cannot exclude the possibility of undiagnosed luminal GI cancers in the comparator group. Third, cancer-related bleeding is associated with prolonged hospital stay. We should seize the opportunity to study the effects of this double-edged sword; anticoagulants may help us reveal occult malignancy, but more importantly, we need to determine whether dabigatranreversal agent idarucizumab can improve bleeding outcomes in patients on dabigatran presenting with cancer-related bleeding.
Siew C. Ng, MD, PhD, AGAF, is professor at the department of medicine and therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong. She has no conflicts of interest.
Dr. Flack and her colleagues should be congratulated for providing important data as they reviewed 546 major GI bleeding events from a large randomized prospective trial of long-term anticoagulation in subjects with AF. They found that 1 in every 12 major GI bleeding events in patients on warfarin or dabigatran was associated with an occult cancer; colorectal cancer being the most common.
How will these results help us in clinical practice? First, when faced with GI bleeding in AF subjects on anticoagulants, a proactive diagnostic approach is needed for the search for a potential luminal GI malignancy; whether screening for GI malignancy before initiating anticoagulants is beneficial requires prospective studies with cost analysis. Second, cancer-related GI bleeding in dabigatran users occurs earlier than noncancer-related bleeding. Given that a fraction of GI bleeding events were not investigated, one cannot exclude the possibility of undiagnosed luminal GI cancers in the comparator group. Third, cancer-related bleeding is associated with prolonged hospital stay. We should seize the opportunity to study the effects of this double-edged sword; anticoagulants may help us reveal occult malignancy, but more importantly, we need to determine whether dabigatranreversal agent idarucizumab can improve bleeding outcomes in patients on dabigatran presenting with cancer-related bleeding.
Siew C. Ng, MD, PhD, AGAF, is professor at the department of medicine and therapeutics, Institute of Digestive Disease, Chinese University of Hong Kong. She has no conflicts of interest.
Occult cancers accounted for one in about every 12 major gastrointestinal bleeding events among patients taking warfarin or dabigatran for atrial fibrillation, according to a retrospective analysis of data from a randomized prospective trial reported in the May issue of Clinical Gastroenterology and Hepatology (2017. doi: org/10.1016/j.cgh.2016.10.011).
These bleeding events caused similarly significant morbidity among patients taking either drug, Kathryn F. Flack, MD, of Icahn School of Medicine at Mount Sinai in New York and her associates wrote. “Patients bleeding from cancer required a mean of approximately 10 nights in the hospital, and approximately one-fourth required intensive care, but 0 of 44 died as a direct result of the bleeding,” the researchers reported. They hoped the specific dabigatran reversal agent, idarucizumab (Praxbind), will improve bleeding outcomes in patients receiving dabigatran.
Source: American Gastroenterological Association
Major gastrointestinal bleeding (MGIB) is the first sign of occult malignancy in certain patients receiving anticoagulation therapy. Starting an anticoagulant is a type of “stress test” that can reveal an occult cancer, the researchers said. Although dabigatran etexilate (Pradaxa) is generally safe and effective, a twice-daily, 150-mg dose of this direct oral anticoagulant slightly increased MGIB, compared with a lower dose in the international, multicenter RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy) trial (N Engl J Med. 2009;361:1139-51). Furthermore, unlike warfarin, dabigatran therapy places active anticoagulant within the luminal gastrointestinal tract, which “might promote bleeding from friable gastrointestinal cancers,” the investigators noted. To explore this possibility, they evaluated 546 unique MGIB events among RE-LY patients.
Medical chart reviews identified 44 (8.1%) MGIB events resulting from occult gastrointestinal cancers. Cancer accounted for similar proportions of MGIB among warfarin and dabigatran recipients (8.5% and 6.8%; P = .6). Nearly all cancers were colorectal or gastric, except for one case each of ampullary cancer, renal cell carcinoma, and melanoma that had metastasized to the luminal gastrointestinal tract. Colorectal cancer accounted for 80% of cancer-related MGIB overall, including 88% in the dabigatran group and 50% in the warfarin group (P = .02). Conversely, warfarin recipients had more MGIB associated with gastric cancer (50%) than did dabigatran recipients (2.9%; P = .001).
Short-term outcomes of MGIB associated with cancer did not vary by anticoagulant, the investigators said. There were no deaths, but two (4.5%) MGIB events required emergency endoscopic treatment, one (2.3%) required emergency surgery, and 33 (75%) required at least one red blood cell transfusion. Compared with patients whose MGIB was unrelated to cancer, those with cancer were more likely to bleed for more than 7 days (27.3% vs. 63.6%; P less than .001). Patients with occult cancer also developed MGIB sooner after starting anticoagulation (223 vs. 343 days; P = .003), but time to bleeding did not significantly vary by type of anticoagulant.
“Most prior studies on cancer bleeding have been case reports and case series in patients receiving warfarin,” the investigators wrote. “Our study is relevant because of the increasing prevalence of atrial fibrillation and anticoagulation in the aging global population, the increasing prescription of direct oral anticoagulants, and the morbidity, mortality, and complex decision making associated with MGIB and especially cancer-related MGIB in patients receiving anticoagulation therapy.”
The RE-LY trial was sponsored by Boehringer Ingelheim . Dr. Flack reported no conflicts of interest. Senior author James Aisenberg, MD, disclosed advisory board and consulting relationships with Boehringer Ingelheim and Portola Pharmaceuticals. Five other coinvestigators disclosed ties to several pharmaceutical companies, and two coinvestigators reported employment with Boehringer Ingelheim. The other coinvestigators had no conflicts.
Occult cancers accounted for one in about every 12 major gastrointestinal bleeding events among patients taking warfarin or dabigatran for atrial fibrillation, according to a retrospective analysis of data from a randomized prospective trial reported in the May issue of Clinical Gastroenterology and Hepatology (2017. doi: org/10.1016/j.cgh.2016.10.011).
These bleeding events caused similarly significant morbidity among patients taking either drug, Kathryn F. Flack, MD, of Icahn School of Medicine at Mount Sinai in New York and her associates wrote. “Patients bleeding from cancer required a mean of approximately 10 nights in the hospital, and approximately one-fourth required intensive care, but 0 of 44 died as a direct result of the bleeding,” the researchers reported. They hoped the specific dabigatran reversal agent, idarucizumab (Praxbind), will improve bleeding outcomes in patients receiving dabigatran.
Source: American Gastroenterological Association
Major gastrointestinal bleeding (MGIB) is the first sign of occult malignancy in certain patients receiving anticoagulation therapy. Starting an anticoagulant is a type of “stress test” that can reveal an occult cancer, the researchers said. Although dabigatran etexilate (Pradaxa) is generally safe and effective, a twice-daily, 150-mg dose of this direct oral anticoagulant slightly increased MGIB, compared with a lower dose in the international, multicenter RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy) trial (N Engl J Med. 2009;361:1139-51). Furthermore, unlike warfarin, dabigatran therapy places active anticoagulant within the luminal gastrointestinal tract, which “might promote bleeding from friable gastrointestinal cancers,” the investigators noted. To explore this possibility, they evaluated 546 unique MGIB events among RE-LY patients.
Medical chart reviews identified 44 (8.1%) MGIB events resulting from occult gastrointestinal cancers. Cancer accounted for similar proportions of MGIB among warfarin and dabigatran recipients (8.5% and 6.8%; P = .6). Nearly all cancers were colorectal or gastric, except for one case each of ampullary cancer, renal cell carcinoma, and melanoma that had metastasized to the luminal gastrointestinal tract. Colorectal cancer accounted for 80% of cancer-related MGIB overall, including 88% in the dabigatran group and 50% in the warfarin group (P = .02). Conversely, warfarin recipients had more MGIB associated with gastric cancer (50%) than did dabigatran recipients (2.9%; P = .001).
Short-term outcomes of MGIB associated with cancer did not vary by anticoagulant, the investigators said. There were no deaths, but two (4.5%) MGIB events required emergency endoscopic treatment, one (2.3%) required emergency surgery, and 33 (75%) required at least one red blood cell transfusion. Compared with patients whose MGIB was unrelated to cancer, those with cancer were more likely to bleed for more than 7 days (27.3% vs. 63.6%; P less than .001). Patients with occult cancer also developed MGIB sooner after starting anticoagulation (223 vs. 343 days; P = .003), but time to bleeding did not significantly vary by type of anticoagulant.
“Most prior studies on cancer bleeding have been case reports and case series in patients receiving warfarin,” the investigators wrote. “Our study is relevant because of the increasing prevalence of atrial fibrillation and anticoagulation in the aging global population, the increasing prescription of direct oral anticoagulants, and the morbidity, mortality, and complex decision making associated with MGIB and especially cancer-related MGIB in patients receiving anticoagulation therapy.”
The RE-LY trial was sponsored by Boehringer Ingelheim . Dr. Flack reported no conflicts of interest. Senior author James Aisenberg, MD, disclosed advisory board and consulting relationships with Boehringer Ingelheim and Portola Pharmaceuticals. Five other coinvestigators disclosed ties to several pharmaceutical companies, and two coinvestigators reported employment with Boehringer Ingelheim. The other coinvestigators had no conflicts.
FROM CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
Key clinical point: Occult cancers accounted for about 1 in every 12 major gastrointestinal bleeding events among patients receiving warfarin or dabigatran for atrial fibrillation.
Major finding: A total of 44 (8.1%) major gastrointestinal bleeds were associated with occult cancers.Data source: A retrospective analysis of 546 unique major gastrointestinal bleeding events from the Randomized Evaluation of Long Term Anticoagulant Therapy (RE-LY) trial.
Disclosures: RE-LY was sponsored by Boehringer Ingleheim. Dr. Flack had no conflicts of interest. Senior author James Aisenberg, MD, disclosed advisory board and consulting relationships with Boehringer Ingelheim and Portola Pharmaceuticals. Five other coinvestigators disclosed ties to several pharmaceutical companies, and two coinvestigators reported employment with Boehringer Ingelheim. The other coinvestigators had no conflicts.
VIDEO: Compassionate care, decriminalization crucial to mitigating addiction epidemic
SAN DIEGO – Health care providers need to practice compassionate care to achieve the best results when managing patients who are dealing with opioid addiction, according to a panel of experts who spoke at the annual meeting of the American College of Physicians.
Caring “compassionately is not enabling, [it’s] doing the right thing by the patient,” explained Chwen-Yuen Angie Chen, MD, of Stanford (Calif.) University. “You can practice compassionate care if you have a knowledge base. Knowledge is extremely powerful and enables you to follow evidence-based medicine, which is truly compassionate care.”
Dr. Chen spoke at length about addiction medicine during a press conference outlining the ACP’s new position paper on preventing and treating substance abuse, where she was joined by ACP President Nitin S. Damle, MD, and ACP Board of Regents Chair Thomas G. Tape, MD. All three emphasized the need for decriminalization and destigmatization of opioid abuse, and they called on physicians to guide patients through resources and compassionate care to help them overcome the affliction.
“We know that we need to either taper, detoxify, or reduce opioid dosing. We know that we ought not to coprescribe with sedatives. We know that, if you need addiction treatment, you get referred, and you don’t just get cut off,” explained Dr. Chen.
In a video interview, Dr. Chen talked about the key take-home messages of the position paper, and she explained other aspects of substance abuse that requires provider’s awareness.
Dr. Chen did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SAN DIEGO – Health care providers need to practice compassionate care to achieve the best results when managing patients who are dealing with opioid addiction, according to a panel of experts who spoke at the annual meeting of the American College of Physicians.
Caring “compassionately is not enabling, [it’s] doing the right thing by the patient,” explained Chwen-Yuen Angie Chen, MD, of Stanford (Calif.) University. “You can practice compassionate care if you have a knowledge base. Knowledge is extremely powerful and enables you to follow evidence-based medicine, which is truly compassionate care.”
Dr. Chen spoke at length about addiction medicine during a press conference outlining the ACP’s new position paper on preventing and treating substance abuse, where she was joined by ACP President Nitin S. Damle, MD, and ACP Board of Regents Chair Thomas G. Tape, MD. All three emphasized the need for decriminalization and destigmatization of opioid abuse, and they called on physicians to guide patients through resources and compassionate care to help them overcome the affliction.
“We know that we need to either taper, detoxify, or reduce opioid dosing. We know that we ought not to coprescribe with sedatives. We know that, if you need addiction treatment, you get referred, and you don’t just get cut off,” explained Dr. Chen.
In a video interview, Dr. Chen talked about the key take-home messages of the position paper, and she explained other aspects of substance abuse that requires provider’s awareness.
Dr. Chen did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
SAN DIEGO – Health care providers need to practice compassionate care to achieve the best results when managing patients who are dealing with opioid addiction, according to a panel of experts who spoke at the annual meeting of the American College of Physicians.
Caring “compassionately is not enabling, [it’s] doing the right thing by the patient,” explained Chwen-Yuen Angie Chen, MD, of Stanford (Calif.) University. “You can practice compassionate care if you have a knowledge base. Knowledge is extremely powerful and enables you to follow evidence-based medicine, which is truly compassionate care.”
Dr. Chen spoke at length about addiction medicine during a press conference outlining the ACP’s new position paper on preventing and treating substance abuse, where she was joined by ACP President Nitin S. Damle, MD, and ACP Board of Regents Chair Thomas G. Tape, MD. All three emphasized the need for decriminalization and destigmatization of opioid abuse, and they called on physicians to guide patients through resources and compassionate care to help them overcome the affliction.
“We know that we need to either taper, detoxify, or reduce opioid dosing. We know that we ought not to coprescribe with sedatives. We know that, if you need addiction treatment, you get referred, and you don’t just get cut off,” explained Dr. Chen.
In a video interview, Dr. Chen talked about the key take-home messages of the position paper, and she explained other aspects of substance abuse that requires provider’s awareness.
Dr. Chen did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ACP INTERNAL MEDICINE
Health law changes under new administration
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
