Percentage of U.S. residents with up-to-date screening for colorectal cancer remains at 60% - what options, other than colonoscopy, do we have?

From the NEJM:

The percentage of U.S. residents with up-to-date screening for colorectal cancer has not increased appreciably since 2010 and remains at approximately 60%. To achieve the highest level of adherence to colorectal cancer screening, it may be best to provide participants a choice, because the “best” strategy is the one that they will adhere to consistently.

The NEJM reviews all the options in this table:

http://blogs.nejm.org/now/wp-content/uploads/sites/6/2017/01/nejmcp1512286_t2.jpeg

Full article is here:

Screening for Colorectal Neoplasia - Now@NEJM http://buff.ly/2ikfKA0

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Overcoming Colonoscopy Fears with Educational Videos by EMMI

From Dartmouth-Hitchcock: patient education and engagement video by EMMI Solutions can decrease anxiety before a colonoscopy, decrease dosage of sedatives during the procedure and shorten recovery time after the procedure.

Emmi(TM), stands for Expectation Management and Medical Information, and was originally developed by physicians with the goal to educate patients and decrease malpractice risk specifically in surgical patients. As of February 2016, there are 4 published studies about EMMI in PubMed:

http://www.ncbi.nlm.nih.gov/pubmed/26210560
http://www.ncbi.nlm.nih.gov/pubmed/26101988
http://www.ncbi.nlm.nih.gov/pubmed/21245476
http://www.ncbi.nlm.nih.gov/pubmed/19606763

Do you have any experience with EMMI?

Watch the Dartmouth-Hitchcock video below:



Here is the standard "Preparing for a Colonoscopy" video by Dartmouth-Hitchcock:



References:

http://www.dartmouth-hitchcock.org/news/newsdetail/64940/

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Highly effective HCV treatment: once daily oral Sofosbuvir/Velpatasvir

The hepatitis C virus (HCV), a single-stranded RNA virus of the family Flaviviridae with six major genotypes, infects up to 150 million people worldwide. Chronic hepatitis C virus infection causes progressive liver fibrosis, which can lead to cirrhosis and hepatocellular carcinoma. There is now an effective oral regimen. New research findings are summarized in this short video from NEJM:



This is a ribavirin-free single-tablet regimen. There 2 medications in the single tablet:

- Sofosbuvir is a nucleotide analogue inhibitor of the HCV NS5B polymerase approved for the treatment of HCV in combination with a variety of other agents, including NS5A inhibitors, ribavirin, and peginterferon–ribavirin.

- Velpatasvir is a new pangenotypic HCV NS5A inhibitor with antiviral activity against HCV replicons in genotypes 1 through 6.

The rate of sustained virologic response among patients receiving sofosbuvir–velpatasvir was 99%.

See the NEJM article, "Sofosbuvir and Velpatasvir for HCV Genotype 1, 2, 4, 5, and 6 Infection":
http://www.nejm.org/doi/full/10.1056/NEJMoa1512610#t=abstract

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"Gluten sensitivity" may be caused by FODMAPs in everyday foods: Fructose in fruit, Lactose in milk, Galactans in beans, Polyols in chewing gum

FODMAPs is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. FODMAPs are sugars that draw water into the intestinal tract. They may be poorly digested or absorbed, and become fodder for colonic bacteria that produce gas and can cause abdominal distress.

FODMAPs are FLF-GP:

- Fructose: A sugar found in many fruits (hence the name), for example, apples, pears, watermelon, mangoes, grapes, blueberries, tomatoes and tomato concentrate, and all dried fruits; vegetables like sugar-snap peas, sweet peppers and pickles; honey; agave; and jams, dressings and drinks made with high-fructose corn syrup.

- Lactose: Sugar in milk from cows, goats and sheep, present in ice cream, soft cheeses, sour cream and custard.

- Fructans: Soluble fiber found in bananas, garlic, onions, leeks, artichokes, asparagus, beets, wheat and rye.

- Galactans: Complex sugars prominent in dried peas and beans, soybeans, soy milk, broccoli, cabbage and brussels sprouts.

- Polyols: Sugar alcohols (sweeteners) isomalt, mannitol, sorbitol and xylitol, present in stone fruits like avocado, cherries, peaches, plums and apricots.

People with irritable bowel syndrome (IBS) or gluten sensitivity often find that their symptoms lessen or disappear when avoiding foods rich in FODMAPs; however, it can take 6-8 weeks on a low-FODMAPs diet to see a significant improvement.

References:

When Gluten Sensitivity Isn't Celiac Disease - NYTimes.com http://nyti.ms/1EmXFDl
Celiac disease and nonceliac gluten sensitivity - 2017 review in Annals of Allergy, Asthma & Immunology http://buff.ly/2pI2x61

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Irritable Bowel Syndrome (IBS) - DW video

Professor Hubert Mönnikes talks about why people with IBS are often mislabeled as hypochondriacs, and how to best treat the symptoms.



Are Dietary FODMAPs a Cause of Irritable Bowel Syndrome? (Fermentable, Oligo-, Di-, Monosaccharides, And Polyols).

IBS symptoms improved with a diet low in short-chain carbohydrates (FODMAPs - fructose, lactose, polyol sweeteners) http://buff.ly/1fdzBWJ -- A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome - the evidence supports its use as a first-line therapy http://buff.ly/1Ch3scU

DOWNLOAD the Handout  Stanford University: Low FODMAP Diet Handout

References:

A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome - supports its use as a first-line therapy http://buff.ly/1Ch3scU

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