Symptomatic internal hemorrhoids are one of the most common reasons that patients seek care in my medical practice. The typical triad of complaints include anal/rectal discomfort, bleeding or prolapse. Most Grade 1 (small) hemorrhoids tend to respond to conservative therapy including, fiber supplements (Metamucil), sitz baths and topical anal creams. However the vast majority of [...]
The hope of finding a vaccine for cancer has been the goal of scientists for decades. With the introduction of Gardisil for vaccination against Human Papiloma virus in 2006, there is now the hope that we can prevent a multitude of genital cancers in the general population. HPV is the most common sexually transmitted infection [...]
Diverticulosis is one of the most common findings in colonoscopy. Approximately 30% of the adults age 60 have diverticular disease. Excess pressure in the colon lumen can lead to sac-like protrusions in the colon wall (especially in areas where blood vessels pass through the muscle layer of the large bowel). Most often diverticulosis occurs [...]
With the advent of new biological agents and better therapeutic interventions in Crohn’s disease and Ulcerative colitis the prognosis of inflammatory bowel disease (IBD) patients have improved in the recent decades. Many of these patients are in remission during their outpatient follow-up. However there are health maintenance issues that are important in these asymptomatic individuals due to their underlying disease. 1. [...]
There are several technical components of colonoscopy that endoscopists need to document to demonstate the quality of their work. These have been summarized previously and adopted by the American Society of Gastrointestinal Endoscopy ( 1) CECAL INTUBATION RATE OF GREATER THAN 95%. The goal of colonoscopy is the perform a thorough and complete evaluation of [...]
Chronic hepatitis B (CHB) remains a common public health problem in much of the developing world and an under diagnosed illness in the U.S. Of the two million Americans that are believed to be infected with the hepatitis B virus (HBV), only 300K patients have been diagnosed and 50K have been treated for this disease. [...]
Rubber band ligation of internal hemorrhoids remains one of the most effective modes of treating internal hemorrhoids in the ambulatory care setting. Unfortunately most primary care physicians and gastroenterologists have not been trained in this modality. A referral to a surgeon often creates anxiety in patients about the potential for surgical intervention. Furthermore 98% with [...]
Is there a role for fecal occult blood testing in the age of endoscopy? In spite of widespread use of endoscopy in the diagnosis and management of digestive disorders, fecal occult testing still plays an important role in medical practice. The conventional quaiac based stool testing has been present for over three decades. However these [...]
Radiological imaging of the colon has undergone significant transformation in the past 50 years. Barium enema (BE) has been in use since the early part of the 20th century for detection of intraluminal colon pathology. The introduction of CT technology in the 1970′s provided opportunity for clinicians to be able to visuaizel 2-D images [...]
Hepatitis B virus (HBV) disease – Although the incidence of acute hepatitis B is diminishing (primarily as a result of vaccination) the prevalence of chronic HBV disease seems to be on the rise due to the influx of new immigrants from endemic areas (Asia and Africa). In addition to interferon, we now have a total [...]