Gastroenterology

Concomitant proton-pump inhibitors and clopidogrel associated with adverse cardiovascular events

Level 1: Mid-level evidenceTwo recent retrospective studies have examined cardiovascular outcomes associated with combining clopidogrel with proton-pump inhibitors (PPIs). A case-control study with 13,636 elderly patients taking clopidogrel after hospitalization for acute MI analyzed PPI use in patients re-admitted for acute MI within 90 days compared with event-free controls (CMAJ. 2009;180:713-718; available at www.cmaj.ca/cgi/content/full/180/7 /713,…

Photomicrograph shows fatty metamorphosis of a human liver. The clear vacuoles indicate fat droplets

What to do for fatty liver

How would you treat fatty liver in a middle-aged overweight woman with the following profile: liver function tests normal; HDL 70 mg/dL; LDL 160 mg/dL; and triglycerides 170 mg/dL. The patient uses alcohol occasionally, takes no medications, and complains of right upper-quadrant discomfort. One clinician recommends aggressive statin treatment. A second clinician says to treat…

Fatigue and dizziness in an iron-deficient patient

I am treating a 44-year-old Filipina who has iron deficiency anemia. Her RBC count, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and mean corpuscular volume are low and her hematocrit/hemoglobin is borderline low. Her ferritin rose from 2 to 3 ng/mL after two months of ferrous sulfate t.i.d. and vitamin C 500 mg daily. A…

Antibiotic-induced diarrhea

To reduce the risk of antibiotic-associated diarrhea, I recommend yogurt with live cultures. The yogurt also helps settle diarrhea after a bout of gastroenteritis. I have my patients try the yogurt for one or two days before getting stool specimens.—Patricia L. Kress, MD, Eau Claire, Wis. (125-10)

H. pylori is a highly motile bacterium and has been linked with the formation of stomach ulcers.

H. pylori in the stool vs. the blood

Is there any difference in sensitivity or specificity when Helicobacter pylori is detected in the stool vs. the blood?—FELIX N. CHIEN, DO, Newport Beach, Calif. Many noninvasive tests diagnose H. pylori, including serology, polymerase chain reaction, stool antigen testing, and the urea breath test (UBT). The best choice for each patient is determined by the…

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