45 Is the new 50: improving colon cancer screening rates.

PURPOSE OF REVIEW: The colonoscopy guidelines recently changed to begin screening at age 45. This review discusses the reasons for lowering the age, adenomatous polyp detection rates for patients 45-49, and to discover innovative health education campaigns aimed at younger patients. RECENT FINDINGS: There are currently approximately 20 million Americans between the age of 45-49 who will need to be screened by gastroenterologists. The prevalence of overall and advanced colorectal neoplasia on screening colonoscopy for average-risk individuals younger than 50 years is 14% and 2%. An important 2022 study using the GI Quality Improvement Consortium Registry demonstrated that patients aged 45-49 had an overall adenoma detection rate of >25%. SUMMARY: Health education campaigns need to immediately target 20 million Americans to begin colorectal cancer screening. Additional research should focus on whether there are sex differences for adenoma detection rates among patients aged 46-49. Innovative health education campaigns such as "Tune It Up: A Concert To Raise Colorectal Cancer" organized by the American College of Gastroenterology are educating younger patients to begin colorectal screening by combining concerts and health communication.

Patient assessments and online ratings of quality care: a "wake-up call" for providers.

OBJECTIVES: Many physicians have been reluctant to embrace physician evaluation websites (PEWs) due to the overwhelming number of PEWs and concerns about negative anonymous feedback. This article provides perspective for the vast array of PEWs, website features and user characteristics, and identifies the most notable websites which merit attention from physicians concerned about their online reputations. METHODS: 35 PEWs met criteria for inclusion in the analysis. Each website was studied to assess its geographic focus, detailed features of physician profiles, nature of patient-generated reviews, number of monthly site visitors, and other points including user demographics and characteristics. RESULTS: Most PEWs provide their services free-of-charge, and physicians are usually allowed to create and enhance online profiles without payment. Anonymous posting of reviews is an almost universal feature of PEWs, but most reviews are positive. A few websites allow physicians to respond publicly or privately to negative patient reviews. These and other notable websites are identified. CONCLUSIONS: Physician evaluation websites have tremendous potential to help doctors and patients. With this review as a guide, physicians should collaborate with PEWs to harness their potential, to improve clinical practices, and to attract new patients. As physicians increasingly interact with the most "doctor-friendly" PEWs, this collaboration could motivate other websites to implement changes that give physicians greater control over their online reputations. The era of doctors avoiding online evaluations is closing, and in the future, physicians who embrace PEWs are most likely to succeed.

Synaptic regulation of the hypothalamic-pituitary-adrenal axis and its modulation by glucocorticoids and stress.

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in a range of affective and stress-related disorders. The regulatory systems that control HPA activity are subject to modulation by environmental influences, and stressful life events or circumstances can promote subsequent HPA dysregulation. The brain is a major regulator of the HPA axis, and stress-induced plasticity of the neural circuitry involved in HPA regulation might constitute an etiological link between stress and the development of HPA dysregulation. This review focuses on the synaptic regulation of neuroendocrine corticotropin-releasing hormone (CRH) neurons of the hypothalamic paraventricular nucleus, which are the cells through which the brain predominantly exerts its influence on the HPA axis. CRH neuronal activity is largely orchestrated by three neurotransmitters: GABA, glutamate, and norepinephrine. We discuss our current understanding of the neural circuitry through which these neurotransmitters regulate CRH cell activity, as well as the plastic changes in this circuitry induced by acute and chronic stress and the resultant changes in HPA function.

Evolving drugs in gastroesophageal reflux disease: pharmacologic treatment beyond proton pump inhibitors.

IMPORTANCE OF THE FIELD: Despite the clinical success of proton pump inhibitors to treat gastroesophageal reflux disease (GERD), for the majority of patients in both gastroenterology and primary care clinics there is still a substantial group of patients (up to 40% in some studies) who do not completely respond symptomatically to a standard dose of proton pump inhibitors (PPIs). Specific explanations for these PPI noncomplete responders included transient lower esophageal sphincter relaxations (TLESRs), sensitivity to weakly acidic and/or alkaline reflux, large volume of reflux and esophageal hypersensitivity. There is a clear need for GERD therapies beyond the PPIs. AREAS COVERED IN THIS REVIEW: These drug classes include the GABA(B) receptor agonists (including lesogaberan and arbaclofen placarbil), mGluR5 receptor antagonists, P-CABs, cholecystokinin(2) antagonists and add-on therapies to PPIs including mosapride and rikkunshito. WHAT THE READER WILL GAIN: Both physicians and patients are eagerly awaiting the development and FDA approval of a new class of anti-GERD medications targeting distinct mechanisms. This article provides information on pharmacologic strategies, clinical trials and side-effect profiles on several of the most promising and heavily researched compounds being developed today for the treatment of GERD symptoms and inflammation. Hopefully, this important research will help a large group of PPI noncomplete responding patients receive symptomatic relief and reduce esophageal inflammation through a unique pharmacologic mechanism in the near future. TAKE HOME MESSAGE: The treatment of GERD has greatly improved with the PPI class of therapy. Despite excellent success, there is a sizeable population of patients who do not have adequate response to therapies directed only at acid suppression. Emerging new pharmacologic treatment options show promise in further advancing the treatment success of GERD.