Gastroparesis for the nongastroenterologist.

Gastroparesis is a heterogeneous motility disorder characterized by nausea, vomiting, and postprandial fullness. Its diagnosis requires objective documentation of delayed gastric emptying of solid food and exclusion of mechanical obstruction. Its epidemiology is unclear, and the main causes are diabetes mellitus and idiopathic disease. Cardinal symptoms often co-occur. Management involves nutritional assessment, dietary changes, drug evaluation, glycemic control (for patients with diabetes mellitus), and symptom relief. In this review, we explore challenges nongastroenterologists may encounter and how they can use current recommendations to manage patients with gastroparesis.

Is computed tomographic colonography being held to a higher standard?

Recent guidelines for colorectal cancer screening have reached different conclusions on whether computed tomographic colonography (CTC) is an acceptable screening option, and the Centers for Medicare & Medicaid Services recently decided not to cover CTC screening. The rationale against recommending or covering CTC screening includes concerns about radiation exposure, false-negative rates for small polyps, the discovery of extracolonic findings, variability in performance, a lack of targeted studies, a higher adenoma rate in the Medicare-eligible age group, and an absence of evidence that covering CTC would increase overall screening rates. Similar concerns can be raised for other recommended and covered colon cancer screening tests, but it seems that CTC is being held to a new and higher standard.

Insulin glargine and glulisine SoloSTAR pens for the treatment of diabetes.

Insulin is an effective medication for lowering hemoglobin A(1c) values and can be used for both basal and prandial coverage of hyperglycemia in Type 1 and Type 2 diabetes. Despite its effectiveness there is still reluctance by patients and physicians to add insulin into the treatment regimen for Type 2 diabetes when needed. One of the key barriers to initiating insulin therapy is the method of delivery. Insulin delivery pens are continually developed as a means to improve upon the vial and syringe and to make it easier for patients to incorporate insulin therapy into their lifestyles. The SoloSTAR pen (Sanofi-Aventis, Paris, France) was developed to make insulin delivery easier and to help eliminate barriers to the initiation of insulin therapy. In this article, we discuss the features and characteristics of SoloSTAR that overcome existing unmet needs.

Chronic constipation: Update on management.

Managing chronic constipation involves identifying and treating secondary causes, instituting lifestyle changes, prescribing pharmacologic and nonpharmacologic therapies, and, occasionally, referring for surgery. Several new drugs have been approved, and others are in the pipeline.

Managing irritable bowel syndrome: The low-FODMAP diet.

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been found to significantly reduce symptoms of irritable bowel syndrome (IBS). The diet is best implemented in two phases: initial strict elimination of foods high in FODMAPs, then gradual reintroduction based on symptoms. Further study of this diet's effect on intestinal microbiota is needed.

Challenges of imaging for cancer in patients with diabetes and obesity.

A growing body of evidence supports a connection among diabetes (predominantly type 2), obesity, and cancer. Multiple meta-analyses of epidemiological data show that people with diabetes are at increased risk of developing a variety of different cancers and suffer from an increased rate of perioperative complications and cancer mortality. Computed tomography (CT) has played an important role in diagnosis and staging of cancer. Positron emission tomography is complementary to CT in the diagnosis, staging, and evaluation of treatment response for many types of cancer. Because of generally poor clinical outcome of cancers when they are detected in late stages, more research is now focused on stratifying risk to allow personalized screening of at-risk patients and cancer detection at an earlier stage. In this review, we summarize basic noninvasive imaging techniques currently in use to detect cancer with emphasis on the challenges of imaging for early cancer detection in obese patients with diabetes.