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FEATURE STORY

Fecal Microbiota Transplantation

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Five Books for Financial Success

AGA TECH SUMMIT

Tips from Digestive Health Innovators

EARLY CAREER

Coding and Reimbursement Basics

IN THIS ISSUE
QUESTIONS // Answers on page 31

Q1: An 18-year-old female college student has a 6-month history of vomiting, with an associated 15-pound weight loss during this time period. Her medical history is significant for gastroenteritis about 1 year ago and surgery for pyloric stenosis as an infant. She has no psychiatric history. Current medication includes an oral contraceptive. She describes the vomiting episodes as effortless regurgitation of food within 30 minutes of a meal. She also reswallows the food if she is in public. The vomiting occurs with almost every meal, either solid or liquid. An upper endoscopy, 4-hour gastric-emptying test by scintigraphy, and basic blood laboratory tests are performed. Upper endoscopy is normal with no retained food. She cannot complete the gastric-emptying test because she vomits the radiolabeled test meal. Her blood work demonstrates a normal fasting blood glucose and complete blood count.

What is the most likely etiology of her symptoms? A. Recurrent small bowel obstruction B. Adaptation to the belch reflex C. Idiopathic gastroparesis D. Bulimia

Q2: A 34-year-old man with ileocolonic Crohn’s disease presents with symptomatic anemia. Staging of his disease reveals active ileal and right colonic disease. His hemoglobin is 9 g/dL with iron 20 mcg/dL, iron saturation 6%, and ferritin 25 ng/mL. You decide to administer intravenous iron replacement.

Which of the following regulators of iron assimilation plays the most significant role in determining the need for intravenous over oral iron replacement?