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1 Von Muhlen M., Ohno-Machado L. J Am Med Inform Assoc. 2012;19( 5):777-81.
2 Childs L.M., Martin C. Y. Am J Health System
Pharm. 2012;69( 23):2044-50.
3. Social media “likes” healthcare. From marketing
to social business – 2012 Report
5. Online Medical Professionalism: Patient and
Public Relationships: Policy Statement From the
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ANSWERS // From page 3
Q1: ANSWER: E
Esophageal sensation perceived by
esophageal nociceptors is transmitted through spinal afferent pathways
to higher cortical centers, which are
susceptible to both peripheral and
central sensitization in the predisposed individual. Such sensitization
can occur in the setting of stressful
situations, such as auditory stress,
sleep deprivation, affective disorders,
and other life events including grief.
Esophageal perception decreases
with age. Intestinal metaplasia (
Barrett’s esophagus) is less perceptive
to acid stimulation, and hence is a
protective mechanism that develops
in patients with a genetic predisposition in the setting of acid exposure.
Patients with Barrett’s esophagus
have a lower sensitivity to chemical,
thermal, as well as mechanical stimulation compared to reflux patients
without Barrett’s esophagus.
1. Fass R., Naliboff B.D., Fass S.S., et al. The effect of
auditory stress on perception of intraesophageal
acid in patients with gastroesophageal reflux disease. Gastroenterology. 2008;134( 3):696-705.
2. Schey R., Dickman R., Parthasarathy S., et al.
Sleep deprivation is hyperalgesic in patients with
gastroesophageal reflux disease. Gastroenterology.
3. Byrne P.J., Mulligan E.D., O’Riordan J., et al. Impaired visceral sensitivity to acid reflux in patients
with Barrett’s esophagus. The role of esophageal
motility. Dis Esoph. 2003; 16( 3):199-203.
Q2: ANSWER: B
The patient has a favorable anatomy
for a surgical drainage procedure such
as a lateral pancreaticojejunostomy
(Peustow procedure). Surgery has
been noted to provide superior pain
relief over 5 years compared with en-
doscopy. Hospital costs and length of
stay were similar between the groups.
Continued medical therapy is unlikely
to add further benefit on top of what
she has already achieved. Endoscopic
ultrasound-guided celiac plexus block
will provide only temporary pain re-
lief. There are limited long-term data
on the effectiveness of total pancre-
atectomy with islet autotransplanta-
tion in alleviating pain.
1. Cahen D.L., Gouma D.J., Laramée P., et al.
Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients
with chronic pancreatitis. Gastroenterology.