30 // THE NEW GASTROENTEROLOGIST SPRING 2017
SNAPSHOTS FROM THE
2000;47:804-11), a feature of IBS whose molecular basis
has been demonstrated by a series of elegant studies (Gut.
2017 Jan 12 [Epub ahead of print]; Gut. 2015;64:1379-88)
demonstrating altered tight junctions and immune activation in IBS with diarrhea. The authors found treatment with
antibiotics increased the risk of PI-IBS but whether this is
attributable to confounding by indication is unclear.
This meta-analysis indicates that PI-IBS also potential-
ly is the most common cause of IBS, given that both the
Centers for Disease Control and Prevention in the United
States and community surveys in the United Kingdom (BMJ.
1999;318:1046-50) indicate that gastroenteritis affects
around one in five of the population each year. If the inci-
dence of PI-IBS is around 10%, modeling suggests PI-IBS
could account for the majority of new cases (J Neurogastro-
enterol Motil. 2012;18:200-4). n
ANSWERS // From page 10
Q1: Answer: A
Rationale: This is a case of high-grade dysplasia within a visible lesion in the setting of Barrett’s esophagus. Guidelines
recommend that any visible irregularities in Barrett’s esophagus should be removed using endoscopic mucosal resection
(EMR) for tumor staging. There is high-quality evidence to
support this recommendation. High-grade dysplasia without
a visible lesion can be treated with radiofrequency ablation
(RFA). RFA reduces progression to esophageal cancer from
a randomized sham-controlled trial. At this time, there is
insufficient evidence for cryotherapy to achieve reversion in
any stage of Barrett’s esophagus. It should also be noted that
this patient has several risk factors for Barrett’s and esophageal cancer including white race, obesity, and long-standing
gastroesophageal reflux disease.
1. Sharma P., Katzka D.A., Gupta N., et al. Quality Indicators for the Management of Barrett’s Esophagus, Dysplasia and Esophageal Adenocarcinoma:
International Consensus Recommendations from AGA Symposium. Gastroenterology. 2015 Aug 18.
2. AGA Medical Position Statement on the Management of Barrett’s Esophagus. Gastroenterology. 2011;140:1084-91.
Q2: Answer: D
Objective: Recognize conditions associated with a high-risk
of pancreatic cancer incidence.
Critique: Familial pancreatic cancer (two or more first-degree relatives with pancreatic cancer), Peutz-Jegher’s,
FAMM syndrome, BRCA2, and Lynch syndrome with
affected first-degree relatives are generally considered
candidates for surveillance based on consensus expert
Patients with Cronkhite-Canada syndrome have gastrointestinal polyposis and are at higher risk for gastrointestinal luminal cancers rather than pancreatic cancer. MRI or
endoscopic ultrasound are considered to be the preferred
tests for surveillance in the population at risk for this syndrome.
1. Canto M.I., Harinck F., Hruban R.H., et al. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients
with increased risk for familial pancreatic cancer. Gut. 2013;62( 3):339-47.