In the United States, colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death. Because most CRC grows relatively slowly over approximately 10 years, routine screening colonoscopy for asymptomatic adults can identify and remove precancerous polyps (ie, adenomas) and reduce CRC incidence. Current guidelines indicate that colonoscopy is the preferred screening method for the early detection and removal of polyps and precancerous lesions in average-risk adults starting at age 50 and earlier in individuals with an increased risk for CRC. However, colonoscopy effectiveness ultimately depends on many variables related to the quality of the examination, which tends to be widely variable in clinical practice. To address this, the American Society of Gastrointestinal Endoscopy (ASGE) and the American College of Gastroenterology (ACG) formed a task force to define measurements and identify quality standards that can be used to document high-quality colonoscopy. This newsletter will specifically focus on an important subset of those indicators, which includes adenoma detection, cecal intubation, timing of repeat colonoscopy, and procedure-related complications.

Intraluminal pH varies along the length of the digestive tract in a relatively predictable pattern. In healthy individuals, there is a progressive increase from the duodenum to the terminal ileum, a decrease in the cecum, and then a slow increase along the colon to the rectum. In patients with ulcerative colitis (UC), a similar but somewhat more acidic pattern is sometimes observed. Colonic pH during a UC flare can be extremely low, secondary to the accumulation of short-chain fatty acids (pKa = 4.8) and lactic acid. Several of the mesalamine formulations available for UC treatment incorporate a pH-dependent coating that is designed to prevent release of the active drug in the upper gastrointestinal tract and subsequently target release in the colon.

In an effort to improve both the efficacy and tolerability of bowel preparation, the American College of Gastroenterology (ACG) recommends a split-dose regimen (also referred to as a 2-day or PM/AM regimen), where half of the bowel preparation is taken the night before the colonoscopy and the other half is taken the day of the procedure. This newsletter will discuss the benefits of split dosing and provide suggestions to help healthcare providers incorporate it into their practice.

Hepatic encephalopathy (HE) is a chronically debilitating spectrum of neuropsychiatric abnormalities in patients with liver disease or portosystemic shunting. The disorder is characterized by cognitive and motor deficits of varying severity, and multiple recurrences of overt HE may cause long-term impairment. Hepatic encephalopathy can affect a patient’s employability, ability to drive, and other activities of daily living. It can also negatively impact other family members who help with caregiving. This newsletter discusses overt HE symptoms and pathogenesis, epidemiology, diagnosis and classification, and treatment.

In a 1998 editorial, the editor-in-chief of Gastroenterology, Daniel Podolsky, noted that the “Internet . . . offer[s] the potential to transform the work of the gastroenterologist.” He called on practitioners to “recognize and understand its impact and opportunities, so that [they] remain at the forefront of patient care in the next millennium.” Now, more than a decade later, 4 in 5 Internet users search the Web for health information and his words continue to ring true. This issue of The GI Digest newsletter will discuss where patients go for health-related information and review the quality of the information they find, as well as address the potential implications for the patient–healthcare provider relationship. It will focus primarily on patients with inflammatory bowel disease (IBD), as much of the research it reviews addresses that population.

While opioid analgesics are commonly used to treat patients with advanced illness who are suffering from moderate-to-severe pain, their safety and effectiveness requires careful management of predictable side effects that can compromise optimal use. Opioid-induced constipation (OIC) is the most common, persistent, and intolerable side effect experienced by patients receiving opioid therapy. Even though OIC reduces patients’ quality of life and increases healthcare resource utilization and healthcare costs, it is often under-assessed and undertreated. This newsletter discusses the epidemiology, pathology, and management of OIC.

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the United States, resulting in the second highest rate of cancer-related mortality. Despite the evidence supporting the effectiveness of colorectal screening, less than half of the US population aged 50 years and older undergoes screening colonoscopy. Split dosing of bowel preparations for colonoscopy has recently emerged as an important factor in bowel cleansing efficacy and may also impact patient tolerability. This newsletter reviews pros and cons of split dosing as they relate to both healthcare professionals and patients.