Obesity Medicine

“Nonspecific” intertrigo: the morphology (borders that aren’t sharp, absence of satellite lesions) is a key diagnostic clue.

Is obesity really leading to an increase in GERD? Or, has GERD just become a catch-all phrase for all sorts of upper GI distress? Has GERD become the new "dyspepsia"? G. Richard Locke, MD, FACG, from the Mayo Clinic, Rochester, MN, discusses his findings as presented at the ACG 2011 program.

A 52-year-old woman presents with severe intra-oral ulceration and oral pain. She reports that several years earlier, she had been taking cephalexin when severe intra-oral ulceration developed.

Clostridium difficile infection is a serious, life-threatening nosocomial infection that can follow on the heels of broad-spectrum antibiotic use. It affects over 500,000 Americans annually, with 15,000 deaths. Infection recurs in 15% to 25% of those initially treated successfully; infection subsequently redevelops in 40% to 50% of those an initial recurrence.

If ACG 2011 had a recurrent theme, it was nicely summed up in this lecture: probiotic treatments are coming. Scientific evidence is accumulating for this approach, and patients will likely embrace it as a “natural” remedy. Primary care physicians should carefully follow this emerging trend-it holds promise for some of our most challenging patients with chronic disease.

Following on the heels of the obesity epidemic, a second epidemic has become apparent-sleep-disordered breathing and its effect on esophageal conditions, primarily gastroesophageal reflux disease (GERD). Many, many primary care providers have heard the following complaint: “I gained 10 pounds and now I have heartburn/cough/worsening asthma” (take your pick). What’s going on?

Prevalence for overweight (BMI 24.9 to 29.9) and obesity (BMI > 30) have been steadily rising for the past 30 years-two-thirds of Americans now qualify as overweight or heavier. Hypertension, hyperlipidemia, coronary artery disease, type 2 diabetes, sleep apnea, and GERD prevalence are following this epidemic. Obesity is now the second most common preventable cause of death, exceeded only by smoking.

How does the chronic care model of diabetes care differ from the acute care model-and how might this approach work for you and your patients?

Dr Robert Gabbay discusses strategies to improve patient compliance with insulin therapy.

A 71-year-old man was admitted to the MICU for weaning from mechanical ventilation. The history revealed a global decline over the previous 3 to 4 weeks predominated by cognitive impairment, mood swings, somnolence, and limb weakness. No respiratory symptoms were noted.

We have long known that many adolescents have chronic pain. A new study highlights just how widespread it is-and the significant impact it can have.

Here: Dr Rosen presents 5 tips about 5 skin disorders that you might not know.

A 56-year-old was seen in the ED after 4 days of hemoptysis and intermittent left chest pain. He also complained of exertional dyspnea and arthralgias. He had been treated for “pneumonia” twice during the past month. Histories were unremarkable.

This 66-year-old black woman presented with a 2-year history of a painless skin eruption. She stated that her skin had “changed overnight” while she was caring for her mother who had been hospitalized.

For years, GI toxicity and risk of bleeding were the issues of most concern when deciding to prescribe an NSAID. The cardiac effects associated with these drugs were considered a positive in that least some have been shown to provide prophylaxis against myocardial infarction.

It should come as no surprise. The combination of the obesity epidemic and delayed childbearing in the US has fostered a novel mini-epidemic. Chronically hypertensive women are becoming pregnant in greater numbers. The trend is not just a perinatal and obstetric problem.

In a recent JAMA commentary, the authors suggest that state intervention might be considered in severe instances of childhood obesity.

A 66-year-old woman presented with a 2-day history of acute onset of redness, pain, and swelling of the right breast.

Acanthosis nigricans is a nonspecific increase of the thickness of the prickle cell layer of the skin and most commonly seen in obese persons.

A 61-year-old man with arthritis and an 80-pack-year smoking history presented with fever, dyspnea, and productive cough of a week’s duration that did not respond to outpatient treatment with levofloxacin.

An 88-year-old man presents with a 2-month history of a non-healing ulcer on his right lower limb.

An 88-year-old woman was brought to the emergency department after she choked on a piece of meat. She had dysphagia of many years’ duration and progressive weight loss over the past 5 years.

For 3 weeks, a previously healthy 24-year-old man had repeated episodes of nonbloody, nonbilious emesis. He denied dysphagia, but he did report a 40-lb (18-kg) weight loss and heartburn.