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Traveler’s Diarrhea: The Basics

This is a guest post by Dr. Erik McLaughlin.


Traveler’s Diarrhea: The Basics

Known around the world by many names including “Montezuma’s revenge,” “Delhi belly” and “mummy tummy,” traveler’s diarrhea (TD) is the most common illness faced by travelers. Nothing can slow down a fun trip as easily as TD — and it can also have serious health implications. TD typically lasts four to six days, and 90 percent of cases occur within the first two weeks of travel.

Anatomy You Need to Know

The gastrointestinal tract starts at the mouth and ends at the anus. After food enters the mouth, it passes through the esophagus to the stomach, where it sits for approximately 45 minutes. After being broken down by gastric secretions, food matter enters the small intestine (duodenum, jejunum, and ileum in order). The small intestine is the site where most nutrients are absorbed by the body. From the small intestine, food matter begins to look more like feces as it progresses to the large intestine or colon. The colon absorbs water from the food material before the material passes through the anus and exits the body as feces.


Recognizing the warning signs of TD, such as blood in the stool, fever, or abdominal cramping, can help a savvy traveler know when to seek medical help.

TD has many definitions; the presence of three or more loose-formed stools in one day is a good one. Abdominal cramping, nausea, vomiting and fever may also occur. The presence of blood in the stool can indicate that infection has directly damaged the intestinal wall and should be taken seriously. Read more »

This post, Traveler’s Diarrhea: The Basics, was originally published on by Paul Auerbach, M.D..

A Giant Artificial Gut

What do you do when you’re one of the world’s biggest food companies and you’re looking to explore what happens after your products get chewed and swallowed? Apparently you build a large refrigerator-sized, million dollar model of a human gut, complete with valves, injection ports for enzymes, and a transparent window for visibility, of course.

Nestle, in their quest to create foods that trick your body into feeling even more satisfied after eating than you otherwise would be, has a research and development center that holds this artificial gut, tucked next to the mountains in Lausanne, Switzerland. Here they’re busy studying and trying to commercialize gastrointestinal phenomenon such as the “ileal break,” a peptidal feedback mechanism that both slows transit through the GI system and reduces food intake by triggering feelings of satiation. They hope to release products based on this science within five years.

From the Wall Street Journal:

Tracking the movement of food in a person’s gastrointestinal tract isn’t easy. So at a “digestion lab”—part of Nestle’s sprawling research and development center here—scientists use a million-dollar model of the human gut.

The machine is about the size of a large refrigerator. It has several compartments linked by valves, and it is carefully calibrated to the body’s temperature. The entire setup is controlled by a computer. The front is glass, allowing observers to watch as food travels through the system.

On a recent day, the “stomach” section at the top slowly squeezed and churned a salt solution, just like the real thing. The liquefied result then wended its way down the other tubes, representing other sections of the digestive tract. At each stage, tiny valves released the appropriate salt, bile and enzymes, which helped to digest the food.

The question still stands: What comes out the other end?

The Wall Street Journal article: Hungry? Your Stomach Really Does Have a Mind of Its Own…

*This blog post was originally published at Medgadget*

In The ER With Abdominal Pain? Lower Your Diagnosis Expectations

Abdominal pain is the bane of many emergency physicians. Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain.

In an essay from Time, Dr. Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.” And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a lot of proverbial prizes.

One reason is the myriad of causes that lead bring a patient to the hospital clutching his abdomen. It can range from something as relatively benign as viral gastroenteritis where a patient be safely discharged home, to any number of “acute” abdominal problems necessitating surgery.

But more importantly, we need to consider how limited doctors actually are in the ER. Consider the ubiquitous CT scan, which is being ordered with increasing regularity:

The pros: CT scans are readily available, able to look at every organ in the abdomen and pelvis, and very good for ruling out many of the immediately life-threatening causes of belly pain. CT scans can also reduce the need for exploratory surgery. The cons: Often, CTs can’t diagnose the actual cause of ER patients’ abdominal pain. Worse, CTs deliver significant doses of radiation to a patient’s abdomen and pelvis (equivalent to between 100 and 250 chest X-rays). Over a lifetime, patients who receive two or three abdominal CT scans are exposed to more radiation than many Hiroshima survivors.

Add that to the fact that patients expect a definitive diagnosis when visiting the hospital — one that doctors can’t always give when it comes to abdominal pain. Read more »

*This blog post was originally published at*

About The Placebo Effect

Placebos helped ease symptoms of irritable bowel syndrome (IBS) even when patients knew that was what they were taking, a new study reports.

Researchers randomly assigned 80 patients with IBS to receive placebo pills (openly labeled as such) or no treatment over a three-week period. Patients taking placebos had significantly higher mean scores on the IBS Global Improvement Scale at 11 and 21 days, and also reported significant improvements in symptom severity and relief. The results of the study, which was funded by the National Center for Complementary and Alternative Medicine, were published online Dec. 22 by PLoS ONE.

Anthony Lembo, M.D., a study coauthor, said in a press release that he didn’t expect the placebo to work. “I felt awkward asking patients to literally take a placebo. But to my surprise, it seemed to work for many of them,” he said.

Ted Kaptchuk, O.M.D., the study’s lead author, told the LA Times that a larger study needs to be done to confirm the findings, and said that he didn’t believe such effects would be possible “without a positive doctor-patient relationship.”

ACP Internist looked at placebos’ place in clinical practice in a 2009 article. (PLoS ONE, Public Library of Science, LA Times, ACP Internist)

*This blog post was originally published at ACP Internist*

Dr. Oz’s First Colonoscopy Finds Pre-Cancerous Polyp: What Can This Teach Us?

Dr. LaPook and Dr. OzDr. Mehmet Oz just might be the last person on earth people would expect to get a colon polyp. He’s physically fit (he left me in the dust the last time we ran together), he eats a healthy diet, he doesn’t smoke, and he has no family history of colorectal cancer or colon polyps.

But several weeks ago, when Mehmet had his first screening colonoscopy at age 50, I removed a small adenomatous polyp that had the potential to turn into cancer over time. Statistically, most small polyps like his don’t become cancer. But almost all colon cancers begin as benign polyps that gradually become malignant over about 10 to 15 years.

Since there’s no way of knowing which polyps will turn bad, we take them all out. The good news is there’s plenty of opportunity to prevent cancer by removing these polyps while they are still benign. But only about 63 percent of Americans between ages 50 and 75 get screened for colorectal cancer. Read more »

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