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Evidence-based gastroenterology

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Is anal sex harmful? Thoughts from a gastroenterologist…

So, after this careful analysis, here are my concluding thoughts on anal sex as a healthcare professional specializing in colon and rectal diseases:

Anal sex seems to significantly raise your risk of having fecal incontinence.
You probably just shouldn’t do it.
If you are going to do it anyway, don’t do it too frequently.
It seems like common sense, but use lots of lube.
When finding a partner for anal sex, smaller is probably better.

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What is the link between meat and cancer?

So what does this all mean? Should you never eat red meat? Is this the end of the bacon cheeseburger? Of course not! When faced with information like this we really need to step back and look at the big picture. How much do you enjoy eating a juicy steak or a grilled hot dog on a warm summer day? What is the purpose of life? What is the lifetime mortality of someone who never eats red meat? (Hint: it’s 100%.) Let’s not forget that red meat is also an excellent source of protein, iron, B vitamins, and zinc…oh, and it tastes pretty good too!

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I have Crohn’s disease. What should I eat? (Part one)

So what are some take home points about meat intake in Crohn’s disease?

Red meat (beef, lamb, pork [yes pork too!]) can be though of as pro-inflammatory foods.
It is reasonable to limit consumption of red meat to once or twice per week at most.
Fish is probably a good alternative to red meat.
These recommendations are based on very limited, low-quality data. Sometimes this is better than no data at all!

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Does aspirin prevent colon cancer?

For many years, the effect of NSAIDs on preventing colon cancer has been described. There are numerous studies showing a small but mostly consistent decrease in both the development of polyps, and the development of colorectal cancer with chronic NSAID use. However, thus far there has not been a recommendation to take NSAIDs specifically with the goal of reducing the development of colon cancer, since the risk of chronic NSAID use is thought to outweigh any benefit in cancer prevention.

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What are the risks of stopping Coumadin for an endoscopy or colonoscopy?

Is this common practice of bridging from Coumadin to an injectable anticoagulant back to Coumadin necessary? From a practical point, it is usually a major inconvenience for patients and doctors alike. Many patients are uncomfortable giving themselves injections at home. The injectable anticoagulants are sometimes expensive. Sometimes despite good instruction, they are administered incorrectly by the patient, or on the wrong dates. What if Coumadin was just held and later restarted without the bridging?

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Why do proton pump inhibitors increase the risk of enteric infections?

Some people seem to get “stomach bugs” all the time, while other people rarely have these issues. Vomiting, abdominal pain, fever, and diarrhea are the common symptoms of a variety of enteric infections that often start after the soon-to-be victim ingests the infectious organism. These bacteria have wonderful names like Salmonella, Shigella, Campylobacter, E. coli, Vibrio, and C. difficile, just to name a few. The symptoms of gastroenteritis and infectious colitis can range from a minor annoyance to life-threatening dehydration due to ongoing vomiting and diarrhea.

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