Frederick Gandolfo, MD

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!

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.

Overtesting and over treatment are big problems in modern medicine. It sometimes goes like this: Have a minor complaint? It's probably nothing, but we should do an exhaustive workup because there is a 0.00001% chance it could be cancer, maybe. However,

Most people know that they cannot eat anything after midnight if they have a procedure scheduled the next day. However, what about when a procedure is not actually scheduled? Sometimes a little bit of common sense and a little foresight needs to be applied to avoid having a procedure delayed an entire day because of the NPO rules. Here are two common situations that I encounter (without exaggeration) several times per week:

"Is it bad" is an honest question. "Is that bad" is usually also an honest question, but one that is much more difficult to answer. Patients usually ask "is that bad" without actually having a diagnosis yet. At the end of our visit I try to summarize the pertinent issues and I will usually list a few of the possible diagnoses that may explain the symptoms. Then we will come up with a plan to test for these diagnoses. I might say "This is probably irritable bowel syndrome, however some of the symptoms could be consistent with Crohn's disease or ulcerative colitis. We need to do further testing to figure out which one it is."

I call this the "Attribution Sign" and once you notice this is happening it is important to remain objective about the history and not fall into the trap that the patient is (inadvertently) setting for you. That is, don't place too much weight on the patient's attribution and don't let it skew your judgement.