What's Hot in the Red Journal This Month

Abstract

The red secTion 359 What's Hot in the red journal t h i s m o n t hColonization With Toxinogenic C. difficile upon Hospital admission, and risk of Infection: a Systematic review and Meta-analysis Clostridium difficile continues to be a major scourge of hospitalized patients. This meta-analysis used 19 studies incorporating more than 8,700 patients. The pooled prevalence of colonization with C. difficile was 8.1%, with an increasing trend over time, and was slightly higher at 10% in North American studies. Patients who became colonized upon hospital admission were much more likely to develop C. difficile infections, at a rate almost six times greater than in those who were not colonized. The absolute risk for C. difficile infection in colonized patients was 21%, much greater than in non-colonized patients. The risk for colonization was determined largely by prior hospitalization, not prior antibiotic or proton pump inhibitor use or even prior C. difficile infection. The authors conclude that patients who are carriers of toxigenic C. difficile are at substantially increased risk of C. difficile infection. These results may have implications for hospital management of this quite severe iatrogenic illness. See page 381 risk Factors on the development of new-onset Gastroesophageal reflux Symptoms. a Population-Based Prospective Cohort Study: The HunT StudyThis study assessed risk factors for recent-onset gastroesophageal reflux symptoms. It is based on a prospective adult population in Norway, with a 61% response rate, encompassing more than 29,000 individuals. Five hundred individuals who had no reflux at the beginning had severe reflux symptoms at follow-up. Increasing age was positively associated, but, interestingly, male gender and high education were negatively associated, with new-onset gastroesophageal reflux disease (GERD) symptoms. Body mass index gain was important, even if the patients were thin at the beginning, and any history of smoking was associated with reflux symptoms. The combination of tobacco smoking cessation with weight gain was also associated with reflux. The authors conclude that, surprisingly, female sex was associated with an increase in GERD symptoms, as were increasing age, lower education, gain in body mass index, and having ever been a smoker. In particular, the observation that tobacco smoking cessation associated with weight gain was associated with reflux symptoms suggests that prospective intervention may be worth considering in patients who stop smoking. See page 393

Recent Progress and Recommendations on Celiac Disease From the Working Group on Prolamin Analysis and Toxicity

“…In some European countries, e.g., Sweden, Finland, and Italy, data indeed show a significantly higher overall CD prevalence (1.6-2.3%) (26,27). Generally speaking, the prevalence of CD is directly related to the population prevalence of HLA-DQ2 or -DQ8 (30-40% in most Western countries) and to the average level of wheat consumed per capita, as shown by data from India: CD is much more common in the Northern part of the country where wheat is the staple food (CD prevalence = 1.2), than in the Southern part with both a lower prevalence of HLA-DQ2/DQ8 and a lower wheat consumption (CD prevalence = 0.13%) (28).…”