Guidelines on endoscopy

The ACP has published guidelines on the appropriate use of EGD, which is indicated for patients with heartburn with "alarm symptoms", to assess healing of esophagitis or Barretts, for recurrent dysphagia/stricture, to assess GERD that has failed PPI therapy, and for men>50 with long term symptoms (>5 years) to assess for adenocarcinoma (abstract).

Careful with acetaminophen dosing in inpatients

In this large retrospective analysis from 2 tertiary care academic medical centers, 7% of patients were exposed to >4 grams/day of acetaminophen; of those >age 65 or with chronic liver disease, 18% exceeded the recommended dose of 3 grams/day. Hospitalists need to be mindful of acetaminophen dosing in hospitalized patients, especially those with chronic liver disease or > age 65 (abstract).

Probiotics for Cdiff prevention

This large meta-analysis of 20 randomized trials found that probiotics reduced the risk of Cdiff by 66% in patients on antibiotics, with fewer adverse events (compared to placebo). Probiotics should be considered for any patient on antibiotics to reduce the risk of Cdiff (abstract).

Feeding tubes in dementia patients

In this prospective cohort of >35,000 nursing home patients, 5% had a feeding tube inserted within 1 year of eating problems. Neither the timing nor the insertion of the feeding tube affected mortality. There is no survival advantage of placing a feeding tube in dementia patients with eating problems (abstract).