2014 change our praxis

During 2014 research that changes aspects of clinical practice in gastroenterology were concluded.

Medicine is a science that progresses relentlessly. It is a constant progress in many lines at once, which only becomes perceptible for citizens when there´s accumulated enough evidence to recommend changes in clinical practice. That is, to change the decision.

The advancement of medical practice is often hampered by economic issues, which are important of course, must be known and stated as such. But doctors are mostly professionals, liberal and generous, they share their knowledge immediately and no compensation, besides, publish knowledge in scientific journals or disclose medical conferences often has cost the professional himself supports. This information is known by today's media simultaneously worldwide and others take advantage of this to continue researching or for drug patents or consumables without the physicians in question receiving royalties as literary authors or songwriters receive. A doctor may spend years researching the cause or treatment of a particular condition or disease management details. Once he gets it, he usually apply and usually writes explanatory reports to their patients and are useful documents for that patient, and is an information that other professionals can use to learn and do the same after reading them. This generosity of doctor is a "detail" that goes unnoticed to society and today I want to highlight because most of my colleagues act that way, some of them avoid making detailed reports about what they do, stop other colleges to attend their consultation or interventions and keep the information for theme selves. In this line, and as an example, here I summarize some results of medical research released in 2014 by colleges, and personal opinions based on my perception and experience that certainly will change clinical practice in gastroenterology without me being able to tell you how long it will take, but I believe it will be very son. 1. In 2014 was released a German large-scale study in which 4.4 million colonoscopies were evaluated. The authors conclude that through these checks 180,000 colorectal cancers could be prevented, 1 for every 28 endoscopies, and also detected 40,000 early-stage tumors (1 per 121 colonoscopies). At the Institute of Digestive Diseases, we spent years conducting a study to a closed group of workers and our results are similar. These studies will change clinical management and make the normal population between 55 and 75 years without any excuses undergo colonoscopy routinely, and before that age if other risk factors exist or if you want and can afford. 2. The big amount of the use of statins to reduce cholesterol levels and the commonly accepted idea that these drugs are harmful to the liver has made physicians to monitor liver enzymes routinely. Well, this concept is changing in light of recent studies that have shown that it is not necessary to perform this monitoring in all cases. It is convenient to identify before starting treatment to a subset of susceptible persons to avoid using them. This fact, together with the high number of non-hepatic side effects of these molecules, under my point of view, will have the need to personalize and review protocols for the future use of statins. The previous mechanism for automatic prescription such as: “You have high cholesterol so I prescribe statins”; will change and in the future will develop a plan of objectives and control of personalized tests for each case. 3. The huge increase in consumption of probiotics, at least in Spain, in every possible presentation, seams to follow the line of an increasingly frequent alteration in the intestinal flora of our patients. They often turn to consultation with diarrhea, bloating and other discomfort, and we doctors treat them and add probiotics to prevent relapse. This, as I say, it is becoming more frequent and I´ve being for a while thinking that this must have a reason. However, in a study that some have seen in the press, conducted in four Spanish important rivers, 100% of the fish tested were contaminated with insecticides which are sold to advertising that “do not accumulate in animals or affecting the environment”. It means that we are swallowing cockroach-killing, insect repellents, tick-killing and lice-killing at will, and this only with fish. It is therefore not uncommon "our bacteria feel threatened and probiotics will take part in the future of our daily diet." 4. The hepatitis C virus finally has an effective treatment. During 2014 was shown that oral treatment with drugs that attack the virus enzyme system can eliminate the virus in a sustained manner to a number of cases ranging between 96% and 99% of patients treated. This breakthrough will change the natural history of this disease and management approach of patients infected by this virus. The gastroenterologists will have to select the patients who urgently need to be treated, then quick guidelines for recently infected patients will be established and we will have to gain knowledge about controlling the improvement of eradicated patients. 5. Genetics is a well known word but until now little used. What happened to genetic is what is now happening to the stem cells, which everyone talks about it but does not finish, given a practical application. Notice that when patients asked us the cause of his illness, doctors resorted to very specific words, infection, tumor, age, trauma, toxic, heritage, autoimmune, idiopathic. With this we explained everything: his problem was caused by a microbe; a tumor is the cause; aging wear; beatings, repeated microtrauma or other physical agents; alcohol, drugs or other intoxicants; inherited from their parents; defects of the immune system that causes it to attack himself; or simply unknown reason. However, increasingly these causes are being associated to a genetic predisposition. The likelihood of developing an infection, cancer, alcohol toxicity, atherosclerosis, the likelihood of developing an addiction and etc ..., we will see that caters to genetic predisposition. Genetic studies we were using for years, definitely from now will become part of our routine clinical practice. Even in those already known genetic diseases, chromosomal variants will help us handling, as in the case of Lynch syndrome, a hereditary form of colon cancer very well known to my colleagues.

6. Furthermore, physicians overestimated often diseases. We have cataloged ill subjects that are only affected by variations of normality. Studies that support this thesis appear, as there one performed in people with Barrett's esophagus. This change in the cells of the end of the esophagus occurs in 12% of people with acid reflux 3 times a week. However the number of patients with Barrett's esophagus is overrated by some doctors to diagnose coming up in 42% of cases. I think that the same is happening in hepatitis, Crohn's disease, lactose intolerance, etc ... Therefore medical practice will change and patients will not settle for one opinion, but seek second opinions or views by collegiate teams of specialists or experts. I want to highlight the option to request a second opinion from pathologists that far from being all equal, there are some specialized and have more or less experience in each disease. Is not bad to have a second person to see a biopsy, you must get used to this without being alarmed when the clinician suggest it, that does not have to attend to anything unusual. 7. The advancement of medicine gets more survival of cancer patients. Furthermore drugs with potent immunosuppressive effect are widely used in highly autoimmune diseases. These two groups of patients clearly require periodic checkups that were made by own medical oncologists and specialists, in view of recent studies, it is my opinion that there should be constituted in the future groups of expert to make the checkups for these patients to avoid missing any possible new illnesses or problems but neither patients undergo unnecessary studies. These units can also ensure appropriate patient vaccination. The case of hepatitis B virus will be a focus of attention because routine is already evident in the medical literature of this virus reactivation in patients treated with chemotherapy or immunosuppressive. 8. Finally for today, I want to comment about focal liver lesions. So many imaging tests that are daily made, type ultrasound, CT scan, etc..., which often detect focal lesions in the liver. We are talking about cystic or solid lesions we diagnose inadvertently. Well, there is enough accumulated experience and it has been established in 2014 guidelines that doctors must learn and they will certainly facilitate the management of these patients and give them more comfort and safety. This issue is more technical, but not bad you know. Medicine is a generous science and as a result I could write this article. We don't charge and we will not charge copyright, and therefore we can never buy a property in Menorca, a vineyard in Medoc or a castle in Scotland as did singers, writers and filmmakers. Our greatest satisfaction is to achieve cure you, but do not be amiss to leave us free Spotify to hear music while operating this singers; to obviate us the canon of the society of authors in televisions hospital if you admit an artist; or exempt from this tax to concerts and charity events as "small compensation". Sure all will appreciate it.