In this issue, we highlight the clinical and research work of faculty and fellows interested in the broad topic of nutrition. John Scherer, MD, discusses a complex hepatobiliary case linked to diet. Julia B. Greer, MD, MPH, provides clear information on healthy eating for physicians to pass on to their patients. UPMC Digest editor Toby O. Graham, MD, provides an update on issues in clinical nutrition, and Stephen O’Keefe, MD, MSc, outlines his fascinating research on the effects of diet on colon cancer development. New faculty member, Joshua Novak, MD, highlights the use of percutaneous endoscopic jejunostomy tubes for those who cannot eat and may have a risk of aspiration or other complications.  Two more educational cases also are included. Elizabeth Blaney, MD, presents an interesting endoscopic unknown image, and Charles Gabbert, MD, presents a great case of a woman with a complex neuroendocrine tumor.

Educational Objectives:

Upon completion of this activity, participants should be able to:

• Summarize the most nutritious and cancer-fighting foods to help guide patient care.
• Discuss pancreatic manifestations of celiac disease.
• Identify myeloid sarcoma as an unusual presentation of acute myelogenous leukemia that can occur in the gastrointestinal tract.
• Improve diagnostic skills for identifying gastric and pancreatic neuroendocrine tumors.

Reading Resources:

1. AsklingJ, LinetM, GridleyG, HalstensenTS, EkstromK, EkbomA.Cancerincidenceina population-based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis. Gastro 2002;123:1428-35.
2. CarroccioA, DiPrimaL, ScaliciC, SoresiM, CefaluAB, NotoD, AvernaMR, MontaltoG, Iacono G. Unexplained elevated serum pancreatic enzymes: a reason to suspect celiac disease. CGH 2006;4:455-59.
3. LeedsJS, HopperAD, HurlstoneDP, EdwardsSJ, McAlindonME, LoboAJ, DonnellyMT, Morley S, Sanders DS. Is exocrine pancreatic insufficiency in adult coeliac disease a cause of persisting symptoms Aliment Pharmacol THer 2007;25:265-71.
4. LudvigssonJF, MontgomerySM, Ekbom A. Risk of pancreatitis in 14,000 individuals with celiac disease. CGH 2007; 5: 1347-53.
5. PatelRS, JohlinFCJr ,Murray JA. Celiac disease and recurrent pancreatitis. GIE 1999;50: 823-7.

Disclosures:

Doctors Scherer, Greer, Novak, Gabbert, Graham, and Blaney have reported no relationships with entities producing health care goods or services. Dr. O’Keefe is a consultant for NPS Pharmaceuticals. Dr. Whitcomb is a consultant for Abbott and Millennium. He is a stockholder with Ambry Genetics. He has received grant funding from the NIH.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The University of Pittsburgh School of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditsTM. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (.05) continuing education units (CEU) which are equivalent to 1.0 contact hours.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.edu and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 11/20/2011 | Last Modified On: 11/20/2011 | Expires: 11/20/2012