Meeting summaries: Internal medicine updates, gynecological issues, gastrointestinal disorders


Conference Roundup

American College of Physicians 


Boston, April 30–May 2, 2015 
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  • Clinical advice aimed at reducing overuse of cervical cancer screening in average-risk women without symptoms was released. It included the recommendations that physicians should start screening average-risk women for cervical cancer at age 21 years, once every 3 years, with cytology tests alone; and that physicians should stop screening average-risk women older than 65 years for cervical cancer who have met select criteria. 

  • In accordance with the meeting, a comprehensive update in internal medicine was released with the following key data points highlighted:

  • New data suggest that a blood pressure (BP) measurement taken at a single office visit indicating hypertension may need to be confirmed with a BP measurement in an ambulatory setting.

  • Patients with deep venous thrombosis who wore elastic compression stockings did not have reduced postthrombotic syndrome compared with patients who wore placebo stockings.

  • Older patients with high cardiovascular risk who followed a Mediterranean diet supplemented with extra-virgin olive oil had reduced onset of new cases of diabetes.

  • Use of epidural glucocorticoid injections for patients with lumbar spinal stenosis has little benefit, and patients should be informed of these minor benefits and about potential adverse reactions. 

  • Low-dose computer tomography appears to be a cost-effective method of screening for lung cancer.

  • Atypical antipsychotics cause acute kidney injury in older adults, along with other adverse effects, and patients who take these treatments should be monitored for BP, renal function, and signs of urine retention.


 

American Congress of Obstetrics and Gynecologists 


San Francisco, May 2–6, 2015 
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  • Metoclopramide administered with diphenhydramine compared with codeine provided faster and more effective headache relief in pregnant women in whom acetaminophen was ineffective with only a modest increase in cost.

  • Data from a retrospective review concluded that minor gynecologic surgical procedures can be undertaken safely in women who are concurrently taking antiplatelet or anticoagulant medications.

  • Results of a nested case–control study suggest that statins may have a therapeutic benefit for uterine leiomyomas, with use of statins in patients with uterine leiomyomas resulting in a lower incidence of menorrhagia, pelvic pain, and anemia compared with nonusers.

  • An evaluation of factors associated with hypertension at 6 weeks postpartum among women with severe preeclampsia found that morbidly obese African American women were at highest risk; increased follow-up and interventions are important to minimize long-term cardiovascular morbidity.

  • Results of an open randomized controlled trial showed that a loading dose of sublingual nifedipine 20 mg was more effective than the oral route (also 20 mg) to achieve faster tocolysis in patients with preterm labor; however, the rate of preterm delivery within 48 hours was similar between groups.

  • A randomized trial evaluating postpartum women receiving 25 mg of oral captopril or 0.1 mg of clonidine for treatment of severe postpartum hypertension showed that the groups were similar in terms of daily mean systolic BP or diastolic BP; however, on the third postpartum day, mean systolic BP was lower in the clonidine group compared with the captopril group.


 

Digestive Disease Week


Washington, DC, May 16–19, 2015 
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In two large prospective cohorts of women, intake of zinc was inversely associated with risk of Crohn disease but not ulcerative colitis, with the association particularly strong for dietary zinc intake, and persisted with long-term zinc use.


Results of a matched case–control study concluded that most classes of antibiotics were associated with an increased risk of irritable bowel syndrome (IBD), but use of statin was associated with a strong protective effect against new-onset IBD, especially Crohn disease.


In patients with older-onset ulcerative colitis, use of corticosteroids resulted in a higher rate of surgery, flares, and hospitalization compared with those not receiving this therapy.


In a retrospective clinical audit of outcomes following withdrawal of anti–tumor necrosis factor (TNF) therapy, planned withdrawal of anti-TNF therapy for sustained clinical remission was associated with a moderate-to-severe relapse of Crohn disease in more than one-half of patients by 2 years.


For pediatric patients with IBD, use of vedolizumab (Entyvio—Takeda) resulted in modest improvements in disease activity as measured by the pediatric Crohn disease activity index (PCDAI) or pediatric ulcerative colitis activity index (PUCAI); further studies are needed to confirm these findings.