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Dr. Lamm's weekly review of relevant articles and research

There is an increasing amount of information available about the gut.  Here are a few informative articles you may find valuable.


HIV and Ecosystem

Bad Bugs Abet HIV

MedPageToday, July 12, 2013.

Increasingly, the ill effects of HIV infection -- even when controlled by highly active antiretroviral therapy (HAART) -- are being linked to chronic inflammation. Now researchers led by Joseph McCune, MD, PhD, of the University of California San Francisco, think they understand at least part of the reason.

They analyzed the gut microbiome -- all the bacteria that live in the intestinal tract -- of 34 people, including seven with untreated HIV, 18 with HIV controlled by HAART, and nine without HIV but matched for other health risks. The HIV patients, according to a report online in Science Translational Medicine, had a markedly different gut microbiome than did the uninfected participants.

Specifically, they harbored more harmful species, such as Pseudomonas, Salmonella, Escherichia coli, and Staphylococcus, that can cause inflammation. The extent of the so-called dysbiosis was correlated with tryptophan catabolism and plasma concentrations of the inflammatory cytokine interleukin-6, which are known markers of HIV progression.

One implication, they concluded, is that intestinal microbiomic engineering in HIV patients might be a new therapeutic strategy for managing disease progression.


Bacteria in the Intestines May Help Tip the Bathroom Scale, Studies Show

Bacteria in the Intestines May Help Tip the Bathroom Scale, Studies Show
By Denise Grady, Published: March 27, 2013, New York Times 

mice-studyThe bacterial makeup of the intestines may help determine whether people gain weight or lose it, according to two new studies, one in humans and one in mice.

The smaller mouse, right, lost weight after gastric bypass surgery, while the heavier ones, left, had “sham” operations.

The research also suggests that a popular weight-loss operation, gastric bypass, which shrinks the stomach and rearranges the intestines, seems to work in part by shifting the balance of bacteria in the digestive tract. People who have the surgery generally lose 65 percent to 75 percent of their excess weight, but scientists have not fully understood why. Now, the researchers are saying that bacterial changes may account for 20 percent of the weight loss.


pH Testing for GERD

Early pH Test in GERD May Save Money
By Nancy Walsh, Staff Writer, MedPage Today, Published: May 20, 2013

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner.

ORLANDO -- Early referral of patients with gastroesophageal reflux disease (GERD) for pH monitoring can help avoid extensive and costly use of proton pump inhibitors (PPIs), a researcher said here.

A cost analysis revealed that, over the course of 10 years, $6,600 could be saved per patient if they underwent pH monitoring, according to David Kleiman, MD, of Weill Cornell Medical College in New York City.

"The costs of PPIs are staggering, reaching almost $10 billion each year," Kleiman toldMedPage Today at the annual Digestive Disease Week.

Patients with GERD typically are given an empiric 2-month course of PPIs, as recommended by the American Gastroenterological Association guidelines, but many remain on the drugs for much longer, as clinicians may be hesitant to refer them for 24-hour pH monitoring. While the latter can definitively rule out the disease, clinicians may think that the test will be associated with unnecessary costs.

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