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These days having a colonoscopy is no easy feat. In addition to the usual inconvenience of a clear liquid diet the day before and a bowel prep to clean you out (thoroughly!), most endoscopy centers now require a negative COVID test a few days before your procedure, and then self quarantine until your procedure is completed. That has lots of people wondering whether the hassle – and risk – is really worth it. Over the last few weeks I’ve spoken with a few patients to help them stratify their risk and decide if a procedure is in the cards.  The first patient I spoke to had ulcerative colitis and was due for her surveillance colonoscopy this month. Patients with ulcerative colitis may be at increased risk for colon cancer depending on how long they’ve had the disease; how much of their colon is affected; and how active their inflammation is. For my patient, although she’d been diagnosed with colitis 14 years…

A new study looking at a non-invasive blood assay method to detect early colorectal cancer (CRC) could eventually mean the end of regular colonoscopy for CRC screening. The test capitalizes on new, more sensitive methods to detect circulating cells in the blood and looks at three blood markers: circulating gastrointestinal epithelial cells, somatic mutations and methylation of cell-free DNA. Researchers tested the assay in 354 patients who were already scheduled for their regular screening colonoscopy with no previous CRC diagnosis – 14% of patients had experienced symptoms or a positive fecal immunochemical test and 86% were asymptomatic. When compared to findings during colonoscopy, the blood test proved a sensitivity (true positives) of 100% for detecting CRC and 76% for detecting advanced adenomas (pre-cancerous polyps). Takeaway: Colonoscopy has the ability to look for pre-cancerous polyps as well as remove them, but it’s invasive nature and the requirement for sedation make it…

Tabatha: I have spent years rebuilding my gut after reading your book, The Microbiome Solution. After 4 years of amazing health, I’m afraid of the damage that my next colonoscopy might do to my rebuilt gut microbiome. Should I be concerned and how can I still do my scheduled colonoscopies with the least amount of damage to my gut? Are there other options than a colonoscopy?  Dr. Chutkan: Tabatha, many of my patients, like you, have spent years working on rehabbing their gut microbiome, so your question is a really valid one. Preparing for a colonoscopy requires fasting and cleansing the colon using strong laxatives 24 hours before the procedure. This process can remove many of the microbes that live inside your gut. Let’s take a look at the science: a 2013 study assessed the effect of traditional colonoscopy prep on the gut microbiota in 10 men and 10 women,…

Celiac disease affects approximately 1% of the population in Western countries, yet about 83% of those who suffer from the disease go undiagnosed or are misdiagnosed. In 2019, celiac diagnostic rates are estimated to reach between 50 and 60% due to raising disease awareness. A 2019 study published in Mayo Clinic Proceedings found that screening for celiac disease in first-degree relatives (parents, children, and siblings) of those who have been diagnosed with celiac disease resulted in high diagnostic rates. Out of 360 first-degree relatives of 104 celiac patients screened for the disease, 160 relatives were diagnosed – approximately 44% of the first-degree relatives. It’s important to note that 42 of the diagnosed relatives had no celiac symptoms and 97 had nonclassical symptoms. Many physicians have noted the study findings and are recommending screening for celiac disease in all first-degree relatives of celiac disease patients.

Did you know the recommended age for colorectal cancer (CRC) screening is now 45 for the general population (or those at average risk)? The age recommendation (previously 50) changed in May 2018 after researchers analyzed data and found that the rate of new CRC cases is increasing in younger adult populations. This new age recommendation will result in earlier CRC detection and will save more lives. While colonoscopy is the gold standard test for CRC screening and recommended every 10 years between ages 45 and 75 for those at average risk, stool-based tests can also be used, as long as immediate follow-up with a colonoscopy is performed in the presence of an abnormal test. These tests include an annual highly sensitive fecal immunochemical test (FIT), an annual highly sensitive guaiac-based fecal occult blood test (gFOBT), and a multi-targeted stool DNA test (MT-sDNA) every 3 years. For some, screening is recommended…

Is your microbiome test giving you an accurate picture? A recent study looked at one of the most well known markers of microbial health – bacterial diversity. The researchers found that taking 5 fecal samples over 5 consecutive days portrays a more accurate picture of microbial diversity than just 1 sample. This study also concluded that when looking at microbial composition (bacterial species and their ratios), 1 fecal sample was sufficient. In a letter to the editor, a group of researchers argue that microbial composition also varies over time. In their study of 61 infants, fecal samples were taken weekly for 6 weeks. Microbial composition varied over time, even from week to week. Researchers point out that the age of the study participants could be partly to blame. But, they ultimately conclude that calculating an average composition from fecal samples taken over a period of time could offer a more complete portrayal. Current Microbiology →Takeaway: Microbiome testing…