RED FLAG FRIDAY: Don't Blow Off Anemia

In a population-based study, 9 percent of adults older than 65 years with iron deficiency anemia had gastrointestinal cancer. Yikes! I know, nine percent doesn't sound like a lot. But think about how many geriatric patients we see each year with anemia! In fact, older adults with anemia had gastrointestinal cancer 31 times as often as adults without anemia. (REFERENCE: Ioannou GN. Am J Med 2002;113:276-80).

Testing for Celiac Disease (Celiac Sprue)

Here are some tips regarding Celiac Disease:

• All patients with history of "irritable bowel syndrome" should be tested for celiac disease
• Testing should be done on a HIGH gluten diet
• These test have the highest diagnostic accuracy (better than IgG):
• Endomysial IgA 
• Tissue transglutaminase IgA 
• Diagnosis needs to be confirmed with small bowel biopsy

Don't Be Fooled by a Negative C. Diff. Toxin Test

As family doctors, we are typically pretty good at screening for C.Diff. But just because someone has a negative C.Diff. Toxin Test does not mean that they do NOT have C.Diff. Remember that this test is imperfect and frequently needs to be repeated. Often it is better just to start empiric treatment while waiting for the workup.

RED FLAG FRIDAY: Diarrhea

Just like back pain, the vast majority of diarrhea is self-limiting and benign. But here are some "red flags" that I typically screen for:

1. RECENT ANTIBIOTIC USE—consider Clostridium Difficile.
2. RECENT CAMPING (or drinking water form a lake, pond, or stream)—consider Guardia. I once had a man who maintained fountains in ponds who we diagnosed with Guardia. My only case in the last 10 years. 
3. CHRONIC WEIGHT LOSS—consider looking for colon cancer or inflammatory bowel
4. ABDOMINAL PAIN or BLOODY STOOLS—Consider invasive organism such as salmonella. Also entertain other infectious causes of abdominal pain.

Again, those are just some of the "red flags" off the top of my head. Do you have any others?