Clostridium difficile infection (CDI) has become the most frequently reported health care-associated infection in the United States [1]. As the incidence of CDI rises, so too does the burden it produces on health care and society. In an attempt to decrease the burden of CDI and provide the best outcomes for patients affected by CDI, there have been many recent advancements in the understanding, diagnosis, and management of CDI. In this article, we review the current recommendations regarding CDI testing and treatment strategies.

Background & Aims Practice guidelines recommend a 1-time screening endoscopy for patients with gastroesophageal reflux disease (GERD) who are at high risk for Barrett’s esophagus or malignancy. However, little is known about the risk of cancer in patients with negative findings from screening endoscopies. Methods We conducted a retrospective cohort study using data from 121 Veterans Health Administration facilities nationwide to determine the incidence rate of esophageal adenocarcinoma (EA) separately, as well as any upper gastrointestinal cancers, in patients with an initial negative screening endoscopy (EGD). We included veteran patients with GERD diagnosed between 2004 and 2009 who had a negative screening EGD within 1 year of diagnosis. We estimated the incidence rate of EA, and any upper gastrointestinal cancer, in patients with GERD who had a negative screening EGD. We examined differences in demographic, clinical, and facility factors among patients with and without cancer. Results We identified 68,610 patients with GERD and a negative screening EGD (mean age, 55.5 years; 90% men; 67.5% white). During a mean follow up of 3.2 years, 10 patients developed EA and 29 developed any upper gastrointestinal malignancies, including EA. The incidence of subsequent EA in this group was 4.6/100,000 patient-years of follow up, whereas the incidence of any upper gastrointestinal cancers was 13.2/100,000 patient-years of follow up. Patients with a subsequent cancer were significantly older and had higher comorbidity scores than patients without cancer. Other clinical and facility factors did not differ significantly between these 2 groups. Conclusion The risk of cancer is low, over a mean 3-year period, for patients with GERD who had a negative screening endoscopy. These findings justify recommendations for a 1-time screening endoscopy for patients with GERD.

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Use of direct cholangiopancreatoscopy to identify pancreaticobiliary fistula ▶ Fig. 3 Endoscopic view of the ampulla with copious mucin discharge. Video 1 Use of a cholangiopancreatoscopy system for the diagnosis of a mucin-producing pancreas tumor with a pancreaticobiliary fistula.