I found the paragraph about ulcerative colitis in your practice pearls by Dr Mitchell (BCMJ 2006;48:84-85) very confusing. Chronic ulcerative colitis, especially pancolitis, is associated with an increased cancer risk after several years. After 10 years of disease, alternate year surveillance colonoscopy with biopsies to detect dysplasia is appropriate, and if dysplasia is found colectomy is indicated to prevent cancer. Barium enema is not an acceptable test since it will not detect dysplasia in the absence of a mass lesion. In general, a good quality barium study read by an experienced radiologist is useful, but remember that it does not evaluate the rectum. A lesser study, particularly if the preparation is poor, should be interpreted with caution, as it may miss polyps and cancer. I assume that the “detection rates” comment referred to cancer, in which case I would point out that your “preferred test” (barium enema) missed 14% (nearly 1 in 5) cancers, dooming these unfortunate people. A potentially lethal diagnosis surely deserves the best test. The diagnosis of a colon cancer represents failure, a failure of screening or surveillance, as this is a preventable disease.
If I could add a gastroenterology pearl, it would be a plea for digital rectal exams. Patients with rectal bleeding demand a rectal exam, and annual rectal exams for your asymptomatic over-fifties will save lives.
—David Pearson, MD
At this time, a province-wide screening program for colorectal carcinoma in asymptomatic individuals that involves screening colonoscopy does not exist. Patients with no known risk factors are recommended to undergo annual digital rectal examination (DRE) and fecal occult blood screening, with an optional flexible sigmiodoscopy every 5 years, age 50 to 75. Don’t forget to do a DRE before inserting the endoscope, as lesions in the rectum may not be visualized. See “Detection of Colorectal Neoplasms in Asymptomatic Patients” at www.healthservices.gov.bc.ca/msp/protoguides/index.html. —ED
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org