Editor's Note: Zeroing in on SIBO

This issue also covers ethics, decisions aids, and dosing and response to common drugs.


For decades, small intestinal bacterial overgrowth, or SIBO, was considered to be rare. Today, though, it's more widely recognized as a potential cause of patients' gastrointestinal symptoms, as changes in the small bowel that affect motility and acid can cause bacteria to run amok. Better recognition is good news, of course. The bad news is that a cure for SIBO is not possible, according to experts. But appropriate treatment can help patients manage the condition and offer them some relief. In our story, staff writer Mollie Frost offers an overview of SIBO prevalence, diagnosis (including risk factors), and varying treatment strategies.

Physicians have had to address questions of ethics since the very beginning of the profession, but such factors as technology and social media can now put different twists on an old problem. Our story in this issue takes a look at how ethics in medicine have evolved and how physicians can take steps to be sure they tackle tricky situations appropriately. One resource is ACP's recently updated Ethics Manual, whose seventh edition offers a six-step decision-making approach to ethical dilemmas.

Moving on to another type of decision, physicians are asked every day to guide patients toward the best course of treatment for their diseases and conditions. Decision aids can be a huge help in this process and in ensuring shared decision making, as long as they're used appropriately. In this issue, experts give some do's and don'ts. Do use aids for decisions you and your patients encounter frequently, for example, but don't always ask patients to complete an aid before they arrive for their visit.

Genetic differences between patients can mean differences in dosing and response to common drugs. One patient may need a lower dose of ibuprofen for pain relief than another, for example, depending on CYP2C8 and CYP2C9 polymorphisms. Other factors, such as patient weight, can also play a role. Our story offers a brief overview of where this area of medicine could be going.

Our conference coverage is from the Society of Hospital Medicine's annual meeting, Hospital Medicine 2019, which was held in March in National Harbor, Md. Learn more about how to assess patients before an airplane flight, including how best to determine when oxygen will be needed on board, as well as how nurse practitioners and physician assistants can be incorporated into hospital practice.

And speaking of conference coverage, next month's issue will be all about Internal Medicine Meeting 2019, which took place in April in Philadelphia. We look forward to bringing you some highlights! Share yours with us at acpinternist@acponline.org.

Sincerely,

Jennifer Kearney-Strouse
Executive Editor