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NCP Gastrointestinal (GI) disorders such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and gastroesophageal reflux disease (GERD) have a unique nutrition connection. Nutrition is a treatment component of each of these GI disorders. In turn, these disorders can adversely affect nutrition status. This issue of Nutrition in Clinical Practice is devoted to the evaluation and discussion of GI disorders and their connections to nutrition. First, Dr Steve McClave gives us "Food for Thought..." in his Invited Commentary emphasizing that clinicians must help patients make the connection between nutrition and the treatment of their disorder. Drs Clark and DeLegge then provide an overview of IBS describing the pathophysiology and treatment of the disorder. Drs McOmber and Shulman review GI disorders specific to the pediatric population. They discuss functional dyspepsia, IBS, functional abdominal pain, and cyclic vomiting. Etiologies, diagnosis, and treatment of each are considered. Researchers have identified gender differences with regard to IBS; these differences and the factors that lead to them are discussed in the article by Drs Heitkemper and Jarrett. The authors also evaluate the pathogenesis and treatment options for IBS. Alternative, nonpharmaceutical therapies for IBS have also been proposed. In their paper, Drs Wald and Rakel address the literature supporting use of cognitive behavior therapy, hypnosis, elimination diets, fiber, probiotics, prebiotics, peppermint, L-glutamine, zinc, and cromolyn sodium for treatment of IBS. Dietary and lifestyle modifications have been associated with relief of symptoms of GERD. Dr Vemulappalli summarizes findings of the effect of cigarette smoking, alcohol ingestion, psychological stress, exercise, body position, obesity, spicy or acid foods, carbonated beverages, caffeine, fiber, and fat on GERD symptoms. The final papers supporting this issue's theme are a pair of Pivotal Paper reviews. Drs Issa and Binion as well as Drs Wiese, Rivera, and Seidner discuss the classic paper by Greenberg et al published in 19881 that showed that gut rest was not a major factor in achieving remission of Crohn's disease.
There are several unsolicited research articles and clinical observation papers in this issue. The first paper by Munera-Seeley and colleagues reviewed the sensitivity and specificity of a carbon dioxide sensor in evaluating misplacement of nasoenteric feeding tubes. Their study included the evaluation of this tool in 424 feeding tube insertions. Dr Kejariwal et al present a case series of 7 patients in whom buried bumper syndrome occurred, and in whom the authors were unable to remove the percutaneous endoscopic gastrostomy bumper. They report their alternative approach–leaving the bumpers in situ and placing alternate PEG feeding sites. A second Clinical Observations paper was authored by Via and colleagues. They report an unusual case whereby a 76-year-old woman developed severe insulin resistance postoperatively that seemed to resolve with intravenous chromium infusion. Most A.S.P.E.N. members are aware that the National Board of Nutrition Support Certification (NBNSC) has combined the nutrition support credential exams to a single exam. Those who pass the exam will be given the credential of Certified Nutrition Support Clinician (CNSC). An article by Schwartz, Mirtallo, and Matarese in this issue describes the process of evolution from 3 exams to 1 exam. They describe the study process and results that led to the decision to provide a CNSC credential. We are pleased to include 3 other categories of articles in NCP this month. Contributing Editors Dr Praveen Goday and Dr Carol Ireton-Jones worked with A.S.P.E.N. volunteers to develop Current Literature reviews and Book Reviews. We hope that these features help keep you current with new publications both in journal and book form. We also include a Letter to the Editor. Finally, this issue marks the first issue in which our A.S.P.E.N. President Kelly Tappenden addresses the readers with her new column.
1 Greenberg GR, Fleming CR, Jeejeebhoy KN, Rosenberg IH, Sales D, Tremaine WJ. Controlled trial of bowel rest and nutritional support in the management of Crohn's disease. Gut. 1988; 29:1309-1315. 
Nutrition in Clinical Practice, Vol. 23, No. 3,
259 (2008)
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