bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of slow and fast colonic transit using a scale of stool form in a community
Authors: CHOUNG R. S. , LOCKE G. R. , ZINSMEISTER A. R. , SCHLECK C. D. , TALLEY N. J.
Published: July 2010

Background  Measurement of gastrointestinal transit is commonly performed in the clinic, but data on transit in the community are lacking.

Aim  To estimate the prevalence of slow and fast colonic transit using stool form, and potential risk factors.

Methods  A validated self‐reported gastrointestinal symptom questionnaire was mailed to 4196 randomly selected members of the community (response rate 54%). One question asked the subject to self‐report their stool form using the Bristol Stool Scale.

Results  Overall, 18%, 9% and 73% met stool form criteria for slow, fast or normal colonic transit, respectively. Increased odds for slow transit were observed with a higher Somatic Symptom Checklist score (OR = 1.6; 1.3–2.0), while a decreased odds for slow transit was observed in males relative to females (OR = 0.6; 0.5–0.8). An increased odds for fast transit was observed with higher Somatic Symptom Checklist score (OR = 2.3; 1.7–2.9) and a history of cholecystectomy (OR = 1.8; 1.2–2.8). Increasing body mass index (per 5 units) was associated with decreased odds for slow (OR = 0.85; 0.78–0.93), and an increased odds for fast (OR = 1.1; 1.04–1.24) colonic transit.

Conclusion  Based on stool form assessment, nearly one in five community members may have slow colonic transit and one in 12 have accelerated colonic transit.
Prospective evaluation of faecal neutrophil‐derived proteins in identifying intestinal inflammation: combination of parameters does not improve diagnostic accuracy of calprotectin
Authors: SCHRÖDER O. , NAUMANN M. , SHASTRI Y. , POVSE N. , STEIN J.
Published: July 2010

Background  Differentiating symptoms of irritable bowel syndrome from those of organic intestinal disease is a common clinical problem. Several neutrophil‐derived proteins have been proposed as a marker of inflammatory bowel disease.

Aim  To compare the diagnostic value of faecal calprotectin, lactoferrin and polymorphonuclear neutrophil‐elastase in distinguishing inflammatory bowel disease from irritable bowel syndrome.

Methods  Eighty‐eight adult patients with a history of chronic diarrhoea of unknown origin were screened. All patients underwent a complete work‐up to identify the underlying cause. In addition, a single stool sample was assayed for faecal calprotectin, lactoferrin and polymorphonuclear neutrophil‐elastase by enzyme‐linked immunosorbent assay.

Results  Within the study cohort inflammatory bowel disease was diagnosed in 45 patients and irritable bowel syndrome in 31 patients. The sensitivity and specificity of calprotectin for inflammatory bowel disease were 93% and 100%, respectively. In contrast, the respective diagnostic values for lactoferrin and polymorphonuclear neutrophil‐elastase were 82% and 100% and 84% and 87%, respectively. Neither combination of markers did improve the diagnostic power compared with calprotectin alone.

Conclusions  Although all faecal biomarkers studied provide a reliable and simple non‐invasive means in the differentiation of inflammatory bowel disease and irritable bowel syndrome, calprotectin appears to represent the most accurate marker to discriminate between these two common causes of chronic diarrhoea.
Upper gastrointestinal bleeding and the changing use of COX‐2 non‐steroidal anti‐inflammatory drugs and low‐dose aspirin
Authors: TAHA A. S. , ANGERSON W. J. , PRASAD R. , MCCLOSKEY C. , BLATCHFORD O.
Published: July 2010

Background  Rofecoxib was withdrawn in 2004.

Aim  To assess the incidence of upper gastrointestinal bleeding in the context of the changing use of cyclo‐oxygenase‐2 non‐steroidal anti‐inflammatory drugs and low‐dose aspirin.

Methods  We examined the characteristics of patients developing upper gastrointestinal bleeding in a defined population in south‐west Scotland. The primary comparisons were made between two calendar years, preceding and following the withdrawal of rofecoxib.

Results  The overall incidence of upper gastrointestinal bleeding rose from 98.7 in 2002 to 143 per 105 of the population per annum in 2005 (χ2 = 21.1; P < 0.001). The rise in the incidence was associated with using low‐dose aspirin, from 26.6 to 38.4 per 105 (χ2 = 5.4; P = 0.02), other antithrombotic drugs, from 12.1 to 30.2 per 105 (χ2 = 19.6; P < 0.001), and excess alcohol, from 23.5 to 36.4 per 105 (χ2 = 7.1; P = 0.008), but insignificantly with using non‐steroidal anti‐inflammatory drugs, from 13.3 to 16.1 per 105 (χ2 = 0.64; P = 0.4). After adjustment for the concomitant use of these drugs, there was no significant trend in the incidence of upper gastrointestinal bleeding associated with non‐steroidal anti‐inflammatory drugs over the period of 1996–2005.

Conclusion  The rise in the incidence of upper gastrointestinal bleeding was weakly related to the change in use of non‐steroidal anti‐inflammatory drugs. Instead, it probably reflected the increasing use of low‐dose aspirin, other antithrombotic drugs and alcohol.
Endosonography‐ vs. endoscopic retrograde cholangiopancreatography‐based strategies in the evaluation of suspected common bile duct stones in patients with normal transabdominal imaging
Authors: ANG T. L. , TEO E. K. , FOCK K. M.
Published: July 2010

Background  Endosonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are highly accurate techniques for evaluating common bile duct stones.

Aim  To compare the clinical impact and costs of EUS‐ and ERCP‐based strategies for evaluating patients with suspected common bile duct stones but normal transabdominal imaging.

Methods  The costs of EUS‐ vs. ERCP‐based strategies were compared in patients with suspected acute biliary obstruction from common bile duct stones but normal transabdominal imaging.

Results  Over a 15‐month period, 110 patients were recruited. EUS detected a common bile duct lesion in 73% (common bile duct stones: 68%; pancreatic cancer: 2%; ampulla tumour: 2%; cholangiocarcinoma: 1%). The sensitivity, specificity, positive predictive value and negative predictive value of EUS were 98%, 100%, 100% and 93%, respectively. EUS prevented 30% unnecessary ERCP. The mean difference in cost per patient between EUS‐ and ERCP‐based strategies was US$166. When stratified according to clinical indications, an EUS‐based strategy was costlier only in suspected biliary sepsis. Costs were similar when the indications were cholestatic jaundice, acute pancreatitis and cholestasis.

Conclusion  EUS prior to biliary interventions in patients with suspected common bile duct stones prevented unnecessary ERCP. It allowed a definitive diagnosis to be made prior to more invasive procedures.
Review article: probiotics in gastrointestinal and liver diseases
Authors: JONKERS D. , STOCKBRÜGGER R.
Published: July 2010

Background  Probiotics, defined as live micro‐organisms with beneficial effects for the host, are widely applied in gastrointestinal and liver diseases.

Aim and method  To review the available evidence of clinical trials on probiotics in gastrointestinal and liver diseases, with a major focus on irritable bowel syndrome, inflammatory bowel disease, pancreatitis and chronic liver diseases.

Results  Evidence for the therapeutic or preventive application of particular probiotic strains is available for antibiotic‐associated diarrhoea, rota‐virus‐associated diarrhoea and pouchitis. Results are encouraging for irritable bowel syndrome, ulcerative colitis and for reducing side effects by Helicobacter pylori eradication therapies, but are less clear for Crohn’s disease, lactose intolerance and constipation. In general, for most of these patient groups, more placebo‐controlled methodologically well‐designed studies that pay attention to both clinical outcome and mechanistic aspects are required. The application in liver disease and pancreatitis is promising, but more human trials have to be awaited. Possible mechanisms of probiotics include modulation of the intestinal microbiota and the immune system, but different bacterial may have different effects.

Conclusion  Further insight into disease entities and the functioning of probiotic strains is required to be able to select disease‐specific strains, which have to be tested in well‐designed placebo‐controlled studies.
Review article: the relevance of surveillance endoscopy in long‐lasting inflammatory bowel disease
Authors: VLEGGAAR F. P. , LUTGENS M. W. M. D. , CLAESSEN M. M. H.
Published: July 2010

Background  Development of colitis‐associated colorectal cancer is an important clinical problem in patients with colonic inflammatory bowel disease (IBD). British and American guidelines recommend to start surveillance after a disease duration of 8–10 or 15–20 years for patients with extensive or left‐sided colitis, respectively.

Aim  To assess the evidence level of current surveillance strategies.

Methods  A PubMed‐based literature search using the search terms inflammatory bowel disease, ulcerative colitis, Crohn’s disease, dysplasia, colorectal cancer and surveillance was performed.

Results  Low‐grade and high‐grade dysplastic lesions progress to cancer in a high percentage of patients. Furthermore, concurrent cancer is found in approximately one‐third of the patients with colonic dysplasia. Low‐level evidence showing reduced colorectal cancer‐related mortality in patients who were undergoing surveillance is available. Patients with concomittant primary sclerosing cholangitis form a subgroup of IBD patients with an even higher risk of colorectal neoplasia.

Conclusions  Colonic surveillance prolongs life expectancy of patients with long‐lasting IBD.
Review article: the management of non‐cirrhotic non‐malignant portal vein thrombosis and concurrent portal hypertension in adults
Authors: SPAANDER V. M. C. W. , VAN BUUREN H. R. , JANSSEN H. L. A.
Published: July 2010

Background  Extrahepatic portal vein thrombosis is an important cause of non‐cirrhotic portal hypertension.

Aim  To provide an update on recent advances in the aetiology and management of acute and chronic non‐cirrhotic non‐malignant extrahepatic portal vein thrombosis.

Method  A PubMed search was performed to identify relevant literature using search terms including ‘portal vein thrombosis’, ‘variceal bleeding’ and ‘portal biliopathy’.

Results  Myeloproliferative disease is the most common risk factor in patients with non‐cirrhotic non‐malignant extrahepatic portal vein thrombosis. Anticoagulation therapy for at least 3 months is indicated in patients with acute extrahepatic portal vein thrombosis. However, in patients with extrahepatic portal vein thrombosis due to a prothrombotic disorder, permanent anticoagulation therapy can be considered. The most important complication of extrahepatic portal vein thrombosis is oesophagogastric variceal bleeding. Endoscopic treatment is the first‐line treatment for variceal bleeding. In several of the patients with extrahepatic portal vein thrombosis biliopathy changes on endoscopic retrograde cholangiography (ERCP) have been reported. Dependent on the persistence of the biliary obstruction, treatment can vary from ERCP to hepaticojejunostomy.

Conclusion  Prothrombotic disorders are the major causes of non‐cirrhotic, non‐malignant extrahepatic portal vein thrombosis and anticoagulation therapy is warranted in these patients. The prognosis of patients with non‐cirrhotic, non‐malignant extrahepatic portal vein thrombosis is good, and is not determined by portal hypertension complications but mainly by the underlying cause of thrombosis.
Review article: gastro‐oesophageal reflux disease – application of the concept of complete remission
Authors: OUDKERK POOL M.
Published: July 2010

Background  Therapeutic success in the treatment of gastro‐oesophageal reflux disease cannot be measured by endoscopic healing or symptomatic relief alone. Assessment of treatment efficacy should be based on symptomatic relief and endoscopic healing. As most questionnaires focus on heartburn, it is important to stress that there is more to gastro‐oesophageal reflux disease than just heartburn. The ‘complete remission’ concept was recently introduced; an approach in which endoscopic appearances and symptomatic relief are integrated, thus allowing the full gastro‐oesophageal reflux disease picture and its changes over time to be described in a simple and accurate manner. Complete remission is defined as the absence of both oesophagitis and symptoms. ReQuest, a relatively new questionnaire acceptable as a clinical endpoint in trials, seems to be of use in daily practice.

Aim  To review the utility of the ReQuest questionnaire.

Results  This questionnaire assesses the gastro‐oesophageal reflux disease symptom profile using 67 symptom descriptions adapted from patients’ view, doctors’ view, clinical trials and from the literature. Individual symptoms are reduced to seven dimensions by factor analysis and expert consensus. This gives insight into multiple symptoms over time as well as individual patient profiles. ReQuest determines symptom relief using a gastro‐oesophageal reflux disease symptom threshold. This unique concept allows the doctor to measure the time to first symptom relief and also to sustained symptom relief.

Conclusions  ReQuest makes it possible to evaluate the complete symptom spectrum in patients with non‐erosive oesophageal reflux disease and gastro‐oesophageal reflux disease. ReQuest is available for daily practice to use for comparability with regard to treatment efficacy.
Review article: new developments in colonic imaging
Authors: VAN DEN BROEK F. J. C. , FOCKENS P. , DEKKER E.
Published: July 2010

Background  Colonoscopic detection and removal of neoplasia from the colorectum prevent the development of colorectal cancer. Sporadic adenomas and neoplasia associated with ulcerative colitis are frequently missed during colonoscopy, as a result of which, interval cancers might develop.

Aim  To review new developments in colonoscopic imaging concerning the detection of neoplasia.

Methods  Medical databases were searched for relevant publications, dealing with advanced endoscopic imaging techniques during colonoscopy.

Results  Pancolonic chromoendoscopy has shown to increase the detection of sporadic adenomas and ulcerative colitis associated neoplasia, at the expense of longer examination times. As chromoendoscopy is labour intensive and time‐consuming, its widespread use has been hampered. Narrow band imaging is a novel endoscopic imaging technique, which enhances mucosal and vascular details. Recent studies indicate that narrow band imaging has a high yield for neoplasia; however, no improvement compared to standard colonoscopy has been demonstrated. Autofluorescence imaging is another new technique for which blue endoscopic light is used to induce mucosal autofluorescence. So far, preliminary results have shown promising results of autofluorescence imaging for neoplasia detection.

Conclusion  Whether chromoendoscopy or novel advanced imaging techniques will change current colonoscopic practice depends on results of future studies comparing these different colonoscopic techniques.
Clinical trial: evaluation of a clinical decision‐support model for upper abdominal complaints in primary‐care practice
Authors: HOROWITZ N. , MOSHKOWITZ M. , LESHNO M. , RIBAK J. , BIRKENFELD S. , KENET G. , HALPERN Z.
Published: July 2010

Background  Gastro‐oesophageal reflux disease (GERD) and dyspepsia affect 25–40% of the general population. In the absence of alarm symptoms, the current recommended policy in young dyspeptic patients is a ‘test and treat’ strategy for Helicobacter pylori; in GERD patients, a therapeutic trial with proton pump inhibitors is the treatment of choice.

Aim  To create a short and simple clinical algorithm, for the diagnosis and treatment of patients with upper gastrointestinal complaints.

Methods  The clinical usefulness and cost‐effectiveness of the new algorithm were evaluated in a controlled clinical trial, held in primary‐care clinics in Israel. Clinical and economical treatment outcomes were evaluated after 1, 3 and 6 months comparing doctors who used the algorithm (cases) vs. those who did not (controls).

Results  78 cases and 54 controls completed the 6 months of follow up. The improvement in symptom severity and quality of life was greater in the cases than in the controls (P < 0.05). General practitioner clinics visits (P = 0.04), gastroenterology clinics visits (P = 0.02) and medication costs (P = 0.004) were all significantly reduced among cases. Controls underwent also more imaging tests (computerized tomography, ultrasound and X‐ray) and endoscopies. The average cost for 6 months’ treatment and follow‐up was $US 199 for cases compared with an average of $US 336 in the control group.

Conclusion  The use of a clinical decision‐support tool can facilitate and promote the implementation of management guidelines by general practitioners. The short algorithm presented in the study was found to be useful and easy to apply in clinical practice. Its effectiveness can be further increased by implementing it in computerized medical systems.
A prospective comparative study of five measures of gluten‐free diet adherence in adults with coeliac disease
Authors: LEFFLER D. A. , EDWARDS GEORGE J. B. , DENNIS M. , COOK E. F. , SCHUPPAN D. , KELLY C. P.
Published: July 2010

Background  Increasing numbers of individuals are now being diagnosed with coeliac disease. The only accepted treatment for coeliac disease is lifelong adherence to a strict gluten‐free diet (GFD). Individuals’ ability to adhere to the GFD varies, but systematic studies guiding the assessment of adherence are currently lacking.

Aim  We sought to compare the predictive value of self‐report and four serologic tests compared to expert nutritionist evaluation.

Methods  In all, 154 individual adults with biopsy‐proven coeliac disease rated their adherence to the GFD on a Likert scale. Serum antibody titres of IgA anti‐tissue transglutaminase, and IgA and IgG anti‐deamidated gliadin peptides were determined. Using anova and ROC analyses, results were compared to a standardized evaluation by an expert nutritionist blinded to the participants’ self‐rated adherence and serology results.

Results  All serologic measures as well as participant reported adherence were significantly associated with GFD adherence as assessed by expert nutritionist evaluation. However, on ROC analysis no measure performed satisfactorily. The performance of serologic testing, but not self‐report, improved with increased time on the GFD.

Conclusion  Although current serologic tests have very high sensitivities and specificities for the diagnosis of coeliac disease, they cannot replace trained nutritionist evaluation in the assessment of GFD adherence.
Review article: the evidence base for interventions used to maintain remission in Crohn’s disease
Authors: AKOBENG A. K.
Published: July 2010

Background  Crohn’s disease is characterised by recurrent flare‐ups alternating with periods of remission. A number of interventions are currently used in clinical practice to try and maintain remission in Crohn’s disease but the evidence base for some of them may be questionable.

Aim  To review the available evidence on interventions, which are currently used to maintain remission in Crohn’s disease.

Methods  The Cochrane Library and Medline (Pubmed) were searched for level 1 evidence on specific interventions. Search terms included ‘Crohn’s disease or synonyms’, ‘remission or synonyms’ and the names of specific interventions.

Results  Azathioprine, infliximab and adalimumab are effective at maintaining remission in Crohn’s disease. Natalizumab is also effective, but there are concerns about its potential association with progressive multifocal leukoencephalopathy. Long‐term enteral nutritional supplementation, enteric‐coated omega‐3 fatty acids and intramuscular methotrexate may also be effective but the evidence for these is based on relatively small studies. The available evidence does not support the use of oral 5‐aminosalicylates agents, corticosteroids, anti‐mycobacterial agents, probiotics or ciclosporin as maintenance therapy in Crohn’s disease.

Conclusion  A better understanding of the evidence base of existing interventions could result in the use of treatments, which are more likely to lead to improved patient outcomes.
Severe symptoms of gastro‐oesophageal reflux disease are associated with cardiovascular disease and other gastrointestinal symptoms, but not diabetes: a population‐based study
Authors: JANSSON C. , NORDENSTEDT H. , WALLANDER M.‐A. , JOHANSSON S. , JOHNSEN R. , HVEEM K. , LAGERGREN J.
Published: July 2010

Background  Few population‐based studies have examined comorbidity in relation to gastro‐oesophageal reflux disease (GERD).

Aim  To study the association between cardiovascular disease, diabetes, gastrointestinal symptoms and GERD.

Methods  Population‐based, cross‐sectional, case‐control study based on a large Norwegian health survey conducted in 1995–97. Among 65 333 participants, 3153 persons reporting severe reflux symptoms were defined as cases, and 40 210 persons without such symptoms were defined as controls. Data on cardiovascular disease, diabetes, gastrointestinal symptoms and potential confounders were collected through questionnaires. Odds ratios (OR) with 95% confidence intervals (CI) were estimated using unconditional logistic regression, in crude and adjusted models.

Results  In the crude models, positive associations were observed between myocardial infarction (OR 1.7, 95% CI 1.4–2.1), angina pectoris (OR 2.5, 95% CI 2.1–2.9) and stroke (OR 1.6, 95% CI 1.2–2.1) and risk of GERD. The associations were attenuated in the adjusted models, but remained significant for angina pectoris (OR 1.9, 95% CI 1.6–2.2). No association was observed between diabetes and GERD. Strong positive associations were seen between all studied gastrointestinal symptoms, i.e. nausea, diarrhoea and constipation, and risk of GERD.

Conclusions  This population‐based study indicates that myocardial infarction, angina pectoris, stroke and symptoms of nausea, diarrhoea and constipation are associated with GERD.
Metabolic syndrome is associated with severe fibrosis in chronic viral hepatitis and non‐alcoholic steatohepatitis
Authors: TSOCHATZIS E. , PAPATHEODORIDIS G. V. , MANESIS E. K. , KAFIRI G. , TINIAKOS D. G. , ARCHIMANDRITIS A. J.
Published: July 2010

Background  The prevalence of metabolic syndrome and its possible impact on the severity of liver histological lesions have not been studied prospectively in chronic liver diseases.

Aim  To investigate the prevalence of metabolic syndrome in patients with chronic viral hepatitis or non‐alcoholic steatohepatitis, and to determine its associations with histological severity.

Methods  We prospectively included 317 patients (hepatitis B e antigen‐negative chronic hepatitis B: 95, chronic hepatitis C: 176, non‐alcoholic steatohepatitis: 46) with liver biopsy. Metabolic syndrome was defined using the Adult Treatment Panel III criteria. Histological lesions were evaluated according to Ishak’s or Brunt’s classification.

Results  Metabolic syndrome was present in 10.4% of patients being significantly more prevalent in non‐alcoholic steatohepatitis than in chronic viral hepatitis (41.3% vs. 5.1%, P < 0.001). In chronic viral hepatitis, cirrhosis (stages 5–6) was independently associated with increasing age, higher aspartate aminotransferase and gamma‐glutamyl‐transpeptidase levels, severe necroinflammation and metabolic syndrome (P = 0.016). In non‐alcoholic steatohepatitis, severe fibrosis (stages 3–4) was independently associated with severe necroinflammation and metabolic syndrome (P = 0.033). Presence of metabolic syndrome was not associated with presence or severity of steatosis both in chronic viral hepatitis and in non‐alcoholic steatohepatitis.

Conclusion  Metabolic syndrome is more prevalent in non‐alcoholic steatohepatitis than in chronic viral hepatitis; it is associated independently with more severe fibrosis but not with the severity of steatosis, both in chronic viral hepatitis and in non‐alcoholic steatohepatitis.
Clinical trial: the effect of somatostatin vs. octreotide in preventing post‐endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices
Authors: VLACHOGIANNAKOS J. , KOUGIOUMTZIAN A. , TRIANTOS C. , VIAZIS N. , SGOUROS S. , MANOLAKOPOULOS S. , SAVERIADIS A. , MARKOGLOU C. , ECONOMOPOULOS T. , KARAMANOLIS D. G.
Published: July 2010

Background Hepatic venous pressure gradient (HVPG) increases significantly after endoscopic therapy in patients with bleeding oesophageal varices, which may precipitate further haemorrhage. Whether vasoactive drugs can suppress these changes remains unknown.

Aim To investigate the efficacy of somatostatin when compared with octreotide in preventing the post‐endoscopic increase in HVPG during acute bleeding and whether the changes affect outcome.

Methods Thirty‐three cirrhotics with bleeding varices were randomized to receive somatostatin (n = 17) or octreotide (n = 16) under double‐blind conditions, soon after their admission. HVPG measurements were performed before and immediately after endoscopic treatment.

Results In the somatostatin group, postendotherapy HVPG values did not change significantly when compared with pre‐treatment values (18.9 vs. 17.2, P = 0.092). Conversely, in the octreotide group, HVPG increased significantly after endoscopy (18.2 vs. 20.8, P = 0.003). The probability of 6‐week survival without treatment failure was significantly higher in the somatostatin group (P = 0.024). Post‐endoscopic HVPG value was independently associated with 6‐week failure.

Conclusions Somatostatin, but not octreotide, effectively prevents the post‐endoscopic increase in HVPG, which may be associated with low probability of treatment failure.
Dietary modifications, nutritional supplements and alternative medicine in paediatric patients with inflammatory bowel disease
Authors: GERASIMIDIS K. , MCGROGAN P. , HASSAN K. , EDWARDS C. A.
Published: July 2010

Background  Data on use of complementary and alternative medicine in children with inflammatory bowel disease are scarce.

Aim To assess prevalence, predictors and parental attitude to the use of complementary and alternative medicine in a paediatric population with inflammatory bowel disease in the west of Scotland.

Methods  Questionnaire survey encompassing alternative therapists, nutritional supplements and dietary modifications used in the management of inflammatory bowel disease was used. Demographics, disease and treatment data were also collected.

Results  86 guardians completed the survey. 61% had used at least one type and 37% were using complementary and alternative medicine recently. The most common types were probiotics (44%) and dairy‐free diet (28%). Higher parental education and young parental age were predictors of complementary and alternative medicine use. An increased number of oral steroid courses and prior use of complementary and alternative medicine for other health reasons were associated with use of alternative therapists. Personal recommendation and to complement conventional medicine were the main reasons for using complementary and alternative medicine. 48% judged complementary and alternative medicine at least partially effective. 86% agreed that doctors should be supportive of use. 89% would give complementary and alternative medicine to their children.

Conclusions  Use of complementary and alternative medicine was higher in children with IBD than in adults with the same disease. The gastrointestinal nature of the disease could explain the high use of nutritional supplements and dietary modifications in this survey.
Review article: minimizing tuberculosis during anti‐tumour necrosis factor‐alpha treatment of inflammatory bowel disease
Authors: THEIS V. S. , RHODES J. M.
Published: July 2010

Background  Tumour necrosis factor (TNF)‐alpha inhibitors are a major advance in the management of inflammatory bowel disease but increase the risk for tuberculosis (TB).

Aim  To examine the reasons for the increase in the risk for TB and the strategies to reduce it.

Methods  PubMed searches were performed using search terms that included TB and each of the current anti‐TNF‐alpha biological agents and also TB and Crohn’s disease.

Results  Increased susceptibility to TB, often with extrapulmonary or disseminated disease, occurs following treatment with all anti‐TNF‐alpha biological agents and amounts to a four‐ to 20‐fold increased risk with infliximab. TB usually occurs shortly after anti‐TNF‐alpha initiation suggesting reactivation of latent infection. Animal studies show that TNF‐alpha inhibition impairs inflammatory cell trafficking and granuloma formation. Currently recommended screening for latent TB typically, risk assessment, tuberculin skin testing and chest radiograph used prior to anti‐TNF‐alpha treatment can reduce TB rates by up to 90% but newer screening interferon gamma assays may enhance screening efficacy. Patients positive on screening who are treated with isoniazid and subsequently receive anti‐TNF‐alpha treatment still have approximately 19% risk for TB.

Conclusions  Tuberculosis following treatment with TNF‐alpha inhibitors usually results from reactivation of latent disease. Screening reduces the risk substantially but does not completely eliminate it.
The prevalence of and risk factors for erosive oesophagitis and non‐erosive reflux disease: a nationwide multicentre prospective study in Korea
Authors: KIM N. , LEE S. W. , CHO S. I. , PARK C. G. , YANG C. H. , KIM H. S. , REW J. S. , MOON J. S. , KIM S. , PARK S. H. , JUNG H. C. , CHUNG I. S. ,   ‘THE H. PYLORI AND GERD STUDY GROUP’ OF KOREAN COLLEGE OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH
Published: July 2010

Background  Prospective nationwide multicentre studies that have evaluated endoscopic findings and reflux symptoms using a well‐designed questionnaire are very rare.

Aim  To compare the prevalence rates of and risk factors for erosive oesophagitis and non‐erosive reflux disease (NERD) in the Korean population.

Methods  A gastroscopic examination was performed on 25 536 subjects who visited 40 Healthcare Centers for a health check‐up. A gastro‐oesophageal reflux questionnaire and multivariate analysis were used to determine the risk factors for erosive oesophagitis and NERD.

Results  2019 (8%) and 996 subjects (4%) had erosive oesophagitis and non‐erosive reflux disease, respectively; only 58% of subjects with erosive oesophagitis had reflux symptoms. Multivariate analysis showed that the risk factors for erosive oesophagitis and NERD differed, i.e. those of erosive oesophagitis were male, a Helicobacter pylori eradication history, alcohol, body mass index ≥25 and hiatal hernia. In contrast, the risk factors for NERD were female, age <40 and ≥60 vs. 40–59 years, body mass index <23 and a monthly income <$1000, glucose ≥126 mg/dL, smoking, a stooping posture at work and antibiotic usage.

Conclusions  The prevalence rates of erosive oesophagitis and NERD were 8% and 4%, respectively, in Korean health check‐up subjects. The risk factors for erosive oesophagitis and NERD were found to differ, which indicates that their underlying pathogeneses are distinct.
Comparison of gastric emptying of a nondigestible capsule to a radio‐labelled meal in healthy and gastroparetic subjects
Authors: KUO B. , McCALLUM R. W. , KOCH K. L. , SITRIN M. D. , WO J. M. , CHEY W. D. , HASLER W. L. , LACKNER J. M. , KATZ L. A. , SEMLER J. R. , WILDING G. E. , PARKMAN H. P.
Published: July 2010

Background  Gastric emptying scintigraphy (GES) using a radio‐labelled meal is used to measure gastric emptying. A nondigestible capsule, SmartPill, records luminal pH, temperature, and pressure during gastrointestinal transit providing a measure of gastric emptying time (GET).

Aims  To compare gastric emptying time and GES by assessing their correlation, and to compare GET and GES for discriminating healthy subjects from gastroparetics.

Methods  Eighty‐seven healthy subjects and 61 gastroparetics enrolled with simultaneous SmartPill and GES. Fasted subjects were ingested capsule and [99mTc]‐SC radio‐labelled meal. Images were obtained every 30 min for 6 h. Gastric emptying time and percentage of meal remaining at 2/4 h were determined for each subject. The sensitivity/specificity and receiver operating characteristic analysis of each measure were determined for each subject.

Results  Correlation between GET and GES‐4 h was 0.73 and GES‐2 h was 0.63. The diagnostic accuracy from the receiver operating characteristic curve between gastroparetics and healthy subjects was GET = 0.83, GES‐4 h = 0.82 and GES‐2 h = 0.79. The 300‐min cut‐off time for GET gives sensitivity of 0.65 and specificity of 0.87 for diagnosis of gastroparesis. The corresponding sensitivity/specificity for 2 and 4 h standard GES measures were 0.34/0.93 and 0.44/0.93, respectively.

Conclusion  SmartPill GET correlates with GES and discriminates between healthy and gastroparetic subjects offering a nonradioactive, standardized, ambulatory alternative to scintigraphy.
Night‐time and daytime atypical manifestations of gastro‐oesophageal reflux disease: frequency, severity and impact on health‐related quality of life
Authors: DEAN B. B. , AGUILAR D. , JOHNSON L. F. , MCGUIGAN J. E. , ORR W. C. , FASS R. , YAN N. , MORGENSTERN D. , DUBOIS R. W.
Published: July 2010

Background  Respondents with gastro‐oesophageal reflux disease (GERD) report having a variety of atypical manifestations. The relationship between these manifestations and disease severity, night‐time GERD and functioning has not been determined.

Aim  To determine if atypical manifestations are related to increased disease severity, night‐time GERD and decreased functioning.

Methods  A web survey among US adults was conducted, using a validated GERD screener. Frequency of night‐time and daytime typical symptoms (acid regurgitation and heartburn) and atypical manifestations were assessed. Respondents were classified as night‐time GERD or daytime GERD based on typical symptom frequency. Prevalence of frequent atypical manifestations (≥2 days or nights/week) was assessed.

Results  Gastro‐oesophageal reflux disease cases had a higher prevalence of each atypical manifestation (P < 0.05 for all) compared with controls. Night‐time GERD respondents had a higher prevalence of atypical manifestations compared with daytime GERD respondents (P < 0.05 for most manifestations) and the prevalence of atypical manifestations increased with GERD symptom severity (P < 0.05 for most). Those with atypical manifestations reported lower functioning scores (P < 0.05 for most).

Conclusions  Respondents with typical GERD symptoms commonly report atypical manifestations, especially those with night‐time symptoms and those with greater underlying GERD severity. Respondents with GERD and atypical manifestations had more impaired functioning than those with typical symptoms only.
Projected impact of colorectal cancer screening with computerized tomographic colonography on current radiological capacity in Europe
Authors: HASSAN C. , LAGHI A. , PICKHARDT P. J. , KIM D. H. , ZULLO A. , IAFRATE F. , MORINI S.
Published: July 2010

Background  The impact of a primary colorectal cancer screening with computerized tomographic colonography on current radiological capacity is unknown. The multispecialty needs for computerized tomographic examinations raise some doubts on the feasibility of a mass colorectal cancer screening with computerized tomographic colonography.

Aim  To assess whether the number of available computerized tomographic units in Europe is adequate to cover population screening with computerized tomographic colonography.

Methods  A mathematical and a Markov model were, respectively, used to assess the number of computerized tomographic colonography procedures needed to be performed each day in the start‐up and in the steady‐state phases of a colorectal cancer screening programme in Europe. Such outcome was divided for the total number of computerized tomographic machines aged <10 years estimated to be present in the European hospitals.

Results  At a simulated 30% compliance, 28 760 130 European people would need to be screened by the 3482 available computerized tomographic units in a 5‐year start‐up period, corresponding to 6.6 CTC/CT unit/day. Assuming a 10‐year repetition of computerized tomographic colonography between 50 and 80 years, the number of computerized tomographic colonography needed to be performed in the steady‐state period appeared to be 4.3/CT unit/day.

Conclusions  The current radiological capacity may cover the need for a primary colorectal cancer screening with computerized tomographic colonography in a steady state. On the other hand, a substantial implementation of the current computerized tomographic capacity or a synergistic approach with other techniques seems to be necessary for the start‐up period.
Adipokines and cytokines in non‐alcoholic fatty liver disease
Authors: JARRAR M. H. , BARANOVA A. , COLLANTES R. , RANARD B. , STEPANOVA M. , BENNETT C. , FANG Y. , ELARINY H. , GOODMAN Z. , CHANDHOKE V. , YOUNOSSI Z. M.
Published: July 2010

Background  Several adipocytokines have been implicated in the pathogenesis non‐alcoholic fatty liver disease (NAFLD).

Aim  To assess adipocytokines in NAFLD patients and controls.

Methods  A total of 95 patients (26 non‐alcoholic steatohepatitis (NASH), 19 simple steatosis (SS), 38 obese controls and 12 non‐obese controls) were included. Fasting serum insulin, glucose, visfatin, resistin, adiponectin, tumour necrosis factor‐α (TNF‐α), interleukin‐8 (IL‐8) and IL‐6 were determined. Univariate and multivariate analyses were used to compare groups and determine associations.

Results  Serum TNF‐α and IL‐8 were higher in NAFLD patients when compared with both obese and non‐obese controls. Analysis involving all patients revealed a significant correlation between serum TNF‐α and IL‐8 (P < 6.319e−08), and between IL‐6 and IL‐8 (P < 5.271e−15). Homeostatic model assessment scores negatively correlated with adiponectin in NAFLD (P < 0.0032). Serum visfatin was higher in all three obese groups than in non‐obese controls (P < 0.02, P < 0.002 and P < 0.008). Visfatin in NASH patients was lower than SS and obese controls. Although TNF‐α was associated with NAFLD (P < 0.02), it was interdependent on visfatin. In comparison to SS, four factors were independently associated with NASH: age, alanine aminotransferase, IL‐8 and adiponectin (P < 0.05). Multivariate analysis indicated that TNF‐α was the only independent predictor of fibrosis in NASH (P < 0.0004).

Conclusion  These findings support a complex interaction between adipocytokines and the pathogenesis of NAFLD.
Intravenous esomeprazole 40 mg vs. intravenous lansoprazole 30 mg for controlling intragastric acidity in healthy adults
Authors: PISEGNA J. R. , SOSTEK M. B. , MONYAK J. T. , MINER P. B.
Published: July 2010

Background  Intravenous (IV) formulations of proton pump inhibitors are effective for patients in whom oral therapy is not appropriate.

Aim  To compare IV esomeprazole and IV lansoprazole for the control of intragastric pH.

Methods  In this open‐label crossover study, healthy, Helicobacter pylori‐negative adults were randomized to one of two treatment sequences, each consisting of two 5‐day dosing periods of IV esomeprazole 40 mg or IV lansoprazole 30 mg. Twenty‐four‐hour intragastric pH monitoring was conducted on days 1 and 5 of each dosing period.

Results  On days 1 and 5, intragastric pH was >4.0 significantly longer with esomeprazole than lansoprazole (least‐squares means: day 1, 40.0% vs. 33.6%; day 5, 61.9% vs. 45.4%; both P < 0.0001). During the first 4 h of pH monitoring, intragastric pH was >4.0 significantly longer on days 1 and 5 with esomeprazole than lansoprazole (P < 0.0001). Kaplan–Meier estimates of median hours to stable pH >4.0 were 4.92 for esomeprazole and 5.75 for lansoprazole (P = 0.0014 for test on Gehan scores).

Conclusion  In healthy adults, IV esomeprazole 40 mg controlled intragastric acidity faster and more effectively than IV lansoprazole 30 mg.
The utility of flexible sigmoidoscopy after a computerized tomographic colonography revealing only rectosigmoid lesions
Authors: YOUNG P. E. , GENTRY A. B. , CASH B. D.
Published: July 2010

Background  Identifying polyps by computerized tomographic colonography typically prompts colonoscopy, increasing its cost, risk and inconvenience. Many polyps are confined to the rectosigmoid and theoretically amenable to resection via flexible sigmoidoscopy.

Aim  To determine the prevalence of advanced proximal colonic neoplasia when computerized tomographic colonography reveals only rectosigmoid polyps, and characterize the yield of polypectomy via flexible sigmoidoscopy in such patients.

Methods  Subjects underwent computerized tomographic colonography and colonoscopy with segmental unblinding. Patients with only rectosigmoid findings by computerized tomographic colonography were identified retrospectively. Flexible sigmoidoscopy findings were estimated by including lesions distal to the descending/sigmoid colon junction during colonoscopy. Proximal lesions were also reviewed. Advanced lesions were defined as: adenocarcinoma, tubular adenoma >1 cm, ≥3 tubular adenomas, tubulovillous histology or high‐grade dysplasia.

Results  By computerized tomographic colonography, 15% (203 of 1372) had only rectosigmoid polyps. Concomitant lesions in the proximal colon were seen in 32% (64 of 203) during colonoscopy. Advanced proximal neoplasia occurred in 2% (three of 203) with only rectosigmoid polyps on computerized tomographic colonography.

Conclusions  Using flexible sigmoidoscopy to follow‐up computerized tomographic colonography demonstrating only rectosigmoid polyps would eliminate 15% of subsequent colonoscopies. This strategy carries a small risk of missed proximal advanced neoplasia. This miss rate appears comparable to that of colonoscopy alone. Further study on the cost‐effectiveness of this approach is warranted.
Coeliac disease: a biopsy is not always necessary for diagnosis
Authors: HILL P. G. , HOLMES G. K. T.
Published: July 2010

Background  In view of the high diagnostic accuracy of immunoglobulin‐A‐tissue transglutaminase antibodies for detecting coeliac disease, we have explored whether a small bowel biopsy is always required to establish the diagnosis.

Aim  To define the transglutaminase antibody level giving a positive predictive value for coeliac disease of 100% and to subsequently assess the proportion of new diagnoses of coeliac disease having such a result.

Methods  The Celikey kit (Phadia GmbH, Frieburg, Germany) was used to measure transglutaminase antibody levels.

Results  All patients with transglutaminase antibody levels >30 U/mL, i.e. 10 × upper limit of normal in 2002/2003 had characteristic small bowel mucosal lesions. In a subsequent audit, 58% of 112 new diagnoses of coeliac disease in 2004/2005 had levels above this cut‐off value.

Conclusions  We have shown that a transglutaminase antibody level can be defined which gives a positive predictive value of 100% for coeliac disease. From published data, these observations can be extended to most second‐generation transglutaminase antibody kits. Our data provide further evidence that diagnostic guidelines could be modified so that small bowel biopsy is no longer regarded as mandatory in patients with such high transglutaminase antibody levels. This will avoid an invasive procedure and lead to a more rapid diagnosis and earlier treatment for over half of the new patients with coeliac disease.
Clinical trial: comparison of the gastrointestinal safety of lumiracoxib with traditional nonselective nonsteroidal anti‐inflammatory drugs early after the initiation of treatment – findings from the Therapeutic Arthritis Research and Gastrointestinal Event Trial
Authors: HAWKEY C. J. , WEINSTEIN W. M. , STRICKER K. , MURPHY V. , RICHARD D. , KRAMMER G. , REBULI R.
Published: July 2010

Background  The large (n = 18 325) Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET) study demonstrated a significant gastrointestinal benefit with lumiracoxib 400 mg o.d. (4× the recommended dose in osteoarthritis) vs. naproxen 500 mg b.d. or ibuprofen 800 mg t.d.s.

Aim  To investigate how early a reduction in ulcer complications could be detected with lumiracoxib vs. nonselective nonsteroidal anti‐inflammatory drugs in TARGET.

Methods  Pointwise 95% confidence intervals were generated for the between‐treatment differences in Kaplan–Meier estimates for definite or probable upper gastrointestinal ulcer complications (ulcer complications) and for all ulcers.

Results  In patients not on aspirin, there was a significant reduction in all ulcers by day 8 and in ulcer complications by day 16 with lumiracoxib compared with both nonselective nonsteroidal anti‐inflammatory drugs combined, by day 6 (all ulcers) and day 14 (ulcer complications) vs. naproxen and by day 32 (all ulcers) and day 33 (ulcer complications) vs. ibuprofen.

Conclusion  Even with short‐term use, there are gastrointestinal safety benefits for lumiracoxib vs. nonselective nonsteroidal anti‐inflammatory drugs.
Clinical trial: individualized treatment duration for hepatitis C virus genotype 1 with peginterferon‐alpha 2a plus ribavirin
Authors: TANG K. H. , HERRMANN E. , PACHIADAKIS I. , PAULON E. , TATMAN N. , ZEUZEM S. , NAOUMOV N. V.
Published: July 2010

Background  Individualized treatment regimens, taking into account the heterogeneity of patients with chronic hepatitis C, are needed to improve treatment outcomes.

Aim  To investigate prospectively the period of undetectable viraemia required for a high rate of sustained virological response in patients with chronic hepatitis C genotype 1 and the relationship to early viral kinetics.

Methods  Forty‐five chronic hepatitis C genotype 1 patients were given peginterferon‐alpha 2a plus ribavirin. Viraemia and hepatocyte HCV‐RNA levels were quantified using a TaqMan assay. Beyond the first time point of undetectable viraemia (<20 IU/mL) between baseline and treatment week 12, 32 of 45 (71%) patients were randomized to additional 12 weeks (G12); 24 weeks (G24) or 36 weeks therapy (G36). The remaining 13 patients received 48 weeks’ treatment (G48).

Results  The sustained virological response rates were: G12 – five of 11 (45%); G24 – eight of 10 (80%); G36 – eight of 11 (73%); G48 – four of 13 (31%). The anti‐viral efficacy (ε) and treatment‐induced loss of infected hepatocytes (Mδ), were significantly higher in patients with early viral clearance. In G12, patients with sustained virological response had lower baseline viraemia than those who relapsed.

Conclusions  Early viraemia clearance is a better marker than baseline viral load and differentiates chronic hepatitis C genotype 1 with high or low probability of sustained virological response. In patients with viraemia clearance within 12 weeks of starting peg‐interferon/ribavirin therapy, an additional period of undetectable viraemia of minimum 24 weeks is required for high sustained virological response.