bluuebunny/crossref_metadata_2025_split huggingface dataset:
Virtual vs. optical colonoscopy in symptomatic gastroenterology out‐patients: the case for virtual imaging followed by targeted diagnostic or therapeutic colonoscopy1
Authors: BOSE M. , BELL J. , JACKSON L. , CASEY P. , SAUNDERS J. , EPSTEIN O. 
Published: July 2010

SummaryAimTo compare virtual colonoscopy with optical colonoscopy findings in symptomatic patients.BackgroundComputer tomographic colonography is an alternative to optical colonoscopy. Studies have shown that two‐dimensional computer tomographic colonography does not have sufficient sensitivity. Three‐dimensional computerized tomographic virtual colonoscopy compares well with optical colonoscopy for colorectal neoplasia screening in asymptomatic individuals.MethodsOne hundred patients aged 50 and older underwent same day virtual colonoscopy and optical colonoscopy. The endoscopists were unaware of the radiologist's report until the withdrawal phase of the endoscopy when segmental unblinding occurred. The virtual colonoscopy and optical colonoscopy findings were compared by using the unblinded optical colonoscopy as the reference standard.ResultsPancolonic endoluminal virtual colonoscopy was achieved in 99 patients. Optical colonoscopy caecal intubation occurred in 91 patients. Direct comparison was possible in 90 patients. Both techniques revealed the three cancers detected. Virtual colonoscopy revealed 11 polyps ≥6mm diameter in nine patients. Optical colonoscopy revealed 10 polyps ≥6mm diameter in nine patients with a further 15‐mm polyp discovered after segmental unblinding.ConclusionIn symptomatic patients, three‐dimensional virtual colonoscopy is equivalent to optical colonoscopy for diagnosing colon cancer and clinically significant polyps. A case can be made for three‐dimensional virtual colonoscopy as a primary modality followed if necessary by same day‐targeted optical colonoscopy.
Sequential evaluation of thiopurine methyltransferase, inosine triphosphate pyrophosphatase, and HPRT1 genes polymorphisms to explain thiopurines' toxicity and efficacy
Authors: PALMIERI O. , LATIANO A. , BOSSA F. , VECCHI M. , D’INCÀ R. , GUAGNOZZI D. , TONELLI F. , CUCCHIARA S. , VALVANO M. R. , LATIANO T. , ANDRIULLI A. , ANNESE V. 
Published: July 2010

SummaryAimTo evaluate the polymorphisms of several genes involved in the azathioprine and mercaptopurine metabolism, in an attempt to explain their toxicity and efficacy in Crohn’s disease and ulcerative colitis.MethodsIn 422 consecutive patients (250 with Crohn’s disease and 172 with ulcerative colitis) and 245 healthy controls, single nucleotide polymorphisms of thiopurine methyltransferase, inosine triphosphate pyrophosphatase and hypoxanthine phosphoribosyl transferase (HPRT1) genes were related to the occurrence of adverse drug reactions (ADRs) and efficacy of therapy.ResultsSeventy‐three patients reported 81 episodes of ADRs; 45 patients did not respond to therapy. Frequency of thiopurine methyltransferase risk haplotypes was significantly increased in patients with leucopenia (26% vs. 5.7% in patients without ADRs, and 4% of controls) (P < 0.001); no correlation with other ADRs and efficacy of therapy was found. Conversely, the frequency of inosine triphosphate pyrophosphatase and HPRT1 risk genotypes was not significantly different in patients with ADRs (included leucopenia). Non‐responders had an increased frequency of inosine triphosphate pyrophosphatase risk genotypes (P = 0.03).ConclusionsThe majority of azathioprine/mercaptopurine‐induced ADRs and efficacy of therapy are not explained by the investigated gene polymorphisms. The combined evaluation of all three genes enhanced the correlation with leucopenia (43.5% vs. 23% in controls) (P = 0.008), at the expense of a reduced accuracy (60%).
Subtyping the irritable bowel syndrome by predominant bowel habit: Rome II versus Rome III
Authors: ERSRYD A. , POSSERUD I. , ABRAHAMSSON H. , SIMRÉN M. 
Published: July 2010

SummaryBackgroundThe agreement between subtyping irritable bowel syndrome (IBS) patients based on Rome II criteria versus Rome III criteria is unknown.AimTo compare IBS subtyping based on Rome II versus III criteria.MethodsThe Rome II Modular Questionnaire and the Bristol Stool Form Scale (one‐week diary cards) were completed by 249 IBS patients. Based on the Rome II criteria, patients were defined as having diarrhoea‐ or constipation‐predominant IBS, or alternating IBS. Based on the Rome III criteria, patients were divided into IBS with constipation, IBS with diarrhoea, mixed IBS or unsubtyped IBS. Agreement between Rome II and Rome III was assessed with kappa statistics.ResultsBased on Rome II there were 92 diarrhoea‐predominant IBS, 45 constipation‐predominant IBS and 112 alternating IBS, and based on Rome III 97 IBS with diarrhoea, 77 IBS with constipation, 16 mixed IBS and 59 unsubtyped IBS. The agreement between Rome II and Rome III subgroups was 46% (kappa = 0.19). Changes from the constipation to the diarrhoea subgroups and vice versa were uncommon (8% of patients). The majority of changes occurred from/to the alternating IBS, mixed IBS and unsubtyped IBS subgroups.ConclusionThere is poor agreement between subtyping of IBS patients based on Rome II versus Rome III criteria.
Persisting symptoms and decreased health‐related quality‐of‐life in a cross‐sectional study of treated achalasia patients
Authors: FRANKHUISEN R. , VAN HERWAARDEN M. A. , HEIJKOOP R. , SMOUT A. J. P. M. , BARON A. , VERMEIJDEN J. R. , GOOSZEN H. G. , SAMSOM M. 
Published: July 2010

SummaryBackgroundLittle is known about symptom characteristics of treated achalasia patients and their effect on health‐related quality‐of‐life (HRQoL).AimsTo examine clinical remission, achalasia‐associated symptoms and HRQoL in treated achalasia patients.MethodsThe Eckardt clinical symptom score, RAND‐36 and a disease‐specific HRQoL questionnaire were sent to 171 treated achalasia patients.Results76.6% of the patients returned their questionnaire. 44.9% of them were not in symptomatic remission. Prevalence of frequent dysphagia (at least daily) and chest pain (at least weekly) was 46% and 38%, respectively. Achalasia patients had lower general HRQoL scores than control subjects (all RAND‐36 subscales, except health change; P ≤ 0.002). Patients with frequent symptoms of chest pain and dysphagia showed lower HRQoL than patients with less frequent symptoms on three RAND‐36 subscales (pain, social functioning and general health perceptions; P < 0.003). Patients in clinical remission showed higher HRQoL than patients who were not, however HRQoL in the ‘remission group’ remained significantly impaired as compared to controls (all RAND‐36 subscales except emotional role limitations and mental health; P < 0.001).ConclusionsMany achalasia patients remain severely symptomatic after treatment and have decreased HRQoL. Frequent symptoms are associated with lower HRQoL. Patients in clinical remission show substantially improved, but not restored HRQoL.
Health‐related quality of life in patients with non‐alcoholic fatty liver disease
Authors: DAN A. A. , KALLMAN J. B. , WHEELER A. , YOUNOSZAI Z. , COLLANTES R. , BONDINI S. , GERBER L. , YOUNOSSI Z. M. 
Published: July 2010

SummaryBackgroundThe relative impact of non‐alcoholic fatty liver disease (NAFLD) on health‐related quality of life (HRQL) compared to other chronic liver diseases has not been fully explored.AimTo compare the domain scores of the 29‐item Chronic Liver Disease Questionnaire (CLDQ) for patients with NAFLD to those with chronic hepatitis B and chronic hepatitis C.MethodsA HRQL questionnaire, CLDQ, was routinely administered to patients attending a liver clinic. Additional clinical and laboratory data were obtained on patients with NAFLD, chronic hepatitis B, and chronic hepatitis C from our quality of life database. Scores for each of the six CLDQ domains were compared using one‐way anova and multiple regression.ResultsComplete data were available for 237 patients. NAFLD patients scored lowest on multiple CLDQ domains. Based on the bivariate data, NAFLD patients have the poorest HRQL, followed by chronic hepatitis C and chronic hepatitis B patients. Multivariate analysis showed that some specific domain score correlations remained significant for NAFLD diagnosis, cirrhosis, gender, and body mass index.ConclusionNAFLD patients had significantly lower quality of life scores compared with patients with hepatitis B or hepatitis C on multiple CLDQ domains, suggesting that HRQL was severely impaired in patients with NAFLD.
Chromogranin A in patients with acid hypersecretion and/or hypergastrinaemia
Authors: HIRSCHOWITZ B. I. , WORTHINGTON J. , MOHNEN J. , HABER M. 
Published: July 2010

SummaryBackgroundChromogranin has been proposed as a marker for gastrin‐dependent enterochromaffin‐like cell proliferation.AimTo examine this question in three populations: acid hypersecretors with gastrinoma (Zollinger–Ellison), or without gastrinoma (non‐Zollinger–Ellison), and also in pernicious anaemia with achlorhydria‐caused hypergastrinaemia.MethodsWe measured serum chromogranin, gastrin, gastric secretion and counted and quantified hyperplasia of enterochromaffin‐like cells in gastric biopsies from 38 Zollinger–Ellison and 13 non‐Zollinger–Ellison patients being treated with lansoprazole, for 5 years (median) and again 2.5 years later. We also studied 12 patients with pernicious anaemia, half with gastric enterochromaffin‐like cell carcinoids.ResultsSerum chromogranin was elevated in patients with gastrinoma, even without any enterochromaffin‐like cell proliferation, but not in non‐Zollinger–Ellison acid hypersecretors with normal gastrin (P < 0.001). In the hypersecretors chromogranin correlated well with serum gastrin (r = 0.82), but not with enterochromaffin‐like cell proliferation. Moreover, chromogranin was normal or near normal (<75 ng/mL) despite very high serum gastrin in five of six patients with pernicious anaemia and enterochromaffin‐like cell carcinoids.ConclusionsChromogranin is not a reliable marker for enterochromaffin‐like cell activity or proliferation up to and including carcinoid; chromogranin originates in the gastrinoma and, like gastrin, is a marker for gastrinoma in acid hypersecretors.
Quantifying exposure to diagnostic medical radiation in patients with inflammatory bowel disease: are we contributing to malignancy?
Authors: NEWNHAM E. , HAWKES E. , SURENDER A. , JAMES S. L. , GEARRY R. , GIBSON P. R. 
Published: July 2010

SummaryBackground  While potential risks of diagnostic medical radiation are acknowledged, actual exposure of patients in routine clinical practice is poorly documented.Aim  To quantify such exposure to vulnerable abdominal organs in patients with inflammatory bowel disease who are already at risk of intestinal cancer.Methods  All incidences of exposure to diagnostic medical radiation were documented in a consecutive series of 100 patients with inflammatory bowel disease (62 Crohn’s disease, 37 ulcerative colitis, 1 indeterminate colitis) attending a hospital‐based clinic. Total effective dose (mSv) was calculated using published tables. Predictors of high or no irradiation were evaluated by multivariate logistic regression analysis.Results  Thirteen patients had no documented diagnostic irradiation. Twenty‐three patients received an effective dose greater than 25 mSv. An at‐risk effective dose >50 mSv was received by 11 patients. Dosage was higher in patients with Crohn’s disease than ulcerative colitis (P = 0.02) and in patients undergoing surgery (P = 0.004). However, no predictive factors for high radiation dosage or for no exposure were identified.Conclusions  At‐risk irradiation from diagnostic medical radiation is common in patients with inflammatory bowel disease, and might potentially contribute to the elevated risk of intra‐abdominal and other cancers. The level of irradiation should be considered in clinical decisions regarding abdominal imaging.
Clinical trial: comparison of weekly once versus twice half‐dose weekly administration of pegylated interferon alpha 2b in combination with ribavirin for the treatment of HCV‐1 positive patients with chronic hepatitis C
Authors: SEBASTIANI G. , FERRARI A. , BOCCATO S. , PISTIS R. , ALBERTI A. 
Published: July 2010

SummaryBackground  Pegylated interferon (PEG‐IFN) alpha2b is currently used as a once weekly injection in combination with ribavirin for the treatment of chronic hepatitis C.Aim  To test whether twice half‐dose weekly administration may improve the virological response in difficult‐to‐treat hepatitis C virus‐1 patients.Methods  Thirty patients were treated with 1.5 μg/kg of PEG‐IFN alpha2b given once weekly for 48 weeks (group A) and were compared with 30 patients treated with the same dose of PEG‐IFN alpha2b divided in twice weekly doses of 0.75 μg/kg for the initial 4 weeks (group B). All patients were hepatitis C virus‐1 positive and received weight‐based ribavirin (800–1400 mg/daily).Results  Weekly twice half‐dose administration of PEG‐IFN alpha2b for the first 4 weeks was associated with lower rates of biochemical and virological response at all time points compared with a once weekly schedule, and with significantly higher rates of in‐therapy breakthrough leading to significantly lower rates of end of therapy response (week 48). The rate of sustained virological response was of 56.7% in group A and 36.7% in group B.Conclusions  Weekly twice half‐dose administration of PEG‐IFN alpha2b is not superior to the standard once weekly schedule, and might be less efficacious.
Clinical trial: an efficacy evaluation of reduced bisacodyl given as part of a polyethylene glycol electrolyte solution preparation prior to colonoscopy
Authors: DIPALMA J. A. , MCGOWAN J. , CLEVELAND M. Vb. 
Published: July 2010

SummaryBackground  In an attempt to further improve patient preparation experience with reduced volume gut lavage solutions using 2‐L sulphate‐free electrolyte lavage solution plus 20‐mg bisacodyl (HalfLytely with Bisacodyl Tablets Bowel Prep Kit, Braintree Laboratories, Inc., Braintree, MA, USA), a low bisacodyl dose preparation was developed using 10 mg bisacodyl.Aim  To compare preparation methods using the 10‐ or 20‐mg bisacodyl with 2‐L sulphate‐free electrolyte lavage method.Methods  At 10 US centres, 455 patients undergoing colonoscopy for routine clinical indications were equally randomized to receive 10‐ or 20‐mg bisacodyl with 2‐L sulphate‐free electrolyte lavage method. Colonoscopists rated the efficacy of colon cleansing, blinded to the preparation assignment.Results  Physician assessment of colon cleansing showed no difference between those randomized to receive the 10‐ or 20‐mg bisacodyl preparations (P = 0.52). The 10‐mg preparation had lower symptom scores for cramping (P < 0.001) and overall discomfort (P = 0.001). Other reported adverse experiences were few, mild and not different between groups.Conclusion  Two‐litre sulphate‐free electrolyte lavage method solution with 10‐mg bisacodyl is as effective as the 20‐mg bisacodyl preparation for cleansing the colon prior to colonoscopy. The 10‐mg bisacodyl regimen has an improved safety profile, with significantly reduced cramping, nausea and overall discomfort.
Clinical trial: healing of NSAID‐associated gastric ulcers in patients continuing NSAID therapy – a randomized study comparing ranitidine with esomeprazole
Authors: GOLDSTEIN J. L. , JOHANSON J. F. , HAWKEY C. J. , SUCHOWER L. J. , BROWN K. A. 
Published: July 2010

SummaryBackground  The use of non‐steroidal anti‐inflammatory drugs (NSAID) is associated with an increased risk of gastric ulcer (GU) development.Methods  This multicentre, randomized, double‐blind, parallel‐group trial compared endoscopic healing rates at 4 and 8 weeks after treatment with oral esomeprazole 40 or 20 mg once daily, or ranitidine 150 mg twice daily, in patients with 1 baseline GU ≥5 mm but no GUs or duodenal ulcers >25 mm in diameter who received continued cyclooxygenase‐2–selective or non‐selective NSAID therapies. The primary outcome was the percentage of patients in each treatment group who had no GUs at week 8.Results  Four hundred and forty patients were randomized to treatment. At week 8, GU healing rates (95% CI) with esomeprazole 40 mg, esomeprazole 20 mg and ranitidine were 85.7 (79.8–91.7)%, 84.8 (78.8–90.8)% and 76.3 (69.2–83.3)%, respectively; between‐group differences were not statistically significant. Week‐4 GU healing rates were 70.7 (62.9–78.4)% and 72.5 (65.0–79.9)% with esomeprazole 40 and 20 mg, respectively, and were significantly higher (P < 0.01 for both doses) than those with ranitidine [55.4 (47.1–63.7)%].Conclusion  In patients who require continued NSAID therapy, GU healing rates at 8 weeks numerically favoured esomeprazole but were not significantly different from ranitidine.
The cost‐effectiveness and budget impact of competing therapies in hepatic encephalopathy – a decision analysis
Authors: HUANG E. , ESRAILIAN E. , SPIEGEL B. M. R. 
Published: July 2010

SummaryBackground Treatment options for hepatic encephalopathy have disparate risks and benefits. Non‐absorbable disaccharides and neomycin are limited by uncertain efficacy and common dose‐limiting side effects. In contrast, rifaximin is safe and effective in hepatic encephalopathy, but is more expensive.Methods We conducted a decision analysis to calculate the cost‐effectiveness of six strategies in hepatic encephalopathy: (i) no hepatic encephalopathy treatment, (ii) lactulose monotherapy, (iii) lactitol monotherapy, (iv) neomycin monotherapy, (v) rifaximin monotherapy and (vi) up‐front lactulose with crossover to rifaximin if poor response or intolerance of lactulose (‘rifaximin salvage’). The primary outcome was cost per quality‐adjusted life‐year gained.Results Under base‐case conditions, ‘do nothing’ was least effective and rifaximin salvage was most effective. Lactulose monotherapy was least expensive, and rifaximin monotherapy was most expensive. When balancing cost and effectiveness, lactulose monotherapy and rifaximin salvage dominated alternative strategies. Compared to lactulose monotherapy, rifaximin salvage cost an incremental US$2315 per quality‐adjusted life‐year‐gained. The cost of rifaximin had to fall below US$1.03/tab in order for rifaximin monotherapy to dominate lactulose monotherapy.Conclusions Rifaximin monotherapy is not cost‐effective in the treatment of chronic hepatic encephalopathy at current average wholesale prices. However, a hybrid salvage strategy, reserving rifaximin for lactulose‐refractory patients, may be highly cost‐effective.
Review article: the endoscopic treatment of gastro‐oesophageal reflux disease
Authors: SCHWARTZ M. P. , SMOUT A. J. P. M. 
Published: July 2010

SummaryBackground  Over the last 10 years a number of endoscopic procedures for treating gastro‐oesophageal reflux disease (GORD) have been developed (suturing, injections, implants and radiofrequency ablation), thus obviating the need for long‐term proton pump inhibitors (PPI) and the potential morbidity of laparoscopic fundoplication.Aim  To present an update of the literature studying the clinical efficacy of endoscopic antireflux procedures, and to discuss further developments.Methods  A PubMed search was performed for endoscopic suturing, antireflux treatment, endoscopic gastroplication, polymer injection, radiofrequency ablation of GORD. Own recent research was compared with existing data. Information concerning GORD endotherapy were gathered.Results  Uncontrolled studies have reported promising clinical results on the short to intermediate term for most endoscopic GORD procedures, but the placebo effect remained unknown. It is, therefore, commendable that the three main procedures (Endocinch, Stretta and Enteryx) have now all been tested against a sham procedure. Although all three techniques were able to improve symptoms, quality of life and PPI use, oesophageal acid reduction was unremarkable. Endocinch and Stretta are safe outpatient procedures. Concerns about the durability of Endocinch have risen. Polymer injection (Enteryx) and gel prosthesis implantation (Gatekeeper) were recalled for severe complications and lack of efficacy, respectively.Conclusions  Endotherapy has shown the potential to treat (uncomplicated) GORD. However, some early procedures have failed or proven unsafe. Further developments and studies are necessary to determine what modifications to these techniques are required to produce optimal efficacy and durability. Until then, widespread clinical use of endotherapy for GORD should probably be avoided.
Review article: the clinical importance of growth in children with inflammatory bowel disease: is it important to the gastroenterologist?
Authors: TAMINIAU J. A. 
Published: July 2010

SummaryBackground  Growth in children with inflammatory bowel disease is often compromised.Aim  To explore the origins of growth retardation in paediatric inflammatory bowel disease and to consider management strategies.Methods  Relevant literature was identified and reviewed.Results  A combination of the following factors results in growth retardation: insufficient food intake, malabsorption, increased catabolism, disease activity, disease extension, complications of disease and the side‐effects of treatment.Conclusions  Failure of normal growth in a child with inflammatory bowel disease is an indicator of insufficient and unsuccessful therapy. The major causative factor is chronic anorexia because of chronic catabolic illness. Growth resumes to normal after effective control of the disease and nutritional intake. Regular follow‐up of growth in these children is mandatory, and the measurement of both height and weight is an ideal indication of effective treatment. Failure of sustained growth in a child or adolescent with inflammatory bowel disease is a warning to consider a change of clinical strategy.
Review article: detection and management of hereditary non‐polyposis colorectal cancer (Lynch syndrome)
Authors: RAMSOEKH D. , VAN LEERDAM M. E. , WAGNER A. , KUIPERS E. J. 
Published: July 2010

SummaryBackground  The most common hereditary colorectal cancer syndrome is hereditary non‐polyposis colorectal cancer (HNPCC), also known as Lynch syndrome. Diagnosis of this syndrome is difficult, because of lack of specific diagnostic fatures.Aim  To discuss the diagnostic criteria and laboratory work up for HNPCC. Furthermore, survelillance programs for HNPCC and treatment of HNPCC associated colorectal cancer are discussed.Results  Current diagnostic criteria, including the Amsterdam II and Bethesda criteria, are suboptimal for the detection of HNPCC. Molecular screening by microsatellite instability (MSI) and immunohistochemistry (IHC) is useful in the diagnosis of HNPCC. Both techniques have a higher sensitivity compared to the Amsterdam II and Bethesda criteria. A combination of both MSI and IHC provides the most optimal selection for mutation analysis. After identification of a mutation in an affected individual, genetic counselling and presymptomatic mutation analysis should be offered to relatives. Furthermore, colonoscopic surveillance should be performed in proven mutation carriers.Conclusions  Identification of HNPCC is a clinical challenge involving many clinicians. Identification of persons at risk can be achieved by a combination of a detailed family history, testing with molecular and mutation analysis.