bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving The Analysis of Esophageal Acid Exposure by A New Parameter: Area Under H+
Authors: Rebecchi Fabrizio , Di Francia Italo , Giaccone Claudio , Morino Mario 
Published: March 2004

ABSTRACT

OBJECTIVES:
We aimed to compare the data provided by 24-h continuous esophageal pH monitoring in a group of patients with gastroesophageal reflux disease (GERD) to those from a group of healthy volunteers using both conventional parameters and calculated area under the curve of hydrogen ion activity (AUH+), a new value that describes the true acid exposure, through both duration and depth of acidity changes.

METHODS:
Thirty healthy controls and 60 patients with GERD (30 symptomatic patients without endoscopic esophagitis or nonerosive GERD and 30 symptomatic patients with Savary I–IV endoscopic esophagitis or erosive GERD) were enrolled in a study based on 24-h pH monitoring to compare reference values by means of receiver operating characteristic (ROC) discriminant analysis.

RESULTS:
The best ROC cutoff value for nonerosive GERD patients was AUH+ = 103.7 (mmol/L) × min with sensitivity of 76.7% and specificity of 93.3%. The best ROC cutoff value for erosive GERD patients was AUH+ = 114.1 (mmol/L) × min with sensitivity of 100% and specificity of 96.7%. These cutoff values increase the sensitivity by 16.7% for nonerosive GERD patients and 10% for erosive GERD patients when compared to a common parameter such as the percentage of total time pH is <4 with a limit of 4.2%.

CONCLUSIONS:
AUH+ is a valid quantitative parameter to measure 24-h esophageal acid exposure. It may be a reliable and significant clinical aid because it is a more sensitive test in discriminating negative or positive adult patients with or without esophagitis who are submitted to 24-h esophageal pH monitoring.
Intestinal Metaplasia of The Gastric Cardia: A Prospective Study With Enhanced Magnification Endoscopy
Authors: Guelrud Moises , Herrera Idamys , Essenfeld Harold , Castro Julio , Antonioli Donald A 
Published: March 2004

ABSTRACT

OBJECTIVE:
There are no endoscopic features that distinguish intestinal metaplasia of the cardia (CIM) from the normal cardia. Biopsy specimens are therefore randomly obtained from normal-appearing mucosa with significant potential sampling errors. Enhanced magnification endoscopy involves the combined use of magnification endoscopy with acetic acid instillation. This study assessed the value of enhanced magnification endoscopy in detecting CIM.

METHODS:
Patients undergoing elective upper endoscopy were invited to participate in the study. Patients were included if the squamocolumnar junction and the esophagogastric junction were judged to be at the same level. Enhanced magnification endoscopy was performed with 3% acetic acid instillation. Standard endoscopy was followed by magnification endoscopy and repeated after acetic acid spraying. Surface patterns were characterized before and after acetic acid spraying. The observed surface patterns were compared with histological results obtained from a single targeted biopsy specimen of each pattern.

RESULTS:
The overall prevalence of CIM was 34.8% (86/247 patients). After excluding 52 patients because of endoscopic evidence of Barrett's esophagus, 195 patients were eligible for participation in the study. In the study group, CIM was detected in 86 patients (44.1%) in targeted biopsy samples. No dysplasia was identified. Enhanced magnification endoscopy detected four different patterns of the mucosal surface: I) round pits, II) reticular, III) villous, and IV) ridged. The yields of detection of intestinal metaplasia according to endoscopic patterns were I) 0%, II) 5.3% (odds ratio = 0.05), III) 57.7% (odds ratio = 7.5, p = 0.0001), and IV) 95.8% (odds ratio = 42.8, p = 0.0001).

CONCLUSIONS:
CIM is more common than previously reported. Enhanced magnification endoscopy identifies two characteristic endoscopic patterns, villous (pattern III) and ridged (pattern IV), with outstanding clarity and resolution that correlate with histological identification of CIM with a single targeted biopsy sample. Enhanced magnification endoscopy will permit longitudinal studies of an entity that can be identified endoscopically.
Upper Gi Malignancy, Uncomplicated Dyspepsia, and The Age Threshold for Early Endoscopy
Authors: Canga Cristino , Vakil Nimish 
Published: March 2004

ABSTRACT

OBJECTIVES:
We sought to determine the frequency with which patients with upper GI malignancies present with uncomplicated dyspepsia and to determine the impact of changing the threshold for early endoscopy from 45 to 55 yr, as has recently been recommended in European studies.

METHODS:
Three hundred forty-one patients with upper GI malignancies at two Milwaukee teaching hospitals were identified from electronic databases. Trained physician-investigators reviewed the charts using a specifically designed questionnaire. Staging of GI cancers was performed using the TNM classification to determine operability. Uncomplicated dyspepsia was defined as dyspepsia without alarm symptoms/signs (dysphagia, vomiting, weight loss, early satiety, GI bleeding, or anemia).

RESULTS:
There were 341 patients with upper GI malignancies with a mean age of 68 yr (range = 22–94). Twenty-one patients were younger than 45 and 65 were under 55. Uncomplicated dyspepsia was the presenting symptom in five of 65 (7.7%) patients younger than 55 and one of 21 (4.8%) patients under 45 (p = 0.99). Five patients 55 or younger presented with uncomplicated dyspepsia. All had advanced, inoperable disease (stage III or higher).

CONCLUSIONS:
1) In a racially diverse United States population, upper GI malignancy presenting without alarm symptoms is uncommon. 2) Raising the threshold for immediate endoscopy in uncomplicated dyspepsia from age 45 to 55 increases the risk of missing an underlying malignancy but may not affect outcome, as incurable disease was present at diagnosis within a few weeks of the onset of symptoms.
Octreotide Relaxes The Hypertensive Sphincter of Oddi: Pathophysiological and Therapeutic Implications
Authors: Fazel Ali , Li Spencer C , Burton Frank R 
Published: March 2004

ABSTRACT

OBJECTIVES:
As our understanding of the pathophysiology of sphincter of Oddi dysfunction (SOD) expands, new avenues arise for pharmacological intervention. Recent evidence suggests that SOD results from a loss of myenteric plexus inhibitory neurons resulting in unopposed cholinergic tone. Octreotide inhibits postganglionic cholinergic neurons, and thus we hypothesize that administration of octreotide will decrease sphincteric pressure in individuals with SOD.

METHODS:
Thirty-eight patients presenting with recurrent abdominal pain and SOD (basal pressure > 40 mm Hg) were studied. The study was prospective, placebo controlled, and blinded. Patient allocation was consecutive. Sphincter of Oddi manometry was performed in standard fashion. The test group (n = 19) received octreotide acetate (100 μg i.v.), and the control group (n = 19) received i.v. saline. Basal, phasic, and duct pressures as well as phasic amplitude and frequency were recorded before and 3 min after the i.v. infusion. Changes in these parameters before and after i.v. infusions were compared.

RESULTS:
Octreotide caused a statistically significant reduction in peak and basal sphincter of Oddi pressures relative to saline (p < 0.01 and p < 0.001). Octreotide did not significantly affect wave amplitude, wave frequency, or duct pressure.

CONCLUSIONS:
Octreotide has the potential to be a valuable addition to the armamentarium for the medical management of SOD.
Budesonide and Mesalazine in Active Crohn's Disease: A Comparison of The Effects on Quality of Life
Authors: Thomsen Ole Ø , Cortot Antoine , Jewell Derek , Wright John P , Winter Trevor , Veloso Fernando T , Vatn Morten , Persson Tore , Pettersson Eva 
Published: March 2004

ABSTRACT

OBJECTIVES:
Controlled ileal release budesonide and slow release mesalazine are both used to treat mild to moderate active Crohn's disease, although data show that budesonide is more effective in inducing remission. When comparing different treatment options, the effects of agents on health-related quality of life must be considered as well as efficacy. In this study, we sought to compare the effects of budesonide and mesalazine on the health-related quality of life of patients with active Crohn's disease.

METHODS:
The study included 182 patients with Crohn's Disease Activity Index scores between 200 and 400. Patients were randomized in a double blind, double dummy, multicenter study to receive 9 mg of budesonide, once daily (n = 93), or 2 g of mesalazine, b.i.d. (n = 89), for 16 wk. Quality of life was assessed at baseline and after 2, 4, 8, 12, and 16 wk of treatment using the Psychological General Well-Being index. In addition, a physician's global evaluation was used to assess how symptoms affected patients' normal activities.

RESULTS:
Patients treated with budesonide experienced significantly greater improvement in Psychological General Well-Being scores than the group treated with mesalazine after 2, 8, 12, and 16 wk. All components of this index showed greater improvements in the budesonide-treated group than in the mesalazine group at 12 and 16 wk. The physician's global evaluation showed significantly greater improvements in the budesonide group than in the mesalazine group at all visits.

CONCLUSION:
Budesonide (9 mg once daily) improves health-related quality of life to a greater extent than mesalazine (2 g b.i.d.) in patients with mild to moderate active Crohn's disease.
Central Processing of Rectal Pain in Patients With Irritable Bowel Syndrome: An Fmri Study
Authors: Bonaz B , Baciu M , Papillon E , Bost R , Gueddah N , Le Bas J-F , Fournet J , Segebarth C 
Published: March 2004

ABSTRACT

OBJECTIVES:
In healthy subjects, the neural correlates of visceral pain bear much similarity with the correlates of somatic pain. In patients with irritable bowel syndrome, the central nervous system is believed to play a strong modulatory or etiological role in the pathophysiology of the disease. We hypothesize that this role must be reflected in aberrations of central functional responses to noxious visceral stimulation in these patients. To verify this hypothesis, we have induced transient rectal pain in patients and assessed the functional responses of the brain by means of functional magnetic resonance imaging.

METHODS:
Twelve right-handed patients (11 female) were examined. Functional imaging (1.5 T) was performed following a block paradigm, alternating epochs with and without noxious stimulation of the rectum. Rectal pain was induced by inflating a latex balloon. Whole-brain coverage was achieved by means of echo-planar magnetic resonance acquisition.

RESULTS:
A strong variability of the individual responses to rectal pain was found in patients with irritable bowel syndrome. Significant activations were found in only two patients, and group analysis did not reveal significant activations. In contrast, all patients exhibited significant deactivations. Group analysis revealed significant deactivations within the right insula, the right amygdala, and the right striatum.

CONCLUSIONS:
This study reveals aberrant functional responses to noxious rectal stimulation in patients with irritable bowel syndrome. Those results add grounds to the hypothesis that the central nervous system plays a significant role in the pathophysiology of this syndrome.
Outcome of Patients With Radiation Enteritis Treated With Home Parenteral Nutrition
Authors: Scolapio James S , Ukleja Andrzej , Burnes Jan U , Kelly Darlene G 
Published: March 2004

ABSTRACT

OBJECTIVES:
Intestinal failure requiring either surgery or home parenteral nutrition (HPN) develops in approximately 5% of patients treated with radiation. The aim of the study was to determine survival, duration of HPN, and complications associated with HPN in patients with intestinal failure after radiation therapy.

METHODS:
Fifty-four patients with radiation enteritis who received HPN were studied (39 women and 15 men with a mean age of 57.9 yr). Retrospective data were collected from the patients' medical records dated between 1975 and 1999. The probability of survival was calculated by the Kaplan-Meier method.

RESULTS:
HPN was initiated a median of 20 months (range = 2–432) from the start of radiation therapy. The mean number of intestinal operations for radiation-related complications was 2.2/patient (range = 0–6). The causes of intestinal failure resulting from radiation therapy were intestinal obstruction (27 patients), short bowel (17), malabsorption (five), fistula (three), and dysmotility (two). The mean duration of HPN was 20.4 months (range = 2–108). At last follow-up, 37 patients (68%) were dead, most as a result of recurrent cancer. One patient died of catheter sepsis, and no other deaths were directly related to HPN. The overall estimated 5-yr probability of survival on HPN calculated by Kaplan-Meier analysis was 64%.

CONCLUSIONS:
HPN is a reasonable treatment option in patients with intestinal failure as a result of radiation enteritis. Survival and complications associated with HPN in patients with radiation enteritis seem to be similar to those in other HPN-treated groups.
Low Free and Total Insulinlike Growth Factor I (Igf-I) and Igf Binding Protein-3 Levels in Chronic Inflammatory Bowel Disease: Partial Normalization During Prednisolone Treatment
Authors: Grønbæk H , Thøgersen T , Frystyk J , Vilstrup H , Flyvbjerg A , Dahlerup J F 
Published: March 2004

ABSTRACT

OBJECTIVES:
Catabolism and growth impairment are well known complications of chronic inflammatory bowel disease (CIBD). This may be caused by disease activity itself and/or the medical treatment, which may lead to changes in the growth hormone and insulinlike growth factor I (IGF-I) axis. Interest has focused on corticosteroids, as they are known to influence the growth hormone/IGF-I axis.

METHODS:
The aim of the present study was to examine changes in total and free IGF-I, IGF binding proteins (IGFBPs), and IGFBP-3 protease activity in 10 patients with severe acute activity in colon CIBD before and during high dose prednisolone treatment (1 wk) and 3 months tapering. Eight healthy subjects served as controls.

RESULTS:
Total and free IGF-I were significantly reduced by 35% and 53%, respectively, before prednisolone treatment (p < 0.05), and free IGF-I remained reduced even by the end of the study period relative to controls (p < 0.05). IGFBP-3 was reduced by 16% before (p < 0.05), with normalization during prednisolone treatment and tapering relative to controls. There was no evidence of increase in IGFBP-3 protease activity. IGFBP-1 was increased before and tended also to be increased during prednisolone treatment and tapering.

CONCLUSIONS:
Marked changes in serum total and free IGF-I and IGFBPs were demonstrated in patients with severe exacerbation of CIBD without complete normalization during high dose prednisolone treatment and tapering. These changes may partly be involved in the catabolism of active CIBD patients.
Awareness of Genetic Testing for Colorectal Cancer Predisposition Among Specialists in Gastroenterology
Authors: Batra Shivani , Valdimarsdottir Heiddis , McGovern Margaret , Itzkowitz Steven , Brown Karen 
Published: March 2004

ABSTRACT

OBJECTIVES:
Adult gastroenterologists practicing in New York State were surveyed to determine their practice with regard to identifying family histories consistent with inherited forms of colorectal cancer, and to assess their awareness of cancer genetic counseling and molecular genetic testing for familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC).

METHODS:
A closed-ended questionnaire was mailed to 815 gastroenterologists identified through the membership Directory of the American Gastroenterological Association (1998). Two mailings resulted in a response rate of 35%.

RESULTS:
In all, 99% of the gastroenterologists obtained a family history from their patients, and 95% were aware of cancer genetic counseling. However, only 51% would routinely refer patients for genetic counseling before providing cancer predisposition testing. In addition, only 52% were aware of the availability of genetic tests for FAP and 34% for HNPCC. Presented with a family history consistent with HNPCC, 79% could identify the syndrome, 26% recommended genetic counseling for the consultand, and 16% advised appropriate screening, according to current recommendations.

CONCLUSIONS:
The majority of gastroenterologists do obtain a family history on their patients. However, there is a need for physician education regarding the recognition of pedigrees consistent with inherited colorectal cancer, the genetic counseling process, and the availability of mutation testing for FAP and HNPCC.
Semiannual and Annual Surveillance of Cirrhotic Patients for Hepatocellular Carcinoma: Effects on Cancer Stage and Patient Survival (Italian Experience)
Authors: Trevisani Franco , De Notariis Stefania , Rapaccini Gianludovico , Farinati Fabio , Benvegnù Luisa , Zoli Marco , Grazi Gian Luca , Del Poggio Paolo , Di Nolfo Maria Anna , Bernardi Mauro 
Published: March 2004

ABSTRACT

OBJECTIVES:
Surveillance of cirrhotic patients for early detection of hepatocellular carcinoma, based on ultrasonography and α1-fetoprotein determination, is a recommended practice. However, it has not been proved that this procedure can improve patient survival.

METHODS:
We conducted a multicenter retrospective study on 1051 consecutive patients with hepatocellular carcinoma. The criteria for eligibility were presence of underlying cirrhosis, and description of cancer stage and modalities of its diagnosis. Among 821 patients fulfilling these criteria, the tumor was detected during semiannual surveillance in 215 individuals (group 1), during annual surveillance in 155 (group 2), and as a result of symptoms or incidentally in 451 (group 3). Survival of patients under surveillance was corrected for lead time.

RESULTS:
Cancer stage was similar in groups 1 and 2 and was less advanced than in group 3 (p < 0.001). The frequency of ablative treatments or chemoembolization was similar in groups 1 and 2 and was greater than in group 3 (p < 0.001). Both surveillance programs doubled the prevalence of potential candidates for liver transplantation (68.5% and 62.5%) with respect to group 3 (32.3%, p < 0.001). However, only 15 patients underwent transplantation. In groups 1 and 2, the 5-yr survival was equivalent and was greater than in group 3 (p < 0.001). By segregating patients according to severity of cirrhosis, the benefit was confined to compensated cirrhosis (adjusted relative risk of death for patients under surveillance: 0.59 [95% CI = 0.45–0.78]).

CONCLUSIONS:
Semiannual and annual surveillance equally improve the survival of cirrhotic patients with hepatocellular carcinoma and greatly increase the amenability rate to liver transplantation. When access to liver transplantation is limited, this benefit is restricted to patients with a good cirrhosis-related prognosis.
Selenoprotein Levels in Patients With Colorectal Adenomas and Cancer
Authors: Early Dayna S , Hill Kristina , Burk Raymond , Palmer Ivan 
Published: March 2004

ABSTRACT

OBJECTIVES:
Selenium is a trace mineral that, as a constituent of certain selenoproteins, acts as an antioxidant. Results of studies addressing a cancer protective effect of selenium have been controversial. The present study measured selenoprotein-P, extracellular glutathione peroxidase, and plasma selenium in patients with colon cancer and adenomatous colon polyps to determine whether patients who develop colorectal adenomas or cancer are selenium deficient.

METHODS:
Patients who presented to an endoscopy center for colonoscopy or who were referred to our institution with a newly diagnosed colorectal cancer were offered enrollment in the trial. Each patient underwent phlebotomy, usually immediately after colonoscopy. In all, 103 patients were enrolled in the study. Of these, 33 patients were found to have colorectal cancer, 35 adenomatous colon polyps, and 17 normal examinations. A total of 18 patients had other diagnoses and were not included in the study group.

RESULTS:
The mean age for the colorectal cancer group was 69 yr, for the adenomatous colon polyp group 62 yr, and for the normal group was 56 yr. The adenomatous colon polyp and normal groups were predominantly female. Based on one way analysis of variance tests, there was no significant difference in selenoprotein-P or plasma selenium levels or extracellular glutathione peroxidase activity among the three groups (p = 0.28, 0.098, and 0.35 respectively).

CONCLUSIONS:
The present data suggest that patients with adenomatous colon polyps and those with colorectal cancer are not selenium deficient.
High Prevalence of Undetected Ulcerative Colitis: Data From The Nottingham Fecal Occult Blood Screening Trial
Authors: Howarth G F , Robinson M H E , Jenkins D , Hardcastle J D , Logan R F A 
Published: March 2004

ABSTRACT

OBJECTIVES:
Inflammatory bowel disease (IBD) is usually diagnosed as a result of symptoms but occasionally is found during investigation for other conditions. An earlier report from Nottingham had found a high prevalence of previously undetected “asymptomatic” IBD detected as a result of colorectal cancer screening, and the aim of this study was to reassess the prevalence, symptoms, and outcome in these patients.

METHODS:
We investigated subjects found to be fecal occult blood (FOB) positive in a randomized trial of FOB screening for colorectal cancer. All FOB-positive subjects were investigated by colonoscopy or flexible sigmoidoscopy and barium enema. Subjects with IBD were referred back to their general practitioner for any further investigation and treatment.

RESULTS:
Seventy-five thousand two hundred fifty-three subjects (aged 45–74) were sent FOB tests and 44,838 (60%) completed a series of tests on one or more occasions. Of 133,000 test series, 1.5% were positive. During investigation 53 cases of previously undetected IBD (52 of ulcerative colitis) were found; 52% (27/52) had proctosigmoiditis only, whereas 25% (13/52) had pancolitis. Only 17% (9/52) were completely asymptomatic, with a half or more reporting some rectal bleeding (54%) or diarrhea (50%). The overall prevalence of undetected ulcerative colitis was 69/105 (95% CI = 50–88/105) in people offered screening and 116/105 (95% CI = 85–147/105) in people accepting screening and was higher in men. Of 32 subjects followed up 2–12 yr after diagnosis, 91% (29) continued to have few or no symptoms, with only 12 currently receiving any treatment for their colitis.

CONCLUSIONS:
In comparison with detected disease, undetected ulcerative colitis is relatively common but does usually cause some symptoms. It generally appears to follow a benign course, but a significant proportion have extensive colitis and may therefore be at an increased risk of colorectal cancer.