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Gastroenterology
Terms modified by Gastroenterology Selected AbstractsGASTROENTEROLOGY: Prospective evaluation of a clinical guideline recommending early patients discharge in bleeding peptic ulcerJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2010María Chaparro Abstract Background and Aim:, To validate an early discharge policy in patients admitted with upper gastrointestinal bleeding (UGIB) due to ulcers. Methods:, Patients with gastroduodenal ulcer or erosive gastritis/duodenitis were included in a previous study aiming to develop a practice guideline for early discharge of patients with UGIB. Variables associated with unfavorable evolution were analyzed in order to identify patients with low-risk of re-bleeding. After that, a one-year prospective analysis of all UGIB episodes was carried out. Results:, A total of 341 patients were identified in the retrospective study. Variables associated with unfavorable evolution were: systolic blood pressure , 100 mmHg, heart rate , 100 bpm, and a Forrest endoscopic classification of severe. 10% of patients were immediately discharged; however, if predictive variables obtained in the multivariate analysis had been used, hospitalization could have been prevented in 34% of patients. A total of 77 patients were included in the prospective analysis. Although only 19.5% of patients were immediately discharged without complications, 29 patients (37.7%) were theoretically suitable for early discharge. Conclusions:, Patients with UGIB who have clean-based ulcers and are stable on admission can be safely discharged immediately after endoscopy. Implementation of the clinical practice guideline safely reduced hospital admission for those patients. [source] EOSINOPHILIC GASTROENTERITIS ASSOCIATED WITH GIANT FOLDSDIGESTIVE ENDOSCOPY, Issue 4 2010Kenji Ishido We describe a 54-year-old man who presented with right subcostal pain. Minocycline had been prescribed to treat pruritus, and the symptoms resolved. Subsequently, the patient consulted a local physician because of right subcostal pain. Giant folds were found in the greater curvature of the gastric body, and he was referred to the Department of Gastroenterology, Kitasato University East Hospital. Upper gastrointestinal endoscopy revealed markedly enlarged folds in the greater curvature of the stomach, with redness and edematous mucosa in the lesser curvature. Biopsy showed marked inflammatory cell infiltration (mainly eosinophils), but no atypical cells. Blood tests showed marked eosinophilia and elevated immunoglobulin E levels in the serum. The results of various allergic examinations were negative, but the clinical course suggested drug-induced eosinophilic gastroenteritis, and treatment was started. Minocycline was withdrawn without adequate resolution of symptoms. Because the leukocyte and eosinophil counts continued to increase, the patient was given suplatast, an anti-allergic agent. The symptoms and hematological values improved promptly. The patient recovered uneventfully, with no recurrence. [source] Detection of Helicobacter pylori DNA by a Simple Stool PCR Method in Adult Dyspeptic PatientsHELICOBACTER, Issue 4 2005Nazime ABSTRACT Introduction.,Helicobacter pylori is the major agent causing peptic ulcer, gastric cancer and mucosa-associated lymphoid tissue (MALT) gastric lymphoma. A simple stool polymerase chain reaction (PCR) method was performed and compared with the gold standards for the diagnosis of H. pylori infection. Material and methods., A total of 54 adult patients (mean age, 46.41 ± 13.12 years) with dyspeptic symptoms from Gastroenterology at Dokuz Eylül University Hospital between May and November 2003 were included. Two antrum and corpus biopsies were taken from each patient. Infection by H. pylori was defined as positivity and negativity of the gold standards. DNA extraction of stool specimens was done using QIAamp DNA Stool Mini Kit (QIAGEN) and PCR conditions included amplification and reamplification steps using the H. pylori ureA gene specific primers (HPU1, HPU2) and were visualized on 1% agarose gel stained with ethidium bromide. Results., Forty-six of 54 patients (85.2%) were diagnosed positive and eight (14.8%) were negative for H. pylori infection by the gold standard methods. Thirty-two patients were positive (59.3%) and 22 of them (40.7%) were detected negative by stool PCR method. The stool PCR method and gold standard methods showed a statistical difference for the detection of H. pylori infection (p < .0001). Sensitivity, specificity, likelihood ratio, and positive and negative predictive values were 65.22%, 75%, 2.61%, 93.75%, and 27.7%, respectively. Discussion., The PCR on the stool specimens resulted as being a very specific test. We suggest that a simple stool PCR method that we developed can be used to detect H. pylori, virulence genes, and in drug resistance studies either first line diagnostic methods in the laboratory or in the clinical management of dyspeptic patients. [source] An audit of antibiotics usage and their effect on MRSA infection or colonisation following percutaneous endoscopic gastrostomy in a district general hospitalINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2004O.A. Ogundipe Summary Percutaneous endoscopic gastrostomy (PEG) has become a widely practised procedure to maintain long-term nutrition in patients with a variety of medical conditions. Incidence of infection and the usage of prophylactic antibiotic continue to remain an area of debate. Guidelines in gastroenterology on antibiotic prophylaxis published by the British Society of Gastroenterology recommend the use of prophylactic antibiotic prior to placement of PEG tube (1). There has been an alarming rise in the incidence of MRSA, which has jumped from a reported 2% in 1992 to about 42% in 2001 in England & Wales. Use of antibiotic may lead to emergence of MRSA in debilitated patients requiring PEG feeding. This audit addresses some of the problems encountered in a small district general hospital. [source] Fifty years of Australian pediatric gastroenterologyJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2009Don Cameron Abstract When the Gastroenterological Society of Australia (GESA) began 50 years ago there were very few pediatric gastroenterologists in the world. The ,Mother' of Paediatric Gastroenterology was Australian Charlotte (,Charlo') Anderson who established one of the world's first pediatric gastroenterology units in Melbourne in the early 1960s. Her earlier work in Birmingham had identified gluten as the component of wheat responsible for celiac disease and helped separate maldigestion (cystic fibrosis) and mucosal malabsorption. The first comprehensive textbook of Paediatric Gastroenterology was edited by Charlotte Anderson and Valerie Burke in 1975. Rudge Townley succeeded Charlotte Anderson in Melbourne and went on to further develop small bowel biopsy techniques making it a safe, simple, and quick procedure that led to much greater understanding of small bowel disease and ultimately the discovery of Rotavirus by Ruth Bishop et al. and subsequently to Rotavirus immunization. Australian Paediatric Gastroenterology subsequently developed rapidly with units being established in all mainland capital cities by the end of the 1970s. The Australian Society of Paediatric Gastroenterology Hepatology and Nutrition (AuSPGHAN) was established in the 1980s. Australians have contributed significantly in many areas of gastroenterology in infants, children, and adolescents including celiac disease, cystic fibrosis, liver disease, transplantation, gastrointestinal infection, allergy, indigenous health, inflammatory bowel disease, gastrointestinal motility, and the development of novel tests of gastrointestinal function and basic science. There have also been major contributions to nutrition in cystic fibrosis, end-stage liver disease, and intestinal failure. The future of Australian Paediatric Gastroenterology is in good hands. [source] Appropriate cut-off value of 13C-urea breath test after eradication of Helicobacter pylori infection in JapanJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2003CHIEKO KATO Abstract Background and Aim:, A cut-off value of 2.5, for the 13C-urea breath test (UBT) is recommended in Japanese persons, based on the result of a multicenter trial in patients prior to treatment for eradication of Helicobacter pylori. The cut-off value of 2.5, has also been used in the assessment of eradication after treatment. The 6,8-week evaluation after treatment is recommended in the guidelines of the Japanese Society of Gastroenterology. The present study aimed to prospectively re-assess the cut-off value of the 13C-UBT at 6 weeks after treatment by using the results obtained at 6 months as an indication of true positive or true negative H. pylori infection status. Methods:, One hundred and ninety patients who were positive for H. pylori underwent eradication treatment, and 177 patients of these patients who were assessed as having true positive or true negative H. pylori,status ,at ,6 months ,after ,treatment ,were ,evaluated ,in ,this ,study. ,Eradication ,was ,assessed ,by 13C-UBT, ,culture, ,and ,histology ,at ,6 weeks ,and ,at ,6 months ,after ,treatment, ,and ,the ,cut-off ,value ,of 13C-UBT at 6 weeks was re-assessed. Results:, A cut-off value of 3.5,. at 6 weeks after treatment showed 97.2% diagnostic accuracy, while a cut-off value of 2.5, at 6 weeks showed 96.0% diagnostic accuracy. For a 3.5, cut-off value, only five patients were positive by 13C-UBT and were negative by culture and histology at 6 weeks, and three patients were true positive and two were false positive by the 13C-UBT at 6 months. Conclusion:, A cut-off value of 3.5, for the 13C-UBT is recommended at 6 weeks after eradication treatment in Japanese persons. [source] Expanding horizons for the Journal: The role of the Journal of Gastroenterology and Hepatology FoundationJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2003GEOFFREY C FARRELL No abstract is available for this article. [source] Journal of Gastroenterology and Hepatology celebrates the first Asia,Pacific Digestive Week, Sydney, September 2001JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2002Geoffrey C Farrell No abstract is available for this article. [source] Antibodies to neutrophil cytoplasma in patients with ulcerative colitis and their first-degree relatives in ThailandJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2001Charkaphan Osangthamnont Abstract Background: The prevalence of perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) does not significantly vary in ethnically diverse populations. The prevalence of p-ANCA is high in ulcerative colitis and primary sclerosing cholangitis. While the prevalence of ulcerative colitis in Asian populations is low, it is interesting to know the prevalence of p-ANCA in such a population. Methods: Sera from 33 cases of ulcerative colitis diagnosed during the last 10 years at the diarrhea clinic, Division of Gastroenterology, Siriraj Hospital, were prospectively compared with case controls consisting of 15 cases of diarrhea from non-inflammatory bowel diseases and 25 non-diarrheic patients. Indirect immunofluorescence assay was used to detect p-ANCA in all the sera. Results: Positive p-ANCA tests were found in 13 of the 33 patients with ulcerative colitis and in one of the 40 controls. Sensitivity of the test was 39.4% and the specificity was 97.5%. The one patient with positive p-ANCA in the control group was the patient with irritable bowel syndrome. Of the 13 p-ANCA-positive ulcerative colitis patients, two cases were found to have proctosigmoiditis, seven cases had left-sided colitis, and four cases had pancolitis. Perinuclear antineutrophil cytoplasmic antibodies was one of the 22 cases of first-degree relatives of ulcerative colitis patients (22 relatives from 12 index ulcerative colitis cases). There was no correlation between the positivity of p-ANCA and disease activity, and extent of the disease. Conclusion: The prevalence of p-ANCA in Thai patients with ulcerative colitis (39.4%) is lower than that in the Western population. Although the prevalence of p-ANCA is low in the Thai population, it should serve as a useful tool in diagnosing ulcerative colitis in this part of the world where the disease is uncommon and difficult to diagnose. The negativity of p-ANCA in almost all first-degree relatives of Thai ulcerative colitis patients should be further elucidated. [source] Gastroenterology in the Asian-Pacific region in the new millennium: The role of the Journal of Gastroenterology and HepatologyJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2000Gc Farrell No abstract is available for this article. [source] A survey of provision of dietetic services for coeliac disease in the UKJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2007M. Nelson Abstract Background, Management guidelines for care of coeliac patients published by the British Society of Gastroenterology (BSG), 2002 recommend that patients should see a dietitian at diagnosis and at least at annual review. In the absence of information on dietetic provision in coeliac disease management in the UK and with surveys in other countries suggesting that patients with coeliac disease gain most information from coeliac support groups (Green et al., 2001), Coeliac UK set out to investigate dietetic services for coeliac patients in the UK. Methods, Questionnaires were sent to dietetic departments in the UK via the Regional Managers Group of the British Dietetic Association (BDA) by email. The questionnaires were in two parts, the first was completed by the dietetic manager and the second by the dietitian with the main responsibility for the management of coeliac patients within the department. Results, Over one-quarter of departments reported allocating a maximum of 1 h of dietitians' time per month per 100 000 population to seeing coeliac patients. More hours were allocated to coeliac patients in departments where dietitians had attended coeliac disease training, where dietitians were professional members of Coeliac UK or where coeliac patient care was undertaken by a multi-disciplinary team. Conclusion, There is wide variation in dietetic provision for diagnosed coeliac patients in the UK. The Coeliac UK survey suggests that the current level of dietetic provision is in the region of one-third of what is required according to the BSG management guidelines (British Society of Gastroenterology (BSG), 2002) to provide diagnosed coeliacs with only basic support and annual review. [source] Liver fibrosis attributed to lipid lowering medications: two casesJOURNAL OF INTERNAL MEDICINE, Issue 3 2001Z. Punthakee Abstract. Punthakee Z, Scully LJ, Guindi MM, Ooi TC (Department of Medicine, Division of Gastroenterology, Department of Pathology and the Laboratory of Medicine and the Division of Endocrinology and Metabolism, The Ottawa Hospital , Civic Campus, University of Ottawa, Ottawa, Canada). Liver fibrosis attributed to lipid lowering medications: two cases (Case Report). J Intern Med 2001; 250: 249,254. We identified two cases of chronic active hepatitis with liver fibrosis induced by lipid lowering drugs of the statin and fibrate classes despite regular monitoring of transaminases. There are few reports of clinically significant hepatitis induced by these drugs and even fewer cases of fibrosis. Given the growing use of these drugs, there are implications for monitoring patients on long-term therapy for liver damage. [source] Clinical trial: a nutritional supplement Viusid, in combination with diet and exercise, in patients with nonalcoholic fatty liver diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009E. VILAR GOMEZ Summary Background, Nonalcoholic fatty liver disease (NAFLD) is a significant health problem for which there is no universally accepted pharmacological treatment. The combination of weight loss and antioxidant drugs to ameliorate insulin resistance and improve steatosis, inflammation and fibrosis provides the rational for therapeutic trials. Aim, To evaluate the efficacy and safety of a nutritional supplement Viusid in association with diet and exercise for NAFLD. Methods, A randomized, controlled and parallel-group trial was conducted at a tertiary care academic centre (National Institute of Gastroenterology, Havana, Cuba). We randomly assigned 60 patients with liver biopsy-proven NAFLD to 6 months of treatment with a hypocaloric diet plus aerobic exercise daily and three Viusid sachets daily or a hypocaloric diet and exercise. Endpoints were improvement in the NAFLD activity score (NAS), fibrosis and normalization of serum aminotransferase levels. Results, A significant improvement in steatosis, necroinflammation and fibrosis was seen in each group of treatment (P < 0.01 for each feature). The Viusid group, as compared with the control group, significantly reduced the mean of NAS [from 4.18 to 0.54 points in the Viusid group vs. 4.45 to 2.2 points in the control group (P < 0.001)]. On between-group comparison, Viusid was found to be associated with a significantly greater improvement in steatosis (P < 0.001), ballooning (P = 0.002) and lobular inflammation (P = 0.025), but not in fibrosis (P = 0.07). Viusid was well tolerated. Conclusions, Our results indicate that treatment with diet and exercise leads to a notable improvement in the histological features of NAFLD; however, the administration of Viusid intensifies the improvements of histological findings, especially of steatosis and inflammation. [source] Efficacy and complications of adalimumab treatment for medically-refractory Crohn's disease: analysis of nationwide experience in Scotland (2004,2008)ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009G. T. HO Summary Background, Adalimumab is a second generation humanized anti-tumour necrosis factor (TNF) monoclonal antibody with established efficacy in Crohn's disease (CD). Aims, To evaluate the efficacy and safety of adalimumab on a nationwide clinical setting. Methods, We used the Scottish Society of Gastroenterology network to identify and follow up the clinical outcomes of patients with CD treated with adalimumab over a 4-year period (2004,2008). Results, A total of 98 patients received adalimumab - 100.5 patient follow-up years were recorded (64.3% females; median age at diagnosis of 20.7 years; 88.8% treated with 80/40 mg induction regimen. Eighty eight (89.8%) had previous infliximab with 29 (32.9%) primary nonresponders; 32 (32.6%) were corticosteroid-dependent; 47 (47.9%) were intolerant/resistant to most immunosuppressive therapies (two or more). In all, 60% of patients were in clinical remission at 1-year follow-up, with 30% and 55% requiring dose escalation to weekly therapy at 1-and 2-year follow-up respectively. Overall, 29 (29.6%) patients developed complications with eight nonfatal serious (8.2%) adverse events and 2 (2.0%) case fatalities (sepsis following perforation and disseminated colorectal cancer, respectively). Conclusions, Adalimumab is efficacious in severe and refractory CD in the clinical setting, although there remain significant therapy- and disease-related risks of serious complications. [source] 21st and 22nd Highlights of Gastroenterology-HepatologyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2007Cornelis B. H. W. Lamers No abstract is available for this article. [source] MELD,Moving steadily towards equality, equity, and fairnessLIVER TRANSPLANTATION, Issue 5 2005James Neuberger Background and aims: A consensus has been reached that liver donor allocation should be based primarily on liver disease severity and that waiting time should not be a major determining factor. Our aim was to assess the capability of the Model for End-Stage Liver Disease (MELD) score to correctly rank potential liver recipients according to their severity of liver disease and mortality risk on the OPTN liver waiting list. Methods: The MELD model predicts liver disease severity based on serum creatinine, serum total bilirubin, and INR and has been shown to be useful in predicting mortality in patients with compensated and decompensated cirrhosis. In this study, we prospectively applied the MELD score to estimate 3-month mortality to 3437 adult liver transplant candidates with chronic liver disease who were added to the OPTN waiting list at 2A or 2B status between November, 1999, and December, 2001. Results: In this study cohort with chronic liver disease, 412 (12%) died during the 3-month follow-up period. Waiting list mortality increased directly in proportion to the listing MELD score. Patients having a MELD score <9 experienced a 1.9% mortality, whereas patients having a MELD score > or =40 had a mortality rate of 71.3%. Using the c-statistic with 3-month mortality as the end point, the area under the receiver operating characteristic (ROC) curve for the MELD score was 0.83 compared with 0.76 for the Child-Turcotte-Pugh (CTP) score (P < 0.001). Conclusions: These data suggest that the MELD score is able to accurately predict 3-month mortality among patients with chronic liver disease on the liver waiting list and can be applied for allocation of donor livers.(Gastroenterology 2003;124:91,96.) Context: The Model for Endstage Liver Disease (MELD) score serves as the basis for the distribution of deceased-donor (DD) livers and was developed in response to "the final rule" mandate, whose stated principle is to allocate livers according to a patient's medical need, with less emphasis on keeping organs in the local procurement area. However, in selected areas of the United States, organs are kept in organ procurement organizations (OPOs) with small waiting lists and transplanted into less-sick patients instead of being allocated to sicker patients in nearby transplant centers in OPOs with large waiting lists. Objective: To determine whether there is a difference in MELD scores for liver transplant recipients receiving transplants in small vs large OPOs. Design and setting: Retrospective review of the US Scientific Registry of Transplant Recipients between February 28, 2002, and March 31, 2003. Transplant recipients (N = 4798) had end-stage liver disease and received DD livers. Main outcome measures: MELD score distribution (range, 6,40), graft survival, and patient survival for liver transplant recipients in small (<100) and large (> or =100 on the waiting list) OPOs. RESULTS: The distribution of MELD scores was the same in large and small OPOs; 92% had a MELD score of 18 or less, 7% had a MELD score between 19 and 24, and only 2% of listed patients had a MELD score higher than 24 (P = .85). The proportion of patients receiving transplants in small OPOs and with a MELD score higher than 24 was significantly lower than that in large OPOs (19% vs 49%; P<.001). Patient survival rates at 1 year after transplantation for small OPOs (86.4%) and large OPOs (86.6%) were not statistically different (P = .59), and neither were graft survival rates in small OPOs (80.1%) and large OPOs (81.3%) (P = .80). Conclusions: There is a significant disparity in MELD scores in liver transplant recipients in small vs large OPOs; fewer transplant recipients in small OPOs have severe liver disease (MELD score >24). This disparity does not reflect the stated goals of the current allocation policy, which is to distribute livers according to a patient's medical need, with less emphasis on keeping organs in the local procurement area. (JAMA 2004;291:1871,1874.) [source] Hepatorenal syndrome, hepatopulmonary syndrome, and now, hepatospinal syndrome?LIVER TRANSPLANTATION, Issue 9 2003Vincent G. Bain MD Background & Aims: Hepatic myelopathy is a rare complication of chronic liver disease, causing progressive spastic paraparesis. Today, no therapy of this disorder has been established. Commonly used therapeutic strategies for hepatic encephalopathy aiming at the reduction of plasma ammonia levels such as protein restriction, oral neomycin, lactulose, or ornithine aspartate fail to improve the symptoms of hepatic myelopathy. The aim of this study was to find out whether orthotopic liver transplantation (OLT) may improve hepatic myelopathy. Methods: Follow-up examinations of 3 patients with severe hepatic myelopathy before and after OLT. Results: In all 3 patients, the neurologic status improved significantly after liver transplantation. The grade of improvement was related to the time interval between onset of the first symptoms of hepatic myelopathy and liver transplantation. Conclusions: Early recognition of hepatic myelopathy is important because timely liver transplantation as an established therapy for end-stage liver disease offers the chance of complete recovery from hepatic paraparesis. (Gastroenterology 2003;124:346-351.) [source] Introduction to the Proceedings of the 2nd International Symposium on Visceral Perception in GastroenterologyNEUROGASTROENTEROLOGY & MOTILITY, Issue 2007Michael Fried No abstract is available for this article. [source] Childhood cirrhosis, hepatopulmonary syndrome and liver transplantationPEDIATRIC TRANSPLANTATION, Issue 3 2008Gokhan Tumgor Abstract:, Objectives:, The hepatopulmonary syndrome (HPS) is characterized as a triad: liver disease, intrapulmonary vascular dilatatiton, and arterial hypoxemia. The aim of this study is to analyze outcome of children with HPS in liver transplant era. Methods:, Between September 1996 and November 2006, 172 cirrhotic patients (median age 5 years; range 0.2,22 years, M/F; 97/75) were followed at Ege University Pediatric Gastroenterology, Hepatology and Nutrition Unit. All patients were evaluated by chest radiography, arterial blood gas analysis, and alveolar-arterial oxygen tension difference, contrast echocardiography (CEE) after and before the liver transplantation. Results:, HPS was diagnosed in 33 patients (19%) by CEE. None of them had pulmonary hypertension. HPS was not found related to etiology of the liver disease. Portal hypertension was found related to the development of HPS (75.7% in patients with HPS and 54.6% in others, p = 0.02). 17 of 33 patients with HPS underwent liver transplantation. Preoperative and postoperative period of these patients was uneventful. Patients were extubated in the operating room except for two. Median follow up of transplanted children was 1.9 year (range; 0.75,10 years). Arterial blood gas analysis and CEE positivity regressed in all of them by postoperative 6th month. Conclusions:, HPS is a serious and important complication of cirrhotic children that leads to tissue hypoxia and central cyanosis. HPS seems reversible after liver transplantation in all patients. [source] Gastroenterology and Hepatology: A Clinical Handbook, 1st editionAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009Barry Morphett No abstract is available for this article. [source] Two-week target for laparoscopic cholecystectomy following gallstone pancreatitis is achievable and cost neutral,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2009S. J. W. Monkhouse Background: The British Society of Gastroenterology recommends that all patients with gallstone pancreatitis should undergo cholecystectomy within 2 weeks. This study assessed whether these guidelines are feasible and cost-effective. Methods: Admissions for gallstone pancreatitis between January 2006 and January 2008 were reviewed. Readmissions for subsequent pancreatitis or biliary pathology were noted together with additional investigations, severity scores, hospital stay and time to cholecystectomy. The costs of readmission and theoretical costs of developing a dedicated operating list were provided by independent accountants. Results: During the 2 years, 153 patients were admitted. Twenty-one patients (13·7 per cent) had further attacks requiring 40 readmissions. There were no deaths. Additional hospital costs related to readmissions were £172 170, including bed occupancy (£67 860), investigations (£12 510) and 153 cholecystectomies on an existing theatre list (£91 800). The estimated cost of staffing a half-day theatre list every fortnight, performing 153 cholecystectomies, was £170 391. Conclusion: Instigating a dedicated theatre for cholecystectomy after biliary pancreatitis has many potential benefits. The costs of readmissions and ad hoc operating are balanced by those of a dedicated theatre list in the long term. Implementation of the guidelines would save approximately £900 annually and be cost neutral. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Atlas of Gastroenterology, 4th editionCOLORECTAL DISEASE, Issue 3 2010M. C. Winslet No abstract is available for this article. [source] The BSG/ACPGBI guidelines for colonoscopic screening: what are we missing?COLORECTAL DISEASE, Issue 7 2008A. Subramanian Abstract Introduction, Before publication of the British Society of Gastroenterology and Association of Coloproctology of Great Britain and Ireland guidelines in 2002, screening for people with a family history of colorectal cancer was sporadic and largely dependant on unvalidated local guidelines. Since 1990 we have been screening patients with both high and moderate risk family histories of colorectal cancer using local protocols which were more liberal than the new guidelines. In this study, we have analysed the pathology that would have been missed if we had been using the new guidelines in the period 1990,2002. Method, A total of 399 consecutive patients with a positive family history of colorectal malignancy underwent screening endoscopy according to local guidelines. Demographic, endoscopic and pathologic data were prospectively collected. Patients were retrospectively divided into those who would have been screened under the new guidelines (group 1) and those who would not (group 2). The recorded pathology was graded as significant or insignificant and the findings compared between the two groups. Results, A total of 399 patients underwent 557 endoscopies of which 278 (50%) were indicated under the new guidelines (group 1) and 279 (50%) were not indicated (group 2). A significant pathology or carcinoma was found in 15.8% of group 1 endoscopies and 10.0% of group 2 endoscopies. This difference was significant. Conclusion, If we had been using the new guidelines in the period 1990,2002, we would not have performed 279 (50%) of the 557 procedures, but would not have discovered significant pathology in 10% of the moderate risk endoscopies representing 39% of the significant pathology, which was actually present in this population. [source] A correlation study on diagnostic endoscopic ultrasound-guided fine-needle aspiration of lymph nodes with histological and clinical diagnoses, the UCLA Medical Center experienceDIAGNOSTIC CYTOPATHOLOGY, Issue 7 2008Bita V. Naini M.D. Abstract Endoscopic ultrasound guided (EUS) FNA procedure has two aspects, the endoscopic sampling and the FNA interpretation. The two aspects of the procedure are performed in two different disciplines; gastroenterology (EUS) and pathology (FNA). The aim of this study was to evaluate the concordance, sensitivity, specificity, positive predictive (PPV), and negative predictive values (NPV). Sixty-one EUS-FNA procedures of the lymph nodes were analyzed by correlating the FNA results with histological or clinical diagnoses. The lymph nodes were divided in five groups; mediastinal, gastrohepatic, peripancreatic, portal, and perirectal. The study showed a concordance of 92% in mediastinal, 80% in gastrohepatic, 81% in peripancreatic, 95% in portal, and 100% in perirectal lymph nodes with an overall sensitivity of 84%, specificity of 92%, PPV of 88%, and NPV of 89%. In conclusion, EUS-FNA offers an invaluable approach for diagnostic examination of the internal lymph nodes where percutaneous FNA is either difficult or impossible. impossible. Diagn. Cytopathol. 2008;36:460,466. © 2008 Wiley-Liss, Inc. [source] An audit of antibiotics usage and their effect on MRSA infection or colonisation following percutaneous endoscopic gastrostomy in a district general hospitalINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2004O.A. Ogundipe Summary Percutaneous endoscopic gastrostomy (PEG) has become a widely practised procedure to maintain long-term nutrition in patients with a variety of medical conditions. Incidence of infection and the usage of prophylactic antibiotic continue to remain an area of debate. Guidelines in gastroenterology on antibiotic prophylaxis published by the British Society of Gastroenterology recommend the use of prophylactic antibiotic prior to placement of PEG tube (1). There has been an alarming rise in the incidence of MRSA, which has jumped from a reported 2% in 1992 to about 42% in 2001 in England & Wales. Use of antibiotic may lead to emergence of MRSA in debilitated patients requiring PEG feeding. This audit addresses some of the problems encountered in a small district general hospital. [source] Antiphospholipid syndrome: a systemic and multidisciplinary diseaseINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2008L. PAGALAVAN Abstract Antiphospholipid syndrome (APS) was first described by Hughes and colleagues in 1983. Since the first few initial descriptions of the syndrome, almost every organ in the body has been reported to be involved in APS. The ,Sapporo' criteria which has been used as the diagnostic criteria since 1999 was recently revised in Sydney before the 11th International Congress on antiphospholipid antibodies in 2006. Over the last 24 years it has evolved into a systemic and multidisciplinary disease. This article looks into the extensive multidisciplinary involvement and presentation of APS including neurology, nephrology, cardiology, respiratory medicine, obstetrics and gynecology, endocrinology, hematology, ophthalmology, dermatology, otorhinolaryngology, gastroenterology, and orthopaedics. [source] Fifty years of Australian pediatric gastroenterologyJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2009Don Cameron Abstract When the Gastroenterological Society of Australia (GESA) began 50 years ago there were very few pediatric gastroenterologists in the world. The ,Mother' of Paediatric Gastroenterology was Australian Charlotte (,Charlo') Anderson who established one of the world's first pediatric gastroenterology units in Melbourne in the early 1960s. Her earlier work in Birmingham had identified gluten as the component of wheat responsible for celiac disease and helped separate maldigestion (cystic fibrosis) and mucosal malabsorption. The first comprehensive textbook of Paediatric Gastroenterology was edited by Charlotte Anderson and Valerie Burke in 1975. Rudge Townley succeeded Charlotte Anderson in Melbourne and went on to further develop small bowel biopsy techniques making it a safe, simple, and quick procedure that led to much greater understanding of small bowel disease and ultimately the discovery of Rotavirus by Ruth Bishop et al. and subsequently to Rotavirus immunization. Australian Paediatric Gastroenterology subsequently developed rapidly with units being established in all mainland capital cities by the end of the 1970s. The Australian Society of Paediatric Gastroenterology Hepatology and Nutrition (AuSPGHAN) was established in the 1980s. Australians have contributed significantly in many areas of gastroenterology in infants, children, and adolescents including celiac disease, cystic fibrosis, liver disease, transplantation, gastrointestinal infection, allergy, indigenous health, inflammatory bowel disease, gastrointestinal motility, and the development of novel tests of gastrointestinal function and basic science. There have also been major contributions to nutrition in cystic fibrosis, end-stage liver disease, and intestinal failure. The future of Australian Paediatric Gastroenterology is in good hands. [source] Emerging leaders of gastroenterology and hepatology in the Asia-Pacific regionJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2007Geoffrey C Farrell [source] Transition in chronic illness: Who is going where?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2008Katharine S Steinbeck Aim: With increasing survival rates for chronic childhood illness, there has been an increasing focus on the transition of clinical care from paediatric to adult services. Data regarding patient numbers are essential for strategic planning and for optimal management. We report on a data collection exercise from the New South Wales Greater Metropolitan Clinical Taskforce Transition Program. Methods: Data were collected between August 2004 and October 2005 through face-to-face interviews with over 200 clinicians in 68 clinical services in tertiary paediatric hospitals in New South Wales, providing information on approximately 4200 patients. Results: Sixty-eight services kept a database on patients with chronic illness but less than half were electronic. Eight services (12%) could specifically identify patients in the active phase of transition on their databases. The five most prevalent clinical groups requiring transition to adult specialist health care (excluding cerebral palsy and developmental disability) were diabetes, other endocrinology, neurology, spina bifida and gastroenterology. Conclusions: There are large numbers of young people with chronic illness and disability who need effective transition to long-term adult care. This study has enabled the identification of paediatric aspects of the transition process that require attention. [source] Changing patterns of coeliac serology requestsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009K. E. EVANS Summary Background, Accurate serological tests have revolutionized the diagnosis of coeliac disease. Aim, To quantify the volume of coeliac serology requests at a district hospital over a decade, identify their origin, assess positivity rates and subsequent duodenal biopsy and histological confirmation rates. Methods, Details of patients in whom coeliac serology was requested from 1997 to 2006 were obtained from laboratory databases. The origins of request were categorized into gastroenterology, general practice, paediatrics and other specialities. Duplicate requests were excluded. Results, A total of 9976 serological tests were requested. Testing increased from 302 in 1997, to 1826 in 2006. In all, 66% of requests were in females. Tests in children accounted for 14,25% of each year's total. General practitioner requests increased from 3.3% in 1997 to 52% in 2006. The proportion of positive serological results fell from 5.7% in 1997 to 2.6% in 2006. Duodenal biopsies were performed in approximately 85% of seropositive patients in earlier years and approximately 75% of seropositive patients in later years. Most nonbiopsied seropositive patients had serology requested by general practitioners. Biopsies confirmed coeliac disease in 91% of seropositive patients. Conclusion, Increasingly, coeliac serological testing is requested by general practitioners. Twice as many females are tested. Increasing test numbers but diminishing positivity rates suggest testing is requested at lower symptom thresholds. Positive serological results are often not confirmed histologically. [source] | ||||||||||||||||||||||||||||