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Upper GI Endoscopy (upper + gi_endoscopy)
Selected AbstractsImpact of the Rome II paediatric criteria on the appropriateness of the upper and lower gastrointestinal endoscopy in childrenALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010E. Miele Aliment Pharmacol Ther 2010; 32: 582,590 Summary Background, The demand for paediatric gastrointestinal (GI) endoscopy has increased, resulting in a significant rise of overall costs. Aim, To assess the clinical impact of the Rome II criteria for functional gastrointestinal disorders when selecting paediatric patients who underwent GI endoscopy. Methods, The indications and findings of GI endoscopic procedures performed before and after the publication of the Rome II criteria were evaluated retrospectively. Results, Upper GI endoscopy was performed in 1124 children, whereas colonoscopy was performed in 500 subjects. A total of 607 (54%) oesophago-gastro-duodenoscopies (OGDs) were positive and 517 (46%) were negative, whereas 306 (61.1%) colonoscopies were positive and 194 (38.9%) were negative. Of the 1624 procedures, 26% were considered inappropriate according to the Rome II criteria. Inappropriate procedures decreased significantly after publication of the Rome II criteria (OR, 3.7; 95% CI, 1.8,7.5). Of 1202 appropriate GI endoscopies, 502 OGD (62.7%) were significantly contributive, compared with only 105 (32.5%) of the 323 inappropriate procedures (OR, 3.5; 95% CI, 2.6,4.6), whereas 265 (65.8%) colonoscopies were significantly contributive, compared with only 41 (42.3%) of the 97 inappropriate procedures (OR, 2.6; 95% CI, 1.6,4.1). Conclusions, The use of the criteria for functional gastrointestinal disorders makes a significant positive impact, they should reduce unnecessary paediatric GI endoscopy. [source] Low-dose aspirin reduces the gene expression of gastrokine-1 in the antral mucosa of healthy subjectsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2008G. MARTIN Summary Background, Gastrokine 1 (GKN1), one of the most abundant transcripts in normal stomach, is down-regulated by Helicobacter pylori infection. Aspirin (ASA), which is often used for secondary prevention of cardiovascular events, can damage gastric-duodenal mucosa within 1 or 2 h of ingestion. Aim, To study the gastric mucosal expression of GKN1 during acute low-dose ASA consumption. Methods, Ten H. pylori -negative human volunteers took 100 mg ASA per day for 1 week, and underwent multiple upper GI endoscopies. GKN1 expression was analysed in antral and corpus mucosa by quantitative reverse-transcriptase polymerase chain reaction, western blot and immunohistochemistry (IHC). Gastric mucosal damage was detected endoscopically and histologically. Results, Gastrokine 1 was similarly expressed in both antral and corpus mucosa. The use of low-dose ASA led to a significant decrease (3.07 a.u. vs. 0.23 a.u., P < 0.001) in antrum at day 7, while GKN1 transcript levels in corpus mucosa were slightly elevated (twofold, P < 0.005). Western blot and IHC confirmed these changes at the protein level. Furthermore, IHC revealed a vesicular staining pattern in the cytoplasm for GKN1 that was confirmed by transfected human gastric adenocarcinoma cell line expressing GKN1. Conclusion, Our data demonstrated that low-dose ASA downregulates GKN1 expression specifically in antral mucosa. [source] Differences in endoscopic views during biopsy through the right and left lower biopsy channels of the upper gastrointestinal endoscopeDIGESTIVE ENDOSCOPY, Issue 3 2004Naoki Mantani Background:, It has not been established as to which side the biopsy (instrument) channel should be placed in the tip of a front-viewing upper gastrointestinal (GI) endoscope to allow an en-face approach to lesions on various aspects of the stomach wall. Methods:, Using a front-viewing two-channel endoscope, we identi,ed a difference in endoscopic views during biopsy between lower-right and lower-left channels. Colored marks were distributed on the lesser curvature (LC), greater curvature (GC), anterior wall (AW), and posterior wall (PW) in the ,stomach' of a dummy for mock-performance of upper GI endoscopy. When biopsy forceps through the different channels touched the marks, an endoscopic photograph was taken. Furthermore, when biopsy specimens were obtained from PW lesions in several patients, endoscopic views were compared between the two biopsy channels. Results:, In the dummy study, no remarkable difference was detected in targeting the marks on AW, LC, or GC of the stomach. The dummy and the patient study showed that the lower-right approach could target PW lesions with a more adequate endoscopic view than from the lower left. The lower-left approach targeted PW lesions on the higher body with a nearly blinded endoscopic view. Specimens from PW of the upper body, which could be precisely obtained under direct visual control through the lower-right channel, were no smaller than those obtained using the channel on the lower left. Conclusion:, The present study suggests that the lower-right channel may be preferable to the lower-left channel in the tip of a front-viewing upper GI endoscope. [source] Factors Related to Helicobacter pylori Prevalence in an Adult Population in BrazilHELICOBACTER, Issue 1 2007Schlioma Zaterka Abstract Background:, The prevalence of Helicobacter pylori is higher in developing countries. Sanitary facilities, crowding and ethnic group are some of the factors related to H. pylori infection. The aim of this study was to investigate in blood donors, free of dyspeptic symptoms, the prevalence and factors influencing H. pylori infection. Materials and Methods:, This study was conducted in São Paulo, a city known to have a mixed population coming from all over the country. A total of 1008 blood donors were initially included in the study. After a final revision of all the questionnaires, 993 were included in the final analysis (746 males). H. pylori status was checked by an ELISA test. The following associations to infection were analyzed: sex, age, ethnic group, previous upper gastrointestinal (GI) endoscopy, smoking, alcoholism, drug addiction, type of drinking water, crowding, sanitary facilities, and family income. Results:, Infection was observed in 496 of 746 male (66.5%) and in 156 of 247 female (63.2%) blood donors. Infection prevalence increased according to age group, regardless of sex. Prevalence was lower in White population than in non-White. No relationship was observed between infection and smoking, drug addiction, and alcohol. A positive relation was observed between infection and previous upper GI endoscopy, and type of drinking water, regardless if currently or during childhood. Crowding and lack of toilet in the house during childhood resulted in a higher infection rate. Lower familial income and educational level showed a positive association to infection. Conclusions:, Prevalence of H. pylori is higher in non-White population, independent of gender. A positive association was observed in aging, previous upper GI endoscopy, crowding, type of drinking water, lack of toilet during childhood, lower family income, and lower educational level. [source] Clinical trial: long-term use of proton pump inhibitors in primary care patients , a cross sectional analysis of 901 patientsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009C. REIMER Summary Background, The use of proton pump inhibitors (PPIs) is extensive. While the incidence of new treatments remains stable, the prevalence of long-term treatment is rising. Studies have shown that up to 70% of patients on chronic acid suppression lack a verified indication for treatment. Aims, To investigate primary care patient characteristics associated with long-term use of PPIs. Methods, A cross-sectional analysis of 42 634 patients registered with 22 general practitioners was performed. Patients with prescriptions of ,120 tablets/year were defined as long-term users. A survey of a subgroup of patients without verified indication was performed. Results, In all, 901 (2.1%) patients were long-term treated. Verified indications for treatment were identified for 247/901 (27%). An upper GI endoscopy had been performed in 418 patients (46%). Of the 194/654 without verified indication who participated in the survey, 71% reported heartburn/acid regurgitation as the reason for therapy. On-demand therapy was reported by 43/194 (22%) and previous attempts to withdraw by 119/194 (61%). Conclusions, The prevalence of PPI long-term treatment among primary care patients is 2.1%. The main reason for treatment is reflux symptoms or verified GERD. Rationalization of use of PPIs is possible as daily treatment without attempts to discontinue is frequently observed. [source] NSAID switching and short-term gastrointestinal outcome rates after the withdrawal of rofecoxibPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 12 2009Sebastian Schneeweiss MD Abstract Objective The consequences of the rofecoxib withdrawal on upper GI toxicity are largely unknown. We sought to estimate the effect of switching from selective Cox-2 inhibitors to non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) on the incidence of upper GI adverse events following the withdrawal of rofecoxib on 30 September 2004. Methods We identified a cohort of 33,045 patients with arthritis and chronic use of any selective Cox-2 inhibitor during the 6 months before the withdrawal of rofecoxib in claims data from several US health plans. We calculated monthly rates of hospitalization for upper GI adverse events or upper GI endoscopy for the 6 months before and 3 months after the switching and compared the time trends in outcomes. Results In the subgroup of 15,916 patients using rofecoxib immediately before its withdrawal, 2626 (17%) switched to nsNSAIDs without co-prescribing of a gastroprotective drug, 146 (1%) with a gastroprotective drug, and 5246 (33%) switched to either celecoxib or valdecoxib. Among those switching to nsNSAID without gastroprotection, time trends of upper GI hospitalization rates and endoscopies did not significantly increase compared with those switching to celecoxib or valdecoxib (+0.3 per 1000 per month; 95%CI ,3.0 to 3.5). The visit rate for peptic ulcer disease (PUD) increased more in the group switching to nsNSAIDs without gastroprotection (+5.2 visits per 1000 per month; 1.2,9.2) compared with the group switching to another coxib. Conclusions Short-term follow-up data suggest that the sudden shift from rofecoxib to nsNSAIDs without gastroprotection did not increase the rate of hospitalization for GI complications but increased outpatient visits for PUD. Copyright © 2009 John Wiley & Sons, Ltd. [source] | ||||||||||