Findings Of Upper Gastrointestinal Endoscopy Research Articles

The Association between Frailty and Abdominal Symptoms: A Hospital-based Cross-sectional Study.

Objective The association between frailty and abdominal symptoms has not been evaluated. Methods We conducted a hospital-based, retrospective cross-sectional study of consecutive outpatients ≥65 years old at the Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center from 2017 to 2019. Patients were included in the study if all of the following information was available from their medical records: patient's profile, the evaluation of osteoporosis, sarcopenia, frailty, nutritional status, findings of upper gastrointestinal endoscopy, and questionnaire results for abdominal symptoms [Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and Constipation Scoring System (CSS)]. We divided the subjects into frailty and non-frailty groups and investigated the risk factors for frailty. Results Of the 313 eligible study subjects [134 men (42.8%) and 179 women (57.2%); mean age, 75.7±6.0 years; mean body mass index, 22.8±3.6 kg/m2], frailty was noted in 71 cases (22.7%). In a univariate analysis, an older age (p<0.001), female gender (p=0.010), successful eradication of Helicobacter pylori (p=0.049), proton pump inhibitor (PPI) use (p<0.001), laxative/prokinetics use (p=0.008), sarcopenia (p<0.001), osteoporosis (p<0.001), hypozincemia (p=0.002), hypoalbuminemia (p<0.001), low lymphocytes (p=0.004), a high CONUT score (p<0.001), a high FSSG score (p=0.001), and a high CSS score (p<0.001) were significantly associated with frailty. A multivariate logistic regression analysis showed that an older age [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.08-1.24, p<0.001], PPI use (OR 2.42; 95% CI 1.18-4.98, p=0.016), sarcopenia (OR 7.35; 95% CI 3.30-16.40, p<0.001), hypozincemia (OR 0.96; 95% CI 0.92-0.99, p=0.027), a high FSSG score (OR 1.08; 95% CI 1.01-1.16, p=0.021), and a high CSS score (OR 1.13; 95% CI 1.03-1.23, p=0.007) were significantly associated with frailty. Conclusion Advanced age, PPI user, sarcopenia, hypozincemia, a high FSSG score, and high CSS score are associated with frailty.

Direct access endoscopy in a Brazilian public healthcare facility: comparable results with specialist referred endoscopy

Background Direct access endoscopy (DAE) is the procedure performed without the pre-evaluation of the patient by a specialist. It is widely available in many medical services around the world, but there is lack of data about this strategy in the setting of the public health system in Brazil. Therefore, the aim of this study is to compare the main endoscopic findings of upper gastrointestinal endoscopy requested through DAE and by specialists. Methods Longitudinal, retrospective single center study in patients who underwent upper digestive endoscopy in a public healthcare facility at the southern region of the state of Mato Grosso, Brazil, from August 2011 to December 2018. Age, gender, modality of endoscopy request (DAE or endoscopy requested by specialists), and endoscopic findings were analyzed. Results A total of 2810 patients were included. Most of them were female 65.23% (1833), mean age was 47.36 years, and 50.71% of the exams (1425) were DAE. Only 4.62% of the exams had normal reports. The most frequent endoscopic findings were gastritis (91.99%), bulboduodenitis (43.59%) and reflux esophagitis (14.76%). Patients who underwent endoscopy requested by specialists were older (50.25 ± 16.57 vs. 44.55 ± 16.31 years, p < .0001) and more frequently men (36.61 vs. 32.98%, p = .0437) in comparison to DAE. However, endoscopic findings were similar in both groups. Conclusion This study shows that direct access upper endoscopy had comparable results to specialist requested endoscopy in a public healthcare facility in the southern region of the state of Mato Grosso, Brazil.

Prevalence of Endoscopic Findings Before Bariatric Surgery and Their Influence on the Selection of the Surgical Technique.

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most popular procedures performed. The decision of which technique is most appropriate depends on the surgeon's preferences and experience. However, several factors strongly influence the decision of the procedure performed, including gastrointestinal disorders or asymptomatic upper gastrointestinal endoscopy (UGE) findings. This study aimed to describe the pathological endoscopic findings in morbidly obese patients undergoing preoperative routine UGE. A retrospective review of a prospectively collected database of all UGEs performed before bariatric surgery was performed. UGE was routinely performed to all the patients as part of the preoperative evaluation protocol. A total of 790 patients were included. Surgical technique included 610 (77.2%) RYGB and 180 (22.8%) SG. Twenty-one asymptomatic patients presented esophagitis at UGE. In only seven patients (0.89%), the endoscopic findings of esophagitis had changed the initial surgical decision. The presence of ulcers or adenomatous or incompletely resected polyps was an indication for SG, to assure future endoscopic access in case it is needed. In 25 patients (3.17%), the initial operation would have been changed based on UGE findings. Preoperative UGE allows the diagnosis of asymptomatic esophagitis related to gastroesophageal reflux disease and the identification of asymptomatic polyps and ulcers, with the potential ability for malignant transformation. In up to 3.17% of the cases, the endoscopic findings changed the operative strategy. As the complication rate associated with the procedure is low, we recommend the routine performance of preoperative UGE before bariatric surgery.

Bile Reflux is a Common Finding in the Gastric Pouch After One Anastomosis Gastric Bypass

IntroductionData on postoperative bile reflux after one anastomosis gastric bypass (OAGB) is lacking. Bile reflux scintigraphy (BRS) has been shown to be a reliable non-invasive tool to assess bile reflux after OAGB. We set out to study bile reflux after OAGB with BRS and endoscopy in a prospective series (RYSA Trial).MethodsForty patients (29 women) underwent OAGB between November 2016 and December 2018. Symptoms were reported and upper gastrointestinal endoscopy (UGE) was done preoperatively. Six months after OAGB, bile reflux was assessed in UGE findings and as tracer activity found in gastric tube and esophagus in BRS (follow-up rate 95%).ResultsTwenty-six patients (68.4%) had no bile reflux in BRS. Twelve patients (31.6%) had bile reflux in the gastric pouch in BRS and one of them (2.6%) had bile reflux also in the esophagus 6 months postoperatively. Mean bile reflux activity in the gastric pouch was 5.2% (1–21%) of total activity. De novo findings suggestive of bile reflux (esophagitis, stomal ulcer, foveolar inflammation of gastric pouch) were found for 15 patients (39.5%) in postoperative UGE. BRS and UGE findings were significantly associated (P = 0.022). Eight patients experienced de novo reflux symptoms at 6 months, that were significantly associated with BRS and de novo UGE findings postoperatively (P = 0.033 and 0.0005, respectively).ConclusionPostoperative bile reflux in the gastric pouch after OAGB is a common finding in scintigraphy and endoscopy. The long-term effects of bile exposure will be analyzed in future reports after a longer follow-up.Trial registrationClinical Trials Identifier NCT02882685

Indications and findings of upper gastrointestinal endoscopy in patients presenting to a District Hospital, Ghana.

IntroductionUpper gastrointestinal (UGI) symptoms are among the commonest complaints for which patients seek medical attention. Characteristics of patients undergoing UGI endoscopy (UGIE) at the district hospital in Ghana are largely unknown. This study was to document the demographic characteristics, indications and endoscopic findings of patients undergoing UGIE at the district hospital in Ghana.MethodsThis study used a cross-sectional design to consecutively recruit 371 patients referred to the Endoscopy Unit of the St. Dominic Hospital, Akwatia for UGIE. Demographic data and indications for the UGIE were recorded. Endoscopic findings per each participant were recorded. Helicobacter pylori (H. pylori) infection was confirmed by rapid-urease examination of gastric antral and body biopsies at endoscopy.ResultsThere were 159(42.9%) males out of the 371 patients. The age ranged from 4 to 94 years with a median age of 46 years. Dyspepsia was the commonest indication occurring in 282(76.0%) patients. The commonest endoscopic diagnosis was gastritis which occurred in 261(70.4%) patients. The prevalence of H. pylori obtained by immediate rapid-urease-campylobacter like- organism (CLO) test was 44.9%.ConclusionThe main indication for UGIE in the studied patients was dyspepsia and most of these patients had gastritis on endoscopy. Only few patients had normal findings. The prevalence of H. pylori in this population was low compared with most of the previous studies done in the country. There is the need to establish more endoscopy centres within the district hospitals in the country and more health professionals trained to perform them.

Diagnostic value of pre-operative upper GI endoscopy in gall bladder stone patients undergoing elective laparoscopic cholecystectomy

Background: Cholecystectomy does not offer all symptomatic relief in most of the patients because of an overlap in the symptomology of biliary and gasroduodenal pathologies. Thus, we aimed at evaluating the efficacy of upper gastrointestinal endoscopy (UGE) in all patients with upper abdominal pain irrespective of ultrasound findings or symptoms.Methods: This prospective study was carried out from November 2015 – August 2017. Patients above 18 years, with ultrasonographically proven diagnosis of cholelithiasis, undergoing laparoscopic cholecystectomy by a single surgeon were studied. UGE was referred to all patients before surgery. Descriptive statistics was used to analyze pathological UGE findings and corresponding 95% confidence levels (CI) was calculated.Results: A total of 117 patients were included in this study with a mean age of 43.6±13.8 years. Majority of the patients were women (59.8%) and most of them presented atypical biliary colic symptoms (n=64, 54.7%). UGE of patients with biliary colic symptoms showed that 65.8% of patients had normal endoscopy findings when compared to 34.2% of patients had positive endoscopy findings. Significantly higher proportion patients with positive UGE findings presented atypical biliary (70%, n=28) when compared to typical biliary colic patients with positive findings (30%, n=12; p&lt;0.05). Among patients being positive for UGE detected lesions, gastritis (~18%), followed by duodenal ulcer (10%) and reflux esophagitis (5%) were the common upper GI problems observed.Conclusions: Pre-elective and routine use of UGE before laparoscopic cholecystectomy helps in reducing persistence of symptoms and in treatment management.

Recurrent abdominal pain and upper gastrointestinal endoscopy findings in children and adolescents presenting at the Lagos University Teaching Hospital.

IntroductionRecurrent abdominal pain (RAP) is a common reason for referral to the paediatric gastroenterology unit and the attending physician needs to be able to rule out an organic cause when evaluating any child with this condition. The aim of this study was to describe the endoscopic findings in children who presented to the paediatric gastroenterology unit of the Lagos University Teaching Hospital (LUTH) with RAP.MethodsThis was a prospective descriptive study which was conducted from January 2015 to July 2018 at the Paediatric Gastroenterology unit of the department of Paediatrics and the endoscopy unit of the LUTH, Lagos, Nigeria. All children and adolescents ≤ 19 years old with recurrent abdominal pain who were referred for upper GI endoscopy during the study period, were recruited. Baseline sociodemographic data, dyspepsia and alarm symptoms if present were documented. Results of other investigations namely stool examination for ova, parasites, occult blood and faecal antigen for Helicobacter pylori and abdominal scan were also documented.ResultsA total of 113 children with recurrent abdominal pain was referred during the study period and 87 (76.7%) of them had upper GI endoscopy done. Out of the participants, 38(43.7%) were boys and 49(56.3) girls. Alarm features were present in 15(17.6%) and dyspepsia was seen in 22(25.3%) of the subjects. The main endoscopic findings were: gastritis in 39 (44.8%), gastric erosions in 14(16.2%), hiatus hernia in 7(8.1%), duodenitis in 6 (6.9%), gastric polyp in 4 (4.6%).ConclusionUpper GI endoscopy remains an invaluable tool in the tool in evaluating RAP in children as it enables accurate diagnosis of GI causes of RAP. There is a need to advocate for easier access to this procedure in the developing countries.

P006 Upper gastrointestinal endoscopy findings are prevalent in children with rare diseases

P006 Upper gastrointestinal endoscopy findings are prevalent in children with rare diseases

Clinical Profile and Upper Gastrointestinal Endoscopy Findings in Patients with Acid Peptic Disease

Clinical Profile and Upper Gastrointestinal Endoscopy Findings in Patients with Acid Peptic Disease

Relationship between Helicobacter pylori infection and bone mineral density: a retrospective cross-sectional study

BackgroundHelicobacter pylori (H. pylori) infection can induce individual inflammatory and immune reactions which associated with extra-digestive disorders. Our aim is to investigate the association between H. pylori infection and bone mineral density.MethodsThis retrospective cross-sectional study was performed by using the data from the health examination database in a medical center of southern Taiwan in 2013. We investigated the relationship between sex, age, body mass index (BMI), waist circumstance, lipid profile, H. pylori infection, the findings of upper gastrointestinal endoscopy and bone mineral density (BMD). Because of nonrandomized assignment and strong confounding effect of age on BMD, the 1:1 propensity score match was applied for age adjustment. The simple and multiple stepwise logistic regression analysis were performed to assess the risk factors of decreased BMD in these well-balanced pairs of participants.ResultsOf the 867 subjects in final analysis with the mean age of 55.9 ± 11.3 years, 381 (43.9%) subjects had H. pylori infection, and 556 (64.1%) subjects had decreased BMD. In decreased BMD group, the portion of woman was higher than a normal BMD group (37.2% versus 29.6%, P = 0.023), the age was significantly older (59.4 ± 9.8 versus 49.8 ± 11.3, p < 0.001) and BMI was significantly lower (24.7 ± 3.5 versus 25.4 ± 3.7, p = 0.006) than the normal BMD group. The prevalence of H. pylori infection was 39.9% and 46.2% in the normal BMD group and the decreased BMD group respectively (P = 0.071). The multivariate analysis which was used for these possible risk factors showed that only advanced age (OR 1.09, 95% CI 1.08–1.11, P < 0.001), and low BMI (OR 0.91, 95% CI 0.87–0.95, P < 0.001) were independently significantly associated with decreased BMD in this nonrandomized study. In the propensity score-matched participants, the multiple stepwise logistic regression analysis revealed H. pylori infection (OR 1.62, 95% CI 1.12–2.35, P = 0.011) and low BMI (OR 0.92, 95% CI 0.87–0.97, P = 0.001) were independently significantly associated with decreased BMD.ConclusionsH. pylori infection and low BMI were independently significantly associated with decreased BMD in selected propensity score-matched populations after age adjustment.

Indications and Patterns of Upper Gastro Intestinal Endoscopy Findings among Patients Attending A Tertiary Care Hospital, Kolkata, India

Indications and Patterns of Upper Gastro Intestinal Endoscopy Findings among Patients Attending A Tertiary Care Hospital, Kolkata, India

Endoscopic ultrasound assessment of gastrointestinal polypoid lesions of indeterminate morphology in patients with portal hypertension.

Background and study aims Polypoid lesions found during upper gastrointestinal endoscopy (UGIE) are occasionally found in patients with portal hypertension (PH). This study aimed to assess the true nature of such polypoid lesions using endoscopic ultrasound (EUS) and determine the accuracy of UGIE in differentiating between vascular and non-vascular lesions in PH. Patients and methods We retrospectively assessed all patients with PH referred for EUS due to polypoid lesions of unknown nature at UGIE over a 7-year period. Cases of known varices were excluded. UGIE findings were compared to EUS findings. Results 66 patients were included (26 male). Commonest UGIE findings were: possible varices (19.4 %), polypoid/neoplastic lesion (52.8 %) and submucosal lesion (16.7 %). After EUS, the final diagnoses were: varices in 25 %, polypoid lesion with underlying vessel/varix in 27.8 % and non-vascular lesion or submucosal lesion in 47.2 %. The diagnostic accuracy of UGIE was suboptimal, since 28.6 % of possible varices were eventually found to be non-vascular, while 15.8 % of polyp/neoplastic looking lesions proved to be varices and 42.1 % were lesions with underlying vessel/varix. 50 % of submucosal lesions were eventually found to be varices. Conclusion Endoscopists should have a high index of suspicion of varices or polyps related to varices when assessing atypical looking polypoid lesions in patients with PH. In such cases EUS should be considered before obtaining biopsies.

Appropriateness of Indications of Upper Gastrointestinal Endoscopy and its Association With Positive Finding

Upper Gastrointestinal Endoscopy is a frequently advised investigation for upper abdominal symptoms. Studies have questioned the appropriateness of indications for upper gastrointestinal endoscopy and have shown that inappropriate indications range from 5% to 49%. The unnecessary upper gastrointestinal endoscopy expose patients to the risk. The number of upper gastrointestinal endoscopy is rising in our region and we assume so is the number of unnecessary upper gastrointestinal endoscopy. With an aim to find out the appropriateness of the indications of upper gastrointestinal endoscopy and compare its association with positive findings, we conducted a cross-sectional descriptive study. All patients undergoing diagnostic upper gastrointestinal endoscopy during study period were included in the study. Appropriateness of indications for upper gastrointestinal endoscopy was defined as per American Society for Gastrointestinal Endoscopy criteria as "appropriate" and "inappropriate". Upper gastrointestinal endoscopy findings were classified as "significant" and "insignificant" based on endoscopy findings. The extent of this association between appropriateness of indications and upper gastrointestinal endoscopy findings was expressed as the odds ratio of finding a relevant diagnosis in patients with an ''appropriate'' indication compared with those with an 'inappropriate'' indication. Seventy-nine patients were included in the study. Fifty- two (65.8%) of the indications were considered appropriate as per American Society for Gastrointestinal Endoscopy guidelines. Thirty-three (63.5%) of the appropriate indications has clinically significant finding as compared to seven (25.9%) of inappropriate indication with an odds ratio of 4.962 (95% CI:1.773 - 13.890, P=0.002) which is statistically significant. Appropriate indications have significantly higher rates of clinically significant findings. Use of guidelines may decrease the number of unnecessary procedures.

Clinical Implications of Associations between Headache and Gastrointestinal Disorders: A Study Using the Hallym Smart Clinical Data Warehouse.

The brain and gastrointestinal (GI) tract are strongly connected via neural, endocrine, and immune pathways. Previous studies suggest that headaches, especially migraines, may be associated with various GI disorders. However, upper GI endoscopy in migraineurs has shown a low prevalence of abnormal findings. Also, the majority of studies have not demonstrated an association between Helicobacter pylori (HP) infection and migraine, although a pathogenic role for HP infection in migraines has been suggested. Further knowledge concerning the relation between headaches and GI disorders is important as it may have therapeutic consequences. Thus, we sought to investigate possible associations between GI disorders and common primary headaches, such as migraines and tension-type headaches (TTH), using the Smart Clinical Data Warehouse (CDW) over a period of 10 years. We retrospectively investigated clinical data using a clinical data analytic solution called the Smart CDW from 2006 to 2016. In patients with migraines and TTH who visited a gastroenterology center, GI disorder diagnosis, upper GI endoscopy findings, and results of HP infection were collected and compared to clinical data from controls, who had health checkups without headache. The time interval between headache diagnosis and an examination at a gastroenterology center did not exceed 1 year. Patients were age- and sex-matched and eligible cases were included in the migraine (n = 168), the TTH (n = 168), and the control group (n = 336). Among the GI disorders diagnosed by gastroenterologists, gastroesophageal reflux disorder was more prevalent in the migraine group, whereas gastric ulcers were more common in the migraine and TTH groups compared with controls (p < 0.0001). With regard to endoscopic findings, there were high numbers of erosive gastritis and chronic superficial gastritis cases in the migraine and TTH groups, respectively, and the severity of gastritis was significantly higher in patients with TTH compared with controls (p < 0.001). However, no differences were observed in the prevalence of HP infection between the groups. The observed association in this study may suggest that primary headache sufferers who experience migraines or TTH are more prone to GI disorders, which may have various clinical implications. Further research concerning the etiology of the association between headaches and GI disorders is warranted.

Diagnosing native liver fibrosis and esophageal varices using liver and spleen stiffness measurements in biliary atresia: a pilot study.

Biliary atresia commonly leads to liver fibrosis and cirrhotic complications, including esophageal varices. To evaluate liver and spleen stiffness measurements using acoustic radiation force impulse (ARFI) imaging for diagnosing grade of liver fibrosis and predicting the presence of esophageal varices in patients treated for biliary atresia. ARFI imaging of the spleen and native liver was performed in 28 patients with biliary atresia. We studied the relation between ARFI imaging values and liver histology findings (n=22), upper gastrointestinal endoscopy findings (n=16) and several noninvasive test results. Diagnostic accuracy was assessed using receiver operating characteristic curve analyses. Liver stiffness measurements exhibited a significant difference among the different grades of liver fibrosis (P=0.009), and showed higher values in patients with high-risk esophageal varices than in the other patients (P=0.04). The areas under the receiver operating characteristic curves of liver stiffness measurements for liver fibrosis grades ≥ F2, ≥F3 and = F4 were 0.83, 0.93 and 0.94, respectively. Patients with high-risk esophageal varices were preferentially diagnosed by the combined liver and spleen stiffness measurements (area under the curve, 0.92). Liver and spleen stiffness measurements using ARFI imaging are potential noninvasive markers for liver fibrosis and esophageal varices in patients treated for biliary atresia.

Perforated Carcinoma in the Gastric Remnant: A Case of Conservative Treatment Prior to Successful Curative R0 Resection.

An 80-year-old man who had undergone distal gastrectomy and Billroth-II gastrojejunostomy 38 years previously, for a benign gastric ulcer, was diagnosed with remnant gastric cancer based on upper gastrointestinal endoscopy findings. He presented at our emergency department with acute-onset epigastric pain due to perforated remnant gastric cancer. Conservative medical management was selected, including nasogastric tube insertion, antibiotics, and proton pump inhibitors, because his peritonitis was limited to his epigastrium and his general condition was stable. Twenty-one days after the perforation occurred, curative total remnant gastrectomy and D2 lymphadenectomy were performed. Adhesion between the lateral segment of the liver and the dissected lesser curvature of the gastric remnant may have contributed to the peritonitis in this case, which was limited to the epigastrium. This is the first report of perforated remnant gastric cancer in which conservative treatment was effective prior to curative resection. The protocol reported here may be of use to other clinicians who may encounter this clinical entity in their practices.

Hallazgos de la endoscopia digestiva alta en pacientes con obesidad mórbida candidatos a cirugía bariátrica

IntroductionBody mass index has been associated with the presence and severity of various gastrointestinal symptoms. The aim of the study was to analyze the endoscopic findings and gastric histology of morbidly obese candidates for bariatric surgery. MethodsWe retrospectively included patients undergoing bariatric surgery at the Hospital de León from March 2005 to April 2013. The findings of upper gastrointestinal endoscopy and antral histology were collected. The relationship of body mass index (BMI) with gastroscopy findings and the presence of Helicobacter pylori were assessed. ResultsA total of 194 patients were included. An abnormality on endoscopy or antral biopsy was found in 48.7% and 78.9% of the patients, respectively. Three patients had gastric peptic ulcer, and consequently the intervention was postponed until healing. H.pylori infection was found in 63.9% of the patients. The presence of H.pylori and endoscopic findings were not related to BMI. ConclusionGastroesophageal disease is common in morbidly obese patients and approximately half of the patients had some kind of alteration on endoscopy. Gastroscopy and H.pylori testing prior to surgery is required to rule out disease that could delay or contraindicate surgery.

A prospective analysis of the preoperative assessment of duodenal involvement in gallbladder cancer

BackgroundDuodenal involvement occurs frequently in gallbladder cancer (GBC) as a result of the proximity of the duodenum to the gallbladder. MethodsThe study group included 74 GBC patients assessed between August 2009 and March 2011 in whom computed tomography (CT) of the abdomen indicated suspicion for duodenal involvement. ResultsOf 172 patients with resectable GBC, 74 (43.0%) had suspected duodenal involvement on imaging. Of these, 51 (68.9%) had suspected duodenal involvement on upper gastrointestinal endoscopy (UGIE). Symptoms of gastric outlet obstruction (GOO) were present in only 14 (18.9%) patients. Thirteen (17.6%) patients underwent staging laparoscopy alone. Of the 61 patients who underwent laparotomy, 31 (50.8%) were found to have actual duodenal involvement. The positive predictive value (PPV) of CT of the abdomen for duodenal involvement was 50.8% (31 of 61 patients). The addition of UGIE increased the PPV to 65.9% (27 of 41 patients). In the subgroup with evidence of duodenal mural thickening or mucosal irregularity on CT of the abdomen (n= 9) or duodenal mucosal infiltration on UGIE (n= 14), the PPV increased to 100%. A total of 33 (44.6%) patients underwent curative resection. The resectability rate was significantly lower in patients with symptoms of GOO [two of 14 (14.3%) vs. 31 of 60 (51.7%); P= 0.010], CT findings of duodenal mural thickening or mucosal irregularity compared with only loss of the fat plane [two of 12 (16.7%) vs. 31 of 62 (50.0%); P= 0.032], and UGIE evidence of duodenal infiltration compared with extrinsic compression or normal endoscopic findings [three of 16 (18.8%) vs. 18 of 35 (51.4%) and 12 of 23 (52.2%), respectively; P= 0.027 and P= 0.036, respectively]. conclusionsOverall, CT of the abdomen demonstrated a PPV of 50.8% in detecting duodenal involvement, which increased to 65.9% with the addition of UGIE. The combined presence of GOO symptoms, CT findings of duodenal mural thickening and mucosal irregularity, and UGIE findings of infiltration of the duodenal mucosa significantly decreases resectability but does not preclude resection.

Lifestyle factors associated with gastroesophageal reflux disease in the Japanese population

We aimed to clarify the lifestyle factors associated with erosive esophagitis and non-erosive reflux disease (NERD) in a Japanese population. Among 886 subjects who underwent health screening, we selected, according to their scores on the FSSG (frequency scale for symptoms of gastroesophageal reflux disease; GERD) questionnaire and the findings of upper gastrointestinal endoscopy, 138 subjects with erosive esophagitis (EE), 148 subjects with NERD (absence of esophagitis, FSSG score ≥8, and acid reflux-related symptoms score ≥4), and 565 control subjects (absence of esophagitis and FSSG score ≤7). We compared clinical characteristics and various lifestyle factors in these three groups. The lifestyle factors significantly associated with NERD compared with findings in the control group were intake of egg (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.01-3.50), sleep shortage (OR 2.44, 95% CI 1.54-3.88), and strong psychological stress (OR 1.77, 95% CI 1.18-2.62). In male subjects, current smoking (OR 2.06, 95% CI 1.13-3.74; OR 1.87, 95% CI 1.09-3.20) was a significant risk factor for both NERD and EE. Moreover, alcohol >200 kcal/day (OR 3.99, 95% CI 1.03-15.55) and intake of a large quantity of food at supper (OR 7.85, 95% CI 1.66-37.05) were significant risk factors for EE in subjects with hiatal hernia. Intake of a large quantity of food at supper (OR 2.09, 95% CI 1.06-4.13) was more common in the NERD group than in the EE group. There were differences in the associated lifestyle factors between patients with NERD and those with EE, and there was also a gender-related difference between these groups.

A Study of Upper GI Endoscopy in a Rural Tertiary Care Centre of Pakistan.

Objective: To determine the common indications, yield and findings of Upper Gastrointestinal Endoscopy(UGIE) in a rural setting of Pakistan.Patients and Methods: Retrospective analysis of the endoscopy data of all 772 patients who underwent UGIEin Muhammad Medical College Hospital between 1st August 2009 and 31st July 2011.Results: Out of the total of 772 patients, there were 398 men (51.5%). The average age was 41 years (range13 –92). Therapeutic endoscopies comprised 27.3% (n = 211) of all UGIEs. All 561 patients who underwent diagnostic procedure were given choice to have UGIE done either under sedation or with pharyngeal anaesthesia only.Vast majority (n = 525; 93.5%) preferred sedation with Midazolam (mean dose 3 mg). Commonest indication forUGIE was acute upper gastrointestinal bleed (AUGIB) (n = 275; 35.6%), followed by dysphagia (n = 136; 17.6%)and upper abdominal pain (n = 126; 16.3%). The commonest finding was normal examination (n = 271; 35.1%),oesophageal varices (n = 206 [26.6%] – bleeding = 147, non-bleeding = 59;), carcinoma of oesophagus (n = 51;6.6%), portal hypertensive gastropathy (n = 50; 6.4%) and peptic ulcer disease (n = 46; 6.2%). Commonest therapeutic procedure performed was endoscopic treatment of oesophageal varices (n = 182). No immediate complication was seen.Conclusion: In our setting, UGIE is a common and safe procedure. 93.5% patients would like to have a diagnostic UGIE done under sedation. AUGIB constitutes over 1/3 of all UGIE indications and oesophageal varices arethe commonest abnormal findings, requiring endoscopic treatment.