Gastroenterol. Insights, Volume 5, Issue 1 (September 2013) – 4 articles

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used class of medications worldwide. It is estimated that more than 20 million people take NSAIDs daily. We examined the underreported use of NSAIDs on a standardized office intake assessment questionnaire of patient reported medications. A questionnaire was administered to patients following written and verbal confirmed report of current medications to nursing staff. One hundred consecutive patient intake assessments were evaluated from the patient intake sheets for a busy private gastroenterology specialty practice. After patients listed their current medications, they were given a survey and asked to acknowledge any use of 30 non-prescription formulations that contained NSAIDs. Patients filled these surveys while waiting for the health care provider who then reviewed the response accuracy with the patient during the visit. Changes in the patient‘s initial and subsequently corroborated use or non-use of NSAIDs were recorded and tabulated. The educational level of all participants was also assessed. Of the 100 surveys completed, 6% of patients had not completed high school, 19% had completed high school, 8% had started but not finished college, 54% had completed college, 2% had started but not finished graduate school, and 11% had completed graduate school. The educational level of the patients did not correlate with underreporting of NSAID usage. On the survey, 18% of patients noted use of an NSAID listed that had not been reported verbally to nursing staff; 8% of those patients reported daily use, 15% weekly use and 76% reported use within the last month. Patients were then asked in the questionnaire as to the reason for not reporting medication intake to nurse; 14% stated they were never asked about the specific medication, 22% did not think the medications were important enough to list, 34% bought the medication with prescriptions, and 30% noted their reason as their doctor did not prescribe the medication to them. Using a prospective questionnaire in a private practice gastrointestinal office, these data show that patients underreport use of non-prescription NSAIDs. Based on the data, it is clear that this underreporting can have a detrimental effect on procedure related as well as long-term patient care. Future studies would be needed to examine the incidence of side effects due to underreporting of NSAIDs. Full article

The development of Barrett’s esophagus above the anastomosis following esophagogastrectomy has been reported in several studies. In this prospective study we set out to examine the prevalence of this phenomenon in a group of patients who have been strictly adherent to post operative proton pump inhibitor (PPI) therapy. Forty-six postoesophagectomy patients were prospectively assessed by upper gastrointestinal endoscopy. Four quadrant biopsies were taken 1 cm proximal to the esophago-gastric anastomosis in all patients and details of endoscopic appearance, biopsy pathology, operative pathology and PPI dose were recorded. All 46 patients had been commenced on a PPI in the immediate postoperative period. Two patients were not taking a PPI regularly. The average time from operation to endoscopy was 3 years (range 0.5 to 9). Mild (Grade 1) erosive oesophagitis was observed in 5 patients. Barrett’s epithelium was not identified in any patient. One patient who was taking a PPI intermittently had macroscopic columnar epithelium for 2 cm above the anastomosis without intestinal metaplasia. One other patient who had no macroscopic abnormality had columnar epithelium without intestinal metaplasia, seen in one of four biopsy specimens. This is the first study to assess for endoscopic evidence of neo-Barrett’s following oesophagogastrectomy, where PPI therapy has been commenced in the immediate postoperative period. Columnar epithelium was present in 2 patients and intestinal metaplasia was not detected in any of the cohort. These outcomes may be due to early commencement of PPI therapy and a high level of compliance. Full article

Signet ring cell carcinoma is a subtype of adenocarcinoma and mainly originated from stomach. Terminal ileum involvement is uncommon and only 2 cases have been reported in the literature. We represent a case of signet ring cell carcinoma of the terminal ileum showing gross features mimicking Crohn’s disease in a patient with ankylosing spondylitis. Full article

In the management of Helicobacter pylori-induced gastroduodenal disease, a pilot study at our hospital (St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway) revealed that culture often seemed to fail compared to the polymerase chain reaction (PCR). A more thorough evaluation was therefore undertaken. We included 201 patients referred to upper gastrointestinal endoscopy in the period 2002-2004. Serology, biopsy rapid urease test, culture and PCR were performed. Conventional PCR was performed using the ureC, vacA and cagA genes, and real-time PCR for ureC. A diagnostic standard was defined on the basis of all four tests, and all four tests were then compared to this standard. One hundred eleven patients were deemed H. pylori-positive by the defined diagnostic standard, and 90 were labeled negative. Compared to this standard, culture showed a sensitivity of 87.4%, which was significantly lower than PCR at 99.1% (P<0.001). Culture showed a perfect specificity of 100%, which was significantly better than PCR at 97.8%. ureC was the gene with the best sensitivity (94.6% in conventional PCR, 97.3% in real-time PCR). vacA sensitivity was 87.4%, which is significantly lower than ureC (P<0.001). cagA was present in 37.8% of our H. pylori-positive patients. By real-time PCR a significantly lower cycle threshold was observed in antral biopsies than in corpal biopsies, indicating a higher H. pylori DNA template concentration in antral biopsies. PCR-testing for H. pylori is faster and significantly more sensitive than culture. Culture on the other hand was significantly more specific than PCR in our hand. Full article