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Sasson AN, Noelting J, Schwenger K, Armstrong D, Raman M, Duerksen D, Whittaker S, Lu Y, Jurewitsch B, Gramlich L, Ananthakrishnan A, Allard J. A287 HOME PARENTERAL NUTRITION FOR INDIVIDUALS WITH SHORT BOWEL SYNDROME SECONDARY TO CROHN’S DISEASE VERSUS OTHER ETIOLOGIES: A PROSPECTIVE COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991271 DOI: 10.1093/jcag/gwac036.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Individuals with short bowel syndrome (SBS) have reduced intestinal absorptive capacity and many require home parenteral nutrition (PN) support. One of the common causes of SBS is secondary to intestinal resections in the management of Crohn’s disease (CD). Complication rates and survival in SBS secondary to CD on PN versus other etiologies remains unknown. Purpose To determine whether patients with SBS secondary to CD versus SBS secondary to other etiologies on home PN, have increased risk of hospitalizations and complications including central line associated bloodstream infection (CLABSI) and venous thromboembolism and whether there is a difference in overall survival between groups. Method This is a multicentre prospective cohort study using the Canadian Home Parenteral Nutrition (HPN) Registry on individuals with defined SBS separated into two cohorts: 1) Patients with SBS secondary to Crohn’s disease vs. 2) Patients with SBS secondary to other aetiologies (trauma, surgical complication, vascular event, volvulus, malignancy). Patient characteristics and clinical factors are presented as mean (standard deviation) for continuous variables and as frequency (percentage) for categorical variables. Comparison between groups (SBS CD vs SBS other) were performed using 2-sample t-test for continuous variables and Chi-square or Fisher exact tests when appropriate for categorical variable. Survival probabilities will be estimated using the Kaplan-Meier method. Result(s) The study included a total of 379 patients with short bowel syndrome on home PN. There are 170 (45%) patients with SBS secondary to CD and 209 (55%) patients with SBS from other secondary causes. The average age of those with CD is 52 and 65% female patients. The average age of those with other causes of SBS is 56 with similar percentage of female patients (65%). There were significant differences in baseline medications with higher use of immunosuppressant therapy (39% vs. 7%, p<0.001) in those with CD. There was no significant difference in total number of hospitalizations, hospitalizations related to PN and CLABSI. Image ![]()
Conclusion(s) Individuals with SBS secondary to CD do not appear to be at increased risk of central line infections or hospitalizations compared those with SBS from other causes. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- A N Sasson
- Gastroenterology, University of Toronto, Toronto, Canada
| | - J Noelting
- Gastroenterology, Essentia Health, Duluth, United States
| | - K Schwenger
- Gastroenterology, University of Toronto, Toronto, Canada
| | - D Armstrong
- Gastroenterology, McMaster University, Hamilton
| | - M Raman
- Gastroenterology, University of Calgary, Calgary
| | - D Duerksen
- Gastroenterology, University of Manitoba, Winnipeg
| | - S Whittaker
- Gastroenterology, University of British Columbia, Vancouver
| | - Y Lu
- Gastroenterology, McGill University, Montreal
| | | | - L Gramlich
- Gastroenterology, University of Alberta, Edmonton, Canada
| | - A Ananthakrishnan
- Gastroenterology, Massachusetts General Hospital, Boston, United States
| | - J Allard
- Gastroenterology, University of Toronto, Toronto, Canada
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2
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Vantomme E, Sulymka B, Stevens M, Duerksen D. A252 DO GLIM CRITERIA FOR DIAGNOSING MALNUTRITION AGREE WITH SGA IN HOSPITALIZED PATIENTS RECEIVING TPN? J Can Assoc Gastroenterol 2022. [PMCID: PMC8859297 DOI: 10.1093/jcag/gwab049.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The Global Leadership Initiative on Malnutrition (GLIM) proposed a new two-step model for diagnosing malnutrition in 2019. A combination of two etiologic and three phenotypic criteria are used to assess malnutrition. The Subjective Global Assessment (SGA) is the most well validated assessment tool for diagnosing malnutrition in hospitalized patients. Evaluation of the performance of GLIM criteria in comparison to SGA is necessary before implementing this new diagnostic tool in practice. Aims To compare GLIM criteria to SGA in assessing malnutrition severity in hospitalized patients requiring parenteral nutrition (PN). Methods This is a retrospective analysis of a prospectively collected database of malnourished hospitalized adult patients requiring PN admitted between March 2020 and March 2021 to an academic hospital in Winnipeg, Canada. 172 cases were evaluated. GLIM malnutrition screening was considered positive if one etiologic (high CRP or low food intake) and one phenotypic (weight loss or low BMI) criteria were identified. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated and expressed with a Wilson 95% confidence interval. Results The prevalence of malnutrition using SGA B or C criteria was 82.3% (CI 73.8, 85.5). Using GLIM criteria, the prevalence of malnutrition was 33.7% (27.1, 41.1). The prevalence of severe malnutrition using SGA C was 32.6% (26.0, 40.0) and using GLIM criteria the prevalence was 19.2% (14.0, 25.7). Using any combination of GLIM criteria versus SGA B or C combined, the PPV was 100% (90.4, 100) and the specificity was 100% (89.9, 100); NPV was 30.0% (22.0, 38.5) and the sensitivity was 42.0% (34.1, 50.4). Using any combination of GLIM criteria versus only SGA C patients, PPV decreased to 72.4% (59.8, 82.3) and specificity was 86.2% (78.8, 91.3); NPV increased to 87.7% (80.4, 92.5) and sensitivity was 75.0% (62.3, 84.5). Comparing severely malnourished patients by GLIM criteria to only SGA C patients, PPV was 97% (84.7, 99.5) and specificity was 99.1% (95.3, 100). NPV was 82.7% (75.6, 88.1) and sensitivity was 57.1% (44.1, 69.2). Conclusions Using SGA as the gold standard for diagnosing malnutrition in hospitalized patients requiring PN, GLIM criteria had a very high PPV but unacceptably low NPV in diagnosing malnutrition. The NPV improved when GLIM criteria was compared only to severely malnourished patients by SGA. Importantly, in comparing severely malnourished patients by GLIM and SGA criteria, the sensitivity was also unacceptably low. Based on these results, GLIM criteria are most useful in confirming the diagnosis of malnutrition or severe malnutrition; a negative result should not reassure clinicians that severe malnutrition is absent. Further studies evaluating GLIM criteria are needed before it replaces SGA as a decision making tool. Funding Agencies None
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Affiliation(s)
- E Vantomme
- University of Manitoba, Winnipeg, MB, Canada
| | - B Sulymka
- University of Manitoba, Winnipeg, MB, Canada
| | - M Stevens
- University of Manitoba, Winnipeg, MB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
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3
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Mistry J, Khaouli M, Weiten D, Case S, Gidrewicz D, Turner J, Duerksen D, Pinto-Sanchez MI. A193 PERCEIVED BARRIERS TO GLUTEN-FREE FOOD ACCESS ON-CAMPUS EXPERIENCED BY STUDENTS FROM DIFFERENT CANADIAN UNIVERSITIES AND COLLEGES. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859143 DOI: 10.1093/jcag/gwab049.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Students with gluten-related disorders (GRD), a spectrum of conditions including celiac disease (CeD) and non-celiac wheat sensitivity (NCWS), often experience challenges when accessing gluten-free (GF) foods.
Aims
To identify barriers perceived by students with GRD to access GF products on-campus of universities and colleges across Canada.
Methods
We conducted a cross sectional survey using the RedCap platform and distributed it to the Canadian Celiac Association community. We included students who reported adopting a GFD for various reasons including CeD and other GRD. We collected data on adherence to the GFD using a validated questionnaire (CDAT), presence of perceived barriers to follow a GFD while dining on campus, persistent symptoms, and altered quality of life. Continuous data are expressed as median (IQR), and categorical data as proportions of patients. Mann-Whitney U and Chi2 with Fisher correction were used to assess differences between groups.
Results
Seventy nine students responded to the survey (5% male and median age = 25 yrs) and 78 had complete data for analysis. Of the 78 students, 52 (66.6%) reported a diagnosis of CeD, while 26 were adopting a GFD for other reasons (non-CeD). The majority were enrolled in university programs (72/78) and 18% were living on-campus. Almost 90% reported difficulties maintaining a GFD while dining on-campus. Similar proportion of CeD and non-CeD reported eating gluten accidentally (75% vs 80%), while 15% reported eating gluten intentionally on-campus at least a few times per week. This was observed more frequently in non-CeD compared with students with CeD (61% vs 17%; p=0.04). Barriers identified in CeD versus non-CeD groups were related to a reduced GF-food variety (48% vs 69%), lack of availability of GF food (21% vs 46%) and increased cost (46% vs 81%) compared with gluten-containing counterparts. The majority of participants were concerned whether the food available on-campus was truly GF (80% vs 54%) as they reported foods not properly labelled. The majority of participants considered their overall health (79%) and quality of life (65%) was fair to terrible while dining on campus. During the pandemic, 76% of them perceived that it was easier to stick to a GF diet.
Conclusions
Students from various universities and colleges across Canada experience barriers to access GF food on-campus. This has a significant impact on their overall health and quality of life. Proper food labeling, GF certification and improving the variety of GF food on-campus are options for improvement.
Funding Agencies
None
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Affiliation(s)
- J Mistry
- McMaster University, Hamilton, ON, Canada
| | - M Khaouli
- McMaster University, Hamilton, ON, Canada
| | - D Weiten
- University of Manitoba, Winnipeg, MB, Canada
| | - S Case
- University of Saskatchewan, Saskatoon, SK, Canada
| | | | - J Turner
- Stollery Children’s Hospital, Edmonton, AB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
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4
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Akman O, Duerksen D. A68 DISTAL MIGRATION OF A PERCUTANEOUS GASTROJEJUNAL DUODOPA INFUSION TUBE DUE TO BEZOAR FORMATION AT THE JEJUNAL TUBE TIP. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Continuous intestinal infusion of levodopa/carbidopa intestinal gel (LCIG) for the treatment of advanced Parkinson’s Disease (PD) leads to less variability in plasma drug levels and improved symptom control. Percutaneous Gastrojejunostomy (PEG-J) tube placement has a high placement success rate; however, delayed tube malfunctions occur in approximately 58% of cases within two years. A rare complication is bezoar formation at the jejunal tube tip.
Aims
To present a case of bezoar formation at the jejunal tip of a PEG-J tube that caused distal migration of the tube with gastroduodenal ulceration and required surgical extraction.
Methods
Full chart review was conducted including clinical notes, laboratory results, radiographic imaging, endoscopy reports, and surgical reports. A relevant literature review was conducted.
Results
A 57-year-old male with severe PD underwent endoscopic guided PEG-J tube insertion for continuous infusion of LCIG; intestinal administration was effective for symptom control. Two years later, he noted that the gastric tube had retracted approximately 15 cm into the stoma without external manipulation of the apparatus. Attempts to externally pull the tube back into position were unsuccessful.
The patient underwent Gastroscopy (EGD) with fluoroscopy. Contrast was used to confirm placement of the jejunal tip within the jejunum, but also showed migration of the gastric tip into the duodenum. A gastroscope was used to reposition the gastric tube in the stomach; the jejunal tube was visualized to be under traction. The bumper on the apparatus was re-positioned and external tape was used to further secure the apparatus and prevent migration.
A month later the tube had migrated again; repeat EGD showed the jejunal tube to be under traction with some resultant ulceration of the pyloric channel and duodenal bulb where the tube had been pressing against the mucosa. The jejunal tube could not be pulled back and appeared to be fixed distally. A CT scan was obtained to assess for complications and a coiled tip was seen in the proximal jejunum.
Surgical extraction of the malfunctioning tube was required. At laparotomy, the coiled tip of the feeding tube was successfully removed via enterotomy. The tube tip had coiled around itself and was encased with food materials, creating a large bezoar that was being pulled distally by peristalsis. The patient subsequently underwent insertion of a new GJ tube for ongoing administration of LCIG and has been doing well since.
Conclusions
Bezoar formation at the jejunal tip of LCIG PEG-J tubes is a rare complication and can lead to distal migration and traction related gastroduodenal ulceration. Surgical removal may be required.
Funding Agencies
None
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Affiliation(s)
- O Akman
- Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
| | - D Duerksen
- Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
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5
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Daoud D, Cartagena EMS, Somlaw N, Schwenger K, Gramlich L, Armstrong D, Raman M, Duerksen D, Whittaker S, Jurewitsch B, Marliss E, Allard J. A240 HOME PARENTERAL NUTRITION IN OLDER VERSUS YOUNGER PATIENTS: CLINICAL CHARACTERISTICS AND OUTCOMES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is a demographic shift toward older patients receiving home parenteral nutrition (HPN) but there is little data on their clinical characteristics and outcomes versus younger HPN patients.
Aims
The objective of this study was to determine if there are any differences between older (> 60 years) and younger (18–59 years) HPN patients in regard to HPN indications, prescriptions and outcomes over the first 2 years receiving HPN.
Methods
This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the password protected web-based Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for 2 years were selected from 8 participating programs across Canada. Data included demographics, anthropometrics, PN prescriptions, line sepsis events, survival and quality of life based on the Karnofsky Performance Status (KPS).
Results
402 patients met the inclusion criteria: 184 patients were 60 years old or above (older group) and 219 patients were between 18 and 59 years old (younger group). Around 64% of both groups were female. There were no significant differences in the main indications for HPN, body mass index (BMI), and PN prescriptions at baseline. At 2-years, younger patients received more calories from PN than older patients (27.88 vs 19.56 Kcal/kg respectively, p <0.001) but BMI remained comparable between groups. There were less line sepsis in the older group versus the younger group (20% vs 36%, p=0.0023) but 78% of younger patients remained alive versus 69 % in the older group (p=0.0401). In those alive, the proportion of patients remaining on HPN was comparable (older group: 77%; younger; group 81%, p=0.4709) and the proportion of patients with a reasonable quality of life (KPS > 60) was similar (older group: 58%; younger group: 63%, p=0.2156).
Conclusions
Older HPN patients have similar clinical characteristics as younger patients but with reduced line sepsis events and higher 2-year mortality.
Funding Agencies
Ontario Medical Supply, Takeda, Fresenius Kabi and Baxter Inc
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Affiliation(s)
- D Daoud
- Centre Hospitalier de l’Université de Montréal - CHUM, Montréal, QC, Canada
| | | | - N Somlaw
- Chulalongkorn University, Bangkok, Bangkok, Thailand
| | | | - L Gramlich
- Community Services Centre, Edmonton, AB, Canada
| | | | - M Raman
- University of Calgary, Calgary, AB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
| | - S Whittaker
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | | | - E Marliss
- McGill University Faculty of Medicine, Montreal, QC, Canada
| | - J Allard
- Toronto General Hospital, Toronto, ON, Canada
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6
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Chibbar R, Weiten D, Green KH, Rigaux L, Bernstein CN, Graff LA, Duerksen D, Silvester J. A266 IS A MULTIVITAMIN SUFFICIENT TO MEET NUTRITIOAL REQUIREMENTS IN CANADIAN ADULTS FOLLOWING A GLUTEN-FREE DIET? J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Concerns exist regarding nutritional deficiencies and risk of metabolic syndrome in patients with celiac disease (CD) on a gluten-free diet (GFD).
Aims
This study assessed if patients with CD trying to follow a GFD meet Recommended Dietary Allowance (RDA) targets for macro- and micronutrients and the effect of supplement use in reaching RDA targets.
Methods
Adults (>16 years) with biopsy confirmed CD (Marsh 3) were recruited within 6 weeks of starting a GFD. Participants prospectively completed a 3-day food record, including dietary supplement use, at 6, 12, and 24 months after study entry. Macro- and micronutrient consumption was determined using the Nutrition Coordinating Center Food & Nutrient Database (NCCDB), USDA National Nutrient Database for Standard Reference (USDA SR28), and CRON-O-Meter Community Database (CCDB). RDA targets were analyzed using a paired t-test and logistic regression, adjusted for age and sex.
Results
Forty-nine participants (71% female; mean age 49 years) completed interpretable food records at all time points. Most (59%) used supplements and supplement use was highest at 6 months (51%). Considering macronutrients, ≥88% met the RDA for carbohydrates and protein at each time point; however, only 44% met the target for fibre. Participants who took a supplement plus a multivitamin were significantly more likely than those who took only a multivitamin to meet the RDA for vitamins B12 and D. Fewer than 20% of those who took neither a multivitamin nor an iron supplement met the RDA, whereas ≥70% of those taking a multivitamin had adequate iron intake. Participants were significantly more likely to meet RDA targets for calcium with a supplement than with a multivitamin only. Even with supplementation, ≤55% met the RDA for folate.
Conclusions
There is a need for ongoing monitoring and dietician support for GFD treatment in CD. Adults with celiac disease met RDA targets for protein and carbohydrate, but not fibre. While specific calcium supplementation was required to meet RDA targets for calcium, a multivitamin was generally sufficient to meet RDA targets for iron, Vitamin B12 and D. Folate was below target at all time points even with supplementation.
Funding Agencies
CAG, CIHRNIH
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Affiliation(s)
| | - D Weiten
- University of Manitoba, Winnipeg, MB, Canada
| | - K H Green
- University of Manitoba, Winnipeg, MB, Canada
| | - L Rigaux
- University of Manitoba, Winnipeg, MB, Canada
| | | | - L A Graff
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
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7
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Elias E, Silvester J, Graff LA, Bernstein CN, Rigaux L, Duerksen D. A107 PATIENT PERSPECTIVES ON THE LONG-TERM MANAGEMENT OF CELIAC DISEASE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Celiac disease (CD) is a common chronic gastrointestinal illness with a range of manifestations. The only available treatment is strict gluten avoidance, therefore patients are effectively self-managed. Despite the critical role patients play in their treatment, patient perspectives on long-term CD care have not been formally assessed and are therefore not represented in current clinical guidelines.
Aims
To determine the opinions of CD patients on the need for long-term CD follow-up, the utility of various aspects of CD follow-up, and the areas in which further information is desired.
Methods
The Manitoba Celiac Disease Cohort includes newly diagnosed adults with elevated TTG and/or EMA antibodies and Marsh III histology. At the 24-month follow-up visit, participants were asked to rate the utility of various aspects of CD care from 1–5 (low-high) and their desire for further information on CD-related issues from 1–6 (low-high).
Results
A total of 213 patients were recruited and 137 participants completed the online survey (median age 41 [interquartile range 29–57] years; 68% female). Adherence to a gluten free diet was variable, with 29% of patients having TTG antibodies above the upper limit of normal.
Two-thirds of participants felt they should be seen regularly for their celiac disease, while 79.8% of those who wished to be followed felt they should be seen every 6–12 months. Blood tests were the most highly rated component of CD care (scored ≥4 by 78% of respondents). Celiac symptom review, information on research in celiac disease, and the opportunity to ask questions about vitamins and supplements were also positively regarded. Diet review was not generally considered helpful. 79% of patients desired further information on research in CD, while approximately 60% desired information on the long-term complications of CD and the risk of nutritional deficiencies.
Conclusions
The majority of CD patients find regular specialist follow-up helpful, particularly for biochemical assessment of disease activity and its complications. Further information on CD research and the long-term complications of CD should be addressed in follow-up visits. These aspects of follow-up care should be reflected in future guidelines.
Funding Agencies
None
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Affiliation(s)
- E Elias
- University of Manitoba, Winnipeg, MB, Canada
| | | | - L A Graff
- University of Manitoba, Winnipeg, MB, Canada
| | | | - L Rigaux
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
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8
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Gutowski E, Silvester J, Rigaux L, Green K, Weiten D, Bernstein CN, Walker JR, Graff LA, Duerksen D. A170 CANADIANS WITH CELIAC DISEASE MISINTERPRET PRODUCT LABEL INFORMATION WHICH MAY LEAD TO UNSAFE FOOD CHOICES DESPITE ALLERGEN LABELLING LAWS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Gutowski
- Harvard Celiac Disease Program, Boston, MA
| | | | - L Rigaux
- St Boniface Hospital, Winnipeg, MB, Canada
| | - K Green
- St Boniface Hospital, Winnipeg, MB, Canada
| | - D Weiten
- Grace General Hospital, Winnipeg, MB, Canada
| | | | | | - L A Graff
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
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9
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Atsawarungruangkit A, Silvester J, Weiten D, Green K, Wilkey K, Rigaux L, Bernstein CN, Graff LA, Walker JR, Duerksen D. A171 DEVELOPMENT AND VALIDATION OF THE DIETITIAN INTEGRATED EVALUATION TOOL FOR GLUTEN-FREE DIETS (DIET-GFD). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - J Silvester
- Harvard Center for Celiac Disease Research, Boston, MA, Boston, MA
| | - D Weiten
- Grace General Hospital, Winnipeg, MB, Canada
| | - K Green
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - K Wilkey
- Harvard Center for Celiac Disease Research, Boston, MA, Boston, MA
| | - L Rigaux
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - C N Bernstein
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - L A Graff
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - J R Walker
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - D Duerksen
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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10
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PONTA ML, Somlaw N, Saqui O, Stevenson D, Boudreault M, Marliss E, Raman M, Duerksen D, Whittaker S, Armstrong D, Jurewitsch B, Jeejeebhoy KN, Gramlich L, Allard J. A321 CANADIAN HOME TOTAL PARENTERAL NUTRITION REGISTRY: 10 YEARS OF DATA ENTRY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M L PONTA
- Medicine, University Health Network, Toronto, ON, Canada
| | - N Somlaw
- Medicine, University Health Network, Toronto, ON, Canada
| | - O Saqui
- University Health Network, Toronto, ON, Canada
| | - D Stevenson
- Regina Qu’Appelle Health Region, Regina, SK, Canada
| | | | - E Marliss
- McGill University Health Centre, Montreal, QC, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
| | - S Whittaker
- Providence Health Care, Vancouver, BC, Canada
| | | | | | | | - L Gramlich
- Community Services Centre, Edmonton, AB, Canada
| | - J Allard
- Medicine, University Health Network, Toronto, ON, Canada
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11
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Hansen T, Silvester J, Rigaux L, Graff LA, Bernstein CN, Walker JR, Duerksen D. A162 PHYSICIAN DIAGNOSES AND SELF-DIAGNOSIS OF PATIENTS WITH CELIAC DISEASE IN THE INTERNET ERA. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Hansen
- University of Manitoba, Winnipeg, MB, Canada
| | - J Silvester
- University of Manitoba, Winnipeg, MB, Canada
| | - L Rigaux
- University of Manitoba, Winnipeg, MB, Canada
| | - L A Graff
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | | | - J R Walker
- University of Manitoba, Winnipeg, MB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
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12
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Noelting J, Jurewitsch B, Gramlich L, Duerksen D, Raman M, Armstrong D, Ponta ML, Saqui O, Arca-Juico CK, Kim P, Stewart B, Allard J. A312 POST MARKET USE OF TEDUGLUTIDE IN CANADA IN PATIENTS WITH SHORT BOWEL SYNDROME ON HOME PARENTERAL NUTRITION: THE REAL WORLD SETTING. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Noelting
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | | | - L Gramlich
- Alberta Health Sciences, Edmonton, AB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
| | | | - M L Ponta
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - O Saqui
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - C K Arca-Juico
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - P Kim
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - B Stewart
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - J Allard
- Toronto General Hospital, Toronto, ON, Canada
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13
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Keller H, Payette H, Laporte M, Bernier P, Allard J, Duerksen D, Gramlich L, Jeejeebhoy K. Patient-reported dietetic care post hospital for free-living patients: a Canadian Malnutrition Task Force Study. J Hum Nutr Diet 2017; 31:33-40. [DOI: 10.1111/jhn.12484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. Keller
- Department of Kinesiology; Schelgel-University of Waterloo Research Institute for Aging; University of Waterloo; Waterloo Ontario Canada
| | - H. Payette
- Research Centre on Aging; CIUSSS de l'Estrie-CHUS and Faculty of Medicine and Health Sciences; University of Sherbrooke; Sherbrooke Québec Canada
| | - M. Laporte
- Réseau de santé Vitalité Health Network; Campbellton Regional Hospital; Campbellton New Brunswick Canada
| | - P. Bernier
- Jewish General Hospital; Montreal Québec Canada
| | - J. Allard
- Department of Medicine; Toronto General Hospital; University of Toronto; Toronto Ontario Canada
| | - D. Duerksen
- Department of Medicine; Faculty of Health Sciences; University of Manitoba; Winnipeg Manitoba Canada
| | - L. Gramlich
- Department of Medicine & Dentistry; Royal Alexandra Hospital; University of Alberta; Edmonton Alberta Canada
| | - K. Jeejeebhoy
- Department of Medicine; University of Toronto ( emeritus ); Toronto Ontario Canada
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14
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Keller H, Allard J, Duerksen D, Jeejeebhoy K, Gramlich L, Laporte M, Bernier P, Payette H. SUN-P164: Predictors of Post-Hospital Discharge Weight Change: A Study of the Canadian Malnutrition Task Force. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Keller H, McCullough J, Davidson B, Allard J, Duerksen D, Jeejeebhoy K, Gramlich L, Laporte M, Bernier P. SUN-P165: Development of the Integrated Nutrition Pathway for Acute Care (INPAC). Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Keller H, Allard J, Vesnaver E, Laporte M, Gramlich L, Bernier P, Davidson B, Duerksen D, Jeejeebhoy K, Payette H. Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force. J Hum Nutr Diet 2015; 28:546-57. [DOI: 10.1111/jhn.12314] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- H. Keller
- Schlegel-UW Research Institute for Aging; University of Waterloo; Waterloo ON Canada
| | - J. Allard
- Department of Medicine; University Hospital Network; University of Toronto; Toronto ON Canada
| | | | - M. Laporte
- Réseau de Santé Vitalité Health Network; Cambellton NB Canada
| | - L. Gramlich
- Department of Medicine; University of Alberta; Alberta Health Services; Edmonton AB Canada
| | - P. Bernier
- Jewish General Hospital; Montréal QC Canada
| | - B. Davidson
- Canadian Malnutrition Task Force; Canadian Nutrition Society; Toronto ON Canada
| | - D. Duerksen
- Department of Medicine St-Boniface Hospital; University of Manitoba; Winnipeg MB Canada
| | - K. Jeejeebhoy
- Department of Medicine St-Michael Hospital; University of Toronto; Toronto ON Canada
| | - H. Payette
- Centre de recherche sur le vieillissement; CSSS-IUGS; Faculté de Médecine et des Sciences de la Santé; Université de Sherbrooke; Sherbrooke QC Canada
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17
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Keller HH, Vesnaver E, Davidson B, Allard J, Laporte M, Bernier P, Payette H, Jeejeebhoy K, Duerksen D, Gramlich L. Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel. J Hum Nutr Diet 2013; 27:192-202. [DOI: 10.1111/jhn.12170] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - B. Davidson
- Canadian Nutrition Society; Toronto ON Canada
| | - J. Allard
- University Health Network; Toronto ON Canada
| | - M. Laporte
- Vitalité Health Network; Campbellton NB Canada
| | - P. Bernier
- Jewish General Hospital; Montreal QC Canada
| | - H. Payette
- University of Sherbrooke; Sherbrooke QC Canada
| | | | - D. Duerksen
- St Boniface General Hospital; Winnipeg MB Canada
| | - L. Gramlich
- Royal Alexandra Hospital; Edmonton AB Canada
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Quon H, Myers C, Martens A, Butler J, Stimpson R, Duerksen D, Campbell-Enns H. Impact of Feeding Tubes on Prospective Functional Outcomes in Patients With Locally-Advanced Head-and-Neck Cancer Undergoing Radiation Therapy. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abdalian R, Fernandes G, Duerksen D, Jeejeebhoy KN, Whittaker S, Gramlich L, Allard JP. Prescription of Trace Elements in Adults on Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2012; 37:410-5. [DOI: 10.1177/0148607112463074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R. Abdalian
- North York General Hospital, Toronto, Ontario, Canada
| | - G. Fernandes
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - D. Duerksen
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - S. Whittaker
- University of British Columbia, Vancouver, British Columbia, Canada
| | - L. Gramlich
- University of Alberta, Edmonton, Alberta, Canada
| | - J. P. Allard
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Allard J, Jeejeebhoy K, Grämlich L, Duerksen D, Payette H, Bernier P, Keller H, Laporte M. LB010-SUN MALNUTRITION IN CANADIAN HOSPITALS: PRELIMINARY RESULTS FROM THE CANADIAN MALNUTRITION TASK FORCE (CMTF). ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1744-1161(11)70539-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sharma S, Arneja A, McLean L, Duerksen D, Leslie W, Sciberras D, Lertzman M. Anabolic steroids in COPD: a review and preliminary results of a randomized trial. Chron Respir Dis 2008; 5:169-176. [DOI: 10.1177/1479972308092350] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Patients with severe chronic obstructive pulmonary disease (COPD) commonly develop weight loss, muscle wasting, and consequently poor survival. Nutritional supplementation and anabolic steroids increase lean body mass, improve muscle strength, and survival in patients enrolled in comprehensive rehabilitation programs. Whether anabolic steroids are effective outside an intensive rehabilitation program is not known. We conducted a prospective, double-blind, placebo-controlled, 16-week trial to study the benefits of anabolic steroids in patients with severe COPD who did not participate in a structured rehabilitation program. Biweekly intramuscular injections of either the drug (nandrolone decanoate) or placebo were administered. Sixteen patients with severe COPD were randomized to either placebo or nandrolone decanoate. The placebo group weighed 55.32 ± 11.33 kg at baseline and 54.15 ± 10.80 kg at 16 weeks; the treatment group weighed 68.80 ± 6.58 at baseline and 67.92 ± 6.73 at 16 weeks. Lean body mass remained unchanged, 71 ± 6 vs. 71 ± 7 kg in placebo group and 67 ± 7 vs. 67 ± 7 in treatment group, at baseline and 16 weeks respectively. The distance walked on 6 min was unchanged at baseline, 8 weeks, and 16 weeks in placebo (291.17 ± 134.83, 282.42 ± 115.39, 286.00 ± 82.63 m) and treatment groups (336.13 ± 127.59, 364.83 ± 146.99, 327.00 ± 173.73 m). No improvement occurred in forced expiratory volume in one second, forced vital capacity, maximal inspiratory pressure, maximal expiratory pressure, VO2 max or 6-min walk distance or health related quality of life. Administration of anabolic steroids (nandrolone decanoate) outside a dedicated rehabilitation program did not lead to either weight gain, improvement in physiological function, or better quality of life in patients with severe COPD.
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Affiliation(s)
- S Sharma
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - A Arneja
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - L McLean
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - D Duerksen
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - W Leslie
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - D Sciberras
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - M Lertzman
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, Canada
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Nehra V, Swails W, Duerksen D, Babineau T, Bistrian BR. Indications for total parenteral nutrition in the hospitalized patient: A prospective review of evolving practice. J Nutr Biochem 1999; 10:2-7. [PMID: 15539243 DOI: 10.1016/s0955-2863(98)00060-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/1997] [Accepted: 07/21/1998] [Indexed: 11/16/2022]
Abstract
The indications for initiating total parenteral nutrition (TPN) were prospectively evaluated in 100 consecutive patients at a tertiary referral hospital with a long-standing Nutritional Support Service to illustrate the reasons why the parenteral route was chosen at this unique institution in terms of patient population. Sixty male and 40 female patients, average age 59 +/- 17 years (range 22-86 years), were classified a priori as to the underlying reasons for initiation of TPN. The study was conducted by a Nutrition Support Service at this hospital without pediatric, trauma, or burn services specializing in the care of patients with diabetes mellitus. Of the 100 patients, 63% were from the surgical service; 24% had diabetes mellitus. Their mean weight (118 +/- 29% of ideal), body mass index (25 +/- 6 kg/m(2)), and serum albumin (2.8 +/- 0.7 g/dL) indicated a reasonable body composition with a moderate systemic inflammatory response. Six patients received preoperative TPN for an average of 5 +/- 3 days with a variety of diagnoses including malignancy, Crohn's disease, bowel obstruction, and gastrointestinal bleeding. The underlying reasons for initiating nutritional support were related to three factors that largely determine the need for involuntary feeding: preexisting protein calorie malnutrition, actual or anticipated semistarvation for a prolonged period, and the presence of a systemic inflammatory response. The choice of TPN was based on anticipated or proven intolerance to full enteral feeding. The duration of time before initiation of TPN postoperatively was 6 +/- 5 days, which reflects our policy that initially well-nourished patients who are experiencing a systemic inflammatory response should not undergo more than 5 to 7 days of inadequate feeding. The duration of TPN overall was 11 +/- 10 days, which primarily illustrates the dramatic reduction in length of hospital stay that has occurred throughout the health care system and the willingness to provide TPN in alternative settings including transitional care units, rehabilitation hospitals, and for short-term care, the patient's home. The most common specific reasons identified for initiating TPN rather than enteral nutrition were ileus (25%), an underlying acid-base or electrolyte/mineral disorder (13%) requiring correction, and the convenience of TPN because a central venous catheter was in place (12%). The usual indication for nutritional support at this tertiary referral and specialty hospital was actual or impending protein calorie malnutrition. TPN was chosen for a variety of reasons related to actual or anticipated tolerance to enteral feeding. This audit demonstrates that our TPN practice has evolved in relation to time of initiation and duration of feeding, which reflect a clearer appreciation of the risks and benefits of TPN.
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Affiliation(s)
- V Nehra
- Division of Clinical Nutrition, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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23
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Abstract
A prospective investigation of the impact of ingested liquids on 24-hr pH test scores was conducted. Eighty-two patients contributed 142 samples. The liquids used were coffee/tea (N = 35), water (N = 32), fruit juice (N = 29), cola (N = 34), and beer (N = 12). The pH of cola, juice, and beer are approximately 3.0. The parameters studied included: total test time, total drink time, total minutes of pH < 4.0 during drink, minutes of < pH 4.0 10 min before drink, and minutes of pH < 4.0 10 min following drink. Analysis was performed using one-way ANOVA and repeated measures. Age of patients, total test time, and total time pH < 4.0 were not significantly different (P > 0.05). The total time to consume the drink was significantly greater (P < 0.05) for beer than all other liquids. The total time (7.7 +/- 6.0 min) pH < 4.0 for cola was significantly different (P < 0.023) than beer (3.3 +/- 3.7 min), tea/coffee (1.4 +/- 6.5 min), and water (1.1 +/- 2.5 min). The percentage of total time pH < 4.0 was not significantly different (P > 0.05) among any of the liquids. The percentage of time pH < 4.0 during the drink was the highest for cola (63 +/- 47%) and juice (51 +/- 57%); water, coffee/tea, and beer were not significantly different (P > 0.05). Although the impact of cola and juice were the greatest, none of these had an impact that exceeded 0.5%. The lack of impact of beer appears to be due to the increased period of time it takes to consume. We conclude that the impact of ingested fluids is minimal and can probably be disregarded in most patient groups.
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Affiliation(s)
- J P Shoenut
- St. Boniface General Hospital, and Department of Medicine, University of Manitoba, Winnipeg, Canada
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Shoenut JP, Duerksen D, Yaffe CS. A prospective assessment of gastroesophageal reflux before and after treatment of achalasia patients: pneumatic dilation versus transthoracic limited myotomy. Am J Gastroenterol 1997; 92:1109-12. [PMID: 9219779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We conducted this study to determine whether reflux should be a major consideration in the choice of treatment for achalasia patients. Achalasia patients undergoing either pneumatic dilation or transthoracic limited esophagomyotomy were monitored for reflux before and after treatment, for comparison. METHODS Twenty-four hour ambulatory esophageal pH tests and esophageal manometry were performed on 32 consecutive, untreated achalasia patients. Studied (before and after treatment) were 17 patients who underwent pneumatic dilation and 15 patients who received transthoracic limited myotomy without fundoplication. All follow-up studies were completed within 12 months of treatment. RESULTS The ages of the two groups were not significantly different (p > 0.05, 45 +/- 9 yr myotomy vs. 44 +/- 13 yr dilation). The resting lower esophageal sphincter pressure was not significantly different (p > 0.05 before treatment) between groups but was reduced significantly (p < 0.05 after treatment) in both groups (30 +/- 9 mm Hg before vs. 9 +/- 4 mm Hg after myotomy, and 27 +/- 10 mm Hg before vs. 11 +/- 4 mm Hg after pneumatic dilation. The total time the pH was < 4.0 was not significantly different, p > 0.05, in either group before treatment (myotomy, 3.7 +/- 4.4%; dilation, 2.9 +/- 4.9%) or after treatment (myotomy, 8.6 +/- 9.2%; dilation, 10.2 +/- 15.9%). Twelve of 32 patients (38%), had a percent total time < 4.0 that exceeded 6% after treatment, eight of whom were asymptomatic. CONCLUSIONS These results indicate that the amount of reflux after treatment by both pneumatic dilation and transthoracic esophagomyotomy is similar. The absence of reflux symptoms in treated achalasia patients does not exclude the possibility of significant acid reflux.
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Affiliation(s)
- J P Shoenut
- Department of Medicine, St. Boniface General Hospital and the University of Manitoba, Winnipeg, Canada
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