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Estremera-Arévalo F, González G, Areste I, Montori S, Zúñiga A, Ezquer S, Iglesias R, Macías E, Alcedo J, Domínguez Carbajo AB, Khashab M, Dent J, Albéniz E. Outcomes of per-oral endoscopic myotomy in patients with spastic esophageal motility disorders not fulfilling Chicago Classification criteria. Rev Esp Enferm Dig 2022; 114:641-647. [PMID: 35105151 DOI: 10.17235/reed.2022.8455/2021] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Per-oral endoscopic myotomy (POEM) has become a mainstream treatment for achalasia and is a promising therapy in spastic disorders. This is a retrospective study of prospectively collected data (case series). We present the first results for use of POEM in patients with atypical spastic esophageal motor disorders that do not satisfy current Chicago Classification criteria. Seven consecutive patients with troublesome and persistent symptoms (12 - 180 months) related to atypical spastic esophageal motor dysfunction were assessed systematically before and after POEM, the extent of which was tailored by manometric findings. In five of the patients other endoscopic or surgical procedures had failed. High-resolution Manometry (HRM) showed a spastic oesophageal body contractile segment in varying positions and lengths along the esophageal body which did not meet Chicago Classification criteria. After POEM, dysphagia and/or chest pain had either resolved or were greatly reduced. HRM 3-6 months after myotomy showed that the regions of spastic contraction targeted by myotomy had been ablated. There were no major complications. The clinical responses have been fully maintained up to the most recent assessments after POEM (range 7-44 months). In our 7 patients, POEM was a highly effective treatment for patients with troublesome symptoms related to atypical spastic esophageal motility disorders.
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Affiliation(s)
| | - Gonzalo González
- Aparato Digestivo, Hospital Universitario de Navarra (HUN), España
| | - Irene Areste
- Aparato Digestivo, Hospital Universitario de Navarra (HUN), España
| | - Sheyla Montori
- Gastrointestinal Endoscopy Research Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), UPNA, IdiSNA, España
| | - Alba Zúñiga
- Aparato Digestivo, Hospital Universitario de Navarra (HUN), España
| | - Sonia Ezquer
- Aparato Digestivo, Hospital Universitario de Navarra (HUN), España
| | - Rosa Iglesias
- Aparato Digestivo, Hospital Universitario de Navarra (HUN), España
| | - Elena Macías
- Aparato Digestivo, Hospital Universitario de Navarra (HUN), España
| | - Javier Alcedo
- Aparato Digestivo, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), España
| | | | | | - John Dent
- Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Eduardo Albéniz
- Aparato Digestivo, Hospital Universitario de Navarra (HUN), Navarrabiomed, UPNA, IdiSNA, España
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2
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Robinson AA, Trankle CR, Eubanks G, Schumann C, Thompson P, Wallace RL, Gottiparthi S, Ruth B, Kramer CM, Salerno M, Bilchick KC, Deen C, Kontos MC, Dent J. Off-label Use of Direct Oral Anticoagulants Compared With Warfarin for Left Ventricular Thrombi. JAMA Cardiol 2021; 5:685-692. [PMID: 32320043 DOI: 10.1001/jamacardio.2020.0652] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [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: 12/22/2022]
Abstract
Importance Left ventricular (LV) thrombi can arise in patients with ischemic and nonischemic cardiomyopathies. Anticoagulation is thought to reduce the risk of stroke or systemic embolism (SSE), but there are no high-quality data on the effectiveness of direct oral anticoagulants (DOACs) for this indication. Objective To compare the outcomes associated with DOAC use and warfarin use for the treatment of LV thrombi. Design, Setting, and Participants A cohort study was performed at 3 tertiary care academic medical centers among 514 eligible patients with echocardiographically diagnosed LV thrombi between October 1, 2013, and March 31, 2019. Follow-up was performed through the end of the study period. Exposures Type and duration of anticoagulant use. Main Outcomes and Measures Clinically apparent SSE. Results A total of 514 patients (379 men; mean [SD] age, 58.4 [14.8] years) with LV thrombi were identified, including 300 who received warfarin and 185 who received a DOAC (64 patients switched treatment between these groups). The median follow-up across the patient cohort was 351 days (interquartile range, 51-866 days). On unadjusted analysis, DOAC treatment vs warfarin use (hazard ratio [HR], 2.71; 95% CI, 1.31-5.57; P = .01) and prior SSE (HR, 2.13; 95% CI, 1.22-3.72; P = .01) were associated with SSE. On multivariable analysis, anticoagulation with DOAC vs warfarin (HR, 2.64; 95% CI, 1.28-5.43; P = .01) and prior SSE (HR, 2.07; 95% CI, 1.17-3.66; P = .01) remained significantly associated with SSE. Conclusions and Relevance In this multicenter cohort study of anticoagulation strategies for LV thrombi, DOAC treatment was associated with a higher risk of SSE compared with warfarin use, even after adjustment for other factors. These results challenge the assumption of DOAC equivalence with warfarin for LV thrombi and highlight the need for prospective randomized clinical trials to determine the most effective treatment strategies for LV thrombi.
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Affiliation(s)
- Austin A Robinson
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville
| | - Cory R Trankle
- Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Grayson Eubanks
- Department of Medicine, University of North Carolina, Chapel Hill
| | - Christopher Schumann
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville
| | - Paul Thompson
- Department of Internal Medicine, Scripps Health, La Jolla, California
| | - Ryan L Wallace
- Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond
| | | | - Benjamin Ruth
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville
| | - Christopher M Kramer
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville.,Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville
| | - Michael Salerno
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville.,Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville.,Cardiovascular Imaging Center, Department of Biomedical Engineering, University of Virginia Health System, Charlottesville
| | - Kenneth C Bilchick
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville
| | - Cody Deen
- Department of Medicine, University of North Carolina, Chapel Hill
| | - Michael C Kontos
- Virginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - John Dent
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville
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3
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Dent J, Deloose E, Dinning P, Corsetti M, Rommel N, Tack J, Wiklendt L, Papageorgiou AW, Arkwright JW. Manometric demonstration of duodenal/jejunal motor function consistent with the duodenal brake mechanism. Neurogastroenterol Motil 2020; 32:e13835. [PMID: 32167632 DOI: 10.1111/nmo.13835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND High-resolution manometric studies below the stomach are rare due to technical limitations of traditional manometry catheters. Consequently, specific motor patterns and their impact on gastric and small bowel function are not well understood. High-resolution manometry was used to record fed-state motor patterns in the antro-jejunal segment and relate these to fasting motor function. METHODS Antro-jejunal pressures were monitored in 15 healthy females using fiber-optic manometry (72 sensors at 1 cm intervals) before and after a high-nutrient drink. KEY RESULTS Postprandial motility showed a previously unreported transition point 18.8 cm (range 13-28 cm) beyond the antro-pyloric junction. Distal to the transition, a zone of non-propagating, repetitive pressure events (11.5 ± 0.5 cpm) were dominant in the fed state. We have named this activity, the duodeno-jejunal complex (DJC). Continuous DJC activity predominated, but nine subjects also exhibited intermittent clusters of DJC activity, 7.4 ± 4.9/h, lasting 1.4 ± 0.55 minutes, and 3.8 ± 1.2 minutes apart. DJC activity was less prevalent during fasting (3.6 ± 3.3/h; P = .04). 78% of fed and fasting state propagating antro-duodenal pressure events terminated proximally or at the transition point and were closely associated with DJC clusters. CONCLUSIONS AND INFERENCES High-resolution duodeno-jejunal manometry revealed a previously unrecognized transition point and associated motor pattern extending into the jejunum, consistent with the duodenal brake previously identified fluoroscopically. Timing suggests DJC activity is driven by chyme stimulating duodenal mucosal chemosensors. These findings indicate that the duodenum and proximal jejunum consists of two major functional motor regions.
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Affiliation(s)
- John Dent
- Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Eveline Deloose
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Philip Dinning
- Department of Gastroenterology & Surgery, Flinders Medical Centre, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Maura Corsetti
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.,National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Nathalie Rommel
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.,Experimental Oto-Rhino-Laryngology, University of Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Lukasz Wiklendt
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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4
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de Groof AJ, Struyvenberg MR, van der Putten J, van der Sommen F, Fockens KN, Curvers WL, Zinger S, Pouw RE, Coron E, Baldaque-Silva F, Pech O, Weusten B, Meining A, Neuhaus H, Bisschops R, Dent J, Schoon EJ, de With PH, Bergman JJ. Deep-Learning System Detects Neoplasia in Patients With Barrett's Esophagus With Higher Accuracy Than Endoscopists in a Multistep Training and Validation Study With Benchmarking. Gastroenterology 2020; 158:915-929.e4. [PMID: 31759929 DOI: 10.1053/j.gastro.2019.11.030] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/31/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS We aimed to develop and validate a deep-learning computer-aided detection (CAD) system, suitable for use in real time in clinical practice, to improve endoscopic detection of early neoplasia in patients with Barrett's esophagus (BE). METHODS We developed a hybrid ResNet-UNet model CAD system using 5 independent endoscopy data sets. We performed pretraining using 494,364 labeled endoscopic images collected from all intestinal segments. Then, we used 1704 unique esophageal high-resolution images of rigorously confirmed early-stage neoplasia in BE and nondysplastic BE, derived from 669 patients. System performance was assessed by using data sets 4 and 5. Data set 5 was also scored by 53 general endoscopists with a wide range of experience from 4 countries to benchmark CAD system performance. Coupled with histopathology findings, scoring of images that contained early-stage neoplasia in data sets 2-5 were delineated in detail for neoplasm position and extent by multiple experts whose evaluations served as the ground truth for segmentation. RESULTS The CAD system classified images as containing neoplasms or nondysplastic BE with 89% accuracy, 90% sensitivity, and 88% specificity (data set 4, 80 patients and images). In data set 5 (80 patients and images) values for the CAD system vs those of the general endoscopists were 88% vs 73% accuracy, 93% vs 72% sensitivity, and 83% vs 74% specificity. The CAD system achieved higher accuracy than any of the individual 53 nonexpert endoscopists, with comparable delineation performance. CAD delineations of the area of neoplasm overlapped with those from the BE experts in all detected neoplasia in data sets 4 and 5. The CAD system identified the optimal site for biopsy of detected neoplasia in 97% and 92% of cases (data sets 4 and 5, respectively). CONCLUSIONS We developed, validated, and benchmarked a deep-learning computer-aided system for primary detection of neoplasia in patients with BE. The system detected neoplasia with high accuracy and near-perfect delineation performance. The Netherlands National Trials Registry, Number: NTR7072.
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Affiliation(s)
- Albert J de Groof
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten R Struyvenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost van der Putten
- Department of Electrical Engineering, Video Coding & Architectures group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Fons van der Sommen
- Department of Electrical Engineering, Video Coding & Architectures group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Kiki N Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Sveta Zinger
- Department of Electrical Engineering, Video Coding & Architectures group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes place Alexis Ricordeau, Nantes, France
| | - Francisco Baldaque-Silva
- Department of Digestive Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Oliver Pech
- Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Bas Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Horst Neuhaus
- Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - John Dent
- Department of Medicine, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Peter H de With
- Department of Electrical Engineering, Video Coding & Architectures group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jacques J Bergman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
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5
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Myers JC, Jamieson GG, Szczesniak MM, Estremera-Arévalo F, Dent J. Asymmetrical elevation of esophagogastric junction pressure suggests hiatal repair contributes to antireflux surgery dysphagia. Dis Esophagus 2020; 33:5645215. [PMID: 31778151 DOI: 10.1093/dote/doz085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/24/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Abstract
The radial distribution of esophago-gastric junction (EGJ) pressures with regard to troublesome dysphagia (TDysph) after antireflux surgery is poorly understood. Before and after antireflux surgery, end-expiratory and peak-inspiratory EGJ pressures were measured at eight angles of 45° radial separation in patients with reflux disease. All 34 patients underwent posterior crural repair, then either 90° anterior (N = 13) or 360° fundoplication (N = 21). Dysphagia was assessed prospectively using a validated questionnaire (score range 0-45) and TDysph defined as a dysphagia score that was ≥5 above pre-op baseline. Compared with before surgery, for 90° fundoplication, end-expiratory EGJ pressures were highest in the left-anterolateral sectors, the position of the partial fundoplication. In other sectors, pressures were uniformly elevated. Compared with 90° fundoplication, radial pressures after 360° fundoplication were higher circumferentially (P = 0.004), with a posterior peak. Nine patients developed TDysph after surgery with a greater increase in end-expiratory and peak-inspiratory EGJ pressures (P = 0.03 and 0.03, respectively) and significantly higher inspiratory pressure at the point of maximal radial pressure asymmetry (P = 0.048), compared with 25 patients without TDysph. Circumferential elevation of end-expiratory EGJ pressure after 90° and 360° fundoplication suggests hiatal repair elevates EGJ pressure by extrinsic compression. The highly localized focal point of elevated EGJ pressure upon inspiration in patients with TDysph after surgery is indicative of a restrictive diaphragmatic hiatus in the presence of a fundoplication.
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Affiliation(s)
- J C Myers
- Discipline of Surgery, The University of Adelaide, Adelaide, SA 5005, Australia.,Oesophageal Function, Surgery, Royal Adelaide Hospital and Queen Elizabeth Hospital, Adelaide, SA 5000, Australia
| | - G G Jamieson
- Discipline of Surgery, The University of Adelaide, Adelaide, SA 5005, Australia
| | - M M Szczesniak
- Department of Gastroenterology, University of NSW, Sydney, NSW 2052, Australia
| | - F Estremera-Arévalo
- Discipline of Surgery, The University of Adelaide, Adelaide, SA 5005, Australia
| | - J Dent
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
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6
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Bergman JJGHM, de Groof AJ, Pech O, Ragunath K, Armstrong D, Mostafavi N, Lundell L, Dent J, Vieth M, Tytgat GN, Sharma P. An Interactive Web-Based Educational Tool Improves Detection and Delineation of Barrett's Esophagus-Related Neoplasia. Gastroenterology 2019; 156:1299-1308.e3. [PMID: 30610858 DOI: 10.1053/j.gastro.2018.12.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/06/2018] [Accepted: 12/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Endoscopic detection of early Barrett's esophagus-related neoplasia (BORN) is a challenge. We aimed to develop a web-based teaching tool for improving detection and delineation of BORN. METHODS We made high-definition digital videos during endoscopies of patients with BORN and non-dysplastic Barrett's esophagus. Three experts superimposed their delineations of BORN lesions on the videos using special tools. In phase one, 68 general endoscopists from 4 countries assessed 4 batches of 20 videos. After each batch, mandatory feedback compared the assessors' interpretations with those from experts. These data informed the selection of 25 videos for the phase 2 module, which was completed by 121 new assessors from 5 countries. A 5-video test batch was completed before and after scoring of the four 5-video training batches. Mandatory feedback was as in phase 1. Outcome measures were scores for detection, delineation, agreement delineation, and relative delineation of BORN. RESULTS A linear mixed-effect model showed significant sequential improvement for all 4 outcomes over successive training batches in both phases. In phase 2, median detection rates of BORN in the test batch increased by 30% (P < .001) after training. From baseline to the end of the study, there were relative increases in scores of 46% for detection, 129% for delineation, 105% for agreement delineation, and 106% for relative delineation (all, P < .001). Scores improved independent of assessors' country of origin or level of endoscopic experience. CONCLUSIONS We developed a web-based teaching tool for endoscopic recognition of BORN that is easily accessible, efficient, and increases detection and delineation of neoplastic lesions. Widespread use of this tool might improve management of Barrett's esophagus by general endoscopists.
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Affiliation(s)
- Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - A Jeroen de Groof
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - O Pech
- Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - K Ragunath
- Nottingham Digestive Diseases Centre, University of Nottingham and National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - D Armstrong
- Division of Gastroenterology, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - N Mostafavi
- Biostatistical Unit, Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - L Lundell
- Department of Surgery, Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - J Dent
- Department of Medicine, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia
| | - M Vieth
- Institute of Pathology, Otto-von-Guericke University, Magdeburg, Germany
| | - G N Tytgat
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P Sharma
- Department of Veterans Affairs Medical Center, University of Kansas School of Medicine, Kansas City, Kansas
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Budde U, Schneppenheim R, Plendl H, Dent J, Ruggeri ZM, Zimmerman TS. Luminographic Detection of von Willebrand Factor Multimers in Agarose Gels and on Nitrocellulose Membranes. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1645215] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryTwo methods for visualization of vWf multimers were compared with respect to sensitivity and detection of normal vWf and vWd variants IIA, IIB, IIC, IID, HE, and HE Autoradiography and luminography after electrotransfer of vWf multimers onto nitrocellulose showed comparable sensitivity with vWf: Ag detectable after 1:500 dilution of normal plasma. The least sensitive method was luminography in agarose gels with vWf: Ag detectable after 1:300dilution of normal plasma. No difference existed in the banding patterns of plasmas from patients with variant vWd.
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Affiliation(s)
- U Budde
- The Blood Transfusion Service AK Harburg, Hamburg, FRG
| | | | - H Plendl
- The Dept. of Human Genetics, University Clinic, Kiel, FRG
| | - J Dent
- The Scripps Clinic and Research Foundation, La Jolla, CA, USA
| | - Z M Ruggeri
- The Scripps Clinic and Research Foundation, La Jolla, CA, USA
| | - T S Zimmerman
- The Scripps Clinic and Research Foundation, La Jolla, CA, USA
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8
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Dent J, Kennedy C. The ASPIRE-to-Excellence Initiative: Can We recognize Excellence in Student Engagement with the Curriculum? MGM Journal of Medical Sciences 2018. [DOI: 10.5005/jp-journals-10036-1177] [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: 11/23/2022] Open
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10
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Vakil N, Vieth M, Wernersson B, Wissmar J, Dent J. Diagnosis of gastro-oesophageal reflux disease is enhanced by adding oesophageal histology and excluding epigastric pain. Aliment Pharmacol Ther 2017; 45:1350-1357. [PMID: 28318045 DOI: 10.1111/apt.14028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Received: 12/08/2016] [Revised: 12/19/2016] [Accepted: 02/14/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The diagnosis of gastro-oesophageal reflux disease (GERD) in clinical practice is limited by the sensitivity and specificity of symptoms and diagnostic testing. AIM To determine if adding histology as a criterion and excluding patients with epigastric pain enhances the diagnosis for GERD. METHODS Patients with frequent upper gastrointestinal symptoms who had not taken a proton pump inhibitor in the previous 2 months and who had evaluable distal oesophageal biopsies were included (Diamond study: NCT00291746). Epithelial hyperplasia was identified when total epithelial thickness was at least 430 μm. Investigation-based GERD criteria were: presence of erosive oesophagitis, pathological oesophageal acid exposure and/or positive symptom-acid association probability. Symptoms were assessed using the Reflux Disease Questionnaire and a pre-specified checklist. RESULTS Overall, 127 (55%) of the 231 included patients met investigation-based GERD criteria and 195 (84%) met symptom-based criteria. Epithelial hyperplasia was present in 89 individuals, of whom 61 (69%) met investigation-based criteria and 83 (93%) met symptom-based criteria. Adding epithelial hyperplasia as a criterion increased the number of patients diagnosed with GERD on investigation by 28 [12%; number needed to diagnose (NND): 8], to 155 (67%). The proportion of patients with a symptom-based GERD diagnosis who met investigation-based criteria including epithelial hyperplasia was significantly greater when concomitant epigastric pain was absent than when it was present (P < 0.05; NND: 8). CONCLUSIONS Histology increases diagnosis of GERD and should be performed when clinical suspicion is high and endoscopy is negative. Excluding patients with epigastric pain enhances sensitivity for the diagnosis of GERD.
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Affiliation(s)
- N Vakil
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - M Vieth
- Klinikum Bayreuth, Bayreuth, Germany
| | | | - J Wissmar
- AstraZeneca Gothenburg, Mölndal, Sweden
| | - J Dent
- Royal Adelaide Hospital and University of Adelaide, Adelaide, SA, Australia
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11
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Hall PS, Lord SR, Collinson M, Marshall H, Jones M, Lowe C, Howard H, Swinson D, Velikova G, Anthoney A, Roy R, Dent J, Cheeseman S, Last K, Seymour MT. A randomised phase II trial and feasibility study of palliative chemotherapy in frail or elderly patients with advanced gastroesophageal cancer (321GO). Br J Cancer 2017; 116:472-478. [PMID: 28095397 PMCID: PMC5318975 DOI: 10.1038/bjc.2016.442] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 11/08/2016] [Accepted: 12/05/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Elderly patients are commonly under-represented in cancer clinical trials. The 321GO was undertaken in preparation for a definitive phase three trial assessing different chemotherapy regimens in a frail and/or elderly population with advanced gastroesophageal (GO) cancer. METHODS Patients with advanced GO cancer considered unfit for conventional dose chemotherapy were randomly assigned in a 1 : 1 : 1 ratio to: epirubicin, oxaliplatin and capecitabine (EOX); oxaliplatin and capecitabine (OX); and capecitabine alone (X) (all 80% of full dose and unblinded). The primary end point was patient recruitment over an 18-month period. A registration study recorded treatment choice for all patients with advanced GO cancer at trial centres. RESULTS A total of 313 patients were considered for palliative chemotherapy for GO cancer over the 18-month period: 115 received full dose treatment, 89 less than standard treatment or entered 321GO and 111 no treatment. Within 321GO, 55 patients were randomly assigned (19 to OX and X; 17 to EOX). Progression-free survival (PFS) for all patients was 4.4 months and by arm 5.4, 5.6 and 3.0 months for EOX, OX and X, respectively. The number of patients with a good overall treatment utility (OTU), a novel patient-centred endpoint, at 12 weeks was 3 (18%), 6 (32%) and 1 (6%) for EOX, OX and X, respectively. At 6 weeks, 22 patients (41%) had experienced a non-haematologic toxicity ⩾grade 3, most commonly lethargy or diarrhoea. The OTU was prognostic for overall survival in patients alive at week 12 (logrank test P=0.0001). CONCLUSIONS It is feasible to recruit elderly and/or frail patients with advanced GO cancer to a randomised clinical trial. The OX is the preferred regimen for further study. Overall treatment utility shows promise as a comparator between treatment regimens for feasibility and randomised trials in the elderly and/or frail GO cancer population.
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Affiliation(s)
- P S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh EH4 2XR, UK
| | - S R Lord
- Department of Oncology, University of Oxford, Oxford, UK
| | - M Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - H Marshall
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - M Jones
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - C Lowe
- NIHR Cancer Research Network Coordinating Centre, Leeds, UK
| | - H Howard
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - D Swinson
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - G Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - A Anthoney
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - R Roy
- Department of Oncology, Castle Hill Hospital, Hull, UK
| | - J Dent
- Department of Oncology, Huddersfield Royal Infirmary, Huddersfield, UK
| | - S Cheeseman
- Department of Oncology, The York Hospital, York, UK
| | - K Last
- Department of Oncology, The York Hospital, York, UK
- Department of Oncology, Bradford Royal Infirmary, Bradford, UK
| | - M T Seymour
- NIHR Cancer Research Network Coordinating Centre, Leeds, UK
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Tofler G, Spinaze M, Dent J, Kopp MM, Bartrop R, Ward C, McKinley S, Mihailidou A, Havyatt J, Whitfield V, Fethney J, Prigerson H, Buckley T. A Randomised Double Blind Placebo-Controlled Trial of Metoprolol and Aspirin in Early Bereavement. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.696] [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: 10/19/2022]
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13
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Vieth M, Mastracci L, Vakil N, Dent J, Wernersson B, Baldycheva I, Wissmar J, Ruth M, Fiocca R. Epithelial Thickness is a Marker of Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol 2016; 14:1544-1551.e1. [PMID: 27374007 DOI: 10.1016/j.cgh.2016.06.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/22/2016] [Accepted: 06/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Histologic criteria have been refined for the diagnosis of gastroesophageal reflux disease (GERD). We aimed to evaluate these criteria for the assessment of GERD and to measure interassessor agreement. METHODS We performed a post hoc analysis of data from the Diamond study (NCT 00291746), conducted in Europe and Canada on adults with frequent upper gastrointestinal symptoms who had not taken a proton pump inhibitor in the previous 2 months. GERD was diagnosed based on the presence of 1 or more of the following: reflux esophagitis, pathologic esophageal acid exposure, and/or positive symptom-acid association probability. Nonerosive reflux disease was defined as the presence of pathologic esophageal acid exposure and/or a positive symptom-acid association probability, but no reflux esophagitis. Biopsies collected from 336 patients from 0.5 cm and 2.0 cm above the Z line were evaluable; they were analyzed independently at pathology centers in Germany and Italy (biopsies from 258 and 195 patients, respectively). The primary outcomes were the accuracy of histologic criteria for the diagnosis of GERD, defined by endoscopy and pH monitoring, and interassessor agreement on histologic criteria. RESULTS At the assessment site for basal cell layer thickness, total epithelial thickness was the best-performing criterion for diagnosis of investigation-defined GERD; it also identified nonerosive reflux disease, reflux esophagitis, and pathologic esophageal acid exposure at 0.5 cm and 2.0 cm above the Z line. Basal cell layer thickness and presence of dilated intercellular spaces did not identify patients with GERD. Among the criteria tested, the best agreement between assessments carried out at the 2 pathology centers was for total epithelial thickness at 0.5 cm and 2.0 cm above the Z line. CONCLUSIONS Based on an analysis of 336 patients with frequent upper gastrointestinal symptoms, total epithelial thickness is a robust histologic marker for GERD.
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Affiliation(s)
| | - Luca Mastracci
- University of Genoa and IRCCS University Hospital S. Marino/IST, Genoa, Italy
| | - Nimish Vakil
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - John Dent
- Royal Adelaide Hospital, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | | | | | - Magnus Ruth
- former employee of AstraZeneca Gothenburg, Mölndal, Sweden
| | - Roberto Fiocca
- University of Genoa and IRCCS University Hospital S. Marino/IST, Genoa, Italy
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Dent J. What’s been happening in AMEE MedEdPublish? - a review of the first themed issue. MedEdPublish 2016. [DOI: 10.15694/mep.2016.000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was marked as recommended. Not required.
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Kirshbaum MN, Dent J, Stephenson J, Topping AE, Allinson V, McCoy M, Brayford S. Open access follow-up care for early breast cancer: a randomised controlled quality of life analysis. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27717057 PMCID: PMC5516199 DOI: 10.1111/ecc.12577] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 12/11/2022]
Abstract
This study evaluated the acceptability of a supportive model of follow‐up. One hundred and twelve women recovering from breast cancer were randomised to receive standard breast clinic aftercare (Control n = 56) or on demand by open access aftercare by breast care nurses (Intervention n = 56). Participants attended a support‐based psycho‐educational programme delivered in four half‐day group sessions. Three quality of life questionnaires (EORTC QLQ‐C30, QLQ‐BR23, HADS) were administered at baseline and 6‐monthly intervals for 2 years. Multilevel linear regression modelling methods were used for evaluation. Age was found to be a statistically significant predictor of quality of life in several sub‐scales. Increasing age was negatively associated with sexual functioning, systematic therapy side effects and physical functioning, and positively associated with future perspective. Aftercare assignment was not found to be a statistically significant predictor. Women treated for early breast cancer were not disadvantaged by allocation to the open access supportive care model in terms of quality of life experienced. The model for follow‐up was demonstrated to be a feasible alternative to routinised hospital‐based follow‐up and adds to the evidence for stratified follow‐up for low‐risk cancer patients, incorporating self‐management education. Stratified follow‐up pathways are viewed as a preferable approach.
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Affiliation(s)
- M N Kirshbaum
- School of Health, Faculty of Engineering, Health, Science and the Environment, Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia
| | - J Dent
- The Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | | | | | - V Allinson
- The Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - M McCoy
- Breast Cancer Care, Sheffield, UK
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Owens JE, Schorling J, Plews-Ogan M, Goodman M, Moorman R, Zaklin R, Dent J. A randomized controlled trial evaluating Mindfulness-Based Stress Reduction (MBSR) for the treatment of palpitations: A pilot study. Int J Cardiol 2016; 223:25-27. [PMID: 27529583 DOI: 10.1016/j.ijcard.2016.08.183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Justine E Owens
- Division of General, Geriatrics, Palliative Care and Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, United States.
| | - John Schorling
- Division of General, Geriatrics, Palliative Care and Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, United States
| | - Margaret Plews-Ogan
- Division of General, Geriatrics, Palliative Care and Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, United States
| | - Matthew Goodman
- Division of General, Geriatrics, Palliative Care and Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, United States
| | - Randall Moorman
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, United States
| | - Ryan Zaklin
- North Shore Medical Center, Boston, MA, United States; UVA School of Medicine, United States
| | - John Dent
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, United States
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Abstract
This article was migrated. The article was marked as recommended. Not requied for this editorial.
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18
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Katz P, Kahrilas PJ, Johnson DA, Lind T, Röhss K, Traxler B, Hugo V, Dent J. Daytime intragastric acid control: post hoc analyses of esomeprazole 20 mg and over-the-counter proton-pump inhibitors. Therap Adv Gastroenterol 2015; 8:322-30. [PMID: 26557888 PMCID: PMC4622284 DOI: 10.1177/1756283x15592583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES In mild gastroesophageal reflux disease, which accounts for the great majority of cases, the major burden of reflux occurs during daytime hours, after food intake. The aim of these analyses was to evaluate intragastric pH control during the typical 14-hour daytime awake period by proton-pump inhibitors (PPIs) given at over-the-counter (OTC) dosages. METHODS In one double-blind and three open-label, randomized, crossover studies, intragastric pH was monitored for 24 hours on day 5 of treatment. The 24-hour data have been reported previously. Post hoc analyses reassessed these studies for the 14-hour daytime period, comparing esomeprazole 20 mg with currently available OTC PPIs omeprazole, pantoprazole (not available in the US) and lansoprazole. RESULTS Subjects maintained intragastric pH >4 for a significantly greater mean percentage of the 14-hour daytime period with esomeprazole 20 mg compared with any of the PPI comparators at OTC dosages. Geometric mean ratios (95% confidence intervals) for esomeprazole 20 mg versus the comparators were: 1.45 (1.14-1.85; p = 0.003) versus omeprazole 20 mg; 2.50 (2.01-3.11; p < 0.0001) versus pantoprazole 20 mg; and 1.69 (1.46-1.97; p < 0.0001) and 1.89 (1.05-3.37; p = 0.03) versus lansoprazole 15 mg. A greater proportion of subjects had better pH control with esomeprazole than with the other PPIs (range: 69-97%). CONCLUSIONS Across the 14-hour daytime period, esomeprazole 20 mg once daily given 30 minutes before breakfast for 5 days provided acid control for a significantly greater average proportion of time versus the PPI comparators omeprazole, pantoprazole and lansoprazole at currently available OTC dosages.
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Affiliation(s)
| | | | | | | | | | | | | | - John Dent
- Royal Adelaide Hospital and University of Adelaide, Australia
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19
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Saji M, Ailawadi G, Conant PA, Downs E, Kern J, Dent J, Ragosta M, Lim S. TCT-151 Cross-sectional Psoas Muscle Area Detected by Computed Tomography as a Measure of Frailty and Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.162] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bilchick KC, Mealor A, Gonzalez J, Norton P, Zhuo D, Mason P, Ferguson JD, Malhotra R, Michael Mangrum J, Darby AE, DiMarco J, Hagspiel K, Dent J, Kramer CM, Stukenborg GJ, Salerno M. Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation. Heart Rhythm 2015; 13:12-9. [PMID: 26341605 DOI: 10.1016/j.hrthm.2015.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Computed tomography angiography (CTA) can identify and rule out left atrial appendage (LAA) thrombus when delayed imaging is also performed. OBJECTIVE In patients referred for CTA to evaluate pulmonary vein anatomy before the ablation of atrial fibrillation (AF) or left atrial flutter (LAFL), we sought to determine the effectiveness of a novel clinical protocol for integrating results of CTA delayed LAA imaging into preprocedure care. METHODS After making delayed imaging of the LAA part of our routine preablation CTA protocol, we integrated early reporting of preablation CTA LAA imaging results into clinical practice as part of a formal protocol in June 2013. We then analyzed the effectiveness of this protocol by evaluating 320 AF/LAFL ablation patients with CTA imaging during the time period 2012-2014. RESULTS In CTA patients with delayed LAA imaging, the sensitivity and negative predictive values for LAA thrombus using intracardiac echocardiography or transesophageal echocardiography (TEE) as the reference standard were both 100%. Intracardiac echocardiography during ablation confirmed the absence of thrombus in patients with negative CTA or negative TEE results. No patients with either negative CTA results or equivocal CTA results combined with negative TEE results had strokes or transient ischemic attacks. Overall, the need for TEE procedures decreased from 57.5% to 24.0% during the 3-year period because of the CTA protocol. CONCLUSION Clinical integration of CTA delayed LAA imaging into the care of patients having catheter ablation of AF or LAFL is feasible, safe, and effective. Such a protocol could be used broadly to improve patient care.
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Affiliation(s)
- Kenneth C Bilchick
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
| | - Augustus Mealor
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Jorge Gonzalez
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Patrick Norton
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - David Zhuo
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Pamela Mason
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - John D Ferguson
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Rohit Malhotra
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - J Michael Mangrum
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Andrew E Darby
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - John DiMarco
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Klaus Hagspiel
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - John Dent
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - George J Stukenborg
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Michael Salerno
- Division of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
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Vakil N, Wernersson B, Wissmar J, Dent J. Sleep disturbance due to heartburn and regurgitation is common in patients with functional dyspepsia. United European Gastroenterol J 2015; 4:191-8. [PMID: 27087946 DOI: 10.1177/2050640615599716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/14/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Reflux symptoms (heartburn and regurgitation) are common in patients with functional dyspepsia who do not have gastroesophageal reflux disease (GERD). OBJECTIVE The purpose of this study was to assess the relationship of reflux symptoms with sleep disturbances in patients with functional dyspepsia without GERD and in those with GERD. METHODS This post-hoc analysis of data from the Diamond study (NCT00291746) included patients with frequent upper gastrointestinal symptoms, of whom 137 had functional dyspepsia and 193 had GERD (diagnosed by endoscopy and pH monitoring). Patients completed symptom questionnaires and were interviewed by physicians. RESULTS During the seven nights before study entry, 46.0% of patients with functional dyspepsia and 64.8% of those with GERD reported sleep disturbances (any frequency) related to reflux symptoms. Frequent (often/every night) sleep disturbances were experienced by 12.4% of patients with functional dyspepsia and 24.9% of those with GERD (p = 0.005). Among patients with functional dyspepsia, the prevalence of sleep disturbances was highest in those whose heartburn and/or regurgitation were moderate to severe (vs mild/very mild) and frequent (4-7 vs 1-3 days/week). CONCLUSIONS Sleep disturbances due to reflux symptoms are common in patients with functional dyspepsia who do not have GERD, and become more frequent with increasing reflux symptom severity and frequency.
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Affiliation(s)
- N Vakil
- School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | | | | | - J Dent
- Royal Adelaide Hospital, Adelaide, Australia; University of Adelaide, Adelaide, Australia
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Saji M, Rossi AM, Ailawadi G, Dent J, Ragosta M, Scott Lim D. Adjunctive intracardiac echocardiography imaging from the left ventricle to guide percutaneous mitral valve repair with the mitraclip in patients with failed prior surgical rings. Catheter Cardiovasc Interv 2015; 87:E75-82. [DOI: 10.1002/ccd.25981] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/20/2015] [Accepted: 04/04/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Mike Saji
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
- Department of Cardiology; Sakakibara Heart Institute; Tokyo
| | - Ann M. Rossi
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
| | - Gorav Ailawadi
- Advanced Cardiac Valve Center; Department of Surgery; Division of Cardiothoracic Surgery; University of Virginia; Virginia
| | - John Dent
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
| | - Michael Ragosta
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
| | - D. Scott Lim
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
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Blankenship JC, Feldman B, Ranaweera P, Dent J, Huang X, Singer S. The interventional cardiologist as cath lab team leader. J Invasive Cardiol 2015; 27:E98-E105. [PMID: 26028665] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Interventional cardiologists act as leaders every time they step into a catheterization laboratory (cath lab), but leadership training is rarely included in cardiology training programs. Cath lab physicians should cultivate and practice effective leadership skills. Specifically, (1) before each procedure assess whether the cath lab team is prepared; (2) delegate authority to trainees and team members when appropriate; (3) use every procedure to improve the performance of team members through teaching, coaching, and mentorship; (4) debrief the team after adverse events; (5) develop the traits, styles, and skills associated with successful leadership; and (6) provide team training for the cath lab team.
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Affiliation(s)
- James C Blankenship
- Geisinger Medical Center, Dept of Cardiology 27-75, 100 N Academy Dr, Danville, PA 17821 USA.
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Saji M, Ragosta M, Dent J, Lim DS. Use of intracardiac echocardiography to guide percutaneous transluminal mitral commissurotomy. Catheter Cardiovasc Interv 2015; 87:E69-74. [DOI: 10.1002/ccd.25943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 03/14/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Mike Saji
- Advanced Cardiac Valve Center; Department of Medicine; University of Virginia; Charlottesville Virginia
| | - Michael Ragosta
- Advanced Cardiac Valve Center; Department of Medicine; University of Virginia; Charlottesville Virginia
| | - John Dent
- Advanced Cardiac Valve Center; Department of Medicine; University of Virginia; Charlottesville Virginia
| | - D. Scott Lim
- Advanced Cardiac Valve Center; Department of Medicine; University of Virginia; Charlottesville Virginia
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Ramamoorthi R, Ramamoorthi R, Graef K, Dent J. Utilizing industry assets and proactive partnering to stimulate neglected
disease product development. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.533] [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: 11/30/2022] Open
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Kuvin JT, Soto A, Foster L, Dent J, Kates AM, Polk DM, Rosenzweig B, Indik J. The Cardiovascular In-Training Examination. J Am Coll Cardiol 2015; 65:1218-1228. [PMID: 25814229 DOI: 10.1016/j.jacc.2015.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/06/2015] [Accepted: 01/14/2015] [Indexed: 10/23/2022]
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Kuvin JT, Soto A, Foster L, Dent J, Kates A, Polk D, Rosenzweig B, Indik J. DEVELOPMENT, IMPLEMENTATION AND RESULTS OF THE AMERICAN COLLEGE OF CARDIOLOGY’S IN-TRAINING EXAMINATION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61399-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vakil N, Wernersson B, Ohlsson L, Dent J. Prevalence of gastro-oesophageal reflux disease with upper gastrointestinal symptoms without heartburn and regurgitation. United European Gastroenterol J 2014; 2:173-8. [PMID: 25360300 DOI: 10.1177/2050640614532458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/13/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Symptomatically 'silent' gastro-oesophageal reflux disease (GORD) may be underdiagnosed. OBJECTIVE To determine the prevalence of untreated GORD without heartburn and/or regurgitation in primary care. METHODS Patients were included if they had frequent upper gastrointestinal symptoms and had not taken a proton pump inhibitor in the previous 2 months (Diamond study: NCT00291746). GORD was diagnosed based on the presence of reflux oesophagitis, pathological oesophageal acid exposure, and/or a positive symptom-acid association probability. Patients completed the Reflux Disease Questionnaire (RDQ) and were interviewed by physicians using a prespecified symptom checklist. RESULTS GORD was diagnosed in 197 of 336 patients investigated. Heartburn and/or regurgitation were reported in 84.3% of patients with GORD during the physician interviews and in 93.4% of patients with GORD when using the RDQ. Of patients with heartburn and/or regurgitation not identified at physician interview, 58.1% (18/31) reported them at a 'troublesome' frequency and severity on the RDQ. Nine patients with GORD did not report heartburn or regurgitation either at interview or on the RDQ. CONCLUSIONS Structured patient-completed questionnaires may help to identify patients with GORD not identified during physician interview. In a small proportion of consulting patients, heartburn and regurgitation may not be present in those with GORD.
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Affiliation(s)
- Nimish Vakil
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | - John Dent
- Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia, Australia
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Myers JC, Dent J. A Case of Post-fundoplication Dysphagia: Another Possible Interpretation of the Manometric Findings. J Neurogastroenterol Motil 2014; 20:561. [PMID: 25273128 PMCID: PMC4204413 DOI: 10.5056/jnm14103] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jennifer C Myers
- Oesophageal Function, General Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - John Dent
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
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Abstract
OBJECTIVE To update the findings of the 2005 systematic review of population-based studies assessing the epidemiology of gastro-oesophageal reflux disease (GERD). DESIGN PubMed and Embase were screened for new references using the original search strings. Studies were required to be population-based, to include ≥ 200 individuals, to have response rates ≥ 50% and recall periods <12 months. GERD was defined as heartburn and/or regurgitation on at least 1 day a week, or according to the Montreal definition, or diagnosed by a clinician. Temporal and geographic trends in disease prevalence were examined using a Poisson regression model. RESULTS 16 studies of GERD epidemiology published since the original review were found to be suitable for inclusion (15 reporting prevalence and one reporting incidence), and were added to the 13 prevalence and two incidence studies found previously. The range of GERD prevalence estimates was 18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America. Incidence per 1000 person-years was approximately 5 in the overall UK and US populations, and 0.84 in paediatric patients aged 1-17 years in the UK. Evidence suggests an increase in GERD prevalence since 1995 (p<0.0001), particularly in North America and East Asia. CONCLUSIONS GERD is prevalent worldwide, and disease burden may be increasing. Prevalence estimates show considerable geographic variation, but only East Asia shows estimates consistently lower than 10%.
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Affiliation(s)
- Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Houston Veterans Affairs Medical Center (152), Houston, Texas, USA
| | - Stephen Sweet
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK
| | - Christopher C Winchester
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK,Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - John Dent
- Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Abstract
OBJECTIVE To update the findings of the 2005 systematic review of population-based studies assessing the epidemiology of gastro-oesophageal reflux disease (GERD). DESIGN PubMed and Embase were screened for new references using the original search strings. Studies were required to be population-based, to include ≥ 200 individuals, to have response rates ≥ 50% and recall periods <12 months. GERD was defined as heartburn and/or regurgitation on at least 1 day a week, or according to the Montreal definition, or diagnosed by a clinician. Temporal and geographic trends in disease prevalence were examined using a Poisson regression model. RESULTS 16 studies of GERD epidemiology published since the original review were found to be suitable for inclusion (15 reporting prevalence and one reporting incidence), and were added to the 13 prevalence and two incidence studies found previously. The range of GERD prevalence estimates was 18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America. Incidence per 1000 person-years was approximately 5 in the overall UK and US populations, and 0.84 in paediatric patients aged 1-17 years in the UK. Evidence suggests an increase in GERD prevalence since 1995 (p<0.0001), particularly in North America and East Asia. CONCLUSIONS GERD is prevalent worldwide, and disease burden may be increasing. Prevalence estimates show considerable geographic variation, but only East Asia shows estimates consistently lower than 10%.
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Affiliation(s)
- Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Houston Veterans Affairs Medical Center (152), , Houston, Texas, USA
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Elliott KM, Dent J, Stanczyk FZ, Woodley L, Coombes RC, Purohit A, Palmieri C. Effects of aromatase inhibitors and body mass index on steroid hormone levels in women with early and advanced breast cancer. Br J Surg 2014; 101:939-48. [PMID: 24687409 DOI: 10.1002/bjs.9477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Aromatase inhibitors (AIs) are central to the management of oestrogen receptor-positive breast cancer in the adjuvant and metastatic setting. Levels of circulating steroid hormones (SHs) were measured in patients established on AIs to investigate: the influence of body mass index (BMI) in both the adjuvant and metastatic setting; the class of AI utilized in the adjuvant setting (steroidal versus non-steroidal); and differences in SH levels between women treated adjuvantly and those receiving a second-line AI for locally advanced/metastatic disease. METHODS Plasma levels of androstenedione, 5-androstene-3β,17β-diol, dehydroepiandrosterone, oestradiol and testosterone were measured by radioimmunoassay in women with breast cancer who were receiving AIs in either an adjuvant or a metastatic setting. Differences between mean SH levels by class of AI, BMI, and second-line versus adjuvant therapy were assessed. RESULTS Sixty-four women were receiving AI therapy, 45 (70 per cent) in an adjuvant setting and 19 (30 per cent) were taking a second-line AI. There was no significant correlation between BMI and SH levels. However, BMI was significantly higher in the second-line AI cohort compared with the adjuvant cohort (29.8 versus 26.2 kg/m2 respectively; P = 0.026). In the adjuvant setting, patients receiving a steroidal AI had significantly higher levels of all five hormones (P < 0.050). In the second-line AI cohort, oestradiol levels were significantly higher than in the adjuvant cohort (4.5 versus 3.3 pg/ml respectively; P = 0.022). Multivariable analysis adjusted for BMI confirmed the higher residual oestradiol level in the second-line AI group (P = 0.063) and a significantly higher androstenedione level (P = 0.022). CONCLUSION Residual levels of SH were not significantly influenced by BMI. However, the significant differences in residual SH levels between the second-line and adjuvant AI cohort is of relevance in the context of resistance to AI therapy, and warrants further investigation.
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Affiliation(s)
- K M Elliott
- Department of Biosurgery and Surgical Technology, Imperial College London, London, UK; Cancer Research UK Laboratories, Imperial Centre for Translational and Experimental Medicine, Division of Cancer, Imperial College London, London, UK
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Zeng X, Nunes MCP, Dent J, Gillam L, Mathew JP, Gammie JS, Ascheim DD, Moquete E, Hung J. Asymmetric versus symmetric tethering patterns in ischemic mitral regurgitation: geometric differences from three-dimensional transesophageal echocardiography. J Am Soc Echocardiogr 2014; 27:367-75. [PMID: 24513242 DOI: 10.1016/j.echo.2014.01.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ischemic mitral regurgitation (IMR) results from mitral leaflet tethering from left ventricular remodeling. Heterogeneity in local or global left ventricular remodeling can result in differential tethering patterns and affect mitral valve function and the degree of mitral regurgitation. The aims of this study were to compare mitral valve geometry in asymmetric and symmetric tethering patterns using three-dimensional transesophageal echocardiography and to examine the impact of tethering pattern on IMR severity. METHODS Sixty-two patients with moderate or greater IMR underwent three-dimensional transesophageal echocardiography for the assessment of mitral valve geometry. Symmetric and asymmetric tethering patterns were determined by mitral regurgitation jet direction and coaptation of the mitral leaflets. The ratio of posterior to anterior leaflet tethering angle was a measure of tethering pattern (the higher the ratio, the more asymmetric the pattern). Overall tethering degree was assessed by tenting volume (TV). RESULTS Compared with the symmetric group, the asymmetric group had less annular dilatation, greater annular heights (10.3 ± 1.9 vs 8.5 ± 1.9 mm, P < .01), greater ratios of posterior to anterior leaflet tethering angle (3.19 ± 0.88 vs 1.95 ± 0.46, P < .01), and smaller TVs with more posterior displacement of the coaptation line. Vena contracta normalized to TV was greater in the asymmetric group (0.38 ± 0.24 vs 0.19 ± 0.13 cm/mL, P < .01). Multivariate analysis showed that both ratio of posterior to anterior leaflet tethering angle (β = 0.46, P < .001) and TV (β = 0.41, P = .001) were predictors of IMR severity. CONCLUSIONS Differences in mitral valve geometry are observed between asymmetric and symmetric tethering patterns in IMR. IMR degree is affected by both the pattern of tethering and the total degree of tethering. For the same degree of tethering, an asymmetric pattern is associated with increased MR severity. The pattern of mitral leaflet tethering may be considered in therapeutic decision making.
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Affiliation(s)
- Xin Zeng
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Maria Carmo P Nunes
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - John Dent
- Cardiovascular Division, University of Virginia, Charlottesville, Virginia
| | - Linda Gillam
- Cardiovascular Medicine, Atlantic Health System, Morristown, New Jersey
| | - Joseph P Mathew
- Division of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Deborah D Ascheim
- Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, New York; Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ellen Moquete
- Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, New York
| | - Judy Hung
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts.
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Dent J, Holloway RH, Eastwood PR. Systematic review: relationships between sleep and gastro-oesophageal reflux. Aliment Pharmacol Ther 2013; 38:657-73. [PMID: 23957437 DOI: 10.1111/apt.12445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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] [Received: 06/04/2013] [Revised: 07/03/2013] [Accepted: 07/18/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Gastro-oesophageal reflux disease (GERD) adversely impacts on sleep, but the mechanism remains unclear. AIM To review the literature concerning gastro-oesophageal reflux during the sleep period, with particular reference to the sleep/awake state at reflux onset. METHODS Studies identified by systematic literature searches were assessed. RESULTS Overall patterns of reflux during the sleep period show consistently that oesophageal acid clearance is slower, and reflux frequency and oesophageal acid exposure are higher in patients with GERD than in healthy individuals. Of the 17 mechanistic studies identified by the searches, 15 reported that a minority of reflux episodes occurred during stable sleep, but the prevailing sleep state at the onset of reflux in these studies remains unclear owing to insufficient temporal resolution of recording or analysis methods. Two studies, in healthy individuals and patients with GERD, analysed sleep and pH with adequate resolution for temporal alignment of sleep state and the onset of reflux: all 232 sleep period reflux episodes evaluated occurred during arousals from sleep lasting less than 15 s or during longer duration awakenings. Six mechanistic studies found that transient lower oesophageal sphincter relaxations were the most common mechanism of sleep period reflux. CONCLUSIONS Contrary to the prevailing view, subjective impairment of sleep in GERD is unlikely to be due to the occurrence of reflux during stable sleep, but could result from slow clearance of acid reflux that occurs during arousals or awakenings from sleep. Definitive studies are needed on the sleep/awake state at reflux onset across the full GERD spectrum.
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Affiliation(s)
- J Dent
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Latta L, Tordoff D, Manning P, Dent J. Enhancing clinical skill development through an Ambulatory Medicine Teaching Programme: an evaluation study. Med Teach 2013; 35:648-654. [PMID: 23758182 DOI: 10.3109/0142159x.2013.801553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Teaching of clinical skills traditionally takes place in hospital wards and outpatient settings. However high acuity and short hospital stays means there are fewer suitable inpatients available for teaching; and time pressures limit students' involvement in other settings. The Ambulatory Medicine Programme was established to develop undergraduate medical students' clinical skills by providing increased exposure to patients with a wide range of chronic medical conditions, in a dedicated learning environment. METHOD A mixed qualitative/quantitative approach was used to evaluate the Programme. This research focuses on staff and student perspectives of teaching and learning in Ambulatory Medicine compared with inpatient and outpatient settings; identifies which teaching methods are considered most effective; and determines the transferability of learning. Patients' perspectives of being involved in student teaching are also reported. RESULTS Results show that the programme has made a positive impact on students' development of clinical skills, which are transferable to the clinical setting. Patients enjoy being involved and find it personally satisfying. CONCLUSIONS The Ambulatory Medicine Programme is an effective way of developing medical students' clinical skills by providing focussed teaching with real patients in a dedicated learning environment.
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Affiliation(s)
- L Latta
- Otago University , New Zealand.
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Bytzer P, Jones R, Vakil N, Junghard O, Lind T, Wernersson B, Dent J. Limited ability of the proton-pump inhibitor test to identify patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2012; 10:1360-6. [PMID: 22813439 DOI: 10.1016/j.cgh.2012.06.030] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [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] [Received: 04/18/2012] [Revised: 06/26/2012] [Accepted: 06/28/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The efficacy of proton-pump inhibitor (PPI) therapy often is assessed to determine whether patients' symptoms are acid-related and if patients have gastroesophageal reflux disease (GERD), although the accuracy of this approach is questionable. We evaluated the diagnostic performance of the PPI test, in conjunction with other tests, for the diagnosis of GERD. METHODS We analyzed data from the DIAMOND study, a multinational trial that compared the ability of the reflux disease questionnaire with that of symptom-based clinical diagnosis to identify GERD in primary care patients with frequent upper-gastrointestinal symptoms. Patients (n = 308) were given placebo and further evaluated by endoscopy, wireless esophageal pH-metry, and symptom association monitoring. Those with GERD (n = 197) were identified based on the presence of reflux esophagitis, esophageal pH level less than 4 for more than 5.5% of 24 hours, or positive results from symptom association monitoring (or a positive result from the PPI test in patients with borderline levels of esophageal acidity). All patients then were given single-blind therapy with esomeprazole (40 mg once daily) for 2 weeks and symptoms were recorded daily. RESULTS A positive response to the PPI test was observed in 69% of patients with GERD and in 51% of those without GERD. Response to placebo did not influence the diagnostic ability of the subsequent PPI test. More patients with reflux esophagitis had a positive result from the PPI test than patients without GERD (57% vs 35%; P = .002) or patients with GERD but no esophagitis. A clinical diagnosis by the primary care physician of an acid-related disease was not associated with response to PPIs. CONCLUSIONS In a well-characterized population of primary care patients with frequent upper-gastrointestinal symptoms of any type, the PPI test has limited ability to identify patients with GERD, diagnosed by current standard tests. (ClinicalTrials.gov Number, NCT00291746.).
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Affiliation(s)
- Peter Bytzer
- Department of Medicine, Køge University Hospital, Køge, Denmark.
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Myers JC, Nguyen NQ, Jamieson GG, Van't Hek JE, Ching K, Holloway RH, Dent J, Omari TI. Susceptibility to dysphagia after fundoplication revealed by novel automated impedance manometry analysis. Neurogastroenterol Motil 2012; 24:812-e393. [PMID: 22616652 DOI: 10.1111/j.1365-2982.2012.01938.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [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: 02/08/2023]
Abstract
BACKGROUND Conventional measures of esophageal pressures or bolus transport fail to identify patients at risk of dysphagia after laparoscopic fundoplication. METHODS Liquid and viscous swallows were evaluated with impedance/manometry in 19 patients with reflux disease before and after surgery. A new method of automated impedance manometry (AIM) analysis correlated esophageal pressure with impedance data and automatically calculated a range of pressure and bolus movement variables. An iterative analysis determined whether any variables were altered in relation to dysphagia. Standard measures of esophago-gastric junction pressure, bolus presence time, and total bolus transit time were also evaluated. KEY RESULTS At 5 months postop, 15 patients reported some dysphagia, including 7 with new-onset dysphagia. For viscous boluses, three AIM-derived pressure-flow variables recorded preoperatively varied significantly in relation to postoperative dysphagia. These were: time from nadir esophageal impedance to peak esophageal pressure (TNadImp-PeakP), median intra-bolus pressure (IBP, mmHg), and the rate of bolus pressure rise (IBP slope, mmHgs(-1) ). These variables were combined to form a dysphagia risk index (DRI=IBP×IBP_slope/TNadImp-PeakP). DRI values derived from preoperative measurements were significantly elevated in those with postoperative dysphagia (DRI=58, IQR=21-408 vs no dysphagia DRI=9, IQR=2-19, P<0.02). A DRI >14 was optimally predictive of dysphagia (sensitivity 75% and specificity 93%). CONCLUSIONS & INFERENCES Before surgery, a greater and faster compression of a swallowed viscous bolus with less bolus flow time relates to postoperative dysphagia. Thus, susceptibility to postfundoplication dysphagia is related to a pre-existing sub-clinical variation of esophageal function.
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Affiliation(s)
- J C Myers
- Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia
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Anwar S, Peter MB, Dent J, Scott NA. Palliative excisional surgery for primary colorectal cancer in patients with incurable metastatic disease. Is there a survival benefit? A systematic review. Colorectal Dis 2012; 14:920-30. [PMID: 21899714 DOI: 10.1111/j.1463-1318.2011.02817.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [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: 12/30/2022]
Abstract
AIM Patients with stage IV colorectal cancer with unresectable metastases can either receive chemotherapy or palliative resection of the primary lesion. In the absence of any randomized data the choice of initial treatment in stage IV colorectal cancer is not based on firm evidence. METHOD A search of MEDLINE, Pubmed, Embase and the Cochrane Library database was performed from 1980 to 2010 for studies comparing palliative resection in stage IV colorectal cancer with other treatment modalities. Audits and observational studies were excluded. Median survival was the primary outcome measure. The morbidity and mortality of surgical and nonsurgical treatments were compared. RESULTS Twenty-one studies (no randomized controlled trials) were identified. Most demonstrated a survival benefit for patients who underwent palliative resection. Multivariate analysis indicates that tumour burden and performance status are both major independent prognostic variables. Selection bias, incomplete follow up and nonstandardized reporting of complications make the data difficult to interpret. CONCLUSION The studies indicate that there may be a survival benefit for primary resection of colorectal cancer in stage IV disease. The findings suggest that resection of the primary tumour should be based on tumour burden and performance status rather than on the presence or absence of symptoms alone.
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Affiliation(s)
- S Anwar
- Department of Colorectal Surgery, Calderdale and Huddersfield NHS Trust, Huddersfield, UK.
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van Wijk MP, Blackshaw LA, Dent J, Benninga MA, Davidson GP, Omari TI. Distension of the esophagogastric junction augments triggering of transient lower esophageal sphincter relaxation. Am J Physiol Gastrointest Liver Physiol 2011; 301:G713-8. [PMID: 21817061 DOI: 10.1152/ajpgi.00523.2010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 01/31/2023]
Abstract
Patients with gastroesophageal reflux disease show an increase in esophagogastric junction (EGJ) distensibility and in frequency of transient lower esophageal sphincter relaxations (TLESR) induced by gastric distension. The objective was to study the effect of localized EGJ distension on triggering of TLESR in healthy volunteers. An esophageal manometric catheter incorporating an 8-cm internal balloon adjacent to a sleeve sensor was developed to enable continuous recording of EGJ pressure during distension of the EGJ. Inflation of the balloon doubled the cross-section of the trans-sphincteric portion of the catheter from 5 mm OD (round) to 5 × 11 mm (oval). Ten healthy subjects were included. After catheter placement and a 30-min adaptation period, the EGJ was randomly distended or not, followed by a 45-min baseline recording. Subjects consumed a refluxogenic meal, and recordings were made for 3 h postprandially. A repeat study was performed on another day with EGJ distension status reversed. Additionally, in one subject MRI was performed to establish the exact position of the balloon in the inflated state. The number of TLESR increased during periods of EGJ distension with the effect being greater after a meal [baseline: 2.0(0.0-4.0) vs. 4.0(1.0-11.0), P=0.04; postprandial: 15.5(10.0-33.0) vs. 22.0(17.0-58.0), P=0.007 for undistended and distended, respectively]. EGJ distension augments meal-induced triggering of TLESR in healthy volunteers. Our data suggest the existence of a population of vagal afferents located at sites in/around the EGJ that may influence triggering of TLESR.
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Affiliation(s)
- Michiel P van Wijk
- Endoscopy Dept., Academic Medical Center Meibergdreef, Amsterdam, The Netherlands.
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Dent J, Topping A, Ferguson C, Stephenson J, McCoy M, Allinson V, Brayford S. To follow up or not? A new model of supportive care for early breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9098] [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: 11/20/2022] Open
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Omari TI, Dejaeger E, van Beckevoort D, Goeleven A, Davidson GP, Dent J, Tack J, Rommel N. A method to objectively assess swallow function in adults with suspected aspiration. Gastroenterology 2011; 140:1454-63. [PMID: 21354152 DOI: 10.1053/j.gastro.2011.02.051] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [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] [Received: 09/18/2010] [Revised: 12/10/2010] [Accepted: 02/06/2011] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Pharyngeal manometry and impedance provide information on swallow function. We developed a new analysis approach for assessment of aspiration risk. METHODS We studied 20 patients (30-95 years old) with suspected aspiration who were referred for videofluoroscopy, along with controls (ages 24-47 years). The pharyngeal phase of liquid bolus swallowing was recorded with manometry and impedance. Data from the first swallow of a bolus and subsequent clearing swallows were analyzed. We scored fluoroscopic evidence of aspiration and investigated a range of computationally derived functional variables. Of these, 4 stood out as having high diagnostic value: peak pressure (PeakP), pressure at nadir impedance (PNadImp), time from nadir impedance to peak pressure (TNadImp-PeakP), and the interval of impedance drop in the distal pharynx (flow interval). RESULTS During 54 liquid, first swallows and 40 clearing swallows, aspiration was observed in 35 (13 patients). Compared to those of controls, patient swallows were characterized by a lower PeakP, higher PNadImp, longer flow interval, and shorter TNadImp-PeakP. A Swallow Risk Index (SRI), designed to identify dysfunctions associated with aspiration, was developed from iterative evaluations of variables. The average first swallow SRI correlated with the average aspiration score (r = 0.846, P < .00001 for Spearman Rank Correlation). An average SRI of 15, when used as a cutoff, predicted aspiration during fluoroscopy for this cohort (κ = 1.0). CONCLUSIONS Pressure-flow variables derived from automated analysis of combined manometric/impedance measurements provide valuable diagnostic information. When combined into an SRI, these measurements are a robust predictor of aspiration.
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Affiliation(s)
- Taher I Omari
- Gastroenterology Unit, Child, Youth & Women's Health Service, North Adelaide, South Australia, Australia.
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Zou D, He J, Ma X, Liu W, Chen J, Shi X, Ye P, Gong Y, Zhao Y, Wang R, Yan X, Man X, Gao L, Dent J, Sung J, Wernersson B, Johansson S, Li Z. Helicobacter pylori infection and gastritis: the Systematic Investigation of gastrointestinaL diseases in China (SILC). J Gastroenterol Hepatol 2011; 26:908-15. [PMID: 21198827 DOI: 10.1111/j.1440-1746.2010.06608.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 12/15/2022]
Abstract
BACKGROUND AND AIM Helicobacter pylori infection remains common in East Asia, though its prevalence is decreasing in Western countries. H. pylori-related atrophic gastritis (AG) may reduce the likelihood of gastroesophageal reflux disease (GERD). We investigated the prevalence of H. pylori infection and AG and their association with endoscopic findings and symptom-defined GERD in Shanghai. METHODS A representative random sample of 3600 Shanghai residents aged 18-80 years was invited to complete a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire, to provide blood samples for H. pylori serology and pepsinogen (PG) I/II assay (to detect AG, defined as PGI < 70 µg/L and/or PGI/PGII < 7), and to undergo endoscopy. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multivariate logistic regression. RESULTS A total of 1022 Shanghai residents underwent endoscopy and were valid for inclusion in the study. Of these, 71.7% tested positive for H. pylori, 63.8% had AG and 30.5% had moderate/severe AG (PGI < 50 µg/L and/or PGI/PGII < 5). Helicobacter pylori infection was equally common in all age groups. Severity of AG increased with age in women. Reflux esophagitis was inversely associated with AG (OR, 0.23 [CI, 0.09-0.55] for moderate/severe AG compared with no H. pylori or gastritis). However, symptom-defined GERD showed no clear association with AG. CONCLUSIONS Helicobacter pylori infection and AG are very common in Shanghai, and the infection is acquired early in life. Atrophic gastritis is inversely associated with reflux esophagitis but is not significantly associated with symptom-defined GERD.
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Affiliation(s)
- Duowu Zou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Malhotra R, West JJ, Dent J, Luna M, Kramer CM, Mounsey JP, Battle R, Saliba E, Rose B, Mistry D, MacKnight J, DiMarco J, Mahapatra S. Cost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: A 5-year experience. Heart Rhythm 2011; 8:721-7. [DOI: 10.1016/j.hrthm.2010.12.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Gastro-oesophageal reflux disease (GERD) is thought to become more prevalent with age. AIM To assess systematically how age affects the prevalence of GERD and its oesophageal complications. METHODS Systematic PubMed searches were used to identify population-based studies on the age-related prevalence and incidence of GERD, and clinical studies on age-related changes in oesophageal complications in GERD. RESULTS Nine population-based studies and seven clinical studies met the inclusion criteria. Four of seven prevalence studies observed no significant effect of age on GERD symptom prevalence, two did not report on statistical significance and one observed a significant age-related increase in symptom prevalence. The two population-based endoscopic surveys showed no significant effect of age on reflux oesophagitis prevalence. Clinical studies in patients with GERD showed an increase in reflux oesophagitis severity and a decrease in heartburn severity with age, and age-related increases in oesophageal acid exposure and anatomical disruption of the gastro-oesophageal junction. CONCLUSIONS Epidemiological studies do not show an increase in GERD symptom prevalence with age. However, in individuals with GERD, ageing is associated with more severe patterns of acid reflux and reflux oesophagitis; despite this, symptoms associated with GERD become less severe and more nonspecific with ageing. Thus, the real prevalence of GERD may well increase with age.
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Zou D, He J, Ma X, Chen J, Gong Y, Man X, Gao L, Wang R, Zhao Y, Yan X, Liu W, Wernersson B, Johansson S, Dent J, Sung JJ, Li Z. Epidemiology of symptom-defined gastroesophageal reflux disease and reflux esophagitis: the systematic investigation of gastrointestinal diseases in China (SILC). Scand J Gastroenterol 2011; 46:133-41. [PMID: 20955088 DOI: 10.3109/00365521.2010.521888] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [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: 02/04/2023]
Abstract
OBJECTIVE Gastroesophageal reflux disease (GERD) is thought to be less prevalent in China than in Western countries. However, essential population-based endoscopy data are lacking for this country. MATERIAL AND METHODS As part of a wider study, 3600 individuals selected randomly from the Shanghai region were asked to undergo endoscopy. Participants completed a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire. When sufficient numbers were available, associations were assessed using multiple logistic regression or the Wilcoxon rank-sum test. RESULTS Of 3153 (87.6%) individuals who completed the survey, 1030 (32.7%) agreed to endoscopy and 1029 endoscopies were suitable for analysis. Symptom-defined GERD was more prevalent in the endoscopy group (4.7%) than in the non-endoscopy group (1.7%). Prevalence estimates were 6.4% for reflux esophagitis, 1.8% for endoscopically suspected esophageal metaplasia and 0.7% for hiatus hernia. Reflux esophagitis was more prevalent in patients with symptom-defined GERD than in those without (12.5% [6/48] vs. 6.1% [60/981]), and was significantly associated with reflux symptoms of any frequency or severity (OR = 2.10, 95% CI 1.13-3.89) and with negative Helicobacter pylori infection (OR = 0.44, 95% CI 0.25-0.80). Only 28.8% of participants with reflux esophagitis had heartburn and/or regurgitation symptoms. Epigastric burning was significantly more severe and frequent in participants with reflux esophagitis than in those without (p = 0.05). CONCLUSIONS Reflux esophagitis is less prevalent in China than reported in Western countries. Further work is needed to establish why reflux esophagitis appears less symptomatic in China than in Western countries.
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Affiliation(s)
- Duowu Zou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Abstract
Interpretation of exploding knowledge about Barrett's esophagus is impaired by use of several conflicting definitions. Because any histological type of esophageal columnar metaplasia carries risk for esophageal adenocarcinoma, the diagnosis of Barrett's esophagus should no longer require demonstration of intestinal-type metaplasia. Endoscopic recognition and grading of Barrett's esophagus remains a significant source of ambiguity. Reflux disease is a key factor for development of Barrett's esophagus, but other factors must underlie its development, since it occurs in only a minority of reflux disease patients. Neither antireflux surgery nor proton pump inhibitor (PPI) therapy has major impacts on cancer risk. Within a year, a major trial should indicate whether low-dose aspirin usefully reduces cancer risk. The best referral centers have transformed the accuracy of screening and surveillance for early curable esophageal adenocarcinoma by use of enhanced and novel endoscopic imaging, visually-guided, rather than blind biopsies and by partnership with expert pathologists. General endoscopists now need to upgrade their skills and equipment so that they can rely mainly on visual targeting of biopsies on mucosal areas of concern in their surveillance practice. General pathologists need to greatly improve their interpretation of biopsies. Endoscopic therapy now achieves very high rates of cure of high-grade dysplasia and esophageal adenocarcinoma with minimal morbidity and risk. Such results will only be achieved by skilled interventional endoscopists. Esophagectomy should now be mainly restricted to patients whose cancer has extended into and beyond the submucosa. Weighing risks and benefits in the management of Barrett's esophagus is difficult, as is the process of adequately informing patients about their specific cancer risk.
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Affiliation(s)
- John Dent
- Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, University of Adelaide, South Australia, Australia.
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Li Z, Zou D, Ma X, Chen J, Shi X, Gong Y, Man X, Gao L, Zhao Y, Wang R, Yan X, Dent J, Sung JJ, Wernersson B, Johansson S, Liu W, He J. Epidemiology of peptic ulcer disease: endoscopic results of the systematic investigation of gastrointestinal disease in China. Am J Gastroenterol 2010; 105:2570-7. [PMID: 20736940 DOI: 10.1038/ajg.2010.324] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [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: 12/11/2022]
Abstract
OBJECTIVES Complications of peptic ulcer disease (PUD) are common in China. Population-based estimates of the prevalence of PUD are needed to quantify and characterize the population at risk of these complications. METHODS As part of a large epidemiological study, 3,600 randomly selected residents of Shanghai (aged 18-80 years) were asked to undergo endoscopy and to provide blood samples for Helicobacter pylori serology. All participants also completed a general information questionnaire and Chinese versions of the reflux disease questionnaire (RDQ) and Rome II questionnaire. Associations between PUD and other factors were analyzed using a multiple logistic regression model. RESULTS In total, 3,153 individuals (87.6%) completed the survey. All underwent blood tests, and 1,030 patients (32.7%) agreed to undergo endoscopy. Results from 1,022 patients were suitable for analysis. In all, 176 participants (17.2%) had PUD (62 with gastric ulcer; 136 with duodenal ulcer). The prevalence of H. pylori infection was 73.3% in the total population and 92.6% among those with PUD. H. pylori infection was associated with the presence of PUD (odds ratio (OR), 6.77; 95% confidence interval (CI), 2.85-16.10). The majority (72.2%) of individuals with PUD had none of the upper gastrointestinal symptoms assessed by the RDQ. PUD was not significantly associated with symptom-defined gastroesophageal reflux disease (GERD) (OR, 0.80; 95% CI, 0.32-2.03), reflux esophagitis (OR, 1.46; 95% CI, 0.76-2.79) or dyspepsia (OR, 1.69; 95% CI, 0.94-3.04). CONCLUSIONS The prevalence of endoscopically confirmed PUD in this Shanghai population (17.2%) is substantially higher than in Western populations (4.1%). The majority of individuals with PUD were asymptomatic.
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Affiliation(s)
- Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Wang R, Zou D, Ma X, Zhao Y, Yan X, Yan H, Fang J, Yin P, Kang X, Li Q, Dent J, Sung JJ, Halling K, Johansson S, Liu W, He J. Impact of gastroesophageal reflux disease on daily life: the Systematic Investigation of Gastrointestinal Diseases in China (SILC) epidemiological study. Health Qual Life Outcomes 2010; 8:128. [PMID: 21062502 PMCID: PMC2996363 DOI: 10.1186/1477-7525-8-128] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 11/10/2010] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux disease imposes a significant burden of illness in Western populations. However, data on the impact of reflux symptoms on daily life in Asian populations are scarce. The current study aimed to evaluate the impact of GERD (defined on the basis of symptoms) on health-related quality-of-life (HRQoL) in individuals from five regions in China, as part of the Systematic Investigation of Gastrointestinal Diseases in China (SILC) study. METHODS In total, 18 000 residents were randomly selected from across five regions of China and asked to complete a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire (RDQ). A randomly selected subsample of one-fifth of subjects (20% from each region) completed Chinese versions of the 36-item self-administered (SF-36) questionnaire and Epworth Sleepiness Scale (ESS) questionnaire. Reflux symptoms were defined as the presence of heartburn and/or regurgitation. Symptom-defined GERD was diagnosed as mild heartburn and/or regurgitation ≥2 days per week, or moderate/severe heartburn and/or regurgitation ≥1 day a week, based on the Montreal Definition of GERD for population-based studies. RESULTS The response rate was 89.4% for the total sample (16 091/18 000), and for the 20% subsample (3219/3600). Meaningful impairment was observed in all 8 SF-36 dimensions in participants with symptom-defined GERD, in 7 of the 8 SF-36 dimensions in participants with troublesome reflux symptoms, and in 6 of the 8 SF-36 dimensions in participants with reflux symptoms below the threshold for symptom-defined GERD. Meaningful daytime sleepiness was also observed in each of these groups. The proportion of individuals reporting troublesome symptoms increased as reflux symptom frequency and severity approached the threshold for symptom-defined GERD, and this was associated with concomitant decreases in all HRQoL measures. Troublesome symptoms were reported by 68.2% (75/110) of individuals with symptom-defined GERD. CONCLUSIONS GERD diagnosed using symptom/frequency criteria (recommended for population-based studies), or based on troublesome reflux symptoms (recommended for the clinic), is associated with significantly impaired HRQoL in Chinese individuals. However, patient groups identified using these definitions do not overlap completely, suggesting that they capture slightly different, though clinically relevant, GERD populations.
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Affiliation(s)
- Rui Wang
- Second Military Medical University, Shanghai, China
| | - Duowu Zou
- Second Military Medical University, Shanghai, China
| | - Xiuqiang Ma
- Second Military Medical University, Shanghai, China
| | - Yanfang Zhao
- Second Military Medical University, Shanghai, China
| | - Xiaoyan Yan
- Second Military Medical University, Shanghai, China
| | - Hong Yan
- Xi'an Jiao Tong University, Xi'an, China
| | - Jiqian Fang
- Zhongshan Medical University, Guangzhou, China
| | - Ping Yin
- Huazhong Science and Technology University, Wuhan, China
| | | | - Qiang Li
- Xi'an Jiao Tong University, Xi'an, China
| | - John Dent
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | | | | | - Wenbin Liu
- AstraZeneca Pharmaceutical Company Limited, Shanghai, China
| | - Jia He
- Second Military Medical University, Shanghai, China
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Abu-Sneineh A, Tam W, Schoeman M, Fraser R, Ruszkiewicz AR, Smith E, Drew PA, Dent J, Holloway RH. The effects of high-dose esomeprazole on gastric and oesophageal acid exposure and molecular markers in Barrett's oesophagus. Aliment Pharmacol Ther 2010; 32:1023-30. [PMID: 20937048 DOI: 10.1111/j.1365-2036.2010.04428.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 02/06/2023]
Abstract
BACKGROUND Acid reflux is often difficult to control medically. AIM To assess the effect of 40 mg twice daily esomeprazole (high-dose) on gastric and oesophageal pH and symptoms, and biomarkers relevant to adenocarcinoma, in patients with Barrett's oesophagus (BO). METHODS Eighteen patients, treated with proton pump inhibitors as prescribed by their treating doctor, had their therapy increased to high-dose esomeprazole for 6 months. RESULTS At entry into the study, 9/18 patients had excessive 24-h oesophageal acid exposure, and gastric pH remained <4 for >16 h in 8/18. With high-dose esomeprazole, excessive acid exposure occurred in 2/18 patients, and gastric pH <4 was decreased from 38% of overall recording time and 53% of the nocturnal period to 15% and 17%, respectively (P < 0.001). There was a reduction in self-assessed symptoms of heartburn (P = 0.0005) and regurgitation (P < 0.0001), and inflammation and proliferation in the Barrett's mucosa. There was no significant change in p53, MGMT or COX-2 expression, or in aberrant DNA methylation. CONCLUSIONS High-dose esomeprazole achieved higher levels of gastric acid suppression and control of oesophageal acid reflux and symptoms, with significant decreases in inflammation and epithelial proliferation. There was no reversal of aberrant DNA methylation.
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Affiliation(s)
- A Abu-Sneineh
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, SA, Australia
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