Increasing prevalence of advanced colonic polyps in young patients undergoing colonoscopy in a referral academic hospital in Hong Kong

Aim: To investigate the distribution and frequency of advanced polyps over eight years. Methods: 6424 colonoscopies were reviewed during the study period 1998 to 2005. The study period was subdivided into period I: 1998 to 2001 and period II: 2002-2005. Results: 1856 polyps (33% advanced polyps) and 328 CRCs were detected. The mean ages of the patients with advanced polyps and cancer were 69.2 ± 12.0 and 71.6 ± 13.8 years, respectively. Advanced polyps were mainly left sided (59.5%). Advanced polyps were found in patients ≤ 60 years from 17.7% in period I to 26.3% in period II (P 0.05). Conclusion: Advanced polyps increased significantly in the younger male group in the most recent period and there seems to be a shift towards a proximal location. © 2007 WJG. All rights reserved.published_or_final_versio

Food for thought, A Perspective on Future GI Training in SA

In South-Africa nurses and doctors are emigrating in significant numbers. Job satisfaction, safety and ensuring career progressionare important in retaining doctors to make a career in RSA. Due to budgetary constraints many hospitals have not been upgraded.Coming home after overseas training seems difficult. In RSA it takes a minimum of 13 years for a young specialist to get on the register and 15 years for subspecialists. Career progression, creating more specialist trainees in public and private hospitals and shortening the period of professional training are potential solutions  the problem. India with a population of more than 1 billion people is struggling with similar problems. For the past 10-15 years private hospitals have assisted in manpower development for medical specialist and subspecialist careers. Currently their private sector trains 60% of their recognised (sub)specialities fellows. A national task force for specialist training in RSA should be instituted. It should discuss, based on the current status and projected specialist and subspecialist personnel requirements, the future structure and logistics of training needs. This is required in all subspecialities including gasteroenterology, as has been done in India. It is hoped that as a consequence well-trained doctors, like in India,might move to provincial hospitals in rural areas, uplifting the medical services and keeping medical power in South-Africa. South-Africa should become a model for Sub-Saharan Africa, as India already is for South-East Asia

The value of the D-xylose test compared with the differential sugar absorption test in recognizing coeliac disease

Objective: To compare the value of the differential sugar absorption test (SAT) with the blood and urine D-xylose tests (DXTs and DXTu) in diagnosing coeliac disease (CD) the SAT and the standard DXTs and DXTu were performed in 14 coeliacs with abnormal small bowel histology and in 12 patients with aspecific gastrointestinal complaints. Methods: In the SAT a solution of lactulose (L) and mannitol (M) was given to the fasting patient after which the L/M ratio was measured in 5 h urine by gas chromatography. In the DXTs and DXTu a solution of 25 g D-xylose was given to the fasting patient and blood was drawn at 0, 30 and 120 min and urine was collected for 5 h, respectively. Results: To measure the power in diagnosing CD of the SAT, DXTs 30 min, DXTs 120 min and DXTu, the test results were plotted in ROC curves and the areas under the curves (AUCs) were calculated. The AUCs were 0.97, 0.77, 0.78 and 0.63, respectively. Conclusion: In our opinion, the DXTs and DXTu are no longer useful in the investigation of mucosal function of the small bowel