Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy

Aim: To determine the effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. Methods: Consecutive patients who underwent capsule endoscopy during the 16-mo study period were either given 250 mg oral erythromycin, 1 h prior to swallowing the capsule endoscope or nothing. The gastric and small bowel transit time, and the small bowel image quality were compared. Results: Twenty-four patients received oral erythromycin whereas 14 patients were not given any prokinetic agent. Patients who received erythromycin had a significantly lower gastric transit time than control (16 min vs 70 min, P = 0.005), whereas the small bowel transit time was comparable between the two groups (227 min vs 183 min, P = 0.18). Incomplete small bowel examination was found in three patients of the control group and in one patient of the erythromycin group. There was no significant difference in the overall quality of small bowel images between the two groups. A marked reduction in gastric transit time was noted in two patients who had repeat capsule endoscopy after oral erythromycin. Conclusion: Use of oral erythromycin significantly reduces the gastric transit time of capsule endoscopy. © 2005 The WJG Press and Elsevier Inc. All rights reserved.published_or_final_versio

Reliability and validity of alternate step test times in subjects with chronic stroke

OBJECTIVE: (i) To investigate the intra-rater, inter-rater and test-retest reliability and minimal detectable change of the Alternate Step Test (AST) when assessing people with chronic stroke. (ii) To quantify the correlation between AST times and stroke-specific impairments. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation centre. PARTICIPANTS: A convenience sample of 86 participants: 45 with chronic stroke, and 41 healthy elderly subjects. METHODS: The AST was administered along with the Fugl-Meyer Lower Extremity Assessment (FMA-LE), the Five Times Sit-To-Stand Test (FTSTS), limits of stability (LOS) measurements, Berg Balance Scale (BBS) scores, Chinese-translated Activities-specific Balance Confidence Scale (ABC-C) ratings, and the Timed “Up and Go” test (TUG). RESULTS: Excellent intra-rater, inter-rater and test-retest reliability were found, with a minimal detectable change of 3.26 s. AST times were significantly associated with FMA-LE assessment, FTSTS times, LOS in the forward and backward directions and to the affected side, BBS ratings and TUG times. CONCLUSION: AST time is a reliable assessment tool that correlates with different stroke-specific impairments in people with chronic stroke.published_or_final_versio

Epidemiology of Acute Myocarditis/Pericarditis in Hong Kong Adolescents Following Comirnaty Vaccination

BACKGROUND: Age-specific incidence of acute myocarditis/pericarditis in adolescents following Comirnaty vaccination in Asia is lacking. This study aimed to study the clinical characteristics and incidence of acute myocarditis/pericarditis among Hong Kong adolescents following Comirnaty vaccination. METHODS: This is a population cohort study in Hong Kong that monitored adverse events following immunization through a pharmacovigilance system for COVID-19 vaccines. All adolescents aged between 12 and 17 years following Comirnaty vaccination were monitored under the COVID-19 vaccine Adverse Event Response and Evaluation Programme. The clinical characteristics and overall incidence of acute myocarditis/pericarditis in adolescents following Comirnaty vaccination were analysed. RESULTS: Between 14 June 2021 and 4 September 2021, 33 Chinese adolescents who developed acute myocarditis/pericarditis following Comirnaty vaccination were identified. 29 (87.88%) were males and 4 (12.12%) were females, with a median age of 15.25 years. 27 (81.82%) and 6 (18.18%) cases developed acute myocarditis/pericarditis after receiving the second and first dose, respectively. All cases are mild and required only conservative management.The overall incidence of acute myocarditis/pericarditis was 18.52 (95% Confidence Interval [CI], 11.67-29.01) per 100,000 persons vaccinated. The incidence after the first and second doses were 3.37 (95%CI 1.12-9.51) and 21.22 (95%CI 13.78-32.28 per 100,000 persons vaccinated, respectively. Among male adolescents, the incidence after the first and second doses were 5.57 (95% CI 2.38-12.53) and 37.32 (95% CI 26.98-51.25) per 100,000 persons vaccinated. CONCLUSIONS: There is a significant increase in the risk of acute myocarditis/pericarditis following Comirnaty vaccination among Chinese male adolescents, especially after the second dose

Wireless capsule endoscopy in Chinese patients with suspected small bowel diseases

Objective. To evaluate the use of wireless capsule endoscopy in Chinese patients. Design. Retrospective analysis. Setting. University teaching hospital, Hong Kong. Patients. Twenty-eight patients who had undergone wireless capsule endoscopy between December 2002 and December 2003. Main outcome measures. Diagnoses according to findings of capsule endoscopy and complications from the procedure. Results. The mean age of the 28 patients (15 men and 13 women) was 60.0 (standard deviation, 18.3) years. The indications for capsule endoscopy were obscure gastro-intestinal bleeding (n=16), unexplained iron-deficiency anaemia (n=9), and recurrent abdominal pain (n=3). Half of the patients had abnormal endoscopy findings that may account for their presenting symptoms. The most common abnormality was angioectasia of the small bowel. Small bowel ulcers and erosions were also noted in three patients with obscure bleeding. In contrast, none of the patients with recurrent abdominal pain had abnormal capsule endoscopy. No complications arose from the procedure. Conclusions. Wireless capsule endoscopy is a safe and useful mode of investigation for the diagnosis of obscure gastro-intestinal bleeding in Chinese patients.link_to_subscribed_fulltex

Initial treatment with lansoprazole in young dyspeptic patients with negative urea breath test result: A randomized controlled trial with 12-month follow-up

INTRODUCTION: Although empirical antisecretory drug therapy is recommended to young dyspeptic patients without alarming features, the effectiveness of this approach remains undetermined. We evaluated the long-term effects of an initial 12-wk course of lansoprazole in young dyspeptic patients without Helicobacter pylori (H. pylori) infection. METHODS: Patients who were less than 45 yr and presented with at least 3 months of dyspepsia in the absence of alarming features were eligible. They were offered 13C-urea breath test (UBT) to determine H. pylori status and all symptomatic patients with negative UBT were randomized to receive lansoprazole 30 mg daily or placebo for 12 wk. Those who had previous endoscopy or positive UBT were excluded. Primary end point was the proportion of patients with treatment failure, defined as worsening of global dyspeptic symptom, while on study medication. Patients were followed up for 26 wk for global dyspeptic symptom as determined by 7-point Likert scale. Quality-of-life assessment (SF-36), need of endoscopy, and utilization of other health-care services were monitored for 52 wk. RESULTS: A total of 157 dyspeptic patients were randomized. At the end of 12-wk treatment, the proportion of patients with treatment failure was similar in the lansoprazole (33.3%) and placebo (30.3%) groups (P = 0.74). Patients' global assessment of their dyspeptic symptom was comparable at all time points measured. There was also no significant difference in the SF-36 mental and physical summary scales. At the end of 52 wk, there was no difference in the proportion of patients who underwent endoscopy, had additional medical consultations, or used other nonstudy medications between the two groups. CONCLUSION: Lansoprazole is not effective in the initial management of young dyspeptic patients without H. pylori infection. © 2007 by Am. Coll. of Gastroenterology.link_to_subscribed_fulltex

Magnetic resonance colonography in the detection of colonic neoplasm in high-risk and average-risk individuals

OBJECTIVES: Magnetic resonance colonography (MRC) is a new noninvasive diagnostic modality for colorectal cancer. However, the use of MRC in the detection of colorectal neoplasm in average-risk individuals remains unknown. This study determined the performance and the patient's preference of MRC in the detection of colorectal neoplasm. METHODS: Both high-risk (i.e., symptoms suggestive of colorectal neoplasm, positive fecal occult blood test, history of colorectal cancer in one or more first-degree relatives) and average-risk (i.e., asymptomatic individuals >50 yr) individuals were recruited. MRC was performed immediately prior to conventional colonoscopy (CC) by using air inflation without contrast. The finding on CC together with histology was used as a gold standard. Patients' pain and discomfort score were recorded immediately and 24 h after the procedure. They were also asked about their preferences for the two procedures. RESULTS: A total of 165 patients (79 average risk and 86 high risk) were recruited. Eight patients had incomplete MRC and one patient had failed CC. Of the remaining 156 patients, 4 were found to have colonic cancer and 31 were found to have 67 polyps. MRC correctly identified 3 cancers (sensitivity 75%, specificity 99.3%) and 4 patients with colonic polyps (sensitivity 12.9% and specificity 97.6%). Sensitivity of MRC tended to be lower in polyps <10 mm in size and in average-risk individuals. The mean procedure time of CC was significantly shorter than MRC (13.6 ± 6.7 vs 20.6 ± 2.7 min, p < 0.001). Although there was no significant difference in the pain and discomfort scores of the 2 procedures, 75% of patients preferred CC to MRC. CONCLUSIONS: The performance of MRC when used in the detection of colonic neoplasm in average-risk individuals is unsatisfactory.link_to_subscribed_fulltex

Treatment of diarrhea-predominant irritable bowel syndrome with traditional Chinese herbal medicine: A randomized placebo-controlled trial

BACKGROUND: As there is no effective treatment for irritable bowel syndrome (IBS), many patients turn to traditional Chinese medicine (TCM) for possible cure. We investigated the therapeutic efficacy of an ancient herbal Chinese formula in patients with diarrhea-predominant IBS. METHODS: This was a randomized double-blinded placebo-controlled trial. Chinese IBS patients with predominant diarrhea symptoms that fulfilled Rome II criteria were recruited. The diagnosis was verified by a TCM herbalist using TCM criteria. Eligible patients were randomized to receive a standard preparation of TCM extracts that contained 11 herbs or placebo with similar appearance and taste for 8 wk after a 2-wk run-in period. Patients were followed up for an additional 8 wk post-treatment. Primary outcome was patient's global symptom assessment. Other outcome measures included individual IBS symptom scores and health-related quality of life (short form 36). RESULTS: One hundred nineteen patients were randomized: 60 to receive TCM and 59 to receive placebo. There was no significant difference in the proportion of patients with global symptom improvement between the TCM and placebo groups at week 8 (35% vs 44.1%, p = 0.38) and at week 16 (31.7% vs 33.9%, p = 0.62). Moreover, there was no difference in individual symptom scores and the quality-of-life assessment between the two groups at all time points. BACKGROUND: The use of this herbal formulation for diarrhea-predominant IBS did not lead to global symptom improvement. Further controlled clinical studies may be necessary to characterize the role of TCM in the management of IBS. © 2006 by Am. Coll. of Gastroenterology. Published by Blackwell Publishing.link_to_subscribed_fulltex