Individualised PPI prescription in patients on combination antiplatelet therapy and upper gastrointestinal events after percutaneous coronary intervention: a cohort study

Zusammenfassung: GRUNDLAGEN: In einer Patientenkohorte, welche nach perkutaner koronarer Intervention (PCI) kombinierte Thrombozytenaggregationshemmung (Aspirin und Clopidogrel) erhielt, wurde die Wirksamkeit einer individualisierten PPI-Gabe zur Reduktion unerwünschter gastrointestinaler Ereignisse untersucht. METHODIK: Das gastrointestinale Risikofaktorprofil und andere Parameter wurden aus einer speziell angelegten elektronischen Datenbank extrahiert. Die Patienten wurden via standardisierten Fragebogen kontaktiert und bei Patienten mit unerwünschten gastrointestinalen Ereignissen wurde zusätzlich ein strukturiertes Telefoninterview durchgeführt. ERGEBNISSE: In einer Kohorte von 718 Patienten erhielten 87 (12,1 %) eine prophylaktische PPI-Therapie. Bei insgesamt 12 % wurden unerwünschte gastrointestinale Ereignisse gefunden, wobei 18,4 % eine PPI-Prophylaxe und 11,1 % kein PPI hatten (OR 1,80, P = 0,054). Eine Komedikation mit Steroiden war der hauptsächliche Risikofaktor für unerwünschte gastrointestinale Ereignissen (adjusted OR 5,45, P = 0,014). SCHLUSSFOLGERUNGEN: Die individualisierte PPI-Therapie basierend auf einer Risikoabschätzung für gastrointestinale Blutungsereignisse scheint ein effizientes Instrument zu sein, um gastrointestinale Ereignisse nach PCI zu minimiere

Functional outcome after perineal stapled prolapse resection for external rectal prolapse

<p>Abstract</p> <p>Background</p> <p>A new surgical technique, the Perineal Stapled Prolapse resection (PSP) for external rectal prolapse was introduced in a feasibility study in 2008. This study now presents the first results of a larger patient group with functional outcome in a mid-term follow-up.</p> <p>Methods</p> <p>From December 2007 to April 2009 PSP was performed by the same surgeon team on patients with external rectal prolapse. The prolapse was completely pulled out and then axially cut open with a linear stapler at three and nine o'clock in lithotomy position. Finally, the prolapse was resected stepwise with the curved Contour^®Transtar™ stapler at the prolapse's uptake. Perioperative morbidity and functional outcome were prospectively measured by appropriate scores.</p> <p>Results</p> <p>32 patients participated in the study; median age was 80 years (range 26-93). No intraoperative complications and 6.3% minor postoperative complications occurred. Median operation time was 30 minutes (15-65), hospital stay 5 days (2-19). Functional outcome data were available in 31 of the patients after a median follow-up of 6 months (4-22). Preoperative severe faecal incontinence disappeared postoperatively in 90% of patients with a reduction of the median Wexner score from 16 (4-20) to 1 (0-14) (<it>P </it>< 0.0001). No new incidence of constipation was reported.</p> <p>Conclusions</p> <p>The PSP is an elegant, fast and safe procedure, with good functional results.</p> <p>Trial registration</p> <p>ISRCTN68491191</p

Development and clinical validation of a blood test based on 29-gene expression for early detection of colorectal cancer

A blood test for colorectal cancer (CRC) screening is a valuable tool to for testing asymptomatic individuals and reducing CRC-related mortality. The objective of this study was to develop and validate a novel blood test able to differentiate patients with CRC and adenomatous polyps (AP) from individuals with a negative colonoscopy. Experimental Design: A case-control, multicenter clinical study was designed to collect blood samples from patients referred for colonoscopy or surgery. Predictive algorithms were developed on 75 controls, 61 large AP (LAP) {greater than or equal to}1cm, 45 CRC, and independently validated on 74 controls, 42 LAP, 52 CRC (23 Stages I-II) as well as on 245 cases including other colorectal findings and diseases other than CRC. The test is based on a 29-gene panel expressed in peripheral blood mononuclear cells alone or in combination with established plasma tumor markers. Results: The 29-gene algorithm detected CRC and LAP with a sensitivity of 79.5% and 55.4%, respectively, with 90.0% specificity. Combination with the protein tumor markers CEA and CYFRA21-2 resulted in a specificity increase (92.2%) with a sensitivity for CRC and LAP detection of 78.1% and 52.3%, respectively. Conclusions: We report the validation of a novel blood test, Colox®, for the detection of CRC and LAP based on a 29-gene panel and the CEA and CYFRA21-1 plasma biomarkers. The performance and convenience of this routine blood test provides physicians a useful tool to test average risk individuals unwilling to undergo upfront colonoscopy

Density, porosity and magnetic susceptibility of the Košice meteorite shower and homogeneity of its parent meteoroid

Bulk and grain density, porosity, and magnetic susceptibility of 67 individuals of Košice H chondrite fall were measured. The mean bulk and grain densities were determined to be 3.43 g/cm3 with standard deviation (s.d.) of 0.11 g/cm3 and 3.79 g/cm3 with s.d. 0.07 g/cm3, respectively. Porosity is in the range from 4.2 to 16.1%. The logarithm of the apparent magnetic susceptibility (in 10−9 m3/kg) shows narrow distribution from 5.17 to 5.49 with mean value at 5.35 with s.d. 0.08. These results indicate that all studied Košice meteorites are of the same composition down to ∼g scale without presence of foreign (non-H) clasts and are similar to other H chondrites. Košice is thus a homogeneous meteorite fall derived from a homogenous meteoroid.Peer reviewe

Correlation of esophageal clearance and dysphagia symptom assessment after treatment for achalasia.

BACKGROUND Early relapse after treatment of achalasia occurs in 10-32 % of patients. The best method to follow up these patients is not known. Symptoms often do not correlate with esophageal clearance: some patients are oligosymptomatic despite persistent esophageal stasis/dilatation. AIM The aim was to compare two methods of measurement of esophageal clearance (impedance manometry with barium swallow) in achalasia patients following treatment. Symptom assessment (Eckardt score/detailed dysphagia questions) was correlated with objective measurements of esophageal stasis (barium swallow and impedance manometry) in achalasia patients following treatment. METHODS Post-treatment patients were followed up after median 38.4 months (median range 1-144 months). Symptoms were quantified using the Eckardt score and detailed dysphagia questions. Timed barium swallow quantified distal esophageal retention 0.5, 1, 3, and 5 minutes after oral contrast and impedance manometry assessed total and segmental esophageal clearance during water/viscous swallows and free drinking (200 mL). RESULTS Thirty-two patients (7 women, age 48.3; range 20-74) completed all investigations. Bolus retention in the distal esophagus assessed by impedance correlated well with barium swallow. There were no differences in impedance and timed barium swallow parameters between patients with Eckardt score 0-2 points or ≥3 points. Nine (28%) patients had an Eckardt score ≥3 points and 21 (66%) had ≥1 point in the detailed dysphagia questions. Patients without any dysphagia history had lower barium column height and width at 3 and 5 minutes compared to those with ≥1 positive answer in the detailed dysphagia questions. Correlation between the Eckardt score and detailed dysphagia questions was moderately good (r = 0.546; p = 0.001). CONCLUSION A detailed history of esophageal dysphagia rather than the Eckardt score is more sensitive to detect oligosymptomatic patients with disturbed esophageal clearance. Impedance manometry correlates well with the timed-barium swallow examination and represents an alternative objective assessment as it avoids radiation exposure

The contribution of intrabolus pressure to symptoms induced by gastric banding

BACKGROUND & AIMS Mechanisms that ultimately lead to dysphagia are still not totally clear. Patients with laparoscopic gastric banding (LAGB) often complain about dysphagia, regurgitation and heartburn. Our aim was to evaluate the contribution of intrabolus pressure to symptoms of gastric banding. METHODS This study investigated 30 patients with LAGB before and 3 months after conversion to Roux-en-Y gastric bypass (RYGB), evaluating symptoms with a 7-point-Likert-scale and esophageal peristalsis, esophageal bolus transit and intrabolus pressure changes using combined impedance-manometry. RESULTS Conversion from LAGB to RYGB leads to a significant reduction in dysphagia (1.9 +/- 0.4 vs. 0.0 +/- 0.0; p< 0.01) and regurgitation (4.2 +/- 0.4 vs. 0.1 +/- 0.1; p< 0.01) symptom scores. For liquid swallows we found a modest but significant correlation between the intensity of dysphagia and intrabolus pressure (r=0.11; p<0.05) and the intensity of regurgitation and intrabolus pressure for viscous swallows (r=0.12, p<0.05) in patients with LAGB. There was a significant (p< 0.05) reduction in intrabolus pressure at 5 cm above LES before (liquid 10.6 +/-1.0; viscous 13.5 +/- 1.5) and after (liquid 6.4 +/- 0.6; viscous 10.5 +/- 0.9) conversion from LAGB to RYGB. CONCLUSION Current data suggest that intraesophageal pressure during bolus presence in the distal esophagus contributes to the development but not to the intensity of dysphagia and regurgitation

Individualised PPI prescription in patients on combination antiplatelet therapy and upper gastrointestinal events after percutaneous coronary intervention: a cohort study

GRUNDLAGEN: In einer Patientenkohorte, welche nach perkutaner koronarer Intervention (PCI) kombinierte Thrombozytenaggregationshemmung (Aspirin und Clopidogrel) erhielt, wurde die Wirksamkeit einer individualisierten PPI-Gabe zur Reduktion unerwünschter gastrointestinaler Ereignisse untersucht. METHODIK: Das gastrointestinale Risikofaktorprofil und andere Parameter wurden aus einer speziell angelegten elektronischen Datenbank extrahiert. Die Patienten wurden via standardisierten Fragebogen kontaktiert und bei Patienten mit unerwünschten gastrointestinalen Ereignissen wurde zusätzlich ein strukturiertes Telefoninterview durchgeführt. ERGEBNISSE: In einer Kohorte von 718 Patienten erhielten 87 (12,1 %) eine prophylaktische PPI-Therapie. Bei insgesamt 12 % wurden unerwünschte gastrointestinale Ereignisse gefunden, wobei 18,4 % eine PPI-Prophylaxe und 11,1 % kein PPI hatten (OR 1,80, P = 0,054). Eine Komedikation mit Steroiden war der hauptsächliche Risikofaktor für unerwünschte gastrointestinale Ereignissen (adjusted OR 5,45, P = 0,014). SCHLUSSFOLGERUNGEN: Die individualisierte PPI-Therapie basierend auf einer Risikoabschätzung für gastrointestinale Blutungsereignisse scheint ein effizientes Instrument zu sein, um gastrointestinale Ereignisse nach PCI zu minimieren. = BACKGROUND: We investigated the effect of individualised proton pump inhibitors (PPI) prescription on upper gastrointestinal adverse events in a cohort of patients who received combination antiplatelet therapy (aspirin and clopidogrel) after percutaneous coronary intervention (PCI). METHODS: Upper gastrointestinal risk factors and other parameters were extracted from a dedicated electronic database. Patients were contacted with a standardised questionnaire. A structured phone interview was performed in all patients with upper gastrointestinal adverse events. RESULTS: A cohort of 718 patients on combination therapy yielded 87 (12.1%) patients with prophylactic PPI treatment. Upper gastrointestinal adverse events occurred in 18.4% patients with and in 11.1% patients without prophylactic PPI (OR 1.80, P = 0.054). Co-treatment with corticosteroids was the main identifiable risk factor for upper gastrointestinal adverse events (adjusted OR 5.45, P = 0.014). CONCLUSIONS: Individualised prescription of PPI-prophylaxis after PCI in patients on combined antiplatelet therapy based on risk assessment for upper gastrointestinal bleeding seems to represent an effective measure to minimise upper gastrointestinal adverse events after PCI