Esophageal Motility Abnormalities in Lung Transplant Recipients With Esophageal Acid Reflux Are Different From Matched Controls.

Background/Aims: There is an increased incidence of gastroesophageal reflux disease (GERD) after lung transplantation (LT) that can be associated with graft dysfunction. It is unclear if the underlying esophageal motility changes in GERD are different following LT. This study aimed to use esophageal high-resolution manometry (HRM) to explore GERD mechanisms in LT recipients compared to matched controls. Methods: This was a retrospective study including patients with pathologic acid reflux who underwent HRM and pH testing at our healthcare facility July 2012 to October 2019. The study included 12 LT recipients and 36 controls. Controls were matched in a 1:3 ratio for age, gender, and acid exposure time (AET). Results: LT recipients had less hypotensive esophagogastric junction (EGJ) (mean EGJ-contractile integral 89.2 mmHg/cm in LT vs 33.9 mmHg/cm in controls, P < 0.001). AET correlated with distal contractile integral and total EGJ-contractile integral only in LT group (r = -0.79, P = 0.002 and r = -0.57, P = 0.051, respectively). Conclusions: Following LT, acid reflux is characterized by a less hypotensive EGJ compared to controls with similar AET. The strongest correlation with AET after LT was found to be esophageal peristaltic vigor. These results add to the understanding of reflux after LT and may help tailor an individualized treatment plan.

Are primary care providers uncomfortable providing routine preventive care for inflammatory bowel disease patients?

BACKGROUND AND AIMS: Those with chronic diseases, including inflammatory bowel disease (IBD), often do not receive preventive care at the same rate as the general population. Attitudes of primary care providers could be key factors in the receipt of preventive care. METHODS: We surveyed attendees of a family medicine review course. The survey contained nine demographic items, four items to assess exposure to and comfort level with IBD, and six clinical vignettes. RESULTS: Of surveys, 36% (61/169) were returned. The large majority were males practicing outpatient family medicine. Mean age was 51 years, and 48% reported a mostly rural practice. Of subjects, 10% reported either having IBD themselves or having a close associate or relative with IBD. Only 37% of subjects felt comfortable providing primary care across a range of illness severity. Forty-six percent reported moderate or high exposure to IBD. For the case vignettes, the overall highest rate of endorsement of the active role was 84% for a case related to stage I hypertension, while the lowest rate was 30% for an item relating to vaccination for immunosuppressed persons. We assessed the following predictors of comfort level and active role responses and found no significant associations: age, gender, years of medical practice, and close contact with IBD. CONCLUSIONS: Our study suggests that family medicine practitioners often do not feel comfortable providing care to IBD patients. Lack of familiarity with IBD medications may be a key factor.

Poor comprehension of colon preparation process in an Appalachian population.

Clear liquids are often part of colonoscopy preparation instructions, regardless of the active cleansing agent. Poor understanding of this facet may yield poor preparation with delays in management. We studied comprehension of this facet of colon preparation in an Appalachian population. Our survey contained demographic items and a list of food items from which subjects could select clear liquids. In Phase I, no prompting was given. In Phase II, subjects reviewed the definition of clear liquids and examples a few minutes before the survey. For Phase III, the survey contained the definition of a clear liquid and examples. Persons about to undergo colonoscopy and companions who escorted them were surveyed, since many persons have help during the preparation process. With the Fisher exact probability test, we compared the association of accurately selecting clear liquids ≥ or <80% of the time with education > or ≤12th grade, age, gender, and subject's stated understanding of preparation. Mean age for all subjects was 52 years and 59% of subjects were female. The majority had ≤12 years of education. Most subjects reported understanding their preparation instructions and yet the minority had ≥80% accuracy on clear liquid selection (range 6%-16%). Phases I-III represent a continuum of progressively more accessible information about clear liquids. Comparison across the 3 phases, for both patients and companions, did not reveal significantly improved clear liquid selection. Multivariate analyses of the above variables, with % correct answer as the dependent variable for all the subgroups, did not reveal any significant associations. Persons from Appalachia do not seem to understand a key portion of the colon preparation process. We demonstrate no significant predictors of understanding the clear liquid aspect of colon preparation. Simple measures to augment comprehension have no clinically significant effect.

Receipt of preventive health services by IBD patients is significantly lower than by primary care patients.

BACKGROUND: Persons with chronic diseases often do not receive preventive care at the same rate as the general population. Reasons for this are not clear. We conducted a cross-sectional survey of patients with inflammatory bowel disease (IBD) and controls to assess receipt of 10 preventive health services. METHODS: From March through October 2006, IBD outpatients and primary care outpatients at the University of Kentucky (UK) were surveyed by trained clinicians, using chart data to augment patient response. A second sample of IBD patients from the University of Chicago was studied with a self-administered survey. RESULTS: One hundred and seventeen IBD subjects were enrolled at UK, 125 IBD subjects were enrolled at UCH, and 100 control subjects were recruited from UK primary care clinics. The overall age-/sex-adjusted screening rate, as measured by the screening index, was significantly lower in UK IBD subjects than in UK controls (75.1% versus 83.9%, P = 0.0002). The UCH data showed a 67% overall age-/sex-adjusted screening rate. After adjusting for insurance status, the difference in screening rates was still lower for IBD patients than for controls (71% versus 78%; P = 0.022). Neither disease type nor disease control rating predicted screening rate. CONCLUSIONS: Our data suggest IBD patients do not receive preventive services at the same rate as general medical patients. Preventive care is a facet of global IBD management that deserves further study.

Gastroduodenal Crohn's disease is associated with NOD2/CARD15 gene polymorphisms, particularly L1007P homozygosity.

Limited data exist on the specific association between gastroduodenal Crohn's disease (GDCD) and NOD2/CARD15 gene polymorphisms. The aim of this study was to assess the association between NOD2 polymorphisms and GDCD, and to assess the specific association between each of the 3 major allelic variants G908R, L1007P, and R702W and the clinical features of Crohn's disease. We retrospectively reviewed the records of 202 patients with confirmed Crohn's disease and complete data was performed. Seventy-one patients (35%) had at least 1 allelic variant: 55 had 1 variant, 4 were homozygous for L1007fs, 2 homozygous for R702W, and 10 were compound heterozygous. Eighteen patients with confirmed GDCD were identified; 10 (56%) had wild type, 4 (22%) had 1 variant, and 4 (22%) had 2 allelic variants (2 were L1007P homozygous and 2 compound heterozygous). Compared to patients without gastroduodenal involvement, those with GDCD were more likely to have 2 allelic variants (22% vs. 6%; odds ratio [OR] 2.7; 95% confidence interval [CI] 1.6-7.3) and to be homozygous for L1007P (11% vs. 1%; OR 5.2; 95% CI 2.5-9.4). G908R heterozygosity was associated with ileal involvement (OR 1.4; 95% CI 1.1-2.9) and smoking habits (OR 2.4; 95% CI 1.2-3.8), whereas L1007P homozygosity was associated with GDCD (OR 5.8; 95% CI 2.6-10.8). L1007P variation was associated with younger age at diagnosis as well. There was no specific association between R702W homo- or heterozygosity and any of the characteristics examined. In conclusion, GDCD is associated with double dose of the NOD2/CARD15 gene variants, particularly L1007P homozygosity. There is evidence of specific variant-phenotype associations. G908R heterozygosity is associated with ileal involvement and smoking, whereas L1007P homozygosity is strongly associated with GDCD and younger age at diagnosis.