Gastric Anisakiasis Masquerading as Gastroesophageal Reflux Disease.

Anisakiasis of the gastrointestinal tract is caused by the consumption of raw or undercooked seafood infected with Anisakis larvae. Penetration of Anisakis larvae into the gastrointestinal mucosa leads to severe epigastric pain, nausea, and vomiting, usually within hours of ingestion of the parasite. Suspicion for gastrointestinal Anisakiasis should be raised in patients with a compatible dietary history. Definitive diagnosis can be made by direct visualization of larvae via endoscopic examination. Although symptoms are self-limiting, the removal of larvae by gastroscopy can hasten relief of symptoms. There are a large number of cases of gastric anisakiasis reported from Japan, Korea, and Western Europe, where it is customary to consume raw fish. Cases reported from the United States are less common, and given the nonspecific symptoms of anisakiasis, the diagnosis can be missed. We report a patient who presented with gastroesophageal reflux disease like symptoms that started after ingesting raw fish. He was found by esophagogastroduodenoscopy to have white, filiform worms penetrating into the wall of his stomach, consistent with a diagnosis of gastric anisakiasis.

Multicentre, prospective, randomised study comparing the diagnostic yield of colon capsule endoscopy versus CT colonography in a screening population (the TOPAZ study).

OBJECTIVE: Colon capsule endoscopy (CCE) has shown promise for colorectal neoplasia detection compared with optical colonoscopy (OC), but has not been compared with other screening tests in average risk screening patients. DESIGN: Patients 50 to 75 years of age (African Americans, 45-75 years) were randomised to CCE or CT colonography (CTC) and subsequent blinded OC. The primary endpoint was diagnostic yield of polyps ≥6 mm with CCE or CTC. Secondary endpoints included accuracy for size and histology, examination completeness, number/proportion of subjects with polyps and adenomas ≥6 mm and ≥10 mm, subject satisfaction and safety. RESULTS: From 320 enrolled subjects, data from 286 (89.4%) were evaluable. The proportion of subjects with any polyp ≥6 mm confirmed by OC was 31.6% for CCE versus 8.6% for CTC (pPr non-inferiority and superiority=0.999). The diagnostic yield of polyps ≥10 mm was 13.5% with CCE versus 6.3% with CTC (pPr non-inferiority=0.9954). The sensitivity and specificity of CCE for polyps ≥6 mm was 79.2% and 96.3% while that of CTC was 26.8% and 98.9%. The sensitivity and specificity of CCE for polyps ≥10 mm was 85.7% and 98.2% compared with 50% and 99.1% for CTC. Both tests were well tolerated/safe. CONCLUSION: CCE was superior to CTC for detection of polyps ≥6 mm and non-inferior for identification of polyps ≥10 mm. CCE should be considered comparable or superior to CTC as a colorectal neoplasia screening test, although neither test is as effective as OC. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov no: NCT02754661.