Use of Bristol Stool Form Scale to predict the adequacy of bowel preparation - a prospective study.

AIM: Inadequate bowel preparation continues to be a substantial problem for colonoscopy. The seven-point Bristol Stool Form Scale (BSFS) has been associated with delayed colonic transit in adults. We evaluated the utility of the BSFS to identify patients more likely to present with an inadequate preparation. METHOD: Two large community-based academic medical centres in New Jersey, USA, studied a prospective cohort of 411 consecutive patients undergoing outpatient colonoscopy who were prescribed similar bowel preparations. The BSFS and several other study variables were collected by gastroenterology fellows during an outpatient visit prior to scheduling colonoscopy. All colonoscopy examinations were performed in the morning by a gastroenterologist who graded the adequacy of bowel preparation. Inadequate preparation was defined as one resulting in a repeat colonoscopy at a shorter time interval than would generally be recommended based solely on risk factors or pathological findings. The ability of study variables to discriminate those who did or did not have an adequate preparation was summarized by the c-statistic. The relationship between variables that provided some discrimination and the probability of an adequate preparation was modelled using logistic regression. RESULTS: The mean age of the study sample was 56 ± 8 (SD) years and 63% were women. Bowel preparation was adequate in 337 (82%) of the patients. The BSFS ratings ranged from 1 to 7. The score was <3 in 144 (35%) indicating lower gastrointestinal motility. There was a statistically significant association between the score and the probability of an adequate bowel preparation (odds ratio 1.4; 95% confidence interval 1.2-1.7; P < 0.001) and the c-statistic was 0.64 (0.58-0.70). CONCLUSION: Use of the BSFS may help identify patients for whom standard bowel preparation most probably will not be adequate.

Acute diverticulitis in the young: a 5-year retrospective study of risk factors, clinical presentation and complications.

AIM: Acute diverticulitis in the young is considered to follow an aggressive course, but there is a paucity of data on factors that could determine a complicated course. METHOD: All patients of 18-40 years of age diagnosed with acute diverticulitis from 1 January 2003 to 31 December 2008 were identified. Patients were included if they had computed tomography (CT) evidence of acute diverticulitis and at least one clinical feature. Demographics, body mass index, presenting symptoms/signs, CT location of diverticulitis and complications were noted. Fisher's exact test and a multivariate logistic regression analysis model were used to detect possible associations between clinical variables and complications. RESULTS: There were 76 patients, of whom 23 (30.2%) had fever (>38°C) and 52 (68.4%) had leucocytosis (≥11000/mm(3)). The majority [48 (63.1%)] were obese. A total of 29 (38.1%) patients had complications, with perforation [18 (62%)] being the most common. Twelve (15.7%) required surgical or radiological intervention. Fever of ≥38.0°C and a body mass index of ≥25 were independently associated with complications (P=0.04 and P=0.03, respectively). CONCLUSION: Fever (≥38°C) at presentation and a body mass index of ≥25 may help to predict a complicated course of acute diverticulitis in patients under 40 years of age.

A rare case report of spontaneous resolution of hepatic portal venous gas associated with cocaine-induced intestinal ischemia.

Hepatic portal venous gas (HPVG) is a rare disease entity. It is an ominous finding, usually, associated with intraabdominal ischemic necrosis. It frequently requires emergent surgical intervention. Herein, we present a case of a patient who complained of intense abdominal pain, with radiographic findings of HPVG as a result of cocaine-induced vascular insufficiency. After 5 h of nonoperative and conservative management, the HPVG spontaneously resolved. The patient clinically improved and was discharged home in a stable condition.