Pre-endoscopic tachycardia predicts increased sedation dose and lower adenoma detection rate in patients undergoing endoscopic procedures: a case control study.

BACKGROUND: Tachycardia prior to endoscopic procedures is commonly encountered which reflect patient anxiety status. Despite this frequent occurrence, it is unclear if in a patient with tachycardia sedation dose should be modified. The aim of our study was to assess the effect of pre-endoscopic tachycardia on sedation dose. METHODS: A retrospective analysis of all patients who underwent upper endoscopy and colonoscopy at EMMS Nazareth hospital were performed. We excluded patients with diseases and medications affecting the heart rate. RESULTS: A total of 2855 patients were included in the study. Two-hundred and thirty-seven patients had tachycardia before endoscopy (8.3%, group A) as compared to 2618 (group B) patients who had heart rate ≤100 beats per minute. The mean dosage of propofol in group A was significantly higher (62.6±33.2 mg vs. 57.4±29.9 mg) than in group B (P=0.01). There was no difference in the cecal intubation rate among the two groups (P=0.9). Notably, the adenoma detection rate was significantly lower among group A patients as compared to group B (13.6% vs. 22.8%, P=0.02) patients. There were no sedation related complications. CONCLUSIONS: Tachycardia prior to endoscopic procedures was associated with higher sedative dosage and lower adenoma detection rate, however no major complications were recorded. These data should be taken into consideration to optimize procedure quality.

Autoimmune diseases in first- and second-degree relatives of patients with inflammatory bowel diseases: a case-control survey in Israel.

BACKGROUND: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic, relapsing, inflammatory diseases of the gastrointestinal tract with unknown etiology. IBD are complex, multi-factorial disorders, in which genetic factors play a major role, the so-called phenomenon of familial aggregation or clustering of IBD. A positive family history of IBD is often reported among CD and UC probands, with percentages depending on the geographic context in which the studies are carried out. Israel is a complex and pluralistic society comprising of two major ethno-national groups (Arabs and Jewish) and, as such, represents a unique living laboratory in which to test the role of genetic factors in the development of IBD as well as of associated autoimmune disorders (ADs). While some studies have found a lower prevalence of ADs among Arabs when compared to Jews, few studies directly compared the two ethnicities. METHODS: The present case-control study was designed to compare the rate of ADs in first- and second-degree relatives of IBD patients, stratified according to Jewish or Arabic ethnicity. RESULTS: We found that first-degree relatives of Jews patients had a higher risk of developing ADs (OR=1.89, P=0.0086). Classifying ADs into systemic and local (endocrinological, gastrointestinal, dermatological, and neurological) types, first-degree relatives of Jews patients had a higher OR of developing local ADs (OR=2.12, P=0.0056). CONCLUSIONS: Israeli Jewish IBD patients had more first-degree relatives with local ADs as compared to Arab patients.