Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis.

BACKGROUND: The Los Angeles (LA) grade of reflux esophagitis (A to D) is assumed to reflect severity of the underlying gastroesophageal reflux disease (GERD). Thus, LA-D esophagitis patients might be expected to have the most conditions predisposing to GERD (eg, obesity, hiatal hernia), and the highest frequency of GERD symptoms. GOALS: The main goal of this study is to compare clinical features of patients with the most severe (LA-D) and mildest (LA-A) grades of esophagitis. STUDY: For this comparative study, we searched our endoscopy database for patients diagnosed with LA-D or LA-A esophagitis, reviewed their endoscopic images, and reviewed medical records of the first 100 we confirmed to have LA-D or LA-A esophagitis. RESULTS: Compared with LA-A patients, LA-D patients were older (mean age, 65±13.4 vs. 56±13.4 y; P<0.001), had lower body mass index (25.9±5.6 vs. 29.4±5.3; P<0.001), were more frequently hospitalized (70% vs. 3%; P<0.001), and in the intensive care unit (15% vs. 0%; P<0.001), and had significantly more serious cardiopulmonary disorders and gastrointestinal bleeding. Conversely, a GERD history was more common in LA-A than LA-D patients (67% vs. 45%; P=0.002). Hiatal hernia was more frequent in LA-A patients than LA-D patients, but not significantly (48% vs. 36%; P=0.09). CONCLUSIONS: LA-D esophagitis primarily affects hospitalized, older, nonobese patients who often have serious comorbidities, and no history of GERD or hiatal hernia. In contrast, LA-A patients are generally younger, obese outpatients who often have a history of GERD and hiatal hernia without serious comorbidities. These profound differences between LA-A and LA-D patients suggest that factors other than typical GERD contribute to LA-D esophagitis pathogenesis.

Trend Analysis of Substance Abuse Treatment Admissions in New Orleans From 2000-2012: A Population-Based Comparison Pre- and Post-Hurricane Katrina.

BACKGROUND: Substance abuse treatment following a natural disaster is often met with challenges. If treatment is available, facilities may be unequipped to service an influx of patients or provide specialized care for unique populations. OBJECTIVES: This paper seeks to evaluate trends in substance abuse treatment over time and assess changes pre- and post-Hurricane Katrina. METHODS: Substance abuse treatment admission data (N = 42,678) from New Orleans, Louisiana, for years 2000 through 2012 were obtained from the Treatment Episode Data Set. Admissions were examined to evaluate demographic, socioeconomic, psychiatric, and criminality trends in substance abuse treatment and assess changes following Hurricane Katrina. RESULTS: Treatment admissions have decreased from 2000 to 2012. About one in five admissions had a psychiatric illness in addition to a substance abuse problem. A staggering 76% of admissions with a psychiatric illness were referred by the criminal justice system post-Katrina as compared to pre-Katrina. Rates of alcohol and marijuana admissions have remained stable from 2000 to 2012. Cocaine/crack admissions have declined and admissions who abused heroin have increased over time. CONCLUSIONS: Treatment admissions stabilized following Hurricane Katrina; however, since 2009, they have begun to decline. Targeted exploration of factors affecting admission to treatment in New Orleans with populations such as the homeless, those with a psychiatric illness in addition to a substance abuse problem, and those referred by the criminal justice system is essential. The results of this study assist in identifying variations in substance abuse treatment characteristics for those admitted to treatment in New Orleans.