Relationship among symptoms, mucosal injury, and acid exposure in gastroesophageal reflux disease.

BACKGROUND: Symptoms, endoscopy, and pH monitoring form the basis of diagnosis of gastroesophageal reflux disease (GERD). Their relationship was meaningful for primary care physicians, but still unclear. Our research aimed to compare questionnaire, endoscopy, and pH monitoring and to analyze their correlations. METHODS: Three hundred patients who underwent the Reflux Disease Questionnaire (RDQ), endoscopy, and esophageal 24-hour pH monitoring from March 2007 to December 2010 in Peking University People's Hospital were enrolled. We analyzed the characteristics of different investigations and their relationships. RESULTS: Male (OR for mild reflux esophagitis (RE) = 2.433, severe RE = 8.386), body mass index (BMI) (OR for mild RE = 1.222, severe RE = 1.297), and hernia (OR for mild RE = 6.059, severe RE = 17.547), were found to be the risk factors for RE; age (OR = 1.074) was correlated with severe RE. The consistency of questionnaire, endoscopy, and pH monitoring was poor: RDQ did not agree well with pH monitoring (κ = 0.061), nor with endoscopy (κ = 0.044); pH monitoring did not agree well with endoscopy (κ = 0.316). However, the severity of mucosa injury in RE was associated with pathological acid exposure (PAE): reflux episodes of >5 minutes (P = 0.035), the percentage time pH <4 (P = 0.017), and the DeMeester score (P = 0.016) increased significantly in patients with severe RE. Chest pain had poor relationship with RE or PAE. CONCLUSIONS: Male, age, BMI, and hernia were probably risk factors for esophagitis. RDQ, endoscopy, and pH monitoring have their own focus and reinforce each other in diagnosis. Of the GERD symptoms, chest pain had negative correlation with RE or PAE.

[Influences of diagnostic modes on an early diagnosis of colorectal cancer].

OBJECTIVE: To explore the influences of diagnostic modes of colorectal cancer (CRC) on an early diagnosis of CRC. METHODS: A total of 405 cases were randomly collected from 1798 CRC patients registered at our hospital from January 2000 to December 2010. A retrospective chart review was undertaken for all identified cases. Besides the demographics and tumor features, TNM stage was obtained from medical records and pathological forms. Other collected data were as follows: (1) Type of clinical examinations leading to diagnosis. (2) Diagnostic duration: including patient duration (period from initial symptoms to consulting a doctor and hospitalization duration (period from patient first seeing a doctor to a confirmed CRC case). (3) Diagnostic delay and its rate: diagnostic delay was identified as the diagnostic duration of over 30 days. We compared the different delay periods of 31 - 60, 61 - 90, 91 - 150 and > 150 days and its corresponding tumor stages at diagnosis. (4) Misdiagnosis and its rate: that CRC subjects were diagnosed and treated as other diseases for at least 30 days was identified as misdiagnosis. The t and Mann-Whitney U tests were performed for the quantitative data and χ(2) test for the qualitative data. RESULTS: Among the study subjects, 67.2% (270/402) CRC cases were examined by colonoscopy, 17.4 % (70/402) cases by CT scan or B ultrasound. The median diagnostic duration of CRC was 90 days (25% percentile: 40 days, 75% percentile: 210 days). The median patient duration was 30 days and median hospital duration 10 days. The overall misdiagnostic rate of CRC was 27.9% (112/401), higher (39.7%, 48/121) in right sited CRC than in left sited CRC (22.9%, 63/275) (χ(2) = 11.7, P = 0.00). 77.7% (313/403) cases had > 30 days diagnostic delay, 50.8% (156/307) delay attributable to the patients, while 29.0% (89/307) attributable to hospitals and 20.2% (62/307) attributable to both. The diagnostic duration of early-stage CRC and advanced-stage CRC appeared to be in the same length. On the other hand, no difference of TNM stage at the initial diagnosis was found in groups with different diagnostic durations of 31 - 60, 61 - 90, 91 - 150 and > 150 days (all P > 0.05). CONCLUSION: Colonoscopy is the most effective in the diagnosis of CRC. The median diagnostic time of CRC is 90 days. The phenomenon of its diagnostic delay often occurs. However, the delay is not a major cause for its advanced stage and a poor outcome. Its inherent biological characteristics may be more important.