Subject(s)
Gastrointestinal Hemorrhage/etiology , Ileal Neoplasms/complications , Female , Humans , Middle AgedSubject(s)
Esophageal Motility Disorders/complications , Gastroesophageal Reflux/complications , Aged , Anti-Ulcer Agents/therapeutic use , Deglutition Disorders/drug therapy , Deglutition Disorders/etiology , Esophageal Motility Disorders/diagnosis , Esophageal Motility Disorders/drug therapy , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/drug therapy , Humans , Male , Omeprazole/therapeutic use , Vomiting/drug therapy , Vomiting/etiologyABSTRACT
BACKGROUND AND STUDY AIM: Polyp miss rates during colonoscopy have been calculated in a few tandem or back-to-back colonoscopy studies. Our objective was to assess the adenoma miss rate while limiting technique or operator expertise biases, i. e. by performing a large multicenter study, with same-day back-to-back video colonoscopy, done by two different operators in randomized order and blinded to the other examination. PATIENTS AND METHODS: 294 patients at 11 centers were included. Among the 286 analyzable tandem colonoscopies, miss rates were calculated in both a lesion- and patient-based analysis. Each of these rates was determined for polyps overall, for adenomas, and then for lesions larger than 5 mm, and for advanced adenomas. Univariate and logistic regression analysis were performed to define independent variables associated with missed polyps or adenomas. RESULTS: The miss rates for polyps, adenomas, polyps > or = 5 mm, adenomas > or = 5 mm, and advanced adenomas were, respectively, 28 %, 20 %, 12 %, 9 % and 11 %. None of the masses with a carcinomatous (n = 3) or carcinoid component (n = 1) was missed. The specific lesion miss rates for patients with polyps and adenomas were respectively 36 % and 26 % but the corresponding rates were 23 % and 9.4 % when calculated for all 286 patients. The diameter (1-mm increments) and number of polyps (> or = 3) were independently associated with a lower polyp miss rate, whereas sessile or flat shape and left location were significantly associated with a higher miss rate. Adequacy of cleansing, presence of diverticula, and duration of withdrawal for the first procedure were not associated with adenoma miss rate. CONCLUSIONS: We confirm a significant miss rate for polyps or adenoma during colonoscopy. Detection of flat polyps is an issue that must be focused on to improve the quality of colonoscopy.
Subject(s)
Colonic Polyps/diagnosis , Colonoscopy/methods , Diagnostic Errors , Adult , Aged , Aged, 80 and over , Female , Humans , Logistic Models , Male , Middle Aged , Prospective Studies , Video RecordingABSTRACT
Gastro-oesophageal reflux events should be related to gastric contents. The goal of this study was to determine the relationship between gastric pH and the nature of reflux events. Ambulatory oesophageal pH-impedance and gastric pH monitoring was performed in 41 patients [29 off and 12 on proton pump inhibitor (PPI) therapy] and 12 controls. The mean gastric pH was measured within 2 min around the reflux episodes, 10 cm below the cardia. Acid reflux events occurred more frequently at gastric pH <4 (89%) than non-acid reflux events (63%, P < 0.0001). Acid reflux events extended more frequently 15 cm above the lower oesophageal sphincter (LOS; 34%) than non-acid reflux episodes (24%, P = 0.005). Gastric pH was significantly lower during interprandial reflux events than during postprandial ones in the three groups (P < 0.001). A positive correlation was found between gastric pH and the nadir oesophageal pH during reflux events in the three groups: this correlation was more significant in patients on PPI therapy. We conclude that most acid and non-acid reflux episodes occur at acid gastric pH, as measured 10 cm below the LOS. This measure does not appear a good predictor of the pH of reflux events.
Subject(s)
Esophageal pH Monitoring , Gastric Acid/metabolism , Gastric Acidity Determination , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/metabolism , Adult , Aged , Anti-Ulcer Agents/therapeutic use , Cardia , Electric Impedance , Female , Gastroesophageal Reflux/drug therapy , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , Proton Pump InhibitorsABSTRACT
BACKGROUND: Laparoscopic fundoplication effectively controls symptoms of gastro-oesophageal reflux disease (GORD) and decreases acid reflux, but its impact on non-acid reflux is not known. The aim of the study was to characterize reflux events after fundoplication using oesophageal combined multichannel intraluminal impedance (MII)-pH monitoring, to demonstrate its efficacy on acid as well as non-acid reflux events. METHODS: Thirty-six patients in whom ambulatory MII-pH recording was performed after laparoscopic fundoplication were reviewed retrospectively. There were 23 symptomatic and 13 asymptomatic patients, whose results were compared with those of 72 healthy volunteers. RESULTS: Oesophageal acid exposure was low in all but one operated patient, and there was no difference between those with and without symptoms. The median number of reflux events over 24 h was lower after fundoplication (11 in operated patients compared with 44 in healthy volunteers; P < 0.001). Almost all reflux events were non-acid after surgery whereas acid reflux episodes were predominant in healthy volunteers. Proximal reflux events were less common in operated patients. Non-acid reflux events were significantly associated with symptoms after surgery in some patients. CONCLUSION: Fundoplication restores a competent barrier for all types of reflux. Reflux events are mostly non-acid after surgery, and such events may be positively correlated with symptoms.