Standardization and quality of endoscopy text reports in ulcerative colitis.

BACKGROUND AND STUDY AIMS: The text report is the primary tool for documenting endoscopic findings but there is no consensus on the content and structure of these reports. Therefore, at four Norwegian hospitals, the content of endoscopy reports concerning ulcerative colitis was assessed. Quality indices for the medical history of active ulcerative colitis and endoscopic signs of inflammation were determined, as well as technical items in the report. The effect of structured compared with free-text reporting was evaluated. MATERIALS AND METHODS: Endoscopy reports in 445 cases of ulcerative colitis were retrieved. Two of the hospitals used a semi-structured computerized documentation system, and two hospitals used transcription-based free-text reports. RESULTS: A substantial amount of information was missing in the majority of the reports. Individual endoscopic signs of inflammation were defined in 27 % - 77 % of the reports. Various clinical symptoms of active ulcerative colitis were defined in 1 % - 44 % of the reports. We observed a reminder effect of structured systems in that they prompted more informative reports. There was a tendency towards better free-text documentation in the transcription-based systems than in the free text of the semi-structured ones. CONCLUSIONS: There is a potential for improving the content, completeness and standardization of endoscopy reports. Standardization efforts may be a part of the solution.

Comparison of three triple regimens with omeprazole or ranitidine bismuth citrate for Helicobacter pylori eradication.

BACKGROUND: Regimens with ranitidine bismuth citrate (RBC) or omeprazole (O) are effective in eradicating Helicobacter pylori. This randomized, open, multicentre trial compares three different regimens with these drugs. METHODS: Consecutive H. pylori +ve outpatients were included. The alternative regimens were: 1) O 20 mg, clarithromycin (C) 250 mg and metronidazole (M) 500 mg (O.C.M), 2) RBC 400 mg, C 250 mg and M 500 mg (RBC.C.M), 3) RBC 400 mg, tetracycline (T) 1000 mg and M 500 mg [RBC.T.M]. All drugs were given twice daily for 7 days. H. pylori infection was assessed with H. pylori urea breath tests. RESULTS: 426 H. pylori +ve patients were included (mean age 58 years [range 18-88], male/female: 244/182). The eradication rates (intention to treat) in the O.C.M, RBC.C.M and RBC.T.M groups were 117/137 (85%), 141/146 (97%) and 117/143 (82%), respectively (P < 0.001, overall assessment). There were no significant differences in side effects between the alternatives. CONCLUSION: In this trial, RBC.C.M was the most effective one, it was well tolerated and compliance was satisfactory. RBC.T.M is an alternative to regimens with clarithromycin.

The natural restricturing process after dilatation of peptic esophageal strictures.

The study analyzes the natural esophageal restricturing process after dilatation of peptic esophageal strictures. Fifty patients (male/female: 30/20) with median age 71 years (range 20-87) with peptic esophageal strictures were dilated with hydrostatic balloons to 20 mm and followed up for 12 months. Stricture size was measured with a 'balloon pull-through' technique before the dilatations, and at follow-ups after 6 and 12 months. The restricturing rate was defined as the difference in stricture diameter at two measurements divided by the time interval. The mean restricturing rate during the first and last 6 month periods were 0.99 and 0.02 mm/month respectively (P < 0.001), and during the first 6 months the restricturing rates were 1.98 and 0.69 mm/month in patients redilated and not redilated respectively (P < 0.001). A tight stricture at the initial dilatation, a long history of reflux symptoms and a short history of dysphagia were all significantly related to a high restricturing during the first 6 months (P < 0.001).

[Bleeding ulcer disease. Its course before and after endoscopic sclerotherapy]. / Blødende ulcus-sykdom. Forløp før og etter innføring av endoskopisk skleroterapi.

The article presents a retrospective assessment of the outcome of bleeding gastrointestinal ulcer disease before and after the advent of endoscopic therapy. In 1985, 97 patients were urgently admitted to our county hospital with ventricular or duodenal ulcers. In 1992, 92 such patients were admitted. No patients received endoscopic therapy in 1985, while 15 patients received endoscopic injections with epinephrine combined with a sclerosant in 1992. 15 patients underwent urgent surgery in 1985 compared with seven patients in 1992. We conclude that endoscopic therapy for bleeding peptic ulceration has decreased the need for urgent surgery by 50%.

Long-term treatment with 300 mg ranitidine once daily after dilatation of peptic oesophageal strictures.

This clinical, double-blind, multicentre trial evaluates the long-term effect of ranitidine in patients dilated for peptic oesophageal strictures. Seventy-one consecutive outpatients were dilated with hydrostatic balloons to a diameter of 18-20 mm and randomized to a 1-year treatment with 300 mg ranitidine in the evening or with placebo. Endoscopies with measurement of the stricture size were performed before the initial dilatation, after 6 and 12 months, and in between when necessary. Symptoms and use of antacids were registered at inclusion and after 3, 6, 9, and 12 months. Thirteen patients were withdrawn before study end point. Fifteen of 30 (50%) in the ranitidine group and 11 of 28 (39.3%) in the placebo group were redilated. The difference in disfavour of ranitidine was 10.7% (95% confidence interval, -14.9; 36.2%). Nor were there any statistically significant differences between the treatment groups with regard to stricture size at end point, symptoms, or use of antacids. In conclusion, there is no evidence of any clinically significant effect of a 1-year treatment with 300 mg ranitidine once daily after dilatation of peptic oesophageal strictures.

Effect of cisapride on symptoms and biliary drainage in patients with postcholecystectomy syndrome.

The study evaluates the effect of 20 mg cisapride twice daily on symptoms and biliary drainage in patients with the postcholecystectomy syndrome. Nineteen patients, all female, went through a randomized, double-blind, placebo-controlled, crossover trial with two 4-week treatment periods separated by a 2-week washout period. Symptoms were registered on diary cards. Biliary drainage was studied with dynamic cholescintigraphy. The down slope of the time-activity curve (T1/2 and elimination index) was used as a measure of the biliary drainage. More symptoms were registered during cisapride therapy than with placebo. This unfavourable effect of cisapride was statistically significant in a subgroup of patients with postcholecystectomy complaints identical to the biliary pain they experienced during injection of contrast at the endoscopic retrograde cholangiopancreatographic examination. Cisapride statistically significantly hastened biliary drainage. The median T1/2 values were 24 and 28 min after cisapride and placebo, respectively (p less than 0.01). In conclusion, cisapride promoted biliary drainage in patients with the postcholecystectomy syndrome but had an unfavourable symptomatic effect in those with bile duct-triggered postcholecystectomy complaints.