Crohn disease: effect on children's lifestyles.

BACKGROUND AND AIM: Crohn disease (CD) presents a range of physical, social, and psychological challenges, and can adversely affect the quality of life of those affected by it. The present study aimed to investigate the health-related quality of life of paediatric patients with CD in the Wellington region. Measuring health-related quality of life assists with resource allocation decisions and assesses various forms of interventions. METHODS: Patients ages 9 to 18 years with CD in the Wellington region were assessed using the IMPACT-III inflammatory bowel disease-specific questionnaire (n = 16). Eight participants filled it out and returned it by post; the remaining 8 filled it out in a meeting with the researcher and then underwent cognitive debriefing as part of a cross-cultural adaptation of the questionnaire. RESULTS: Of a maximum possible value of 175, the total health-related quality of life score had a mean value of 119.2 (standard deviation 30.7). Using Spearman rank correlation analysis, significant findings included a positive correlation between disease duration and quality of life (ρ = 0.534, sig. <0.05) and a negative correlation between disease activity and quality of life (ρ = -0.596, sig. <0.05). Qualitative information included difficulties in coping with long-term and unpleasant treatments and feelings of isolation. CONCLUSIONS: Children with Crohn disease in the Wellington region may benefit from age-specific social and psychological support. Because there is limited information on quality of life in young patients with CD in New Zealand, the results of the present study may be used as baseline data for future studies.

Functional gastrointestinal disorders in New Zealand.

BACKGROUND: Functional gastrointestinal disorders are common worldwide. AIM: To review functional gastrointestinal disorder prevalence, diagnosis and treatment in New Zealand. METHODS: A Medline search was performed to identify all published studies relating to prevalence, diagnosis and treatment of functional gastrointestinal disorders in New Zealand. RESULTS: Reflux prevalence is 30% and non-reflux dyspepsia is 34.2%. Helicobacter pylori prevalence varies considerably in NZ by geographical area and ethnicity and overall prevalence of infection is 24% in adults. 50% of patients with dyspepsia presenting for endoscopy in NZ will have no mucosal abnormality identified. National Dyspepsia Guidelines assist in management of patients. Guidelines exist for undifferentiated dyspepsia, Gastro-oesophageal Reflux Disease (GORD), H. pylori, peptic ulcer, NSAID's and gastrointestinal complications. Irritable Bowel Syndrome (IBS) is reported by 21% of adults. Symptoms were more than twice as frequent and severe in females than males. Access to colonoscopy for investigation of bowel symptoms is limited in NZ and priority is given to patients with "alarm features". Non-invasive markers of inflammation, such as faecal calprotectin, are being used to differentiate the patient with functional diarrhoea from inflammatory bowel disease. Treatment for irritable bowel symptoms is targeted to the predominant symptom. CONCLUSIONS: Functional gastrointestinal disorders are common in New Zealand. There is increasing awareness of dietary management for functional bowel symptoms.

An audit of combined multichannel intraluminal impedance manometry in the assessment of dysphagia.

BACKGROUND: Multichannel Intraluminal Impedance (MII) Monitoring is a method of examining oesophageal bolus transit without the need for radiation. In combination with oesophageal manometry it allows correlation of bolus transit with peristaltic activity. The clinical application of impedance manometry is still being refined. This audit looked to examine whether impedance manometry had advantages over standard manometry in assessment of patients with dysphagia. METHODS: 41 patients with the presenting symptom of dysphagia were assessed by combined MII and oesophageal manometry at a Wellington Hospital between February 2008 and December 2009. Each underwent manometry and MII using standardised techniques. FINDINGS: Achalasia was diagnosed in 23 patients (56.1%), Ineffective oesophageal motility (IEM) in 5 patients (12.2%), Diffuse oesophageal Spasm (DES) in 7 patients (17.1%), and Nutcracker oesophagus in 2 patients (4.9%). 4 patients had normal manometry studies (9.8%). All patients with achalasia, IEM, and DES had abnormal bolus transit. All patients with normal manometry had abnormal bolus transit. Both patients with nutcracker oesophagus had normal bolus transit. 4 patients with achalasia had undergone previous Hellers myotomy. Two of these patients (50.0%) now had normal LES relaxation pressures, but all four still had abnormal oesophageal peristalsis and abnormal bolus transit. INTERPRETATION: Multichannel Intraluminal Impedance manometry has advantages over standard manometry in characterising the physiological abnormalities associated with dysphagia. Patients in this study had severe defects including achalasia where bolus transit was invariably poor meaning little further information was gained. Extension of this study to include a wider group of patients with dysphagia may yield different results.

Eosinophilic oesophagitis: an emerging important cause for undiagnosed dysphagia.

BACKGROUND: The finding of an eosinophilic infiltration of the oesophageal epithelium has long been thought to be a result of gastro-oesophageal reflux disease. The association between this finding, an abnormal endoscopic appearance to the oesophagus with ridges and furrows in the oesophagus, and an association with recurrent food impactions in young men has also been described. It was first proposed that this was a distinct clinicopathological syndrome in 1993. Since that series, there have been increasing reports in the literature. AIMS AND METHODS: This retrospective case series describes eight patients with eosinophilic oesophagitis. The mode of presentation, history, endoscopic findings, and histopathology of this condition are discussed. The first of these cases is described to illustrate the features of this condition, the salient features from the remaining cases are presented in tabular form. CONCLUSIONS: The syndrome of eosinophilic oesophagitis is considered a rare cause of dysphagia, however we report eight recent presentations to our general gastroenterological practice in Wellington, New Zealand and propose that it may be an important cause for dysphagia where no diagnosis has been forthcoming.