US physician perspective on the use of biomarker and ctDNA testing in patients with melanoma.

New treatments have increased survival of patients with melanoma, and methods to monitor patients throughout the disease process are needed. Circulating tumor DNA (ctDNA) is a predictive and prognostic biomarker that may allow routine, real-time monitoring of disease status. We surveyed 44 US physicians to understand their preferences and practice patterns for biomarker and ctDNA testing in their patients with melanoma. Tumor biomarker testing was often ordered in stage IIIA-IV patients. Barriers to biomarker testing include insufficient tissue (60%) and lack of insurance coverage (54%). ctDNA testing was ordered by 16-18% of physicians for stages II-IV. Reasons for not using ctDNA testing included lack of prospective data (41%), ctDNA testing used for research only (18%), and others. Physicians (≥74%) believed that ctDNA assays could help with monitoring and treatment selection throughout the disease process. Physicians consider ctDNA testing potentially valuable for clinical decision-making but cited concerns that should be addressed.

Capsule endoscopy: impact on patient management.

Capsule endoscopy (CE) is an emerging technology in the diagnosis of a variety of gastrointestinal (GI) disorders. However, for CE to play a significant role in the care of GI disease, changes in patient management and positive patient outcomes must be seen. The objective of this study was to determine the impact of CE findings in the management of patients referred for CE. The study was a retrospective chart review of all patients who underwent CE at the University of South Alabama College of Medicine from April 2002 to May 2005. Demographic data was collected, as well as indications for CE. Findings included active bleeding (some within reach of a therapeutic endoscope), masses or polyps potentially missed by prior evaluation, and ulcers or lesions that would require a change in medical or surgical management (eg, the discontinuation of medications such as nonsteroidal anti-inflammatory drugs [NSAIDs] or a change in inflammatory bowel disease [IBD] treatment regimen, based on evidence of active disease from CE). A total of 210 cases were reviewed in this study. Overall, CE findings would lead to a change in patient management in 81 of 210 patients (38.6%). When the sample was restricted to the 93 patients with obscure-occult bleeding, 34 patients (36.6%) would have a change in patient management. Of the 79 obscure-overt bleeding patients, 33 patients (41.8%) would experience a change in patient management. Of the 36 patients who had CE for known or suspected IBD, 13 patients (36%) would have a patient management change based on capsule findings. This study demonstrates that CE meets a reasonable criteria for clinical utility in its ability to change patient management. In our study, 36-41.8% of patients with suspected small-bowel disorders would experience a change in patient management as a result of CE. Also of importance is the ability of CE to provide information that reassures patients and eliminates the need for further testing.

Durability of the diagnosis of irritable bowel syndrome based on clinical criteria.

Our purpose was to evaluate the durability of the diagnosis of irritable bowel syndrome (IBS) based on clinical criteria. The study population consisted of a cohort of previously published study patients evaluated for IBS between 1989 and 1992, who met the International Congress of Gastroenterology criteria for IBS. Patients were reinterviewed for cardinal features of IBS, Rome I, Rome II, and Manning criteria 10-13 years after the initial diagnosis. During the observational follow-up period, there were 75 patients, 14 males and 61 females, with a mean age of 47.5 +/- 11.3 years (SD; range, 20 to 75 years). Mean time of reinterview after initial diagnosis was 11.8 +/- 0.9 years (range, 10 to 13 years). None of the 75 patients had an abdominal condition which could have been mistaken for IBS. Other abdominal conditions diagnosed during this period included diverticulitis (five), uterine fibromyoma (three), and gallbladder disease (three). Sixty-nine patients (92%) did not consider their symptoms as resolved. Thirty-five (46.7%) had repeat structural evaluation of the colon for similar symptoms without any new diagnoses made. Twenty-six (34.7%) and 32 (42.7%) presently meet the Rome II and Rome I criteria for IBS, respectively. Clinicians are advised to use clinical criteria for a specific and durable diagnosis of IBS.