Relationship of faecal calprotectin and long-term outcomes in Finnish patients with Crohn's disease: retrospective multi-centre chart review study.

Background and Aims: A retrospective non-interventional, multi-centre patient chart review study was conducted to investigate the association of faecal calprotectin (FC) 1 year (±2 months) after biological therapy initiation with composite event-free survival (CEFS) consisting of surgical procedures, corticosteroid initiation, treatment failure or dose increase in patients with Crohn's disease (CD). In addition, the correlations of FC and other tests of disease activity were assessed.Materials and methods: Data on Finnish CD patients initiating a biological therapy between 2010 and 2016, were collected. The association of FC and CEFS was analysed with Kaplan-Meier and Cox proportional hazard modelling. The correlations were tested with Pearson's test.Results: Biological therapy was initiated in 186 patients, of which 87 (46.8%) had FC results available at 1 year and 80 had follow-up exceeding 14 months. The characteristics of patients with and without FC results were similar. Patients with elevated FC (>250 µg/g) had a significantly increased risk of experiencing composite event (HR 3.4, 95% CI: 1.3-8.9; p = .013) when compared to patients with normal FC (FC ≤ 100). No such risk was observed in patients with intermediately increased FC level (100 µg/g < FC ≤ 250 µg/g) (HR 2.2 (95% CI: 0.8-6.2; p = .120). FC value had significant positive correlation with CRP, HBI and leukocyte values when measured at similar timepoints.Conclusions: Elevated level of FC approximately 1 year after the initiation of biological therapy was associated with an increased risk of either surgical procedures, corticosteroid initiation, treatment failure or dose increase (i.e. composite outcome) in patients with CD.

Build your own multipurpose, economically priced portable stereo microscope.

Binocular loupes and stereo microscopes are expensive items of equipment. However, inexpensive operating microscopes (ophthalmic) with coaxial illumination have been constructed for use in developing countries, where there is little medical funding. We describe one method of transforming economically priced pocket binoculars into a portable stereo microscope with nearly coaxial illumination.

Epidemiology and aetiology of middle ear cholesteatoma.

A total of 500 patients with cholesteatoma diagnosed and operated during 1982-91 in the region of Tampere University Hospital and Mikkeli Central Hospital in Finland were analysed retrospectively. The mean annual incidence was 9.2 per 100,000 inhabitants (range 3.7-13.9) and during the study period the annual incidence decreased significantly. The incidence was higher among males under the age of 50 years. There was no accumulation of cholesteatoma diseases in lower social groups. The majority (72.4%) of cholesteatoma patients had suffered from otitis media episodes. Tympanostomy was carried out in 10.2% and adenoidectomy or adenotonsillectomy in 15.9% of all cholesteatoma ears prior to cholesteatoma surgery. Cholesteatoma behind an intact tympanic membrane with no history of otitis media was verified in 0.6% of patients and in cleft palate patients in 8%. In this study, 13.2% of patients had ear trauma or ear operation in anamnes.

Lifestyle, stress, and genes in peptic ulcer disease: a nationwide twin cohort study.

BACKGROUND: The familial accumulation of peptic ulcer disease observed in several studies may be attributable to genetic effects, aggregation of environmental exposure (shared environment), or both. The intrafamilial spread of Helicobacter pylori infection has raised the question whether shared environment could explain the familial aggregation of peptic ulcer disease rather than genetic similarity of family members. OBJECTIVE: To examine the contribution of genetic and environmental factors to the pathogenesis of peptic ulcer disease in a nationwide population-based cohort of adult twins. METHODS: The Finnish Twin Cohort consists of all same-sexed twin pairs born before 1958 with both twins alive in 1975. The total number of twin pairs is 13888, of whom 4307 are monozygotic (MZ) and 9581 are dizygotic (DZ) twins. Questionnaire surveys of twins were carried out in 1975, 1981, and 1990, including medical and psychosocial questions. One question asked whether a physician had ever made a diagnosis of gastric or duodenal ulcer. In addition, hospital discharge data from 1972 to 1991 were linked with the twin cohort to obtain those twin individuals who had been treated for gastric or duodenal ulcer. The prevalence of and concordance for peptic ulcer disease were examined in MZ and DZ twins. Model-fitting analysis was used to specify the relative roles of genetic and environmental factors. The contribution of lifestyle factors and stress was examined prospectively in an incidence study and by comparison of discordant pairs. RESULTS: The prevalence of peptic ulcer disease was 6.2% in men and 2.8% in women in 1975. There were 63 MZ and 86 DZ pairs concordant for peptic ulcer disease. Concordance for disease was significantly higher in MZ than in DZ twin pairs; the probandwise concordance rate was 23.6% (95% confidence interval [CI], 20.9%-26.3%) in MZ twins and 14.8% (95% CI, 13.3%-16.3%) in DZ twins. In the model-fitting analysis, a model with both additive genetic and unshared environmental effects had the best goodness-of-fit. Thirty-nine percent (95% CI, 32%-47%) of the liability to peptic ulcer disease was explained by genetic factors and 61% (95% CI, 53%-68%) by individual environmental factors. In the incidence study (logistic regression analysis of the entire cohort initially free of peptic ulcer disease, with subjects diagnosed as having peptic ulcer after 1975 as cases), current smoking (relative risk, 2.2; 95% CI, 1.5-3.2) and high stress levels (relative risk, 3.2; 95% CI, 1.4-7.6) in men and regular use of analgesics (relative risk, 3.3; 95% CI, 1.3-8.1) in women predicted peptic ulcer disease during the follow-up from 1976 to 1991. In the analysis of discordant pairs, smoking in men and regular use of analgesics in both sexes were predictors of peptic ulcer disease. CONCLUSIONS: The questionnaire and hospital usage data on peptic ulcer disease in the population-based twin cohort suggest that the familial aggregation of the disease is modest, and attributable almost solely to genetic factors. Environmental effects not shared by family members were significant predictors of disease, and they were attributable to smoking and stress in men and the use of analgesics in women. The minor effects of shared environment to disease liability do not support the concept that the clustering of risk factors, such as H pylori infection, would explain the familial accumulation of peptic ulcer disease.

Characteristics of Helicobacter pylori-negative and -positive peptic ulcer disease.

OBJECTIVE: To examine histological and other features of patients with Helicobacter pylori-positive (HP+) and -negative (HP-) peptic ulcers and characterize typical features of peptic ulcer in elderly patients. METHODS: 137 consecutive patients with peptic ulcer and 70 patients with dyspepsia were studied over 24 months. Endoscopy and a structured personal interview were carried out in all patients. Three histological specimens were obtained from the antral mucosa. RESULTS: The mean age of ulcer patients was 62.4 (SD 15.7) years and that of dyspepsia patients was 56.9 (SD 18.1) years (P=0.026). Of patients with HP- ulcers, 80.6% were aged 65 years or over; the corresponding proportion of patients with HP+ ulcer was 33.7% (P=0.0001). The use of non-steroidal anti-inflammatory analgesics was more common among those whose ulcer was HP- (69.4% vs 33%, P=0.0002). The occurrence of antral inflammation, atrophy and intestinal metaplasia did not differ between those with HP- and HP+ ulcers, but activity of gastritis was more common in HP+ than in HP- patients (94.9% vs 47.1%, P=0.0001). In the logistic regression analysis, HP- peptic ulcer disease was independently associated with older age, bile reflux, the use of non-steroidal anti-inflammatory analgesics and intestinal metaplasia, while HP+ ulcer disease was associated with active inflammation of the antral mucosa and tendency to ulcer recurrence. CONCLUSION: HP+ and HP- peptic ulcers have well-defined characteristics which probably reflect their different pathogenesis. Peptic ulcer disease of elderly people is mostly HP-.

Serum pepsinogen I and gastrin in peptic ulcer patients using nonsteroidal anti-inflammatory drugs.

BACKGROUND/AIMS: The inhibition of prostaglandin synthesis induced by nonsteroidal anti-inflammatory drugs (NSAIDs) have very complex effects on the gastric mucosa. They, for instance, inhibit mucosal cell proliferation in gastric ulcer patients. The aim of this study was to investigate whether these effects manifest as changes in pepsinogen I and gastrin concentrations. METHODOLOGY: Fasting serum pepsinogen I and gastrin samples were collected from 53 consecutive Helicobacter pylori (HP) positive peptic ulcer patients. Ulcer was diagnosed by endoscopy. The presence of HP was determined from the histological specimen taken from the antral mucosa. Histological changes in the gastric mucosa were evaluated according to the Sydney system. A structured personal interview was carried out with all patients at endoscopy, including detailed questions on the daily use of NSAIDs. Patients were divided into two groups according to their use of NSAIDs. RESULTS: The age-adjusted mean pepsinogen I concentration was significantly lower in patients who used NSAIDs compared to those who did not (91 vs 127 ng/l, p = 0.0035). There was no difference in the mean gastrin concentration between these two groups (91 vs 86 micrograms/l, p = 0.74). CONCLUSIONS: Serum pepsinogen I concentration was lower in HP positive peptic ulcer patients who used NSAIDs compared to those who did not.

Clinical presentation of peptic ulcer in the elderly.

The aim of this study was to determine the age-related characteristics of peptic-ulcer patients. A total of 125 consecutive patients (63 men and 62 women) with peptic ulcer were studied prospectively. The ulcers were diagnosed at endoscopy. The mean age of patients was 62 years (57 years in men and 68 in women). Patients were asked about their use of nonsteroidal anti-inflammatory drugs (NSAIDs). The main symptom, the duration of symptoms, the ulcer location and size, and the presence of Helicobacter pylori (HP) from the histologic specimen were recorded. Ulcer complications such as bleeding or perforation were also noted. These parameters were compared in two age groups: 65 years or under (n = 65) and over 65 years (n = 60). In the older age group, duodenal ulcer was less common (42 vs. 66%, p = 0.008) and typical epigastric pain was rare (35 vs. 91%, p < 0.001). Ulcer bleeding was present more commonly in the older age group (50 vs. 14%, p < 0.001). The duration of symptoms was shortest in patients who used NSAIDs, especially among older patients. Elderly patients also had an atypical location more often (39 vs. 15%, p = 0.003). After adjustment for use of NSAIDs, these characteristics remained among the elderly. The presence of HP was less common in the older age group (56 vs. 92%, p < 0.001). Furthermore, in the group of elderly patients who did not use NSAIDs, 35% were HP-negative. In conclusion, the presentation of peptic ulcer in the elderly has distinct characteristics, which are not entirely related to the use of NSAIDs.

Clinical presentation of bleeding peptic ulcer in the elderly.

The aim of this study was to evaluate the characteristics and risk factors of bleeding peptic ulcer in elderly people. The histories of 206 consecutive patients (110 men and 96 women) with peptic ulcer were examined from hospital records. The ulcer was confirmed by endoscopy, surgery or autopsy. Clinical parameters were compared in different age groups. The mean age of the patients with bleeding ulcer (N = 105) was 65.5 years compared to 57.1 years in those without bleeding (N = 101) (p = 0.0001). In the univariate analysis, the duration of symptoms was shorter than seven days in 84% of bleeders compared to 40% of non-bleeders (p = 0.0001). Ninety percent of the bleeding patients were painfree, compared to 23% of patients without bleeding (p = 0.0001). Even when patients using nonsteroidal anti-inflammatory drugs (NSAIDs) were excluded, short duration of symptoms as well as absence of epigastric pain were significantly associated with bleeding. The bleeders tended to use more NSAIDs than non-bleeders, but the difference was significantly only in patients who had used NSAIDs for 30 or fewer days. Atypically located as well as giant ulcers bled more often than typically situated ulcers or smaller ulcers. In the logistic regression analysis, advanced age, short duration of symptoms and absence of epigastric pain independently predicted bleeding of peptic ulcer. In conclusion, although bleeding is a complication of peptic ulcer, it can also be considered a variant type of ulcer with specific characteristics. Old age seems to be an independent risk factor for bleeding, but it has no effect on the clinical presentation of the disease.