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Biomedical subjects

R E Sampliner

Publications and source records attributed to R E Sampliner.

At least 55 records · Page 3Linked to original sources
PubMed1999

Progress report: the Arizona phase III study of the effect of wheat bran fiber on recurrence of adenomatous colon polyps.

A double-blind, placebo-controlled Phase III cancer prevention trial in subjects with previous resection of adenomatous colon polyps is nearing completion. The study's primary objective is to evaluate the effects of daily dietary supplementation with large (13.5 g/day) versus small (2.0 g/day) doses of wheat bran fiber for 3 years. A summary of the study design and a progress report are presented.

Adenomatous Polyposis Coli↗
PubMed1999

Laser and multipolar electrocoagulation ablation of early Barrett's adenocarcinoma: long-term follow-up.

BACKGROUND: Endoscopic ablation of Barrett's esophagus, including associated dysplasia and adenocarcinoma, can be achieved by various techniques, but few long-term results are available. The aim of our study was ablation of intramucosal adenocarcinoma with a combination of Nd:YAG laser plus multipolar electrocoagulation. METHODS: Patients with documented Barrett's esophagus and adenocarcinoma who either had refused surgery or were poor candidates for surgery because of high risk were offered endoscopic therapy. Patients underwent therapy with Nd:YAG laser and multipolar electrocoagulation. They were treated with omeprazole (20 mg twice daily) as maintenance therapy. RESULTS: Six patients were enrolled in the study over a 7-year period. All were men with a mean age of 78.2 years. The mean length of Barrett's esophagus was 6.0 cm (range, 3 to 10 cm). Seventeen Nd:YAG laser (mean, 2.8/patient) and 20 multipolar electrocoagulation (mean, 3.3/patient) sessions were used during the study period. All patients had a complete initial response to therapy. One patient on chronic immunosuppressive medications had recurrence of the tumor after an initial complete response (36-month follow-up). Two patients have no evidence of Barrett's esophagus, and 3 patients have residual intestinal metaplasia on biopsy of an irregular appearing "neo" Z-line. Mean follow-up in this group is 3.4 years (range, 9 to 86 months). CONCLUSIONS: Laser photocoagulation and multipolar electrocoagulation can be successfully and safely used to ablate intramucosal adenocarcinoma in the setting of Barrett's esophagus. Patients remain functional with normal swallowing.

Adenocarcinoma↗
PubMed1999

Durability of new squamous epithelium after endoscopic reversal of Barrett's esophagus.

BACKGROUND: Endoscopic reversal of Barrett's esophagus with multipolar electrocoagulation and high-dose omeprazole has been previously described but long-term results are not available. The aim of this study was to follow patients after endoscopic reversal and to perform a detailed analysis of the "new" squamous mucosa. METHODS: After reversal, patients with Barrett's esophagus were maintained on high-dose omeprazole and underwent interval endoscopy, and large biopsies were obtained of the former Barrett's epithelium. RESULTS: Nine of 11 patients were men; the mean age was 62 years. The mean length of Barrett's mucosa was 4.4 cm; the mean dose of omeprazole used was 49 mg/day. All patients had an initial complete response to treatment-no evidence of Barrett's endoscopically and histologically. Three patients had intestinal metaplasia underlying the new squamous mucosa in the latest follow-up biopsies. In these 3 patients, only 0.4%, 2%, and 8% of the total biopsy area had intestinal metaplasia. All but 4 patients had underlying intestinal metaplasia at variable times during the study period. Patients have been followed for a mean of 36 months (range 19 to 53 months). CONCLUSIONS: New squamous mucosa is durable and resembles normal squamous tissue. Underlying glands of intestinal metaplasia are intermittently found. Because the significance of this residual intestinal metaplasia is unclear, surveillance endoscopy with biopsies of the treated segment is recommended even after reversal therapy.

Aged↗
PubMed1999

Effect of ambulatory 24-hour esophageal pH monitoring on reflux-provoking activities.

Ambulatory 24-hr esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease (GERD). The current approach is to encourage patients to pursue their everyday activity in order to obtain near-physiological recordings. However, the effect of the test itself on reflux-provoking activities has never been evaluated. Thus, the aim of our study was to assess daily food consumption, habits, symptoms, sleep, and perceived experience of patients undergoing pH testing as compared to an off test (normal) day. Patients reported type and time spent in each activity pursued, food ingested and length of each meal, habits, frequency and severity of GERD and other related symptoms, sleep disturbances, side effects, and overall perceived experience during pH testing and four weeks later, during a normal day. Fifty-four patients enrolled. pH testing significantly reduced time spent being active, number of meals and cups of coffee consumed, and frequency of GERD symptoms. Almost half of the patients reported having dysphagia during the test. Most patients experienced side effects and stated that the test bothered them most of the time. In conclusion, pH testing has a significant effect on decreasing reflux-provoking activities-patients tend to assume a more sedentary lifestyle. This may influence the reliability of the test as a physiologic measure of acid reflux.

Activities of Daily Living↗
PubMed1999

Correlation of ambulatory 24-hour esophageal pH monitoring results with symptom improvement in patients with noncardiac chest pain due to gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) accounts for up to 60% of patients with noncardiac chest pain (NCCP). Twenty-four-hour esophageal pH monitoring has been considered the most sensitive test for identifying acid reflux as the probable cause for chest pain. It is unclear if there is a correlation between the degree of esophageal acid exposure as determined by 24-hour esophageal pH monitoring and symptom improvement during a short course of high-dose omeprazole (the omeprazole test) in patients with NCCP due to GERD. Twenty-three patients with GERD-related NCCP were studied. All patients were referred by a cardiologist and evaluated by upper endoscopy and 24-hour esophageal pH monitoring. Diagnosis of GERD was defined by one or both tests being abnormal. Subsequently, patients underwent baseline symptom intensity assessment during 1 week off therapy followed by 1 week on therapy with high-dose omeprazole (40 mg A.M. and 20 mg P.M.). There was a statistically significant correlation between the esophageal acid exposure by 24-hour esophageal pH monitoring and the change in symptom intensity score after treatment. However, there was no significant correlation between the pH values and symptom intensity score during baseline or during the omeprazole test. In patients with GERD-related NCCP undergoing the omeprazole test, 24-hour esophageal pH monitoring has a therapeutic predictive value in addition to its diagnostic merit. Patients with greater esophageal acid exposure appear to have a greater response to antireflux treatment.

Anti-Ulcer Agents↗
PubMed1998

The clinical and economic value of a short course of omeprazole in patients with noncardiac chest pain.

BACKGROUND & AIMS: Evaluation of new patients with noncardiac chest pain (NCCP) may require a variety of costly tests. The aim of this study was to evaluate the efficacy of the omeprazole test (OT) in diagnosing gastroesophageal reflux (GERD) in patients with NCCP and estimate the potential cost savings of this strategy compared with conventional diagnostic evaluations. METHODS: Thirty-nine patients referred by cardiologists were enrolled. Baseline symptoms were recorded, and the patients were randomized to either placebo or omeprazole (40 mg AM and 20 mg PM) groups for 7 days. Patients were crossed over to the other arm after a washout period and repeat baseline symptom assessment. All patients underwent 24-hour esophageal pH monitoring and upper endoscopy before randomization. RESULTS: Thirty-seven patients (94.9%) completed the study. Twenty-three (62.2%) were classified as GERD positive and 14 as GERD negative. Eighteen (78%) GERD-positive patients and 2 (14%) GERD-negative patients had a positive OT (P < 0.01), yielding a sensitivity of 78.3% (95% confidence interval, 61.4-95.1) and specificity of 85.7% (95% confidence interval, 67.4-100). Economic analysis showed that the OT saves $573 per average patient evaluated and results in a 59% reduction in the number of diagnostic procedures. CONCLUSIONS: The OT is sensitive and specific for diagnosing GERD in patients with NCCP. This strategy results in significant cost savings and decreased use of diagnostic tests.

Adult↗
PubMed1998

Methylene blue staining for intestinal metaplasia of the gastric cardia with follow-up for dysplasia.

BACKGROUND: Previous studies by our group have identified a 23% prevalence of intestinal metaplasia involving the gastric cardia in patients undergoing elective esophagogastroduodenoscopy (EGD). The current study evaluates the potential clinical utility of vital staining with methylene blue for detecting intestinal metaplasia of the cardia. In addition, the prevalence of Helicobacter pylori infection and incidence of dysplasia in cardia intestinal metaplasia was assessed. METHODS: Twenty-four of 104 patients undergoing elective EGD were previously identified with cardia intestinal metaplasia. Twenty-one of these 24 returned for follow-up EGD with methylene blue staining and cardia biopsies. During EGD four random biopsies were taken in the cardia. After staining with methylene blue, four targeted biopsy specimens were taken from any stained areas. H. pylori infection was assessed by rapid urease testing and serologic evaluation. RESULTS: Staining with methylene blue was positive in 16, equivocal in 4, and negative in 1. Overall, cardia intestinal metaplasia was identified in 17 of 21 patients (81%) by at least one of the 8 biopsies. The sensitivity of detecting intestinal metaplasia by targeted biopsies to stained areas was 67% as opposed to 38% for random biopsies (odds ratio 3.0: 95% CI [0.88,10.24]). The prevalence of H. pylori infection in patients with cardia intestinal metaplasia was 76%. One patient developed low-grade dysplasia, whereas the others remained negative. CONCLUSIONS: Intestinal metaplasia of the gastric cardia is associated with a high prevalence of H. pylori infection and is a reproducible finding in the majority of patients. Methylene blue staining and an increasing number of biopsies improve the sensitivity of detecting this potentially neoplastic lesion.

Aged↗
PubMed1998

Prevalence of Barrett's esophagus in Hispanics is similar to Caucasians.

Barrett's esophagus (BE) is considered to be a disease of white males with a prevalence ranging from 0.5 to 4.0% in patients undergoing upper endoscopy (EGD) for any indication, and from 12 to 15% in patients with gastroesophageal reflux disease (GERD). The prevalence of BE in Hispanics is not known, but it is assumed to be lower. The aims of this study were to determine the prevalence of BE in Hispanic patients and to compare demographic and endoscopic characteristics with Caucasian patients with BE. Records of patients undergoing an EGD between October 1993 and October 1996 were retrospectively reviewed. Patients were included in the study only if they had columnar-appearing esophageal mucosa at endoscopy and intestinal metaplasia with Alcian blue-staining goblet cells on biopsy. An extensive chart review was performed in patients with BE. There were 75 new cases of BE discovered: 60 (80%) were Caucasians, 6 (8%) Hispanics, 1 (1.4%) Native American, and 8 (10.6%) patients with either unknown or unconfirmed ethnicity. Of the 75 patients, 74 male, and the mean age was 65 +/- 11.4 years (range 36-92 years). The prevalence of BE in Caucasians and Hispanics undergoing EGD for any reason was similar (5.3% and 3.8%, respectively, P = 0.563). The prevalence of BE in patients presenting with GERD symptoms was also similar between Caucasians and Hispanics (25% and 16%, respectively, P = 0.304). The two groups did not differ significantly with respect to age, symptoms, habits, or endoscopic findings. In conclusion, the prevalence of BE among Hispanic patients is similar to Caucasian patients, an unexpected finding.

Adult↗
PubMed1998

Short segment Barrett's esophagus--the need for standardization of the definition and of endoscopic criteria.

There has been a recent increase in abstracts and publications reporting intestinal metaplasia in the distal esophagus and cardia. The terms "short segment Barrett's esophagus," "intestinal metaplasia of the esophagogastric junction," and "intestinal metaplasia of the cardia" are being used to describe either similar or different entities. This review article deals with the current data on these issues, the definition of short segment Barrett's esophagus including the endoscopic and histologic criteria, the rationale for separating short segment Barrett's esophagus from intestinal metaplasia of the cardia, and a simple classification of intestinal metaplasia.

Barrett Esophagus↗
PubMed1998

Squamous islands in Barrett's esophagus: what lies underneath?

OBJECTIVE: Squamous islands are frequently visualized at the time of upper endoscopy in patients with Barrett's esophagus, especially those on proton pump inhibitor therapy (PPI). The significance of these islands is not clearly understood. The aim of this study was to systematically biopsy macroscopic squamous islands and to examine their histologic characteristics. METHODS: Patients with Barrett's esophagus undergoing surveillance had squamous islands documented and biopsied at the time of endoscopy. Barrett's esophagus was defined as the presence of a columnar lined esophagus on endoscopy with intestinal metaplasia on biopsy. All biopsies were obtained by a single senior endoscopist and were stained with alcian blue at pH 2.5. Biopsy samples with inadequate tissue quantity were not included in the study. RESULTS: A total of 39 biopsies were obtained from 22 patients. Twenty of the 22 patients were male, with a mean age of 65.4 yr (range 47-80 yr). The mean length of Barrett's mucosa was 5.6 cm (range 1-11 cm). Eleven of 22 patients were on omeprazole (mean dose 29.1 mg/day), whereas seven patients were on lansoprazole (60 mg/day). The mean duration of PPI therapy was 2.3 yr (range 9-71 months) at the time of biopsy of the squamous islands. Three patients were on H2-blocker therapy whereas the remaining patient had not been started on acid suppression therapy. On histology, 24 biopsy specimens (61.5%) revealed only squamous epithelium, whereas 15 (38.5%) showed the presence of intestinal metaplasia underlying the squamous epithelium. There was no significant difference between the patients with and without underlying intestinal metaplasia in regard to age, Barrett's length, dose, and duration of PPI therapy. CONCLUSION: In more than one-third of biopsies of macroscopic squamous islands within Barrett's esophagus, microscopic intestinal metaplasia is detected. The presence of squamous islands should not be equated with regression of Barrett's esophagus or with decreased cancer risk.

Aged↗
PubMed1997

Ablative therapies for the columnar-lined esophagus.

Endoscopic ablative therapy could reduce the risk for the development of adenocarcinoma in patients with Barrett's esophagus. Combination therapy, which includes pharmacologic or surgical acid control plus endoscopic mucosal ablation, can reverse Barrett's esophagus that has not been accomplished with prior medical or surgical therapy. Pharmacologic esophageal acid control often takes higher than usual doses of proton pump inhibitor therapy. The preliminary results of endoscopic ablation techniques, including laser, photodynamic therapy, and multipolar electrocoagulation, are reviewed. The goal of ablative therapy is to eliminate all intestinal metaplasia and therefore the risk for the development of adenocarcincoma. Endoscopic ablative therapies need to be validated with larger and longer term trials. Better criteria to estimate the risk for the development of adenocarcinoma are needed to select appropriate candidates for combination therapy.

Barrett Esophagus↗