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PubMed1999

Rates of small intestinal mucosal protein synthesis in human jejunum and ileum.

We investigated possible differences in the rates of mucosal protein synthesis between the proximal and distal regions of the small intestine. We took advantage of access to the gut mucosa available in otherwise healthy patients with ileostomy in whom the terminal ileum was histologically normal. All subjects received primed, continuous intravenous infusions of L-[1-(13)C]leucine after an overnight fast. After 4 h of tracer infusion, jejunal biopsies were obtained using a Crosby-Kugler capsule introduced orally; ileal biopsies were obtained via endoscopy via the ileostomy. Protein synthesis was calculated from protein labeling relative to intracellular leucine enrichment obtained by appropriate mass spectrometric measurements. Rates of jejunal and ileal mucosal protein synthesis were significantly different (P < 0.001) at 2.14 +/- 0.2 and 1.2 +/- 0.2 %/h (means +/- SD). These are lower than rates in normal healthy duodenum (2.53 +/- 0.25 %/h), suggesting a gradation of rates of synthesis along the bowel. Together with other data, these results suggest that mucosae of the bowel contribute not more than 10% to whole body protein turnover.

Adult↗
PubMed2003

[Clinical features of obscure-overt gastrointestinal bleeding].

BACKGROUND/AIMS: Obscure gastrointestinal bleeding (OGIB) is defined as recurrent acute or chronic bleeding for which no sources have been identified by routine endoscopic and contrast studies. The patients with OGIB are frequently difficult to manage and often undergo extensive investigation and even laparatomy without diagnosis. The aim of this study was to review our overall experiences of the investigation and treatment of OGIB. METHODS: We reviewed, retrospectively, medical records of 41 cases with OGIB from June 1996 to July 2002. RESULTS: Of the 41 patients with OGIB, there were 21 men and 20 women and their mean age was 47.8 years (range, 18 to 81 years). Diagnosis was possible in 13 patients (31.7%) and no specific causes were identified in the remaining 28 patients (68.3%). The principal etiologies were gastrointestinal stromal tumor of the small bowel in 3 cases, duodenal diverticulum in 2 cases. Other causes are as follows: adenocarcinoma of the duodenal 3rd portion, duodenal varix at the 4th portion, splenic artery pseudoaneurysm, Crohn's disease, jejunal ulcer, ileal ulcer, ileal angiodysplasia, and anastomosis site bleeding after hemicolectomy. CONCLUSIONS: We conclude that further and logical diagnostic investigations such as small bowel enteroscopy and wireless capsule endoscopy will promise better results.

Adult↗
PubMed2005

Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding.

PURPOSE: Capsule endoscopy (CE) has been shown to have a high diagnostic yield in patients with obscure gastrointestinal bleeding (OGIB). It is not known if repeating CE improves diagnostic yield or changes patient management when the initial CE is negative or nondiagnostic. The aims of this study are (1) to understand the reasons for repeat CE, (2) to determine the diagnostic yield of repeat CE, and (3) to establish if findings on repeat CE resulted in a change in patient management. METHODS: Between August 2001 and October 2003, we performed 391 capsule studies. Of these, 24 were repeat studies in patients with OGIB. We retrospectively reviewed the charts of these 24 patients. RESULTS: The reasons for repeat CE were: recurrent gastrointestinal bleeding (13), limited visualization on first exam due to poor prep or blood (10), complication (1) (capsule impaction at cricopharyngeus). Eighteen of 24 (75%) repeat capsule studies revealed additional findings (7 arteriovenous malformations, 2 gastropathy, 2 erosions, 2 masses, 1 ulcer, 2 red spots, 1 linear streak, 1 erythema). These findings led to changes in patient management in 15 of the 24 (62.5%) cases. CONCLUSIONS: Indications for repeat CE most commonly include recurrent gastrointestinal bleeding and limited visualization on initial study. Repeat CE results in a high yield of new findings that lead to changes in patient management. Repeat CE should be considered in patients with persistent OGIB when the initial study is negative or inconclusive.

Aged↗
PubMedDate not supplied

Capsule endoscopy examination of patients with obscure gastrointestinal bleeding: evaluation of clinical impact.

BACKGROUND: Wireless video capsule endoscopy (WVCE) has been reported to contribute to the diagnostic management of patients with obscure gastrointestinal bleeding (OGB). Nevertheless, clinical impact data is lacking. The aim of our study was to determine the clinical outcome of patients undergoing WVCE for OGB. PATIENTS AND METHODS: 38 patients who were referred for OGB and who underwent WVCE examination were included in this study. A questionnaire was sent to the referring doctors after the capsule investigation. The following items were investigated: the final diagnosis of OGB, treatment applied and clinical outcome. RESULTS: Data was recorded for 26 patients out of 38 (17F, 9M). The mean age was 63 years (range, 21-84). A positive finding was noted in 11 patients. Findings included small bowel lesions in 7 cases and gastroduodenal lesions in 4 cases. As a result of the capsule investigation, specific therapy was administered in 9 patients. Six of the 9 patients treated had no further anemia. Final diagnosis of OGB was in agreement with positive findings of WVCE in all these 11 patients. Among the 15 patients with a negative WVCE, 9 had a digestive lesion (3 small bowel lesions) as a final diagnosis. CONCLUSION: Patients with a positive result at WVCE had further intervention in 82% and were successfully treated in 67% of cases. We had no false positive results in this study, which suggest a high positive predictive value of WVCE. Moreover, negative WVCE had also an indirect clinical impact.

Adult↗
PubMed2005

A quantitative analysis of NSAID-induced small bowel pathology by capsule enteroscopy.

BACKGROUND & AIMS: Conventional acidic nonsteroidal anti-inflammatory drugs frequently cause small bowel inflammation. Diagnosis is largely based on assay of surrogate markers of inflammation in stool, such as fecal calprotectin. However, stool markers are not widely available and the precise nature of this inflammation is uncertain. We used wireless capsule enteroscopy to quantitate and assess the nature of the small bowel damage caused by nonsteroidal anti-inflammatory drugs when taken on a short-term basis. METHODS: Forty healthy volunteers underwent a baseline capsule enteroscopy and fecal calprotectin test. After taking diclofenac slow-release 75 mg twice a day (with omeprazole 20 mg twice a day for gastroprotection) for a total of 14 days, both investigations were repeated. RESULTS: After drug treatment, 30 subjects (75%) had increased repeat fecal calprotectin concentrations above the upper limit of normal. Capsule enteroscopy showed new pathology in 27 subjects (68%). The commonest lesions were mucosal breaks, seen in 16 (40%), which were seen to be bleeding in 2 (5%); reddened folds in 14 (35%); petechiae or red spots in 13 (33%); denuded mucosa in 8 (20%); and blood in the lumen without a visualized source in 3 (8%). Fifteen of the 27 subjects had more than one lesion concurrently. CONCLUSIONS: This study provides both biochemical and direct evidence of macroscopic injury to the small intestine in 68%-75% of volunteers resulting from 2 weeks' ingestion of slow-release diclofenac.

Adult↗
PubMed2006

Preparations and prokinetics.

The evaluation of the importance of bowel preparations, prokinetics and postural tricks for bowel cleanliness, completeness of evaluation, and ultimately for the diagnostic yield of VCE is hampered by several factors. First, most studies are published in abstract form. Second, the methodological quality of the studies is rather low, because randomized comparisons are only a small minority. Third,there is no accepted and validated scale to evaluate bowel cleanliness. For all of these reasons, comparisons between studies are very difficult, and drawing general conclusions is almost impossible. As a consequence, at the Fifth International Conference on Capsule Endoscopy [9], only a limited measure of consensus could be reached on the fact that preparations/prokinetics probably improve the quality of small bowel cleanliness. It also was agreed that it is possible that preps/prokinetics improve GTT, SBTT and completeness of examination, and that keeping the patients recumbent in the right lateral position may shorten the GTT. It was noted, however, that the best type of preparation, and dose and time of administration remain to be determined. Additionally, data on prokinetics and postural tricks are insufficient to reach a firm conclusion. Unanswered questions concern the effect of medications on the diagnostic yield of VCE, whether prokinetics increase the miss rate, whether preparations/prokinetics cause adverse effects and the influence of medications on patient acceptance.

Endoscopes, Gastrointestinal↗
PubMed2001

Small-intestinal endoscopy.

A small imaging capsule without cables, wires, or external connections has been developed for exploration of the small bowel. This swallowable device is propelled by peristalsis through the intestinal tract, and transmits data to a nearby receiver that captures video images on a regular basis. This technology will soon be available throughout the world, and it promises to revolutionize deep endoscopy of the small bowel. Sonde enteroscopy will be laid to rest forever. There continues to be considerable interest in the use of push enteroscopy in the investigation of obscure gastrointestinal bleeding. Physicians are beginning to rely more on intraoperative enteroscopy, because of its high degree of accuracy and its ability to provide visualization of the entire small bowel in selected patients in whom the bleeding source cannot be diagnosed, but who require blood transfusions.

Endoscopes, Gastrointestinal↗
PubMed1998

[Current status of shoulder arthroscopy].

Arthroscopic and open shoulder surgery have to be combined for a successful surgical therapy of the shoulder joint. A surgeon performing open surgery only or just treating by arthroscopic measurements can not cover the full spectrum of modern shoulder surgery. Isolated diagnostic arthroscopy is rarely indicated. Far more common, diagnostic arthroscopy is combined with an operative procedure both to confirm preoperative assessment of pathology and to uncover associated lesions. The results of arthroscopic stabilisation of chronic anterior posttraumatic dislocations fail to compare with high success rates of open procedures. Better patient selection will probably be the key to improving results. In case of acute traumatic first time dislocation in young highly sportive athletes the arthroscopic repair of the isolated Bankart-Perthes lesion offers the attractive advantage of anatomic reconstruction with minimal soft tissue dissection. Further indications for arthroscopic measurements of pathologies of the glenohumeral joint are synovectomy in rheumatoid arthritis, capsulotomy of shrunk capsule in frozen shoulder and tenodesis for lesions of the long head of the biceps. The arthroscopic subacromial decompression according to Ellman is the most often and successful performed procedure at the shoulder joint and has overcome the classic Neer open acromioplasty. For smaller tears of the supraspinatus tendon the arthroscopic acromioplasty can be combined with an all arthroscopic suture repair or with an mini-open repair. Larger tears of the rotator cuff are still the domain for open reconstructive procedures. In case of associated or isolated AC-joint arthritis an arthroscopic Mumford procedure can be performed. For chronic calcific tendinitis isolated arthroscopic excision of the calcium deposit is of great value. Additionally, acromioplasty is needed for true mechanical obstruction of the subacromial space.

Acromioclavicular Joint↗
PubMed2005

Sensitivity and specificity of the suspected blood identification system in video capsule enteroscopy.

BACKGROUND AND STUDY AIMS: Capsule enteroscopy has become a standard tool for the evaluation of obscure gastrointestinal bleeding. Reviewing the video recordings of capsule examinations is time-consuming and requires prolonged attention. Recently, software that can recognize the frames containing "red spots", the Suspected Blood Identification system (SBIS), has been developed with the aim of assisting in the analysis of video recordings. We assessed the sensitivity and specificity of the SBIS in patients undergoing capsule enteroscopy. PATIENTS AND METHODS: 100 consecutive patients underwent capsule enteroscopy at our tertiary referral center, for the following indications: obscure gastrointestinal bleeding (75 patients), metastatic carcinoid (7 patients) known or suspected Crohn's disease (5 patients), miscellaneous (13 patients). Capsule endoscopy was carried out by the standard method. Four gastroenterologists, experienced in capsule endoscopy, reviewed the recordings. RESULTS: Small-bowel visualization was obtained in 95 cases. The physicians identified 209 "red spots", 54 of which (25.8%) were also identified by the SBIS. The overall sensitivity, specificity, and positive and negative predictive values of the SBIS, calculated on the number of true-positive, true-negative, false-positive and false-negative results, were 40.9%, 70.7%, 69.2% and 42.6%, respectively. Sensitivity was higher for the identification of red blood (60.9%) than for nonbleeding "red" lesions such as arteriovenous malformations (25.8%). CONCLUSIONS: The SBIS has low sensitivity and specificity. It can be used as a complementary and rapid screening tool, but complete review of the recordings is still necessary.

Adult↗
PubMed1999

EUS-guided radiofrequency ablation in the pancreas: results in a porcine model.

BACKGROUND: Our aim in this study was to investigate the feasibility and safety of performing radiofrequency (RF) ablation in the pancreas with endoscopic ultrasound (EUS). METHODS: RF was applied to normal pancreatic tissue in 13 anesthetized Yorkshire pigs with specially modified 19-gauge needle electrodes (1.0 to 1.5 cm tip). The pancreas was localized with EUS and punctured through a transgastric approach. RF current (285 +/- 120 mA) was delivered for 6 minutes. Diagnostic imaging (EUS and CT) and serum amylase and lipase levels were obtained at baseline, immediately after ablation, and 1 to 14 days after the procedure. Pigs were killed immediately (n = 5), 1 to 2 days after ablation (n = 2), and 2 weeks after the procedure (n = 6). Pathologic examination was performed. RESULTS: Sixteen ablations were performed. During ablation, round hyperechoic foci (diameter to 1.0 cm) gradually surrounded the tip of the electrode. Immediately after the procedure CT demonstrated 1 cm hypodense foci that did not enhance with iodinated contrast. In pigs killed immediately and 1 to 2 days after ablation, pathologic examination showed discrete, well-demarcated spherical foci of coagulation necrosis measuring 8 to 12 mm in diameter surrounded by a 1 to 2 mm rim of hemorrhage. Radiologic-pathologic correlation was within 2 mm. In 4 of 6 (67%) pigs killed on day 14, retraction of the coagulated focus was observed. A 1 to 3 mm fibrotic capsule surrounded the coagulated tissue in the remaining 2 pigs. One pig had mild hyperlipasemia, a focal zone of pancreatitis (<1 cm), and later a pancreatic fluid collection. Biochemical parameters were normal in the remaining pigs. Other complications included three gastric and one intestinal burn caused by improper electrode placement. CONCLUSIONS: EUS-guided RF ablation can be used safely to produce discrete zones of coagulation necrosis in the porcine pancreas. Potential clinical uses of this technology include management of small neuroendocrine tumors and possibly palliation of unresectable pancreatic adenocarcinoma.

Animals↗
PubMedDate not supplied

Capsule endoscopy--a new frontier.

Capsule endoscopy (CE)--about the size of a vitamin pill--has enormous potential for the noninvasive investigation of diseases of the small bowel--"the last frontier" of endoscopy. Its use is spreading rapidly-over 150,000 capsules have been ingested worldwide since CE was introduced in 2001--reflecting the enormous impact of CE on the field of gastroenterology. CE has a higher diagnostic yield in recognizing Crohn's disease than any other method available. CE is able to establish a diagnosis in a high proportion of patients with obscure gastrointestinal bleeding, detecting small bowel lesions. New indications and applications of CE are emerging: CE has proven useful in the diagnosis of celiac disease, NSAID enteropathy and small bowel malignancies, its use in pediatric gastroenterology, the new Pill Cam ESO specifically-designed to visualize the esophageal mucosa etc. The objectives of this article are to present an overview of the CE: its history and development, indications, contraindications, and CE role in the diagnosis of small bowel diseases. Finally, it is presented the experience with CE at our institutions.

Contraindications↗
PubMed2006

Capsule endoscopy: a meta-analysis for use with obscure gastrointestinal bleeding and Crohn's disease.

In this study, CE was superior to push enteroscopy and small bowel radiography for diagnosing small bowel pathology in patients who had OGIB, and its yield may be comparable to intraoperative endoscopy. Incremental yield of CE over push enteroscopy and barium radiography is greater than 30% for clinically significant findings, primarily because visualization of additional vascular and inflammatory lesions is possible by CE.CE was also found to be superior to small bowel barium radiography, colonoscopy with ileoscopy, CT enterography, and push enteroscopy for diagnosing nonstricturing small bowel CD. These findings primarily result from a marked improvement in yield with the use of CE over all other methods in patients who had established CD and were evaluated for a small bowel recurrence. Because this analysis was designed to evaluate trials that examined the yield of various methods for the diagnosis of OGIB and CD, it is unknown whether these results will translate into improved patient outcomes with the use of CE versus alternate methods. Randomized controlled trials will be necessary to clarify this issue.

Crohn Disease↗
PubMed2005

Capsule endoscopy - comparison of two strategies of bowel preparation.

BACKGROUND: Capsule endoscopy can identify lesions of the small bowel that cannot be detected by other techniques. In addition to patient safety, quality of care and cost-efficiency, good preparation is an important factor for good visualization. AIM: To evaluate the efficacy of oral sodium phosphate preparation. METHODS: Forty-six consecutive patients scheduled for capsule endoscopy in two medical centres. The patients treated in Dallas were prepared by 12 h fasting (group A), and those treated in Israel were also asked to drink 45 mL of sodium phosphate with water (group B). An experienced endoscopist, blinded to the method used, graded the quality of preparation according to visual capability, and to relative durations of each grade. RESULTS: The quality of the preparation was poor in 35% of group A compared with 4% of group B (P = 0.023). The mean duration of good preparation with excellent visualization was 122 +/- 110 min in group A and 180 +/- 96 min in group B (P = 0.006). Preparation with sodium phosphate and lower patient weight were significant predictive factors for good visualization. CONCLUSIONS: Bowel preparation offers better visualization than overnight fasting alone and is associated with fewer disturbances by intraluminal turbid fluid.

Adult↗
PubMed2006

The economics of PillCam.

Evaluation of the economics of PillCam technology is in its infancy. Most studies of the use of the PillCam, both small bowel and esophageal, have focused only on the capsules' diagnostic characteristics. Although the results have compared favorably with other more invasive and sometimes less accurate modalities, the true cost effectiveness of PillCam is not yet fully known. The few cost-effectiveness assessments performed suggest that PillCam compares favorably with traditional diagnostic methods in Crohn's disease and in screening for complications of GERD and for esophageal varices. The data included in these models are quite limited, however. Sensitivity analyses can permit assessment of a wide range of possibilities regarding cost and diagnostic efficacy. Still, these models need to be anchored by robust and reproducible data input. Large-scale studies with long-term follow-up are needed. Capture of both direct and indirect medical costs accrued by using PillCam or other diagnostic tests in these studies will permit more robust economic analyses. As data accrue,they may give clinicians more confidence that PillCam use will realize economic savings and improve patient outcomes.

Chronic Disease↗
PubMed2006

[Sealing of percutaneous nephrolithotomy access after complete stone removal with a hemostyptic gelatin powder (Spongostan)].

PURPOSES: Parallel to the pilot project of Lee et al. which was published in February 2004, we also considered the possibility to seal the percutaneous nephrolithotomy (PCNL) access after complete stone removal via the local amplatz sheath. We started our project with the aims of increasing postoperative patient comfort, minimizing the risk of bleeding, and reducing postoperative cost and length of the hospital stay by performing this minimally invasive technique in 7 patients with medium stone burden. MATERIALS AND METHODS: All patients were treated by removing stones via a working channel passing through the lower pole calix. After complete stone removal a hemostyptic gelatin powder (Spongostan, Johnson & Johnson) was prepared to a doughy paste, some drops of contrast medium were added and the whole material was introduced through the amplatz sheath into the working channel under imaging control. Imaging-controlled insertion of the doughy gelatin clot through the amplatz sheath into the parenchymal part of the channel alone resulted in immediate hemostasis in all patients. The amplatz sheath was retracted over a 28 Fr. rectal tube which was used to push the gelatin forward. There was no need for an additional tamponade of the renal fat capsule or the abdominal wall. After 2 minutes when no channel bleeding was apparent, the skin sutures were placed. RESULTS: Bleeding of the nephrostomy tract did not occur in any of the 7 patients. Average operating time was 50 minutes which was not significantly reduced by performing the new procedure. However, the hospital stay was reduced by 2 days. Two of the patients showed a single fever episode during the second postoperative evening. All patients presented with steady postoperative laboratory values without evidence of bleeding. Free urinary flow from the collecting system was controlled by means of ultrasound and urography. CONCLUSIONS: Similar to the recent usage of FloSeal/Baxter reported by Lee et al. we can confirm very reliable and immediate hemostasis using a pasty preparation of Spongostan (Johnson and Johnson) gelatin powder which was classified as being less toxic by the FDA in 2003 due to the lack of glutaraldehyde and bovine thrombin. Therefore, tubeless PCNL can be used for complete percutaneous clearance of stones without bleeding.

Administration, Topical↗
PubMed2003

Gastrointestinal mucosal injury following repeated daily oral administration of conventional formulations of indometacin and other non-steroidal anti-inflammatory drugs to pigs: a model for human gastrointestinal disease.

Non-steroidal anti-inflammatory drugs (NSAIDs) vary in their propensity to cause damage in different regions of the gastrointestinal (GI) tract in laboratory animals and humans. This may depend on the type of drug formulation as well as the intrinsic pharmacological properties of the drugs. The purpose of this study was to determine the effects of NSAIDs, with cyclooxygenase 1 and 2 inhibitory activity but with different potency as inhibitors of prostaglandin production, when given orally as tablet/capsule formulations of NSAIDs for 10 days to pigs, a species that has close resemblance in structure and function of the tract to that in humans. Three capsule or tablet formulations of NSAIDs were given orally to pigs for 10 days. GI bleeding was measured by determination of radioactive iron in the faeces from (59)Fe-pre-labelled red blood cells. The blood loss was compared with the pathological changes in the GI mucosa observed at autopsy, mucosal myeloperoxidase (MPO) activity as an index of leucocyte infiltration, and plasma and mucosal concentrations of the drugs at termination assayed by high-performance liquid chromatography. Mucosal damage and bleeding varied according to the type of NSAID. Gastroduodenal ulcers and lesions occurred with the cyclooxygenase inhibitors indometacin (indomethacin) (Indocid capsules 10 or 5 mg kg(-1) day(-1) b.i.d.), aspirin (USP tablets 150 mg kg(-1) day(-1) b.i.d) and naproxen (Apotex tablets 50 or 75 mg kg(-1) day(-1) b.i.d.), and there was an increase in the cumulative (i.e. 10-day) blood loss at higher doses of indometacin and naproxen, and with aspirin. There was no statistically significant increase in gastric or intestinal mucosal MPO activity in the non-damaged mucosa with these drugs and this was confirmed by histological observations in non-lesioned areas of the mucosa. Indometacin produced focal ulcers in the caecum but this was not observed with the other drugs. All the NSAIDs produced significant blood loss coincident with gastric ulceration but no increase in gastric or intestinal MPO activity. Plasma concentrations of the non-aspirin NSAIDs were within the range encountered therapeutically in humans. The mucosal concentrations of indometacin in the gastric and intestinal mucosa correlated with mucosal injury. These findings show that: (i) NSAIDs vary in their propensity to produce mucosal injury in different regions of the GI tract according to their pharmacological properties and formulation; (ii) mucosal injury from some NSAIDs may not directly relate to blood loss at low doses of NSAIDs and this may depend on inhibition of platelet aggregation; and (iii) the occurrence of caecal ulcers uniquely observed with indometacin treatment may be relevant to the development of intestinal pathology (e.g. diaphragm-like structures) seen occasionally in humans. These results suggest that the pig model employed in the present studies may be useful for investigations of GI damage from NSAID tablets/capsules, especially in regions that are generally inaccessible to routine endoscopic investigations in humans (e.g. the proximal regions of the large intestine).

Administration, Oral↗
PubMed2005

The rate of lesions found within reach of esophagogastroduodenoscopy during push enteroscopy depends on the type of obscure gastrointestinal bleeding.

BACKGROUND AND STUDY AIMS: Many lesions found during push enteroscopy to evaluate obscure gastrointestinal bleeding are within the reach of standard endoscopes. The aim of this study was to determine whether the rate of proximal lesions varies in relation to the type of obscure bleeding that is present. PATIENTS AND METHODS: A retrospective review of consecutive push enteroscopies carried out for obscure gastrointestinal bleeding between July 1996 and July 2000 was conducted. The patients were categorized into three groups: those with recurrent obscure/overt gastrointestinal bleeding; those with persistent obscure/overt gastrointestinal bleeding; and those with obscure/occult gastrointestinal bleeding. RESULTS: A total of 63 patients (24 men, 39 women; mean age 69.8) were included. Push enteroscopy examinations were conducted for recurrent obscure/overt bleeding in 32 patients; for persistent obscure/overt bleeding in 12 patients; and for obscure/occult bleeding in 19 patients. The overall diagnostic yield of push enteroscopy was 47 % (15 of 32) in the group with recurrent obscure/overt bleeding; 66 % (eight of 12) in the group with persistent obscure/overt bleeding; and 63 % (12 of 19) in the group with obscure/occult bleeding. However, when lesions within the reach of standard esophagogastroduodenoscopy (EGD) were excluded, the yield of push enteroscopy was slightly higher in the group with recurrent obscure/overt bleeding (41 %) than in the groups with persistent obscure/overt bleeding (33 %) and obscure/occult bleeding (26 %). There were fewer lesions within the reach of EGD in the group with recurrent obscure/overt bleeding than in the groups with persistent obscure/overt bleeding (6 % vs. 33 %; P < 0.05) or obscure/occult bleeding (6 % vs. 37 %; P < 0.05). CONCLUSIONS: Patients undergoing push enteroscopy for recurrent obscure/overt bleeding were significantly less likely to have lesions within the reach of EGD than patients with persistent obscure/overt bleeding or obscure/occult bleeding. Patients in the latter two groups would be able to undergo a repeat EGD examination before more intense evaluation with push enteroscopy or capsule endoscopy.

Aged↗
PubMed1993

Efficacy and safety of omeprazole for severe gastroesophageal reflux in children.

Omeprazole, a potent inhibitor of acid secretion, is effective in adults with severe gastroesophageal reflux, but no such data are available on children. We studied 15 children in whom treatment with histamine (type 2) blockers and prokinetic agents had failed; 4 had also had one or more fundoplications. Their ages were 0.8 to 17 years (mean, 8.1 years) and weights were 7.5 to 30.7 kg (mean, 18.6 kg). Of the 15 children, 8 were neurologically handicapped. All patients had endoscopic and histologic evidence of esophagitis; most had esophagitis grade 3 to 4. Patients were initially given omeprazole at 10 to 20 mg; the dose was titrated upward until results of a subsequent 24-hour intraesophageal pH study was normal. Symptoms and signs abated and evidence of esophagitis diminished in all patients. Omeprazole was given for periods of 5.5 to 26 months (mean, 12.2 months). The effective total dose was 20 to 40 mg (0.7 to 3.3 mg/kg) in 11 patients, 10 mg (0.7 mg/kg) in 1 patient, and 60 mg (1.9 to 2.4 mg/kg) in 3 patients. The dosage range was 0.7 to 3.3 to mg/kg per day (mean, 1.9 mg/kg). Mildly elevated transaminase values in 7 patients and elevated fasting gastrin levels in 11 patients were present; in 6 of the 11, gastrin levels were 3 to 5.5 times the upper limit of normal. We found omeprazole to be highly effective in this group of patients with severe esophagitis refractory to other measures. We recommend a starting dose of 0.7 mg/kg as a single morning dose; the adequacy of reflux control is then determined by follow-up 24-hour intraesophageal pH studies. Omeprazole appears to be safe for short-term use, but further studies are needed to assess long-term safety because the significance of chronically elevated gastrin levels in children is unknown.

Acute Disease↗