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[The economic evaluation of group examination for gastrointestinal disease in an electronics corporation--the cost-benefit analysis of follow-up study for peptic ulcer].

To investigate the usefulness of gastrointestinal fiberscope examination (GIF) for peptic ulcer in the health care station (station), a cost-benefit analysis was performed from the standpoint of the company, the health insurance society (insurance society), and workers. Before the analysis, the clinical course of the peptic ulcer, direct cost of the examination, and indirect cost due to time taken for the examination at the station were compared with those in a private hospital (hospital). In 1994, 202 cases of gastric ulcer (GU) (194 male cases, 8 female cases) and 199 cases of duodenal ulcer (DU) (195 male cases, 4 female cases) underwent GIF examination at the station. Cases of admission and emergency operation due to GU and DU at the station were less than those at the hospital. The benefits obtained for the company, the insurance society and the workers were as follows: we saw a decrease in the loss of working time, a decrease in the medical care cost, a decrease in patient cost sharing and a prevention of income loss due to admission (or prevention of the loss of a paid holiday). The time spent for GIF at the station was also less than at the hospital. This was a direct benefit for the company (a decrease in the loss of working time) and for the workers (prevention of the loss of a paid holiday). A further benefit for the company was a decrease in the cost of the miniature gastrointestinal mass survey of the workers who were followed up by GIF examination at the station. Total of more than 30 million yen in cost benefits was obtained. The economic evaluation of follow-up studies at the station was necessary to demonstrate the importance of health care to the company, and to the workers. A cost-benefit analysis was suited to this purpose, creating easily understandable results even if productivity did not count.

Cost-Benefit Analysis↗

[Clinical study of cis-platinum in the chemotherapy for malignant gastrointestinal disease: arterial infusion and intraperitoneal administration].

We studied the antitumor effects and the side effects of CDDP in the main cancer chemotherapy for gastrointestinal cancer. CDDP (100mg) was administered through the hepatic artery, systemic vein and peritoneal cavity. The administration period was four weeks. In the cases of the hepatic arterial infusion, the size of metastatic liver tumors and CEA level decreased markedly. In those of the intraperitoneal administration, ascites decreased and performance status was well maintained. There was no bone marrow depression or nephropathy. Nausea and vomiting were the main side effects, being associated with 29 administrations (52%). Acute intrahepatic biliary stasis was found in the case of hepatic arterial administration of 300mg of CDDP.

Adult↗

Surveillance and management of upper gastrointestinal disease in Familial Adenomatous Polyposis.

Almost all patients affected by Familial Adenomatous polyposis (FAP) will develop foregut as well as hindgut polyps, and following prophylactic colectomy duodenal cancer constitutes one of the leading causes of death in screened populations. Without prophylactic colectomy, FAP patients predictably develop colorectal cancer, but the lifetime risk of upper gastrointestinal cancer is lower, estimated at approximately 5%. Management of the upper gastrointestinal cancer risk is one of the greatest challenges facing clinicians involved in the care of Polyposis families, and with improved survival following prophylactic colectomy, the burden of foregut disease (particularly duodenal adenomatosis) will increase. Until recently, the value of upper gastrointestinal surveillance in FAP populations has been contentious, but with improved understanding of the natural history coupled with developments in surgery, interventional endoscopy and medical therapy, treatment algorithms for duodenal adenomatosis in FAP are becoming clearer.

Adenomatous Polyposis Coli↗

Heightened visceral sensation in functional gastrointestinal disease is not site-specific. Evidence for a generalized disorder of gut sensitivity.

Alteration in visceral sensation locally at the site of presumed symptom origin in the gastrointestinal tract has been proposed as an important etiopathological mechanism in the so-called functional bowel disorders. Patients presenting with one functional gastrointestinal syndrome, however, frequently have additional symptoms referable to other parts of the gut, suggesting that enhanced visceral nociception may be a panintestinal phenomenon. We measured the sensory thresholds for initial perception (IP), desire to defecate (DD), and urgency (U) in response to rectal balloon distension, and the thresholds for initial perception and for discomfort in response to esophageal balloon distension in 12 patients with irritable bowel syndrome (IBS) and 10 patients with functional dyspepsia (FD), in comparison with healthy controls. As expected, IBS patients exhibited lower rectal sensory thresholds than controls (P < 0.0001), but in addition had significantly lower sensory thresholds for both perception and discomfort evoked by balloon distension of the esophagus (mean +/- SEM: 8.8 +/- 1.3 ml vs 12.1 +/- 1.5 ml (P < 0.05) and 12.2 +/- 1.4 ml vs 16.4 +/- 1.4 ml (P < 0.02) respectively. Patients with FD showed similarly enhanced esophageal sensitivity, with thresholds for perception and discomfort of 8.1 +/- 0.9 ml (P < 0.02), and 10.1 +/- 1.0 ml (p < 0.001), respectively, but were also found to have sensory thresholds for rectal distension similar to those observed in the IBS group, significantly lower than in controls: IP 45.0 +/- 17.6 vs 59.3 +/- 1.5 ml (P < 0.001), DD 98.0 +/- 17.9 vs 298.7 +/- 9.0 ml (P < 0.0001), U 177.2 +/- 25.4 vs 415.1 +/- 12.6 ml (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The role of probiotics in gastrointestinal disease.

Patients with intestinal failure often have diarrhea for a variety of reasons. Treatment of diarrhea has centered on the use of antidiarrheal medications and antibiotic therapy. Recently, there has been interest in the oral administration of probiotics for these patients with small bowel bacterial overgrowth, inflammatory bowel disease, and radiation enteritis. This paper reviews the studies that have used probiotics to treat patients with short bowel syndrome and gastrointestinal disorders. Additionally, some of the specific issues regarding probiotics are addressed.

Journal Article↗

Gastric retention of sucralfate gel and suspension in upper gastrointestinal diseases.

This study was designed to compare by scintigraphy the gastric retention of a new dosage form of sucralfate as gel (Gastrogel) with that of sucralfate suspension in 25 patients with upper gastrointestinal symptoms referred for routine endoscopy. After endoscopy 4 subgroups were defined: macroscopically normal mucosa (n = 7), antral gastritis and/or erosions (n = 6), gastric ulcer (n = 6) and duodenal ulcer (n = 6). Each patient received either sucralfate gel or sucralfate suspension in equivalent doses (5 ml containing 1 g sucralfate). Both formulations were labelled with 111 MBq 99mTc-DTPA before administration. The mean value of t1/2 in the total group was significantly longer when patients were taking sucralfate gel (61.6 min) compared to sucralfate suspension (33.8 min) (P < 0.001). The mean values of t1/2 were significantly longer for sucralfate gel compared to sucralfate suspension also among the subgroups (macroscopically normal P < 0.02, antral gastritis P < 0.05, gastric ulcer P < 0.02 and duodenal ulcer P < 0.05). After 2 and 3 hours, the percentage residual activity in the gastric area was significantly higher following administration of sucralfate gel compared to sucralfate suspension. This study has shown that, compared to sucralfate suspension, sucralfate gel persists longer in the stomach of patients with gastritis and peptic ulcer.

Adolescent↗

Detection and antimicrobial susceptibility patterns of Salmonella enterica subsp. arizonae and Proteus spp. associated with gastrointestinal disease in rescued hedgehogs (Erinaceus europaeus).

Western European hedgehogs (Erinaceus europaeus) are frequently admitted to wildlife rehabilitation centres, where infectious diseases may affect recovery and raise One Health concerns. This study aimed to identify bacterial isolates recovered from hedgehog samples submitted for suspected gastrointestinal infection and to characterise their antimicrobial susceptibility profiles. Five bacterial isolates were analysed using the MicroScan WalkAway Plus&#xae; system with the Neg-Urine-Combo 98 panel, and the results were interpreted in accordance with EUCAST guidelines. The identified bacteria included one isolate of Salmonella enterica subsp. arizonae, three isolates of Proteus mirabilis and one isolate of Proteus penneri. The Salmonella enterica subsp. arizonae isolate was susceptible to all antimicrobials for which a valid result was obtained. Proteus spp. isolates were susceptible to cefotaxime, nalidixic acid, ciprofloxacin, levofloxacin, norfloxacin, amikacin, gentamicin, tobramycin, aztreonam, cefoxitin, ceftazidime and fosfomycin. However, resistance was observed to amoxicillin-clavulanic acid, ampicillin, ertapenem, meropenem, trimethoprim-sulfamethoxazole, cefuroxime, piperacillin-tazobactam, colistin and nitrofurantoin, with the latter two showing resistance in all Proteus spp. The Proteus penneri isolate displayed the broadest resistance profile, including resistance to several &#x3b2;-lactams, carbapenems. As expected, all Proteus spp. showed intrinsic non-susceptibility to colistin and nitrofurantoin. Although the Salmonella enterica subsp. arizonae isolate was susceptible to the tested agents, Proteus spp. from hedgehog samples may display relevant antimicrobial resistance (AMR) patterns. Therefore, continuous bacteriological monitoring and antimicrobial susceptibility testing are important in wildlife rehabilitation settings to guide treatment decisions and support One Health surveillance.

Antimicrobial resistance↗

Review article: the potential role for photodynamic therapy in the management of upper gastrointestinal disease.

Photodynamic therapy involves the activation of an exogenously administered, or an endogenously generated, photosensitizer with light to produce localized tissue destruction. It is an attractive, predominantly endoscopic technique for the palliation of advanced upper gastrointestinal cancer and the eradication of early neoplastic and pre-neoplastic lesions. The nature of the biological response allowing safe healing and the exploitation of tissue threshold effects mean that adjacent tissue damage can be minimized. This review used a database of 368 papers. The nature of the photosensitizer is critical to the depth of tissue damage and the risk of adjacent tissue damage and stricture formation. The generation of protoporphyrin IX following administration of 5-aminolaevulinic acid has proved useful for the treatment of high-grade dysplasia in Barrett's oesophagus. A double-blind randomized placebo controlled trial has confirmed that it is a safe and effective method for the ablation of low-grade dysplasia. The treatment of more advanced lesions requires exogenously administered photo-sensitizers. However, recent data indicate that the neoplastic potential remains in some patients and continued follow-up is necessary. Photodynamic therapy can be used to eradicate early neoplasia and palliate advanced cancer, but caution is required before a definitive cure can be claimed.

Barrett Esophagus↗

Evidence that the enterotoxin gene can be episomal in Clostridium perfringens isolates associated with non-food-borne human gastrointestinal diseases.

Clostridium perfringens enterotoxin (CPE) is responsible for the diarrheal and cramping symptoms of human C. perfringens type A food poisoning. CPE-producing C. perfringens isolates have also recently been associated with several non-food-borne human gastrointestinal (GI) illnesses, including antibiotic-associated diarrhea and sporadic diarrhea. The current study has used restriction fragment length polymorphism (RFLP) and pulsed-field gel electrophoresis (PFGE) analyses to compare the genotypes of 43 cpe-positive C. perfringens isolates obtained from diverse sources. All North American and European food-poisoning isolates examined in this study were found to carry a chromosomal cpe, while all non-food-borne human GI disease isolates characterized in this study were determined to carry their cpe on an episome. Collectively, these results provide the first evidence that distinct subpopulations of cpe-positive C. perfringens isolates may be responsible for C. perfringens type A food poisoning versus CPE-associated non-food-borne human GI diseases. If these putative associations are confirmed in additional surveys, cpe RFLP and PFGE genotyping assays may facilitate the differential diagnosis of food-borne versus non-food-borne CPE-associated human GI illnesses and may also be useful epidemiologic tools for identifying reservoirs or transmission mechanisms for the subpopulations of cpe-positive isolates specifically responsible for CPE-associated food-borne versus non-food-borne human GI diseases.

Chromosome Mapping↗

Analysis of the N-glycosylation of the serum glycoproteins defined by Con A, PHA-E, RCA1 and WGA in Chinese patients with gastrointestinal diseases.

Glycoproteins from tumor cells isolated by Con A, PHA-E and RCA1, were coupled to horse radish peroxidase and then used as reporters to evaluate the oligosaccharides change on serum glycoproteins in digestive tract diseases and individual healthy persons. A value 2 standard deviation above the mean of the healthy person group was considered positive. The results indicated that the positive rates of the oligosaccharides bound with Con A, PHA-E and RCA1 were 51% (61/119), 70.6% (84/119), and 76.4% (91/119) in patients with gastric cancer; 53.3% (16/30), 46.7% (14/30) and 66.7% (20/30) in esophageal cancers; 28.5% (15/49), 49.0% (24/49) and 46.9% (23/49) in colorectal cancer; 78.1% (25/32), 81.3% (26/32) and 31.3% (10/32) in gallbladder tumors; 60.4% (29/48), 54.1% (26/48) and 39.5% (19/48) in hepatocellular cancer. The positive rates among the patients with benign diseases were also found to be 12.7% (16/126), 15.5% (20/126) and 26.2% (33/126). However, the expression of the oligosaccharide moieties recognized by WGA on the glycoprotein bound with Con A, was significantly lower in the serum of patients with tumors than in those with benign disease and in healthy individuals (P < 0.01, P < 0.01).

Adult↗