AIM: Recently, drinking load tests with water or nutritional beverages have been proposed as diagnostic tools for functional dyspepsia (FD), therefore we sought to reproduce if these tests can discriminate between FD ...AIM: Recently, drinking load tests with water or nutritional beverages have been proposed as diagnostic tools for functional dyspepsia (FD), therefore we sought to reproduce if these tests can discriminate between FD patients and controls in a Mexican population. METHODS: Twenty FD-Rome Ⅱ patients were matched by age and gender with 20 healthy controls. All underwent both drinking tests at a 15 mL/min rate, randomly, 7 d apart. Every 5 min within each test, four symptoms were evaluated (satiety, bloating, nausea and pain) by Likert scales. Maximum tolerated volume (MTV) was defined as the ingested volume when a score of 5 was reached for any symptom or when the test had to be stopped because the patients could not tolerate more volume. Sensitivity and specificity were analyzed. RESULTS: FD patients had higher symptom scores for both tests compared to controls (water: t= 4.1, P= 0.001 ＜0.01; Nutren(R): t= 5.2, P= 0.001＜0.01). The MTV forwater and Nutren(R) were significantly lower in FD (water: 1014±288 vs 1749±275 mL; t = 7.9, P = 0.001＜0.01;Nutren(R): 652±168 vs 1278±286 mL; t= 6.7, P = 0.001＜0.01). With the volume tolerated by the controls, the percentile 10 was determined as the lower limit fortolerance. Sensitivity and specificity were 0.90, 0.95 for water and 0.95, 0.95 for Nutren(R) tests.CONCLUSION: A drinking test with water or a nutritional beverage can discriminate between FD patients and healthy subjects in Mexico, with high sensitivity and specificity. These tests could be used as objective, noninvasive, and safe diagnostic approaches for FD patients.展开更多
Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of the non-Hodgkin’s lymphoma (NHL) accounting for about 40% of all NHLs. This is a case report about the endoscopic appearance of a DLBCL w...Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of the non-Hodgkin’s lymphoma (NHL) accounting for about 40% of all NHLs. This is a case report about the endoscopic appearance of a DLBCL with infiltration to the stomach in a 39-year-old female. She had a 6-mo history of lumbar and left upper quadrant pain with intermittent episodes of melena. A computer tomograghy (CT) scan showed mural thickening of the gastric antrum. Endoscopic examination revealed multiple gastric ulcers. Definite diagnosis could be made by endoscopic biopsies and the patient had a good response to chemotherapy. This response correlated well with a further endoscopic follow-up. A follow-up endoscopic examination could be considered to evaluate a good response to chemotherapy in DLBCL patients with secondary gastric dissemination.展开更多
AIM: To compare magnetic imaging-assisted colonoscopy(MIC) with conventional colonoscopy(CC).METHODS: Magnetic imaging technology provides a computer-generated image of the shape and position of the colonoscope onto a...AIM: To compare magnetic imaging-assisted colonoscopy(MIC) with conventional colonoscopy(CC).METHODS: Magnetic imaging technology provides a computer-generated image of the shape and position of the colonoscope onto a monitor to give visual guidance to the endoscopist. It is designed to improve colonoscopy performance and tolerability for patients by enabling visualization of loop formation and endoscope position. Recently, a new version of MIC technology was developed for which there are limited data.To evaluate this latest generation of MIC among experienced rather than inexperienced or trainee endoscopists, a prospective randomized trial was performed using only gastroenterologists with therapeutic endoscopy training. Consecutive patients undergoing elective outpatient colonoscopy were randomized to MIC or CC, with patients blinded to their group assignment. Endoscopic procedural metrics and quantities of conscious sedation medications were recorded during the procedures. The procedure was classified as "usual" or "difficult" by the endoscopist at the conclusion of each case based on the need for adjunctive maneuvers to facilitate endoscope advancement. After more than one hour post-procedure, patients completed a 10 cm visual analogue pain scale to reflect the degree of discomfort experienced during their colonoscopy. The primary outcome was patient comfort expressed by the visual analogue pain score. Secondary outcomes consisted of endoscopic procedural metrics as well as a sedation score derived from standardized dose increments of the conscious sedation medications.RESULTS: Two hundred fifty-three patients were randomized and underwent MIC or CC between September 2011 and October 2012. The groups were similar in terms of the indications for colonoscopy and patient characteristics. There were no differences in cecal intubation rates(100% vs 99%), insertion distance-tocecum(82 cm vs 83 cm), time-to-cecum(6.5 min vs 7.2 min), or polyp detection rate(47% vs 52%) between the MIC and CC groups. The primary outcome of mean pain score(1.0 vs 0.9 out of 10, P = 0.41) did not differ between MIC and CC groups, nor did the mean sedation score(8.2 vs 8.5, P = 0.34). Within the subgroup of cases considered more challenging or difficult, timeto-cecum was significantly faster with MIC compared to CC, 10.1 min vs 13.4 min respectively(P = 0.01). Sensitivity analyses confirmed a similar pattern of overall findings when each endoscopist was considered separately, demonstrating that the mean results for the entire group were not unduly influenced by outlier results from any one endoscopist.CONCLUSION: Although the latest version of MIC resulted in faster times-to-cecum within a subgroup of more challenging cases, overall it was no better than CC in terms of patient comfort, sedation requirements and endoscopic procedural metrics, when performed in experienced hands.展开更多
文摘AIM: Recently, drinking load tests with water or nutritional beverages have been proposed as diagnostic tools for functional dyspepsia (FD), therefore we sought to reproduce if these tests can discriminate between FD patients and controls in a Mexican population. METHODS: Twenty FD-Rome Ⅱ patients were matched by age and gender with 20 healthy controls. All underwent both drinking tests at a 15 mL/min rate, randomly, 7 d apart. Every 5 min within each test, four symptoms were evaluated (satiety, bloating, nausea and pain) by Likert scales. Maximum tolerated volume (MTV) was defined as the ingested volume when a score of 5 was reached for any symptom or when the test had to be stopped because the patients could not tolerate more volume. Sensitivity and specificity were analyzed. RESULTS: FD patients had higher symptom scores for both tests compared to controls (water: t= 4.1, P= 0.001 ＜0.01; Nutren(R): t= 5.2, P= 0.001＜0.01). The MTV forwater and Nutren(R) were significantly lower in FD (water: 1014±288 vs 1749±275 mL; t = 7.9, P = 0.001＜0.01;Nutren(R): 652±168 vs 1278±286 mL; t= 6.7, P = 0.001＜0.01). With the volume tolerated by the controls, the percentile 10 was determined as the lower limit fortolerance. Sensitivity and specificity were 0.90, 0.95 for water and 0.95, 0.95 for Nutren(R) tests.CONCLUSION: A drinking test with water or a nutritional beverage can discriminate between FD patients and healthy subjects in Mexico, with high sensitivity and specificity. These tests could be used as objective, noninvasive, and safe diagnostic approaches for FD patients.
文摘Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of the non-Hodgkin’s lymphoma (NHL) accounting for about 40% of all NHLs. This is a case report about the endoscopic appearance of a DLBCL with infiltration to the stomach in a 39-year-old female. She had a 6-mo history of lumbar and left upper quadrant pain with intermittent episodes of melena. A computer tomograghy (CT) scan showed mural thickening of the gastric antrum. Endoscopic examination revealed multiple gastric ulcers. Definite diagnosis could be made by endoscopic biopsies and the patient had a good response to chemotherapy. This response correlated well with a further endoscopic follow-up. A follow-up endoscopic examination could be considered to evaluate a good response to chemotherapy in DLBCL patients with secondary gastric dissemination.
文摘AIM: To compare magnetic imaging-assisted colonoscopy(MIC) with conventional colonoscopy(CC).METHODS: Magnetic imaging technology provides a computer-generated image of the shape and position of the colonoscope onto a monitor to give visual guidance to the endoscopist. It is designed to improve colonoscopy performance and tolerability for patients by enabling visualization of loop formation and endoscope position. Recently, a new version of MIC technology was developed for which there are limited data.To evaluate this latest generation of MIC among experienced rather than inexperienced or trainee endoscopists, a prospective randomized trial was performed using only gastroenterologists with therapeutic endoscopy training. Consecutive patients undergoing elective outpatient colonoscopy were randomized to MIC or CC, with patients blinded to their group assignment. Endoscopic procedural metrics and quantities of conscious sedation medications were recorded during the procedures. The procedure was classified as "usual" or "difficult" by the endoscopist at the conclusion of each case based on the need for adjunctive maneuvers to facilitate endoscope advancement. After more than one hour post-procedure, patients completed a 10 cm visual analogue pain scale to reflect the degree of discomfort experienced during their colonoscopy. The primary outcome was patient comfort expressed by the visual analogue pain score. Secondary outcomes consisted of endoscopic procedural metrics as well as a sedation score derived from standardized dose increments of the conscious sedation medications.RESULTS: Two hundred fifty-three patients were randomized and underwent MIC or CC between September 2011 and October 2012. The groups were similar in terms of the indications for colonoscopy and patient characteristics. There were no differences in cecal intubation rates(100% vs 99%), insertion distance-tocecum(82 cm vs 83 cm), time-to-cecum(6.5 min vs 7.2 min), or polyp detection rate(47% vs 52%) between the MIC and CC groups. The primary outcome of mean pain score(1.0 vs 0.9 out of 10, P = 0.41) did not differ between MIC and CC groups, nor did the mean sedation score(8.2 vs 8.5, P = 0.34). Within the subgroup of cases considered more challenging or difficult, timeto-cecum was significantly faster with MIC compared to CC, 10.1 min vs 13.4 min respectively(P = 0.01). Sensitivity analyses confirmed a similar pattern of overall findings when each endoscopist was considered separately, demonstrating that the mean results for the entire group were not unduly influenced by outlier results from any one endoscopist.CONCLUSION: Although the latest version of MIC resulted in faster times-to-cecum within a subgroup of more challenging cases, overall it was no better than CC in terms of patient comfort, sedation requirements and endoscopic procedural metrics, when performed in experienced hands.
