Description: Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used class of medications worldwide. It is estimated that more than 20 million people take NSAIDs daily. We examined the underreported use of NSAIDs on a standardized office intake assessment questionnaire of patient reported medications. A questionnaire was administered to patients following written and verbal confirmed report of current medications to nursing staff. One hundred consecutive patient intake assessments were evaluated from the patient intake sheets for a busy private gastroenterology specialty practice. After patients listed their current medications , they were given a survey and asked to acknowledge any use of 30 non-prescription formulations that contained NSAIDs. Patients filled these surveys while waiting for the health care provider who then reviewed the response accuracy with the patient during the visit. Changes in the patient‘s initial and subsequently corroborated use or non-use of NSAIDs were recorded and tabulated. The educational level of all participants was also assessed. Of the 100 surveys completed, 6% of patients had not completed high school, 19% had completed high school, 8% had started but not finished college, 54% had completed college, 2% had started but not finished graduate school, and 11% had completed graduate school. The educational level of the patients did not correlate with underreporting of NSAID usage. On the survey, 18% of patients noted use of an NSAID listed that had not been reported verbally to nursing staff; 8% of those patients reported daily use, 15% weekly use and 76% reported use within the last month. Patients were then asked in the questionnaire as to the reason for not reporting medication intake to nurse; 14% stated they were never asked about the specific medication, 22% did not think the medications were important enough to list, 34% bought the medication with prescriptions, and 30% noted their reason as their doctor did not prescribe the medication to them. Using a prospective questionnaire in a private practice gastrointestinal office, these data show that patients underreport use of non-prescription NSAIDs. Based on the data, it is clear that this underreporting can have a detrimental effect on procedure related as well as long-term patient care. Future studies would be needed to examine the incidence of side effects due to underreporting of NSAIDs.

Description: The development of Barrett’s esophagus above the anastomosis following esophagogastrectomy has been reported in several studies. In this prospective study we set out to examine the prevalence of this phenomenon in a group of patients who have been strictly adherent to post operative proton pump inhibitor (PPI) therapy. Forty-six postoesophagectomy patients were prospectively assessed by upper gastrointestinal endoscopy. Four quadrant biopsies were taken 1 cm proximal to the esophago-gastric anastomosis in all patients and details of endoscopic appearance, biopsy pathology, operative pathology and PPI dose were recorded. All 46 patients had been commenced on a PPI in the immediate postoperative period. Two patients were not taking a PPI regularly. The average time from operation to endoscopy was 3 years (range 0.5 to 9). Mild (Grade 1) erosive oesophagitis was observed in 5 patients. Barrett’s epithelium was not identified in any patient. One patient who was taking a PPI intermittently had macroscopic columnar epithelium for 2 cm above the anastomosis without intestinal metaplasia. One other patient who had no macroscopic abnormality had columnar epithelium without intestinal metaplasia, seen in one of four biopsy specimens. This is the first study to assess for endoscopic evidence of neo-Barrett’s following oesophagogastrectomy, where PPI therapy has been commenced in the immediate postoperative period. Columnar epithelium was present in 2 patients and intestinal metaplasia was not detected in any of the cohort. These outcomes may be due to early commencement of PPI therapy and a high level of compliance.

Description: Signet ring cell carcinoma is a subtype of adenocarcinoma and mainly originated from stomach. Terminal ileum involvement is uncommon and only 2 cases have been reported in the literature. We represent a case of signet ring cell carcinoma of the terminal ileum showing gross features mimicking Crohn’s disease in a patient with ankylosing spondylitis.

Description: In the management of Helicobacter pylori -induced gastroduodenal disease, a pilot study at our hospital (St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway) revealed that culture often seemed to fail compared to the polymerase chain reaction (PCR). A more thorough evaluation was therefore undertaken. We included 201 patients referred to upper gastrointestinal endoscopy in the period 2002-2004. Serology, biopsy rapid urease test, culture and PCR were performed. Conventional PCR was performed using the ureC , vacA and cagA genes, and real-time PCR for ureC . A diagnostic standard was defined on the basis of all four tests, and all four tests were then compared to this standard. One hundred eleven patients were deemed H. pylori- positive by the defined diagnostic standard, and 90 were labeled negative. Compared to this standard, culture showed a sensitivity of 87.4%, which was significantly lower than PCR at 99.1% (P〈0.001). Culture showed a perfect specificity of 100%, which was significantly better than PCR at 97.8%. ureC was the gene with the best sensitivity (94.6% in conventional PCR, 97.3% in real-time PCR). vacA sensitivity was 87.4%, which is significantly lower than ureC (P〈0.001). cagA was present in 37.8% of our H. pylori -positive patients. By real-time PCR a significantly lower cycle threshold was observed in antral biopsies than in corpal biopsies, indicating a higher H. pylori DNA template concentration in antral biopsies. PCR-testing for H. pylori is faster and significantly more sensitive than culture. Culture on the other hand was significantly more specific than PCR in our hand.

Description: Intestinal microbiota play an important role in maintaining normal gastrointestinal (GI) function and ensuring that changes in the composition of the intestinal microbiota can promote GI function. The digestive tract is full of bacteria and many of these, including probiotics, are necessary for optimal digestive function. During bacterial gastroenteritis, harmful bacteria invade the digestive tract causing unpleasant symptoms and upsetting the balance between good and bad bacteria. Supplemental probiotics can help restore this balance. Studies have demonstrated that probiotics can often help reduce the severity of symptoms such as diarrhea and may help accelerate recovery. Probiotics are therapeutic preparations of live microorganisms administered in sufficient dosage to be beneficial to health. The therapeutic effects of these microorganisms appear to be strain specific. Primal Defense®, a unique, probiotic , bacterial compound, contains probiotics that support gut flora balance, promote consistent bowel function, control stomach acid levels to quickly eliminate burning sensation in the stomach and maintain immune system response. The probiotics in Primal Defense® maximize the benefits of a healthy diet by supporting normal absorption and assimilation of nutrients in the gut. Nearly 75% of our immune defenses are located in the digestive tract, so maintaining a favorable bacterial balance in the intestines (ideally 80% good or neutral bacteria to 20% bad or harmful bacteria) is crucial to achieving and maintaining optimum health.

Description: Helicobacter pylori consist in a helical shaped Gram-negative bacterium, approximately 3 micrometers long with a diameter of approximately 0.5 micrometers. It has 4-6 flagella. It is microaerophilic and tests positive for oxidase, catalase and urease. With its flagella, the bacterium moves through the stomach lumen and drills into the mucus gel layer of the stomach. In humans, H. pylori have been associated with peptic ulcers, chronic gastritis, duodenitis and stomach cancer. It is widely believed that in the absence of treatment, H. pylori infection, once established in its gastric niche, persists for life. The aim of this research is to study the cultural characteristics and antibiotic susceptibility pattern of H. pylori strains isolated from southwest Nigeria. The cultural characteristics and antibiotic susceptibility pattern of Helicobacter pylori strains isolated from gastric mucosal antral biopsy specimens collected from 43 of 52 dyspepsia patients in the University College Hospital Ibadan, Oyo State, Nigeria, were determined using standard microbiological methods for Helicobacter pylori isolation. The 43 isolates were subjected to 23 different antibiotics and each of the antibiotics demonstrated a variable degree of activity against the isolates. Among the antibiotics to which the organism was most susceptible are: ofloxacin (30 μg) 100% activity, ciprofloxacin (5 μg) 97.67% activity, gentamicin (120 μg) 95.35 activity, amikacin (30 μg), kanamycin (30 μg) and chloramphenicol (30 μg) each 90.70% activity, clarithromycin (15 μg) 93.02, while the less active antibiotics are: augmentin (30 μg) 23.26% active, amoxycillin (25 μg) and metronidazole (50 μg) each 27.91% active and clindamycin (2 mg) 30.23% active. From the result of the antibiotic susceptibility pattern of the strains of the organism, 95.35% of the total isolates are multi drug resistant. Resistance was developed to, among others, augmentin (30 μg), amoxycillin (25 μg), metronidazole (50 μg) and clindamycin (2 mg).

Description: Cytomegalovirus (CMV) infection is widespread in the general population. In patients with severe and/or steroid-refractory ulcerative colitis (UC), local reactivation of CMV can be detected in actively inflamed colonic tissue in approximately 30% of cases. However, the role of CMV in patients with UC is not clearly understood. There is evidence to show a possible role in exacerbating a colitis flare, whereas other studies describe CMV as an innocent bystander. We report the case of a patient with severe UC complicated by CMV infection who did not respond to conventional therapy. A complete diagnostic panel for CMV diagnosis, including tissue polymerase chain reaction and immunohistochemistry, was carried out. Three-week therapy with oral valganciclovir resulted in dramatic clinical and endoscopic improvement. Timing of diagnosis and treatment of CMV infection complicating UC is crucial in order to recognize the organ-disease and plan appropriate treatment.

Description: Primary care physicians face challenges in diagnosing and managing gastroesophageal reflux disease (GERD). The Reflux Disease Questionnaire (RDQ) meets the standards of validity, reliability, and practicability. This paper reports on the validation of the Greek translation of the RDQ. RDQ is a condition specific instrument. For the validation of the questionnaire, the internal consistency of its items was established using the alpha coefficient of Chronbach. The reproducibility (test-retest reliability) was measured by kappa correlation coefficient and the criterion of validity was calculated against the diagnosis of another questionnaire already translated and validated into Greek (IDGP) using kappa correlation coefficient. A factor analysis was also performed. Greek RDQ showed a high overall internal consistency (alpha value: 0.91) for individual comparison. All 8 items regarding heartburn and regurgitation, GERD, had good reproducibility (Cohen’s κ 0.60-0.79), while the remaining 4 items about dyspepsia had a moderate reproducibility (Cohen’s κ=’ 0.40-0.59) The kappa coefficient for criterion validity for GERD was rather poor (0.20, 95% CI: 0.04, 0.36) and the overall agreement between the results of the RDQ questionnaire and those based on the IDGP questionnaire was 70.5%. Factor analysis indicated 3 factors with Eigenvalue over 1.0, and responsible for 76.91% of variance. Regurgitation items correlated more strongly with the third component but pain behind sternum and upper stomach pain correlated with the second component. The Greek version of RDQ seems to be a reliable and valid instrument following the pattern of the original questionnaire, and could be used in primary care research in Greece.

Description: Leptospirosis is a reemerging zoonosis of global importance. Outbreaks are related to agricultural environments and exposure to flooding, and it is primarily found in tropical countries. Although cases with typical presentation are relatively easy to diagnose and treat, atypical cases make it difficult to differentiate from other diseases, especially those patients with digestive symptoms who present to departments of gastroenterology. A 54-year old man was admitted to hospital for jaundice, vomiting and fatty liver. leptospirosis antibody test and polymerase chain reaction did not help us to make a definite diagnosis. However, based on the patient’s presentation, physical characteristics and the muscular biopsy, Weil’s syndrome was diagnosed. This is a reminder that leptospirosis may be found in a developed city of southern China. Clinical experience, disease characterizations, physical signs and biopsy should be applied as more efficient ways to recognize atypical cases of leptospirosis.

Description: Primary care physicians face challenges in diagnosing and managing Gastro-oesophageal reflux disease (GERD). The Reflux Disease Questionnaire (RDQ) meets the standards of validity, reliability, and practicability. This paper reports on the validation of the translated into Greek RDQ. RDQ is a condition specific instrument. For the validation of the questionnaire, the internal consistency of its items was established using the alpha coefficient of Chronbach, the reproducibility (test – retest reliability) was measured by kappa correlation coefficient and the criterion of validity was calculated against the diagnosis of another questionnaire already translated and validated into Greek (IDGP) using kappa correlation coefficient. A factor analysis was also performed. Greek RDQ showed a high overall internal consistency (alpha value: 0.91) for individual comparison. All 8 items regarding heartburn and regurgitation (GERD) had “good” reproducibility (Cohen's κ = 0.60 to 0.79), while the remaining 4 items about dyspepsia had a “moderate” reproducibility (Cohen's κ= 0.40 to 0.59). The kappa coefficient for criterion validity for GERD was rather poor (0.20, 95% CI: 0.04, 0.36) and the overall agreement between the results of the RDQ questionnaire and those based on the IDGP questionnaire was 70.5%. Factor analysis indicated three factors with Eigenvalue over 1.0, and responsible for 76.91% of variance. Regurgitation items correlated more strongly with the 3rd component but pain behind sternum and upper stomach pain correlated with the 2nd component. The Greek version of RDQ seems to be a reliable, valid and responsive instrument following the pattern of the original questionnaire, and could be used in primary care research in Greece