This month in Gastroenterology
Section snippets
Screening for colonic adenomas
In this month's journal, two articles dealing with colonic adenomas are interesting and potentially important. In the first article by Pariente et al., 185 first-degree relatives of patients with sporadic colon cancer were examined by colonoscopy and found to have an odds ratio of 1.5 for adenomas, 2.5 for large adenomas, 1.2 for small adenomas, and 2.6 for high-risk adenomas (≥1 cm and/or a villous component). The prevalence of high-risk adenomas in relatives was found to be higher when the
Anti-p53 antibodies in patients with Barrett's esophagus
Based on prior observations by this group that anti-p53 circulating antibodies predated a diagnosis of malignancy in subjects at increased risk for liver, lung, and prostate cancer, Cawley et al. determined whether these antibodies were present in the plasma of 88 serially endoscoped patients with Barrett's metaplasia (n = 36), esophageal squamous cell carcinoma (n = 23), esophageal adenocarcinoma (n = 10), or esophagitis or a normal esophagus (n = 19). This antibody was detected in 4 patients
Oral beclomethasone for graft-versus-host disease
McDonald et al. report on their study in which they randomized 60 allogeneic hematopoietic cell recipients with anorexia and poor oral intake secondary to biopsy-proven intestinal graft-versus-host disease (GVHD) to receive prednisone (1 mg/kg) plus either oral beclomethasone dipropionate (BDP) or placebo capsules. Initial responders, who were eating at least 70% of their caloric needs at day 10 evaluation, continued to take study capsules for an additional 20 days, while their prednisone was
Exercise and bone density in Crohn's disease
Based on the fact that physical exercise increases bone mineral density (BMD) in healthy young adults and slows the rate of bone loss in later life, Robinson et al. performed a randomized control trial to investigate the potential effects of exercise on BMD in patients with Crohn's disease. Patients with this disorder (n = 117) were randomized to either a control group or to a low-impact exercise program of increasing intensity. The patients' BMD (g/cm2) was measured at the initiation of the
The omeprazole test in patients with noncardiac chest pain
In this issue Fass et al. report on their evaluation of the efficacy of the “omeprazole test” in diagnosing gastroesophageal reflux disease (GERD) in 38 patients with noncardiac chest pain (NCCP), referred to them by cardiologists, as well as on this test's potential cost savings compared with conventional diagnostic evaluations. The results of their studies indicated that the test was sensitive (78.3%) and specific (85.7%) for diagnosing GERD in NCCP patients. Moreover, this strategy resulted
Clinical significance of virulence-associated genotypes of H. pylori
Two articles deal with the clinical significance of virulence-associated genotypes of Helicobacter pylori. In the first article, Vicari et al. report on their studies that assessed the prevalence of cagA-positive H. pylori strains in 153 patients with gastroesophageal reflux disease (GERD), Barrett's esophagus, and Barrett's esophagus complicated by dysplasia or adenocarcinoma, compared with 57 control patients who underwent upper endoscopy for reasons other than GERD. They found that patients
COX-1 and inflammation
Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to cause ulceration and bleeding in the gastrointestinal tract. The characterization of two isoforms of the key enzyme responsible for prostaglandin synthesis, cyclooxygenase (COX), has lead to the concept that selective inhibitors of the inducible isoform of this enzyme, COX-2, would be effective anti-inflammatory and analgesic agents without causing significant gastrointestinal injury, which has been attributed to the NSAID-induced
Pathogenesis and treatment of gallbladder microlithiasis
The presence of stones <3 mm in diameter in the gallbladder is termed microlithiasis. These stones are generally not detectable by transabdominal ultrasonography or by conventional cholecystography, but may be detected in some patients by endoscopic ultrasonography as biliary sludge or small stones. The diagnosis of microlithiasis can then be confirmed by the detection of biliary crystals by microscopic examination of bile collected from the duodenum. In this issue Sharma et al. studied 10