Canadian Journal of Gastroenterology最新文献

{"title":"Hepatitis C.","authors":"D. Lavanchy, P. Gavinio","doi":"10.3949/ccjm.67.s1.20","DOIUrl":"https://doi.org/10.3949/ccjm.67.s1.20","url":null,"abstract":"Hepatitis C has been identified as the most common cause of post-transfusion hepatitis worldwide, accounting for approximately 90% of this disease in Japan, the United States and Western Europe. Hepatitis C is a major global public health problem. New infections continue to occur, and the source of infection includes transfusion of blood or blood products from unscreened donors; transfusion of blood products that have not undergone viral inactivation; parenteral exposure to blood through use of contaminated and inadequately sterilized instruments and needles used in medical, dental and 'traditional' medicine; procedures such as hemodialysis; high risk sexual practices; household or sexual contacts of hepatitis C virus (HCV)-infected persons; and infants of HCV-infected mothers. In many countries, the relative contribution of the various sources of infection has not been defined with population-based epidemiological studies. Such studies are necessary to enable countries to prioritize their preventive measures and to make the most appropriate use of available resources. Given the substantial morbidity and mortality attributable to HCV-related chronic liver disease, each country, irrespective of economic status, should develop a plan of HCV-related public health activities for the prevention of new HCV infections and the treatment of established chronic infections.","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"7 1","pages":"67B-76B"},"PeriodicalIF":2.7,"publicationDate":"2015-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83515090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of funding gastroenterology research in Canada illustrates the beneficial role of partnerships.","authors":"Philip M Sherman,&nbsp;Kimberly Banks Hart,&nbsp;Keeley L Rose,&nbsp;Kwadwo Bosompra,&nbsp;Christopher Manuel,&nbsp;Paul Belanger,&nbsp;Sandra Daniels,&nbsp;Paul Sinclair,&nbsp;Stephen Vanner,&nbsp;Andre Buret","doi":"10.1155/2013/989203","DOIUrl":"https://doi.org/10.1155/2013/989203","url":null,"abstract":"<p><strong>Background: </strong>Funders of health research in Canada seek to determine how their funding programs impact research capacity and knowledge creation.</p><p><strong>Objective: </strong>To evaluate the impact of a focused grants and award program that was cofunded by the Canadian Institutes of Health Research Institute of Nutrition, Metabolism and Diabetes, and the Canadian Association of Gastroenterology; and to measure the impact of the Program on the career paths of funded researchers and assess the outcomes of research supported through the Program.</p><p><strong>Methods: </strong>A survey of the recipients of grants and awards from 2000 to 2008 was conducted in 2012. The CIHR Funding Decisions database was searched to determine subsequent funding; a bibliometric citation analysis of publications arising from the Program was performed.</p><p><strong>Results: </strong>Of 160 grant and award recipients, 147 (92%) completed the survey. With >$17.4 million in research funding, support was provided for 131 fellowship awards, seven career transition awards, and 22 operating grants. More than three-quarters of grant and award recipients continue to work or train in a research-related position. Combined research outputs included 545 research articles, 130 review articles, 33 book chapters and 11 patents. Comparative analyses indicate that publications supported by the funding program had a greater impact than other Canadian and international comparators.</p><p><strong>Conclusions: </strong>Continuity in support of a long-term health research funding partnership strengthened the career development of gastroenterology researchers in Canada, and enhanced the creation and dissemination of new knowledge in the discipline.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 12","pages":"717-20"},"PeriodicalIF":2.7,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/989203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31955876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A polyp from another polyp.","authors":"Vincent Kuo,&nbsp;Wareef Kabbani,&nbsp;Jeffrey Linder","doi":"10.1155/2013/412059","DOIUrl":"https://doi.org/10.1155/2013/412059","url":null,"abstract":"An 86-year-old woman presented for initial evaluation after an abnormal positron emission tomography (PET) scan revealed activity in the sigmoid colon suggestive of malignancy. She had a medical history of chronic obstructive pulmonary disease with a recent lung nodule that was found to be malignant. As part of her workup, a PET scan was performed and the results prompted evaluation by a gastroenterologist. The patient had never undergone a colonoscopy and denied any gastrointestinal symptoms. Colonoscopy revealed a sessile polyp 1 cm in size in the cecum, which was removed by snare electrocautery. There was an additional 1 cm pedunculated polyp in the sigmoid colon; arising from the stalk of the pedunculated polyp was another sessile polyp 7 mm in size. There was a 1 cm segment of normal-appearing mucosa on the stalk separating the two polyps (Figure 1A). Both were removed by snare electrocautery at the base of the stalk. \u0000 \u0000 \u0000 \u0000Figure 1) \u0000 \u0000A Sigmoid polyp. B Adenocarcinoma with submucosal invasion. C Polypectomy site with negative margins. Hematoxylin and eosin stain, original magnification ×20 \u0000 \u0000 \u0000 \u0000Pathology revealed the cecal polyp to be a tubular adenoma. The sigmoid polyp was a tubulovillous adenoma; the tumour emanating from the stalk was a low-grade, moderately differentiated adenocarcinoma with invasion into the submucosa (Figure 1B). There were negative margins within 1 mm of the polypectomy site, and no angiolymphatic or perineural invasion (Figure 1C). Immunostains were negative for transcription termination factor-1 and positive for CDX-2, which was consistent with a primary colorectal adenocarcinoma. The patient returned for follow-up and denied any complaints. She is scheduled to undergo a repeat colonoscopy in six months to ensure complete removal of the lesion. \u0000 \u0000There have been studies determining the utility of a PET scan in detecting colon polyps. Often, patients undergo a PET scan as part of a malignancy workup and may incidentally have suspicious lesions apparent in the colon. This is due to increased glucose metabolism and fluorodeoxy glucose uptake in colon adenomas. Studies have suggested that the degree of uptake is proportional to the degree of dysplasia in an adenoma (1). Correlation with colonoscopic findings generally shows that polyps >10 mm in size have a higher detection rate on PET. The pathology of the polyps can include hyperplastic, tubular adenoma, tubulovillous adenoma and carcinoma (2). Uptake on PET scan can have a focal or nonfocal pattern. Nonfocal uptake often represents a physiological variant and can be a nonspecific finding. Review of the literature suggests that a focal pattern of colorectal uptake can be associated with a 65% chance of identifying a malignant or premalignant lesion (3).","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 12","pages":"686"},"PeriodicalIF":2.7,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/412059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31958168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasonographic features of gastric mucosa-associated lymphoid tissue lymphoma with a 'pseudocircumvolutory' appearance.","authors":"João Santos-Antunes,&nbsp;Susana Lopes,&nbsp;Manuel Sobrinho-Simões,&nbsp;Helder Cardoso,&nbsp;Guilherme Macedo","doi":"10.1155/2013/195690","DOIUrl":"https://doi.org/10.1155/2013/195690","url":null,"abstract":"1Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. Joao; 2Department of Biochemistry, Faculty of Medicine, University of Porto; 3Deparment of Hematology, Centro Hospitalar S. Joao, Porto, Portugal Correspondence: Dr Joao Santos-Antunes, Gastroenterology Department, Centro Hospitalar S. Joao. Al. Prof. Hernâni Monteiro 4200–319 Porto, Portugal. Telephone 351-22-551-2100, fax 351-22-502-5766, e-mail joao.claudio.antunes@gmail.com Received for publication July 11, 2013. Accepted September 15, 2013 Case presentation A 45-year-old man with a history of drug abuse, alcoholism and heavy smoking habits was referred to the hepatology outpatient clinic because of the presence of anti-hepatis B virus (HBV) surface antigen, anti-HBV core antigen and anti-hepatitis C virus antibodies. He was being treated with tiapride and methadone. He had no anemia, a normal white blood cell count, negative autoimmune serology, undetectable HBV DNA and hepatitis C virus RNA, and mildly elevated aminotransferase levels. Immunoglobulin (Ig) M and IgA levels were elevated, with a monoclonal peak in protein electrophoresis. Myelography and bone biopsy revealed a cytological phenotype of Waldestrom macroglobulinemia with bone marrow involvement of small B cell lymphocytes, compatible with lymphoplasmacytoid lymphoma. An abdominal ultrasound and computed tomography scan revealed a thick gastric wall, and retroperitoneal and mesenteric adenopathies, raising suspicion for malignancy. Esophagogastroduodenoscopy was remarkable for diffuse hard and edematous gastric folds of the body and fundus with some erosions (Figure 1). Endoscopic ultrasonography showed an asymmetrically thickened gastric wall (20 mm maximum), with disease limited to the mucosa and preservation of wall layers, and adenopathies (Figures 2 to 4). Biopsies were performed and histology revealed dense infiltration of mucosa by small B cells with irregular nuclei, plasmacytic differentiation and formation of lymphoepithelial lesions, strongly suggestive of mucosa-associated lymphoid tissue (MALT) lymphoma. imagEs of thE month","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 12","pages":"687-8"},"PeriodicalIF":2.7,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/195690","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31958169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of chronic hepatitis C in a Canadian Aboriginal population: results from the PRAIRIE study.","authors":"Gerald Y Minuk,&nbsp;Meaghan O'Brien,&nbsp;Kim Hawkins,&nbsp;Didi Emokpare,&nbsp;James McHattie,&nbsp;Paul Harris,&nbsp;Lawrence Worobetz,&nbsp;Karen Doucette,&nbsp;Kelly Kaita,&nbsp;Stephen Wong,&nbsp;Gilles Pinette,&nbsp;Julia Uhanova","doi":"10.1155/2013/963694","DOIUrl":"https://doi.org/10.1155/2013/963694","url":null,"abstract":"<p><strong>Background: </strong>The Aboriginal population of Canada is at increased risk of exposure to the hepatitis C virus (HCV). Previous data indicate that spontaneous clearance of HCV occurs more often in Aboriginals than Caucasians. Whether this enhanced response extends to antiviral therapy for chronic HCV remains to be determined.</p><p><strong>Objectives: </strong>To document and compare the biochemical and virological responses to antiviral therapy in HCV-infected Canadian Aboriginals and Caucasians.</p><p><strong>Methods: </strong>A total of 101 treatment-naive adult patients (46 Aboriginal, 55 Caucasian) with chronic HCV genotype 1 infections were prospectively treated with pegylated-interferon and ribavirin and followed as per national guidelines.</p><p><strong>Results: </strong>Aboriginals had higher HCV-RNA loads at baseline (6.42log(10) versus 5.98log(10); P<0.03). Although normalization of serum aminotransferase levels, decreases in viral loads, and rapid, early and end-of-treatment virological responses were similar in the two cohorts, sustained virological responses were significantly lower in Aboriginals (35% versus 55%; P=0.047). Premature discontinuation of treatment and⁄or loss of patients to follow-up was common (Aboriginals 37%, Caucasians 27%). Treatment-related side effects were similar in the two cohorts.</p><p><strong>Conclusion: </strong>Despite higher rates of spontaneous HCV clearance, the response to antiviral therapy was similar, if not lower, in Aboriginals compared with Caucasians with chronic HCV genotype 1 infections. Compliance with treatment is an issue that needs to be addressed in the management of these patients.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 12","pages":"707-10"},"PeriodicalIF":2.7,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/963694","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31955874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection in the colorectum: Feasibility in the Canadian setting.","authors":"Marietta Iacucci,&nbsp;Gregory Eustace,&nbsp;Toshio Uraoka,&nbsp;Yutaka Saito,&nbsp;Miriam Fort Gasia,&nbsp;Jon Love,&nbsp;Naohisa Yahagi","doi":"10.1155/2013/536190","DOIUrl":"https://doi.org/10.1155/2013/536190","url":null,"abstract":"<p><p>Endoscopic submucosal dissection is a minimally invasive endoscopic technique for the removal of gastrointestinal tumours that is increasingly being used for colonic neoplasms to spare resection of colon in selected patients. Colonic endoscopic submucosal dissection is technically challenging and was initially pioneered in Japan but increasingly used in selected western centres. Its use in Canada is currently limited, and the authors review the challenges and opportunities, in addition to the unique training infrastructure required to practice the procedure under supervision. Specific tools are required to perform endoscopic submucosal dissection and meticulous attention to detail is essential. The authors provide a combined Japanese and Canadian perspective to this technique, and discuss training and performance of endoscopic submucosal dissection as well as potential indications. </p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 12","pages":"689-93"},"PeriodicalIF":2.7,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/536190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31958170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized controlled trial comparing sequential with triple therapy for Helicobacter pylori in an Aboriginal community in the Canadian North.","authors":"Amy L Morse,&nbsp;Karen J Goodman,&nbsp;Rachel Munday,&nbsp;Hsiu-Ju Chang,&nbsp;John Wi Morse,&nbsp;Monika Keelan,&nbsp;Janis Geary,&nbsp;Veldhuyzen van Zanten Sander","doi":"10.1155/2013/143047","DOIUrl":"https://doi.org/10.1155/2013/143047","url":null,"abstract":"<p><strong>Background: </strong>Helicobacter pylori infection occurs more frequently in Arctic Aboriginal settings than elsewhere in North America and Europe. Research aimed at reducing health risks from H pylori infection has been conducted in the Aboriginal community of Aklavik, Northwest Territories.</p><p><strong>Objective: </strong>To compare the effectiveness of the Canadian standard therapy with an alternative therapy for eliminating H pylori infection in Aklavik.</p><p><strong>Methods: </strong>Treatment-naive H pylori-positive individuals were randomly assigned to a 10-day regimen (oral twice-daily doses) with rabeprazole (20 mg): standard triple therapy (proton pump inhibitor, added clarithromycin [500 mg] and amoxicillin [1 g] [PPI-CA]); sequential therapy (ST) added amoxicillin (1 g) on days 1 to 5, and metronidazole (500 mg) and clarithromycin (500 mg) on days 6 to 10. Participants with clarithromycin-resistant H pylori were randomly assigned to ST or quadruple therapy. Treatment effectiveness was estimated as per cent (95% CI) with a negative urea breath test at least 10 weeks after treatment.</p><p><strong>Results: </strong>Of 104 (53 PPI-CA, 51 ST) randomized participants, 89 (49 PPI-CA, 40 ST) had post-treatment results. Per-protocol treatment effectiveness was 59% (95% CI 45% to 73%) for PPI-CA and 73% (95% CI 58% to 87%) for ST. Based on intention to treat, effectiveness was 55% (95% CI 41% to 69%) for PPI-CA and 57% (95% CI 43% to 71%) for ST. Of 77 participants (43 PPI-CA, 34 ST) with 100% adherence, effectiveness was 63% (95% CI 43% to 82%) for PPI-CA and 81% (95% CI 63% to 99%) for ST.</p><p><strong>Conclusions: </strong>While additional evidence is needed to confirm that ST is more effective for Arctic Aboriginal communities than the Canadian standard H pylori treatment, these results show standard PPI-CA treatment to be inadequate for communities such as Aklavik.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 12","pages":"701-6"},"PeriodicalIF":2.7,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/143047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31955873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yield and cost of performing screening tests for constipation in children.","authors":"Ashish Chogle,&nbsp;Miguel Saps","doi":"10.1155/2013/945165","DOIUrl":"https://doi.org/10.1155/2013/945165","url":null,"abstract":"<p><strong>Background: </strong>Chronic constipation is one of the most common reasons for pediatric outpatient visits. Clinical guidelines recommend that the work-up for chronic refractory constipation include thyroid function tests, celiac serology, and measurement of calcium and lead levels. Data to justify routine screening of constipated children using these laboratory tests are lacking.</p><p><strong>Objectives: </strong>To study the prevalence of celiac disease, hypothyroidism, hypercalcemia and lead poisoning in children with chronic constipation; and to estimate the health care costs of applying the guideline recommendations.</p><p><strong>Method: </strong>Charts of constipated children from 2007 to 2011 were reviewed for the present retrospective cohort study. Results and costs of thyroid function tests, celiac panel, total immunoglobulin (Ig) A, and determination of lead and calcium levels were analyzed.</p><p><strong>Results: </strong>A total of 7472 children (mean age 7.9 years; 3908 female) were evaluated: 1731 patients were screened for celiac antibodies; 55 had elevated tissue transglutaminase IgA levels and 29 had biopsy-positive celiac disease. Only three celiac patients had constipation as the sole presenting symptom; 1703 patients were screened for total IgA levels; 55 had IgA deficiency and two had biopsy-positive celiac disease; 2332 had free T4 and⁄or thyroid-stimulating hormone levels; and 14 had hypothyroidism. Only two patients had constipation as the sole presenting symptom; 4651 patients had calcium levels measured, 10 of whom had high levels but normal repeat values. Three patients had normal lead levels. The mean cost per patient was USD$1,014. Total screening cost for all patients was USD$4.7 million.</p><p><strong>Conclusion: </strong>Constipation alone did not increase the likelihood of celiac disease or hypothyroidism above the population prevalence. No benefit of screening for hypercalcemia was found. High health care costs were associated with the use of screening tests for organic constipation.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 12","pages":"e35-8"},"PeriodicalIF":2.7,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/945165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31863104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the best regimen for Helicobacter pylori eradication in Canadian Arctic Aboriginals?","authors":"Nicola Jones","doi":"10.1155/2013/856395","DOIUrl":"https://doi.org/10.1155/2013/856395","url":null,"abstract":"Canadian Aboriginal populations have a high prevalence of Helicobacter pylori infection and an increased risk for the development of gastric cancer (1). Thus, there is a need to identify effective H pylori eradication regimens in this at-risk population. In the current issue of the Journal, Morse et al (2) (pages 701–706) report results from a randomized controlled trial comparing sequential versus standard clarithromycin-containing triple therapy in H pylori-infected adults from the community of Aklavik (Northwest Territories) (2). The study was part of a participatory research project focusing on community-identified research goals investigating the burden of H pylori disease in Arctic Aboriginal communities. \u0000 \u0000In the study by Morse et al (2), H pylori-infected patients >15 years of age were randomly assigned to either a 10-day treatment of standard triple therapy consisting of a proton pump inhibitor (rabeprazole), amoxillicin and clarithromycin, or sequential therapy. Antibiotic resistance rates to clarithromycin and metronidazole were available for almost one-half of the subjects, allowing tailored treatment. If clarithromycin resistance was detected, patients were randomly assigned to sequential therapy or quadruple therapy. \u0000 \u0000Several important points are noteworthy in this study. First, as identified in other Canadian Aboriginal populations, the prevalence of H pylori infection remains high in this community despite a diminishing H pylori prevalence in most segments of the Canadian population. Second, the prevalence of precancerous lesions, gastric atrophy and intestinal metaplasia were high, supporting the increased risk for development of gastric cancer in this population and underscoring the need for effective H pylori eradication regimens. \u0000 \u0000When outcomes were assessed by the more stringent intention-to-treat analysis, the effectiveness of both therapies was disappointing, with only 55% efficacy with triple therapy and 57% with sequential therapy. With these poor outcomes, it is important to consider why the results were suboptimal. The success of treatment for H pylori is determined, in large part, by the presence of antibiotic resistance and patient adherence (3). In the study by Morse et al (2), of the 50 subjects who underwent sensitivity testing, the rates of clarithromycin and metronidazole resistance were 10% and 26%, respectively. Thus, it is likely that similar resistance rates were present in the remaining subjects who were randomly assigned to triple versus sequential therapy. The updated Maastricht guidelines (4) do not recommend clarithromycin therapy if the local clarithromycin resistance rate is >15%. Thus, one potential explanation for the poor efficacy is antibiotic resistance. \u0000 \u0000Poor adherence to therapy is an additional important determinant of efficacy (3). In the study by Morse et al, the overall adherence levels were suboptimal (60%). In fact, even in the group who underwent antibiotic sensitivity-directed the","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 12","pages":"694"},"PeriodicalIF":2.7,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/856395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31958171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Putting an end to the misuse of the fecal occult blood test in diagnostic medicine.","authors":"Catherine Dubé","doi":"10.1155/2013/325091","DOIUrl":"https://doi.org/10.1155/2013/325091","url":null,"abstract":"Fecal occult blood tests (FOBTs) have been commercially available since the late 1950s. Based on the peroxidase activity of the heme component, they can detect a minimum of 0.3 mg to 1 mg hemoglobin/g of stool, and can be made more sensitive (level of detection of 0.15 mg hemoglobin/g of stool) by hydrating the sample using the test kit (eg, Hemoccult Sensa, Beckman Coulter Inc, USA). Healthy subjects normally lose <1 mL of blood per day through the gastrointestinal (GI) tract, which can increase up to fivefold with the intake of nonsteroidal anti-inflammatory drugs (1). FOBTs have variable levels of sensitivity, which depend on the test’s characteristics, the sampling method, the number of samples and whether there were any concomitant factors affecting test performance. Most importantly, blood loss can be intermittent or variable, such that FOBTs do not demonstrate consistently positive results in patients with underlying GI malignancies. Nevertheless, FOBTs have the ability to identify an acceptable proportion of the population who have early-stage colorectal cancer or adenoma, and who can, in turn, be amenable to successful treatment, yielding a decrease in colorectal cancer mortality by 15% to 33% in randomized controlled trials (2). \u0000 \u0000The purpose of a screening test is to identify, in asymptomatic individuals at risk for a given condition, those who have an increased likelihood of that condition; in screening, the pretest probability depends solely on those individuals’ risk factors. The purpose of a diagnostic test is different. The decision to use a test to derive, from a constellation of symptoms, signs and laboratory abnormalities, a most likely diagnosis should be based on the likelihood that the results of such a test would impact the overall likelihood of a given diagnosis, or impact future therapeutic or investigative decisions. Under which circumstances, then, would the use of an FOBT have an impact on a diagnostic or therapeutic decision? Are there any clinical circumstances in which the result of an FOBT would or should impact our decisions to treat or further investigate patients? The answer is no. Patients who present with symptoms and/or laboratory abnormalities that raise the suspicion of an overt or obscure GI blood loss have, by definition, and solely because of that clinical presentation, a pretest probability of GI bleeding that is beyond the use of an FOBT. The approach to patients with symptoms suggestive of GI blood loss cannot and should not be influenced by the result of an FOBT; the use of an FOBT under such circumstances is, therefore, inappropriate. \u0000 \u0000To further demonstrate the ineffectiveness of FOBT as a diagnostic test, Van Rijn et al (3) investigated the reasons for ordering an FOBT and the impact of the FOBT result on the subsequent diagnostic workup in 2993 FOBTs ordered in 14 hospitals in the Netherlands over a one-year period. The authors found that FOBTs were ordered because of anemia (41%), suspicion o","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 12","pages":"695"},"PeriodicalIF":2.7,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/325091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31958172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}