Canadian Journal of Gastroenterology最新文献

{"title":"Isolated pancreatic tuberculosis mimicking inoperable pancreatic cancer: a diagnostic challenge resolved using endoscopic ultrasound-guided fine-needle aspiration.","authors":"Adrien Sportes,&nbsp;Raimi Kpossou,&nbsp;Stephanie Bernardin","doi":"10.1155/2013/198715","DOIUrl":"https://doi.org/10.1155/2013/198715","url":null,"abstract":"1Department of Gastroenterology, Strasbourg University, Strasbourg; 2Department of Hematology, University of Nice, Nice, France Correspondence: Dr Adrien Sportes, Department of Gastroenterology, Strasbourg University, 1 place de l’hopital, 67000 Strasbourg, France. Telephone 0-33-369-55-1008, fax 0-336-955-0315, e-mail adrien.sportes@chru-strasbourg.fr Received for publication March 14, 2013. Accepted May 6, 2013 Case presentation In December 2010, a 52-year-old man was admitted to hospital for febrile cholestatic jaundice. The patient was of Algerian origin and had immigrated to Alsace (France) two years previously. He was a construction worker with no medical or surgical history, nor was there history of contact with tuberculosis. The clinical history began one month previously, with diffuse abdominal pain, weight loss and jaundice. Physical examination on admission revealed a temperature of 38.5°C, epigastric abdominal pain associated with scleral jaundice and no lymphadenopathy. The remainder of the physical examination was unremarkable. The patient’s initial laboratory analysis revealed a leukocyte count of 7.07×109/L, a hemoglobin level of 97 g/L and a platelet count of 259×109/L. Cholestasis was demonstrated by increased serum levels of gamma-glutamyltransferase (336 U/L; normal range 11 U/L to 82 U/L), alkaline phosphatase (177 U/L; normal range 41 U/L to 117 U/L) and total bilirubin (30 μmol/L; normal range 1.7 μmol/L to 21 μmol/L), with a direct bilirubin level of 20 μmol/L (normal range 1 μmol/L to 10 μmol/L) and alanine aminotransferase level of 120 U/L (normal range 10 U/L to 49 U/L). Acute phase reactants increased, with a C-reactive protein level of 63 mg/L (normal <4 mg/L). Tests for HIV 1 and 2, and hepatitis B and C were negative. Computed tomography (CT) showed a heterogeneous mass in the head of the pancreas 3.5 cm × 4.5 cm in size, causing a compression of the bile duct, with dilation of the intraand extrahepatic bile ducts. The tumour was in contact with the superior mesenteric vein and artery. In addition, many peripancreatic lymph nodes were present (Figure 1). Magnetic resonance cholangiopancreatography was performed and revealed dilation of the intraand extrahepatic bile ducts upstream of a cephalic pancreatic mass, with dilation of the duct of Wirsung (Figure 2). The initial differential diagnosis was cholangitis secondary to a malignant tumour of the pancreatic head without knowledge of the histological type. Given the septic context and the presence of a locally advanced tumour (invasion of the superior mesenteric artery and vein), it was decided to perform endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of the mass of the head of the pancreas, along with placement of a metal biliary stent. EUS revealed a large tumour in the head region of the pancreas compressing the bile duct, and many peripancreatic lymph nodes and some ascites (Figure 3). Cytology demonstrated granuloma with caseous necrosis and th","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 8","pages":"445-7"},"PeriodicalIF":2.7,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/198715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31674055","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":"The burden of celiac disease in Canada: more work needed to lighten the load.","authors":"John K Marshall","doi":"10.1155/2013/516498","DOIUrl":"https://doi.org/10.1155/2013/516498","url":null,"abstract":"Celiac disease was first recognized as a distinct clinical entity more than 60 years ago. However, its full spectrum and impact have only been appreciated over the past decade. In part, this reflects the increasing availability of serological testing that has enabled earlier diagnosis, and a greater appreciation of the protean clinical manifestations and high prevalence of gluten sensitivity. In the current issue of the Canadian Journal of Gastroenterology, Pulido et al (1) (pages 449–453) surveyed the memberships of the Canadian Celiac Association and the Fondation Quebecoise de la Maladie Coeliaque to characterize a Canadian adult population with celiac disease. Remarkably, 5912 of 10,693 invitees responded. Key findings included an average diagnostic delay of 12.0 years and a high prevalence of persistent symptoms despite the avoidance of gluten. Methodological shortfalls, however, must be acknowledged. Most notably, the retrospective survey design is prone to both response bias and recall bias, and members of national celiac organizations represent a highly selected subset of the overall population with celiac disease. Nonetheless, these data provide useful insight into the symptom burden and clinical challenges faced by patients with celiac disease. To some extent, delayed diagnosis of celiac is understandable, given that ‘classic’ presentations are now rare and many patients initially present with extraintestinal signs such as anemia. However, diagnostic delay can have important health consequences that range from persistent symptoms to micronutrient deficiencies and even malignancies. There is ample evidence that celiac disease remains underdiagnosed in Western populations and that its incidence is increasing (2). What is the solution? Population-based screening remains controversial; however, better education of health care providers and proactive screening of those at increased risk could help. In Canada, more consistent access to serological screening assays is needed because not all provincial health ministries reimburse the test. The primary treatment for celiac disease is elimination of gluten from the diet on diagnosis (3). For most patients, this is highly effective, but persistent symptoms are common, as demonstrated by Pulido et al (1). There are three potential explanations for such therapeutic failure. Some patients have symptoms unrelated to gluten sensitivity, and other competing etiologies must be investigated. Other patients may either surreptitiously or unintentionally continue to ingest gluten, which mandates a careful review of diet and other environmental exposures. However, the most challenging scenario is that of refractory celiac disease, for which novel approaches are needed. Nonresponsive celiac disease is classified as either type I, in which duodenal lymphocytic infiltration resembles untreated disease, or type II, in which lymphocytes carry an abnormal immunophenotype with oligoclonal expansi","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 8","pages":"448"},"PeriodicalIF":2.7,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/516498","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31650419","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":"Transnasal endoscopic evaluation of swallowing: a bedside technique to evaluate ability to swallow pureed diets in elderly patients with dysphagia.","authors":"Torao Sakamoto,&nbsp;Akira Horiuchi,&nbsp;Yoshiko Nakayama","doi":"10.1155/2013/646373","DOIUrl":"https://doi.org/10.1155/2013/646373","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic evaluation of swallowing (EES) is not commonly used by gastroenterologists to evaluate swallowing in patients with dysphagia.</p><p><strong>Objective: </strong>To use transnasal endoscopy to identify factors predicting successful or failed swallowing of pureed foods in elderly patients with dysphagia.</p><p><strong>Methods: </strong>EES of pureed foods was performed by a gastroenterologist using a small-calibre transnasal endoscope. Factors related to successful versus unsuccessful swallowing of pureed foods were analyzed with regard to age, comorbid diseases, swallowing activity, saliva pooling, vallecular residues, pharyngeal residues and airway penetration⁄aspiration. Unsuccessful swallowing was defined in patients who could not eat pureed foods at bedside during hospitalization. Logistic regression analysis was used to identify independent predictors of swallowing of pureed foods.</p><p><strong>Results: </strong>During a six-year period, 458 consecutive patients (mean age 80 years [range 39 to 97 years]) were considered for the study, including 285 (62%) men. Saliva pooling, vallecular residues, pharyngeal residues and penetration⁄aspiration were found in 240 (52%), 73 (16%), 226 (49%) and 232 patients (51%), respectively. Overall, 247 patients (54%) failed to swallow pureed foods. Multivariate logistic regression analysis demonstrated that the presence of pharyngeal residues (OR 6.0) and saliva pooling (OR 4.6) occurred significantly more frequently in patients who failed to swallow pureed foods.</p><p><strong>Conclusions: </strong>Pharyngeal residues and saliva pooling predicted impaired swallowing of pureed foods. Transnasal EES performed by a gastroenterologist provided a unique bedside method of assessing the ability to swallow pureed foods in elderly patients with dysphagia.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 8","pages":"459-62"},"PeriodicalIF":2.7,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/646373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31650422","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":"Predictors of early rebleeding after endoscopic therapy in patients with nonvariceal upper gastrointestinal bleeding secondary to high-risk lesions.","authors":"Davide Maggio,&nbsp;Alan N Barkun,&nbsp;Myriam Martel,&nbsp;Sara Elouali,&nbsp;Ian M Gralnek","doi":"10.1155/2013/128760","DOIUrl":"https://doi.org/10.1155/2013/128760","url":null,"abstract":"<p><strong>Background: </strong>In an era of increasingly shortened admissions, data regarding predictors of early rebleeding among patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) exhibiting high-risk stigmata (HRS) having undergone endoscopic hemostasis are lacking.</p><p><strong>Objectives: </strong>To determine predictors of early rebleeding, defined as rebleeding before completion of recommended 72 h intravenous proton pump inhibitor infusion postendoscopic hemostasis.</p><p><strong>Methods: </strong>Data from a national registry of patients with upper gastrointestinal bleeding (the REASON registry) were accessed. Univariable and multivariable analyses were sequentially performed to identify significant independent predictors among a comprehensive list of clinical and laboratory characteristics.</p><p><strong>Results: </strong>Overall, 393 patients underwent endoscopic hemostasis for NVUGIB with HRS. Forty patients rebled ≤72 h thereafter (32.5% female, mean [± SD] age 70.2 ± 11.8 years, 2.88 ± 2.11 comorbidities), while 21 rebled later (38.1% female, mean 70.5 ± 14.1 years of age, 2.62 ± 2.06 comorbidities). Hematemesis or bright red blood per nasogastric tube aspirate was identified as the sole independent significant predictor of early rebleeding versus later among both NVUGIB and, more specifically, patients with peptic ulcer bleeding (OR 7.94 [95% CI 1.80 to 35.01]; P<0.01, and OR 8.41 [95% CI 1.54 to 46.10]; P=0.014, respectively).</p><p><strong>Conclusions: </strong>When attempting to determine the optimal duration of pharmacotherapy and timing of discharge for patients following endoscopic hemostasis for NVUGIB with HRS, it is noteworthy that individuals who present with hematemesis or bright red blood per nasogastric tube aspirate are at particularly high risk for rebleeding within the first 72 h.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 8","pages":"454-8"},"PeriodicalIF":2.7,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/128760","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31650421","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":"Patient and parent satisfaction with a dietitian- and nurse- led celiac disease clinic for children at the Stollery Children's Hospital, Edmonton, Alberta.","authors":"Seema Rajani,&nbsp;Jessica Sawyer-Bennett,&nbsp;Leanne Shirton,&nbsp;Gail DeHaan,&nbsp;Cheryl Kluthe,&nbsp;Rabindranath Persad,&nbsp;Hien Q Huynh,&nbsp;Justine Turner","doi":"10.1155/2013/537160","DOIUrl":"https://doi.org/10.1155/2013/537160","url":null,"abstract":"<p><strong>Objective: </strong>To assess patient and parent satisfaction with a primarily nurse- and dietitian-led celiac disease clinic in a tertiary pediatric centre.</p><p><strong>Methods: </strong>An online survey was sent to families and patients attending the Stollery Children's Hospital's Multidisciplinary Pediatric Celiac Clinic (Edmonton, Alberta) since 2007. The survey focused on clinic attendance, satisfaction with clinic structure, processes, and education and preference for alternatives to the current process. Respondents were asked to rank satisfaction or preference on a five-point Likert scale, with 1 being lowest and 5 being highest.</p><p><strong>Results: </strong>Most satisfaction related to follow-up with serology (4.6) and with a dietitian (4.3). The most preferred changes included either meeting the entire multidisciplinary team after the biopsy (4.7), or meeting with only the dietitian and nurse after the biopsy (4.4). The preferred education resources were the Internet (4.3) and the dietitian (4.2). The mean overall satisfaction score of the Multidisciplinary Pediatric Celiac Clinic was 4.0.</p><p><strong>Conclusions: </strong>Results of the present survey suggested that patients and families value a multidisciplinary follow-up clinic for children with celiac disease. In particular, feedback based on repeat blood work and regular contact with a dietitian were highly valued. The present survey, outlining the most valued aspects of the clinic, may be useful for service delivery in other regions. In addition, it provides information on how to better support pediatric patients with celiac disease.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 8","pages":"463-6"},"PeriodicalIF":2.7,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/537160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31650423","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":"Aortoduodenal fistula: not always bleeding.","authors":"John C T Wong,&nbsp;David C Taylor,&nbsp;Michael F Byrne","doi":"10.1155/2013/957193","DOIUrl":"https://doi.org/10.1155/2013/957193","url":null,"abstract":"1Division of Gastroenterology, Department of Medicine; 2Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia Correspondence: Dr Michael F Byrne, Division of Gastroenterology, Department of Medicine, University of British Columbia, 5153-2775 Laurel Street, Vancouver, British Columbia V5Z 1M9. Telephone 604-875-5640, fax 604-875-5378, e-mail michael.byrne@vch.ca Received for publication March 17, 2013. Accepted May 12, 2013 Case Presentation A 73-year-old woman presented to a community hospital with three months of intermittent, followed by continuous epigastric pain. There was no gastrointestinal bleeding, nausea, vomiting or fever. A noncontrast abdominal computed tomography scan identified gas locules around an aortobifemoral bypass graft performed in 1992, with surrounding inflammatory fat stranding (Figure 1A). Graft infection was suspected. Metronidazole was prescribed with outpatient follow-up by a vascular surgeon who referred her for gastroscopy. At the third part of the duodenum, a wall defect 3 cm × 2 cm in size was replaced by a yellow-coloured foreign body suspected to be the external surface of an aortic Dacron graft (Figure 1B). The aortoduodenal fistula was treated with an axillofemoral graft, removal of the infected graft and a duodenal-jejunostomy, in which the lateral wall defect at the junction of the third and fourth parts of the duodenum was closed with a loop of proximal jejunum (Figure 1C). Cultures from the excised graft had growth of Candida lusitaniae and Streptococcus constellatus. Antimicrobials were commenced, with recovery in two months.","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 8","pages":"444"},"PeriodicalIF":2.7,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/957193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31674053","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":"Clinical features and symptom recovery on a gluten-free diet in Canadian adults with celiac disease.","authors":"Olga Pulido,&nbsp;Marion Zarkadas,&nbsp;Sheila Dubois,&nbsp;Krista Macisaac,&nbsp;Isabelle Cantin,&nbsp;Sebastien La Vieille,&nbsp;Samuel Godefroy,&nbsp;Mohsin Rashid","doi":"10.1155/2013/741740","DOIUrl":"https://doi.org/10.1155/2013/741740","url":null,"abstract":"<p><strong>Background: </strong>Celiac disease can present with mild or nongastrointestinal symptoms, and may escape timely recognition. The treatment of celiac disease involves a gluten-free diet, which is complex and challenging.</p><p><strong>Objective: </strong>To evaluate clinical features and symptom recovery on a gluten-free diet in a Canadian adult celiac population.</p><p><strong>Methods: </strong>All adult members (n=10,693) of the two national celiac support organizations, the Canadian Celiac Association and Fondation québécoise de la maladie coeliaque, were surveyed using a questionnaire.</p><p><strong>Results: </strong>A total of 5912 individuals (≥18 years of age) with biopsy-confirmed celiac disease and⁄or dermatitis herpetiformis completed the survey. The female to male ratio was 3:1, and mean (± SD) age at diagnosis was 45.2 ± 16.4 years. Mean time to diagnosis after onset of symptoms was 12.0 ± 14.4 years. Abdominal pain and bloating (84.9%), extreme weakness⁄tiredness (74.2%), diarrhea (71.7%) and anemia (67.8%) were the most commonly reported symptoms at the time of diagnosis. Many respondents continued to experience symptoms after being on a gluten-free diet for >5 years. Sex differences were reported in clinical features before diagnosis, recovery after being on gluten-free diet and perceived quality of life, with women experiencing more difficulties than men.</p><p><strong>Conclusions: </strong>Delays in diagnosis of celiac disease in Canada remain unacceptably long despite wider availability of serological screening tests. Many patients report continuing symptoms despite adhering to a gluten-free diet for >5 years, with women experiencing more symptoms and a lower recovery rate than men. Awareness of celiac disease needs improvement, and follow-up with a physician and a dietitian is essential for all patients with celiac disease.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 8","pages":"449-53"},"PeriodicalIF":2.7,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/741740","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31650420","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":"Chilaiditi's syndrome with interposed sigmoid colon mimicking traumatic pneumoperitoneum.","authors":"Liu Wen-Cheng,&nbsp;Hsiang Chih-Weim,&nbsp;Liu Chang-Hsien,&nbsp;Huang Guo-Shu","doi":"10.1155/2013/864034","DOIUrl":"https://doi.org/10.1155/2013/864034","url":null,"abstract":"1Department of Internal Medicine; 2Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Correspondence: Dr Chang-Hsien Liu, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. Telephone 886-2-87927244, fax 886-2-87927245, e-mail cute610627@yahoo.com.tw Received for publication May 3, 2013. Accepted May 6, 2013 Case presentation A 61-year-old man experienced a contusion on the right hypochondrium in a traffic accident. He was immediately taken to the emergency department and presented with severe pain over the contusion site. His surgical history was unremarkable. On arrival, physical examination revealed decreased breathing sounds in the right lower lung area on auscultation. Distention, hypertympanic percussion and local tenderness over the right upper quadrant of abdomen were also observed. A posteroanterior chest radiograph revealed elevation of the right hemidiaphragm with concerning features for subphrenic free air as well as fracture of right fifth to eighth ribs (Figure 1A). A computed tomography scan of the abdomen with coronal reconstruction revealed hepatodiaphragmatic interposition of the dilated sigmoid colon (Figure 1B). No evidence of pneumoperitoneum was identified. Conservative treatment with oxygenation, chest care and pain control was performed. After the medical therapy, the patient was discharged uneventfully.","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 7","pages":"389"},"PeriodicalIF":2.7,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/864034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31230735","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":"In a 'real-world', clinic-based community setting, sorafenib dose of 400 mg/day is as effective as standard dose of 800 mg/day in patients with advanced hepatocellular carcimona, with better tolerance and similar survival.","authors":"Alexandra Shingina,&nbsp;Al Moutaz Hashim,&nbsp;Mazhar Haque,&nbsp;Michael Suen,&nbsp;Eric M Yoshida,&nbsp;Sharlene Gill,&nbsp;Fergal Donnellan,&nbsp;Alan A Weiss","doi":"10.1155/2013/170546","DOIUrl":"https://doi.org/10.1155/2013/170546","url":null,"abstract":"<p><strong>Background: </strong>Sorafenib, an oral multityrosine kinase inhibitor, has been approved for treatment of unresectable hepatocellular carcinoma (HCC). British Columbia (BC) was the first province in Canada to provide drug coverage for sorafenib.</p><p><strong>Objective: </strong>To review the BC experience with sorafenib to assess its effectiveness and tolerance in a 'real-world' clinical setting.</p><p><strong>Methods: </strong>A retrospective clinic chart review identified 99 patients referred to the BC Cancer Agency from 2008 to 2010 with a diagnosis of HCC who qualified for treatment with sorafenib.</p><p><strong>Results: </strong>Therapy with sorafenib was initiated and continued at a reduced dosage of 400 mg⁄day in 66 of 99 patients, with 22 patients requiring further dose reduction. Full- and reduced-dose group patients had similar baseline characteristics, except for a higher proportion of female patients (P=0.02) and individuals with alcoholic liver disease (P=0.04) in the full-dose group. The incidence of any grade of adverse effects was higher in the full-dose group (94% versus 77% in the reduced-dose group; P=0.04). Dose reduction rates were significantly higher in the full-dose group, occurring in 66% versus 24% of reduced-dose group patients (P=0.001). The overall survival rates were similar between the two groups: 7.8 months versus 7.1 months in full- versus reduced-dose groups (P=0.14), as were radiological progression rates and alpha-fetoprotein levels.</p><p><strong>Conclusions: </strong>In a review of 99 patients in a 'real-world' community setting, a sorafenib dose of 400 mg⁄day was better tolerated and had similar efficacy compared with a sorafenib dose of 800 mg⁄day with respect to survival and outcomes.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 7","pages":"393-6"},"PeriodicalIF":2.7,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/170546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31586629","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":"Prolonged treatment duration is required for successful Helicobacter pylori eradication with proton pump inhibitor triple therapy in Canada.","authors":"Carlo A Fallone,&nbsp;Alan N Barkun,&nbsp;Andrew Szilagyi,&nbsp;Karl M Herba,&nbsp;Maida Sewitch,&nbsp;Myriam Martel,&nbsp;Stefanie S Fallone","doi":"10.1155/2013/801915","DOIUrl":"https://doi.org/10.1155/2013/801915","url":null,"abstract":"<p><strong>Background: </strong>Traditional seven-day proton pump inhibitor triple therapy for Helicobacter pylori eradication has recently shown disappointing results outside of Canada. Prolonging therapy may be associated with poorer compliance and, hence, may not have a better outcome in a real-world setting.</p><p><strong>Objective: </strong>To compare the outcomes of seven- and 14-day triple therapy for first-line treatment of H pylori infection in an effectiveness setting in Canada.</p><p><strong>Methods: </strong>A total of 314 consecutive treatment-naive, adult H pylori-infected patients were allocated to either a seven- or 14-day triple therapy regimen, with a subgroup of 172 consecutive patients quasi-randomized to treatment according to date of visit. Eradication was confirmed using either urea breath test or gastric biopsies. Analysis was by intention to treat.</p><p><strong>Results: </strong>Eradication was achieved in a higher proportion of patients who underwent 14-day versus seven-day treatment regimens (overall: 85% versus 70% [P≤0.001]; subgroup: 83% versus 64% [P≤0.01]). Although successful eradication was also associated with older age and a diagnosis of ulcer disease, multivariate analysis revealed only longer treatment duration and lack of yogurt ingestion as independent predictors of successful eradication. There was a trend toward reduced success in the latter years of the study. Side effects were similar in both groups and were not prevented by yogurt ingestion.</p><p><strong>Conclusions: </strong>The currently recommended duration of proton pump inhibitor triple therapy in Canada should be increased from seven to 14 days, the latter having achieved an excellent result in this particular real-world setting. Yogurt added no benefit. Further study is required to compare 10-day with 14-day treatment regimens.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 7","pages":"397-402"},"PeriodicalIF":2.7,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/801915","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31586630","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}