Randall Frey

Hallucination Nation …

British researchers report that a high intake of caffeine—more than the equivalent of seven cups of instant coffee a day—may cause you to hear voices and see things that aren't there. The authors from Durham University (England) say “high caffeine users” were three times likelier than “low caffeine users” (less than that instant cuppa's-worth daily) to have hallucinatory experiences—voices, imaginary friends, and “the presence of dead people.” Of course, it's not just food equals mood—there's the intermediate chemistry of stress, particularly the stress hormone cortisol, which caffeine tends to boost, the paper published in the journal Personality and Individual Differences notes. Still, it's kind of deflating to think the “I see dead people” kid in “The Sixth Sense” movie may just have had a few too many Cokes or hot chocolates.

… and a Handy Head-Trip Guide

For more on heady experiences, our online sibling rival, Weird Medical News (

weirdmedicalnews.wordpress.com

Golf Car Nation

Golfers enjoy a 5-year life expectancy edge over non-golfers of the same age, sex, and socioeconomic status, according to Karolinska Institute researchers. But the Bureau of Indications would like to point out that the findings are based on walking golf—and if European researchers saw a U.S. golf course on a typical weekend, they'd realize that walkers are a minority in our car-crazy country. But for those who would pursue this “low-intensity form of exercise,” the researchers had another interesting conclusion: The better you play golf, the more health benefits you gain; that is, low handicappers lived more than 5 extra years. So the obvious question is, will Tiger Woods live to the age of 200 … or 250?

Hallucination Nation …

British researchers report that a high intake of caffeine—more than the equivalent of seven cups of instant coffee a day—may cause you to hear voices and see things that aren't there. The authors from Durham University (England) say “high caffeine users” were three times likelier than “low caffeine users” (less than that instant cuppa's-worth daily) to have hallucinatory experiences—voices, imaginary friends, and “the presence of dead people.” Of course, it's not just food equals mood—there's the intermediate chemistry of stress, particularly the stress hormone cortisol, which caffeine tends to boost, the paper published in the journal Personality and Individual Differences notes. Still, it's kind of deflating to think the “I see dead people” kid in “The Sixth Sense” movie may just have had a few too many Cokes or hot chocolates.

… and a Handy Head-Trip Guide

For more on heady experiences, our online sibling rival, Weird Medical News (

weirdmedicalnews.wordpress.com

Golf Car Nation

Golfers enjoy a 5-year life expectancy edge over non-golfers of the same age, sex, and socioeconomic status, according to Karolinska Institute researchers. But the Bureau of Indications would like to point out that the findings are based on walking golf—and if European researchers saw a U.S. golf course on a typical weekend, they'd realize that walkers are a minority in our car-crazy country. But for those who would pursue this “low-intensity form of exercise,” the researchers had another interesting conclusion: The better you play golf, the more health benefits you gain; that is, low handicappers lived more than 5 extra years. So the obvious question is, will Tiger Woods live to the age of 200 … or 250?

Hallucination Nation …

British researchers report that a high intake of caffeine—more than the equivalent of seven cups of instant coffee a day—may cause you to hear voices and see things that aren't there. The authors from Durham University (England) say “high caffeine users” were three times likelier than “low caffeine users” (less than that instant cuppa's-worth daily) to have hallucinatory experiences—voices, imaginary friends, and “the presence of dead people.” Of course, it's not just food equals mood—there's the intermediate chemistry of stress, particularly the stress hormone cortisol, which caffeine tends to boost, the paper published in the journal Personality and Individual Differences notes. Still, it's kind of deflating to think the “I see dead people” kid in “The Sixth Sense” movie may just have had a few too many Cokes or hot chocolates.

… and a Handy Head-Trip Guide

For more on heady experiences, our online sibling rival, Weird Medical News (

weirdmedicalnews.wordpress.com

Golf Car Nation

Golfers enjoy a 5-year life expectancy edge over non-golfers of the same age, sex, and socioeconomic status, according to Karolinska Institute researchers. But the Bureau of Indications would like to point out that the findings are based on walking golf—and if European researchers saw a U.S. golf course on a typical weekend, they'd realize that walkers are a minority in our car-crazy country. But for those who would pursue this “low-intensity form of exercise,” the researchers had another interesting conclusion: The better you play golf, the more health benefits you gain; that is, low handicappers lived more than 5 extra years. So the obvious question is, will Tiger Woods live to the age of 200 … or 250?

GERD vs. Barrett's Esophagus

A study of 3,000 randomly sampled residents of two Swedish communities found that 1.6% of the general population tested had Barrett's esophagus.

Dr. Jukka Ronkainen of the Karolinska Institute, Sweden, and colleagues found that Barrett's esophagus (BE) was nearly twice as prevalent in subjects with symptoms of gastroesophageal reflux disease (GERD) and esophagitis than in subjects without those conditions. More than 40% of those who presented with BE had no prior symptoms of GERD, a presumed precursor to BE (Gastroenterology 2005;129:1825-31).

The researchers solicited study participants via mail. After detailed data collection with a questionnaire and follow-up interviews, 1,000 selected participants underwent upper endoscopy.

The findings support the theory that asymptomatic people can have BE, and that screening only those with reflux will not reveal all cases.

Alcohol consumption and cigarette smoking also were significant risk factors for BE in this study.

Treating Chronic Cough in GERD

Use of a proton pump inhibitor to treat persistent cough associated with gastroesophageal reflux disease has some effect in some adults, but the effect is less universal than suggested in consensus guidelines on chronic cough, according to a metaanalysis of five randomized controlled trials.

A.B. Chang, Ph.D., of Royal Children's Hospital, Brisbane, Australia, and his fellow reviewers considered 84 papers for inclusion, and 11 of these were selected for systematic review. The metaanalysis was limited to the five studies that compared proton pump inhibitors (PPIs) with placebo in adults. All studies were randomized, controlled trials of gastroesophageal reflux disease (GERD) treatment for chronic cough that had lasted for more than 3 weeks and was not primarily related to an underlying respiratory disorder (BMJ, doi:10.1136/bmj.38677.559005.55, published Dec. 5, 2005).

All outcomes favored PPIs over placebo, but the reviewers considered the magnitude of effect to be too uncertain to support guidelines, such as those published in 1998 by a consensus panel of the American College of Chest Physicians, suggesting empirical treatment for reflux (Chest 1998;114:133S-81S).

Infliximab for Ulcerative Colitis

The chimeric monoclonal antibody Inifliximab, known to be effective in Crohn's disease, also is efficacious as an induction and maintenance therapy in moderate to severe ulcerative colitis, according to two randomized, double-blind, placebo-controlled clinical trials.

The Active Ulcerative Colitis Trials 1 and 2 (ACT 1 and ACT 2) each included 364 patients randomly assigned to IV infusions of placebo or infliximab (Remicade, Centocor) at either 5 mg/kg or 10 mg/kg at weeks 0, 2, and 6, then every 8 weeks through week 22 (ACT 2) or week 46 (ACT 1).

Dr. Paul Rutgeerts of the Universitaire Ziekenhuizen Leuven, Belgium led ACT 1; Dr. William J. Sandborn of the Mayo Clinic, Rochester, Minn., headed up ACT 2 (N. Engl. J. Med. 2005;353:2462-76). Patients then were followed through week 30 in ACT 2 and week 54 in ACT 1.

In ACT 1, clinical responses to infliximab at week 8 occurred in 69% at 5 mg and 62% at 10 mg, compared with 37% of patients given placebo. In ACT 2, the clinical response rates were 65% and 69% at 5 mg and 10 mg infliximab, and 29% with placebo.

Coffee, Tea Protect High-Risk Livers

Persons at high risk for liver injury who drank more than 2 cups of regular coffee or tea per day had a 39% lower incidence of chronic liver disease than those who drank less than 1 cup a day, based on data on 9,849 persons followed for a median of 19 years.

Chronic liver disease leading to hospitalization or death occurred in 1.8% of those drinking less than 1 cup of the caffeine-containing beverages per day, 1.6% of those drinking 1-2 cups, and 1.1% of those drinking more than 2 cups. Caffeine appeared to contributed to the protective effect, reported Dr. Constance E. Ruhl of Social and Scientific Systems Inc., Silver Spring, Md., and Dr. James E. Everhart of the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md. (Gastroenterology 2005;129:1928-36).

Liver disease was defined based on alcohol intake (more than 2 drinks/day), body mass index, diabetes mellitus, and serum iron overload. The data came from the first National Health and Nutrition Examination Survey (NHANES I; 1971-1975) and the NHANES I Epidemiologic Follow-Up Study (1982-1984, 1986, 1987, 1992-1993).

The findings “potentially offer people at high risk for developing chronic liver disease a practical way to decrease that risk,” Dr. Ruhl said in a statement.

GERD vs. Barrett's Esophagus

A study of 3,000 randomly sampled residents of two Swedish communities found that 1.6% of the general population tested had Barrett's esophagus.

Dr. Jukka Ronkainen of the Karolinska Institute, Sweden, and colleagues found that Barrett's esophagus (BE) was nearly twice as prevalent in subjects with symptoms of gastroesophageal reflux disease (GERD) and esophagitis than in subjects without those conditions. More than 40% of those who presented with BE had no prior symptoms of GERD, a presumed precursor to BE (Gastroenterology 2005;129:1825-31).

The researchers solicited study participants via mail. After detailed data collection with a questionnaire and follow-up interviews, 1,000 selected participants underwent upper endoscopy.

The findings support the theory that asymptomatic people can have BE, and that screening only those with reflux will not reveal all cases.

Alcohol consumption and cigarette smoking also were significant risk factors for BE in this study.

Treating Chronic Cough in GERD

Use of a proton pump inhibitor to treat persistent cough associated with gastroesophageal reflux disease has some effect in some adults, but the effect is less universal than suggested in consensus guidelines on chronic cough, according to a metaanalysis of five randomized controlled trials.

A.B. Chang, Ph.D., of Royal Children's Hospital, Brisbane, Australia, and his fellow reviewers considered 84 papers for inclusion, and 11 of these were selected for systematic review. The metaanalysis was limited to the five studies that compared proton pump inhibitors (PPIs) with placebo in adults. All studies were randomized, controlled trials of gastroesophageal reflux disease (GERD) treatment for chronic cough that had lasted for more than 3 weeks and was not primarily related to an underlying respiratory disorder (BMJ, doi:10.1136/bmj.38677.559005.55, published Dec. 5, 2005).

All outcomes favored PPIs over placebo, but the reviewers considered the magnitude of effect to be too uncertain to support guidelines, such as those published in 1998 by a consensus panel of the American College of Chest Physicians, suggesting empirical treatment for reflux (Chest 1998;114:133S-81S).

Infliximab for Ulcerative Colitis

The chimeric monoclonal antibody Inifliximab, known to be effective in Crohn's disease, also is efficacious as an induction and maintenance therapy in moderate to severe ulcerative colitis, according to two randomized, double-blind, placebo-controlled clinical trials.

The Active Ulcerative Colitis Trials 1 and 2 (ACT 1 and ACT 2) each included 364 patients randomly assigned to IV infusions of placebo or infliximab (Remicade, Centocor) at either 5 mg/kg or 10 mg/kg at weeks 0, 2, and 6, then every 8 weeks through week 22 (ACT 2) or week 46 (ACT 1).

Dr. Paul Rutgeerts of the Universitaire Ziekenhuizen Leuven, Belgium led ACT 1; Dr. William J. Sandborn of the Mayo Clinic, Rochester, Minn., headed up ACT 2 (N. Engl. J. Med. 2005;353:2462-76). Patients then were followed through week 30 in ACT 2 and week 54 in ACT 1.

In ACT 1, clinical responses to infliximab at week 8 occurred in 69% at 5 mg and 62% at 10 mg, compared with 37% of patients given placebo. In ACT 2, the clinical response rates were 65% and 69% at 5 mg and 10 mg infliximab, and 29% with placebo.

Coffee, Tea Protect High-Risk Livers

Persons at high risk for liver injury who drank more than 2 cups of regular coffee or tea per day had a 39% lower incidence of chronic liver disease than those who drank less than 1 cup a day, based on data on 9,849 persons followed for a median of 19 years.

Chronic liver disease leading to hospitalization or death occurred in 1.8% of those drinking less than 1 cup of the caffeine-containing beverages per day, 1.6% of those drinking 1-2 cups, and 1.1% of those drinking more than 2 cups. Caffeine appeared to contributed to the protective effect, reported Dr. Constance E. Ruhl of Social and Scientific Systems Inc., Silver Spring, Md., and Dr. James E. Everhart of the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md. (Gastroenterology 2005;129:1928-36).

Liver disease was defined based on alcohol intake (more than 2 drinks/day), body mass index, diabetes mellitus, and serum iron overload. The data came from the first National Health and Nutrition Examination Survey (NHANES I; 1971-1975) and the NHANES I Epidemiologic Follow-Up Study (1982-1984, 1986, 1987, 1992-1993).

The findings “potentially offer people at high risk for developing chronic liver disease a practical way to decrease that risk,” Dr. Ruhl said in a statement.

GERD vs. Barrett's Esophagus

A study of 3,000 randomly sampled residents of two Swedish communities found that 1.6% of the general population tested had Barrett's esophagus.

Dr. Jukka Ronkainen of the Karolinska Institute, Sweden, and colleagues found that Barrett's esophagus (BE) was nearly twice as prevalent in subjects with symptoms of gastroesophageal reflux disease (GERD) and esophagitis than in subjects without those conditions. More than 40% of those who presented with BE had no prior symptoms of GERD, a presumed precursor to BE (Gastroenterology 2005;129:1825-31).

The researchers solicited study participants via mail. After detailed data collection with a questionnaire and follow-up interviews, 1,000 selected participants underwent upper endoscopy.

The findings support the theory that asymptomatic people can have BE, and that screening only those with reflux will not reveal all cases.

Alcohol consumption and cigarette smoking also were significant risk factors for BE in this study.

Treating Chronic Cough in GERD

Use of a proton pump inhibitor to treat persistent cough associated with gastroesophageal reflux disease has some effect in some adults, but the effect is less universal than suggested in consensus guidelines on chronic cough, according to a metaanalysis of five randomized controlled trials.

A.B. Chang, Ph.D., of Royal Children's Hospital, Brisbane, Australia, and his fellow reviewers considered 84 papers for inclusion, and 11 of these were selected for systematic review. The metaanalysis was limited to the five studies that compared proton pump inhibitors (PPIs) with placebo in adults. All studies were randomized, controlled trials of gastroesophageal reflux disease (GERD) treatment for chronic cough that had lasted for more than 3 weeks and was not primarily related to an underlying respiratory disorder (BMJ, doi:10.1136/bmj.38677.559005.55, published Dec. 5, 2005).

All outcomes favored PPIs over placebo, but the reviewers considered the magnitude of effect to be too uncertain to support guidelines, such as those published in 1998 by a consensus panel of the American College of Chest Physicians, suggesting empirical treatment for reflux (Chest 1998;114:133S-81S).

Infliximab for Ulcerative Colitis

The chimeric monoclonal antibody Inifliximab, known to be effective in Crohn's disease, also is efficacious as an induction and maintenance therapy in moderate to severe ulcerative colitis, according to two randomized, double-blind, placebo-controlled clinical trials.

The Active Ulcerative Colitis Trials 1 and 2 (ACT 1 and ACT 2) each included 364 patients randomly assigned to IV infusions of placebo or infliximab (Remicade, Centocor) at either 5 mg/kg or 10 mg/kg at weeks 0, 2, and 6, then every 8 weeks through week 22 (ACT 2) or week 46 (ACT 1).

Dr. Paul Rutgeerts of the Universitaire Ziekenhuizen Leuven, Belgium led ACT 1; Dr. William J. Sandborn of the Mayo Clinic, Rochester, Minn., headed up ACT 2 (N. Engl. J. Med. 2005;353:2462-76). Patients then were followed through week 30 in ACT 2 and week 54 in ACT 1.

In ACT 1, clinical responses to infliximab at week 8 occurred in 69% at 5 mg and 62% at 10 mg, compared with 37% of patients given placebo. In ACT 2, the clinical response rates were 65% and 69% at 5 mg and 10 mg infliximab, and 29% with placebo.

Coffee, Tea Protect High-Risk Livers

Persons at high risk for liver injury who drank more than 2 cups of regular coffee or tea per day had a 39% lower incidence of chronic liver disease than those who drank less than 1 cup a day, based on data on 9,849 persons followed for a median of 19 years.

Chronic liver disease leading to hospitalization or death occurred in 1.8% of those drinking less than 1 cup of the caffeine-containing beverages per day, 1.6% of those drinking 1-2 cups, and 1.1% of those drinking more than 2 cups. Caffeine appeared to contributed to the protective effect, reported Dr. Constance E. Ruhl of Social and Scientific Systems Inc., Silver Spring, Md., and Dr. James E. Everhart of the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md. (Gastroenterology 2005;129:1928-36).

Liver disease was defined based on alcohol intake (more than 2 drinks/day), body mass index, diabetes mellitus, and serum iron overload. The data came from the first National Health and Nutrition Examination Survey (NHANES I; 1971-1975) and the NHANES I Epidemiologic Follow-Up Study (1982-1984, 1986, 1987, 1992-1993).

The findings “potentially offer people at high risk for developing chronic liver disease a practical way to decrease that risk,” Dr. Ruhl said in a statement.

Tegaserod for IBS in Women

A large, international trial has shown that tegaserod is significantly more effective than placebo for irritable bowel syndrome with constipation.

Jan Tack, M.D., of the Centre for Gastroenterological Research, University of Leuven (Belgium), and coauthors worked with physicians from 20 countries to randomize 2,660 female patients; 2,135 received tegaserod (6 mg twice daily) and 525 took a placebo for the initial treatment phase of 1 month.

After a treatment-free interval, the researchers rerandomized 983 patients (488 tegaserod, 495 placebo) who qualified for repeated treatment because they responded to the first treatment and then they had recurrence of IBS symptoms (Gut 2005;54:1707–13).

The patients treated with tegaserod had better work productivity and quality of life than did placebo patients during both the initial therapy and the repeated treatment. The drug, marketed as Zelnorm by Novartis, was initially approved in 2002 for IBS with constipation in women. Due to subsequent concerns about overuse, the label advises physicians and patients to “periodically assess the need for continued therapy.”

Nicotine Enemas in Ulcerative Colitis

Nicotine enemas are no more effective than placebo enemas for patients with active ulcerative colitis, according to a randomized, double-blind study.

In the study by John R. Ingram, M.D., of the department of gastroenterology at Cardiff (Wales) and Vale National Health Services Trust, and his colleagues, 104 patients were given enemas containing 6 mg nicotine or placebo daily for 6 weeks. Patients who had been receiving oral therapy for ulcerative colitis continued on their medications. The nicotine enemas were well tolerated and 14 of 52 patients who received them achieved remission of their ulcerative colitis, as did 14 of the 43 patients who received placebo enemas—a nonsignificant difference (Clin. Gastroenterol. Hepatol. 2005;3:1107–14).

A previous study at the University Hospital of Wales in Cardiff had concluded that nicotine enemas might be more effective than transdermal delivery (Aliment. Pharmacol. Ther. 1997;11:859–63).

A Century of Family G's Genetics

Molecular diagnostic testing has transformed the care offered to families with a mutation for Lynch syndrome, according to an historical cohort study of the 929 known descendants of a German immigrant to America, known as “family G.”

In their prospective analysis of living descendants within family G, Julie A. Douglas, Ph.D., of the University of Michigan, Ann Arbor, and her colleagues tested frequencies and types of cancers, ages at diagnosis, and the presence of the T to G transversion of certain cancer-gene mutations in 40 members of the family (JAMA 2005;294:2195–202).

The family's unusually high incidence of colorectal, stomach, and endometrial cancers has come to be known as Lynch syndrome. The original documentation of family G was in 1913 by Aldred S. Warthin, M.D., based on observations he started in 1895. The most recent update prior to the current study was in 1971 by Henry T. Lynch, M.D., for whom the syndrome subsequently was named.

Molecular diagnostic testing has shown that 5 of the 40 tested members of family G carry the T to G mutation. Among the living relatives of those 5, a total of 15 are at increased risk of developing one or more colorectal or Lynch syndrome-associated cancers, and another 97 can now be excluded as mutation carriers.

Wireless Esophageal pH Monitoring

A catheter-free wireless capsule shows promise as a reliable device for monitoring esophageal pH in the diagnosis of gastroesophageal reflux disease, researchers said based on a prospective study.

S. Bruley des Varannes, M.D., of Hôpital Hôtel Dieu, Nantes, France, and colleagues compared the new Bravo pH monitoring system (Medtronic) with a conventional pH measurement system (CPHMS) by simultaneously recording data with both devices for 24 hours in 36 patients, then continuing for another 24 hours with Bravo only (Gut 2005;54:1682–6).

The Bravo system uses a radiotelemetric capsule that attaches to the esophageal wall and transmits pH data to a small receiver on the patient's belt. The CPHMS with an antimony catheter remains free in the esophageal lumen. Although the Bravo device recorded less acid exposure than did the CPHMS on the first day, the researchers discounted this due to mitigating circumstances such as the capsule's lower sample rate (6 seconds vs. 4 seconds for CPHMS) and presence of the pH catheter on the first day.

R.H. Holloway, M.D., said in an editorial that because patients can undergo recordings with less disruption of their daily activities with the capsule, its use “will provide more meaningful data for evaluation of patients and, hopefully, more discriminative diagnosis”(Gut 2005;54:1672–81).

Tegaserod for IBS in Women

A large, international trial has shown that tegaserod is significantly more effective than placebo for irritable bowel syndrome with constipation.

Jan Tack, M.D., of the Centre for Gastroenterological Research, University of Leuven (Belgium), and coauthors worked with physicians from 20 countries to randomize 2,660 female patients; 2,135 received tegaserod (6 mg twice daily) and 525 took a placebo for the initial treatment phase of 1 month.

After a treatment-free interval, the researchers rerandomized 983 patients (488 tegaserod, 495 placebo) who qualified for repeated treatment because they responded to the first treatment and then they had recurrence of IBS symptoms (Gut 2005;54:1707–13).

The patients treated with tegaserod had better work productivity and quality of life than did placebo patients during both the initial therapy and the repeated treatment. The drug, marketed as Zelnorm by Novartis, was initially approved in 2002 for IBS with constipation in women. Due to subsequent concerns about overuse, the label advises physicians and patients to “periodically assess the need for continued therapy.”

Nicotine Enemas in Ulcerative Colitis

Nicotine enemas are no more effective than placebo enemas for patients with active ulcerative colitis, according to a randomized, double-blind study.

In the study by John R. Ingram, M.D., of the department of gastroenterology at Cardiff (Wales) and Vale National Health Services Trust, and his colleagues, 104 patients were given enemas containing 6 mg nicotine or placebo daily for 6 weeks. Patients who had been receiving oral therapy for ulcerative colitis continued on their medications. The nicotine enemas were well tolerated and 14 of 52 patients who received them achieved remission of their ulcerative colitis, as did 14 of the 43 patients who received placebo enemas—a nonsignificant difference (Clin. Gastroenterol. Hepatol. 2005;3:1107–14).

A previous study at the University Hospital of Wales in Cardiff had concluded that nicotine enemas might be more effective than transdermal delivery (Aliment. Pharmacol. Ther. 1997;11:859–63).

A Century of Family G's Genetics

Molecular diagnostic testing has transformed the care offered to families with a mutation for Lynch syndrome, according to an historical cohort study of the 929 known descendants of a German immigrant to America, known as “family G.”

In their prospective analysis of living descendants within family G, Julie A. Douglas, Ph.D., of the University of Michigan, Ann Arbor, and her colleagues tested frequencies and types of cancers, ages at diagnosis, and the presence of the T to G transversion of certain cancer-gene mutations in 40 members of the family (JAMA 2005;294:2195–202).

The family's unusually high incidence of colorectal, stomach, and endometrial cancers has come to be known as Lynch syndrome. The original documentation of family G was in 1913 by Aldred S. Warthin, M.D., based on observations he started in 1895. The most recent update prior to the current study was in 1971 by Henry T. Lynch, M.D., for whom the syndrome subsequently was named.

Molecular diagnostic testing has shown that 5 of the 40 tested members of family G carry the T to G mutation. Among the living relatives of those 5, a total of 15 are at increased risk of developing one or more colorectal or Lynch syndrome-associated cancers, and another 97 can now be excluded as mutation carriers.

Wireless Esophageal pH Monitoring

A catheter-free wireless capsule shows promise as a reliable device for monitoring esophageal pH in the diagnosis of gastroesophageal reflux disease, researchers said based on a prospective study.

S. Bruley des Varannes, M.D., of Hôpital Hôtel Dieu, Nantes, France, and colleagues compared the new Bravo pH monitoring system (Medtronic) with a conventional pH measurement system (CPHMS) by simultaneously recording data with both devices for 24 hours in 36 patients, then continuing for another 24 hours with Bravo only (Gut 2005;54:1682–6).

The Bravo system uses a radiotelemetric capsule that attaches to the esophageal wall and transmits pH data to a small receiver on the patient's belt. The CPHMS with an antimony catheter remains free in the esophageal lumen. Although the Bravo device recorded less acid exposure than did the CPHMS on the first day, the researchers discounted this due to mitigating circumstances such as the capsule's lower sample rate (6 seconds vs. 4 seconds for CPHMS) and presence of the pH catheter on the first day.

R.H. Holloway, M.D., said in an editorial that because patients can undergo recordings with less disruption of their daily activities with the capsule, its use “will provide more meaningful data for evaluation of patients and, hopefully, more discriminative diagnosis”(Gut 2005;54:1672–81).

Tegaserod for IBS in Women

A large, international trial has shown that tegaserod is significantly more effective than placebo for irritable bowel syndrome with constipation.

Jan Tack, M.D., of the Centre for Gastroenterological Research, University of Leuven (Belgium), and coauthors worked with physicians from 20 countries to randomize 2,660 female patients; 2,135 received tegaserod (6 mg twice daily) and 525 took a placebo for the initial treatment phase of 1 month.

After a treatment-free interval, the researchers rerandomized 983 patients (488 tegaserod, 495 placebo) who qualified for repeated treatment because they responded to the first treatment and then they had recurrence of IBS symptoms (Gut 2005;54:1707–13).

The patients treated with tegaserod had better work productivity and quality of life than did placebo patients during both the initial therapy and the repeated treatment. The drug, marketed as Zelnorm by Novartis, was initially approved in 2002 for IBS with constipation in women. Due to subsequent concerns about overuse, the label advises physicians and patients to “periodically assess the need for continued therapy.”

Nicotine Enemas in Ulcerative Colitis

Nicotine enemas are no more effective than placebo enemas for patients with active ulcerative colitis, according to a randomized, double-blind study.

In the study by John R. Ingram, M.D., of the department of gastroenterology at Cardiff (Wales) and Vale National Health Services Trust, and his colleagues, 104 patients were given enemas containing 6 mg nicotine or placebo daily for 6 weeks. Patients who had been receiving oral therapy for ulcerative colitis continued on their medications. The nicotine enemas were well tolerated and 14 of 52 patients who received them achieved remission of their ulcerative colitis, as did 14 of the 43 patients who received placebo enemas—a nonsignificant difference (Clin. Gastroenterol. Hepatol. 2005;3:1107–14).

A previous study at the University Hospital of Wales in Cardiff had concluded that nicotine enemas might be more effective than transdermal delivery (Aliment. Pharmacol. Ther. 1997;11:859–63).

A Century of Family G's Genetics

Molecular diagnostic testing has transformed the care offered to families with a mutation for Lynch syndrome, according to an historical cohort study of the 929 known descendants of a German immigrant to America, known as “family G.”

In their prospective analysis of living descendants within family G, Julie A. Douglas, Ph.D., of the University of Michigan, Ann Arbor, and her colleagues tested frequencies and types of cancers, ages at diagnosis, and the presence of the T to G transversion of certain cancer-gene mutations in 40 members of the family (JAMA 2005;294:2195–202).

The family's unusually high incidence of colorectal, stomach, and endometrial cancers has come to be known as Lynch syndrome. The original documentation of family G was in 1913 by Aldred S. Warthin, M.D., based on observations he started in 1895. The most recent update prior to the current study was in 1971 by Henry T. Lynch, M.D., for whom the syndrome subsequently was named.

Molecular diagnostic testing has shown that 5 of the 40 tested members of family G carry the T to G mutation. Among the living relatives of those 5, a total of 15 are at increased risk of developing one or more colorectal or Lynch syndrome-associated cancers, and another 97 can now be excluded as mutation carriers.

Wireless Esophageal pH Monitoring

A catheter-free wireless capsule shows promise as a reliable device for monitoring esophageal pH in the diagnosis of gastroesophageal reflux disease, researchers said based on a prospective study.

S. Bruley des Varannes, M.D., of Hôpital Hôtel Dieu, Nantes, France, and colleagues compared the new Bravo pH monitoring system (Medtronic) with a conventional pH measurement system (CPHMS) by simultaneously recording data with both devices for 24 hours in 36 patients, then continuing for another 24 hours with Bravo only (Gut 2005;54:1682–6).

The Bravo system uses a radiotelemetric capsule that attaches to the esophageal wall and transmits pH data to a small receiver on the patient's belt. The CPHMS with an antimony catheter remains free in the esophageal lumen. Although the Bravo device recorded less acid exposure than did the CPHMS on the first day, the researchers discounted this due to mitigating circumstances such as the capsule's lower sample rate (6 seconds vs. 4 seconds for CPHMS) and presence of the pH catheter on the first day.

R.H. Holloway, M.D., said in an editorial that because patients can undergo recordings with less disruption of their daily activities with the capsule, its use “will provide more meaningful data for evaluation of patients and, hopefully, more discriminative diagnosis”(Gut 2005;54:1672–81).

Significant differences were found in the cortical pain responses of patients with irritable bowel syndrome, compared with healthy controls, in a small study by Canadian researchers.

C.L. Kwan of the Institute of Medical Science, University of Toronto, and associates used functional MRI to evaluate the responses of 9 IBS patients and 11 controls during rectal distensions that elicited either pain or a moderate urge to defecate. They noted specific differences between the two groups' responses in the insular cortex, where visceral and somatosensory input are known to be integrated. Regardless of distension level, the dorsal pole of the right anterior insula was activated in controls but not in IBS patients, suggesting a “ceiling” effect from the chronic pain state in IBS (Neurology 2005;65:1268–77).

This contrasted with findings of urge-related responses in the primary sensory cortex and pain-related responses in the medial thalamus and hippocampus in the IBS patients that were absent in the controls. The authors noted that interpreting brain activation during rectal distension combined both conscious responses and unconscious processing, through which the IBS patients were found to be abnormally conscious of the brain-gut relationship.

Significant differences were found in the cortical pain responses of patients with irritable bowel syndrome, compared with healthy controls, in a small study by Canadian researchers.

C.L. Kwan of the Institute of Medical Science, University of Toronto, and associates used functional MRI to evaluate the responses of 9 IBS patients and 11 controls during rectal distensions that elicited either pain or a moderate urge to defecate. They noted specific differences between the two groups' responses in the insular cortex, where visceral and somatosensory input are known to be integrated. Regardless of distension level, the dorsal pole of the right anterior insula was activated in controls but not in IBS patients, suggesting a “ceiling” effect from the chronic pain state in IBS (Neurology 2005;65:1268–77).

This contrasted with findings of urge-related responses in the primary sensory cortex and pain-related responses in the medial thalamus and hippocampus in the IBS patients that were absent in the controls. The authors noted that interpreting brain activation during rectal distension combined both conscious responses and unconscious processing, through which the IBS patients were found to be abnormally conscious of the brain-gut relationship.

Significant differences were found in the cortical pain responses of patients with irritable bowel syndrome, compared with healthy controls, in a small study by Canadian researchers.

C.L. Kwan of the Institute of Medical Science, University of Toronto, and associates used functional MRI to evaluate the responses of 9 IBS patients and 11 controls during rectal distensions that elicited either pain or a moderate urge to defecate. They noted specific differences between the two groups' responses in the insular cortex, where visceral and somatosensory input are known to be integrated. Regardless of distension level, the dorsal pole of the right anterior insula was activated in controls but not in IBS patients, suggesting a “ceiling” effect from the chronic pain state in IBS (Neurology 2005;65:1268–77).

This contrasted with findings of urge-related responses in the primary sensory cortex and pain-related responses in the medial thalamus and hippocampus in the IBS patients that were absent in the controls. The authors noted that interpreting brain activation during rectal distension combined both conscious responses and unconscious processing, through which the IBS patients were found to be abnormally conscious of the brain-gut relationship.

High-Dose Ibuprofen and GI Bleeding

Fecal blood loss in subjects taking ibuprofen regularly at twice the recommended dosage was 3.64 times greater than in a placebo group, a retrospective analysis by Canadian researchers showed.

The study, by Barry Bowen of the McMaster University Health Sciences Centre (Hamilton, Ont.) and his colleagues, analyzed two separate randomized, double-blind experiments in which fecal blood loss was measured daily at baseline and during 4 weeks of treatment with ibuprofen (800 mg, 3 times daily) or placebo in 68 healthy volunteers (Clin. Gastroenterol. Hepatol. 2005;3:1075–82).

The authors predicted that due to the recent withdrawal of rofecoxib and valdecoxib, many patients will be switched back to nonselective NSAIDs such as ibuprofen for management of chronic pain.

Denis M. McCarthy, M.D., noted in an editorial that “overt GI bleeding is but the tip of the iceberg, and the contributions of preexisting disease and other factors to its genesis cannot be ignored” (Clin. Gastroenterol. Hepatol. 2005;3:1071–4).

Narcotic Use in Crohn's Disease

The long-term prescription of opioids may obscure the status of inflammatory bowel disease activity, resulting in a “vicious cycle” of overtreating symptoms and narcotics dose escalation, according to a study of patients with Crohn's disease.

Raymond K. Cross, M.D., of the University of Maryland at Baltimore and his colleagues performed a retrospective analysis of 291 CD patients followed over a 5-year period. Clinical status was measured with the Harvey-Bradshaw Index (HBI) of disease activity (Am. J. Gastroenterol. 2005;100:2225–9).

The researchers found that 38 of the 291 patients (13.1%) were using narcotic analgesics on a chronic basis; these patients had worse disease activity (HBI of 9.1 vs. 5.0), higher rates of disability (15.4% vs. 3.6%), and higher prevalence of neuropsychiatric drug use (37% vs. 19%) than nonusers.

An editorial by Jennifer L. Jones, M.D., and Edward V. Loftus Jr., M.D., of the Mayo Clinic in Rochester, Minn., noted the context of today's “increasing pressure from medical specialty societies and the lay press to maximize opioid use for the management of chronic nonmalignant pain.” The authors cautioned physicians that prescribing opioids over the long term in CD “is fraught with difficulty, as it may lead to opioid dependence and gastrointestinal dysfunction” as well as confusion over the status of disease activity (Am. J. Gastroenterol. 2005;100:2230–2).

Brain Activity in IBS Patients

Significant differences were found in the cortical pain responses of patients with irritable bowel syndrome, compared with healthy controls, in a small study by Canadian researchers.

C.L. Kwan of the Institute of Medical Science, University of Toronto, and associates used functional MRI to evaluate the responses of 9 IBS patients and 11 controls during rectal distensions that elicited either pain or a moderate urge to defecate. Differences were found between the two groups' responses in the insular cortex, where visceral and somatosensory input are known to be integrated. Regardless of distension level, the dorsal pole of the right anterior insula was activated in controls but not in IBS patients, suggesting a “ceiling effect” from the chronic pain state in IBS (Neurology 2005;65:1268–77).

IBS patients had urge-related responses in the primary sensory cortex and pain-related responses in the medial thalamus and hippocampus that were absent in the controls. The authors noted that interpreting brain activation during rectal distension combined both conscious responses and unconscious processing, through which the IBS patients were found to be abnormally conscious of the brain-gut relationship.

H. pylori Infection Clearance

Patients with preneoplastic gastric lesions need to be treated and cured of their Helicobacter pylori infections in order to minimize the carcinogenic threat, reported Robertino Mera, M.D., of the Louisiana State University Health Sciences Center, New Orleans, and his colleagues after their 12-year randomized study documented a strong effect from anti-H. pylori therapy.

The placebo-controlled study of 795 adults with gastric lesions, conducted in an area of Colombia with high gastric cancer risk, involved endoscopies at baseline and at 3, 6, and 12 years (Gut 2005;54:1536–40).

Among the 394 patients who received anti-H. pylori therapy at baseline, eradication rates were 51% at 3 years, 75% at 6 years, and 51% at 12 years. Among patients not receiving anti-H. pylori therapy at baseline but given the treatment at 6 years, the clearance rate at 12 years was 47%. The spontaneous clearance rate was 2.9% per year. The authors noted that although eradication of H. pylori via chemoprevention is viable, the beneficial effects might not be evident in the first 3–6 years.

High-Dose Ibuprofen and GI Bleeding

Fecal blood loss in subjects taking ibuprofen regularly at twice the recommended dosage was 3.64 times greater than in a placebo group, a retrospective analysis by Canadian researchers showed.

The study, by Barry Bowen of the McMaster University Health Sciences Centre (Hamilton, Ont.) and his colleagues, analyzed two separate randomized, double-blind experiments in which fecal blood loss was measured daily at baseline and during 4 weeks of treatment with ibuprofen (800 mg, 3 times daily) or placebo in 68 healthy volunteers (Clin. Gastroenterol. Hepatol. 2005;3:1075–82).

The authors predicted that due to the recent withdrawal of rofecoxib and valdecoxib, many patients will be switched back to nonselective NSAIDs such as ibuprofen for management of chronic pain.

Denis M. McCarthy, M.D., noted in an editorial that “overt GI bleeding is but the tip of the iceberg, and the contributions of preexisting disease and other factors to its genesis cannot be ignored” (Clin. Gastroenterol. Hepatol. 2005;3:1071–4).

Narcotic Use in Crohn's Disease

The long-term prescription of opioids may obscure the status of inflammatory bowel disease activity, resulting in a “vicious cycle” of overtreating symptoms and narcotics dose escalation, according to a study of patients with Crohn's disease.

Raymond K. Cross, M.D., of the University of Maryland at Baltimore and his colleagues performed a retrospective analysis of 291 CD patients followed over a 5-year period. Clinical status was measured with the Harvey-Bradshaw Index (HBI) of disease activity (Am. J. Gastroenterol. 2005;100:2225–9).

The researchers found that 38 of the 291 patients (13.1%) were using narcotic analgesics on a chronic basis; these patients had worse disease activity (HBI of 9.1 vs. 5.0), higher rates of disability (15.4% vs. 3.6%), and higher prevalence of neuropsychiatric drug use (37% vs. 19%) than nonusers.

An editorial by Jennifer L. Jones, M.D., and Edward V. Loftus Jr., M.D., of the Mayo Clinic in Rochester, Minn., noted the context of today's “increasing pressure from medical specialty societies and the lay press to maximize opioid use for the management of chronic nonmalignant pain.” The authors cautioned physicians that prescribing opioids over the long term in CD “is fraught with difficulty, as it may lead to opioid dependence and gastrointestinal dysfunction” as well as confusion over the status of disease activity (Am. J. Gastroenterol. 2005;100:2230–2).

Brain Activity in IBS Patients

Significant differences were found in the cortical pain responses of patients with irritable bowel syndrome, compared with healthy controls, in a small study by Canadian researchers.

C.L. Kwan of the Institute of Medical Science, University of Toronto, and associates used functional MRI to evaluate the responses of 9 IBS patients and 11 controls during rectal distensions that elicited either pain or a moderate urge to defecate. Differences were found between the two groups' responses in the insular cortex, where visceral and somatosensory input are known to be integrated. Regardless of distension level, the dorsal pole of the right anterior insula was activated in controls but not in IBS patients, suggesting a “ceiling effect” from the chronic pain state in IBS (Neurology 2005;65:1268–77).

IBS patients had urge-related responses in the primary sensory cortex and pain-related responses in the medial thalamus and hippocampus that were absent in the controls. The authors noted that interpreting brain activation during rectal distension combined both conscious responses and unconscious processing, through which the IBS patients were found to be abnormally conscious of the brain-gut relationship.

H. pylori Infection Clearance

Patients with preneoplastic gastric lesions need to be treated and cured of their Helicobacter pylori infections in order to minimize the carcinogenic threat, reported Robertino Mera, M.D., of the Louisiana State University Health Sciences Center, New Orleans, and his colleagues after their 12-year randomized study documented a strong effect from anti-H. pylori therapy.

The placebo-controlled study of 795 adults with gastric lesions, conducted in an area of Colombia with high gastric cancer risk, involved endoscopies at baseline and at 3, 6, and 12 years (Gut 2005;54:1536–40).

Among the 394 patients who received anti-H. pylori therapy at baseline, eradication rates were 51% at 3 years, 75% at 6 years, and 51% at 12 years. Among patients not receiving anti-H. pylori therapy at baseline but given the treatment at 6 years, the clearance rate at 12 years was 47%. The spontaneous clearance rate was 2.9% per year. The authors noted that although eradication of H. pylori via chemoprevention is viable, the beneficial effects might not be evident in the first 3–6 years.

High-Dose Ibuprofen and GI Bleeding

Fecal blood loss in subjects taking ibuprofen regularly at twice the recommended dosage was 3.64 times greater than in a placebo group, a retrospective analysis by Canadian researchers showed.

The study, by Barry Bowen of the McMaster University Health Sciences Centre (Hamilton, Ont.) and his colleagues, analyzed two separate randomized, double-blind experiments in which fecal blood loss was measured daily at baseline and during 4 weeks of treatment with ibuprofen (800 mg, 3 times daily) or placebo in 68 healthy volunteers (Clin. Gastroenterol. Hepatol. 2005;3:1075–82).

The authors predicted that due to the recent withdrawal of rofecoxib and valdecoxib, many patients will be switched back to nonselective NSAIDs such as ibuprofen for management of chronic pain.

Denis M. McCarthy, M.D., noted in an editorial that “overt GI bleeding is but the tip of the iceberg, and the contributions of preexisting disease and other factors to its genesis cannot be ignored” (Clin. Gastroenterol. Hepatol. 2005;3:1071–4).

Narcotic Use in Crohn's Disease

The long-term prescription of opioids may obscure the status of inflammatory bowel disease activity, resulting in a “vicious cycle” of overtreating symptoms and narcotics dose escalation, according to a study of patients with Crohn's disease.

Raymond K. Cross, M.D., of the University of Maryland at Baltimore and his colleagues performed a retrospective analysis of 291 CD patients followed over a 5-year period. Clinical status was measured with the Harvey-Bradshaw Index (HBI) of disease activity (Am. J. Gastroenterol. 2005;100:2225–9).

The researchers found that 38 of the 291 patients (13.1%) were using narcotic analgesics on a chronic basis; these patients had worse disease activity (HBI of 9.1 vs. 5.0), higher rates of disability (15.4% vs. 3.6%), and higher prevalence of neuropsychiatric drug use (37% vs. 19%) than nonusers.

An editorial by Jennifer L. Jones, M.D., and Edward V. Loftus Jr., M.D., of the Mayo Clinic in Rochester, Minn., noted the context of today's “increasing pressure from medical specialty societies and the lay press to maximize opioid use for the management of chronic nonmalignant pain.” The authors cautioned physicians that prescribing opioids over the long term in CD “is fraught with difficulty, as it may lead to opioid dependence and gastrointestinal dysfunction” as well as confusion over the status of disease activity (Am. J. Gastroenterol. 2005;100:2230–2).

Brain Activity in IBS Patients

Significant differences were found in the cortical pain responses of patients with irritable bowel syndrome, compared with healthy controls, in a small study by Canadian researchers.

C.L. Kwan of the Institute of Medical Science, University of Toronto, and associates used functional MRI to evaluate the responses of 9 IBS patients and 11 controls during rectal distensions that elicited either pain or a moderate urge to defecate. Differences were found between the two groups' responses in the insular cortex, where visceral and somatosensory input are known to be integrated. Regardless of distension level, the dorsal pole of the right anterior insula was activated in controls but not in IBS patients, suggesting a “ceiling effect” from the chronic pain state in IBS (Neurology 2005;65:1268–77).

IBS patients had urge-related responses in the primary sensory cortex and pain-related responses in the medial thalamus and hippocampus that were absent in the controls. The authors noted that interpreting brain activation during rectal distension combined both conscious responses and unconscious processing, through which the IBS patients were found to be abnormally conscious of the brain-gut relationship.

H. pylori Infection Clearance

Patients with preneoplastic gastric lesions need to be treated and cured of their Helicobacter pylori infections in order to minimize the carcinogenic threat, reported Robertino Mera, M.D., of the Louisiana State University Health Sciences Center, New Orleans, and his colleagues after their 12-year randomized study documented a strong effect from anti-H. pylori therapy.

The placebo-controlled study of 795 adults with gastric lesions, conducted in an area of Colombia with high gastric cancer risk, involved endoscopies at baseline and at 3, 6, and 12 years (Gut 2005;54:1536–40).

Among the 394 patients who received anti-H. pylori therapy at baseline, eradication rates were 51% at 3 years, 75% at 6 years, and 51% at 12 years. Among patients not receiving anti-H. pylori therapy at baseline but given the treatment at 6 years, the clearance rate at 12 years was 47%. The spontaneous clearance rate was 2.9% per year. The authors noted that although eradication of H. pylori via chemoprevention is viable, the beneficial effects might not be evident in the first 3–6 years.

Colorectal Screening Goals Unmet

A new retrospective analysis of National Health Interview Survey data underscores the need for physicians to order colorectal cancer screening: Only 17.2% of 12,477 men and women aged 50 and older had undergone a fecal occult blood test in the year before the survey.

The analysis, by Steven S. Coughlin, Ph.D., and Trevor Thompson of the Centers for Disease Control and Prevention, also found that only 33.9% of those surveyed had been evaluated for colorectal cancer during the previous 10 years with either sigmoidoscopy or colonoscopy, the most common screening procedures after the fecal occult blood test (Health Promot. Pract. 2005;6:369–78).

Among survey respondents who had gone to a doctor in the past year but had not had the occult blood test, about 95% reported that their doctor had not recommended one in the past year. African Americans, Hispanics, and American Indians/Alaska Natives were reportedly less likely to have had a recommendation for endoscopy, compared with whites. Of those who did not have a fecal occult blood test in the previous year, 22.9% attributed the oversight primarily to the fact that no doctor ordered the procedure. Similarly, 21.6% of respondents who had not had a sigmoidoscopy or colonoscopy in the past 10 years said it was because their physicians had not ordered the procedures.

FDA Posts Notice on Recall of Enteryx

The Food and Drug Administration's Center for Devices and Radiological Health has posted a new Preliminary Public Health Notification (PPHN), “Recall of Boston Scientific Enteryx Procedure Kits and Enteryx Injector Single Packs for Treatment of Gastroesophageal Reflux Disease (GERD),” on its Web site.

The PPHN informs health care practitioners about the recall and advises them to immediately stop using Enteryx and return unused products to the manufacturer. Specifically, the PPHN advises: “The serious adverse events involve unrecognized transmural injections of Enteryx into structures surrounding the esophagus. Transmural injections can potentially result in death or serious injury. Signs and symptoms of transmural injection can potentially include chest pain, flulike symptoms, pneumonia, atelectasis, reactive pneumonitis, mediastinitis, pneumomediastinum, reactive pleuritis, pleural effusion, pericardial effusion, syncopal episodes, and flank pain.”

The full text of the notification is available at

www.fda.gov/cdrh/safety/101405-Enteryx.html

www.fda.gov/cdrh/medicaldevicesafety/atp/101405-Enteryx.html

Capsule Endoscopy in GI Bleeding

Wireless video capsule endoscopy in patients with obscure GI bleeding not diagnosed with a conventional work-up provided information that improved health outcomes, a literature review determined.

Kathleen M. Ziegler, Pharm. D., and her colleagues at the Blue Cross Blue Shield Association, Chicago, found that capsule endoscopy identified small-bowel lesions usually beyond the reach of push enteroscopy in 25%–50% of patients; surgical resection of the lesions was either performed or ruled out according to the findings. Capsule imagery provided additional diagnostic findings in 25% of patients, compared with small-bowel barium radiographic studies (JACR 2005;2:818–20).

In one of the studies reviewed—a comparison of capsule endoscopy with small-bowel follow-through—capsule endoscopy yielded diagnostic results in 9 of 20 patients (45%), versus 4 of 20 patients (20%) for small-bowel follow-through (Gastroenterology 2002;123:999–1005).

Liver Enzymes in HIV-HCV Coinfection

Hepatitis C virus coinfection in patients with HIV leads to more episodes of liver enzyme elevation and increases the number of days antiretroviral therapy must be withdrawn due to elevated liver enzymes, a retrospective study at a Spanish hospital has shown.

Julian Olalla Sierra, M.D., of the Hospital Costa del Sol, Marbella, Spain, and colleagues followed 145 patients who had visited the HIV infection unit of a Madrid hospital. All were on highly active antiretroviral treatment (HAART) and developed liver enzyme elevation (LEE) grade 3 or 4 (Eur. J. Intern. Med. 2005;16:405–7).

The researchers compared patients with and without HCV coinfection; they concluded that HCV leads not only to a greater number of episodes of LEE, but also to a greater number of days (58 vs. 5) that the patient must be off HAART. A total of 38 patients with coinfection had 104 episodes of LEE grade 3, compared with only 7 episodes in 3 patients without coinfection.

Colorectal Screening Goals Unmet

A new retrospective analysis of National Health Interview Survey data underscores the need for physicians to order colorectal cancer screening: Only 17.2% of 12,477 men and women aged 50 and older had undergone a fecal occult blood test in the year before the survey.

The analysis, by Steven S. Coughlin, Ph.D., and Trevor Thompson of the Centers for Disease Control and Prevention, also found that only 33.9% of those surveyed had been evaluated for colorectal cancer during the previous 10 years with either sigmoidoscopy or colonoscopy, the most common screening procedures after the fecal occult blood test (Health Promot. Pract. 2005;6:369–78).

Among survey respondents who had gone to a doctor in the past year but had not had the occult blood test, about 95% reported that their doctor had not recommended one in the past year. African Americans, Hispanics, and American Indians/Alaska Natives were reportedly less likely to have had a recommendation for endoscopy, compared with whites. Of those who did not have a fecal occult blood test in the previous year, 22.9% attributed the oversight primarily to the fact that no doctor ordered the procedure. Similarly, 21.6% of respondents who had not had a sigmoidoscopy or colonoscopy in the past 10 years said it was because their physicians had not ordered the procedures.

FDA Posts Notice on Recall of Enteryx

The Food and Drug Administration's Center for Devices and Radiological Health has posted a new Preliminary Public Health Notification (PPHN), “Recall of Boston Scientific Enteryx Procedure Kits and Enteryx Injector Single Packs for Treatment of Gastroesophageal Reflux Disease (GERD),” on its Web site.

The PPHN informs health care practitioners about the recall and advises them to immediately stop using Enteryx and return unused products to the manufacturer. Specifically, the PPHN advises: “The serious adverse events involve unrecognized transmural injections of Enteryx into structures surrounding the esophagus. Transmural injections can potentially result in death or serious injury. Signs and symptoms of transmural injection can potentially include chest pain, flulike symptoms, pneumonia, atelectasis, reactive pneumonitis, mediastinitis, pneumomediastinum, reactive pleuritis, pleural effusion, pericardial effusion, syncopal episodes, and flank pain.”

The full text of the notification is available at

www.fda.gov/cdrh/safety/101405-Enteryx.html

www.fda.gov/cdrh/medicaldevicesafety/atp/101405-Enteryx.html

Capsule Endoscopy in GI Bleeding

Wireless video capsule endoscopy in patients with obscure GI bleeding not diagnosed with a conventional work-up provided information that improved health outcomes, a literature review determined.

Kathleen M. Ziegler, Pharm. D., and her colleagues at the Blue Cross Blue Shield Association, Chicago, found that capsule endoscopy identified small-bowel lesions usually beyond the reach of push enteroscopy in 25%–50% of patients; surgical resection of the lesions was either performed or ruled out according to the findings. Capsule imagery provided additional diagnostic findings in 25% of patients, compared with small-bowel barium radiographic studies (JACR 2005;2:818–20).

In one of the studies reviewed—a comparison of capsule endoscopy with small-bowel follow-through—capsule endoscopy yielded diagnostic results in 9 of 20 patients (45%), versus 4 of 20 patients (20%) for small-bowel follow-through (Gastroenterology 2002;123:999–1005).

Liver Enzymes in HIV-HCV Coinfection

Hepatitis C virus coinfection in patients with HIV leads to more episodes of liver enzyme elevation and increases the number of days antiretroviral therapy must be withdrawn due to elevated liver enzymes, a retrospective study at a Spanish hospital has shown.

Julian Olalla Sierra, M.D., of the Hospital Costa del Sol, Marbella, Spain, and colleagues followed 145 patients who had visited the HIV infection unit of a Madrid hospital. All were on highly active antiretroviral treatment (HAART) and developed liver enzyme elevation (LEE) grade 3 or 4 (Eur. J. Intern. Med. 2005;16:405–7).

The researchers compared patients with and without HCV coinfection; they concluded that HCV leads not only to a greater number of episodes of LEE, but also to a greater number of days (58 vs. 5) that the patient must be off HAART. A total of 38 patients with coinfection had 104 episodes of LEE grade 3, compared with only 7 episodes in 3 patients without coinfection.

Colorectal Screening Goals Unmet

A new retrospective analysis of National Health Interview Survey data underscores the need for physicians to order colorectal cancer screening: Only 17.2% of 12,477 men and women aged 50 and older had undergone a fecal occult blood test in the year before the survey.

The analysis, by Steven S. Coughlin, Ph.D., and Trevor Thompson of the Centers for Disease Control and Prevention, also found that only 33.9% of those surveyed had been evaluated for colorectal cancer during the previous 10 years with either sigmoidoscopy or colonoscopy, the most common screening procedures after the fecal occult blood test (Health Promot. Pract. 2005;6:369–78).

Among survey respondents who had gone to a doctor in the past year but had not had the occult blood test, about 95% reported that their doctor had not recommended one in the past year. African Americans, Hispanics, and American Indians/Alaska Natives were reportedly less likely to have had a recommendation for endoscopy, compared with whites. Of those who did not have a fecal occult blood test in the previous year, 22.9% attributed the oversight primarily to the fact that no doctor ordered the procedure. Similarly, 21.6% of respondents who had not had a sigmoidoscopy or colonoscopy in the past 10 years said it was because their physicians had not ordered the procedures.

FDA Posts Notice on Recall of Enteryx

The Food and Drug Administration's Center for Devices and Radiological Health has posted a new Preliminary Public Health Notification (PPHN), “Recall of Boston Scientific Enteryx Procedure Kits and Enteryx Injector Single Packs for Treatment of Gastroesophageal Reflux Disease (GERD),” on its Web site.

The PPHN informs health care practitioners about the recall and advises them to immediately stop using Enteryx and return unused products to the manufacturer. Specifically, the PPHN advises: “The serious adverse events involve unrecognized transmural injections of Enteryx into structures surrounding the esophagus. Transmural injections can potentially result in death or serious injury. Signs and symptoms of transmural injection can potentially include chest pain, flulike symptoms, pneumonia, atelectasis, reactive pneumonitis, mediastinitis, pneumomediastinum, reactive pleuritis, pleural effusion, pericardial effusion, syncopal episodes, and flank pain.”

The full text of the notification is available at

www.fda.gov/cdrh/safety/101405-Enteryx.html

www.fda.gov/cdrh/medicaldevicesafety/atp/101405-Enteryx.html

Capsule Endoscopy in GI Bleeding

Wireless video capsule endoscopy in patients with obscure GI bleeding not diagnosed with a conventional work-up provided information that improved health outcomes, a literature review determined.

Kathleen M. Ziegler, Pharm. D., and her colleagues at the Blue Cross Blue Shield Association, Chicago, found that capsule endoscopy identified small-bowel lesions usually beyond the reach of push enteroscopy in 25%–50% of patients; surgical resection of the lesions was either performed or ruled out according to the findings. Capsule imagery provided additional diagnostic findings in 25% of patients, compared with small-bowel barium radiographic studies (JACR 2005;2:818–20).

In one of the studies reviewed—a comparison of capsule endoscopy with small-bowel follow-through—capsule endoscopy yielded diagnostic results in 9 of 20 patients (45%), versus 4 of 20 patients (20%) for small-bowel follow-through (Gastroenterology 2002;123:999–1005).

Liver Enzymes in HIV-HCV Coinfection

Hepatitis C virus coinfection in patients with HIV leads to more episodes of liver enzyme elevation and increases the number of days antiretroviral therapy must be withdrawn due to elevated liver enzymes, a retrospective study at a Spanish hospital has shown.

Julian Olalla Sierra, M.D., of the Hospital Costa del Sol, Marbella, Spain, and colleagues followed 145 patients who had visited the HIV infection unit of a Madrid hospital. All were on highly active antiretroviral treatment (HAART) and developed liver enzyme elevation (LEE) grade 3 or 4 (Eur. J. Intern. Med. 2005;16:405–7).

The researchers compared patients with and without HCV coinfection; they concluded that HCV leads not only to a greater number of episodes of LEE, but also to a greater number of days (58 vs. 5) that the patient must be off HAART. A total of 38 patients with coinfection had 104 episodes of LEE grade 3, compared with only 7 episodes in 3 patients without coinfection.

Melatonin for IBS Patients

Administration of melatonin at bedtime for 2 weeks significantly increased rectal pain threshold and attenuated abdominal pain in patients with irritable bowel syndrome and sleep disturbance, according to a randomized, double-blind, placebo-controlled study conducted in Singapore.

G.H. Song of the National University of Singapore and colleagues reported that 40 patients with IBS took 3 mg of melatonin or placebo nightly and completed questionnaires about their psychological, sleep, and bowel symptoms. Patients also underwent overnight polysomnography and rectal manometry. Their abdominal pain showed improvement, but their sleep disturbance or psychological distress did not (Gut 2005;54:1402–7).

In a commentary, Sigrid Elsenbruch, Ph.D., of the University Clinic of Essen, Germany, noted that the Singapore researchers did not screen their patients for mood disorders, which can be associated with alterations in sleep physiology, but concluded that the findings “are intriguing and call for replication and further study” (Gut 2005;54:1353–4).

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene of Kaunas University of Medicine, Kaunas, Lithuania, and colleagues found that 8–10 mg/kg daily of ursodeoxycholic acid (UDCA) outperformed 8 g daily of cholestyramine in reducing the pruritus that characterizes intrahepatic cholestasis (Gastroenterology 2005;129:894–901).

Pruritus scores were reduced by 67% with UDCA and 19% with cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after UDCA, but by only 21.4% each after cholestyramine. The study results confirm that UDCA should be used as first-line therapy for intrahepatic cholestasis, the researchers stated.

Reflux-Related ENT Symptoms

A new algorithm for diagnostic and treatment approaches to suspected extraesophageal manifestations of gastroesophageal reflux disease has been proposed by two Belgian researchers on the basis of their uncontrolled clinical study; the patients had chronic pulmonary and ear, nose, and throat symptoms.

Johan Poelmans, M.D., and Jan Tack, M.D., of the Centre for Gastroenterological Research, Catholic University of Leuven, Belgium, reviewed recent studies establishing that gastroesophageal reflux disease (GERD) frequently underlies or contributes to ENT symptoms and disorders, such as chronic cases of sinusitis or otitis media, paroxysmal laryngospasm, excessive throat phlegm, and postnasal drip (Gut 2005;54:1492–9).

The researchers then treated 405 consecutive adults with one or more of these symptoms, administering proton pump inhibitor (PPI) therapy while using upper gastrointestinal endoscopy and 24-hour pH monitoring. They prospectively assessed the coexistence of GERD in the patients and found the diagnostic yield of endoscopy higher than previously shown; conversely, pH monitoring with PPI therapy had a low yield.

The new algorithm is designed to avoid prolonged high-dose PPI therapy when GERD is presumed but not fully established. Short-term, standard-dose PPI therapy, combined with lifestyle changes, is a logical initial approach, they said.

Selenomethionine for Esophageal Ca

Selenomethionine had a protective effect in patients with mild esophageal squamous dysplasia at baseline, according to a 10-month chemoprevention trial conducted in an area of China where the annual death rate from esophageal squamous cell cancer is among the highest in the world.

Paul J. Limburg, M.D., of the Mayo Medical School, Rochester, Minn., and his colleagues conducted a randomized, double-blind, placebo-controlled trial of two promising selenium compounds: selenomethionine (a synthetic form of organic selenium) and celecoxib (a selective inhibitor of cyclooxygenase-2) among residents of Linxian County, People's Republic of China (Gastroenterology 2005;129:863–73).

The 600 subjects were asymptomatic adults with histologically confirmed mild or moderate esophageal squamous dysplasia at baseline. The chemoprevention trial assessed the effects of 200 mcg daily of selenomethionine and 200 mg twice daily of celecoxib. The entire cohort showed no overall benefit from either candidate drug, but the mild dysplasia subgroup had significantly increased regression and decreased progression with selenomethionine, compared with placebo.

Melatonin for IBS Patients

Administration of melatonin at bedtime for 2 weeks significantly increased rectal pain threshold and attenuated abdominal pain in patients with irritable bowel syndrome and sleep disturbance, according to a randomized, double-blind, placebo-controlled study conducted in Singapore.

G.H. Song of the National University of Singapore and colleagues reported that 40 patients with IBS took 3 mg of melatonin or placebo nightly and completed questionnaires about their psychological, sleep, and bowel symptoms. Patients also underwent overnight polysomnography and rectal manometry. Their abdominal pain showed improvement, but their sleep disturbance or psychological distress did not (Gut 2005;54:1402–7).

In a commentary, Sigrid Elsenbruch, Ph.D., of the University Clinic of Essen, Germany, noted that the Singapore researchers did not screen their patients for mood disorders, which can be associated with alterations in sleep physiology, but concluded that the findings “are intriguing and call for replication and further study” (Gut 2005;54:1353–4).

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene of Kaunas University of Medicine, Kaunas, Lithuania, and colleagues found that 8–10 mg/kg daily of ursodeoxycholic acid (UDCA) outperformed 8 g daily of cholestyramine in reducing the pruritus that characterizes intrahepatic cholestasis (Gastroenterology 2005;129:894–901).

Pruritus scores were reduced by 67% with UDCA and 19% with cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after UDCA, but by only 21.4% each after cholestyramine. The study results confirm that UDCA should be used as first-line therapy for intrahepatic cholestasis, the researchers stated.

Reflux-Related ENT Symptoms

A new algorithm for diagnostic and treatment approaches to suspected extraesophageal manifestations of gastroesophageal reflux disease has been proposed by two Belgian researchers on the basis of their uncontrolled clinical study; the patients had chronic pulmonary and ear, nose, and throat symptoms.

Johan Poelmans, M.D., and Jan Tack, M.D., of the Centre for Gastroenterological Research, Catholic University of Leuven, Belgium, reviewed recent studies establishing that gastroesophageal reflux disease (GERD) frequently underlies or contributes to ENT symptoms and disorders, such as chronic cases of sinusitis or otitis media, paroxysmal laryngospasm, excessive throat phlegm, and postnasal drip (Gut 2005;54:1492–9).

The researchers then treated 405 consecutive adults with one or more of these symptoms, administering proton pump inhibitor (PPI) therapy while using upper gastrointestinal endoscopy and 24-hour pH monitoring. They prospectively assessed the coexistence of GERD in the patients and found the diagnostic yield of endoscopy higher than previously shown; conversely, pH monitoring with PPI therapy had a low yield.

The new algorithm is designed to avoid prolonged high-dose PPI therapy when GERD is presumed but not fully established. Short-term, standard-dose PPI therapy, combined with lifestyle changes, is a logical initial approach, they said.

Selenomethionine for Esophageal Ca

Selenomethionine had a protective effect in patients with mild esophageal squamous dysplasia at baseline, according to a 10-month chemoprevention trial conducted in an area of China where the annual death rate from esophageal squamous cell cancer is among the highest in the world.

Paul J. Limburg, M.D., of the Mayo Medical School, Rochester, Minn., and his colleagues conducted a randomized, double-blind, placebo-controlled trial of two promising selenium compounds: selenomethionine (a synthetic form of organic selenium) and celecoxib (a selective inhibitor of cyclooxygenase-2) among residents of Linxian County, People's Republic of China (Gastroenterology 2005;129:863–73).

The 600 subjects were asymptomatic adults with histologically confirmed mild or moderate esophageal squamous dysplasia at baseline. The chemoprevention trial assessed the effects of 200 mcg daily of selenomethionine and 200 mg twice daily of celecoxib. The entire cohort showed no overall benefit from either candidate drug, but the mild dysplasia subgroup had significantly increased regression and decreased progression with selenomethionine, compared with placebo.

Melatonin for IBS Patients

Administration of melatonin at bedtime for 2 weeks significantly increased rectal pain threshold and attenuated abdominal pain in patients with irritable bowel syndrome and sleep disturbance, according to a randomized, double-blind, placebo-controlled study conducted in Singapore.

G.H. Song of the National University of Singapore and colleagues reported that 40 patients with IBS took 3 mg of melatonin or placebo nightly and completed questionnaires about their psychological, sleep, and bowel symptoms. Patients also underwent overnight polysomnography and rectal manometry. Their abdominal pain showed improvement, but their sleep disturbance or psychological distress did not (Gut 2005;54:1402–7).

In a commentary, Sigrid Elsenbruch, Ph.D., of the University Clinic of Essen, Germany, noted that the Singapore researchers did not screen their patients for mood disorders, which can be associated with alterations in sleep physiology, but concluded that the findings “are intriguing and call for replication and further study” (Gut 2005;54:1353–4).

Intrahepatic Cholestasis of Pregnancy

Pruritus was reduced more effectively in patients with intrahepatic cholestasis of pregnancy after treatment with ursodeoxycholic acid, according to a randomized study of 84 symptomatic patients in Lithuania.

Jurate Kondrackiene of Kaunas University of Medicine, Kaunas, Lithuania, and colleagues found that 8–10 mg/kg daily of ursodeoxycholic acid (UDCA) outperformed 8 g daily of cholestyramine in reducing the pruritus that characterizes intrahepatic cholestasis (Gastroenterology 2005;129:894–901).

Pruritus scores were reduced by 67% with UDCA and 19% with cholestyramine; likewise, levels of serum aminotransferases and serum bile acids were markedly reduced by 78.5% and 73.8%, respectively, after UDCA, but by only 21.4% each after cholestyramine. The study results confirm that UDCA should be used as first-line therapy for intrahepatic cholestasis, the researchers stated.

Reflux-Related ENT Symptoms

A new algorithm for diagnostic and treatment approaches to suspected extraesophageal manifestations of gastroesophageal reflux disease has been proposed by two Belgian researchers on the basis of their uncontrolled clinical study; the patients had chronic pulmonary and ear, nose, and throat symptoms.

Johan Poelmans, M.D., and Jan Tack, M.D., of the Centre for Gastroenterological Research, Catholic University of Leuven, Belgium, reviewed recent studies establishing that gastroesophageal reflux disease (GERD) frequently underlies or contributes to ENT symptoms and disorders, such as chronic cases of sinusitis or otitis media, paroxysmal laryngospasm, excessive throat phlegm, and postnasal drip (Gut 2005;54:1492–9).

The researchers then treated 405 consecutive adults with one or more of these symptoms, administering proton pump inhibitor (PPI) therapy while using upper gastrointestinal endoscopy and 24-hour pH monitoring. They prospectively assessed the coexistence of GERD in the patients and found the diagnostic yield of endoscopy higher than previously shown; conversely, pH monitoring with PPI therapy had a low yield.

The new algorithm is designed to avoid prolonged high-dose PPI therapy when GERD is presumed but not fully established. Short-term, standard-dose PPI therapy, combined with lifestyle changes, is a logical initial approach, they said.

Selenomethionine for Esophageal Ca

Selenomethionine had a protective effect in patients with mild esophageal squamous dysplasia at baseline, according to a 10-month chemoprevention trial conducted in an area of China where the annual death rate from esophageal squamous cell cancer is among the highest in the world.

Paul J. Limburg, M.D., of the Mayo Medical School, Rochester, Minn., and his colleagues conducted a randomized, double-blind, placebo-controlled trial of two promising selenium compounds: selenomethionine (a synthetic form of organic selenium) and celecoxib (a selective inhibitor of cyclooxygenase-2) among residents of Linxian County, People's Republic of China (Gastroenterology 2005;129:863–73).

The 600 subjects were asymptomatic adults with histologically confirmed mild or moderate esophageal squamous dysplasia at baseline. The chemoprevention trial assessed the effects of 200 mcg daily of selenomethionine and 200 mg twice daily of celecoxib. The entire cohort showed no overall benefit from either candidate drug, but the mild dysplasia subgroup had significantly increased regression and decreased progression with selenomethionine, compared with placebo.