Background In the absence of a clear biomarker for irritable bowel syndrome (IBS), clinical criteria are used. In this study, we conduct a systematic review to examine the validation and utilization ...of IBS criteria.
Methods A systematic review was performed in two stages. The first was a review of literature from 1978 validating IBS diagnostic criteria. The second stage of review was to select studies published in IBS between 1992 and 2011. This time period was divided into three segments (Rome I era from 1992 to 1999, Rome II era from 2000 to 2006, and Rome III era from 2007 to 2011). The number and type of study (RCT or other) and criteria used were evaluated for each era.
Key Results The first stage of the systematic review identified only 14 published studies validating diagnostic tests for IBS (with three studies evaluating more than one criterion). There were eight validations for Manning, three validations for Kruis, four validations for Rome I, three validations for Rome II, and no validation for Rome III. In the second review of utilization of Rome criteria, only 25.7% of published IBS papers used Rome III criteria during the Rome III era (Rome II was used most in 64.8% of studies).
Conclusions & Inferences This review identified that comparator groups varied widely between studies making comparison of criteria impossible. Manning criteria are the most valid and accurate criteria. More importantly, Rome III is not validated and is poorly adopted in clinical research trial enrollment.
Aliment Pharmacol Ther 2011; 34: 825–831
Summary
Background Obesity is a major medical problem worldwide. Different treatment modalities have emerged to treat obese patients, but the best long‐term ...results are achieved with bariatric surgery. Currently, the interventions most commonly performed are laparoscopic adjustable gastric banding (LAGB), Roux‐en‐Y‐ gastric bypass (RYGB) and sleeve gastrectomy.
Aim To review the gastrointestinal motor complications associated with each of these types of bariatric interventions and the clinical implications of such complications.
Methods Search of medical database (PubMed) on English‐language articles from January 1996 to March 2011. The search terms used were laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (LSG), roux‐en‐Y‐gastric bypass (RYGB), using the AND operator with the terms: complications, motility, GERD, reflux, gastric emptying, esophagitis, dysphagia.
Results Of the three bariatric interventions reviewed, LAGB was the most studied. Most studies reported short follow‐up, of ≤1 year. Oesophageal motor dysfunction is the most common motility complication following the bariatric interventions that were reviewed and is mainly observed after LAGB. Some data suggest that oesophageal motor function testing predicts development of post‐operative symptoms and oesophageal dilation. RYGB offers protection from gastro‐oesophageal reflux. Sleeve gastrectomy was the least studied and was associated with an acceleration of gastric emptying.
Conclusions The effects of these interventions on GI motility should be considered when selecting patients for bariatric surgery. There is scant information regarding the overall effect of sleeve gastrectomy on gastro‐oesophageal reflux patterns and oesophageal motility.
«Jackhammer esophagus» (o esófago en «martillo hidráulico» en español), es un trastorno motor esofágico identificado recientemente. Diversos estudios han descrito su experiencia con este novel ...padecimiento. Sin embargo, no existe información al respecto en Latinoamérica. Nuestro trabajo describe la prevalencia, características demográficas, clínicas y manométricas en una serie de casos con «jackhammer esophagus» en Bogotá, Colombia.
Este es un trabajo observacional retrospectivo de corte transversal. Pacientes consecutivos referidos para manometría esofágica de alta resolución diagnosticados con «jackhammer esophagus» fueron considerados para el estudio. Los expedientes clínicos y manométricos de estos enfermos fueron revisados y la información pertinente extraída.
Durante el periodo de estudio, 6445 pacientes fueron evaluados con manometría esofágica, 27 fueron diagnosticados con «jackhammer esophagus» (prevalencia 0.42%). La mayor parte, fueron mujeres (n=17,63%) en la sexta década. El síntoma más común fue la regurgitación (n=17, 63%), seguido por disfagia (n=15, 56%). El promedio de contracción distal integral observado fue 9,384 (5,095-18,546) mm Hg-s-cm. Disfagia fue más común (79% p<0.01) en pacientes de >60 años y regurgitación más frecuente (92%, p <0.03) en <60 años.
Este es el primer estudio en caracterizar la prevalencia, hallazgos demográficos, clínicos y manométricos en pacientes con «jackhammer esophagus» en Latinoamérica. En nuestra población, la prevalencia de este trastorno es notablemente más baja que en series internacionales. Nuestros hallazgos sugieren la existencia de importantes diferencias geográficas en la prevalencia y presentación clínica de «jackhammer esophagus» en comparación con datos de otros centros internacionales.
Jackhammer esophagus is a recently identified motility disorder. Experience with the novel pathologic condition has been reported in different studies but there is little information on the subject in Latin America. Our case series conducted in Bogota, Colombia, describes the prevalence of jackhammer esophagus and its demographic, clinical, and manometric characteristics.
A retrospective, observational, cross-sectional study included consecutive patients diagnosed with jackhammer esophagus that were referred for high-resolution esophageal manometry. Their clinical and manometric records were reviewed, and the pertinent information for the present study was collected.
Within the study period, 6,445 patients were evaluated with esophageal manometry, 27 of whom were diagnosed with jackhammer esophagus (prevalence of 0.42%). The majority of those patients were women (n=17, 63%) in the sixth decade of life. The most common symptom was regurgitation (n=17, 63%), followed by dysphagia (n=15, 56%). The mean distal contractile integral was 9,384 (5,095-18,546) mmHg·s·cm. Dysphagia was more common in patients >60 years of age (79%, p <.01) and regurgitation was more frequent in patients <60 years of age (92%, p <.03).
The present study is the first to characterize the prevalence of jackhammer esophagus and its demographic, clinical, and manometric characteristics in Latin American patients. The prevalence of jackhammer esophagus in our study population was considerably lower than that reported in international case series. Our findings suggest that there are important geographic differences in the epidemiology and clinical presentation of jackhammer esophagus, compared with data from other international centers.
Jackhammer esophagus is a recently identified motility disorder. Experience with the novel pathologic condition has been reported in different studies but there is little information on the subject ...in Latin America. Our case series conducted in Bogota, Colombia, describes the prevalence of jackhammer esophagus and its demographic, clinical, and manometric characteristics.
A retrospective, observational, cross-sectional study included consecutive patients diagnosed with jackhammer esophagus that were referred for high-resolution esophageal manometry. Their clinical and manometric records were reviewed, and the pertinent information for the present study was collected.
Within the study period, 6,445 patients were evaluated with esophageal manometry, 27 of whom were diagnosed with jackhammer esophagus (prevalence of 0.42%). The majority of those patients were women (n=17, 63%) in the sixth decade of life. The most common symptom was regurgitation (n=17, 63%), followed by dysphagia (n=15, 56%). The mean distal contractile integral was 9,384 (5,095-18,546) mmHg·s·cm. Dysphagia was more common in patients >60 years of age (79%, p <.01) and regurgitation was more frequent in patients <60 years of age (92%, p <.03).
The present study is the first to characterize the prevalence of jackhammer esophagus and its demographic, clinical, and manometric characteristics in Latin American patients. The prevalence of jackhammer esophagus in our study population was considerably lower than that reported in international case series. Our findings suggest that there are important geographic differences in the epidemiology and clinical presentation of jackhammer esophagus, compared with data from other international centers.
Jackhammer esophagus is a recently identified motility disorder. Experience with the novel pathologic condition has been reported in different studies but there is little information on the subject ...in Latin America. Our case series conducted in Bogota, Colombia, describes the prevalence of jackhammer esophagus and its demographic, clinical, and manometric characteristics.
A retrospective, observational, cross-sectional study included consecutive patients diagnosed with jackhammer esophagus that were referred for high-resolution esophageal manometry. Their clinical and manometric records were reviewed, and the pertinent information for the present study was collected.
Within the study period, 6445 patients were evaluated through esophageal manometry, 27 of whom were diagnosed with jackhammer esophagus (prevalence of 0.42%). The majority of those patients were women (n = 17, 63%) in the sixth decade of life. The most common symptom was regurgitation (n = 17, 63%), followed by dysphagia (n = 15, 56%). The mean distal contractile integral was 9384 (5,095−18,546) mmHg·s·cm. Dysphagia was more common in patients > 60 years of age (79%, p < 0.01) and regurgitation was more frequent in patients < 60 years of age (92%, p < 0.03).
The present study is the first to characterize the prevalence of jackhammer esophagus and its demographic, clinical, and manometric characteristics in Latin American patients. The prevalence of jackhammer esophagus in our study population was considerably lower than that reported in international case series. Our findings suggest that there are important geographic differences in the prevalence and clinical presentation of jackhammer esophagus, compared with data from other international centers.
“Jackhammer Esophagus” (o esófago en “martillo hidráulico” en español), es un trastorno motor esofágico identificado recientemente. Diversos estudios han descrito su experiencia con este novel padecimiento. Sin embargo, no existe información al respecto en Latinoamérica. Nuestro trabajo describe la prevalencia, características demográficas, clínicas y manométricas en una serie de casos con “Jackhammer Esophagus” en Bogotá, Colombia.
Este es un trabajo observacional retrospectivo de corte transversal. Pacientes consecutivos referidos para manometría esofágica de alta resolución diagnosticados con “Jackhammer Esophagus” fueron considerados para el estudio. Los expedientes clínicos y manométricos de estos enfermos fueron revisados y la información pertinente extraída.
Durante el periodo de estudio, 6445 pacientes fueron evaluados con manometría esofágica, 27 fueron diagnosticados con “Jackhammer Esophagus” (prevalencia 0.42%). La mayor parte, fueron mujeres (n = 17,63%) mujeres en la sexta década. El síntoma más común fue la regurgitación (n = 17 63%), seguido por disfagia (n = 15 56%). El promedio de contracción distal integral observado fue 9,384 (5,095-18,546) mm Hg-s-cm. Disfagia fue más común (79% p < .01) en pacientes de > 60 años y regurgitación más frecuente (92%, p < .03) en < 60 años.
Este es el primer estudio en caracterizar la prevalencia, hallazgos demográficos, clínicos y manométricos en pacientes con “Jackhammer Esophagus” en Latino América. En nuestra población, la prevalencia de este trastorno es notablemente más baja que en series internacionales. Nuestros hallazgos sugieren la existencia de importantes diferencias geográficas en la prevalencia y presentación clínica de “Jackhammer Esophagus” en comparación con datos de otros centros internacionales.
Abstract
Background
In Latin America the experience in clinical practice with tofacitinib for moderate to severe Ulcerative Colitis (UC), in terms of both effectiveness and safety, is still limited. ...In Colombia, the incidence of UC as well as the availability of these new therapeutic options has been increasing, also, patients are frequently more refractory to treatments with higher rates of hospitalizations and surgeries. The aim of this study is to describe the real-life experience in Colombian patients with UC treated with Tofacitinib.
Methods
descriptive observational study, patients with moderate-severe UC as defined by the American College of Gastroenterology Ulcerative Colitis Activity Index (ACG score) treated with tofacitinib in induction phase (10mg every 12 hours) and maintenance (5mg every 12 hours), in different reference centers nationwide. Therapeutic response was evaluated in endoscopic (Mayo score), paraclinical (CRP, ESR, fecal calprotectin, hemoglobin) and clinical (absence of abdominal pain, diarrhea and rectorrhagia) terms. Additionally, the frequency of adverse events, steroid use and extraintestinal manifestations were measured.
Results
51 patients, 55% women, the average age was 37,14 years (range14-72). All patients had moderate to severe UC; 73% patients with pancolitis, and 21,6% with left colitis. The mean age at UC diagnosis was 29,77 (SD17,8) years (range 12.77-66,4). And the mean time between disease onset and tofacitininb initiation was 7,33 (SD17,1) years (range 0.001-22.72).
42/51(82,4%) patients had previously failed tumor necrosis factor inhibitors and 15/51(29,4%) had failed alpha4 beta7 integrin inhibitor (Vedolizumab). Six patients were naïve to any biologic drug. Ten patients had extraintestinal manifestations.
During the induction phase, 68,6% achieved clinical remission, 58,8% endoscopic remission, and 60,8% paraclinical remission. During maintenance phases, information was obtained from 18 patients during the first 6 months, 16 of whom reported clinical, paraclinical and endoscopic remission, while information was obtained from 7 patients at 12 months, 5 of whom showed clinical remission, and 6/7 endoscopic and paraclinical remission.
Four patients reported adverse events No thromboembolic or cardiovascular events were reported.
Conclusion
Tofacitinib is an effective and safe therapeutic alternative in the management of moderate-severe UC in our population. It is safe in patients with previous use of anti-TNF and anti-integrin, without presenting thrombotic or cardiovascular events. Also, it is a promising alternative in the bio-naïve patient. Its use in pediatric patients is off-label, the patients included presented clinical and paraclinical remission.
Background
Eckardt symptom score (ESS) is the most used tool for the evaluation of esophageal symptoms. Recent data suggest that it might have suboptimal reliability and validity. The aims of this ...study were as follows: (a) Develop and validate an international Spanish ESS version. (b) Perform psychometric ESS evaluation in patients with achalasia and non‐achalasia patients.
Methods
Eckardt symptom score translation was performed by Delphi process. ESS psychometric evaluation was done in two different samples of patients referred for manometry. First sample: 430 dysphagia non‐achalasia patients. Second sample: 161 achalasia patients. Internal consistency was evaluated using Cronbach's α and Guttman coefficient (<0.5 = unacceptable. 0.5‐0.7 = fair. >0.7 = acceptable).
Key Results
Our data show that in patients without and with achalasia, ESS behaves similarly. Both show a fair reliability with Cronbach's α of 0.57 and 0.65, respectively. Based on our results, we recommend interpretation of the Spanish ESS be done with caution. The psychometric quality of the ESS could not be improved by removal of any items based on the single‐factor structure of the scale and no items meeting criteria for elimination.
Conclusions and Inferences
Eckardt symptom score Spanish translation was developed. ESS showed a fair reliability for the evaluation of patients with any causes of dysphagia. Our results highlight the need for development and psychometric validation of new dysphagia scoring tools.
The Spanish version of ESS showed reasonable reliability for the evaluation of patients with any cause of dysphagia, although its interpretation should be conservative. The development and psychometric validation of new dysphagia scoring tools is needed.
Background
The recently developed Brief Esophageal Dysphagia Questionnaire (BEDQ) evaluates esophageal obstructive symptoms. Its initial evaluation showed strong psychometric properties. The aims of ...this study were to (a) translate and validate an international Spanish version of BEDQ and (b) evaluate its psychometric properties in a large Hispano‐American sample of symptomatic individuals.
Methods
A Spanish BEDQ version was performed by Hispano‐American experts using a Delphi process and reverse translation. Patients were prospectively recruited from seven centers in Spain and Latin America among individuals referred for high‐resolution manometry (HRM). Patients completed several scores: Hospital Anxiety & Depression Scale (HADS), Eckardt score (ES), Gastroesophageal Reflux Questionnaire (GERDQ), and the BEDQ. Standardized psychometric analyses were performed.
Key Results
A total of 426 patients were recruited. Spanish BEDQ showed excellent reliability (Cronbach's alpha = 0.91). Factor analysis confirmed its unidimensional character. Moderate significant correlations between BEDQ and other symptomatic scores were found, suggesting sufficient convergent validity. Patients with abnormal or obstructive HRM findings scored significantly higher when compared to normal or non‐obstructive findings, respectively. Using a cutoff of 10, BEDQ showed a sensitivity of 65.38% and a specificity of 66.21% and an area under the curve of 0.71 for obstructive or major manometric diagnosis.
Conclusions and Inferences
A widely usable Spanish BEDQ version has been validated. We confirm its excellent psychometric properties in our patients, confirming the appropriateness of its use in different populations.
Evaluating/grading dysphagia is crucial for clinicians and researchers. We developed and validated a Spanish version of the Brief Esophageal Dysphagia Questionaire. We showed excellent reliability and validity, supporting the appropriateness of its use in Spanish speaking countries.
Introduction
Grading dysphagia is crucial for clinical management of patients. The Eckardt score (ES) is the most commonly used for this purpose. We aimed to compare the ES with the recently ...developed Brief Esophageal Dysphagia Questionnaire (BEDQ) in terms of their correlation and discriminative capacity for clinical and manometric findings and evaluate the effect of gastroesophageal reflux symptoms on both.
Methods
Symptomatic patients referred for high‐resolution manometry (HRM) were prospectively recruited from seven centers in Spain and Latin America. Clinical data and several scores (ES, BEDQ, GERDQ) were collected and contrasted to HRM findings. Standard statistical analysis was performed.
Key Results
426 patients were recruited, 31.2% and 41.5% being referred exclusively for dysphagia and GERD symptoms, respectively. Both BEDQ and ES were independently associated with achalasia. Only BEDQ was independently associated with being referred for dysphagia and with relevant HRM findings. ROC curve analysis for achalasia diagnosis showed AUC of 0.809 for BEDQ and 0.765 for ES, with the main difference being higher BEDQ sensitivity (80.0% vs 70.8% for ES). GERDQ independently predicted ES but not BEDQ. In the absence of dysphagia (BEDQ = 0), GERD symptoms significantly determine ES.
Conclusions and Inferences
Our study suggests both the BEDQ and ES can complementarily describe symptomatic burden in achalasia. BEDQ has several advantages over the ES in the dysphagia evaluation, basically due to its higher sensitivity for manometric diagnosis and independence of GERD symptoms. ES should be used as an achalasia‐specific metric, while BEDQ is a better symptom‐generic evaluating tool.
BEDQ has a better diagnostic accuracy for achalasia and relevant manometric diagnosis than the Eckardt score.
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