The diagnosis of celiac disease (CD) in patients with different autoimmune diseases including Graves disease (GD) remains a challenge. The aims of our study were to: (1) assess the prevalence of CD ...in Polish patients with GD and (2) evaluate the prevalence of CD in the subgroups of patients with GD divided on the basis of clinical and human leukocyte antigen (HLA) typing criteria.
The prospective study was conducted at an academic referral center. The study groups consisted of consecutive, euthyroid patients with GD (n = 232) and healthy volunteers without autoimmune thyroid diseases (n = 122). The diagnosis of CD was based on elevated immunoglobulin A autoantibodies to the enzyme tissue transglutaminase (IgA-TTG) and small intestine biopsy findings.
CD was diagnosed in 8 patients with GD (3.4%) and 1 healthy volunteer (0.8%). The development of CD in patients with GD was strongly associated with HLA-DQ2 haplotype (as predicted from linkage disequilibria, 14.6% vs. 1.5%, P = .009; odds ratio OR = 11.3; 95% confidence interval CI 1.3-252.7): 6 patients with CD carried HLA-DRB1(*)03, 1 carried an HLA-DRB1(*)04 allele, and 1 had an HLA-DRB1(*)07/(*)11 genotype. Multivariate analysis showed independent associations between CD and early GD onset (P = .014, OR = 9.6), autoimmunity in family (P = .029, OR = 6.3) and gastroenterologic symptoms (P = .031, OR = 8.1).
The results of our study suggest that serologic screening for CD may be considered in GD patients (1) with the HLA alleles typical for CD, (2) with an early onset of GD, or (3) a family history of autoimmunity. Moreover, the diagnosis of CD should be explored in euthyroid GD patients with nonspecific gastrointestinal symptoms.
Adoption of the endoscopic submucosal dissection (ESD) technique for early GI cancer from Japan requires expert-supervised experimental training before unsupervised implementation of clinical ESD. ...The aim of this study was to evaluate unsupervised implementation of ESD intention-to-treat (ie, any resection planned and started as en bloc ESD).
ESD workshops (in vivo porcine model) lasted 3.3 days, including a 1-day theory seminar, for 177 participants from 135 Western referral centers. A questionnaire was sent to the senior participant of all 135 centers. This cross-sectional questionnaire survey included main outcome measurements such as performance, organ distribution, and severe adverse events of ESD intention-to-treat.
Feedback was received from 113 centers (84%): 73 (54%) ESD centers and 40 centers (30%) with zero ESDs. Ten (7%) had published ESDs; no feedback was received from 12 (9%) centers with unknown status. Altogether, 83 centers (61.5%) performed ESDs: 21 (16%) had >150 ESDs (professional category), 33 (24%) had 31 to 150 ESDs (competent category), and 29 (21.5%) had ≤30 ESDs (initial learning category). Most implemented ESD centers (91% 72 of 79) were analyzed: centers on initial learning (420 ESD) compared with centers with >30 ESDs (5676 ESDs) performed en bloc ESDs in 64% versus 84%, hybrid ESD in 26% versus 11%, and piecemeal EMR in 10% versus 5.2%. The majority of ESDs (66%-68%) performed were in the colorectum, with a low risk overall (30-day mortality, 0.03%; surgical repair, 3.5% vs 1.7%) and satisfactory outcome (oncosurgery, 7.4% vs 5.2%; local recurrence, 1.5% vs 0.3%).
Beyond guideline recommendations, unsupervised implementation of ESD was successful in the colorectum with a step-up approach. Western ESD centers must now aim for professional (ie, >80%) curative ESD.
Background: Argon plasma coagulation APC, high-dose-rate brachytherapy HDR, and photodynamic therapy PDT have been used in palliative treatment of malignant dysphagia. However, these methods as a ...monotherapy result in a relatively short period of good swallowing. The aim of this study is to evaluate whether an additional HDR or PDT after APC recanalization of malignant stenosis may prolong dysphagia-free period DFP in patients pts with non-operable esophageal or cardia cancer. Material:We considered for inclusion 72 pts (median age 70 yrs, range: 39-90) with malignant dysphagia who were not suitable for or did not accept radical treatment. However, 24 of them were excluded due to: bronchial involvement on EUS (n=9), esophago-bronchial fistula (n=4), perforation (n=1), lack of pts consent (n=7), death before randomization (n=3). The remaining 48 pts compromise study material. Methods: The stenosis was treated with APC until the patient could eat solid foods. After recanalization, pts were randomized to one of three groups: 1.additional HDR (n=16), 2.additional PDT (n=16), 3.observation without additional treatment (n=16). HDR was performed using 10-14 mm wide “bougie” applicator. Single dose of 12 Gy was given, specified 0.5 cm from the surface of the applicator. PDT was performed using Photosan-3 (dose 2.5 mg/kg) and low power laser irradiation (630 nm) to a dose of 250 J/cm of tumor. After the treatment pts were followed until death. Kaplan-Meier survival analysis of DFP was calculated for each group compared (fig). Results: The median DFP in HDR, PDT, and control group was 87 (range 16-219), 52.2 (16-303), and 27 (11-66) days respectively. The difference between HDR and control group and between PDT and control group were significant (log rank test, p=0.002and p=0.013 respectively). There was no significant difference between HDR and PDT group. Conclusions: These results show significant prolongation of DFP in pts who underwent additional HDR or PDT after recanalization with APC as compared to recanalization only.
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