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Mallory-Weiss syndrome in the era of therapeutic endoscopy
AJG – September, 2000
epithelium was seen in 1 case which was H. pylori positive. Intestinal metaplasia was seen in 3 cases of which 2 cases were positive for H. pylori. Conclusion: High incidence of H. pylori induced chronic Gastritis in children (39.7%) is noteworthy in rural South India compared to other similar literatures. This could be attributed to unsafe drinking water, feeding without washing hands & high intake of coffee.
130 Mallory-Weiss syndrome in the era of therapeutic endoscopy Sripriya Balasubramanian, M.D., Adolfo R. Duran, M.D., Stanley S. Rogers, M.D., John P. Cello, M.D., FACG. Departments of Medicine and Surgery, Illinois Masonic Medical Center, Chicago IL, University of California, San Francisco, San Francisco, CA. Purpose: To determine the clinical significance of Mallory-Weiss (MW) Syndrome and the role of therapeutic endoscopy. Methods: We conducted a retrospective case study of all patients diagnosed with upper GI bleeding caused by a MW tear over two years at San Francisco General Hospital. Data points collected included age, sex, presenting complaint, precipitating event, alcohol and NSAID use, comorbid illnesses, hematocrit at presentation and after volume resuscitation, BUN, creatinine, prothrombin time, platelet count, endoscopic findings, transfusion requirements, duration of hospital stay, ICU admission, therapeutic intervention and outcome (rebleed, death, discharge). The clinical features of the patients who underwent therapeutic intervention were compared with those managed conservatively. The results were analyzed for statistical significance by the student’s two-tailed t test and the 2 test. Results: Data from 55 patients comprising 47 men and 8 women were reviewed. The mean age was 47.01 ⫾ 13.74 years, mean transfusion requirement was 4.51 ⫾ 4.03 units, 33 subjects required ICU admission, 5 rebled during hospitalization, 3 failed therapeutic endoscopy. Patients requiring therapeutic intervention differed significantly from the group managed conservatively in transfusion requirements (5.80 ⫾ 4.57 vs. 2.72 ⫾ 2.4, p ⫽ 0.0018), prothrombin time (15.22 ⫾ 4.97 vs. 13.26 ⫾ 2.28, p ⫽ 0.0510), platelet count (170.10 ⫾ 93.66 vs. 239.89 ⫾ 86.57, p ⫽ 0.0045), need for ICU admission (25 vs. 8, p ⫽ 0.0246) and hospital stay (6.54 ⫾ 5.53 vs. 4.14 ⫾ 2.42, p ⫽ 0.0394). No significant difference between the two groups was observed in age, presenting complaints, hematocrit, NSAID use, partial thromboplastin time, comorbid conditions such as alcoholic liver disease, hemodynamic stability at presentation or outcome. Conclusion: Mallory-Weiss tears remain a substantial cause of morbidity with sizeable transfusion requirements, need for therapeutic intervention, incidence of rebleeding and death.
131 Oral alendronate 10 mg daily does not cause serious sympotomatic gastroduodenal ulcers and complications Douglas C. Bauer, Kristine Ensrud, Marc Hochberg, Debra Freedholm, Julie Chandler, Anastasia Daifotis*. Merck Research Laboratories, Rahway, NJ, United States. Purpose: Questions have been raised about whether bisphosphonates may cause clinically symptomatic gastric or duodenal ulcers. A recent large retrospective cohort study demonstrated that osteoporosis itself, as represented by non-pathologic fracture in women over age 60, was associated with increased risk of hospitalization due to perforations, ulcers and bleeds (HPUBs). In fact, a comparison of the HPUB rate in ALN users to women with fracture showed no significant increase [adjusted IRR ⫽ 1.14 (0.57, 2.27)] (Chan, Pharmacoepidemiology and Drug Safety, 2000, Suppl., in press). To further explore the potential relationship of ALN and hospitalizations due to ulcer-related events, we compared the incidence of HPUBs in ALN vs. placebo groups in the largest clinical trial of alendronate, the Fracture Intervention Trial (FIT).
Abstracts
2449
Methods: FIT was a randomized, placebo-controlled trial of 6459 women, age 54 – 81 years with low bone mineral density. Women received daily oral ALN (5 mg/day for 2 years and 10 mg/day thereafter) or placebo and were followed for a mean of 3.8 years. All serious upper GI adverse experiences, including HPUBs, were reported by the investigators to the sponsor within 24 hours and follow-up information, including hospital discharge summaries and endoscopy reports were solicited in all cases. These documents were blindly reviewed by a coordinating center physician with 95% of these cases (115 of 124) confirmed by medical records. Evaluation, diagnosis and treatment of upper GI complaints were determined by treating physician and were not dictated by the protocol. Results: Of the 6459 postmenopausal women enrolled in FIT (mean age 69 years), 54% of each group reported a history of digestive disease prior to study entry; 14% had a history of upper GI irritation or ulcers. 88% of the women used NSAIDs or ASA during the study. HPUBs occurred in 0.5% ALN vs. 0.6% PBO patients (RR ⫽ 0.84, 95% CI 0.43, 0 1.63). ALN use was not associated with a significant increase in upper GI tract events even among women in high risk subgroups (those aged ⬎75, with prior upper GI disease, or using NSAIDs). Conclusions: Neither a large retrospective cohort study nor a large prospective clinical trial demonstrate an increase in the incidence of hospitalization due to gastroduodenal ulcers or their complications with the use of daily oral alendronate. Osteoporotic fracture itself is associated with an increase in the incidence of HPUBs, which may at least partly explain the perceived high incidence of ulcer disease in patients receiving alendronate.
132 Unsedated transnasal videogastroscopy: A prospective evaluation of feasibility and safety Sandro Boschetto, MD, Mauro Tosoni, MD, Virginia Festa, MD, Maurizio Giovannone, MD, Fausto Barberani, MD*. “S.Camillo” Hospital, Rieti, Italy. Purpose: Previous studies have described feasibility and safety of transnasal fiberoptic EGD (T-fEGD) in large series of patients (Barberani Endoscopy 1999). Recently ultrathin videoendoscopes have been successfully used to perform transnasal EGD (T-EGD). Aim of this study is to evaluate feasibility and safety of transnasal videoEGD (T-vEGD) in unsedated patients. Methods: Three hundred and forty-seven consecutive outpatients (age range: 16 –98 years M/F ratio: 186/151) referred for diagnostic endoscopy were submitted to unsedated T-vEGD. T-fEGD was performed second if the progression of the videoendoscope failed. Two narrow-diameter endoscopes were used: 6.0 mm videoendoscope (Pentax EG 1840) and a 5.3 mm fiberoptic endoscope (Pentax FG 16V). Transnasal progression was conducted according to Barberani’s technique: without topical nasal anesthesia, on left decubitus, approaching middle meatus of the nose, without asking the patient to swallow (Barberani et al. It J Gastroenterol Hepatol 1998). Results: T-vEGD was successfully completed in 313 pts (90%). Videoendoscope insertion failed in 34/347 (10%) for anatomical reasons, but in 23 of these patients (70%) was possible to perform T-fEGD. Eleven patients were crossed over to the oral route using the same ultrathin instrument. No complications including epistaxis occurred. Conclusions: Tv-EGD is feasible in over the 90% of patients. In our experience, this new technique is easy and safe. Use of the smaller diameter fiberoptic endoscope results in successfully achieving intubation in 2/3 of patients with nasal anatomical abnormalities. Only in 3% of patients endoscope insertion is not possible. We think T-vEGD has the potential to become an office procedure in the routine practice of diagnostic EGD.
epithelium was seen in 1 case which was H. pylori positive. Intestinal metaplasia was seen in 3 cases of which 2 cases were positive for H. pylori. Conclusion: High incidence of H. pylori induced chronic Gastritis in children (39.7%) is noteworthy in rural South India compared to other similar literatures. This could be attributed to unsafe drinking water, feeding without washing hands & high intake of coffee.
130 Mallory-Weiss syndrome in the era of therapeutic endoscopy Sripriya Balasubramanian, M.D., Adolfo R. Duran, M.D., Stanley S. Rogers, M.D., John P. Cello, M.D., FACG. Departments of Medicine and Surgery, Illinois Masonic Medical Center, Chicago IL, University of California, San Francisco, San Francisco, CA. Purpose: To determine the clinical significance of Mallory-Weiss (MW) Syndrome and the role of therapeutic endoscopy. Methods: We conducted a retrospective case study of all patients diagnosed with upper GI bleeding caused by a MW tear over two years at San Francisco General Hospital. Data points collected included age, sex, presenting complaint, precipitating event, alcohol and NSAID use, comorbid illnesses, hematocrit at presentation and after volume resuscitation, BUN, creatinine, prothrombin time, platelet count, endoscopic findings, transfusion requirements, duration of hospital stay, ICU admission, therapeutic intervention and outcome (rebleed, death, discharge). The clinical features of the patients who underwent therapeutic intervention were compared with those managed conservatively. The results were analyzed for statistical significance by the student’s two-tailed t test and the 2 test. Results: Data from 55 patients comprising 47 men and 8 women were reviewed. The mean age was 47.01 ⫾ 13.74 years, mean transfusion requirement was 4.51 ⫾ 4.03 units, 33 subjects required ICU admission, 5 rebled during hospitalization, 3 failed therapeutic endoscopy. Patients requiring therapeutic intervention differed significantly from the group managed conservatively in transfusion requirements (5.80 ⫾ 4.57 vs. 2.72 ⫾ 2.4, p ⫽ 0.0018), prothrombin time (15.22 ⫾ 4.97 vs. 13.26 ⫾ 2.28, p ⫽ 0.0510), platelet count (170.10 ⫾ 93.66 vs. 239.89 ⫾ 86.57, p ⫽ 0.0045), need for ICU admission (25 vs. 8, p ⫽ 0.0246) and hospital stay (6.54 ⫾ 5.53 vs. 4.14 ⫾ 2.42, p ⫽ 0.0394). No significant difference between the two groups was observed in age, presenting complaints, hematocrit, NSAID use, partial thromboplastin time, comorbid conditions such as alcoholic liver disease, hemodynamic stability at presentation or outcome. Conclusion: Mallory-Weiss tears remain a substantial cause of morbidity with sizeable transfusion requirements, need for therapeutic intervention, incidence of rebleeding and death.
131 Oral alendronate 10 mg daily does not cause serious sympotomatic gastroduodenal ulcers and complications Douglas C. Bauer, Kristine Ensrud, Marc Hochberg, Debra Freedholm, Julie Chandler, Anastasia Daifotis*. Merck Research Laboratories, Rahway, NJ, United States. Purpose: Questions have been raised about whether bisphosphonates may cause clinically symptomatic gastric or duodenal ulcers. A recent large retrospective cohort study demonstrated that osteoporosis itself, as represented by non-pathologic fracture in women over age 60, was associated with increased risk of hospitalization due to perforations, ulcers and bleeds (HPUBs). In fact, a comparison of the HPUB rate in ALN users to women with fracture showed no significant increase [adjusted IRR ⫽ 1.14 (0.57, 2.27)] (Chan, Pharmacoepidemiology and Drug Safety, 2000, Suppl., in press). To further explore the potential relationship of ALN and hospitalizations due to ulcer-related events, we compared the incidence of HPUBs in ALN vs. placebo groups in the largest clinical trial of alendronate, the Fracture Intervention Trial (FIT).
Abstracts
2449
Methods: FIT was a randomized, placebo-controlled trial of 6459 women, age 54 – 81 years with low bone mineral density. Women received daily oral ALN (5 mg/day for 2 years and 10 mg/day thereafter) or placebo and were followed for a mean of 3.8 years. All serious upper GI adverse experiences, including HPUBs, were reported by the investigators to the sponsor within 24 hours and follow-up information, including hospital discharge summaries and endoscopy reports were solicited in all cases. These documents were blindly reviewed by a coordinating center physician with 95% of these cases (115 of 124) confirmed by medical records. Evaluation, diagnosis and treatment of upper GI complaints were determined by treating physician and were not dictated by the protocol. Results: Of the 6459 postmenopausal women enrolled in FIT (mean age 69 years), 54% of each group reported a history of digestive disease prior to study entry; 14% had a history of upper GI irritation or ulcers. 88% of the women used NSAIDs or ASA during the study. HPUBs occurred in 0.5% ALN vs. 0.6% PBO patients (RR ⫽ 0.84, 95% CI 0.43, 0 1.63). ALN use was not associated with a significant increase in upper GI tract events even among women in high risk subgroups (those aged ⬎75, with prior upper GI disease, or using NSAIDs). Conclusions: Neither a large retrospective cohort study nor a large prospective clinical trial demonstrate an increase in the incidence of hospitalization due to gastroduodenal ulcers or their complications with the use of daily oral alendronate. Osteoporotic fracture itself is associated with an increase in the incidence of HPUBs, which may at least partly explain the perceived high incidence of ulcer disease in patients receiving alendronate.
132 Unsedated transnasal videogastroscopy: A prospective evaluation of feasibility and safety Sandro Boschetto, MD, Mauro Tosoni, MD, Virginia Festa, MD, Maurizio Giovannone, MD, Fausto Barberani, MD*. “S.Camillo” Hospital, Rieti, Italy. Purpose: Previous studies have described feasibility and safety of transnasal fiberoptic EGD (T-fEGD) in large series of patients (Barberani Endoscopy 1999). Recently ultrathin videoendoscopes have been successfully used to perform transnasal EGD (T-EGD). Aim of this study is to evaluate feasibility and safety of transnasal videoEGD (T-vEGD) in unsedated patients. Methods: Three hundred and forty-seven consecutive outpatients (age range: 16 –98 years M/F ratio: 186/151) referred for diagnostic endoscopy were submitted to unsedated T-vEGD. T-fEGD was performed second if the progression of the videoendoscope failed. Two narrow-diameter endoscopes were used: 6.0 mm videoendoscope (Pentax EG 1840) and a 5.3 mm fiberoptic endoscope (Pentax FG 16V). Transnasal progression was conducted according to Barberani’s technique: without topical nasal anesthesia, on left decubitus, approaching middle meatus of the nose, without asking the patient to swallow (Barberani et al. It J Gastroenterol Hepatol 1998). Results: T-vEGD was successfully completed in 313 pts (90%). Videoendoscope insertion failed in 34/347 (10%) for anatomical reasons, but in 23 of these patients (70%) was possible to perform T-fEGD. Eleven patients were crossed over to the oral route using the same ultrathin instrument. No complications including epistaxis occurred. Conclusions: Tv-EGD is feasible in over the 90% of patients. In our experience, this new technique is easy and safe. Use of the smaller diameter fiberoptic endoscope results in successfully achieving intubation in 2/3 of patients with nasal anatomical abnormalities. Only in 3% of patients endoscope insertion is not possible. We think T-vEGD has the potential to become an office procedure in the routine practice of diagnostic EGD.