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Use of a computerized GI sound analysis system
944
Letters to the Editor
REFERENCES 1. Famularo G, DeSimone C. Fatal esophageal perforation with alendronate. Am J Gastroenterol 2001;96:3212–3. 2. Daifotis AG. Re: Famularo—Esophageal perforation in a patient with esophageal diverticulum on daily alendronate. Am J Gastroenterol 2002;97:2678. 3. Jeyarajah DR, Harford WV. Esophageal diverticula. In: Sleisenger MH, Fordtran JS, eds. Gastrointestinal and liver disease, 7th ed. Philadelphia: WB Sanders, 2002:359 –62. 4. Boyce GA, Boyce HW. Esophageal diverticula. In: Yamada T, ed. Textbook of gastroenterology, 2nd ed. Philadelphia: Lippincott, 1995:1167–9. 5. Langdon DE. Medications and giant esophageal diverticula. Mayo Clin Proc 1999;74:744. 6. Baron SH. Zenker’s diverticulum, a cause for loss of drug availability: A “new” complication. Am J Gastroenterol 1982; 77:152–3. Reprint requests and correspondence: David E. Langdon, M.D., F.A.C.G., University of Texas Southwestern Medical School, 1005 Findlay Drive, Arlington, TX 76012-2716. Received Nov. 14, 2002; accepted Nov. 21, 2002.
AJG – Vol. 98, No. 4, 2003
However, it did seem to be efficacious in distinguishing between IBS and Crohn’s disease patients (3). We believed this might be important because a large number of Crohn’s patients are initially misdiagnosed as having IBS. We agree that there is a need for considerable investigation of the clinical role of quantitative analysis of GI sounds. The physiological basis of the frequency of sound formation is not well understood, and there does not seem to be a simple relationship between sound generation and motility. For example, we have observed that both diarrhea-dominant and constipation-dominant IBS patients have markedly increased fasting rates of sound production. We have also observed a surprising increase in sound production rates after administration of diphenoxylate. These observations led us to hypothesize that disordered motility may contribute to increased rates of sound production, and the effects of drugs may not be easily predicted. Yuki et al. (1) suggest analysis of longer recordings may provide useful information. The Enterotach analysis system is designed to facilitate such studies, including those that investigate sound production over long periods of time. Brian L. Craine, M.D., Ph.D. Michael L. Silpa, M.D.
Use of a Computerized GI Sound Analysis System TO THE EDITOR: A recent letter in this section indicated that the Enterotachogram analysis system (Enterotach, Western Research, Tucson, AZ) for the quantitative analysis of GI sound patterns could only record sounds for a 2-min period (1). In fact, the Enterotach system can determine the average sound-to-sound interval, sounds/min, percentage of total time involved, average length of sounds, and average sound frequency for recordings of any length of time. The Enterotach system saves the individual details of detected sounds (e.g., power spectrum, duration, mean frequency, and envelope amplitude) for the first 1000 sounds. This is the result of considerations regarding typical memory capabilities of desktop computers; however, it does not limit the length of recording that can be analyzed for the average parameters describing that recording. The 2-min protocol that we had published for the differentiation of irritable bowel syndrome (IBS) patients from normal subjects was arrived at through a consideration of obtaining practical measurements in the clinic environment and the acquisition of statistically significant data (2). We have observed that the 2-min protocol results in an average count of about 100 sounds for normal control subjects and about 240 sounds for IBS patients (2). Recording for longer periods up to 15 min did not significantly alter the average parameters for either category of subjects. However, we noted that after 3– 4 min, it became increasingly more common for subjects to cause noise artifacts attributed primarily to movement. Using the 2-min protocol, we concluded that it would not be useful for distinguishing Crohn’s disease from the normal condition, which has been confirmed by Yuki et al. (1).
Western Research Company Tucson, Arizona Department of Gastroenterology Alameda County Medical Center (Highland Campus) Oakland, California
REFERENCES 1. Yuki M, Adachi K, Fujishiro H, et al. Is a computerized bowel sound auscultation system useful for the detection of increased bowel motility? Am J Gastroenterol 2002;97:1846 –7. 2. Craine BL, Silpa M, O’Toole CJ. Computerized auscultation applied to irritable bowel syndrome. Dig Dis Sci 1999;44: 1887–92. 3. Craine BL, Silpa M, O’Toole CJ. Enterotachogram analysis to distinguish irritable bowel syndrome from Crohn’s disease. Dig Dis Sci 2001;46:1974 –9. Reprint requests and correspondence: Brian L. Craine, M.D., Ph.D., 85 Bolinas Road, Suite 18, Fairfax, CA 94930. Received Nov. 14, 2002; accepted Nov. 21, 2002.
Relationship Between Diabetes Mellitus and the Site of Colorectal Cancer TO THE EDITOR: Recently, utility of total colonoscopy has been reported (1, 2). Okamoto et al. (3) suggested that the frequency of right-sided colon cancer increases with patient age. We would like to comment on another factor associated with right-sided colon cancer, i.e., diabetes mel-
Letters to the Editor
REFERENCES 1. Famularo G, DeSimone C. Fatal esophageal perforation with alendronate. Am J Gastroenterol 2001;96:3212–3. 2. Daifotis AG. Re: Famularo—Esophageal perforation in a patient with esophageal diverticulum on daily alendronate. Am J Gastroenterol 2002;97:2678. 3. Jeyarajah DR, Harford WV. Esophageal diverticula. In: Sleisenger MH, Fordtran JS, eds. Gastrointestinal and liver disease, 7th ed. Philadelphia: WB Sanders, 2002:359 –62. 4. Boyce GA, Boyce HW. Esophageal diverticula. In: Yamada T, ed. Textbook of gastroenterology, 2nd ed. Philadelphia: Lippincott, 1995:1167–9. 5. Langdon DE. Medications and giant esophageal diverticula. Mayo Clin Proc 1999;74:744. 6. Baron SH. Zenker’s diverticulum, a cause for loss of drug availability: A “new” complication. Am J Gastroenterol 1982; 77:152–3. Reprint requests and correspondence: David E. Langdon, M.D., F.A.C.G., University of Texas Southwestern Medical School, 1005 Findlay Drive, Arlington, TX 76012-2716. Received Nov. 14, 2002; accepted Nov. 21, 2002.
AJG – Vol. 98, No. 4, 2003
However, it did seem to be efficacious in distinguishing between IBS and Crohn’s disease patients (3). We believed this might be important because a large number of Crohn’s patients are initially misdiagnosed as having IBS. We agree that there is a need for considerable investigation of the clinical role of quantitative analysis of GI sounds. The physiological basis of the frequency of sound formation is not well understood, and there does not seem to be a simple relationship between sound generation and motility. For example, we have observed that both diarrhea-dominant and constipation-dominant IBS patients have markedly increased fasting rates of sound production. We have also observed a surprising increase in sound production rates after administration of diphenoxylate. These observations led us to hypothesize that disordered motility may contribute to increased rates of sound production, and the effects of drugs may not be easily predicted. Yuki et al. (1) suggest analysis of longer recordings may provide useful information. The Enterotach analysis system is designed to facilitate such studies, including those that investigate sound production over long periods of time. Brian L. Craine, M.D., Ph.D. Michael L. Silpa, M.D.
Use of a Computerized GI Sound Analysis System TO THE EDITOR: A recent letter in this section indicated that the Enterotachogram analysis system (Enterotach, Western Research, Tucson, AZ) for the quantitative analysis of GI sound patterns could only record sounds for a 2-min period (1). In fact, the Enterotach system can determine the average sound-to-sound interval, sounds/min, percentage of total time involved, average length of sounds, and average sound frequency for recordings of any length of time. The Enterotach system saves the individual details of detected sounds (e.g., power spectrum, duration, mean frequency, and envelope amplitude) for the first 1000 sounds. This is the result of considerations regarding typical memory capabilities of desktop computers; however, it does not limit the length of recording that can be analyzed for the average parameters describing that recording. The 2-min protocol that we had published for the differentiation of irritable bowel syndrome (IBS) patients from normal subjects was arrived at through a consideration of obtaining practical measurements in the clinic environment and the acquisition of statistically significant data (2). We have observed that the 2-min protocol results in an average count of about 100 sounds for normal control subjects and about 240 sounds for IBS patients (2). Recording for longer periods up to 15 min did not significantly alter the average parameters for either category of subjects. However, we noted that after 3– 4 min, it became increasingly more common for subjects to cause noise artifacts attributed primarily to movement. Using the 2-min protocol, we concluded that it would not be useful for distinguishing Crohn’s disease from the normal condition, which has been confirmed by Yuki et al. (1).
Western Research Company Tucson, Arizona Department of Gastroenterology Alameda County Medical Center (Highland Campus) Oakland, California
REFERENCES 1. Yuki M, Adachi K, Fujishiro H, et al. Is a computerized bowel sound auscultation system useful for the detection of increased bowel motility? Am J Gastroenterol 2002;97:1846 –7. 2. Craine BL, Silpa M, O’Toole CJ. Computerized auscultation applied to irritable bowel syndrome. Dig Dis Sci 1999;44: 1887–92. 3. Craine BL, Silpa M, O’Toole CJ. Enterotachogram analysis to distinguish irritable bowel syndrome from Crohn’s disease. Dig Dis Sci 2001;46:1974 –9. Reprint requests and correspondence: Brian L. Craine, M.D., Ph.D., 85 Bolinas Road, Suite 18, Fairfax, CA 94930. Received Nov. 14, 2002; accepted Nov. 21, 2002.
Relationship Between Diabetes Mellitus and the Site of Colorectal Cancer TO THE EDITOR: Recently, utility of total colonoscopy has been reported (1, 2). Okamoto et al. (3) suggested that the frequency of right-sided colon cancer increases with patient age. We would like to comment on another factor associated with right-sided colon cancer, i.e., diabetes mel-