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Yield of screening sigmoidoscopy in Puerto Rican born immigrants to the mainland United States
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Abstracts
AJG – Vol. 95, No. 9, 2000
At year’s end, only 17 of the 54 initial responders (32%) did not require further prednisone or surgical resection. Of the initial responders, 18 patients (33%) required surgery within the first year. Eleven of the 13 non-responders (85%) required surgery within the year. Conclusions: While the majority of CD patients (⬃80%) exhibit some degree of response to the initial course of steroids, approximately 20% are steroid resistant. Of the initial responders, 65% maintained this degree of response for 30 days, but only 32% completed the year without surgery and off of prednisone. With this perspective, early consideration of steroidsparing therapy (ie immunomodulators or biologic agents) is warranted. 421 Yield of screening sigmoidoscopy in Puerto Rican born immigrants to the mainland United States Kishore Gaddipati, Murray Orbuch, Anthony Weiss*. Mount Sinai School of Medicine, New York, NY, United States. Purpose: It has previously been described that populations emigrating from low risk countries gradually assume a risk of colorectal cancer (CRC) risk comparable to the general population of the United States. The yield of colorectal cancer screening in native born Puerto Ricans who emigrate to the mainland United States has not been previously described. Methods: We reviewed the experience of our flexible sigmoidoscopy CRC screening clinic at the Internal Medicine Associates of the Mount Sinai Medical Center, a large ambulatory care center situated in East Harlem. Between 6/97 and 3/00 a total of 393 sigmoidoscopies were performed for routine CRC screening. Information regarding country of birth (either through chart review or patient interview) was available in 323 individuals. We identified 129 individuals born in Puerto Rico, 118 individuals born in the mainland U.S. and 76 individuals born in various other countries. Excluding individuals ⱕ49 years of age (below the age at which CRC screening is recommended) left a total of 123 native born Puerto Rican individuals (PR) and 99 individuals born in the mainland U.S. (ML). The two groups were comparable in age and male:female ratio. Findings of pathologically confirmed adenomas or cancer were recorded in both groups. Results: Results are shown in Table 1, Chi-square test ⫽ 602 (NS). Among PR born individuals, those found to have polyps were slightly older (mean 68.4 vs. 64 yrs) and had spent more years living in the mainland U.S. (mean 45.6 yrs vs. 39.88 yrs), however these differences did not achieve statistical significance. Conclusions: Individuals born in Puerto Rico who have emigrated to the mainland U.S. have a risk of CRC comparable to individuals born in the mainland U.S. Current screening guidelines are applicable to this group. Place of Birth PR ML
No Polyp
Adenomas
Cancer
116 92
7 (5.7%) 7 (7%)
— 1
422 The pro-con device: A new non-surgical approach for prevention of fecal incontinence Paola Giamundo, MD, Argelia Welber, RNC, Eric G. Weiss, MD, Jonathan Efron, MD, Anthony M. Vernava III, MD, Juan J. Nogueras, MD, Steven D. Wexner, MD, FACG. Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida. Purpose: This pilot study was designed to assess the efficacy and reliability of the PRO-CON device in preventing fecal accidents and to evaluate its impact on quality of life. A secondary aim was to define and establish a specific group of patients who would most benefit from this device. Methods: The PRO-CON device consists of a disposable, pliable, rubber catheter with an infrared photo-interrupter sensor and flatus vent holes on the distal tip that is connected to a beeper. An inflatable 20cc capacity cuff fixes the catheter in the anal canal and provides a mechanical barrier to prevent leakage of stool. When stool enters the rectum, the photo-inter-
rupter sensor signals to the beeper, alerting the patient of an imminent bowel movement. The mechanical barrier created by the inflated balloon allows the patient enough time to reach a toilet. Voluntary evacuation is accomplished by deflating the balloon and removing the catheter from the rectum. The device was prospectively assessed in patients with significant fecal incontinence who had previously undergone anorectal manometry, ultrasound, and electromyography with PNTML assessment. The PROCON device was used for 14 consecutive days. A quality of life questionnaire and a daily log of bowel activity and incontinent episodes were completed before and after the study. Results: 7 patients, 5 females and 2 males with a mean age of 72.7 (range 39 – 81) years, completed the study. Etiology of incontinence included idiopathic in 4 patients, a sphincter defect in 2, and a neurological disorder in one. The PRO-CON device yielded an overall significant improvement in the quality of life (p ⬍ 0.05). A significant reduction in the fecal incontinence score was observed at the completion of the study [12.7 (9 –18) vs 5.2 (range 1–10) (p ⬍ 0.05)]. Conclusion: The PRO-CON is a promising, unique new device that can prevent episodes of fecal incontinence, thereby improving quality of life. Its role includes patients with severe fecal incontinence impairing their quality of life, who are sufficiently psychologically motivated to participate in their own treatment, have either failed or are unfit to undergo surgery, are mentally capable, and have good manual dexterity.
423 An acute inflammatory insult induces long-term colonic hypersensitivity Matthew S Gibson, Beverley Greenwood-Van Meerveld*. Oklahoma Foundation for Digestive Research, VA Medical Center, Oklahoma City, OK, United States. Purpose: The onset of symptomatology in a subset of patients with the irritable bowel syndrome (IBS) can occur after an acute inflammatory response. The purpose of our study was to examine whether long-term changes in colonic sensitivity follow an acute colitic episode. Methods: In male rats, colitis was induced by intracolonic administration of 2,4,6-trinitrobenzenesulfonic acid (TNBS). Control rats received a saline enema. The level of inflammation was evaluated visually using a damage score index and biochemically by measuring myeloperoxidase (MPO) activity. Innocuous colorectal distention (30 mmHg for 10 min) was performed and the level of colonic stimulation determined by recording the number of abdominal contractions (a visceromotor behavioral response in rats) on days 3, 30, and 60 post-TNBS. At the same time points, morphological damage and colonic inflammation were evaluated. Results: On day 3 post-TNBS, the colonic damage score and MPO activity were significantly elevated, while on days 30 and 60 damage scores and MPO activity returned to control levels. During the active inflammatory response, colorectal distention induced a significant increase in the number of abdominal contractions (30.4 ⫾ 2.9, p ⬍ 0.01) as compared to controls (8.4 ⫾ 0.3). Although there was recovery of the colonic mucosa on days 30 and 60, the response to colorectal distention remained exaggerated (day 30 ⫽ 21.3 ⫾ 2.3, p ⬍ 0.01; day 60 ⫽ 16.8 ⫾ 2.8, p ⬍ 0.05). Conclusions: In this study we have shown that changes in colonic sensitivity persist long after resolution of a colonic inflammatory response. This post-inflammatory colonic hypersensitivity supports the clinical finding which suggests that a subset of patients with IBS experience the onset of symptoms following recovery from an acute inflammatory insult.
424 Digital rectal examination as a part of colorectal cancer screening in hospitalized veterans N. Gopalswamy, M.D., FACG; S. Newaz, M.D.; S. Gianti, M.D., A. Bhutani, M.D., R. J. Markert, Ph.D., L. Swamy, M.D. VA Medical Center and Wright State University, Dayton, Ohio.
Abstracts
AJG – Vol. 95, No. 9, 2000
At year’s end, only 17 of the 54 initial responders (32%) did not require further prednisone or surgical resection. Of the initial responders, 18 patients (33%) required surgery within the first year. Eleven of the 13 non-responders (85%) required surgery within the year. Conclusions: While the majority of CD patients (⬃80%) exhibit some degree of response to the initial course of steroids, approximately 20% are steroid resistant. Of the initial responders, 65% maintained this degree of response for 30 days, but only 32% completed the year without surgery and off of prednisone. With this perspective, early consideration of steroidsparing therapy (ie immunomodulators or biologic agents) is warranted. 421 Yield of screening sigmoidoscopy in Puerto Rican born immigrants to the mainland United States Kishore Gaddipati, Murray Orbuch, Anthony Weiss*. Mount Sinai School of Medicine, New York, NY, United States. Purpose: It has previously been described that populations emigrating from low risk countries gradually assume a risk of colorectal cancer (CRC) risk comparable to the general population of the United States. The yield of colorectal cancer screening in native born Puerto Ricans who emigrate to the mainland United States has not been previously described. Methods: We reviewed the experience of our flexible sigmoidoscopy CRC screening clinic at the Internal Medicine Associates of the Mount Sinai Medical Center, a large ambulatory care center situated in East Harlem. Between 6/97 and 3/00 a total of 393 sigmoidoscopies were performed for routine CRC screening. Information regarding country of birth (either through chart review or patient interview) was available in 323 individuals. We identified 129 individuals born in Puerto Rico, 118 individuals born in the mainland U.S. and 76 individuals born in various other countries. Excluding individuals ⱕ49 years of age (below the age at which CRC screening is recommended) left a total of 123 native born Puerto Rican individuals (PR) and 99 individuals born in the mainland U.S. (ML). The two groups were comparable in age and male:female ratio. Findings of pathologically confirmed adenomas or cancer were recorded in both groups. Results: Results are shown in Table 1, Chi-square test ⫽ 602 (NS). Among PR born individuals, those found to have polyps were slightly older (mean 68.4 vs. 64 yrs) and had spent more years living in the mainland U.S. (mean 45.6 yrs vs. 39.88 yrs), however these differences did not achieve statistical significance. Conclusions: Individuals born in Puerto Rico who have emigrated to the mainland U.S. have a risk of CRC comparable to individuals born in the mainland U.S. Current screening guidelines are applicable to this group. Place of Birth PR ML
No Polyp
Adenomas
Cancer
116 92
7 (5.7%) 7 (7%)
— 1
422 The pro-con device: A new non-surgical approach for prevention of fecal incontinence Paola Giamundo, MD, Argelia Welber, RNC, Eric G. Weiss, MD, Jonathan Efron, MD, Anthony M. Vernava III, MD, Juan J. Nogueras, MD, Steven D. Wexner, MD, FACG. Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida. Purpose: This pilot study was designed to assess the efficacy and reliability of the PRO-CON device in preventing fecal accidents and to evaluate its impact on quality of life. A secondary aim was to define and establish a specific group of patients who would most benefit from this device. Methods: The PRO-CON device consists of a disposable, pliable, rubber catheter with an infrared photo-interrupter sensor and flatus vent holes on the distal tip that is connected to a beeper. An inflatable 20cc capacity cuff fixes the catheter in the anal canal and provides a mechanical barrier to prevent leakage of stool. When stool enters the rectum, the photo-inter-
rupter sensor signals to the beeper, alerting the patient of an imminent bowel movement. The mechanical barrier created by the inflated balloon allows the patient enough time to reach a toilet. Voluntary evacuation is accomplished by deflating the balloon and removing the catheter from the rectum. The device was prospectively assessed in patients with significant fecal incontinence who had previously undergone anorectal manometry, ultrasound, and electromyography with PNTML assessment. The PROCON device was used for 14 consecutive days. A quality of life questionnaire and a daily log of bowel activity and incontinent episodes were completed before and after the study. Results: 7 patients, 5 females and 2 males with a mean age of 72.7 (range 39 – 81) years, completed the study. Etiology of incontinence included idiopathic in 4 patients, a sphincter defect in 2, and a neurological disorder in one. The PRO-CON device yielded an overall significant improvement in the quality of life (p ⬍ 0.05). A significant reduction in the fecal incontinence score was observed at the completion of the study [12.7 (9 –18) vs 5.2 (range 1–10) (p ⬍ 0.05)]. Conclusion: The PRO-CON is a promising, unique new device that can prevent episodes of fecal incontinence, thereby improving quality of life. Its role includes patients with severe fecal incontinence impairing their quality of life, who are sufficiently psychologically motivated to participate in their own treatment, have either failed or are unfit to undergo surgery, are mentally capable, and have good manual dexterity.
423 An acute inflammatory insult induces long-term colonic hypersensitivity Matthew S Gibson, Beverley Greenwood-Van Meerveld*. Oklahoma Foundation for Digestive Research, VA Medical Center, Oklahoma City, OK, United States. Purpose: The onset of symptomatology in a subset of patients with the irritable bowel syndrome (IBS) can occur after an acute inflammatory response. The purpose of our study was to examine whether long-term changes in colonic sensitivity follow an acute colitic episode. Methods: In male rats, colitis was induced by intracolonic administration of 2,4,6-trinitrobenzenesulfonic acid (TNBS). Control rats received a saline enema. The level of inflammation was evaluated visually using a damage score index and biochemically by measuring myeloperoxidase (MPO) activity. Innocuous colorectal distention (30 mmHg for 10 min) was performed and the level of colonic stimulation determined by recording the number of abdominal contractions (a visceromotor behavioral response in rats) on days 3, 30, and 60 post-TNBS. At the same time points, morphological damage and colonic inflammation were evaluated. Results: On day 3 post-TNBS, the colonic damage score and MPO activity were significantly elevated, while on days 30 and 60 damage scores and MPO activity returned to control levels. During the active inflammatory response, colorectal distention induced a significant increase in the number of abdominal contractions (30.4 ⫾ 2.9, p ⬍ 0.01) as compared to controls (8.4 ⫾ 0.3). Although there was recovery of the colonic mucosa on days 30 and 60, the response to colorectal distention remained exaggerated (day 30 ⫽ 21.3 ⫾ 2.3, p ⬍ 0.01; day 60 ⫽ 16.8 ⫾ 2.8, p ⬍ 0.05). Conclusions: In this study we have shown that changes in colonic sensitivity persist long after resolution of a colonic inflammatory response. This post-inflammatory colonic hypersensitivity supports the clinical finding which suggests that a subset of patients with IBS experience the onset of symptoms following recovery from an acute inflammatory insult.
424 Digital rectal examination as a part of colorectal cancer screening in hospitalized veterans N. Gopalswamy, M.D., FACG; S. Newaz, M.D.; S. Gianti, M.D., A. Bhutani, M.D., R. J. Markert, Ph.D., L. Swamy, M.D. VA Medical Center and Wright State University, Dayton, Ohio.