Landmark reading alterations in patients with gastro-oesophageal reflux symptoms undergoing diagnostic gastroscopy

Background and study aims: There is still a debate about the exact measurement of the oesophagogastric junction and the diaphragmatic hiatus among clinicians. The aim of this study was to investigate the differences between landmark readings of gastroscopy on intubation and extubation, and to correlate these readings with a gastro-oesophageal reflux questionnaire

Patients and methods: 116 cases who underwent diagnostic gastroscopy between January 2013 and June 2013 were included in this study. Landmark measurements were noted while withdrawing the endoscope and were also evaluated after the gastric air was fully emptied. We first used a frequency scale for the gastro-oesophageal reflux disease symptoms [FSSG] questionnaire in order to investigate dysmotility and acid reflux symptoms in the study population and correlated the FSSG questionnaire with intubation and extubation measurements at endoscopic examination

Results: Mean age of included subjects was 49.41 +/- 17.7 [19-82] years. Males and females were equally represented. On FSSG scores, the total dysmotility score was 7.99 +/- 5.06 and the total score was 15.18 +/- 10.11. The difference between intubation and extubation measurements ranged from -3 cm to +2 cm [mean: -0.4]. When an FSSG score of 30 was accepted as a cut-off value, we detected a significant difference between the measurements [p < 0.05; t: 0.048]

Conclusion: Accuracy of landmark measurements during gastroscopy is clearly affected from insertion or withdrawal of the endoscope. When differences in measurements between insertion and withdrawal were evident, comparable with the FSSG scores, the results became significantly different. In conclusion, according to FSSG scores, these measurements should be performed at the end of the endoscopy

RE: Liver Shear-Wave Velocity to Diagnose Hepatic Fibrosis in Patients with Chronic Viral Hepatitis B

No abstract available.

Tuberculosis and crohn's disease revisited

Crohn's Disease [CD] and Intestinal Tuberculosis [ITB] share confusingly similar clinical, endoscopic, radiological and pathological manifestations. There is no simple test for differentiating ITB from CD. Although there are a number of sensitive and specific parameters for distinguishing between CD and ITB, the differential diagnosis still remains challenging and both clinical suspicion and appropriate clinical and laboratory studies are required to establish the diagnosis. Correct diagnosis is crucial because the therapy strategies of the two diseases are dramatically different. Treatment of ITB with immunosuppressive agents would lead to worsening of the patients' condition. Likewise, unnecessary antituberculosis therapy would delay the treatment of CD. Another important consideration is the risk of reactivation TB in patients with inflammatory bowel diseases which has been significantly increased following the widespread use of anti-Tumor Necrosis Factor Alpha [TNFalpha] therapy. The majority of reactivation cases are extrapulmonary or disseminated TB. And it is widely recommended that patients with IBD who are to receive TNF inhibitor therapy should be screened for evidence of latent TB. This paper mainly reviews current literature on differential diagnosis between CD and ITB, and summarizes strategies to reduce the TB risk among candidates for TNF antagonist therapy in this specific patient population