Interobserver Variation in the Endoscopic Diagnosis of Gastroesophageal Reflux Disease / 대한소화기내시경학회지

BACKGROUND/AIMS: A diagnosis of gastroesophageal reflux disease (GERD) is based on the typical symptoms, such as acid regurgitation and heartburn. However, there is a very high inter-observer variation in the evaluation of GERD patients. METHODS: The endoscopic images of forty-two cases with reflux symptoms (2 still images and 15-second video images per case) were analyzed by 18 experienced endoscopists and 22 trainees. The findings were classified into the following: (1) 6 groups (modified LA classification: 4 LA groups, minimal, and normal), (2) erosinve and non-erosive, and (3) confluent erosive and others. The level of inter-observer variation is expressed as a kappa value. RESULTS: The level of inter-observer agreement of the 18 experienced endoscopists for classifying the patients into 6 groups was fairly low (kappa=0.364). However, when the findings were classified into the 2 groups suggested in the Genval workshop (NERD, A, or B versus C or D), the level of inter- observer agreement increased substantially (kappa=0.710). The kappa value of the 22 trainees for classifying the patients into 6 groups was 0.402. CONCLUSIONS: Modified LA classification with minimal change lesions showed a fairly low level of agreement. The problem caused by inter-observer variations decreased significantly when the findings were classified into two groups.

The effect of plant sterol on serum cholesterol in patients with hypercholesterolemia

BACKGROUND AND OBJECT: Phytosterols(Plant sterols) have been known to reduce serum cholesterol concentrations by inhibiting absorption of both dietary and biliary cholesterol from the small intestines. However, the hypocholesterolemic effect of plant sterols has not been evaluated in Korea. We investigated the effect of plant sterol containing beverage on blood lipid profiles in the hypercholesterolemic patients. MATERIALS AND METHODS: Forty-five hypercholesterolemic patients(fasting LDL-cholesterol>130 mg/dl) were fed either a placebo beverage for 4 weeks or a test beverage containing plant sterols or 8 weeks in a single-blind, randomized cross-over study. The subjects were instructed to maintain the same amount of dietary intake of fat and cholesterol during the study. After 4 week treatment of plant sterols, the dose of plant sterols was doubled (3.2 g/d) for subjects whose LDL-cholesterol reduction rate was not reached by 15%. RESULTS: 1. The total study population who completed the whole protocol was 45 patients(15 males, 30 females, mean age 56). 2. At baseline, the mean dietary intake of saturated fat of subjects was 11.12 g, and cholesterol was 135.2 mg. 3. After 8 week treatment with plant sterols, serum concentrations of total cholesterol and LDL-cholesterol were significantly reduced by 4.38%(p= 0.039), 8.28%(p=0.036) respectively. However, HDL-cholesterol and triglyceride did not change significantly. 4. Two-thirds of the subjects responded to treatment with plant sterols, and the mean reduction rates in LDL-cholesterol and total cholesterol of those subjects were 14.1% and 9.2% respectively. CONCLUSION: We conclude that plant sterols reduce serum total cholesterol and LDL-cholesterol concentrations significantly. These results suggest that plant sterols are also effective for those with low cholesterol intake.