Sensitivity and specificity of colorectal cancer mass screening a systematic review of the literature

Colorectal cancer is the second cause of the cancer related mortalities in the world. Screening can effectively reduce the mortality and morbidity rate of this cancer. Sensitivity and specificity of screening methods play an important role in their efficacy. The aim of this study is to review sensitivity and specificity of selected colorectal cancer screening methods systematically. This study conducted a systematic review of sensitivity and specificity of five common colorectal cancer screening methods. The sites Pubmed, Cochrane library and the center for review and dissemination [CRD database] were searched systematically in Jan 2009. Key questions for this search were focused on the sensitivity and specificity of the 5 screening methods. In these databases 2713 articles were matched well with our subject. Of these 130 articles were selected with specified inclusion-exclusion criteria. The mean +/- standard deviation per patient sensitivities of colonoscopy, sigmoidoscopy, double contrast barium enema, CT colonography and fecal occult blood test for detecting colorectal cancer were respectively 94.7 +/- 4.6%, 82.0 +/- 9.3%, 82.3 +/- 8.7%, 95.7 +/- 5.9% and 45.7 +/- 26.5%. Specificities of these tests were respectively 99.8 +/- 0.2%, 83.9%, 92.4 +/- 14.7%, 98.5 +/- 1.3% and 87.6 +/- 11.4%. Based on available evidences, colonoscopy has the highest sensitivity and specificity among the selected screening methods and fecal occult blood test has the lowest sensitivity. Almost all of the tests except stool exams have acceptable sensitivity and specificity for detecting colorectal cancer

[Extra-intestinal symptoms and their relationship to psychological symptoms in patients with irritable bowel syndrome]

Irritable bowel syndrome [IBS] is one of the most common functional gastrointestinal disorders. A significant number of IBS patients have extra-intestinal symptoms [EIS], but the etiology of co-morbidity of IBS with these symptoms is unclear. The aim of this study was to evaluate the relationship of EIS with psychological symptoms in IBS patients. This multicenter, cross-sectional study was conducted on 18 to 65 year old IBS patients [Rome III criteria] referred to four gastroenterology outpatient clinics in the city of Isfahan from 2008-2009. Patients completed the IBS symptom severity scale, EIS severity scale, and anxiety and depression scale. Linear regression analysis was applied to evaluate the relationship of psychological symptoms with EIS, controlling for other variables. During the study period, 142 IBS patients [mean age=30.9 +/- .1 years, 81.7% female] were included. ESI score was significantly correlated to IBS severity score [r=0.534], anxiety [r=0.551] and depression scores [r=0.407]; P<0.001. With linear regression analysis, female gender [P=0.028], IBS severity [P<0.001], and severity of anxiety [P=0.001] were related to ESI scores. According to these results, psychological symptoms are associated with EIS in IBS patients, though prospective studies are needed to evaluate a causative association. Thus, gastroenterologists must pay attention to the association of psychological symptoms with EIS in the treatment of IBS patients and refer them for appropriate therapies

Prevalence of celiac disease in patients with irritable bowel syndrome

Celiac disease [CD] may be misdiagnosed as Irritable Bowel Syndrome [IBS] resulting in long delays in diagnosing CD. There are contradictory reports on the association of CD with IBS. Appropriateness of screening all patients with IBS for CD and how to screen them are still under question. In a cross-sectional study, 328 IBS patients [Rome II] referred to the Poursina Hakim Gastroenterology Clinic were investigated for CD. Total serum anti-tissue transglutaminase IgA [anti-tTG IgA] concentration was measured in all patients. In IgA deficient cases, antigliadin antibody [AGA] IgG concentration was also measured. Moreover, in patients who underwent upper endoscopy [as their necessary workup] duodenal biopsies were taken. Fifty-eight patients were excluded. The remaining patients were 166 [61.5%] women and 104 [38.5%] men with the mean age of 35.3 years [SD = 11.8]. No one had positive serological test of IgA anti tTG antibody. Five patients were IgA deficient; none of them had positive IgG AGA. Duodenal biopsies were taken in 60 patients and pathologic evaluation showed 53Marsh 0, three Marsh I, three Marsh II, and one Marsh IIIa. Only the patient with Marsh IIIa adhered to gluten-free diet [GFD] which led to decrease in severity of symptoms. In patients who did not adhere to GFD, no one had positive serological test after 12 months of follow-up. Prevalence of CD in patients with IBS referred to outpatient gastroenterology clinic might be significant but serum anti-tTG IgA antibody is not helpful in detecting CD in these patients. Further studies are needed to clarify this issue

Effects of ramadan fasting on acute upper gastrointestinal bleeding due to peptic ulcer

As, acid negatively affects duodenal and gastric mucosal defense, we designed this study to investigate if fasting during Ramadan can promote peptic ulcer and its complication, acute upper gastrointestinal bleeding. All patients files who had admitted to hospital with acute upper gastrointestinal bleeding from 10th day of Ramadan till one month later, in 2002 to 2004 were reviewed. Patients were divided into two groups: fasting group who were fasting, at least 10 days before admission and non-fasting group. A total of 236 patients were included in the study; fasting group involved 108 subjects and non-fasting group 128 ones. Both groups were matched regarding sex, predisposing factors and underlying diseases. Fasting group showed more frequent duodenal ulcer [38%] compared to non-fasting group [19.5%] [P = 0.002]. The frequency of esophageal varices was significantly higher in non-fasting group. There was no correlation between fasting and other causes of gastrointestinal bleeding. In fasting group 38%, and in non-fasting group 18.9%, had previous dyspeptic symptoms [P = 0.001]. Two groups were similar regarding prognostic factors. It seems Ramadan fasting can increase acute upper gastrointestinal bleeding due to duodenal ulcer, but it does not make its prognosis poorer than that in non-fasting patients. Dyspeptic symptoms could be considered as alarming signs for patients who want to fast during Ramadan

[Epidemiology of colorectal cancer in Isfahan Province]

The aim of this study was to assess epidemiology of colorectal cancer [CRC] in Isfahan, Iran. Data were gathered from hospital documents of hospital admissions for colonoscopy, surgery, chemotherapy or radiotherapy due to colorectal cancer during 1996-2003. 1100 cases with colorectal cancer in seven years were detected and reviewed. Our minimum incidence rate estimation was 1.3 per 100,000 in 1996, 3.7 /100,000 in 2001 and 3.1 / 100,000 in 2003. One third of CRC cases were diagnosed between thirties to fifties in both genders in our province with a peak incidence in the fifties for females and in the sixties for males. CRC in more than 85% of the patients was left sided. The one, five and seven year's survival rates were 97%, 43% and 21% respectively. A significant lower survival rate was seen in right colon in oppose to the left colon [13% vs. 40%] [p<0.05] after five years of follow up. Incidence of CRC in Isfahan Proviene is increasing. Rectum is the most common site [61.6%] for CRC. Many of Iranians who have CRC are young Regarding to fact program, Screening is recommended earlier than Western countries