Description of a novel grading system to assess the quality of bowel preparation in video capsule endoscopy.

BACKGROUND AND STUDY AIMS: Inadequate bowel preparation negatively influences the reliability of examinations by video capsule endoscopy (VCE). Currently, only subjective scales are available to describe mucosal visibility. We aimed to design a score that was derived directly from the VCE images. PATIENTS AND METHODS: A computed assessment of cleansing score was developed based on color intensities of the tissue color bar. The feasibility of this score was retrospectively tested in 24 VCE studies. A prospective study was conducted using 40 VCE segments from 10 consecutive VCE studies. The computed scores were compared with three existing methods of assessing small-intestinal cleansing. Correlations between the existing scoring systems and the computed score were evaluated using the intraclass correlation coefficient and Spearman's rho correlation. RESULTS: All computed measurements were obtained twice and resulted in exactly the same results. Both overall and segmental mucosal visibility could be assessed. The computed score and the 10-point quantitative index were significantly associated for both readers (Spearman's rho: 0.68 and 0.75, respectively; P < 0.001). The intraclass correlation coefficient for the 4-point qualitative evaluation and the computed score was 0.67 for reader 1 and 0.64 for reader 2. For reader 1, the mean computed score for segments assessed as either inadequately or adequately cleansed was 5.0 and 6.4 ( P = 0.001). For reader 2 these values were 4.0 and 6.3, respectively ( P = 0.005). CONCLUSIONS: A computed assessment of small-bowel mucosal visibility based on the ratio of color intensities of the red and green channel of the tissue color bar is feasible and more reproducible than existing subjective scales. Such a computed scale could be integrated into VCE reading software. For this novel scoring system we propose the term Computed Assessment of Cleansing (CAC) score.

Efficacy of serology driven "test and treat strategy" for eradication of H. pylori in patients with rheumatic disease in the Netherlands.

The treatment of choice of H. pylori infections is a 7-day triple-therapy with a proton pump inhibitor (PPI) plus amoxicillin and either clarithromycin or metronidazole, depending on local antibiotic resistance rates. The data on efficacy of eradication therapy in a group of rheumatology patients on long-term NSAID therapy are reported here. This study was part of a nationwide, multicenter RCT that took place in 2000-2002 in the Netherlands. Patients who tested positive for H. pylori IgG antibodies were included and randomly assigned to either eradication PPI-triple therapy or placebo. After completion, follow-up at 3 months was done by endoscopy and biopsies were sent for culture and histology. In the eradication group 13% (20/152, 95% CI 9-20%) and in the placebo group 79% (123/155, 95% CI 72-85%) of the patients were H. pylori positive by histology or culture. H. pylori was successfully eradicated in 91% of the patients who were fully compliant to therapy, compared to 50% of those who were not (difference of 41%; 95% CI 18-63%). Resistance percentages found in isolates of the placebo group were: 4% to clarithromycin, 19% to metronidazole, 1% to amoxicillin and 2% to tetracycline.

The prevalence of H. pylori is still substantial in rheumatic patients.

The separate contribution of NSAIDs and H. pylori in the pathogenesis of peptic ulcer disease has not been fully elucidated. The aim of this study was to investigate the seroprevalence of H. pylori in patients with rheumatic diseases and chronic NSAID treatment. Patients with a rheumatic disease, age 40-80 years, and regular use of NSAIDs (at least 3 times a week) were included (n= 1214). IgG-antibodies to H. pylori were found in 39% and increased gradually with age: from 25% in patients in the 40-50 years age group to 48% in patients aged 70-80 years (p<0.0001). No difference was observed between men and women, or between the three centres. In our population of rheumatic patients treated with NSAIDs the seroprevalence of H. pylori is substantial (39%), but seems to be lower than in previous reports, which may be due to a cohort effect.