Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 29
Filter
1.
J Gastrointest Oncol ; 10(4): 641-644, 2019 Aug.
Article in English | MEDLINE | ID: mdl-31392044

ABSTRACT

BACKGROUND: Not much is known of the yield of endoscopy in relation to ethnic descent. The aim is to study endoscopy of the lower digestive tract in relation to the ethnicity. METHODS: A prospectively collected dataset was used. Presence four endoscopic findings (diverticuli, polyps, colorectal cancer, and signs of inflammation) was studied. The patients were divided in four groups. Group 1 patients of Western descent, group 2 patients of Turkish descent, group 3 patients originating from Morocco, Northern Africa and the Middle East, and, group 4 patients of Asian descent. RESULTS: In group 1, 35,340 procedures were done in 24,223 patients, in group 2 this was 1,776 in 1,338 patients respectively. In groups 3 and 4 this was 465 in 371 patients, and 416 in 305 patients. There was no difference in gender between the four groups, the number of women undergoing endoscopy was higher in all groups. Overall abnormalities in colon and rectum were significantly more often seen in group 1. Colorectal cancer was significantly less often diagnosed in patients of groups 3 and 4. Polyp(s) were significantly less often seen in patients of groups 2 and 3. While diverticulosis of the colon was significantly more often diagnosed in patients of group 1. Signs of inflammation in colon and/or rectum were significantly more often seen in patients of groups 2, 3, and 4. CONCLUSIONS: There are clear differences in presence of colorectal abnormalities in patients from different ethnic descent. The implication of this finding in daily practice is not obvious.

2.
J Gastrointest Oncol ; 10(1): 1-5, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30788152

ABSTRACT

BACKGROUND: Fludeoxyglucose positron-emission tomography (FDG-PET) shows colic uptake regularly. Complementary colonoscopy is done. Aim: study the findings of colonoscopy. METHODS: All consecutive scans in 5 years were studied. Focal FDG uptake in colon and/or rectum were scored as + or ++. Clinical files and endoscopy reports were studied for final diagnosis. RESULTS: Focal FDG uptake was noted in 173 out of 2,075 scans (8.4%). Focal FDG activity was judged ++ in 73 patients (42.2%) and + in 100 (57.8%). The majority of colorectal cancers scored ++. Patients with ++ activity underwent or had undergone significantly more often a colonoscopy compared with patients with + activity, 82% versus 65% (P=0.02). FDG PET/CT was false positive with respect to polyp(s) or cancer in 13 cases (22%) of ++ FGD activity and in 38 cases of + FDG (P<0.001). In 25 patients a total of 69 polyps were not FDG avid. CONCLUSIONS: FDG-PET scanning is a useful tool in oncology. However, false-positive and false-negative findings with respect to colonic uptake are present in a significant number of patients. If the clinical condition and the potential prognosis allows the performance of colonoscopy this procedure should be done.

3.
Ned Tijdschr Geneeskd ; 1632019 01 30.
Article in Dutch | MEDLINE | ID: mdl-30719892

ABSTRACT

An 88-year old woman had a sudden onset of nausea and vomiting. She had an end colostomy following a curative resection of rectal cancer six years earlier. As we suspected a high gastrointestinal obstruction, an abdominal CT scan was made. This showed a paracolostomic herniation, including herniation of the stomach.


Subject(s)
Colostomy/adverse effects , Hernia, Abdominal/etiology , Intestinal Obstruction/etiology , Nausea/etiology , Postoperative Complications/etiology , Vomiting/etiology , Aged, 80 and over , Female , Humans , Rectal Neoplasms/surgery
4.
J Gastrointest Oncol ; 9(4): 674-678, 2018 Aug.
Article in English | MEDLINE | ID: mdl-30151263

ABSTRACT

BACKGROUND: Years ago, it was established that removal of adenomas will lead to a lower incidence of colorectal cancer. This study aims to establish the occurrence of colorectal cancer in unselected patients after index colonoscopy with polyp removal. METHODS: A prospectively collected dataset on colonoscopy covering 25 consecutive years was used. Patients in who during the index (first) procedure a polyp(s) was removed were included. Excluded were patients with colorectal cancer and patients belonging to Lynch families. In case of cancer time after the index and previous procedure, tumor stage, histology of earlier removed polyps, localization of the tumor and demographics were noted. RESULTS: In 1,617 patients polyp(s) were removed. Thirty (1.9%) patients developed colorectal cancer. In 18 cases adenomas were removed during prior endoscopies. Five patients only had hyperplastic polyp(s). Nine patients with cancer already were older than 75 years when the previous endoscopy was done. Patients with adenomas prior to the cancer were older compared with patients with hyperplastic polyps [mean (SD): 71.6 (5.8) versus 64.2 (10.5) years, P=0.046]. The majority of cancers were located in the proximal colon (75%). The time between diagnosing cancer and the previous colonoscopy was mean 70.6 months with a median of 60.0 months (range, 12.0-167.0 months). CONCLUSIONS: It is concluded that follow-up after removal of polyps in normal daily practice is associated with a low incidence of developing colorectal cancer.

5.
J Gastrointest Oncol ; 8(4): 625-628, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28890811

ABSTRACT

BACKGROUND: Evaluate the preoperative TN stage with MR and the postoperative stage with histology. METHODS: Patients diagnosed with rectal cancer (2002-2015) and a pre-operative MR were included. A chart review was done. Pathology reports were evaluated for the post-operative tumor stage. Down staging was defined as a lower disease stage in the resection specimen compared with the pre-operative MR. Upgrading ("progression") was defined as a higher disease stage in the resection specimen. The study was approved by ethical committee of the Zaans Medisch Centrum. RESULTS: From 176 out of 231 operated patients a pre-operative MR was available for evaluation. 142 patients (80.7%) underwent neo-adjuvant treatment; the remainder 19.3% underwent immediate surgery. Neo-adjuvant therapy resulted in significant down staging. However, almost 14% of patients had a higher TN stage as determined by the pre-operative MR. In patients who underwent immediate surgery the percentage with "progression" was 30%. The number of patients with stage 1 and 2 were higher in the group not treated with neo-adjuvant therapy. There was no significant difference in tumor stage as determined by histological examination of the resection specimen. CONCLUSIONS: The diagnostic accuracy of the MR is not perfect. Underestimation as well as overestimation of the tumor occurred both in the patients treated with radiotherapy as well as those who underwent immediate operation. As such, MR results should be interpreted with caution when devising a treatment strategy.

6.
J Gastrointest Oncol ; 7(3): 321-5, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27284462

ABSTRACT

BACKGROUND: Radiotherapy and surgery have shown to improve local control and survival in rectal cancer. There are two applied schedules; radiotherapy with a long or short waiting period before surgery. The effect on survival and recurrence of both schedules was studied. METHODS: All consecutive patients with rectal cancer in the period 2002-2008 were included. Data were gathered on survival, tumour stage, co-morbidity score, and cause of death. The patients were divided in three groups: group 1 patients undergoing surgery without neo-adjuvant radiotherapy; group 2 patients undergoing radiotherapy followed by immediate surgery; and group 3 patients treated with (chemo) radiotherapy followed by a longer waiting period. RESULTS: A total of 113 patients with rectal cancer underwent surgery. Twenty two patients in group 1, 71 patients in group 2, and 20 in group 3. There was no difference in gender, time to recurrence, co-morbidity score, or causes of death. Fifty percent of patients died due to non-cancer related causes. Mean age in patients of group 3 was significantly lower than in groups 1 and 2 (P=0.02). There was a trend towards a lower tumour stage in the patients of group 3. Overall five year survival was 32% in group 1, 48% in group 2, and 35% in group 3. CONCLUSIONS: Neo-adjuvant radiotherapy seems to be of benefit in daily practice in patients with rectal cancer. A longer waiting period results in down-staging. Clinicians have to be aware that many patients will die due to other causes than those related to the rectal cancer.

7.
Eur J Gastroenterol Hepatol ; 28(7): 831-5, 2016 Jul.
Article in English | MEDLINE | ID: mdl-26928565

ABSTRACT

BACKGROUND: Up to 37% of colorectal cancer (CRC) survivors report depressive and anxiety symptoms. The identification of risk factors for depressive or anxiety symptoms might help focus supportive care resources on those patients most in need. The present study aims to explore which factors are associated with heightened anxiety or depression symptom severity. METHODS: In this cross-sectional study, individuals diagnosed with CRC 3.5 to 6 years ago completed questionnaires on sociodemographic information, medical comorbidities, anxiety symptoms (Beck Anxiety Inventory), and depressive symptoms (Inventory of Depressive Symptomatology). The general linear model analysis of covariance was used to identify factors associated with heightened anxiety or depressive symptom severity. RESULTS: The sample included 91 CRC survivors, 40.7% women, mean age 69.1 years. A minority of CRC survivors had moderate (3.4%) or severe (2.3%) anxiety symptoms, and moderate (7.7%) or severe (0%) depressive symptoms. Shorter time since diagnosis and higher number of comorbid diseases were associated with higher anxiety symptom severity. Female sex and higher number of comorbid diseases were associated with higher depressive symptom severity. CONCLUSION: From this explorative study, it follows that survivors with multiple comorbid diseases, shorter time since diagnosis, and female survivors might be at risk for higher anxiety and/or depressive symptom severity. Survivors with these characteristics might need extra monitoring.


Subject(s)
Anxiety/etiology , Colorectal Neoplasms/psychology , Depression/etiology , Survivors/psychology , Aged , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Comorbidity , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Neoplasm Staging , Psychiatric Status Rating Scales , Risk Factors , Sex Factors
8.
J Gastrointest Oncol ; 6(6): 605-12, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26697191

ABSTRACT

BACKGROUND: Patients with colorectal cancer are often excluded from clinical trials based on age or a poor performance score. However, 70% of colorectal cancer is diagnosed in patients over 65. Evaluation on the influence of age and comorbidity on survival and cause of death in a non-selected population. METHODS: Included were 621 consecutive patients with colorectal cancer. An extensive chart review was performed for 392 patients with colon cancer and 143 patients with rectal cancer. Analyses were performed separately for both groups. RESULTS: Median survival of colon cancer patients was 5.13 years, 131 patients (34.3%) died from tumour progression. Age and comorbidity were significant predictors for overall survival (P<0.001). Age was also a significant predictor of cause of death (P=0.001). In rectal cancer patients median survival was 4.67 years, 51 (35.7%) of patients died from tumour progression. Neither age nor comorbidity was significant predictors of survival. Age was a significant predictor of cause of death (P<0.001). CONCLUSIONS: In colon cancer patient age and comorbidity predict survival. This represents possible bias or a reduced survival benefit of treatment, and is an indication that colon cancer is not the prognosis defining illness in the majority of patients. In rectal cancer patients neither age or comorbidity significantly impacted survival.

9.
J Gastrointest Oncol ; 6(6): 613-7, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26697192

ABSTRACT

BACKGROUND: The goal of surgery for colorectal cancer is cure. Unfortunately post-operative mortality occurs. This study aims to identify co-morbidity and causes of mortality in the post-operative period in relation to direct technical complications of surgery. METHODS: All consecutive patients who underwent surgery for colorectal cancer were included. Co-morbidity was determined via the Charlson co-morbidity score. The post-operative course was studied and cause of death within 30 days was determined. Patients were divided in two groups: group 1 died within 30 days after surgery and group 2 survived for longer than 30 days. RESULTS: Twenty three out of 333 patients (6.9%) with colon cancer and 6 out of 112 (5.3%) with rectal cancer died in the post-operative period. Patients in group 1 were significantly older than patients in group 2 (P<0.001). Patients in group 1 with colon cancer also significantly had more often a higher stage of cancer (P=0.03). The Charlson co-morbidity score for patients with colon cancer in group 1 was mean 5.17 (SD 1.57, range, 1-8), and for rectal cancer mean 4.83 (SD 2.32, range, 2-7). There was no difference in Charlson co-morbidity score when patients from groups 1 and 2 were compared. In group 1, 13 (44%) died as a direct consequence of technical surgical complications. Sixteen patients died due to complications because of pre-existing co-morbidity. CONCLUSIONS: Post-operative mortality very often is the direct result of pre-existing co-morbidity and not always the direct result of the surgical procedure.

10.
Int Sch Res Notices ; 2015: 790186, 2015.
Article in English | MEDLINE | ID: mdl-27347548

ABSTRACT

Patients with stage 2 and stage 3 colon cancer often are treated with adjuvant chemotherapy. However, patients seen in daily practice have more comorbidity than those enrolled in clinical trials. This study aims to evaluate prognostic factors for recurrence and to ascertain the benefit of adjuvant chemotherapy on recurrence-free survival (RFS) of patients in a nonselected population. Furthermore, the impact of relative dose intensity (RDI) of adjuvant therapy on RFS is examined. Chart review was performed for 243 consecutive patients diagnosed and treated at a single center for stage 2 and stage 3 colon cancer from 2002 to 2008. Adjuvant chemotherapy was administered to 66 patients. Median overall survival (OS) was 5.84 years and median RFS was 5.37 years. For stage 2 disease, patients treated with or without adjuvant therapy had a median RFS of 5.49 and 5.73, respectively (p = ns). For stage 3 disease, median RFS rates were 5.08 and 1.19, respectively (p = 0.084). Overall RDI of oxaliplatin based chemotherapy higher than median was associated with increased RFS (p = 0.045). In conclusion, adjuvant therapy did not significantly increase recurrence-free survival. This could be the result of comorbidity in patients. Relative dose intensity of oxaliplatin based therapy is associated with RFS.

11.
J Gastrointest Oncol ; 5(6): 469-73, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25436127

ABSTRACT

INTRODUCTION: There is a difference in approach between colon and rectal cancer. AIM: EVALUATE THE METHODS OF LOCALISATION: endoscopy and radiology. MATERIALS AND METHODS: Patients with cancer in the sigmoid or rectum diagnosed with endoscopy, were included. Patients underwent additional radiological examinations. The resection specimen served as the gold standard. A tumour surrounded by serosa was considered a sigmoid cancer, surrounded by perirectal fat, than it was rectal cancer. If the frontal edge of the tumour showed serosa and the dorsal plane perirectal fat than the tumour was located in the "rectosigmoid". RESULTS: A total of 182 cancers were diagnosed. Of the 128 cancers with gold standard, endoscopy had the correct localisation in 112 (87.5%), and radiology in 114 (90.5%) cases. Concordance between both techniques was present in 80%. In 28 cases there was discordance. Radiology located 10 sigmoidal cancers wrongly in the rectum. One rectal cancer was placed in the sigmoid. In 16 cases the endoscopic localisation wrongly was the sigmoid. Sensitivity and specificity for endoscopy in sigmoidal cancer is 100% and 77% respectively, for rectal cancer 77% and 100%. Sensitivity of radiology for cancer in the sigmoid and rectum are 80% and 98% respectively. Specificity for both cancers is 98% and 80% respectively. CONCLUSIONS: The endoscopist and the radiologist should not be too overconfident with localisation of the tumour in cases of high rectal or low sigmoidal cancer.

12.
J Microbiol Methods ; 106: 55-56, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25128081

ABSTRACT

The Helicobacter pylori virulence gene dupA is usually detected by PCR, but the primer binding sites used are highly variable. Our newly designed qPCR against a conserved region of dupA was positive in 64.2% of 394 clinical isolates while the positivity rate of the commonly used PCRs ranged from 29.9% to 37.8%.


Subject(s)
Helicobacter pylori/genetics , Polymerase Chain Reaction/methods , Virulence Factors/genetics , DNA Primers/genetics , Humans , Sensitivity and Specificity
13.
Ned Tijdschr Geneeskd ; 157(22): A6026, 2013.
Article in Dutch | MEDLINE | ID: mdl-23714294

ABSTRACT

A 78-year-old woman presented at the emergency room with abdominal pain and diarrhea. At physical examination an abdominal tumour was palpated. The CT-scan showed an invagination of the colon, whereupon an explorative laparatomy was performed. A right-hemicolectomy was conducted and pathology showed an invasive mucineus cystadenocarcinoma in the caecum.


Subject(s)
Abdominal Pain/diagnosis , Cecal Neoplasms/diagnosis , Cystadenocarcinoma, Mucinous/diagnosis , Abdominal Pain/etiology , Abdominal Pain/surgery , Aged , Cecal Neoplasms/complications , Cecal Neoplasms/surgery , Colectomy , Cystadenocarcinoma, Mucinous/complications , Cystadenocarcinoma, Mucinous/surgery , Female , Humans , Treatment Outcome
14.
J Gastrointest Oncol ; 4(1): 14-9, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23450097

ABSTRACT

BACKGROUND AND AIM: Obstruction of the gastrointestinal tract due to cancer can be treated with stenting. The aim was to review the local experience with endoscopic stenting. All patients treated with stenting in a ten years period from 2001-2010 were studied. RESULTS: Fifty one patients received 57 stents because of oesophageal cancer. Mean survival after stent placement was 141 days. No case of perforation occurred. In nine cases (17%) clogging with food occurred. Tumour overgrowth was noted in four cases. Twenty four patients received 28 stents in their colon or rectum. The stents were placed in the rectum (n=6), the sigmoid (n=14), the descending colon (n=1), and the transverse colon (n=3). Mean survival was 276 days. Perforation did not occur. Tumour ingrowth was seen in two patients. One patient received a second stent. Dislocation occurred in two cases. There were two cases of clogging (8%) by stool. Fourteen patients received a total of 18 stents because of obstructing stomach cancer. Mean survival after placement was 121 days. There was no perforation, one case of clogging, and four cases of tumour ingrowth. Eight patients had stent placement in their duodenum. Mean survival after stent placement was 84 days. No perforation or clogging occurred. But three cases of tumour ingrowth were seen. CONCLUSIONS: The present series shows that placement of expandable stents in the digestive tract in normal daily practice is feasible, safe, with a low number of complications, and provides good palliation for their remaining life.

15.
BMC Gastroenterol ; 12: 94, 2012 Jul 24.
Article in English | MEDLINE | ID: mdl-22828158

ABSTRACT

BACKGROUND: Given the increasing burden on colonoscopy capacity, it has been suggested that faecal immunochemical test (FIT) results could guide surveillance colonoscopy intervals. Against this background, we have evaluated the test accuracy of single and double FIT sampling to detect colorectal cancer (CRC) and/or advanced adenomas in an asymptomatic colonoscopy-controlled high-risk population. METHODS: Cohort study of asymptomatic high-risk patients (personal history of adenomas/CRC or family history of CRC), who provided one or two FITs before elective colonoscopy. Test accuracy of FIT for detection of CRC and advanced adenomas was determined (cut-off level 50 ng/ml). RESULTS: 1,041 patients provided a FIT (516 personal history of adenomas, 172 personal history of CRC and 353 family history of CRC). Five CRCs (0.5%) and 101 advanced adenomas (9.7%) were detected by colonoscopy. Single FIT sampling resulted in a sensitivity, specificity, PPV and NPV for CRC of 80%, 89%, 3% and 99.9%, respectively, and for advanced adenoma of 28%, 91%, 24% and 92%, respectively. Double FIT sampling did not result in a significantly higher sensitivity for advanced neoplasia. Simulation of multiple screening rounds indicated that sensitivity of FIT for advanced adenoma could reach 81% after 5 screening rounds. CONCLUSIONS: In once-only FIT sampling before surveillance colonoscopy, 70% of advanced neoplasia were missed. A simulation approach indicates that multiple screening rounds may be more promising in detecting advanced neoplasia and could potentially alleviate endoscopic burden.


Subject(s)
Adenoma/diagnosis , Colonoscopy , Colorectal Neoplasms/diagnosis , Diagnostic Tests, Routine/methods , Feces , Immunohistochemistry/methods , Adenoma/epidemiology , Adult , Aged , Aged, 80 and over , Cohort Studies , Colorectal Neoplasms/epidemiology , Epidemiological Monitoring , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Factors , Sensitivity and Specificity
16.
Gastrointest Endosc ; 76(1): 136-43, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22726472

ABSTRACT

BACKGROUND: Colorectal cancer screening by fecal immunochemical tests (FITs) is hampered by frequent false-positive (FP) results and thereby the risk of complications and strain on colonoscopy capacity. Hemorrhoids might be a plausible cause of FP results. OBJECTIVE: To determine the contribution of hemorrhoids to the frequency of FP FIT results. DESIGN: Retrospective analysis from prospective cohort study. SETTING: Five large teaching hospitals, including 1 academic hospital. PATIENTS: All subjects scheduled for elective colonoscopy. INTERVENTIONS: FIT before bowel preparation. MAIN OUTCOME MEASUREMENTS: Frequency of FP FIT results in subjects with hemorrhoids as the only relevant abnormality compared with FP FIT results in subjects with no relevant abnormalities. Logistic regression analysis to determine colonic abnormalities influencing FP results. RESULTS: In 2855 patients, 434 had positive FIT results: 213 had advanced neoplasia and 221 had FP results. In 9 individuals (4.1%; 95% CI, 1.4-6.8) with an FP FIT result, hemorrhoids were the only abnormality. In univariate unadjusted analysis, subjects with hemorrhoids as the only abnormality did not have more positive results (9/134; 6.7%) compared with subjects without any abnormalities (43/886; 4.9%; P = .396). Logistic regression identified hemorrhoids, nonadvanced polyps, and a group of miscellaneous abnormalities, all significantly influencing false positivity. Of 1000 subjects with hemorrhoids, 67 would have FP results, of whom 18 would have FP results because of hemorrhoids only. LIMITATIONS: Potential underreporting of hemorrhoids; high-risk individuals. CONCLUSIONS: Hemorrhoids in individuals participating in colorectal cancer screening will probably not lead to a substantial number of false-positive test results.


Subject(s)
Adenoma/diagnosis , Anus Diseases/etiology , Colorectal Neoplasms/diagnosis , Gastrointestinal Hemorrhage/etiology , Hemorrhoids/diagnosis , Occult Blood , Adenoma/pathology , Aged , Colonoscopy , Colorectal Neoplasms/complications , Early Detection of Cancer , False Positive Reactions , Female , Hemorrhoids/complications , Humans , Logistic Models , Male , Middle Aged
17.
J Gastroenterol Hepatol ; 27(2): 368-71, 2012 Feb.
Article in English | MEDLINE | ID: mdl-21777284

ABSTRACT

BACKGROUND AND AIM: Reflux esophagitis needs maintenance therapy. Data on comparison between trademark and generic medications are not available. Complaints and use of acid-suppressive therapy 10 years after diagnosis were determined. METHODS: A total of 672 patients with esophagitis between 1998 and 2000 were reviewed. Patients received a questionnaire regarding the use of acid-suppressive therapy, dosage, compliance and satisfaction. The use of trademark and generic medications was assessed. The presence of reflux complaints was assessed via a questionnaire, and a symptom score was calculated using a five-point Likert scale. RESULTS: A total of 208 patients returned the questionnaire, of whom 161 (78%) used acid-suppressive therapy. Of the patients still on therapy, 72% (n = 116, group 1) had reflux complaints, while the remaining 45 patients (28%, group 2) were in remission. There was no difference in sex, age, or severity of the initially diagnosed reflux esophagitis. Patients in group 1 were significantly less compliant and satisfied compared to patients from group 2 (73% vs 96% and 83% vs 100%, P < 0.001, respectively). An equal number of patients in both groups used trademark and generic medications (P = not significant). The presence of reflux complaints, as well as the symptom score, showed no difference between users of trademark or generic medication. CONCLUSION: More than 10 years after the diagnosis, 22% of patients stopped using acid-suppressive therapy. Only a minority (28%) were in clinical remission, associated with significantly higher satisfaction and compliance to therapy, as compared to their symptomatic counterparts. There was no difference in effect and usage of trademark versus generic medication preparations.


Subject(s)
Drugs, Generic/therapeutic use , Endoscopy, Gastrointestinal , Esophagitis, Peptic/drug therapy , Proton Pump Inhibitors/therapeutic use , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Drugs, Generic/adverse effects , Esophagitis, Peptic/diagnosis , Female , Humans , Male , Medication Adherence , Middle Aged , Netherlands , Patient Satisfaction , Predictive Value of Tests , Proton Pump Inhibitors/adverse effects , Remission Induction , Surveys and Questionnaires , Time Factors , Treatment Outcome , Young Adult
18.
Geriatr Gerontol Int ; 12(2): 298-303, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22050603

ABSTRACT

AIM: A high diagnostic yield of colonoscopy has been reported in elderly patients, but there is no data on the yearly yield. Our aim was to detect the yearly yield of colonoscopy in elderly patients. METHODS: All consecutive endoscopies in the years 1992-2009 were included. Important endoscopic diagnoses were defined as colorectal cancer (CRC), polyps, diverticuli and inflammation. RESULTS: In total, 19 569 endoscopies were performed, of which 1706 (8.7%) were in patients age 80 years or older. The number of women was significantly higher (P < 0.001). The percentage of patients who were 80 years or older was higher than in the general population and remained stable during the study period, though there has been a proportional increase of elderly people in the general population. Inconclusive procedures were present in 106 (6.2%) elderly patients compared with 277 (1.6%) patients under 80 years of age (P < 0.001). There were no significant changes in the consecutive years. A procedure revealing no endoscopic diagnosis was observed less often in patients who were 80 years or older (P < 0.001). CRC was diagnosed in 221 (19.6%) older patients. This figure remained more or less constant each year. Polyps were seen in 448 (8.8%) patients 80 years of age or older. The percentage of patients with diverticuli and inflammation was constant. The number of patients 80 years or older with CRC and polyps rose at a lower rate than the number of older people in the general population. CONCLUSION: The yield of colonoscopy in patients 80 years or older was high and constant over the years. The number of tumors rose less than expected compared to the increase of elderly in the general population.


Subject(s)
Colonoscopy/statistics & numerical data , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Colonic Polyps/diagnosis , Colonic Polyps/epidemiology , Female , Humans , Male , Middle Aged , Time Factors , Young Adult
19.
Eur J Gastroenterol Hepatol ; 23(12): 1122-6, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21934510

ABSTRACT

INTRODUCTION: Patients with gastroesophageal reflux disease (GERD) need long-term treatment with acid-suppressive therapy. Data on long-term follow-up are very rare. For this reason, a study was performed to detect complaints many years after diagnosis. PATIENTS AND METHODS: All patients diagnosed with reflux oesophagitis in the years 1998-2000 were included. In the summer of 2010, they received a questionnaire with four different lists of questions pertaining to reflux complaints and use of medication. Severity and frequency were scored on 5-point and 6-point Likert scales, respectively; the GerdQ, a symptom activity index, and the gastrointestinal symptom-rating scale were also used. RESULTS: Complaints were reported by 130 patients (63%); the majority of these, 115 (88%), used acid suppressive therapy. Only 78 patients were in clinical remission, with or without therapy. The respondents with complaints were divided into two groups. Group 1: all patients with reflux complaints using acid suppressive therapy. Group 2: all patients with complaints without medication. Patients in group 1 were significantly older at the time of the endoscopic diagnosis compared with patients of group 2, and patients in group 1 had a hiatal hernia more often (P<0.001). There was no difference in the overall symptom or the frequency score per patient between both groups, with a mean of 5.97 versus 6.8 and 13.4 versus 13.8 respectively. However, heartburn, nausea, acid regurgitation, epigastric pain, dysphagia and nocturnal complaints showed a significantly higher prevalence in patients of group 2. Scores for specific complaints were significantly lower in group 2 and there was no difference between the GerdQ, the symptom activity index and the gastrointestinal symptom-rating scale. CONCLUSION: Despite effective therapy, only 37% of the patients are in complete remission. However, the individual symptom score is rather low. Patients without medication more often have reflux complaints but lower severity scores. Patients who still had complaints and used medication had a hiatal hernia significantly more often.


Subject(s)
Esophagitis, Peptic/diagnosis , Adult , Aged , Endoscopy, Gastrointestinal , Esophagitis, Peptic/complications , Esophagitis, Peptic/drug therapy , Female , Follow-Up Studies , Heartburn/etiology , Humans , Male , Middle Aged , Nausea/etiology , Proton Pump Inhibitors/therapeutic use , Remission Induction , Severity of Illness Index , Young Adult
20.
Ned Tijdschr Geneeskd ; 155: A2170, 2011.
Article in Dutch | MEDLINE | ID: mdl-21329543

ABSTRACT

A 52-year-old man was admitted to hospital with abdominal pain, erythema and mild eosinophilia. Medical history revealed fatigue and dyspnoea on exertion after returning from the Gambia a year previously, and allergic rhinitis with nasal polyps that were surgically excised. Before a cause of the abdominal symptoms was determined he developed mononeuropathy, severe eosinophilia and arthralgia in combination with positive anti-neutrophil cytoplasmic antibodies (ANCA) against myeloperoxidase, which lead to the diagnosis of 'Churg-Strauss syndrome'. Despite treatment with high-dose corticosteroids (prednisone 1 mg/kg) his abdominal complaints intensified. A CT-scan of the abdomen showed a soft tissue mass around the caecum. Subsequent colonoscopy showed severe ulcerative lesions and signs of colonic ischemia. When PCR for cytomegalovirus appeared to be negative, treatment was intensified with cyclophosphamide 2 mg/kg, resulting in resolution of the abdominal complaints and healing of the ulcerative lesions in the colon.


Subject(s)
Abdominal Pain/diagnosis , Churg-Strauss Syndrome/diagnosis , Abdominal Pain/etiology , Anti-Inflammatory Agents/therapeutic use , Churg-Strauss Syndrome/complications , Churg-Strauss Syndrome/drug therapy , Cyclophosphamide/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Prednisone/therapeutic use , Treatment Outcome
SELECTION OF CITATIONS
SEARCH DETAIL
...