1
|
Grant RK, Brindle WM, Taylor CL, Rycroft EJ, Oyewole O, Morgan SC, Watson EF, Anand A, McAvoy NC, Penman ID, Church NI, Trimble KC, Noble CL, Plevris JN, Masterton GSM, Kalla R. Tailoring follow-up endoscopy in patients with severe oesophagitis. Frontline Gastroenterol 2024; 15:117-123. [PMID: 38486669 PMCID: PMC10935538 DOI: 10.1136/flgastro-2023-102485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/10/2023] [Indexed: 03/17/2024] Open
Abstract
Objective We aimed to investigate the clinical utility of follow-up oesophagogastroduodenoscopy (OGD2) in patients with severe oesophagitis (Los Angeles grades C or D) through evaluating the yield of Barrett's oesophagus (BO), cancer, dysplasia and strictures. Second, we aimed to determine if the Clinical Frailty Scale (CFS) may be used to identify patients to undergo OGD2s. Design/method Patients in NHS Lothian with an index OGD (OGD1) diagnosis of severe oesophagitis between 1 January 2014 and 31 December 2015 were identified. Univariate analysis identified factors associated with grade. Patients were stratified by frailty and a diagnosis of stricture, cancer, dysplasia and BO. Results In total 964 patients were diagnosed with severe oesophagitis, 61.7% grade C and 38.3% grade D. The diagnostic yield of new pathology at OGD2 was 13.2% (n=51), new strictures (2.3%), dysplasia (0.5%), cancer (0.3%) and BO (10.1%). A total of 140 patients had clinical frailty (CFS score ≥5), 88.6% of which were deceased at review (median of 76 months). In total 16.4% of frail patients underwent OGD2s and five new pathologies were diagnosed, none of which were significantly associated with grade. Among non-frail patients at OGD2, BO was the only pathology more common (p=0.010) in patients with grade D. Rates of cancer, dysplasia and strictures did not vary significantly between grades. Conclusion Our data demonstrate that OGD2s in patients with severe oesophagitis may be tailored according to clinical frailty and only be offered to non-frail patients. In non-frail patients OGD2s have similar pick-up rates of sinister pathology in both grades of severe oesophagitis.
Collapse
Affiliation(s)
- Rebecca K Grant
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William M Brindle
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
- Victoria Hospital, Department of Gastroenterology, NHS Fife, Kirkcaldy, Fife, UK
| | - Caitlyn L Taylor
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Edward J Rycroft
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Oluwadara Oyewole
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sarah C Morgan
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Atul Anand
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Norma C McAvoy
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ian D Penman
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas I Church
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Kenneth C Trimble
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Colin L Noble
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - John N Plevris
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gail S M Masterton
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rahul Kalla
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Asaoka D, Takeda T, Inami Y, Abe D, Shimada Y, Matsumoto K, Ueyama H, Matsumoto K, Komori H, Akazawa Y, Osada T, Hojo M, Nagahara A. The Association between Frailty and Abdominal Symptoms: A Hospital-based Cross-sectional Study. Intern Med 2020; 59:1677-1685. [PMID: 32669514 PMCID: PMC7434549 DOI: 10.2169/internalmedicine.4399-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective The association between frailty and abdominal symptoms has not been evaluated. Methods We conducted a hospital-based, retrospective cross-sectional study of consecutive outpatients ≥65 years old at the Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center from 2017 to 2019. Patients were included in the study if all of the following information was available from their medical records: patient's profile, the evaluation of osteoporosis, sarcopenia, frailty, nutritional status, findings of upper gastrointestinal endoscopy, and questionnaire results for abdominal symptoms [Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and Constipation Scoring System (CSS)]. We divided the subjects into frailty and non-frailty groups and investigated the risk factors for frailty. Results Of the 313 eligible study subjects [134 men (42.8%) and 179 women (57.2%); mean age, 75.7±6.0 years; mean body mass index, 22.8±3.6 kg/m2], frailty was noted in 71 cases (22.7%). In a univariate analysis, an older age (p<0.001), female gender (p=0.010), successful eradication of Helicobacter pylori (p=0.049), proton pump inhibitor (PPI) use (p<0.001), laxative/prokinetics use (p=0.008), sarcopenia (p<0.001), osteoporosis (p<0.001), hypozincemia (p=0.002), hypoalbuminemia (p<0.001), low lymphocytes (p=0.004), a high CONUT score (p<0.001), a high FSSG score (p=0.001), and a high CSS score (p<0.001) were significantly associated with frailty. A multivariate logistic regression analysis showed that an older age [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.08-1.24, p<0.001], PPI use (OR 2.42; 95% CI 1.18-4.98, p=0.016), sarcopenia (OR 7.35; 95% CI 3.30-16.40, p<0.001), hypozincemia (OR 0.96; 95% CI 0.92-0.99, p=0.027), a high FSSG score (OR 1.08; 95% CI 1.01-1.16, p=0.021), and a high CSS score (OR 1.13; 95% CI 1.03-1.23, p=0.007) were significantly associated with frailty. Conclusion Advanced age, PPI user, sarcopenia, hypozincemia, a high FSSG score, and high CSS score are associated with frailty.
Collapse
Affiliation(s)
- Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Yoshihiro Inami
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Daiki Abe
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Yuji Shimada
- Department of Gastroenterology, University of Juntendo, School of Medicine, Japan
| | - Kenshi Matsumoto
- Department of Gastroenterology, University of Juntendo, School of Medicine, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, University of Juntendo, School of Medicine, Japan
| | - Kohei Matsumoto
- Department of Gastroenterology, University of Juntendo, School of Medicine, Japan
| | - Hiroyuki Komori
- Department of Gastroenterology, University of Juntendo, School of Medicine, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, University of Juntendo, School of Medicine, Japan
| | - Taro Osada
- Department of Gastroenterology, University of Juntendo, School of Medicine, Japan
| | - Mariko Hojo
- Department of Gastroenterology, University of Juntendo, School of Medicine, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, University of Juntendo, School of Medicine, Japan
| |
Collapse
|
3
|
Kim LH, Chen YR. Risk Adjustment Instruments in Administrative Data Studies: A Primer for Neurosurgeons. World Neurosurg 2019; 128:477-500. [DOI: 10.1016/j.wneu.2019.04.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022]
|
4
|
Piqué N, Ponce M, Garrigues V, Rodrigo L, Calvo F, de Argila CM, Borda F, Naranjo A, Alcedo J, José Soria M, Rey E, Bujanda L, Gisbert JP, Suarez D, Calvet X, Ponce J. Prevalence of severe esophagitis in Spain. Results of the PRESS study (Prevalence and Risk factors for Esophagitis in Spain: A cross-sectional study). United European Gastroenterol J 2015; 4:229-35. [PMID: 27087951 DOI: 10.1177/2050640615595916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/21/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND *N.P. and M.P. contributed equally to this study.The current prevalence of esophagitis in southern Europe is unknown. In addition, the risk factors for reflux esophagitis are not fully understood. OBJECTIVE The objective of this article is to assess the prevalence and risk factors for esophagitis in Spain. METHODS A prospective, observational, cross-sectional, multicenter study (PRESS study) was conducted among 31 gastrointestinal endoscopy units throughout Spain. A total of 1361 patients undergoing upper gastrointestinal endoscopy were enrolled. Sociodemographic, clinical and treatment data were recorded. RESULTS A total of 95% of patients were Caucasian and 52% were male (mean age: 53 ± 17 years). The most frequent symptoms prompting endoscopy were heartburn (40%), regurgitation (26%) and dysphagia (15%). Fifty-four percent of patients undergoing endoscopy were receiving proton pump inhibitor (PPI) treatment. Esophagitis (mainly mild-moderate) was present in 154 (12.4%) patients. The severe form was recorded in only 11 (0.8%) patients. Multivariate analysis results indicated that the likelihood of esophagitis was higher in men (OR = 1.91, 95% CI = 1.31-2.78), in patients with high GERD-Q scores (OR = 1.256, 95% CI = 1.176-1.343), weight increase (OR = 1.014, 95% CI = 1.003-1.025) and high alcohol consumption (OR = 2.49, 95% CI = 1.16-5.36). CONCLUSION Severe esophagitis is a rare finding in the Spanish population. Male gender, high GERD-Q score, weight increase and high alcohol consumption are main risk factors for its appearance.
Collapse
Affiliation(s)
- Núria Piqué
- Department of Microbiology and Parasitology, Pharmacy Faculty, Universitat de Barcelona, Spain
| | - Marta Ponce
- Department of Gastroenterology, Hospital Universitario La Fe, Valencia, Spain
| | - Vicente Garrigues
- Department of Gastroenterology, Hospital Universitario La Fe, Valencia, Spain
| | - Luis Rodrigo
- Digestive Tract Department, Hospital Central de Asturias, Oviedo, Spain
| | - Félix Calvo
- Department of Gastroenterology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Fernando Borda
- Service of Digestive Tract, Hospital de Navarra, Pamplona, Spain
| | - Antonio Naranjo
- Gastroenterology and Hepatology Department, University Hospital Reina Sofia, Córdoba, Spain
| | - Javier Alcedo
- Gastroenterology and Hepatology, Hospital San Jorge, Huesca, Spain
| | - María José Soria
- Department of Digestive Tract, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Enrique Rey
- Department of Digestive Tract, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Luis Bujanda
- Department of Gastroenterology Hospital de Donostia, San Sebastian, Spain; Instituto Biodonostia (Universidad del País Vasco UPV/EHU), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - David Suarez
- Unitat d'Epidemiologia i Avaluació-Fundació Parc Taulí, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autónoma de Barcelona, Sabadell, Spain
| | - Xavier Calvet
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain; Department of Gastroenterology, Corporació Sanitaria Universitària Parc Taulí, Sabadell (Barcelona), Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Ponce
- Department of Gastroenterology, Hospital Universitario La Fe, Valencia, Spain
| | | |
Collapse
|
5
|
Cardin F. Special considerations for endoscopists on PEG indications in older patients. ISRN GASTROENTEROLOGY 2012; 2012:607149. [PMID: 23227352 PMCID: PMC3512294 DOI: 10.5402/2012/607149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/31/2012] [Indexed: 01/29/2023]
Abstract
Undernutrition in frail elderly people is a pathological condition that needs to be recognized and addressed early. Neurological dysphagia is among the most frequent causes of this condition in the elderly but should be considered a terminal event in Alzheimer-type dementias. Tube feeding is an important resource for facilitating metabolic recovery in cachectic patients and is particularly successful in "bridging" and stabilizing therapies prior to major treatment able to cure the patient. Clinical management of tube feeding in "incurable" conditions is complex and becomes part of the palliative care and comfort provided in the terminal stages of illness. Non-specialized physicians are often unfamiliar with the theory and practice of end-of-life interventions, and the resulting decisions are in many cases actually contrary to patient comfort. These problems deserve to be more carefully addressed when the patient is unable to cooperate or express his/her preferences and needs. The success of percutaneous endoscopic gastrostomy has led to increasingly frequent referrals for placement in critically ill elderly patients. Endoscopists therefore become a key figure in stimulating rational, correct treatment of these patients.
Collapse
Affiliation(s)
- Fabrizio Cardin
- Geriatric Surgery Unit, Geriatric Department, Padova University and General Hospital, Via Giustiniani 1, 35100 Padova, Italy
| |
Collapse
|
6
|
Abstract
Esophageal stricture is a rare complication of paediatric cancer treatment that usually occurs after esophageal exposure to radiotherapy. We describe 4 cases of esophageal stricture during chemotherapy for acute lymphoblastic leukemia. All patients presented with refractory vomiting and were diagnosed with radiologic contrast studies. None of the patients had received radiotherapy. Esophageal candidiasis was seen in 2 patients but the remaining 2 patients had earlier systemic candidiasis. High-dose dexamethasone may predispose these children to both esophageal candidiasis and peptic esophagitis. The etiology of esophageal strictures during treatment for acute leukemia is likely to be multifactorial but systemic candidiasis may play a significant role.
Collapse
|
7
|
|
8
|
Bauer JM, Sieber CC. Sarcopenia and frailty: a clinician's controversial point of view. Exp Gerontol 2008; 43:674-678. [PMID: 18440743 DOI: 10.1016/j.exger.2008.03.007] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 03/11/2008] [Accepted: 03/17/2008] [Indexed: 11/25/2022]
Abstract
Sarcopenia and frailty are both highly relevant entities with regard to functionality and independence in the elderly. The term sarcopenia has been introduced already in the late 80s and since then attracted the interest of many researchers, the majority being interested in its pathophysiology. Nevertheless there is still no consensus on the definition of sarcopenia and its diagnosis. Despite its relevance for functionality and autonomy most clinicians caring for the elderly are not familiar with sarcopenia and it has not become part of the routine geriatric evaluation. The concept of frailty has recently been supported by the introduction of two new working definitions. Since then clinical research on frailty has steeply increased. The influence of frailty on different age-associated diseases has been investigated and populations at risk for complications of medical or operative therapy are identified with the help of this concept. Simultaneously the pathophysiologic mechanisms involved in the development of frailty are explored. While sarcopenia may be regarded as a clinical sign that is not specific for the elderly, frailty may be seen as a multidimensional geriatric syndrome which implies a greater relevance for the clinician than the one dimensional approach of sarcopenia.
Collapse
Affiliation(s)
- J M Bauer
- Department of Internal Medicine/Geriatric Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Prof.-Ernst-Nathan-Strasse 1, D-90419 Nuremberg, Germany.
| | | |
Collapse
|
9
|
Bibliography. Current world literature. Laryngology and bronchoesophagology. Curr Opin Otolaryngol Head Neck Surg 2007; 15:417-24. [PMID: 17986882 DOI: 10.1097/moo.0b013e3282f3532f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|