Eosinophilic oesophagitis in patients presenting with dysphagia--a prospective analysis

BACKGROUND

Eosinophilic oesophagitis (EoO) may be a common finding in adults presenting with dysphagia.

AIM

To identify the risk factors and prevalence of EoO in an adult population with dysphagia.

METHODS

All patients with dysphagia referred for an upper endoscopy (EGD) were asked to participate. Patients completed a detailed questionnaire followed by EGD with four quadrant biopsies in the distal and mid-oesophagus. Primary endpoint was the prevalence of EoO; secondary endpoints included age, gender, asthma, food allergies, gastro-oesophageal reflux disease/dysphagia score and endoscopic findings.

RESULTS

Two hundred and sixty-one patients enrolled between December 2005 and January 2007. Thirty-one patients (12%) met pathological criteria for EoO. There was no difference in EoO prevalence within each gender. Mean age of EoO patients was 42 +/- 15 vs. 61 +/- 15 for non-EoO patients (P < 0.001). EoO was diagnosed in 35% of patients <50 years of age. EoO was present in 22% of asthmatics vs. 9% non-asthmatics (P < 0.01). EoO was present in 36.8% of patients with self-reported food allergies vs. 9.3% those without allergy (P < 0.001). A 13/31(42%) of EoO patients did not have the classic EGD findings (rings +/- furrows) and would have been missed without oesophageal biopsies.

CONCLUSIONS

Eosinophilic oesophagitis was diagnosed in 12% of the patients presenting with dysphagia with relative risk of 9.5 if age <50 years. Oesophageal biopsies are warranted in patients presenting with dysphagia especially in the younger population. Patients may not present with classic endoscopic findings and EoO can be missed without biopsies.

The effect of ejaculation on prostate-specific antigen in a prostate cancer-screening population

OBJECTIVES

To measure the impact of ejaculation on the serum levels of prostate-specific antigen (PSA) in a prostate cancer-screening population.

METHODS

Questionnaires regarding history of ejaculation were administered to all participants in a prostate cancer-screening trial. Two groups were analyzed. The first cohort consisted of 618 men who answered the questionnaire, and their serum PSA values were compared according to time since last ejaculation. The second cohort consisted of 89 volunteers who agreed to come back for a postejaculation PSA for whom a before and after ejaculation PSA was measured. Regression analysis was conducted between change in PSA and time since ejaculation as well as in the magnitude of change and baseline PSA.

RESULTS

The mean (+/-SD) age of the studied population was 60.43 +/- 9.23 years. A non-statistically significant difference in PSA levels was observed for either cohort. For the 89 volunteers the mean PSA change after ejaculation was -0.62 +/- 0.75 (not significant). Initially, the PSA decreased, and then after 9 hours a steady increase was observed. After 12 hours, the serum PSA returns to baseline. The regression analysis between baseline PSA and magnitude of change showed a strong correlation (r = .557). The higher the baseline PSA, the greater the magnitude of change.

CONCLUSIONS

FOR the total screened population, ejaculation has no clinically significant effect. Men should not be asked to abstain from sexual activities before a PSA-screening test.

Management of asymptomatic rising PSA after prostatectomy or radiation therapy

Controversy exists over the optimal management of patients with an asymptomatic rising prostate-specific antigen (PSA) following definitive therapy for clinically localized prostate adenocarcinoma. Post-prostatectomy patients whose residual disease is felt to be confined to the area immediately adjacent to the prostatic bed may benefit from external-beam radiation therapy. Systemic recurrence may be managed with either watchful waiting or treated with hormone deprivation. Post-radiation therapy patients felt to have local disease progression may undergo salvage radical prostatectomy (if disease is clinically confined to the prostate gland) or cryotherapy (although this is still considered "experimental"). Patients who are not candidates for salvage therapy can be managed with watchful waiting or hormone deprivation. For patients in whom definitive therapy has failed, treatment should be individualized according to pathologic stage (if post-prostatectomy), rate of PSA progression, surgical candidacy status (if post-radiation therapy), and attitudes and expectations of the physician and patient.

The effect of bicycle riding on serum prostate specific antigen levels

PURPOSE

We determined if bicycle riding causes an increase in prostate specific antigen (PSA) levels.

MATERIALS AND METHODS

Baseline PSA levels were measured from all 260 volunteers before a 250-mile bicycle ride. After this 4-day race PSA was again measured and this level was compared to the pre-race levels.

RESULTS

The overall change from baseline to post-race PSA in all 260 men was 0.069 ng./ml. The change for the 256 men with normal baseline PSA (0.0 to 4.0 ng./ml.) was 0.044 ng./ml. The 4 men with an already elevated PSA (more than 4.0 ng./ml.) showed a large change of 1.65 ng./ml.

CONCLUSIONS

There is no statistically or clinically significant increase in PSA after bicycle riding. However, the few participants with an initially elevated PSA had an increase after bicycle riding, although this change does not represent the population and more research is warranted to define further its clinical implications.