Edy Stermer

Is Traveler's Diarrhea a Significant Risk Factor for the Development of Irritable Bowel Syndrome? A Prospective Study

A total of 564 travelers were enrolled in a study aimed at investigating the influence of travelers diarrhea in the development of irritable bowel syndrome. At 6-7 months after repatriation, we found that an episode of travelers diarrhea was associated with a quintuple risk of developing irritable bowel syndrome.

The changing epidemiology of diverticular disease in Israel

In a retrospective evaluation of 1244 consecutive barium enemas performed at two hospitals over a five-year period (1979 to 1984), colonic diverticula were found in 177 (14.2 percent). The prevalence among the Ashkenazi Jews was 19.7 percent, among the Sephardi and Oriental Jews, 16 percent, and among the Arabs, 9.5 percent. Comparing these figures with the results of a similar study performed ten years ago, it becomes obvious that the prevalence of diverticular disease in the Ashkenazi group remained the same, while there was a three-fold increase among Sephardi and Oriental Jews, and a seven-fold increase among Arabs. It is postulated that, in less than one generation, diverticular disease will be equally frequent among all ethnic groups in Israel.

Bowel habits in Israel : a cohort study

We interviewed 1,900 healthy subjects who belonged to one of the three following ethnic groups: (a) Ashkenazi Jews, (b) Sephardi and Oriental Jews, and (c) Arabs (including Druses)-about their bowel habits, laxative use, and beliefs about bowel action. Using stepwise logistic regression, we found that the following variables were significantly and independently related to bowel frequency: (a) sex-male > female (p = 0.0001); (b) age-young > old (p = 0.0001); (c) physical activity-high > little (p = 0.001); (d) body habitus-lean > obese (p = 0.02); (e) marital status-married > single (0 = 0.009); and (f) ethnic group-Arab > Jewish (p = 0.004). Regular use of laxatives was found in 18.4% of women and 10.8% of men (p < 0.0001). This habit was more common among Ashkenazi Jews (17%) than among Sephardi and Oriental Jews (10.7%) and Arabs (4.8%). Laxative intake was higher among the elderly (p = 0.0001) and the obese (p = 0.0004). Concerning the “ideal” bowel frequency, 12.4% of the Ashkenazis, 22.7% of the Sephardis and Oriental Jews, and 26.1% of the Arabs preferred to have at least 9 movements per week. Strikingly, 51.8% of all interviewed believed that constipation was “harmful to health;” women were more concerned than men (56.3% versus 47.5%). Subjects with a high level of education were significantly more concerned about constipation.

Ambience in the endoscopy room has little effect on patients

With hopes of alleviating discomfort and improving the tolerance of patients undergoing endoscopy, we have assessed the influence of various background conditions in the endoscopy room. Two hundred twenty-one candidates for upper endoscopy were randomly allocated to four groups, each with one of the following conditions in the endoscopy room: background music and conversation related to the patients complaints (n=50); background music and conversation unrelated to the patient (n=53); background music only, with the staff maintaining silence (n=49); and complete silence (n=47). Before endoscopy patients answered a 26-item questionnaire that included an evaluation of their degree of anxiety before the examination. Conscious sedation was induced by using 3 mg midazolam. After complete recovery from sedation, patients answered another set of questions. Patients in all four groups felt quite comfortable with the atmosphere in which gastroscopy was performed. Neither music, conversation, nor silence had a great effect on patients as far as improving tolerance or diminishing anxiety. Therefore, endoscopists and nurses may have a free hand in choosing the prevailing conditions during the examination. This conclusion may be valid for both patients and the staff involved in other invasive procedures performed under light sedation.

A nine-year audit of open-access upper gastrointestinal endoscopic procedures: results and experience of a single centre.

BACKGROUND The appropriateness and safety of open-access endoscopy are very important issues as its use continues to increase. OBJECTIVE To present a review of a nine-year experience with open-access upper gastrointestinal endoscopy with respect to indications, diagnostic efficacy, safety and diseases diagnosed. METHODS A retrospective, observational case series of all patients who underwent open-access endoscopy between January 2000 and December 2008 was conducted. Indications were classified as appropriate or not appropriate according to American Society of Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic diagnoses were based on widely accepted criteria. Major complication rates were assessed. RESULTS A total of 20,620 patients with a mean age of 58 years were assessed, of whom 11,589 (56.2%) were women and 9031 (43.8%) were men. Adherence to ASGE indications led to statistically significant, clinically relevant findings. The most common indications in patients older than age 45 years of age were dyspepsia (28.5%) and anemia (19.7%) in the ASGE-appropriate group, and dyspepsia in patients younger than 45 years of age without therapy trial (6.6%) in the nonappropriate group. Of the examinations, 38.57% were normal. Hiatal hernia and nonerosive gastritis were the most common findings. Important diagnoses such as malignancies and duodenal ulcers would have been missed if endoscopies were performed only according to appropriateness. There were only two major complications and no mortalities. CONCLUSIONS Open-access upper gastrointestinal endoscopy is a safe and effective system. More relevant findings were found when adhering to the ASGE guidelines. However, using these guidelines as the sole determining factor in whether to perform an endoscopy is not advisable because many clinically relevant diagnoses may be overlooked.

Effect of ranitidine on the urea breath test: a controlled trial.

Because Helicobacter pylori is an acid-sensitive organism, an elevation of the gastric pH by H2 inhibitors might improve the intragastric conditions for the development of this organism. We tested this hypothesis in a prospective and controlled trial including 43 patients positive for H. pylori using the rapid urease test. Twenty-six patients received 150 mg ranitidine twice daily and 17 patients received no treatment. The 14C-urea breath test was performed in both groups at the beginning of the study and 2 weeks later. Radioactive 14C in exhaled carbon dioxide was significantly increased (p = 0.045) in the patients treated with ranitidine, compared with the patients in the control group. Administration of this drug to patients infected with H. pylori is associated with an increase in the bacterial load after 2 weeks of treatment. This phenomenon might be attributed to increased bacterial growth due to the H2 blocker.

Acute Pancreatitis and Upper Gastrointestinal Bleeding as Presenting Symptoms of a Duodenal Brunner’s Gland Hamartoma

Brunners gland hamartomas are rare, benign small bowel tumours. There were fewer than 150 cases reported in the English literature until the end of the last century. These hamartomas may be discovered incidentally during an upper gastrointestinal tract endoscopy. Otherwise, they may be diagnosed in patients presenting with acute upper gastrointestinal bleeding, anemia or symptoms of intestinal obstruction. The case of a young woman admitted for acute upper gastrointestinal bleeding along with acute pancreatitis is presented. The investigation revealed a giant Brunners gland hamartoma in the second part of the duodenum. After total endoscopic resection of the tumour, the patient has remained completely asymptomatic for a follow-up period of seven months.

Incidental Colorectal Computed Tomography Abnormalities: Would You Send every Patient for a Colonoscopy?

BACKGROUND The clinical significance of colorectal wall thickening (CRWT) in patients undergoing abdominal computed tomography (CT) has not yet been definitively established. OBJECTIVES To compare alleged findings on abdominal CT with those of a follow-up colonoscopy. METHODS Ninety-four consecutive patients found to have large-bowel abnormalities on abdominal CT were referred for colonoscopy. Of these patients, 48 were referred for a suspected colorectal tumour and 46 for CRWT. Colonoscopy was performed and findings were compared. RESULTS Of the 48 suspected colorectal tumours, 34 were determined to be neoplastic lesions on colonoscopy. Of these, 26 were malignant and eight were benign. Colonoscopy revealed no abnormality in 30 of 46 patients with CRWT as a solitary finding, and revealed some abnormality in 16 patients (12 had diverticular disease, four had benign neoplastic lesions). CONCLUSIONS CRWT as an incidental and solitary finding on CT should not be regarded as a pathology prompting a colonoscopy. Approximately two-thirds of the patients had a normal colonoscopy and the remaining patients had benign lesions (12 had diverticular disease and four had benign neoplastic lesions). However, many of these patients seem to warrant colonoscopy regardless of CT findings, particularly patients who have a family history of colorectal cancer, have positive fecal occult blood test results or who are older than 50 years of age.

Seasonal fluctuations in acute gastrointestinal bleeding

We investigated the seasonal variability of upper gastrointestinal bleeding retrospectively during 1988-92 in Haifa, Israel, a city with a subtropical climate. Four hundred and thirty three patients were included in the study: duodenal ulcer, 202; hemorrhagic gastritis 108; gastric ulcer 101; duodenal ulcer and hemorrhagic gastritis 12; and duodenal ulcer and gastric ulcer, 10. The highest incidence of bleeding was observed during winter (31.7%) and spring (28.3%), progressively diminishing throughout summer (18.5%) and fall (21.5%) (p < 0.0001). Both females and males showed this significant seasonal variation (p < 0.025 and p < 0.005, respectively). As a group, patients over 57 years of age had the highest incidence of bleeding during winter and spring (p < 0.005). Interestingly, the ingestion of NSAID had no influence in the increased seasonal bleeding. Duodenal ulcer (p < 0.01) and hemorrhagic gastritis (p < 0.05) showed a significant seasonal variation while gastric ulcer did not. Although there are several reports in the literature concerning seasonal fluctuations in duodenal and gastric ulcers, no such studies have hitherto been published on hemorrhagic gastritis.

Extensive Idiopathic Colonic Varices in a Young Patient

Varices of the colon are a rare cause of lower gastroin- testinal bleeding and are usually associated with portal hypertension or portal venous obstruction (1-4). There are numerous reports of bleeding from secondary colonic varices but very few of bleeding from idiopathic (primary) colonic varices. Among those, the rarest report varices throughout the entire colon. We report such a patient with recurrent episodes of life-threatening bleeding due to id- iopathic colonic varices throughout the entire colon. This is an exceptionally rare condition in such a young patient, treated successfully with a subtotal colectomy. examination findings were normal except for slight signs of fresh blood on rectal examination. Evaluation included normal WBC, platelet count, erythrocyte sedimentation rate, blood chemistry, coagulation studies, liver function tests, and albumin. Technetium scan showed signs of bleeding at the area of hepatic flexure. Selective inferior mesenteric angiography was normal during the arterial phase, and the venous phase showed dilated and tortuous veins in the sigmoid area, with suspected blood extravasation. A Meckel technetium scan was negative. An echocardiogram showed mild LV and RV dilatation. An abdominal computed tomographic (CT) scan was normal. An additional colonoscopy supported the findings of the previous one, with varices through the whole length of the colon and signs of active bleeding in the right colon. Due to repeated episodes of life-threatening anemia and hema- tochezia secondary to extensive colonic varices, the patient underwent a subtotal colectomy with ileorectal anastomosis showing vascular malformations and, occasionally, bleeding varices from the ileocecal valve to the rectum. At follow-up 4 years after the operation, his hematocrit was stable and no recurrent episodes of rectal bleeding had occurred.