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Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with colonic angiodysplasia.

PurposeAngiodysplasia is a frequent cause of colonic bleeding. Argon plasma coagulation was reported to be useful in endoscopic hemostasis. However, the long-term outcomes have been poorly evaluated. This study was designed to assess the long-term outcomes of bleeding patients with colonic angiodysplasia treated by argon plasma coagulation.MethodsA cohort of 100 patients with gastrointestinal bleeding caused by colonic angiodysplasia was studied prospectively. The endoscopic intervention was considered successful if there was no further overt bleeding and hemoglobin concentration was stabilized (primary end point). Secondary end points were the requirement of blood transfusions, the need for surgery, bleeding-related mortality, and overall mortality.ResultsOvert bleeding resolved and hemoglobin levels were stabilized without transfusions or iron therapy in 85 of 100 patients (85 percent) after a median follow-up of 20 (range, 6-62) months. Transfusion requirements ceased in 90 percent of patients and only one required surgery. No patient died because of hemorrhage. In the subgroup of patients with anemia, mean hemoglobin levels increased from 9.3 (range, 5.5–12.2) g/dl before treatment to 12.6 (range, 7.4–16.7) g/dl after treatment (P < 0.01). The probability of remaining free of rebleeding at one and two year follow-up was 98 percent (95 percent confidence interval, 96–100) and 90 percent (95 percent confidence interval, 83–97), respectively. Among 118 procedures, only two complications were observed (1.7 percent).ConclusionsEndoscopic argon plasma ablation therapy is useful in the management of bleeding from colonic angiodysplasia.

Uninvestigated Dyspepsia in Latin America: A Population-Based Study

We sought to assess the prevalence, severity of symptoms, and risk factors of uninvestigated dyspepsia in a population-based study in Argentina. Eight hundred thirty-nine valid questionnaires were evaluated. Dyspepsia was present in 367 subjects (43.2%; 95% confidence interval [CI], 39.8–46.6); 110 (13.6%) had overlap with gastroesophageal reflux disease (GERD). The group with dyspepsia without GERD consisted of 257 subjects (29.6%; 95% CI, 26.5–32.7), 183 (71.1%) had ulcer-like dyspepsia, and 74 (28.9%) had dysmotility-like dyspepsia. Symptoms were considered very severe in 1.9%, severe in 14.0%, moderate in 59.5%, and mild in 24.5% of the subjects. Dyspepsia was associated with a score >14 on the psychosomatic symptom scale (PSC) (OR, 2.52; 95% CI, 1.75–3.61), a family history of diseases of the esophagus or stomach (OR, 1.73; 95% CI, 1.19–2.52) and an educational level >12 years (OR, 1.55; 95% CI, 1.05–2.29). Dyspepsia is especially prevalent in Argentina. In a significant proportion of dyspeptic subjects, the severity of symptoms interferes with daily activities. A higher PSC, positive family history, and a higher educational level are risk factors for dyspepsia.

M1225 Effect of Gluten-Free Diet in Body Mass Index in Celiac Patients

diarrhoea (34%) and constipation (30%) (p=0.66). Heartburn, abdominal pain, dyspepsia and bloating were all common being present respectively in 22 (44%), 14 (28%), 14 (28%), and 13 (26%) patients. Weight loss was the least common symptom (18%). Iron deficiency, osteoporosis, thyroid disease and a family history of CD were also common being present respectively in 15 (30%), 5 (10%), 7 (14%), and 6 (12%) patients. There was a significant difference between the unexpected and expected groups for heartburn (62% vs. 31%, p= 0.02) and dyspepsia (52% vs. 10%, p=0.001) but not bloating (38% vs. 17%, p=0.09). Performing routine duodenal biopsy increased the yield of diagnosing CD by 72%, providing an additional 21 cases to the 29 expected cases. The cost of performing routine duodenal biopsy was

Colonoscopy in the Elderly. Do They Really Need It

44.35 per patient with a total cost of

Push Enteroscopy and Argon Plasma Coagulation in the Prevention of Recurrent Bleeding From Small Bowel Angiodysplasia

1980 for every new diagnosis of coeliac disease. Conclusion: given the high prevalence of CD in the population undergoing upper endoscopy, routine duodenal biopsy is a cost-effective way to diagnose a disease that is often missed due to its non-specific presentation.