Scott Grisolano

Are endoscopic ultrasonography imaging characteristics reliable for the diagnosis of small upper gastrointestinal subepithelial lesions

Purpose of the Study To compare the accuracy of endoscopic ultrasonography (EUS) imaging with histopathology in the diagnosis of upper gastrointestinal subepithelial lesions. Methods Thirty-seven patients (21 female; mean age: 55 y) underwent endoscopic submucosal resection (ESMR) of upper gastro intestinal subepithelial lesions at a tertiary care facility. All patients underwent EUS before ESMR of the lesion. Information regarding location, size, echogenecity, layer of origin, presumptive diagnosis based on EUS imaging, and histopathology diagnosis after ESMR of the subepithelial lesion was recorded. Results Twenty-seven subepithelial lesions were resected from the stomach, 5 from the esophagus, and 5 from the duodenum. The mean size of the lesions was 9 mm (range, 6-18 mm). Thirty-six lesions originated from the submucosa, and 1 from the muscularis propria. Using histopathology as the gold standard, the overall diagnostic accuracy of EUS imaging was 49% (18 out of 37). The accuracy of EUS imaging for the diagnosis of esophageal, gastric, and duodenal subepithelial lesions was 20%, 56%, and 40%, respectively. One patient developed a microperforation, and 1 developed bleeding during the ESMR procedure. No complications were reported with the EUS procedure. Conclusions The diagnostic accuracy of EUS imaging is inferior to histopathology in the diagnosis of small upper gastrointestinal subepithelial lesions. Endoluminal resection is a relatively safe and noninvasive modality that not only provides tissue sample for accurate diagnostic interpretation, but also aids in the complete removal of small subepithelial lesions of the upper gastrointestinal tract.

Disseminated histoplasmosis with colonic ulcers in a patient receiving infliximab

The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact. Gastrointest Endosc 2005;62:545-50. 6. Hekmat H, Al-toma A, Mallant MP, et al. Endoscopic N-butyl-2-cyanoacrylate (Histoacryl) obliteration of jejunal varices by using the double balloon enteroscope. Gastrointest Endosc 2007;65:350-2. 7. Concha R, Amaro R, Barkin JS. Obscure gastrointestinal bleeding: diagnostic and therapeutic approach. J Clin Gastroenterol 2007;41:242-51. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.

M1333 Irritable Bowel Syndrome and the Association With Small Intestinal Bacterial Overgrowth: Putting the Concept in Perspective

Aim: To explore triggers and warning sensations that precede diarrhea and how individuals make use of these. Methods: 579 individuals (68.6% female; ages 19-71, mean=30.5) with recurring diarrhea completed an internet survey including the Rome III diagnostic functional bowel disorders modules and a detailed questionnaire asking about diarrhea history, triggers, warning sensations and self-management. Individuals with inflammatory bowel disease, celiac disease, lactose intolerance or GI surgery history were excluded. Results: Most respondents (90.7%) had diarrhea at least 2-3 times per month. 23.7% had consulted health care providers about diarrhea. 70.5% met Rome III irritable bowel syndrome criteria but only 0.3% met functional diarrhea criteria. Diarrhea was self-defined by survey respondents, and typically considered to be characterized by loose/watery stools (92.5%), urgency (56.4%), pain/ discomfort (40.2%) and frequent stools (35.3%). 79.8% of subjects reported specific diarrhea triggers (i.e., actions or experiences they knew might result in diarrhea), and 44.0% stated that diarrhea resulted half or more of the times that these triggers occurred. Most common triggers were specific foods or drinks (72.3% of subjects), especially high-fat or spicy foods or caffeine beverages; stress/anxiety (49.7%); and large meals (25.2%). 83% of subjects with triggers rated stress/anxiety as the most frequent trigger. Nearly all subjects (95.6%) reported one or more types of physical warning sensations in advance of diarrhea, usually the same in nature for each subject and generally first occurring 10-25 minutes before diarrhea. The earliest warnings were typically either pain/discomfort (44.6%) or rumbling/bowel sounds (29.1%). 84.9% reported doing nothing to prevent or diminish diarrhea after warning sensations, but 15.1% used anti-diarrheal or antispasmodic drugs to counter the anticipated diarrhea. 74.4% used no medication once diarrhea started, 9.9% took medication early after onset, and 13.3% only later if it did not stop on its own. Warning sensations preceded at least half of all diarrhea bowel movements for 84.5% of subjects. Conclusions: Recognizable triggers and warning sensations precede diarrhea in most individuals, but few make efforts to prevent anticipated diarrhea. [Supported by McNeil Consumer Healthcare and R24 DK067674]