Stephanie D. Bright

Randomised clinical trial: high-dose acid suppression for chronic cough - a double-blind, placebo-controlled study.

Aliment Pharmacol Ther 2011; 33: 225–234

Association of adiponectin multimers with Barrett's oesophagus.

Objective: Barrett’s oesophagus is associated with abdominal obesity. Adiponectin is a peptide that is secreted from adipocytes and circulates in three multimeric forms: low molecular weight (LMW), middle molecular weight (MMW), and high molecular weight (HMW). The anti-inflammatory effects of adiponectin are specific to individual multimers, with LMW being most anti-inflammatory. We postulated that circulating levels of adiponectin and its multimers would be associated with the risk of Barrett’s oesophagus. Design: Cross-sectional study. Setting: Outpatient clinic in North Carolina, USA. Patients: Cases of Barrett’s oesophagus and controls undergoing upper endoscopy for gastro-oesophageal reflux disease (GORD). Main outcome measures: Adjusted odds ratios of plasma adiponectin levels and its multimers for Barrett’s oesophagus. Results: There were 112 cases of Barrett’s oesophagus and 199 GORD controls. Total adiponectin was not associated with Barrett’s oesophagus (3rd tertile vs 1st tertile adjusted odds ratio (aOR)  = 0.88; 95% confidence interval (CI)  = 0.44 to 1.78). High levels of LMW adiponectin were associated with a decreased risk of Barrett’s oesophagus (3rd tertile vs 1st tertile aOR = 0.33; 95% CI, 0.16 to 0.69), and a high LMW/total ratio appeared particularly inversely associated with Barrett’s oesophagus (3rd tertile vs 1st tertile aOR = 0.27; 95% CI, 0.13 to 0.58). Conclusions: High levels of LMW adiponectin are associated with a decreased risk of Barrett’s oesophagus among patients with GORD. Further human studies are required to confirm these findings, and in vitro studies are needed to understand if there is a mechanism whereby adiponectin may affect Barrett’s metaplasia.

Detection of Dysplasia in Barrett's Esophagus With In Vivo Depth-Resolved Nuclear Morphology Measurements

BACKGROUND & AIMS Patients with Barretts esophagus (BE) show increased risk of developing esophageal adenocarcinoma and are routinely examined using upper endoscopy with biopsy to detect neoplastic changes. Angle-resolved low coherence interferometry (a/LCI) uses in vivo depth-resolved nuclear morphology measurements to detect dysplasia. We assessed the clinical utility of a/LCI in the endoscopic surveillance of patients with BE. METHODS Consecutive patients undergoing routine surveillance upper endoscopy for BE were recruited at 2 endoscopy centers. A novel, endoscope-compatible a/LCI system measured the mean diameter and refractive index of cell nuclei in esophageal epithelium at 172 biopsy sites in 46 patients. At each site, an a/LCI measurement was correlated with a concurrent endoscopic biopsy specimen. Each biopsy specimen was assessed histologically and classified as normal, nondysplastic BE, indeterminate for dysplasia, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). The a/LCI data from multiple depths were analyzed to evaluate its ability to differentiate dysplastic from nondysplastic tissue. RESULTS Pathology characterized 5 of the scanned sites as HGD, 8 as LGD, 75 as nondysplastic BE, 70 as normal tissue types, and 14 as indeterminate for dysplasia. The a/LCI nuclear size measurements separated dysplastic from nondysplastic tissue at a statistically significant (P < .001) level for the tissue segment 200 to 300 μm beneath the surface with an accuracy of 86% (147/172). A receiver operator characteristic analysis indicated an area under the curve of 0.91, and an optimized decision point gave 100% (13/13) sensitivity and 84% (134/159) specificity. CONCLUSIONS These preliminary data suggest a/LCI is accurate in detecting dysplasia in vivo in patients with BE.

Overutilization of endoscopic surveillance in nondysplastic Barrett's esophagus: a multicenter study

BACKGROUND Guidelines suggest that patients with nondysplastic Barretts esophagus (BE) undergo endoscopic surveillance every 3 to 5 years, but actual use of surveillance endoscopy and the determinants of variation in surveillance intervals are not known. OBJECTIVE To measure use of surveillance endoscopy and its variation in patients with nondysplastic BE. DESIGN Multicenter, cross-sectional study. SETTING Three sites in Arizona, Minnesota, and North Carolina. PATIENTS This study involved patients who had prevalent BE without a history of high-grade dysplasia or esophageal adenocarcinoma. INTERVENTION Participants were given validated measures of quality of life, numeracy, and cancer risk perception, and the total number of prior endoscopic surveillance examinations was measured. MAIN OUTCOME MEASUREMENTS Oversurveillance was defined as >1 surveillance examination per 3-year period. RESULTS Among 235 patients with nondysplastic BE, 76% were male and 94% were white. The average (± standard deviation [SD]) duration of BE was 6.5 ± 5.9 years. The mean (± SD) number of endoscopies per 3-year period was 2.7 ± 2.6. Oversurveillance was present in 65% of participants, resulting in a mean of 2.3 excess endoscopies per patient. Neither numeracy skills nor patient perception of cancer risk were associated with oversurveillance. LIMITATIONS Endoscopies were measured by patient report, which is subject to error. Results may be generalizable only to patients seen in academic centers. CONCLUSION Most patients with nondysplastic BE had more surveillance endoscopic examinations than is recommended by published guidelines. Patient factors did not predict oversurveillance, indicating that other factors may influence decisions about the interval and frequency of surveillance examinations.

A 25-year analysis of the American College of Gastroenterology Research Grant Program:: Factors associated with publication and advancement in academics

OBJECTIVES:The American College of Gastroenterology (ACG) has awarded research grants for 25 years. We assessed the characteristics of grant recipients, their current academic status, and the likelihood of publication resulting from the grant.METHODS:Demographic data, the year and amount of award, title of project, and recipients institution were extracted from ACG databases. Using ACG reports and medical literature search engines, we assessed publication based on grant-funded research, as well as career publication record. We also determined the current position of awardees. A similar analysis was performed for recipients of junior investigator awards.RESULTS:A total of 396 clinical research awards totaling

Clinical Trial: High-Dose Acid Suppression for Chronic Cough: A Randomized, Double-Blind, Placebo-Controlled Trial

5,374,497 (

Randomised clinical trial: high-dose acid suppression for chronic cough - a double-blind, placebo-controlled study: Randomised clinical trial: high-dose PPI for chronic cough

6,867,937 in 2008 dollars) were awarded to 341 recipients in the 25 years between 1983 and 2008. The most commonly funded areas of research were endoscopy (22% of awards) and motility/functional disorders (21%). At least one peer-reviewed publication based on grant-funded research occurred in 255 of the awards (69%). Higher award value was associated with subsequent publication. Of 341 past awardees, 195 (62%) are currently in academic positions. Factors associated with staying in academics included higher award value (P<0.01), a Masters degree (P=0.02), and publishing grant-funded research (P<0.01). The junior faculty career development award was granted to 27 individuals for a total of

M1030 Impact of Barrett's Esophagus Containing Dysplasia On Patient Quality of Life: Interim Results of a Randomized, Sham-Controlled Trial of Radiofrequency Ablation (AIM Dysplasia Trial)

3,000,000 (3,398,004 in 2008 dollars). Publication resulted from 90% of the funded projects, and 95% of awardees have remained in academics. Overall, the mean cost in grant dollars per published paper based on the research was

511c: Detection of Dysplasia in Barrett's Esophagus With Angle-Resolved Low Coherence Interferometry

14,875.CONCLUSIONS:The majority of ACG grant recipients published the results of their research and remained in academics. Higher amount of award, holding an advanced degree, and publication were associated with careers in academics. The ACG research grant award program is an important engine of investigation, publication, and academic career development in the field of gastroenterology.

M1027 Psychological Well-Being and Quality of Life (QOL) in Barrett's Esophagus (BE) Compared to Gastroesophageal Reflux Disease (GERD)

Aliment Pharmacol Ther 2011; 33: 225–234