Yael Kopelman

Acupuncture treatment for irritable bowel syndrome: A double-blind controlled study

Background/Aim: Irritable bowel syndrome is one of the most common gastrointestinal disorders in Western society, affecting around 15% of the population, especially young adults. The cause(s) of irritable bowel syndrome and effective treatment(s) have remained elusive. This study aimed at exploring the therapeutic value of acupuncture by comparing the responses of irritable bowel syndrome sufferers to true acupuncture versus sham acupuncture in a controlled double-blind study. Methods: Twenty-five patients who fulfilled the Rome criteria (irritable bowel syndrome symptoms persisting for more than 1 year) comprised the final study population. They were recruited through a ‘call for’ bulletin sent to gastroenterologists practicing in the region of our medical center. True acupuncture was performed at LI-4 (colonic meridian, needle only) and sham acupuncture at BL-60 (urinary vesicle meridian, needle only). Patient assignment to one of the two groups was random. Results: The effect of the first true acupuncture on overall symptoms and abdominal pain was a clear and significant improvement (p = 0.05). No comparable effect was seen in the second session. Conclusions: Although the true acupuncture results were consistently better, no difference was found between the two groups in the overall statistical analysis. We could not show a therapeutic benefit of this treatment modality in irritable bowel syndrome.

The use of induced sputum in the assessment of pulmonary involvement in Crohn’s disease

Abstract OBJECTIVE: Our aim was to evaluate lung involvement in Crohn’s disease (CRD) patients by induced sputum (IS). Extraintestinal manifestations are frequent in CRD, but lung involvement is rare. Induced sputum is a reliable noninvasive method of investigating the pathogenesis, pathophysiology, and treatment of lung disease. METHODS: Twenty-four CRD patients and nine control subjects (all nonsmokers) without respiratory symptoms were tested. Sputum was induced by 20′ inhalation of 3.5% saline using ultrasonic nebulizer. Samples were studied by differential counts of 200 cells on cytopreps stained by Giemsa. T-lymphocyte subset analyses were done by FACS using three monoclonal antibodies: CD3 = total T cells, CD4 = T helper cells, and CD8 = T suppressor-cytotoxic cells. CD4/CD8 >2.5 was considered abnormal. RESULTS: Four patients did not produce sputum. Of the remaining 20 patients, seven had active CRD and 13 were in remission. They were divided into two groups: Group A patients had abnormal CD4/CD8 ratio of 6.7 ± 2.5; Group B (seven patients) had normal CD4/CD8 ratio of 1.7 ± 0.52 (p = 0.0001). The differential counts of IS samples were similar in both groups, but lymphocyte count was significantly higher in CRD patients than in the control group (13.2 ± 11.2 vs 4.8 ± 3.6, p = 0.036). There were no differences in spirometry, treatment, extent, or activity of CRD. CONCLUSION: Using a simple noninvasive method, we found that among CRD patients without respiratory symptoms there was a high (65%) incidence of lung involvement.

New frontiers in capsule endoscopy

Capsule endoscopy (CE) was launched at the beginning of this millennium and has since become a well‐established tool for evaluating the entire small bowel for manifold pathologies. CE far exceeded our early expectations by providing us with a tool to establish the correct diagnosis for elusive gastrointestinal (GI) conditions such as obscure GI bleeding, Crohns disease, polyposis syndrome, and others. Recent evidence has shown CE to be superior to other imaging modalities, such as small bowel follow‐through X‐ray, colonoscopy with ileoscopy, computerized tomographic enterography, magnetic resonance enteroclysis, and push enteroscopy, for diagnosing small bowel pathologies.

Ethnic differences in colorectal cancer among Arab and Jewish neighbors in Israel

OBJECTIVES:Migrant studies indicate that the differences in the incidence of colorectal cancer (CRC) are probably environmental and not genetic. There is epidemiological documentation that Israeli-born Arabs have much less CRC than Israeli-born Jews. We investigated these differences among Jews and Arabs living within the same central coastal region in Israel.METHODS:The files of pathology-diagnosed patients with CRC hospitalized from 1988 to 1996 were reviewed, and demographic data and incidence and location of malignancies were retrieved for this relative frequency study.RESULTS:Of the 527 patients (51.4% men) diagnosed as having CRC, 489 (92.8%) were Jews and 38 (7.2%) were Arabs (p < 0.001), representing 0.46% and 0.04% of the respective populations in the region. The average age at disease diagnosis of the Jews was 73.8 yr and that of the Arabs 61.4 yr (p < 0.001). Both groups shared identical health facilities and habits of attending them. The Arab patients were or had been employed in occupations that involved more physical activity. The site of lesion was on the right colon in 24.9% of all the cases—23.5% of the Jewish patients and 42.1% of the Arab patients (p < 0.001). Rectal cancer was found in 25.7% of the former and 15.8% of the latter (p < 0.001).CONCLUSIONS:The lower incidence of CRC among the Arabs persisted over time, and that group had greater right side and lesser rectal involvement than their Jewish neighbors, possible indications of genicity. The incidence of CRC among the Jews rose concomitantly with “Westernization” of their lifestyle, supporting a role for environmental influences.

Trends in incidence of colorectal cancer in Jewish and Arab populations in central Israel.

Background/Aims: To compare the current differences with our earlier findings on the incidence and locations of colorectal cancer (CRC) among Israeli-born Jews and Arabs living within the same central coastal region in Israel. Methods: Data on demographics and the incidence and locations of malignancies were retrieved from hospital files of pathology-diagnosed patients with CRC throughout 1997–2003 and compared with equivalent data from 1988 to 1996. Results: Of the 624 patients recently diagnosed as having CRC, 562 (90.1%) were Jews and 62 (9.9%) were Arabs (p < 0.001). The average age of the entire cohort was significantly lower since our earlier study (72.9 ± 12.5 compared to 67.9 ± 12.7 years, p < 0.0001). The Jewish patients were significantly younger (p < 0.0001) but the Arab patients were not. The percentage of the adenocarcinoma being located in the right colon was significantly lower (p < 0.0006) and significantly higher in the rectum (p < 0.008). The reverse was true among the Jewish patients, but not significantly. Conclusions: Both study groups were younger than those in our earlier study. The lower incidence of CRC among the Arab patients persisted over time, but the location of their adenocarcinoma changed significantly. The increased incidence of CRC in ‘westernized’ countries is reflected in the Jewish but not the Arab community.

Prevalence of short-segment Barrett's epithelium

BACKGROUND/AIMS The incidence of adenocarcinoma of the oesophagus has increased. Its major risk factor is Barretts epithelium of which the sine qua non is microscopically diagnosed intestinal metaplasia. Short segment Barretts epithelium may often be overlooked during routine endoscopy. In routine biopsies taken from normal-appearing mucosa of the distal oesophagus, the reported rates of short segment Barretts epithelium in the distal oesophagus reached 36%. We compared these rates with the results obtained in a community hospital in Israel. METHODS Consecutive patients undergoing oesophagogastroduodenoscopy were enrolled. Biopsy specimens taken from cardia, oesophagogastric junction and 2 cm above the oesophagogastric junction were stained with haematoxylin & eosin and Alcian blue. RESULTS There were 112 study patients (mean age +/- SD 48. 9+/-18.3 years, 51.8% males). Nine (8.04%) patients had intestinal metaplasia (according to specimen from 2 cm above oesophagogastric junction), and symptoms of gastro-oesophageal reflux were found in only four (44.4%) of them. Of these nine patients, six (6.66%) had normal-appearing mucosa and three (3.33%) had macroscopic Barretts epithelium. Alcian blue staining revealed two patients with intestinal metaplasia that haematoxylin & eosin staining had missed. CONCLUSION We found an 8% prevalence of intestinal metaplasia compared to 18-36% reported in the literature. We also determined that the added advantage of routine biopsy was 5.4%.

Trends in evolving technologies in the operating room of the future.

Technology has much to offer the surgical disciplines. However, teamwork, open communication, and a willingness to adapt and adopt new skills and processes are critical to achieving improved clinical outcomes.

Simulation of a colorectal polypoid lesion—a pilot porcine model

BACKGROUND Large sessile polyps almost always contain villous tissue with appreciable premalignant potential and tend to recur locally after colonoscopic resection. Developing new endoscopic techniques for the removal of polyps requires a large animal model of colorectal polypoid lesions. So far, no appropriate large animal model of a colorectal or other GI polyp has been described in the English literature. OBJECTIVE Our purpose was to develop a large animal model simulating large, perfused and viable, sessile colorectal polypoid lesions, with distinct easily detectable histologic features. SETTING An animal laboratory. INTERVENTIONS Two simulated rectal polyps, using 2 different techniques, were created in each of 10 animals. The polyps were simulated by ovarian tissue that was introduced either intraluminally through the rectal wall or into a dissected submucosal space in the rectal wall. In 2 animals the created polyps were endoscopically resected. RESULTS All submucosal lesions were sessile-like polypoid lesions because the base of the polyp was the widest diameter of the lesion. All transmural polypoid lesions had short and thick pedicles. Resection by snaring and cutting was demonstrated to be feasible. MAIN OUTCOME MEASUREMENTS The mean measurements of the submucosal-simulated polyps were as follow: 1.74 cm (+/-0.32) x 2.07 cm (+/-0.42) x 1.51 cm (+/-0.27). The mean measurements of the transmural-simulated polyps were significantly larger: 2.55 cm (+/-0.52) x 3.57 cm (+/-1.1) x 2.7 cm (+/-0.64). LIMITATION This model does not simulate a real intestinal neoplasia. CONCLUSION Either method, the submucosal or the transmural, could be helpful in the research and development efforts of surgical and endoscopic treatments of intestinal polyps.

Helicobacter pylori and Peptic Ulcer Disease Therapies: A Survey of Gastroenterologists in Israel

Background. Eradication of Helicobacter pylori has become a therapeutic option in the treatment of patients with peptic ulcer disease. The aim of this study was to evaluate the current management strategies of Israeli gastroenterologists in the diagnosis and treatment of H. pylori‐related peptic ulcer disease, 14 years after the discovery of H. pylori.

A Gelatin-Based Prophylactic Sealant for Bowel Wall Closure, Initial Evaluation in Mid-rectal Anastomosis in a Large Animal Model

Background: Leakage is the most significant complication of gastrointestinal surgery and advanced endoscopic procedures. Sealants applied over the closure lines may help in the prevention of leakage by reinforcing the anastomosis during the initial susceptible healing period, allowing the natural healing process additional time by mechanically supporting the bowel edges. Objective: To evaluate the safety and performance of a gelatin-based sealant in a porcine model. Design: A prospective double arm, randomized study of 21 pigs, 12 in the sealant study group and 9 controls. Setting: Animal laboratory Main Outcome Measurements: Animal wellbeing, radiological contrast studies, gross intra-abdominal pathology and histological evaluation at post-operative days 5, 7, and 10. Intervention: Transection and re-anastomosing of the mid-rectum Results: In all 12 sealant arm animals, bowel motility was restored within 24 hours. No adverse effects were detected. No significant difference was noted in type or severity of adhesions. All but one demonstrated a full staple line coverage, transparency, flexibility and perfect adherence of the sealant. Contrast studies did not show leakage. The local wound healing process in both groups was identical, as assessed by histology. The tissue reaction to the sealant was characterized by a capsular formation on the outer surface, mimicking a serosal layer. Limitation: Differences between porcine and human colorectal anatomy Conclusions: A gelatin-based liquid sealant is safe to use on colorectal closure in a swine model and shows a favorable performance profile. Clinical studies are required in order to evaluate its efficacy in reducing the rate of gastrointestinal anastomotic leakage.