Aim: There is relatively little published information regarding gastro‐oesophageal reflux (GOR) in preterm infants, therefore the aim of this study was to elucidate the incidence of GOR and management regimes employed for this condition in major neonatal intensive care units (NICUs). Methods: A standard questionnaire was sent to consultants in 77 level II (or secondary) and III (or tertiary) NICUs. Results: Seventy‐eight percent of consultants responded. Of babies born in these units, 40% were less than 34 wk gestational age and the estimated incidence of GOR in this group was 22%. GOR was diagnosed on a clinical basis alone in 42% of units, 8% used clinical features and/or investigations, and 50% used clinical features plus investigations and/or therapeutic trials. Intra‐oesophageal pH monitoring was available in 93% of units but used regularly in only 32% of suspected cases. Common treatment strategies for diagnosed GOR included non‐drug options—body positioning (98%) and placement on a slope (96%); and drugs—H2‐receptor antagonists (100%), feed thickeners (98%), antacids (96%), prokinetic agents (79%), proton‐pump inhibitors (65%) and dopamine‐receptor antagonists (53%). However, the frequency with which all of these treatments were used varied widely between units. Surgery was required in only 1% of cases. Conclusions: GOR is perceived to be a common condition in preterm infants but the lack of published evidence relating to the management of GOR in preterm infants is reflected in the wide variation in diagnostic and treatment strategies used in major NICUs. It is clear that randomized, controlled trials to evaluate appropriate and effective treatments are needed.
IntroductionThe gold standard for diagnosis of primary oesophageal dysmotility (POD) is high-resolution manometry (HRM). Barium swallow (BS) studies remain integral to many diagnostic algorithms for dysphagia. Our aim was to assess the sensitivity and specificity of BS in the diagnosis of POD including achalasia as defined using HRM.MethodPatients that had a BS and HRM within a year of each other over a period of 10 years were identified. Those with a history of upper gastrointestinal surgery were excluded. The HRM diagnosis was algorithmically deduced from the raw dataset using the appropriate Chicago classification1. All HRM diagnoses and barium term extractions were manually verified by the authors. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) and accuracy for BS were calculated for each of the positive BS terms identified. Subset analysis for achalasia specifically and all spasticity excluding achalaisa were performed.ResultsConclusionThis study suggests that BO patients with LGD have a high risk of developing HGD or Cancer. Furthermore, BO patients with ID have a low risk of progression. It is of paramount importance that patients diagnosed with LGD are intensively monitored through endoscopic surveillance or treated. ID patients should also be followed up but less frequently. This study highlighted that abnormal p53 expression detected through immunohistochemistry is a stronger predictor of malignant progression than LGD.Disclosure of InterestNone DeclaredAbstract PWE-113 Table 1Sensitivity and specificity for diagnosing all spasticity (i.e including DES, nutcracker, jackhammer, rapid contraction, hypertensive) EXCLUDING achalasia Barium swallow termSensitivitySpecificityNPVPPVAccuracyNo of positive BSNo of negative BSTPFPTNFN Tertiary6068.268.198.93.1941983911962Dysmotility091.289.798.10252670252625Spasm099.397.698.202290022855
pH5 + 1mM NaNO 2 (high nitrosative stress), 1mM H 2 O 2 pH7 (high oxidative stress) and 1mM methyl viologen (MV) pH7 (super oxidative stress). Plates were incubated overnight at 37 o C. Results All four CD AIEC showed tolerance to low pH, high nitrosative and oxidative stress mimicking the intra-phagolysosome environment. CD AIEC demonstrated greater tolerance to growth at pH5. Compared to growth seen on LB agar pH7 (100%), LF82 showed 99.3 ± 22.2% growth at pH5 [mean ±SD]. Likewise, growth of HM427 (104.4 ± 15.2%), HM605 (81.1 ± 15.5%) and HM615 (94.2 ± 9.4%) was also seen at pH5. Conversely,% growth seen for laboratory strains was only 64.2 ± 9.9% for XL-1 and 61.3 ± 8.7% for EPI300; N=4 expts, n = 3 replicates (P < 0.01; ANOVA). Most remarkable was tolerance on super oxidative LB agar containing 1mM MV, with LF82 showing growth at 95.9 ± 11.5%, HM427 81.3 ± 17.9%, HM615 102.4 ± 14.3% and HM605 86.1 ± 13.5% vs. that seen on standard LB agar (100%). Non-AIEC strains showed little tolerance to all stress conditions tested (in 1mM MV; XL-1, no growth; EPI300, 1.8 ± 1.2% growth vs. LB agar alone, 100%); (P < 0.0001). The four CD AIEC were also observed to grow better after 8h in a low nutrient M9 medium supplemented 0.1% casamino acids (pH4) than the laboratory E. coli tested and 3 additional E.coli isolates from healthy controls (ECOR1, ECOR35, ECOR51); N = 1, n = 3. Conclusion Crohn's AIEC, unlike non-AIEC E. coli, tolerate low nutrient, low pH and high chemical stress conditions that mimic the macrophage phagolysosome environment. REFERENCES1 Bringer MA, et al.
IntroductionEosinophilic oesophagitis (EoE) is an inflammatory condition characterised by symptoms of oesophageal dysfunction (typically dysphagia and food bolus obstruction) and at least 15 eosinophils/hpf on oesophageal biopsy. Although there are endoscopic features associated with EoE, 10%–25% of endoscopies in patients with this condition will be normal [1]. Currently, it is unclear if oesophageal biopsies should be taken in every patient presenting with dysphagia and a normal oesophagus. A more patient focussed strategy can be more cost effective.Our aim was to determine clinical risk factors predictive for EoE, that may then guide the endoscopist for when to take oesophageal biopsies.Method127 patients presenting with dysphagia or FBO and a new diagnosis of EoE (eosinophils>15/hpf) were compared to 127 patients presenting with dysphagia or FBO but no evidence of EoE on biopsies.A multivariate logistic regression analysis was carried out to predict who might have EoE prior to taking biopsies, based on history where available and endoscopic findings. Receiver operator characteristic (ROC) curves were generated and the area under the curve (AUC) was calculated to test the accuracy of the model.ResultsFrom the EoE group, 95 (75%) were male and 32 (25%) were female, with an average age of 39 years. From the control group 59 (46%) were male and 68 (54%) were female with an average age of 60 years. The mean number of biopsies taken between the 2 groups was non-significant.In the EoE cohort, the most common abnormal endoscopic findings were strictures (40%) followed by trachealization (15%) and furrows (15%). 19% had a normal endoscopy.A multivariate logistic regression analysis identified age (p<0.001) and sex (p<0.001) as the strongest predictors of EoE. The AUC for younger age and male sex was 0.86 (95% CI 0.81–0.90). Using the Youden index, the optimal cut-off for age was 46 years giving a sensitivity of 86% and specificity of 69%.ConclusionIn patients presenting with dysphagia or FBO and a normal endoscopy, utilising a simple bedside tool comprising of age (<46 years) and male sex can reliably predict the presence of EoE.Reducing the number of potentially low yield histological examinations for EoE has significant implications for time and cost.Reference. Dellon ES. Diagnostics of eosinophilic esophagitis: clinical, endoscopic, and histologic pitfalls. Dig Dis2014;32(1-2):48–53.Disclosure of InterestNone Declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.