Bulimia nervosa and other eating disorders have been on the increase for the past half century. Self-induced vomiting is often practiced as a method of weight control in these patients, potentially causing acidic damage to the esophagus of the kind observed in cases of gastroesophageal reflux disease. To ascertain whether patients suffering from bulimia nervosa had an increased rate of reflux-related symptoms, potentially placing them at risk of developing sequelae such as Barrett's esophagus and esophageal adenocarcinoma, a literature review was performed via searches of databases including PubMed, Medline, OVID and PsycINFO and a recursive search of the literature. The search terms were: bulimia nervosa; reflux; esophageal adenocarcinoma; Barrett's esophagus; eating disorders; oral; dental; complications. Several case reports were identified detailing the occurrence of an esophageal tumor in patients with a history of bulimia. This was supported to some degree by studies detailing higher incidences of reflux symptoms in eating disordered patients compared to controls but there was large variability in study design, quality and results. From these results an association is suggested as possible but is far from being proved conclusively. Further investigation is required using larger patient groups, better study design controlling for confounding factors and symptom characterisation.
Introduction:There is a paucity of evidence on which to produce recommendations on neither the clinical nor the imaging follow-up of lung cancer patients after curative intent radiotherapy. In the 2019 NICE lung cancer guidelines further research into risk stratification models to inform follow up protocols was recommended.
Methods: A retrospective study of consecutive patients undergoing curative-intent radiotherapy for NSCLC from 01/10/2014 to 01/10/2016 across nine UK trusts. Twenty two demographic, clinical and treatment-related variables were collected and multivariable logistic regression used to develop and validate two risk stratification models to determine the risk of disease recurrence and death. Results: 898 patients were included in the study. Mean age was 72yrs, 63% (562/898) were good PS (0-1) and 43% (388/898), 15% (134/898) & 42% (376/898) were clinical stage I, II and III respectively. 36% (322/898) suffered disease recurrence and 41% (369/898) in the first two years following radiotherapy. The ASSENT score (Age, performance Status, Smoking status, staging EBUS, N-stage, Tstage) was developed that stratifies the risk for disease recurrence within 2 years with an AUROC for the total score of 0.712 (0.671-0.753) and 0.72 (0.65-0.789) in the derivation and validation set respectively. The STEPS score (Sex, Performance status, staging EBUS, T-stage, N-Stage) was developed that stratifies the risk of death within 2 years with an AUROC for total score of 0.625 (0.581-0.669) and 0.607 (0.53-0.684) in the derivation and validation set respectively.Conclusions: These validated risk stratification models could be used to inform follow-up protocols after curative intent radiotherapy for lung cancer. The modest performance highlights the need for more advanced risk prediction tools.
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