Proton pump inhibitor use is associated with elevated faecal calprotectin levels. A cross-sectional study on subjects referred for colonoscopy

Objectives: Faecal Calprotectin (FC) is a sensitive marker for gut inflammation. However, slightly elevated FC levels are also common in subjects without inflammation. We investigated the association between FC and clinical factors including concomitant use of medical therapy in patients with a normal colonoscopy.

Material and methods: Out-patients (n?=?1263) referred for colonoscopy, performed FC test (CALPRO) the day before the start of bowel preparation. All subjects answered questionnaires that included questions on the present and past health history, concomitant medical treatment and gastrointestinal symptoms (GSRS). A medical record chart review was performed to check for concomitant disease, cause of referral and the result of the colonoscopy including biopsies. Inclusion criteria were a normal colonoscopy. Exclusion criteria were inflammatory bowel disease, colon cancer and high-grade dysplasia.

Results: Five hundred ninety subjects fulfilled the inclusion criteria and completed the study. Thirty-six per cent of the subjects had a FC >50 µg/g. In a logistic regression analysis, age (adjusted OR: 1.051; CI: 1.032–1.071), and the use of proton pump inhibitors (adjusted OR: 3.843; CI: 2.338–6.316), non-steroid anti-inflammatory drugs (adjusted OR: 2.411; CI: 1.162–5.002) and acetylsalicylic acid (adjusted OR: 2.934; CI: 1.085–3.448) were significantly associated with an elevated FC (>50 µg/g).

Conclusions: More than one-third of the patients with a normal colonoscopy performed in clinical routine had a slightly elevated FC level. Our results emphasise the need for attention to age, the use of proton pump inhibitors, non-steroid anti-inflammatory drugs and acetylsalicylic acid in the interpretation of FC tests in clinical practice.     

Diagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice

BACKGROUND: Faecal calprotectin (FC) is a new marker of intestinal inflammation. Data on FC in paediatric gastroenterology clinical practice are still scarce. AIMS: To assess FC values in different paediatric gastrointestinal diseases comparing them with those obtained in healthy children. PATIENTS: Two hundred and eighty-one children (age range 13-216 months) consecutively referred for gastrointestinal symptoms. Seventy-six healthy controls (age range 13-209 months). The exclusion criteria in healthy children were the following: any known underlying chronic disease or a history of abdominal pain, diarrhoea, acute respiratory tract infection, intake of non-steroidal anti-inflammatory drugs, gastric acidity inhibitors, antibiotics, drugs influencing gut motility, and menstrual or nasal bleeding in the last 3 weeks. METHODS: Stool samples stored, prepared and analyzed by an ELISA assay. RESULTS: In healthy children the median FC value was 28.0 microg/g (15-57 interquartile range) with a 95th percentile value of 95.3 microg/g. An increase in FC concentration was observed in all diseases characterized by gastrointestinal mucosa inflammation, and the active inflammatory bowel disease patients showed the higher FC values. All children affected by functional bowel disorders or by non-inflammatory diseases showed normal values. We calculated an optimized FC cut off value of 102.9266 microg/g (revealed by the receiver operating characteristic curve) to distinguish patients with active organic/inflammatory disorders from healthy subjects and from patients with functional bowel disorders. CONCLUSIONS: Calprotectin is a sensitive, but not disease specific, marker to easily detect inflammation throughout the whole gastrointestinal tract. It may help in identifying an organic disease characterized by intestinal mucosa inflammation and in the differential diagnosis of functional bowel disorders.     

Quality indicators for colonoscopy in Egypt: A prospective multicenter study

Background and Study AimsDespite its wide availability, we do not have sufficient data about the quality of colonoscopy in Egypt. In this study, we proposed 13 indicators to assess the quality of colonoscopy procedures in the included study centers aiming to attain a representative image of the quality of CS in Egypt.Patients and MethodsA multicenter prospective study was conducted between July and December 2020, which included all patients who underwent colonoscopy in the participating centers. The following were the proposed quality indicators: indications for colonoscopy, preprocedure clinical assessment, obtaining written informed consent, adequate colon preparation, sedation, cecal intubation rate (CIR), withdrawal time, adenoma detection rate (ADR), complication rate, photographic documentation, automated sterilization, regular infection control check, and well-equipped postprocedure recovery room.ResultA total of 1,006 colonoscopy procedures were performed during the study duration in the included centers. Our analysis showed the following four indicators that were fulfilled in all centers: appropriate indications for colonoscopy, preprocedure assessment, written informed consent, and automated sterilization. However, photographic documentation and postprocedure follow-up room were fulfilled only in 57 %. Furthermore, 71 % of the centers performed regular infection control checks. Adequate colon preparation was achieved in 61 % of the procedures, 81 % of the procedures were performed under sedation, 95.4 % CIR, 11-min mean withdrawal time, 15 % ADR, and 0.1 % overall complication rate. Statistically significant factors affecting CIR were age > 40 years, high-definition endoscope, previous colon intervention, and rectal bleeding, whereas those affecting ADR were age > 40 years, the use of image enhancement, previous colon intervention, rectal bleeding, the use of water pump, and a withdrawal time of > 9 min.ConclusionOur study revealed the bright aspects of colonoscopy practice in Egypt, including high CIRs and low complication rates; conversely, ADR, bowel cleansing quality, and infection control measures should be improved.     

A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn's disease

BackgroundFaecal calprotectin (FC) is a non-invasive marker of gastrointestinal inflammation.AimTo determine whether higher FC levels in individuals with quiescent Crohn's disease are associated with clinical relapse over the ensuing 12 months.MethodsA single centre prospective study was undertaken in Crohn's disease patients in clinical remission. The receiver operating characteristic (ROC) curve for the primary endpoint of clinical relapse by 12 months, based on FC at baseline, was calculated. Kaplan–Meier curves of time to relapse were based on the resulting optimal FC cutoff for predicting relapse.ResultsOf 97 patients recruited, 92 were either followed up for 12 months without relapsing, or reached the primary endpoint within that period. Of these, 10 (11%) relapsed by 12 months. Median FC was lower for non-relapsers, 96 μg/g (IQR 39–237), than for relapsers, 414 μg/g (IQR 259–590), (p = 0.005). The area under the ROC curve to predict relapse using FC was 77.4%. An optimal cutoff FC value of 240 μg/g to predict relapse had sensitivity of 80.0% and specificity of 74.4%. Negative predictive value was 96.8% and positive predictive value was 27.6%, FC ≥ 240 μg/g was associated with likelihood of relapse by 12-months 12.18 (95%CI 2.55–58.2) times higher than lower values (p = 0.002).ConclusionsIn this prospective dataset, FC is a useful tool to help identify quiescent Crohn's disease patients at a low risk of relapse over the ensuing 12 months. FC of 240 μg/g was the optimal cutoff in this cohort.     

Effectiveness of very low-volume preparation for colonoscopy: A prospective,multicenter observational study

BACKGROUND The effectiveness of colonoscopy strictly depends on adequate bowel cleansing.Recently, a 1L polyethylene glycol plus ascorbate(PEG-ASC) solution(Plenvu;Norgine, Harefield, United Kingdom) has been introduced on the evidence of three phase-3 randomized controlled trials, but it had never been tested in the real-life.AIM To assess the effectiveness and tolerability of the 1L preparation compared to 4L and 2L-PEG solutions in a real-life setting.METHODS All patients undergoing a screening or diagnostic colonoscopy after a 4, 2 or 1L PEG preparation, were consecutively enrolled in 5 Italian centers from September2018 to February 2019. The primary endpoints of the study were the assessment of bowel cleansing success and high-quality cleansing of the right colon. The secondary endpoints were the evaluation of tolerability, adherence and safety of the different bowel preparations. Bowel cleansing was assessed through the Boston Bowel Preparation Scale. Adherence was defined as consumption of at least 75% of each dose, while tolerability was evaluated through a semiquantitative scale. Safety was systematically monitored through adverse events reporting.RESULTS Overall, 1289 met the inclusion criteria and were enrolled in the study. Of these,490 patients performed a 4L-PEG preparation(Selgesse~?), 566 a 2L-PEG cleansing(Moviprep~? or Clensia~?) and 233 a 1L-PEG preparation(Plenvu~?).Bowel cleansing by Boston Bowel Preparation Scale was 6.5 ± 1.5 overall and 6.3 ±1.5, 6.2 ± 1.5, 7.3 ± 1.5(P 0.001) in the subgroups of 4L, 2L and 1L-PEG preparation, respectively. Cleansing success was achieved in 72.4%, 74.1% and90.1%(P 0.001), while a high-quality cleansing of the right colon in 15.9%,12.0% and 41.4%(P 0.001) for 4L, 2L and 1L-PEG preparation groups,respectively. The 1L preparation was the most tolerated compared to the 2 and 4L-PEG solutions in the absence of serious adverse events within any of the three groups. Multiple regression models confirmed 1L PEG-ASC preparation as an independent predictor of overall cleansing success, high-quality cleansing of the right colon and of tolerability.CONCLUSION This study supports the effectiveness and tolerability of 1L PEG-ASC, also showing it is an independent predictor of overall cleansing success, high-quality cleansing of the right colon and of tolerability.     

Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy

Abstract

Objective: Determine diagnostic accuracy of a quantitative faecal immunochemical haemoglobin test (QuikRead go^® FIT, Orion Diagnostica Oy) in symptomatic patients referred for colonoscopy, at various cut-offs and for one or two tests.

Methods: Patients referred to four endoscopy units in mid-Sweden between 2013 and 2017 provided information on lower abdominal symptoms and faecal samples from two separate days prior to colonoscopy.

Results: In all, 5.4% (13/242) patients had colorectal cancer (CRC). For one FIT at cut-off 10?µg Hb/g faeces, sensitivity for CRC was 92% (95% CI 78–100%) and specificity 77% (95% CI 72–83%); equal to 74%; 95% CI 68–80 (178/242) colonoscopies potentially avoidable and one CRC missed. Based on the maximal outcome of two FITs, sensitivity was 100%, specificity 71% (66–77%) and 68%; 95% CI 62–74 (160/237) colonoscopies potentially avoidable. Among 17% (42/242) patients with one FIT of >200?µg Hb/g faeces, 85% (11/13) had CRC. Positive predictive values of FIT varied 16.9–26.2% depending on cut-off and one or two FITs, whereas NPVs were 99% and above in all scenarios.

In 60 patients reporting rectal bleeding, one FIT at cut-off 10?µg Hb/g discriminated well between CRC and other conditions (p?=?.001). In regression models, FIT was more important than age, sex and all symptoms.

Conclusion: One or two FITs in symptomatic patients referred for colonoscopy imply powerful risk stratification abilities for CRC, even among patients reporting rectal bleeding. Larger studies in various settings will clarify how to make the best use of this opportunity.

Trial registration: Clinicaltrails.gov NCT 02491593     

Biological variability of fecal calprotectin in patients referred for colonoscopy without colonic inflammation or neoplasm

OBJECTIVE: Fecal calprotectin concentration in stool has recently been proposed as a marker of colonic neoplasm and inflammation, but the intraindividual day-to-day variability has so far received little attention. The present study was undertaken to determine the biological variability of fecal calprotectin in patients referred for colonoscopy. METHODS: A prospective design was applied. In each of 14 consecutive patients submitted for colonoscopy, eight stool samples were collected before the endoscopy. A detailed questionnaire was used. Calprotectin was measured by quantitative enzyme-linked immunoassay, and standard deviation for the within-patient variability was estimated from one-way analysis of variance. RESULTS: In absence of colonic neoplasm and inflammation, two populations of patients emerged: one (36%) with remarkably low and stable fecal calprotectin values all within the recommended cut-off of 50 microg/g, and one (64%) with labile values also beyond this limit. In this latter group. fecal calprotectin was 70 microg/g (mean) (single tests ranged from 9 to 461), and SD within patients was 52 microg/g, showing considerable day-to-day variation. History, concurrent diseases, or findings at colonoscopy could not explain labile values. A similar pattern was observed for spot variation in one stool sample from healthy volunteers, suggesting that factors other than disease contribute to the significant intraindividual biological variation of fecal calprotectin. CONCLUSIONS: Day-to-day variation of fecal calprotectin is considerable in patients without colonic inflammation or neoplasm, for whom the pattern of stabile low fecal calprotectin may seem to be a valid negative predictor. The origin and pattern of fecal calprotectin excretion deserve further attention.     

Fecal calprotectin levels predict colorectal inflammation among patients with chronic diarrhea referred for colonoscopy

OBJECTIVE: Chronic diarrhea is a relatively common condition with multiple diverse etiologies. Stool testing may serve as a diagnostic aid to discriminate the presence or absence of organic pathology, such as colorectal inflammation. Calprotectin (a leukocyte-derived protein) and hemoglobin can be measured quantitatively from stool and represent candidate inflammation biomarkers. The aim of this study was to assess and compare the screening performance of fecal calprotectin and fecal hemoglobin among colonoscopy referral patients with chronic diarrhea of unknown origin or chronic colitis of unknown activity. METHODS: All subjects were identified prospectively and each submitted a single stool sample before purgation. Fecal calprotectin (PhiCal; Nycomed Pharma, Oslo, Norway) and fecal hemoglobin (HemoQuant; Mayo Medical Laboratories, Rochester, MN) assays were performed in separate laboratories by masked technicians. Colonoscopic and histological findings served as criterion standards for establishing the presence or absence of colorectal inflammation. RESULTS: Among 110 subjects who provided complete fecal assay data, 29 (26%) had and 81 (74%) did not have colorectal inflammation. Increased fecal calprotectin levels were significantly (p = 0.0001) associated with the presence of colorectal inflammation, whereas fecal hemoglobin levels were not (p = 0.61). Direct comparison of the fecal assays revealed that calprotectin was a more sensitive biomarker for colorectal inflammation at all specificity levels (p = 0.0001). CONCLUSIONS: In this study of colonoscopy referral patients, colorectal inflammation was reflected by fecal calprotectin but not by fecal hemoglobin levels. Assay of fecal calprotectin holds promise as a triage tool to identify inflammatory causes of chronic diarrhea.     

Sedated vs unsedated colonoscopy:A prospective study

AIM:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the procedure.METHODS:Consecutive patients who underwent colonoscopies over a 2-year period were invited to participate.All patients who were to undergo our endoscopy unit were offered sedation with standard intravenous sedatives and analgesics,or an unsedated colonoscopy was attempted.Demographic details were recorded.The patient anxiety level prior to the procedure,time to reach the cecum,total discharge time,patient and endoscopist pain assessments,satisfaction after the examination and the patient’s willingness to return for the same procedure in the future were recorded.RESULTS:Among the 403 observed patients,more males were observed in the unsedated group(66.2%vs 55.2%,P=0.04).Additionally,the unsedated group patients were less anxious prior to the procedure(5.1vs 6.0,P<0.01).The colonoscopy completion rates were comparable between the 2 groups(85.9%vs84.2%,P=0.66).The time to reach the cecum was also comparable(12.2 min vs 11.8 min);however,the total discharge times were shorter in the unsedated group(20.7 min vs 83.0 min,P<0.01).Moreover,the average patient pain score(3.4 vs 5.7,P<0.01)was lower in the sedated group,while the satisfaction score(8.8 vs 7.8,P<0.01)was significantly higher.There was no significant difference,however,between the groups in terms of willingness to repeat the procedure if another was required in the future(83.3%vs 77.3%,P=0.17).CONCLUSION:Unsedated colonoscopy is feasible in willing patients.The option saves the endoscopy units up to one hour per patient and does not affect the patient willingness to return to the same physician again for additional colonoscopies if a repeated procedure is needed.     

Diagnostic and prognostic value of Holter-detected ST-segment deviation in unselected patients with chest pain referred for coronary angiography: a long-term follow-up analysis

OBJECTIVE: To evaluate the diagnostic and prognostic significance of ST-segment deviation detected by ambulatory Holter monitoring in unselected chest pain patients referred for coronary angiography. METHODS: Two hundred seventy-seven patients (71% were men) who underwent coronary angiography for evaluation of chest pain were studied with 24-h ambulatory Holter monitoring within 72 h of angiography. A lumen diameter reduction of > or = 50% was considered coronary artery disease. The ST-segment deviation was defined as > or = 1-mm deviation from the baseline lasting > or = 1 min separated by a minimum of 1 min. The patients were followed up for 65 +/- 21 months (mean +/- SD) for occurrences of death, myocardial infarction, hospitalization for unstable angina, and need for revascularization. RESULTS: Of the 277 patients, 223 (80%) had coronary artery disease. The prevalence of coronary artery disease was not significantly different in patients with (43 of 48 patients; 90%) and without (180 of 229 patients; 79%) Holter-detected ST-segment deviation. The diagnostic accuracy of Holter-detected ST-segment deviation in predicting the presence of coronary artery disease was poor (33%), with a sensitivity of 19% and a specificity of 91%. The presence of Holter-detected ST-segment deviation was not predictive of future cardiac events or death. CONCLUSION: The ST-segment changes detected on ambulatory Holter monitoring are of limited value in identifying coronary artery disease and predicting the future adverse cardiac events or death in unselected patients with chest pain.     

Informed consent for colonoscopy. A prospective study

Central to the nature of the physician-patient relationship is how fully patients are informed about their disease and prognosis and how active a role they take in deciding treatment; the "autonomy" and "paternalistic" models represent current poles of physician behavior. While informed consent has become ubiquitous in medical practice, it is not clear to what extent the value of patient autonomy has entered into everyday medical decisions. To evaluate informed consent, we prospectively surveyed 102 outpatients scheduled to undergo a colonoscopy and 16 of their physicians. The colonoscopy examination is straightforward and offers an optimal opportunity for patient participation in decision making. We found that most patients wanted guidance from their physicians and most physicians did not view the patient as autonomous. The more traditional parentalistic model continues to influence the physician-patient relationship, at least for this technical endeavor.     

粪便钙卫蛋白检测在肠道疾病诊断中的价值

钙卫蛋白(calprotectin)是近年来新发现的一种急性炎症标志物,最早于1980年从中性粒细胞中分离发现,是一种杂合性的钙结合蛋白,具有抗蛋白酶的活性,并因具有螯合锌离子的能力而具有抗热性。钙卫蛋白是中性粒细胞更新的标志物,具有抗微生物、调节免疫、抗增殖、传递信号等多种生物学功能,在许多炎症情况下升高。研究发现,炎症性肠病(IBD)患者粪便中的钙卫蛋白水平明显高于结肠癌患者及肠易激综合征(IBS)患者,并且同患者病变程度呈正相关。因此,可以作为一项诊断指标区分IBD、结肠癌、IBS,并用来监测IBD活动性,对疾病的复发、治疗效果具有重要指导意义。     

Diagnostic tests in the evaluation of dementia. A prospective study of 200 elderly outpatients

We studied the components of the diagnostic evaluation in 200 patients older than 60 years of age with suspected dementia who received standardized diagnostic evaluation and follow-up. The most common dementia diagnoses were Alzheimer's-type dementia (74.5%) and dementia due to toxic effects of drugs (9.5%). Eleven patients with hypothyroidism, metabolic encephalopathies due to hyponatremia, hyperparathyroidism, and hypoglycemia required laboratory tests for diagnosis, whereas the other dementia diagnoses were made primarily on the basis of data available on the history and physical and neurologic examinations. The complete blood cell count, blood chemistry battery (especially sodium, calcium, and glucose concentrations), and thyroid function tests were of definite value for the diagnosis of unsuspected disease and were useful as routine tests in evaluating patients for dementia. A careful history and physical examination accompanied by complete blood cell count, chemistry battery, and a thyroid function test would have been effective in diagnosing treatable illnesses causing cognitive impairment. Other diagnostic tests could have been used selectively based on results of the examination and screening tests. Estimated diagnostic charges from a selective approach would be 25% to 34% of those for the "routine" evaluation.     

Diagnosing colorectal cancer and inflammatory bowel disease in primary care: The usefulness of tests for faecal haemoglobin,faecal calprotectin,anaemia and iron deficiency. A prospective study

Objective: Abdominal complaints are common reasons to consult primary care but they are seldom caused by colorectal cancer (CRC), high-risk adenomas (HRAs), or inflammatory bowel disease (IBD). Reliable diagnostic aids would be helpful in deciding which patients to refer for bowel imaging. Our aim was to assess the value of a faecal immunochemical test (FIT) and a faecal calprotectin (FC) test in detecting CRC, HRAs and IBD in primary care, and the value of combining these tests with anaemia and iron-deficiency tests.

Materials and methods: This prospective study included 373 consecutive patients that received a FIT or a FC test ordered by a primary care physician. We collected samples for FITs, FC tests, full blood counts and iron-deficiency tests. Physicians were instructed to refer patients with a positive FIT or FC test (cut-off ≥100μg/g) for bowel imaging. The patients’ presenting symptoms were recorded. Patients were followed for 2 years.

Results: The best test for detecting CRC and IBD was the combination of the FIT and haemoglobin concentration. This test had a sensitivity, specificity, positive predictive value and negative predictive value of 100%, 61.7%, 11.7% and 100%, respectively. The FIT detected a significantly larger proportion of CRC, HRAs and IBD than the FC test (0.92 versus 0.46, 95% confidence interval 0.22–0.67).

Conclusion: A negative FIT combined with a normal haemoglobin concentration could rule out CRC and IBD with a high degree of safety. This could be useful in prioritising referrals for bowel imaging from primary care.     

Colorectal neoplasm in asymptomatic Asians: a prospective multinational multicenter colonoscopy survey

BACKGROUND: Colorectal neoplasm is rapidly increasing in Asia, but a guideline for screening is not available. OBJECTIVE: To evaluate the characteristics of colorectal neoplasm in asymptomatic Asian subjects. DESIGN: Prospective cohort study. SETTING: Multinational multicenters, including both primary and referral centers in Asia. PATIENTS: A total of 860 consecutive asymptomatic adults undergoing screening colonoscopy in 11 Asian cities from July 2004 to December 2004. Patients under 16 years old; those patients with a colorectal resection history, colonoscopies, or barium enema within 5 years; symptoms suggestive of colorectal diseases; and those who had undergone surveillance colonoscopy were excluded. MAIN OUTCOME MEASUREMENTS: The incidence and distribution of colorectal neoplasm and advanced neoplasm. RESULTS: The mean age (+/-SD) was 54.4+/-11.6 years; 471 were men (54.8%). The prevalence of colorectal neoplasm and advanced neoplasm was 18.5% and 4.5%, respectively. Male sex, advancing age, and a family history of colorectal cancer were risk factors for advanced neoplasm. Of the 168 patients with colorectal neoplasm, 76 had distal neoplasm only (45.2%), 66 had proximal neoplasm only (39.3%), and 26 had both proximal and distal neoplasms (15.5%). Although the presence of distal advanced neoplasm was a significant risk factor for proximal advanced neoplasm, 14 of the 758 subjects without distal neoplasm had proximal advanced neoplasm (1.8%). LIMITATIONS: The small number of enrolled subjects, especially from certain ethnic groups. CONCLUSIONS: The overall prevalence of advanced colorectal neoplasm in asymptomatic Asians is comparable with the West. Male sex, advancing age, and a family history of colorectal cancer were associated with a higher risk of advanced neoplasm.     

Virtual CT colonoscopy versus conventional colonoscopy: a prospective study

BACKGROUND/AIMS: Diagnosis of colorectal diseases might be a challenge. This prospective study aimed to evaluate virtual CT colonoscopy (CT colonography) as a new diagnostic modality in colorectal diseases. METHODOLOGY: Thirty-two patients (22 males and 10 females, mean age 47 years) with different colorectal complaints were investigated by CT colonography. Scanning parameters were collimation of 5mm, table speed of 6.25mm/s and pitch of 1.25. All images were evaluated in axial slices, reformatted images with endoluminal and extraluminal views. All patients were re-examined by the conventional colonoscope. The CT colonography and the colonoscopy findings were correlated. RESULTS: CT colonography suspected colorectal malignancy in 14 patients, diagnosed colorectal polyps in 4 (out of 6), suspected inflammatory bowel diseases in 5 (out of 6), showed colonic diverticulae in 3 (out of 4), and found no abnormality in 2 patients. CT colonography displayed the proximal colon above the obstructing lesion in extraluminal views, fungating mass in endoluminal view and accurately localized the lesion. In inflammatory bowel diseases, segmental (in 4 patients) or skipped (one patient) wall thickening, loss of colonic haustration (3 patients) and pseudopolyps (one patient) were detected. Superficial ulcers were missed. Endoluminal images displayed the orifices of the diverticulae in 3 patients. The CT colonography sensitivity was 86.7% and its specificity was 100%. CONCLUSIONS: The high resolution and multiple image display of CT colonography allow detection of many colorectal lesions. CT colonography is also a noninvasive imaging modality that is particularly valuable in poor risk patients and for colorectal examination proximal to an obstructing lesion.     

The diagnostic yield of colonoscopy in hospitalized patients. An observational multicenter prospective study.

BackgroundColonoscopy demands a considerable amount of resources, and little is known about its diagnostic yield among inpatients.AimsTo assess indications, diagnostic yield and findings of colonoscopy for inpatients, and to identify risk factors for relevant findings and cancer.MethodsMulticentre, prospective, observational study including 12 hospitals. Consecutive adult inpatients undergoing colonoscopy were evaluated from February through November 2019.Results1,302 inpatients underwent colonoscopy. Diagnostic yield for relevant findings and cancer was 586 (45%) and 112 (8.6%), respectively. Adequate colon cleansing was achieved in 896 (68.8%) patients. Split-dose/same-day regimen was adopted in 847 (65%) patients. Factors associated to relevant findings were age ≥70 years (RR 1.32), male gender (RR 1.11), blood loss (RR 1.22) and adequate cleansing (RR 1.63). Age ≥70 years (RR 2.08), no previous colonoscopy (RR 2.69) and split-dose/same-day regimen (RR 1.59) significantly increased cancer detection. Implementing adequate cleansing and split-dose/same-day regimen in all patients would increase the diagnostic yield for any relevant findings and cancer from 43% to 70% and from 6% to 10%, respectively.ConclusionRelevant colorectal diseases and cancer were frequent among inpatients. Factors associated with detection of relevant findings were identified. Adequate colon cleansing and split-dose/same-day regimen significantly increased colonoscopy diagnostic yield.     

Aetiology, medical history, and faecal weight in adult patients referred for diarrhoea. A prospective survey

All patients referred for diarrhoea over a 2-year period were studied to determine the relative frequency of organic diarrhoea and functional disorder. One hundred and nine patients had diarrhoea of established aetiology at admission. Two hundred and one patients with diarrhoea of unestablished aetiology at admission were interviewed about symptoms, and faecal output was measured. An organic or other explanation was eventually found in 78 patients (39%), whereas the bowel symptoms were categorized as functional or transient in 58%. Chronic diarrhoea of unknown origin was seen in 3%. Only 40% of the patients referred for diarrhoea had faecal output greater than 200 g/day. A reliable differentiation between organic and functional diarrhoea based solely on history and a physical examination at admission was not possible, as the initial diagnostic guess was only confirmed in 42% of the patients. More sensitive and specific indicators of functional diarrhoea are needed before the patients can be safely classified without the need for thorough diagnostic study.