The effect of Helicobacter pylori eradication on dyspeptic symptoms,acid reflux and quality of life in patients with functional dyspepsia

BackgroundThe aims of this study were to investigate the effect of Helicobacter pylori eradication on gastroesophageal reflux, gastrointestinal symptoms and quality of life in patients with functional dyspepsia.Methods20 H. pylori positive patients diagnosed as having functional dyspepsia according to Roma-II criteria completed the study period. Esophageal motility testing and pH recordings were obtained from each patient before and at the end of the study period. Each patient's gastrointestinal symptoms were evaluated according to Glasgow dyspepsia score. 36-Item short-form health survey (SF-36) and EDQ5 health survey were obtained form each patient.ResultsH. pylori eradication was accomplished in 13 patients (65%). Glasgow dyspepsia symptom score improved in H. pylori eradicated patients (10.3 vs 7.5, p < 0.05) compared to baseline. Fasting lower esophageal sphincter pressures increased (21.6 vs 25.4 mmHg, p < 0.05) after H. pylori eradication Neither the amplitude of peristaltic contractions in the esophageal body (59.4 vs 57.7 mmHg, p = ns) nor the velocity of peristaltic contractions changed before and after eradication. The percent time of esophageal pH < 4 (0.7 vs 2.6, p < 0.001), reflux events longer than 5 min (0 vs 0.7, p < 0.005) and total reflux number (10.3 vs 19.3, p < 0.005) significantly increased after eradication therapy. In the SF-36 health-related quality of life survey, general health score was 3.5 vs. 3.4, physical activity 25.2 vs. 26.4, physical role 5.9 vs. 6.3, emotional pain 4.6 vs. 4.5, social activity 2.0 vs. 1.9, physical pain 3.4 vs. 3.0, vitality 32.3 vs. 34.6, and mental health 11.9 vs. 11.5, before and at the end of treatment (p = ns), respectively.ConclusionsH. pylori eradication did not influence quality of life in patients with functional dyspepsia. Majority of the patients experienced a significant change in esophageal acid exposure after H. pylori eradication. H. pylori eradication significantly decreases gastrointestinal symptoms, however has no effect on quality of life in patients with functional dyspepsia.     

Economic burden of gastro-oesophageal reflux disease and dyspepsia: A community-based study

Background and study aimsGastro-oesophageal reflux disease (GERD) and dyspepsia are common digestive disorders that inflict serious harm, burden and economic consequences on individuals worldwide. The aim of this study was to estimate the direct and indirect economic burden of GERD and dyspepsia in the whole population of Tehran, the capital of Iran.Patients and methodsThe study was performed on a total of 18,180 adult subjects (age > 18 years) taken as a random sample in Tehran province, Iran (2006–2007). A valid and reliable questionnaire was used to enquire about the symptoms of GERD, dyspepsia and the frequency of the utilization of health services including physician visits, hospitalisations and productivity loss due to GERD/dyspepsia symptoms in the preceding 6 months.ResultsGERD was found in 518 (41.9% males) patients and dyspepsia in 404 patients (38.9% males). Further 1007 subjects had both GERD and dyspepsia. The total direct costs of disease per patient for GERD, dyspepsia and their overlap were PPP$97.70, PPP$108.10 and PPP$101.30, respectively (PPP, purchasing power parity dollars). The total indirect cost of disease per patient was PPP$13.7, PPP$12.1 and PPP$32.7, for GERD, dyspepsia and their overlap, respectively.ConclusionAccording to our results, hospitalisation and physician visits were the main cost of disease that could be minimised by revision of the insurance business in Iran.     

The relationship between gastro-oesophageal reflux disease and asthma during childhood

BackgroundThe relationship between GERD and asthma is complex. It is not yet clear whether GERD is an accompanying finding or a cause of asthma, or even if it is an aggravating factor. The aim of this study was to determine the frequency of asthma and allergic diseases in patients who underwent 24-h pH monitoring for a suspicion of GERD, including a comparison between subjects with and without GERD.MethodSubjects who were evaluated by 24 h ambulatory intraoesophageal pH monitoring were investigated for the presence of asthma and allergic disorders. All participants were subjected to a skin prick test and a complete blood count and serum levels of specific IgE.ResultsA total of 204 subjects (49.5% male) with a mean age of 7.8 ± 4.3 years were enrolled. A diagnosis of GERD was made in 78 (38.2%) subjects after 24 h pH monitoring. The frequency of asthma in subjects with GERD was 20.5% compared to 25.4% in subjects without GERD (p = 0.424). Subjects with GERD presenting with respiratory symptoms have higher incidence of asthma compared to subjects with GERD presenting with gastrointestinal symptoms (35.3% and 5.3% respectively; p = 0.001).ConclusionAlthough, patients with and without GERD had comparable frequencies of asthma, our findings suggest that subjects who present with respiratory symptoms suggestive of GERD should also be evaluated for the presence of an underlying asthma.     

Gastroesophageal reflux disease: Impact on work productivity and daily-life activities of daytime workers. A French cross-sectional study

BackgroundFew studies have evaluated the impact of gastroesophageal reflux disease symptoms on work productivity and no French data are available.AimTo compare the impact of typical symptoms of nocturnal vs diurnal gastroesophageal reflux disease on work productivity and daily activities.MethodsA French prospective, multicenter, observational study was performed in primary care setting. Patient characteristics, symptomatology and treatment were reported. Work productivity loss was assessed using the work productivity and activity impairment questionnaire, predictors were identified using multivariate regression models, and estimated cost was calculated.Results716 eligible patients (mean age: 46.3 years) were included by 407 physicians. Nocturnal symptoms were reported in 50.8% of patients and exclusively diurnal symptoms in 49.2%. Mean work productivity and daily activities decreased by 31.4% and 32.6%, respectively (both p < 0.001). Work productivity was influenced by symptom intensity, diurnal symptoms occurrence, regurgitation and diurnal sleepiness. The mean associated cost per patient/week (€313) was higher in patients with diurnal symptoms (without (€346) or with nocturnal (€312) symptoms) than in patients with exclusive nocturnal symptoms (€253) (p < 0.001).ConclusionGastroesophageal reflux disease incurs high work productivity loss especially in patients with diurnal symptoms. Further medico-economic analyses are needed to estimate the cost effectiveness ratio according to therapeutic strategies.     

Esophageal motility and 24-h pH profiles of patients with heterotopic gastric mucosa in the cervical esophagus

BackgroundHeterotopic gastric mucosa occurs as a flat island of red mucosa in the proximal third of the esophagus where it gives rise to the cervical inlet patch. The aims of this study were to investigate the esophageal motility pattern and 24-h pH profiles of patients with cervical inlet patch.MethodsThirty patients (16 women, mean age: 44.9 years, range: 23–72) diagnosed as having heterotopic gastric mucosa in the cervical esophagus with upper gastrointestinal symptoms had undergone esophageal motility testing and 24-h pH monitorisation with a double-channel pH probe.ResultsManometric investigation was abnormal in 7 patients (non-specific esophageal motor disorder in 4 patients, esophageal hypomotility in 1 patient, and hypotensive LES in 2 patients). Pathological acid reflux (pH < 4) was found in 9 (30%) of 30 heterotopic gastric mucosa patients during pH monitorisation from the distal probe. Pathological acid reflux in the proximal esophagus (percentage of total time of pH < 4) was seen in four of these nine patients. Only four of the 30 patients (13.3%) presented with “acid independent episodes” during the 24-h esophageal pH monitorisation.ConclusionManometric investigation and 24-h pH monitorisation revealed that some of the patients with HGM have signs of esophageal motor dysfunction and “acid independent episodes” from the patches. These abnormalities may be responsible for some of the symptoms of HGM patients.     

Prevalencia y características clínicas de pacientes con parche de mucosa gástrica ectópica en esófago

Introduction and aimsAn inlet patch (IP) is the presence of gastric columnar epithelium outside of the stomach. No studies have been conducted in Mexico on that pathology. The aim of the present study was to determine the prevalence of esophageal IP and the clinical characteristics of the patients that present it.Materials and methodsA cross-sectional study was conducted that included consecutive patients referred for endoscopy within the time frame of September 2015 to May 2016. The patients answered a questionnaire, and high-definition endoscopy with digital chromoendoscopy was performed. The prevalence of IP was identified. The chi-square test was used to compare the clinical characteristics between patients that presented with esophageal IP and those without it.ResultsA total of 239 patients were included in the study. Their mean age was 53 years, and 130 (54.4%) were women. IP was found in 26 patients (10.9%), 15 of whom were men (57.7%). The main reason for referral to endoscopy was gastroesophageal reflux disease, present in 69.2% of the patients with IP and in 55.9% without IP (p = .19). The most common symptoms were heartburn and regurgitation. The former was present in 69.2% of the patients with IP and in 59.1% without IP (p = .32), and the latter was present in 65.4% of the patients with IP and 69.1% without IP (p = .7). Extraesophageal manifestation distribution was: cough in 46.2% of the patients with IP and 38% without IP (p = .45) and dysphonia in 54% with IP and 47% without IP (p = .53). Twenty-three percent of the patients with IP had Barrett's esophagus, as did 23% without IP (p = .99).ConclusionsThe prevalence of IP was high. The primary referral diagnosis was gastroesophageal reflux disease. No differences were found in relation to symptoms or the presence of Barrett's esophagus between the patients with and without IP.     

Does the preoperative mild renal dysfunction effect mortality and morbidity following valve cardiac surgery?

AimsThe objective of this study was to investigate the effect of preoperative mild renal dysfunction (RD), not requiring dialysis, on mortality and morbidity after valve cardiac surgery (VCS).PopulationWe studied 340 consecutive patients (2008–2012), who underwent VCS with or without coronary artery bypass graft (CABG).MethodsPreoperative RD was calculated with the abbreviated Modification of Diet in Renal Disease formula and was defined as a glomerular filtration rate <60 ml/min/1.73 m². Logistic regression analysis was used to assess the effect of preoperative renal dysfunction (RD) on operative and adverse outcomes.Results80 patients (30%) had preoperative mild RD. Patients with preoperative RD were older, had a higher rate of preoperative anemia (43% vs. 25%, p < 0.001), and more comorbidities. Patients with preoperative RD had worse outcomes with more reoperation (6.8% vs. 2.3%, p < 0.001).ConclusionPreoperative RD was significantly and independently associated with more red blood cell transfusions and longer hospital stay (median 9 vs. 8 days, p < 0.001). Mortality was similar in both groups (3.4% vs. 2.3%, p = 0.43). Preoperative mild RD in patients undergoing cardiac valve surgery is an independent marker of postoperative morbidity.     

Valoración laríngea mediante videolaringoestroboscopia en pacientes con artritis reumatoide

AimTo evaluate the larynx involvement in patients with rheumatoid arthritis (RA) in a clinical setting and correlate with the different clinical features related to more aggressive disease.MethodsCross-sectional study including 36 consecutive patients with RA. Reflux symptoms were evaluated by the Reflux Symptom Index (RSI) and vocal cord impairment by the Voice Handicap Index-10 (VHI-10). Laryngeal involvement was done by videolaryngostroboscopy (VLS).ResultsThe mean age was 56,3 ± 14 years with a mean disease duration of 2,6 ± 3,1 years (range 0-16 years). Voice use was considered as professional users in 33%. Twenty-four (67%) out of 36 patients had abnormal findings of VLS. One patient had larynx nodules (bamboo nodules). Eleven patients (31%) were diagnosed with muscle tension dysphonia, and there were symptoms and signs of pharyngeal-laryngeal reflux in 23 (64%) patients. No signs of cricoarytenoid joint impairment was found.ConclusionsOrganic larynx involvement was uncommon in patients with RA. However symptoms and signs of pharyngeal-laryngeal reflux were seen in around 60% of patients. There was no correlation between the clinical phenotype, severity of disease, immunological profile or treatment with VLS findings.     

Frecuencia y aspectos clínicos del cáncer gástrico precoz en relación con el avanzado en un área sanitaria de España

IntroductionGastric cancer (GC) incidence is currently decreasing; however, survival is still low. Early GC (EGC) has better prognosis and it could be cured by endoscopic methods.Patients and methodsObservational study of a retrospective cohort of all patients with GC during a five-year period in a health area of Spain. EGC diagnosis was defined as mucosal or submucosal (T1) cancers regardless of lymph node involvement, whereas the advanced GC were T2-T4.Results209 patients were included, and 26 (12%) of them were EGC. There was no difference between EGC and advanced GC in age, sex, HP infection, precancerous lesions or histological type. Other characteristics of EGC were different from advanced GC: location (antrum and incisura in 76% vs 38%, p = 0.01), alarm symptoms (69% vs 90%, p < 0.01), curative treatment (100% vs 30%, p < 0.01), performance status (PS 0-1: 92% vs 75%, p = 0.03) and survival (85% vs 20%, p < 0.001). Among patients who received curative treatment, 98% (79/81) underwent surgery and 2% (2/81) were treated by mucosectomy. Seven (27%) patients with EGC could have benefited from treatment by endoscopic submucosal resection.DiscussionEGC frequency was low (12% of GCs) in our health area. EGC had a high percentage of alarm symptoms, and was located in the distal third of the stomach (antrum and incisura) and had better prognosis compared to advanced GC. Strategies to increase detection and endoscopic treatment of EGC should be implemented.     

Role of laryngoscopy in children with respiratory complaints and suspected reflux

BackgroundIn recent years, laryngopharyngeal reflux (LPR) in children has been taken into consideration.ObjectiveThe aim of this study was to assess the laryngoscopic findings in children diagnosed LPR and/or gastro-oesophageal reflux (GERD).MethodsThe findings of 49 patients with at least one or more respiratory complaint such as chronic cough, wheezing, hoarseness, recurrent laryngitis, and throat clearing/postnasal discharge suggesting LPR were evaluated retrospectively. The diagnosis of LPR + GERD or GERD was done by the clinical history and 24 h double-probe pH monitoring and/or scintigraphy.ResultsThirty eight out of 49 patients examined by laryngoscopy underwent 24 h double-probe pH monitoring and/or scintigraphy. Thirty of them were diagnosed as LPR + GERD or GERD by any test positivity. Twelve of 30 patients diagnosed with LPR + GERD or GERD had a positive laryngeal finding on the examination of fibre optic laryngoscopy. The most common finding with eight cases was arytenoid erythema A sensitivity of 40% and specificity of 50% for the laryngoscopy in the diagnosis of LPR/GERD were found.ConclusionIn children with unexplained respiratory symptoms, laryngopharyngeal reflux should be suspected. Therefore, until enough data on this issue in the literature accumulates, the history and the laboratory findings of the patients obtained from various techniques to document paediatric LPR should be evaluated together.     

Differences in ST-elevation and T-wave amplitudes do not reliably differentiate takotsubo cardiomyopathy from acute anterior myocardial infarction

BackgroundPrevious efforts to distinguish acute anterior ST-elevation myocardial infarction (anterior-STEMI) from various forms of takotsubo cardiomyopathy (TTC) by electrocardiography (ECG) have produced differing results.MethodsWe performed a retrospective comparison of acute ECGs between 48 apical and 9 mid-ventricular TTC patients, with 96 anterior-STEMI patients. ECG was recorded in acute phase (< 24 h from onset of pain), and analyzed for ST-changes, negative T-waves, abnormal Q-waves and QT-interval duration. Time from onset of pain to ECG was gathered from patient records.ResultsAnterior-STEMI patients had ST-elevation in lead V₁ more frequently than apical (70% vs 15%, p < 0.0001) or mid-ventricular TTC patients (70% vs 0%, p < 0.0001), and higher ST-elevation amplitudes in leads V₂–V₅ (p < 0.02). Lack of ST-elevation in lead V₁ and ST-elevation amplitude < 2 mm in lead V₂ distinguished TTC from anterior-STEMI patients with 63% sensitivity and 93% specificity, with 79% predictive value.ConclusionsIn patients with anterior ST-elevation and acute chest pain, lack of ST-elevation in lead V₁ and ST-elevation amplitude < 2 mm in lead V₂ suggests a TTC diagnosis. However, this criterion is not reliable enough in clinical practice to distinguish between TTC and anterior-STEMI patients.     

Esophageal chemical clearance and baseline impedance values in patients with chronic autoimmune atrophic gastritis and gastro-esophageal reflux disease

BackgroundThe factors influencing new markers of gastro-esophageal reflux disease detected by impedance-pH monitoring – mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index – need to be evaluated.AimTo compare endoscopy-negative heartburn with chronic autoimmune atrophic gastritis (CAAG).Materials and methods24 patients with CAAG, 25 with non-erosive reflux disease (NERD) and 25 with functional heartburn (FH) were included. In all patients the main impedance-pH monitoring parameters were calculated.ResultsCAAG and NERD patients had a number of reflux events (non-acid ones being more common among the former group) which was higher than that found in FH (p < 0.001). MNBI decreased progressively in FH (>3000 Ohm), CAAG (>2000 Ohm) and NERD (<1000 Ohm) patients (p = 0.0046). The PSPW index was similar between CAAG and NERD patients but significantly lower in comparison to FH (p < 0.0001).ConclusionPatients with CAAG have evidence of non-acid reflux based on the high number of reflux events and confirmed by low values of MNBI and PSPW index. MNBI is a strong marker of acid/non-acid reflux-induced mucosal damage, whereas the PSPW index can reliably discriminate patients with reflux from those with FH, independently of the acidity of refluxate.     

Guideline-adherent therapy for stroke prevention in atrial fibrillation in different health care settings: Results from RAMSES study

ObjectiveNo studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies.MethodsBaseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared.ResultsOf the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8 ± 9.8 vs. 68.7 ± 11.4 years, p < 0.001), had a lower socioeconomic status, had a higher CHA₂DS₂VASc and HASBLED scores (3.4 ± 1.4 vs. 3.1 ± 1.7, p < 0.001 and 1.7 ± 1.0 vs. 1.6 ± 1.1, p < 0.001 respectively), and had more comorbidities than patients treated in THs. Inappropriate oral anticoagulant use was more prevalent in SHs than THs (31.4% vs. 25.6%, p < 0.001). When over- and undertreatment rates were compared among hospital types, overtreatment was more prevalent in THs (7.6% vs. 0.9%, p < 0.001) while undertreatment was more common in SHs (30.5% vs. 17.9%, p < 0.001).ConclusionThis study demonstrates the marked disparity between patient groups with AF presenting at SHs and THs. The use of guideline-recommended therapy is not adequate in either type of centre, overtreatment was more prevalent in THs and undertreatment was more prevalent in SHs.     

Enfermedad por reflujo gastroesofágico posterior a miotomía endoscópica a través de la boca: Resultados a corto,mediano y largo plazo

Introduction and aimsAchalasia is characterized by incomplete relaxation of the lower esophageal sphincter and esophageal aperistalsis. The efficacy of peroral endoscopic myotomy (POEM) is similar to that of the Heller myotomy, with an apparently greater prevalence of gastroesophageal reflux disease. Our aim was to determine the presence of GERD in a post-POEM cohort of Mexican patients with achalasia and follow-up of at least 12 months.Materials and methodsA retrospective cohort study was conducted on post-POEM patients with a minimum of 12 months of follow-up, within the time frame of 2012 to 2017. Pregnant patients were excluded. Serial endoscopy, pH study, and GERDQ application were performed. Univariate and bivariate data analyses were carried out and statistical significance was set at a P < 0.05.ResultsSixty-eight patients had post-POEM follow-up for 12 months. Of those patients, follow-up continued to 24 months for 58, 36 months for 47, 48 months for 39, and 60 months for 25. Mean patient age was 47.8 ± 14.3 years, 57.3% of the patients were women, 77.9% were treatment-naïve, and 54.4% had type II achalasia. The pH study, endoscopy, and questionnaire were positive in 73, 28, and 18% at 3 months; 48, 35, and 13% at 6 months, and 55, 30, and 15% at 12 months, respectively. Once the proton pump inhibitor was begun, the percentages decreased to 5, 2, and 6% at 24 months; 6, 2, and 8% at 36 months; 4,1, and 6% at 48 months; and 3, 1, and 4% at 60 months, respectively. There was no relation between the efficacy of POEM and the presence or intensity of GERD. There were no secondary complications due to gastroesophageal reflux.ConclusionsThe post-POEM prevalence of GERD was 50% in the short term (12 months), with no evidence of complications at the medium term or long term (60 months). Gastroesophageal reflux was adequately controlled through proton pump inhibitors administration in over 95% of the cases.     

Iron deficiency anemia despite effective gluten-free diet in celiac disease: Diagnostic role of small bowel capsule endoscopy

Background & aimIron deficiency anemia (IDA) is associated with celiac disease (CD). Although gluten-free diet (GFD) is an efficient treatment for CD, IDA remains an occasional finding during follow-up and correlates to inadequate gluten exclusion. Little is known regarding persistent IDA despite effective GFD.We aimed to evaluate the role of small bowel capsule endoscopy (SBCE) in this setting.MethodsWe prospectively included consecutive patients undergoing GFD for ≥24 months with persistent concomitant IDA. Patients were assessed serologically and, if negative, underwent endoscopic evaluation.ResultsTwenty-six patients underwent esophago-gastro-duodenoscopy (EGD), colonoscopy and SBCE. Altogether, 11 patients resulted positive. EGD showed mucosal lesions in 7: erosive gastritis (n = 3), erosive duodenitis (n = 1), active CD (n = 3). Colonoscopy showed hemorrhoids in 2. SBCE was positive in 6 cases: erosive jejunitis (n = 3, 1 eventually diagnosed as refractory CD, 2 as Crohn’s disease), angiodysplasias (n = 2), lymphangectasia (n = 1). Some overlap was observed between procedures, since in 4 subjects EGD and SBCE produced significant findings. However, in 3 cases SBCE documented severe disease, not found at EGD. Hypoalbuminemia was significantly associated with a positive SBCE outcome (p < 0.01).ConclusionSBCE yielded significant findings in 23% of celiacs with persistent IDA despite adequate GFD. These were associated to hypoalbuminemia, indicating their occurrence at more severe stages of the disease.     

Wireless oesophageal pH monitoring: Establishing values in a multiracial cohort of asymptomatic Asian subjects

BackgroundWireless oesophageal (Bravo) readings in healthy European and American subjects show varied results. Values in Asians remain unstudied.AimsWe performed Bravo studies in healthy Asians to determine if values differed from previously published and identified reflux parameters to differentiate healthy volunteers from patients.MethodsFifty healthy volunteers were recruited between August 2009 and August 2011 to undergo 48 h wireless pH monitoring. Bravo capsule was introduced transorally and placed 6 cm above the squamocolumnar junction. Acid reflux parameters were compared against 41 patients previously evaluated for non-erosive reflux disease.ResultsFive volunteers were excluded. Capsule dislodgement occurred in four and three volunteers on study days 1 and 2 respectively. Forty and 37 volunteers (73% male, mean age 33.0 ± 7.6 years) had interpretable readings at 24 and 48 h, respectively. Percentage of time oesophageal pH < 4 in 37 volunteers who completed 48 h recordings was 1.6% (7.5%), 1.5% (6.3%) and 1.9% (5.8%) on days 1, 2 and overall study duration, respectively.ConclusionBravo readings in Asians differed from previously published. Percentage of time oesophageal pH < 4 on day 2 and DeMeester score on day 2 (95th percentile 22.9) best discriminated healthy volunteers from patients.     

Prevalence of symptoms suggestive of gastroparesis in a cohort of patients with diabetes mellitus

AimsTo estimate the prevalence of symptoms suggestive of gastroparesis and their association to clinical and demographic data in a large population of patients with diabetes mellitus and in the general population in Israel.MethodsA cross-sectional survey of type 2 diabetic patients treated in community settings was performed. All patients and controls completed a demographic questionnaire as well as the Gastroparesis Cardinal Symptom Index (GCSI). Data regarding disease duration, medications, complications, recent blood glucose and HbA1C levels, were also collected.ResultsA total of 382 patients and 88 healthy volunteers were included. Patients and controls were aged 63.07 ± 10.63 and 58.69 ± 10.73 years respectively with a BMI of 30.45 ± 8.15 and 25.64 ± 4.25 kg/m² respectively. Compared to controls, more patients with diabetes complained of nausea (24.8% vs. 4.5%, p < 0.0001), post-prandial fullness (44.6% vs. 26.1%, p = 0.001), bloating (48.8% vs. 36.4%, p = 0.035) and stomach or belly visibly larger after a meal (53% vs. 29.5%, p < 0.0001). In multivariate analysis, symptoms were associated with female sex, BMI, blood glucose, HbA1C, metformin treatment and disease duration.ConclusionsThe prevalence of symptoms suggestive of gastroparesis among patients with diabetes mellitus in Israel is high and is independently associated with female sex and metformin therapy.     

Troponin T in acute heart failure: Clinical implications and prognosis in the Spanish National Registry on Heart Failure

BackgroundElevated troponin in heart failure has been associated with worse prognosis, but there are differences in the design and results of published studies. Our objective was to determine the association of troponin T with mortality and readmissions in patients with acute heart failure in clinical practice conditions.MethodsWe included patients from the RICA registry who were hospitalized for acute heart failure. They were classified into 3 groups according to troponin T levels: normal, intermediate and high (< 0.02, 0.02–0.049 and ≥ 0.05 ng/mL, respectively). Survival was studied by Kaplan–Meier curves and the association of variables was tested by Cox regression analysis.ResultsA total of 406 patients was included. Average age was 76.9 (76.0–77.7) years. Hypertensive heart disease was the most common etiology. Left ventricular ejection fraction was < 45% in 22.1% of the patients. The group with elevated troponin T had higher proportions of women, systolic dysfunction, renal failure and anemia, a lower body mass index and longer hospital stay. At one year, patients with elevated troponin T had higher mortality than patients with normal troponin (35.5 vs. 13.9%, p < 0.001). The composite event (mortality and readmissions) was also more frequent (51.6 vs. 30.9%, p < 0.001), but there were no differences in readmissions alone. Troponin T ≥ 0.02 ng/mL was independently associated with mortality.ConclusionsElevated troponin T levels are common in patients with heart failure in clinical practice and are associated with increased mortality and events after one year of follow-up.     

Differential characteristics in polypathological inpatients in internal medicine departments and acute geriatric units: The PLUPAR study

AimTo determine whether there are any differences between polypathological patients attended in Internal Medicine departments and acute Geriatric units.MethodsA cross-sectional multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data of age, sex, living in a nursing residence or at home, diagnostic category, use of chronic medication, Charlson, Barthel and Lawton–Brody indexes, Pfeiffer questionnaire, delirium during last admission, need of a caregiver, and having a caregiver were gathered. The need of a caregiver was defined when the Barthel index was < 60 or Pfeiffer questionnaire ≥ 3 errors.Results471 polypathological patients, 337 from internal medicine and 144 from geriatrics units were included. Geriatrics inpatients were older and more frequently female. Cardiac (62.1% vs 49.6%; p = .01), digestive (8.3% vs 3.0%; p = .04) and oncohematological diseases (30.2% vs 18.8%; p = .01) were more frequent in patients of internal medicine units and neurological (66.2% vs 40.2%; p < .001) and locomotive ones (39.1% vs 20.4%; p < .001) in geriatrics inpatients. Charlson index was higher for internal medicine inpatients [4.0(2.1) vs 3.5(2.1); p = .04). Patients attended in geriatrics scored higher in Pfeiffer questionnaire [5.5(3.7) vs 3.8(3.3); p < .001], and lower in Barthel [38.8(32.5) vs 61.2(34.3); p = .001] and Lawton–Brody indexes [0.9(1.6) vs 3.0(2.9); p < .001], and more frequently needed a caregiver (87.8% vs 53.6%; p < .001) and had it.ConclusionsThere are differences in disease profile and functional and cognitive situation between polypathological patients of internal medicine and geriatrics departments.     

Outcomes of patients hospitalized for suspected acute coronary syndrome,in whom the diagnosis was not confirmed: Results from the CZECH-1 and CZECH-2 registries

BackgroundSuspicion of acute coronary syndrome (ACS) is one of the most common reasons for hospital admission. However, ACS is not confirmed in a high proportion of these patients during hospitalization. Very few details exist about these patients.AimTo evaluate the clinical characteristics and outcomes of hospitalized patients with a suspicion for ACS that has not been confirmed and compare these results with patients with confirmed ACS.Methods and resultsData were used from the CZECH-1 and CZECH-2 registries, collected in November 2005 and October–November 2012. Both registries contain data from all consecutive patients who have been hospitalized with an initial diagnosis of ACS. ACS was not confirmed during hospitalization in 578 of 1921 patients (30.1%) in the CZECH-1 registry and in 372 of 1221 (30.5%) in the CZECH-2 registry. In both registries, higher proportions of females (52 vs. 36%; p < 0.001 and 46 vs. 33%; p < 0.01, respectively) were observed between patients with unconfirmed ACS compared to those with confirmed ACS. A history of myocardial infarction was known in 25% of the patients with unconfirmed ACS in both registries. On admission, atrial fibrillation or other non-sinus rhythm on ECG was present in 17% of patients with unconfirmed ACS, bundle branch block in 18%, ST depression in 8%, and ST elevation in 3.6%. Coronary angiography was performed on 36% of these patients in CZECH-1 and 27% of patients in CZECH-2 (p < 0.01). In-hospital mortality of the ACS unconfirmed patients was 1.2% in the CZECH-1 registry and 2.1% in the CZECH-2 registry (p = NS). 30-day and 1-year mortality in patients with unconfirmed ACS in the CZECH-2 registry were significantly lower compared to patients with confirmed ACS (3.5 vs. 6.6%; p < 0.05 and 6.5 vs. 13%; p < 0.05, respectively). Musculoskeletal pain and acute heart failure were the most common discharge diagnosis in patients with unconfirmed ACS.ConclusionHospitalized patients in whom the suspicion of ACS had not been confirmed were more often female and a high proportion had abnormal ECG on admission. In-hospital mortality was very low, and the 1-year mortality was significantly lower compared to patients with confirmed ACS.