S A C van Tuyl

St. Antonius Ziekenhuis, Nieuwegen, Utrecht, Netherlands

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Publications (12)34.57 Total impact

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    ABSTRACT: BACKGROUND & AIMS: Infliximab (IFX) and adalimumab (ADA) are thought to have equal efficacies for treatment of Crohn's disease (CD), although no direct comparison has been performed. We compared the effectiveness and safety of IFX and ADA in carefully matched cohorts. METHODS: We performed a retrospective cohort study of 200 patients with CD (100 treated with IFX and 100 with ADA, starting in 2006 or later) who had not previously received anti-tumor necrosis factor (TNF)ą -agents; the patients were identified from databases of 6 hospitals in the Netherlands. The groups were carefully matched for indication, duration of disease, age, and Montreal classification. The primary endpoint was the steroid-free clinical response, defined by a combination of multiple clinical parameters, after 1 year. RESULTS: Of the total patient population, 63.5% and 45% had a clinical response after 1 and 2 years respectively. There were no significant differences between treatment groups-at 1 and 2 years, 62% and 41% of those receiving ADA vs 65% and 49% of those receiving IFX had responses, respectively. Kaplan-Meier curves showed identical decreases in response rates over time. Combining IFX or ADA with immunomodulator therapy was associated with a higher clinical response than monotherapy, although this was only significant among patients that received IFX ( P =.03). There were no differences in numbers of side effects or opportunistic infections. CONCLUSIONS: The effectiveness of ADA or IFX treatment in anti-TNFą- naive patients with CD is comparable after 1 and 2 years of follow up. The efficacies of IFX and ADA each seem increase when given with immunomodulator therapy, although only significantly for IFX.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 01/2013; · 5.64 Impact Factor
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    ABSTRACT: - Domperidone is an antiemetic drug with relatively few side-effects. In the Netherlands, domperidone is available over the counter.- Recently, discussion on the safety of domperidone has arisen because an association with sudden cardiac death has been suggested. We performed a systematic literature search to investigate whether these concerns can be justified.- Three out of four case-control studies found statistically significant increased odds ratios for sudden cardiac death when using domperidone. A dose-response relationship was described in one study. Results may be influenced by several confounders.- We conclude that there is a relationship between domperidone use and sudden cardiac death at doses of more than 30 mg per day. We recommend that the indication be weighed up properly, that domperidone be provided only on prescription, and dose advice be given.- At a dose of 30 mg per day, domperidone can be prescribed safely.
    Nederlands tijdschrift voor geneeskunde 01/2013; 157(45):A6770.
  • M Struijk, D F Postma, S A C van Tuyl, M A van de Ree
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    ABSTRACT: Upper gastrointestinal bleeding is a common adverse effect of chronic aspirin treatment. Traditionally, most physicians might tend to discontinue aspirin therapy after related gastrointestinal bleeding. However, recent studies have shown that continuation of aspirin is beneficial because of a decrease of cardiovascular complications and only a relatively small increase of recurrent peptic ulcer bleeding when combined with a proton pump inhibitor. There might be individual cases where the burden of recurrent gastrointestinal complications outweighs the risk of vascular events. In these cases the physician needs to carefully consider other precipitating factors for the recurrent gastrointestinal symptoms. At the moment, alternative antiplatelet therapy does not lead to lower gastrointestinal risks. In the near future, therapies with a more favorable profile might emerge.
    European Journal of Internal Medicine 04/2012; 23(3):227-30. · 2.30 Impact Factor
  • S A C van Tuyl, H den Ouden, M F J Stolk, E J Kuipers
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    ABSTRACT: Visualization of the small bowel by video capsule endoscopy (VCE) is frequently impaired by intestinal contents. Different bowel preparations have been studied with controversial results. The aim of this study was to determine a satisfactory and tolerable bowel preparation for VCE. Ninety patients were randomized to three preparation regimens. Group A underwent VCE after clear liquid diet and overnight fast, while groups B and C received respectively 1 or 2 L of polyethylene glycol (PEG) solution before VCE. For each VCE five segments of 10 minutes were selected, one at the start of each quartile of the small-intestinal transit time, the fifth being the last 10 minutes of the ileum transit. Mucosal visibility was regarded as good if more than 75 % of the mucosa could be evaluated. All patients answered a questionnaire regarding procedure tolerability. The use of PEG solution led to a significant improvement in mucosal visualization. Mucosal visibility was good in the terminal ileum in 25 % of patients in group A, 52 % in group B, and 72 % in group C. The diagnostic yield did not change significantly. The use of 2 L of PEG solution was considered more uncomfortable than no PEG solution or 1 L of the same. One liter of PEG solution improves mucosal visualization without causing discomfort for the patient.
    Endoscopy 01/2008; 39(12):1037-40. · 5.74 Impact Factor
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    ABSTRACT: Videocapsule endoscopy (VCE) has a high diagnostic yield in the analysis of GI bleeding and Crohn's disease. Little information is available on the impact of VCE findings on clinical care. Assess the impact of VCE findings on clinical management and outcome. Retrospective descriptive study. General hospital. VCE was performed in 150 patients for GI bleeding (n = 97), Crohn's disease (n = 36), and miscellaneous reasons (n = 17). Clinical consequences were evaluated by using a questionnaire and were divided into change of management or unchanged management. Change of medication, endoscopic procedures, surgical procedures, other consequences, and avoidance of additional investigations were considered a change of management. For all patients, an assessment of the actual clinical condition and the most recent Hb level were registered. A definite diagnosis was established in 34%, a probable diagnosis in 34%, and no diagnosis in 32%. Management was changed in 38% of patients, increasing to 59% if a definite diagnosis was established at VCE. No relation between change of management and clinical improvement or increased Hb level could be established. The start of ethinylestradiol/norethisterone in case of telangiectasia was considered a change of management, although controversy on the rationale of this treatment exists. A more detailed and objective evaluation of the clinical condition should be performed to assess the clinical outcome. VCE findings have a serious impact on clinical practice. VCE in particular leads to a change of management in 59% of the patients in whom a definite diagnosis is established.
    Gastrointestinal Endoscopy 01/2008; 66(6):1164-70. · 5.21 Impact Factor
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    ABSTRACT: The case of a postmenopausal woman with a congenital aortic stenosis is presented. She presented with severe iron deficiency anemia. After negative extensive gastrointestinal analysis, she was treated with octreotide for six months. After cessation of octreotide, anemia rapidly recurred. A second capsule endoscopy and a double balloon enteroscopy were performed, and an intestinal vascular malformation was found. After surgical segment resection, the patient had stable, normal levels of hemoglobin and no complaints after 14 months of follow-up.
    Canadian journal of gastroenterology = Journal canadien de gastroenterologie 10/2007; 21(9):597-600. · 1.53 Impact Factor
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    ABSTRACT: Hereditary hemorrhagic teleangiectasia (HHT) is an autosomal dominant disorder with mucocutaneous teleangiectasia and visceral arteriovenous malformations. Mutations of endoglin and Activin A receptor like kinase-1 have different phenotypes, HHT1 and HHT2, respectively. The gastrointestinal tract is frequently affected, but limited information is available on the relationship with genotype. To determine whether different genotypes have different phenotypes with respect to intestinal teleangiectasia. HHT patients, referred for anemia, underwent videocapsule endoscopy. Chart review was performed for information on genotype and HHT manifestations. Twenty-five patients were analyzed (men/women 13/9, mean age 49+/-15 years.), 14 HHT1, eight HHT2 and three without known mutation. Epistaxis occurred in 96% of patients. Gastroduodenoscopy revealed teleangiectasia in 7/12 (58%) HHT1 and 3/8 (38%) HHT2 patients. Videocapsule endoscopy found teleangiectasia in all HHT1 and 5/8 (63%) HHT2 patients. In 9/14 HHT1 patients, teleangiectasia were large. Teleangiectasia in the colon was restricted to 6/11 (55%) HHT1 patients. Hepatic arteriovenous malformations were present in 1/7 HHT1 and 5/6 HHT2 patients. Large teleangiectasia in small intestine and colon appear to occur predominantly in HHT1. Hepatic arteriovenous malformations are mainly found in HHT2. In HHT patients with unexplained anemia, videocapsule endoscopy should be considered to determine the size and extent of teleangiectasia and exclude other abnormalities.
    European Journal of Gastroenterology & Hepatology 03/2007; 19(2):153-8. · 1.92 Impact Factor
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    ABSTRACT: Carcinoid tumors are the most common GI neuroendocrine tumors (NET). They often originate in the small intestine. The primary tumor is often difficult to locate, and resection in an early phase is recommended to prevent complications. This study evaluated the value of videocapsule endoscopy (VCE) in the detection of small-intestinal primary carcinoid tumor. Prospective descriptive study. Tertiary referral center. Twenty consecutive patients (13 men, 7 women; 60.5 +/- 9.3 years) with metastatic NET of unknown primary tumor. All patients underwent CT, enteroclysis, nuclear imaging, and VCE of the small bowel. CTs and enteroclysis did not detect a primary small-intestinal carcinoid tumor. Nuclear imaging demonstrated abnormalities in the abdominal area in 13 patients but was unable to relate this to an intestinal localization in any patient. VCE revealed a small-intestinal tumor in 9 patients. Three other patients showed external compression and erosions. At surgery, 5 patients had a small-intestinal carcinoid tumor, and, in 2 patients, a small-intestinal ischemic segment was present. The number of false-positive VCE findings was not clear, because not all patients underwent surgery. The absence of abnormalities at VCE in patients with abnormalities at nuclear imaging might be related to the presence of carcinoid tumor restricted to the mesenterium or to a false-negative VCE. VCE had a high diagnostic yield of 45% for identification of primary small-intestinal carcinoid tumors. Although nuclear imaging had a comparable diagnostic yield, it could not differentiate between intestinal and mesenterial localization of the carcinoid.
    Gastrointestinal Endoscopy 08/2006; 64(1):66-72. · 5.21 Impact Factor
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    ABSTRACT: We aimed to assess technical feasibility, clinical applicability, and diagnostic yield of videocapsule endoscopy (VCE) in a large group of unselected patients. VCE was performed with the Given Imaging swallowable capsule. Findings were considered diagnostic if the observed finding could explain the symptomatology of the patient. Findings were considered suspicious if an observed finding failed to completely explain the patient's symptoms. We studied 250 patients. A definite diagnosis was made in 95 patients (38%). Suspicious findings were noted in 80 patients (32%). No diagnosis was obtained in 74 patients (30%). The yield of VCE was higher in patients with suspected Crohn's disease. Mean viewing time decreased significantly from 51 +/- 14 to 30 +/- 7 minutes after reviewing 50 procedures. VCE is an important diagnostic tool, but a definite diagnosis is established in only 38% of the patients. The highest diagnostic yield is obtained in patients with suspected Crohn's disease.
    Digestive Diseases and Sciences 06/2006; 51(5):900-5. · 2.26 Impact Factor
  • S A C van Tuyl, M F J Stolk, R Timmer
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    ABSTRACT: Non-invasive imaging of the complete small bowel has become possible with the recently available video capsule endoscopy technique. The aim of this study was to review and assess the possibilities and limitations of the clinical application of video capsule endoscopy. Literature review. Video capsule endoscopy is a new promising technique with good to excellent visualization of the mucosa of the small bowel. It has a high diagnostic yield in patients with occult gastrointestinal blood loss (OGIB) and Crohn disease (CD). Several other indications need further study. Compared to small-bowel X-ray and push enteroscopy, diagnostic yield appears to be superior. Video capsule endoscopy is very well tolerated by patients. Its most important limitation is the impossibility of taking biopsies and therapeutic interventions. Video capsule endoscopy is a promising new diagnostic tool for small-bowel disease.
    Scandinavian journal of gastroenterology. Supplement 02/2003;
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    S A C van Tuyl, P H Th J Slee
    The Netherlands Journal of Medicine 05/2002; 60(3):130-2. · 2.38 Impact Factor
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    S A C van Tuyl, E J Kuipers, R Timmer, M F J Stolk
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    ABSTRACT: Video capsule endoscopy (VCE) is a new noninvasive imaging technique for the complete small bowel. It provides good to excellent visualisation of the mucosa of the small bowel and has a high diagnostic yield in selected patients with gastrointestinal blood loss of suspected small bowel origin and in patients with Crohn's disease. In comparison with small bowel X-ray and push enteroscopy, diagnostic yield appears to be superior. Although VCE is becoming increasingly popular, good studies on its clinical implications and application are only just emerging. In this paper we review the possibilities and limitations of clinical application of VCE.
    The Netherlands Journal of Medicine 62(7):225-8. · 2.38 Impact Factor