E Stermer

Publications of E Stermer

• Incidental colorectal computed tomography abnormalities: Would you send every patient for a colonoscopy?

  Authors: E Stermer, A Lavy, T Rainis, O Goldstein, D Keren, A R Zeina

  Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 10/2008; 22(9):758-60.

  BACKGROUND: The clinical significance of colorectal wall thickening (CRWT) in patients undergoing abdominal computed tomography (CT) has not yet been definitively established. OBJECTIVES: To compareBACKGROUND: The clinical significance of colorectal wall thickening (CRWT) in patients undergoing abdominal computed tomography (CT) has not yet been definitively established. OBJECTIVES: To compare alleged findings on abdominal CT with those of a follow-up colonoscopy. METHODS: Ninety-four consecutive patients found to have large-bowel abnormalities on abdominal CT were referred for colonoscopy. Of these patients, 48 were referred for a suspected colorectal tumour and 46 for CRWT. Colonoscopy was performed and findings were compared. RESULTS: Of the 48 suspected colorectal tumours, 34 were determined to be neoplastic lesions on colonoscopy. Of these, 26 were malignant and eight were benign. Colonoscopy revealed no abnormality in 30 of 46 patients with CRWT as a solitary finding, and revealed some abnormality in 16 patients (12 had diverticular disease, four had benign neoplastic lesions). CONCLUSIONS: CRWT as an incidental and solitary finding on CT should not be regarded as a pathology prompting a colonoscopy. Approximately two-thirds of the patients had a normal colonoscopy and the remaining patients had benign lesions (12 had diverticular disease and four had benign neoplastic lesions). However, many of these patients seem to warrant colonoscopy regardless of CT findings, particularly patients who have a family history of colorectal cancer, have positive fecal occult blood test results or who are older than 50 years of age.

• Do forceps biopsies truthfully reflect the nature of endoscopically uncovered polypoid lesions of the colon?

  Authors: E Stermer, J Bejar, I Miselevich, O Goldstein, D Keren, A Lavy, J H Boss

  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 08/2005; 7(4):345-9.

  BACKGROUND: Total excision of colonic polyps is not always attainable and in some patients it is clinically contraindicated. Also, a resected polyp may be lost at any step between its endoscopicBACKGROUND: Total excision of colonic polyps is not always attainable and in some patients it is clinically contraindicated. Also, a resected polyp may be lost at any step between its endoscopic removal and its embedding in paraffin. The aim of this study was to compare the histological features of colonic polyps as analysed by the study of biopsy-forceps obtained samples with those assessed on scrutinizing the totally resected growths. PATIENTS AND METHODS: This prospective study included a cohort of 59 patients in whom, in the course of an elective colonoscopy, a total excision of a 6 mm-sized or larger polyp was called for. Sizeable biopsies were obtained by means of an Olympus Multibyte forceps prior to the total polypectomy. Subsequent to the study of the polypectomy specimens, the forceps biopsy samples were submitted for histological examination. The pathologists were blinded as to the source of the tissue they were studying. The diagnoses rendered by evaluating the biopsy samples and polypectomy specimens of each patient were contrasted with each other. RESULTS: Major discrepancies between the histological features of the fragments captured by the biopsy-forceps and the factual nature of the totally removed polyps were uncovered in 11 (18.6%) of 59 cases. Intriguingly, the grade of the tumours was underrated in all the 11 cases, as judged by contrasting the tentative diagnoses of the forceps-biopsies with the decisive diagnoses of the polypectomies. Importantly, 2 adenocarcinomas would have been missed by just looking at the forceps-retrieved sample. CONCLUSIONS: In our experience, a discordance of 18.6% is to be expected between the diagnoses rendered after examining forceps-biopsies of and totally excised colonic polyps. Nevertheless, it is advisable to procure biopsies prior to the excision of the growths, because on those occasions in which patients' growths cannot be removed or have not been retrieved for one reason or another, a small forceps-captured tissue sample correctly reflects the characteristics of the polyp in 81.4% of the cases. Finally, the biopsies may be discarded in the event that total removal was successful.

• Diverse effects of ascorbic acid and palmitoyl ascorbate on Helicobacter pylori survival and growth.

  Authors: M Tabak, R Armon, G Rosenblat, E Stermer, I Neeman

  FEMS microbiology letters. 08/2003; 224(2):247-53.

  Among many antioxidants used in the food, pharmaceutical and cosmetic industries, ascorbic acid (AA) is one of the most important. AA has been suggested to decrease the risk of gastric diseaseAmong many antioxidants used in the food, pharmaceutical and cosmetic industries, ascorbic acid (AA) is one of the most important. AA has been suggested to decrease the risk of gastric disease (gastritis, duodenal ulcer, and carcinoma) by direct action on Helicobacter pylori. However, there are limited studies on the possible role of AA and its derivatives such as palmitoyl ascorbate (PA) on the growth and survival of H. pylori. In the present study it was demonstrated in vitro that AA in the concentration range 10-20 mg x ml(-1) (50-100 mM) inhibited H. pylori growth in liquid medium under microaerophilic conditions. In contrast, under aerobic conditions AA in the concentration range 2-20 mg x ml(-1) (10-100 mM) significantly increased the survival of H. pylori presumably eliminating the toxic effect of reactive oxygen species on bacterial cells. The hydrophobic derivative of AA, PA (a food antioxidant), demonstrated a strong antibacterial effect, under both aerobic and microaerophilic conditions in the concentration range 0.04-0.4 mg x ml(-1) (0.1-1.0 mM). This effect was also tested on other bacterial strains: Escherichia coli, Proteus vulgaris, Proteus mirabilis, Pseudomonas aeruginosa, Enterococcus faecalis, Bacillus cereus, Bacillus subtilis, Staphylococcus aureus, Staphylococcus epidermidis, Clostridium sporogenes and Campylobacter jejuni. Among these bacterial strains, PA showed a similar inhibitory effect on B. cereus and B. subtilis as observed with H. pylori. The results suggest that PA may be considered an important AA derivative in eradication of H. pylori in vitro and in vivo and to decrease the risk for gastric diseases.

• Controlled trial of the effect of cinnamon extract on Helicobacter pylori.

  Authors: Y Nir, I Potasman, E Stermer, M Tabak, I Neeman

  Helicobacter. 07/2000; 5(2):94-7.

  BACKGROUND: Helicobacter pylori has been associated with the pathogenesis of antral gastritis, duodenal ulcer, and gastric lymphoma. Eradication of H. pylori has been shown to reverse or preventBACKGROUND: Helicobacter pylori has been associated with the pathogenesis of antral gastritis, duodenal ulcer, and gastric lymphoma. Eradication of H. pylori has been shown to reverse or prevent relapse of these diseases. Antimicrobials employed in the eradication of H. pylori are not without adverse effects. Newer treatment modalities, therefore, are required. In vitro studies have shown the effectiveness of cinnamon extract against H. pylori and its urease. In this pilot study, we tested the activity of an alcoholic extract of cinnamon in a group of patients infected with H. pylori. MATERIALS AND METHODS: Fifteen patients (11 women, 4 men) aged 16 to 79 years were given 40 mg of an alcoholic cinnamon extract twice daily for 4 weeks; eight patients aged 35 to 79 (7 women, 1 man) received placebo. The amount of H. pylori colonization was measured by the 13C urea breath test before and after therapy. RESULTS: The mean urea breath test counts in the study and control groups before and after therapy were 22.1 and 23.9 versus 24.4 and 25.9, respectively. The cinnamon extract was well tolerated, and side effects were minimal. CONCLUSIONS: We concluded that cinnamon extract, at a concentration of 80 mg /day as a single agent, is ineffective in eradicating H. pylori. Combination of cinnamon with other antimicrobials, or cinnamon extract at a higher concentration, however, may prove useful.

• Patient-controlled analgesia for conscious sedation during colonoscopy: a randomized controlled study.

  Authors: E Stermer, L Gaitini, M Yudashkin, G Essaian, A Tamir

  Gastrointestinal endoscopy. 04/2000; 51(3):278-81.

  BACKGROUND: The aim of this study was to assess whether patient-controlled anesthesia (PCA) can improve patient tolerance for colonoscopy. We compared baseline sedation and analgesia with baselineBACKGROUND: The aim of this study was to assess whether patient-controlled anesthesia (PCA) can improve patient tolerance for colonoscopy. We compared baseline sedation and analgesia with baseline sedation and PCA. METHODS: Fifty-six consecutive patients were alternatively allocated to 1 of 2 groups: either to control group (n = 28) to receive standard sedation (meperidine and midazolam as baseline and additional doses of meperidine administered by the anesthesiologist) or to a PCA group (n = 28) to receive the same baseline premedication but additional analgesia with meperidine being self-administered. Cardiopulmonary parameters were recorded and tolerance for the examination was evaluated by a numeric rating scale, 0 meaning "no pain" and 10 meaning "maximal pain." RESULTS: Patients' mean pain score (on a scale of 0 to 10) was 4.85 +/- 3.74 for the PCA group and 5.30 +/- 3.53 (not significant) for the control group. Physicians' assessment of patient tolerance registered a lower numeric rating score than patients' assessment. The duration of the procedure was slightly longer in the PCA group. None of the patients experienced a decline in oxygen saturation below 90%; a decrease in expiratory carbon dioxide during the examination was noted in both groups of patients, particularly during the first minutes of the examination. Mean additional sedation per patient in the PCA group was slightly higher, but not significantly different. CONCLUSIONS: Our results suggest that patient-controlled analgesia during colonoscopy is as effective as standard sedation with respect to patient tolerance and safety of the examination.

• Ambience in the endoscopy room has little effect on patients.

  Authors: E Stermer, N Levy, A Beny, R Meisels, A Tamir

  Journal of clinical gastroenterology. 07/1998; 26(4):256-8.

  With hopes of alleviating discomfort and improving the tolerance of patients undergoing endoscopy, we have assessed the influence of various background conditions in the endoscopy room. Two hundredWith hopes of alleviating discomfort and improving the tolerance of patients undergoing endoscopy, we have assessed the influence of various background conditions in the endoscopy room. Two hundred twenty-one candidates for upper endoscopy were randomly allocated to four groups, each with one of the following conditions in the endoscopy room: background music and conversation related to the patient's complaints (n=50); background music and conversation unrelated to the patient (n=53); background music only, with the staff maintaining silence (n=49); and complete silence (n=47). Before endoscopy patients answered a 26-item questionnaire that included an evaluation of their degree of anxiety before the examination. Conscious sedation was induced by using 3 mg midazolam. After complete recovery from sedation, patients answered another set of questions. Patients in all four groups felt quite comfortable with the atmosphere in which gastroscopy was performed. Neither music, conversation, nor silence had a great effect on patients as far as improving tolerance or diminishing anxiety. Therefore, endoscopists and nurses may have a free hand in choosing the prevailing conditions during the examination. This conclusion may be valid for both patients and the staff involved in other invasive procedures performed under light sedation.

• Lanzoprazole and ranitidine affect the accuracy of the 14C-urea breath test by a pH-dependent mechanism.

  Authors: E Stermer, N Levy, M Tabak, I Neeman

  The American journal of gastroenterology. 10/1997; 92(9):1575-6.

• Effect of ranitidine on the urea breath test: a controlled trial.

  Authors: E Stermer, M Tabak, I Potasman, N Levy, A Tamir, I Neeman

  Journal of clinical gastroenterology. 08/1997; 25(1):323-7.

  Because Helicobacter pylori is an acid-sensitive organism, an elevation of the gastric pH by H2 inhibitors might improve the intragastric conditions for the development of this organism. We testedBecause Helicobacter pylori is an acid-sensitive organism, an elevation of the gastric pH by H2 inhibitors might improve the intragastric conditions for the development of this organism. We tested this hypothesis in a prospective and controlled trial including 43 patients positive for H. pylori using the rapid urease test. Twenty-six patients received 150 mg ranitidine twice daily and 17 patients received no treatment. The 14C-urea breath test was performed in both groups at the beginning of the study and 2 weeks later. Radioactive 14C in exhaled carbon dioxide was significantly increased (p = 0.045) in the patients treated with ranitidine, compared with the patients in the control group. Administration of this drug to patients infected with H. pylori is associated with an increase in the bacterial load after 2 weeks of treatment. This phenomenon might be attributed to increased bacterial growth due to the H2 blocker.

• Helicobacter pylori and lanzoprazole.

  Authors: E Stermer, N Levy

  The American journal of gastroenterology. 09/1996; 91(8):1667-8.

• Seasonal fluctuations in acute gastrointestinal bleeding.

  Authors: E Stermer, N Levy, A Tamir

  Journal of clinical gastroenterology. 07/1995; 20(4):277-9.

  We investigated the seasonal variability of upper gastrointestinal bleeding retrospectively during 1988-92 in Haifa, Israel, a city with a subtropical climate. Four hundred and thirty three patientsWe investigated the seasonal variability of upper gastrointestinal bleeding retrospectively during 1988-92 in Haifa, Israel, a city with a subtropical climate. Four hundred and thirty three patients were included in the study: duodenal ulcer, 202; hemorrhagic gastritis 108; gastric ulcer 101; duodenal ulcer and hemorrhagic gastritis 12; and duodenal ulcer and gastric ulcer, 10. The highest incidence of bleeding was observed during winter (31.7%) and spring (28.3%), progressively diminishing throughout summer (18.5%) and fall (21.5%) (p < 0.0001). Both females and males showed this significant seasonal variation (p < 0.025 and p < 0.005, respectively). As a group, patients over 57 years of age had the highest incidence of bleeding during winter and spring (p < 0.005). Interestingly, the ingestion of NSAID had no influence in the increased seasonal bleeding. Duodenal ulcer (p < 0.01) and hemorrhagic gastritis (p < 0.05) showed a significant seasonal variation while gastric ulcer did not. Although there are several reports in the literature concerning seasonal fluctuations in duodenal and gastric ulcers, no such studies have hitherto been published on hemorrhagic gastritis.

• Helicobacter pylori-associated peptic ulcer in heterotopic gastric mucosa within ileal duplication.

  Authors: E Stermer, D Hardoff, E Zuckerman, I Miselevich

  Journal of clinical gastroenterology. 04/1994; 18(2):133-5.

  A 12-year-old boy, operated on for remitting abdominal pain and hematochezia, had an ileal duplication, with Helicobacter "gastritis" under a chronic peptic ulcer in the ectopic fundic gastricA 12-year-old boy, operated on for remitting abdominal pain and hematochezia, had an ileal duplication, with Helicobacter "gastritis" under a chronic peptic ulcer in the ectopic fundic gastric mucosa. We suggest the Helicobacter infection might have played a role in the pathogenesis of the inflammation and the peptic ulceration in this rare location.

• Bowel habits in Israel. A cohort study.

  Authors: N Levy, E Stermer, Z Steiner, L Epstein, A Tamir

  Journal of clinical gastroenterology. 06/1993; 16(4):295-9.

  We interviewed 1,900 healthy subjects who belonged to one of the three following ethnic groups: (a) Ashkenazi Jews, (b) Sephardi and Oriental Jews, and (c) Arabs (including Druses)--about their bowelWe interviewed 1,900 healthy subjects who belonged to one of the three following ethnic groups: (a) Ashkenazi Jews, (b) Sephardi and Oriental Jews, and (c) Arabs (including Druses)--about their bowel habits, laxative use, and beliefs about bowel action. Using stepwise logistic regression, we found that the following variables were significantly and independently related to bowel frequency: (a) sex--male > female (p = 0.0001); (b) age--young > old (p = 0.0001); (c) physical activity--high > little (p = 0.001); (d) body habitus--lean > obese (p = 0.02); (e) marital status--married > single (0 = 0.009); and (f) ethnic group--Arab > Jewish (p = 0.004). Regular use of laxatives was found in 18.4% of women and 10.8% of men (p < 0.0001). This habit was more common among Ashkenazi Jews (17%) than among Sephardi and Oriental Jews (10.7%) and Arabs (4.8%). Laxative intake was higher among the elderly (p = 0.0001) and the obese (p = 0.0004). Concerning the "ideal" bowel frequency, 12.4% of the Ashkenazis, 22.7% of the Sephardis and Oriental Jews, and 26.1% of the Arabs preferred to have at least 9 movements per week. Strikingly, 51.8% of all interviewed believed that constipation was "harmful to health;" women were more concerned than men (56.3% versus 47.5%). Subjects with a high level of education were significantly more concerned about constipation.

• Brucellosis as a cause of severe colitis.

  Authors: E Stermer, N Levy, I Potasman, M Jaffe, J Boss

  The American journal of gastroenterology. 08/1991; 86(7):917-9.

  A 16-yr-old girl presented with osteomyelitis and massive rectal bleeding. Colonoscopy revealed severe nonspecific colitis. Multiple laboratory investigations failed to disclose the etiology ofA 16-yr-old girl presented with osteomyelitis and massive rectal bleeding. Colonoscopy revealed severe nonspecific colitis. Multiple laboratory investigations failed to disclose the etiology of either the bone or colon infections. Empiric treatment with corticosteroids and sulfasalazine resulted in only transient improvement. One month after discharge, her original symptoms recurred. Blood and pus cultures at this time yielded Brucella melitensis. After tetracycline treatment, the patient recovered. At 1-yr follow-up, she was found completely asymptomatic. Although osteomyelitis is a well-known manifestation of brucellosis, colitis related to this agent has so far not been described.

• Chronic functional gastrointestinal symptoms in Holocaust survivors.

  Authors: E Stermer, H Bar, N Levy

  The American journal of gastroenterology. 05/1991; 86(4):417-22.

  In Nazi-occupied Europe (1939-1945), Jews were submitted to extreme mental and physical hardships (the Holocaust). This study was designed to investigate the impact of the severe protracted sufferingIn Nazi-occupied Europe (1939-1945), Jews were submitted to extreme mental and physical hardships (the Holocaust). This study was designed to investigate the impact of the severe protracted suffering on the development of chronic functional gastrointestinal symptoms. Thus, we studied 623 consecutive patients of Eastern European origin who had been admitted for nongastrointestinal complaints. They filled out detailed questionnaires, and were divided into the following two groups: A) Holocaust survivors [237 subjects who had been for at least 6 months in either German concentration/extermination camps (95 subjects), ghetto and/or underground movements (65 subjects), labor camps not directly supervised by Germans (79 subjects)], and B) a control group (384 subjects from the same demographic background, who had not been exposed to Nazi persecutions). The symptoms investigated were the following: abdominal pain, irregular bowel habits, diarrhea, constipation, abdominal distension, heartburn, flatulence, anorexia, nausea, vomiting, mucus in stool, tenesmus, and aerophagia. Patients were defined as having functional symptoms after these had been present for at least 5 yr and relevant organic disease had been excluded. The prevalence, duration of suffering, and frequency of appearance of most symptoms were significantly higher in the group of Holocaust survivors. This study supports the clinical observations that severe and protracted suffering contributes to the development of chronic functional gastrointestinal symptomatology.

• Overt gastrointestinal bleeding in the course of chronic low-dose aspirin administration for secondary prevention of arterial occlusive disease.

  Authors: J E Naschitz, D Yeshurun, M Odeh, H Bassan, I Rosner, E Stermer, N Levy

  The American journal of gastroenterology. 05/1990; 85(4):408-11.

  We describe 13 patients who developed erosive gastritis with overt gastrointestinal bleeding while receiving 75-250 mg nonbuffered aspirin per day for the secondary prevention of cardiac orWe describe 13 patients who developed erosive gastritis with overt gastrointestinal bleeding while receiving 75-250 mg nonbuffered aspirin per day for the secondary prevention of cardiac or cerebrovascular events. The bleeding occurred despite good initial tolerance to aspirin for several months or years. All patients were elderly and had severe atherosclerotic cardiovascular disease. Our data suggest that, contrary to common belief, very low doses of nonbuffered aspirin are attendant with clinically apparent gastrointestinal complications.

• Ileus as a complication of colonoscopy.

  Authors: E Stermer, N Levy

  The American journal of gastroenterology. 04/1990; 85(3):333-4.

• Does a detailed explanation prior to gastroscopy reduce the patient's anxiety?

  Authors: N Levy, L Landmann, E Stermer, M Erdreich, A Beny, R Meisels

  Endoscopy. 12/1989; 21(6):263-5.

  The object of this study was to investigate the assumption that a detailed explanation and description of gastroscopy to a patient reduces his fears of the procedure. In order to check thisThe object of this study was to investigate the assumption that a detailed explanation and description of gastroscopy to a patient reduces his fears of the procedure. In order to check this assumption, 243 consecutive patients who underwent elective gastroscopy were randomly distributed to 4 groups: Group A received a standard brief description of upper G-I endoscopy by the treating physician; Group B patients were given a detailed description by the endoscopist himself; Group C was given a comprehensive explanation and was shown an album of pictures illustrating each stage of the procedure; Group D saw a specially prepared video film of the procedure. A fifth group, E, consisted of patients who had previously undergone upper gastrointestinal endoscopy. Patient anxiety was measured using the "Spielberger State and Trait Anxiety Scales". According to the scoring on these scales there was no significant difference between the groups, thus showing that increasingly detailed description of the procedure did not diminish patients' fear. Neither did ethnic background or age have any significant influence on these results. Higher education had marginal influence on patients' apprehension about the procedure. However, female patients had significantly higher anxiety state and trait anxiety scoring than men. If endoscopy can be taken as typically representative of all invasive procedures, these results may have a much more general application.

• The Groll-Hirschowitz syndrome.

  Authors: I Potasman, E Stermer, N Levy, H Dar, H Bassan

  Clinical genetics. 08/1985; 28(1):76-9.

  Two sisters showed a similar disorder with cachexia, sensory deafness, and upper gastrointestinal abnormalities. The family pedigree suggests autosomal recessive inheritance of the disorder.Two sisters showed a similar disorder with cachexia, sensory deafness, and upper gastrointestinal abnormalities. The family pedigree suggests autosomal recessive inheritance of the disorder. Demyelinization demonstrated by a peripheral nerve biopsy may explain the basis for the manifestations. Only one family with this unique syndrome has been reported in the literature. The term "The Groll-Hirschowitz Syndrome" has been suggested, named after the two physicians who first described this condition.