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ABSTRACT: Abstract Objective. To assess the occurrence of functional bowel (FB) symptoms in Northern Norway, and to describe gender differences, comorbidity, and association to risk factors, including Helicobacter pylori infection. Materials and methods. Adult subjects (18-85 years) from the communities Bodø and Sørreisa were invited to complete a questionnaire on gastrointestinal symptoms, and to provide stool samples for assessment of H. pylori. Results. Of 3927 invited subjects, 1731 (44.1%) responded to the questionnaire and 1416 (36.0%) provided stool samples. Functional bowel symptoms were found in 25%, somewhat more frequent in females (28.6%). Symptom pattern differed between genders only with regard to constipation. Presence of FB symptoms was significantly associated with gastroesophageal reflux symptoms, headache, dizziness, palpitations, sleep disturbances, and musculoskeletal symptoms. Psychometric traits were also more prevalent: feeling of low coping ability, feeling depressed, feeling of time pressure, and a low self-evaluation of health. In a multivariate regression model, factors that influenced the reporting FB symptoms were male gender (OR 0.71, 95% CI (0.52; 0.96)), age 50-69 years or ≥70 years (OR 0.49 (0.30; 0.80) and 0.40 (0.21; 0.79)), obesity (OR 1.61 (1.05; 2.47)), NSAID use (OR 2.50 (1.63; 3.83)), and previous abdominal surgery (OR 1.54 (1.05; 2.26)). The presence of H. pylori was not associated with FB symptoms. Conclusions. Functional bowel symptoms are prevalent, but our findings may be prone to self-selection bias. FB symptoms carry a significant burden of comorbidity. Female gender and low age are known risk factors for FB symptoms, whereas NSAID use as a risk factor deserves further clarification.
Scandinavian journal of gastroenterology 11/2012; 47(11):1274-82. · 2.08 Impact Factor
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ABSTRACT: We report a case of patient-to-surgeon transmission of hepatitis C virus (HCV), and the subsequent transmission of HCV to surgical patients.
In 2007, a cardiac surgeon tested positive for hepatitis C. A complete look-back investigation was initiated that involved screening of all patients on the surgeon's operating lists between September 2004 and April 2007. Genotyping and phylogenetic analyses were performed where HCV RNA was detected.
Of the 499 patients invited to HCV testing, 431 responded, 13 of whom were found anti-HCV positive. One patient, who had surgery in August 2005, was found most likely to be the source of transmission to the surgeon. Of the 270 patients who had surgery after this incident, 10 became infected, giving an estimated rate of transmission of 3.7%. The HCV polymerase chain reaction positive samples were found to be the same genotype 1a strain by phylogenetic analyses. All the 10 subsequently infected patients had undergone open heart surgery, whereas none of the 103 noncardiac patients became infected, giving an estimated risk of transmission during open heart surgery of 6.0% (95% confidence interval [3.3% to 10.7%]).
The transmission rate from an HCV positive surgeon to patients in a cardiothoracic setting was higher than previously reported and significantly higher during open heart surgery compared with vascular and pulmonary surgery. These results indicate the need for unequivocal routines for testing and handling of HCV positive health care workers and patients.
The Annals of thoracic surgery 11/2010; 90(5):1425-31. · 3.74 Impact Factor
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ABSTRACT: Endoluminal gastroplication has been used with limited success for the treatment of gastro-oesophageal reflux disease (GORD). This method was used in 119 patients with GORD, and the results from short-term and long-term followup of symptoms and the use of acid suppression medication are reported. The purpose of this study was also to report on the effect of a second procedure on selected patients.
The Bard EndoCinch endosuturing system was used for all procedures. Data were recorded at 3 and 12 months, and symptoms and medication use were registered by means of a telephone survey after an average of 41 months (range 27-55 months). A second procedure was carried out in 20 of the initial patients, and mean follow-up time was 39 months (range 15-51 months).
There were very few complications of the procedure. Heartburn severity score was reduced from an initial 21.4 to 12.4 (p < 0.01) and 13.4 (p < 0.01) at 3 and 12 months, respectively, corresponding to a reduction in the use of acid suppression from 8.7 doses per week (DD/w) to 4.0 (p < 0.01) and 5.6 DD/w (p < 0.01). At long-term follow-up there was a return towards baseline values for acid suppression use (6.4 DD/w, p = 0.06), whereas the heartburn severity score remained low (8.5, p < 0.01). Loss of sutures was significant, from an average of 2.51 applied sutures to 1.87 (p < 0.01) and 1.81 (p < 0.01) remaining sutures at 3 and 12 months, respectively. After the second procedure, the heartburn severity score fell from an initial 22.5 to 12.7 (p < 0.01) after 3 months and remained low at long-term follow-up (6.6, p < 0.01). The corresponding data for acid suppression use were 11.7, 3.6 (p < 0.01) and 5.2 (p < 0.01) DD/w. Number of sutures increased from an average of 2.15 sutures placed initially, with 2.65 sutures added at the second procedure, to an average of 2.80 remaining sutures (p < 0.01) at 3 months.
Endoluminal gastroplication has a significant, yet transient effect on symptom score and the use of acid suppressants in GORD patients. A selection of patients for a subsequent procedure may be of value.
Scandinavian Journal of Gastroenterology 01/2008; 43(1):5-12. · 2.02 Impact Factor
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ABSTRACT: Endoscopy is an observer-dependent diagnostic method, which, until recently, has lacked precise guidelines for written reports. There is an increasing demand for improvement in endoscopy records, which may necessitate the supplementation of image documentation. The aim of this study was to estimate interobserver as well as intra-observer variability in the assessment of images from gastroscopy.
We designed an Internet interface presenting endoscopy images, accompanied by a multiple-choice questionnaire for assessing pathology in the images. Ten images from the distal oesophagus and 10 images from the pyloric antrum were chosen. In order to study interobserver variability, physicians with varying endoscopy experience were invited to complete the questionnaire. The physicians were re-invited 5 months later to assess the same images again, this time in order to assess intra-observer variability. Kappa statistics were used for analysis of agreement.
Initially, 13 of 20 invited physicians responded. Interobserver agreement varied between poor (kappa<0.2) and moderate (0.4<kappa<0.6). In the second part of the study, 10 of 11 invited physicians responded. Intra-observer agreement varied between moderate (0.4<kappa<0.6) and good (0.6<kappa<0.8). A higher level of experience does not imply either better interobserver or better intra-observer agreement. Images of concise endoscopy findings, such as the presence of an ulcer, resulted in better agreement than did the assessment of images of less definable findings.
The variability in the interpretation of endoscopy images is large. We therefore believe that systematic inclusion of a set of images into endoscopy reports will improve their quality.
Scandinavian Journal of Gastroenterology 10/2007; 42(9):1106-12. · 2.02 Impact Factor
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ABSTRACT: Gastrooesophageal reflux disease is a common disorder, its most significant pathophysiological mechanism being a dysfunction of the lower oesophageal sphincter.
On the basis of our own experience and relevant literature, we present a novel method of treating this disease by means of strengthening the lower oesophageal sphincter by endoscopic suture.
The commercially available Bard EndoCinch endosuture device was attached to a normal gastroscope and was used to fasten a Prolene thread in a fold of the gastric mucosa approximately one centimetre below the lower oesophageal sphincter. By tying two mucosal folds together, a plication was obtained. Usually, two or three complications were made. The procedure was performed on patients only mildly sedated and typically took 20 to 40 minutes. The method is suitable for patients with moderate or severe reflux disease with hiatal hernias less than 3 cm and may be an alternative to continuous proton pump inhibitor treatment or fundoplication. Contraindications are few, and complications limited. Controlled studies or treatment protocols should be initiated.
Tidsskrift for Den norske legeforening 06/2002; 122(13):1282-4.
