Office Research Studies
Barrett’s Esophagus In Our Community Over the Past 12
Years
We found a very low incidence of cancer associated with long
standing Barrett’s Esophagus with only 0.5% incidence per
year. Low grade dysplasia returned to benign tissue 93% of the
time. 70% of patients were men, 30% women. Most all of the
patients who did develop cancer had the new onset of symptoms of
difficulty swallowing, heartburn or chest pain while on
appropriate medication. Current recommendations are for
endoscopy every 3 years.
[ Link
to full Abstract ]
[ Abstract
Presentation Poster 1 ] [ Abstract
Presentation Poster 2 ]
Colon polyps, colon cancer, and colonoscopy in the
community
We studied patients in our practice and found that men and women
equally produced polyps and cancer. Most cancers are in the left
colon. 35% of patients made polyps. There was a higher chanced
of polyps if there was a family history of colon cancer. 22% of
colon cancers were in patients under age 50. And 18% were
between 50-55 years old. 5% of patients developed colon cancer
within 3 years. 10% of patients who have colon cancer can get a
recurrence within four years of their surgery. We advocate
screening colonoscopy at age 50. If there is a family history of
colon cancer, you should begin by age 40-45.
[ Link to full Colonoscopy Abstract ] [ Link to full Colon Cancer Abstract ]
Microscopic Colitis
Microscopic Colitis is a relatively new type of colitis,
recognized since the 1980’s as a form of microscopic
inflammation, which causes chronic diarrhea. All stool
studies, labs and x-rays are usually normal. Even the
Colonoscopy appears normal, and only if biopsies are taken and
examined under the microscope can the diagnosis be made.
There are 2 types that we find: (1) Lymphatic colitis (equal in
men and women) and (2) Collagenous colitis (5:1, female: male
ratio). Sometimes a single individual has both types.
Patients usually have non-bloody diarrhea with stools ranging from less than or equal to 3/day (33%), to 4-9/day (52%) and more than 10/day (15%). In our study 47% of cases began suddenly and 53% insidiously. 66% of patients had only one episode of colitis, whereas 34% had either recurrent bouts or chronic symptoms. This is in contrast to other studies that showed few single episodes, and mostly chronic intermittent problems. 10% of our patients had concomitant celiac disease.
Treatments can include antibiotics such as Azulfidine & Flagyl, Lomotil/Immodium, and steroids, which were the most effective (Prednisone, Entocort).
As opposed to other studies we found only about 22% had abdominal pain or weight loss.
In summary, microscopic colitis, primarily a disease of middle aged women, can begin suddenly or insidiously, with the majority improving within 2 months. Some will have chronic or recurrent diarrhea and require ongoing therapy, the most successful being low dose Prednisone. The overall number of cases is still small and it appears to still lag far behind the frequency of ulcerative colitis.
In our study, we had a total of 39 patients with microscopic colitis over the past 10 years. 78% female and 22% male. There were equal numbers of males and females with Lymphocytic colitis, but 5 times as many females had Collagenous colitis.
Time for Colonoscopic Withdrawal of the Endoscope during
Colonoscopy
We set up a prospective study, to see if the time spent in
examining the colon when withdrawing it from the end of the
colon was similar to national recommendations. These
recommendations were based on a very small study, so we wished
to see how this related to the Orlando GI community. Over
a 6 month period, 14 endoscopists were clocked on their
procedure times, and a total of 1337 colonoscopies were
examined. The average withdrawal time was 6.15 minutes without
polyps and 8.75 minutes with polyps or biopsies. This did
fall into the lower range of what had been recommended,
suggesting a high level of quality regarding colonoscopic
evaluations in this community.
[ Link to full Colonic Withdrawal Abstract Presentation Poster ]
Endoscopic Appearance of the Terminal Ileum in 100 Normal
Patients
Out of interest 100 patients were studied during Colonoscopy to
evaluate the anatomic variants associated with normal
individuals. This has never been reported in the
endoscopic literature. We did not find any pathology, but
found lymphoid nodules (Peyer’s patches) in 14% of patients and
large visible villi in 12%. This should help avoid
unnecessary biopsies by the inexperienced endoscopist.
[ Link to full Endoscopic Appearance of the Terminal Ileum Abstract Poster ]
Low Prevalence of H. Pylori Associated Gastric Cancer in
Our Community
Over the past 15 years we saw 49 patients with gastric cancer.
Only 12% were H. Pylori positive. The remainder (88%) did
not have H. Pylori associated with the cancer. The
prevalence of Gastric Cancer seemed to decline in the last 5
years. Interestingly, we did not find a stronger
association with H. Pylori in patients born outside the United
States.
Our conclusion was that H. Pylori does not appear to have a strong correlation with Gastric Cancer.
[ Link to full Gastric Cancer Abstract ]
For more information on H. Pylori, see the H. Pylori information page in the Patient Information section.
[A separate article titled What is the Role Of Helicobacter Pylori in Peptic Ulcer and Gastric Cancer Outside the Big Cities was published by our practice]
Lack of Relationship of Ischemic Colitis with Irritable
Bowel Syndrome
We reviewed our experience with patients who were diagnosed with
ischemic colitis, finding only 32 patients over the past 10
years. 88% were female, 12% were males. Only 2
required surgery, the rest healed with conservative treatment.
Ischemic Colitis is inflammation of the colon due to a lack of oxygen to the tissue for a period of time. It is uncommon, occurring in 0.16% of colonoscopies we performed. 0.13% of IBS patients seen over the past decade developed ischemic colitis, showing no clear relationship between the 2 entities. This data refutes some of the published studies over the past few years.
The Risk of Colorectal Cancer in Ulcerative Colitis in a
Population-Based Setting
This editorial in the journal Gastroenterology reviewed our
findings of extremely low incidence of cancer, even in patients
with long standing Ulcerative Colitis. This reflects our
experience over the past 15 years. There is likewise a very low
incidence of any type of dysplasia that has been found on
surveillance biopsies. This may be due to changes in the disease
process itself, or due in part to the better chronic medical
treatment most patients receive. In either case this is
excellent news for our patients.
[ Link to Abstract ]
New Abstracts published in the 2006 American Journal of Gastroenterology:
Does
the Timing of Laxatives make a Difference in Colonoscopy Prep
Outcomes?
(see larger version of individual abstract)
This study revealed that by starting the preparation late in the afternoon, as opposed to the morning, the patients had much cleaner colons and that means a better exam. They likely spent more time drinking fluids all day. That helped hydrate the colon. Also, patients did not have to miss much work. They only had to get home by 5pm the day prior to the procedure, helping them to avoid the costs of lost wages and the costs to their companies of an absent employee.
Declining Prevalence of New Cases of Ulcerative Colitis
(see larger version of individual abstract)
Rapidly Rising Prevalence of Microscopic Colitis
(see larger version of individual abstract)
This study, over the past 15 years, revealed a sharp rise in the number of cases of Microcopic colitis since 2004. It is still relatively rare, but it has now significantly exceeded the number of cases of Crohn's disease and Ulcerative colitis that we see. We are the first to report this observation, and will keep a vigilant eye for further developments. This is now the most common (of the unusual) causes of diarrhea, excluding bacterial and viral diseases.
Prevalence of Barrett's Esophagus among Symptomatic Patients in
a Community GI Practice
(see larger version of individual abstract)
This study revealed a much lower prevalence (or cases of Barrett's per year) than was previously thought. There is not much community data available in general and less in this country. We are the first community report on these figures. Fewer than 0.5% of patients had a long segment Barrett's, and 1% of patients had a short segment Barrett's Esophagus.
Prevalence of Adenocarcinoma in Small Adenomas
(see larger version of individual abstract)
Celiac Disease in the Adult Community: Still a Rare Occurrence
The pharmaceutical companies have focused on pharmacist review data that suggests that caution be given to using antispasmodic drugs in patients over age 65, due to the potential of increased side effects. As a practitioner of clinical medicine for almost 30 years, it has been my long term observation that patients over 65, and up to the mid-nineties (90’s) benefit tremendously from these drugs and suffer few if any adverse effects, even at routine doses. All of these drugs are generics at this point, and have been available for over 65 years. I studied 100 patients over the age of 65 and found 85% to have very good results, 12% good results and only 3% didn’t benefit or had side effects. The most common side effect is a dry mouth that does not preclude its use, but is more of a nuisance. Examples of these drugs are Levsin, Hyoscyamine, Bentyl, Dicyclomine, Librax and Donnatal/Belladona. Unfortunately, proper usage and dosing is often not applied by many doctors, and therefore their results are suboptimal. That, however, can be improved with proper education of the patients to the optimal manner of taking these medicines.
