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To evaluate the adequacy of benzodiazepine/opiate sedation for endoscopic procedures and to identify patient and procedure characteristics that may predict poor procedural tolerance.A total of 2155 patients who underwent sedated gastroscopy, colonoscopy or flexible sigmoidoscopy between January and December 2007, participated in the prospective evaluation of procedural tolerance and the procedures were evaluated using three questionnaires completed by the patient, endoscopist and assisting nurse. Perception of procedural tolerance was scored using a 100-point visual analog scale (VAS), 0: very good to 100: very poorly. In order to identify patient and procedure characteristics predictive of poor procedural tolerance, we compared 10% of patients who tolerated the procedure least well with the remaining patients.About 216 (10%) of 2155 patients gave a VAS score of30, and were compared with the 1939 patients with a VAS30. Patients who tolerated the procedure least well (VAS ≥30) were more likely female [odds ratio (OR) 2.8, 95% confidence interval 1.9-4.1], had colonoscopy (OR 2.9, 1.8-4.5) or had a training endoscopist perform the procedure (OR 3.2, 2.2-4.8). Patients with BMI ≥35 were also more likely to have a VAS ≥30 (p0.01). Sedation type and American Society of Anesthesiologists grade had no significant effect on patient tolerance.A majority of patients tolerate endoscopic procedures well when benzodiazepine/opiate sedation is used. Accurately identifying the minority who tolerate these procedures less well remains difficult.

Background and Aims The CLOtest® and other rapid urease detection kits are widely used in the endoscopic diagnosis of Helicobacter pylori. A new formulation CLOtest has been developed with the goal of obtaining a positive result more rapidly. The aims of this study were to validate the sensitivity and specificity of the new test and compare the time taken for a positive result to be visible in both the new and standard CLOtest. Methods Patients presenting for endoscopy at three Western Australian hospitals were prospectively enrolled. Gastric mucosal biopsies were obtained for the standard and new CLOtest and for histology. Grading of color change was conducted by staff blinded to the type of CLOtest used and conducted according to a standardized color chart. Helicobacter pylori status was defined by the combination of a positive standard CLOtest and histology, against which the new CLOtest was compared. Results were obtained at 1, 3 and 24 h, and at one center, at 10 min intervals for the first hour. Results Three hundred and thirty-five patients were enrolled. Eighty-eight Helicobacter pylori-positive individuals were identified. At 24 h, the new test correctly identified all 88, with one false-positive result (sensitivity 100%, specificity 99.6%). At 1 h, sensitivity was 93% with a number of early false-positive results reducing specificity to 96%. Compared to the current CLOtest, the new formulation became positive faster at 20 min (P = 0.001, n = 51), but was similar at 1 h (P = 0.06, n = 88) and equivalent at 3 h. Conclusions The new formulation CLOtest is sensitive and specific, with a trend to give early positive results more quickly, although accuracy at 3 and 24 h is the same.

Whipple's disease is a multisystem disorder that was first reported just over 100 years ago. Only recently, the bacillus responsible for the condition was identified and subsequently cultured. However, differences of opinion remain regarding the best antibiotic regimen and duration of therapy at primary diagnosis and there is also great uncertainty about the management of disease relapse. We report a case of clinical relapse of Whipple's disease in a man who was on a prolonged therapy with trimethoprim-sulfamethoxazole. We describe his management and review the literature on the treatment of this condition, with particular reference to the recurrence of the disease.