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Introduction: Anti-endomysial antibodies have high specificity (90%) for the presence of coeliac disease, but there are ethical and cost issues associated with using monkey oesophagus for clinical tests. Tissue transglutaminase [...]

Background: Previous researchers have shown that non-medical endoscopists can perform lower gastrointestinal endoscopy as safely and effectively as medical staff. However, it is not known if upper gastrointestinal endoscopy performed by medical and non-medical endoscopists in clinical practice yields similar results in terms of performance, patient discomfort, and satisfaction. Aim: To determine differences in the yield of diagnosis for significant disease during upper gastrointestinal endoscopy performed by nurse and medical endoscopists and to measure patient discomfort, satisfaction, and attitudes towards future endoscopy. Patients: This two part study included 3009 patients in a retrospective analysis and 480 in a prospective study. Methods: The first part of the study assessed indications for endoscopy, diagnoses, and procedures performed by medical and nurse endoscopists. In a second prospective study, 480 patients were included to determine the association between endoscopist type and sedation, patient anxiety, discomfort, satisfaction, and attitudes towards future sedation. Results: No patient refused endoscopy by either a nurse or medical endoscopist and there were no complications in either group. Nurses performed 1487 procedures and reported fewer endoscopies as "normal" than medical staff (p=0.006). Multivariate analysis showed that male sex, older age, inpatient status, dysphagia, and gastrointestinal bleeding, but not endoscopist type, were all associated with significant disease. In relation to discomfort and satisfaction, a similar proportion of patients received sedation in both groups (p=0.81). There were no differences in pre-procedure anxiety (p=0.61), discomfort during intubation (p=0.97), discomfort during examination (p=0.90), or post-procedure examination rating (p=0.79) in patients examined by medical or nurse endoscopists. Conclusion: Experienced nurses perform routine diagnostic gastroscopy safely in everyday clinical practice and with as little discomfort and as much patient satisfaction as medical staff. [ABSTRACT FROM AUTHOR]

OBJECTIVE:There are few data to guide the choice between colonoscopy and flexible sigmoidoscopy in patients with nonacute rectal bleeding, especially in younger age groups. Our aim was to determine the yield of colonoscopy for significant proximal large bowel disease in the absence of significant distal disease, with special reference to young patients.METHODS:This was a retrospective study of data collected prospectively in 1766 patients (median age 57 yr, 711 women). The endoscopic database (GI-Trac) contained 152 discrete fields for data input. Multiple logistic regression analysis was performed to identify variables independently associated with the presence of isolated significant proximal disease.RESULTS:Young patients had a higher percentage of normal examinations than did older patients. The incidence of diverticular disease, small polyps, large polyps, and cancer rose with increasing age. No patient aged <40 yr had an isolated proximal cancer, but 7% had other significant isolated proximal disease. There was no overall association between age and significant proximal disease in the absence of significant distal disease (p = 0.66). The only variable associated with isolated proximal disease was anemia (odds ratio = 1.81; 95% CI = 1.11–2.93; p = 0.02).CONCLUSION:The yield of colonoscopy (beyond the range of sigmoidoscopy) for neoplasia is low in patients aged <40 yr, but other significant disease may be missed if age is the only criterion determining colonoscopy use. [Copyright &y& Elsevier]

Introduction: There has been a 1000% increase in the output of colorectal cancer research over the past 30 years and many diagnostic, surgical, and oncological advances. These might be expected to have had a favourable impact on survival but it is not known if this is the case. Aim: To determine colorectal cancer survival trends over a 20 year period in a single institution. Patients: 1853 consecutive patients admitted to St Vincent's University Hospital, Dublin between 1983 and 2002 were prospectively entered onto a database. Demographic, clinical, and pathological data were collected and patients were followed until death. For analysis, the study group was divided into tertiles based upon year of diagnosis. Results: Age rose over the study period (p < 0.001) while the percentage of patients undergoing tumour resection decreased from 96% to 88% (p < 0.001). There were no changes in sex (p = 0.35), tumour site (p = 0.52), or overall tumour stage (0.58). However, on subsection analysis, the proportion of stage II tumours decreased and stage III tumours increased in frequency over time (p = 0.02). Cancer related survival improved over the period from 45% to 56% (p = 0.005). On substage analysis, only those with stage Ill cancers had a significant improvement in survival (p = 0.05). Conclusions: There has been a modest improvement in colorectal cancer survival over the past 20 years that may be related to a number of discrete factors. The improvement appears greatest in stage III tumours but this is as likely to be related to stage migration over the 20 years as it is to any therapeutic advances. [ABSTRACT FROM AUTHOR]