Heidi Splete

PARIS – Patients with mild traumatic brain injury who reported all or nothing behavior were significantly more likely to have postconcussional syndrome 3 months later, data from a prospective study of 107 adults have shown.

Approximately 15%-30% of mild traumatic brain injury (MTBI) patients are at risk of developing postconcussional syndrome (PCS), Dr. Ruihua Hou of the University of Southampton (England) explained at the annual meeting of the European Congress of Neuropsychopharmacology.

PCS is a symptom cluster that includes physical, cognitive, emotional, and behavioral symptoms. To investigate the etiology of PCS, the researchers developed a cognitive-behavioral model that compared MTBI patients who did and did not develop the syndrome.

Patients were assessed for cognitive, behavioral, emotional, and social variables at baseline using the Brief Illness Perception Questionnaire, the Behavioral Responses to Illness Questionnaire, the Impact of Events Scale, the Hospital Anxiety and Depression Scale, the Anxiety Sensitivity Index, and the Brief Social Support Questionnaire.

At the 3- and 6-month follow-up visits, the researchers used the Rivermead Post-Concussion Symptoms Questionnaire to assess the severity of PCS symptoms and the ICD-10 code F07.2 to diagnose PCS.

All or nothing behavior shortly after MTBI was a significant predictor for the onset of PCS at 3 months (odds ratio, 1.141).

However, all or nothing behavior was not a significant predictor of PCS after 6 months, the researchers noted. Instead, patients’ early negative injury perception was a significant predictor of the onset of PCS after 6 months (odds ratio, 1.053).

At 3 months and 6 months, no significant differences were observed between PCS cases and noncases with regard to demographics, including age, sex, education level, and occupation.

Although the findings were limited by the prospective nature of the study, they provide support for the cognitive model that was used, Dr. Hou said.

In addition, "the findings provide research evidence for the role of illness perception and coping behavior shortly after MTBI in the development of PCS and indicate that they may be important early-intervention targets," Dr. Hou emphasized.

The study was funded by the Faculty of Medicine Research Management Committee at the University of Southampton. The researchers said they had no relevant financial disclosures.

PARIS – Patients with mild traumatic brain injury who reported all or nothing behavior were significantly more likely to have postconcussional syndrome 3 months later, data from a prospective study of 107 adults have shown.

Approximately 15%-30% of mild traumatic brain injury (MTBI) patients are at risk of developing postconcussional syndrome (PCS), Dr. Ruihua Hou of the University of Southampton (England) explained at the annual meeting of the European Congress of Neuropsychopharmacology.

PCS is a symptom cluster that includes physical, cognitive, emotional, and behavioral symptoms. To investigate the etiology of PCS, the researchers developed a cognitive-behavioral model that compared MTBI patients who did and did not develop the syndrome.

Patients were assessed for cognitive, behavioral, emotional, and social variables at baseline using the Brief Illness Perception Questionnaire, the Behavioral Responses to Illness Questionnaire, the Impact of Events Scale, the Hospital Anxiety and Depression Scale, the Anxiety Sensitivity Index, and the Brief Social Support Questionnaire.

At the 3- and 6-month follow-up visits, the researchers used the Rivermead Post-Concussion Symptoms Questionnaire to assess the severity of PCS symptoms and the ICD-10 code F07.2 to diagnose PCS.

All or nothing behavior shortly after MTBI was a significant predictor for the onset of PCS at 3 months (odds ratio, 1.141).

However, all or nothing behavior was not a significant predictor of PCS after 6 months, the researchers noted. Instead, patients’ early negative injury perception was a significant predictor of the onset of PCS after 6 months (odds ratio, 1.053).

At 3 months and 6 months, no significant differences were observed between PCS cases and noncases with regard to demographics, including age, sex, education level, and occupation.

Although the findings were limited by the prospective nature of the study, they provide support for the cognitive model that was used, Dr. Hou said.

In addition, "the findings provide research evidence for the role of illness perception and coping behavior shortly after MTBI in the development of PCS and indicate that they may be important early-intervention targets," Dr. Hou emphasized.

The study was funded by the Faculty of Medicine Research Management Committee at the University of Southampton. The researchers said they had no relevant financial disclosures.

PARIS – Patients with mild traumatic brain injury who reported all or nothing behavior were significantly more likely to have postconcussional syndrome 3 months later, data from a prospective study of 107 adults have shown.

Approximately 15%-30% of mild traumatic brain injury (MTBI) patients are at risk of developing postconcussional syndrome (PCS), Dr. Ruihua Hou of the University of Southampton (England) explained at the annual meeting of the European Congress of Neuropsychopharmacology.

PCS is a symptom cluster that includes physical, cognitive, emotional, and behavioral symptoms. To investigate the etiology of PCS, the researchers developed a cognitive-behavioral model that compared MTBI patients who did and did not develop the syndrome.

Patients were assessed for cognitive, behavioral, emotional, and social variables at baseline using the Brief Illness Perception Questionnaire, the Behavioral Responses to Illness Questionnaire, the Impact of Events Scale, the Hospital Anxiety and Depression Scale, the Anxiety Sensitivity Index, and the Brief Social Support Questionnaire.

At the 3- and 6-month follow-up visits, the researchers used the Rivermead Post-Concussion Symptoms Questionnaire to assess the severity of PCS symptoms and the ICD-10 code F07.2 to diagnose PCS.

All or nothing behavior shortly after MTBI was a significant predictor for the onset of PCS at 3 months (odds ratio, 1.141).

However, all or nothing behavior was not a significant predictor of PCS after 6 months, the researchers noted. Instead, patients’ early negative injury perception was a significant predictor of the onset of PCS after 6 months (odds ratio, 1.053).

At 3 months and 6 months, no significant differences were observed between PCS cases and noncases with regard to demographics, including age, sex, education level, and occupation.

Although the findings were limited by the prospective nature of the study, they provide support for the cognitive model that was used, Dr. Hou said.

In addition, "the findings provide research evidence for the role of illness perception and coping behavior shortly after MTBI in the development of PCS and indicate that they may be important early-intervention targets," Dr. Hou emphasized.

The study was funded by the Faculty of Medicine Research Management Committee at the University of Southampton. The researchers said they had no relevant financial disclosures.

NATIONAL HARBOR, MD. – Treating patients with both rosacea and small intestinal bacterial overgrowth with the drug rifaximin was associated with improved rosacea symptoms in some patients, in a small, preliminary study. The findings were presented at the annual meeting of the American College of Gastroenterology.

Previous studies have shown a relationship between gastrointestinal bacteria and various skin disorders such as scleroderma, and a small case series showed that rosacea improved when patients with small intestinal bacterial overgrowth (SIBO) were treated with rifaximin, said Dr. Leonard B. Weinstock of Specialists in Gastroenterology in St. Louis.

Dr. Weinstock identified 63 patients with rosacea; the average age of the patients was 56 years. Most of them, 57 patients, had been diagnosed with facial rosacea by a dermatologist, and 4 had been diagnosed with ocular rosacea by an ophthalmologist. The rosacea patients were compared to 30 healthy controls and 30 general population controls. All study participants underwent lactulose breath testing to determine whether they had SIBO.

Overall, SIBO was significantly more common in the rosacea patients (50%) than in the general population controls (23%) or the healthy controls (10%). All four patients with ocular rosacea had SIBO.

A total of 32 rosacea patients were positive for SIBO, and 28 of these (including all ocular rosacea patients) received 1200 mg/day of rifaximin (two 200-mg tablets 3 times daily) for 10 days. Of the treated patients, 46% showed clearance of, or marked improvement in, rosacea symptoms, while another 25% showed moderate improvement.

"All four patients with ocular rosacea and SIBO reported marked improvement in conjunctivitis, sclera erythema, and dry eyes following treatment with rifaximin," Dr. Weinstock noted.

A large, randomized clinical trial is underway to further explore the possible benefits of rifaximin in patients with rosacea and SIBO, Dr. Weinstock added.

The study was supported by a grant from Salix Pharmaceuticals, maker of rifaximin.

NATIONAL HARBOR, MD. – Treating patients with both rosacea and small intestinal bacterial overgrowth with the drug rifaximin was associated with improved rosacea symptoms in some patients, in a small, preliminary study. The findings were presented at the annual meeting of the American College of Gastroenterology.

Previous studies have shown a relationship between gastrointestinal bacteria and various skin disorders such as scleroderma, and a small case series showed that rosacea improved when patients with small intestinal bacterial overgrowth (SIBO) were treated with rifaximin, said Dr. Leonard B. Weinstock of Specialists in Gastroenterology in St. Louis.

Dr. Weinstock identified 63 patients with rosacea; the average age of the patients was 56 years. Most of them, 57 patients, had been diagnosed with facial rosacea by a dermatologist, and 4 had been diagnosed with ocular rosacea by an ophthalmologist. The rosacea patients were compared to 30 healthy controls and 30 general population controls. All study participants underwent lactulose breath testing to determine whether they had SIBO.

Overall, SIBO was significantly more common in the rosacea patients (50%) than in the general population controls (23%) or the healthy controls (10%). All four patients with ocular rosacea had SIBO.

A total of 32 rosacea patients were positive for SIBO, and 28 of these (including all ocular rosacea patients) received 1200 mg/day of rifaximin (two 200-mg tablets 3 times daily) for 10 days. Of the treated patients, 46% showed clearance of, or marked improvement in, rosacea symptoms, while another 25% showed moderate improvement.

"All four patients with ocular rosacea and SIBO reported marked improvement in conjunctivitis, sclera erythema, and dry eyes following treatment with rifaximin," Dr. Weinstock noted.

A large, randomized clinical trial is underway to further explore the possible benefits of rifaximin in patients with rosacea and SIBO, Dr. Weinstock added.

The study was supported by a grant from Salix Pharmaceuticals, maker of rifaximin.

NATIONAL HARBOR, MD. – Treating patients with both rosacea and small intestinal bacterial overgrowth with the drug rifaximin was associated with improved rosacea symptoms in some patients, in a small, preliminary study. The findings were presented at the annual meeting of the American College of Gastroenterology.

Previous studies have shown a relationship between gastrointestinal bacteria and various skin disorders such as scleroderma, and a small case series showed that rosacea improved when patients with small intestinal bacterial overgrowth (SIBO) were treated with rifaximin, said Dr. Leonard B. Weinstock of Specialists in Gastroenterology in St. Louis.

Dr. Weinstock identified 63 patients with rosacea; the average age of the patients was 56 years. Most of them, 57 patients, had been diagnosed with facial rosacea by a dermatologist, and 4 had been diagnosed with ocular rosacea by an ophthalmologist. The rosacea patients were compared to 30 healthy controls and 30 general population controls. All study participants underwent lactulose breath testing to determine whether they had SIBO.

Overall, SIBO was significantly more common in the rosacea patients (50%) than in the general population controls (23%) or the healthy controls (10%). All four patients with ocular rosacea had SIBO.

A total of 32 rosacea patients were positive for SIBO, and 28 of these (including all ocular rosacea patients) received 1200 mg/day of rifaximin (two 200-mg tablets 3 times daily) for 10 days. Of the treated patients, 46% showed clearance of, or marked improvement in, rosacea symptoms, while another 25% showed moderate improvement.

"All four patients with ocular rosacea and SIBO reported marked improvement in conjunctivitis, sclera erythema, and dry eyes following treatment with rifaximin," Dr. Weinstock noted.

A large, randomized clinical trial is underway to further explore the possible benefits of rifaximin in patients with rosacea and SIBO, Dr. Weinstock added.

The study was supported by a grant from Salix Pharmaceuticals, maker of rifaximin.

NATIONAL HARBOR, MD. – Polyp detection rates were significantly higher among endoscopists who completed a quality-improvement training program, compared with rates of those who did not in a randomized, controlled trial of 15 endoscopists and 2,400 procedures. The findings were presented at the annual meeting of the American College of Gastroenterology.

Adenoma detection rate is a key quality indicator for colonoscopy, and previous studies have shown associations between physicians’ behavior (such as looking behind folds, and the time spent inspecting the colon) and rates of adenoma detection, said Dr. Susan Coe of the Mayo Clinic in Jacksonville, Fla.

However, attempts at improving polyp detection rates, including discussions with low-performing physicians, required withdrawal times, and financial penalties, have proven unsuccessful, she said.

Dr. Coe and her colleagues, including senior investigator Dr. Michael B. Wallace, designed a prospective, randomized educational intervention to determine whether targeted endoscopist training would increase polyp detection rates.

"This is the first study to our knowledge to prospectively show that adenoma detection rate can be significantly improved through an intensive, structured endoscopist training program," Dr. Coe said.

In the first phase of the study, the endoscopists performed 1,200 colonoscopies to determine their baseline detection rates. The average baseline rate was 36% among endoscopists randomized to both the training and non-training groups.

In the second phase of the study, the endoscopists performed another 1,200 colonoscopies after half of them had completed the training program. Among endoscopists in the training group, the average adenoma detection rate increased significantly to 47%, compared to 35% in the non-training group.

The Endoscopic Quality Improvement Program consisted of two 1-hour small group sessions. The first session included literature, photo, and video examples of polyps, explanations of techniques from high-detecting endoscopists, and information about subtle lesions such as flat and serrated polyps.

The second session consisted of a validated surface pattern recognition exercise. The participants in the training program received monthly feedback on their adenoma detection rates, withdrawal times, and group averages after completing the program.

The baseline characteristics of the endoscopists who underwent training and those who did not were similar overall. Median age in the trained and untrained groups was 45 years and 50 years, respectively.

Dr. Coe noted that the findings were limited by the small number of endoscopists and the single setting, but the study is ongoing to see whether the improvements associated with training persist. Larger studies are also planned, she said.

Dr. Coe said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Polyp detection rates were significantly higher among endoscopists who completed a quality-improvement training program, compared with rates of those who did not in a randomized, controlled trial of 15 endoscopists and 2,400 procedures. The findings were presented at the annual meeting of the American College of Gastroenterology.

Adenoma detection rate is a key quality indicator for colonoscopy, and previous studies have shown associations between physicians’ behavior (such as looking behind folds, and the time spent inspecting the colon) and rates of adenoma detection, said Dr. Susan Coe of the Mayo Clinic in Jacksonville, Fla.

However, attempts at improving polyp detection rates, including discussions with low-performing physicians, required withdrawal times, and financial penalties, have proven unsuccessful, she said.

Dr. Coe and her colleagues, including senior investigator Dr. Michael B. Wallace, designed a prospective, randomized educational intervention to determine whether targeted endoscopist training would increase polyp detection rates.

"This is the first study to our knowledge to prospectively show that adenoma detection rate can be significantly improved through an intensive, structured endoscopist training program," Dr. Coe said.

In the first phase of the study, the endoscopists performed 1,200 colonoscopies to determine their baseline detection rates. The average baseline rate was 36% among endoscopists randomized to both the training and non-training groups.

In the second phase of the study, the endoscopists performed another 1,200 colonoscopies after half of them had completed the training program. Among endoscopists in the training group, the average adenoma detection rate increased significantly to 47%, compared to 35% in the non-training group.

The Endoscopic Quality Improvement Program consisted of two 1-hour small group sessions. The first session included literature, photo, and video examples of polyps, explanations of techniques from high-detecting endoscopists, and information about subtle lesions such as flat and serrated polyps.

The second session consisted of a validated surface pattern recognition exercise. The participants in the training program received monthly feedback on their adenoma detection rates, withdrawal times, and group averages after completing the program.

The baseline characteristics of the endoscopists who underwent training and those who did not were similar overall. Median age in the trained and untrained groups was 45 years and 50 years, respectively.

Dr. Coe noted that the findings were limited by the small number of endoscopists and the single setting, but the study is ongoing to see whether the improvements associated with training persist. Larger studies are also planned, she said.

Dr. Coe said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Polyp detection rates were significantly higher among endoscopists who completed a quality-improvement training program, compared with rates of those who did not in a randomized, controlled trial of 15 endoscopists and 2,400 procedures. The findings were presented at the annual meeting of the American College of Gastroenterology.

Adenoma detection rate is a key quality indicator for colonoscopy, and previous studies have shown associations between physicians’ behavior (such as looking behind folds, and the time spent inspecting the colon) and rates of adenoma detection, said Dr. Susan Coe of the Mayo Clinic in Jacksonville, Fla.

However, attempts at improving polyp detection rates, including discussions with low-performing physicians, required withdrawal times, and financial penalties, have proven unsuccessful, she said.

Dr. Coe and her colleagues, including senior investigator Dr. Michael B. Wallace, designed a prospective, randomized educational intervention to determine whether targeted endoscopist training would increase polyp detection rates.

"This is the first study to our knowledge to prospectively show that adenoma detection rate can be significantly improved through an intensive, structured endoscopist training program," Dr. Coe said.

In the first phase of the study, the endoscopists performed 1,200 colonoscopies to determine their baseline detection rates. The average baseline rate was 36% among endoscopists randomized to both the training and non-training groups.

In the second phase of the study, the endoscopists performed another 1,200 colonoscopies after half of them had completed the training program. Among endoscopists in the training group, the average adenoma detection rate increased significantly to 47%, compared to 35% in the non-training group.

The Endoscopic Quality Improvement Program consisted of two 1-hour small group sessions. The first session included literature, photo, and video examples of polyps, explanations of techniques from high-detecting endoscopists, and information about subtle lesions such as flat and serrated polyps.

The second session consisted of a validated surface pattern recognition exercise. The participants in the training program received monthly feedback on their adenoma detection rates, withdrawal times, and group averages after completing the program.

The baseline characteristics of the endoscopists who underwent training and those who did not were similar overall. Median age in the trained and untrained groups was 45 years and 50 years, respectively.

Dr. Coe noted that the findings were limited by the small number of endoscopists and the single setting, but the study is ongoing to see whether the improvements associated with training persist. Larger studies are also planned, she said.

Dr. Coe said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – A screening colonoscopy can provide a convenient opportunity to simultaneously test older adults for hepatitis, based on a study of 500 patients, 75% of whom agreed to blood tests for hepatitis A, B, and C.

Adults aged 50-65 years (the "baby boomers") represent a high-risk population for hepatitis, and hepatitis C in particular, because of possible exposure to high-risk activities in their teens and twenties, said Dr. Dawn Sears of Scott & White Hospital in Temple, Tex. The findings were presented at the annual meeting of the American College of Gastroenterology.

Men make up 70% of chronic hepatitis cases, and they are less likely to see a doctor regularly than women, she noted. "Colorectal cancer screenings are often the only physician encounter for men aged 50 to 60 years," she said.

To increase hepatitis screening in older adults, Dr. Sears and her colleagues tested whether combining hepatitis testing with routine colonoscopy appointments would be effective.

Patients were mailed information about hepatitis along with their instructions for colonoscopy preparation. On the day of their colonoscopies, patients met with a research nurse, signed a consent form, and completed a patient risk form. Blood was drawn for hepatitis screening when the IV was placed prior to the colonoscopy.

A total of 376 of 500 patients (75%) undergoing colonoscopies agreed to hepatitis testing. The study population was 42% male and 58% female. Risk factors in the patients’ histories included high-risk sexual activity, getting a tattoo prior to the year 2000, injecting or snorting drugs, having a blood transfusion before 1992, having a sexual partner with known hepatitis, being a health care worker who had been stuck with a needle, and spending at least 2 days in jail.

None of the patients had hepatitis B surface antigens, and 77% did not have antibodies against hepatitis A and B. Four patients had results suggesting previously undiagnosed hepatitis C, and all four complied with the recommended follow-up polymerase chain reaction (PCR) testing. One patient had a positive PCR follow-up, and that patient is beginning triple therapy, Dr. Sears said. All patients who were found to have hepatitis C antibodies had risk factors for hepatitis C infection, she noted.

"We should ask about risk factors and consider screening for hepatitis B and C," Dr. Sears said. "Gastroenterologists see most baby boomers at least once. We understand the [test] results, and this provides the highest quality, most efficient health care for our patients."

Dr. Sears said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – A screening colonoscopy can provide a convenient opportunity to simultaneously test older adults for hepatitis, based on a study of 500 patients, 75% of whom agreed to blood tests for hepatitis A, B, and C.

Adults aged 50-65 years (the "baby boomers") represent a high-risk population for hepatitis, and hepatitis C in particular, because of possible exposure to high-risk activities in their teens and twenties, said Dr. Dawn Sears of Scott & White Hospital in Temple, Tex. The findings were presented at the annual meeting of the American College of Gastroenterology.

Men make up 70% of chronic hepatitis cases, and they are less likely to see a doctor regularly than women, she noted. "Colorectal cancer screenings are often the only physician encounter for men aged 50 to 60 years," she said.

To increase hepatitis screening in older adults, Dr. Sears and her colleagues tested whether combining hepatitis testing with routine colonoscopy appointments would be effective.

Patients were mailed information about hepatitis along with their instructions for colonoscopy preparation. On the day of their colonoscopies, patients met with a research nurse, signed a consent form, and completed a patient risk form. Blood was drawn for hepatitis screening when the IV was placed prior to the colonoscopy.

A total of 376 of 500 patients (75%) undergoing colonoscopies agreed to hepatitis testing. The study population was 42% male and 58% female. Risk factors in the patients’ histories included high-risk sexual activity, getting a tattoo prior to the year 2000, injecting or snorting drugs, having a blood transfusion before 1992, having a sexual partner with known hepatitis, being a health care worker who had been stuck with a needle, and spending at least 2 days in jail.

None of the patients had hepatitis B surface antigens, and 77% did not have antibodies against hepatitis A and B. Four patients had results suggesting previously undiagnosed hepatitis C, and all four complied with the recommended follow-up polymerase chain reaction (PCR) testing. One patient had a positive PCR follow-up, and that patient is beginning triple therapy, Dr. Sears said. All patients who were found to have hepatitis C antibodies had risk factors for hepatitis C infection, she noted.

"We should ask about risk factors and consider screening for hepatitis B and C," Dr. Sears said. "Gastroenterologists see most baby boomers at least once. We understand the [test] results, and this provides the highest quality, most efficient health care for our patients."

Dr. Sears said she had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – A screening colonoscopy can provide a convenient opportunity to simultaneously test older adults for hepatitis, based on a study of 500 patients, 75% of whom agreed to blood tests for hepatitis A, B, and C.

Adults aged 50-65 years (the "baby boomers") represent a high-risk population for hepatitis, and hepatitis C in particular, because of possible exposure to high-risk activities in their teens and twenties, said Dr. Dawn Sears of Scott & White Hospital in Temple, Tex. The findings were presented at the annual meeting of the American College of Gastroenterology.

Men make up 70% of chronic hepatitis cases, and they are less likely to see a doctor regularly than women, she noted. "Colorectal cancer screenings are often the only physician encounter for men aged 50 to 60 years," she said.

To increase hepatitis screening in older adults, Dr. Sears and her colleagues tested whether combining hepatitis testing with routine colonoscopy appointments would be effective.

Patients were mailed information about hepatitis along with their instructions for colonoscopy preparation. On the day of their colonoscopies, patients met with a research nurse, signed a consent form, and completed a patient risk form. Blood was drawn for hepatitis screening when the IV was placed prior to the colonoscopy.

A total of 376 of 500 patients (75%) undergoing colonoscopies agreed to hepatitis testing. The study population was 42% male and 58% female. Risk factors in the patients’ histories included high-risk sexual activity, getting a tattoo prior to the year 2000, injecting or snorting drugs, having a blood transfusion before 1992, having a sexual partner with known hepatitis, being a health care worker who had been stuck with a needle, and spending at least 2 days in jail.

None of the patients had hepatitis B surface antigens, and 77% did not have antibodies against hepatitis A and B. Four patients had results suggesting previously undiagnosed hepatitis C, and all four complied with the recommended follow-up polymerase chain reaction (PCR) testing. One patient had a positive PCR follow-up, and that patient is beginning triple therapy, Dr. Sears said. All patients who were found to have hepatitis C antibodies had risk factors for hepatitis C infection, she noted.

"We should ask about risk factors and consider screening for hepatitis B and C," Dr. Sears said. "Gastroenterologists see most baby boomers at least once. We understand the [test] results, and this provides the highest quality, most efficient health care for our patients."

Dr. Sears said she had no financial conflicts to disclose.

CHICAGO – The shingles vaccine does not increase the risk of shingles in patients taking biologics for autoimmune or inflammatory conditions, based on data from more than 7,000 adults. The findings were presented at the annual meeting of the American College of Rheumatology.

The findings suggest that the current recommendations that biologics users avoid live virus vaccines may be overly cautious, said Dr. Jeffrey R. Curtis of the University of Alabama, Birmingham.

The shingles vaccine (Zostavax) is recommended to protect older adults against herpes zoster, Dr. Curtis said, but concerns have been raised that reactivation of the live virus after vaccination for patients taking immunosuppressive medications might increase their risk of a shingles eruption.

To determine the risk of shingles in a population taking immunosuppressive medication, Dr. Curtis and his colleagues reviewed Medicare data from 2006 to 2009. They identified 7,781 adults aged 60 years and older who had rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease, and who had received a shingles vaccine while taking medication including biologics, disease modifying antirheumatic drugs (DMARDs), and oral glucocorticoids. The mean age of the study population was 74 years, most were white women, and none had any evidence of shingles infection at baseline.

Overall, the incidence rate for shingles at least 42 days after vaccination was 8 cases/1,000 person-years among vaccinated adults, compared with 12 cases/1,000 person-years in a cohort of unvaccinated adults.

In a subset of 636 vaccinated adults who were taking biologics (regardless of concomitant DMARDs or oral glucocorticoids), no cases of shingles were reported within the first 42 days after vaccination, Dr. Curtis emphasized. In fact, vaccination was associated with a decrease in herpes zoster incidence of approximately 30%, he added. By contrast, the incidence rate of shingles in unvaccinated patients taking biologics was 16 per 1,000 person-years. The incidence of infection was not significantly different in vaccinated patients taking biologics than in vaccinated patients taking non-biologic DMARDs, Dr. Curtis added.

The study was limited by the lack of information about the disease severity, Dr. Curtis noted. But the findings support the safety and effectiveness of the shingles vaccine for biologics users.

There are persistent unmet vaccination needs for patients with diseases that require immunosuppressive therapy, said Dr. Curtis. "A controlled safety trial of the zoster vaccine in biologic users may be indicated to further demonstrate its safety and effectiveness in preventing zoster infection," he said.

The study was supported by the Agency for Healthcare Research and Quality and the National Institutes of Health. Dr. Curtis has received research grants and consulting fees from Abbott, Amgen, Bristol-Myers Squibb, Centocor, Genentech, Merck, Roche, and UCB.

CHICAGO – The shingles vaccine does not increase the risk of shingles in patients taking biologics for autoimmune or inflammatory conditions, based on data from more than 7,000 adults. The findings were presented at the annual meeting of the American College of Rheumatology.

The findings suggest that the current recommendations that biologics users avoid live virus vaccines may be overly cautious, said Dr. Jeffrey R. Curtis of the University of Alabama, Birmingham.

The shingles vaccine (Zostavax) is recommended to protect older adults against herpes zoster, Dr. Curtis said, but concerns have been raised that reactivation of the live virus after vaccination for patients taking immunosuppressive medications might increase their risk of a shingles eruption.

To determine the risk of shingles in a population taking immunosuppressive medication, Dr. Curtis and his colleagues reviewed Medicare data from 2006 to 2009. They identified 7,781 adults aged 60 years and older who had rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease, and who had received a shingles vaccine while taking medication including biologics, disease modifying antirheumatic drugs (DMARDs), and oral glucocorticoids. The mean age of the study population was 74 years, most were white women, and none had any evidence of shingles infection at baseline.

Overall, the incidence rate for shingles at least 42 days after vaccination was 8 cases/1,000 person-years among vaccinated adults, compared with 12 cases/1,000 person-years in a cohort of unvaccinated adults.

In a subset of 636 vaccinated adults who were taking biologics (regardless of concomitant DMARDs or oral glucocorticoids), no cases of shingles were reported within the first 42 days after vaccination, Dr. Curtis emphasized. In fact, vaccination was associated with a decrease in herpes zoster incidence of approximately 30%, he added. By contrast, the incidence rate of shingles in unvaccinated patients taking biologics was 16 per 1,000 person-years. The incidence of infection was not significantly different in vaccinated patients taking biologics than in vaccinated patients taking non-biologic DMARDs, Dr. Curtis added.

The study was limited by the lack of information about the disease severity, Dr. Curtis noted. But the findings support the safety and effectiveness of the shingles vaccine for biologics users.

There are persistent unmet vaccination needs for patients with diseases that require immunosuppressive therapy, said Dr. Curtis. "A controlled safety trial of the zoster vaccine in biologic users may be indicated to further demonstrate its safety and effectiveness in preventing zoster infection," he said.

The study was supported by the Agency for Healthcare Research and Quality and the National Institutes of Health. Dr. Curtis has received research grants and consulting fees from Abbott, Amgen, Bristol-Myers Squibb, Centocor, Genentech, Merck, Roche, and UCB.

CHICAGO – The shingles vaccine does not increase the risk of shingles in patients taking biologics for autoimmune or inflammatory conditions, based on data from more than 7,000 adults. The findings were presented at the annual meeting of the American College of Rheumatology.

The findings suggest that the current recommendations that biologics users avoid live virus vaccines may be overly cautious, said Dr. Jeffrey R. Curtis of the University of Alabama, Birmingham.

The shingles vaccine (Zostavax) is recommended to protect older adults against herpes zoster, Dr. Curtis said, but concerns have been raised that reactivation of the live virus after vaccination for patients taking immunosuppressive medications might increase their risk of a shingles eruption.

To determine the risk of shingles in a population taking immunosuppressive medication, Dr. Curtis and his colleagues reviewed Medicare data from 2006 to 2009. They identified 7,781 adults aged 60 years and older who had rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease, and who had received a shingles vaccine while taking medication including biologics, disease modifying antirheumatic drugs (DMARDs), and oral glucocorticoids. The mean age of the study population was 74 years, most were white women, and none had any evidence of shingles infection at baseline.

Overall, the incidence rate for shingles at least 42 days after vaccination was 8 cases/1,000 person-years among vaccinated adults, compared with 12 cases/1,000 person-years in a cohort of unvaccinated adults.

In a subset of 636 vaccinated adults who were taking biologics (regardless of concomitant DMARDs or oral glucocorticoids), no cases of shingles were reported within the first 42 days after vaccination, Dr. Curtis emphasized. In fact, vaccination was associated with a decrease in herpes zoster incidence of approximately 30%, he added. By contrast, the incidence rate of shingles in unvaccinated patients taking biologics was 16 per 1,000 person-years. The incidence of infection was not significantly different in vaccinated patients taking biologics than in vaccinated patients taking non-biologic DMARDs, Dr. Curtis added.

The study was limited by the lack of information about the disease severity, Dr. Curtis noted. But the findings support the safety and effectiveness of the shingles vaccine for biologics users.

There are persistent unmet vaccination needs for patients with diseases that require immunosuppressive therapy, said Dr. Curtis. "A controlled safety trial of the zoster vaccine in biologic users may be indicated to further demonstrate its safety and effectiveness in preventing zoster infection," he said.

The study was supported by the Agency for Healthcare Research and Quality and the National Institutes of Health. Dr. Curtis has received research grants and consulting fees from Abbott, Amgen, Bristol-Myers Squibb, Centocor, Genentech, Merck, Roche, and UCB.

Perhaps the best news about the cholesterol testing now recommended for all children aged 9-11 years by an expert panel convened by the National Heart, Lung, and Blood Institute is that children don’t have to fast before getting their blood drawn. The guidelines were published online on Nov. 13 and appear in the December issue of Pediatrics.

Dr. Stephen R. Daniels, chair of the expert panel that reviewed the guidelines, emphasized that the new approach to cholesterol screening can be accomplished with a blood test that does not require fasting, so it should be relatively easy to include in a busy practice. This strategy "ensures that children with elevated LDL (or bad) cholesterol will be identified."

Data from studies of the previous cholesterol-screening approach suggest that children with high cholesterol have often been missed, said Dr. Daniels, pediatrician-in-chief at the University of Colorado at Denver, Aurora.

Data from previous studies have shown that atherosclerosis begins in youth, and that heart attacks, strokes, and other cardiovascular problems in adulthood are often the end result of cardiovascular risk factors that went unrecognized throughout childhood, according to the report (Pediatrics 2011 Nov. 13 [doi:10.1542/peds.2009-2107C]).

The current guidelines represent the latest update since the 1990s, said Dr. Daniels.

"These guidelines are different in that they are based on a comprehensive and systematic review of the literature, they are integrated across all risk factors (hypertension, dyslipidemia, obesity, diabetes, and cigarette smoking) and lifestyle factors (diet and physical activity), and they address issues across the pediatric age range," he said in an interview.

Data from studies of the previous cholesterol-screening approach suggest that children with high cholesterol have often been missed, said Dr. Stephen R. Daniels.

The "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Summary Report" provides details for how to reduce risk factors and help prevent cardiovascular problems in children from birth to 21 years of age, starting with a recommendation for exclusive breastfeeding of children for the first 6 months of life.

However, the most notable new element in the guidelines is universal cholesterol-screening recommendation for preadolescents.

According to the guidelines, doctors should obtain a universal lipid screen with nonfasting non-HDL cholesterol (that is, total cholesterol minus HDL cholesterol) or a fasting lipid profile (FLP) for all children at least once between the ages of 9 and 11 years, and "manage per lipid algorithms as needed." Diet and exercise are recommended as first-line treatment, but statins may be considered in children whose high cholesterol persists despite diet and lifestyle interventions.

The guidelines recommend obtaining an FLP at age 12-17 years if a child’s family history is newly positive, if a parent has dyslipidemia, or if the child has any other risk factors or high-risk conditions, and then managing per lipid algorithms as needed.

For all patients aged 18-21 years, the guidelines recommend measuring one nonfasting non-HDL or FLP, and then reviewing the results with patients and managing them with lipid algorithms per Adult Treatment Panel III as needed.

Preventive steps to reduce risk and prevent cardiovascular disease in all ages include regular physical activity, with vigorous activity 3 days a week, according to the "Physical Activity Guidelines Advisory Committee Report 2008" from the Department of Health and Human Services.

Other preventive measures include a diet low in saturated fat for all children starting at 1 year of age, as well as both practice- and school-based interventions to keep children from smoking and to help them quit.

The guidelines also recommend annual blood pressure measurement for all children starting at 3 years of age, and interpreted for age, sex, and height. The report has a chart with an algorithm and flow diagram to assist clinicians in diagnosing hypertension in children.

"The rationale for these guidelines is that there is more and more evidence for the concept that atherosclerosis begins in childhood and depends on the same risk factors we are concerned about in adults," Dr. Daniels said. "This means that we should try to prevent these risk factors from developing in the first place (primordial prevention) and identify children at higher risk, so we can work on improving their lifestyle," he added.

"Cardiovascular disease is the most common cause of death for both men and women. So, this places great importance on these issues for primary care pediatricians. The new approach to screening may actually be easier to implement than the old strategy, which requires constant updating of the family history," noted Dr. Daniels, who is also chairman and professor of pediatrics at the university.

"This test should be done once for every child in the 9- to 11-year age range. The universal approach to screening will identify children with a genetic cause for their high cholesterol (1 in 500 children) and children with cholesterol abnormalities based more on lifestyle," said Dr. Daniels. "Both groups will benefit from lifestyle intervention, which can be useful in lowering their lifetime risk of cardiovascular disease."

Dr. Daniels has served as a consultant for Abbott Laboratories, Merck, and Schering-Plough, and has received funding/grant support for research from the National Institutes of Health. Other members of the committee that reviewed the guidelines disclosed research support from various agencies and pharmaceutical companies.

Perhaps the best news about the cholesterol testing now recommended for all children aged 9-11 years by an expert panel convened by the National Heart, Lung, and Blood Institute is that children don’t have to fast before getting their blood drawn. The guidelines were published online on Nov. 13 and appear in the December issue of Pediatrics.

Dr. Stephen R. Daniels, chair of the expert panel that reviewed the guidelines, emphasized that the new approach to cholesterol screening can be accomplished with a blood test that does not require fasting, so it should be relatively easy to include in a busy practice. This strategy "ensures that children with elevated LDL (or bad) cholesterol will be identified."

Data from studies of the previous cholesterol-screening approach suggest that children with high cholesterol have often been missed, said Dr. Daniels, pediatrician-in-chief at the University of Colorado at Denver, Aurora.

Data from previous studies have shown that atherosclerosis begins in youth, and that heart attacks, strokes, and other cardiovascular problems in adulthood are often the end result of cardiovascular risk factors that went unrecognized throughout childhood, according to the report (Pediatrics 2011 Nov. 13 [doi:10.1542/peds.2009-2107C]).

The current guidelines represent the latest update since the 1990s, said Dr. Daniels.

"These guidelines are different in that they are based on a comprehensive and systematic review of the literature, they are integrated across all risk factors (hypertension, dyslipidemia, obesity, diabetes, and cigarette smoking) and lifestyle factors (diet and physical activity), and they address issues across the pediatric age range," he said in an interview.

Data from studies of the previous cholesterol-screening approach suggest that children with high cholesterol have often been missed, said Dr. Stephen R. Daniels.

The "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Summary Report" provides details for how to reduce risk factors and help prevent cardiovascular problems in children from birth to 21 years of age, starting with a recommendation for exclusive breastfeeding of children for the first 6 months of life.

However, the most notable new element in the guidelines is universal cholesterol-screening recommendation for preadolescents.

According to the guidelines, doctors should obtain a universal lipid screen with nonfasting non-HDL cholesterol (that is, total cholesterol minus HDL cholesterol) or a fasting lipid profile (FLP) for all children at least once between the ages of 9 and 11 years, and "manage per lipid algorithms as needed." Diet and exercise are recommended as first-line treatment, but statins may be considered in children whose high cholesterol persists despite diet and lifestyle interventions.

The guidelines recommend obtaining an FLP at age 12-17 years if a child’s family history is newly positive, if a parent has dyslipidemia, or if the child has any other risk factors or high-risk conditions, and then managing per lipid algorithms as needed.

For all patients aged 18-21 years, the guidelines recommend measuring one nonfasting non-HDL or FLP, and then reviewing the results with patients and managing them with lipid algorithms per Adult Treatment Panel III as needed.

Preventive steps to reduce risk and prevent cardiovascular disease in all ages include regular physical activity, with vigorous activity 3 days a week, according to the "Physical Activity Guidelines Advisory Committee Report 2008" from the Department of Health and Human Services.

Other preventive measures include a diet low in saturated fat for all children starting at 1 year of age, as well as both practice- and school-based interventions to keep children from smoking and to help them quit.

The guidelines also recommend annual blood pressure measurement for all children starting at 3 years of age, and interpreted for age, sex, and height. The report has a chart with an algorithm and flow diagram to assist clinicians in diagnosing hypertension in children.

"The rationale for these guidelines is that there is more and more evidence for the concept that atherosclerosis begins in childhood and depends on the same risk factors we are concerned about in adults," Dr. Daniels said. "This means that we should try to prevent these risk factors from developing in the first place (primordial prevention) and identify children at higher risk, so we can work on improving their lifestyle," he added.

"Cardiovascular disease is the most common cause of death for both men and women. So, this places great importance on these issues for primary care pediatricians. The new approach to screening may actually be easier to implement than the old strategy, which requires constant updating of the family history," noted Dr. Daniels, who is also chairman and professor of pediatrics at the university.

"This test should be done once for every child in the 9- to 11-year age range. The universal approach to screening will identify children with a genetic cause for their high cholesterol (1 in 500 children) and children with cholesterol abnormalities based more on lifestyle," said Dr. Daniels. "Both groups will benefit from lifestyle intervention, which can be useful in lowering their lifetime risk of cardiovascular disease."

Dr. Daniels has served as a consultant for Abbott Laboratories, Merck, and Schering-Plough, and has received funding/grant support for research from the National Institutes of Health. Other members of the committee that reviewed the guidelines disclosed research support from various agencies and pharmaceutical companies.

Perhaps the best news about the cholesterol testing now recommended for all children aged 9-11 years by an expert panel convened by the National Heart, Lung, and Blood Institute is that children don’t have to fast before getting their blood drawn. The guidelines were published online on Nov. 13 and appear in the December issue of Pediatrics.

Dr. Stephen R. Daniels, chair of the expert panel that reviewed the guidelines, emphasized that the new approach to cholesterol screening can be accomplished with a blood test that does not require fasting, so it should be relatively easy to include in a busy practice. This strategy "ensures that children with elevated LDL (or bad) cholesterol will be identified."

Data from studies of the previous cholesterol-screening approach suggest that children with high cholesterol have often been missed, said Dr. Daniels, pediatrician-in-chief at the University of Colorado at Denver, Aurora.

Data from previous studies have shown that atherosclerosis begins in youth, and that heart attacks, strokes, and other cardiovascular problems in adulthood are often the end result of cardiovascular risk factors that went unrecognized throughout childhood, according to the report (Pediatrics 2011 Nov. 13 [doi:10.1542/peds.2009-2107C]).

The current guidelines represent the latest update since the 1990s, said Dr. Daniels.

"These guidelines are different in that they are based on a comprehensive and systematic review of the literature, they are integrated across all risk factors (hypertension, dyslipidemia, obesity, diabetes, and cigarette smoking) and lifestyle factors (diet and physical activity), and they address issues across the pediatric age range," he said in an interview.

Data from studies of the previous cholesterol-screening approach suggest that children with high cholesterol have often been missed, said Dr. Stephen R. Daniels.

The "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Summary Report" provides details for how to reduce risk factors and help prevent cardiovascular problems in children from birth to 21 years of age, starting with a recommendation for exclusive breastfeeding of children for the first 6 months of life.

However, the most notable new element in the guidelines is universal cholesterol-screening recommendation for preadolescents.

According to the guidelines, doctors should obtain a universal lipid screen with nonfasting non-HDL cholesterol (that is, total cholesterol minus HDL cholesterol) or a fasting lipid profile (FLP) for all children at least once between the ages of 9 and 11 years, and "manage per lipid algorithms as needed." Diet and exercise are recommended as first-line treatment, but statins may be considered in children whose high cholesterol persists despite diet and lifestyle interventions.

The guidelines recommend obtaining an FLP at age 12-17 years if a child’s family history is newly positive, if a parent has dyslipidemia, or if the child has any other risk factors or high-risk conditions, and then managing per lipid algorithms as needed.

For all patients aged 18-21 years, the guidelines recommend measuring one nonfasting non-HDL or FLP, and then reviewing the results with patients and managing them with lipid algorithms per Adult Treatment Panel III as needed.

Preventive steps to reduce risk and prevent cardiovascular disease in all ages include regular physical activity, with vigorous activity 3 days a week, according to the "Physical Activity Guidelines Advisory Committee Report 2008" from the Department of Health and Human Services.

Other preventive measures include a diet low in saturated fat for all children starting at 1 year of age, as well as both practice- and school-based interventions to keep children from smoking and to help them quit.

The guidelines also recommend annual blood pressure measurement for all children starting at 3 years of age, and interpreted for age, sex, and height. The report has a chart with an algorithm and flow diagram to assist clinicians in diagnosing hypertension in children.

"The rationale for these guidelines is that there is more and more evidence for the concept that atherosclerosis begins in childhood and depends on the same risk factors we are concerned about in adults," Dr. Daniels said. "This means that we should try to prevent these risk factors from developing in the first place (primordial prevention) and identify children at higher risk, so we can work on improving their lifestyle," he added.

"Cardiovascular disease is the most common cause of death for both men and women. So, this places great importance on these issues for primary care pediatricians. The new approach to screening may actually be easier to implement than the old strategy, which requires constant updating of the family history," noted Dr. Daniels, who is also chairman and professor of pediatrics at the university.

"This test should be done once for every child in the 9- to 11-year age range. The universal approach to screening will identify children with a genetic cause for their high cholesterol (1 in 500 children) and children with cholesterol abnormalities based more on lifestyle," said Dr. Daniels. "Both groups will benefit from lifestyle intervention, which can be useful in lowering their lifetime risk of cardiovascular disease."

Dr. Daniels has served as a consultant for Abbott Laboratories, Merck, and Schering-Plough, and has received funding/grant support for research from the National Institutes of Health. Other members of the committee that reviewed the guidelines disclosed research support from various agencies and pharmaceutical companies.

NATIONAL HARBOR, MD. – Endoscopists using the water-infusion method of screening colonoscopy found significantly more adenomas if they added indigo dye, compared with the water method alone, a new study has shown.

"Indigo carmine enhances any surface irregularities" when used as part of screening colonoscopies, Dr. Joseph W. Leung said in a late-breaking abstract session at the annual meeting of the American College of Gastroenterology.

Indigo carmine is used to enhance adenoma detection in chromoendoscopy, which is a more cumbersome process than the water method, Dr. Leung said. He and his colleagues conducted a randomized, controlled trial to assess the value of adding indigo carmine to the water method. The protocol was to add 10 mL 0.8% indigo carmine per 1 liter of water (0.008% indigo carmine).

A total of 84 patients were randomized to screening colonoscopies via the water method alone, and another 84 were randomized to the water method with indigo carmine. The mean age of the patients was 58 years, and more than 75% of patients in each group were men. Body mass index and family history of colon cancer were similar in the two groups, but the indigo carmine group included significantly more smokers than the water-method-only group.

Overall, the adenoma detection rate was 62% in the water-plus-indigo carmine group, compared with 44% in the water-only group, and this difference was statistically significant (P = .03). One cancer was detected in each group.

The colonoscopies were performed by two endoscopists who had experience with both methods, noted Dr. Leung of the Sacramento VA Medical Center in Mather, Calif. Patients were blinded as to which procedure they had, and all patients underwent intravenous conscious sedation.

In both groups, air was suctioned out of the rectum when a high-resolution colonoscope was inserted. Water was infused, and any residual stool or cloudiness was suctioned out, followed by another infusion of clear water. "Water infusion and suction was done in rapid sequence," Dr. Leung said.

"Upon seeing the appendix opening under water, water was suctioned and air was insufflated to facilitate inspection on scope withdrawal," he added.

Dr. Leung offered several possible explanations for the increased adenoma detection rate when indigo carmine was added to the water method.

"The water exchange minimizes residual water and allows undistracted examination during withdrawal," he said. The addition of indigo carmine dye enhances the contrast between a lesion and the surrounding mucosa, which improves polyp detection, he noted. Also, the water method offers improved visualization, and the warm water may reduce spasm in the colon, he added.

The study was supported in part by clinical research grants from the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology. Dr. Leung had no personal financial disclosures.

NATIONAL HARBOR, MD. – Endoscopists using the water-infusion method of screening colonoscopy found significantly more adenomas if they added indigo dye, compared with the water method alone, a new study has shown.

"Indigo carmine enhances any surface irregularities" when used as part of screening colonoscopies, Dr. Joseph W. Leung said in a late-breaking abstract session at the annual meeting of the American College of Gastroenterology.

Indigo carmine is used to enhance adenoma detection in chromoendoscopy, which is a more cumbersome process than the water method, Dr. Leung said. He and his colleagues conducted a randomized, controlled trial to assess the value of adding indigo carmine to the water method. The protocol was to add 10 mL 0.8% indigo carmine per 1 liter of water (0.008% indigo carmine).

A total of 84 patients were randomized to screening colonoscopies via the water method alone, and another 84 were randomized to the water method with indigo carmine. The mean age of the patients was 58 years, and more than 75% of patients in each group were men. Body mass index and family history of colon cancer were similar in the two groups, but the indigo carmine group included significantly more smokers than the water-method-only group.

Overall, the adenoma detection rate was 62% in the water-plus-indigo carmine group, compared with 44% in the water-only group, and this difference was statistically significant (P = .03). One cancer was detected in each group.

The colonoscopies were performed by two endoscopists who had experience with both methods, noted Dr. Leung of the Sacramento VA Medical Center in Mather, Calif. Patients were blinded as to which procedure they had, and all patients underwent intravenous conscious sedation.

In both groups, air was suctioned out of the rectum when a high-resolution colonoscope was inserted. Water was infused, and any residual stool or cloudiness was suctioned out, followed by another infusion of clear water. "Water infusion and suction was done in rapid sequence," Dr. Leung said.

"Upon seeing the appendix opening under water, water was suctioned and air was insufflated to facilitate inspection on scope withdrawal," he added.

Dr. Leung offered several possible explanations for the increased adenoma detection rate when indigo carmine was added to the water method.

"The water exchange minimizes residual water and allows undistracted examination during withdrawal," he said. The addition of indigo carmine dye enhances the contrast between a lesion and the surrounding mucosa, which improves polyp detection, he noted. Also, the water method offers improved visualization, and the warm water may reduce spasm in the colon, he added.

The study was supported in part by clinical research grants from the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology. Dr. Leung had no personal financial disclosures.

NATIONAL HARBOR, MD. – Endoscopists using the water-infusion method of screening colonoscopy found significantly more adenomas if they added indigo dye, compared with the water method alone, a new study has shown.

"Indigo carmine enhances any surface irregularities" when used as part of screening colonoscopies, Dr. Joseph W. Leung said in a late-breaking abstract session at the annual meeting of the American College of Gastroenterology.

Indigo carmine is used to enhance adenoma detection in chromoendoscopy, which is a more cumbersome process than the water method, Dr. Leung said. He and his colleagues conducted a randomized, controlled trial to assess the value of adding indigo carmine to the water method. The protocol was to add 10 mL 0.8% indigo carmine per 1 liter of water (0.008% indigo carmine).

A total of 84 patients were randomized to screening colonoscopies via the water method alone, and another 84 were randomized to the water method with indigo carmine. The mean age of the patients was 58 years, and more than 75% of patients in each group were men. Body mass index and family history of colon cancer were similar in the two groups, but the indigo carmine group included significantly more smokers than the water-method-only group.

Overall, the adenoma detection rate was 62% in the water-plus-indigo carmine group, compared with 44% in the water-only group, and this difference was statistically significant (P = .03). One cancer was detected in each group.

The colonoscopies were performed by two endoscopists who had experience with both methods, noted Dr. Leung of the Sacramento VA Medical Center in Mather, Calif. Patients were blinded as to which procedure they had, and all patients underwent intravenous conscious sedation.

In both groups, air was suctioned out of the rectum when a high-resolution colonoscope was inserted. Water was infused, and any residual stool or cloudiness was suctioned out, followed by another infusion of clear water. "Water infusion and suction was done in rapid sequence," Dr. Leung said.

"Upon seeing the appendix opening under water, water was suctioned and air was insufflated to facilitate inspection on scope withdrawal," he added.

Dr. Leung offered several possible explanations for the increased adenoma detection rate when indigo carmine was added to the water method.

"The water exchange minimizes residual water and allows undistracted examination during withdrawal," he said. The addition of indigo carmine dye enhances the contrast between a lesion and the surrounding mucosa, which improves polyp detection, he noted. Also, the water method offers improved visualization, and the warm water may reduce spasm in the colon, he added.

The study was supported in part by clinical research grants from the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology. Dr. Leung had no personal financial disclosures.

TORONTO – Topiramate in combination with quetiapine was well tolerated in adolescents who had bipolar disorder and reported frequent cannabis use, based on a 75-patient study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Concurrent substance use is a barrier to treating adolescents with bipolar disorder, said Dr. Melissa DelBello of the University of Cincinnati. Topiramate is approved by the Food and Drug Administration as an antiepileptic drug for children as young as age 2 years. Topiramate has been shown to reduce drug cravings, but is not approved for that indication, she added.

The researchers recruited adolescents, aged 12-21 years, who met criteria for bipolar disorder, had a Young Mania Rating Scale (YMRS) score of at least 20, and were using cannabis an average of at least twice a week for the 28 days before entering the study. In a previous study, Dr. DelBello and her colleagues found that topiramate was effective for reducing mania symptoms in adolescents (J. Am. Acad. Child Adolesc. Psychiatry 2005; 44:539-47).

The 75 teens were randomized to a maximum of 800 mg of quetiapine and placebo or to quetiapine and a minimum dose of 75 mg of topiramate twice daily that was increased gradually to 150 mg twice daily by day 21 of treatment.

At baseline, the average number of joints smoked per week was 14 in the quetiapine and placebo group and 11 in the quetiapine and topiramate group.

After 16 weeks of treatment, the average weekly use dropped to four joints in the quetiapine and placebo group and to 0.4 joints in the quetiapine and topiramate group. The difference was statistically significant.

On average, teens in the quetiapine and topiramate group used cannabis 1 day per week, and teens in the quetiapine and placebo group used cannabis 2 days per week, Dr. DelBello said.

Over the 16-week study, scores on the YMRS improved significantly from baseline, with an average drop of –14 with quetiapine and topiramate and –16 with quetiapine and placebo. Scores on the Childhood Rating Depression Scale-Revised (CRDS-R) also improved significantly from baseline to 16 weeks in both groups.

The presence of conduct disorder and ADHD were significant predictors of reduction in cannabis use while taking topiramate, said Dr. DelBello. Teens given topiramate showed significant improvement in general scores on the Marijuana Craving Questionnaire, compared with teens given placebo.

The groups did not differ in laboratory measures or vital signs, but excitement and pallor occurred in 26% of the topiramate group and in 16% of the placebo group.

Eleven serious events occurred during the study; five occurred in the topiramate group (two cases of suicidal ideation with intent and three cases of mania) and six occurred in the placebo group (four cases of mania, one suicide attempt, and one pregnancy).

The study was limited by a lack of data on cognition, Dr. DelBello noted. The neurobiological effects of topiramate and its effects when combined with other medications and used in different mood states need further study.

Dr. DelBello has received research support and/or served as a consultant, advisory board member, or speakers’ bureau member for multiple companies including Schering-Plough, Merck, Bristol-Myers Squibb Somerset, Lilly, and Pfizer.

TORONTO – Topiramate in combination with quetiapine was well tolerated in adolescents who had bipolar disorder and reported frequent cannabis use, based on a 75-patient study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Concurrent substance use is a barrier to treating adolescents with bipolar disorder, said Dr. Melissa DelBello of the University of Cincinnati. Topiramate is approved by the Food and Drug Administration as an antiepileptic drug for children as young as age 2 years. Topiramate has been shown to reduce drug cravings, but is not approved for that indication, she added.

The researchers recruited adolescents, aged 12-21 years, who met criteria for bipolar disorder, had a Young Mania Rating Scale (YMRS) score of at least 20, and were using cannabis an average of at least twice a week for the 28 days before entering the study. In a previous study, Dr. DelBello and her colleagues found that topiramate was effective for reducing mania symptoms in adolescents (J. Am. Acad. Child Adolesc. Psychiatry 2005; 44:539-47).

The 75 teens were randomized to a maximum of 800 mg of quetiapine and placebo or to quetiapine and a minimum dose of 75 mg of topiramate twice daily that was increased gradually to 150 mg twice daily by day 21 of treatment.

At baseline, the average number of joints smoked per week was 14 in the quetiapine and placebo group and 11 in the quetiapine and topiramate group.

After 16 weeks of treatment, the average weekly use dropped to four joints in the quetiapine and placebo group and to 0.4 joints in the quetiapine and topiramate group. The difference was statistically significant.

On average, teens in the quetiapine and topiramate group used cannabis 1 day per week, and teens in the quetiapine and placebo group used cannabis 2 days per week, Dr. DelBello said.

Over the 16-week study, scores on the YMRS improved significantly from baseline, with an average drop of –14 with quetiapine and topiramate and –16 with quetiapine and placebo. Scores on the Childhood Rating Depression Scale-Revised (CRDS-R) also improved significantly from baseline to 16 weeks in both groups.

The presence of conduct disorder and ADHD were significant predictors of reduction in cannabis use while taking topiramate, said Dr. DelBello. Teens given topiramate showed significant improvement in general scores on the Marijuana Craving Questionnaire, compared with teens given placebo.

The groups did not differ in laboratory measures or vital signs, but excitement and pallor occurred in 26% of the topiramate group and in 16% of the placebo group.

Eleven serious events occurred during the study; five occurred in the topiramate group (two cases of suicidal ideation with intent and three cases of mania) and six occurred in the placebo group (four cases of mania, one suicide attempt, and one pregnancy).

The study was limited by a lack of data on cognition, Dr. DelBello noted. The neurobiological effects of topiramate and its effects when combined with other medications and used in different mood states need further study.

Dr. DelBello has received research support and/or served as a consultant, advisory board member, or speakers’ bureau member for multiple companies including Schering-Plough, Merck, Bristol-Myers Squibb Somerset, Lilly, and Pfizer.

TORONTO – Topiramate in combination with quetiapine was well tolerated in adolescents who had bipolar disorder and reported frequent cannabis use, based on a 75-patient study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Concurrent substance use is a barrier to treating adolescents with bipolar disorder, said Dr. Melissa DelBello of the University of Cincinnati. Topiramate is approved by the Food and Drug Administration as an antiepileptic drug for children as young as age 2 years. Topiramate has been shown to reduce drug cravings, but is not approved for that indication, she added.

The researchers recruited adolescents, aged 12-21 years, who met criteria for bipolar disorder, had a Young Mania Rating Scale (YMRS) score of at least 20, and were using cannabis an average of at least twice a week for the 28 days before entering the study. In a previous study, Dr. DelBello and her colleagues found that topiramate was effective for reducing mania symptoms in adolescents (J. Am. Acad. Child Adolesc. Psychiatry 2005; 44:539-47).

The 75 teens were randomized to a maximum of 800 mg of quetiapine and placebo or to quetiapine and a minimum dose of 75 mg of topiramate twice daily that was increased gradually to 150 mg twice daily by day 21 of treatment.

At baseline, the average number of joints smoked per week was 14 in the quetiapine and placebo group and 11 in the quetiapine and topiramate group.

After 16 weeks of treatment, the average weekly use dropped to four joints in the quetiapine and placebo group and to 0.4 joints in the quetiapine and topiramate group. The difference was statistically significant.

On average, teens in the quetiapine and topiramate group used cannabis 1 day per week, and teens in the quetiapine and placebo group used cannabis 2 days per week, Dr. DelBello said.

Over the 16-week study, scores on the YMRS improved significantly from baseline, with an average drop of –14 with quetiapine and topiramate and –16 with quetiapine and placebo. Scores on the Childhood Rating Depression Scale-Revised (CRDS-R) also improved significantly from baseline to 16 weeks in both groups.

The presence of conduct disorder and ADHD were significant predictors of reduction in cannabis use while taking topiramate, said Dr. DelBello. Teens given topiramate showed significant improvement in general scores on the Marijuana Craving Questionnaire, compared with teens given placebo.

The groups did not differ in laboratory measures or vital signs, but excitement and pallor occurred in 26% of the topiramate group and in 16% of the placebo group.

Eleven serious events occurred during the study; five occurred in the topiramate group (two cases of suicidal ideation with intent and three cases of mania) and six occurred in the placebo group (four cases of mania, one suicide attempt, and one pregnancy).

The study was limited by a lack of data on cognition, Dr. DelBello noted. The neurobiological effects of topiramate and its effects when combined with other medications and used in different mood states need further study.

Dr. DelBello has received research support and/or served as a consultant, advisory board member, or speakers’ bureau member for multiple companies including Schering-Plough, Merck, Bristol-Myers Squibb Somerset, Lilly, and Pfizer.

TORONTO – Macroencephaly was not significantly more common in twins with autism spectrum disorders than in their unaffected co-twins, according to data from 202 twin pairs presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Macroencephaly, defined as a head circumference greater than the 97th percentile, is a common physical characteristic of children with autism spectrum disorders, said Dr. Wendy Froehlich of Stanford (Calif.) University and her colleagues.

The researchers recruited 404 children (202 twin pairs) aged 4-18 years. At least one twin in each pair met criteria for an autism spectrum disorder. The children were identified through the California Department of Public Health’s Department of Developmental Services.

"Macrocephaly may represent an endophenotype within autism spectrum disorders."

Overall, there were no significant differences in the rates of macrocephaly between affected and unaffected twins. Macrocephaly was noted in 20% of boys and 27% of girls with autism spectrum disorders and in 19% of boys and 24% of girls who were unaffected co-twins.

The researchers also examined the relationship between head circumference and cognitive measures. After age and gender were controlled for, small but significant negative correlations were found between head circumference and Verbal Intelligence Quotient (VIQ) and Full Scale Intelligence Quotient (FSIQ) in twins with autism spectrum disorders, but there was no correlation between head circumference and other autistic symptoms or functioning.

"Other studies have demonstrated a positive correlation between head circumference and/or brain volume and IQ in typical individuals," the researchers noted.

"Macrocephaly may represent an endophenotype within autism spectrum disorders, and the process leading to macrocephaly is not sufficient for the development of autism," the researchers said. In addition, unaffected co-twins could represent "an intermediate phenotype between affected individuals whose head circumferences correlate negatively and truly unaffected and unrelated individuals whose head circumferences correlate positively with IQ."

The study was funded by grants from Autism Speaks, a nonprofit organization; and the National Institute of Mental Health. Dr. Froehlich had no personal financial conflicts to disclose.

TORONTO – Macroencephaly was not significantly more common in twins with autism spectrum disorders than in their unaffected co-twins, according to data from 202 twin pairs presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Macroencephaly, defined as a head circumference greater than the 97th percentile, is a common physical characteristic of children with autism spectrum disorders, said Dr. Wendy Froehlich of Stanford (Calif.) University and her colleagues.

The researchers recruited 404 children (202 twin pairs) aged 4-18 years. At least one twin in each pair met criteria for an autism spectrum disorder. The children were identified through the California Department of Public Health’s Department of Developmental Services.

"Macrocephaly may represent an endophenotype within autism spectrum disorders."

Overall, there were no significant differences in the rates of macrocephaly between affected and unaffected twins. Macrocephaly was noted in 20% of boys and 27% of girls with autism spectrum disorders and in 19% of boys and 24% of girls who were unaffected co-twins.

The researchers also examined the relationship between head circumference and cognitive measures. After age and gender were controlled for, small but significant negative correlations were found between head circumference and Verbal Intelligence Quotient (VIQ) and Full Scale Intelligence Quotient (FSIQ) in twins with autism spectrum disorders, but there was no correlation between head circumference and other autistic symptoms or functioning.

"Other studies have demonstrated a positive correlation between head circumference and/or brain volume and IQ in typical individuals," the researchers noted.

"Macrocephaly may represent an endophenotype within autism spectrum disorders, and the process leading to macrocephaly is not sufficient for the development of autism," the researchers said. In addition, unaffected co-twins could represent "an intermediate phenotype between affected individuals whose head circumferences correlate negatively and truly unaffected and unrelated individuals whose head circumferences correlate positively with IQ."

The study was funded by grants from Autism Speaks, a nonprofit organization; and the National Institute of Mental Health. Dr. Froehlich had no personal financial conflicts to disclose.

TORONTO – Macroencephaly was not significantly more common in twins with autism spectrum disorders than in their unaffected co-twins, according to data from 202 twin pairs presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Macroencephaly, defined as a head circumference greater than the 97th percentile, is a common physical characteristic of children with autism spectrum disorders, said Dr. Wendy Froehlich of Stanford (Calif.) University and her colleagues.

The researchers recruited 404 children (202 twin pairs) aged 4-18 years. At least one twin in each pair met criteria for an autism spectrum disorder. The children were identified through the California Department of Public Health’s Department of Developmental Services.

"Macrocephaly may represent an endophenotype within autism spectrum disorders."

Overall, there were no significant differences in the rates of macrocephaly between affected and unaffected twins. Macrocephaly was noted in 20% of boys and 27% of girls with autism spectrum disorders and in 19% of boys and 24% of girls who were unaffected co-twins.

The researchers also examined the relationship between head circumference and cognitive measures. After age and gender were controlled for, small but significant negative correlations were found between head circumference and Verbal Intelligence Quotient (VIQ) and Full Scale Intelligence Quotient (FSIQ) in twins with autism spectrum disorders, but there was no correlation between head circumference and other autistic symptoms or functioning.

"Other studies have demonstrated a positive correlation between head circumference and/or brain volume and IQ in typical individuals," the researchers noted.

"Macrocephaly may represent an endophenotype within autism spectrum disorders, and the process leading to macrocephaly is not sufficient for the development of autism," the researchers said. In addition, unaffected co-twins could represent "an intermediate phenotype between affected individuals whose head circumferences correlate negatively and truly unaffected and unrelated individuals whose head circumferences correlate positively with IQ."

The study was funded by grants from Autism Speaks, a nonprofit organization; and the National Institute of Mental Health. Dr. Froehlich had no personal financial conflicts to disclose.