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Esophageal Manometry Found Useful
Esophageal manometry provided new information leading to a change in patient management in up to 60% of cases in a prospective study, Dr. Brian E. Lacy said at the annual meeting of the American College of Gastroenterology.
The clinical utility of esophageal manometry (EM) had never been formally examined, even though the test is ordered 100,000 times yearly in the United States, said Dr. Lacy of Dartmouth-Hitchcock Medical Center, Lebanon, N.H. During a recent 6-month period when 303 EMs were performed there, he and his colleagues sent pre- and postprocedure questionnaires to all ordering physicians and received 152 complete responses. The mean duration of symptoms prior to EM was 64 months. One-third of EMs were ordered for evaluation of dysphagia, 29% for assistance in placing a pH probe or Bravo monitoring capsule, 13% for reflux symptoms, and 10% for evaluation of chest pain.
Physicians reported that EM yielded new information in 100% of patients with reflux symptoms and in 86% of those with chest pain or dysphagia. The test results led to a change in diagnosis in 48% of patients with dysphagia, 21% of those with chest pain, and 20% of those with gastroesophageal reflux disease (GERD).
More importantly, the EM results led to a change in management for 60% of patients evaluated for dysphagia, 45% of those with GERD, and 43% of those evaluated primarily for chest pain, Dr. Lacy said. Most often this management change involved stopping medications that were not useful or adding a new drug.
Lanreotide Curbs Pancreatitis Pain
A single dose of the somatostatin analog lanreotide cut the incidence of pain relapse after an episode of acute, necrotizing pancreatitis in a randomized, controlled study with 77 patients.
Patients treated with lanreotide had a 3% rate of relapsing pain, compared with 15% in the placebo group, during the period from 8 to 28 days after treatment, reported Dr. Philippe Levy and his associates in a poster at the 13th United European Gastroenterology Week.
The study enrolled patients at several centers in France; patients had an average age of 53 years and were recovering from an episode of pancreatitis that had not required surgery or radiologic drainage. When oral feeding was judged possible, 38 patients received a 30-mg injection of lanreotide and 39 control patients received a placebo injection.
During the first 7 days after the injection, one lanreotide patient and no placebo patients reported a pain relapse. From day 8 to 28, one additional patient in the lanreotide group (3%) and six placebo patients (15%) had pain relapses, a statistically significant difference, reported Dr. Levy, chief of the gastroenterology service at Beaujon Hospital in Clichy, France.
The drug was well tolerated, with no treatment-related adverse effects reported. In the United States, lanreotide is not yet approved and is being tested in patients with acromegaly or neuroendocrine tumors in phase III studies.
Gum Boosts Motility After Colectomy
Chewing gum soon after open partial resection of the sigmoid colon stimulates bowel motility, markedly reducing the delay before full bowel function returns, reported Dr. Rob Schuster and his associates at Santa Barbara (Calif.) Cottage Hospital.
Previous studies showed that starting an oral diet soon after colon surgery can hasten recovery. In one study, bowel function returned sooner in patients who chewed gum after laparoscopic colectomy.
Based on these results, Dr. Schuster and his associates conducted a prospective, case-control study in 34 patients undergoing open sigmoid colon resection for recurrent diverticular disease or cancer. Half of the patients were randomly assigned to chew gum three times daily, starting the morning after surgery and continuing until bowel function returned. The other 17 patients served as controls.
Patients in the treatment group reported that their first hunger sensations, passage of flatus, and bowel movement occurred 63.5 hours, 65.4 hours, and 63.2 hours, respectively, after surgery. Those intervals were 72.8 hours, 80.2 hours, and 89.4 hours in the control group. Hospital stays were 4.3 days in the gum-chewing group and 6.8 days in controls. The researchers calculated that gum chewing after colectomy could conceivably save the nation $118,828,000 yearly, based on estimates of 79,219 colectomies performed annually and a mean daily hospital room fee of $1,500 (Arch. Surg. 2006;141:174–6).
It's not clear how gum chewing works in this situation. It most likely reverses postoperative ileus via “direct stimulation of the cephalic-vagal system and resultant increased levels of neural and humoral hormones that stimulate bowel motility in the stomach, small bowel, and colon,” the researchers said.
Esophageal Manometry Found Useful
Esophageal manometry provided new information leading to a change in patient management in up to 60% of cases in a prospective study, Dr. Brian E. Lacy said at the annual meeting of the American College of Gastroenterology.
The clinical utility of esophageal manometry (EM) had never been formally examined, even though the test is ordered 100,000 times yearly in the United States, said Dr. Lacy of Dartmouth-Hitchcock Medical Center, Lebanon, N.H. During a recent 6-month period when 303 EMs were performed there, he and his colleagues sent pre- and postprocedure questionnaires to all ordering physicians and received 152 complete responses. The mean duration of symptoms prior to EM was 64 months. One-third of EMs were ordered for evaluation of dysphagia, 29% for assistance in placing a pH probe or Bravo monitoring capsule, 13% for reflux symptoms, and 10% for evaluation of chest pain.
Physicians reported that EM yielded new information in 100% of patients with reflux symptoms and in 86% of those with chest pain or dysphagia. The test results led to a change in diagnosis in 48% of patients with dysphagia, 21% of those with chest pain, and 20% of those with gastroesophageal reflux disease (GERD).
More importantly, the EM results led to a change in management for 60% of patients evaluated for dysphagia, 45% of those with GERD, and 43% of those evaluated primarily for chest pain, Dr. Lacy said. Most often this management change involved stopping medications that were not useful or adding a new drug.
Lanreotide Curbs Pancreatitis Pain
A single dose of the somatostatin analog lanreotide cut the incidence of pain relapse after an episode of acute, necrotizing pancreatitis in a randomized, controlled study with 77 patients.
Patients treated with lanreotide had a 3% rate of relapsing pain, compared with 15% in the placebo group, during the period from 8 to 28 days after treatment, reported Dr. Philippe Levy and his associates in a poster at the 13th United European Gastroenterology Week.
The study enrolled patients at several centers in France; patients had an average age of 53 years and were recovering from an episode of pancreatitis that had not required surgery or radiologic drainage. When oral feeding was judged possible, 38 patients received a 30-mg injection of lanreotide and 39 control patients received a placebo injection.
During the first 7 days after the injection, one lanreotide patient and no placebo patients reported a pain relapse. From day 8 to 28, one additional patient in the lanreotide group (3%) and six placebo patients (15%) had pain relapses, a statistically significant difference, reported Dr. Levy, chief of the gastroenterology service at Beaujon Hospital in Clichy, France.
The drug was well tolerated, with no treatment-related adverse effects reported. In the United States, lanreotide is not yet approved and is being tested in patients with acromegaly or neuroendocrine tumors in phase III studies.
Gum Boosts Motility After Colectomy
Chewing gum soon after open partial resection of the sigmoid colon stimulates bowel motility, markedly reducing the delay before full bowel function returns, reported Dr. Rob Schuster and his associates at Santa Barbara (Calif.) Cottage Hospital.
Previous studies showed that starting an oral diet soon after colon surgery can hasten recovery. In one study, bowel function returned sooner in patients who chewed gum after laparoscopic colectomy.
Based on these results, Dr. Schuster and his associates conducted a prospective, case-control study in 34 patients undergoing open sigmoid colon resection for recurrent diverticular disease or cancer. Half of the patients were randomly assigned to chew gum three times daily, starting the morning after surgery and continuing until bowel function returned. The other 17 patients served as controls.
Patients in the treatment group reported that their first hunger sensations, passage of flatus, and bowel movement occurred 63.5 hours, 65.4 hours, and 63.2 hours, respectively, after surgery. Those intervals were 72.8 hours, 80.2 hours, and 89.4 hours in the control group. Hospital stays were 4.3 days in the gum-chewing group and 6.8 days in controls. The researchers calculated that gum chewing after colectomy could conceivably save the nation $118,828,000 yearly, based on estimates of 79,219 colectomies performed annually and a mean daily hospital room fee of $1,500 (Arch. Surg. 2006;141:174–6).
It's not clear how gum chewing works in this situation. It most likely reverses postoperative ileus via “direct stimulation of the cephalic-vagal system and resultant increased levels of neural and humoral hormones that stimulate bowel motility in the stomach, small bowel, and colon,” the researchers said.
Esophageal Manometry Found Useful
Esophageal manometry provided new information leading to a change in patient management in up to 60% of cases in a prospective study, Dr. Brian E. Lacy said at the annual meeting of the American College of Gastroenterology.
The clinical utility of esophageal manometry (EM) had never been formally examined, even though the test is ordered 100,000 times yearly in the United States, said Dr. Lacy of Dartmouth-Hitchcock Medical Center, Lebanon, N.H. During a recent 6-month period when 303 EMs were performed there, he and his colleagues sent pre- and postprocedure questionnaires to all ordering physicians and received 152 complete responses. The mean duration of symptoms prior to EM was 64 months. One-third of EMs were ordered for evaluation of dysphagia, 29% for assistance in placing a pH probe or Bravo monitoring capsule, 13% for reflux symptoms, and 10% for evaluation of chest pain.
Physicians reported that EM yielded new information in 100% of patients with reflux symptoms and in 86% of those with chest pain or dysphagia. The test results led to a change in diagnosis in 48% of patients with dysphagia, 21% of those with chest pain, and 20% of those with gastroesophageal reflux disease (GERD).
More importantly, the EM results led to a change in management for 60% of patients evaluated for dysphagia, 45% of those with GERD, and 43% of those evaluated primarily for chest pain, Dr. Lacy said. Most often this management change involved stopping medications that were not useful or adding a new drug.
Lanreotide Curbs Pancreatitis Pain
A single dose of the somatostatin analog lanreotide cut the incidence of pain relapse after an episode of acute, necrotizing pancreatitis in a randomized, controlled study with 77 patients.
Patients treated with lanreotide had a 3% rate of relapsing pain, compared with 15% in the placebo group, during the period from 8 to 28 days after treatment, reported Dr. Philippe Levy and his associates in a poster at the 13th United European Gastroenterology Week.
The study enrolled patients at several centers in France; patients had an average age of 53 years and were recovering from an episode of pancreatitis that had not required surgery or radiologic drainage. When oral feeding was judged possible, 38 patients received a 30-mg injection of lanreotide and 39 control patients received a placebo injection.
During the first 7 days after the injection, one lanreotide patient and no placebo patients reported a pain relapse. From day 8 to 28, one additional patient in the lanreotide group (3%) and six placebo patients (15%) had pain relapses, a statistically significant difference, reported Dr. Levy, chief of the gastroenterology service at Beaujon Hospital in Clichy, France.
The drug was well tolerated, with no treatment-related adverse effects reported. In the United States, lanreotide is not yet approved and is being tested in patients with acromegaly or neuroendocrine tumors in phase III studies.
Gum Boosts Motility After Colectomy
Chewing gum soon after open partial resection of the sigmoid colon stimulates bowel motility, markedly reducing the delay before full bowel function returns, reported Dr. Rob Schuster and his associates at Santa Barbara (Calif.) Cottage Hospital.
Previous studies showed that starting an oral diet soon after colon surgery can hasten recovery. In one study, bowel function returned sooner in patients who chewed gum after laparoscopic colectomy.
Based on these results, Dr. Schuster and his associates conducted a prospective, case-control study in 34 patients undergoing open sigmoid colon resection for recurrent diverticular disease or cancer. Half of the patients were randomly assigned to chew gum three times daily, starting the morning after surgery and continuing until bowel function returned. The other 17 patients served as controls.
Patients in the treatment group reported that their first hunger sensations, passage of flatus, and bowel movement occurred 63.5 hours, 65.4 hours, and 63.2 hours, respectively, after surgery. Those intervals were 72.8 hours, 80.2 hours, and 89.4 hours in the control group. Hospital stays were 4.3 days in the gum-chewing group and 6.8 days in controls. The researchers calculated that gum chewing after colectomy could conceivably save the nation $118,828,000 yearly, based on estimates of 79,219 colectomies performed annually and a mean daily hospital room fee of $1,500 (Arch. Surg. 2006;141:174–6).
It's not clear how gum chewing works in this situation. It most likely reverses postoperative ileus via “direct stimulation of the cephalic-vagal system and resultant increased levels of neural and humoral hormones that stimulate bowel motility in the stomach, small bowel, and colon,” the researchers said.