Follow-up study conducted from October 1997 through October 1999 of a prospective randomized trial of medical and surgical antireflux treatments in patients with complicated GERD. Mean (median) duration of follow-up was 10.6 years (7.3 years) for medical patients and 9.1 years (6.3 years) for surgical patients. Although frequent vomiting reflexes during esophagogastroduodenoscopy (EGD) causes suffering in patients, very few studies have investigated the characteristics of subjects who frequently develop vomiting reflexes. This study examined the incidence of the vomiting reflex and related factors, especially upper gastrointestinal symptoms, among individuals undergoing transoral EGD. The differential diagnosis of Behçet’s syndrome or Crohn’s disease can be extremely difficult.
Allergic reactions or other acute toxic reactions did not occur, even in patients with tumor responses, each patient receiving more than 35 injections of MTX-HSA. This study evaluated changes in health-related quality of life (HRQL) outcomes of once-daily omeprazole compared with ranitidine for the short-term treatment of patients with poorly responsive symptomatic gastroesophageal reflux disease (GERD).
MRI was available in five controls. While MRI was normal, FOI showed minimal changes in CI and P2 (1 out of 60 joints, 1.2%, and 2 out of 60 joints, 3.3%) and none in P1 and P3. CE and laboratory tests (erythrocyte sedimentation rate (ESR) and C reactive protein (CRP)) were performed. Clinical swollen and tender joints (including distal interphalangeal joint (DIP)) were scored for presence and absence (0-1). The Disease Activity Score 28 (DAS28)18 was used to assess disease activity in patients with RA, psoriatic arthritis (PsA) and undifferentiated arthritis (uA).
The scale was easy to apply and proved to be useful in comparing the effectiveness of different modes of treatment in two clinical trials. Follow-up data were available for 176 patients at one year and for 106 patients at two years. The mean (+/- SE) activity-index score (possible range, 74 to 172) decreased in one year from 108 +/- 3 to 87 +/- 2 in the group receiving continuous medical therapy, from 107 +/- 3 to 88 +/- 2 in the group receiving medical therapy for symptoms only, and from 109 +/- 3 to 78 +/- 2 in the surgical-therapy group (P less than 0.0001 for the change from base line, for all comparisons).
FOI findings were compared with clinical findings in 750 joints (128 tender, 148 swollen, 83 swollen and tender). FOI was compared with MRI findings in 300 joints (figure 4). Fifty-nine joints showed MRI synovitis, and 75 joints showed synovitis or tenosynovitis. MRI detected inflammatory changes in 31 out of 194 (16%) clinically asymptomatic joints. FOI displayed positive findings in 387 out of 750 (77%) joints and in 250 out of 557 (45%) clinically asymptomatic joints.
MRI is considered the gold standard for imaging of synovitis, and MRI bone marrow oedema has been shown to be the strongest independent predictor of radiographic progression in RA.6 7 However, broader usage of MRI in clinical routine settings may be restricted by workflow considerations, cost and limited availability. MTX-HSA every 2-4 weeks, achieving plasma concentrations between 10 and 20 μmol/liter, proved to be safe and effective, based on observation of the three responding patients. All 17 patients were evaluable for DLT within the first two consecutive courses; 13 patients received at least three courses, 12 patients received at least seven courses, and 8 patients received more than seven consecutive courses. One patient withdrew informed consent after two courses, and treatment was discontinued in two patients because of tumor-induced health deterioration after the second or third injection. Indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) is an established technology for imaging of inflammation in animal models.
Evaluation of the GSRS and UESS with regard to internal consistency, construct validity, and the ability to detect changes showed them to be satisfactory. The psychometric documentation of the measures indicates that they may give reliable and clinically valid information when used for evaluation of medical treatments in upper gastrointestinal disease. Further documentation of the methods is, however, needed to establish a generally acceptable QoL assessment in gastroenterology. Many questionnaires that assess subjective symptoms or health-related quality of life (HRQOL) have been developed to confirm the efficacy of treatment in patients with gastroesophageal reflux disease (GERD). However, few reports have correlated early improvements in scale scores with predictions of subsequent therapeutic responses.
FOI agreed in a higher range with PDUS, which also displays vascularity. FOI agreed well with MRI synovitis and tenosynovitis. Taking MRI as reference, FOI had a sensitivity of 76% and a specificity of 54%, with a higher specificity (94% and 89%) and a lower sensitivity (27% and 47%) for P1 and P3, respectively.
The correlations of the scores were calculated using Spearman’s rank correlation coefficient. Statistical significance was concluded with two-sided p values below 0.05. Fluorescence optical imaging (FOI) is an established technology that has been evaluated for imaging of inflammation in a variety of animal models.13 In experimental models of arthritis, indocyanine green (ICG)-enhanced FOI findings corresponded to histologically proven synovitis.14 15 The feasibility of this approach in humans was tested,16 17 and an FOI system with fixed optical geometry was developed (Xiralite X4; mivenion GmbH, Berlin, Germany).
Our initial results suggest that this questionnaire is valid and should be applicable in population-based studies to assess gastroesophageal reflux disease. To develop a questionnaire to measure gastroesophageal reflux disease in the community and to test its reliability and validity. Two hundred thirty-nine (97%) of the original 247 study patients were found (79 were confirmed dead). Among the 160 survivors (157 men and 3 women; mean [SD] age, 67  years), 129 (91 in the medical treatment group and 38 in the surgical treatment group) participated in the follow-up.
Three patients were treated at each dose level. In each group, at least eight injections (one injection/week) were intended.
None of the 360 joints was FOI positive in P1 or P3. Positive findings were in low grade.
FOI was more sensitive than CE. In addition, FOI could be helpful in the differentiation of nail involvement and arthritis of DIPs in patients with psoriasis and/or PsA. However, further investigations are needed for a comprehensive definition of FOI pathologies, advancement of methodical standards and evaluation of sensitivity to change and prognostic value.