Identification of upper gastrointestinal malignancy in patients with uncomplicated dyspepsia referred under the two-week-wait cancer pathway: a single-centre, 10-year experience.

Introduction: In the United Kingdom, the National Institute for Health and Care Excellence 2015 guidance recommend that for suspected gastric or oesophageal cancer, general practitioners consider a non-urgent, direct-access endoscopy in patients over 55 years with only uncomplicated treatment-resistant dyspepsia. In practice, patients are referred under the urgent 2-week-wait cancer pathway.

Methods: We compared the frequency of gastric or oesophageal carcinoma in patients referred to our centre on the 2-week-wait pathway with uncomplicated dyspepsia to those who have a combination of additional alarm symptoms.

ECOLOGICAL AND EVOLUTIONARY APPLICATIONS FOR ENVIRONMENTAL SEX REVERSAL OF FISH.

Environmental sex reversal (ESR), which results in a mismatch between genotypic and phenotypic sex, is well documented in numerous fish species and may be induced by chemical exposure. Historically, research involving piscine ESR has been carried out with a view to improving profitability in aquaculture or to elucidate the processes governing sex determination and sexual differentiation. However, recent studies in evolution and ecology suggest research on ESR now has much wider applications and ramifications.

Choledocholithiasis presenting with very high transaminase level.

We present three cases of choledocholithiasis presenting with a rise in transaminase to levels normally associated with acute hepatitis (alanine aminotransferase in excess of 1000 IU/l). All three cases had repeated investigation for liver disease before identification of common bile duct stones with magnetic resonance cholangiopancreatogram, and removal at endoscopic retrograde cholangiopancreatogram. We discuss the existing literature and the potential mechanisms of hepatocyte injury in extrahepatic obstruction.

Midazolam with meperidine or fentanyl for colonoscopy: results of a randomized trial.

Background: A combination of midazolam and opioid is usually used to achieve sedation and analgesia during colonoscopy. Two commonly used opioids are meperidine and fentanyl, but few studies have compared their efficacy.

Objective: This randomized trial aimed to compare the efficacy and recovery time of 2 sedation regimens consisting of midazolam in combination with either meperidine or fentanyl.

Gastrointestinal evaluation of anaemic patients without evidence of iron deficiency.

Background: Bleeding lesions are commonly identified in the gastrointestinal (GI) tract of patients with iron deficiency anaemia (IDA). Gastroenterologists, however, are frequently referred patients with anaemia without supporting evidence of iron deficiency, where the merit of GI investigation is unknown.

Methods: We conducted a retrospective, case-control study to determine the prevalence of bleeding GI lesions in 100 anaemic patients without evidence of iron deficiency [noniron deficiency anemia (NIDA) group] and 271 patients with confirmed IDA (IDA group).

Terminal ileal photography or biopsy to verify total colonoscopy: does the endoscope agree with the microscope?

Background: Various modalities exist to document the extent of colonoscopy, including a terminal ileum (TI) biopsy, which is considered the criterion standard by some authorities. A TI biopsy adds to procedure costs, is potentially hazardous, and the detection of pathology in routinely acquired biopsy specimens of a macroscopically normal TI is limited. A safer, less costly alternative for documenting total colonoscopy is desirable.

Gallstone ileus following endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy.

Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) is the treatment of choice for common bile duct (CBD) stones. Complication rates of 5-15%, and mortality rates of 1.0% have been reported.

Lack of efficacy of a reduced microparticle diet in a multi-centred trial of patients with active Crohn's disease.

Background And Aims: Dietary microparticles, which are bacteria-sized and non-biological, found in the modern Western diet, have been implicated in both the aetiology and pathogenesis of Crohn's disease. Following on from the findings of a previous pilot study, we aimed to confirm whether a reduction in the amount of dietary microparticles facilitates induction of remission in patients with active Crohn's disease, in a single-blind, randomized, multi-centre, placebo controlled trial.

Methods: Eighty-three patients with active Crohn's disease were randomly allocated in a 2 x 2 factorial design to a diet low or normal in microparticles and/or calcium for 16 weeks.