Abstract Background Celiac disease (CD) has an estimated prevalence of 1% worldwide, including North America. Barrett’s esophagus (BE) is a complication of chronic gastroesophageal reflux disease (GERD), which predisposes to development of dysplasia, which can transition to esophageal adenocarcinoma (EAC). GERD is commonly found in patients with CD and there is evidence that reflux symptoms improve after starting the gluten-free diet. However, the prevalence of CD in patients with BE, and its impact on progression to EAC have not been studied. Aims To assess the prevalence of CD in patients with BE and its impact on development of dysplasia and EAC. Methods We performed a retrospective review of medical records of patients attending the Digestive Diseases Clinic and the specialized Barrett’s Clinic at McMaster University Medical Centre. We collected information related to demographics, esophageal and duodenal biopsies, as well as CD serological markers. CD diagnosis was based on the presence of Marsh III lesions in duodenal biopsies and/or positive tissue transglutaminase IgA antibodies (TTG). Categorical data was presented as n/N and %, continuous data as mean ±SD. Logistic regression was performed to estimate the association between BE and CD. For dysplasia development, Kaplan Meyer Breslow survival curve was used. Results CD was found in 1.8% of patients attending the Digestive Diseases Clinic (n=4800). Two hundred and sixteen patients with BE from the Digestive Diseases Clinic and the Barret’s Clinic (age 63 ±11.2, 70.3% males; follow-up period 7.0 ±5.5 years) were included in the analysis. Patients with or without CD were similar in demographic factors, concomitant diseases or previous surgeries, use of PPI, presence of symptoms and duration of treatment. The prevalence of CD was increased 5-fold in patients with BE (OR=6.0; 95% CI 2.1–17.4; p=0.006). BE patients with CD developed dysplasia earlier than those without CD (Long Rank 0.004; mean 6.0; 95% CI 3.0–4.97[PB1]). The risk of EAC was higher in BE patients with CD compared to those without CD (2/11 vs 2/205; OR=22.5; 95% CI 2.8–178.8; p= 0.003). The mean time for development of EAC from the time of BE diagnosis [PB2] was 1.5 years in patients with CD and 6.5 years in patients without CD. Conclusions The prevalence of CD is higher in patients with BE compared with the population attending a tertiary gastroenterology clinic, and with the general population. Patients with BE and concomitant CD are at increased risk of accelerated development of dysplasia and EAC, suggesting that both conditions may have a synergic detrimental effect. Funding Agencies CIHR

Abstract Background Faecal microbiota transplantation (FMT) is widely being studied for its therapeutic efficacy for a variety of ailments. Despite its gaining popularity, there is a limited understanding of firsthand patient experiences. We explored perceptions of patients who chose to pursue FMT and patients who declined FMT in favour of conventional medications for the treatment of their ulcerative colitis (UC). Methods Using qualitative descriptive design, eligible patients were invited to participate in face-to-face semi-structured interviews before and after FMT treatment. Interviews were audiotaped, transcribed, and analysed using a thematic analysis. Results Main baseline themes across the FMT (n = 9) and non-FMT (n = 8) groups included: (i) knowledge of FMT, (ii) attitudes around FMT, and (iii) factors contributing to the decision to pursue FMT. Post-FMT themes included: (i) experiences with FMT, and (ii) perceived response to treatment. We found a poor general understanding of FMT across both cohorts, suggesting a need for improving patient education. Non-FMT patients were less likely to have heard or researched FMT in the past due to feelings of ‘it just sounds weird’. Similar concerns were found across both groups, including fear of transmissible infections, cost of experimental therapy, and aversion to stool. Expectations varied between the two groups, with feelings of hope and a sense of ‘last resort’ driving patients to pursue FMT. In contrast, the non-FMT cohort felt a need to further research FMT, explore other treatment options before committing to FMT, and were more likely to describe their disease activity as ‘not at the severe end’. This demonstrates that FMT may be perceived as a ‘last-ditch effort’. Despite initial aversion, the non-FMT group demonstrated an interest in learning more about FMT and felt more open to the possibility of pursuing FMT in the future. The FMT group was more likely to harbour a positive view of natural medicine and classify FMT as natural, while the non-FMT cohort expressed ‘I’m not really into the weird stuff’. Post-FMT, some patients expressed delight in the perceived changes in their symptoms, including improved quality of life, decreased urgency, and less concerns with accidents. Conclusion Our results suggest that important motivating factors for pursuing FMT are a perception of naturality and a sense of last resort. With improved education, FMT may pose an acceptable and tolerable treatment option for patients with UC.

OBJECTIVES: To reevaluate both discriminatory and threshold levels associated with visualization of gestational sacs, yolk sacs, and fetal poles in patients presenting with vaginal bleeding, pain, or vaginal bleeding and pain in the first trimester of pregnancy using current ultrasonographic technology.METHODS: We reviewed the records of patients with first-trimester vaginal bleeding, pelvic pain, or both who were evaluated with a serum beta-hCG level and a transvaginal ultrasonogram within 6 hours of each other and had a known pregnancy outcome. Discriminatory and threshold beta-hCG levels for visualization of a gestational sac, yolk sac, and fetal pole were identified for all ultimately viable pregnancies. Logistic regression was used to model the predicted probability of visualizing these structures as a function of beta-hCG values using fractional polynomials.RESULTS: Six hundred fifty-one pregnancies met inclusion criteria; 366 were viable. Discriminatory beta-hCG levels at which structures would be predicted to be seen 99% of the time were 3,510 milli-international units/mL, 17,716 milli-international units/mL, and 47,685 milli-international units/mL for gestational sac, yolk sac, and fetal pole, respectively. In our population, threshold values for beta-hCG levels at which these structures could be seen were 390 milli-international units/mL, 1,094 milli-international units/mL, and 1,394 milli-international units/mL, respectively.CONCLUSIONS: Improvements in ultrasonographic technology have led to lower threshold beta-hCG values for ultrasonographic visualization of early intrauterine gestational structures. However, discriminatory levels for serum beta-hCG levels were higher than values currently used in practice. (Obstet Gynecol 2013;121:65-70) DOI: http://10.1097/AOG.0b013e318278f421

OBJECTIVE:Neural tube defects occur in 1/2000 live births. Imaging of the intracranial translucency (IT) during first-trimester screening has been proposed as an early screen for open neural tube defects (ONTD). This study evaluates visualization of the IT and factors influencing its visualization during first-trimester ultrasound screening for aneuploidy.METHODS:Ultrasound images for patients undergoing first-trimester screening for aneuploidy from January 1, 2009, through July 31, 2009, were reviewed for IT visualization, defined as an intracranial translucency parallel to the nuchal translucency. Second-trimester ultrasounds and delivery records were reviewed for the presence of fetal ONTD.RESULTS:The IT was visualized in 74.8% of 759 gestations studied at a mean gestational age of 12 weeks, 5 days. Among gestations where the IT was visualized, we found a larger crown-rump length, lower maternal weight, and more fetuses in the supine position (p < 0.0001). Predictive models for visualization of the IT were formulated based on these factors.CONCLUSION:The IT can be visualized in the majority of patients in the standard midsagittal plane used for measurement of the nuchal translucency. Visualization is significantly associated with crown-rump length, gestational age, maternal weight, and fetal position. Visualization of the IT is feasible.