WTS database

Title	Pub Year Sort ascending	Author	SearchLink
Containing a haemorrhagic fever epidemic: the Ebola experience in Uganda (October 2000-January 2001)	2004	Uganda Ministry of Health, Kampala, Uganda. mlamunu@yahoo.co.uk	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases Periodical, Abbrev. Int.J.Infect.Dis. Pub Date Free Form Jan Volume 8 Issue 1 Start Page 27 Other Pages 37 Notes LR: 20130715; JID: 9610933; ppublish Place of Publication Canada ISSN/ISBN 1201-9712; 1201-9712 Accession Number PMID: 14690778 Language eng SubFile Journal Article; IM DOI S1201971203000079 [pii] Output Language Unknown(0) PMID 14690778 Abstract INTRODUCTION: The Ebola virus, belonging to the family of filoviruses, was first recognized in 1976 when it caused concurrent outbreaks in Yambuku in the Democratic Republic of Congo (DRC), and in the town of Nzara in Sudan. Both countries share borders with Uganda. A total of 425 cases and 224 deaths attributed to Ebola haemorrhagic fever (EHF) were recorded in Uganda in 2000/01. Although there was delayed detection at the community level, prompt and efficient outbreak investigation led to the confirmation of the causative agent on 14 October 2000 by the National Institute of Virology in South Africa, and the subsequent institution of control interventions. CONTROL INTERVENTIONS: Public health interventions to contain the epidemic aimed at minimizing transmission in the health care setting and in the community, reducing the case fatality rate due to the epidemic, strengthening co-ordination for the response and building capacity for on-going surveillance and control. Co-ordination of the control interventions was organized through the Interministerial Committee, National Ebola Task Force, District Ebola Task Forces, and the Technical Committees at national and district levels. The World Health Organization (WHO) under the Global Outbreak Alert and Response Network co-ordinated the international response. The post-outbreak control interventions addressed weaknesses prior to outbreak detection and aimed at improving preparations for future outbreak detection and response. Challenges to control efforts included inadequate and poor quality protective materials, deaths of health workers, numerous rumors and the rejection of convalescent cases by members of the community. CONCLUSIONS: This was recognized as the largest reported outbreak of EHF in the world. Control interventions were very successful in containing the epidemic. The community structures used to contain the epidemic have continued to perform well after containment of the outbreak, and have proved useful in the identification of other outbreaks. This was also the first outbreak response co-ordinated by the WHO under the Global Outbreak Alert and Response Network, a voluntary organization recently created to co-ordinate technical and financial resources to developing countries during outbreaks. Descriptors Communicable Disease Control/methods, Disease Outbreaks, Ebolavirus/growth & development, Hemorrhagic Fever, Ebola/epidemiology/prevention & control/virology, Humans, Uganda/epidemiology, World Health Organization Links Book Title Database Publisher Data Source Authors Lamunu,M., Lutwama,J. J., Kamugisha,J., Opio,A., Nambooze,J., Ndayimirije,N., Okware,S. Original/Translated Title URL Date of Electronic PMCID Editors
Quantitative comparisons between a nicotine delivery device (Eclipse) and conventional cigarette smoking	2004	National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA.	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Periodical, Abbrev. Nicotine Tob.Res. Pub Date Free Form Feb Volume 6 Issue 1 Start Page 95 Other Pages 102 Notes LR: 20151119; GR: 5-P50-CA84718/CA/NCI NIH HHS/United States; JID: 9815751; 6M3C89ZY6R (Nicotine); 7U1EE4V452 (Carbon Monoxide); ppublish Place of Publication England ISSN/ISBN 1462-2203; 1462-2203 Accession Number PMID: 14982693 Language eng SubFile Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.; IM DOI 10.1080/14622200310001656911 [doi] Output Language Unknown(0) PMID 14982693 Abstract In 1997, R. J. Reynolds introduced Eclipse, a nicotine delivery device (NDD) purported to deliver lower levels of smoke than conventional cigarettes. This NDD uses a carbon fuel element to vaporize the nicotine in the rod; the user then inhales the nicotine vapor. In the present study, the effects of this NDD on smoking topography; substance delivery factors; and physiological, subjective, and biochemical markers of smoking were compared with commercial cigarettes (referred to as Own Brand). All smoking occurred ad lib with the cigarette or NDD hand-held (conventional) or held in a topography mouthpiece. A total of 10 adults (seven males) smoked on five occasions: NDD conventional, NDD topography, Own Brand conventional, Own Brand topography (twice). Sessions were separated by at least 24 hr. Measures were taken before and 2, 5, 10, 15, 30, and 60 min after smoking. The NDD took longer to smoke (366 s vs. 292 s), required more puffs (14.8 vs. 10.8), and caused a larger increase in exhaled carbon monoxide (CO; 7.3 ppm vs. 4.2 ppm) than Own Brand. However, venous plasma nicotine boost was significantly larger 2 min after smoking Own Brand as compared with the NDD (16.4 ng/ml vs. 10.7 ng/ml). Puff volume (90.7 ml vs. 63.0 ml) and puff velocity (81.6 ml/s vs. 58.2 ml/s) were greater after the NDD than Own Brand, whereas inter-puff interval and puff duration were similar. Subjects rated the NDD as less satisfying (5.2 vs. 9.8), less rewarding (9.5 vs. 14.3), and more aversive (5.0 vs. 3.1) than their own brand. The results of this study indicate that this NDD exposes the user to significant quantities of nicotine, CO, and possibly other harmful components of tobacco smoke. The findings further validate the use of a topography device as an effective instrument to quantify smoke exposure. Descriptors Adult, Blood Pressure/drug effects, Carbon Monoxide/analysis, Equipment Design, Female, Heart Rate/drug effects, Humans, Male, Middle Aged, Nicotine/administration & dosage/adverse effects/blood, Smoking Cessation/methods, Tobacco Use Disorder/epidemiology, Volatilization Links Book Title Database Publisher Data Source Authors Lee,E. M., Malson,J. L., Moolchan,E. T., Pickworth,W. B. Original/Translated Title URL Date of Electronic PMCID Editors
Patent foramen ovale: an underrated risk for divers?	2004	Klinik fur Anasthesiologie und Spezielle Intensivmedizin, Rheinische Friedrich-Wilhelms-Universitat Bonn. Heiko.Lier@ukb.uni-bonn.de	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Deutsche medizinische Wochenschrift (1946) Periodical, Abbrev. Dtsch.Med.Wochenschr. Pub Date Free Form 2-Jan Volume 129 Issue 2-Jan Start Page 27 Other Pages 30 Notes LR: 20061115; JID: 0006723; RF: 26; ppublish Place of Publication Germany ISSN/ISBN 0012-0472; 0012-0472 Accession Number PMID: 14703578 Language ger SubFile English Abstract; Journal Article; Review; IM DOI 10.1055/s-2004-812652 [doi] Output Language Unknown(0) PMID 14703578 Abstract The foramen ovale which is the fetal connection between the right and left atrium persists in about 30 % of the adult population. In the presence of a persistent foramen ovale (PFO) shunting of blood may occur from the right to the left atrium, and bubbles can reach the systemic circulation during or after the decompression phase of a dive with compressed air. Therefore, divers with PFO may have an increased risk to develop ischemic cerebral lesions and neurologic decompression sickness (DCS). Significant right-to-left shunting may be diagnosed using transcranial doppler ultrasound of the medial cerebral artery and echocardiography with echo contrast media and Valsalva provocation. However, there are no official guidelines concerning PFO screening in medical fitness exams for professional or recreational divers in Germany. Therefore, it remains in the diver's choice to be screened for PFO. Divers with a history of DCS should be monitored for PFO, especially when diving strictly adhered to decompression tables. Divers with PFO who refuse to stop diving after DCS should be advised to adhere to very save dive profiles. Descriptors Decompression Sickness/etiology, Diving, Echocardiography, Doppler, Echocardiography, Transesophageal, Heart Septal Defects, Atrial/complications/diagnosis/physiopathology, Humans, Mass Screening, Risk Factors Links Book Title Database Publisher Data Source Authors Lier,H., Schroeder,S., Hering,R. Original/Translated Title Persistierendes Foramen ovale: ein unterschatztes Risiko fur Taucher? URL Date of Electronic PMCID Editors
A deep stop during decompression from 82 fsw (25 m) significantly reduces bubbles and fast tissue gas tensions	2004	DAN Europe Foundation, Research Division.	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc Periodical, Abbrev. Undersea Hyperb.Med. Pub Date Free Form Summer Volume 31 Issue 2 Start Page 233 Other Pages 243 Notes LR: 20050627; JID: 9312954; CIN: Undersea Hyperb Med. 2005 Mar-Apr;32(2):85-8; author reply 89-92. PMID: 15926299; ppublish Place of Publication United States ISSN/ISBN 1066-2936; 1066-2936 Accession Number PMID: 15485086 Language eng SubFile Evaluation Studies; Journal Article; IM; S DOI Output Language Unknown(0) PMID 15485086 Abstract In spite of many modifications to decompression algorithms, the incidence of decompression sickness (DCS) in scuba divers has changed very little. The success of stage, compared to linear ascents, is well described yet theoretical changes in decompression ratios have diminished the importance of fast tissue gas tensions as critical for bubble generation. The most serious signs and symptoms of DCS involve the spinal cord, with a tissue half time of only 12.5 minutes. It is proposed that present decompression schedules do not permit sufficient gas elimination from such fast tissues, resulting in bubble formation. Further, it is hypothesized that introduction of a deep stop will significantly reduce fast tissue bubble formation and neurological DCS risk. A total of 181 dives were made to 82 fsw (25 m) by 22 volunteers. Two dives of 25 min and 20 min were made, with a 3 hr 30 min surface interval and according to 8 different ascent protocols. Ascent rates of 10, 33 or 60 fsw/min (3, 10, 18 m/min) were combined with no stops or a shallow stop at 20 fsw (6 m) or a deep stop at 50 fsw (15 m) and a shallow at 20 fsw (6 m). The highest bubbles scores (8.78/9.97), using the Spencer Scale (SS) and Extended Spencer Scale (ESS) respectively, were with the slowest ascent rate. This also showed the highest 5 min and 10 min tissue loads of 48% and 75%. The lowest bubble scores (1.79/2.50) were with an ascent rate of 33 fsw (10 m/min) and stops for 5 min at 50 fsw (15 m) and 20 fsw (6 m). This also showed the lowest 5 and 10 min tissue loads at 25% and 52% respectively. Thus, introduction of a deep stop significantly reduced Doppler detected bubbles together with tissue gas tensions in the 5 and 10 min tissues, which has implications for reducing the incidence of neurological DCS in divers. Descriptors Atmospheric Pressure, Decompression/standards, Decompression Sickness/prevention & control/ultrasonography, Diving/adverse effects/standards, Humans, Reference Values, Regression Analysis, Time Factors Links Book Title Database Publisher Data Source Authors Marroni,A., Bennett,P. B., Cronje,F. J., Cali-Corleo,R., Germonpre,P., Pieri,M., Bonuccelli,C., Balestra,C. Original/Translated Title URL Date of Electronic PMCID Editors
Adapting smoking cessation interventions for developing countries: A model for the Middle East	2004	Ward, K.D., Center for Community Health, University of Memphis, Memphis, TN 38157, United States	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full International Journal of Tuberculosis and Lung Disease Periodical, Abbrev. Int.J.Tuberc.Lung Dis. Pub Date Free Form / Volume 8 Issue 4 Start Page 403 Other Pages 413 Notes Place of Publication ISSN/ISBN 1027-3719 Accession Number Language SubFile DOI Output Language Unknown(0) PMID Abstract OBJECTIVE: To describe the rationale and methods for the development of culturally-sensitive smoking cessation interventions for primary care settings in developing countries. RATIONALE: Smokers in the Middle East have great difficulty quitting. Effective smoking cessation programs are currently lacking in the Middle East, and the development of culturally sensitive programs is hindered by the dearth of standardized information regarding tobacco use and dependence in this region. METHODs. Epidemiological and clinical laboratory methods are needed to determine the prevalence and patterns of tobacco use and nicotine dependence. One strategy is to adapt smoking cessation methods widely used in industrialized countries to the Syrian and Middle Eastern environment. In a recently initiated project, the Syrian Center for Tobacco Studies has been established to address these issues. Initial work is focusing on collecting formative data including key informant interviews, focus groups, and epidemiological surveys to assess smokers' use patterns, needs, and resources. Clinical laboratory techniques are also being applied to assess the physiological, behavioral, and subjective effects of local tobacco use methods, such as narghile (water pipe) smoking. These data will be used to help adapt existing smoking cessation interventions from industrialized countries to be evaluated in a randomized controlled trial. CONCLUSION: There is a great need to develop and disseminate effective cessation interventions in low-income countries. Successful interventions will contribute to a culturally sensitive and sustainable regional tobacco control infrastructure. This paper describes one approach to the development of such an infrastructure that is currency underway in the Middle East. Descriptors nicotine, developing country, epidemiological data, female, human, industrialization, male, Middle East, prevalence, primary medical care, priority journal, review, smoking, smoking cessation, standardization, tobacco dependence Links Book Title Database Embase; MEDLINE Publisher Data Source Embase Authors Maziak,W., Eissenberg,T., Klesges,R. C., Keil,U., Ward,K. D. Original/Translated Title URL Date of Electronic PMCID Editors
Prevalence and characteristics of narghile smoking among university students in Syria	2004	Maziak, W., Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full International Journal of Tuberculosis and Lung Disease Periodical, Abbrev. Int.J.Tuberc.Lung Dis. Pub Date Free Form / Volume 8 Issue 7 Start Page 882 Other Pages 889 Notes Place of Publication ISSN/ISBN 1027-3719 Accession Number Language SubFile DOI Output Language Unknown(0) PMID Abstract SETTING: Narghile (waterpipe) smoking is increasing in all Arab societies, but little is known about its pattern of use. METHODS: In 2003, a cross-sectional survey was conducted among students at Aleppo University using an interviewer-administered questionnaire. A representative sample of 587 students participated (278 males, 309 females; mean age 21.8 Â± 2.1 years; response rate 98.8%). RESULTS: Ever narghile smoking was seen among 62.6% of men and 29.8% of women, while current smoking was seen among 25.5% of men and 4.9% of women. Only 7.0% of the men used narghile daily. Age of initiation was 19.2 Â± 2.2 and 21.7 Â± 3.2 years for men and women, respectively (P < 0.001). The salient feature of narghile smoking was its social pattern, where most users initiated and currently smoked narghile with friends. Narghile and cigarette smoking were related among students, with narghile smoking most prevalent among daily cigarette smokers. Multivariate correlates of narghile smoking were being older, male, originating from the city, smoking cigarettes, having friends who smoke narghile, and coming from a household where a greater number of narghiles were smoked daily. CONCLUSIONS: Narghile smoking is prevalent among university students in Syria, where it is mainly practiced by men, intermittently, and in the context of social activities with friends. Descriptors adult, age, article, smoking, college student, female, gender, health survey, human, male, prevalence, priority journal, social aspect, social behavior, Syrian Arab Republic Links Book Title Database Embase; MEDLINE Publisher Data Source Embase Authors Maziak,W., Fouad,F. M., Asfar,T., Hammal,F., Bachir,E. M., Rastam,S., Eissenberg,T., Ward,K. D. Original/Translated Title URL Date of Electronic PMCID Editors
Gender and smoking status-based analysis of views regarding waterpipe and cigarette smoking in Aleppo, Syria	2004	Maziak, W., Syrian Center for Tobacco Studies, Aleppo, Syrian Arab Republic	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Preventive medicine Periodical, Abbrev. Prev.Med. Pub Date Free Form / Volume 38 Issue 4 Start Page 479 Other Pages 484 Notes Place of Publication ISSN/ISBN 0091-7435 Accession Number Language SubFile DOI Output Language Unknown(0) PMID Abstract Background. Narghile (waterpipe) smoking is increasing across the Eastern Mediterranean region (EMR), though little is known about the social attitudes and perceptions related to this method of tobacco use, and how those attitudes and perceptions are influenced by gender. Methods. Data from two cross-sectional surveys conducted in 2003 in Aleppo, Syria, were used to examine these issues. Overall, 855 participants were included (439 men, 416 women; mean age, 24.4Â±7.1 years; response rate, 97%). The current analysis focuses on responses to four similar nine-item questions tapping perceptions related to narghile smoking by women or men, and cigarette smoking by women or men. Scores on the nine items were summed to yield a total score to gauge participants' perceptions about narghile and cigarette. Results. Generally, participants were less positive about women smoking relative to men smoking, and cigarette smoking relative to narghile smoking. Cigarette smoking by women was the behavior least associated with positive perceptions. Individuals who resided in the city, were economically better-off, and were Christian, had higher perception scores (i.e., more positive attitudes) toward all forms of smoking, whereas older and married participants had higher perception scores for narghile only. Smoking status of participants, especially narghile smoking, was also associated with more positive perceptions toward smoking in general. Conclusions. We conclude that preliminary analysis shows that views on different forms of smoking in Syria differ by gender and smoking status. Â© 2003 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. Descriptors adult, article, smoking, controlled study, female, gender, health behavior, health survey, human, interview, male, narghile smoking, normal human, perception, priority journal, questionnaire, sex difference, smoking habit, social behavior, Syrian Arab Republic Links Book Title Database Embase; MEDLINE Publisher Data Source Embase Authors Maziak,W., Rastam,S., Eissenberg,T., Asfar,T., Hammal,F., Bachir,M. E., Fouad,M. F., Ward,K. D. Original/Translated Title URL Date of Electronic PMCID Editors
Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic	2004		Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Tob Control Periodical, Abbrev. Tob.Control Pub Date Free Form Volume 13 Issue 4 Start Page 327 Other Pages 33 Notes ID: 15564614 Place of Publication ISSN/ISBN Accession Number Language en SubFile DOI Output Language Unknown(0) PMID Abstract CONTEXT: The global tobacco epidemic may kill 10 million people annually in the next 20-30 years, with 70% of these deaths occurring in developing countries. Current research, treatment, and policy efforts focus on cigarettes, while many people in developing regions (Asia, Indian subcontinent, Eastern Mediterranean) smoke tobacco using waterpipes. Waterpipes are increasing in popularity, and more must be learned about them so that we can understand their effects on public health, curtail their spread, and help their users quit. OBJECTIVE: To conduct a comprehensive review regarding global waterpipe use, in order to identify current knowledge, guide scientific research, and promote public policy. DATA SOURCES: A Medline search using as keywords "waterpipe", "narghile", "arghile", "shisha", "hookah", "goza", "hubble bubble" and variant spellings (for example, "hooka"; "hukka") was conducted. Resources compiled recently by members of GLOBALink were used. STUDY SELECTION: Every identified published study related to waterpipe use was included. DATA SYNTHESIS: Research regarding waterpipe epidemiology and health effects is limited; no published studies address treatment efforts. Waterpipe use is increasing globally, particularly in the Eastern Mediterranean Region, where perceptions regarding health effects and traditional values may facilitate use among women and children. Waterpipe smoke contains harmful constituents and there is preliminary evidence linking waterpipe smoking to a variety of life threatening conditions, including pulmonary disease, coronary heart disease, and pregnancy related complications. CONCLUSIONS: More scientific documentation and careful analysis is required before the spread of waterpipe use and its health effects can be understood, and empirically guided treatment and public policy strategies can be implemented. Descriptors Developing Countries/statistics & numerical data, Smoking/epidemiology, Carbon Monoxide/analysis, Carbon Monoxide/toxicity, Child, Female, Health Policy, Health Status, Humans, Male, Nicotine/analysis, Nicotine/toxicity, Pregnancy, Prevalence, Smoking/adverse effects, Smoking/trends, Tobacco/chemistry, Tobacco Smoke Pollution/adverse effects Links http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1747964/?tool=pubmed Book Title Database MEDLINE; http://www.globalhealthlibrary.net/ Publisher Data Source Authors Maziak,W., Ward,K. D., Afifi Soweid,R.A., Eissenberg,T. Original/Translated Title URL Date of Electronic PMCID Editors
Factors related to frequency of narghile (waterpipe) use: The first insights on tobacco dependence in narghile users	2004	Maziak, W., Syrian Center for Tobacco Studies, P.O. Box 16542, Aleppo, Syrian Arab Republic	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Drug and alcohol dependence Periodical, Abbrev. Drug Alcohol Depend. Pub Date Free Form 2004/10 Volume 76 Issue 1 Start Page 101 Other Pages 106 Notes Place of Publication ISSN/ISBN 0376-8716 Accession Number Language SubFile DOI Output Language Unknown(0) PMID Abstract Aims: To evaluate factors related to level of narghile (waterpipe) use as a first step towards modeling tobacco dependence among narghile users. Design: Cross sectional survey done in 2003 using interviewer-administered anonymous questionnaires. Setting: Cafes/restaurants serving narghiles in Aleppo, Syria. Participants: Narghile smokers (161 men and 107 women; mean age, 30.1 Â± 10.2, 161; age range, 18-68 years; response rate, 95.3%) randomly selected from the 17 cafes/restaurants sampled. Measurements: Frequency of narghile use (daily, weekly, monthly) was assessed as a function of several factors potentially indicative of dependence, including situational characteristics (where, when, and with whom smoking occurs; seasonality of use, and sharing of narghile), attitudes, and experience with quitting narghile use, escalation of use over time, future intentions regarding use, perception of being "hooked" on narghile, and cognitions/behaviors engaged in to support use (carrying one's own narghile; think of narghile when it is not available; considering narghile for selection of cafes/restaurants). Findings: Frequency of narghile use was strongly correlated with participant's subjective judgment of how hooked they are on narghile (coefficient, 0.5). Predictors of narghile use frequency according to multinomial logistic regression were: male gender, smoking mainly alone versus with others; smoking mainly at home versus outside; smoking more frequently since initiation, being hooked on narghile, carrying narghile, and considering it for cafe/restaurant choice. Conclusions: Our data reveal two main domains of a tobacco dependence syndrome likely to be relevant to narghile; the first reflects the effects of nicotine contained in narghile tobacco, and is not very different from what is seen with other tobacco products, and the second is unique to narghile and is related mainly to its social dimension, with more intensive smokers showing an increasingly individual pattern of narghile smoking. Â© 2004 Elsevier Ireland Ltd. All rights reserved. Descriptors adult, aged, article, behavior, catering service, cognition, correlation analysis, female, human, logistic regression analysis, male, prevalence, priority journal, questionnaire, smoking, Syrian Arab Republic, tobacco dependence, tube Links Book Title Database Embase; MEDLINE Publisher Data Source Embase Authors Maziak,W., Ward,K. D., Eissenberg,T. Original/Translated Title URL Date of Electronic PMCID Editors
The Munich Barrett follow up study: suspicion of Barrett's oesophagus based on either endoscopy or histology only--what is the clinical significance?	2004	Central Interdisciplinary, Endoscopy Unit, Department of Gastroenterology, Campus Virchow, Charite University Hospitals, Berlin, Germany. Thomas.Roesch@charite.de	Read more...
Source Type Print(0) Ref Type Journal Article Periodical, Full Gut Periodical, Abbrev. Gut Pub Date Free Form Oct Volume 53 Issue 10 Start Page 1402 Other Pages 1407 Notes LR: 20140608; JID: 2985108R; OID: NLM: PMC1774245; ppublish Place of Publication England ISSN/ISBN 0017-5749; 0017-5749 Accession Number PMID: 15361485 Language eng SubFile Journal Article; Multicenter Study; AIM; IM DOI 10.1136/gut.2003.036822 [doi] Output Language Unknown(0) PMID 15361485 Abstract BACKGROUND: The incidence of distal oesophageal adenocarcinoma is rising, with chronic reflux and Barrett's oesophagus being considered risk factors. Reliable detection of Barrett's oesophagus during upper endoscopy is therefore mandatory but requires both endoscopy and histology for confirmation. Appropriate management of patients with endoscopic suspicion but negative on histology, or vice versa, or of patients with no endoscopic suspicion but with a biopsy diagnosis of intestinal metaplasia at the gastro-oesophageal junction, has not yet been studied prospectively. PATIENTS AND METHODS: In a prospective multicentre study, 929 patients (51% male, mean age 50 years) referred for upper gastrointestinal endoscopy were included; 59% had reflux symptoms. The endoscopic aspect of the Z line and any suspicion of Barrett's oesophagus were noted, and biopsies were taken in all patients from the Z line (n = 4), gastric cardia (n = 2), and body and antrum (n = 2 each). Biopsies positive for specialised intestinal metaplasia (SIM) were reviewed by a reference pathologist for a final Barrett's oesophagus diagnosis. All patients with endoscopic and/or histological suspicion of Barrett's oesophagus were invited for a follow up endoscopy; the remaining cases (no endoscopic or histological suspicion of Barrett's oesophagus) were followed clinically. RESULTS: Of 235 patients positive for Barrett's oesophagus on endoscopy and/or histology, 63% agreed to undergo repeat endoscopy (mean follow up period 30.5 months). 46% of patients with an endoscopic Barrett's oesophagus diagnosis but no histological confirmation (group A) showed the same distribution, a further 42% did not have Barrett's oesophagus, and 11% had confirmed Barrett's oesophagus on both endoscopy and biopsy on follow up. In the group with a histological Barrett's oesophagus diagnosis but negative on initial endoscopy (group B), follow up showed the same in 26% whereas 46% had no Barrett's oesophagus, and confirmed Barrett's oesophagus (endoscopy plus histology) was diagnosed in 17%. Of the study population, 16 patients had Barrett's oesophagus on initial endoscopy confirmed by histology which remained constant in 70% at follow up (group C). Of the remaining patients without an initial Barrett's oesophagus diagnosis on either endoscopy or histology (group D) and only clinical follow up (mean follow up period 38 months), one confirmed Barrett's oesophagus case was found among 100 patients re-endoscoped outside of the study protocol. However, no single case of dysplasia or cancer of the distal oesophagus was detected in any patient during the study period. CONCLUSIONS: Even in a specialised gastroenterology setting, reproducibility of presumptive endoscopic or histological diagnoses of Barrett's oesophagus at follow up were poor. Only 10-20% of cases with either endoscopic or histological suspicion of Barrett's oesophagus had established Barrett's oesophagus after 2.5 years of follow up. The risk of dysplasia in this population was very low and hence meticulous follow up may not be required. Descriptors Adolescent, Adult, Aged, Aged, 80 and over, Barrett Esophagus/diagnosis/pathology, Esophageal Neoplasms/diagnosis/pathology, Esophagoscopy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Selection, Precancerous Conditions/diagnosis/pathology, Prognosis, Prospective Studies, Reproducibility of Results Links Book Title Database Publisher Data Source Authors Meining,A., Ott,R., Becker,I., Hahn,S., Muhlen,J., Werner,M., Hofler,H., Classen,M., Heldwein,W., Rosch,T. Original/Translated Title URL Date of Electronic PMCID PMC1774245 Editors

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