Differences in the diagnostic yield of upper gastrointestinal endoscopy in dyspeptic patients receiving proton-pump inhibitors and H2-receptor antagonists

Patients attending for diagnostic oesophagogastroduodenoscopy (OGD) for dyspeptic symptoms are often receiving acid-suppression therapy that has not been discontinued prior to endoscopy, and this may reduce the diagnostic yield of endoscopy. The aim of this study was to compare the diagnostic yield of OGD in uncomplicated dyspepsia in patients receiving no medication, those receiving acid-suppression therapy, and those receiving nonsteroidal anti-inflammatory drugs (NSAIDs) at the time of endoscopy.

An audit of hospital admissions for acute upper gastrointestinal haemorrhage

A retrospective survey was made of all 189 patients admitted with acute upper gastrointestinal haemorrhage to the Belfast City Hospital in one year. The commonest single reason for admission was peptic ulcer disease, but this was lower than in other published series from the United Kingdom. Overall mortality was 4.8%. The majority of patients did not require either blood transfusion or surgery. There may be potential benefits of endoscopic haemostatic techniques to deal with this condition.

Circulating gastrointestinal hormones in patients with flatulent dyspepsia, with and without gallbladder disease

Fasting and post-prandial circulating levels of insulin, gastrin, gastric inhibitory polypeptide, pancreatic polypeptide and neurotensin were measured in patients with flatulent dyspepsia, with and without gallbladder disease and post-cholecystectomy. Levels were also measured in non-dyspeptic patients with gallbladder disease and normal controls. There were no consistent significant differences from controls for fasting and post-prandial responses in patients with a history of dyspepsia or those who experienced dyspepsia at the time of the test. In patients with gallbladder disease, with and without dyspepsia, there was a reduced neurotensin response compared to normal controls. It is concluded that circulating levels of these hormones are not related to symptoms of flatulent dyspepsia.

Plasma somatostatin and gastrointestinal peptides in Alzheimer's disease and vascular dementia

Few markers distinguish between different dementia types. As dementia affects many body systems outside the central nervous system, we investigated gastrointestinal regulatory peptides as possible disease markers in Alzheimer's Disease (AD) and vascular dementia (VaD). Subjects with mild-to-moderate dementia were diagnosed as probable AD and VaD according to defined criteria. Gastrointestinal peptides were stimulated using a standardized meal test, administered after an overnight fast to 58 dementia patients (40 AD, 18 VaD) and 47 controls matched for age and sex. Blood samples were taken at designated time intervals, and basal and stimulated plasma concentrations of eleven peptides were determined by radio-immunoassay. Results were analysed using the Kruskal-Wallis one-way analysis of variance; the Mann-Whitney U test was used in post hoc analysis where appropriate. There were significant differences in somatostatin levels but in none of the other peptides. Basal somatostatin was significantly increased in VaD compared to controls (p

Assessment of the solubility and bioaccessibility of arsenic in realgar wine using a simulated gastrointestinal system

Consumption of arsenic (As) wine is a traditional activity during the classic Chinese festival of Duanwu, colloquially known worldwide as the Dragon Boat Day. Arsenic wine is drunk on the morning of the fifth day of the fifth lunar calendar month to commemorate the death of Qu Yuan, a famed Chinese poet who drowned himself in protest of a corrupt government, and to protect against ill fortune. Although realgar minerals are characteristically composed of sparingly soluble tetra-arsenic tetra-sulfides (As(4)S(4)), purity does vary with up to 10% of As being present as non-sulfur bound species, such as arsenate (As(v)) and arsenite (As(III)). Despite, the renewed interest in As speciation and the bioaccessibility of the active As components in realgar based Chinese medicines, little is known about the safety surrounding the cultural practice of drinking As wine. In a series of experiments the speciation and solubility of As in a range of wines were investigated. Furthermore, a simulated gastrointestinal system was employed to predict the impact of digestive processes on As bioavailability. The predominant soluble As species found in all the wines were As(III) and As(v). Based on typical As wine recipes employing 0.1 g realgar mL(-1) wine, the concentration of dissolved As ranged from ca. 100 to 400 mg L(-1) depending on the ethanol content of the preparation: with the As solubility found to be higher in wines with a lower proportion of ethanol. Based on a common 100 mL measure of wine with a concentration of 400 mg As L(-1), the amount of soluble As would equate to around half of the acute minimal lethal dose for adults. This is likely an underestimate of the bioaccessible concentration, as a three-fold increase in bioaccessibility could be observed in the intestinal phase based on the results from the stimulated gastrointestinal system. (C) 2011 Elsevier B.V. All rights reserved.

The Next Generation Transit Survey (NGTS)

The Next Generation Transit Survey (NGTS) is a new ground-based sky survey designed to find transiting Neptunes and super-Earths. By covering at least sixteen times the sky area of Kepler we will find small planets around stars that are sufficiently bright for radial velocity confirmation, mass determination and atmospheric characterisation. The NGTS instrument will consist of an array of twelve independently pointed 20cm telescopes fitted with red-sensitive CCD cameras. It will be constructed at the ESO Paranal Observatory, thereby benefiting from the very best photometric conditions as well as follow up synergy with the VLT and E-ELT. Our design has been verified through the operation of two prototype instruments, demonstrating white noise characteristics to sub-mmag photometric precision. Detailed simulations show that about thirty bright super-Earths and up to two hundred Neptunes could be discovered. Our science operations are due to begin in 2014.

The frequency of gastrointestinal endocrine tumours in a well-defined population--Northern Ireland 1970-1985

The reported incidence of gastrointestinal endocrine tumours is variable. In Northern Ireland circumstances allowing such an assessment are favourable with a central diagnostic laboratory and register established to collect data on tumours from a well-defined population of 1.5 million people. From 1970 to 1985, 368 cases were recorded of which 85 per cent were carcinoid tumours. The annual incidence of carcinoid tumours was 1.3 per 100,000 of the population and the majority occurred in the appendix (61 per cent). No patients presented with the carcinoid syndrome. The annual incidence for other tumours was 0.12 per 100,000 for insulinomas; islet cell tumours of unknown type 0.07; Zollinger-Ellison syndrome 0.05; and multiple endocrine neoplasia (MEN) 0.05. There were two cases of VIPoma, one glucagonoma, one neurotensinoma and one tumour producing ACTH. It is possible that some tumours are more uncommon than others because of difficulty in diagnosis.

Digital slide viewing for primary reporting in gastrointestinal pathology: a validation study

Despite the increasing availability of digital slide viewing, and numerous advantages associated with its application, a lack of quality validation studies is amongst the reasons for poor uptake in routine practice. This study evaluated primary digital pathology reporting in the setting of routine subspecialist gastrointestinal pathology, commonplace in most tissue pathology laboratories and representing one of the highest volume specialties in most laboratories. Individual digital and glass slide diagnoses were compared amongst three pathologists reporting in a gastrointestinal subspecialty team, in a prospective series of 100 consecutive diagnostic cases from routine practice in a large teaching hospital laboratory. The study included a washout period of at least 6 months. Discordant diagnoses were classified, and the study evaluated against recent College of American Pathologists (CAP) recommendations for evaluating digital pathology systems for diagnostic use. The study design met all 12 of the CAP recommendations. The 100 study cases generated 300 pairs of diagnoses, comprising 100 glass slide diagnoses and 100 digital diagnoses from each of the three study pathologists. 286 of 300 pairs of diagnoses were concordant, representing intraobserver concordance of 95.3 %, broadly comparable to rates previously published in this field. In ten of the 14 discordant pairs, the glass slide diagnosis was favoured; in four cases, the digital diagnosis was favoured, but importantly, the 14 discordant intraobserver diagnoses were considered to be of minor clinical significance. Interobserver, or viewing modality independent, concordance was found in 94 of the total of 100 study cases, providing a comparable baseline discordance rate expected in any second viewing of pathology material. These overall results support the safe use of digital pathology in primary diagnostic reporting in this setting

Transit timing variations in WASP-10b induced by stellar activity

The hot-JupiterWASP-10bwas reported by Maciejewski et al. to showtransit timing variations (TTVs) with an amplitude of ~3.5 min. These authors proposed that the observed TTVs were caused by a 0.1M_Jup perturbing companion with an orbital period of ~5.23 d, and hence, close to the outer 5:3 mean-motion resonance with WASP-10b. To test this scenario, we present eight new transit light curves of WASP-10b obtained with the Faulkes Telescope North and the Liverpool Telescope. The new light curves, together with 22 previously published ones, were modelled with a Markov Chain Monte Carlo transit fitting code. Transit depth differences reported forWASP-10b are thought to be due to starspot-induced brightness modulation of the host star. Assuming the star is brighter at the activity minimum, we favour a small planetary radius. We find Rp = 1.039^+0.043 _-0.049R_Jup in agreement with Johnson et al. and Maciejewski et al. Recent studies find no evidence for a significant eccentricity in this system. We present consistent system parameters for a circular orbit and refine the orbital ephemeris ofWASP-10b. Our homogeneously derived transit times do not support the previous claimed TTV signal, which was strongly dependent on two previously published transits that have been incorrectly normalized. Nevertheless, a linear ephemeris is not a statistically good fit to the transit times of WASP-10b. We show that the observed transit time variations are due to spot occultation features or systematics. We discuss and exemplify the effects of occultation spot features in the measured transit times and show that despite spot occultation during egress and ingress being difficult to distinguish in the transit light curves, they have a significant effect in the measured transit times. We conclude that if we account for spot features, the transit times of WASP-10b are consistent with a linear ephemeris with the exception of one transit (epoch 143) which is a partial transit. Therefore, there is currently no evidence for the existence of a companion to WASP-10b. Our results support the lack of TTVs of hot-Jupiters reported for the Kepler sample. 

Aristarchos RISE2: A Wide-Field Fast Imager for Exoplanet Transit Timing

The detection of exoplanets is currently of great topical interest in astronomy. The Rapid Imager for Surveys of Exoplanets 2 (RISE2) camera will be built for exoplanet studies and in particular for detection of transit timing variations (TTV) induced by the presence of a third body in the system. It will be identical to RISE which has been running successfully on the 2m Liverpool Telescope since 2008 but modified for the 2.3m ARISTARCHOS telescope. For TTV work the RISE/LT combination is regularly producing timings with accuracy <10 seconds making it the best suited instrument for this work. Furthermore, RISE2/AT has the added benefit of being located at a significantly different longitude to the LT/RISE on La Palma, hence extending the transit coverage.

Transit Observations of the Hot Jupiter HD 189733b at X-Ray Wavelengths

We present new X-ray observations obtained with Chandra ACIS-S of the HD 189733 system, consisting of a K-type star orbited by a transiting Hot Jupiter and an M-type stellar companion. We report a detection of the planetary transit in soft X-rays with a significantly deeper transit depth than observed in the optical. The X-ray data favor a transit depth of 6%-8%, versus a broadband optical transit depth of 2.41%. While we are able to exclude several possible stellar origins for this deep transit, additional observations will be necessary to fully exclude the possibility that coronal inhomogeneities influence the result. From the available data, we interpret the deep X-ray transit to be caused by a thin outer planetary atmosphere which is transparent at optical wavelengths, but dense enough to be opaque to X-rays. The X-ray radius appears to be larger than the radius observed at far-UV wavelengths, most likely due to high temperatures in the outer atmosphere at which hydrogen is mostly ionized. We furthermore detect the stellar companion HD 189733B in X-rays for the first time with an X-ray luminosity of log LX = 26.67 erg s-1. We show that the magnetic activity level of the companion is at odds with the activity level observed for the planet-hosting primary. The discrepancy may be caused by tidal interaction between the Hot Jupiter and its host star.