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Biomedical subjects

C N Bernstein

Publications and source records attributed to C N Bernstein.

At least 37 records · Page 2Linked to original sources
PubMed2001

Development of an assay for antibodies to Saccharomyces cerevisiae: Easy, cheap and specific for Crohn's disease.

OBJECTIVE: To develop a serological test to measure antibodies to Saccharomyces cerevisiae in patients with inflammatory bowel disease. METHODS: An ELISA to the mannan of S cerevisiae that is commercially available was developed. Sera were tested from randomly chosen sera specimens kept frozen at the University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba. Clinical diagnoses were kept blinded until the assay results were finalized. One hundred thirty-six sera were tested, including 51 with Crohn's disease, 32 with ulcerative colitis, one with indeterminate colitis and 16 other control subjects. Thirty-six samples were duplicates from patients already studied but were either run on separate days or drawn on different days. RESULTS: Using a cutoff of 15 binding units as a positive result, Crohn's disease was found to have a sensitivity of 53% but a specificity of 100% compared with ulcerative colitis. Compared with all other diagnoses (including ulcerative colitis), Crohn's disease had a sensitivity of 53% and a specificity of 96%. For patients with Crohn's disease only, those who were anti-S cerevisiae antibody (ASCA) positive (n=27) were significantly more likely to have proximal gastrointestinal disease and significantly less likely to have colonic or inflammatory type disease than those who were ASCA negative (n=24). The direct cost of this assay was $6.00 per positive test, and the total charge was set at $38.15. CONCLUSIONS: A reasonably inexpensive, easy and reproducible assay to assess for antibodies to S cerevisiae has been developed. Using a cutoff for positivity of 15 binding units, this test had a specificity of 100% for ruling out Crohn's disease and a lower (60%) sensitivity compared with ulcerative colitis. This test could identify a specific phenotype of patients with Crohn's disease as being more likely to have small bowel Crohn's disease and less likely to have colonic (isolated) or inflammatory disease, as opposed to fibrostenotic disease or penetrating disease. The test proved reliable when assaying samples drawn or assayed on different days.

Adult↗
PubMed2001

The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study.

BACKGROUND: There is an impression mostly from specialty clinics that patients with inflammatory bowel disease (IBD) have an increased risk of venous thromboembolic disorders. Our aim was to determine the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) from a population-based database of IBD patients and, to compare the incidence rates to that of an age, gender and geographically matched population control group. METHODS: IBD patients identified from the administrative claims data of the universal provincial insurance plan of Manitoba were matched 1:10 to randomly selected members of the general population without IBD by year, age, gender, and postal area of residence using Manitoba Health's population registry. The incidence of hospitalization for DVT and PE was calculated from hospital discharge abstracts using ICD-9-CM codes 451.1, 453.x for DVT and 415.1x for PE. Rates were calculated based on person-years of follow-up for 1984-1997. Comparisons to the population cohort yielded age-adjusted incidence rate ratios (IRR). Rates were calculated based on person-years of follow-up (Crohn's disease = 21,340, ulcerative colitis = 19,665) for 1984-1997. RESULTS: In Crohn's disease the incidence rate of DVT was 31.4/10,000 person-years and of PE was 10.3/10,000 person-years. In ulcerative colitis the incidence rates were 30.0/10,000 person-years for DVT and 19.8/10,000 person-years for PE. The IRR was 4.7 (95% CI, 3.5-6.3) for DVT and 2.9 (1.8-4.7) for PE in Crohn's disease and 2.8 (2.1-3.7) for DVT and 3.6 (2.5-5.2) for PE, in ulcerative colitis. There were no gender differences for IRR. The highest rates of DVT and PE were seen among patients over 60 years old; however the highest IRR for these events were among patients less than 40 years. CONCLUSION: IBD patients have a threefold increased risk of developing DVT or PE.

Adult↗
PubMed2000

The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study.

BACKGROUND: The clinical significance of the high prevalence of osteopenia in inflammatory bowel disease is unclear. OBJECTIVE: To determine whether persons with inflammatory bowel disease have increased incidence of fracture. DESIGN: Population-based matched cohort study. SETTING: Manitoba, Canada. PATIENTS: Patients with inflammatory bowel disease in the University of Manitoba IBD Database (n = 6027) were matched to 10 randomly selected persons in the general population without inflammatory bowel disease (n = 60 270) by year, age, sex, and postal area of residence. MEASUREMENTS: The incidence of hospitalization for hip fracture was determined on the basis of hospital discharge abstracts. Outpatient medical billing records and hospital discharge abstracts were used to calculate the incidence of spine, rib, and forearm fractures. Rates were calculated on the basis of person-years of follow-up for 1984 to 1997. RESULTS: Persons with inflammatory bowel disease had significantly increased incidence of fractures at the spine (incidence rate ratio [IRR], 1.74 [95% CI, 1.34 to 2.24]; P < 0.001), hip (IRR, 1.59 [CI, 1.27 to 2.00]; P < 0.001), wrist/forearm (IRR, 1.33 [CI, 1.11 to 1.58]; P = 0.001), and rib (IRR, 1.25 [CI, 1.02 to 1.52]; P = 0.03) and of any of these fractures (IRR, 1.41 [CI, 1.27 to 1.56]; P < 0.001). CONCLUSION: The incidence of fracture among persons with inflammatory bowel disease is 40% greater than that in the general population.

Adult↗
PubMed2000

Neoplastic and other complications of inflammatory bowel disease.

Patients with inflammatory bowel disease (IBD) have long been known to be at increased risk of development of colorectal cancer; however, there are many nuances to cancer prevention strategies in IBD that remain unresolved. During the past year, two publications reported on the resection of otherwise typical adenoma-like masses by means of polypectomy, after which these patients were followed with continued endoscopic surveillance, rather than pursuing colectomy. Another concern in IBD is whether there is an increase in the number of other cancers, in particular lymphomas. One issue regarding lymphoma risk is whether immunomodulatory drug use predisposes to this cancer. One study of a large group of 6-mercaptopurine users did not suggest an increased risk for patients with IBD using this drug. There are a variety of nonintestinal problems that patients with IBD may confront. Osteopenia has received considerable attention in the past decade. This year, data have been published that quantify for the first time the risk of fractures in patients with IBD based on population, and these data were compared with a matched control group from the same population. Data on the further exploration of the issue of osteopenia in pediatric IBD have also been reported, as have some of the only studies of therapy for osteopenia in IBD. These and data on other extraintestinal manifestations of IBD have all emerged in the past year.

Alendronate↗
PubMed2000

Viruses and inflammatory bowel disease: is there evidence for a causal association?

There has been a resurgent interest in potential microbial etiologies of inflammatory bowel disease (IBD). Over the past decade there have been both epidemiological and tissue studies exploring the potential role of paramyxoviruses in IBD, particularly Crohn's disease. This article will review the evidence and hence plausibility of a causal association between these viruses and IBD.

Antibodies, Viral↗
PubMed2000

Direct hospital costs for patients with inflammatory bowel disease in a Canadian tertiary care university hospital.

OBJECTIVE: We set out to determine the direct costs of hospitalizations of patients with Crohn's disease and ulcerative colitis admitted to a university-affiliated tertiary care hospital and to contrast the costs of medical versus surgical inpatient care, Crohn's disease versus ulcerative colitis, and to identify dominant components of inpatient costs. METHODS: We used a patient-specific case costing system at Saint Boniface General Hospital, Winnipeg, Manitoba, for fiscal years 1994 and 1995. We extracted all inpatients whose hospital discharge abstracts included ICD-9-CM codes 555 (Crohn's disease) and 556 (ulcerative colitis) among the top eight discharge diagnoses, and performed a chart review on all cases to ensure that the hospitalization was for inflammatory bowel disease and the diagnoses were accurate. We analyzed cases based on their disease diagnosis, primary mode of therapy associated with the hospitalization (medical vs surgical), and their major diagnosis-related group (DRG). This study evaluated direct patient care costs only and costs are expressed in Canadian dollars. RESULTS: Of 362 hospital admissions, 325 were eligible and of these admissions 275 belonged to the digestive system DRGs. Seventy-one (37%) were admitted more than once during the 2 yr of the study, accounting for 202 (62%) of the total number of admissions. The mean cost per admission of all cases of Crohn's disease was $3,149 (95% confidence interval [CI], $2,665-$3,634) and for ulcerative colitis was $3,726 (95% CI $3,008-$4,445). Surgical therapy cases accounted for 49.8% of all admissions, 57.8% of all hospital days, and 60.5% of all costs. Patients treated surgically had more costly hospitalizations than those treated medically, particularly when analyzing only nontotal parenteral nutrition (TPN) cases. Surgical treatment admissions were significantly more costly for ulcerative colitis digestive DRG admissions than Crohn's disease. The nondigestive DRG admissions were more costly than the digestive DRGs in all categories although this was only statistically different among medically treated Crohn's disease. Patients treated medically were similarly costly whether they had Crohn's disease or ulcerative colitis. There was no significant difference in cost per admission among cases admitted multiple times, compared with those admitted only once. TPN cases accounted for 9.5% of cases but 27.1% of costs. TPN-associated hospitalizations were more costly than non-TPN-use hospitalizations but these costs were primarily driven by duration of stay rather than TPN use itself. For all cases, the top five cost categories in descending order were nursing unit bed-days, drugs and pharmacy, diagnostic lab tests, operating room, and diagnostic imaging and endoscopy. CONCLUSIONS: Using our system we could determine direct costs for inpatients with inflammatory bowel disease and the factors that determined increased costs. Medical therapy admissions were similarly costly between Crohn's disease and ulcerative colitis; however, surgical therapy admissions were costlier among ulcerative colitis patients. Admissions for nondigestive DRGs were more costly than those for digestive DRGs. TPN use identified a sicker group of patients who remained in the hospital longer than nonusers and, not surprisingly, these were the costliest patients.

Adolescent↗
PubMed2000

Clinically significant gastrointestinal bleeding in critically ill patients in an era of prophylaxis.

OBJECTIVE: Clinical studies examining stress-related gastrointestinal bleeding in critically ill patients vary in their clinical definitions and assessment of clinical significance. Although there is evidence that routine prophylaxis decreases stress-related gastrointestinal bleeding, recent studies indicate a decreasing incidence, independent of the use of prophylactic medications. The purpose of this study was to determine the incidence of and risk factors for clinically significant, endoscopically proven gastrointestinal bleeding in critically ill patients. METHODS: A database (prospectively collected data) of 8338 patients admitted to the surgical and medical intensive care units at major tertiary care center from July 1988 to April 1995 was examined. All patients with significant upper gastrointestinal bleeding as defined by a drop in hemoglobin of >20 g/L and endoscopic evidence of an upper GI tract source were identified. Risk factors for GI bleeding from stress ulceration were compared in bleeding and nonbleeding patients. A case-control study analyzing risk factors for bleeding in the abdominal aortic aneurysm subgroup was performed. RESULTS: After exclusion criteria, 12/7231 (0.17%) patients had clinically significant, endoscopically proven bleeding. Significant risk factors included age, septic shock, abdominal aortic aneurysm repair, and nutritional support. Intensive care unit stay was prolonged in patients with stress-related bleeding. There was no difference in incidence of hypotension, clamp time, APACHE score, or operating room time in patients with abdominal aortic aneurysm repair as compared with controls. CONCLUSIONS: In an intensive care unit where stress prophylaxis is widely used, clinically important gastrointestinal bleeding is uncommon. Further study is needed to define the optimal prophylaxis regimen and the role for its selective use in high-risk patients.

Aged↗
PubMed2000

Perceptual responses in patients with inflammatory and functional bowel disease.

BACKGROUND AND AIMS: Enhanced visceral sensitivity following a transient inflammatory process in the gut has been postulated as an aetiological mechanism of irritable bowel syndrome (IBS). In this study we compared perceptual responses to rectosigmoid distension in patients with mild chronic inflammation of the rectum (ulcerative colitis (UC)) and patients without mucosal inflammation (IBS) to determine if chronic low grade mucosal inflammation may be a plausible explanation for rectosigmoid hypersensitivity reported in both IBS and UC patients. METHODS: UC disease activity was quantified using activity index scores. Perception thresholds for discomfort during rectosigmoid distension were compared between 11 UC patients with quiescent or mild disease activity, 18 IBS patients, and 13 healthy controls. RESULTS: Although UC activity index scores negatively correlated with perceptual thresholds for discomfort (r=-0.76, p=0.016), UC patients had higher discomfort thresholds compared with IBS patients and controls before (p=0.02) and after (p<0.001) a noxious sigmoid conditioning stimulus. CONCLUSIONS: Rectal perception was attenuated in UC but enhanced in IBS. In chronic mild inflammation, activation of antinociceptive mechanisms may prevent the development of visceral hyperalgesia. Low grade mucosal inflammation alone is unlikely to be responsible for symptoms in functional gastrointestinal disorders.

Adult↗
PubMed2000

Colonoscopy plus biopsy in the inflammatory bowel diseases.

Colon biopsies are critical in helping to diagnose diarrhea, to distinguish different forms of colitis, to determine the extent of disease, and to determine if neoplasia has arisen in the setting of chronic colitis. Table 3 summarizes the recommended locations and numbers of biopsies for different scenarios. Some of the technical aspects pertaining to those are also discussed elsewhere in this issue. Colon biopsies in some instances can be definitive, but this usually requires the appropriate clinical scenario. For instance, to appreciate that segmental granulomatous colitis is Crohn's disease and not the much rarer colonic sarcoidosis requires ancillary clinical information. Often colon biopsies may definitively reveal an abnormality, but the findings may be nonspecific in regards to a definitive diagnosis. To use colon biopsies most appropriately in patient management and to get the most mileage from them usually requires frequent clinician-pathologist interaction, often repeat endoscopy with [table: see text] biopsies at a different time, and the assessment of the biopsies in the clinical context.

Biopsy↗
PubMed1999

Epidemiology of Crohn's disease and ulcerative colitis in a central Canadian province: a population-based study.

The aim of this study was to assess the accuracy and utility of administrative health data in identifying persons with inflammatory bowel disease on a population basis and to determine the incidence and prevalence of this disease in the Canadian province of Manitoba. The data from Manitoba Health (the province's single insurer) were used to identify residents with physician and/or hospital contacts for Crohn's disease or ulcerative colitis based on International Classification of Diseases, Ninth Revision, Clinical Modification, codes between 1984 and 1995. Of 5,182 eligible individuals, 4,514 were mailed questionnaires and 2,725 responded. Cases were defined as individuals with five or more separate medical contacts with one of these diagnoses or three or more such contacts if they were resident for less than 2 years. The accuracy of the study case definitions was high when compared with either self-report or chart review. The 1989-1994 age- and sex-adjusted annual incidence was 14.6/100,000 for Crohn's disease and 14.3/100,000 for ulcerative colitis. The prevalence of Crohn's disease in 1994 was 198.5/100,000, and that of ulcerative colitis was 169.7/100,000. In conclusion, the authors have successfully established and validated a population-based database of inflammatory bowel disease based on administrative data. The high incidence rates and dynamic epidemiology of inflammatory bowel disease in Manitoba indicate the presence of important environmental risk factors, which warrants further investigation.

Adolescent↗
PubMed1999

Cancer surveillance in inflammatory bowel disease.

This article reviews the rationale and approach to dysplasia surveillance colonoscopy in inflammatory bowel disease. Recent developments in the field are also highlighted, including approaches to polyps that arise in patients with colitis and new diagnostic markers that may complement morphologic assessment for dysplasia.

Biomarkers, Tumor↗
PubMed1999

Seroprevalence of Helicobacter pylori, incidence of gastric cancer, and peptic ulcer-associated hospitalizations in a Canadian Indian population.

The living conditions of many aboriginal communities in Canada may place their residents at risk for H. pylori infection. Our aims were to determine: (1) the seroprevalence of H. pylori in a traditional Indian community, (2) the clinical relevance of H. pylori infection in this population, and (3) if H. pylori could be identified by polymerase chain reaction from the local water. A demographic questionnaire was administered, and blood was collected from subjects in an Indian community in northwestern Manitoba. The serum was analyzed by ELISA for IgG to H. pylori and to CagA. ABO and Lewis antigens were tested. Age-adjusted incidence of gastric cancer and of hospitalizations associated with diagnoses of peptic ulcer were determined for the Indian and non-Indian Manitoba population in the years 1989-1993. Nested PCR was performed on lake water using H. pylori-specific primers and the amplicons probed with an internal Dig-labeled probe. Three hundred six (59%) of approximately 518 individuals who were resident in the community at the time of the study were enrolled. The ELISA for H. pylori was positive in 291 (95%). There was no association between H. pylori seropositivity and age, sex, gastrointestinal complaints, medications, housing characteristics, and ABO or Lewis antigen status. CagA was positive in 84.5% of infected subjects. The average annual age-adjusted incidence of hospitalizations associated with diagnoses of peptic ulcer disease in Manitoba was higher for treaty-status Indians (394.3/100,000) than for non-Indians (203.8/100,000), but gastric cancer rates were similar (11.2/100,000 vs 11.6/100,000). No H. pylori DNA was detected in the lake water. In conclusion, the seroprevalence of CagA-positive H. pylori is high in this representative Manitoban Indian community. This may be associated with an increased risk for peptic ulcer disease but is not associated with an increased risk for gastric cancer.

Adolescent↗
PubMed1999

The effects of physical exercise on patients with Crohn's disease.

OBJECTIVE: Despite the suggested benefits of exercise training in the prevention and management of chronic diseases, few data exist regarding the safety of exercise in Crohn's disease and whether or not exercise may have beneficial effects on patients' health. We performed a pilot study to evaluate the effects of regular light-intensity exercise on sedentary patients with Crohn's disease. METHODS: Sedentary patients with inactive or mildly active Crohn's disease were eligible for the study. A thrice-weekly, 12-wk walking program was supervised, although if subjects could not attend the group walking sessions they were allowed to walk on their own. Logbooks of performance were maintained, and individual exercise heart rate goals were established. Measures performed at baseline and at study completion included the Inflammatory Bowel Disease Stress Index, the Inflammatory Bowel Disease Quality of Life Score, the Harvey and Bradshaw Simple Index, the Canadian Aerobic Fitness Test, VO2 Max, and body mass index (BMI). RESULTS: Twelve subjects completed the 12-wk exercise program. Subjects walked an average of 2.9 sessions/wk, at an average of 32.6 min/session, and for an average distance of 3.5 km/session. Statistically significant improvements at study end were seen by all measures, with a trend toward reduction in BMI. No patient's disease flared during the study. CONCLUSIONS: Sedentary patients with Crohn's disease can tolerate low-intensity exercise of moderate duration without an exacerbation of symptoms. Twelve weeks of walking was adequate to elicit psychological and physical improvements and did not adversely affect disease activity.

Adult↗
PubMed1999

An international survey of the use and attitudes regarding alternative medicine by patients with inflammatory bowel disease.

OBJECTIVE: There is a perception of increasing and widespread use of alternative medicine for inflammatory bowel disease (IBD). We assessed the usage of alternative therapies among patients with IBD, whether there were similar or contrasting variables that were predictive of such use, and contrasted the use in four different centers in North America and Europe. METHODS: Patients in four IBD centers completed a self-administered questionnaire regarding alternative medicine. The centers were in Cork, Los Angeles, Stockholm, and Winnipeg. Patient demographics, the use of 18 types of alternative medicine, and attitudes towards alternative and conventional medicine were compared. A multiple logistic regression analysis was used. RESULTS: Fifty-one percent of 289 patients used some form of alternative medicine. The percentages of use by site were Cork = 31%, Los Angeles = 68%, Stockholm = 32%, and Winnipeg = 57%. The six most commonly used therapies in descending order were: exercise (28%), prayer (18%), counseling (13%), massage (11%), chiropractic (11%), and relaxation (10%). Only 7% used acupuncture or homeopathy and 5% used herbal medicine. The highest odds ratios (confidence intervals [CIs]) for using any form of alternative medicine were associated with: being single 3.1 (1.7-5.7), Los Angeles patient 4.4 (2.3-8.3), Winnipeg patient 2.7 (1.3-5.9), and an increase of alternative medicine use of 2.7% for every M.D. visit (CI, 2-11%/visit). The patient age, gender, disease diagnosis, or duration of disease were not predictive of any type of alternative medicine use. Regarding attitudes, respondents from Cork were most favorable toward alternative medicine use and least favorable toward conventional medicine. Based on attitudes, subjects were more likely to use alternative medicine if they were not satisfied with conventional therapy, viewed hospitals as dangerous places, thought that alternative medicine practitioners should have a role in hospitals, and felt their medical situation was hopeless. CONCLUSIONS: Fifty-one percent of respondents used some form of alternative medicine. The use was greater among the North American patients than the European ones. Respondents were more likely to use alternative medicine if they were single, in a higher income bracket, and an urban dweller.

Attitude↗
PubMed1999

Helicobacter pylori in the Canadian arctic: seroprevalence and detection in community water samples.

OBJECTIVE: Many North American arctic communities are characterized by risk markers associated with Helicobacter pylori (H. pylori) infection, including overcrowded housing and inadequate water supply and sanitation systems. Our aim was to determine the seroprevalence of H. pylori infection in two traditional Inuit communities in the central Canadian arctic and to test for the presence of H. pylori, by polymerase chain reaction (PCR), in local water supplies. METHODS: Samples of venous whole blood from adults and capillary blood from children were collected and analyzed by enzyme immunoassay and Helisal Rapid Test, respectively, for IgG antibody to H. pylori. Antibodies to CagA were detected by enzyme immunoassay, and ABO and Lewis antigens were also determined. Demographic and clinical information were collected by questionnaire. Water samples from each community were tested for H. pylori by PCR. RESULTS: One hundred-thirty (50.8%) of 256 subjects from the two communities were positive for H. pylori IgG antibodies. Seropositive subjects were more likely to be male, compared with seronegative individuals (p = 0.01). Antibody status did not differ with respect to age, community, alcohol or cigarette use, number of persons per household, gastrointestinal complaints or previous investigations, medications, or presence of blood group O, Lewis a-b+. CagA antibodies were detected in 78 (61.9%) of 126 H. pylori-seropositive subjects tested; however, 41 (35.3%) of 116 H. pylori-seronegative subjects were also CagA positive. Water samples taken from the water delivery truck in Chesterfield Inlet and two lakes near Repulse Bay were positive for H. pylori. CONCLUSION: The seroprevalence of H. pylori in the study group was higher than rates in southern Canadian populations, but lower than the seroprevalence previously documented in a Canadian subarctic Indian (First Nations) community. The detection of H. pylori in local water supplies may indicate a natural reservoir for the organism or possible contamination from human sewage.

ABO Blood-Group System↗