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Background The aim of this study was to assess whether high-resolution impedance-manometry (HRIM) could be utilized to assess bolus retention similar to the timed barium esophagram (TBE). Method 20 achalasia patients [10 males, ages 21–79] were prospectively evaluated with HRIM and TBE to determine the correlation between barium column height and the impedance bolus height (IBH). The TBE protocol utilized a 200 ml barium challenge and the HRIM protocol utilized a 200 ml saline challenge protocol. Both protocols were performed in an upright position and the heights of the barium and impedance columns were measured at 1 and 5 minutes. Analysis of IBH was performed with a topographic technique and a spatial impedance variation plot. Results There was no significant difference between the median IBH and barium column at 1 minute [IBH 12.0 cm (IQR, 8.0–18.0), TBE 12.0 cm (IQR, 7.0–19.0), P=0.90] or 5 minutes [IBH 11.0 cm (IQR, 1.0–17.0), TBE 9.0 cm (IQR, 4.0–12.0), P=0.47]. Additionally, the correlation between the two measurements at 1 and 5 minutes was 0.60 and 0.86, respectively. Using a barium column or impedance height of >5.0 as a definition of bolus retention was associated with 75% concordance at 1 minute and 95% concordance at 5 minutes. Conclusion There was excellent agreement between TBE and HRIM for assessing bolus retention at 5 minutes. Thus, HRM with impedance may be utilized as a single test to assess bolus retention and motor function in the management of achalasia.

Aims/hypothesisFTO gene single nucleotide polymorphisms (SNPs) have been shown to be associated with obesity-related traits and type 2 diabetes. Several small studies have suggested a greater than expected effect of the FTO rs9939609 SNP on weight in polycystic ovary syndrome (PCOS). We therefore aimed to examine the impact of FTO genotype on BMI and weight in PCOS.MethodsA systematic search of medical databases (PubMed, EMBASE and Cochrane CENTRAL) was conducted up to the end of April 2011. Seven studies describing eight distinct PCOS cohorts were retrieved; seven were genotyped for SNP rs9939609 and one for SNP rs1421085. The per allele effect on BMI and body weight increase was calculated and subjected to meta-analysis.ResultsA total of 2,548 women with PCOS were included in the study; 762 were TT homozygotes, 1,253 had an AT/CT genotype, and 533 were AA/CC homozygotes. Each additional copy of the effect allele (A/C) increased the BMI by a mean of 0.19 z score units (95% CI 0.13, 0.24; p = 2.26 × 10−11) and body weight by a mean of 0.20 z score units (95% CI 0.14, 0.26; p = 1.02 × 10−10). This translated into an approximately 3.3 kg/m2 increase in BMI and an approximately 9.6 kg gain in body weight between TT and AA/CC homozygotes. The association between FTO genotypes and BMI was stronger in the cohorts with PCOS than in the general female populations from large genome-wide association studies. Deviation from an additive genetic model was observed in heavier populations.Conclusions/interpretationThe effect of FTO SNPs on obesity-related traits in PCOS seems to be more than two times greater than the effect found in large population-based studies. This suggests an interaction between FTO and the metabolic context or polygenic background of PCOS.

IntroductIonThe landmark Diabetes Control and Complications Trial (DCCT) established that intensive insulin therapy with either multiple dai ly injections (MDI) or continuous subcutaneous insulin infusion (CSII), resulting in lower hemo globin A 1c (HbA 1c ) levels compared with standard treatment in type 1 diabetic patients, prevents the occurrence and postpones the progression of microvascular complications. 1,2 Thus, main taining nearnormal glucose levels is a crucial

Background and Aims Poor sleep quality in Crohn’s disease (CD) is associated with histologic activity and clinical relapse. We sought to characterize sleep dysfunction and determine the effect of poor sleep quality on risk for hospitalization and surgery. Methods Clinical data were collected for CD subjects including the Pittsburgh Sleep Quality Index (PSQI) and Harvey-Bradshaw index (HBI). The PSQI score and a brief medical history were obtained for control subjects. The PSQI and HBI correlation was tested at an initial clinic visit and at follow-up. Crohn’s disease subjects with and without poor sleep were compared for risk of hospitalization or surgery by Kaplan–Meier and Cox proportional hazards. Results Ninety-two CD and 82 control subjects were included. Crohn’s disease and control subjects shared similar baseline characteristics and PSQI (8.3 vs 7.8, P = 0.31), and 77% of the CD population had PSQI >5. Crohn’s disease subjects with PSQI >5 more often had inflammatory phenotypes and reported increased benzodiazepine and psychiatric medication use. Crohn’s disease subjects with PSQI >5 also reported more night awakenings due to pain and bathroom use. The PSQI correlated with HBI (r = 0.256, P = 0.014), and ΔPSQI on follow-up correlated with ΔHBI (r = 0.47, P = 0.002). Cox proportional hazards model for hospitalization or surgery showed that PSQI >8 was predictive of surgery or hospitalization (hazards ratio 5.37; 95% confidence interval, 1.39–27.54). Conclusion There is a high burden of poor sleep quality in CD, which is associated with risk for adverse outcomes. Sleep quality may identify CD patients at risk for complications and have prognostic value in CD.