Summary Background Cough may be a manifestation of gastro-esophageal reflux disease (GERD). The utility of acid suppression in GERD-related cough is uncertain. Aim To assess the impact of high-dose acid suppression with proton pump inhibitors (PPI) on chronic cough in subjects with rare or no heartburn. Methods Subjects were non-smokers without history of asthma, with chronic cough for > 8 weeks. All subjects underwent a baseline 24 hr pH/impedance study, methacholine challenge test (MCT), and laryngoscopy. Subjects were randomized to either 40 mg of esomeprazole twice daily or placebo for 12 weeks. The primary outcome measure was the Cough-Specific Quality of Life Questionnaire (CQLQ). Secondary outcomes were response on Fisman Cough Severity/Frequency scores, and change in laryngeal findings. Results 40 subjects were randomized (22 PPI, 18 placebo) and completed the study. There was no difference between PPI and placebo in CQLQ (mean improvement 9.8, vs. 5.9 in placebo, p = 0.3), or Fisman Cough Severity/Frequency scores. The proportion of patients who improved by >1 standard deviation on the CQLQ was 27.8% (5/18) and 31.8% (7/22) in the placebo and PPI groups respectively. Conclusions In subjects with chronic cough and rare or no heartburn, high-dose PPI did not improve cough-related quality of life or symptoms in this randomized controlled trial.

Background & Aims-Patients with Barrett's esophagus (BE) show increased risk for developing esophageal adenocarcinoma and are routinely examined using upper endoscopy with biopsy to search for neoplastic changes. Angle-resolved low coherence interferometry (a/LCI) uses in vivo depth-resolved nuclear morphology measurements to detect dysplasia. We assessed the clinical utility of a/LCI in the endoscopic surveillance of BE patients.

Objective Barrett’s oesophagus is associated with abdominal obesity. Adiponectin is a peptide that is secreted from adipocytes and circulates in three multimeric forms: low molecular weight (LMW), middle molecular weight (MMW), and high molecular weight (HMW). The anti-inflammatory effects of adiponectin are specific to individual multimers, with LMW being most anti-inflammatory. We postulated that circulating levels of adiponectin and its multimers would be associated with the risk of Barrett’s oesophagus. Design Cross-sectional study. Setting Outpatient clinic in North Carolina, USA. Patients Cases of Barrett’s oesophagus and controls undergoing upper endoscopy for gastro-oesophageal reflux disease (GORD). Main outcome measures Adjusted odds ratios of plasma adiponectin levels and its multimers for Barrett’s oesophagus. Results There were 112 cases of Barrett’s oesophagus and 199 GORD controls. Total adiponectin was not associated with Barrett’s oesophagus (3rd tertile vs 1st tertile adjusted odds ratio (aOR) = 0.88; 95% confidence interval (CI) = 0.44 to 1.78). High levels of LMW adiponectin were associated with a decreased risk of Barrett’s oesophagus (3rd tertile vs 1st tertile aOR = 0.33; 95% CI, 0.16 to 0.69), and a high LMW/total ratio appeared particularly inversely associated with Barrett’s oesophagus (3rd tertile vs 1st tertile aOR = 0.27; 95% CI, 0.13 to 0.58). Conclusions High levels of LMW adiponectin are associated with a decreased risk of Barrett’s oesophagus among patients with GORD. Further human studies are required to confirm these findings, and in vitro studies are needed to understand if there is a mechanism whereby adiponectin may affect Barrett’s metaplasia.

Background Guidelines suggest that patients with non-dysplastic BE undergo endoscopic surveillance every 3–5 years, but actual utilization of surveillance endoscopy and the determinants of variation in surveillance intervals are not known. Objective To measure utilization of surveillance endoscopy and its variation in patients with non-dysplastic BE. Design Multi-center, cross-sectional study Setting Three sites in Arizona, Minnesota, and North Carolina. Patients Participants had prevalent BE without a history of high grade dysplasia or EAC. Interventions Participants were given validated measures of quality of life, numeracy, and cancer risk perception, and the total number of prior endoscopic surveillance exams was measured. Main outcome measurements Over-surveillance was defined as >1 surveillance exam per 3 year period. Results Among 235 patients with non-dysplastic BE, 76% were male and 94% Caucasian. The average duration of BE was 6.5 years (± 5.9 years). The mean number of endoscopies per 3 year period was 2.7 (± 2.6 years). Over-surveillance was present in 65% of participants, resulting in a mean of 2.3 excess endoscopies per patient. Neither numeracy skills nor patient perception of cancer risk were associated with over-surveillance. Limitations Endoscopies were measured by patient report, which is subject to error. Results may only be generalizable to patients seen in academic centers. Conclusions Most patients with non-dysplastic BE had more surveillance endoscopic exams than is recommended by published guidelines. Patient factors did not predict over-surveillance, indicating that other factors may influence decisions about the interval and frequency of surveillance exams.

Introduction The American College of Gastroenterology (ACG) has awarded research grants for 25 years. We assessed the characteristics of grant recipients, their current academic status, and the likelihood of publication resulting from the grant. Methods Demographic data, year and amount of award, title of project, and recipient’s institution were extracted from ACG databases. Using ACG reports and medical literature search engines, we assessed publication based on grant-funded research, as well as career publication record. We also determined the current position of awardees. Similar analysis was performed for recipients of junior investigator awards. Results A total of 396 clinical research awards totaling $5,374,497 ($6,867,937 in 2008 dollars) were awarded to 341 recipients in the 25 years between 1983 and 2008. The most commonly funded areas of research were endoscopy (22% of awards) and motility/functional disorders (21%). At least one peer-reviewed publication based on grant-funded research occurred in 255 of the awards (69%). Higher award value was associated with subsequent publication. Of 341 past awardees, 195 (62%) are currently in academic positions. Factors associated with staying in academics included higher award value (p<0.01), a Master’s degree (p=0.02) and publishing grant-funded research (p<0.01). The junior faculty career development award was granted to 27 individuals for a total of $3,000,000 (3,398,004 in 2008 dollars). Publication resulted from 90% of the funded projects, and 95% of awardees have remained in academics. Overall, the mean cost in grant dollars per published paper based on the research was $14,875. Conclusion The majority of ACG grant recipients published the results of their research and remained in academics. Higher amount of award, holding an advanced degree, and publication were associated with careers in academics. The ACG research grant award program is an important engine of investigation, publications, and academic career development in the field of gastroenterology.