ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Fiberoptic endoscopy has enabled clinicians to make accurate diagnoses of the cause of acute upper gastrointestinal (GI) bleeding, but, contrary to expectation, that information by itself has not led to improved morbidity or mortality in patients with upper GI bleeding. However, the identification of the so-called stigmata of recent hemorrhage and the subsequent development of effective endoscopic treatments of bleeding lesions have provided hope, based on evidence from numerous clinical trials, that some patients with acute upper GI bleeding will benefit from endoscopic intervention. Injection sclerotherapy, now standard treatment for bleeding esophageal varices, is capable of controlling acute variceal bleeding and is equally effective or better than surgical procedures such as portosystemic shunts and esophageal transection. The question remains whether sclerotherapy of esophageal varices improves survival. With regard to therapeutic endoscopy of bleeding ulcers, multipolar electrocoagulation, laser photocoagulation, and injection of various agents all may be effective and beneficial. All of these methods appear to be capable of controlling acute bleeding and may improve survival, but because of the safety and low cost of injection therapy, that treatment ultimately may be preferred.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Topically active agents (i.e., colloidal bismuth subcitrate and sucralfate) have proved to be effective in promoting the healing of both gastric and duodenal ulcers and in relieving ulcer symptoms. Sucralfate alone has also been shown to maintain peptic ulcers in remission when taken continuously for a long period of time, whereas successful short-term therapy with bismuth subcitrate is associated with a more prolonged remission of duodenal ulcer disease when compared to H2blockers. The antiulcer efficacy of these agents is partially counteracted by the need for multiple daily administrations, which requires greater patient compliance than with H2antagonists. A specific subgroup of patients who might particularly benefit from these drugs are those with duodenal ulcer resistant to H2blockers, whereas chronic nonsteroidal antiinflammatory drug users with peptic ulcer respond to therapy with site-protective agents as well as to antisecretory drugs.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Here, I review various conditions from my practice as a consultant gastroenterologist that present with abdominal pain in which the cause of the pain is the result of abdominal wall conditions, or disorders that affect the nerves to the abdominal wall. The diagnosis of abdominal wall pain can be made by careful history and physical examination, thus eliminating numerous unnecessary and sometimes dangerous invasive procedures and tests.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To clarify the interactions between stressful life events and other risk factors in the development of duodenal ulcer disease, we studied 33 patients with active ulcer, symptomatic for ≤ 6 months and untreated during the previous year, using the Paykel Interview for stressful life events, the Minnesota Multiphasic Personality Inventory (MMPI), and Zung's Anxiety and Depression scales. MMPIs were abnormal in 64% of the patients, and 61% showed some degree of depression. The 16 patients whose symptoms had been preceded by severe stress had more pathological MMPIs, especially on paranoia and dependency scales; were more depressed; and had used less nonsteroidal anti-inflammatory drugs than those without p < 0.05). They were somewhat more likely to be single, to be of low social class, and to have recently increased use of cigarettes, alcohol, or coffee (though their absolute level of alcohol consumption was low). Anxiety levels did not differ between stress and nonstress groups. Correspondence analysis yielded four clusters of patients, characterized by (a) alcohol/cigarette use, personality disorder, chronicity; (b) early onset, neurosis; (c) depression, life events; (d) late onset, psychosocial stability. The analysis changed little according to whether life events were or were not considered in cluster formation. We conclude that ulcer patients who become ill under stress form a distinct subgroup, that depressed mood and stress-related increases in use of alcohol and cigarettes may mediate between stress and ulcer formation, and that life events are a quantitatively minor factor in ulcerogenesis.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We have conducted a meta-analysis of 12 placebo controlled trials to determine the efficacy of single drug therapy in Crohn's disease for both induction (seven trials) and maintenance (five trials) of remission. A total of 767 and 796 patients were studied, respectively. Various clinical criteria of success were analyzed. The Dersimonian-Laird method for meta-analysis was used to calculate the risk difference (RD). Therapeutic advantage, defined as the difference between drug and placebo response, was also determined. Using various criteria of success, we found that single drug therapy conferred an 11–29% therapeutic advantage (RD = 0.13–0.33) over placebo for the induction of remission. In trials for maintenance, no therapeutic advantage was found for single drug therapy over placebo. All forms of maintenance therapy followed nearly identical linear rates of relapse over time, showing an −90% maintenance of remission rate at 3 months, which decreased to 25% at 36 months. In conclusion, meta-analysis has established a standard of reference against which future drug trials can be compared. This standard of reference for drug and placebo rates, as well as the corresponding risk differences and therapeutic advantages can help determine the relative value of newer agents in the therapy of Crohn's disease.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The etiology of Crohn's disease remains elusive. Though there may be a genetic predisposition to the disease, epidemiologic evidence suggests that environmental factors are important. The role of dietary components and enhanced intestinal permeability deserve more attention. From this review of past studies, this investigator believes that ingested compounds may play an important role in the pathogenesis of Crohn's disease, Silica and various silicates provide models of how dietary factors might cause the disease and explain some of its features.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We systematically analyzed the relationship between 47 clinicoepidemiologic parameters and stage of colon cancer in 315 patients who underwent colon cancer surgery from 1982 through 1988 at the Robert Johnson University Hospital. A history of hemorrhoids was correlated with early cancer, possibly because of earlier self-referral (odds ratio = 18.2; χ2= 10.4; degrees of freedom = 1; p < 0.001). However, anemia was correlated with advanced cancer (odds ratio = 0.21; χ2= 13.7; degrees of freedom = 1; p < 0.0002). Anemia may result from chronic bleeding due to a longstanding cancer. Prior studies have suggested that intensive screening programs may produce earlier colon cancer detection; this study demonstrated forallpatients at a medical center a significant trend from 1982 through 1988 of detecting colon cancer at an earlier pathologic stage and with a better differentiated histologic grade (for first half of study period 44.4% had Dukes' stage A or B cancer, second half of study period 58.6% had Dukes' stage A or B cancer; odds ratio = 0.56; χ2= 5.8; degree of freedom = 1; p < 0.02). Possible explanations for this phenomenon are earlier self-referral because of increased patient awareness of cancer warning signs, and earlier physician detection because of greater use of colonoscopy and polypectomy and because of increased screening and surveillance. This earlier detection may herald a future significant decrease in colon cancer mortality at this hospital because prognosis is closely related to cancer stage. Further studies are required to determine if this is part of a national trend.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Manometry of sphincter of Oddi (SO) carries a risk of acute pancreatitis by a mechanism not yet clearly understood. This study attempted to evaluate the role of the flow rate of the perfusion system in the development of acute pancreatitis. During the past 60-months, we have performed 81 manometry studies of SO in 79 patients, 61 women and 18 men, who were referred for recurrent attacks of abdominal pain suggestive of SO dysfunction. All procedures were done by the same operator, utilizing the same instrumentation and similar premedication. In the first 54 studies, the pneumohydraulic system had a flow rate of 0.55 ml/min and a tank pressure of 15 lb/in2while in the last 27 studies a flow rate of 0.27 ml/min and a pressure of 7.5 lb/in2were employed. Acute pancreatitis was diagnosed after 16 (19.7%) procedures. Fourteen (26%) of them occurred after high-flow-rate perfusion. In contrast, only 2 (7%) of the 27 patients who had the procedure done at the low flow rate developed this complication (p < 0.05). There was no correlation between the occurrence of pancreatitis, clinical suspicion of SO dysfunction, and the underlying manometric profile of the sphincter. We conclude that the incidence of procedure-related pancreatitis after manometry of SO is higher than following diagnostic endoscopic retrograde cholangiopancreatography and that the flow rate in the perfusion system is a precipitating factor in the development of this complication.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Liver dysfunction in hyperthyroid patients has not been well characterized. We analyzed the clinical records of 43 patients with hyperthyroidism to define the spectrum of clinical and liver test abnormalities. The patients were divided into three categories: (a) 18 patients with uncomplicated hyperthyroidism (HT) (b) 19 with hyperthyroidism and congestive heart failure (HT/CHF), and (c) 6 with hyperthyroidism and concomitant unrelated liver disease (HT/ULD). Hepatomegaly and/or spenomegaly were noted in 15 of 19 (79%) patients with HT/CHF as compared to 6 of 18 (33%) patients with HT and 3 of 6 (50%) patients with HT/ULD. Four patients with HT/CHF had ascites. Serum aminotransferase levels > 250 IU/L were noted in only 1 of 37 (3%) patients without unrelated liver disease. Patients with HT/ULD or HT/CHF had markedly low prothrombin time. Serum bilirubin levels as high as 323 $mUM were noted in patients with HT. No characteristic liver histology due to hyperthyroidism was noted. Severe liver test abnormalities, including deep jaundice and prolonged prothrombin time, can occur in patients with hyperthyroidism alone or with HT/CHF. This makes the diagnosis of concomitant, unrelated liver disease difficult until the hyperthyroidism has been controlled.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID