ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Because nutrition is an integral aspect of the science and practice of gastroenterology, all gastroenterology fellows should receive training in core aspects of nutrition (level 1 training). Some gastroenterologists also wish to train more extensively in nutrition (level 2) and become physician nutrition specialists. The Intersociety Professional Nutrition Education Consortium, composed of representatives from eight national societies with significant nutrition interests, including the American Gastroenterological Association, and three credentialing bodies, has developed a paradigm and training requirements for physician–nutrition specialists that recognizes their varied backgrounds and areas of interest. Opportunities exist for gastroenterology fellows to obtain physician nutrition specialist training within their gastroenterology fellowships and to be eligible to take the Certification Examination for Physician Nutrition Specialists offered by the new American Board of Physician Nutrition Specialists.* This article reviews the development of consensus on subspecialty training for physicians in nutrition; it also encourages directors of gastroenterology fellowships to develop training opportunities and gastroenterology fellows to consider identifying nutrition as an area of emphasis for their careers.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Goals and BackgroundFundoplication is increasingly used for the treatment of gastroesophageal reflux disease (GERD). Few studies have tracked patient outcomes of the Toupet method for more than 1 year. Further clinical, physiologic, and patient-based outcome measures have not been well characterized for this method. The current study conducts a long-term, comprehensive outcome evaluation in patients receiving Toupet fundoplication.StudyFifty-five patients who had previously undergone fundoplication were examined. In a subset of 24 patients, esophagogastroduodenoscopy was used to assess the severity of reflux esophagitis. Manometry and ambulatory pH monitoring also were performed.ResultsPatients were studied 2.9 (± 0.7) years after surgery. Sixty-seven percent of the sample reported heartburn, 51% reported postoperative bloating, 33% reported regurgitation, and 20% reported dysphagia. Thirty-three percent reported the use of prescription medications for GERD-related symptoms. Health status was diminished relative to population norms. Degree of GERD severity was associated with symptom reports and medication use.ConclusionsAlthough fundoplication is thought to be a curative procedure, the current findings suggest that many patients take symptomatic therapies and report symptoms and diminished health status up to 2 years after the procedure. These outcomes are associated with physiologic findings. Thus, these findings suggest that symptom-free status and absence of medication use cannot be assumed for all patients after Toupet fundoplication.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

GoalsTo compare the dyspepsia severity, general health, and psychologic health of patients with uninvestigated dyspepsia presenting in private and public settings.StudyPatients in this cross-sectional study were recruited from the Houston Veterans Administration (VA) General Medicine Outpatient Clinic and from the nearby private practice of a family physician. To be included, patients had to be at least 18 years of age and had to report a history of dyspepsia (epigastric discomfort) without alarm of at least 1 week's duration. Clinical information was obtained. Dyspepsia severity was measured using dyspepsia-related health scales, general health was measured using the Short Form 36, and psychologic health was measured using six scales.ResultsThe authors enrolled 159 patients (59 VA). There were no differences in VA and private patients in most of the clinical characteristics related to dyspepsia. Compared with the private patients, the VA patients had worse scores on all Short Form 36 subscales, had lower expectations for treatment outcome, were more depressed, and had less optimism about life.ConclusionsBurden of illness and psychologic factors such as patient expectations are known to have important effects on patient outcomes. Striking differences in these factors exist in patients with uninvestigated dyspepsia seen in private and public settings. In the future, these factors must be taken into account both in conducting studies in dyspepsia and in interpreting the results for different practice settings.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundUnusual resistance to treatment in 5% to 7% of 1,845 peptic ulcers examined under endoscopy from 1987 to 1996 prompted a search for unusual causes. Although some ulcers were caused by Zollinger–Ellison syndrome (ZES), an atypical clinical course in other patients, especially with those with multiple ulcers, suggested abuse of aspirin.StudyPatients who did not have ZES were questioned closely regarding aspirin use and were tested for serum salicylate to detect surreptitious abuse.ResultsThe authors identified 37 patients with aspirin-related ulcers but otherwise intact upper gastrointestinal tracts. There were 12 men and 25 women aged 18 to 73 years; 18 admitted to current aspirin abuse (>1 g/d), but 19 denied it despite objective evidence from elevated serum salicylate (8.4 ± 1.2 mg/dL). The clinical presentation was atypical, with only 10 patients having single ulcers, whereas 27 had 83 multiple or multiorgan ulcers. Overall, there were 32 duodenal, 57 gastric, and 4 esophageal ulcers. Omeprazole healed 64% of ulcers, but despite follow-up maintenance with H2receptor antagonists, all ulcers recurred rapidly, often in a new location. Thirty of 37 patients had serious complications: 18 bled; 9 had pyloric and 2, duodenal stenosis; 2, esophageal strictures; and 2, perforation. Six patients who stopped using aspirin healed easily. The 80% who did not stop on advice after diagnosis were considered abusers.ConclusionPatients with aspirin abuse have atypical, often multiple, intractable ulcers with many complications. These ulcers differ from conventionalHelicobacter pyloripeptic ulcers and also from those found in patients with ZES. Unless aspirin use is stopped, these ulcers remain incurable and dangerous.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundTiclopidine is a novel antiplatelet agent used alone or in combination with aspirin and anticoagulants in the treatment and prevention of various vascular diseases. Gastrointestinal side effects, including bleeding, have been reported with use of ticlopidine in most of the vascular prevention trials. We studied the endoscopic evidence of mucosal damage in patients taking ticlopidine compared with patients taking aspirin/nonsteroidal antiinflammatory drugs (NSAIDs) and matched controls.StudyWe performed a longitudinal review of gastrointestinal endoscopy, pharmacy databases, and medical records of patients referred to our service over a period of 6 months for endoscopic evaluation of upper gastrointestinal bleeding, unexplained anemia, or abdominal pain. Data were collected and analyzed for 55 patients taking ticlopidine, 77 age- and gender-matched patients taking aspirin or NSAIDs, and 560 age- and gender-matched control patients not taking any of these medications.ResultsThe overall prevalence of ulcers was marginally higher in the aspirin/NSAID group than in the ticlopidine group (35% vs. 29%) and was significantly higher among patients taking aspirin, NSAIDs, or ticlopidine than among controls (15%). Gastritis was also noted more frequently in the aspirin/NSAID and ticlopidine groups than in the control group. Endoscopic evidence of esophagitis was significantly more frequent in the control group than in the aspirin/NSAID and ticlopidine groups. There was no significant difference across groups in the prevalence of ulcers, gastritis, or esophagitis.ConclusionsPatients taking ticlopidine are more likely to have endoscopic evidence of mucosal damage than matched control patients and are nearly as likely to have such damage as endoscopically evaluated patients taking aspirin or NSAIDs. However, these findings must be confirmed using prospective cohort data for patients in primary care settings, to avoid referral bias.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

GoalTo determine the prevalence of associated primary tumors in patients with gastric cancer.StudyRetrospective study of 2,668 patients with gastric cancer observed at our department between July 1974 and December 1999. Associated tumors were diagnosed using Warren and Gates criteria, and included tumors that were not considered to be a metastasis, invasion, or recurrence of gastric cancer.ResultsOf all, 3.4% (n = 78) had primary tumors other than gastric cancer, 27% of which were synchronous (n = 21) and 73%, metachronous (n = 57). The mean follow-up time was 4 years (range, 1–13 years), and the male-to-female ratio was 1:1. The median age at diagnosis of gastric cancer was 67 years (range, 37–84 years), 69 years for patients with synchronous tumors versus 60 years for those with metachronous (p= 0.050). For at least half the patients the median time interval to metachronous cancer was 3 years (range, 1–22 years). Seventy-eight percent (n = 61) had two cancers; most were colonic (19%), uterine and ovarian (16%), and breast tumors (13%). Seventeen percent (n = 13) had three tumors: colon (46%), breast (23%), and skin (23%). Four percent (n = 3) had four tumors. One case with seven tumors was also observed [colon, breast (two tumors), uterus, skin, and stomach (two tumors)]. No statistically significant differences were found between synchronous and metachronous with regard to sex, gastric cancer location, and staging (TNM). Sixty-three percent (n = 49) died while under observation.ConclusionsWe found associated tumors in 3.4% of patients with gastric cancer. The most frequent associated tumors were breast and colon cancer. Surveillance for these tumors would be appropriate, at least in first years, after diagnosis of gastric cancer.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID