ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Multichannel intraluminal impedance (MII) is a new technique for evaluating esophageal function and gastroesophageal reflux. This technique depends on changes in resistance to alternating current between two metal electrodes produced by the presence of bolus inside the esophageal lumen. Combined MII and manometry (MII-EM) provides simultaneous information on intraluminal pressure changes and bolus movement, whereas combined MII and pH (MII-pH) allows detection of pH episodes irrespective of their pH values (ie, acid and non-acid reflux). Combined MII-EM studies are performed very similarly to standard manometry. Based on studies in healthy volunteers and patients, combined MII-EM challenges current existing criteria that define the effectiveness of esophageal body function. Combined MII-pH testing brings a shift in gastroesophageal reflux testing paradigm. In MII-pH studies, reflux events are no longer detected by pH. Refluxate presence, distribution, and clearing are primarily detected by MII and simply characterized as acid versus non-acid based on pH change and as liquid, gas, or mixed based on MII. MII determines refluxate clearance time, whereas pH measures acid clearance time. MII-pH shows promise to become an important clinical tool, particularly to assess gastroesophageal reflux in the postprandial period and in patients with persistent symptoms on therapy and with atypical symptoms.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Crohn's disease is a heterogeneous inflammatory disorder characterized by strictures or perforating complications. Information on natural history is limited. In the present study, 150 patients with long-standing Crohn's disease, including 81 females and 69 males, were seen continuously by a single clinician for at least 20 years. Additional retrospective data were available extending for >40 years and 13 have now died, usually with an advanced malignancy. To evaluate disease expression, phenotypic clinical characteristics defined by the 1998 Vienna classification for Crohn's disease were used and included age at diagnosis, location of disease, and disease behavior at the time of diagnosis or 10 years or 20 years after diagnosis. Most patients were initially diagnosed before the age of 40 years (94%) and had ileocolonic disease (65.3%). At diagnosis, both females and males were most often classified with inflammatory disease (nonstenosing, nonpenetrating); however, over the course of the disease, particularly in the first decade, decreased numbers of patients with inflammatory disease and increased numbers with penetrating disease were seen. In addition, some with stenosing disease eventually developed penetrating disease. Disease localized to ileum alone was most often complicated by stricture formation, whereas ileocolonic disease was usually complicated by a penetrating complication. This shift in disease behavior indicates that Crohn's disease is a dynamic process that phenotypically evolves and progresses with time.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and AimsThe efficacy of 6-mercaptopurine (6-MP) in the treatment and long-term maintenance of remission of inflammatory bowel disease and prevention of recurrence after resection in Crohn's disease have been established. Concern about 6-MP toxicity remains, especially the development of neoplasm. The aim of this study is to determine the incidence of all short- and long-term toxicity by follow-up of all patients with inflammatory bowel disease treated with 6-MP over a 20-year period.Materials and MethodsWe reviewed the office and hospital records and also determined the recent status of 410 patients with inflammatory bowel disease treated with 6-MP from 1980 to 1999. All toxicity was recorded.ResultsThere was a low incidence of early drug-related allergic reactions (3.9%) and pancreatitis (1.2%). Desensitization to either 6-MP or azathioprine is often successful with the same or the other drug. Significant leukopenia (≤3,500) was observed in 11.5%. In some cases, this was caused purposefully. Infectious complications occurred at different times during treatment with 6-MP in 14%, including pneumonia in 3.9% and herpes zoster in 3%. We now establish diabetes as a 6-MP-related complication. No significant difference in the incidence of neoplasm was seen from our earlier study or from patients not treated with 6-MP. We have now seen three lymphomas and two leukemias, again not greater in incidence than the overall inflammatory bowel disease population.ConclusionsOur data support the long-term safety of 6-MP in the management of patients with inflammatory bowel disease. Earlier development of a neoplasm in a patient predisposed, without a change in incidence, remains possible.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsThe aim of this study was to evaluate our results of laparoscopic treatment of perforated gastroduodenal ulcers during a 5-year period and to compare the outcome of open and laparoscopic surgery.BackgroundThe value of laparoscopic treatment of gastroduodenal ulcers is still controversially debated because its superiority to conventional open surgery has not been established.StudyFrom January 1996 to December 2001, 24 patients were treated laparoscopically and 31 patients underwent conventional open suture repair. The results of these patients were retrospectively reviewed.ResultsThere were 55 patients with a mean age of 55 years (range 18–92 years) who were eligible for the study. Patients with laparoscopic repair had a lower mean ASA score (2 vs. 2.9;P= 0.02) and a less severe Mannheimer peritonitis index (16.5 vs. 21;P= 0.00001) compared with patients with open repair. Three patients who were begun by the laparoscopic approach had to be converted to open surgery (12.5%). Three patients who underwent open repair died postoperatively (5.5%). There was no difference between treatment groups regarding operative time, morbidity, or postoperative hospital stay. The laparoscopic group required significantly fewer analgesics postoperatively (2.2 vs. 4 dosages;P= 0.04).ConclusionsLaparoscopic treatment of perforated gastroduodenal ulcers is an effective treatment option and should be considered in suited patients for the initial approach.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsThe role that vitamin B12deficiency plays in upper gastrointestinal motor dysfunction is not clear. The aim of this study was to determine whether B12replacement therapy improves prolonged gastric emptying time in dyspeptic patients withHelicobacter pyloriinfection.Materials and MethodsThe study included 34H. pylori-positive patients who had low serum levels of B12but had no other factors associated with altered gastric motility. Each patient underwent a radionuclide gastric emptying study before and after 3 months of B12replacement therapy. Dyspepsia scores were calculated pretherapy and posttherapy using a semiquantitative scale. A vitamin B12preparation (1,000 &mgr;g/d) was given intramuscularly for the first 10 days and then orally for 80 days.H. pylorieradication therapy was delayed for 3 months until the posttreatment radionuclide study was completed.ResultsThe mean gastric emptying time before B12treatment was significantly longer than that after treatment (230 ± 190 minutes vs. 98 ± 29 minutes, respectively;P< 0.0001). The mean dyspepsia score was also significantly improved by treatment (5.4 ± 1.0 vs. 1.2 ± 1.0, respectively;P< 0.0001).ConclusionVitamin B12deficiency appears to play an important role in the development of gastric dysmotility and its clinical consequences. Replacement therapy will improve gastric emptying in some patients with dyspepsia.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsTo describe the clinical course of a patient with Gaucher disease who subsequently developed amyloidosis.BackgroundWe present a case of a splenectomized patient with Gaucher disease who developed portal hypertension secondary to an enlarged, cirrhotic-like liver, and recurrent life-threatening upper gastrointestinal bleeding.StudyDespite repeated diagnostic biopsies, amyloidosis was only ascertained after death.ResultsAlbeit very rare, there are four other similar cases in the literature, but unlike these previous reports of concurrence of Gaucher disease and amyloidosis, in this patient the gastrointestinal symptoms were life-threatening but there was no evidence of gammopathy or renal disease. Also, this is the first patient who was treated with enzyme replacement therapy for 5 years prior to manifestation of amyloidosis.ConclusionsCoexistence of apparently unrelated diseases with Gaucher disease demands a greater awareness of abnormalities at the biochemical and/or molecular level to adequately manage patients with Gaucher disease, regardless of concurrent enzyme replacement therapy.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

After routine investigations, including a thorough history, routine laboratory study, and noninvasive imaging with transcutaneous ultrasonogram, 10% to 25% of cases of acute pancreatitis have no readily identifiable cause and are termed idiopathic. But modern medicine has made notable advances in uncovering various causes of acute pancreatitis, and several new diagnostic tools that allow clinicians to less invasively approach the patient without sacrificing the diagnostic yield have been introduced. By being knowledgeable of these new changes and by their proper use in a proper circumstances, clinicians will be able to find the cause more accurately and earlier. This better management will not only improve the well-being of the patients but also reduce the number of “true” idiopathic acute pancreatitis to a minimum.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID