ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Tissue staining during endoscopy (chromoendoscopy) is a technique used to study the fine details of the mucosa throughout the gastrointestinal tract. Unfortunately, its applications and results are not known by many gastrointestinal or surgical endoscopists. Each stain has a few specific clinical applications. The mechanism of action of the stains should be fully understood before their use. Ideally, the clinician should use chromoendoscopy and the variety of stains either to confirm a clinical suspicion or to provide new information that could aid management in a specific setting. Endoscopic tattooing is a different technique where a specific site in the gastrointestinal tract is labeled by an intramural injection of a carbon ink suspension solution for future surgical or endoscopic identification.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Achalasia is a primary esophageal motor disorder of unknown etiology producing complaints of dysphagia, regurgitation, and chest pain. The current treatments for achalasia involve the reduction of lower esophageal sphincter (LES) pressure resulting in improved esophageal emptying. Calcium channel blockers and nitrates, once used as initial treatment strategy for early achalasia, are now only used in patients who are not candidates for pneumatic dilation or surgery and those not responding to botulinum toxin injections. By virtue of the more rigid balloons, the current pneumatic dilators are more effective and have better efficacy than the older more compliant balloons. The graded approach to pneumatic dilation using the Rigiflex balloons (3.0, 3.5, and 4.0 cm) are now the most commonly used nonsurgical means of treating patients with achalasia, resulting in symptom improvement in up to 90% of patients. Surgical myotomy, once with high morbidity and long hospital stay, can now be performed laparoscopically with similar efficacy to the open surgical approach (94% vs. 84%, respectively), reduced morbidity, and hospitalization time. Given the advances in both balloon dilation and laparoscopic myotomy, most patients with achalasia can now choose between these two equally efficacious treatment options. Botulinum toxin injection of the LES should be reserved for patients who cannot undergo balloon dilation and are not surgical candidates.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Radiation proctopathy can be a disabling delayed outcome of radiation therapy directed at pelvic malignancies. Rectal outlet bleeding can be severe enough to result in anemia and transfusion dependency. Bleeding typically develops from 6 months to 1 year after completion of radiation therapy and is caused by friable mucosal angioectasias. Although many approaches to controlling bleeding from chronic radiation proctopathy have been attempted, ranging from topical enema formulations to surgical diversion of the rectum, endoscopic coagulation therapy remains the most effective. This review provides the background issues surrounding the development of chronic bleeding radiation proctopathy and focuses on endoscopic methods of treatment.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Hereditary hemochromatosis (HH) is a human leukocyte antigen-linked inherited disease that is characterized by inappropriately high absorption of iron by the gastrointestinal mucosa. The spectrum of disease presentation is changing with more and more patients now being identified before they are symptomatic with complications of iron overload. A candidate gene for HH, calledHFE,was identified in 1996, and a test for the gene is commercially available. A review of the recent identification of the gene and its implications for clinical diagnosis and therapy is presented. We also propose an algorithm for evaluation of patients for HH. Early diagnosis and appropriate therapy can prevent significant morbidity and mortality associated with the development of end-organ complications of HH. The understanding of the C282Y and H63D mutations is still evolving, and the algorithm and the contribution of various heterozygous mutations to the diagnosis and management of iron overload need to be confirmed by further clinical and genetic studies.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A competent lower esophageal sphincter (LES) prevents gastroesophageal reflux disease (GERD) in the setting of increased abdominal pressure. Therefore, we have assessed whether a back support belt causes gastroesophageal reflux (GER). Ten healthy volunteers underwent esophageal manometric studies to locate the LES. Subsequently, each subject underwent two separate 8-hour intra-esophageal pH monitor studies on different days, the first without wearing a back support belt, and the subsequent one wearing a back support belt. A symptom diary and continuous intra-esophageal pH data were obtained during both study periods. The mean LES pressure (LESP) was 14 ± 3.6 mm Hg without a back support belt and 15.8 ± 4.3 mm Hg with a back support belt which was not significantly different. There were no significant differences in total episodes of GER, esophageal acid exposure, or any other parameters monitored. Symptoms of GER were the same comparing the back support belt with no back support belt. We conclude that healthy people with normal LESP do not have increased GER as a result of wearing a back support belt.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Helicobacter pyloriantibody testing is accurate for diagnosing untreated patients. Rapid serum testing is as accurate as formal enzyme-linked immunosorbent assay (ELISA) testing. As whole blood fingerstick tests may become the diagnostic method of choice if they are of similar accuracy, 51 patients were studied who had not taken antibiotics, bismuth, sucralfate, or proton pump inhibitors. Concordance between C-14 Urea Breath Testing and HM-CAP ELISA testing served as the study standard forH. pyloridiagnosis. Rapid antibody testing was performed with the AccuStat whole blood (Boehringer Mannheim, Mannheim, Germany) and FlexSure HP (Smith Kline Diagnostics, San Jose, CA) serum tests. Antral biopsy for CLO testing and histological evaluation with thiazine staining were available for 18 (35.3%) and 20 patients (39.2%), respectively.Nineteen of 50 patients (38%) were infected. (One patient had discordant tests and was excluded.) FlexSure HP and AccuStat were each positive in 18 (36%) and 19 patients (38%) with sensitivity, specificity, and positive and negative predictive values of 89.5% and 89.5%, 96.8% and 93.5%, 94.4% and 89.5%, and 93.8% and 93.5%, respectively. There were two false-negative FlexSure HP and AccuStat tests and three false-positive tests-1 FlexSure and 2 AccuStat results. CLO test and histology concurred in every case tested.We conclude that both rapid antibody tests are accurate and suitable for screening patients not previously treated forH. pyloriinfection. Since the AccuStat has preserved diagnostic strength, is less costly, takes less time, and is less labor intensive, whole blood testing is the screening test of choice.

ISSN:0192-0790    

出版商:OVID    

年代:1998

数据来源: OVID