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:

Gastroesophageal reflux disease (GERD) is associated with ear, nose, and throat (ENT) signs and symptoms. Previously, experiments in animal larynx suggested that acid in combination with pepsin resulted in more laryngeal injury than acid alone. Recently, similar experiments expanded on the above observation, finding no laryngeal inflammation with bile acid, trypsin, or combination of bile constituents in alkaline pH values. Combined, experimental evidence highlights the importance of acidic refluxates that contain pepsin and/or bile acids; however, many patients with laryngeal signs suggestive of GERD do not respond to aggressive acid suppression. This has resulted in controversy about the exact nature of relationship between GERD and ENT signs and symptoms. Because the diagnosis is initially suspected after a laryngoscopic examination by the ENT physicians, the suboptimal clinical response may be caused by the poor specificity of this exam in identifying GERD as the cause of patients' laryngeal symptoms. Hence, a multidisciplinary approach is often required in the optimum treatment of these patients.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A close link has been established betweenHelicobacter pyloriinfection and gastric cancer. In this article, we suggest that using a risk stratification technique (like that for colorectal cancer), the high-risk group of first-degree relatives of patients with gastric cancer can be separated out forH. pyloritesting and treatment. This would be more manageable and more cost–effective than screening the whole population, in which the mortality from distal gastric cancer has declined concomitant with the eradication ofH. pyloriinfection. Support for the feasibility of this approach is derived from studies showing that the family is the core unit ofH. pyloritransmission and that childhood colonization, especially with a virulent strain, is apparently a major risk factor for disease progression to the neoplastic stage. When there is a case of gastric cancer in the family, first-degree relatives, who might be infected by a bacterium with an identical genetic fingerprint, are at higher risk than normal for developing gastric cancer. Furthermore, genetic and epidemiologic studies based on the Correa model have shown that both primary and secondary prevention of gastric cancer is possible. Calculations done in high-risk populations, such as Japanese–Americans, confirm the savings in cost and the safety of the test-and-treat strategy. Considering thatH. pylorieradication should be done as early as possible, at a point in the cascade when the changes are still reversible, and that gastric cancer is associated with a high mortality rate, we suggest that this strategy be applied to this high-risk population.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsDespite a high success rate, pneumatic dilatation for achalasia is accompanied by a significant risk of esophageal perforation. Injection of botulinum toxin (botox) into the lower esophageal sphincter (LES) can lead to improvement in symptoms with reduced risk of complications. Direct comparisons of the two techniques are needed to define their role in clinical management.StudyWe compared pneumatic dilatation to botox for patients with achalasia using a double blind, randomized study design. Patients underwent clinical, manometric, radiographic and endoscopic evaluation to confirm primary achalasia. They were randomized to receive either 80 units of botox into the LES or Witzel balloon dilatation. Patients also received sham dilatation or injection, respectively. The patients and investigators assessing symptom response were blinded to therapy. Symptoms and esophageal function were assessed at 3 weeks, 3 months and 1 year after therapy. Treatment failure was defined as the lack of decrease in symptom grade more than 1 or recurrence of symptoms. Patients with treatment failure crossed over to the alternative treatment.ResultsThirty four patients were studied, and 31 completed the trial. Of the 18 patients randomized to Witzel dilatation, 16 (89%) of 18 remained in clinical remission. Of the two patients with treatment failure, one responded to botox injection. Of the 16 patients randomized to botox, (38%) 6 of 16 remained in clinical remission. Four patients had initial failure, and 6 relapsed at a mean of 4 months after therapy. Of the nine patients who crossed over to dilatation, seven responded well, but two required surgical management of perforation. Although both treatments had excellent initial clinical improvement, patients randomized to Witzel dilatation had superior long-term success (P< 0.01).ConclusionInitial therapy with Witzel dilatation is associated with better long-term outcome than a single injection of botox. Because of the risk of endoscopic perforation, botox remains a viable alternative to dilatation.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundSeveral studies have attempted to investigate the association of thermal difference between malignant tumors and inflammatory benign lesions. In this work, we evaluated whether thermal heterogeneity of solid tumors in the stomach constitutes a marker for the diagnosis of benign, preneoplastic, and malignant lesions.StudyA thermistor probe was used that attached to the distal end of a long and steerable, 3fr-thermography catheter passed through the biopsy channel of the gastroscope and came in touch with the stomach epithelium to measure temperature differences (&Dgr;T) between normal tissue and various types of lesions. The method was applied in 8 patients with benign hyperplastic gastric lesions, 19 patients with gastritis, 9 patients with peptic ulcer, 7 patients with dysplasia and 11 patients with gastric adenocarcinoma.ResultsProgressive changes in &Dgr;T between hyperplastic gastric lesions, gastritis, ulcer, dysplasia and adenocarcinoma were observed (P< 0.001). Statistical analysis showed that &Dgr;T greater than 1.7°C, constitutes a crucial point for the diagnosis of malignancy, in stomach lesions, with sensitivity (72%) and specificity (94%).ConclusionsThese findings suggest that the detection of &Dgr;T, between normal tissue and neoplastic lesions, could be useful in clinical practice for the differential diagnosis of stomach lesions, even in the early stages.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsAlthough anti-tissue transglutaminase antibodies (anti-tTG) are effective for celiac disease (CD) routine laboratory screening, there are no studies evaluating correlation between degree of intestinal damage and positivity to anti-tTG. Since recent studies showed that anti-gliadin (AGA) and anti-endomysium (EMA) antibodies are ineffective in diagnosing mild gluten-sensitive enteropathy, the aim of this study was to evaluate the prevalence of anti-tTG in different degrees of intestinal damage of celiac patients and whether there is a correlation between serum value of anti-tTG and the degree of histologic damage.StudyWe studied 119 consecutive adult patients affected by CD (47 men and 72 women; mean age, 28 years; range, 22–51 years). All patients were stratified for histologic damage according to Marsh classification, and in all of them an anti-tTG evaluation was performed.ResultsMarsh I lesions were present in 13 patients (10.92%), Marsh II in 24 anti-tTG (20.16%), Marsh IIIa in 27 anti-tTG (22.68%), Marsh IIIb in 31 anti-tTG (26.05%) and Marsh IIIc in 24 anti-tTG (20.16%). Anti-tTG positivity was ranging from 1 of 13 anti-tTG (7.69%) in Marsh I lesions to 23 of 24 anti-tTG (95.83%) in Marsh IIIc lesions respectively (P< 0.005), while mean serum value of anti-tTG ranged from 3.61 (range, 0.7–9.2) UA/mL in Marsh I lesions to 7.3 (range, 1–25.1), 18.5 (range, 1.8–56.2), 36 (range, 3.7–83.5) and 74.95 (range, 6.5–257) UA/mL in Marsh II, IIIb and IIIc lesions respectively (P< 0.005).ConclusionsOur study showed that anti-tTG prevalence and their mean serum value was higher in celiacs with severe enteropathy (Marsh IIIb-c lesions) than in those showing slight enteropathy (Marsh I-IIIa). So, serologic tests without histologic evaluation may underestimate the real prevalence of CD and there is the risk of delaying the diagnosis of CD in patients who run an increased risk of deficiencies, non-malignant conditions and malignancy.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsWe evaluated whether the number of positive responses on a review of systems questionnaire predicted the diagnosis of functional gastrointestinal (GI) disorders.StudyNew patients to the University of Michigan GI clinics fill out a standardized questionnaire that includes a comprehensive review of systems which lists 87 items under 11 headings. We determined the number of items circled on the review of systems from the first 100 new patients seen in GI clinic in the year 2000. After a mean of 14 months follow-up, the final diagnoses in these patients were compared with the number of items circled on the review of systems.ResultsCompleted questionnaires were available for review in 82/100 patients. Twenty-six patients were diagnosed with a functional GI disorder, 53 patients had a nonfunctional diagnosis, and 3 patients had no diagnosis determined. The mean number of items circled on the review of systems was 15.9 (SD = 11.2) for the functional GI group, compared with 5.9 (SD = 6.9) for the nonfunctional GI diagnosis group (P< 0.005). When the symptom headings were analyzed individually, the differences in general, gastroenterological, cardiovascular, urinary, neurological, eye, ear, nose and throat, and psychiatric symptoms were statistically significant.ConclusionsPatients with functional GI disorders have a significantly greater number of GI and non-GI symptoms on review of systems. If seven positive symptoms is used as a threshold, the standardized review of systems questionnaire had a sensitivity of 92% and specificity of 80% in detecting patients with functional GI disorders.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundColorectal cancer is one of the most common cancers in the elderly. Information on tolerability and efficacy of 5-Fluorouracil-based chemotherapy in such patients is limited. Primary aim of the study was to describe tolerability and activity of chemotherapy with the “de Gramont” schedule (FU bolus [400 mg/m2] + FU continuous infusion [600 mg/m2] + folinic acid [100 mg/m2] on days 1 and 2, every 2 weeks), in patients with advanced colorectal cancer aged 70 or older.Patients and methodsPatients aged 70 or more, with stage IV colorectal cancer, ECOG performance status not worse than 2.ResultsThirty-four patients were treated at two participating centers. Seven (20.6%, 95% exact CI = 8.7–37.9) had an objective response, complete in 3 and partial in 4 patients. Five cases of unacceptable toxicity were registered (2 cardiac, 1 each for liver, anemia and diarrhea). Fitting the statistical model to the observed data indicated that the treatment was sufficiently active and tolerated.ConclusionsThe de Gramont scheme is active and tolerated in elderly patients with advanced colorectal cancer.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

6-Thioguanine (6-TG) is a thiopurine analogue that is closely related to 6-mercaptopurine (6-MP) and azathioprine (AZA). These agents have potent cytotoxic and immunomodulatory effects and are useful in the treatment of a variety of conditions, including inflammatory bowel disease. Both 6-MP and AZA are widely used and are known to cause hepatotoxicity in a proportion of patients. 6-Thioguanine is being increasingly used in the treatment of inflammatory bowel disease but has not been reported to cause liver injury in this context. We describe a case of significant elevation of serum transaminases in a patient treated with 6-TG for a flare of Crohn's disease. We believe the temporal association of the abnormal liver enzymes in this patient, in the absence of other offending agents, argues strongly in favor of 6-TG as a cause of liver enzyme abnormalities. This case highlights the need to monitor liver enzymes in patients treated with 6-TG and identifies the need for additional research focused on the mechanism of thiopurine-induced hepatic injury.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID