ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Endoscopic mucosal resection (EMR), or mucosectomy technique, developed by Japanese endoscopists consists of resecting flat and polypoid neoplasms of the mucosa by longitudinal section through the submucosa. This technique is relatively simple and carries a low morbidity. It represents an important advance for endoscopists in both technical and cancer areas. Compared with the endoscopic methods of tumor destruction (laser, plasma coagulation), EMR presents the advantage of obtaining a complete specimen for histologic analysis.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Gastroparesis may be related to a variety of underlying disorders, but management options are fairly universal. Dietary measures and pharmacologic agents, primarily in the form of prokinetic medications, form the foundation of standard management. Some patients will have refractory symptoms and alternative dosing schemes or drug combinations may be used. An occasional patient will still require venting gastrostomy and/or jejunal feeding. This review addresses the standard dietary and pharmacologic approaches to gastroparesis, as well as issues pertaining to gastrostomy/jejunostomy tubes and to surgical options for refractory cases. Finally, experimental agents and techniques, such as gastric pacing, will be discussed.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Gastroesophageal reflux disease (GERD) affects more than one third of the population. It is generally a chronic condition and has the potential to be serious. Some patients with GERD experience persistent daytime or nighttime heartburn and some sustain severe damage, including ulceration, stricture, and Barrett's esophagus, which can predispose to development of adenocarcinoma. Extraesophageal manifestations of GERD can include otolaryngologic, respiratory, and cardiac problems. Severe GERD responds best to agents that suppress gastric acid secretion. Of these, proton pump inhibitors (PPIs) provide the most effective control of gastric acidity and are, therefore, the medical treatment of choice. In fact, nonresponse to a PPI should raise the suspicion that the diagnosis is not GERD. Proton pump inhibitors are quickly becoming the treatment of choice for GERD, especially for severe or refractory cases. For patients whose GERD is refractory even to PPIs or who are unwilling to face years of PPI therapy, antireflux surgery remains an option.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Proton pump inhibitors (PPIs) are the most effective antisecretory drugs available for controlling gastric acid acidity and volume. They are the drugs of choice in the treatment of moderate-to-severe gastroesophageal reflux disease, hypersecretory disorders, and peptic ulcers. Currently in the United States, they are only available in an oral formulation. However, pantoprazole will soon be available in an intravenous formulation and will extend the power of PPIs to inpatient hospital settings. Intravenous pantoprazole has been shown to be effective and safe in clinical trials. Intravenous pantoprazole is indicated for the treatment of patients who require PPI therapy but who are unable to take oral medication. Intravenous pantoprazole has been shown to maintain acid suppression in patients switched from oral PPIs, so no change in dosage is required when switching from one formulation to the other. Potential hospital-based uses for intravenous PPI therapy include perioperative use as prophylaxis for acid aspiration syndrome during induction of anesthesia, prophylaxis for stress-related mucosal disease, and management of gastrointestinal bleeding from stress or acid peptic disease.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Our aim was to review the use of esophageal investigations in patients with suspected connective tissue disease (CTD). Forty-seven patients (39 women and 8 men) with suspected CTD were referred for esophageal manometry at the gastrointestinal physiology unit in the Royal Victoria Hospital, Belfast, U.K., over a 10-year period (1987–1997). The mean age was 51.7 years (range = 21–79 years). Chart review was conducted 1 to 10 years after manometry to confirm the final diagnoses: scleroderma was found in 11; CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia), 8; mixed connective tissue disease, 14; Raynaud's alone, 5; and other CTDs, 9. All 47 successfully underwent esophageal manometry. In addition to manometry, 24 underwent gastroscopy; 27, barium meal; and 3, esophageal pH studies. Clinically significant esophageal abnormalities were noted in 8 (33%) on gastroscopy, in 15 (56%) on barium meal, and in 31 (66%) on manometry. Gastroscopy had a significantly lower positivity rate than the others (p< 0.05). Only three patients had pH testing, yet all three pH tests were abnormal. During manometry, abnormal findings were significantly more common in scleroderma–CREST when compared with other diagnoses (89% vs. 50%;p< 0.02). Thirty-three patients reported dysphagia. Abnormal manometry was more likely in these cases (82% vs. 33%;p< 0.02). A high percentage of patients with CTD have significant esophageal motility disorders. Investigations were more likely to be positive with scleroderma–CREST than other CTDs, even if dysphagia was present. Barium meal and manometry are more useful than OGD. pH studies were under-used. There is need for a standardized approach to esophageal investigations in patients with CTDs.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Over the past 60 years, the epidemiology of gastric adenocarcinoma has changed considerably. The most striking change in the epidemiology of gastric adenocarcinoma has been the rapid increase in cancers of the proximal stomach. We performed a retrospective analysis of all gastric adenocarcinomas diagnosed at two hospitals in Little Rock, Arkansas, U.S.A., between 1985 and 1996. Two hundred seventeen patients were diagnosed with gastric adenocarcinoma. Patients were divided into three 4-year cohorts. We found that the proportions of gastric cardia adenocarcinoma in cohorts 1, 2, and 3 were 31%, 36%, and 42%, respectively (p= 0.52). Median survival in the three cohorts was 5, 8, and 8 months, respectively (p= 0.22). Median survival (stages 1–4) was 41.5, 11.5, 10, and 3 months, respectively (p< 0.0001). Well-, moderately-, and poorly-differentiated adenocarcinoma had median survivals of 18, 7.5, and 6 months, respectively (p= 0.07). We concluded that patients with gastric adenocarcinoma continue to be diagnosed at late stages. There has been a trend toward an increasing proportion of cardia adenocarcinoma. Stage at presentation was the only significant predictor of survival.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Although serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19–9 are commonly measured before surgery for gastric carcinoma, this clinical significance is not fully understood. We evaluated a total of 549 patients with gastric cancer who underwent gastrectomy. Levels of CEA and CA19-9 were measured preoperatively in all patients. We retrospectively analyzed correlations between CEA or CA19-9 and clinicopathologic features, and estimated the prognostic utility of the tumor markers by analyzing clinicopathologic characteristics of the carcinoma as a function of seropositivity or negativity of the antigens in combination or by raising the levels. The positivity rates of CEA (≥5 ng/mL) and CA19-9 (≥37 U/mL) were 19.5% and 18%, respectively. Serum CEA and CA19-9 positivity significantly correlated with depth of invasion, hepatic metastasis, and curativity. Forty-nine patients positive for both CEA and CA19-9 had significantly higher frequencies of lymph node metastasis, deeper invasion by the tumor, lower rates of curative resection (p< 0.01), and higher rates of hepatic metastasis (p< 0.05) than 377 patients with normal levels of CEA and CA19-9. Surgical outcomes of patients who were CEA-and CA19-9–positive were poorer than those of patients with normal CEA and CA19-9 levels (p< 0.01). Significant correlation was found between serum CEA and CA19-9 level (p< 0.001,r= 0.24). Doubling the threshold level of serum positivity to 10 ng/mL (CEA) and 74 U/mL (CA19-9) improved the prognostic value of these factors. However, multivariate analysis using Cox's hazards model revealed that only CEA positivity using the doubled threshold value (10 ng/mL) (p= 0.04, hazard ratio =1.7), nodal involvement (p= 0.01, hazard ratio = 1.9), and depth of invasion (p= 0.02 hazard ratio =1.5) significantly predicted prognosis. Carcinoembryonic antigen positivity using the doubled threshold level (10 ng/mL) was an important prognostic factor in patients with gastric cancer.

ISSN:0192-0790    

出版商:OVID    

年代:2001

数据来源: OVID