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:

GoalsReview of research directions in the etiology, evaluation, and treatment of patients with noncardiac chest pain. The author proposes a combined practical approach to noncardiac chest pain that incorporates these findings, which is useful in a clinical practice setting.BackgroundSeveral major schools of thought have emerged in the etiology of noncardiac chest pain: acid reflux, motor disorder, altered pain threshold/hypersensitivity, and association with psychiatric dysfunction. There is significant overlap among these. Occult gastroesophageal reflux disease (GERD) is more common than motor disorders and is found in 30% to 40% of these patients; a subset has hypersensitivity, with a normal pH profile. Esophageal motility testing and endoscopy have a more limited role than 24-hour pH testing. Impedance planimetry and balloon sensory provocative testing remain research tools. Provocative testing with hydrochloric acid or edrophonium is less helpful than pH monitoring. Gastroesophageal reflux disease–induced chest pain requires high-dose long-term proton pump inhibitors (PPIs): at least 4 to 8 weeks. Psychotropics are superior to placebo, both in patients with and without psychiatric dysfunction.ResultsThe author found combined PPIs and psychotropics helpful in patients with esophageal hypersensitivity and GERD, although supporting data is scant.ConclusionsA brief 1-week high-dose PPI challenge, i.e., omeprazole test, may be cost-effective in a primary care setting. However, this approach may not be useful in a referral setting, where pH data and diary assessment of associated symptoms provide useful management help. A behavioral model approach, with early emphasis on patient education, integrated with physiologic data helps the most.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

During the past two decades, remarkable progress has been made in the treatment of cancers of the colon and rectum. Both oncologic and functional outcomes for this disease have improved dramatically. The reasons for the improved patient outcome in this disease include advances in knowledge of the biology of the disease, advances in surgical instrumentation and techniques, and ongoing advances in multimodality therapy, with the use of radiation and chemotherapy as an adjuvant to surgical resection. This review details many of these advances in a comprehensive manner and illustrates the necessity of a multidisciplinary approach for optimizing outcome for patients with these cancers.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Tegaserod is a medication that has been shown to be of benefit in women with irritable bowel syndrome (IBS) associated with abdominal pain, bloating, and constipation. Tegaserod is a selective serotonin receptor subtype 4 partial agonist designed to interact with the network of cells and nerves throughout the gastrointestinal tract that use serotonin. Tegaserod has been shown to modulate both gastrointestinal motility and visceral sensitivity. Specifically, it increases the peristaltic reflex and decreases visceral sensitivity. Clinical studies have shown that tegaserod improves symptoms of abdominal pain, bloating, and constipation in women with IBS. This article discusses the role of serotonin in gastrointestinal tract physiology, the structure and pharmacokinetic profile of tegaserod, and clinical applications of this new drug.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

GoalsTo determine the prevalence, severity, and outcome of gastroparesis after heart and lung transplantation (HLT).StudyTen patients (five women; age range, 27–57 years) underwent HLT at Temple University Hospital from 1996 to 1999. The charts of these patients were reviewed, including results from gastric emptying scans and upper endoscopies. Symptoms were assessed with a standardized questionnaire.ResultsThe indications for HLT included pulmonary hypertension in six patients, Eisenmenger syndrome in two, and dilated cardiomyopathy and congenital heart disease in two. Four patients died before the start of this clinical analysis. The six surviving patients constituted our study population. The patients' posttransplantation follow-up period ranged from 1.4 to 4.4 years (average, 2.6 years). Five patients (83%) were symptomatic with nausea, vomiting, and postprandial abdominal distension. Solid phase gastric emptying was delayed in all five patients with mean gastric retention of 93% at 2 hours (normal <50%). Patients generally did not respond to prokinetic agents. Four patients required pyloroplasty with J tube placement for symptom control, nutrition, and delivery of immunosuppressive medication.ConclusionsThere is a high prevalence of symptomatic gastroparesis in patients after HLT. The gastroparesis is severe and often resistant to prokinetic agents.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

GoalsThe causes of Crohn's disease (CD) are still considered to be unknown. It is likely that an immune defect leads to an increase in T helper 1 (Th1) cytokine responses, which may then contribute to the characteristic morphologic changes. Increased values in distinct immune activation parameters connected with a Th1 immune response have also been found in patients who are depressed. Because various clinical observations have asserted that a depressive disposition may have some connection with the development of CD, we examined whether a relationship exists between T-cell activation parameters and depressive personality characteristics in patients with CD.StudySeventy-one patients (62% women; age, 38 ± 13 years) with CD (23 with CD Activity Index [CDAI] >150 and 48 with CDAI ≤150) were included in this study. Sixty patients were re-examined after 4.4 ± 1.8 months. The T cell parameters CD2, CD3, CD26, CD28, and CD95 and the activity of dipeptidyl peptidase IV (DPP IV) in serum were examined in the peripheral blood. The patient's subjective health status was assessed by means of a standardized psychometric instrument (Short-form Inflammatory Bowel Disease Questionnaire [SIBDQ]). The presence of various characteristics indicative of a depressed mood was also assessed (Center of Epidemiological Studies-Depression Scale, Berliner Stimmungsfragebogen), as well as indicators of a personality disposed to depression (Giessentest) and a depressive illness coping strategy (Freiburger Krankheitsverarbeitungs-Fragebogen), all using the above-mentioned standardized instruments.ResultsThe immune parameters connected with the activation of Th1 (CD25+, CD25+/CD26+) are increased in patients, depending on the stage of illness. In addition, DPP IV activity was significantly lower in patients with an active disease, as was their subjective health status (SIBDQ). A connection with an indicator of mental depression could not be found.ConclusionThe observed changes in immune parameters support the idea that morphologic changes could be connected with an increased Th1 response and that DPP IV activity could play an immunomodulatory role. A relationship between the measured immune parameters and individual characteristics of depression could not be found.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundPatients with active Crohn's disease (CD) often report having abdominal symptoms after ingestion of milk products, but the pathomechanism for lactose malabsorption seems to be complex.GoalsTo investigate the prevalence of clinical milk intolerance and to objectify symptoms with hydrogen (H2) breath testing, analysis of lactase protein, and enzyme activity in the duodenal mucosa in patients with CD and in healthy controls.StudyIn 49 patients with CD and 24 controls, H2breath testing was performed. All individuals underwent endoscopy of the upper gastrointestinal tract, in which multiple pinch samples were taken from the distal duodenum. Lactase activity was measured using the method of Dahlquist. The lactase protein expression was analyzed by gel electrophoresis using the monoclonal antibodymlac 10and by immunochemistry using the monoclonal antibodymlac 4.ResultsPrevalence of milk intolerance in healthy controls was 16.6% versus 46.9% in patients with CD, with a high frequency (83.3%) in patients with active disease (CD activity index >150). Milk intolerance was correlated to the duration of inflammatory bowel disease (p= 0.023) but not to the location or previous bowel resection. Hydrogen breath testing had a moderate sensitivity in detecting lactose maldigestion (70.4%) and a high specificity (95.6%). Duodenal lactase levels were also correlated to disease activity, whereas correlations to clinical symptoms remained poor. Patients with milk intolerance had a significantly reduced bone density at the lumbar spine (z-score, −1.33 ± 0.92 vs. −0.19 ± 0.95 [mean ± SD];p= 0.002)ConclusionsMilk intolerance is a frequent problem in active CD, which can be objectified accurately by H2lactose breath testing. Decreased lactase levels in the duodenal mucosa may be found during an acute flare but are not the predominant cause of milk intolerance in CD.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We report a 48-year-old patient who developed secondary achalasia because of esophageal sarcoidosis. Sarcoidosis can involve many gastrointestinal tract organs and can affect the esophagus in different ways. We describe how achalasia was diagnosed and treated in our patient and provide a review of the presentations of esophageal sarcoidosis.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID