ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Definitive treatment of peptic ulcer has traditionally focused on “acid control,” including such operations as partial gastrectomy and truncal vagotomy. Whereas these therapies have generally been successful, untoward side effects persist, especially after major operations. The recent discovery that Helicobacter pylori is the prime causative agent of the peptic diathesis and that its eradication from the stomach lining is associated with long-term remission of ulcer disease suggests that current surgical treatment protocols should now be modified accordingly. For treatment of life-threatening complications, such as bleeding, perforation, and obstruction, operation is still mandatory; however, the bleeding artery should simply be ligated, the perforation “plugged,” or the obstruction bypassed. For definitive management of the ulcer, short-term treatment with H2 and proton blockers should be promptly instituted. For long-term “cure,” H. pylori should be eliminated from the stomach by administration of appropriated antibiotic drugs. Vagotomy and partial gastrectomy and its myriad varaitions to prevent ulcer recurrence are no longer necessary nor appropriate

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The pathogenesis of pain in chronic pancreatitis is multifactorial and not totally clear. No therapy offers relief from pain in all patients, underlining individual differences in the causation of pain. The most prudent and simplest advice to patients is to abstain from alcohol use. However, despite the logical strength of the advice, even the value of abstinence in the prevention of or relief from abdominal pain is questioned. In this editorial, I summarize the pathogenesis of pain and attempt to explain the scientific basis for our failure to manage pancreatic pain satisfactorily.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We made a prospective assessment of acid exposure in the distal esophagus in 48 consecutive untreated patients with achalasia using 24-h ambulatory esophageal pH studies. The majority of patients (38/48) experienced reflux that was within reported values for normal controls (total time pH<4.0, 1.8 ±1.9%). Approximately 20% (10/48), however, demonstrated abnormal acid exposure (total time pH<4.0, 18.8 ± 14.8%). The difference in reflux expressed by these two groups was not due to a significant difference in lower esophageal sphincter pressure (p>0.05) or retained food. An in vitro model of lactobacillus fermentation supported the contention that true acid reflux accounted for changes in esophageal pH. Repeat pH studies were obtained in 23 patients following treatment: 15 underwent pneumatic dilatation and 8 underwent limited myotomy. Although no significant differences were found between pre- and posttreatment reflux, some patients undergoing either treatment were found to demonstrate increased acid exposure. In conclusion, we believe that patients with achalasia should be tested by pH study both before and after treatment. Most of the patients who demonstrated significant pretreatment reflux were asymptomatic, and both methods that were used to decrease resting sphincter pressure were shown to be able to increase distal acid exposure.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The aim of this study was twofold: first, to investigate the effectiveness of a standard triple therapy (tripotassium dicitrato bismuthate, 125 mg q.i.d., tetracycline hydrochloride 500 mg q.i.d., and metronidazole 500 mg t.i.d.) in eradicating Helicobacter pylori in patients with duodenal ulcer successfully healed with omeprazole or ranitidine; second, to examine the influence of the eradication on duodenal ulcer recurrence rate after 12 months. Two hundred forty-five consecutive H. pyloripositive patients with healed duodenal ulcer either with omeprazole (20 mg/day, 126 patients) or with ranitidine (150 mg b.i.d., 119 patients) given at random, began triple therapy for 15 days. H. pylori eradication was looked for 4—5 weeks later by culture of biopsy material, hematoxylin-eosin stain, and rapid urease test. H. pylorieradicated patients were followed up for 12 months. Endoscopy was carried out at the end of the follow-up or whenever symptoms appeared. Five patients (2.0%) withdrew because of triple-therapy-related side effects. The eradication rate was 92% (220 of 240 patients); no difference was found between those healed with omeprazole (93%, 114 of 123 patients) or ranitidine (91%, 106 of 117 patients). Of 220 successfully treated patients, 132 completed the 12-month follow-up. The duodenal ulcer recurrence rate was 4% (5 of 132 patients); 3% (2 of 70) in the omeprazole group and 5% (3 of 62) in the ranitidine group healed. All the recurrences were asymptomatic. H. pylori recurrence rate was 11% (14 of 132 patients); no difference was found between patients healed with omeprazole (10%, 7 of 70 patients) or with ranitidine (11%, 7 of 62 patients). All the recurrent duodenal ulcers occurred in H. pylori-positive patients (36%, 5 of 14 patients). Standard triple therapy after duodenal ulcer healing with omeprazole or ranitidine eradicates H. pylori in comparable high rates. Side effects currence rate 12 months after eradication was low and comparable between those healed with omeprazole or ranitidine.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We compared the diagnostic accuracy of a new immunological marker of celiac sprue (CS), the antijejunum antibody (JAB), with that of antigliadin (AGA) and antiendomysium (EmA) antibodies. One hundred untreated adults with biopsy-proven CS, 52 healthy controls, and 57 patients with inflammatory bowel disease, lymphoma of the small bowel, Whipple's disease, and irritable bowel syndrome were investigated. Only JAB and EmA were detected at a similar titer in all patients with untreated CS but in no controls (100% sensitivity and specificity). Sensitivity of AGA was, respectively, 55% for IgA and 78% for Ig class, with a 100 and 82% specificity. The differences in frequencies between both EmA and JAB with IgA and IgG AGA were highly significant. We conclude that JAB and EmA provide a reliable noninvasive screening test for clinically significant gluten- sensitive enteropathy. The lower cost of IgA-JAB is a major advantage, owing to the different availability of the lower third of the esophagus and jejunum from primates. The sensitivity and specificity of the two tests are almost identical, but we find interpreting EmA easier than JAB especially when the titer is low.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We traced 1,000 patients with Crohn's disease hospitalized at Lenox Hill Hospital in New York City during 1972-1987 to identify those who died, the events preceding death, and their relationship to Crohn's disease. We considered any management early in the disease that might have influenced outcome. We introduce the term “virulent” Crohn's disease to describe those patients with most or all of the following: young age at onset, multiple surgical procedures, short bowel/malabsorption, chronic steroid therapy, narcotic addiction, and sepsis. Twenty-five patients (2.6%) had died. Major events preceding 18 deaths related to Crohn's disease were virulent Crohn's disease (six), gastrointestinal neoplasms (six), complications in the elderly (five), and complications of drug therapy (one). Those seven deaths probably unrelated to Crohn's disease were attributed to extraintestinal neoplasms (four) and myocardial infarction (three). Death was related to Crohn's disease or its treatment in 72% and perhaps in all. Ten of the 25 died at age 46 or younger (mean 36 years, range 25—46 years). Twenty-two (88%) who died had undergone surgery for Crohn's disease (mean 3.3 procedures) including eight who died postoperatively (six elderly), attributable to sepsis in seven and pulmonary embolism in one. The events preceding death suggest that early aggressive nonoperative therapy for severe Crohn's disease warrants a careful controlled evaluation.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Troublesome perianal disease occurs in ~35% of patients with Crohn's disease, yet conventional disease activity indices do not reflect the severity of this feature. To assess the degree of impairment and response to therapy, we identified five simple elements and graded each on a 5-point Likert scale in 37 patients at 124 visits. At each visit a Crohn's Disease (CDAI) or Simple Activity Index (HBDAI), Perianal Disease Activity Index (PDAI), and treatment were recorded. The PDAI was validated against physician (MDGA) and patient (PGA) global assessments, and treatment was prescribed for the perianal disease. Measurement error was evaluated in 19 patients who were clinically stable at two consecutive visits. The ability of the PDAI to detect important clinical change was tested in 20 subjects exhibiting a change on PGA at consecutive visits. There were strong correlations between PDAI, MDGA, and PGA scores at all visits (R=0.66-0.72; p<0.001), whereas the CDAI and HBDAI correlated poorly with PDAI (R<0.23). Physicians prescribed more aggressive therapy for higher PDAI scores (r=0.53). Mean PDAI scores between visits in clinically stable subjects were not significantly different [5.58 ± 2.79 (initial); 5.42 ± 2.55 (follow-up); p=0.63]. PDAI significantly improved between visits when the perianal disease had improved (PDAI score difference 3.05 ± 2.96; P=.0002). We conclude that the PDAI is simple and clinically useful for patient management. It should now be assessed in a clinical trial.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To study the role that continuous drinking plays in the pain of chronic pancreatitis, we have examined 67 patients with alcoholic chronic pancreatitis with pain and 29 patients without pain, and we report on their alcoholic habits. Drinking habits played a part 92 (67.6%) of 136 times in patients with pain; in 185 without pain, 86 (46.5%) had continued their drinking habit (p<0.001). Advanced pancreatic exocrine insufficiency was seen in 27 patients; 11 of them had pain during follow-up, whereas 16 did not. The nondrinker rate was similar in patients with and without pain, whereas among 69 patients with better pancreatic exocrine function, 56 had pain episodes and 13 did not. Alcoholic consumers were significantly more in number in the pain group: 70.4% versus 35% of the no pain group (p<0.002). Our study shows that drinking alcohol in patients with chronic pancreatitis increased the frequency of painful episodes when there was relatively good pancreatic function, whereas in severe pancreatic insufficiency drinking had less influence on the development of pain.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The role of alcohol in causing chronic pancreatitis is well-known, but the role of abstinence remains controversial and not well-understood. In this article, I examine the literature dealing with the effect of abstinence on chronic pain and the long-term outcome of chronic pancreatitis. A series of 50 patients with alcoholic chronic pancreatitis from my practice supplements the data. Alcohol consumption >70 g/day for 7 or more years is characteristic. Moderate to severe abdominal pain is the dominant symptom. When patients stop drinking, abdominal pain disappears in the majority, pancreatic function deteriorates more slowly, the death rate diminishes, and a normal life is often possible. If abdominal pain continues after abstinence and the pancreatic duct remains dilated, a lateral pancreatojejunostomy helps most patients. In many patients not suitable for surgery, pain resolves with time.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID