Seminars in gastrointestinal disease最新文献_第7页

Medical and surgical management of severe colitis. 严重结肠炎的内科和外科治疗。

Seminars in gastrointestinal disease Pub Date : 2000-01-01

J A Katz

引用次数: 0

Controversies in the construction of the ileal pouch anal anastomosis. 回肠袋肛管吻合术施工中的争议。

Seminars in gastrointestinal disease Pub Date : 2000-01-01

T Sonoda, V W Fazio

引用次数: 0

The long-term results of resection and multiple resections in Crohn's disease. 克罗恩病切除和多次切除的长期结果。

Seminars in gastrointestinal disease Pub Date : 2000-01-01

A S Krupnick, J B Morris

{"title":"The long-term results of resection and multiple resections in Crohn's disease.","authors":"A S Krupnick, J B Morris","doi":"","DOIUrl":"","url":null,"abstract":"Crohn's disease is a panenteric, transmural inflammatory disease of unknown origin. Although primarily managed medically, 70% to 90% of patients will require surgical intervention. Surgery for small bowel Crohn's is usually necessary for unrelenting stenotic complications of the disease. Fistula, abscess, and perforation can also necessitate surgical intervention. Most patients benefit from resection or strictureplasty with an improved quality of life and remission of disease, but recurrence is common and 33% to 82% of patients will need a second operation, and 22% to 33% will require more than two resections. Short-bowel syndrome is unavoidable in a small percentage of Crohn's patients because of recurrent resection of affected small bowel and inflammatory destruction of the remaining mucosa. Although previously a lethal and unrelenting disease with death caused by malnutrition, patients with short-bowel syndrome today can lead productive lives with maintenance on total parenteral nutrition (TPN). This lifestyle, however, does not come without a price. Severe TPN-related complications, such as sepsis of indwelling central venous catheters and liver failure, do occur. Future developments will focus on more powerful and effective anti-inflammatory medication specifically targeting the immune mechanisms responsible for Crohn's disease. Successful medical management of the disease will alleviate the need for surgical resection and reduce the frequency of short-bowel syndrome. Improving the efficacy of immunosuppression and the understanding of tolerance induction should increase the safety and applicability of small-bowel transplant for those with short gut. Tissue engineering offers the potential to avoid immunosuppression altogether and supplement intestinal length using the patient's own tissues.","PeriodicalId":79377,"journal":{"name":"Seminars in gastrointestinal disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21558646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Approaching the patient with chronic malabsorption syndrome. 慢性吸收不良综合征患者的诊治。

Seminars in gastrointestinal disease Pub Date : 1999-10-01

G C Harewood, J A Murray

{"title":"Approaching the patient with chronic malabsorption syndrome.","authors":"G C Harewood, J A Murray","doi":"","DOIUrl":"","url":null,"abstract":"The causes of chronic malabsorption may be categorized as decreased intestinal absorption, most commonly caused by celiac sprue; or maldigestion caused by pancreatic insufficiency. The initial step in the evaluation of these patients should include stool studies to confirm fat malabsorption. If fat malabsorption is confirmed, endoscopy with small-bowel biopsies and aspirates for bacterial culture usually follows. A normal endoscopic examination should lead to assessment of pancreatic function. In the setting of normal pancreatic function and the absence of bile acid deficiency, a barium radiograph of the small bowel should be made, looking for anatomical abnormalities. Celiac sprue is an intolerance to gluten caused by a combination of genetic, environmental, and immunologic factors. It classically causes malabsorption. However, it is likely that many patients who exhibit only minor manifestations of the disease go unrecognized and untreated. A presumed diagnosis of celiac sprue is confirmed after a clinical and endoscopic response to a gluten-free diet. Serological markers are available with high degrees of sensitivity and specificity, but duodenal biopsy remains the gold standard for diagnosis. A minority of patients are unresponsive to a gluten-free diet, and intestinal lymphoma should be suspected in these cases.","PeriodicalId":79377,"journal":{"name":"Seminars in gastrointestinal disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21409891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surreptitious laxative abuse: keep it in mind. 偷偷地滥用泻药:记住这一点。

Seminars in gastrointestinal disease Pub Date : 1999-10-01

S F Phillips

引用次数: 0

Overview of chronic diarrhea caused by functional neuroendocrine neoplasms. 功能性神经内分泌肿瘤引起的慢性腹泻综述。

Seminars in gastrointestinal disease Pub Date : 1999-10-01

R T Jensen

引用次数: 0

Microscopic colitis syndrome: lymphocytic colitis and collagenous colitis. 显微镜下结肠炎综合征:淋巴细胞性结肠炎和胶原性结肠炎。

Seminars in gastrointestinal disease Pub Date : 1999-10-01

L R Schiller

{"title":"Microscopic colitis syndrome: lymphocytic colitis and collagenous colitis.","authors":"L R Schiller","doi":"","DOIUrl":"","url":null,"abstract":"Microscopic colitis is a syndrome consisting of chronic watery diarrhea, a normal or near-normal gross appearance of the colonic lining, and a specific histological picture described as either lymphocytic colitis or collagenous colitis. Since its initial descriptions a quarter of a century ago, microscopic colitis has become a frequent diagnosis in patients with chronic diarrhea. Understanding of the cause and pathogenesis of microscopic colitis remain incomplete, but potentially important clues have been discovered that shed light on predisposing factors. In particular, specific HLA-DQ genotypes may be permissive for the development of microscopic colitis, and suggest a linkage to the pathogenesis of celiac sprue. Although the differential diagnosis of chronic watery diarrhea is broad, the diagnosis of microscopic colitis is straightforward, involving endoscopic inspection of the colonic mucosa and proper pathologic interpretation of biopsy specimens. As the limitations of drugs ordinarily used for other forms of inflammatory bowel disease are being recognized, new approaches, such as the use of bismuth subsalicylate, are being evaluated. The prognosis of patients with microscopic colitis syndrome remains good, and symptomatic improvement can be expected in most patients.","PeriodicalId":79377,"journal":{"name":"Seminars in gastrointestinal disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21409892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Management of postfundoplication complications. 复底后并发症的处理。

Seminars in gastrointestinal disease Pub Date : 1999-07-01

J P Waring

{"title":"Management of postfundoplication complications.","authors":"J P Waring","doi":"","DOIUrl":"","url":null,"abstract":"The role of surgical therapy in the management of gastroesophageal reflux disease (GERD) continues to evolve in the laparoscopic era. As the number of surgical procedures increases, so does the number of patients with postfundoplication complications. The most effective strategy is to prevent the complication in the first place. Patients who are most likely to have trouble after surgery are those with refractory, atypical, or complicated disease. Gastroenterologists should take care to make an accurate diagnosis, heal the esophagitis, and dilate any strictures before sending a patient to surgery. The surgeon should be a skilled laparoscopist. In patients with complicated GERD, the surgeon must be able to recognize severe disease and perform advanced procedures. Postoperatively, symptoms are usually the same (suggesting a failure of the operation or incorrect original diagnosis) or different (suggesting a complication) than before surgery. Most patients should have a barium swallow and an endoscopy to evaluate the integrity of the wrap. If intact, postoperative heartburn and dysphagia will usually resolve with conservative therapy. If the fundoplication is poorly oriented, too long, too tight, twisted, or herniated above the diaphragm, surgical revision is often necessary.","PeriodicalId":79377,"journal":{"name":"Seminars in gastrointestinal disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21300399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnosis of esophageal ulcers in acquired immunodeficiency syndrome. 获得性免疫缺陷综合征食管溃疡的诊断。

Seminars in gastrointestinal disease Pub Date : 1999-07-01

K E Mönkemüller, C M Wilcox

引用次数: 0

Achalasia: diagnosis and management. 失弛缓症的诊断和治疗。

Seminars in gastrointestinal disease Pub Date : 1999-07-01

M F Vaezi

{"title":"Achalasia: diagnosis and management.","authors":"M F Vaezi","doi":"","DOIUrl":"","url":null,"abstract":"Achalasia is a primary esophageal motor disorder of unknown cause that produces 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 an initial treatment strategy for early achalasia, are now used only in patients who are not candidates for pneumatic dilation or surgery, and in patients who do not respond to botulinum toxin injections. Because of the more rigid balloons, the current pneumatic dilators are more effective than the older, more compliant balloons. The graded approach to pneumatic dilation, using the Rigiflex (Boston Scientific Corp, Boston, MA) balloons (3.0, 3.5, and 4.0 cm) is 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 plagued by high morbidity and long hospital stay, can now be performed laparoscopically, with similar efficacy to the open surgical approach (94% versus 84%, respectively), reduced morbidity, and reduced hospitalization time. Because of 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 can not undergo balloon dilation and are not surgical candidates.","PeriodicalId":79377,"journal":{"name":"Seminars in gastrointestinal disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21300398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0