Seminars in gastrointestinal disease最新文献_第8页

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":"10 3","pages":"103-12"},"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

Supraesophageal manifestations of gastroesophageal reflux disease. 胃食管反流病的食管上表现。

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

G Al-Sabbagh, J M Wo

引用次数: 0

Recent advances in Barrett's esophagus: short-segment Barrett's esophagus and cardia intestinal metaplasia. 巴雷特食管的最新进展:短段巴雷特食管和贲门肠化生。

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

P Sharma

{"title":"Recent advances in Barrett's esophagus: short-segment Barrett's esophagus and cardia intestinal metaplasia.","authors":"P Sharma","doi":"","DOIUrl":"","url":null,"abstract":"The recent rapid increase in the incidence of adenocarcinoma of the distal esophagus and the gastric cardia has generated significant interest in the premalignant lesion, Barrett's esophagus. The traditional definition of Barrett's esophagus included the presence of 3 cm or greater of columnar mucosa in the distal esophagus. Studies have clarified that intestinal metaplasia was not only the most common and distinctive type of epithelium detected within the columnar mucosa, but also the one with greatest malignant potential; therefore, Barrett's esophagus has come to be defined by the histological presence of intestinal metaplasia. Previous studies evaluating the association of esophageal adenocarcinoma with Barrett's esophagus have only included patients with traditional or long-segment Barrett's esophagus. However, recent studies have suggested that dysplasia and adenocarcinoma can also be associated with short-segment Barrett's esophagus (SSBE), ie, less than 3 cm of columnar mucosa. Data are also emerging regarding the significance of intestinal metaplasia detected in biopsy specimens obtained immediately below the gastroesophageal junction, ie, from the gastric cardia. However, the premalignant potential of cardia intestinal metaplasia (CIM) is unknown at this time. Although the exact incidence of adenocarcinoma in SSBE is not known, endoscopic surveillance of such patients, although controversial, appears to be prudent at this time. With the currently available information, routine biopsy of a normal-appearing squamocolumnar junction is not advocated. This review critically evaluates and summarizes recent data on SSBE and CIM.","PeriodicalId":79377,"journal":{"name":"Seminars in gastrointestinal disease","volume":"10 3","pages":"93-102"},"PeriodicalIF":0.0,"publicationDate":"1999-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21300397","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

Small-bowel investigation in occult gastrointestinal bleeding. 隐蔽性消化道出血的小肠调查。

Seminars in gastrointestinal disease Pub Date : 1999-04-01

A J Morris

引用次数: 0

Gastrointestinal tract evaluation in patients with iron deficiency anemia. 缺铁性贫血患者胃肠道评价。

Seminars in gastrointestinal disease Pub Date : 1999-04-01

D C Rockey

{"title":"Gastrointestinal tract evaluation in patients with iron deficiency anemia.","authors":"D C Rockey","doi":"","DOIUrl":"","url":null,"abstract":"Iron deficiency anemia is the most common form of anemia encountered in clinical practice and is an extremely common manifestation of chronic occult gastrointestinal bleeding. Current evidence suggests that a large proportion of men and postmenopausal women with iron deficiency anemia harbor significant gastrointestinal tract pathological lesions as the source of blood loss. As such, the evaluation of patients with iron deficiency anemia is generally focused on the gastrointestinal tract. Importantly, the diagnosis of iron deficiency anemia should be firmly established before an extensive evaluation is undertaken. Management strategies for patients with iron deficiency anemia are reviewed; an important general point is that clinical features (ie, symptoms) may help direct specific investigation. The role of small-intestinal investigation in patients with iron deficiency anemia is controversial and should probably be reserved for patients with iron deficiency anemia and persistent gastrointestinal symptoms or those who fail to respond to appropriate therapy. The treatment and prognosis of patients with iron deficiency anemia and the majority of gastrointestinal tract lesions are straightforward. However, patients with vascular ectasias as the source of blood loss can represent a true management challenge.","PeriodicalId":79377,"journal":{"name":"Seminars in gastrointestinal disease","volume":"10 2","pages":"53-64"},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21230241","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

Fecal occult blood tests in occult gastrointestinal bleeding. 隐蔽性胃肠道出血的粪便隐血检查。

Seminars in gastrointestinal disease Pub Date : 1999-04-01

J H Bond

引用次数: 0

Medical and hormonal therapy in occult gastrointestinal bleeding. 隐蔽性消化道出血的药物及激素治疗。

Seminars in gastrointestinal disease Pub Date : 1999-04-01

B S Lewis

{"title":"Medical and hormonal therapy in occult gastrointestinal bleeding.","authors":"B S Lewis","doi":"","DOIUrl":"","url":null,"abstract":"In this age of modern technology and aggressive but noninvasive therapies, the idea of treating an identifiable but discrete bleeding lesion with systemic medical therapy seems an anachronism. But medical therapy can be the treatment of choice for some bleeding vascular lesions of the gut. Though most vascular lesions appear similar endoscopically and are a cause of gastrointestinal bleeding, they consist of various pathologic identities. These different lesions have not only different pathologic appearances, but also different prognoses. The natural history of many of these lesions remains largely unknown. Long-term success in controlling bleeding must be measured in the context of the responsible lesion's frequency of occurrence and recurrence. Medical therapy can include hopeful watchful waiting, routine blood transfusions, or specific medications. Medical therapy has been pursued along two lines. The most common form of medical therapy has been simple supportive care. This may include iron therapy and avoidance of aspirin and other anticoagulants. Transfusions may be necessary, occasionally or on a regular basis. The second form of medical therapy has been the use of estrogens. There have been other medical attempts to control bleeding from intestinal vascular lesions. Somatostatin has been used in an uncontrolled fashion, as has aminocaproic acid. Vascular lesions of the bowel are not all the same. Medical therapy of vascular lesions is contrary to general present practice. Endoscopic or surgical therapy is presently considered best because of its ease, relatively good long-term results, and the lack of a clearly effective, well-tolerated medical therapy. Medical therapy is usually reserved for diffuse vascular diseases of the bowel, for vascular lesions located in relatively inaccessible locations, for patients with continued bleeding despite endoscopic or surgical management, and for patients who are not candidates for either endoscopic or surgical therapy.","PeriodicalId":79377,"journal":{"name":"Seminars in gastrointestinal disease","volume":"10 2","pages":"71-7"},"PeriodicalIF":0.0,"publicationDate":"1999-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21230243","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

The role of surgery in occult gastrointestinal bleeding. 手术在隐匿性消化道出血中的作用。

Seminars in gastrointestinal disease Pub Date : 1999-04-01

L B Katz

引用次数: 0

Refractory gastrointestinal symptoms: a combined medical psychiatric approach. 难治性胃肠道症状:综合医学精神病学方法

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

K W Olden

引用次数: 0

Placebos in medicine. 医学上的安慰剂。

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

C N Bernstein

引用次数: 0