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Nonalcoholic fatty liver (NASH syndrome). 非酒精性脂肪肝(NASH综合征)。
The Gastroenterologist Pub Date : 1997-12-01
B J O'Connor, B Kathamna, A S Tavill
{"title":"Nonalcoholic fatty liver (NASH syndrome).","authors":"B J O'Connor,&nbsp;B Kathamna,&nbsp;A S Tavill","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Nonalcoholic steatohepatitis (NASH) is the term used for a common form of fatty liver presenting in adults with varied clinical manifestations. The most common presentation is asymptomatic elevation of liver enzymes (AST or SGOT and ALT or SGPT), which can be discovered incidentally in the course of an annual checkup, life insurance examination, or as part of surrogate screening before blood donation. At the other end of the clinical spectrum is the patient with complications from cryptogenic cirrhosis, who also shows a lack of evidence of alcohol as an etiological factor in pathogenesis. Clinical associations of probable relevance include gender (female), obesity, diabetes, and hyperlipidemia, but many patients do not conform to any of these stereotypes (e.g., young men of normal weight with normal fasting glucose and lipid levels). Liver biopsy confirms the diagnosis of NASH, the association of steatosis with an inflammatory response being the sine qua non for the condition and \"creeping fibrosis\" being a variable but possibly sinister feature. Newer imaging techniques may provide convincing evidence of steatosis, but they give little insight into ongoing fibrosis, and liver biopsy therefore remains the gold standard. The mainstay of treatment remains judicious weight loss coupled with positive dietary advice, including the ingestion of adequate but not excessive vitamins. After initial encouraging data. the assessment of ursodeoxycholic acid currently being studied under randomized controlled conditions is eagerly awaited.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 4","pages":"316-29"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20363829","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
Helicobacter pylori: beyond peptic ulcer disease. 幽门螺杆菌:超越消化性溃疡疾病。
The Gastroenterologist Pub Date : 1997-12-01
R M Wisniewski, D A Peura
{"title":"Helicobacter pylori: beyond peptic ulcer disease.","authors":"R M Wisniewski,&nbsp;D A Peura","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Beyond peptic ulcer disease, Helicobacter pylori infection is associated with intestinal-type gastric cancer and low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. It is also currently implicated as a possible cause of dyspepsia and extraintestinal disorders such as coronary artery disease, rosacea, chronic urticaria, and delayed growth in children. There are strong epidemiological data from large cohort studies linking H. pylori to gastric adenocarcinoma. Several cofactors, including early childhood acquisition of infection, strain-specific differences, genetic predisposition of the host, and the environment, appear to play a role in the progression of chronic gastritis to gastric cancer. H. pylori infection is seen in over 90% of MALT lymphomas, and about 70% of localized nonbulky tumors will undergo complete histological regression after eradication of the bacterium. Because follow-up data are limited to less than 2 years, those undergoing H. pylori eradication as primary therapy for MALT lymphoma require frequent histological surveillance for tumor recurrence. There are conflicting data from short-term studies regarding the effect of H. pylori eradication on dyspeptic symptoms. The decision to test or not for H. pylori in the dyspeptic patient may become easier when well-controlled studies with longer periods of follow-up become available. Because H. pylori induces a systemic inflammatory response, investigators are beginning to explore possible extraintestinal disease associations with the infection. The global prevalence of both peptic ulcer disease and gastric cancer has led to studies focusing on noninvasive screening for H. pylori in high-risk populations and prevention of primary infection by means of vaccination.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 4","pages":"295-305"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20363827","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
Endoscopic therapy of pancreatic disease. 胰腺疾病的内镜治疗。
The Gastroenterologist Pub Date : 1997-12-01
S Sherman, G A Lehman
{"title":"Endoscopic therapy of pancreatic disease.","authors":"S Sherman,&nbsp;G A Lehman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Endoscopic management of a variety of benign and malignant biliary tract diseases is now a well-established alternative to surgery. Similar techniques are now applied to the pancreas and are being used in the setting of acute pancreatitis, chronic pancreatitis, complications of pancreatitis, and pancreas divisum. This review analyzes the current state of the art of these exciting applications of endoscopy. Selection of appropriate candidates for the various treatment modalities appears important for optimal results of therapy. However, definite recommendations are difficult to make because there are limited controlled studies, follow-up in most series is brief, and there are no comparison studies of endoscopic versus surgical therapy. At present, careful case selection and conservatism are the appropriate general rule in these therapeutic endeavors. Further prospective random studies are awaited.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 4","pages":"262-77"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20363218","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
Cholangiocarcinoma: a review. 胆管癌:综述。
The Gastroenterologist Pub Date : 1997-12-01
P J Thuluvath, R Rai, A C Venbrux, C J Yeo
{"title":"Cholangiocarcinoma: a review.","authors":"P J Thuluvath,&nbsp;R Rai,&nbsp;A C Venbrux,&nbsp;C J Yeo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cholangiocarcinoma is associated with several etiological factors including cystic dilation of the bile duct, clonorchiasis, hepatolithiasis, and sclerosing cholangitis. Jaundice is the presenting symptom in over 90% of patients who present with cholangiocarcinoma. The disease is suspected on the basis of an abnormal ultrasound or computed tomography (CT). Tumor markers are often normal, but a significant elevation of carcinoembryonic antigen or CA 19-9 should alert the clinician of a possible diagnosis of cholangiocarcinoma. Cholangiogram is essential to dileneate the bile duct anatomy in hilar or distal cholangiocarcinoma. A tissue diagnosis can be obtained in 60 to 70% of patients using bile cytology, brush cytology, or percutaneous fine-needle aspiration. A multidisciplinary approach is essential for optimal management. Management is based on a number of factors, including age of the patient, performance status, other comorbid conditions, location of the tumor, and tumor resectability. Complete surgical resection offers the only chance for cure in patients with cholangiocarcinoma. Tumor resectability can be accomplished using a combination of CT or magnetic resonance imaging, cholangiography, and visceral angiography. The 5-year survival rate after a potentially curative resection for hilar cholangiocarcinoma ranges from 0 to 22% (mean 14%). By comparison, the 5-year survival rate for distal cholangiocarcinoma ranges from 0 to 39% (mean 25%). Symptomatic patients who are unsuitable for curative resection can have pallitive decompression performed using either percutaneously or endoscopically placed drainage catheters.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 4","pages":"306-15"},"PeriodicalIF":0.0,"publicationDate":"1997-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20363828","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
Enteric neuropathology: recent advances and implications for clinical practice. 肠神经病理学:最近的进展和对临床实践的影响。
The Gastroenterologist Pub Date : 1997-09-01
E M Quigley
{"title":"Enteric neuropathology: recent advances and implications for clinical practice.","authors":"E M Quigley","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Because of their high prevalence in clinical practice, the field of gastrointestinal motility has tended to focus its clinical and research efforts on such functional disorders as nonulcer dyspepsia, the irritable bowel syndrome, and functional constipation. Because these disorders are difficult to define and their diagnosis remains exclusively symptomatic, progress has been difficult in these areas, and advances in clinical gastrointestinal motility generally have been hampered. This review attempts to emphasize the prevalence and importance of \"organic\" motility disorders, ie, those disorders of gastrointestinal motor dysfunction that are to a greater or lesser extent based on defined pathology and pathophysiology. Although some of these disorders are rare, recent dramatic progress has important lessons for motility in general and should point the way toward a greater understanding of the more common motor disorders.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 3","pages":"233-41"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20238802","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
Watermelon stomach. 西瓜的肚子。
The Gastroenterologist Pub Date : 1997-09-01
M Abedi, G B Haber
{"title":"Watermelon stomach.","authors":"M Abedi,&nbsp;G B Haber","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Watermelon stomach (WMS) is an uncommon cause of chronic gastrointestinal blood loss, which once suspected can often be easily diagnosed and endoscopically managed in most cases. The current review intends to heighten the gastroenterologist's awareness of this condition to avoid costly delays in its diagnosis. The characteristic endoscopic appearance of WMS and the other variants of gastric vascular ectasia (GVE) are described. The conditions often associated with WMS are reviewed, including the recently described occurrence of WMS in bone marrow transplant patients presenting with acute upper gastrointestinal hemorrhage. We have clearly differentiated GVE from portal hypertensive gastropathy. The biopsy findings, although usually not required for diagnosis, are discussed. The theories of pathogenesis of WMS are presented and their relation to the observed phenomena is explored. Finally, the management of GVE, which essentially involves endoscopic application of thermal ablation methods, and the newer developments in the field, such as argon plasma coagulation, are discussed.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 3","pages":"179-84"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20237559","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
Ablation of Barrett's mucosa. Barrett粘膜消融。
The Gastroenterologist Pub Date : 1997-09-01
R E Sampliner
{"title":"Ablation of Barrett's mucosa.","authors":"R E Sampliner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Barrett's esophagus is the premalignant lesion of adenocarcinoma of the esophagus and gastric cardia, two rapidly increasing incidence cancers. Barrett's esophagus has been documented to be reversed with a combination of pharmacologic acid control or antireflux surgery and endoscopic ablative therapy. A variety of endoscopic techniques can be applied to ablate the Barrett's epithelium. With sufficient acid reduction, squamous repopulation of the injured area occurs. This injury can be accomplished using laser, photodynamic therapy, electrocautery, and mechanical techniques. The relative success rates, complications, and consistency of depth of injury have not been well defined. Ablative therapy represents an exciting alternative to surgery in elderly patients with comorbidity or in patients averse to surgical therapy. Because of the local nature of this therapy, improved clinical staging is essential to appropriately select candidates. Endoscopic ablation therapy of Barrett's esophagus remains experimental until reversal has been documented over a longer period of time and criteria are validated to select appropriate candidates at high risk of developing adenocarcinoma of the esophagus.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 3","pages":"185-8"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20237560","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
Islet cell tumors. 胰岛细胞瘤。
The Gastroenterologist Pub Date : 1997-09-01
B E Stabile
{"title":"Islet cell tumors.","authors":"B E Stabile","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although quite rare, the islet cell tumors present an important challenge to the clinician because of their protean manifestations and potential lethality. Early diagnosis is essential and depends on recognition of the classic and variant clinical syndromes followed by confirmation of elevated peptide levels by radioimmunoassay. Medical control of the hormonal syndrome with agents such as diazoxide for insulinoma, omeprazole for gastrinoma, and octreotide for vipoma and glucagonoma allows an orderly and thorough investigation for associated endocrinopathies and comorbid medical conditions. Localization and staging of the tumors are important because they may be small and occult, widely metastatic, or multifocal in the context of multiple endocrine neoplasia type I (MEN I) syndrome. Computed tomography, visceral angiography, endoscopic ultrasonography, and indium-labeled octreotide scanning are the most useful preoperative imaging techniques. Surgical exploration that includes intraoperative ultrasonography remains an essential localization technique for occult tumors, particularly insulinomas and gastrinomas. For all patients other than some with advanced metastatic disease or MEN I syndrome, an aggressive surgical approach with the intent of complete and curative tumor excision is indicated. Surgical cure is possible in most insulinomas, a substantial proportion of gastrinomas, and some patients with the other more rare and malignant islet cell tumors. At present, adjuvant medical therapies for unresectable malignant disease have limited efficacy. However, a variety of newer and innovative tumor localization techniques, operative strategies, and nonoperative treatment modalities hold considerable promise for the attainment of higher cure rates and improved palliation.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 3","pages":"213-32"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20237563","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
Diagnostic tests for Helicobacter pylori infection. 幽门螺杆菌感染的诊断试验。
The Gastroenterologist Pub Date : 1997-09-01
A F Cutler
{"title":"Diagnostic tests for Helicobacter pylori infection.","authors":"A F Cutler","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The two major catagories of diagnostic methods for Helicobacter pylori are invasive tests, or those that require endoscopy, and noninvasive, or nonendoscopic, tests. Diagnostic tests that use endoscopy include rapid urease tests, histology, and culture. Tests for which esophagogastroduodenoscopy is not necessary include various methods of antibody detection and carbon-labeled urea breath tests. Most tests are accurate, although none works perfectly and no gold standard for diagnosis exists. This article reviews the diagnostic methods available to establish H. pylori infection status and identifies some common mistakes made in testing. The costs associated with H. pylori diagnosis are evaluated and some cost-effective approaches to testing are suggested. Finally, the article offers some guidelines on choosing the appropriate diagnostic test in different clinical situations to determine the H. pylori infection status.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 3","pages":"202-12"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20237562","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
Linitis plastica of the colon in ulcerative colitis. 溃疡性结肠炎中结肠的可塑性结肠炎。
The Gastroenterologist Pub Date : 1997-09-01
C S Wrobleski, J Li, C Floch, M Bush, M H Floch
{"title":"Linitis plastica of the colon in ulcerative colitis.","authors":"C S Wrobleski,&nbsp;J Li,&nbsp;C Floch,&nbsp;M Bush,&nbsp;M H Floch","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 3","pages":"247-51"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20238803","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
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