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Acute and chronic management of lower gastrointestinal bleeding: cost-effective approaches. 急性和慢性下消化道出血的管理:成本效益的方法。
The Gastroenterologist Pub Date : 1997-09-01
G A Machicado, D M Jensen
{"title":"Acute and chronic management of lower gastrointestinal bleeding: cost-effective approaches.","authors":"G A Machicado,&nbsp;D M Jensen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article is concerned with current diagnosis and treatment of patients with severe lower gastrointestinal (GI) bleeding. Our purposes were to discuss tests available for diagnosis and treatment and to present our approach and to discuss cost assessment of different approaches. We evaluated 100 consecutive patients who presented with severe and persistent lower GI bleeding. Patients were continually monitored and had polyethylene sulfate purge to cleanse the colon. Panendoscopy revealed an upper GI source in 11%. Presumed small bowel bleeding accounted for 9%, and no site was found in 6%. During emergency colonoscopy at the bedside, a definite colonic lesion was found in 74% of patients. Angiomata accounted for 30% of total or 41% of all colonic bleeding sites. Diverticula were the source of bleeding in 23%, ulcerated colonic polyps or cancers in 15% of colonic sites, focal colitis or ulceration in 12%, rectal lesions in 5%, and other colonic sources in 4%. Based on 1990 data and costs of services to the patients with severe ongoing hematochezia, we estimated that by using emergency colonoscopy rather than medical, angiographic, and surgical management, a mean of $10,065 per patient was saved.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 3","pages":"189-201"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20237561","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 acute gastrointestinal hemorrhage in anticoagulated patients. 抗凝患者急性消化道出血的处理。
The Gastroenterologist Pub Date : 1997-09-01
C P Choudari
{"title":"Management of acute gastrointestinal hemorrhage in anticoagulated patients.","authors":"C P Choudari","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Bleeding is the major risk associated with anticoagulation therapy. The gastrointestinal tract is the most common site of bleeding. Anticoagulated patients who present with acute gastrointestinal hemorrhage pose great therapeutic challenges. In patients who experience a life-threatening hemorrhage, difficult decisions must be made regarding reversal of anticoagulation, timing of endoscopy and endoscopic therapy, and when to reinstitute anticoagulation. The current literature on the approach to patients who present with major gastrointestinal bleeding while on anticoagulant therapy is reviewed.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 3","pages":"242-6"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20272358","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
Current approach to the surgical management of chronic pancreatitis. 慢性胰腺炎手术治疗的现状。
The Gastroenterologist Pub Date : 1997-06-01
H S Ho, C F Frey
{"title":"Current approach to the surgical management of chronic pancreatitis.","authors":"H S Ho,&nbsp;C F Frey","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The indications for surgical intervention in chronic pancreatitis are suspicion of malignancy, local complications, and intractable pain. Chronic pancreatitis is a risk factor for development of pancreatic carcinoma, and carcinomas may present, initially with a clinical picture of chronic pancreatitis. Local complications of chronic pancreatitis such as common bile duct or duodenal obstruction and enlarging or symptomatic pseudocyst also mandate surgical intervention. Thrombosis of the splenic vein with left-sided portal hypertension is common and associated with a 10% incidence of gastric variceal hemorrhage, which requires splenectomy. The role of surgery in the management of pain associated with chronic pancreatitis is to provide relief. When the pain interferes substantially with the patient's quality of life or narcotics are required for pain relief, surgical intervention is indicated. Other factors that should be incorporated in assessing the need for surgical intervention are malnutrition due to the inability to eat or malabsorption, the need for frequent hospitalization, and the inability to work. The operation selected for chronic pancreatitis should correct or deal with all structural abnormalities, provide long-term pain relief, have a low mortality and morbidity rate, minimize subsequent exocrine and endocrine insufficiency, and have results independent of abstinence from alcohol. No single operation can provide an optimal solution to the management of pain or these diverse complications of chronic pancreatitis. The operation chosen must be individualized to treat the patient's needs.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 2","pages":"128-36"},"PeriodicalIF":0.0,"publicationDate":"1997-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20139766","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
Colonic angiodysplasia. 结肠血管畸形。
The Gastroenterologist Pub Date : 1997-06-01
P G Foutch
{"title":"Colonic angiodysplasia.","authors":"P G Foutch","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Colonic angiodysplasia (AD) is an important vascular lesion responsible for approximately 6.0% of cases of lower gastrointestinal hemorrhage. Lesions are usually located in the right colon and, although the pathophysiology is unknown, most are probably acquired as the result of a degenerative process associated with aging. Diagnosis is usually made during colonoscopy, but angiography can be efficacious when hemorrhage is severe. Most patients with bleeding AD are treated by endoscopy. Various methods have been used (monopolar electrocoagulation, injection therapy, contact probes, and lasers) with acceptable safety and success. perforation of the right colon is the main concern, especially with monopolar electrocoagulation and the YAG laser. In clinical practice, contact probes are used most often, although this approach has not been well studied as treatment for colonic AD.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 2","pages":"148-56"},"PeriodicalIF":0.0,"publicationDate":"1997-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20139768","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
Spastic disorders of the esophagus. 食道痉挛性疾病
The Gastroenterologist Pub Date : 1997-06-01
R E Clouse
{"title":"Spastic disorders of the esophagus.","authors":"R E Clouse","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Spastic disorders of the esophagus are found in up to 50% of patients referred for manometry, therapy representing the most prevalent motility disorders in clinical practice. They share in common their manifestations of hypermotility, one of two principal types of esophageal motor dysfunction. Diffuse esophageal spasm is segregated from the nonspecific spastic disorders because of its demonstrated interference with bolus transit. However, the overlap among the spastic disorders in manifestation, course, and management is great; segregation of any disorder within this group is not of paramount importance. Spastic disorders, pain reproduction with provocative testing, and psychological abnormalities are coprevalent in patients with unexplained symptoms, but a cause-effect relationship of the motor abnormalities with the other findings is not established. The physician's charge in determining the relevance of a spastic disorder to the clinical presentation and for creating a treatment plan is to establish a direct relationship of motor dysfunction with symptoms-a task that may require correlation of transit abnormalities with symptoms using tests other than manometry. A variety of treatment options, invasive and noninvasive, are available today for patients who have spastic disorders, and each is effective in appropriately selected candidates.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 2","pages":"112-27"},"PeriodicalIF":0.0,"publicationDate":"1997-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20139833","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 ultrasound. 内窥镜超声检查。
The Gastroenterologist Pub Date : 1997-06-01
W Wassef, A Zfass
{"title":"Endoscopic ultrasound.","authors":"W Wassef,&nbsp;A Zfass","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Endoscopic ultrasound is currently an accepted part of the clinical practice of gastroenterology. It is used to evaluate submucosal lesions, thickened gastric folds, and depth of gastrointestinal tumor penetration. As the capabilities of the instruments improve, their role in the practice of gastroenterology widens. This review is designed to update the practicing physicians on this rapidly evolving field, pertaining to instrumentation for endosonography, clinical indications for endosonography, and future directions.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 2","pages":"165-72"},"PeriodicalIF":0.0,"publicationDate":"1997-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20139770","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
Antibiotics and pancreatitis. 抗生素和胰腺炎。
The Gastroenterologist Pub Date : 1997-06-01
A Foxx-Orenstein, R Orenstein
{"title":"Antibiotics and pancreatitis.","authors":"A Foxx-Orenstein,&nbsp;R Orenstein","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite improvements in the general supportive care of patients with acute pancreatitis, the morbidity of infectious complications remains high and bacterial infections account for most deaths. The role of antibiotics in reducing infectious morbidity and mortality has been debated for decades because of a lack of supportive clinical data. Research completed over the past decade has helped to define the microbiology, establish the risk factors, and improve the understanding of the pathogenesis of infectious complications in patients with acute pancreatitis. Patients with acute necrotizing pancreatitis are at the greatest risk of developing an infection with enteric gram-negative or gram-positive bacteria translocated from the bowel lumen into the necrotic pancreatic tissue. The most effective antimicrobial agents are the fluoroquinolones, imipenem-cilastatin, and metronidazole, which achieve adequate penetration into pancreatic juice and necrotic tissue and inhibit the growth of enteric bacteria. Animal and human studies support the use of antibiotics for the prevention of infectious morbidity and mortality in severe acute pancreatitis. Recent clinical trials have assessed the role of both systemic antibiotic prophylaxis and selective bowel decontamination with nonabsorbable oral antimicrobials in high-risk patients with acute necrotizing pancreatitis. This article provides an overview of our current knowledge of pancreatic infections and a critical analysis of studies on the role of antibiotics in this disease.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 2","pages":"157-64"},"PeriodicalIF":0.0,"publicationDate":"1997-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20139769","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
Manometric evaluation of defecation disorders: Part II. Fecal incontinence. 排便障碍的压力测量评估:第二部分。大便失禁。
The Gastroenterologist Pub Date : 1997-06-01
S S Rao
{"title":"Manometric evaluation of defecation disorders: Part II. Fecal incontinence.","authors":"S S Rao","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Fecal incontinence is a silent affliction that often leads to self-imposed ostracism. For many years, a lack of understanding regarding its pathophysiology and a lack of empathy among many physicians has bedeviled this problem. However, during the last two decades, remarkable strides have been made, both in the evaluation and in the treatment of incontinence. These advances stem from the ability to perform a detailed and comprehensive assessment of anorectal physiology. Anorectal manometry has spearheaded this renaissance. Manometry is not a single test but consists of a series of measurements that include an assessment of anal sphincter function, rectal sensation, rectoanal reflexes, and rectal compliance. Electrophysiological assessments such as pudendal nerve terminal latency can provide additional information regarding neuromuscular integrity. Newer techniques such as vectography, saline continence test, impedance planimetry, and prolonged ambulatory anorectal manometry have added a new dimension to the overall assessment. Radiological tests such as defecography and anal endosonography can provide complimentary information. These tests of anorectal function have advanced immensely our understanding of the pathophysiological mechanisms that are responsible for fecal incontinence. Equipped with sound objective information, today, it is possible to treat most incontinent patients with novel treatments that include medical, biofeedback, or surgical therapies. This is the second article in a two-part evaluation of defecation disorders that discusses the manometric evaluation of fecal incontinence.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 2","pages":"99-111"},"PeriodicalIF":0.0,"publicationDate":"1997-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20139832","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
Immunology of liver transplantation: clinical management aspects. 肝移植免疫学:临床管理方面。
The Gastroenterologist Pub Date : 1997-06-01
V Shah, A L Friedman, V J Navarro
{"title":"Immunology of liver transplantation: clinical management aspects.","authors":"V Shah,&nbsp;A L Friedman,&nbsp;V J Navarro","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Orthotopic liver transplantation has developed into the treatment of choice for many patients who develop complications of end-stage liver disease. With improvements in surgical technique and overall survival since the inception of liver grafting, a major consideration in the longterm care of liver transplant patients has become the management of allograft rejection and immunosuppressive therapy. With an increasing number of patients having undergone successful transplantation in the community, practicing gastroenterologists will likely be called upon more frequently to render care to these patients. In this article, the immunobiology of transplantation and rejection is discussed with an emphasis placed on the T-cell-major histocompatibility complex interaction, cytokine stimulation, and adhesion molecule binding. Commonly used immunosuppressive medications and promising ones for the future are reviewed. Also, clinical aspects of the short- and long-term management of immunosuppression are explored.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 2","pages":"137-47"},"PeriodicalIF":0.0,"publicationDate":"1997-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20139767","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 ultrasonography for esophageal and gastric mass lesions. 食管和胃肿块病变的超声内镜检查。
The Gastroenterologist Pub Date : 1997-03-01
M F Catalano
{"title":"Endoscopic ultrasonography for esophageal and gastric mass lesions.","authors":"M F Catalano","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Endoscopic ultrasonography is a relatively new and evolving imaging modality incorporating endoscopy and ultrasonography into one comprehensive examination of the gut wall. Its principal indication has been the locoregional staging (T and N) of gastrointestinal tumors, particularly of the esophagus and stomach. Accuracy of conventional radiographic modalities (computed tomography and magnetic resonance imaging) has been disappointing (50-60%). Alternatively, the staging accuracy of the depth of tumor penetration (T stage) approaches 85-90% in most series, whereas that for lymph node assessment (N stage) has been in the 70-80% range. The precise stage of upper gastrointestinal neoplasms provides accurate pretreatment assessment of the patient's prognosis and may influence therapeutic decisions. Endosonography is also the diagnostic modality of choice in the evaluation of submucosal tumors. It can demonstrate size, layer of origin, and, by its echo texture, can accurately predict etiology of the neoplasm. The only limitation may be in the differentiation of benign from malignant smooth muscle tumors.</p>","PeriodicalId":79381,"journal":{"name":"The Gastroenterologist","volume":"5 1","pages":"3-9"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20029535","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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