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J H Butt

Publications and source records attributed to J H Butt.

At least 19 recordsLinked to original sources
PubMed1992

Outpatient management of inflammatory bowel disease. Let's keep it as simple as possible.

Inflammatory bowel disease is a conglomeration of disorders of unclear etiology and pathogenesis. Confirming the diagnosis of active disease may be difficult but is critical to judicious therapy. Sulfasalazine (Azulfidine) and its newer derivatives mesalamine (Asacol, Rowasa) and olsalazine sodium (Dipentum) are used for treatment of mild disease and maintenance. Corticosteroid therapy controls moderate disease in most patients, but withdrawal may be difficult. Immunosuppression or surgery may be necessary in severe or refractory cases. The risk of cancer as a complication of inflammatory bowel disease is often exaggerated but cannot be ignored.

Abdominal Pain↗
PubMed1991

Ischemic colitis associated with dextroamphetamine use.

Ischemic colitis can be caused by a variety of medications including a number of sympathomimetic agents. We report the case of a 47-year-old narcoleptic man who had abdominal pain and rectal bleeding. The clinical, radiographic, and histologic findings supported the diagnosis of ischemic colitis associated with oral dextroamphetamine use.

Colitis↗
PubMed1990

Air-contrast barium enema studies after flexible proctosigmoidoscopy: randomized controlled clinical trial.

The authors performed a randomized clinical trial to determine the effect of flexible proctosigmoidoscopy (FPS) on the quality of air-contrast barium enema (ACBE) studies performed on the same day and whether it mattered if air or carbon dioxide was used for endoscopic insufflation. One hundred twenty-one patients were randomly assigned to one of the following groups: Same-day studies were performed, with air used for insufflation, in group 1; same-day studies, with carbon dioxide, in group 2; and separate-day studies in group 3. Scout images obtained before the ACBE study were graded for the amount of air seen, and ACBE studies were graded for overall quality; each was graded on a scale of 0-3 in a blinded fashion. The air score was significantly greater in group 1 (2.69) than in group 2 (2.01) (P less than .001), which in turn was significantly greater than in group 3 (1.53) (P less than .01). The ACBE quality scores in the three groups were not significantly different. The authors conclude that FPS can be done before ACBE examination without impairing the quality of the ACBE study. Although carbon dioxide insufflation results in less intestinal air after FPS, the quality of the ACBE study is not affected.

Air↗
PubMed1989

Gastroesophageal reflux disease. Recognizing and managing major complications.

Complications of gastroesophageal reflux disease are reassuringly few, considering the widespread morbidity from reflux disease. The major ones are bleeding, ulcer, stricture, and carcinoma. These serious, disabling complications, although infrequent, can be life-threatening. Management is not entirely satisfactory. Improved medical and surgical therapy awaits further clinical research.

Barrett Esophagus↗
PubMed1988

Clinical spectrum of the upper gastrointestinal effects of nonsteroidal anti-inflammatory drugs. Natural history, symptomatology, and significance.

Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve rheumatic pain and are in extensive use. Symptomatic complications of NSAIDs requiring the discontinuation of their use occur in 2 to 10 percent of patients with rheumatic diseases in sharp contrast to the common asymptomatic problems of gastroduodenal erosions, ulcerations, and bleeding, with resulting anemia in more than 40 percent of these patients. Opinions concerning the clinical significance of these complications are not uniform. The natural history of the effects of NSAIDs on the gastroduodenal mucosa reveals a sequence of initial subepithelial hemorrhage over a 24-hour period followed by gastroduodenal erosions and ulcerations in the next two weeks. From one week to three months, gastroduodenal erosions and ulcerations disappear in about half of the patients as an adaptation to continuing NSAID ingestion occurs. Hemorrhage may occur at any time in most patients and in a small minority (1 percent) it is massive. Non-aspirin NSAIDs (NANSAIDs) exhibit significantly fewer complications than do aspirin. These complications, however, demand considerable clinical attention and are ordered in a constant hierarchy, suggesting variable risks of complications among agents. NSAIDs are a blessing for those who have chronic pain, but that blessing does not prevent significant asymptomatic complications in the same patients. Prophylaxis for high-risk groups, such as women over the age of 65 years, should be subjected to study.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1988

NSAIDs: a clinical approach to the problems of gastrointestinal side-effects.

Despite the fact that non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs in medicine today, 2-10% of patients must discontinue their use primarily due to gastrointestinal (GI) side-effects. While the development of non-aspirin NSAIDs (NA-NSAIDs) has significantly reduced GI side-effects, major problems persist. A practical clinical approach to these problems includes informing the patient about the risks and benefits of NSAIDs, risk management during treatment with NSAIDs and investigation of symptomatic side-effects during treatment. Prophylaxis of GI side-effects is feasible in selected populations, but it has not been studied widely and may not be cost-effective. At present, costs of prophylaxis in all but selected populations with multiple risks probably outweight the benefits.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1986

Measuring liver span. Bedside examination versus ultrasound and scintiscan.

In 75 hospital patients an estimation of liver span was made independently by students (I), fellows (II), and consultants (III). These bedside estimates were made three times at full inspiration in a right parasagittal line one third of the sternal length from the midline by palpation, direct, and indirect percussion. These bedside estimates were compared to each other and to ultrasound in full inspiration in the supine position and to scintiscan in quiet respiration. We found that bedside estimate of liver span by direct percussion was accurate as ultrasound, but that indirect percussion estimate of liver span was inaccurate. Scintiscanning during quiet respiration over-estimates the liver span in comparison to ultrasound. Previous suggestions that clinical estimates of liver span should be abandoned may be in error.

Humans↗
PubMed1983

Macroscopic lesions in dysplasia and carcinoma complicating ulcerative colitis.

Visible changes associated with dysplasia or carcinoma have been assessed in 62 colectomy specimens from patients with ulcerative colitis. In 34 colectomy specimens with one or more carcinomas, there were 51 visible carcinomas and 65 macroscopic dysplastic lesions; only one carcinoma was found in flat mucosa. Among 28 specimens with microscopic dysplasia but no carcinoma, eight contained no visible dysplastic lesion, and the remaining 20 contained a total of 40 polypoid or elevated dysplastic areas. In 32 operative specimens removed for long-standing chronic colitis without dysplasia or carcinoma, nine contained visible inflammatory polypoid lesions. On radiological or endoscopic examination of the colon in long-standing colitis close attention should be given to the identification and biopsy of polyps, elevated nodular areas or plaques, strictures, and isolated ulcers. It is likely that colectomy specimens with visible polypoid or elevated dysplastic lesions will contain a carcinoma more often than those removed for dysplasia in flat mucosa.

Carcinoma↗
PubMed1983

Paracentesis.

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Ascites↗
PubMed1983

Ascites.

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Ascites↗
PubMed1981

Effect of anti-inflammatory drug administration in patients with rheumatoid arthritis. An endoscopic assessment.

A prospective endoscopic study was carried out in 65 patients with rheumatoid arthritis to assess the prevalence of gastroduodenal lesions on aspirin alone or aspirin plus another anti-inflammatory drug (n = 26). All patients were taking greater than or equal to 8 tablets aspirin/day for greater than or equal to 3 months. Drug therapy consisted of regular, buffered or enteric-coated aspirin +/- one other non-steroidal anti-inflammatory drug or less than or equal to 10 mg prednisone/day. Endoscopic findings were graded as normal, or gastric and/or duodenal erythema, erosions, or ulcer; only the most serious lesion was tabulated. Fifty-three percent of patients on aspirin alone has a gastric ulcer or erosions, and 13% duodenal ulcer or erosions compared to 35% with gastric lesions and 4% with duodenal lesions on aspirin plus a second drug. Twenty-two percent of patients taking regular aspirin had gastric ulcers compared to only 6% taking enteric coated. Patients on enteric coated aspirin and prednisone had only a 10% prevalence of severe gastro-duodenal lesions. In conclusion, the combination of a second anti-inflammatory drug and aspirin therapy did not result in a higher prevalence of gastro-duodenal damage over that produced by aspirin therapy alone. Enteric coated aspirin produced significantly fewer serious lesions than regular or buffered aspirin. The combination of enteric-coated aspirin plus low dose prednisone caused a low prevalence of severe gastro-duodenal lesions.

Anti-Inflammatory Agents↗
PubMed1980

The prevalence of duodenal lesions in patients with rheumatic diseases on chronic aspirin therapy.

Peroral endoscopy was performed in 56 patients with rheumatic disease who had been taking 8 or more aspirin tablets daily for more than 3 months yet who had no major gastrointestinal symptoms or history of peptic ulcer disease. Duodenal mucosal lesions were observed in 16 patients; 15 (27%) had erythema, 7 (13%) had erosions, and 2 (4%) had ulcers. The prevalence of duodenal lesions was the same in patients taking regular, buffered, or enteric-coated aspirin preparations. Patients with duodenal lesions were more likely to have associated gastric lesions.

Adult↗