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At least 253 records · Page 14Linked to original sources
PubMed1999

Update on medications used to treat gastrointestinal disease in children.

Progress in the pharmacotherapy of pediatric gastrointestinal diseases continued during 1998 despite ongoing obstacles encountered by clinicians and researchers. The major change involved warnings that cisapride, a widely used prokinetic agent, could cause potentially fatal arrythmias in susceptible people. The risk for children is unclear and a consensus of prescribing guidelines is needed. Excellent pediatric-oriented reviews have been published that summarize our knowledge of proton pump inhibitors, probiotics, 5-hydroxtryptamine-3 (5-HT3) antagonists, and the treatment of gastrointestinal infections and chronic abdominal pain. Triple medication therapy for the eradication of Helicobacter pylori is now the standard of care, but the optimal combination and duration of therapy needs to be determined. Also described are interesting developments requiring further confirmation: the treatments of infectious diarrhea with zinc; achalasia and Hirschsprung's disease with botulinum toxin; weight loss with megestrol acetate; and sialorrhea with glycopyrollate.

Anti-Bacterial Agents↗
PubMed1987

Factors affecting methane production in humans. Gastrointestinal diseases and alterations of colonic flora.

Breath methane was studied in 394 subjects. Among 152 controls, 50.0% produced methane--42.1% of males and 57.9% of females. One hundred sixteen patients with gastrointestinal diseases were studied. Among 32 with Crohn's disease, only 2 (6.1%) produced methane, as well as 16 of 51 ulcerative colitis patients (31.4%) and 11 of 32 patients with the irritable bowel syndrome (34.4%). Breath methane is thus unusual in Crohn's disease. After bowel cleansing for colonoscopy or surgery, 15 of 18 methane producers became nonproducers, whereas after antibiotic treatment, 24 of 30 producers sustained their methane-producing status. After gentamycin and cephazolin therapy, methane production was abolished in three of eight patients. Slight spontaneous variations in methane production were also noticed with two of 23 control subjects, becoming nonproducers on restudy after 10-25 months. Thus gastrointestinal diseases, bowel cleansing and, to a much lesser degree, antibiotic therapy, affect methane production.

Adolescent↗
PubMed1996

Prevalence of adverse reactions to food in patients with gastrointestinal disease.

The role of allergic reactions in the pathogenesis of inflammatory bowel disease and irritable bowel syndrome has been disputed. This study aimed to determine the prevalence of adverse reactions to food in patients with gastrointestinal disease. A total of 375 adult patients of a gastroenterologic outpatient clinic were examined by history, skin tests, measurements of laboratory parameters, and intestinal provocation with food allergens by colonoscopy. Some 32% complained of adverse reactions to food as a cause of their abdominal symptoms. In 14.4%, the diagnosis of intestinal food allergy could be suspected according to several criteria such as elevated total IgE, specific IgE against food antigens, eosinophilia, responsiveness to cromoglycate, and clinical signs of atopic disease. In 3.2%, the diagnosis could be confirmed by endoscopic allergen provocation and/or elimination diet and rechallenge. In conclusion, the data suggest that allergic reactions to food antigens may be a causative factor in a subgroup of patients with inflammatory and functional gastrointestinal disease.

Adolescent↗
PubMed2002

Parenteral nutrition for horses with gastrointestinal disease: a retrospective study of 79 cases.

Parenteral nutrition is advocated for sick foals and horses, although there is no report which has critically evaluated its benefits in this species. Therefore, the hypothesis that parenteral nutrition (PN) is beneficial for horses with severe gastrointestinal disease was investigated in a retrospective study. Records from 79 treatment courses in horses with gastrointestinal disease were reviewed for the years 1992-2000. The fatality rate (48.1%) was attributed to the severity of the primary disease. Complications due to PN were recorded and hyperglycaemia was the most common complication associated with PN. The number of laparatomies, proportion of horses that received lipid emulsion and the daily cost were higher in nonsurvivors than in survivors. The length of PN course was longer in survivors, although glucose peak was observed later in nonsurvivors after initiation of PN. The content of vitamins in PN solution and plasma protein at the beginning of PN were higher for survivors, while the volume of plasma administered was significantly larger in nonsurvivors. In horses with inflammatory diseases, the rate of glucose infusion and the amount of vitamins administered were higher than in horses with nonstrangulated obstruction. The proportion of horses that received lipid emulsion was higher among those with nonstrangulated and strangulated obstruction than in the group with inflammatory conditions. Because of the diverse group of diseases and the variability in the clinical signs, evaluating the effect of PN on disease outcome was not possible. A prospective study to compare horses with similar clinical conditions treated and not treated with PN is needed to evaluate fully the benefits of PN, and to establish guidelines for patient selection for PN.

Animals↗
PubMed1994

[Osteoarticular manifestations during liver and gastrointestinal diseases].

The most important osteoarticular complications occurring during gastrointestinal and liver diseases are reviewed. Although etiopathogenesis of these disorders is not yet fully understood, their knowledge is required to gastroenterologists for two main reasons: to establish a correct diagnosis and to start an appropriate therapy.

Bone Diseases↗
PubMed2006

Unmet needs in non-steroidal anti-inflammatory drug-induced upper gastrointestinal diseases.

The use of traditional and cyclooxygenase (COX)-2-selective non-steroidal anti-inflammatory drugs (NSAID) for the relief of pain and inflammation increases the risk of gastrointestinal side-effects ranging from dyspepsia to symptomatic and complicated ulcers. The COX-2-selective agents were designed to provide comparable pain relief to traditional NSAID, with a reduced rate of adverse gastrointestinal events. However, there appears to be little clinically significant difference between COX-2 and traditional NSAID in terms of dyspepsia, a common cause of the discontinuation of a traditional NSAID. Furthermore, concomitant aspirin use substantially reduces the gastrointestinal safety advantage of COX-2-selective drugs. An increase in the numbers of people taking low-dose aspirin for cardioprotection, an aging population and potential chemoprevention benefits are resulting in the rising consumption of NSAID. Proton pump inhibitors have a demonstrated role in the treatment and prevention of both non-selective NSAID and selective COX-2 inhibitor-related upper gastrointestinal damage. However, the use of gastroprotective agents is far from optimal, and many high-risk patients are not being clearly identified. At the same time, inappropriate low-dose aspirin use is placing low cardiovascular risk patients at risk of gastrointestinal bleeding. Combined with the recent withdrawal of rofecoxib and valdecoxib from the market because of excess cardiovascular adverse events, and concerns about the safety of other COX-2 inhibitors, a review of strategies to reduce the overall risks in users of anti-inflammatory drugs is timely. This article examines the current issues of understanding and managing NSAID-induced upper gastrointestinal diseases.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Prevalence of Helicobacter pullorum among patients with gastrointestinal disease and clinically healthy persons.

Feces from 531 patients with gastroenteritis and from 100 clinically healthy individuals were tested for Helicobacter pullorum by use of PCR. Samples positive by PCR were qualified for isolation. H. pullorum DNA was demonstrated to be present in feces from 4.3% of patients with gastrointestinal disease but also in feces from 4.0% of clinically healthy persons. One strain was isolated from one patient with gastrointestinal disease.

DNA, Bacterial↗
PubMed1989

Enteric protein loss in various gastrointestinal diseases determined by intestinal alpha 1-antitrypsin clearance.

Intestinal protein loss was measured by means of faecal alpha 1-antitrypsin clearance (alpha 1 ATC) in patients with various gastrointestinal diseases. In healthy controls and in patients with various gastrointestinal diseases there is a remarkable intraindividual fluctuation of the faecal protein loss from day to day. Alpha 1 AT clearance calculated from a three-day stool collection is usually sufficient to indicate enteric protein loss in Crohn's disease, ulcerative colitis, celiac sprue, and Whipple's disease. However, in two patients with intermittent diarrhea coinciding with edema and hypalbuminemia excessive enteric protein loss was observed on one day during a two week stool sampling period only. In one of these patients suction biopsies showed histologically intestinal lymphangiectasia of a 10 cm segment of the upper jejunum. The alpha 1 ATC is a suitable and cheap method to determine enteric protein loss without the use of radioactive tracers and therefore can be used in clinics without departments of nuclear medicine. In contrast to the conventional Gordon test the use of the endogenous marker alpha 1 AT facilitates the determination of faecal protein loss over long time periods, which might be of value in the diagnosis of intermittent occurring enteric protein loss. Furthermore, the endogenous marker alpha 1 AT is of use in following the course of illness and in monitoring the efficacy of therapy in patients with enteric protein loss.

Adult↗
PubMed1996

Clinical economics review: gastrointestinal disease in primary care.

Gastrointestinal disorders are common in the general population, with annual prevalence figures ranging from 20% for irritable bowel syndrome to over 40% for dyspepsia. Less than one-third of patients consult general practitioners for these problems, and anxiety about serious disease and cancer are as important in the decision to consult as symptom severity. Gastrointestinal disorders have significant socioeconomic effects in the community, and account for 10% of the work of general practitioners in the UK. The health economics implications of management in primary care relate principally to the costs of investigation and therapy, notably antisecretory drugs, endoscopy, radiology and specialist referral. Although guidelines based on evidence and agreed between primary and secondary care physicians offer an attractive approach to rationalizing the use of resources, there is at present little health service research evidence on which to base important decisions. For example, in dyspepsia, the role of Helicobacter pylori identification and eradication in an overall management strategy in primary care has yet to be defined. An exploration of the clinical economics of gastrointestinal disorders in general practice raises a number of research questions, which will require the attention of both generalists and specialists.

Gastrointestinal Diseases↗
PubMed1982

[Possibilities and limits of ultrasonography in gastrointestinal diseases (author's transl)].

Sonography has become a widely accepted method for noninvasive imaging of abdominal viscera. This report demonstrates the value of ultrasonography in comparison with other methods in diagnosing gastrointestinal diseases. The sonographic demonstration of an abdominal tumor by ultrasound enables to get informations about the extent, and in connection with sonographically guided fine needle aspiration biopsy about the malignancy of the tumor. In cases of clinically suspected gallstones, biliary obstruction or pancreatic pseudocysts sonography allows the definitive diagnosis and determines the further therapeutical proceeding. In the differential diagnosis of cholestasis ultrasonography should be the initial technique. The differentiation between obstructive and "internal" jaundice can be achieved in most cases, through the cause can not be obtained in all cases. The sonographic findings, however, reduce the differential diagnostic possibilities so that further diagnostics can be abbreviated and coordinated in the right and the patient considerate way. In many clinical situations sonography has to be interpreted in connection with clinical and biochemical findings and the results of other investigations.

Biliary Tract Diseases↗
PubMed1999

[Glucocorticoid-induced diabetes mellitus in gastrointestinal diseases].

Glucocorticoid excess causes insulin resistance i.e. a reduced effectiveness of insulin to suppress hepatic glucose production and to increase glucose uptake in muscle and fat tissue. Persons who cannot compensate for the resulting additional insulin need develop overt diabetes during glucocorticoid therapy. In the field of gastroenterology, glucocorticoids are mainly employed for the therapy of chronic inflammatory bowel diseases, alcoholic and autoimmune hepatitis, and after liver transplantation. The risk of developing steroid diabetes depends among other things on the genetic predisposition, the body composition, the underlying gastrointestinal disease, the age, and the steroid dose. The treatment of glucocorticoid-induced diabetes resembles essentially the treatment of type 2-diabetes. In addition to dietary measures, oral antihypoglycemic drugs and/or insulin are applied. If oral antihypoglycemic drugs are used, specific problems that might result from the gastrointestinal diseases need to be observed. In the short and medium term, the prognosis of glucocorticoid-induced diabetes is good since it is well treatable. If glucocorticoid treatment is continued for a long time, the alterations of glucose metabolism and the resulting hyperinsulinemia may lead to increased cardiovascular risk.

Adolescent↗
PubMed2003

Bioelectrical impedance measurements in patients with gastrointestinal disease: validation of the spectrum approach and a comparison of different methods for screening for nutritional depletion.

BACKGROUND: Bioelectrical impedance spectroscopy (BIS) may be of value in identifying patients with nutritional depletion. OBJECTIVE: The primary aim of the study was to assess the validity of BIS in patients with gastrointestinal disease. The secondary aim was to compare different screening methods for identifying nutritionally depleted patients. DESIGN: In 70 patients with gastrointestinal disease, BIS measurements were performed and fluid compartments were calculated from extrapolated resistance (R) values of extracellular (R(ECW)) and intracellular (R(ICW)) water based on mixture equations. Results were compared with total body water and ECW, which were measured by dilution methods. Patients were classified as depleted if their actual fat-free mass (FFM) was <90% of their ideal FFM (iFFM). Different screening approaches for depletion were compared: the impedance vector method and the resistance index (RI) in relation to iFFM (RI/iFFM). RESULTS: Total body water and ICW were largely underestimated (4 L) in the not-depleted patients but not in the depleted patients. In both groups, ECW was slightly overestimated (0.6-0.7 L). The critical frequency was 60% higher and the membrane capacitance was 40% lower in the depleted than in the not-depleted patients. The impedance vector method failed to identify depleted patients, whereas the proposed ratio at R(50) (R measured at 50 kHz) and R(inf) (R at infinite frequency) resulted in comparable sensitivity (86%) and specificity (73-80%). CONCLUSIONS: BIS measures of body fluids are influenced by the presence of depletion, probably because of alterations in the electric properties of the body at the cellular level. However, for screening purposes, the use of the ratio (L(2)/R)/iFFM at R(50) and R(inf) may be of value.

Aged↗
PubMed1975

Fiberoptic endoscopy. Precise definition of upper gastrointestinal disease.

When properly employed, endoscopic examination of the upper gastrointestinal tract with the flexible maneuverable-tip fiberoptic instruments is the most accurate method of diagnosing any upper gastrointestinal tract disease. Two hundred consecutive endoscopic procedures in the upper gastrointestinal tract were performed without significant morbidity or mortality; the results were reviewed to ascertain the overall diagnostic value of this modality. Although the overall numbers in each subgroup are still small, the experience indicates that: (1) thorough endoscopic examination of the upper gastrointestinal tract can be carried out expeditiously in most patients without morbidity; (2) upper gastrointestinal tract disease can be precisely defined in the majority of patients; and (3) endoscopic examination frequently alters the initial clinical diagnosis. The precise cause of upper gastrointestinal tract hemorrhage can be diagnosed in at least three of four cases. Some unnecessary operations can be avoided and proper therapy for specific sources of bleeding can be initiated promptly.

Adolescent↗
PubMed1995

Helicobacter pylori and upper gastrointestinal disease: a survey of gastroenterologists in the United Kingdom.

The objective of this study was to conduct a survey of the opinions and practices of gastroenterologists in the United Kingdom concerning the impact of Helicobacter pylori infection on the management of upper gastrointestinal diseases. A postal questionnaire was sent to all medically qualified members of the British Society of Gastroenterology working in the UK. Replies were received from 670 of 1037 eligible BSG members (65%). Of these, 73% thought that H pylori was a cause of duodenal ulcer and 84% thought that eradication of H pylori decreased ulcer recurrence in comparison with acid suppression. While 80% used anti-H pylori therapy for a chronic relapsing duodenal ulcer, only 25% used such therapy for an ulcer at first presentation and 17% never used anti-H pylori therapy for patients with duodenal ulcer. Although 75% of respondents did not agree that H pylori was a cause of non-ulcer dyspepsia, 69% used anti-H pylori therapy to treat a patient with this condition. At the time of the survey, 69% of those who used anti-H pylori therapy adopted some variant of standard triple therapy. Only 7% routinely tested for bacterial sensitivity to antibiotics and only 22% assessed their patients for eradication after treatment. There was a lack of consensus about whether H pylori was a cause of gastric ulcer or gastric cancer with only 47% and 17% respectively believing in these associations. In conclusion, at the time of the survey, the use of anti-H pylori therapy had been accepted by a majority of specialist UK gastroenterologists in the management of upper gastrointestinal disease. There was, however, a substantial degree of uncertainty and divergence about which patients should be treated.

Adult↗
PubMed1992

Septic complications of endoscopic laser treatment of gastrointestinal diseases.

This study was designated to establish the incidence of septic complications associated with Nd:YAG-laser treatment of varied gastrointestinal lesions. A total of 30 laser procedures were performed for 27 patients with both upper and lower gastrointestinal diseases. Thirty minutes after the completion of laser therapy, blood culture was obtained from each patient. Only one patient developed sepsis with fever, chills and positive blood culture, the organism isolated was Streptococcus mitis. All the other patients tolerated the treatment well and without signs of septic complications. According to this study, antibiotic prophylaxis is not necessary for gastrointestinal laser treatment. However, the conclusions must be cautious due to the small number of patients included in this study.

Adult↗