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At least 523 records · Page 29Linked to original sources
PubMed1994

Esophageal varices.

Numerous conditions lead to portal hypertension with the development of esophageal varices. Treatment for acute variceal hemorrhage should progress in a logical, stepwise fashion. Therapy after fluid resuscitation includes vasopressin, somatostatin, or a Sengstaken-Blakemore tube. This is followed by treatment with sclerotherapy, variceal ligation, or a combination of both. Continued bleeding is managed by more invasive measures that include radiologic embolization or shunting, esophageal transection, distal splenorenal shunt, or liver transplantation. Beta-blockade may be useful to prevent recurrent bleeding in compliant patients without medical conditions that would preclude use of beta-blockade. Once control of the bleeding has been achieved, sclerotherapy or ligation should be used to obliterate the varices, but prophylactic use of sclerosant is not particularly beneficial.

Adrenergic beta-Antagonists↗
PubMed1994

The role of the gastrointestinal assistant.

Thorough and accurate fulfillment of the GIA's role is integral to the successful completion of endoscopic procedures. Strong basic nursing skills, a well-developed knowledge of gastrointestinal anatomy and physiology, and a thorough understanding of endoscopic equipment and accessories are required for the fulfillment of the GIA's role. Clear communication and cooperation between the nurses, associates, and physicians creates a team approach that optimizes patient care.

Biopsy↗
PubMed1994

Erythromycin as a prokinetic agent: a prospective, randomized, controlled study of efficacy in nasoenteric tube placement.

OBJECTIVES: Erythromycin, a macrolide antibiotic, has been shown to mimic the effects of the polypeptide motilin in the gastrointestinal tract. To determine whether erythromycin ethylsuccinate elixir would facilitate the transpyloric passage of a standard nasoenteric feeding tube once the tube was placed into the stomach, 20 patients were randomized to receive erythromycin or standard therapy. METHODS: Twenty patients (ages 45-78), mean age 63 yr, all male, had 43-inch nasoenteric tubes placed and were randomized to receive erythromycin ethylsuccinate elixir (400 mg/5 ml per os every 8 h for three doses) through the feeding tube or to receive standard therapy that involved no drug intervention. RESULTS: Three placements resulted in immediate transpyloric passage. This represented 3/21 (14%) with immediate passage. One patient dropped out after initial tube placement. The remaining 17 patients had initial tube placement in the stomach; of these, eight were randomized to receive erythromycin and nine to receive standard therapy. Six of the eight nasoenteric tubes in the erythromycin group achieved transpyloric passage in 1 day. Zero of the nine nasoenteric tubes in the standard therapy group achieved transpyloric passage in 1 day (p = 0.0023, Fisher's exact test). CONCLUSION: This study demonstrates that erythromycin ethylsuccinate elixir improves the success of transpyloric feeding tube passage in 1 day and is superior to the standard therapy, which consists of no drug intervention.

Enteral Nutrition↗
PubMed1994

[Endoscopy in the intensive care unit].

The present study retrospectively evaluates all endoscopies performed on a medical intensive care unit during the period from 1986 to 1992. During these seven years, 415 endoscopies were performed of which 77.8% were done as an upper gastrointestinal endoscopy. The most frequent findings consisted in esophagitis (23.6%), ulcers of the stomach or duodenum (20.2%), esophageal varices (10.1%) and erosive-hemorrhagic gastritis (9.6%). More than 2/3 of all endoscopies were performed because of an gastrointestinal bleeding with upper bleeding being three times more frequent than lower bleeding. The endoscopy was able to identify the cause and site of bleeding with certainty or high probability in 92.8%. Esophagitis was the most frequent cause of bleeding (30.7%) followed by ulcers in the duodenum and stomach (25.6%), esophageal varices (14.8%) and erosive gastritis (13.7%). In more than 90% of patients with esophagitis a nasogastric tube had been administered during the two preceding days. Therefore, the tube is probably responsible for the esophagitis. The present data show that bleeding from esophageal lesions are about ten times more frequent in patients treated in an intensive care unit when compared to data published for the general group of patients with gastrointestinal bleeding. Considering the frequency of bleeding from esophagitis in intensive care patients, an administration of a nasogastric tube should be done only when mandatory.

Critical Care↗
PubMedDate not supplied

[Treatment of hemorrhage of the digestive system with amine alpha-adrenergic stimulants].

Noradrenaline was administered through the stomach or peritoneum in thirty patients of the Raza Hospital of the I.M.S.S. in an attempt to control severe gastro-intestinal bleeding as described by Dr. H. H. Le Veen. In 84% of the cases this was accomplished with an average elapsed time of 82 minutes. The method proved to be effective of various etiologies except in those cases in which an important size artery was involved. There were no side effects.

Adolescent↗
PubMed1993

[Assessment of gastric emptying].

In the absence of overt mucosal lesions, abnormalities of gastroduodenal motorfunction are considered to be important in the pathogenesis of many upper abdominal symptoms. These may be idiopathic, occur following gastric surgery, or in association with diseases such as diabetes mellitus. A variety of investigations have been developed to examine the motility of the stomach and duodenum. To date the most reliable and useful techniques are those which assess gastric transit either radiologically or scintigraphically. Assessment of the expulsion of radio-opaque gastric markers with a single abdominal x-ray can be performed as a simple outpatient screening procedure. More precise radioisotopic definition of delayed gastric emptying, however, requires access to a Nuclear Medicine Department. A number of other approaches are currently under investigation as potential diagnostic tests. The future role of these techniques is unclear, although 13C breath testing may soon permit rapid and simple screening of gastric emptying abnormalities without exposure to ionizing radiation. At present, other techniques such as ultrasound, antropyloroduodenal manometry, and magnetic resonance imaging have application only in research centers.

Barium Sulfate↗
PubMed1997

Effect of cisapride on oesophageal motility and duodenogastro-oesophageal reflux in patients with Barrett's oesophagus.

OBJECTIVE: Both gastric acid and duodenal juice have been implicated in Barrett's oesophagus. The aim of this study was to look at duodenal reflux in the oesophagus together with motility characteristics in a group of patients with Barrett's oesophagus and compare them with a mild oesophagitis group and to assess the effect of cisapride on any abnormalities. DESIGN: A prospective study comparing the two groups of patients was carried out. METHODS: Twenty patients with histologically proven Barrett's oesophagus and 20 patients with Savary-Miller grade 2 oesophagitis were studied. Standard oesophageal manometric measurements were carried out and on a separate occasion duodenogastro-oesophageal reflux (DGOR) was measured over a 4-h period using a sodium ion selective electrode. Patients with more than 5% DGOR were given cisapride (10 mg four times daily) and the studies repeated after 7 days of treatment. RESULTS: Barrett's patients showed more DGOR, 12.2% of the study time compared to 5.1% in the mild oesophagitis group, P = 0.012, but manometric findings were not significantly different. Sixteen patients were treated with cisapride. DGOR was reduced in 8 out of 12 Barrett's patients and 2 out of 4 oesophagitis patients, and proximal amplitude and distal oesophageal pressures were significantly elevated (P = 0.05 and P = 0.03, respectively). CONCLUSION: Monitoring of sodium ions in the oesophagus shows that patients with Barrett's oesophagus have significantly more DGOR than patients with uncomplicated oesophagitis and cisapride may be effective in removal of this reflux.

Adult↗