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At least 883 records · Page 49Linked to original sources
PubMed1976

Treatment of hemorrhagic gastritis by antacid.

A simple and safe method of nonsurgical treatment for the control of massive acute gastric mucosal hemorrhage is described. The procedure was developed from experimental and clinical observations that the presence of gastric hydrocloric acid played an important part in the development and perpetuation of the entity. The treatment consists of complete neutralization of gastric acid with antacid to a pH of 7. The antacid is intermittently added and aspirate at 7. In a retrospective analysis, the hemorrhage was controlled in 44 of 49 patients (89%). Five patients who continued to bleed underwent surgery (10%). Three patients had vagotomy and pyloroplasty and their bleeding ceased without recurrence. Two patients underwent partial gastrectomy, but they developed recurrent bleeding and died. One patient whose bleeding has been controlled by vagotomy and pyloroplasty died without hemorrhage 10 days after operation. Of the 44 patients whose bleeding had been controlled by antacid, 11 patients died without hemorrhage one or more weeks later. These results of 89% control of hemorrhage compare favorably with those in the literature.

Adult↗
PubMedDate not supplied

Critical care nutrition: getting involved as a gastrointestinal endoscopist.

The route, timing, and volume of enteral feeding delivered to a patient in the intensive care unit have a profound effect on clinical outcome. At the height of critical illness, problems with ileus, aspiration, and the systemic inflammatory response syndrome make the provision of enteral nutrients a difficult and somewhat risky endeavor. The gastrointestinal endoscopist has the technical skills to place feeding tubes deep within the jejunum and an underlying expertise in gut physiology to monitor patients effectively once feeds are initiated. Attention to detail in the techniques for attaining enteral access, early identification of potential problems, and quick institution of simple endoscopic strategies help improve delivery of nutrition support, minimize the likelihood for in-hospital complications, and optimize patient outcome.

Critical Care↗
PubMed2006

Acid and nonacid gastro-oesophageal reflux in neurologically impaired children: investigation with the multiple intraluminal impedance procedure.

OBJECTIVES: The diagnosis of gastro-oesophageal reflux (GOR) is more difficult in children with neurological impairment because symptoms are often less interpretable and frequently go undetected. The use of combined pH and multiple intraluminal impedance allows for the detection of both acid (pH < 4) and nonacid (pH > 4) GOR episodes, in addition to the height of the refluxate and the total acid and bolus clearance time in this cohort. METHODS: Sixteen neurologically impaired children (9 were fed nasogastrically, 7 were fed orally) underwent 12-hour combined pH and multiple intraluminal impedance. RESULTS: There were a total of 425 reflux episodes during the study period, of which 239 (56.2%) were nonacid. The median of reflux episodes per hour was 1.8 (range, 0.2-6.3/h). The median height of the refluxate was 1.5 channels (range, 1.1-2.9); and 71.3% of reflux episodes reached the upper oesophagus, of which 52.4% were nonacid reflux events. On average there were more GOR events (both acid and nonacid) in the children who were fed via a nasogastric tube, and the median height of refluxate was also higher in this group. However, the median acid clearance time was longer (both proximal and distal) in the children who were fed orally (28.6 s vs 16.2 s proximally; 67.9 s vs 38.3 s distally). The median acid clearance time (21.7 s proximally; 39.5 s distally) was longer when compared with bolus clearance (14.9 s). CONCLUSIONS: More than half of the reflux events in neurologically impaired children are nonacidic and would therefore go undetected by conventional pH metry. There are more reflux events in children fed nasogastrically than oral-fed children.

Adolescent↗
PubMed1974

Functional differentiation of human jejunum and ileum: a comparison of the handling of glucose, peptides, and amino acids.

The characteristics of glucose, glycine, L-alanine, and glycyl-L-alanine absorption from the jejunum and ileum have been compared in normal human subjects. A perfusion technique has been used, and correct positioning of the perfusion tube has been confirmed by measuring the differential jejunal and ileal handling of bicarbonate. Glucose and glycine were absorbed faster from the jejunum than from the ileum of all subjects studied, and L-alanine was absorbed faster from the jejunum than from the ileum in five out of six subjects studied. In contrast, the dipeptide glycyl-L-alanine was absorbed at comparable rates from the jejunum and ileum. Higher concentrations of free amino acids were detected in the luminal contents aspirated during the ileal dipeptide perfusions.These results emphasize the importance of oligopeptide transport in the absorption of protein digestion products, especially in the human ileum, and the practical implications of these findings are discussed.

Adult↗
PubMed2003

Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy--feasibility study.

A feasibility study was conducted to evaluate two biphasic computed tomographic (CT) enterography protocols, a noninvasive CT technique with water administered perorally and CT enteroclysis with methylcellulose administered through a nasojejunal tube, in 23 patients known or suspected to have Crohn disease. Results were compared with the results of fluoroscopic small bowel examination and terminal ileoscopy for the detection of active Crohn disease in the terminal ileum. Luminal distention did not differ significantly between the two CT protocols. Arterial phase imaging was noncontributory in 22 of 23 cases. The noninvasive peroral water CT enterography protocol had similar accuracy (12 of 15 cases, 80%) for enabling the detection of active Crohn disease in comparison with CT enteroclysis with nasojejunal tube (seven of eight, 88%) and fluoroscopic small bowel examination (17 of 23, 74%). No fistulas were missed with use of either CT technique. The authors conclude that noninvasive peroral portal venous phase CT enterography with use of water is an accurate and feasible technique for detecting active small bowel inflammation in patients with Crohn disease.

Administration, Oral↗
PubMed1993

Gastroesophageal varices: pathogenesis and therapy of acute bleeding.

Numerous conditions lead to portal hypertension and the development of esophageal or gastric varices, or both. Treatment of patients with acute bleeding should progress in a logical, stepwise fashion. Initial therapy includes vasopressin, somatostatin, or balloon tamponade with a Sengstaken-Blakemore tube. The next step is treatment with sclerotherapy, variceal ligation, or a combination of both. Continued bleeding is managed by more invasive measures, which may include radiologic embolization or shunting, esophageal transection, distal splenorenal shunt, or liver transplantation.

Acute Disease↗
PubMed1995

Percutaneous endoscopic gastrostomy. A useful tool for the otolaryngologist-head and neck surgeon.

OBJECTIVE: To review our series of percutaneous endoscopic gastrostomy (PEG) tube placement by the Division of Otolaryngology. DESIGN: Charts from a total of 29 patients were reviewed; 23 patients with head and neck cancer and six patients with chronic aspiration. INTERVENTIONS: Placement of a PEG tube and other associated procedures, including primary tumor resection, tracheostomy, and surgical endoscopy. MAIN OUTCOME MEASURES: The feasibility, morbidity, and mortality of PEGs performed at the time of the primary surgical procedure compared with those being performed with a minor procedure. RESULTS: In almost all cases, the PEG was performed in conjunction with another procedure requiring general anesthesia, thereby decreasing the total number of procedure days. Morbidity and mortality were absent for all patients in whom PEG was performed. CONCLUSIONS: When properly applied, PEG can be performed by the otolaryngologist-head and neck surgeon with minimal or no morbidity at the time of staging or definitive procedure. Thus, the PEG can be of great benefit in patients with head and neck cancer.

Aged↗
PubMed1996

A randomized controlled trial of postoperative nasogastric tube decompression in gynecologic oncology patients undergoing intra-abdominal surgery.

OBJECTIVE: To evaluate the effect of nasogastric decompression after extensive intra-abdominal surgery in gynecologic oncology patients. METHODS: Over a 1-year period, 110 gynecologic oncology patients undergoing extensive intra-abdominal surgery were enrolled in a randomized controlled trial of postoperative nasogastric tube versus intra-operative orogastric tube decompression. RESULTS: The nasogastric and orogastric groups were similar in age, case distribution, surgery length, and blood loss. The nasogastric group had significantly longer times to first passage of flatus and tolerance of a clear liquid diet than did the orogastric group. However, both groups were similar in time to tolerance of a regular diet and hospital stay. On average, the nasogastric tube was maintained for 3.2 +/- 2.1 days (range 1-8) after surgery. The average daily nasogastric output was 440 +/- 283 mL (range 68-1565). No patient in the orogastric group required a nasogastric tube postoperatively, but one patient in the nasogastric group had a nasogastric tube reinserted for recurrent nausea and vomiting. Use of a nasogastric tube led to significantly more subjective complaints, eg, ear pain, painful swallowing, and nasal soreness, but did not significantly reduce the incidence of abdominal distention or nausea and vomiting. Major complications, eg, pneumonia, atelectasis, gastrointestinal bleeding, and wound breakdown or infection, occurred equally in both groups. However, the incidence of febrile morbidity was significantly greater in the nasogastric group. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematological indices and electrolytes were comparable in both groups. CONCLUSION: Postoperative nasogastric tube decompression in gynecologic oncology patients undergoing extensive intra-abdominal surgery does not appear to provide any substantial benefit but significantly increases patient discomfort. As a result of this study, we have eliminated postoperative nasogastric decompression except in highly selected circumstances, such as extensive bowel surgery in patients with prior irradiation or substantial edema from bowel obstruction.

Female↗