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The study of actual nutrition of patients with erosive-ulcerative lesions in the gastroduodenal zone and of patients with operated ulcer has revealed defects in intake of essential nutrients by these patients: overeating of animal fat and refined carbohydrates, deficiency of oil, vitamins A, B2, C, D and food fibers.
As knowledge of the human genome grows, there will be a direct impact on the management of specific diseases. Within gastroenterology and hepatology, there has been a change in the understanding of how variations or mutations in genes involved in drug metabolism or disease pathophysiology affect response to therapy. This review discusses the application of clinical pharmacogenetics to the following diseases and disorders: inflammatory bowel disease, Helicobacter pylori infections, gastroesophageal reflux disease, irritable bowel syndrome, functional dyspepsia, liver transplantation and colon cancer. Although only a few genotyping tests are regularly used in clinical practice, it is anticipated that studies will propel the routine use of many of the tests described in this review, in the future.
This review addresses the clinical picture of rheumatic diseases seen in Whipple's disease, gluten-sensitive enteropathy, pseudomembranous colitis, collagenous colitis and that developing after enteric infections and intestinal bypass operations for morbid obesity. These disorders exemplify the interplay between antigen entrance through the gastrointestinal canal, specific bacterial properties and genetic host factors such as HLA B27. In most cases such as interplay results in formation of circulating immune complexes causing the development of peripheral joint disease.
The authors relate their experiences in using questionnaires for taking the history of patients with gastroenterological enterological ailments. They have found that the older the patient, the more the results of the questionnaire diverge from those obtained by conventional methods of history-taking. Consequently the authors advise a cautious approach to the use of questionnaires when dealing with elderly patients.
The article covers up-to-date information about the incidence of psychosomatic pathology among patients of gastroenterologic profile including patients with gastroesophageal reflux disease and syndrome of irritable colon. From the point of view of psychosomatic idea the article considers the factors predisposing, permitting and retarding the development of the disease. A detailed description is available in psychosomatic disturbances, modern concepts about their pathogenesis including a break of correlation between limbic and frontal regions of central nervous system and disorder in serotonin metabolism--clinical manifestations, methods of diagnosis and treatment including selective inhibitors and stimulators of serotonin reuptake and neuroleptics.
An emerging body of data support the efficacy of psychological treatments in functional gastrointestinal disorders. Twenty-two studies that used a controlled design to compare psychological treatment with conventional medical treatment and/or supportive therapy were reviewed. Most of the research to date has focused on irritable bowel syndrome. In terms of reduction of bowel symptoms, 19 studies showed statistically significant superiority of psychological over conventional treatment at the end of treatment and/or at follow-up. Of 12 studies with follow-up data, 8 showed superiority of psychological treatment. Another 8 studies with follow-up data only for those who received psychotherapy, showed further improvement or that gains were maintained after completion of treatment. In conclusion, psychological treatment appears superior to conventional treatment. Successful outcomes have been observed with dynamic psychotherapy, hypnosis, cognitive-behavior therapy, and relaxation training. Differences in outcomes based on specific treatment techniques have not been studied. Thus, given the current state of knowledge, psychotherapists should use the technique with which they are most experienced.
In this workshop Quality of Life (QOL) was discussed in relation to other measures such as treatment efficacy and cost-benefit in evaluation of clinical treatments. Demands from regulatory authorities, patients as well as nurses and doctors were believed to high-light the status of QOL measurements and use as an evaluation of medical regimens as well as of new medical treatments. Four different areas; inflammatory bowel disease, non-ulcer dyspepsia, peptic ulcer disease and surgical management of GI disease, were discussed in working groups. For inflammatory bowel disease the McMaster QOL instruments was suggested to be further developed and investigated. Non-ulcer dyspepsia was believed to differ from the other areas due to the lack of specific symptoms and evaluable factors. Peptic ulcer disease was suggested to be further evaluated by methods recently suggested by the SCUR group. Surgical management of GI disease was believed to be an important area for QOL assessment due to the fact that surgery is forever. Therefore the bases for decisions of surgical treatment has to involve such an instrument. The potential role of QOL assessments for politicians, pressure groups and health care authorities in the decision for funding, treatment regimens and individual investigators was also pointed out.
Antibiotics will always be needed in horses for many types of infections, but the adverse consequences also must be considered. For the conditions described in this article, there is justification for antibiotic therapy. The intestinal problems that antibiotics can induce are among the risks from their administration to horses. Disruption of the endogenous bacterial population, colitis, and diarrhea are the most common complications from antibiotic therapy.
Part I of this article, which appeared in the previous issue of the Journal, covered the following agents: histamine H2-receptor antagonists (cimetidine, ranitidine, famotidine, nizatidine); muscarinic-M1-receptor antagonists (pirenzepine); proton pump inhibitors (omeprazole); site-protective agents (colloidal bismuth subcitrate, sucralfate); antacids and prostaglandin analogues; antiemetics and prokinetics (metoclopramide, domperidone, cisapride); and antispasmodics. In Part II, we consider the anti-inflammatory salicylates, nonspecific antidiarrhoeal agents, laxatives and cathartics.
Overall 303 patients with digestive diseases who had been exposed to adverse factors because of the Chernobyl accident were examined. Of these 124 subjects (40.9%) had degree II-III dysbacteriosis of the large intestine that is believed to develop in the wake of disordered immunity, cholesecretion, and bilification as well as of decline in the enzyme-excretory function of the pancreas.
Differential treatment of inflammatory and functional conditions of gastroenterological tract organs is one of the main issues of current gastroenterology. Last observation has shown that the number of patients with gastroduodenal and hepatobiliary system diseases keeps growing. It is conditioned by many social and economical causes to be managed with new approaches in their diagnostics. The main objective of the work is an effective use of gastroenterological pH-metric measurement to assess the staged treatment of children with functional and organic gastroenterological conditions with the use of morshinsk mineral water mineralized from 3.0-7.0 to 14 g/L.
Society is changing rapidly, and new aspects need to be considered when evaluating treatment of disease. Health-related quality of life (HRQL) is a relatively new addition to the tools clinicians use to gain a better understanding of the impact of disease and its treatment. The questions 'What is it?', 'How it is measured?' and 'How can the information be used?' are now better understood than a few years ago. Generic instruments to capture HRQL enable a broad assessment of a range of aspects and can be used to make comparisons between different patient populations. Irrespective of the choice of instrument, they can classify the influence of different factors, such as gender, age, general health status and disease severity. Health-related quality of life assessments have been made in many areas of gastroenterology, such as reflux disease, inflammatory bowel disease and irritable bowel syndrome, to describe the burden of illness and the impact of treatment. Health-related quality of life as a prediction of treatment response is another interesting option. Its ability in the context of surgical intervention and outcomes is also emerging even though more work must be done in this area. Health-related quality of life evaluations, as an additional tool in the management of patients, are here to stay.
Helicobacter pylori infection is quite common. In the United States, prevalence varies considerably with race, nationality, socio-economic status and location of residence. In Western countries, the prevalence of the infection has shown a steady increase with increasing age. H. pylori has been shown to cause chronic gastritis. Most patients infected with H. pylori are asymptomatic and require no therapy. The precise role of the infection in the pathogenesis of peptic ulcer disease is unknown. However, H. pylori infection is associated with a high recurrence rate of both gastric and duodenal ulcers. Eradication of the infection reduces the recurrence rate. Once H. pylori infection is acquired, it usually persists for years, possibly for the patient's lifetime. Although a causative role in gastric cancer has not been proved, evidence suggests an association between H. pylori infection and well-differentiated gastric adenocarcinoma and gastric lymphoma.
The etiology of peptic ulcer disease is completely unknown. However, gastric acid secretion plays an important role in the pathogenesis of the disease. Acetylcholine, gastrin and histamine are recognized as the main stimulators of the acid secretion. Extensive studies on blood gastrin have not incriminated this hormone in the pathogenesis of the disease. The present study was done to evaluate the role of circulating histamine in peptic ulcer disease using a sensitive and specific radioimmunoassay method. Since gastrin at least in some species seems to exert its stimulatory effect by releasing histamine, serum gastrin was also determined. There was no significant difference in plasma histamine between patients with duodenal or gastric ulcer, nonulcer dyspepsia or ulcer patients after proximal gastric vagotomy. However, patients taking a histamine-2 blocker (cimetidine or ranitidine) had significantly higher plasma histamine than those not taking these drugs. This effect was not due to interference in the histamine assay. There was no correlation between plasma histamine and plasma gastrin. Plasma gastrin was significantly increased in patients having been operated on with a proximal gastric vagotomy. In conclusion, plasma histamine is similar in patients with different upper gastrointestinal disorders. However, histamine-2 blockers may increase plasma histamine.
Dyspepsia, defined as discomfort in the upper abdomen after a meal, is the most frequent indication for gastroscopy. Such dyspepsia was earlier considered to be an element of the ulcer disease, Moynihan's disease. Whether examination showed an ulcer or not was of minor importance as long as the treatment was the same. Similar opinions still contribute to a negative attitude towards the need to obtain a more specific diagnosis, especially in young patients where risk of cancer is low. We are of the opinion that dyspepsia is a non-specific symptom of several different diseases, and that curative therapy is often available today provided the diagnosis is correct. It is therefore necessary to make an active effort to diagnose the cause of the dyspepsia, also in younger persons. In practice, this means that there are many different indications for gastroscopy. We try, however, to practice a restrictive policy with respect to control gastroscopy.
The recognition of several disease processes that cause or are associated with gastrointestinal malabsorption has led to extensive investigation into their pathogenesis, diagnosis, and treatment. This review of selected articles covers a range of subjects related to some of the more common malabsorptive disease. Selected topics including celiac disease, disaccharidase deficiencies, short bowel syndrome, and Crohn disease are discussed.
11.7% of all cases with inability to work, 11.3% of all days with inability to work, and 13.6% of all dismissals from hospital of working people concern diseases of the digestive system. Gastroenterological diseases occupy an anterior place in inability to work. The inability to work is essentially determined by 7 diagnoses--gastritis and duodenitis, cholelithiasis, gastroenteritis and colitis, cholecystitis and cholangitis, ulcus ventriculi and duodeni, acute appendicitis. They comprise 78% of the days of inability to work. The endoscopic diagnostics is further to be developed with the further improvement of the organisation of treatment, particularly the cooperation between outpatient department and hospital and the interdisciplinary work.
As our knowledge of genetic variation grows, our ability to use this information to unravel the mysteries of human disease expands. Identification of genes and inexpensive methods to sequence them has resulted in a rising interest in evaluating specific variants and whether they may result in clinical manifestations or symptoms. Genetic variants include restriction fragment length polymorphisms, variable number tandem repeats, DNA microsatellites, and single nucleotide polymorphisms. Using these variants, genetic association studies, also referred to as candidate gene association or genotype-disease association studies are being performed by clinical and basic researchers alike. They are relatively easy to perform, but as a result of their deceivingly simple design, can be conducted or interpreted poorly. A positive association between a genotype and a GI disease of interest may be because the genotype causes (or increases susceptibility to) the disease, but may also be the result of the genotype being in linkage disequilibrium with the actual disease susceptibility gene, or be a false positive due to chance or bias in study design. An excellent understanding of the genetic and methodological issues surrounding these studies is therefore essential. We provide an overview of terminology and provide insight into the complexities underlying these studies. Recommendations for reporting the results of a genetic association study are provided to assist with study planning and manuscript preparation.