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Results for “Upper Gastrointestinal Tract”

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At least 19 recordsLinked to original sources
PubMed1995

Familial adenomatous polyposis: should patients undergo surveillance of the upper gastrointestinal tract?

Upper gastrointestinal (UGI) endoscopy was performed in 35 asymptomatic patients with familial adenomatous polyposis (FAP) to assess the prevalence of gastric and duodenal polyps and to demonstrate efficacy of endoscopic surveillance in patients with FAP. UGI polyps were found in 25 (71%) of 35 polyposis patients. Among these, gastric fundic gland polyps were involved in seven patients, and UGI adenomas in 18 patients; there were nine gastric adenomas and 14 duodenal adenomas, including six cases of duodenal cancer. UGI polyps were found in 13 of 15 patients with extracolonic manifestations (87%), but in only 12 of 20 patients (60%) without. The median follow-up interval was 8.7 years in growing duodenal adenomas, but 3.5 years in adenomas without changes in size and number. It was concluded that surveillance gastroduodenoscopy every 3-5 years might be enough to treat duodenal adenomas by endoscopic mucosal resection.

Adenomatous Polyposis Coli↗
PubMed2005

Human defensin 5 expression in intestinal metaplasia of the upper gastrointestinal tract.

BACKGROUND: Upper gastrointestinal tract intestinal metaplasia (IM) is termed Barrett's oesophagus (BO) or gastric intestinal metaplasia (GIM), depending on its location. BO and GIM are associated with chemical exposure resulting from gastro-oesophageal reflux and chronic Helicobacter pylori infection, respectively. Paneth cells (PCs), characterised by cytoplasmic eosinophilic granules, are found in a subset of IM at these sites, but histology may not accurately detect them. AIM: To determine human defensin 5 (HD5; an antimicrobial peptide produced by PCs) expression in BO and GIM, and to investigate its association with H pylori infection. METHODS: Endoscopic biopsies from 33 patients with BO and 51 with GIM, and control tissues, were examined by routine histology and for H pylori infection and HD5 mRNA and protein expression. RESULTS: In normal tissues, HD5 expression was specific for PCs in the small intestine. Five patients with BE and 42 with GIM expressed HD5, but few HD5 expressing cells in IM had the characteristic histological features of PCs. Most HD5 positive specimens were H pylori infected and most HD5 negative specimens were not infected. CONCLUSIONS: HD5 immunohistochemistry was often positive in IM when PCs were absent by conventional histology. Thus, HD5 immunohistochemistry may be superior to histology for identifying metaplastic PCs and distinguishing GIM from BO. The higher frequency of HD5 expression in GIM than in BO is associated with a higher frequency of H pylori infection, suggesting that in IM PCs may form part of the mucosal antibacterial response.

Adult↗
PubMed1992

Outpatient dilation of anastomotic strictures of the upper gastrointestinal tract.

Anastomotic upper gastrointestinal strictures in 32 patients were dilated on an outpatient basis. Strictures had developed following resection-anastomosis of the esophagus in 27, total esophagectomy in two and total/partial gastrectomy in three patients. Patients with benign anastomotic strictures (group A; n = 21) presented within 6 (median 2) months of surgery while those with recurrent tumors at the site of anastomosis (group B; n = 11) presented 7 (median 14) months later. Dilation using Savary-Gilliard (n = 24), through the scope balloon (n = 2) and Eder Puestow (n = 1) dilators or a combination of these (n = 1) was possible in 20 (95%) patients in group A and 8 (73%) patients in group B. All the 28 patients had relief of dysphagia. Median duration of response after first dilation was 4.2 and 1.2 months in groups A and B respectively. Nature of previous surgery, length of the remaining stomach and recurrence of tumor at anastomosis appeared to affect the technique and outcome of dilation. Savary-Gilliard dilators can be used in a majority of patients except those with short stomachs where through the scope balloon dilators may be preferred.

Deglutition Disorders↗
PubMedDate not supplied

Prospective evaluation of a clinical guideline recommending hospital length of stay in upper gastrointestinal tract hemorrhage.

CONTEXT: Upper gastrointestinal tract hemorrhage (UGIH) is a common and potentially life-threatening disorder. Resource utilization can vary without adverse effect on patient outcome. Clinical practice guidelines are a potential solution to reduce variation in practice while improving patient outcomes. OBJECTIVE: To validate prospectively the safety, acceptability, and impact of a clinical practice guideline defining the medically appropriate length of stay (LOS) for patients hospitalized with UGIH. DESIGN: Prospective, controlled time-series study with an alternate-month design. Outcome surveyors and patients were blinded to study group allocation. GUIDELINE: A retrospectively validated scoring system using 4 independent variables: hemodynamics, time from bleeding, comorbidity, and esophagogastroduodenoscopy (EGD) findings to predict risk of adverse events. The quantitative risk for the low-risk subset was 0.6% (95% confidence interval [CI], 0.0%-2.0%) for subsequent complications and 0% (95% CI, 0.0%-0.9%) for life-threatening complications from this retrospective evaluation. SETTING: A 1000-bed, not-for-profit, university-affiliated teaching hospital. PATIENTS: Consecutive adult patients hospitalized for acute UGIH. INTERVENTION: Concurrent feedback of guideline recommendation (same-day hospital discharge) to physicians caring for patients at low risk for complication. No risk information was provided during control months. RESULTS: Seventy percent (209/299) of UGIH patients achieved low-risk status according to the guideline and were therefore potentially suitable for early discharge from the hospital. Providing real-time quantitative risk information (intervention group only) was associated with an increase in guideline compliance from 30% to 70% (P<.001) and a decrease in mean (SD) LOS from 4.6 (3.5) days to 2.9 (1.3) days (mean reduction of 1.7 days per patient; P<.001). No differences in complications, patient health status, or patient satisfaction were found when measured 1 month after discharge. An independent variable predicting decreased hospital LOS for low-risk UGIH patients was early EGD. CONCLUSIONS: Implementation of the clinical practice guideline safely reduced hospital LOS for selected low-risk patients with acute UGIH. Further prospective validation in other settings is warranted.

Adult↗
PubMed2002

Alendronate and risedronate: what you need to know about their upper gastrointestinal tract toxicity.

Adverse upper gastrointestinal (GI) tract events can occur with alendronate or risedronate therapy. Although the short-term, non-placebo-controlled comparisons of alendronate and risedronate indicated that risedronate therapy may be associated with a lower risk of upper GI toxicity than alendronate therapy, the placebo-controlled comparison shows no difference in the risk of upper GI toxicity between the two drugs. The risk of an adverse upper GI event increases when these drugs are used concurrently with nonsteroidal anti-inflammatory drug (NSAID) therapy, but this incidence is no more than that observed with concurrent placebo and NSAID therapy. Also, the risk of these adverse GI tract events can be decreased by following the dosing instructions (e.g., avoid lying down for 30 minutes after taking the drug and take the drug with a full glass of water) and may be decreased with once-weekly dosing.

Alendronate↗
PubMed1996

[Diagnosis and therapy of leiomyoma of the upper gastrointestinal tract].

Leiomyoma of the upper gastrointestinal tract is a "soft tissue tumor" and is a rare and benign lesion. The incidence of leiomyoma in the upper G-I tract is 4% of all tumors of the esophagus and 1% of the stomach. However it is difficult to differentiate leiomyoma from leiomyoblastoma and malignant leiomyosarcoma. For this reason some surgeons prefer the resection of the tumor to enucleation. Between 1984 and 1994, 24 patients with leiomyoma were treated at the Department of Surgery of the University Charité (esophagus n = 4, stomach n = 18, ileum n = 2) by local enucleation/excision in 11 cases and by wide resection of the tumor in 13 cases. In the further follow-up (after 36-84 months) there was no lethality or local recurrence.

Adult↗
PubMed2006

[Gastrointestinal bleeding--concepts of surgical therapy in the upper gastrointestinal tract].

Bleeding of the upper gastrointestinal tract is the main symptom of a variety of possible conditions and still results in considerable mortality. Endoscopy is the first diagnostic modality, enabling rapid therapeutic intervention. In case of intractable or relapsing bleeding, surgery is often inevitable. However, emergency operations result in significantly higher mortality rates. Therefore the option of early elective surgical intervention should be considered for patients at increased risk of relapsing bleeding. If bleeding is symptomatic due to a complex underlying condition such as hemosuccus pancreaticus or hemobilia, angiography is now recognized as the definitive investigation. Angiographic hemostasis can be achieved in most cases. Due to the underlying condition, surgical management still remains the mainstay in treating these patients. This paper reviews surgical strategy in handling upper gastrointestinal bleeding.

Angiography↗
PubMed1985

Chemical burns of the upper gastrointestinal tract.

Burns of the upper gastrointestinal tract, caused by acids, alkalis, drugs or heat may lead to stenoses, some of them severe, to perforations, to inanition and to the patient's death. The type of damage differs among the various groups of noxious agents. First aid at home is almost non existent. On admission every effort must be made to identify the ingested material. Parenteral fluids and antibiotics are used and in some patients nutritional support will be required. The extent of the damage must be evaluated endoscopically. Strictures, caused by intramuscular collagen formation, could possibly be prevented by steroid therapy. If stenoses occur, these must be cautiously dilated. A late complication of oesophageal burns is carcinoma. There appears to be a relation between this grave complication and the use of very hot beverages in certain countries where oesophageal cancer is common. Upper gastrointestinal burns are similar to skin burns, however, their dangers may be greater as they occur in a pipe-like structure and very close to vital viscera.

Acids↗
PubMed1983

Endoscopic incision of postoperative stenoses in the upper gastrointestinal tract.

Membrane-like upper gastrointestinal stenoses, such as may occur after surgery, can be treated by making radial diathermy incisions, producing an increased caliber and a smooth, supple wall at the site of the stenosis. This method has been used in six patients with stenoses after various operations on the upper gastrointestinal tract, including two esophageal and two gastric anastomoses, one gastroplasty, and one pyloric stenosis. The result was favorable in all cases except the pyloric stenosis.

Adult↗
PubMed1976

Endoscopy of the upper gastrointestinal tract.

Fiberendoscopy of the upper gastrointestinal tract recently has become a routine diagnostic procedure. This is due to its broad spectrum of applications and to its "reputation" of simplicity and innocuousness. The possible complications of fiberendoscopy, however, are similar to those of rigid endoscopy. Most of these complications can and must be avoided by strict adhesion to elementary precautions: adequate teaching and supervision of endoscopists in training; emphasis on all stages of the patient's preparation, psychological and pharmacological, each adopted to the individual patient and constant awareness of the possibility of complications.

Bacterial Infections↗