Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
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Clin. Gastroenterol. Hepatol. · May 2015
Inflammation, psychiatric symptoms, and opioid use are associated with pain and disability in patients with cirrhosis.
Cirrhosis is associated with significant pain and disability, the etiologies of which are poorly understood. We investigated whether the pain and disability in patients with cirrhosis are associated with systemic inflammation and psychiatric symptoms. ⋯ Pain and disability are common among patients with cirrhosis, and are associated with inflammation, psychiatric symptoms, and opioid use, which potentially are modifiable. Although opioids are used commonly to treat pain, psychiatric symptoms and inflammation also might be treatment targets in this population.
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Patients hospitalized for an acute complication of cirrhosis who also have organ failure(s) are at high risk of short-term death. The term acute-on-chronic liver failure (ACLF) is used to characterize these patients. Until recently, there was no evidence-based definition of ACLF. ⋯ ACLF should be considered as a whole that includes subcategories such as severe sepsis, severe alcoholic hepatitis, and others, which have yet to be defined. ACLF is a relatively common syndrome because it occurs in 31% of hospitalized patients with cirrhosis who have an acute complication of their liver disease. In these patients, ACLF is the most common cause of death.
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Clin. Gastroenterol. Hepatol. · May 2015
Categorization of patients with reflux symptoms referred for pH and impedance testing while off therapy.
Patients with suspected gastroesophageal reflux disease (GERD) often are treated empirically with proton pump inhibitors (PPIs). Patients whose symptoms are not reduced during the PPI trial are referred for further tests. We investigated whether patients referred for the evaluation of reflux symptoms had GERD. We also aimed to categorize patients with a poor response to PPIs into groups with hypersensitive esophagus or functional heartburn. ⋯ In a retrospective analysis of 221 patients, roughly half of the patients referred for testing did not have evidence of GERD. Further categorization of patients can help guide diagnosis and management.