Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
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Clin. Gastroenterol. Hepatol. · Sep 2008
Screening and surveillance colonoscopy in chronic Crohn's colitis: results of a surveillance program spanning 25 years.
Since 1980, we have followed 259 patients with chronic Crohn's colitis in a prospective colonoscopic surveillance program. Our initial results through August 1998 showed a 22% chance of developing definite dysplasia or cancer by the fourth surveillance examination. We now update the results of all examinations since September 1998 until April 2005. ⋯ Periodic surveillance colonoscopy should be part of the routine management of chronic extensive Crohn's colitis.
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Clin. Gastroenterol. Hepatol. · Sep 2008
Case ReportsCerebral edema and hyperammonemia after transjugular intrahepatic portosystemic shunt placement in a cirrhotic patient.
Transjugular intrahepatic portosystemic shunt (TIPS) placement has been widely performed for nearly two decades and has been shown to alleviate refractory ascites in patients with cirrhosis. Hepatic encephalopathy after TIPS is rarely severe; however, a risk of cerebral edema resulting from hyperammonemia after TIPS does exist. Here we describe a case demonstrating the development of severe hepatic encephalopathy with cerebral edema caused by hyperammonemia as a complication of TIPS in a patient with chronic liver disease with relatively preserved liver function.
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Clin. Gastroenterol. Hepatol. · Jul 2008
Randomized Controlled Trial Multicenter StudyEffect of the antidepressant venlafaxine in functional dyspepsia: a randomized, double-blind, placebo-controlled trial.
Antidepressants could be effective in the treatment of functional gastrointestinal disorders through their anticholinergic and pain-modulating effects. Previous studies with these drugs lacked sufficient power and were predominantly conducted in patients with irritable bowel syndrome. This study aimed to assess the effectiveness of the serotonin and norepinephrine reuptake inhibitor venlafaxine in patients with functional dyspepsia. ⋯ Treatment with the selective serotonin and norepinephrine reuptake inhibitor venlafaxine is not more effective than placebo in patients with functional dyspepsia.
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Clin. Gastroenterol. Hepatol. · Jul 2008
Evaluation of the guidelines for management of pancreatic branch-duct intraductal papillary mucinous neoplasm.
The 2006 Sendai Consensus Guidelines recommend surgical resection for all suspected branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) greater than 3 cm irrespective of symptoms, and those less than 3 cm with worrisome features. We aimed to evaluate the surgical characteristics of these guidelines retrospectively in pathologically confirmed cases of BD-IPMN. ⋯ Implementation of the Consensus Guidelines to our single-institution, referral-based, surgical BD-IPMN population would have recommended resection of all histologically high-risk lesions. All lesions recommended for nonsurgical management were histologically low-risk lesions. For presumed BD-IPMNs less than 3 cm, the application of the Consensus Guidelines may reduce the resection rate for low-risk lesions.
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Clin. Gastroenterol. Hepatol. · Jul 2008
Relationship between hospital volume and outcomes of esophageal variceal bleeding in the United States.
Esophageal variceal bleeding has a high mortality rate and requires complex management. High provider volume has been associated with improved outcomes for various surgical procedures and medical diagnoses, and volume-based referral has been advocated. The objective of this study was to assess the volume-outcome relationship in patients with esophageal variceal bleeding. ⋯ The volume-outcome relationship observed for some procedures and conditions does not apply to patients with esophageal variceal bleeding. Therefore, volume-based referral is not indicated to improve short-term outcomes in this condition.