Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
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Clin. Gastroenterol. Hepatol. · Oct 2007
Case ReportsThe narcotic bowel syndrome: clinical features, pathophysiology, and management.
Narcotic bowel syndrome (NBS) is a subset of opioid bowel dysfunction that is characterized by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of narcotics. This syndrome is underrecognized and may be becoming more prevalent. ⋯ The evidence for the enhanced pain perception is based on the following: (1) activation of excitatory antianalgesic pathways within a bimodal opioid regulation system, (2) descending facilitation of pain at the rostral ventral medulla and pain facilitation via dynorphin and cholecystokinin activation, and (3) glial cell activation that produces morphine tolerance and enhances opioid-induced pain. Treatment involves early recognition of the syndrome, an effective physician-patient relationship, graded withdrawal of the narcotic according to a specified withdrawal program, and the institution of medications to reduce withdrawal effects.
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Clin. Gastroenterol. Hepatol. · Sep 2007
Randomized Controlled TrialA phase I/II trial of chemoembolization for hepatocellular carcinoma using a novel intra-arterial drug-eluting bead.
To assess the safety and efficacy of transarterial chemoembolization (TACE) using doxorubicin-eluting beads (DEB) for hepatocellular carcinoma (HCC). ⋯ This study shows that TACE using DEB is a safe and effective treatment for HCC, supporting a phase III randomized trial to compare this novel treatment with conventional TACE using doxorubicin-Lipiodol emulsion.
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Clin. Gastroenterol. Hepatol. · Sep 2007
Nationwide increase in hospitalizations and hepatitis C among inpatients with cirrhosis and sequelae of portal hypertension.
Advanced liver disease and complications of portal hypertension are common indications for hospitalization. Our objectives were to characterize longitudinal trends in incidence, characteristics, and outcomes of patients hospitalized with complications of portal hypertension using a nationally representative data set. ⋯ A significant increase in the incidence of hospitalization for complicated portal hypertension between 1998 and 2003 and a growing burden of hepatitis C-related disease have profound economic impact and underscore the need for interventions to prevent progression to advanced liver disease.
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Clin. Gastroenterol. Hepatol. · Aug 2007
Impact of comorbidity on colorectal cancer screening in the veterans healthcare system.
The quality assessment measure of colorectal cancer screening in the veteran's health system reports the proportion of patients aged 52-80 years who were tested. This approach does little to assess for comorbid illnesses, which might limit the utility of screening. Our aim was to determine the relationship between patient comorbidity and screening by fecal occult blood test in a national sample of veterans. ⋯ Although there was a strong relationship in the veteran population between the Charlson score and survival, colorectal cancer screening utilization was not impacted by Charlson score. Instead, resources were expended evenly throughout the population, rather than directed toward screening the patients with the most life-years at stake. The quality measure for colorectal cancer screening should be modified to account for patient comorbidity.