Journal of clinical gastroenterology
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J. Clin. Gastroenterol. · Aug 2008
Prognostic factors in gastrointestinal bleeding due to peptic ulcer: construction of a predictive model.
The identification of prognostic factors of easy application in clinical practice can improve the diagnostic and therapeutic decision making process in upper gastrointestinal bleeding (UGB). The present study estimates the capacity to predict an unfavorable clinical course (mortality, unstable bleeding, and/or interventional therapy) on the basis of the preendoscopic and endoscopic clinical analytical findings in patients with UGB owing to peptic ulcer. ⋯ The Forrest classification is the principal predictive factor for an unfavorable course in patients with gastrointestinal bleeding owing to peptic ulcer, though clinical factors are also important and should complement the decision taking process.
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J. Clin. Gastroenterol. · Jul 2008
Case ReportsSpinal cord stimulation for chronic visceral pain secondary to chronic non-alcoholic pancreatitis.
Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model. In humans, it may be an effective therapy for chronic pain of pelvic origin, irritable bowel syndrome, and persistent unspecified abdominal pain. Described here is the case of SCS for 38-year-old woman with visceral pain secondary to chronic pancreatitis. ⋯ Pain Disability Index changed from 62 to 15. Opiate use decreased to none. It seems that SCS may have a significant therapeutic potential for the treatment of visceral pain secondary to chronic pancreatitis.
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This review focuses on the efficacy of probiotics for diarrhea in children in different settings: day-care centers, diarrhea acquired in the hospital, antibiotic-associated diarrhea, and treatment of acute infectious diarrhea. For prevention of diarrhea acquired in day-care centers, 5 randomized and placebo-controlled trials have been published. Probiotics tested were Lactobacillus GG, Bifidobacterium lactis (alone or in combination with Streptococcus thermophilus), and Lactobacillus reuteri. ⋯ They consistently show a statistically significant benefit and moderate clinical benefit of a few, well-identified probiotic strains-mostly Lactobacillus GG and S. boulardii, but also L. reuteri-in the treatment of acute watery diarrhea, primarily rotaviral, in infants and young children of developed countries. Such a beneficial effect seems to result in a reduction of diarrhea duration of little more than 1 day, and to be exerted mostly on diarrhea due to rotavirus. The effect is not only strain-dependent, but also dose-dependent, with doses of at least 10 billion/d being necessary.
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J. Clin. Gastroenterol. · Jul 2008
ReviewRole of probiotics in antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, and recurrent Clostridium difficile-associated diarrhea.
The role of probiotics in the prevention and treatment of antibiotic-associated diarrhea, Clostridium difficile diarrhea, and recurrent C. difficile diarrhea is reviewed. Various probiotics have variable efficacy. More studies are needed to define further their efficacies, roles, and indications.
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J. Clin. Gastroenterol. · Jul 2008
Multicenter StudyMulticenter study of gastroenterologists' ability to identify anxiety and depression in a new patient encounter and its impact on diagnosis.
Although gastroenterologists are frequently exposed to psychopathology few data exist regarding their ability to accurately assess anxiety and depression or the impact of their perceptions of anxiety and depression on diagnostic decisions. The aims of this study were to determine gastroenterologists' ability to correctly identify anxiety and depression in patients with gastrointestinal symptoms and to determine whether gastroenterologist perceptions of anxiety and depression affected postvisit diagnosis. ⋯ Anxiety and depression were prevalent in the study population yet gastroenterologists did not accurately detect these conditions. However, gastroenterologists were more than twice as likely to diagnose patients whom they perceived as anxious as having an FGID, highlighting a need for improved psychosocial assessment in clinical practice and education to diminish misattributions regarding FGID.