Gastroenterology clinics of North America
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Gastroenterol. Clin. North Am. · Dec 2002
ReviewFlexible sigmoidoscopy for colorectal cancer screening: valid approach or short-sighted?
Flexible sigmoidoscopy is a safe, effective test that may be delivered feasibly on a large scale for mass colorectal cancer screening. Flexible sigmoidoscopy is 67% to 80% as sensitive as colonoscopy in a screening population, but is probably 10 to 20 times safer than colonoscopy in terms of complications. ⋯ There is limited evidence to support this practice, and the added benefit to an existing flexible sigmoidoscopy screening program although real, may be marginal. In the future, it is likely that flexible sigmoidoscopy screening among patients aged 50 to 65 will be supplemented with total colonic screening, using molecular-based fecal tests or virtual colonoscopy, after age 65.
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Dyssynergic defecation is a common clinical problem that affects half of patients with chronic constipation. In many patients, there is a significant overlap with slow transit constipation. The chief underlying pathophysiologic mechanism is a failure of rectoanal coordination. ⋯ Controlled trials are under way to evaluate the efficacy of biofeedback therapy. Meanwhile, it is possible to treat most patients by using neuromuscular conditioning and biofeedback therapy. Further refinements in diagnostic criteria and in rehabilitation therapy programs should facilitate better diagnosis and treatment of patients with dyssynergic defecation.
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Functional anorectal and pelvic pain syndromes represent a diverse group of disorders that affect the quality of life and about which many physicians possess little understanding. Nongynecologic causes include levator ani syndrome, proctalgia fugax, and coccygodnia, which can often be distinguished by careful history and physical examination. In women, chronic pelvic pain may arise from the uterus, cervix, ovaries, or from endometriosis and pelvic adhesions. This article reviews these diverse disorders and the approach to diagnosis and management.
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Gastroenterol. Clin. North Am. · Mar 2000
ReviewHematologic management of gastrointestinal bleeding.
The hematologic management of gastrointestinal (GI) bleeding requires evaluation of the underlying cause of bleeding, associated diseases that can exacerbate the bleeding, and identification of related and unrelated coagulation abnormalities. Erythrocyte transfusions are given to increase oxygen carrying capacity; however, there is limited information on the level of anemia that places a patient at increased risk of adverse events after a GI bleed and when patients should receive erythrocyte transfusion. ⋯ The coagulopathy of liver disease is the most common abnormality seen in the setting of GI bleeding. Fresh-frozen plasma (FFP) should be given in a dose equivalent to the underlying abnormality and the common practice of administering 2 units of FFP is often insufficient in a bleeding patient.
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Gastroenterol. Clin. North Am. · Jun 1999
ReviewCancer risk in patients with inflammatory bowel disease.
Patients with inflammatory bowel disease (IBD) are at increased risk for developing cancer of the gastrointestinal tract, particularly colorectal cancer. Because of the relative rarity of IBD in the general population, it has been difficult to quantify this risk. ⋯ Because of the potential impact on quality of life and life expectancy, the optimal strategy for reducing this risk has not been defined. This article reviews the current literature relating to the risk of cancer for patients with IBD and methods to reduce this risk.