European journal of gastroenterology & hepatology
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Eur J Gastroenterol Hepatol · Oct 2001
Editorial CommentScoring systems and risk assessment for upper gastrointestinal bleeding.
Mortality associated with acute upper gastrointestinal bleeding remains high despite advances in diagnosis and therapy. This was emphasized by the findings of the seminal English National Audit of acute gastrointestinal haemorrhage undertaken by Rockall and associates in the mid-1990s. The apparent lack of progress is largely due to less selective reporting in an ageing population with greater co-morbidity. ⋯ These advances in therapy are becoming more widely adopted and may influence the predictive ability of the Rockall score. The study from Edinburgh, in this issue, although small and with wide confidence intervals, supports the ability of the Rockall score to identify high risk cases amongst those given endoscopic treatment. It also suggests that an adjustment of the score may be required in these circumstances to prevent overcalling the risk of rebleeding and death.
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Eur J Gastroenterol Hepatol · Sep 2001
The role of gastrointestinal endoscopy in long-distance runners with gastrointestinal symptoms.
Exercise-related gastrointestinal symptoms are not uncommon among athletes. The occurrence of gastrointestinal bleeding has been reported, especially in long-distance runners. We studied gastrointestinal mucosal damage, using gastrointestinal endoscopy, in competitive long-distance runners. Gastrointestinal blood loss and anaemia before and after running were also assessed. ⋯ Gastrointestinal symptoms and gastrointestinal mucosal damage are prevalent among long-distance runners. Prior to treatment, gastrointestinal endoscopy should be considered in long-distance runners with gastrointestinal symptoms and/or anaemia.
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Eur J Gastroenterol Hepatol · Aug 2001
Randomized Controlled Trial Clinical TrialFamotidine versus omeprazole, in combination with amoxycillin and tinidazole, for eradication of Helicobacter pylori infection.
Eradication regimens combining two antibiotics with a proton pump inhibitor have been studied intensively. In contrast, only a few studies have focused on the possible role of H2-receptor antagonists in eradication therapy. The mechanism involved in the synergy between antibiotics and proton pump inhibitors is still controversial. ⋯ Two-week courses of either high-dose famotidine or omeprazole, both combined with amoxycillin and tinidazole, are equally effective for eradication of H. pylori infection. In a 2-week triple therapy, metronidazole resistance has no significant impact on eradication rates.
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Eur J Gastroenterol Hepatol · Aug 2001
Key points from the revised Maastricht Consensus Report: the impact on general practice.
The Maastricht 2 Consensus Report features evidence-based recommendations for the management of Helicobacter pylori infection. Strongly recommended indications for H. pylori eradication include duodenal and gastric ulcer, mucosa-associated lymphoid tissue lymphoma, atrophic gastritis, post gastric cancer resection, first-degree relation to gastric cancer patients, and patient's wishes. Advisable indications include functional dyspepsia, with the statement that eradication can lead to long-term improvement of symptoms in a subset of patients. ⋯ Also advisable is H. pylori eradication before administration of non-steroidal anti-inflammatory drugs (NSAIDs), although this alone may be insufficient to reduce recurrent bleeding or enhance ulcer healing in patients receiving antisecretory therapy who continue to take NSAIDs. Maastricht 2 also introduced the concept of the 'treatment package' that considers first- and second-line eradication therapies together. A 'search and treat' strategy should be considered in patients with peptic ulcers; for patients with uncomplicated duodenal ulcer, administration of proton pump inhibitors can be limited to the period of antibiotic treatment.
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Eur J Gastroenterol Hepatol · May 2001
Intrarectal injection of glycerol induces hypersensitivity to rectal distension in healthy subjects without modifying rectal compliance.
Rectal sensory thresholds are lowered in patients with irritable bowel syndrome (IBS), reflecting visceral hyperlagesia, which might be related to subclinical inflammation. ⋯ Intraluminal injection of glycerol significantly increases rectal tone and sensitizes healthy volunteers to rectal distension, since they show significantly lower thresholds after glycerol. This could constitute a model of visceral hypersensitivity in healthy volunteers.