European journal of gastroenterology & hepatology
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Eur J Gastroenterol Hepatol · Sep 1999
ReviewAcute liver failure; clinical features and management.
Acute liver failure (ALF) is uncommon and may be associated with a high mortality rate. Its aetiology shows considerable geographical variation, with viral hepatitis the most common worldwide, whilst acetaminophen (paracetamol) induced hepatotoxicity forms the most common precipitant in many developed countries. ⋯ The early identification of patients unlikely to survive without emergency liver transplantation is important to maximize the possibility of an available graft. Survival in those patients who undergo transplantation may be in excess of 75%.
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Eur J Gastroenterol Hepatol · Aug 1999
Comparative StudyComparison of assays for N-amino terminal propeptide of type III procollagen in chronic hepatitis C by using receiver operating characteristic analysis.
During the process of liver fibrosis, type III procollagen is converted to type III collagen by cleavage of its amino terminal and carboxy terminal propeptides. Serum levels of amino terminal propeptide of type III procollagen (PIIINP) are a marker of collagen turnover in liver fibrosis. Two assays for PIIINP are available, one which measures both Col 1-3 (collagen synthesis) and Col 1 (collagen degradation) peptides, and one which measures Col 1-3 only. Using receiver operating characteristic analysis, the two PIIINP assays were compared with serum ALT as markers of liver disease in chronic hepatitis C. ⋯ A serum PIIINP assay which measures both Col 1-3 and Col 1 peptides instead of Col 1-3 peptide alone is more predictive of severity of liver disease and should be used in preference as a non-invasive marker of liver injury in chronic hepatitis C.
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Although upper gastrointestinal endoscopy provides very useful information about organic diseases, such as ulcers or cancer, there are still some questions about the most cost-effective strategy to apply in gastroesophageal reflux disease (GERD). In other words, is it mandatory to perform endoscopy in all patients before starting anti-reflux therapy, or is it better to treat empirically with an antisecretory drug? There are several factors in support of an empirical approach for the management of GERD in clinical practice. Indeed, typical symptoms like heartburn or regurgitation are very specific for the diagnosis of GERD when they are dominant. ⋯ Symptom relief can also be used as an indication of healing in patients with mild or moderate esophagitis at initial endoscopy. In contrast, endoscopy is still indicated in patients with persistent or recurrent symptoms of GERD. The role of the PPI test for diagnosis of GERD should be further validated before being widely recommended.
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Dyspepsia is a common problem necessitating strategies for investigation and management because of the scarcity of available resources for investigation, i.e. endoscopy, and the need to focus on those at risk of serious disease. It is agreed that those in the older age group, with the presence of alarm symptoms or non-steroidal anti-inflammatory drug use require prompt endoscopy, but there remains a significant proportion of patients in whom the underlying diagnosis is unclear, presenting a management problem. Unfortunately, no universally applicable approach to investigation and management is available. ⋯ H. pylori status, may help in management. In addition, there is a clinical need for accurate, inexpensive tests of foregut motility. Integrating clinical data with specific investigation in dyspepsia is required in order for the practising clinician to better define the dyspeptic so that patients can be managed effectively and simply.
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Eur J Gastroenterol Hepatol · Feb 1999
Ileogastrostomy or jejunoileal bypass with drainage of the bypassed bowel into the stomach.
Ileogastrostomy was first performed for morbid obesity in 1982. In this review, the rationale and technique for the operation are described, and the results and complications discussed. ⋯ The surgery is simple to perform and achieves excellent weight loss and reversal of co-morbid conditions such as non-insulin-dependent diabetes mellitus, but requires long-term follow-up. The principal long-term problem is calcium oxalate renal stones, with occasional patients having troublesome diarrhoea.