Minerva medica
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Review Comparative Study
Diagnostic and therapeutic strategies in the irritable bowel syndrome.
The management of patients with irritable bowel syndrome (IBS) is a frequent, yet challenging task in both primary care and gastroenterology practice. A diagnostic strategy guided by keen clinical judgment should focus on positive symptom criteria and on the absence of alarm symptoms. In younger patients lacking alarm features, invasive testing has a low-yield. ⋯ In patients with IBS and abdominal pain, antispasmodics and antidepressants can be used, with the best evidence supporting the prescription of tricyclic antidepressants. The efficacy of psychological treatments in terms of relieving the symptoms of IBS is still uncertain. Limited evidence suggests that anti-enkephalinase agents, somatostatin analogues, alpha(2)-receptor agonists, opioid antagonists, selective serotonin reuptake inhibitors, probiotics and herbal treatments may be useful in IBS patients.
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Recent studies have provided evidence to suggest a possible role for mucosal immune activation in the pathophysiology of irritable bowel syndrome (IBS). On the other hand, novel findings using functional brain-imaging techniques support the concept that altered perception of visceral stimuli plays a key role in IBS symptom generation. These seemingly contradictory findings have revived the discussion about the relative contribution of peripheral versus central mechanisms in the symptom generation of IBS. In this review, we will provide evidence for the hypothesis that, in the absence of changes in visceral perception and alterations in endogenous pain modulation systems, chronic inflammatory mucosal changes in the gut are not a plausible mechanism to explain the presence of chronic abdominal pain, a clinical hallmark of IBS.
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Experimental research and early clinical studies have shown that regional haemoglobin desaturation, measured by near infrared spectroscopy (NIRS), follows blood loss. To further assess NIRS as a blood loss monitor, we evaluated it on patients undergoing major surgery. ⋯ Cerebral, but not peripheral, haemoglobin oxygen saturation decreases proportionally to blood loss and correlates with measurements of systemic oxygen extraction. With further research, NIRS measurements of CsO(2) may be developed into a useful tool to monitor blood loss.
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Comparative Study
[After the 2001 European Society of Cardiology Guidelines: is it possible to reduce the number of patients with syncope to be hospitalized?].
The aim of this paper was to evaluate how many patients with syncope should be hospitalized according to the 2001 European Society of Cardiology (ESC) Guidelines on the management of syncope. ⋯ The implementation of the ESC Guidelines on Syncope is technically feasible. Nevertheless, even when the Guidelines are strictly observed, a high percentage of patients with syncope has still to be hospitalized. Our data suggest that new criteria should be established for a safe Emergency Department discharge of the patients with syncope, particularly of those with structural heart disease or abnormal ECG.
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Review Comparative Study
Psychological influences on the irritable bowel syndrome.
Irritable bowel syndrome (IBS) is often considered as a purely psychosomatic condition. However, there is now good evidence that it is a multifactorial condition with a whole variety of influences leading to disease expression, of which psychological issues are only one. Nevertheless, addressing psychosocial problems forms an important part of the therapeutic approach to IBS. It is now known that ongoing social stress can make IBS refractory to treatment and there is increasingly firm data to support the notion that antidepressant pharmacotherapy and a variety of behavioural treatments, offer patients with more severe forms of the illness a chance of long-term improvement.