The American journal of gastroenterology
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Am. J. Gastroenterol. · Feb 1996
Case ReportsHemorrhagic complications of large volume abdominal paracentesis.
The incidence of hemorrhagic complications from large volume paracentesis in patients with cirrhosis and portal hypertension is unknown. We have reviewed the cases of 179 outpatients undergoing large volume paracentesis at our institution during a 1-yr period. Of these 179 patients, four developed severe hemorrhagic complications requiring hospital admission and blood transfusion. ⋯ The mechanism of delayed hemorrhage is not known but may relate to the the rupture of large intra-abdominal venous collaterals in these patients. The literature does not support a correlation between degree of coagulopathy or thrombocytopenia and risk of bleeding in this setting. To promote early detection of this potentially life-threatening complications, a mechanism should exist for close outpatient follow-up of patients after large volume paracentesis.
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Am. J. Gastroenterol. · Feb 1996
Case ReportsFibroproliferative disorder of the antrum after an alkali ingestion.
We describe a 2 1/2-yr-old Chinese boy who ingested potassium carbonate solution and presented with gastric outlet obstruction. He underwent successful antral resection. A severe fibroproliferative process of the antral submucosa obliterating the lumen was found to be the cause of this gastric outlet obstruction. To the best of our knowledge, this is the first report describing such a fibroproliferative process of the stomach.
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Am. J. Gastroenterol. · Feb 1996
Comparative StudyCost-effectiveness of treatment regimens for the eradication of Helicobacter pylori in duodenal ulcer.
Eradication of Helicobacter pylori with antimicrobials was recommended by a recent NIH consensus panel for all infected patients with peptic ulcer disease. The precise regimen that should be used for eradication of the infection remains uncertain because of the variety of regimens described, variable results with the regimens, and difficulties in predicting drug compliance outside clinical trials. ⋯ Treatment to eradicate H. pylori in infected patients with duodenal ulcer is a less expensive strategy than traditional therapy with H2 receptor antagonists. Triple drug therapy is the optimal regimen in areas where metronidazole resistance rates are < 36% and compliance is > 53%. Omeprazole and amoxicillin is not cost-effective unless eradication rates are greater than 74%. Dual drug therapy with omeprazole and clarithromycin is effective in regions where metronidazole resistance is high or where it is anticipated that there would be poor compliance with the more complicated triple drug therapy regimen.