The American journal of gastroenterology
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Am. J. Gastroenterol. · Sep 1996
Case ReportsEsophageal intramural pseudodiverticulosis associated with achalasia.
Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition in which multiple small outpouchings are seen in the wall of the esophagus. Although EIPD is typically associated with esophageal narrowing, only a few cases have been described in which it was associated with esophageal dysmotility. We report the case of a 52-yr-old female who presented with dysphagia and who had EIPD protruding from a 5-cm-long concentric distal esophageal stricture, with a markedly dilated upper and middle third of the esophagus. ⋯ Barium column was held up above a nonrelaxing lower esophageal sphincter that opened after inhalation of amylnitrate. Esophageal manometry confirmed the presence of vigorous achalasia. Although EIPD has been associated with several other conditions, this is the first report of an association with achalasia.
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Am. J. Gastroenterol. · Sep 1996
ReviewSplanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome.
The incidence of multiple organ failure syndrome (MOFS) has increased dramatically in most intensive care units (ICU) in the United States and is now the leading cause of death after sepsis, trauma, and burns (1). Despite advances in resuscitation, availability of potent antibiotics, and modern techniques of organ support (2), the survival of critically ill patients with MOFS has not significantly improved since the syndrome was first described over 2 decades ago (3). In the ICU, the monitoring and management of critically ill patients with MOFS has relied, in large part, on readily available measurements of global hemodynamics and oxygen transport. ⋯ The role of gastric tonometry in the monitoring of splanchnic oxygenation and its utility in critically ill patients is then analyzed. In addition, the effects and clinical implications of commonly used vasoactive agents on intestinal oxygenation are discussed. Finally, novel therapeutic strategies based on the "gut-origin hypothesis" of MOFS are reviewed.