The American journal of gastroenterology
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Am. J. Gastroenterol. · Jul 1998
Randomized Controlled Trial Comparative Study Clinical TrialAn endoscopic comparison of gastroduodenal injury with over-the-counter doses of ketoprofen and acetaminophen.
The objective of this study was to endoscopically assess in healthy subjects the gastrointestinal effects of over-the-counter (OTC) doses of ketoprofen. Ketoprofen is a potent nonsteroidal antiinflammatory agent (NSAID) recently approved for OTC use as an analgesic/antipyretic at doses of 75 mg versus the usual dose of < or = 300 mg daily. In epidemiological studies, ketoprofen at prescription doses has consistently been in the higher relative risk group of NSAIDs in the occurrence of gastrointestinal complications of therapy. The gastrointestinal effects of the OTC (US) dose of ketoprofen have not been reported. ⋯ These results indicate that even at lower (OTC) doses (75 mg/day) ketoprofen is associated with significant gastrointestinal irritation.
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Although rare in childhood, gastric volvulus and wandering spleen share a common etiology: congenital absence of intraperitoneal visceral attachments. We report an unusual case of a patient who presented with three episodes of intractable vomiting and abdominal mass but no abdominal pain. ⋯ During the third episode, diagnostic imaging was performed before inserting an NG tube, and the diagnosis of a mesenteroaxial gastric volvulus and an abnormally positioned spleen was made. Although both conditions are caused by abnormalities of fixation, the association of gastric volvulus and wandering spleen has been reported only once before.
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Ascites due to congestive heart failure (CHF) is characteristically serous in gross appearance. Although hemorrhage into ascites commonly indicates a malignant or inflammatory cause, cirrhosis of the liver is a well known cause of bloody ascites. We report a case of hemorrhagic ascites due to biventricular congestive heart failure in which workup for other causes was negative and hemorrhage cleared after 4 months. In as much as the mechanism of ascites is similar in both cirrhosis and CHF, we propose that a similar mechanism could cause bleeding into ascites in CHF.
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Am. J. Gastroenterol. · Jul 1998
Comparative StudyIs Barrett's esophagus characterized by more pronounced acid reflux than severe esophagitis?
Barrett's esophagus is related to gastroesophageal reflux disease (GERD). However, only a small fraction of patients with GERD develop Barrett's esophagus. We evaluated whether gastroesophageal acid reflux is more pronounced in Barrett's patients than in patients with moderate or severe endoscopic esophagitis. ⋯ Although acid reflux is increased in patients with Barrett's esophagus and esophageal motility is impaired, other factors apart from acid exposure and motility contribute to the development of Barrett's esophagus.
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Am. J. Gastroenterol. · Jul 1998
Case ReportsTwo-step procedure in Budd-Chiari syndrome with severe intrahepatic vena cava stenosis: vena cava stenting and portocaval shunt.
Budd-Chiari syndrome is characterized by hepatic venous outflow obstruction, which often leads to death as a result of portal hypertension and liver failure. Venous decompressive shunt surgery and liver transplantation represent efficient surgical treatments of Budd-Chiari syndrome. ⋯ A two-step procedure with preoperative radiological dilation and stenting of the intrahepatic IVC followed by a portocaval shunt was successfully performed. Consequently, liver transplantation and its subsequent immunosuppression could be avoided.