The American journal of gastroenterology
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Am. J. Gastroenterol. · Jun 2009
Comparative Study Clinical TrialNovel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans.
Internally fully covered self-expandable metal stents (FCSEMSs) have recently become available offering the possibility of removal. However, to our knowledge, the feasibility, techniques for endoscopic removal, and tissue reaction to FCSEMS have not been reported in humans. Our aims are (1) to report reasons for and success of FCSEMS removal in consecutive patients, (2) to describe methods of esophageal stent retrieval, and (3) to describe stent reactions induced by FCSEMS in humans. ⋯ FCSEMSs palliate dysphagia from both benign and malignant conditions and seal postoperative tracheoesophageal fistulas and mediastinal leaks. Tissue reaction to the stents was common but remained clinically insignificant in the majority of patients. Close follow-up of patients with FCSEMS is required and repeat endoscopy with stent retrieval might be necessary with the development of new symptoms or complications from the stent.
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Am. J. Gastroenterol. · Jun 2009
Randomized Controlled Trial Multicenter Study Comparative StudySafety and efficacy of a new 3.3 g b.i.d. tablet formulation in patients with mild-to-moderately-active ulcerative colitis: a multicenter, randomized, double-blind, placebo-controlled study.
To evaluate the safety and efficacy of a new twice-daily balsalazide disodium 1.1 g tablet dosing regimen (6.6 g/day, three tablets twice daily) for the treatment of mild-to-moderately-active ulcerative colitis (UC). ⋯ Balsalazide disodium 1.1 g tablets administered as 3.3 g twice daily are effective, well tolerated and significantly better than placebo for improving signs and symptoms of mild-to-moderately-active UC. This new formulation with a reduced pill and dosing burden offers the potential to improve convenience and compliance in patients with active UC.
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Am. J. Gastroenterol. · Jun 2009
Randomized Controlled Trial Multicenter Study Comparative StudyPerformance of the hepatic encephalopathy scoring algorithm in a clinical trial of patients with cirrhosis and severe hepatic encephalopathy.
The grading of hepatic encephalopathy (HE) is based on a combination of indicators that reflect the state of consciousness, intellectual function, changes in behavior, and neuromuscular alterations seen in patients with liver failure. ⋯ HESA extends the traditional WHC for grading HE. In the absence of a "gold" standard, the most useful indicators noted in this trial should be further validated.
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Am. J. Gastroenterol. · Jun 2009
Editorial CommentHyponatremia in hepatic encephalopathy: an accomplice or innocent bystander?
Hyponatremia, a common complication inpatients with advanced liver disease and impaired free water clearance, has been shown to be an important predictor of short-term mortality. Hepatic encephalopathy, also a late complication of end-stage liver disease, has been associated with low-grade cerebral edema as a result of swelling of astrocytes. Guevara et al. hypothesized that hyponatremia and the resultant depletion of organic osmolytes (e.g.,myo-inositol) from brain cells contribute to brain edema, playing an important role in the pathogenesis of hepatic encephalopathy. ⋯ Their magnetic resonance spectroscopy data correlated low brain concentrations of myoinositol with hepatic encephalopathy. As both hyponatremia and encephalopathy occur in patients with advanced liver disease, it has been difficult to implicate hyponatremia independently in the pathogenesis of hepatic encephalopathy. Guevara's data do suggest that hyponatremia is more likely an accomplice than an innocent bystander.
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Am. J. Gastroenterol. · Jun 2009
Review Meta AnalysisMeta-analysis of randomized clinical trials comparing open and laparoscopic anti-reflux surgery.
The aim of this study was to conduct a meta-analysis of randomized evidence to determine the relative merits of laparoscopic anti-reflux surgery (LARS) and open anti-reflux surgery (OARS) for proven gastro-esophageal reflux disease (GERD). ⋯ On the basis of this meta-analysis, the authors conclude that LARS is an effective and safe alternative to OARS for the treatment of proven GERD. LARS enables a faster convalescence and return to productive activity, with a reduced risk of complications and a similar treatment outcome, than an open approach. However, there is a significantly higher rate of re-operation (79%) in the LARS group.