The American journal of gastroenterology
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Am. J. Gastroenterol. · Nov 2001
Review Case ReportsMushroom poisoning--from diarrhea to liver transplantation.
Mushroom poisoning from the genus Amanita is a medical emergency, with Amanita phalloides being the most common species. The typical symptoms of nausea, vomiting, abdominal pain, and diarrhea are nonspecific and can be mistaken for gastroenteritis. If not adequately treated, hepatic and renal failure may ensue within several days of ingestion. ⋯ Use of i.v. penicillin G is supported by most reports. Silibinin, although preferred over penicillin, is not easily available in the United States. In those with acute liver failure, liver transplantation can be life saving.
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Am. J. Gastroenterol. · Nov 2001
Comparative StudyFecal occult blood testing for colorectal cancer screening: use the finger.
Fecal occult blood testing (FOBT) has been widely underused as a means of colorectal cancer screening. Less than 35% of Americans have had the recommended FOBT in the last 5 yr. Guidelines suggest FOBT of three spontaneously passed stools (SPS) on a prescribed diet. Testing stool obtained by digital rectal exam (DRE) is discouraged because its yield in colorectal cancer screening is unknown. The aim of this study is to compare the positive predictive value of FOBT for the detection of colorectal neoplasia done by SPS versus DRE in asymptomatic outpatients. ⋯ The positive predictive value of FOBT on DRE for detecting neoplasia is similar to that of SPS in asymptomatic outpatients undergoing colorectal cancer screening. Positive FOBT on DRE warrants colonoscopic evaluation. Hemoccult testing by DRE may be performed in the office to increase patient compliance with colorectal cancer screening. A negative FOBT on DRE should be followed up with FOBT of SPS.
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Am. J. Gastroenterol. · Oct 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialSymptom relief in gastroesophageal reflux disease: a randomized, controlled comparison of pantoprazole and nizatidine in a mixed patient population with erosive esophagitis or endoscopy-negative reflux disease.
Gastroesophageal reflux disease (GERD) in primary care practice presents symptomatically, and resources to distinguish promptly between erosive esophagitis and endoscopy-negative reflux disease (ENRD) are limited. It is therefore important to determine the roles of proton pump inhibitors and histamine-2-receptor antagonists for first-line symptom-based therapy in patients with erosive esophagitis and ENRD. The aim of this study was to compare pantoprazole 40 mg once daily versus nizatidine 150 mg b.i.d. in a mixed GERD patient population with ENRD or erosive esophagitis (Savary-Miller grades 1-3). ⋯ Pantoprazole once daily was superior to nizatidine b.i.d. in producing complete heartburn relief in a mixed population of GERD patients and in achieving erosion healing. The proportions of patients with complete symptom relief were greater with pantoprazole after 7 days of therapy than with nizatidine after 28 days. The present study data suggest that pantoprazole is a highly effective first-line therapy for the management of gastroesophageal reflux disease in a primary care practice setting.
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Am. J. Gastroenterol. · Oct 2001
Randomized Controlled Trial Clinical TrialHelicobacter pylori eradication and standardized 3-month omeprazole therapy in functional dyspepsia.
The role of Helicobacter pylori in functional dyspepsia remains unclear. This study evaluated the long term consequences for symptoms and quality of life in patients with H. pylori-positive functional dyspepsia after H. pylori eradication therapy with a standardized 3-month omeprazole treatment. ⋯ No clear differences in symptoms or in quality of life were found between patients treated with H. pylori eradication therapy and omeprazole compared with patients receiving placebo and omeprazole after 1 yr. Regardless of H. pylori status, omeprazole treatment reduced heartburn and regurgitation. The placebo effect on the symptoms of functional dyspepsia and on quality of life was marked.
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Am. J. Gastroenterol. · Oct 2001
Gastric myoelectrical activity and its relationship to the development of nausea and vomiting after intensive chemotherapy and autologous stem cell transplantation.
Gastric motor dysfunction may be responsible, in some patients, for the nausea and emesis that occur after high-dose chemotherapy (HDT) and autologous stem cell transplantation (SCT). Because gastric myoelectrical abnormalities may result in nausea and vomiting in other contexts, we sought to define the prevalence of these abnormalities and their relationship to the development of nausea and vomiting in patients undergoing autologous HDT and SCT, and to determine whether electrogastrography (EGG) could serve to detect gastric motor dysfunction in this population. ⋯ Baseline abnormalities in gastric myoelectrical activity occur frequently in patients who undergo HDT and autologous SCT despite normal gastric emptying scintigraphy and an absence of symptoms. Although slowing of the dominant frequency was seen as symptoms worsened, we failed to identify any EGG parameter at baseline that could predict the severity of nausea, vomiting or anorexia after transplantation.