The American journal of gastroenterology
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Am. J. Gastroenterol. · Jul 1997
Review Practice Guideline GuidelineDiagnosis and treatment of gastrointestinal bleeding secondary to portal hypertension. American College of Gastroenterology Practice Parameters Committee.
Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care, which are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its practice parameters committee. These guidelines are also approved by the governing boards of American College of Gastroenterology and Practice Parameters Committee. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time. The following guidelines are intended for adults and not for pediatric patients. ⋯ Once esophageal varices have been established by endoscopy as the site of bleeding, either sclerotherapy or endoscopic variceal ligation should be performed to control the bleeding episodes. Concomitant use of vasoactive drugs lowers portal pressure, potentially offers the endoscopist a clearer field in which to work, and is the only noninvasive treatment for nonesophagogastric variceal sites of bleeding related to portal hypertension. For patients failing medical therapy, the transjugular intrahepatic portasystemic shunt procedure is a reasonable alternative to an emergency surgically created shunt. Nonselective beta-adrenergic blockers are the only proven therapy for prevention of first variceal hemorrhage. Both nonselective beta-adrenergic blockers and endoscopic variceal ligation (which has replaced sclerotherapy for this indication) are effective in reducing the risk of recurrent variceal bleeding. For patients failing these approaches, selective or total shunts or, in selected patients, liver transplantation are appropriate rescue procedures.
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Am. J. Gastroenterol. · Jul 1997
Significance of interleukin-1beta and interleukin-1 receptor antagonist genetic polymorphism in inflammatory bowel diseases.
Genetic susceptibility to inflammatory bowel disease is well recognized. There is also increasing evidence for the activation of the mucosal immune system and the production of inflammatory cytokines, i.e., interleukin (IL)-1ra and IL-1beta in the inflammatory bowel disease. The aim of this study was to analyze the IL-1beta and IL-1ra gene polymorphism and linkage disequilibrium coefficient between the different alleles of these genes in patients with Crohn's disease (CD) or ulcerative colitis (UC), according to the severity of the disease. ⋯ IL-1ra and IL-1beta gene polymorphism analysis from a clinical standpoint might help in defining UC prognosis. However, functional studies at both the circulating and mucosal level with stratification on allele associations, especially IL-1ra allele 2-IL-1beta allele 2 subgroups must be realized before therapeutic implications.
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Am. J. Gastroenterol. · May 1997
Randomized Controlled Trial Clinical TrialCO2 provocation of panic: symptomatic and manometric evaluation in patients with noncardiac chest pain.
Occult panic disorder (PD) may underlie 10-43% of chest pain syndromes in patients with normal coronary arteries. A variety of agents, such as intravenous lactate, oral caffeine, and inhaled CO2, has been identified that may provoke panic attacks in susceptible patients. The aims of this study were (1) to better define the relationship between noncardiac chest pain syndromes and panic disorder; and (2) to assess the diagnostic utility of PD provocative testing with inhaled CO2 in eliciting chest pain and/or esophageal manometric disturbances. ⋯ CO2 inhalation is as effective as Tensilon in provoking chest pain in patients with noncardiac chest pain. The high prevalence of PD in such patients suggests that CO2 inhalation, a known panicogen, may be useful in evaluating such patients. The mechanism of CO2 induced chest pain remains unknown, but does not appear to be attributable to demonstrable esophageal motility abnormalities.
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Am. J. Gastroenterol. · May 1997
Correlation between patterns of antral contractility and gastric emptying of radiopaque markers.
Gastric clearance of radiopaque markers (ROMs) has been proposed as an easy and noninvasive technique for assessment of gastric emptying. This study was conducted to evaluate the role of antral obliterating contractions in gastric emptying of ROMs in healthy volunteers. ⋯ There was a considerable intersubject variation in the time of first antral obliterating contraction after the test meal. In the healthy volunteers, all ROMs were passed when there was a postprandial antral obliterating contraction. However, some of the ROMs still passed from the stomach in the absence of antral obliterating contractions.