The American journal of gastroenterology
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Am. J. Gastroenterol. · Apr 1995
Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities.
Upper gastrointestinal bleeding (UGIB) remains a commonly encountered medical emergency with significant morbidity and mortality. Most large studies detailing the specific incidence, demographic, and mortality data were performed more than a decade ago. This study analyzes 3,294 cases of UGIB from 139 military medical treatment facilities over a 12-month period. ⋯ We conclude: 1) The incidence of UGIB is 2-fold greater in males than in females, in all age groups; however, the death rate is similar in both sexes. 2) The mortality rate in this study is slightly lower than in most previous studies and may be more reflective of the average mortality in the community at large. 3) In UGIB patients, comorbid illness and not actual bleeding is the major cause of death. 4) Upper endoscopy was performed less often in this study than in other studies, and there were fewer blood transfusions; however, rebleeding and mortality rates remained similar.
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Am. J. Gastroenterol. · Mar 1995
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPrevention of beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo.
To determine the safety and efficacy of a new preventive agent for antibiotic-associated diarrhea (AAD) in patients receiving at least one beta-lactam antibiotic. ⋯ The prophylactic use of S. boulardii given with a beta-lactam antibiotic resulted in a significant reduction of AAD with no serious adverse reactions.
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Am. J. Gastroenterol. · Feb 1995
Circadian variations in gastric acid and pepsin secretion and intragastric bile acid in patients with reflux esophagitis and in healthy controls.
Duodenogastric reflux is a physiological phenomenon in both fasting and postprandial state. Because this suggests that bile acids may reflux into the esophagus together with the acid in patients with reflux esophagitis, we investigated the circadian variations of acid and pepsin secretion and intragastric bile acid concentrations in 25 patients with reflux esophagitis and in 15 healthy controls. ⋯ Our data indicate that almost all "acid" gastroesophageal refluxes should be considered as "mixed" refluxes. Because bile acids are found in the stomach irrespective of whether the environment was acid or alkaline, pH-metry provides no useful information on the pattern of duodenogastric reflux into the esophagus. Variability in the composition of the gastro-esophageal refluxate may explain why the severity of esophageal lesions differs in patients with similar pattern of acid refluxes.
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Am. J. Gastroenterol. · Feb 1995
Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study.
To obtain epidemiological data on hospitalization for acute upper gastrointestinal hemorrhage (AUGIH) in a demographically defined population. ⋯ 1) The annual incidence of hospitalization for AUGIH was 102.0 per 100,000, increased markedly with age, and was twice as high in males as in females. 2) Peptic ulcer was the most common cause. 3) Gastric ulcer was associated with older age, female gender, and NSAID use. 4) Mortality rates were high when AUGIH started after hospitalization for another disorder.
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Am. J. Gastroenterol. · Sep 1994
Etiology and incidence of unconjugated hyperbilirubinemia after orthotopic liver transplantation.
Gilbert's syndrome, or slow bilirubin glucuronidation phenotype, is a common cause of benign hyperbilirubinemia in the general population. There have been only two previously reported cases of Gilbert's syndrome occurring in patients after liver transplantation. This study was conducted to determine the frequency of Gilbert's syndrome in liver transplant recipients. ⋯ This study was performed to determine the incidence of unconjugated hyperbilirubinemia and particularly to determine the incidence of Gilbert's disease in liver transplant recipients. The apparently low frequency of Gilbert's after liver transplantation may reflect the masking of the diagnosis by other transplant-associated pathology or donor selection bias because of unexplained hyperbilirubinemia. Post-transplant patients who fit the Gilbert's syndrome profile of unconjugated hyperbilirubinemia should have a postprandial bilirubin drawn as a first step. The awareness of this syndrome may avoid a costly and invasive evaluation in the liver transplant recipient.