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
Comparative StudyClues to patient dissatisfaction with conscious sedation for colonoscopy.
Most colonoscopy is performed using conscious sedation to facilitate the procedure. However, little is known about which patients are dissatisfied with sedation and why. The goal of this study was to examine whether certain patient- and procedure-specific variables are associated with patient dissatisfaction. ⋯ Highly educated patients and those who underwent longer procedures were more likely to be dissatisfied with conscious sedation used for colonoscopy. A thorough discussion of expectations and/or patient-controlled sedation might improve satisfaction with colonoscopy in educated patients. Regular supplementation of sedation, termination of a lengthy procedure with the offer of a further attempt at a later date, and referral to a more experienced endoscopist when appropriate might all improve patient satisfaction with colonoscopy.