The American journal of gastroenterology
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Although the nutcracker esophagus, characterized by high amplitude peristaltic contractions with mean distal amplitude greater than 180 mm Hg, is the most common esophageal motility disorder associated with noncardiac chest pain, little is known about its natural history. Therefore, we reviewed the manometric tracings of 23 patients with the nutcracker esophagus who had an average of 4.6 studies during a mean period of 32 months. Ten age-matched volunteers with normal baseline manometry who had undergone multiple studies (mean 5.8) over a mean time span of 32 months served as controls. ⋯ Changes in motility patterns were intermittently seen in six of 23 patients: one diffuse spasm and five nonspecific motility disorders. None of the control subjects developed high amplitude contractions or changed their motility pattern on serial testing. The possible pathophysiological implications of the changing faces of the nutcracker esophagus are discussed.
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Am. J. Gastroenterol. · Apr 1988
Case ReportsDuodenal perforation by a Linton-Nachlas balloon tube.
In a patient with bleeding esophageal varices, inadvertent inflation of a Linton-Nachlas balloon in the third portion of the duodenum led to bowel perforation and death. This complication emphasizes a potential problem in passing a balloon catheter as far as possible down the nares, a technique that has been suggested to prevent balloon catheter inflation in the esophagus. To the best of our knowledge, this is the first reported case of duodenal rupture from attempted balloon tamponade for variceal hemorrhage.
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Am. J. Gastroenterol. · Jan 1988
Clinical TrialTreatment of ulcerative colitis with oral 5-aminosalicylic acid including patients with adverse reactions to sulfasalazine.
Sulfasalazine is an effective drug for maintaining remission in ulcerative colitis, but its use may be precluded by side effects. Eighty-five patients with active ulcerative colitis participated in a prospective open trial to examine the tolerance of the active constituent 5-aminosalicylic acid (5-ASA), coated with an acrylic resin, and its efficacy in inducing and subsequently maintaining a remission. Fifty-one of the patients had previously developed adverse reactions to sulfasalazine. ⋯ Supplementary corticosteroids for 6 wk or less induced a remission in 27 of the patients who had failed on 5-ASA alone. Fifty patients were therefore eligible for the maintenance phase of the trial, and 39 (78%) had a sustained clinical and endoscopic remission upon 1-yr follow-up. 5-ASA appears to be an effective drug for inducing remission in mild or moderate ulcerative colitis and for the maintenance of remission. It thus represents a valuable addition to the management of patients intolerant to sulfasalazine.
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Am. J. Gastroenterol. · Aug 1987
Case ReportsPyoderma gangrenosum associated with ulcerative colitis: treatment with disodium cromoglycate.
Pyoderma gangrenosum is an uncommon skin disorder that is associated with ulcerative colitis, Crohn's disease, polyarthritis, and other conditions. Clinically it is usually characterized by painful ulceration of the skin and subcutaneous tissues, predominantly of the lower limbs. Treatment is empirical and often unsatisfactory. We report two cases of pyoderma gangrenosum associated with inflammatory bowel disease successfully treated with topical disodium cromoglycate.
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Am. J. Gastroenterol. · Apr 1987
Review Case ReportsIntramural duodenal hematoma: an unusual complication of endoscopic small bowel biopsy.
We report a case of intestinal obstruction secondary to intramural duodenal hematoma after endoscopic small bowel biopsy. Review of the literature indicates that intramural duodenal hematoma occurs mainly in infants and children after trauma to the abdomen. ⋯ Physicians should be alerted to the possibility of developing intramural duodenal hematoma after small bowel biopsy. This is the first report of such an unusual complication after endoscopic small bowel biopsy in children.