The American journal of gastroenterology
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Celiac disease (CD) is a chronic inflammatory disease of the small bowel that is characterized by increased intraepithelial lymphocytes (IELs) and villous atrophy of the mucosa. It is unclear how often intraepithelial lymphocytosis in the absence of atrophy is a manifestation of gluten sensitive enteropathy. The objective of this study was to identify factors that discriminate patients with CD from those with lymphocytic duodenosis (LD, intraepithelial lymphocytosis without villous atrophy). We compared Class 2 HLA type, presenting symptoms, and serology in patients with LD and CD. ⋯ The LD cohort differs significantly in terms of HLA type, serology, and clinical features, suggesting that the majority of patients with LD do not belong in the spectrum of CD.
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Am. J. Gastroenterol. · Jan 2009
Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings.
The American College of Radiology (ACR) recommends that polyps < or =5 mm in size not be reported on computed tomography (CT) colonography studies. Patients with 1 or 2 polyps 6-9 mm in size can be offered "CTC surveillance" in 3 years in lieu of polypectomy. The aim of the study was to determine the impact of ACR recommendations on resection of high-risk adenoma findings using an endoscopic polyp/histology database. ⋯ If computed tomographic colonography (CTC) rather than colonoscopy were used in this population, assuming 100% sensitivity of CTC for polyps > or =6 mm and ACR interpretation recommendations, then 29% of all patients and 33% of screening patients age > or =50 years with high-risk adenoma findings would be interpreted as normal, and an additional 18-23% of these groups with high-risk adenoma findings, respectively, could have polypectomy delayed at least 3 years.
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Am. J. Gastroenterol. · Dec 2008
ReviewClinical review of the management of fulminant clostridium difficile infection.
Clostridium difficile infection (CDI) is a frequent cause of morbidity and mortality among elderly hospitalized patients. A small but increasing number of patients have developed fulminant CDI, and a significant number of these patients require emergency colectomy. In this review, we discuss the risk factors, pathophysiology, diagnosis, and management of fulminant CDI. ⋯ Both the incidence and severity of CDI are increasing. Fulminant CDI is underappreciated as a life-threatening disease because of a lack of awareness of its severity and its nonspecific clinical syndrome. Early diagnosis and treatment are essential for a good outcome, and early surgical intervention should be used in patients who are unresponsive to medical therapy. The surgical procedure of choice is a total abdominal colectomy with end ileostomy, although the mortality rate remains high.
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Am. J. Gastroenterol. · Dec 2008
Randomized Controlled Trial Multicenter StudyEffects of adalimumab maintenance therapy on health-related quality of life of patients with Crohn's disease: patient-reported outcomes of the CHARM trial.
We evaluated the effects of adalimumab maintenance therapy on health-related quality of life (HRQOL) in patients with moderate to severe Crohn's disease. ⋯ Adalimumab maintenance therapy provided sustained improvements in HRQOL for patients with moderate to severe Crohn's disease through week 56.