1/9. H pylori infection. review of the guideline for diagnosis and treatment.helicobacter pylori infection is prevalent among persons over age 60, is strongly associated with peptic and duodenal ulcer, and is caused by a microbe classified as a carcinogen. These factors combine to make the primary care physician key to proper diagnosis and treatment of H pylori infection. In 1998, the American College of gastroenterology published an evidence-based guideline for the management of this infection. The guideline produced several fundamental recommendations that help clarify the management process: asymptomatic persons should not undergo testing, but testing should be performed on certain persons, testing should only be done if the intention is to treat; the choice of test is governed by the need for endoscopy; and several triple-therapy regimens are effective for eradication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. dexamethasone treatment during ventilator dependency: possible life threatening gastrointestinal complications.Corticosteroids in high doses have been used effectively to decrease the duration of ventilator dependency in very low birthweight infants at risk for chronic lung disease. Randomised prospective studies have shown benefit, with only minimal complications being reported. However, review of our experience over 2.5 years with high dose steroids in 80 premature neonates yielded three major complications: one case each of perforated duodenal ulcer, perforated gastric ulcer, and upper gastrointestinal haemorrhage. Two of the three patients died. Thus the use of steroids in neonates may not be without risk, and significant complications can occur. When high dose corticosteroids are to be used in very low birthweight neonates, H2 receptor antagonist treatment and gastric pH monitoring are recommended. The physician must remain alert to the possibilities of upper gastrointestinal bleeding and ulcer perforation in these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Hemolytic anemia associated with the use of omeprazole.omeprazole is the first drug designed to block the final step in the acid secretory process within the parietal cell. It has been shown to be extremely effective in the treatment of peptic ulcer disease, reflux esophagitis, and the zollinger-ellison syndrome. Although clinical experience with omeprazole is still limited, many controlled studies have established the short-term safety of this drug. We report the first case of a serious short-term adverse reaction with the use of omeprazole: hemolytic anemia. The patient developed weakness, lethargy, and shortness of breath 2 days after starting therapy with omeprazole. Two weeks after the initiation of therapy, her hematocrit had decreased from 44.1% to 20.4%, and she had a positive direct Coombs antiglobulin test and an elevated indirect bilirubin. After she discontinued the omeprazole, her hemoglobin and hematocrit gradually returned to normal. The mechanism by which omeprazole caused the patient's hemolytic anemia is uncertain, but physicians should be alerted to this possible adverse effect.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Simultaneous gastropleural and gastrocolic fistulae in a quadriplegic male.A 56-year-old, quadriplegic man presented to a physician's office with a large, left pleural effusion. He subsequently was found to have a gastropleural and gastrocolic fistula. These two very rare complications of benign peptic ulcer disease are discussed with special reference to patients with profoundly altered sensation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. Sarcomas arising after radiotherapy for peptic ulcer disease.Therapeutic gastric irradiation has been used to reduce peptic juice secretion in patients with peptic ulcer disease. Between 1937 and 1968 a total of 2049 patients received such therapy at the University of chicago. Three of these patients are known to have developed sarcomas in the field of radiation. Two gastric leiomyosarcomas of the stomach were diagnosed 26 and 14 years after treatment and a malignant fibrous histiocytoma of the anterior chest wall was removed six years after gastric irradiation. Of 743 peptic ulcer patients treated without irradiation and constituted as a control group for the study of therapeutic gastric radiation, none is known to have developed sarcoma. As the incidence of sarcoma in these patient groups is known only from the tumor registry of the University of chicago, other cases of sarcoma may exist in the groups. While an increased incidence of sarcoma has not been proven to occur in patients who received therapeutic gastric irradiation for peptic ulcer disease, the possibility of such a risk should be borne in mind by physicians caring for such patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. dyspepsia. The broad etiologic spectrum.dyspepsia remains one of mankind's most common afflictions. It affects virtually everybody at one time or another, it is responsible for the hundreds of millions of dollars spent each year on antacids and H2 antagonists, and it ranks second only to the common cold as a cause of loss of time from work. The condition denotes widely different things to different people, but by definition, complaints of dyspepsia must bear some relation to food or drink. (The term "dyspepsia" derives from dys, meaning "bad," and pepsis, meaning "digestion.") A physician writing in the Lancet more than a hundred years ago referred to dyspepsia as "the remorse of a guilty stomach." Unfortunately, the problem often turns out to be more serious than the transient pangs emanating from overindulgence. "Dyspepsy," De Quincey wrote in 1823, "is the ruin of most things: empires, expeditions, and everything else." That may be an overstatement. Still, dyspepsia can certainly be the harbinger of disastrous illness, as the following case illustrates.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Disorders of the gastrointestinal tract in children: consultation-liaison experience.Disorders of the gastrointestinal tract are common in children. Fortunately, many are short-lived, related to infection, food intolerance, or specific etiology. Those that persist or recur require greater attention on the part of the physician and can require psychiatric consultation. The frequency of consultation will depend in large part on the psychosocial sophistication and philosophy of care of the referring physician. When consulted, the child psychiatrist can complement the medical care by examination in greater detail of the psychosocial environment of the child, the family, and by psychiatric evaluation of the child. Formulation of these factors may then point the way to more helpful management of the child and treatment. The most serious problems, such as regional ileitis and ulcerative colitis, require not only collaboration of pediatricians and child psychiatrist, but surgeons as well if patients are to receive optimum care.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/9. Primary carcinoma of the remnant stomach--report of three cases.Among the 318 patients operated on for gastric carcinoma during the last six years in our department, three patients were operated on for carcinoma which developed in the remnant stomach 25, 22 and 12 years respectively after partial gastrectomy for peptic ulcers. Their surgical results were uniformly poor because of far advanced malignant lesions. Another patient who developed adenomatous polyps near the stoma 23 years after gastrectomy for duodenal ulcer was treated by polypectomy through gastrotomy. Both from our experiences and from review of literatures, it was concluded that patients gastrectomized for benign lesions should be followed up regularly ten or more years after the surgery, especially by gastroscopy, in order to detect remnant stomach carcinoma as early as possible. And any physicians should always be aware of this disease and should not attribute any late appearing abdominal complaints to gastrectomy itself.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Complications following gastric surgery in children.Although the diagnosis of peptic ulcer disease may be difficult in the pediatric age group, this problem is being faced increasingly by the physicians charged with the care of these children. Chronicity of symptoms has been documented in over 50 per cent of the patients demonstrating early peptic ulcers and therefore an aggressive approach to management has been advocated. Although the numbers are small, postgastrectomy syndromes of mechanical and nutritional nature appear less common in the young patient than in adults. Satisfactory growth and development are reported in nearly all series of patients followed after various gastric procedures. Both pyloroplasty and vagotomy and vagotomy and antrectomy appear to be extraordinarily well tolerated by the pediatric patient. Experimental evidence suggests that these patients should enjoy normal growth and development.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |