2009 January 05

Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation.

Jan 052009

Impact of gastro-oesophageal reflux disease symptoms on COPD exacerbation.

Thorax. 2008 Nov;63(11):951-5

Authors: Terada K, Muro S, Sato S, Ohara T, Haruna A, Marumo S, Kinose D, Ogawa E, Hoshino Y, Niimi A, Terada T, Mishima M

BACKGROUND: The association between gastro-oesophageal reflux disease (GORD) and chronic obstructive pulmonary disease (COPD) exacerbation has so far remained unclear. OBJECTIVE: To prospectively establish the clinical significance of GORD symptoms on exacerbation. METHODS: 82 patients with COPD and 40 age matched controls were enrolled in this study. Symptoms were evaluated by a questionnaire using the Frequency Scale for the Symptoms of GORD (FSSG). Patients with COPD were prospectively surveyed for 6 months, and episodes of exacerbation were identified using a diary based on modified Anthonisen's criteria. Exhaled breath condensate (EBC) pH was measured in both groups, and induced sputum was evaluated in patients with COPD. RESULTS: Positive GORD symptoms were reported in 22 (26.8%) patients with COPD and in five (12.5%) controls (p = 0.10). The frequency of exacerbations was significantly associated with the FSSG score (p = 0.03, r = 0.24, 95% CI 0.02 to 0.43). Multiple regression analysis revealed that GORD symptoms were significantly associated with the occurrence of exacerbations (p<0.01; relative risk 6.55, 95% CI 1.86 to 23.11). EBC pH was inversely correlated with FSSG score in both groups (p = 0.01, r = -0.37, 95% CI -0.55 to -0.14 in patients with COPD, and p<0.01, r = -0.45, 95% CI -0.67 to -0.16 in control subjects). CONCLUSIONS: GORD symptoms were identified as an important factor associated with COPD exacerbation.

PMID: 18535116 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

The risk of developing Crohn’s disease after an appendectomy: a meta-analysis.

Am J Gastroenterol Start a Discussion »

Jan 052009

The risk of developing Crohn's disease after an appendectomy: a meta-analysis.

Am J Gastroenterol. 2008 Nov;103(11):2925-31

Authors: Kaplan GG, Jackson T, Sands BE, Frisch M, Andersson RE, Korzenik J

BACKGROUND: Studies exploring the association between appendectomy and Crohn's disease (CD) have reported conflicting findings. We conducted a systematic review of the literature and a meta-analysis to assess the risk of CD following an appendectomy and determine the effect of time between appendectomy and CD diagnosis. METHODS: MEDLINE was used to identify observational studies evaluating the association between appendectomy and CD. Authors were contacted when data were insufficient. Relative risks (RR) with 95% confidence intervals (CI) were calculated using a random effects model. Studies that analyzed their data by the interval between the appendectomy and the diagnosis of CD were assessed separately. The Woolf chi(2) statistic was used to test for homogeneity. Egger's test was used to evaluate publication bias. RESULTS: The summary RR estimate for CD following an appendectomy was significantly elevated (RR 1.61, 95% CI 1.28-2.02), though heterogeneity was observed (P < 0.0001). The risk was elevated within the first year following the operation (RR 6.69, 95% CI 5.42-8.25). The risk of CD was also significantly increased 1-4 yr following an appendectomy (RR 1.99, 95% CI 1.66- 2.38); however, after 5 yr or more, the risk fell to baseline levels (RR 1.08, 95% CI 0.99-1.18). Publication bias was not detected (P = 0.2). CONCLUSION: The meta-analysis demonstrated a significant risk of CD following an appendectomy, though heterogeneity was observed between the studies. The elevated risk early after an appendectomy, which diminishes thereafter, likely reflects diagnostic problems in patients with incipient CD.

PMID: 18775018 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use.

Am J Gastroenterol Start a Discussion »

Jan 052009

ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use.

Am J Gastroenterol. 2008 Nov;103(11):2890-907

Authors: Bhatt DL, Scheiman J, Abraham NS, Antman EM, Chan FK, Furberg CD, Johnson DA, Mahaffey KW, Quigley EM, Harrington RA, Bates ER, Bridges CR, Eisenberg MJ, Ferrari VA, Hlatky MA, Kaul S, Lindner JR, Moliterno DJ, Mukherjee D, Schofield RS, Rosenson RS, Stein JH, Weitz HH, Wesley DJ, , ,

PMID: 18853965 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Progress in pain assessment: the cognitively compromised patient.

Curr Opin Anaesthesiol Start a Discussion »

Jan 052009

Progress in pain assessment: the cognitively compromised patient.

Curr Opin Anaesthesiol. 2008 Oct;21(5):610-5

Authors: Chapman CR

PURPOSE OF REVIEW: Pain assessment is essential for patient care in many settings, but it proves difficult when the patient is cognitively compromised or otherwise unable to produce a conventional pain report. The present review describes the progress in pain assessment technology that involves the coding of human facial expression. RECENT FINDINGS: It is possible to quantify facial expression by coding patterns of facial muscle contraction and relaxation. These patterns are action units, and they can gauge the intensity of pain as well as signal its occurrence. The experience of pain seems to generate a unique facial expression comprising several action units. Concerns have existed about whether demented patients produce diagnostically meaningful facial expressions of pain because they tend to generate more nonspecific facial expressions and perhaps code pain intensity less well than normals. Recent work shows that facial expression reflects pain as well or better in demented patients compared with normals. SUMMARY: Although still nascent, coded facial expression appears to work reliably as a pain assessment tool with cognitively compromised patients. Clinical application awaits the development of technology that can automate facial coding and scoring.

PMID: 18784487 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Cutaneous manifestations of liver diseases.

Clin Dermatol Start a Discussion »

Jan 052009

Cutaneous manifestations of liver diseases.

Clin Dermatol. 2008 May-Jun;26(3):274-82

Authors: Ghosn SH, Kibbi AG

The cutaneous manifestations of liver disorders are protean. In addition to the well-recognized stigmata of liver cirrhosis, various infectious, metabolic, autoimmune, hereditary, developmental, and neoplastic liver disorders can result in various cutaneous and mucosal changes as well as in pruritus and abnormal hair and nail growth. Although many of these changes are nonspecific, some are associated with distinct liver diseases and correlate with the severity of hepatic pathology. Familiarization with the spectrum of these manifestations is important for early detection and treatment of hepatic diseases. We review the medical literature and discuss the spectrum of dermatologic manifestations of liver cirrhosis and of important liver diseases, their etiopathogenesis, significance, and treatment.

PMID: 18640524 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Rifaximin versus nonabsorbable disaccharides in the management of hepatic encephalopathy: a meta-analysis.

Eur J Gastroenterol Hepatol Start a Discussion »

Jan 052009

Rifaximin versus nonabsorbable disaccharides in the management of hepatic encephalopathy: a meta-analysis.

Eur J Gastroenterol Hepatol. 2008 Nov;20(11):1064-70

Authors: Jiang Q, Jiang XH, Zheng MH, Jiang LM, Chen YP, Wang L

OBJECTIVE: To compare the positive and negative effects of rifaximin and nonabsorbable disaccharides in patients with hepatic encephalopathy. METHODS: We used the method recommended by The Cochrane Collaboration to perform a meta-analysis of comparative randomized trials of rifaximin and nonabsorbable disaccharides. RESULTS: Seven randomized controlled trials were identified, but only five trials involving 264 patients met all the inclusion criteria. There was no significant difference between rifaximin and nonabsorbable disaccharides on improvement in patients with hepatic encephalopathy [relative risk (RR) 1.08; 95% confidence interval (CI), 0.85-1.38; P=0.53]. RR was 0.98 (95% CI: 0.85-1.13; P=0.74) for acute hepatic encephalopathy in 157 patients and 0.87 (95% CI: 0.40-1.88; P=0.72) for chronic hepatic encephalopathy in 96 patients, respectively. There was no significant difference between rifaximin and nonabsorbable disaccharides on diarrhea (RR=0.90; 95% CI: 0.17-4.70; P=0.90). However, a significant difference in favor of rifaximin on abdominal pain (RR=0.28; 95% CI: 0.08-0.95; P=0.04) was identified. CONCLUSION: Rifaximin is not superior to nonabsorbable disaccharides for acute or chronic hepatic encephalopathy in the long-term or short-term treatment except that it may be better tolerated. Further studies on larger populations are required to provide more sufficient evidence for assessment of the use of rifaximin.

PMID: 19047837 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

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