Entries Tagged as 'Digestion'
Treatment of gastroparesis: an update.
Digestion. 2008;78(4):173-9
Authors: Gumaste V, Baum J
Gastroparesis is a chronic disorder of gastric motility that is characterized by delayed emptying of either solids or liquids from the stomach in the absence of any mechanical obstruction. Nausea, vomiting, early satiety and bloating are some of the manifestations of gastroparesis. Idiopathic, diabetes mellitus and postsurgical states account for the majority of cases. Gastroparesis is a difficult condition to treat. Prokinetic drugs like metoclopramide and erythromycin form the mainstay of therapy but are less than ideal. Some patients may benefit from endoscopic botolinium toxin injection. Gastric electrical stimulation, though promising, is not ready for prime time yet.
PMID: 19092243 [PubMed - indexed for MEDLINE]
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Tags: Digestion
Intermittent versus continuous pantoprazole infusion in peptic ulcer bleeding: a prospective randomized study.
Digestion. 2008;78(1):39-43
Authors: Yüksel I, Ataseven H, Köklü S, Ertu?rul I, Ba?ar O, Odemi? B, Ibi? M, Sa?maz N, Sahin B
BACKGROUND AND AIM: Rebleeding has remained the most important determinant of poor prognosis in peptic ulcer bleeding. Gastric acid plays an important role in the pathogenesis of rebleeding. We aimed to compare the efficiency of intermittent and continuous pantoprazole infusion treatment on peptic ulcer rebleeding after endoscopic therapy. MATERIALS AND METHOD: In this prospective study, patients with active peptic ulcer bleeding or non-bleeding visible vessel were treated initially with endoscopic therapy. They were randomized to receive intermittent or continuous intravenous pantoprazole treatment. Rebleeding rate, duration of hospital stay, need for total blood transfusion and need for urgent surgery were compared among both groups. RESULTS: Rebleeding rate (6.1 vs. 8.3%), duration of hospital stay (4.17 vs. 4.41), need for total blood transfusion (2.18 vs. 2.59) and need for urgent surgery (4.1 vs. 4.2%) were similar in intermittent and continuous pantoprazole infusion therapy groups, respectively. There was no bleeding-related death in either group. CONCLUSION: In patients with peptic ulcer bleeding, intermittent and continuous pantoprazole infusion after successful endoscopic therapy have comparable outcomes in reducing rebleeding. Both have similar effects on hospital stay, need for blood transfusion and urgent surgery. Intermittent administration has application and cost advantages over continuous infusion.
PMID: 18824852 [PubMed - indexed for MEDLINE]
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Tags: Digestion
Efficacy of prokinetic agents in improving bowel preparation for colonoscopy.
Digestion. 2008;77(3-4):166-72
Authors: Mishima Y, Amano Y, Okita K, Takahashi Y, Moriyama N, Ishimura N, Furuta K, Ishihara S, Adachi K, Kinoshita Y
BACKGROUND AND AIM: Colonoscopy plays an important role in the diagnosis and treatment of gastrointestinal illness in both Western countries and Japan. However, preparative bowel cleansing for colonoscopy is frequently troublesome for elderly and/or constipated patients, since they must drink larger volumes of lavage solution for adequate cleansing. We investigated the use of prokinetic agents for improving the efficacy and tolerability of bowel cleansing prior to colonoscopy. METHODS: 613 patients were divided into two groups according to oral lavage solution used (polyethylene glycol or magnesium citrate), and were further randomized to receive either vehicle (100 ml water) alone, vehicle with 5 mg mosapride citrate, or vehicle with 50 mg itopride hydrochloride 30 min before administration of lavage solution. Experimental parameters included bowel cleansing quality, times to first defecation and completion of bowel cleansing, and incidence of uncomfortable abdominal symptoms during colonoscopy preparation. RESULTS: Administration of mosapride citrate or itopride hydrochloride prior to oral lavage solution did not significantly improve bowel cleansing quality. However, statistically significantly fewer uncomfortable abdominal symptoms were found in patients who received mosapride citrate or itopride hydrochloride versus vehicle alone. CONCLUSION: Prokinetic agents effectively decreased the incidence of uncomfortable abdominal symptoms experienced during colonoscopy preparation.
PMID: 18577886 [PubMed - indexed for MEDLINE]
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Tags: Digestion
Gastric antral vascular ectasia (GAVE): an update on clinical presentation, pathophysiology and treatment.
Digestion. 2008;77(2):131-7
Authors: Selinger CP, Ang YS
Gastric antral vascular ectasia (GAVE), though a rare disorder, causes up to 4% of non-variceal upper GI bleeding. This paper gives an overview of studies examining clinical presentation and pathophysiology, and reviews the current evidence for invasive and non-invasive treatments. GAVE is often associated with systemic illnesses, such as cirrhosis of the liver, autoimmune connective tissue disorders, bone marrow transplantation and chronic renal failure. The pathophysiological changes leading to GAVE have not been fully explained and remain controversial. Patient presentation varies from chronic iron-deficiency anaemia to heavy acute gastrointestinal bleeding. It is important to differentiate GAVE from portal hypertensive gastropathy as GAVE does not respond to measures reducing portal pressures. Endoscopic ablation (Nd:YAG-laser or argon plasma coagulation) is the first-line treatment of choice. As evidence for pharmacological therapy with oestrogen (and/or progesterone), tranexamic acid or thalidomide stems from case reports only, these should be used if endoscopic measures have failed to stop chronic blood loss. Surgical antrectomy should be reserved for unresponsive cases as it is associated with a high mortality. Ultimately, treatment of the underlying medical co-morbidities may lead to resolution of GAVE.
PMID: 18391491 [PubMed - indexed for MEDLINE]
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Tags: Digestion
