Abstract:
:Physicians occasionally embark on a work-up that, after a lengthy path, leads them to a clinical situation similar to that from which they started their original pursuit. This article aims to describe the characteristics of circular medical management and means for its avoidance. The underlying medical problem often presents itself initially as a bewildering array of consecutive outcomes similar to a complex decision tree. On closer inspection, however, few of the outcomes are associated with a high probability, and only one path stands out as the most likely one to take. This path usually ends in such options as expectant management, supportive measures or doing nothing, which are already available at the onset of work-up. If medical management is drawn out and takes a long time to complete, sight of its circular nature is easily lost. If many different specialists care for a patient, little appreciation for circular paths occurs. A prospective outline of the management plan and the elimination of paths with low a priori probability can help to prevent unnecessary medical interventions. The physician may then come to realize that standing still and waiting become as effective and less costly than a lengthy circular work-up.
journal_name
Aliment Pharmacol Therjournal_title
Alimentary pharmacology & therapeuticsauthors
Sonnenberg Adoi
10.1111/j.0269-2813.2004.01849.xsubject
Has Abstractpub_date
2004-01-15 00:00:00pages
191-5issue
2eissn
0269-2813issn
1365-2036pii
1849journal_volume
19pub_type
杂志文章abstract:BACKGROUND:Proton pump inhibitors including omeprazole and lansoprazole inhibit gastric acid secretion by selectively and non-competitively inactivating the H+, K+ ATPase molecules of the parietal cell, but possibly only those that are actively secreting acid. This might imply that stimulation of acid secretion by a me...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1046/j.1365-2036.2000.00829.x
更新日期:2000-10-01 00:00:00
abstract:BACKGROUND:Several studies have explored the effect of non-alcoholic fatty liver disease (NAFLD) on bone mineral density (BMD) and risk of osteoporotic fractures in adults. However, the extent to which NAFLD adversely affects bone health remains uncertain. AIM:To provide a quantitative estimation of the magnitude of t...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,meta分析
doi:10.1111/apt.15087
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:The presence of antibodies towards infliximab (ATI) is associated with lower infliximab (IFX) trough concentrations and loss of response. IFX treatment intensification is effective for restoring response in most, but not all patients with Crohn's disease (CD). AIM:To compare outcome, pharmacokinetics and im...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章
doi:10.1111/apt.14452
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:No definitive method for quantitative evaluation of hepatic function has as yet been established. AIM:To investigate whether the (13)C-phenylalanine breath test would be useful for the evaluation of hepatic function in patients with liver cirrhosis and acute hepatitis. METHODS:L-[1-(13)C]-phenylalanine was...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章
doi:10.1111/j.1365-2036.2005.02409.x
更新日期:2005-04-01 00:00:00
abstract::Gastro-oesophageal reflux disease is a motor disorder principally caused by defective function of the lower oesophageal sphincter. Proton pump inhibitor (PPI) drugs alleviate symptoms, heal oesophagitis and improve quality of life but do not address the underlying motor disorder, and prolonged treatment is often neede...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2036.2004.02226.x
更新日期:2004-12-01 00:00:00
abstract:BACKGROUND:Refractory sprue with malabsorption carries a risk of lymphoma. AIM:To examine whether a good clinical but poor histological response during a strict gluten-free diet predicts a poor outcome. METHODS:The study involved all coeliac patients who showed no histological recovery within 2 years on a strict glut...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1365-2036.2007.03311.x
更新日期:2007-05-15 00:00:00
abstract:BACKGROUND:In patients with pruritus of cholestasis, response to conventional drug treatment may be unsatisfactory. Activation of 5-hydroxytryptamine receptors on dermal sensory nerve-endings plays a role in the perception of pruritus. The 5-hydroxytryptamine(3) receptor antagonist, ondansetron, has been used in the tr...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1365-2036.2005.02430.x
更新日期:2005-04-15 00:00:00
abstract:BACKGROUND:Transjugular intrahepatic portosystemic stent-shunts (TIPSS) are becoming widely used in the management of oesophageal variceal haemorrhage (OVH). Their place in the treatment of gastric variceal haemorrhage (GVH), a condition with a traditionally poor prognosis, remains unclear. The aims of our study were t...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 临床试验,杂志文章
doi:10.1046/j.1365-2036.1997.106277000.x
更新日期:1997-02-01 00:00:00
abstract::At present, the concept of visceral hypersensitivity provides the leading hypothesis regarding the generation of symptoms in functional gastrointestinal disorders. This paper discusses the current clinical evidence for drugs that have been proposed to interfere with visceral sensitivity in functional gastrointestinal ...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2036.2005.02392.x
更新日期:2005-03-15 00:00:00
abstract:BACKGROUND:Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common functional disorders without defined pathology. Mast cells and eosinophils interact with T lymphocytes and may alter enteric nerve and smooth muscle function. AIM:To examine mast cell, eosinophil and intraepithelial lymphocyte populatio...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章
doi:10.1111/j.1365-2036.2009.03937.x
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:Malnutrition/sarcopenia and frailty are common in patients with cirrhosis and are associated with poor outcomes. AIM:To provide an overview of data on the importance, assessment and management of malnutrition/sarcopenia and frailty in cirrhosis. METHODS:A literature search was conducted in PubMed and other...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,评审
doi:10.1111/apt.15571
更新日期:2020-01-01 00:00:00
abstract::Epidemiological, experimental, and clinical studies have demonstrated that colon carcinogenesis may be prevented by nonsteroidal anti-inflammatory drugs (NSAIDs). Although controversy remains, recent studies, including ours, have revealed that NSAIDs suppress colon carcinogenesis at the adenoma stage where cyclooxygen...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,评审
doi:10.1046/j.1365-2036.16.s2.8.x
更新日期:2002-04-01 00:00:00
abstract:BACKGROUND:HS-10234 is a novel prodrug of tenofovir developed to increase anti-viral potency and to reduce systemic toxicities. AIMS:To evaluate the tolerability, pharmacokinetics and anti-viral efficacy of HS-10234 in patients with chronic hepatitis B (CHB) infection METHODS: Treatment-naïve subjects with non-cirrhot...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章
doi:10.1111/apt.16196
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:There are patients with chronic hepatitis C who are not eligible for the current interferon-based therapies or refuse to be treated due to secondary effects. AIM:To provide information on alternative treatments for the management of these patients. METHODS:A PubMed search was performed to identify relevant...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,评审
doi:10.1111/apt.12562
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:The prevalence of coeliac disease (CD) may be increased in individuals with dyspepsia, but evidence is conflicting. AIMS:To conduct a systematic review and meta-analysis of studies reporting prevalence of CD in dyspepsia. METHODS:MEDLINE, EMBASE, and CINAHL were searched up to February 2009. Case series an...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,meta分析,评审
doi:10.1111/j.1365-2036.2009.04008.x
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:The role of mesalazine in preventing the clinical recurrence of Crohn's disease after surgery has been shown in a meta-analysis of all published studies. No clear relationship, however, has been shown between dosage and response. AIM:To evaluate whether 4.0 g/day of mesalazine may offer therapeutic advantag...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1046/j.1365-2036.2003.01462.x
更新日期:2003-02-15 00:00:00
abstract:BACKGROUND:There is a lack of evidence for the efficacy of preventive medications for peptic ulcers (PUs) among long-term users of non-steroidal anti-inflammatory drugs (NSAIDs) in Japan. AIM:To estimate the preventive effect by normal dose, not high-dose histamine-H2 receptor antagonists (H2RA) for NSAID-induced ulce...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1365-2036.2005.02477.x
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Distal ulcerative colitis may prove to be resistant to steroids and aminosalicylates, but total colectomy is more difficult to justify than in severe extensive colitis. Immunosuppression is of established benefit in generalized colitis, but there are no data available specific to distal disease. AIM:To dete...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,评审
doi:10.1046/j.1365-2036.2002.01170.x
更新日期:2002-02-01 00:00:00
abstract:BACKGROUND:Two studies were carried out in order to investigate the issue of meal-provoked nocturnal gastrooesophageal reflux. METHODS:In Experiment 1, 20 symptomatic reflux patients underwent both pH and polysomnographic monitoring on two nights. On one night, patients ate a non-provocative meal prior to 19.00 hours,...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 临床试验,杂志文章
doi:10.1046/j.1365-2036.1998.00407.x
更新日期:1998-10-01 00:00:00
abstract:BACKGROUND:Comparative long-term efficacy of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) for prevention of disease progression to hepatocellular carcinoma (HCC) among high-risk patients with chronic hepatitis B (CHB)-related compensated cirrhosis is controversial. AIMS:To compare the long-term efficacy of ...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章
doi:10.1111/apt.16116
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Controversy exists on how to measure patient-reported outcomes in irritable bowel syndrome (IBS) clinical trials effectively. Pain numeric rating scales (NRS) are widely used in the non-IBS pain literature. The Food and Drug Administration has proposed using the NRS in IBS. AIM:To test the psychometrics of ...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章
doi:10.1111/j.1365-2036.2009.04144.x
更新日期:2009-12-01 00:00:00
abstract:BACKGROUND:The reflux disease questionnaire (RDQ) is a short, patient-completed instrument. AIMS:To investigate the psychometric characteristics of the RDQ in patients with heartburn-predominant (HB) and non-heartburn predominant (NHB) dyspepsia. METHODS:HB (n = 388) and NHB (n = 733) patients were randomized to esom...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1365-2036.2007.03271.x
更新日期:2007-05-01 00:00:00
abstract::The effect of ephedrine, a non-selective adrenoreceptor agonist, and yohimbine, a selective alpha 2-adrenolytic drug, on gastric emptying of a radiolabelled solid meal was examined in groups of 8 (all women) and 15 (4 men and 11 women) obese patients, respectively. Patients were given orally, double-blind in random or...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1365-2036.1991.tb00045.x
更新日期:1991-08-01 00:00:00
abstract:BACKGROUND:Pneumatic dilation has re-emerged as a first line treatment for achalasia, but conclusions are limited by the relatively small numbers of patients studied and the lack of long term follow-up. AIM:To summarise and analyse 29 available studies evaluating pneumatic dilation for achalasia with focus on efficacy...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2036.2011.04816.x
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Mycophenolate mofetil has been claimed to be effective and well tolerated in refractory inflammatory bowel disease although there is little information regarding its use in clinical practice. AIM:To review our experience in achieving and maintaining remission in refractory inflammatory bowel disease and to ...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章
doi:10.1046/j.1365-2036.2003.01581.x
更新日期:2003-06-01 00:00:00
abstract:BACKGROUND:The effect of anti-viral treatment on downstream costs for hepatitis C virus (HCV)-infected patients is unknown. AIM:To evaluate follow-up costs in patients with chronic HCV, stratified by liver disease severity. METHODS:Using a US private insurance database, mean all-cause per-patient-per-month (PPPM) US ...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章
doi:10.1111/apt.12454
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Little is known about the distinctive characteristics of subjects with frequent (at least weekly) and occasional gastro-oesophageal reflux symptoms. AIM:To compare the characteristics and disease management of subjects complaining of at least weekly and less frequent gastro-oesophageal reflux symptoms. MET...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章
doi:10.1111/j.1365-2036.2006.02811.x
更新日期:2006-03-01 00:00:00
abstract:AIM:To compare the efficacy of ranitidine bismuth citrate plus clarithromycin (RBC-C) vs. omeprazole plus amoxycillin (OME-AMO) in the cure of Helicobacter pylori infection. METHODS:In this double-blind, multicentre, parallel-group study 122 H. pylori-positive patients with active duodenal ulcer or gastritis, with con...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1046/j.1365-2036.1997.00254.x
更新日期:1997-12-01 00:00:00
abstract:BACKGROUND:In 1997-1998, 6127 asymptomatic children aged 2-4 years were screened for coeliac disease (CD) by anti-endomysium (EmA) testing in the Netherlands. After 6 (+/-2) months, biopsies were performed in 57 seropositive children; 31(54%) had villous atrophy, but 26 (46%), all HLA-DQ2/DQ8 positive, had normal histo...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1365-2036.2009.04226.x
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:For patients with UC, flexible maintenance dosing therapy may confer advantages for safety, efficacy, costs and patient preference. Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of UC. AIM:To assess the efficacy and safety of tofacitinib dose de-escalation and escalation in patients...
journal_title:Alimentary pharmacology & therapeutics
pub_type: 杂志文章,多中心研究
doi:10.1111/apt.15555
更新日期:2020-01-01 00:00:00