Abstract:
BACKGROUND:Diagnosing a potentially life-threatening disease may adversely affect patient quality of life (QOL) independent of biologic effects. It is unknown whether the mere diagnosis of Barrett's esophagus (BE) adversely impacts patients' preferences (health-state utility) sufficiently to impair the cost-effectiveness of endoscopic screening for esophageal adenocarcinoma. GOAL:To calculate the threshold impact on utility incurred by diagnosing BE that would allow screening to remain cost-effective. STUDY:A Markov model was developed to examine strategies of no screening, and screening with surveillance of BE. Patients were 50-year-old white men with symptoms of gastroesophageal reflux followed until 80 years of age or death. The primary outcomes were the threshold decrements in utility incurred by diagnosing BE based on willingness to pay (WTP) of dollar 50,000 and dollar 100,000 per quality-adjusted life-year (QALY) gained. RESULTS:For a WTP of dollar 50,000/QALY, the decrement in utility could be as great as 9%, meaning that screening is cost-effective as long as diagnosing BE does not impair QOL by more than 9%. For a WTP of dollar 100,000, the decrement could be as great as 10.5%. CONCLUSIONS:The decrement in utility caused by diagnosing BE may be substantial without compromising the cost-effectiveness of endoscopic screening.
journal_name
J Clin Gastroenteroljournal_title
Journal of clinical gastroenterologyauthors
Rubenstein JH,Inadomi JMdoi
10.1097/01.mcg.0000196186.19426.4asubject
Has Abstractpub_date
2006-02-01 00:00:00pages
109-15issue
2eissn
0192-0790issn
1539-2031pii
00004836-200602000-00005journal_volume
40pub_type
杂志文章abstract::We assessed the clinical and biochemical parameters associated with the development of posttransplantation diabetes (PTDM) in 52 liver transplant recipients followed up for 1 year. Diabetes was present before transplantation in 9.6% (5 of 52) of patients, and PTDM occurred in 23% (11 of 47) of the remaining liver tran...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199801000-00009
更新日期:1998-01-01 00:00:00
abstract::A unique case of granulomatous gastritis of unknown etiology is reported. The patient, a 43-year-old Haitian woman, suffered a gastric perforation from a disease process limited to the stomach. The stomach was markedly enlarged and edematous with transmural, serpiginous granulomatous tracks throughout the gastric wall...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198302000-00013
更新日期:1983-02-01 00:00:00
abstract:BACKGROUND:Portal or bridging fibrosis is an indication for antiviral treatment in patients with chronic hepatitis B (CHB). An early marker predictive of liver fibrosis in hepatitis B e antigen (HBeAg)-negative CHB patients can alert clinicians to plan for treatment before disease progression. GOALS:To predict early a...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e3181dd5357
更新日期:2011-03-01 00:00:00
abstract::We compared the diagnostic accuracy of a new immunological marker of celiac sprue (CS), the antijejunum antibody (JAB), with that of antigliadin (AGA) and antiendomysium (EmA) antibodies. One hundred untreated adults with biopsy-proven CS, 52 healthy controls, and 57 patients with inflammatory bowel disease, lymphoma ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199501000-00006
更新日期:1995-01-01 00:00:00
abstract:GOALS:To describe the association of untreated celiac disease with hyperhomocysteinemia and variants of the methylenetetrahydrofolicacid reductase (MTHFR) gene found in clinical practice. STUDY:Case studies with description of associated clinical, biochemical, and genetic findings and review of literature. RESULTS:Fi...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200608000-00007
更新日期:2006-08-01 00:00:00
abstract::We have studied the morphologic aspects of the duodenal bulb in relation to Helicobacter pylori infection in a large group of patients with endoscopically assessed duodenitis to learn more about the pathogenesis of nonspecific duodenitis (bulbitis) and to clarify the specific role of H. pylori. Eight duodenal biopsy s...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199801000-00020
更新日期:1998-01-01 00:00:00
abstract:GOALS:To understand the degree to which psychosocial factors were preventing veterans with chronic hepatitis C virus from being eligible for antiviral treatment. BACKGROUND:Nearly 2% of the US population is infected with hepatitis C. Antiviral treatment requires substantial adherence despite challenging side effects. ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/01.mcg.0000123203.36471.70
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND AND AIMS:Human enteric antimicrobial peptides composed predominantly of human enteric α-defensins (HD5 and HD6) are important in the mucosal antimicrobial barrier. Previous studies have identified that genetic variations at rs2066844, rs2066845, rs2066847 are associated with diminished enteric α-defensins in...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0000000000001146
更新日期:2020-07-01 00:00:00
abstract::Portal hypertension, a consequence of end-stage liver disease and liver cirrhosis can lead to significant morbidity and mortality for patients through abnormal fluid accumulation as well as the formation of portosystemic shunts and varices. Treatment of the sequelae of portal hypertension can be achieved through endov...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/MCG.0000000000001180
更新日期:2019-05-01 00:00:00
abstract::Gastric cancer is often diagnosed in middle-aged patients undergoing upper gastrointestinal endoscopy for abdominal complaints or constitutional symptoms, such as dyspepsia, vomiting or anorexia, weight loss, anemia, jaundice, and ascites. Sometimes, all of these symptoms may be absent, and gastric cancer is diagnosed...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200107000-00021
更新日期:2001-07-01 00:00:00
abstract::We approached the early diagnosis of gastric infiltrating carcinoma, scirrhous cancer, by a retrospective study of 19 patients, together with a prospective study of a single patient, by reexamination and follow-up of gastric roentgenographs and endoscopic films. This study suggests that an early feature of this type o...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198103000-00004
更新日期:1981-03-01 00:00:00
abstract::We documented the natural history of esophageal carcinoma and its rapid growth by measuring the change in tumor diameter radiographically in 10 patients during an observation period because the diagnosis had been missed. Nine men and one woman (age range, 48-74 years; mean, 60 years) were included in the study. Eight ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199104000-00003
更新日期:1991-04-01 00:00:00
abstract::In this paper, I have focused on the issue of the clinical gastroenterologist who refuses to evaluate and endoscope the patient with AIDS. The discussion centers around the legal and ethical properties of such a decision, and the legal doctrine of abandonment. Finally, I have reviewed recent recommendations regarding ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:
更新日期:1984-06-01 00:00:00
abstract::A 61-year-old man developed obstructive jaundice and had ultrasonographic and cholangiopancreatographic findings consistent with carcinoma of the pancreas. However, pathologically the obstruction proved to be from heterotopic pancreatic tissue compressing the common bile duct. This patient and eight previously reporte...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198304000-00014
更新日期:1983-04-01 00:00:00
abstract::We examined California Medicaid (Medi-Cal) service use and expenditures for peptic ulcer and other acid-related diseases during the 10-year period fiscal year (FY) 1976-1985. Between FY 1976 and FY 1980, hospitalizations rose irregularly, operations declined by 37%, endoscopies tripled, physician visits fluctuated fro...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198912000-00003
更新日期:1989-12-01 00:00:00
abstract::The mechanism of drug resistance of gastric cancer cells has rarely been investigated. We specifically examine the magnitude and the biologic significance of multidrug resistance-1 (MDR-1) expression in human gastric cancer. All patients had previously been treated in prospective clinical trials for advanced gastric c...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199806000-00012
更新日期:1998-06-01 00:00:00
abstract:GOALS:We evaluated the efficacy of initial and follow-up hepatic venous pressure gradient (HVPG), models of end-stage liver disease (MELD), and MELD-Na for predicting the survival of patients with decompensated liver cirrhosis (LC). BACKGROUND:MELD with/without Na score and HVPG have been important predictors of morta...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e31825f2622
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVES:Hepatic ultrasound (US) is readily available and physicians usually trust the results of an US report suggesting fatty liver, but there are conflicting reports on its accuracy, especially in patients with chronic liver disease (CLD). Therefore, we retrospectively examined liver biopsies in patients with CLD ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/01.mcg.0000225680.45088.01
更新日期:2007-07-01 00:00:00
abstract::Hepatocellular carcinoma (HCC) is the most common hepatic malignancy worldwide. The primary risk factor for the development of HCC is cirrhosis. Even patients without cirrhosis who develop HCC are typically found to have some underlying hepatic abnormality, such as steatohepatitis or chronic viral hepatitis. Although ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/00004836-200211002-00003
更新日期:2002-11-01 00:00:00
abstract:BACKGROUND AND AIM:Intestinal fatty acid-binding protein (I-FABP) is a useful marker in the detection of intestinal ischemia. However, more insight into the test characteristics of I-FABP release is needed. This study aimed to investigate the relationship between plasma I-FABP levels and the severity of ischemic mucosa...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e3182a87e3e
更新日期:2014-03-01 00:00:00
abstract::A 53-year-old white woman developed diabetes mellitus, migratory erythema, and anemia, clinical features suggesting the presence of a "glucagonoma." Ten years earlier, after laparotomy and pancreatic biopsy, she had been told that she had an inoperable pancreatic carcinoma. Review of that biopsy together with current ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-197909000-00005
更新日期:1979-09-01 00:00:00
abstract::The methods used to discern the structure (anatomy) and function (physiology) of the indigenous microbiota can be divided according to which aspect of the microbiota they can interrogate and are positioned accordingly. At the most basic level, methods can simply describe the community structure of the microbiota, that...
journal_title:Journal of clinical gastroenterology
pub_type:
doi:10.1097/MCG.0000000000001106
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:Ascites due to cirrhosis may be difficult to distinguish from ascites due to heart failure by clinical features alone. More invasive testing is usually necessary, such as measurement of the hepatic venous pressure gradient, or paracentesis with measurement of the ascitic fluid total protein. AIM:The aim of ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e318198113b
更新日期:2010-01-01 00:00:00
abstract::Esophageal function was evaluated in 51 children less than 2 years of age with radiologic evidence of gastroesophageal reflux. Detection of an acid esophageal pH was a sensitive measure of gastroesophageal reflux. Lower esophageal sphincter pressures were greater in reflux patients with respiratory symptoms (18.0 +/- ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-197906000-00004
更新日期:1979-06-01 00:00:00
abstract::Hereditary hemorrhagic telangiectasia is a group of autosomal dominant disorders, characterized by telangiectases that develop in the skin, mucous membranes, and visceral organs. Currently, there is no satisfactory treatment of hereditary hemorrhagic telangiectasia. Interferon has never been used for the treatment of ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200404000-00015
更新日期:2004-04-01 00:00:00
abstract::In this study we investigated the relationship between chronic gastric ulcers and the appearance of connexin 32 or connexin 43. Samples were taken endoscopically and the appearance of connexin 32 or connexin 43 was assessed by Western blotting using anticonnexin 32 or anticonnexin 43 antibodies. Normal gastric mucosa ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:
更新日期:1995-01-01 00:00:00
abstract::Bleeding caused by ectopic varices is an uncommon but important and life-threatening complication of portal hypertension. Spontaneous external hemorrhage from a recanalized umbilical varix is an extremely rare source of ectopic variceal bleeding. We report on the acute presentation of a patient with a bleeding umbilic...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e31822b7f9a
更新日期:2012-02-01 00:00:00
abstract::A 79-year-old woman visiting our hospital with chief complaints of epigastric pain and jaundice was emergently admitted. Her alpha-fetoprotein (AFP) level was as high as 2265 ng/mL at admission. Her abdominal computed tomography scan revealed dilation of the intrahepatic bile duct and a tumorlike lesion protruding int...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200607000-00016
更新日期:2006-07-01 00:00:00
abstract::There is a lack of consensus as to whether there is a difference in the amount of gastroesophageal reflux when lying with the right versus the left side down. In an attempt to answer this question we conducted a two-part study. The first consisted of a questionnaire distributed to 103 gastroenterologists with a specia...
journal_title:Journal of clinical gastroenterology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00004836-199406000-00004
更新日期:1994-06-01 00:00:00
abstract::A patient with cirrhosis developed hemoperitoneum, lactic acidosis, and hyperphosphatemia in the absence of shock. At post-mortem examination occult multicentric hepatocellular carcinoma eroding the liver capsule was present. The case emphasizes the central role of the liver in lactic acidosis, indicates that hemoperi...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198604000-00025
更新日期:1986-04-01 00:00:00