Abstract:
GOALS:To define both risks and costs of optimal care of patients with gastric acid hypersecretion. BACKGROUND:The management of Zollinger-Ellison syndrome and other gastric acid hypersecretory disorders remains challenging. The optimal strategy for follow-up including gastric acid analysis, laboratory studies, and endoscopy is unknown but important given the potential complications from uncontrolled acid secretion. STUDY:Over the last 18 years, patients with gastric acid hypersecretory disorders have been followed prospectively with gastric acid analysis and endoscopy titrating oral lansoprazole and evaluating for complications. Protocol driven charges were calculated using the most recent information available. RESULTS:After 1 year of treatment optimization, 19 of 67 patients had 43 relapses, (once only in 10 patients). Risk markers for relapse included: (1) antrectomy, 67% relapsed versus 21% in unoperated patients; (2) basal acid output >5 mmol/h (risk=5.17); and (3) poor compliance. On treatment, 79% of 58 intact patients (excluding antrectomy) were lesion-free; 11% had only 1 relapse. Thus 90% were well managed with optimized lansoprazole alone. Protocol driven charges exceeded $25,000 the first year and $7000 annually thereafter. CONCLUSIONS:Relapse is infrequent and generally mild with acid secreting status closely monitored. The ideal strategy to balance costs and testing awaits further study.
journal_name
J Clin Gastroenteroljournal_title
Journal of clinical gastroenterologyauthors
Hirschowitz BI,Fineberg N,Wilcox CM,Mohnen J,Worthington Jdoi
10.1097/MCG.0b013e3181a59aa5subject
Has Abstractpub_date
2010-01-01 00:00:00pages
28-33issue
1eissn
0192-0790issn
1539-2031journal_volume
44pub_type
临床试验,杂志文章abstract::We assessed bowel sounds in controls and patients with acute abdominal conditions using a new computer-aided sound analysis system (C.A.S.A.S.). Sixty-three controls and 61 patients with an acute abdomen had 10-min recordings of bowel sounds in a silent environment with computer analysis of the digitized acoustic sign...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:
更新日期:1994-03-01 00:00:00
abstract::The benefit of early endoscopy in the management of peptic ulcer bleeding remains controversial. In this study we looked at the role of early endoscopy in bleeding peptic ulcer patients with clear, "coffee grounds," or bloody nasogastric aspirate. A consecutive series of 325 patients with peptic ulcer bleeding were in...
journal_title:Journal of clinical gastroenterology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00004836-199606000-00005
更新日期:1996-06-01 00:00:00
abstract:INTRODUCTION:Endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) is a minimally invasive option for pancreaticobiliary access in patients with Roux-en-Y anatomy. The procedure involves creating a fistulous tract between the remnant stomach or jejunum and the bypassed ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0000000000001326
更新日期:2020-07-01 00:00:00
abstract::A large number of ascitic fluid tests, e.g., fibronectin and cholesterol, have been proposed as helpful in detecting malignancy as the cause of ascites. Unfortunately, these "humoral tests of malignancy" are nonspecific. Although the ascitic fluid concentrations of these proteins or protein-bound substances tend to be...
journal_title:Journal of clinical gastroenterology
pub_type: 社论,评审
doi:10.1097/00004836-199403000-00002
更新日期:1994-03-01 00:00:00
abstract:BACKGROUND:For patients with Crohn's disease (CD) who have colonoscopy during periods of clinical remission, the utility of taking ileocolonic biopsy specimens to assess disease activity is disputed. GOALS:We explored the clinical implications of histologic disease activity in such patients. STUDY:We reviewed medical...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0000000000000507
更新日期:2017-01-01 00:00:00
abstract::Helicobacter pylori infection may play a role in the development of gastric cancer; however, a quantitative evaluation of the density of H. pylori infection has not been reported previously in relation to the histologic stage and type of cancer. This study was designed to compare the density of H. pylori infection to ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200010000-00006
更新日期:2000-10-01 00:00:00
abstract::In two patients, treatment of amebic dysentery was followed (despite the disappearance of the infecting organism) by an illness with the clinical, pathological, and radiological characteristics of nonspecific ulcerative colitis. Their case histories indicate that in addition to persistent or recurrent amebic infection...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198306000-00004
更新日期:1983-06-01 00:00:00
abstract::Multiple biopsies were taken from the duodenum of 100 patients (46 active duodenal ulcer, 14 healed duodenal ulcer, 40 control subjects) to detect duodenitis, gastric metaplasia and Helicobacter pylori (Hp). Histamine-induced congo-red staining of the duodenal bulb was performed in additional 25 cases of active duoden...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199310000-00007
更新日期:1993-10-01 00:00:00
abstract:BACKGROUND/GOALS:Many patients with a history of injection drug use (IDU) are excluded from hepatitis C virus (HCV) treatment. This prospective multicenter study aimed to determine the impact of IDU history on HCV treatment candidacy and outcomes. STUDY:Between 1999 and 2001, 4318 HCV-infected patients seen at 24 VA M...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,多中心研究
doi:10.1097/01.mcg.0000212644.82853.51
更新日期:2007-02-01 00:00:00
abstract::Over a 3-year period, arteriovenous malformations (angiodysplasia) were identified at upper gastrointestinal endoscopy in 41 patients. The lesions were multiple in one-third of patients and were predominantly situated in the proximal stomach. We considered angiodysplasia to be the cause of upper gastrointestinal bleed...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198608000-00004
更新日期:1986-08-01 00:00:00
abstract::We describe a patient who presented with mechanical obstruction of the small bowel secondary to impaction of the ileocecal valve from a gallstone. The stone impaction of the ileocecal valve was confirmed by colonoscopy. Although the stone was disimpacted, it could not be trapped and extracted during colonoscopy. There...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200004000-00027
更新日期:2000-04-01 00:00:00
abstract:BACKGROUND:Self-expanding metal stents (SEMSs) are used to treat malignant stenosis of the gastrointestinal (GI) tract, as a safe, feasible, and minimally invasive option for reestablishing luminal patency. However, the literature offers scant prospective data on the clinical outcome of these patients. AIM:To assess t...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,多中心研究
doi:10.1097/MCG.0b013e318033d30a
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:Tormentil extracts (TE) have antioxidative properties and are used as a complementary therapy for chronic inflammatory bowel disease. In individual patients with ulcerative colitis (UC) positive effects have been observed. GOALS:To assess the safety, pharmacology, and clinical effects of different doses of ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e31804b2173
更新日期:2007-10-01 00:00:00
abstract::Diverticular disease of the colon is quite common in developed countries, and its prevalence increases with age. Although present in perhaps two thirds of the elderly population, the large majority of patients will remain entirely asymptomatic. Nonetheless, an estimated 20% of those affected may manifest clinical illn...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/00004836-199910000-00004
更新日期:1999-10-01 00:00:00
abstract::Acetaminophen-induced hepatotoxicity is a common consequence of acetaminophen overdose and may lead to acute liver failure (ALF). Currently acetaminophen is the most common cause of ALF in both United States and United Kingdom, with a trend to increasing incidence in the United States. N-acetylcysteine is the most eff...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/MCG.0b013e31818a3854
更新日期:2009-04-01 00:00:00
abstract::Recent reports of reduced appendectomy rates in patients with ulcerative colitis have not distinguished between primary appendectomy (surgery for appendicitis) and incidental appendectomy (removal of the appendix for other reasons). In the present case control study, we examined the frequency of primary appendectomy i...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199512000-00006
更新日期:1995-12-01 00:00:00
abstract::Meal period exclusion from 24-h pH testing allows better separation between controls and patients with gastroesophageal reflux disease. We reviewed the results of 24-h pH studies of 350 patients with reflux symptoms. They were divided into two groups based on the 95th percentile of the total percentage of time when pH...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199707000-00003
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Fundic gland polyps (FGPs) are now the most common gastric polyp encountered by endoscopists. However, they have minimal clinical significance. If they could be reliably predicted by endoscopic features, it might prevent the need for and cost of biopsy. GOALS:To determine the positive predictive value of en...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200305000-00007
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND AND AIMS:Current methods to diagnose malignant biliary strictures are of low sensitivity. Confocal endomicroscopy is a new approach that may improve the diagnosis of indeterminate biliary strictures. The purpose of this study was to evaluate indeterminate biliary strictures using probe-based confocal laser e...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e3181fbdc38
更新日期:2011-03-01 00:00:00
abstract::Acute acalculous cholecystitis is an uncommon but very serious illness, that, if undiagnosed, may lead to gallbladder perforation and death. The condition has numerous causes that result in bile stasis and ischemia leading to inflammation and infection in the gallbladder wall. The bedside diagnosis may be difficult, e...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/00004836-199210000-00014
更新日期:1992-10-01 00:00:00
abstract::Identical twins presented as sexagenarians with heartburn, regurgitation, and dysphagia; each had a Barrett esophagus remarkably similar to the other. This instance suggests a hereditary influence upon the development of mucosal dysplasia in some patients with this condition. ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198306000-00011
更新日期:1983-06-01 00:00:00
abstract::Gastroesophageal reflux disease, especially when refractory to standard therapy, remains a significant clinical problem. Although symptom pathogenesis in erosive reflux disease is relatively easy to understand, it is less clear how exposure of the macroscopically normal mucosa in nonerosive reflux disease (NERD) is ab...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/MCG.0b013e318299f181
更新日期:2014-01-01 00:00:00
abstract::Progressive systemic sclerosis (PSS) causes smooth muscle atrophy and fibrosis of the distal two-thirds of the esophagus. Motility studies show reduced-amplitude or absent peristaltic contractions in this region and normal or decreased lower esophageal sphincter pressure. Patients complain of dysphagia, heartburn, and...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/01.mcg.0000225549.19127.90
更新日期:2006-10-01 00:00:00
abstract::Adhesive tape wound around the shaft of an upper GI endoscope serves as a simple method to dilate upper GI strictures under endoscopic control. This technique avoids the need for guidewires and fluoroscopy. ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198506000-00005
更新日期:1985-06-01 00:00:00
abstract:BACKGROUND AND AIM:Voice-related complaints are the most common extraesophageal manifestation of gastroesophageal reflux disease (GERD). The aim of this study was to compare objectively measured voice parameters in normal subjects and patients with GERD and to assess the impact of antireflux surgery on these parameters...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e31822f386e
更新日期:2012-02-01 00:00:00
abstract::Juvenile chronic pancreatitis presenting with painless obstructive jaundice is extremely rare. Pancreatic disease in association with multiple somatic abnormalities presenting in late childhood is uncommon. We report such a case. ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198512000-00019
更新日期:1985-12-01 00:00:00
abstract:BACKGROUND:Data on Asian patients who present to primary care physicians with dyspepsia are limited. AIM:To determine predictors of response to a trial of proton pump inhibitor therapy. METHOD:One hundred ninety patients presenting to their general practitioners with dyspeptic symptoms but without alarm symptoms, und...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/01.mcg.0000225620.02094.c3
更新日期:2008-02-01 00:00:00
abstract::Kidney stones in patients with inflammatory bowel disease are usually composed of calcium oxalate. Two factors are important in the increased absorption of dietary oxalate which is responsible for those stones: 1) increased absorption of oxalate in the presence of steatorrhea, and 2) increased permeability of the colo...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198502000-00002
更新日期:1985-02-01 00:00:00
abstract::The tissue distribution of a previously identified M(r) 40 K epithelial autoantigen in ulcerative colitis was examined in situ in the fetal tissue by immunocytochemical method, using an immunoglobulin M (IgM) monoclonal antibody (7E12H12). Fetal-autopsy tissue from 9 to 19 weeks of development (11-21 gestational weeks...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199212000-00009
更新日期:1992-12-01 00:00:00
abstract::Guillain-Barré syndrome (GBS) is often preceded by an infectious disease. A case of GBS after hepatitis A in a pregnant woman is described. The patient was treated with intravenous immunoglobulin and had full recovery with no neurologic sequelae. She gave birth in term to a healthy baby. This is the first reported cas...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200102000-00020
更新日期:2001-02-01 00:00:00