Abstract:
:The intensity of diagnostic workup of patients with human immunodeficiency virus (HIV)-related chronic diarrhea is controversial. In the ideal setting in which an enteric pathogen is detected with minimal evaluation (stool tests) and in which specific treatment clears the diarrhea, eradicates the pathogen, and improves the patient's quality of life, the need for diagnostic workup is clear. However, problems frequently occur in the evaluation and treatment of patients that preclude such a straightforward approach. They are (a) failure to detect enteric pathogens; (b) detection of organisms of uncertain significance; (c) lack of effective treatment; (d) the presence of a severe coexisting illness that is the major determinant of the patient's outcome; and (e) lack of evidence that detecting enteric pathogens leads to improvement in broad patient outcomes, such as quality of life. I discuss these problems and examine the two opposing diagnostic workup strategies--minimal and intensive evaluation--that have been advocated. My main conclusion is that both approaches fall short, and that clinicians lack the information needed to guide clinical decision making. I urge investigators to analyze the full effects of alternative diagnostic interventions on broad patient outcomes so that clinical guidelines can be developed to assist the evaluation of patients.
journal_name
J Clin Gastroenteroljournal_title
Journal of clinical gastroenterologyauthors
Rabeneck Ldoi
10.1097/00004836-199304000-00018subject
Has Abstractpub_date
1993-04-01 00:00:00pages
245-50issue
3eissn
0192-0790issn
1539-2031journal_volume
16pub_type
杂志文章,评审abstract::Thromboangiitis obliterans characteristically affects small- and medium-sized vessels of the limbs in young smokers. There is some controversy about the existence of visceral localizations of the disease. The case of a patient with a well-established diagnosis of thromboangiitis obliterans who presented with mesenteri...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/00004836-200101000-00020
更新日期:2001-01-01 00:00:00
abstract:GOAL:The goal of this study was to investigate the relationship between Helicobacter pylori (H. pylori) infection and short-segment and long-segment Barrett's esophagus (SSBE and LSBE). BACKGROUND:H. pylori infection is reported to be inversely associated with Barrett's esophagus (BE) in western countries. However, th...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0000000000001264
更新日期:2020-05-01 00:00:00
abstract:GOALS:The current study presents 1 tertiary endoscopy center's 20-year experience using endoscopic therapy to treat patients with symptomatic primary sclerosing cholangitis (PSC). BACKGROUND:Endoscopic therapy for patients with PSC and dominant strictures has been used for more than 20 years, but there is concern that...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e3181646713
更新日期:2008-10-01 00:00:00
abstract:BACKGROUND:An association between Helicobacter pylori infection and colorectal neoplasia has been reported in cross-sectional studies. GOALS:We examined the association between H. pylori infection and the development of advanced colorectal neoplasia (AN) in a screening cohort. STUDY:We identified 3753 adults, who und...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0000000000001273
更新日期:2020-09-01 00:00:00
abstract:GOALS:We investigated the distribution of pathogens on stool gastrointestinal (GI) polymerase chain reaction (PCR) testing in those who subsequently developed inflammatory bowel disease (IBD). BACKGROUND:Infectious gastroenteritis has been associated with later development of IBD. STUDY:This retrospective study inclu...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0000000000001470
更新日期:2020-11-25 00:00:00
abstract:BACKGROUND:The Maastricht 2-2000 guidelines on the current management of Helicobacter pylori infection were recently adopted by the Israeli Gastroenterological Association. GOAL:To determine the impact of these clinical guidelines on the current knowledge, attitudes, and management of H. pylori among primary care phys...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200404000-00005
更新日期:2004-04-01 00:00:00
abstract::We report a case of microcystic (glycogen-rich) adenoma of the whole pancreas with coexistent pancreatic low-grade malignant islet cell tumor in a 29-year-old woman. She complained of nausea, vomiting, and growing abdominal mass. Abdominal computed tomography showed multiple cysts in the whole pancreas and a calcified...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200105000-00018
更新日期:2001-05-01 00:00:00
abstract::Zoonotic visceral leishmaniasis is common in western Mediterranean countries. A strong link between visceral leishmaniasis and human immunodeficiency virus (coinfection) has been proved, especially in Spain, which is an endemic area. This suggests that Leishmania may behave opportunistically. We report a case of colon...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199712000-00029
更新日期:1997-12-01 00:00:00
abstract::Helicobacter pylori infection has proven to be extraordinarily difficult to eradicate. Antimicrobial monotherapies have been particularly disappointing, with most eradication rates in the range of 0-15%. Clarithromycin has potential advantages over other macrolides to which H. pylori is susceptible because of its acid...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199306000-00004
更新日期:1993-06-01 00:00:00
abstract::Total colonoscopy was performed in 38 consecutive cirrhotics (15 alcoholic, 19 postviral, four unknown) with portal hypertension, 32 of whom were enrolled in a program of esophageal sclerotherapy because of variceal bleeding (Child's grading: A, 13; B, 21; C, 4 patients). In 34 of them, multiple biopsies from the colo...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199406000-00014
更新日期:1994-06-01 00:00:00
abstract::A 69-year old woman suffered from severe dysphagia, abdominal pain, and weight loss. The dysphagia was accompanied by nasal speech, nasal regurgitation of food, weakness, and wasting of the proximal muscles of the upper and lower girdles. Laboratory data revealed T3 sephadex uptake 65.2%; T4 15.1 mcg%; and T3 250 ng%....
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198410000-00009
更新日期:1984-10-01 00:00:00
abstract::One hundred forty-six consecutive specimens of excised bowel from patients with Crohn's disease were studied to determine the relationships between strictures, sinuses, and "fissures." A significant coincidence of sinuses and strictures was observed and sinuses tended to arise proximal to the point of maximal strictur...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198610000-00024
更新日期:1986-10-01 00:00:00
abstract::Ammonia is a neurotoxin that is normally cleared by the intact liver and if not, hyperammonemia results in hepatic encephalopathy. Hyperammonemia may be owing to primary or secondary causes. Early diagnosis is important to prevent permanent brain damage. Advanced malignancy involving the liver is associated with hyper...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0b013e3181d96aad
更新日期:2010-09-01 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::Abnormalities in esophageal peristaltic function and acid clearance appear to be responsible for prolonged esophageal acid exposure, a major determinant of the reflux esophagitis and esophageal stricture. We evaluated esophageal motility by manometry in 50 healthy controls and in 35 symptomatic reflux patients before,...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199102000-00005
更新日期:1991-02-01 00:00:00
abstract:GOALS:The study aimed to compare the level and characteristics of disease-related knowledge of patients with inflammatory bowel disease (IBD) between the West and the East using an international version of a questionnaire regarding knowledge of inflammatory bowel disease (IBD-KNOW). BACKGROUND:The authors recently dev...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0000000000001283
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Celiac disease (CeD) is a systemic disease with manifestations not limited to small intestine. The data on association between CeD and infertility is contradictory. There are no recommendations for the screening of female patients with infertility for CeD. AIM:We conducted a meta-analysis to find out whethe...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,meta分析
doi:10.1097/MCG.0000000000000285
更新日期:2016-01-01 00:00:00
abstract::Helicobacter pylori is absent in the antrum of approximately 5, 25, and 35% of patients with duodenal ulcer, gastric ulcer, and non-ulcer dyspepsia respectively and in the majority of asymptomatic healthy subjects from the West. The absence of H. pylori from the antrum could result from failure of exposure to (Group A...
journal_title:Journal of clinical gastroenterology
pub_type: 社论
doi:
更新日期:1991-10-01 00:00:00
abstract:BACKGROUND:Vitamin deficiency is frequently associated with inflammatory bowel disease (IBD). Supplementation of vitamins could thus serve as an adjunctive therapy. The present meta-analysis reviews the deficiencies and alterations in serum fat-soluble vitamins (A, D, E, and K) reported in IBD patients. MATERIALS AND ...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,meta分析,评审
doi:10.1097/MCG.0000000000000911
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Duodenal intraepithelial lymphocytosis (D-IEL) is an early marker for celiac disease (CD). However, the majority of cases are due to non-CD-related conditions. GOALS:To identify the predictors of CD when presented with D-IEL. METHODS:A total of 215 adult patients with D-IEL had undergone prospective and sy...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/MCG.0000000000000184
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:Beneficial findings concerning probiotics are increasing day by day. However, one of the most important parameter which affects the probiotic activity of a microorganism is its survival during the gastroduodenal transit. Some microencapsulation techniques could be applied to bacterial cells to improve this p...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,随机对照试验
doi:10.1097/MCG.0b013e3181ed0e71
更新日期:2010-09-01 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 AND AIMS:Probiotic supplementation seems to provide beneficial effects in the prevention and treatment of radiation-induced diarrhea. We performed a systematic review and meta-analysis to estimate the efficacy of probiotic supplementation for prevention and treatment of radiation-induced diarrhea. METHODS:T...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,meta分析,评审
doi:10.1097/MCG.0b013e3181a1f59c
更新日期:2009-07-01 00:00:00
abstract::The bewildering array of medications in the therapy of inflammatory bowel disease (IBD) often confounds the clinician in the choice of specific agents regarding the balance between safety and efficacy. This review surveys and evaluates currently available IBD therapies as well as those used in clinical trials of ulcer...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/00004836-200204000-00004
更新日期:2002-04-01 00:00:00
abstract::The synthesis of prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) in colonic mucosal cells was investigated in 7 patients and 10 controls. Biopsies obtained from the descending colon were isolated biochemically by a special technique and the suspension of isolated colonic cells was incubated during 45 min. Compared w...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199603000-00009
更新日期:1996-03-01 00:00:00
abstract::The term indeterminate colitis (IC) is an interim, or preliminary, descriptive term used by pathologists for cases of inflammatory bowel disease (IBD) in which a definite diagnosis of ulcerative colitis (UC) or Crohn's disease (CD) cannot be established based on the information available at the time of surgical sign-o...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/01.mcg.0000127686.69276.5b
更新日期:2004-05-01 00:00:00
abstract::In a double-blind trial 60% of acute variceal bleeding episodes were controlled with terlipressin (glypressin) compared with 37% in patients given placebo (NS). Rebleeding was more common in the placebo group so that at 5 days bleeding remained under control in 54% of patients treated with terlipressin compared with o...
journal_title:Journal of clinical gastroenterology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00004836-198902000-00014
更新日期:1989-02-01 00:00:00
abstract:BACKGROUND:Elevated plasma total homocysteine (tHcy) is associated with a higher risk of thrombosis. Crohn's disease (CD) is associated with hypercoagulability of undefined etiology. We investigated tHcy in patients with CD and its relationship with vitamin status, disease activity, location, duration, and history of t...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-200108000-00008
更新日期:2001-08-01 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:BACKGROUND:There has been constant speculation about the association between metabolic syndrome (MetS) and colorectal neoplasia (CN); however, the published results are conflicting. The aims of this study are to conduct a systematic search, and assess the literature to determine the available evidence on the associatio...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,meta分析,评审
doi:10.1097/MCG.0b013e3182688c15
更新日期:2013-01-01 00:00:00