Dyspepsia: A stepwise approach to evaluation and management.

Let a patient's age and specific symptoms steer your initial investigation. Consider treatment options beyond antibiotics for H pylori gastritis and PPIs.

Predictive variables for half-Ironman triathlon performance.

Objectives: To examine the relationship between training, anthropometric characteristics, tapering, and time performance for a half-Ironman distance race.

Design: Cross sectional study in triathletes.

Methods: Data were obtained for 209 participants (155 males; 54 females) competing in a half-Ironman triathlon.

Evaluating screening age for colonoscopy: a quality assurance assessment.

Objective: To evaluate colonoscopies in patients aged 40 to 49 and 50 to 59 years from multiple endoscopy surgery centers serving a wide geographical area.

Methods: An observational prospective multicenter quality assurance review was conducted in 49 Ambulatory Surgery Centers in 17 states with 315 gastroenterologists. Care of patients and routine of gastroenterologists continued as standard practice with patients attending for purposes of screening, surveillance, and symptoms.

Withdrawal times and associated factors in colonoscopy: a quality assurance multicenter assessment.

Objective: To evaluate the use and impact of the recommended withdrawal time of at least 6 minutes from the cecum in colonoscopy in multiple gastroenterology endoscopy ambulatory surgery centers serving a wide geographical area.

Methods: An observational prospective multicenter quality assurance review was conducted in 49 ambulatory surgery centers in 17 states with 315 gastroenterologists. There was no intervention with this quality assessment program as care of patients and the routine of gastroenterologists continued as standard practice.

Gastrointestinal endoscopy in pregnant and lactating women: emerging standard of care to guide decision-making.

Endoscopic procedures generally are considered to be low-risk modalities, being performed on an on-demand basis in many ambulatory endoscopy centers and hospitals. However, the safety and efficacy of gastrointestinal endoscopy in pregnancy has not been well studied. In pregnancy, the risks to the fetus and mother are numerous and the magnitude of this risk will differ depending on trimester, the disease process being addressed, the underlying health and status of the maternofetal unit, and the nature of the endoscopic intervention being contemplated.

Use of omeprazole in the management of giant duodenal ulcer: results of a prospective study.

Background: Giant duodenal ulcer (GDU) is generally thought to require surgical intervention. Proton pump inhibitors have beneficial effects in peptic ulcer disease, but their role in GDU disease is unknown. We examined the use of omeprazole in GDU management.

Arterial oxygen saturation during emergency esophagogastroduodenoscopy. The effects of nasal oxygen.

Cardiopulmonary events account for many of the serious gastrointestinal endoscopy complications. Pulse oximetry monitoring detects hypoxemia to allow prevention of complications. Alternatively, prophylaxis by continuous nasal oxygen during the procedure may offset any tendency toward oxygen desaturation.

Pancreatitis in patients with end-stage renal disease.

In a population of 716 patients with end-stage renal disease (ESRD), 46 patients (6.4%) were identified as having pancreatitis. Pancreatitis was significantly more common in those with alcohol abuse, systemic lupus erythematosus (SLE), and polycystic kidney disease.

Limitations of percutaneous endoscopic jejunostomy.

Thirty-six patients at the University of Kentucky Medical Center underwent percutaneous endoscopic jejunostomy placement between January 1 and December 31, 1989. We retrospectively reviewed their charts for indications and complications of the procedure. Experience and outcome with the initial placement of the percutaneous jejunostomy tube was evaluated.

A multicenter, double-blind, randomized, placebo-controlled comparison of nocturnal roxatidine in the treatment of active duodenal ulcer disease. Multicenter Roxatidine Cooperative Study Group.

This multicenter randomized, double-blind, 4-wk study compared the new H2-receptor antagonistic roxatidine (R) to placebo (P) for treatment of endoscopically diagnosed active duodenal ulcer disease. Subjects were evaluated after 2 and 4 wk of treatment. Those whose ulcer was unhealed at 2 wk received 2 more weeks of treatment before final evaluation.

Lipid responses of hypercholesterolemic men to oat-bran and wheat-bran intake.

The hypocholesterolemic effects of oat bran (OB) have been recently challenged. To carefully document the hypocholesterolemic effects of OB, 20 hypercholesterolemic men admitted to a metabolic ward were randomly allocated to either OB or wheat bran (WB) for 21 d after a 7-d control-diet period. Control and treatment diets were designed to be identical in energy content and nutrients, differing only in the amount of soluble fiber.

Gaucher's disease complicated by bleeding esophageal varices and colonic infiltration by Gaucher cells.

We report a 10-yr-old child with Gaucher's disease who developed upper gastrointestinal bleeding from esophageal varices, as well as hemorrhage from a colonic polyp infiltrated with Gaucher cells. Both the varices and polyp were treated endoscopically, and the outcome was successful. Although gastrointestinal hemorrhage due to portal hypertension is considered a rare complication of Gaucher's disease, colonic infiltration with Gaucher cells has not been recognized previously.

Right ventricular thrombosis after peritoneovenous shunt: nonoperative treatment with successful outcome.

Complications of peritoneovenous shunt for intractable ascites include a high propensity to malfunction, facilitation of infection, and the induction of coagulopathies. Right heart thrombosis is a rarely encountered adverse effect, the management of which has not yet been defined. We report a patient with an extensive right heart thrombus in the setting of a blocked peritoneovenous shunt that was discovered incidentally and treated expectantly with subsequent complete resolution and satisfactory outcome.

Peptic ulcer disease in the elderly.

Peptic ulcer disease in the elderly poses challenges to the physician distinct from those encountered in younger individuals. Factors predisposing to the more aggressive natural history of peptic ulcer disease in the elderly are examined. These are of great importance in considering diagnostic investigations, the choice of therapeutic agents, and the management of complications.

Pancreatic function testing. Methods to identify exocrine insufficiency.

The diagnosis of chronic pancreatitis is ideally established by an appropriate clinical history and confirmatory radiologic imaging. However, in cases where imaging results are normal or equivocal, pancreatic function testing is necessary. Direct (intubation) tests are generally accepted as the best methods for study of pancreatic exocrine capacity, but indirect tests, which are well tolerated and generally simple to perform, are gaining interest.

Fatal amiodarone hepatoxicity.

The antiarrhythmic agent amiodarone is associated with numerous adverse effects, but clinically significant liver disease is rare. A patient is described who presented with muscle weakness, hepatomegaly, and ascites following 28 months of amiodarone usage. His condition deteriorated despite discontinuation of amiodarone therapy.

Peptic ulcer disease in the elderly.

The elderly are a growing minority; they comprise approximately 12% of the population but consume an increasing proportion of health care resources. Disease in the aged is unique in many ways, demanding special attention and study. This is particularly evident with regard to peptic ulceration, which is a more serious disorder in the elderly than in younger individuals, often presenting in an atypical manner and having a greater propensity to complications.

Immunoproliferative small-intestinal disease: clinical features and outcome in 30 cases.

Experience with 30 patients with immunoproliferative small intestinal disease followed prospectively between 1971 and 1986 is described. All presented with malabsorption or growth retardation and had similar clinical, biochemical, and radiological features, irrespective of the presence of lymphoma or immunological abnormality. Alpha-chain disease protein was detected in 4 of the 11 patients who had a non-lymphomatous, predominantly plasmacytic infiltration of the small bowel; and in 5 of the 19 cases with diffuse intestinal lymphoma.

Nocturnal dosage regimen of sucralfate in maintenance treatment of gastric ulcer.

Sixty-six patients with recently healed gastric ulcers were entered into a double-blind, placebo-controlled, six-month maintenance trial to determine whether sucralfate 2 g at night reduces the liability to recurrent ulceration. Thirty-three patients were randomly assigned to treatment with sucralfate and 33 were assigned to placebo. Endoscopy was performed at the time of entry into the study and at 24 weeks, or earlier if clinical relapse occurred during this period.

Annular pancreas associated with diffuse chronic pancreatitis.

A patient with longstanding diabetes and renal failure presented with painless vomiting due to duodenal obstruction was found to have an annular pancreas. Initial operative evaluation, later pathologically confirmed, demonstrated involvement of not only the annulus, but also the entire gland by diffuse atrophic chronic pancreatitis. We speculate on the possible influence of the underlying diabetes and renal disease on the pathogenesis of the unusual generalized chronic inflammatory changes and the precipitation of duodenal obstruction in this patient.

Asymmetry of lineages and the direction of evolutionary time.

Evolutionary time has a characteristic direction as demonstrated by the asymmetry of clade diversity diagrams in large statistical samples. Evolutionary groups generally concentrate diversity during their early histories, producing a preponderance of bottom-heavy clades among those that arise early in the history of a larger group. This pattern holds across taxonomic levels and across differences in anatomy and ecology (marine invertebrates, terrestrial mammals).