Prospective, randomized, controlled comparison of the use of polyethylene glycol electrolyte lavage solution in four-liter versus two-liter volumes and pretreatment with either magnesium citrate or bisacodyl for colonoscopy preparation.

Background: Laxative pretreatment decreases the volume of polyethylene glycol electrolyte lavage solution (PEG-ELS) required for colonoscopy without compromising preparation quality. We compared the use of 4 L of PEG-ELS with the use of 2 L plus a laxative.

Methods: One hundred fifty consecutive patients (148 men) undergoing outpatient colonoscopy were randomly selected for one of three preparations (Prep 1: 4 L PEG-ELS; Prep 2: 2 L PEG-ELS plus 296 mL magnesium citrate 1 hour prior; Prep 3: 2 L PEG-ELS plus bisacodyl 20 mg).

A study of the prevalence of Helicobacter pylori infection and other markers of upper gastrointestinal tract disease in patients with rosacea.

Objective: Recent reports have suggested that patients with rosacea, a chronic inflammatory skin disorder of unknown etiology, have an increased prevalence of Helicobacter pylori infection. However, no causal relation has been identified. This study was designed to determine the prevalence of H.

Randomized controlled trial of rectal tube placement for the management of abdominal distension following colonoscopy.

Background: Traditionally, endoscopists have sought to provide maximum comfort for patients undergoing colonoscopy but may have been less concerned with the level of patient discomfort following the procedure. The aim of this study was to examine the effectiveness of rectal tube placement for abdominal decompression following colonoscopy in an effort to limit patient discomfort.

Methods: We conducted a prospective, single-blind, randomized controlled trial in 67 consecutive men undergoing elective colonoscopy.

For what conditions is there evidence-based justification for treatment of Helicobacter pylori infection?

Evidence-based medicine combines clinical expertise and the best available evidence from systematic research to aid decision making in patient care. Levels of evidence can be graded from I to V, with level I, the strongest, coming from large randomized controlled trials (RCTs). When a definitive RCT has not been performed, or is impracticable or inappropriate, lesser grades of evidence are used.

Nonencapsulated, intact omeprazole granules effectively suppress intragastric acidity when administered via a gastrostomy.

Unlabelled: Because of its acid-labile nature, omeprazole is usually administered as encapsulated enteric-coated granules. The gelatin capsule and acid-resistant coating are essential for effective drug absorption and optimal bioavailability.

Objective: This study tested the effectiveness of nonencapsulated, intact omeprazole granules in suppressing intragastric acidity when administered through a gastrostomy.

Randomized, controlled comparison of two forms of preparation for screening flexible sigmoidoscopy.

Objective: There is a paucity of data regarding the optimal form of bowel preparation for flexible sigmoidoscopy. Most endoscopists recommend enemas. A simpler preparation that is easy, acceptable, and that reduces patient encounter time would be desirable, and might be cost-effective.

Helicobacter pylori: clarifying the issues and curing the disease.

This paper summarizes the presentations and discussions at a recent meeting on H. pylori infection attended by gastroenterologists from around Europe and North America. The meeting was sponsored by Abbott Laboratories International Division.

Optimizing the pharmacology of acid control in acid-related disorders.

Clinical evidence supports the relationship between acid suppression and healing of duodenal ulceration and reflux esophagitis. In contrast to H2-receptor antagonists which suppress acid secretion by inhibiting the initial stimulation of the parietal cell, proton pump inhibitors directly inhibit hydrogen ion secretion and can, therefore, better provide the degree and duration of intragastric pH elevation necessary for the optimal management of duodenal ulceration and reflux esophagitis. Clinical studies have shown that proton pump inhibitors, such as omeprazole and lansoprazole, provide more rapid healing and higher healing rates for both duodenal ulcers and reflux esophagitis than do H2-receptor antagonists.

Candida splenic abscess in the absence of obvious immunodeficiency.

Focal hepatosplenic candidiasis has been increasingly recognized as a variant of disseminated candidiasis in immunocompromised patients. It rarely presents as Candida splenic abscess. Its occurrence in non-leukemic patients is quite rare.

Outcomes of routine testing of liver enzymes in institutionalized geriatric patients.

This study sought to identify any benefit of routine liver function tests (LFTs) in chronically ill, geriatric patients and to assess which patients require evaluation for abnormal LFT levels. A retrospective chart review was carried out on 268 consecutive patients (M:F = 1.2, mean age 77 years, range 61-98 years) presenting for acute care from a long-term care facility.

Recurrent peptic ulceration.

Recurrent peptic ulcer disease has traditionally posed problems for practicing physicians. While many treatment options have been promoted in the past, recent understanding of the role of Helicobacter pylori has completely altered our approach to this clinical problem. Since most ulcers are related to H.

Clinical expressions of Helicobacter pylori infection.

Helicobacter pylori infection is very common both in the United States and internationally. However, clinical manifestations of this infection vary markedly among different individuals. Apart from gastritis, which may be asymptomatic, patients may develop peptic ulceration or a gastric neoplasm.

The tolerability and safety profile of famotidine.

Famotidine is a specific, long-acting histamine2-receptor antagonist. It is indicated for the treatment of duodenal ulcer, gastric ulcer, gastroesophageal reflux disease, and Zollinger-Ellison syndrome. Since its introduction for the treatment of acid-related disorders in 1985, an estimated 18.

A systematic review of the association between Barrett's esophagus and colon neoplasms.

Objective: Patients with Barrett's esophagus may be at increased risk of colon neoplasms, including cancer. However, different studies of this have yielded conflicting results. The objective of this analysis was to review all existing published data in an attempt to determine whether there is such an association and, if so, to estimate the level of risk.

The rationale for continuous maintenance treatment of reflux esophagitis.

Reflux esophagitis is a chronic process associated with frequent episodes of relapse in many patients. In addition, the disease may be progressive in at least some patients. Erosion of the esophageal mucosa precedes the development of some of the complications of the condition.

Critical issues in the pathophysiology and management of peptic ulcer disease.

Objective: To discuss some of the critical issues in the pathophysiology and management of peptic ulcer disease.

Opinion: Peptic ulcer disease has multiple causes, although gastric acid has traditionally been considered the primary aggressive factor. Helicobacter pylori infection is established as a major causative factor, but some aspects of the mechanisms by which H.

Optimizing acid suppression for treatment of acid-related diseases.

Gastric acid is of central importance in the pathogenesis of duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease. Pharmacological reduction of acid secretion is, therefore, the mainstay of current treatment, but the optimal degree of acid suppression remains incompletely understood. This paper considers the ideal ways of assessing and reporting the pharmacological effectiveness of acid-inhibiting drugs and relating such data to clinical efficacy.

Intestinal permeability in patients with Crohn's disease and their first-degree relatives.

Objective: To measure small intestinal permeability in a group of patients with Crohn's disease in clinical remission and their apparently healthy first-degree relatives.

Methods: Administration of 51Cr-labeled EDTA and subsequent measurement of its excretion in a 24-h urine collection.

Results: Excretion of 51Cr-EDTA was not elevated in either the patients or in first-degree relatives.

Appropriate acid suppression for optimal healing of duodenal ulcer and gastro-oesophageal reflux disease.

Comparisons of the effectiveness of treatments for healing duodenal ulcer are essential to determine optimal management strategies for both economic analysis and quality-of-life evaluation. Differences are usually made on the basis of the proportion of ulcers healed at varying time intervals. It has been shown by meta-analysis that healing of duodenal ulcers with antisecretory drugs is directly correlated to the degree of acid suppression.