Review article: the role of antisecretory therapy in the management of non-variceal upper gastrointestinal bleeding.

Non-variceal, upper gastrointestinal bleeding accounts for 300,000 hospitalizations annually in the US and the risk of rebleeding and mortality remain high. The aim of this study was to review the incidence and causes of non-variceal upper gastrointestinal haemorrhage, criteria for early discharge, risk stratification and intravenous vs. oral proton-pump inhibitor use.

Patterns of use and public perception of over-the-counter pain relievers: focus on nonsteroidal antiinflammatory drugs.

Objective: To assess the frequency and indications for over-the-counter (OTC) nonsteroidal antiinflammatory drug (NSAID) use and to what degree the public is aware of their side effects.

Methods: Two surveys totaling 9062 respondents were performed of the American public. The Roper survey, conducted in 1997, and the National Consumers League (NCL) survey, conducted in December 2002, were intended primarily to assess the public's use of and attitudes toward NSAID and OTC analgesics.

Appropriate choice of proton pump inhibitor therapy in the prevention and management of NSAID-related gastrointestinal damage.

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with gastrointestinal adverse effects, ranging from dyspepsia and peptic ulcer disease to more serious complications such as haemorrhage or perforation. NSAID-induced gastrointestinal toxicity is a significant medical problem worldwide. Misoprostol is effective in reducing NSAID-induced mucosal damage, but patient compliance is limited by poor tolerance.

Endoscopic antireflux therapy: the Stretta procedure.

The Stretta procedure is safe and effective for the treatment of GERD. There are well-documented clinical trial data supporting its use, including a randomized sham-controlled study, single- and multi-center prospective trials, and community practice reports. The complication rate is within the acceptable range for therapeutic endoscopic procedures and less than the published complication rate for laparoscopic fundoplication.

Endoscopic therapy for Barrett's esophagus.

With the increase in the rate of esophageal adenocarcinoma in the United States and the Western world matched with the high morbidity and mortality of esophagectomy, there is an increasing need for new and effective techniques to treat and prevent esophageal adenocarcinoma. A wide variety of endoscopic mucosal ablative techniques have been developed for early esophageal neoplasia. However, long-term control of neoplasic risk has not been demonstrated.

Secretin-stimulated amylase release into blood is impaired in type 1 diabetes mellitus.

Background: Prior studies have provided data indicating the existence of close interaction between pancreatic endocrine and exocrine function, but few clinical studies have explored this relationship in depth. We compared pancreatic exocrine function non-endoscopically in individuals with type 1 diabetes mellitus, type 2 diabetes mellitus, and normal glucose tolerant controls, to assess the importance of local insulin production to pancreatic exocrine function.

Methods: The plasma amylase response to intravenous secretin challenge was measured in men with type 1 diabetes mellitus (n = 5), type 2 diabetes mellitus (n = 5), and normal controls (n = 3).

Control of intra-oesophageal and intra-gastric pH with proton pump inhibitors in patients with Barrett's oesophagus.

Background: A significant percentage of patients with Barrett's oesophagus (BE) will continue to manifest abnormal intra-oesophageal pH profiles regardless of proton pump inhibitor (PPI) therapy.

Aims: We conducted a prospective study in order to determine whether a change in PPI therapy would alter intra-oesophageal and intra-gastric acid suppression in BE patients.

Patients: Seventeen Helicobacter pylori-negative BE patients (16 males, 1 female; mean+/-S.

Patient-derived health state utilities for gastroesophageal reflux disease.

Background And Aims: Gastroesophageal reflux disease is a chronic disease that adversely affects health-related quality of life. The purpose of this study was to derive health state utilities for patients with chronic heartburn symptoms.

Methods: We used a custom-designed computer program in order to elicit utilities with the time-tradeoff and standard-gamble techniques.

A prospective study of oesophageal 24-h ambulatory pH monitoring in patients with functional dyspepsia.

Background: The diagnostic utility of 24-h oesophageal ambulatory pH monitoring in patients with functional dyspepsia has not been well established.

Aims: We performed a prospective study of oesophageal pH monitoring in patients with functional dyspepsia in order to assess whether a positive pH test might predict response to proton pump inhibitor therapy in a subset of functional dyspepsia patients.

Patients: Forty Helicobacter pylori-negative functional dyspepsia patients (35 males and 5 females, mean age (+/-S.

Gastroesophageal reflux.

Purpose Of Review: Gastroesophageal reflux disease (GERD) is a very common disorder that affects substantially the patient's quality of life. A number of important new developments in the diagnosis, clinical management, and medical, endoscopic, and surgical therapies were described in 2003, and they are summarized here.

Recent Findings: Most patients with symptomatic GERD do not have erosive reflux disease.

Cost-effectiveness of photodynamic therapy for high-grade dysplasia in Barrett's esophagus.

Background: Photodynamic therapy appears to be effective in ablating high-grade dysplasia in Barrett's esophagus. Our aim was to identify the most effective and cost-effective strategy for managing high-grade dysplasia in Barrett's esophagus without associated endoscopically visible abnormalities.

Methods: By using decision analysis, the lifetime costs and benefits of 4 strategies for which long-term data exist were estimated by us: esophagectomy, endoscopic surveillance, photodynamic therapy, followed by esophagectomy for residual high-grade dysplasia; and photodynamic therapy followed by endoscopic surveillance for residual high-grade dysplasia.

Review article: oesophageal complications and consequences of persistent gastro-oesophageal reflux disease.

The major oesophageal complications associated with persistent gastro-oesophageal reflux disease (GERD) include erosive oesophagitis, ulceration, strictures and gastrointestinal (GI) bleeding. Although the causes of these complications are uncertain, studies indicate that erosive oesophagitis may progress to the development of ulcers, strictures and GI bleeding. Pharmacological treatment with proton pump inhibitors is favoured over that with H(2)-receptor antagonists for the treatment of strictures.

Cost-effectiveness model of endoscopic screening and surveillance in patients with gastroesophageal reflux disease.

Background & Aims: Endoscopic screening and periodic surveillance for patients with Barrett's esophagus has been shown to be cost-effective in patients with esophageal dysplasia, with treatment for esophageal cancer limited to esophagectomy. Most gastroenterologists refer patients with high-grade dysplasia for esophagectomy, and effective endoscopic therapies are available for nonoperative patients with esophageal cancer. The cost-effectiveness of screening strategies that incorporate these nonsurgical treatment modalities has not been determined.

Communicating with patients with inflammatory bowel disease.

Ulcerative colitis and Crohn's disease, the two main forms of inflammatory bowel disease (IBD), are chronic illnesses that affect hundreds of thousands of Americans. Patients with IBD suffer chronically from diarrhea, abdominal pain, gastrointestinal bleeding, malabsorption, and weight loss requiring continuous medical and surgical attention. Despite recent advances in therapy, IBD follows a course of exacerbations and remissions with approximately 25-50% of patients relapsing annually.

GERD: the potential for endoscopic intervention.

Gastroesophageal reflux disease (GERD) is a common disorder that significantly affects patients' quality of life. Most patients with symptomatic GERD do not have erosive reflux disease. Frequent transient lower oesophageal sphincter relaxations and the presence of hiatal hernia have emerged as major and interacting factors in GERD.

Oesophageal and gastric pH profiles in patients with gastro-oesophageal reflux disease and Barrett's oesophagus treated with proton pump inhibitors.

Background: Acid plays a significant role in the development of gastro-oesophageal reflux symptoms and tissue damage. It is generally assumed that acid suppressive therapy with proton pump inhibitors improves or eliminates symptoms of gastro-oesophageal reflux disease by normalizing intra-oesophageal pH. However, the degree of acid suppression induced by proton pump inhibitor therapy in patients with gastro-oesophageal reflux disease and/or Barrett's oesophagus has not been adequately studied.

Features of gastroesophageal reflux disease in women.

Objectives: Gastroesophageal reflux disease (GERD) is as common in women as in men, and may present with various symptoms, such as heartburn, regurgitation, dysphagia, or chest pain. In this study, we evaluated the patterns of symptomatic GERD and the spectrum of disease activity in women and compared them to a cohort of disease- and age-matched men.

Methods: We studied 543 adults, both men and women, referred for evaluation because of symptoms or signs suggestive of GERD.

Risk of serious upper gastrointestinal and cardiovascular thromboembolic complications with meloxicam.

Purpose: To assess the risk of serious gastrointestinal and thromboembolic complications with approved doses of meloxicam.

Methods: We pooled data from clinical trials of meloxicam at doses of 7.5 or 15 mg/d.

Antimicrobial resistance incidence and risk factors among Helicobacter pylori-infected persons, United States.

Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer. H. pylori infection is curable with regimens of multiple antimicrobial agents, and antimicrobial resistance is a leading cause of treatment failure.