Cost-effectiveness of proton pump inhibitor cotherapy in patients taking long-term, low-dose aspirin for secondary cardiovascular prevention.

Background: Patients with coronary heart disease (CHD) require long-term therapy with low-dose aspirin (ASA). Although these patients are at increased risk for upper gastrointestinal bleeding (UGIB) and proton pump inhibitor (PPI) cotherapy may reduce such risk, it is not known whether lifelong PPI cotherapy is cost-effective.

Methods: A Markov model was developed to compare lifelong therapy with ASA alone vs therapy with ASA plus PPI in patients with CHD who are at least 50 years old.

Early detection of liver cancer: diagnosis and management.

Hepatocellular carcinoma (HCC) is the fifth most common cause of cancer deaths worldwide, and the incidence is rising. Despite a wide array of treatment options, fewer than half of candidates for potentially curative treatments receive them. The diagnosis and management of HCC require a multidisciplinary approach involving various clinical specialties.

Sphincter of Oddi dysfunction and bile duct microlithiasis in acute idiopathic pancreatitis.

Although there are numerous causes of acute panc-reatitis, an etiology cannot always be found. Two potential etiologies, microlithiasis and sphincter of Oddi dysfunction, are discussed in this review. Gallbladder microlithiasis, missed on transcutaneous ultrasound, is reported as the cause of idiopathic acute pancreatitis in a wide frequency range of 6%-80%.

Transjugular intrahepatic portosystemic shunts in liver transplant recipients.

Background: The aim of this study was to determine the efficacy and safety of transjugular intrahepatic portosystemic shunts (TIPS) in liver transplant (LT) recipients with refractory ascites/variceal bleeding and to compare the observed outcomes with those obtained in cirrhotic controls.

Methods: Clinical features of 14 LT recipients referred for TIPS placement between August 1985 and September 2006 were reviewed and compared with published series and 28 cirrhotic control patients undergoing TIPS.

Results: The median age of the 14 LT recipients was 52 years, 57% had chronic hepatitis C virus and the median time from LT to TIPS placement was 46 months.

Management of cystic lesions of the pancreas.

Pancreatic cystic lesions are being increasingly identified. Clinical decision making is driven by the differential diagnosis of the cyst and, for the asymptomatic patient, its likelihood of causing harm. The fundamental issue is whether the cyst is neoplastic, and, if so, what is its risk for malignant degeneration.

Gastroparesis: symptoms, evaluation, and treatment.

Gastroparesis presents with gastrointestinal symptoms and nongastrointestinal manifestations in association with objective delays in gastric emptying. The condition may complicate several systemic disorders or may be idiopathic in nature. The diagnosis is made by directed evaluation to exclude organic diseases, which can mimic the clinical presentation of gastroparesis coupled with quantification of gastric emptying.

Type 1 diabetes and gastroparesis: diagnosis and treatment.

Patients with gastroparesis present with gastrointestinal symptoms and non-gastrointestinal manifestations in association with objective delays in gastric emptying. The condition complicates the course of many patients with type 1 diabetes mellitus, usually in those with longstanding poor glycemic control with other associated diabetic complications. The diagnosis is made by directed evaluation to exclude organic diseases that can mimic the clinical presentation of gastroparesis, coupled with verification of gastric retention.

A genotype-independent real-time PCR assay for quantification of hepatitis B virus DNA.

Accurate quantification of hepatitis B virus (HBV) DNA levels is important for monitoring patients with chronic HBV infection and for assessing their responses to antiviral therapy. This study aimed to develop a real-time PCR assay that is sensitive and can accurately quantify a wide range of HBV DNA levels across the known HBV genotypes. An "in-house" real-time PCR assay using primers and a TaqMan probe in a highly conserved region of the HBV surface gene was designed.

Hepatocellular carcinoma.

The number of patients who have hepatocellular carcinoma (HCC) is expected to more than double over the next 1 to 2 decades. Patients who have cirrhosis, regardless of cause, are at the highest risk for developing HCC. This article discusses surveillance of these patients for HCC by alpha-fetoprotein and ultrasound, evaluation using imaging, classification of HCC using the Barcelona staging classification, and treatment.

Management of drug-resistant chronic hepatitis B.

Lamivudine, adefovir, and entecavir are safe and effective orally administered inhibitors of hepatitis B virus (HBV) replication, but drug-resistant strains of HBV with point mutations in the HBV polymerase gene are being reported with prolonged treatment that can lead to viral rebound and serum alanine aminotransferase flares. Salvage treatment with antiviral agents including investigational nucleoside/nucleotide analogues is available but highlights the limitations and hazards of sequential antiviral monotherapy for chronic HBV. Studies of pegylated interferon combined with an antiviral agent or dual nucleoside/nucleotide combination therapy are awaited to minimize the incidence of drug-resistant HBV and improve long-term outcomes.

Biologic clocks and the gut.

The gastrointestinal tract displays biologic rhythms in basal gastric acid output, epithelial cell proliferation, gastrointestinal motility, and appetite regulation. Furthermore, the development of gastrointestinal complications after administration of aspirin and after chemo- and radiotherapy for metastatic colon cancer depends on the time of administration. Biologic rhythms are driven by so-called clock genes.

A survey of physician practices on prophylactic pancreatic stents.

Background: Several prospective studies confirm that prophylactic stent placement in the pancreatic duct (PD) during high-risk ERCP procedures decreases the risk of post-ERCP pancreatitis. Inconsistencies exist regarding the indications for prophylactic PD stent placement, the type of stent used, and stent follow-up.

Objective: To assess the current practice patterns of expert biliary endoscopists regarding prophylactic pancreatic duct stents.

Levofloxacin-based triple therapy versus bismuth-based quadruple therapy for persistent Helicobacter pylori infection: a meta-analysis.

Background: Levofloxacin-based triple therapy has been suggested as an alternative salvage therapy to bismuth-based quadruple therapy for persistent Helicobacter pylori (H. pylori) infection.

Methods: A search of PUBMED, EMBASE, EBM Review databases and abstracts from recent Digestive Disease Week, United European Gastroenterology Week, and European Helicobacter Study Group conferences was performed.

Sensitive line probe assay that simultaneously detects mutations conveying resistance to lamivudine and adefovir.

The INNO-LiPA HBV DR v2 assay is designed to detect hepatitis B virus mutations conveying resistance to lamivudine and adefovir. Our study confirms that this assay can simultaneously detect the presence of lamivudine and adefovir resistance mutations in clinical samples, has a high degree of concordance with sequencing, and can detect mutants earlier.

Tegaserod in the treatment of irritable bowel syndrome with constipation.

Tegaserod, a novel serotonin receptor agonist, has gained acceptance and widespread use for the treatment of women with irritable bowel syndrome and constipation. Development of this therapy evolved from the emerging role of serotonin in gastrointestinal motor, secretory and sensory functions. The efficacy and safety of tegaserod has been well established in women suffering from irritable bowel syndrome with constipation.

Adefovir-resistant hepatitis B can be associated with viral rebound and hepatic decompensation.

Background/aims: The susceptibility of adefovir-resistant hepatitis B virus (HBV) mutants is only reduced by 3-10-fold in in vitro studies, suggesting that virologic breakthrough and clinical deterioration are unlikely. The aim of this study was to describe the clinical course of patients with adefovir-resistant HBV infection.

Methods: Testing for adefovir-resistant mutations was performed on patients who had a suboptimal response or virologic breakthrough on adefovir.

GP73, a resident Golgi glycoprotein, is a novel serum marker for hepatocellular carcinoma.

Background/aims: Golgi protein-73 (GP73) is up-regulated in hepatocellular carcinoma (HCC). The aims of this study were to determine if GP73 is detected in the serum, and to establish the sensitivity and specificity of serum GP73 for diagnosing HCC.

Methods: Serum GP73 was detected by immunoblots and quantified by densitometric analysis.

Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: results of the HALT-C cohort.

Knowledge of the presence of cirrhosis is important for the management of patients with chronic hepatitis C (CHC). Most models for predicting cirrhosis were derived from small numbers of patients and included subjective variables or laboratory tests that are not readily available. The aim of this study was to develop a predictive model of cirrhosis in patients with CHC based on standard laboratory tests.

Sphincter of Oddi Dysfunction.

Sphincter of Oddi dysfunction (SOD) is a benign noncalculous obstruction of bile or pancreatic drainage at the level of the sphincter of Oddi. The disorder is clinically associated with either biliary pain or idiopathic pancreatitis, depending on the portion of the sphincter affected. Patients with suspected SOD are subdivided into three categories: these are type I, II, and III, depending on associated clinical evidence for the diagnosis.

Alcohol, tobacco and obesity are synergistic risk factors for hepatocellular carcinoma.

Background/aims: Alcohol has been shown to be an important risk factor for hepatocellular carcinoma (HCC). The role of tobacco as a risk factor for HCC is controversial. Recently, obesity has been reported to be a risk factor for HCC.

Esophageal Dilation / Dilators.

Esophageal dilation is the treatment of choice for most patients with esophageal dysphagia (functional and mechanical). Multiple forms of esophageal dilators are available. Mechanical dilators (guidewire/nonguidewire assisted) are the major forms of dilators used.

Prevention of hepatitis B virus-related hepatocellular carcinoma.

The most effective means of preventing hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) is to prevent HBV infection via global vaccination of infants. Universal vaccination of newborns has been shown to significantly reduce the incidence of HCC among Taiwanese children. Among HBV carriers, the incidence of HCC was significantly higher in those who were hepatitis B e antigen positive, suggesting that antiviral therapy that results in viral clearance or sustained suppression of HBV replication should reduce the incidence of HCC.

Newer markers for hepatocellular carcinoma.

The incidence of hepatocellular carcinoma (HCC) is increasing worldwide; the overall survival of patients with HCC is grim because most patients are diagnosed late, when curative treatment is not possible. Cirrhosis is the strongest risk factor for the development of HCC. HCC surveillance with alpha-fetoprotein (AFP) and ultrasonography has been recommended for persons with cirrhosis.