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1.
Pedrosa M 《Current Treatment Options in Gastroenterology》2001,4(1):67-71
Opinion statement
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| – | Dysplasia is the most important marker of progression to invasive cancer in Barrett’s esophagus. |
| – | Intensive endoscopic surveillance with biopsy may identify invasive cancer in a patient with high-grade dysplasia (HGD). |
| – | Close relationship with an experienced gastrointestinal pathologist and thoracic surgeon will improve treatment decisions and patient outcomes. |
| – | No intervention is required in patients with low-grade dysplasia (LGD); continued surveillance is recommended. |
| – | Surgical resection is the currently accepted therapy for high-grade dysplasia. Endoscopic ablative therapy remains experimental. |
2.
Andersen JM 《Current Treatment Options in Gastroenterology》2001,4(5):433-440
Opinion statement
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| – | Venous malformations of blue rubber bleb nevus syndrome (BRBNS) may involve any area of the gastrointestinal tract. |
| – | Gastrointestinal blood loss and anemia brings these patients to the attention of gastroenterologists. |
| – | Effective treatment of these malformations throughout the gastrointestinal tract requires aggressive management to ultimately decrease blood loss and restore the patient’s hemoglobin to a near-normal level. |
| – | Treatment of patients with BRBNS includes supportive measures, endoscopic ablation, and surgery. |
| – | Supportive therapy consists of proton pump inhibitors and octreotide to decrease blood loss, iron replacement, and blood transfusions. |
| – | The effective management of patients with anemia demands aggressive treatment of venous malformations in the small bowel. This requires a collaboration between the surgeon and the therapeutic endoscopist, ie, laparotomy and excision of larger lesions with surgically assisted enteroscopy and thermal ablation of smaller lesions via enterotomy. |
| – | There is no effective systemic therapy for treatment of the vascular malformations in patients with BRBNS. |
3.
Buchman AL 《Current Treatment Options in Gastroenterology》2002,5(3):173-180
Opinion statement
相似文献
| – | An oral calcium supplement (1000 mg/day) is recommended. |
| – | Regular exercise should be performed. |
| – | Ethanol intake should be moderate. |
| – | Protein intake should be moderate. |
| – | The patient’s vitamin D status should be determined and corrected with an oral supplement when deficiency is present. |
| – | Baseline and yearly bone density measurement should be taken. |
| – | Alendronate, 10 mg/d orally, or risedronate, 5 mg/d orally, should be given to patients with osteopenia. |
| – | Use of corticosteroids, cyclosporin, tacrolimus, and methotrexate should be limited to the short term when possible. |
| – | Estrogen replacement therapy is recommended in postmenopausal women unless contraindications exist. |
4.
Navarro VJ 《Current Treatment Options in Gastroenterology》1999,2(6):457-462
Opinion statement
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| – | A suspicion, even if low, of spontaneous bacterial peritonitis (SBP) should prompt a diagnostic paracentesis to be performed on presentation. |
| – | Empiric antibiotic therapy with a third-generation cephalosporin should commence upon demonstration of over 250 granulocytes/mm3 in ascitic fluid. |
| – | Treatment for 5 days in uncomplicated SBP is sufficient; persistent symptoms and/or ascites fluid showing persistent granulocytosis (over 250 cells/mm3) should be handled by broadening of antibiotic spectrum and searching for secondary causes of peritonitis. |
| – | Antibiotic prophylaxis for cirrhotic patients with ascites and acute gastrointestinal hemorrhage and in those with a prior history of SBP is indicated. |
5.
Opinion statement
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| – | Treatment of hepatic cysts should be considered only for those patients who are symptomatic. |
| – | For simple cysts, percutaneous aspiration invariably leads to recurrence; laparoscopic deroofing is usually curative. |
| – | Open deroofing (fenestration) should be reserved for cysts inaccessible by laparoscopy. |
| – | Percutaneous instillation of sclerosing agents (ethanol, iophendylate, minocycline) into nonbiliary and nonparasitic cysts is an alternative therapeutic option in certain cases. |
| – | Due to increased morbidity, hepatic resection should be reserved for polycystic liver disease, diffuse hepatic involvement, or recurrence after a deroofing procedure. |
| – | Patients with congenital fibropolycystic disorders (eg, congenital hepatic fibrosis) with evidence of hepatic decompensation, should be considered for liver transplantation. |
| – | For hepatic hydatid cysts, simple cystectomy or the PAIR (puncture, aspirate, inject, and reaspirate) technique with albendazole treatment have been shown to be equally successful. |
| – | In the case of alveolar echinococcosis, hepatic resection and liver transplantation are the only effective modalities for localized and extensive hepatic disease, respectively. |
6.
Opinion statement
相似文献
| – | Fulminant ulcerative colitis necessitates immediate hospitalization. |
| – | Supportive therapy such as aggressive rehydration, restriction of oral intake, and consideration of parenteral nutrition should be initiated. |
| – | High-dose intravenous steroids should be started in almost all cases. |
| – | Antibiotics and cyclosporine should be considered, especially in disease refractory to steroid therapy. |
| – | Indications for surgery should always be kept in mind, and early involvement of the surgical team is always encouraged. |
| – | Avoidance of life-threatening complications such as toxic megacolon, hemorrhage, and perforation is the goal of any treatment for fulminant ulcerative colitis. |
7.
Perlmutter DH 《Current Treatment Options in Gastroenterology》2000,3(6):451-456
Opinion statement
相似文献
| – | Most of the care of liver disease in alphα1-antitrypsin (α1-AT) deficiency involves supportive management for complications of chronic liver disease including gastrointestinal bleeding, ascites, edema, encephalopathy, coagulation disturbances, spontaneous bacterial peritonitis, and hepatorenal syndrome. |
| – | Some of these patients will have manifestations of cholestatic injury, including pruritus, hypercholesterolemia, and steatorrhea with fat-soluble vitamin deficiencies. |
| – | The major challenge for the clinician taking care of these patients is the timing of referral for liver transplantation therapy. |
| – | Timing of such referral is a relatively straightforward decision in α1-AT-deficient patients with progressive liver dysfunction. |
| – | Some patients have nonprogressive or slowly progressing liver disease even after the development of cirrhosis or portal hypertension. Timing of liver transplantation in these patients should not be based simply on the presence of cirrhosis, portal hypertension or mild liver synthetic dysfunction, but rather on the basis of a subjective judgment by the hepatologist, patient, and family that manifestations of liver disease are interfering with overall life functioning. |
8.
Opinion statement
相似文献
| – | Oropharyngeal dysphagia (OPD) develops when a large number of local and systemic causes lead to abnormal oropharyngeal bolus transport and/or compromise of airway safety. |
| – | Only a minority of cases of OPD are amenable to curative therapy. |
| – | Rehabilitation of swallowing function is the cornerstone of therapy for the overwhelming majority of patients. |
| – | Optimal management of oropharyngeal dysphagia requires a multidisciplinary approach involving a gastroenterologist, swallow/therapist, ENT physician, and rehabilitation and nutrition professionals, along with the support of family members. |
| – | Therapy of OPD is directed at improvement of oropharyngeal bolus transport, ensuring adequate airway safety, and enhancing overall quality of life. |
| – | A better understanding of the pathophysiologic basis of OPD has resulted in more efficacious therapy. However, given the large social and economic impact of OPD, continuing research is needed for development of better diagnostic and therapeutic modalities. |
9.
Hasler WL 《Current Treatment Options in Gastroenterology》2001,4(4):339-349
Opinion statement
相似文献
| – | Disorders of augmented visceral perception include functional (or nonulcer) dyspepsia and irritable bowel syndrome (IBS). |
| – | Enhancement of luminal perception can result from alterations in normal elastic gut wall properties or exaggerated responsiveness of visceral sensory nerve pathways. |
| – | Standard therapies for functional dyspepsia are effective in subsets of patients and may act in part by compensating for gastric hypersensitivity (as with acid-suppressing drugs) or by enhancing gastric compliance (as with some motor-stimulating agents). |
| – | Likewise, conventional treatments of patients with IBS reduce visceral perception via effects on sensory nerve function (fiber supplements) or luminal wall properties (antispasmodic drugs). |
| – | Antidepressants are increasingly used in patients with functional dyspepsia or IBS. These drugs have several purported mechanisms, including 1) luminal relaxation, 2) blunting of visceral hypersensitivity, and 3) modulation of central nervous system pain processing pathways. |
| – | The efficacy of available and investigational agents that act as visceral analgesics or luminal relaxants is an area of intense pharmaceutical research. |
10.
Opinion statement
相似文献
| – | Transposition of the great arteries (TGA) is a lethal condition without intervention. |
| – | Cross-sectional echocardiography is the diagnostic investigation of choice. |
| – | Intravenous infusion of prostaglandin is employed to maintain ductal patency and allow mixing of blood, thus improving tissue oxygenation. |
| – | Balloon atrial septostomy is recommended once the diagnosis is made. |
| – | The arterial switch is accepted as the best option for simple TGA. |
| – | Late follow-up includes survivors of the intra-atrial repair (Mustard and Senning operations), and the emerging cohort of survivors of the arterial switch procedure. |
| – | Arrhythmia, baffle stenosis, tricuspid valve dysfunction, systemic ventricular dysfunction, and sudden death may occur late during follow-up after the Mustard or Senning procedure. |
| – | There are less data for late follow-up after arterial switch; however, late death is rare, usually is related to reoperation, and important arrhythmias are uncommon. The long-term fate of the coronary circulation is unknown but coronary arterial obstruction has been reported. |
| – | Continuing long-term surveillance is essential to detect the development of late problems in all groups of survivors. |
11.
Opinion statement
相似文献
| – | Balloon valvuloplasty provides optimal treatment for moderate and severe pulmonary valve stenosis. |
| – | Dysplastic pulmonary valves may not respond to balloon dilation and frequently require surgical treatment. |
| – | Balloon angioplasty with or without stenting is the preferred treatment of peripheral pulmonary stenosis. |
12.
Opinion statement
相似文献
| – | There are four unique liver diseases that occur only during pregnancy and resolve after delivery. |
| – | Several liver diseases occur more commonly during pregnancy. |
| – | These must be distinguished form acute or chronic liver diseases that coincidentally occur during pregnancy. |
13.
Opinion statement
相似文献
| – | Endoscopic procedures, particularly those requiring mucosal biopsy or polypectomy, are associated with an increased risk of gastrointestinal bleeding during or after procedure. This risk is increased in patients treated with chronic anticoagulant therapy. |
| – | Anticoagulant therapy needs to be withheld for certain high-risk endoscopic procedures to prevent bleeding complications. However, this may expose some patients to an increased risk of thromboembolic complications during this period, particularly in patients with recent episodes of venous or arterial thromboembolism and those with prosthetic mechanical valves. |
| – | Identifying patients at a high risk for thromboembolic complications and more aggressively managing their anticoagulant regimen (by switching to heparin) in preparation for the endoscopic procedure decreases the length of time they remain unanticoagulated and helps minimize complications. |
| – | Low molecular weight heparin as a bridging therapy in preparation for endoscopic procedures can obviate unnecessary hospitalization and is an attractive strategy for managing high-risk patients. |
14.
Panganamamula KV Fisher RS Parkman HP 《Current Treatment Options in Gastroenterology》2002,5(2):153-160
Opinion statement
相似文献
| – | Functional (nonulcer) dyspepsia refers to upper abdominal pain or discomfort with or without symptoms of early satiety, nausea, or vomiting with no definable organic cause. The current Rome II criteria help to diagnose functional dyspepsia and avoid misdiagnosis of gastroesophageal reflux disease and irritable bowel syndrome as functional dyspepsia. |
| – | Assessment of gastric emptying with scintigraphy or breath testing may be useful in identifying delayed gastric emptying in patients with dyspeptic symptoms and may be helpful in patient management. Electrogastrography is a noninvasive test that evaluates for gastric dysrhythmias. Satiety testing is being evaluated as an indirect test for impaired fundic relaxation and visceral hypersensitivity. |
| – | The symptom response to Helicobacter pylori therapy in patients with functional dyspepsia and a negative endoscopy examination but a positive H. pylori test is marginal. |
| – | Lifestyle modifications often are suggested for initial treatment of functional dyspepsia. Dietary changes such as frequent small meals, low-fat diet, and avoidance of certain aggravating foods may improve symptoms. Additional measures include cessation of smoking, avoiding excess alcohol intake, and minimizing coffee intake. Antacids and over-the-counter histamine type 2 receptor antagonists may be helpful as an “on-demand” therapy for intermittent symptoms. They are safe and relatively inexpensive. |
| – | Different subgroups of functional dyspepsia are based on the predominant symptom and may help in choosing an appropriate drug to initiate therapy. If the predominant symptom is epigastric pain (ulcer-like functional dyspepsia), histamine-2 receptor antagonists or proton pump inhibitors are the initial treatment of choice. If fullness, bloating, early satiety or nausea is the predominant complaint (dysmotility-like functional dyspepsia), a prokinetic agent may help. Metoclopramide is the only available effective prokinetic agent at present. If metoclopramide is used, short-term treatment and discussion of possible side effects with the patient are advised. |
| – | If there is no response to these initial treatments, switching therapy from proton pump inhibitor to prokinetic or vice versa can be tried. |
| – | If these treatment options fail, patient re-evaluation for other disorders (including other functional bowel disorders) is advised. A low-dose tricyclic antidepressant at bedtime may be helpful for treatment of visceral hypersensitivity. |
15.
Opinion statement
相似文献
| – | Esophageal malignancies presenting with dysphagia from luminal obstruction generally are not resectable for cure, and palliative therapy is the primary focus. |
| – | Self-expandable metal stents (SEMS) have replaced plastic stents as a primary mode of palliation for malignant esophageal obstruction because of the relative ease of insertion, lower initial morbidity, and larger stent diameter. |
| – | Self-expandable metal stents are ideal for patients with midesophageal tumors. |
| – | A majority of patients experience relief of dysphagia with SEMS and dietary modification, but the initial cost is high and early morbidity may be significant. |
| – | The placement of SEMS across the gastroesophageal junction may result in free reflux that may improve with a stent containing a one-way gastric flap valve. |
| – | The placement of SEMS in the cervical esophagus, although more difficult, less effective, and less well tolerated, also may be successful. |
| – | Coated SEMS are a treatment of choice for individuals with tracheoesophageal fistula. |
| – | Delayed complications occur in up to 40% of patients and include stent migration, bleeding, perforation, fistula formation, and occlusion. Most complications can be managed endoscopically and additional stents may be placed for tumor overgrowth. |
| – | The comparison of three currently available SEMS for esophageal malignancy show no statistically significant differences with regard to ease of placement, effectiveness, complications, and mortality. |
| – | The use of SEMS for patients with benign disease is still considered experimental. |
16.
Opinion statement
相似文献
| – | Idiopathic slow-transit constipation is a clinical syndrome predominantly affecting women, characterized by intractable constipation and delayed colonic transit. This syndrome is attributed to disordered colonic motor function. |
| – | The disorder spans a spectrum of variable severity, ranging from patients who have relatively mild delays in transit but are otherwise indistinguishable from irritable bowel syndrome to patients with colonic inertia or chronic megacolon. |
| – | The diagnosis is made after excluding colonic obstruction, metabolic disorders (hypothyroidism, hypercalcemia), drug-induced constipation, and pelvic floor dysfunction (as discussed by Wald [1]). |
| – | Most patients are treated with one or more pharmacologic agents, including dietary fiber supplementation, saline laxatives (milk of magnesia), osmotic agents (lactulose, sorbitol, and polyethylene glycol 3350), and stimulant laxatives (bisacodyl and glycerol). |
| – | A subtotal colectomy is effective and occasionally is indicated for patients with medically refractory, severe slow-transit constipation, provided pelvic floor dysfunction has been excluded or treated. |
17.
Shabetai R 《Current treatment options in cardiovascular medicine》2000,2(5):385-397
Opinion statement
相似文献
| – | The treatment of sarcoid cardiomyopathy can be considered in part the treatment of the systemic disorder, and in part cardiac involvement, the manifestations of which may differ greatly. Therapy for the systemic disease is corticosteroid. Therapy for cardiac involvement includes prednisone, but because treatment must ameliorate or abolish many differing manifestations, therapy differs among patients. |
| – | Asymptomatic patients (the majority) who are free from serious manifestations of the disease do not require pharmacologic or interventional treatment. |
| – | Patients with dilated cardiomyopathy require treatment for congestive heart failure. |
| – | High-grade atrioventricular conduction delay usually necessitates a permanent electronic pacemaker. |
| – | Life-threatening arrhythmia usually requires implantation of an automatic implantable cardiac defibrillator (AICD). Antiarrhythmic drugs may also be needed. |
| – | Cardiac tamponade should be treated by drainage of pericardial fluid. |
| – | Pericardiectomy is usually the appropriate treatment for patients who develop significant constrictive pericarditis. |
| – | Calcium channel blockers may be helpful for severe diastolic dysfunction that occurs in those with restrictive cardiomyopathy. |
| – | Therapy should be given to those few patients who manifest hypertrophic cardiomyopathy to relieve left ventricular outflow obstruction. |
| – | Cardiac transplantation for intractable heart failure or arrhythmia may be needed. |
18.
Opinion Statement
相似文献
| – | Early diagnosis permits preventive therapy to preempt development of organ damage. |
| – | In all diagnosed patients, both symptomatic and asymptomatic, pharmacologic therapy is lifelong, and maintenance treatment to prevent copper toxicity is mandatory. |
| – | Patients with either fulminant hepatic failure or hepatic insufficiency unresponsive to medical therapy should be considered for orthotopic liver transplantation, which effectively cures Wilson’s disease. |
| – | Prognosis is excellent for compliant patients receiving pharmacologic therapy. |
19.
Vakil N 《Current Treatment Options in Gastroenterology》2000,3(4):341-345
Opinion statement
相似文献
| – | There is no definitive therapy for this disorder. |
| – | Heliobacter pylori eradication therapy is only useful in areas with a high prevalence of H. pylori-related ulcer disease |
| – | Proton pump inhibitors are effective in short-term treatment for dyspepsia with a predominant symptom of epigastric pain |
| – | Prokinetic agents may be useful in some patients, particularly those with dysmotility-like dyspepsia, but serious side effects limit their usefulness. |
20.
Broughan TA 《Current Treatment Options in Gastroenterology》1999,2(2):154-161
Opinion statement
相似文献
| – | Gallstone disease is a common clinical problem that poses particular difficulties for our aging and increasingly obese population. |
| – | Exciting new research suggests an infectious cause for most cholesterol stones. |
| – | The keys to managing patients with gallstone disease are recognition of the wide spectrum of clinical disease resulting from gallstones and a flexible, multidisciplinary approach to diagnosis and treatment. |
| – | The biliary tract has been a proving ground in the development of minimally invasive technology. |