共查询到20条相似文献，搜索用时 765 毫秒
1.
Opinion statement
相似文献
| – | Crohn’s disease of the small intestine is a chronic relapsing disease that requires all the knowledge and ingenuity of the gastroenterologist to successfully treat the disease and the patient. |
| – | For mild to moderate disease, the first line of therapy is to utilize maximum doses of mesalamine to achieve a remission. |
| – | If the patient relapses, the maximum dose of mesalamine required to achieve remission should be continued. |
| – | If the disease relapses despite maximum mesalamine, antibiotics should be tried (before prescribing corticosteroids) using ciprofloxacin 500 mg b.i.d., alone or in combination with metronidazole 250 mg q.i.d. for 2 to 3 weeks. If successful, antibiotics can be slowly tapered off. |
| – | If antibiotics are unsuccessful, one may try elemental diet for 2 weeks before starting corticosteroids. |
| – | For moderate to severe Crohn’s disease, begin 40 mg of prednisone. After 2 weeks, taper slowly and start 6-MP or azathioprine, which can be used for several years. |
| – | If the disease recurs on 6-MP or azathioprine, or prior to 6-MP or azathioprine having a chance to be effective, give an IV infusion of Infliximab, which can be repeated at 4 to 8 weeks after the initial infusion. |
| – | If the patient continues to be unwell, surgery should be contemplated. |
2.
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. |
3.
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. |
4.
Opinion statement
相似文献
| – | 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. |
5.
Opinion statement
相似文献
| – | Coagulopathy in patients with liver disease results from impairments in the clotting and fibrinolytic systems, as well as from reduced number and function of platelets. |
| – | Parenteral vitamin K replacement corrects coagulopathy related to biliary obstruction, bacterial overgrowth, or malnutrition. Vitamin K is less effective for coagulopathy caused by severe parenchymal liver injury. |
| – | Transfusion of fresh frozen plasma is the hallmark of treatment of significant coagulopathy in patients with liver disease and active bleeding. |
| – | Transfusion of fresh frozen plasma also reverses moderate to severe coagulopathy of cirrhosis prior to invasive procedures. |
| – | Cryoprecipitate is useful for severe coagulopathy with hypofibrinogenemia, especially when avoidance of volume overload is desired. |
| – | Exchange plasmapheresis is useful in selected patients with coagulopathy due to liver disease, in whom fresh frozen plasma fails to correct coagulopathy or in patients who have coexistent severe fluid overload. |
| – | Platelet transfusions, pooled or single donor, are useful in thrombocytopenic patients prior to performing invasive procedures or in the presence of significant bleeding, especially when the platelet count is below 50,000/mL. |
| – | The use of recombinant factor VIIa and thrombopoietin therapy for correction of coagulopathy and thrombocytopenia, respectively, in patients with cirrhosis, is currently under investigation. |
| – | Therapy with prothrombin complex concentrates, 1-deamino-8-D-arginine vasopressin and antithrombin III concentrates for the management of coagulopathy caused by liver disease can be hazardous and the use of these products is considered investigational at the present time. |
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.
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. |
8.
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. |
9.
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. |
10.
Anil Tumbapura MD Scott Kuwada MD James A. DiSario MD 《Current Treatment Options in Gastroenterology》2000,3(1):51-57
Opinion statement
相似文献
| – | Adenocarcinomas of the small intestine are rare tumors accounting for about 1% of all gastrointesinal neoplasms. |
| – | These cancers have a poor prognosis, perhaps because of the nonspecific symptoms and delay in diagnosis. |
| – | They can arise in the setting of Crohn’s disease, celiac sprue, and inherited colon cancer syndromes like familial adenomatous polyposis (FAP). |
| – | As most of these lesions occur in the duodenum or proximal jejunum, upper endoscopy and push enteroscopy are reasonable initial diagnostic tests. Enteroclysis and intraoperative enteroscopy may be complementary to these procedures. |
| – | Surgical cures may be possible in patients with tumors detected at an early and resectable stage. Endoscopic therapy is useful for cure of premalignant lesions and palliation of unresectable disease. |
| – | Chemotherapy and radiotherapy have limited impact in the management of these tumors, because they are often of advanced stage at the time of presentation. |
11.
Opinion statement
相似文献
| – | More than 80% of cases of amebic liver abscess can be managed with a 14-day course of intravenous or oral metronidazole. In cases of suspected amebic liver abscess, treatment should be started before diagnostic confirmation. |
| – | If no clinical improvement is evident by 72 to 96 hours, treatment should be changed to dehydroemetine and chloroquine. |
| – | Invasive treatment is necessary only in patients in whom medical treatment fails within 5 days or in whom signs of clinically severe disease are present. |
| – | A 10-day course with a luminal agent such as paromomycin to eliminate intestinal cysts, which are resistant to imidazoles, should always follow treatment of the liver abscess. |
| – | Percutaneous catheter drainage is indicated in patients with impending rupture, with a lesion 6 cm or more in diameter, with an abscess located in the left lobe or high in the dome of the right lobe, or in whom medical treatment fails. |
| – | Although sympathetic pleural effusion is not an indication for drainage, direct pulmonary involvement or spread to pleural or lung tissues requires drainage. |
| – | Intraperitoneal rupture and peritonitis necessitate open surgical drainage. |
| – | Only a small minority of amebic liver abscesses are secondarily infected by other organisms. |
| – | Because relapses are possible, feces should be checked for cysts monthly for several months after therapy. |
12.
Opinion statement
相似文献
| – | In the United States, the majority of patients with granulomatous liver disease do not have an identifiable cause. |
| – | When a specific diagnosis can be made, therapy should be directed at eradicating the cause. |
| – | A plan of management must recognize the drug history and nationality of the patient, chest radiograph, slit lamp examination of the eyes, skin tests, special stains of liver biopsies, and serum antibodies. |
| – | In those patients for whom a specific diagnosis cannot be established, the use of corticosteroids requires that the patient have a clinical justification for treatment or manifest important changes in findings of liver biopsies. |
| – | Patients selected for steroid treatment should be subjected to close laboratory monitoring, and the decision to continue therapy should be based on objective parameters. |
| – | Treatment of steroid-resistant disease might require methotrexate, chloroquine, cyclosporine, azathioprine, or ursodeoxycholic acid. |
13.
Albert J. Czaja MD 《Current Treatment Options in Gastroenterology》1999,2(5):423-436
Opinion statement
相似文献
| – | Autoimmune hepatitis can be treated effectively with either prednisone alone or a lower dose of prednisone in combination with azathioprine. |
| – | All types of autoimmune hepatitis should be treated similarly. |
| – | The combination schedule of prednisone and azathioprine is preferred since it is associated with fewer side effects than a higher dose of prednisone alone. |
| – | Lifestyle changes are essential if overeating, under-exercising, excessive alcohol consumption, or overexposure to hepatotoxic medication or chemicals are common. |
| – | Adjunctive therapies, including calcium supplementation, vitamin D, and hormonal replacement, are important in postmenopausal women to preserve skeletal integrity. |
| – | Initial treatment should be continued until complete clinical, laboratory and histologic resolution. Relapse after attainment of an “ideal” end point tempers the goals of subsequent treatments. |
| – | Relapse after a second treatment and drug withdrawal is associated with a diminishing benefit-risk ratio for retreatment. Long-term, indefinite therapy with low dose prednisone or azathioprine alone is the appropriate treatment strategy. |
| – | Deterioration despite compliance with conventional therapy (treatment failure), incomplete response, and drug toxicity are adverse outcomes that warrant modifications in the conventional treatment protocol. High dose corticosteroid regimens, longterm low dose maintenance schedules, and investigational drugs can be considered. |
| – | Liver transplantation is an effective strategy for patients who have decompensated disease despite corticosteroid therapy. |
| – | Tacrolimus and budesonide are the most promising new therapies for autoimmune hepatitis and controlled treatment trials are sorely needed. |
14.
Opinion Statement Non-ulcer dyspepsia (NUD) refers to pain or discomfort centered in the upper abdomen that is not explained by the findings
at esophagogastroduodenoscopy or other routine testing. To manage this condition:
相似文献
| – | Ensure the diagnosis is correct: Avoid the misdiagnosis of gastroesophageal reflux disease (GERD) or irritable bowel syndrome (IBS) as NUD. |
| – | Reassure the patient that there is no evidence of serious disease, and discuss the prognosis. |
| – | Advise the patient about diet (eg, small regular meals, reduction of dietary fat, avoidance of specific foods that induce symptoms, minimizing coffee intake). |
| – | Antacids or over-the-counter (OTC) H2 blockers are safe and if they provide good symptom control with intermittent use they should be encouraged, although probably any benefit is due to the placebo response in NUD. |
| – | If symptoms are chronic or troublesome, test for Helicobacter pylori and treat if this infection is present. This will prevent future ulcer disease and manage misdiagnosed ulcer patients appropriately, but is usually disappointing in NUD (at best one in five will have a sustained response). |
| – | Determine the predominant symptom if drug treatment is indicated: Ask the patient to rank his or her most bothersome symptom; most patients can do this even though typically they have multiple symptoms. |
| – | If pain or burning in the epigastrium is the predominant complaint (ulcer-like dyspepsia), prescribe an H2 blocker or proton pump inhibitor (PPI). |
| – | If fullness, bloating, early satiety, or nausea is the predominant complaint (dysmotility-like dyspepsia), prescribe cisapride. |
| – | If initial therapy provides adequate relief with one month of treatment, implement a drug holiday. If symptoms recur, prescribe the lowest previously effective dose regimen and then try on-demand treatment. |
| – | If initial treatment fails after 4 weeks, switch therapy (@#@ eg, from a PPI to cisapride). |
| – | If lower abdominal symptoms or non-gastrointestinal symptoms (@#@ eg, headaches, backaches, or fatigue) are the predominant complaints, review your diagnosis (it’s probably not NUD). |
| – | If the above treatment plan fails, and the diagnosis is unchanged on review, consider a low-dose tricyclic antidepressant |
15.
Opinion statement
相似文献
| – | Primary biliary cirrhosis (PBC) is one of the most common chronic cholestatic liver diseases affecting the adult population. |
| – | The clinical presentation of PBC can be diverse, ranging from the presymptomatic individual to the patient with advanced liver disease. The initial evaluation to establish the diagnosis, and the appropriate followup, are very important in the lifelong management of these patients. |
| – | The primary medical treatment in PBC should focus on reducing the rate of disease progression. To this extent, ursodeoxycholic acid has been extensively evaluated and proven to improve liver biochemistries and survival in patients with PBC. |
| – | The secondary medical management in PBC should address the treatment of complications of chronic cholestasis, hepatic cirrhosis, and failure. |
| – | Liver transplantation remains the only established therapeutic approach in treating patients with end-stage PBC and its associated complications. |
16.
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. |
17.
Opinion statement
相似文献
| – | Drug-induced liver disease can result from dosage-dependent hepatotoxicity or from adverse reactions to drugs used in therapeutic dosage. The latter idiosyncratic hepatotoxins can cause clinical syndromes that mimic all known liver diseases, so that drugs must be considered as the possible causal agent for all unexplained cases of liver disease. |
| – | The only specific antidote for dosage-dependent hepatotoxicity is N-acetylcysteine (and some other sulfhydryl donors), which is highly effective for the prevention of significant hepatotoxicity after acetaminophen overdose. |
| – | Early diagnosis and prompt withdrawal of the offending drug is the key to successful management of most drug-induced liver diseases. |
| – | The mainstay of treatment is supportive care, with careful monitoring for signs of acute liver failure or progression to chronic liver disease. |
| – | In cases of liver failure, close liaison with a liver transplant center is crucial; referral for liver transplantation should be considered if standard transplant criteria are fulfilled. |
| – | Pruritus is a major symptom of drug-induced cholestasis; protracted cases may respond to ursodeoxycholic acid. |
| – | Corticosteroids can be considered for cases of drug-induced hepatitis, especially those with evidence of immune hypersensitivity, if no improvement is seen in 8 to 12 weeks. Although there are no controlled trials, some patients may respond favorably. |
18.
Opinion statement
相似文献
| – | The treatment of pancreatic duct strictures is based on an accurate assessment of the etiology of the disease, and then the degree of symptomatology. Our outline for therapy is as follows: |
| – | Exclude a diagnosis of malignancy by using radiologic, endoscopic, histologic, and molecular biologic modalities. |
| – | Once a benign stricture has been demonstrated, we favor a trial of endoscopic dilation and stent placement |
| – | For the unresectable pancreatic neoplasm, in which an obstructive etiology for pain is suspected, a trial of endoscopic dilation and stent placement also should be considered. |
| – | In benign pancreatic duct strictures complicated by biliary obstruction, and where the most durable treatment modality is sought, surgical intervention merits earlier consideration. |
| – | Pancreatic duct stent placement should seldom be considered definitive therapy, and the risk of stent-induced duct injury must be weighed against potential therapeutic benefit. |
19.
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. |
20.
Opinion statement
相似文献
| – | Lack of endoscopic esophagitis does not exclude gastroesophageal reflux disease (GERD). |
| – | Ambulatory pH testing is also an imperfect standard, and patients with both a normal endoscopy and a normal pH test may still have symptoms produced by acid reflux. |
| – | A therapeutic trial of acid suppression is often the best approach to these patients. |
| – | Ideally, therapeutic trials should use a medication with a high degree of efficacy in the treatment of GERD to avoid a false-negative test. |
| – | Proton pump inhibitors (PPIs) are the best currently available medical therapy for all forms of GERD. |
| – | If the patient does not respond to a once daily PPI, options include increasing the dose of PPIs, and, perhaps, adding another class of agent or studying the patient with an ambulatory pH test. |
| – | Patients with a negative endoscopy, negative pH test. and those who do not respond to an adequate trial of acid suppression are unlikely to benefit from antireflux surgery. |