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1.
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. |
2.
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. |
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.
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. |
5.
Pedrosa M 《Current Treatment Options in Gastroenterology》2001,4(1):67-71
Opinion statement
相似文献
| – | 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. |
6.
Opinion statement
相似文献
| – | The percutaneous approach-specifically, ultrasound-guided percutaneous catheter drainage-associated with intravenous administration of antibiotics is the therapy of choice in patients with single or multiple pyogenic liver abscesses. |
| – | The initial empiric antibiotic therapy should be modified based on results of blood and pus cultures. |
| – | Surgery should be reserved for patients in whom antibiotic therapy and percutaneous drainage is unsuccessful. |
7.
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. |
8.
Bacon BR 《Current Treatment Options in Gastroenterology》1999,2(1):58-60
Opinion Statement
相似文献
| – | The mainstay of treatment for hemochromatosis is therapeutic phlebotomy. The procedure is safe, effective, and relatively cheap. |
| – | Deferoxamine (iron chelation) is necessary only in iron-loaded individuals who cannot undergo therapeutic phlebotomy. |
| – | If therapy is initiated before complications develop, it is expected that no complications will ever develop. |
9.
Opinion Statement
相似文献
| – | Infectious esophagitis is a common problem in immunocompromised patients that can result in prolonged discomfort and malnutrition. |
| – | Common infectious causes of esophagitis can be confirmed by laboratory testing, but esophagoscopy is often necessary not only to visualize the esophageal mucosa but also to obtain diagnostic biopsies |
| – | Empiric, systemic antifungal or antiherpetic therapies are often prescribed prior to confirming an etiologic diagnosis in esophagitis. In some cases, however, endoscopy is needed to guide therapy |
| – | Systemic antifungal therapy is usually superior to topical therapy for Candida esophagitis and the first choice of agent is generally fluconazole. |
| – | Valacyclovir or famciclovir are the preferred first treatments for herpetic esophagitis because of their clinical efficacy and convenient dosing schedules. |
| – | Thalidomide may be useful in the management of aphthous ulcerations of the mouth and esophagus in patients with HIV. |
10.
Raju GS 《Current Treatment Options in Gastroenterology》2002,5(2):113-121
Opinion statement
相似文献
| – | The management of patients with postoperative biliary stricture is a challenging problem that spans across several disciplines. |
| – | A team approach involving endoscopists, interventional radiologists, and biliary surgeons is crucial for the successful management of individuals with this complex problem. |
| – | Hepaticojejunostomy is the therapy of choice. Prolonged stenting, either through the percutaneous route or through the endoscopic retrograde route, is an alternative. |
| – | Stricture recurrence is not infrequent and requires lifelong follow-up. |
11.
Opinion statement
相似文献
| – | Up to 35% of patients infected with Helicobacter pylori fail to respond to standard anti-H. pylori therapy. |
| – | With the rising prevalence antimicrobial resistance, the failure rates of conventional proton pump inhibitor-containing triple therapy are expected to increase. Pretreatment antibiotic resistance testing should be done whenever possible to allow for tailoring of the treatment regimens. |
| – | The data on second-line or rescue therapy are limited and usually are subjected to various biases and confounding factors. Switching between clarithromycin and metronidazole should be considered if repeated courses of proton pump inhibitor-containing triple therapy are used as second-line therapy in the absence of antimicrobial sensitivity testing. |
| – | The prolongation of therapy duration with proton pump inhibitor, amoxicillin, and clarithromycin is ineffective for clarithromycin-resistant strains. |
| – | The bismuth-containing quadruple therapy is the best salvage treatment in the absence of pretreatment antibiotic susceptibility. |
| – | Furazolidone quadruple therapy (where available) and rifabutin triple therapy are salvage therapies of last resort. If these regimens fail, culture and susceptibility testing is required. |
12.
Pisegna J 《Current Treatment Options in Gastroenterology》1999,2(3):195-203
Opinion statement The first goal of therapy is the control of gastric acid hypersecretion using PPIs or high-dose H2R antagonists.
相似文献
| – | The diagnosis of Multiple Endocrine Neoplasia (MEN I) should be established early in the disease. |
| – | Localization of gastrinoma tumor should be performed using a combination of endoscopic ultrasonography (EUS), somatostatin receptor scintigraphy (SRS), and computerized tomography (CT), or Magnetic Resonance Imaging (MRI). |
| – | Surgical resection in sporadic ZES should be performed to attempt cure of tumor. |
| – | Surgery, hormonal, chemotherapy, embolization therapy or therapeutic OctreoScan should be considered in patients with metastatic tumor. |
13.
Andersen JM 《Current Treatment Options in Gastroenterology》2001,4(5):433-440
Opinion statement
相似文献
| – | 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. |
14.
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. |
15.
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. |
16.
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. |
17.
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. |
18.
Opinion statement
相似文献
| – | Physicians must aggressively treat heart failure in the early stages to prevent disease progression and improve survival. Early treatment implies early diagnosis of left ventricular (LV) dysfunction, before the onset of symptoms. Patients with risk factors for the development of heart failure, especially coronary disease or hypertension, should undergo echocardiography to evaluate LV function. Patients with LV systolic dysfunction should be further evaluated to determine the type of cardiac dysfunction, uncover correctable etiologic factors, determine prognosis, and guide treatment. |
| – | Angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic blocking drugs improve survival and are integral to the treatment plan. Physicians should prescribe an ACE inhibitor as initial therapy for all patients with LV systolic dysfunction unless there are specific contraindications. The combination of hydralazine and isosorbide dinitrate is an acceptable alternative therapy for patients who cannot take ACE inhibitors. |
| – | Diuretics should be used if there are signs or symptoms of volume overload. |
| – | Beta-adrenergic blocking drugs should be added to therapy in stable patients with mild to moderate heart failure after optimal treatment with ACE inhibitors, diuretics, or other vasodilators. |
| – | Digoxin should be used routinely in patients with severe heart failure and should be added to therapy in patients with mild to moderate heart failure who remain symptomatic despite optimal doses of ACE inhibitors and diuretics. |
| – | Spironolactone should be added, but electrolytes should be closely monitored. |
| – | Warfarin anticoagulation should be considered in patients with a left ventricular ejection fraction (LVEF) of 35% or less. |
| – | Until survival data exist, angiotensin receptor blockers (ARBs) should not be used as initial therapy or as sole therapy but can be used for ACE-intolerant patients or can be added to standard heart failure therapy. |
| – | Outpatient use of intravenous inotropic therapy should be avoided. |
| – | Patients with severe heart failure should have peak oxygen consumption measured to quantify functional impairment, determine prognosis, and identify the need for advanced heart failure therapy. |
| – | Patients who remain symptomatic while receiving optimal standard therapy should be referred early to a specialized heart failure center. |
19.
Navarro VJ 《Current Treatment Options in Gastroenterology》1999,2(6):457-462
Opinion statement
相似文献
| – | 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. |
20.
Opinion statement
相似文献
| – | The key to successful management of biliary tract carcinoma is early diagnosis and a multidisciplinary team approach involving a hepatobiliary surgeon, therapeutic endoscopist, and oncologist. |
| – | Management depends on the location of the tumor ( proximal or distal), and resectability. |
| – | Distal tumors that are resectable are best treated with radical pancreaticoduodenectomy, while nonresectable distal tumors are treated by using endoscopic or percutaneous biliary stents for biliary decompression. |
| – | Treatment of proximal resectable tumors depends on the Bismuth Classification. Bismuth I and II tumors can be resected without concomitant hepatic resection, and Bismuth III and IV tumors require local tumor and hepatic parenchymal resection. Nonresectable proximal tumors are best treated with percutaneous transhepatic biliary stents. |
| – | The role of chemotherapy, radiotherapy, and photodynamic therapy in these patients remains investigational. |