Video capsule endoscopy in life-threatening GI hemorrhage after negative primary endoscopy (with video).

BACKGROUND: Video capsule endoscopy (VCE) continues to evolve as a key diagnostic tool. Traditionally VCE has been used to detect occult and obscure GI bleeding in adult patients. VCE has not been documented or accepted as an early diagnostic tool for acute life-threatening GI hemorrhage. OBJECTIVE: Our purpose was to demonstrate the use of VCE as an early diagnostic tool in acute life-threatening GI hemorrhage. DESIGN: Case series. PATIENTS: Patients with life-threatening GI hemorrhage. INTERVENTIONS: VCE after negative primary endoscopy. RESULTS: VCE allowed rapid diagnosis and reliable data before surgical intervention. Although proving to be a beneficial diagnostic tool for acute GI hemorrhage, VCE was not associated with increased morbidity or mortality rates. LIMITATIONS: This report only focuses on cases where VCE successfully led to a diagnosis. There is no prospective control group to which these patients can be compared. There were no other attempted acute VCE studies in patients with life-threatening bleeding during the time period of these case reports. CONCLUSIONS: The use of VCE is a simple and relatively safe diagnostic tool in the evaluation of continuing GI hemorrhaging in endoscopy-negative patients. The use of VCE can be considered as a another useful tool in the armamentarium of the endoscopist in the evaluation of GI bleeding. Prospective studies should be undertaken to determine the appropriate timing and clinical use in this group of patients.

Cyclic vomiting syndrome: what a gastroenterologist needs to know.

BACKGROUND: CVS (cyclic vomiting syndrome) is a functional disorder that may occur in any age group of patients. In the past the disorder was considered to be fairly uncommon of unknown etiology. Treatment has generally been based on anecdotal reports. METHODS: Literature review was performed based on internet/Medline search as of April 2006. RESULTS: CVS is much more common than previously thought, especially in adults and is commonly associated with migraine headaches and sharing many of its characteristic features. Genetic association with mitochondrial DNA has been recognized with CVS. Prompt diagnosis is essential in order to prevent the significant morbidity associated with CVS. It is mandatory to rule out certain life-threatening disorders that can mimic CVS. Treatment options are based on the particular phase of the syndrome in which a patient is in and carried out in a systematic manner. CONCLUSION: Expert consensus is that CVS is a distinct disorder and is a part of the migraine spectrum (migraine headaches, CVS, and abdominal migraines). Once patients are properly diagnosed, treatment is highly effective. Because of renewed interest in CVS since the 1990's, many more patients in all age groups are being recognized who suffer from this disabling disorder. An increase in basic science and clinical research in CVS will hopefully lead to better patient outcomes.

Prokinetic therapy reduces aspiration pneumonia in tube-fed patients with severe developmental disabilities.

To evaluate the clinical benefit of prokinetic therapy in aspiration pneumonia in patients with developmental disabilities, we conducted a retrospective study; records of 22 tube-fed patients were reviewed from December 1990 to October 1998 for a mean of 22.7 months before and 38.9 months during Cisapride therapy. Numbers of hospital admissions per patient-year before and during Cisapride administration were reduced from 2.75 to .61, with a relative risk reduction of 4.5. Days of hospitalization were reduced from 32.3 to 6.4. There were no adverse events noted from the therapy. Appropriately monitored prokinetic therapy may prove to be beneficial in preventing aspiration pneumonia in selected patients with developmental disabilities.