Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36
Filtrar
Más filtros

Banco de datos
País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
Endoscopy ; 53(1): 36-43, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32459000

RESUMEN

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a leading cause of morbidity and is associated with a 2 % - 17 % mortality rate in the UK and USA. Bleeding peptic ulcers account for 50 % of UGIB cases. Endoscopic intervention in a timely manner can improve outcomes. Hemostatic spray is an endoscopic hemostatic powder for GI bleeding. This multicenter registry was created to collect data prospectively on the immediate endoscopic hemostasis of GI bleeding in patients with peptic ulcer disease when hemostatic spray is applied as endoscopic monotherapy, dual therapy, or rescue therapy. METHODS: Data were collected prospectively (January 2016 - March 2019) from 14 centers in the UK, France, Germany, and the USA. The application of hemostatic spray was decided upon at the endoscopist's discretion. RESULTS: 202 patients with UGIB secondary to peptic ulcers were recruited. Immediate hemostasis was achieved in 178/202 patients (88 %), 26/154 (17 %) experienced rebleeding, 21/175 (12 %) died within 7 days, and 38/175 (22 %) died within 30 days (all-cause mortality). Combination therapy of hemostatic spray with other endoscopic modalities had an associated lower 30-day mortality (16 %, P < 0.05) compared with monotherapy or rescue therapy. There were high immediate hemostasis rates across all peptic ulcer disease Forrest classifications. CONCLUSIONS: This is the largest case series of outcomes of peptic ulcer bleeding treated with hemostatic spray, with high immediate hemostasis rates for bleeding peptic ulcers.


Asunto(s)
Hemostasis Endoscópica , Hemostáticos , Úlcera Péptica , Francia , Alemania , Humanos , Minerales , Recurrencia Local de Neoplasia , Úlcera Péptica Hemorrágica/terapia , Polvos , Recurrencia , Sistema de Registros , Resultado del Tratamiento
2.
J Gastroenterol Hepatol ; 36(11): 3027-3032, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34132412

RESUMEN

BACKGROUND AND AIM: Upper gastrointestinal tumors account for 5% of upper gastrointestinal bleeds. These patients are challenging to treat due to the diffuse nature of the neoplastic bleeding lesions, high rebleeding rates, and significant transfusion requirements. TC-325 (Cook Medical, North Carolina, USA) is a hemostatic powder for gastrointestinal bleeding. The aim of this study was to examine the outcomes of upper gastrointestinal bleeds secondary to tumors treated with Hemospray therapy. METHODS: Data were prospectively collected on the use of Hemospray from 17 centers. Hemospray was used during emergency endoscopy for upper gastrointestinal bleeds secondary to tumors at the discretion of the endoscopist as a monotherapy, dual therapy with standard hemostatic techniques, or rescue therapy. RESULTS: One hundred and five patients with upper gastrointestinal bleeds secondary to tumors were recruited. The median Blatchford score at baseline was 10 (interquartile range [IQR], 7-12). The median Rockall score was 8 (IQR, 7-9). Immediate hemostasis was achieved in 102/105 (97%) patients, 15% of patients had a 30-day rebleed, 20% of patients died within 30 days (all-cause mortality). There was a significant improvement in transfusion requirements following treatment (P < 0.001) when comparing the number of units transfused 3 weeks before and after treatment. The mean reduction was one unit per patient. CONCLUSIONS: Hemospray achieved high rates of immediate hemostasis, with comparable rebleed rates following treatment of tumor-related upper gastrointestinal bleeds. Hemospray helped in improving transfusion requirements in these patients. This allows for patient stabilization and bridges towards definitive surgery or radiotherapy to treat the underlying tumor.


Asunto(s)
Hemorragia Gastrointestinal , Neoplasias Gastrointestinales , Hemostasis Endoscópica , Hemostáticos , Minerales , Anciano , Anciano de 80 o más Años , Neoplasias Duodenales/complicaciones , Neoplasias Esofágicas/complicaciones , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Neoplasias Gastrointestinales/complicaciones , Hemostáticos/administración & dosificación , Hemostáticos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Minerales/administración & dosificación , Minerales/uso terapéutico , Polvos , Recurrencia , Sistema de Registros , Neoplasias Gástricas/complicaciones , Resultado del Tratamiento
3.
Dig Endosc ; 32(1): 96-105, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31365756

RESUMEN

BACKGROUND AND AIM: Acute gastrointestinal bleeding carries poor outcomes unless prompt endoscopic hemostasis is achieved. Mortality in these patients remains significant. Hemospray is a novel intervention that creates a mechanical barrier over bleeding sites. We report the largest dataset of patient outcomes after treatment with Hemospray from an international multicenter registry. PATIENTS AND METHODS: Prospective data (Jan 2016-May 2018) from 12 centers across Europe were collected. Immediate hemostasis was defined as endoscopic cessation of bleeding within 5 min after application of Hemospray. Rebleeding was defined as subsequent drop in hemoglobin, hematemesis, persistent melena with hemodynamic compromise post-therapy. RESULTS: Three hundred and fourteen cases were recruited worldwide (231 males, 83 females). Median pretreatment Blatchford score was 11 (IQR: 8-14) and median complete Rockall score (RS) was 7 (IQR: 6-8) for all patients. Peptic ulcer disease (PUD) was the most common pathology (167/314 = 53%) and Forrest Ib the most common bleed type in PUD (100/167 = 60%). 281 patients (89.5%) achieved immediate hemostasis after successful endoscopic therapy with Hemospray. Rebleeding occurred in 29 (10.3%) of the 281 patients who achieved immediate hemostasis. Seven-day and 30-day all-cause mortality were 11.5% (36/314) and 20.1% (63/314), respectively (lower than the predicted rates as per the RS). Similar hemostasis rates were noted in the Hemospray monotherapy (92.4%), combination therapy (88.7%) and rescue therapy (85.5%) groups. CONCLUSIONS: These data show high rates of immediate hemostasis overall and in all subgroups. Rebleeding and mortality rates were in keeping/lower than predicted rates.


Asunto(s)
Hemorragia Gastrointestinal/terapia , Hemostasis Endoscópica/métodos , Hemostáticos/administración & dosificación , Minerales/administración & dosificación , Enfermedad Aguda , Administración Tópica , Anciano , Anciano de 80 o más Años , Femenino , Hemorragia Gastrointestinal/etiología , Gastroscopía , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Úlcera Péptica Hemorrágica/etiología , Úlcera Péptica Hemorrágica/terapia , Estudios Prospectivos , Recurrencia , Sistema de Registros , Medición de Riesgo , Resultado del Tratamiento
5.
J Clin Gastroenterol ; 46(7): 595-601, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22334219

RESUMEN

BACKGROUND: High-quality video colonoscopy requires adequate preparation of the bowel to ensure both adequate procedure completion rates and polyp detection rates. We sought to examine our practice to determine which bowel preparation cleansed most effectively in our patients. AIM: A prospective audit of the efficacy, safety, and acceptability of low-volume polyethylene glycol (2-L Moviprep; Norgine Pharmaceuticals) versus standard volume polyethylene glycol (4-L KleanPrep; Norgine Pharmaceuticals) versus magnesium citrate (Citramag; Sanochemia UK Ltd.) plus stimulant laxative as bowel preparation for colonoscopy. SETTING: District General Hospital. PATIENTS: Patients attending for day case colonoscopy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Overall cleansing grades of preparations used: patient compliance, taste, and acceptability. METHODS: A prospective audit of patient experience of taking bowel preparation and blinded colonic scoring assessment of bowel cleansing of each of the tested regimes. RESULTS: A total of 258 (female,138; 53.5%) patients were recruited, 91 in the KleanPrep group (F:45, 49.5%), 86 patients in the Moviprep group (female, 45; 52.3%), and 81 in the Senna/Citramag group (female, 44; 54.3%). Significantly more patients were unable to take the prescribed dose of KleanPrep when compared with the other 2 regimes (19.6%; P<0.0001 vs. Moviprep; P<0.0001 vs. Senna/Citramag). A total of 45.65% of patients reported KleanPrep as tasting unpleasant. This was significantly more than both Moviprep (10.47%; P=0.008) and Senna/Citramag (9.88%; P<0.0001). The overall cleansing efficacy across the 3 groups (those with grades A or B) was 73.9%, 74.5%, and 86.5% for KleanPrep, Moviprep, and Senna/Citramag, respectively. In this series Senna/Citramag proved significantly better at bowel cleansing than KleanPrep (P<0.05) and it showed a trend toward better cleansing when compared with Moviprep (P=0.08). LIMITATIONS: Nonrandomized trial. Split-dosing regime for morning and afternoon lists may have confounded results. CONCLUSIONS: In summary, low-volume PEG (Moviprep) and Senna/Citramag combination were better tolerated than large volume PEG with Senna/Citramag providing superior mucosal cleansing.


Asunto(s)
Catárticos , Ácido Cítrico , Colonoscopía/métodos , Laxativos , Compuestos Organometálicos , Polietilenglicoles , Extracto de Senna , Adulto , Anciano de 80 o más Años , Catárticos/administración & dosificación , Catárticos/efectos adversos , Ácido Cítrico/administración & dosificación , Ácido Cítrico/efectos adversos , Femenino , Humanos , Laxativos/administración & dosificación , Laxativos/efectos adversos , Masculino , Persona de Mediana Edad , Compuestos Organometálicos/administración & dosificación , Compuestos Organometálicos/efectos adversos , Aceptación de la Atención de Salud , Cooperación del Paciente , Polietilenglicoles/administración & dosificación , Polietilenglicoles/efectos adversos , Estudios Prospectivos , Extracto de Senna/administración & dosificación , Extracto de Senna/efectos adversos , Resultado del Tratamiento , Adulto Joven
6.
Dig Dis Sci ; 56(8): 2404-8, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21380762

RESUMEN

BACKGROUND: Nicorandil is widely accepted in the therapeutic armamentarium of ischemic heart disease and, although nicorandil-induced oral and anal ulcerations have been established in the literature, only five cases have reported the possibility of nicorandil-induced ulceration elsewhere in the gastrointestinal tract. There have been recent case reports which have suggested the possible causative association between nicorandil and colonic ulceration, either in isolation or in combination with anal ulceration. METHODS: We report a case series of eight patients prescribed with nicorandil therapy presenting with gastrointestinal symptoms and subsequently diagnosed with colonic ulceration on colonoscopy. RESULTS: Eight patients were identified (five female, three male). Colonoscopic findings varied from solitary to multiple colonic ulcers. No concomitant oral or anal ulcerations were noted in these patients. Biopsies from the ulcers showed only non-specific inflammation. Cessation of nicorandil therapy resulted in resolution of symptoms and complete healing of colonic ulcers. CONCLUSION: Nicorandil therapy appears to be an emerging etiology in the development of idiopathic colonic ulceration and therefore should be considered as a differential diagnosis in a selected group of patients.


Asunto(s)
Enfermedades del Colon/inducido químicamente , Nicorandil/efectos adversos , Úlcera/inducido químicamente , Vasodilatadores/efectos adversos , Anciano , Anciano de 80 o más Años , Biopsia , Enfermedades del Colon/diagnóstico , Colonoscopía , Femenino , Humanos , Masculino , Isquemia Miocárdica/tratamiento farmacológico , Nicorandil/uso terapéutico , Resultado del Tratamiento , Vasodilatadores/uso terapéutico
7.
United European Gastroenterol J ; 8(10): 1155-1162, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32588788

RESUMEN

INTRODUCTION: With increasing advances in minimally invasive endoscopic therapies and endoscopic resection techniques for luminal disease, there is an increased risk of post-procedure bleeding. This can contribute to significant burden on patient's quality of life and health resources when reintervention is required. Hemospray (Cook Medical, North Carolina, USA) is a novel haemostatic powder licensed for gastrointestinal bleeding. The aim of this single-arm, prospective, non-randomised multicentre international study is to look at outcomes in patients with upper gastrointestinal bleeds following elective endoscopic therapy treated with Hemospray to achieve haemostasis. METHODS: Data was prospectively collected on the use of Hemospray from 16 centres (January 2016-November 2019). Hemospray was used during the presence of progressive intraprocedural bleeding post-endoscopic therapy as a monotherapy, dual therapy with standard haemostatic techniques or rescue therapy once standard methods had failed. Haemostasis was defined as the cessation of bleeding within 5 min of the application of Hemospray. Re-bleeding was defined as a sustained drop in haemoglobin (>2 g/l), haematemesis or melaena with haemodynamic instability after the index endoscopy. RESULTS: A total of 73 patients were analysed with bleeding post-endoscopic therapy. The median Blatchford score at baseline was five (interquartile range 0-9). The median Rockall score was six (interquartile range 5-7). Immediate haemostasis following the application of Hemospray was achieved in 73/73 (100%) of patients. Two out of 57 (4%) had a re-bleed post-Hemospray, one was following oesophageal endoscopic mucosal resection and the other post-duodenal endoscopic mucosal resection. Both patients had a repeat endoscopy and therapy within 24 h. Re-bleeding data was missing for 16 patients, and mortality data was missing for 14 patients. There were no adverse events recorded in association with the use of Hemospray. CONCLUSION: Hemospray is safe and effective in achieving immediate haemostasis following uncontrolled and progressive intraprocedural blood loss post-endoscopic therapy, with a low re-bleed rate.


Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Endoscopía Gastrointestinal/efectos adversos , Hemorragia Gastrointestinal/terapia , Hemostasis Endoscópica/métodos , Hemostáticos/administración & dosificación , Minerales/administración & dosificación , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Electivos/efectos adversos , Endoscopía Gastrointestinal/métodos , Mucosa Esofágica/irrigación sanguínea , Mucosa Esofágica/diagnóstico por imagen , Mucosa Esofágica/efectos de los fármacos , Mucosa Esofágica/cirugía , Femenino , Mucosa Gástrica/irrigación sanguínea , Mucosa Gástrica/diagnóstico por imagen , Mucosa Gástrica/efectos de los fármacos , Mucosa Gástrica/cirugía , Hemorragia Gastrointestinal/etiología , Humanos , Cuidados Intraoperatorios/métodos , Masculino , Estudios Prospectivos , Recurrencia , Resultado del Tratamiento
8.
Frontline Gastroenterol ; 11(4): 259-271, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32587669

RESUMEN

INTRODUCTION: Endoscopic therapy for the management of patients with Barrett's oesophagus (BE) neoplasia has significantly developed in the past decade; however, significant variation in clinical practice exists. The aim of this project was to develop expert physician-lead quality indicators (QIs) for Barrett's endoscopic therapy. METHODS: The RAND/UCLA Appropriateness Method was used to combine the best available scientific evidence with the collective judgement of experts to develop quality indicators for Barrett's endotherapy in four subgroups: pre-endoscopy, intraprocedure (resection and ablation) and postendoscopy. International experts, including gastroenterologists, surgeons, BE pathologist, clinical nurse specialist and patient representative, participated in a three-round process to develop 15 QIs that fulfilled the RAND/UCLA definition of appropriateness. RESULTS: 17 experts participated in round 1 and 20 in round 2. Of the 24 proposed QIs in round 1, 20 were ranked as appropriate (put through to round 2) and 4 as uncertain (discarded). At the end of round 2, a final list of 15 QIs were scored as appropriate. CONCLUSIONS: This UK national consensus project has successfully developed QIs for patients undergoing Barrett's endotherapy. These QIs can be used by service providers to ensure that all patients with BE neoplasia receive uniform and high-quality care.

9.
J Clin Gastroenterol ; 43(5): 414-9, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19197196

RESUMEN

BACKGROUND: Gastroesophageal reflux is implicated in the pathogenesis of asthma and chronic cough. To date most studies have focused on acid reflux measured by pH below the upper esophageal sphincter (UES). The aim of this study was to assess the relationship between cough and reflux through the UES into the pharynx. METHODS: Thirty-seven patients with asthma (19) and chronic cough (18) were recruited from the respiratory clinic. Reflux was monitored using a combined multichannel intraluminal impedance and pH probe by detecting (1) bolus reflux episodes within the esophagus and in the pharynx and (2) acidic reflux episodes within the esophagus and in the pharynx. All acid suppressive therapy was stopped for at least 7 days before the study. Demonstration of cough being linked to reflux was achieved using the symptom association probability (SAP). This was calculated using a 2-minute association window between symptoms and bolus entry into the esophagus. SAP was considered positive if >95%. RESULTS: A positive SAP for cough was noted in 7/26 patients reporting symptoms on the day of monitoring. Compared with SAP-negative patients, SAP-positive patients had both a greater number [median (interquartile range), 5(2 to 8) vs. 2(0 to 4), P<0.05] and a higher proportion of reflux episodes crossing the UES into the pharynx [25%(14% to 28%) vs. 7% (2% to 14%), P<0.02]. There was no difference in the number of reflux episodes or acid exposure time in the distal esophagus between SAP-positive and SAP-negative patients. Only 1% to 2% of episodes were detected by the pharyngeal pH sensor. CONCLUSIONS: Impedance detected pharyngeal reflux episodes are important factors in symptom production in cough patients.


Asunto(s)
Asma/complicaciones , Tos/etiología , Trastornos de la Motilidad Esofágica/complicaciones , Esfínter Esofágico Superior/fisiopatología , Reflujo Gastroesofágico/complicaciones , Faringe/fisiopatología , Adulto , Anciano , Asma/fisiopatología , Enfermedad Crónica , Tos/fisiopatología , Disnea/etiología , Disnea/fisiopatología , Impedancia Eléctrica , Trastornos de la Motilidad Esofágica/fisiopatología , Monitorización del pH Esofágico , Reflujo Gastroesofágico/fisiopatología , Ronquera/etiología , Ronquera/fisiopatología , Humanos , Manometría , Persona de Mediana Edad , Ruidos Respiratorios/etiología , Ruidos Respiratorios/fisiopatología , Factores de Riesgo
10.
Am J Gastroenterol ; 103(5): 1090-6, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18445095

RESUMEN

BACKGROUND: Persistent symptoms on acid suppressive therapy are due to either acid or nonacid gastroesophageal reflux (GER) episodes or are not related to reflux. AIM: To compare physical and chemical characteristics of GER episodes associated with symptoms in patients on acid suppressive therapy. METHODS: Patients with persistent symptoms on acid suppressive therapy underwent combined impedance-pH monitoring. Reflux episodes were classified as acid if nadir pH was <4.0, and nonacid if it remained at >/=4.0, separated into liquid-only or mixed (liquid-gas), and considered to reach the proximal esophagus if liquid was present 15 cm above the lower esophageal sphincter (LES). Reflux episodes were considered symptomatic if patients recorded a symptom within 5 min after the reflux episode. Risk factors of symptomatic reflux episodes were identified using multivariable generalized estimating equations (GEEs). RESULTS: One hundred twenty patients (85 women, median age 54 yr, range 18-85 yr) recorded 3,547 reflux episodes (84.3% nonacid, 50.6% mixed), of which 468 (13.2%) were symptomatic. Based on multivariable GEE analysis with episode-level symptom status (symptomatic vs nonsymptomatic) as the outcome variable, reflux episode acidity was not significantly associated with symptoms (P= 0.40). Mixed reflux episodes were significantly associated with symptoms relative to liquid-only episodes (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.19-1.87, P= 0.0005), as were reflux episodes reaching the proximal esophagus compared with those reaching the distal esophagus only (OR 1.28, 95% CI 1.06-1.55, P= 0.012). CONCLUSION: The majority of reflux episodes on acid suppressive therapy are asymptomatic. Reflux episodes extending proximally and having a mixed (liquid-gas) composition are significantly associated with symptoms, irrespective of whether pH is acid (<4) or nonacid (>/=4).


Asunto(s)
Determinación de la Acidez Gástrica , Reflujo Gastroesofágico/tratamiento farmacológico , Inhibidores de la Bomba de Protones/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Combinada , Femenino , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/etiología , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
11.
J Clin Gastroenterol ; 42(6): 676-9, 2008 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-18496394

RESUMEN

BACKGROUND: The addition of a bedtime H2 receptor antagonist (H2RA) to proton pump inhibitor (PPI) b.i.d. to inhibit nocturnal acid breakthrough (NAB) is controversial. H2RA tolerance has been documented suggesting limitations in its long-term effect. AIM: To compare the intragastric pH and NAB occurring with twice daily PPI with or without the addition of a H2RA. METHOD: Multichannel intraluminal impedance-pH studies in 100 patients were reviewed. Fifty-eight patients (female 41; mean age, 54 y; range, 17 to 85) were studied on twice daily PPI. Forty-two patients (female 36; mean age, 53 y; range 20 to 85) were studied on a PPI b.i.d.+H2RA for at least 1 month at bedtime. The percentage time of intragastric pH<4 (upright, recumbent, and total) and NAB were compared between the groups. RESULTS: In the patients with PPI b.i.d. 64% had NAB, compared with only 17% of patients on PPI b.i.d. and H2RA q.h.s. (P<0.001). The percent time intragastric pH<4 for patients on PPI b.i.d. was significantly higher (P<0.01) compared with patients on PPI b.i.d.+H2RA q.h.s. during upright (29.1+/-3.0 vs. 18.3+/-2.9), recumbent (33.5+/-3.4 vs. 12.5+/-3.1), and entire period (31.5+/-2.8 vs. 18.0+/-3.0). CONCLUSIONS: The addition of a bedtime H2RA reduces the percentage time of the intragastric pH<4 and also NAB. H2RA should be considered as adjunct therapy in whom greater suppression of gastric acid control is considered desirable.


Asunto(s)
Antiulcerosos/uso terapéutico , Reflujo Gastroesofágico/tratamiento farmacológico , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Inhibidores de la Bomba de Protones/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiulcerosos/administración & dosificación , Quimioterapia Combinada , Tolerancia a Medicamentos , Impedancia Eléctrica , Femenino , Ácido Gástrico/metabolismo , Determinación de la Acidez Gástrica , Reflujo Gastroesofágico/fisiopatología , Antagonistas de los Receptores H2 de la Histamina/administración & dosificación , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , Inhibidores de la Bomba de Protones/administración & dosificación , Estudios Retrospectivos , Factores de Tiempo
13.
Chest ; 130(2): 386-91, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16899836

RESUMEN

BACKGROUND: It is generally accepted that extraesophageal gastroesophageal reflux disease (GERD) symptoms and their persistence despite acid-suppressive therapy are poor prognostic factors for antireflux surgery. Recent studies indicating that cough can be temporally associated with reflux episodes of pH 4 to 7 (ie, nonacid reflux) reinvigorates the need for a more careful workup in patients with cough suspected to be due to GERD. AIM: To evaluate the frequency of chronic cough associated with nonacid reflux and the response of these patients to laparoscopic Nissen fundoplication. METHODS: We retrospectively reviewed data from patients with persistent cough despite twice-daily proton pump inhibitor (PPI) with or without the use of nighttime regimens of histamine-2 receptor antagonist (H2RA), who had undergone combined multichannel intraluminal impedance and pH monitoring. The association of cough and reflux was evaluated by calculating the symptom index (SI) [positive if > or = 50%]. A subset of patients with positive SI values for impedance-detected reflux with therapy was referred for laparoscopic Nissen fundoplication. RESULTS: Of 50 patients (38 female patients; mean age, 43 years; age range, 6 months to 84 years) who were monitored while receiving therapy, 13 patients (26%) had a positive SI for cough. The SI-positive group had a lower percentage of female patients and patients of younger age compared to the SI-negative group. Laparoscopic Nissen fundoplication was performed in six SI-positive patients who became asymptomatic and stopped receiving acid-suppressive therapy during follow-up evaluations (median time, 17 months; range, 12 to 27 months). CONCLUSION: Impedance pH monitoring should be performed while receiving therapy in patients with persistent symptoms who are receiving PPI therapy. A positive SI for nonacid reflux may be helpful in selecting patients who will benefit from antireflux surgery.


Asunto(s)
Antiulcerosos/uso terapéutico , Tos/etiología , Reflujo Gastroesofágico/complicaciones , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , ATPasas de Translocación de Protón/antagonistas & inhibidores , Adolescente , Adulto , Anciano , Niño , Preescolar , Enfermedad Crónica , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Fundoplicación , Determinación de la Acidez Gástrica , Reflujo Gastroesofágico/metabolismo , Reflujo Gastroesofágico/terapia , Humanos , Concentración de Iones de Hidrógeno , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
14.
Trans Am Clin Climatol Assoc ; 116: 321-33; discussion 333-4, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16555624

RESUMEN

Multichannel intraluminal impedance (MII) is a new technique for evaluating esophageal function and gastroesophageal reflux. This technique depends on changes in resistance to alternating current between two metal electrodes produced by the presence of liquid or gas bolus inside the esophageal lumen. Combined multichannel intraluminal impedance and manometry (MII-EM) provides simultaneous information on intraluminal pressure changes and bolus movement whereas combined multichannel intraluminal impedance and pH (MII-pH) allows detection of gastroesophageal reflux (GER) episodes irrespective of their pH values (i.e. acid and non-acid reflux). Combined MII-pH testing presents a new paradigm for reflux testing. In MII-pH studies reflux events are no longer primarily detected by pH. Refluxate presence, distribution and clearing is primarily detected by MII and simply characterized as acid or non-acid based on pH change and as liquid, gas or mixed based on MII. MII determines refluxate clearance time while pH measures acid clearance time. MII-pH shows promise to become an important clinical tool, particularly to assess GER in the postprandial period and in patients with persistent symptoms on acid suppression therapy.


Asunto(s)
Reflujo Gastroesofágico/diagnóstico , Adulto , Algoritmos , Unión Esofagogástrica/fisiopatología , Reflujo Gastroesofágico/clasificación , Reflujo Gastroesofágico/fisiopatología , Humanos , Concentración de Iones de Hidrógeno , Lactante , Pletismografía de Impedancia
15.
18.
Eur J Gastroenterol Hepatol ; 23(6): 455-60, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21505346

RESUMEN

BACKGROUND: Undernutrition has been shown to be predictive of 30-day mortality in patients undergoing self-expanding metal stent (SEMS) insertion for inoperable oesophageal cancer. The aim of this study was to assess the relationship between nutritional factors and 30-day mortality in patients undergoing SEMS insertion for palliation of oesophageal cancer. METHODS: A retrospective cohort study was conducted from April 2007 to June 2009. BMI, swallowing ability, calorific intake and nature of nutritional support were recorded. ICD-10 causes of death were obtained from the Department of Health and Social Services. RESULTS: Fifty-six stents were inserted into 53 patients (mean age 70 years, male n=35). Median (interquartile range) BMI was 21.0 kg/m (18.7-24.0). Median pre-SEMS swallowing grade was 3. Median calorific intake as a percentage of estimated daily requirements was 94.0% (75.6-100.0%). Thirty (56.6%) patients tolerated an oral diet enhanced with supplement drinks whereas 23 (43.4%) patients required more invasive forms of enteral and parenteral support. The 30-day mortality rate was 11.3% (n=6) and cumulative median survival was 84 (interquartile range 38-156) days. BMI, calorific intake and swallowing capacity were not predictors of survival. Although there was a nonsignificant trend for reduced survival in those patients who did (n=23) receive invasive nutritional support compared with those who did not (n=30) (83.9 vs. 151.3 days, P=0.053), invasive nutritional support itself was not predictive of 30-day mortality (P=0.74). CONCLUSION: The requirement for invasive nutritional support before SEMS insertion is associated with a poor prognosis and possibly represents more aggressive tumour pathology. Further prospective assessment of prognostic factors, including nutritional parameters, to facilitate reliable selection of appropriate palliative modalities in oesophageal cancer is required.


Asunto(s)
Neoplasias Esofágicas/terapia , Esofagoscopía/instrumentación , Desnutrición/terapia , Metales , Estado Nutricional , Apoyo Nutricional , Stents , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Deglución , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Ingestión de Energía , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/fisiopatología , Esofagoscopía/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Desnutrición/etiología , Desnutrición/mortalidad , Desnutrición/fisiopatología , Persona de Mediana Edad , Irlanda del Norte , Apoyo Nutricional/mortalidad , Cuidados Paliativos , Selección de Paciente , Diseño de Prótesis , Análisis de Regresión , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
19.
Frontline Gastroenterol ; 1(2): 112-117, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28839558

RESUMEN

The past decade has seen new technological advances in the investigation of oesophageal motility disorders. Multichannel intraluminal impedance monitoring has been used as an adjunct to conventional manometry in the assessment of oesophageal function, independent of radiography. High resolution manometry provides additional information over conventional manometry, and its topographic analysis makes interpretation of studies easier. Both utilities in non-obstructive dysphagia have been used ultimately in research; however, more studies are addressing their clinical application.

SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA