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Gastroenterología

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70 papers 25 to 100 followers
https://www.readbyqxmd.com/read/28502438/celiac-disease-and-nonceliac-gluten-sensitivity
#1
REVIEW
Runa D Watkins, Shamila Zawahir
Gluten-related disorders include celiac disease (CD), wheat allergy, and nonceliac gluten sensitivity. CD is an autoimmune enteropathy caused by damage to small intestinal mucosa when gluten is ingested in genetically susceptible individuals. Currently, the only available treatment of CD is gluten-free diet. Several potential treatments are being researched. Wheat allergy is a hypersensitivity reaction caused by IgE-mediated and/or non-IgE-mediated immune response, and can involve the gastrointestinal tract, skin, or respiratory tract...
June 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/29221664/mechanisms-of-damage-to-the-gastrointestinal-tract-from-non-steroidal-anti-inflammatory-drugs
#2
REVIEW
Ingvar Bjarnason, Carmelo Scarpignato, Erik Holmgren, Michael Olszewski, Kim D Rainsford, Angel Lanas
Non-steroidal anti-inflammatory drugs (NSAIDs) can damage the gastrointestinal tract, causing widespread morbidity and mortality. Although mechanisms of damage involve the activities of prostaglandin-endoperoxide synthase 1 (PTGS1 or COX1) and PTGS1 (COX2), other factors are involved. We review mechanisms of gastrointestinal damage induction by NSAIDs, via COX-mediated and COX-independent processes. NSAIDs interact with phospholipids and uncouple mitochondrial oxidative phosphorylation, which initiates biochemical changes that impair function of the gastrointestinal barrier...
December 5, 2017: Gastroenterology
https://www.readbyqxmd.com/read/29258378/hepatorenal-syndrome-the-clinical-impact-of-vasoactive-therapy
#3
Isabelle Colle, Pierre-François Laterre
Hepatorenal syndrome (HRS) is a unique form of acute kidney injury seen in cirrhotic patients and associated with significant mortality and morbidity. Despite its impact, diagnosis and treatment of HRS remains challenging and this review aims to assess and compare the available vasoconstrictors used as first-line treatment for HRS. Areas covered: A literature review was undertaken on the use of vasoconstrictors in HRS, using PubMed/Medline database searches of: 'hepatorenal syndrome', 'HRS' and 'vasoconstrictor'...
February 2018: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/22557825/structured-approach-to-treat-patients-with-acute-liver-failure-a-hepatic-emergency
#4
Ramesh Kumar, Vikram Bhatia
Acute liver failure (ALF) is a condition of acute hepatic emergency where rapid deterioration of hepatocyte function leads to hepatic encephalopathy, coagulopathy, cerebral edema (CE), infection and multi-organ dysfunction syndrome resulting in a high mortality rate. Urgent liver transplantation is the standard of care for most of these patients in Western countries. However, in India, access to liver transplantation is severely limited and, hence, the management is largely based on intensive medical care. With earlier recognition of disease, better understanding of pathophysiology and improved intensive care, ALF patients have shown a significant improvement in spontaneous survival...
January 2012: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/25581440/autonomic-nervous-system-dysregulation-in-irritable-bowel-syndrome
#5
B Salvioli, G Pellegatta, M Malacarne, F Pace, A Malesci, M Pagani, D Lucini
BACKGROUND: Autonomic nervous system (ANS) regulation may be altered in functional diseases, including irritable bowel syndrome (IBS), but published data are not clear to date. The aim of the study was to analyze ANS function in IBS subjects classified by Rome III criteria and healthy controls using standardized technique. METHODS: ANS activity was evaluated by autoregressive spectral analysis of RR interval and systolic arterial pressure variabilities, to obtain indices of sympatho-vagal modulation of the heart and of spontaneous cardiac baroreflex (α index)...
March 2015: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/25954497/management-of-cirrhotic-ascites
#6
REVIEW
Julie Steen Pedersen, Flemming Bendtsen, Søren Møller
The most common complication to chronic liver failure is ascites. The formation of ascites in the cirrhotic patient is caused by a complex chain of pathophysiological events involving portal hypertension and progressive vascular dysfunction. Since ascites formation represents a hallmark in the natural history of chronic liver failure it predicts a poor outcome with a 50% mortality rate within 3 years. Patients with ascites are at high risk of developing complications such as spontaneous bacterial peritonitis, hyponatremia and progressive renal impairment...
May 2015: Therapeutic Advances in Chronic Disease
https://www.readbyqxmd.com/read/25561779/fluid-resuscitation-in-acute-pancreatitis
#7
REVIEW
Aakash Aggarwal, Manish Manrai, Rakesh Kochhar
Acute pancreatitis remains a clinical challenge, despite an exponential increase in our knowledge of its complex pathophysiological changes. Early fluid therapy is the cornerstone of treatment and is universally recommended; however, there is a lack of consensus regarding the type, rate, amount and end points of fluid replacement. Further confusion is added with the newer studies reporting better results with controlled fluid therapy. This review focuses on the pathophysiology of fluid depletion in acute pancreatitis, as well as the rationale for fluid replacement, the type, optimal amount, rate of infusion and monitoring of such patients...
December 28, 2014: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/29043071/recent-advances-in-the-management-of-peptic-ulcer-bleeding
#8
REVIEW
Ian Beales
Acute upper gastrointestinal haemorrhage due to peptic ulcer bleeding remains an important cause of emergency presentation and hospital admission. Despite advances in many aspects of management, peptic ulcer bleeding is still associated with significant morbidity, mortality, and healthcare costs. Comprehensive international guidelines have been published, but advances as well as controversies continue to evolve. Important recent advances include the evidence supporting a more restrictive transfusion strategy aiming for a target haemoglobin of 70-90 g/l...
2017: F1000Research
https://www.readbyqxmd.com/read/22570745/nash-is-an-inflammatory-disorder-pathogenic-prognostic-and-therapeutic-implications
#9
Geoffrey C Farrell, Derrick van Rooyen, Lay Gan, Shivrakumar Chitturi
While non-alcoholic fatty liver disease (NAFLD) is highly prevalent (15% to 45%) in modern societies, only 10% to 25% of cases develop hepatic fibrosis leading to cirrhosis, end-stage liver disease or hepatocellular carcinoma. Apart from pre-existing fibrosis, the strongest predictor of fibrotic progression in NAFLD is steatohepatitis or non-alcoholic steatohepatitis (NASH). The critical features other than steatosis are hepatocellular degeneration (ballooning, Mallory hyaline) and mixed inflammatory cell infiltration...
April 2012: Gut and Liver
https://www.readbyqxmd.com/read/28473039/approach-to-the-patient-with-hematochezia
#10
REVIEW
Thomas G Cotter, Niamh S Buckley, Conor G Loftus
The evaluation of the patient with hematochezia can be complex because of the broad differential diagnosis and the number of management strategies available. In this article, a simplified approach to the history and physical examination is presented, with management illustrated in a case-oriented manner.
May 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28467190/risk-of-gastrointestinal-bleeding-during-anticoagulant-treatment
#11
REVIEW
Aitor Lanas-Gimeno, Angel Lanas
Gastrointestinal bleeding (GIB) is a major problem in patients on oral anticoagulation therapy. This issue has become even more pressing since the introduction of direct oral anticoagulants (DOACs) in 2009. Areas covered: Here we review current evidence related to GIB associated with oral anticoagulants, focusing on randomized controlled trials, meta-analyses, and post-marketing observational studies. Dabigatran 150 mg twice daily and rivaroxaban 20 mg once daily increase the risk of GIB compared to warfarin...
June 2017: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/28839832/upper-gastrointestinal-haemorrhage-an-update
#12
REVIEW
Wisam Jafar, Anisa Jabeen Nasir Jafar, Abhishek Sharma
Upper gastrointestinal (GI) haemorrhage is a common cause for admission to hospital and is associated with a mortality of around 10%. Prompt assessment and resuscitation are vital, as are risk stratification of the severity of bleeding, early involvement of the multidisciplinary team and timely access to endoscopy, preferably within 24 h. The majority of bleeds are due to peptic ulcers for which Helicobacter pylori and non-steroidal anti-inflammatory agents are the main risk factors. Although proton pump inhibitors (PPIs) are widely used before endoscopy, this is controversial...
January 2016: Frontline Gastroenterology
https://www.readbyqxmd.com/read/28838972/acute-pancreatitis-recent-advances-through-randomised-trials
#13
REVIEW
Sven M van Dijk, Nora D L Hallensleben, Hjalmar C van Santvoort, Paul Fockens, Harry van Goor, Marco J Bruno, Marc G Besselink
Acute pancreatitis is one of the most common GI conditions requiring acute hospitalisation and has a rising incidence. In recent years, important insights on the management of acute pancreatitis have been obtained through numerous randomised controlled trials. Based on this evidence, the treatment of acute pancreatitis has gradually developed towards a tailored, multidisciplinary effort, with distinctive roles for gastroenterologists, radiologists and surgeons. This review summarises how to diagnose, classify and manage patients with acute pancreatitis, emphasising the evidence obtained through randomised controlled trials...
November 2017: Gut
https://www.readbyqxmd.com/read/28802875/primary-sclerosing-cholangitis-a-comprehensive-review
#14
REVIEW
Tom H Karlsen, Trine Folseraas, Douglas Thorburn, Mette Vesterhus
Primary sclerosing cholangitis (PSC) is a rare disorder characterised by multi-focal bile duct strictures and progressive liver disease. Inflammatory bowel disease is usually present and there is a high risk of cholangiocarcinoma and colorectal cancer. Most patients ultimately require liver transplantation, after which disease recurrence may occur. With limited therapeutic options and a lack of proven surveillance strategies, patients currently have significant unmet needs. In the present seminar, we provide a comprehensive review of the status of the field...
December 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28655976/iron-deficiency-anemia-in-chronic-liver-disease-etiopathogenesis-diagnosis-and-treatment
#15
REVIEW
Eleana Gkamprela, Melanie Deutsch, Dimitrios Pectasides
Chronic liver disease is accompanied by multiple hematological abnormalities. Iron deficiency anemia is a frequent complication of advanced liver disease. The etiology is multifactorial, mostly due to chronic hemorrhage into the gastrointestinal tract. The diagnosis of iron deficiency anemia is very challenging, as simple laboratory methods, including serum iron, ferritin, transferrin saturation (Tsat), and mean corpuscular volume are affected by the liver disease itself or the cause of the disease, resulting in difficulty in the interpretation of the results...
2017: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/28677333/review-article-new-treatments-in-non-alcoholic-fatty-liver-disease
#16
REVIEW
S A Townsend, P N Newsome
BACKGROUND: Non-alcoholic fatty liver disease is the fastest growing cause of liver disease in the Western world, yet there is no approved pharmacotherapy. While lifestyle modifications remain the mainstay of treatment, only a proportion of individuals are able to make or sustain them, and so more treatment options are required. AIM: To review the potential benefit of drugs used in clinical practice, those entering phase II trials, and compounds being investigated in pre-clinical studies...
July 4, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28673695/scoring-systems-used-to-predict-mortality-in-patients-with-acute-upper-gastrointestinal-bleeding-in-the-ed
#17
Yuedong Tang, Jie Shen, Feng Zhang, Xiaoyong Zhou, Zhongyan Tang, Tingting You
OBJECTIVE: Acute upper gastrointestinal bleeding (UGIB) is a potentially life-threatening condition that requires rapid assessment in the emergency department (ED). We aimed to compare the performance of the AIMS65, Glasgow-Blatchford (Blatchford), preendoscopic Rockall (pre-Rockall), and preendoscopic Baylor bleeding (pre-Baylor) scores in predicting 30-day mortality in patients with acute UGIB in the ED setting. METHODS: Consecutive patients with acute UGIB who were admitted to the ED ward during 2012-2016 were retrospectively recruited...
January 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28682038/-hepato-renal-syndrome
#18
REVIEW
Luca Di Lullo, Claudio Ronco, Vincenzo Barbera, Francesca Santoboni, Antonio Bellasi
Hepatic and kidney failure are often closely linked (Hepato-Renal Sindrome - HRS). Acute kidney injury (AKI) represents a well-known complication of liver or biliary tract disease. Pathophysiology of HRS is still not completely clear. At this stage we know the biological pathways of several kidney abnormalities in end stage liver disease patients. At the same time patient's prognosis is poor with bad outcomes despite the reversible nature of the kidneys' involvement. Liver transplantation represents the ultimate treatment for HRS patients...
March 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/22287700/medical-management-of-hepatorenal-syndrome
#19
REVIEW
Andrew Davenport, Jawad Ahmad, Ali Al-Khafaji, John A Kellum, Yuri S Genyk, Mitra K Nadim
Hepatorenal syndrome (HRS) is defined as the occurrence of renal dysfunction in a patient with end-stage liver cirrhosis in the absence of another identifiable cause of renal failure. The prognosis of HRS remains poor, with a median survival without liver transplantation of <6 months. However, understanding the pathogenesis of HRS has led to the introduction of treatments designed to increase renal perfusion and mean arterial blood pressure using vasopressors and albumin, which has led to improvement in renal function in ∼50% of patients...
January 2012: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27016168/severe-acute-pancreatitis-and-necrotizing-pancreatitis
#20
REVIEW
Rahul Maheshwari, Ram M Subramanian
Acute pancreatitis results in nearly 250,000 admissions annually. Acute pancreatitis varies widely in its clinical presentation. Pancreatic necrosis accounts for substantial additional morbidity, with mortality rates remaining as high as 10% to 20% despite advances in critical care. The extent of necrosis correlates well with the incidence of infected necrosis, multiorgan failure, need for pancreatic debridement, and morbidity and mortality. Having established the diagnosis of pancreatic necrosis, goals of appropriately aggressive resuscitation should be established and adhered to in a multidisciplinary approach involving both medical and surgical critical care...
April 2016: Critical Care Clinics
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