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Gastroenterología

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45 papers 0 to 25 followers Acute pancreatitis
https://www.readbyqxmd.com/read/28431202/pharmacological-interventions-for-acute-pancreatitis
#1
REVIEW
Elisabetta Moggia, Rahul Koti, Ajay P Belgaumkar, Federico Fazio, Stephen P Pereira, Brian R Davidson, Kurinchi Selvan Gurusamy
BACKGROUND: In people with acute pancreatitis, it is unclear what the role should be for medical treatment as an addition to supportive care such as fluid and electrolyte balance and organ support in people with organ failure. OBJECTIVES: To assess the effects of different pharmacological interventions in people with acute pancreatitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 9), MEDLINE, Embase, Science Citation Index Expanded, and trial registers to October 2016 to identify randomised controlled trials (RCTs)...
April 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27248703/-we-are-what-our-bacteria-eat-the-role-of-bacteria-in-personalizing-nutrition-therapy-in-gastrointestinal-conditions
#2
REVIEW
Ruth Harvie, Russell Walmsley, Michael Schultz
The theme for the 2016 World Digestive Health Day is "Your Diet and Gut Health". The World Gastroenterology Organization thereby wishes to raise awareness of the relationship between what we eat and gastrointestinal symptoms. World Digestive Health Day (WDHD) is celebrated each year on May 29. This brief review article on behalf of the New Zealand Society of Gastroenterology will highlight recent developments in this highly active area of research with a special emphasis on gastrointestinal disorders.
February 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28452210/functional-dyspepsia-advances-in-diagnosis-and-therapy
#3
REVIEW
Nicholas J Talley
Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. Epidemiologically, there are two clinically distinct FD syndromes (although these often overlap clinically): postprandial distress syndrome (PDS; comprising early satiety or meal-related fullness) and epigastric pain syndrome. Symptoms of gastroesophageal reflux disease overlap with FD more than expected by chance; a subset has pathological acid reflux...
May 15, 2017: Gut and Liver
https://www.readbyqxmd.com/read/28427116/current-trends-in-the-management-of-gastroesophageal-reflux-disease
#4
REVIEW
Dalbir S Sandhu, Ronnie Fass
Gastroesophageal reflux disease (GERD) characterized by heartburn and/or regurgitation symptoms is one of the most common gastrointestinal disorders managed by gastroenterologists and primary care physicians. There has been an increase in GERD prevalence, particularly in North America and East Asia. Over the past three decades proton pump inhibitors (PPIs) have been the mainstay of medical therapy for GERD. However, recently there has been an increasing awareness amongst physicians and patients regarding the side effects of the PPI class of drugs...
April 24, 2017: Gut and Liver
https://www.readbyqxmd.com/read/28417882/easl-clinical-practical-guidelines-on-the-management-of-acute-fulminant-liver-failure
#5
(no author information available yet)
The term acute liver failure (ALF) is frequently applied as a generic expression to describe patients presenting with or developing an acute episode of liver dysfunction. In the context of hepatological practice, however, ALF refers to a highly specific and rare syndrome, characterised by an acute abnormality of liver blood tests in an individual without underlying chronic liver disease. The disease process is associated with development of a coagulopathy of liver aetiology, and clinically apparent altered level of consciousness due to hepatic encephalopathy...
May 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28395784/acute-mesenteric-ischemia-part-i-incidence-etiologies-and-how-to-improve-early-diagnosis
#6
REVIEW
Jussi M Kärkkäinen, Stefan Acosta
Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/26195207/novel-ammonia-lowering-agents-for-hepatic-encephalopathy
#7
REVIEW
Robert S Rahimi, Don C Rockey
Hepatic encephalopathy (HE) is a common complication of cirrhosis, leading to frequent hospitalizations. Because ammonia is thought to play an important role in the pathogenesis of HE, therapies specifically aimed at reducing ammonia levels have been developed for conditions causing hyperammonemia, including HE. Ammonia scavengers have been used in HE patients, leading to improvements in symptoms. Bowel cleansing with polyethylene glycol has also been studied recently, resulting in more rapid improvement in acute HE compared with lactulose...
August 2015: Clinics in Liver Disease
https://www.readbyqxmd.com/read/26195206/ammonia-and-its-role-in-the-pathogenesis-of-hepatic-encephalopathy
#8
REVIEW
Parth J Parekh, Luis A Balart
Hepatic encephalopathy (HE) is a commonly encountered sequela of chronic liver disease and cirrhosis with significant associated morbidity and mortality. Although ammonia is implicated in the pathogenesis of HE, the exact underlying mechanisms still remain poorly understood. Its role in the urea cycle, astrocyte swelling, and glutamine and gamma-amino-n-butyric acid systems suggests that the pathogenesis is multifaceted. Greater understanding in its underlying mechanism may offer more targeted therapeutic options in the future, and thus further research is necessary to fully understand the pathogenesis of HE...
August 2015: Clinics in Liver Disease
https://www.readbyqxmd.com/read/21145874/new-assessment-of-hepatic-encephalopathy
#9
REVIEW
Juan Córdoba
Hepatic encephalopathy (HE) is a common complication of cirrhosis that requires careful appraisal of the clinical manifestations, evaluation of the underlying neurological disorders, and assessment of liver function and the portal-systemic circulation. This article reviews recent developments in the assessment of HE and discusses the controversy regarding the use of a categorical or a continuous approach in measuring the severity of this condition. New scales facilitate effective monitoring and assessment of episodic HE...
May 2011: Journal of Hepatology
https://www.readbyqxmd.com/read/19890967/ammonia-and-the-neutrophil-in-the-pathogenesis-of-hepatic-encephalopathy-in-cirrhosis
#10
REVIEW
Debbie L Shawcross, Shabnam S Shabbir, Nicholas J Taylor, Robin D Hughes
Hepatic encephalopathy (HE) constitutes a neuropsychiatric syndrome which remains a major clinical problem in patients with cirrhosis. In the severest form of HE, cirrhotic patients may develop varying degrees of confusion and coma. Ammonia has been regarded as the key precipitating factor in HE, and astrocytes have been the most commonly affected cells neuropathologically. Although the evidence base supporting a pivotal role of ammonia is robust, in everyday clinical practice a consistent correlation between the concentration of ammonia in the blood and the manifest symptoms of HE is not observed...
March 2010: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/24149188/hepatic-encephalopathy-effects-of-liver-failure-on-brain-function
#11
REVIEW
Vicente Felipo
Liver failure affects brain function, leading to neurological and psychiatric alterations; such alterations are referred to as hepatic encephalopathy (HE). Early diagnosis of minimal HE reveals an unexpectedly high incidence of mild cognitive impairment and psychomotor slowing in patients with liver cirrhosis - conditions that have serious health, social and economic consequences. The mechanisms responsible for the neurological alterations in HE are beginning to emerge. New therapeutic strategies acting on specific targets in the brain (phosphodiesterase 5, type A GABA receptors, cyclooxygenase and mitogen-activated protein kinase p38) have been shown to restore cognitive and motor function in animal models of chronic HE, and NMDA receptor antagonists have been shown to increase survival in acute liver failure...
December 2013: Nature Reviews. Neuroscience
https://www.readbyqxmd.com/read/24690075/cerebral-haemodynamics-in-cirrhotic-patients-with-hepatic-encephalopathy
#12
COMPARATIVE STUDY
Ricardo U Macías-Rodríguez, Andrés Duarte-Rojo, Carlos Cantú-Brito, Tilman Sauerbruch, Astrid Ruiz-Margáin, Jonel Trebicka, Marina Green-Gómez, Jorge B Díaz Ramírez, Manuel Sierra Beltrán, Misael Uribe-Esquivel, Aldo Torre
BACKGROUND & AIMS: Factors other than elevated levels of ammonia may be implicated in hepatic encephalopathy (HE) pathophysiology, including abnormal cerebral haemodynamics. Transcranial Doppler ultrasonography (TCD) evaluates cerebrovascular structural integrity and reactivity, through pulsatility index (PI) and breath-holding index (BHI) respectively. The aim of this study was to evaluate cerebral haemodynamics by TCD in patients with compensated and decompensated cirrhosis, and patients with and without HE...
February 2015: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/26618922/review-article-potential-mechanisms-of-action-of-rifaximin-in-the-management-of-hepatic-encephalopathy-and-other-complications-of-cirrhosis
#13
REVIEW
J S Bajaj
BACKGROUND: Progressive gut milieu (microbiota) changes occur in patients with cirrhosis and are associated with complications [e.g. hepatic encephalopathy (HE)]. AIM: To examine the role of rifaximin in the management of HE and other complications of cirrhosis, including potential mechanisms of action and the need for future studies. METHODS: A literature search was conducted using the keywords 'rifaximin', 'hepatic encephalopathy', 'ascites', 'variceal bleeding', 'peritonitis', 'portal hypertension', 'portopulmonary hypertension' and 'hepatorenal syndrome'...
January 2016: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/23471642/the-nutritional-management-of-hepatic-encephalopathy-in-patients-with-cirrhosis-international-society-for-hepatic-encephalopathy-and-nitrogen-metabolism-consensus
#14
Piero Amodio, Chantal Bemeur, Roger Butterworth, Juan Cordoba, Akinobu Kato, Sara Montagnese, Misael Uribe, Hendrik Vilstrup, Marsha Y Morgan
UNLABELLED: Nitrogen metabolism plays a major role in the development of hepatic encephalopathy (HE) in patients with cirrhosis. Modulation of this relationship is key to the management of HE, but is not the only nutritional issue that needs to be addressed. The assessment of nutritional status in patients with cirrhosis is problematic. In addition, there are significant sex-related differences in body composition and in the characteristics of tissue loss, which limit the usefulness of techniques based on measures of muscle mass and function in women...
July 2013: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/26164219/covert-and-overt-hepatic-encephalopathy-diagnosis-and-management
#15
REVIEW
Kavish R Patidar, Jasmohan S Bajaj
Hepatic encephalopathy (HE) is part of a spectrum of neurocognitive changes in cirrhosis. HE is divided into 2 broad categories based on severity: covert hepatic encephalopathy (CHE) and overt hepatic encephalopathy (OHE). CHE has a significant impact on a patient's quality of life, driving performance, and recently has been associated with increased hospitalizations and death. Likewise, OHE is associated with increased rates of hospitalizations and mortality, and poor quality of life. Given its significant burden on patients, care takers, and the health care system, early diagnosis and management are imperative...
November 2015: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/24411831/management-of-hepatic-encephalopathy-in-the-hospital
#16
REVIEW
Michael D Leise, John J Poterucha, Patrick S Kamath, W Ray Kim
Hepatic encephalopathy (HE) develops in up to 50% of patients with cirrhosis and is a feature of decompensated cirrhosis. With the goal of reviewing the evidence for treatment and prevention of overt hepatic encephalopathy, pubmed was searched using search terms hepatic encephalopathy AND treatment, limited to human studies from January 1, 2003, through December 1, 2013, and supplemented by key references. The inpatient incidence of HE is approximately 23,000 annually, and management of these patients is common for internists and subspecialists...
February 2014: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/20335583/rifaximin-treatment-in-hepatic-encephalopathy
#17
RANDOMIZED CONTROLLED TRIAL
Nathan M Bass, Kevin D Mullen, Arun Sanyal, Fred Poordad, Guy Neff, Carroll B Leevy, Samuel Sigal, Muhammad Y Sheikh, Kimberly Beavers, Todd Frederick, Lewis Teperman, Donald Hillebrand, Shirley Huang, Kunal Merchant, Audrey Shaw, Enoch Bortey, William P Forbes
BACKGROUND: Hepatic encephalopathy is a chronically debilitating complication of hepatic cirrhosis. The efficacy of rifaximin, a minimally absorbed antibiotic, is well documented in the treatment of acute hepatic encephalopathy, but its efficacy for prevention of the disease has not been established. METHODS: In this randomized, double-blind, placebo-controlled trial, we randomly assigned 299 patients who were in remission from recurrent hepatic encephalopathy resulting from chronic liver disease to receive either rifaximin, at a dose of 550 mg twice daily (140 patients), or placebo (159 patients) for 6 months...
March 25, 2010: New England Journal of Medicine
https://www.readbyqxmd.com/read/27474889/proton-pump-inhibitors-as-a-risk-factor-for-hepatic-encephalopathy-and-spontaneous-bacterial-peritonitis-in-patients-with-cirrhosis-with-ascites
#18
Gitte Dam, Hendrik Vilstrup, Hugh Watson, Peter Jepsen
UNLABELLED: Proton pump inhibitors (PPIs) may be a risk factor for hepatic encephalopathy (HE) in patients with cirrhosis, possibly through translocation of gut bacteria, which can also lead to spontaneous bacterial peritonitis (SBP). We examined the associations between PPIs and development of HE or SBP in patients with cirrhosis with ascites. We used data from three 1-year trials of satavaptan for ascites control. We used Cox regression to compare HE and SBP rates between users and nonusers of PPIs...
October 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/27081787/nonabsorbable-disaccharides-for-hepatic-encephalopathy-a-systematic-review-and-meta-analysis
#19
Lise L Gluud, Hendrik Vilstrup, Marsha Y Morgan
UNLABELLED: Nonabsorbable disaccharides (NADs) have been used to treat hepatic encephalopathy (HE) since 1966. However, a Cochrane Review, published in 2004, found insufficient evidence to recommend their use in this context. This updated systematic review evaluates the effects of the NADs, lactulose and lactitol, for the treatment and prevention of HE in patients with cirrhosis. Thirty-eight randomized controlled trials, involving 1,828 patients, were identified through electronic and manual searches; 31 randomized controlled trials looked at the treatment of HE, while seven looked at its primary/secondary prevention...
September 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/19302444/neuropsychological-assessment-of-hepatic-encephalopathy-ishen-practice-guidelines
#20
REVIEW
Christopher Randolph, Robin Hilsabeck, Ainobu Kato, Parampreet Kharbanda, Yu-Yuan Li, Daniela Mapelli, Lisa D Ravdin, Manuel Romero-Gomez, Andrea Stracciari, Karin Weissenborn
Low-grade or minimal hepatic encephalopathy (MHE) is characterised by relatively mild neurocognitive impairments, and occurs in a substantial percentage of patients with liver disease. The presence of MHE is associated with a significant compromise of quality of life, is predictive of the onset of overt hepatic encephalopathy and is associated with a poorer prognosis for outcome. Early identification and treatment of MHE can improve quality of life and may prevent the onset of overt encephalopathy, but to date, there has been little agreement regarding the optimum method for detecting MHE...
May 2009: Liver International: Official Journal of the International Association for the Study of the Liver
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