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By: Rasheed Adebayo Gbadegesin, MBBS

  • Professor of Pediatrics
  • Professor in Medicine
  • Affiliate of Duke Molecular Physiology Institute


Lock J: Adjusting cognitive behavior therapy for adolescents with bulimia nervosa: results of a case series womens health nyu cheap lovegra 100 mg mastercard. Am J Psychother 2005; 59:267281[G] Treatment of Patients With Eating Disorders 123 Copyright 2010 breast cancer 800 number buy lovegra without a prescription, American Psychiatric Association history of women's health issues buy 100mg lovegra with mastercard. Johnson C: Diagnostic survey for eating disorders in initial consultation for patients with bulimia and anorexia nervosa women's health center at uic best order for lovegra, in Handbook of Psychotherapy for Anorexia Nervosa and Bulimia menstruation and diarrhea lovegra 100 mg free shipping. Treasure J womens health vest order lovegra without a prescription, Schmidt U, Troop N, Tiller J, Todd G, Keilen M, Dodge E: First step in managing bulimia nervosa: controlled trial of therapeutic manual. Minneapolis, University of Minnesota Hospital and Clinic, Department of Psychiatry, 1989 [G] 696. Minneapolis, University of Minnesota Hospital and Clinic, Department of Psychiatry, 1991 [G] 697. Riva G, Bacchetta M, Cesa G, Conti S, Molinari E: Six-month follow-up of in-patient experiential cognitive therapy for binge eating disorders. Tanco S, Linden W, Earle T: Well-being and morbid obesity in women: a controlled therapy evaluation. The content is provided Educational Activity Learning Objectives solely by faculty who have been selected because of Upon completion of this activity, the participants recognized expertise in their field. The France Foundation and InterMune assume Accreditation Statement no liability for the information herein. Physicians should only claim credit commensurate with the extent of their participation in the activity. He has received grant and Inova Fairfax Hospital research support from Actelion, Gilead, InterMune, and Falls Church, Virginia United Therapeutics. All faculty and activity planners involved in the development of this activity have disclosed any significant financial interest or other relationship with manufacturer(s) of any commercial product(s)/device(s) and/or provider(s) of commercial services included in this educational activity. The intent of this disclosure is not to prevent a faculty member with a relevant financial or other relationship from participating in the activity, but rather to provide participants with information on which they can base their own judgments. The France Foundation has identified and resolved any and all faculty conflicts of interest prior to the release of this activity. Despite attrition rate on the transplant wait list with this, a significant number of patients succumb to their mortality rates in excess of 30%. The new system sorts patients into one of months credit on the transplant list under the old four groups based on their underlying primary disease. Models incorporating numerous factors have been developed for each of these groups to determine the prognosis during the ensuing year with and without Figure 1. According to the new lung allocation system, transplant benefits for each patient are computed based on the difference between these projected outcomes. This then is balanced against wait 7 list urgency based on the patient listing characteristics to determine organ allocation. This involves assessing the Patient Evaluation projected risk of death while waiting for an organ Initial history and physical (urgency) and the projected life expectancy after Testing to establish the severity of disease and to transplant (benefit). In addition, a structured program provides Alpha-1-Antitrypsind Deficiency 500 Idiopathic Pulmonary Arterial Hypertension an opportunity to develop stress management Retransplant/Graftd Failure 7 Congenital Disease methods and relaxation techniques. It can also 400 Other C O provide a forum for sharing social, financial, and 300 logistic information with patients and act as an informal support group. King et al9 showed that the median survival from the time of the initial visit decreased from ~100 months in patients less than 50 years old d N to ~27 months in patients 60 to 70 years old (Figure 1 4). However, there are data to suggest that 0 select older patients without significant comorbidities can be successfully transplanted with acceptable 11 outcomes. Conceptually, it is desirable to get maximum performed between 1995 and 2006 was 1. This team should is important for patients to be aware of the survival include19: statistics associated with transplantation, as this should weigh into their decision. The oneand five Thoracic surgeons year survival rates for all lung recipients are 78% Pulmonologists and 50%. The advantages of bilateral lung transplant versus single lung transplant in different patient groups are debatable. Induction cytolytic therapy is sometimes used to deplete the recipients immune 0. The objective of 0 2 this approach is to avoid early immunologic interaction Analysis Time (years) between the donor and recipient and thereby decrease # At risk 23 acute rejection as well as minimize inflammation. Although induction therapy appears to reduce the maintain cardiovascular homeostasis and glucose frequency and severity of episodes of acute rejection, control. They should be given appropriate prophylaxis this might come at the expense of a heightened risk of for peptic ulcer disease, infection, and deep vein infections. Nutritional supplementation should be induction therapy either prolongs survival or reduces the considered for patients who are likely to require risk of chronic rejection. Early referral of candidates to a transplant 0 0 1 5 10 15 18 center is encouraged due to the unpredictable nature Years of the disease in most patients. The procedure may predispose to a myriad of complications and therefore has significant shortand long-term risks. Registry of candidates: 2006 update a consensus report the International Society for Heart and Lung from the Pulmonary Scientific Council of the Transplantation: twenty-fifth official adult lung and International Society for Heart and Lung Transplant. Lung lung transplantation for patients with idiopathic transplantation in older patientsfi Immunosuppression for lung Transplantation: twenty-fourth official adult lung transplantation. Heart and lung tacrolimus, sirolimus, azathioprine, mycophenolate transplantation in the United States, 19962005. K < 5% K 6-20% K 21-40% K 41-60% K > 60% May we contact you in the future with a brief survey to assess how you have used the information presented at this activity or to assess other educational needsfi It was hypothesized that the sham procedure would not be inferior to the cricoid pressure. The secondary end points were related to pulmonary aspiration, difficult tracheal intubation, and traumatic complications owing to the tracheal intubation or cricoid pressure. Secondary end points were not significantly different among the 2 groups (pneumonia, length of stay, and mortality), although the comparison of the Cormack and Lehane grade (Grades 3 and 4, 10% vs 5%; P <. Downloaded From: on 10/18/2018 Research OriginalInvestigation CricoidPressureComparedWithaShamProcedureinRapidSequenceInductionofAnesthesia nduction of anesthesia induces a loss of protective upper airway reflexes and may be associated with pulmonary Key Points I aspiration. However, in emernoninferiorityofashamprocedureinpreventingpulmonary gency conditions, noncompliance with preoperative fasting aspirationcomparedwiththecricoidpressure. Mortality, rules and delayed gastric emptying markedly increase the pneumonia,andlengthofstaydidnotdiffersignificantlybetween risk of pulmonary aspiration. The goal of the cricoid pressure is to compress the esophagus between the cricoid cartilage and the fifth cervical vertebra. The cricoid pressure was described more than 45 years ago6 and is Setting and Participants widely recommended, although its efficacy has been poorly Patients undergoing any type of surgery under general anesdocumented. The inbecause occlusion of the esophagus is often uncomplete,8 clusioncriteriawerepatients18yearsandolderwithafullstomand it could even facilitate the opening of the lower esophaach (<6 hours fasting) or the presence of at least 1 risk factor geal sphincter. We assessed the body mass index, Mallampati score,17 mouth opening, and thyromental distance, enabling calculationoftheriskofdifficulttrachealintubation(posthoc). After preoxygenation bycomparingtheincidenceofpulmonaryaspirationwhether (either until an expired oxygen fraction >90% had been obthis maneuver is applied or feigned. Regencycases),anesthesiawasinducedusingarapidactivehypcruitmentbeganinFebruary2014andended(includingfollownotic (propofol or thiopental or etomidate or ketamine) and up) in February 2017. The use of rocuronium was not authoclose relative/surrogate in case of emergency conditions. Tracheal intubation was performed in the sniffing poShould such a person be absent, the patient was randomized sitionandusingMacIntoshlaryngoscopewithametallicblade according to the specifications of emergency consent authobecause a plastic blade increases the rate of difficult tracheal rized by the ethical committee and the patient was asked to intubation. Correct positioning of the tracheal tube was Consolidated Standards of Reporting Trials statement exconfirmedbymonitoringofend-tidalcarbondioxide. Downloaded From: on 10/18/2018 CricoidPressureComparedWithaShamProcedureinRapidSequenceInductionofAnesthesia OriginalInvestigation Research Intervention lowing categorical end points: pulmonary aspiration, aspiraPatients were randomly allocated in a 1:1 ratio to 1 of the foltionpneumonia,difficultandimpossibletrachealintubation, lowing 2 groups: Sellick group and sham group. The population included patients requiring tracheal individuals were authorized to perform the cricoid pressure. To ensure appropriate blinding of the rest of the team, ing room5 and was thought to be closed to that expected in anopaquecoverwasappliedinbothgroupsmaskingiftheinour study. To maintain appropriate blindto the cricoid pressure if the incidence of pulmonary aspiraing in case of difficult tracheal intubation, the unique untion was not more than 50% higher (relative risk of 1. A blindedinvestigatorwhoappliedthecricoidpressurecouldnot difference of less than 50% was considered clinically neglireplace the blind investigator who performed tracheal intugible because aspiration is a rare event that may occur bation. Among junior operators, only those with more than despite the use of the cricoid pressure and also because the 1 year of training (2 years for nurse) were authorized to perpressure itself is associated with adverse effects. PneumoQualitative variables were compared using the Pearson fi2 nia was considered as severe when at least 1 of the following test, Fisher exact test, or Cochrane-Armitage test for trend, itemswaspresent:decreaseinoxygensaturationgreaterthan and continuous variables were compared using the Wilcoxon 10% compared with the value before anesthesia; ratio of parrank sum test. All superiortialpressurearterialoxygentofractionofinspiredoxygenless ity tests were 2-sided, and P values of less than. Adverse events included the folThe10participatingcentersrecruited3472patients(Figure1; jamasurgery. FlowofParticipantsThroughtheStudy subgroupsofpatientswithoutnasogastrictube(n = 3032)and thoserequiringemergencysurgery(n = 2286)(datanotshown; 3472 Eligible patients randomized post hoc analysis). The incidence of difficult tracheal intubation was higher in the Sellick group but did not reach statistical significance, 1736 Sellick group 1736 Sham group although the comparison of the Cormack and Lehane grade and the longer intubation time suggest an increased diffi1 Patient excluded culty of tracheal intubation in the Sellick group (Table 2). All traumatic complications were related to tra6 Minor protocol violation 6 Minor protocol violation cheal intubation, and there was no significant difference 4 Rocuronium useda 4 Rocuronium used between groups. Most patients (n = 1703; 33 Lost on follow-up 28 Lost on follow-up 90%)whoreceivedanondepolarizingmuscularrelaxantdur1 Withdrew consent 1 Withdrew consent ing surgery and were extubated postoperatively underwent 30 Death 27 Death 1 Without surgeryb eithertrain-of-4measurementtoassessneuromuscularblock1 Psychiatric disorders ade and/or reversal of neuromuscular blockade. Therefore, 1735 patients in the Sellobservedalowincidenceofpulmonaryaspiration(0. The baseline characteristics of the 2 groups were well Although the cricoid pressure has been used in clinical balanced (Table 1). In a systematic review, Algie et al30 identified ceededthenoninferioritymarginof1. Theriskdifferthere is no relevant information available from randomized ence was fi0. Downloaded From: on 10/18/2018 CricoidPressureComparedWithaShamProcedureinRapidSequenceInductionofAnesthesia OriginalInvestigation Research Table1. Downloaded From: on 10/18/2018 Research OriginalInvestigation CricoidPressureComparedWithaShamProcedureinRapidSequenceInductionofAnesthesia Table1. Our primary end point was the occurrence of pulmonary tionofintubationandlaryngealexposurebutwithoutsignifiaspiration either during laryngoscopy or tracheal aspiration. This result is in agreement with that obtained in a the cricoid pressure and minimize lost on follow-up because randomized study. This end sure is usually interrupted when facing unexpected difficult pointisprobablylesssensitivethanthoseusingabiomarker32 tracheal intubation. Together with the lack of significant difbut has the advantage of excluding aspirations that could ocference in traumatic complications, this result suggests that curintraoperativelyorpostoperativelyandthatcannotbepretheinterferenceofthecricoidpressurewithairwaycontrolhas vented by the cricoid pressure. We do not tiveness of the cricoid pressure, we standardized anesthesia, think that this was related to the inclusion of patients with a tracheal intubation, and cricoid pressure procedures, which too-lowriskofregurgitationbecauseourstudypopulationreareconsideredessentialinsuchatrial. We did not standardize the tions),morefrequentuseofsuccinylcholine(99%vs60%)and useofgastrictubes,butexcludingpatientswithagastrictube propofol (90% vs 18%), and less frequent cardiac arrests (0% did not change our results. When looking at other secondary end points (mortality, pneumonia, adverse effects, and length of stay) no inLimitations dication was noted in favor of the cricoid pressure. Weexcludedpregnantwomen the cricoid pressure has been accused of leading to diffiand children, and thus, our results may not apply to obstetric cult tracheal intubation or even difficult mask ventilation. This is important because pulmoOur study confirmed that it adversely interferes with duranary aspiration still remains a cause of maternal death. Downloaded From: on 10/18/2018 CricoidPressureComparedWithaShamProcedureinRapidSequenceInductionofAnesthesia OriginalInvestigation Research Table2. Downloaded From: on 10/18/2018 Research OriginalInvestigation CricoidPressureComparedWithaShamProcedureinRapidSequenceInductionofAnesthesia Table2. We did not observe any significant dence-based indication for the exact weight of these factors. FurVery low levels of aspiration could have also been clinically untherrandomizedstudiesarerequiredinpregnantwomenand noticed. Finally, our study took place in urban academic ceninemergencyconditionsoutsidetheoperatingroom,bothconters and might not be generalizable in other settings. Downloaded From: on 10/18/2018 Research OriginalInvestigation CricoidPressureComparedWithaShamProcedureinRapidSequenceInductionofAnesthesia 20. It was also felt that the format of recommendations in the 2012 Guideline did not offer the flexibility required to address the 06 special issues of older people and their varied physical, cognitive, and social needs. This Guideline is unique as it has been developed to 09 provide the clinician with recommendations that assist in clinical management of a wide range of older adults such as 10 those who are not only relatively well and active but those who are functionally dependent. This latter group has been categorized 11 as those with frailty, or dementia, or those at the end of life. We have included practical advice on assessment measures that 12 enable the clinician to categorize all older adults with diabetes and allow the appropriate and relevant recommendations to be applied. Also included is a section of special considerations where areas such as pain and end of life care are addressed. No fees were paid to Working Group members in connexion with the current activity. This Guideline provides further support for clinicians by defining Population ageing is unprecedented, without parallel in the history what physical and cognitive assessments can assist the clinician of humanity. Increases in the proportions of older persons (60 years in making decisions about the functional status and comorbidity or older) are being accompanied by declines in the proportions of level of individuals being seen as a guide to treatment strategies the young (under age 15) such that by 2050, the proportion of older adopted. Physicians predominately working with older people often persons will have risen from 15% today to 25%. The regions with the with numerous problems being identified such as poor access to highest diabetes prevalence are the Pacific Islands and the Middle services, lack of educational resources, poor follow-up practices East. This problem is compounded by (caregivers) are often the primary source of everyday advice, variations of diabetes care across different countries where there emotional support, and practical help for a large number of older may be political, socioeconomic, and cultural factors that influence people with diabetes.

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The majority of this variation was due to women's health clinic uihc order lovegra 100mg fast delivery differences in the definition of dyspepsia menstruation relief discount lovegra online. Surveys that included dominant refiux symptoms in the definition gave a prevalence of 39 pregnancy symptoms at 4 weeks purchase lovegra 100mg. A meta-analysis of these trials suggests that dyspepsia is slightly more common in women womens health nyc purchase lovegra cheap. A study of 27 Scottish men in 1968 reported a 29% prevalence in 1487 Scottish men menopause kit gag gift purchase lovegra on line. The prevalence of dyspepsia therefore appears to women's health center york pa buy lovegra 100 mg line have increased slightly from 30% to 40% in recent years, although the definitions used in the earlier reports may not be comparable to later studies. Authors Year of Country Dyspepsia Number % dyspepsia report definition studied Jones et al. Rome: dyspepsia definitions that only include pain or discomfort centred in the upper abdomen as the predominant symptom. Local differences in prevalence will exist where there has been substantial immigration from countries with a higher prevalence of infection. The organism could be transmitted by the faeco-oral or oro-oral 28 route, although H. Whatever the method of transmission, epidemiological data suggests that most individuals acquire the 27,30 31 infection in childhood with social deprivation, household crowding and number of siblings being important risk factors. Socio-economic conditions were poor 70 years ago and so most children were infected with H. This is consistent with the observation that the incidence of peptic ulcer and distal gastric cancer are falling with time, as these are H. Prevalence of peptic ulcer disease Ten percent of patients undergoing endoscopy have a diagnosis of duodenal ulcer (see Figure 3). This proportion has been falling dramatically over recent years, with 20% of patients having duodenal ulcer in 1989 (see Figure 4). Previously, duodenal ulcers were treated with acid suppression, whereas now they are usually permanently cured with a course of H. This striking fall in the prevalence of duodenal ulcer over a short period of time is therefore predictable. There should also be a reduction in the incidence of duodenal ulcer as the prevalence of H. Ten percent of patients endoscoped were diagnosed as having a gastric ulcer (see Figure 3). This will be an overestimate of the true prevalence as it is recommended that patients with a diagnosis of gastric ulcer have a repeat endoscopy to ensure healing. Gastric ulcer is increasingly common with age and equally as common in females as in males (see Figure 6). Prevalence of gastro-oesophageal refiux disease Gastro-oesophageal refiux disease is more common than peptic ulcer disease, with oesophagitis present in 20% of endoscopy patients (see Figure 3). Hospital Episode Statistics suggest the prevalence of oesophagitis is remaining stable, although this is based on only eight years of follow-up (see Figure 4). Case series from endoscopy units suggest that the diagnosis of oesophagitis is increasing with 30,31,34,35 time. Prevalence of non-ulcer dyspepsia this is the most common diagnosis in dyspepsia patients referred for endoscopy (see Figure 3). Primary care consultations with non-ulcer dyspepsia increase with age and the prevalence is similar in both genders (see Figure 4). The change in prevalence of non-ulcer dyspepsia with time is difficult to establish as the definition of this condition is continually changing. The prevalence of Barretts also increases dramatically over the fifth decade and is a rare diagnosis uncer the 38 age of 40 years. The main concern with Barretts oesophagus is the risk of developing adenocarcinoma. Surveys have suggested that the risk of developing oesophageal adenocarcinoma is 1% per year although 39 this may be an overestimate due to publication bias. The incidence has declined dramatically in recent years with a concomitant rise in incidence of adenocarcinoma of the oesophagus (see Figure 8). The overall incidence of upper gastrointestinal malignancy has fallen slightly over recent years. Gastric neoplasia incidence is probably falling because of the decreasing prevalence of H. Patients with dyspepsia will consult their general practitioner or present in A&E with dyspeptic symptoms or upper gastrointestinal bleeding. Primary care services There are 32 000 general practitioners in England and Wales. Population surveys suggest approximately 25% of subjects with dyspepsia will present with their symptoms to their general practitioner. As age increases, an increasing number of ongoing (chronic) cases add to the burden of disease (see Figure 9). Total consultations for all conditions were 29 000 per 10 000 person years at risk. Reasons for consultation with dyspepsia According to the health belief model, the decision to consult the general practitioner is determined by the presence of cues, and the balance between costs and benefits is modified by specific belief in threat from, or 40,41 vulnerability to, specific conditions. A study in the Netherlands examined why patients consult their general practitioner, by means of two questionnaires completed in the waiting rooms of practices by 1000 42 patients. Multiple logistic regression was used to determine the principal predictors of consultation, and the health belief model showed a 98. Perceived efficacy of self-care and perceived need for information also infiuenced the model, but frequency and duration of complaint did not. Zola has identified five infiuences as to whether patients consult a doctor: the availability of medical care; whether the patient can afford it; the availability of non-medical therapies; how the patient perceives the problem; and how the patients peers perceive the problem. Other triggers are required to force a medicalisation of the symptoms before they are perceived as illness and consultation considered. These triggers are, according to Zola: an interpersonal crisis; perceived interference with personal relationships; sanctioning by another individual. A qualitative study of 46 working class women showed that although complex concepts of multi-factorial causation existed, women were most concerned with finding causal life events with which to invest their symptoms with individual relevance. There was no difference in the frequency, or subjective severity, of symptoms between the two groups. Consulters were significantly more likely to believe that their symptoms were due to serious illness (74% v. Fear of serious illness Jones and Lydeards study was essentially positivist in nature, concentrating on facts (in this case the reasons for consulting with dyspepsia), and analysed in a quantitative manner. A qualitative approach to the subject may provide more information about feelings and motives that would be of value in meeting the needs of patients in the consultation. An alternative, interactionist approach to the subject would aim 48 to obtain authentic insight into patients experiences. In addition, although exploring the issue of vulnerability, Jones and Lydeards study did not examine the threat component of the health belief model in terms of utility. Consulters and non-consulters with dyspepsia were identified similarly to Jones and Lydeard, but were interviewed in depth and transcribed tapes were subjected to a thematic analysis. Many of the subjects were fatalistic with respect to medical interventions and their ability to significantly alter the prognosis of illness, and the belief in dietary or mechanistic aetiology may refiect patients expectations of increasing age. Viewed in terms of theories of illness causation, the patients interviewed displayed a predominantly personalistic view. The principal explanations for symptoms lay in the areas of degeneration (age), imbalance (of foods, etc. The principal predictors of consultation in this analysis were a family or close friend having being diagnosed with a serious condition, and the potential explanation of the patients own symptoms being due to something similar. The paradoxical feature of some patients expecting the worse but not consulting can be explained within the model by reference to costs and benefits. The medical interventions, for cancer in particular, were perceived as costs, patients either not wishing to be told or not wanting to be messed around with. As in Hacketts study of delay in seeking medical advice at the Massachusetts General Hospital, patients who worried more about cancer tended to delay seeking help 50 more than non-worriers. An element of denial was also evident in the explanation of symptoms as being due to diet or increasing age. Secondary care services There are an estimated 539 gastroenterologists working in England and Wales and this figure increases at a 51 rate of approximately 7% per year. There is a wide variation in the number of gastroenterologists working per head of population between Health Authorities (see Figure 10). Some of this variation may be explained by differences in gastrointestinal disease rates, but this is unlikely to account for the eight-fold differences seen in some regions (see Figure 10). Cross-sectional studies estimate 52 that dyspepsia accounts for 50% of a gastroenterologists workload. General physicians and surgeons are also involved with the secondary care management of dyspepsia, but the proportion of time devoted to this is difficult to quantify. Investigations available Dyspepsia is common, and investigation of this symptom complex is therefore likely to be in demand. The investigation of choice until the 1980s was a barium meal but now this has been superseded by endoscopy. This is because upper gastrointestinal endoscopy is perceived to be more accurate, biopsies can be taken of 53 suspicious lesions, and access has improved with development of open access services. The demand for endoscopy doubled in the first five years of the last decade (see Figure 11). The number of patients having this procedure is now stabilising, with 1% of the population of England having an endoscopy each year (see Figure 11). Table 3: Proportion of the population endoscoped by English Health Authority Hospital Episode Statistics 1993 Region Total population Number of Endoscopy per 1,000 (thousands) endoscopies of population Northern 3,102 28,563 9. The other disadvantage of radiology is that biopsies of suspicious lesions cannot be obtained. This has now become the gold standard test for detecting oesophageal, gastric and duodenal lesions. Endoscopy can be performed with local anaesthetic throat spray, although light intravenous benzodiazepine sedation is often given. This figure is based on secondary-care data and therefore includes high risk patients. Complications can be minimised by obtaining intravenous access before the procedure, careful monitoring of the patient and giving oxygen via nasal cannulae whilst performing the endoscopy. Serology involves measuring the antibody response to the organism in the patients serum. This is the 62 cheapest test but also the least accurate, with a 8090% sensitivity and specificity. This technique can be adapted to provide a near patient test giving a diagnosis within 5 minutes. This is convenient in the 63 64 primary care setting and some studies have shown sensitivities and specificities approaching 90%. The test is more expensive than serology and involves giving a stool sample, which is not acceptable to all patients. The urea breath tests have a sensitivity and specificity >95% and are more 70 14 71 14 accurate than serology. The C-urea breath test is simple and cheap but C is radioactive and 68 13 needs to be administered in a medical physics department, which is not ideal for primary care. Cis not radioactive, so it avoids these problems, but it is difficult to detect, requiring expensive mass 13 spectrometry equipment. There have been a number of technological advances in C-urea breath tests, 72,73 making analysis cheaper but the test is still expensive compared with other non-invasive alternatives. Anti-refiux surgery the Nissen fundoplication and the Hill posterior gastropexy are the two commonest anti-refiux procedures. The Nissen fundoplication involves mobilisation of the fundus of the stomach that is then wrapped around the lower oesophagus. The gastro-oesophageal junction is sutured to the median arcuate ligament in a Hill posterior gastropexy and the stomach is also held in position by a partial anterior fundic wrap. Surgery is associated with a 1% mortality and a 28% morbidity, consisting mainly of gas-bloat syndrome and dysphagia. The short-term success rate of surgery in carefully selected cases is 85% but 10% 74 have a recurrence of symptoms during follow-up. Laparoscopic Nissen fundoplication may make surgery more attractive although one randomised controlled trial suggested it was associated with more 75 morbidity than the open procedure. Surgery for gastric cancer Surgical resection is the only procedure that provides a potential cure for gastric malignancy. A total or subtotal gastrectomy with removal of lymph nodes within 3 cm of the stomach (a D1 resection) has been the traditional approach in Europe. This has been shown to have a significantly lower post-operative mortality than more radical surgery removing more 76 distant lymph nodes and performing a splenectomy (a D2 resection) with similar three year survival. The Japanese report less post-operative mortality and better survival with D2 resections. This may be due to the Japanese presenting with gastric cancer at a younger age or more technical expertise at performing radical resections. Oesophageal cancer surgery Oesophageal resection was associated with one of the highest post-operative mortality of any of the routine 81 surgical procedures. The operation now has a <10% post-operative mortality in specialised centres, although five year survival from potentially curative resections is still less than 30%. Randomised controlled trials are currently being conducted to assess whether chemotherapy, radiotherapy or combined adjuvant therapy can improve survival. The cost of endoscopy varies according to whether it is performed as a day case or inpatient procedure, and whether any therapeutic intervention is performed. The mean cost of day case diagnostic gastroscopy was fi250 in 2000, the range fi52fi1333, and the interquartile range fi203fi380.

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Use of a low cut-off value for the fecal compared with primary colonoscopy screening for colorectal immunochemical test enables better detection of proximal neoplasia pregnancy guide generic lovegra 100mg line. Screening and surveillance neoplasms in proximal colon by simulated sigmoidoscopy vs for the early detection of colorectal cancer and adenomatous polyps menstruation 60 year old lovegra 100 mg otc, fecal immunochemical tests women's health center weirton wv buy lovegra 100mg online. Immunochemical fecal occult blood test is inadusual care for boosting colorectal cancer screening among the equate for screening test of stomach cancer menstruation starter kit generic 100 mg lovegra with amex. Uptake of faecal immunobe safely suspended for up to menstrual cramps 7dpo buy lovegra paypal 5 years after a negative colonoscopy in chemical test screening among nonparticipants in a flexible sigmoidasymptomatic average-risk patients pregnancy 6 weeks cramping lovegra 100mg sale. Diagnostic yield improves with Group of the National Colorectal Cancer Roundtable. Gastrointest collection of 2 samples in fecal immunochemical test screening Endosc 2007;65:757-66. J Gen Intern Med tive fecal immunochemical test varies with location of neoplasia 2010;25:833-9. Colorectal cancer screening: Society Task Force on Colorectal Cancer and the American Cancer why immunochemical faecal occult blood test performs as well Society. Cost-effectiveness of one testing in a colonoscopy based screening programme detects addiversus two sample faecal immunochemical testing for colorectal tional pathology. Evaluating test testing in a colonoscopic surveillance program speeds detection of strategies for colorectal cancer screening: a decision analysis for colorectal neoplasia. Quality indicators for colonospatients on low-dose aspirin, warfarin, clopidogrel, or non-steroidal copy. An automated intervention screening: results from a nested in a cohort case-control study. Eur with stepped increases in support to increase uptake of colorectal J Gastroenterol Hepatol 2011;23:323-6. Cancer Epidemiol Biomarkers Prev 2014;23: on the outcome of faecal immunochemical test. Cancer in ambient temperatures on performance of immunochemical faecal Epidemiol Biomarkers Prev 2016;25:344-50. Am J Gastroenterol Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (2); University of California, San Francisco Medical Center, San Francisco, 2012;107:99-107. Performance of the fecal immunochemical test is not decreased by high ambient temperature in the rapid Sound Health Care System, University of Washington School of Medicine, return system. Seasonal variations do not affect the superiority of fecal immunochemical tests over guaiac tests San Francisco Veterans Affairs Medical Center, University of California, for colorectal cancer screening. False negative fecal Portland, Oregon (9); Kaiser Permanente Medical Center, Walnut Creek, California (10); Indiana University School of Medicine, Indianapolis, occult blood tests due to delayed sample return in colorectal cancer screening. Gastric polyps sdale, Arizona, where Dr Lam-Himlin is encompass a spectrum of pathologic conditions that can vary in an assistant professor of laboratory medihistology, neoplastic potential, and management. Despite their cine and pathology in the Department of high prevalence, there is a paucity of literature to support managePathology and Dr Nguyen is an associate professor of medicine in the Division of ment and treatment decisions for endoscopists. Gastric polyps most Fax: 480-301-8673; frequently originate in the mucosa but encompass a broad spectrum E-mail: nguyen. Found in 6% of upper endoscopies, gastric polyps are a heterogeneous group of epithelial and subepithelial lesions that can vary in histology, neoplastic potential, and management (Table). Most have no risk of cancer, but there are certain subsets of polyps with malignant potential, necessitating further endoscopic treatment and/or periodic surveillance. Tese polyps are typically identifed histologically because they have no reliable distinguishing endoscopic features. As many gastric polyps have similar endoscopic appearances, their classifcation depends on the histologic compartments from which they arise (ie, epithelial, hamartomatous, or mesenchymal). Epithelial Polyps Epithelial polyps are the most commonly encountered gastric polyps. Other less common epithelial lesions that may present as polyps include neuroendocrine Keywords tumors (formerly carcinoids), ectopic pancreatic tissue, and pyloric Gastric polyps, stomach polyps, management gland adenomas. Clinical history and number of emic, translucent, broad-based polyps with a smooth polyps are critical in this assessment, although the precise surface. The lesions vary in size from 1 mm to 8 mm number of polyps needed to prompt further investigation and are most commonly found in middle-aged women,9 is not defned. Howated with atrophic gastritis, and the prevalence of Helicoever, despite the characteristic endoscopic appearance of bacter pylori infection is low. The overall incidence of the mutation is between Gastric hyperplastic polyps may contain pyloric glands, 1 in 10,000 and 1 in 15,000 births. Due to the low dysplastic potential of these polyps and the risk of synchronous cancers, it is not clear if hyperplastic polyps should be endoscopically resected or simply biopsied. The lack of consensus stems from the concern that forceps biopsy sampling may miss the dysplastic foci within a hyperplastic polyp. As such, current recommendations require multiple biopsies of the fat uninvolved mucosa surrounding the polyp. A: Gastric adenomas are quently is not recommended due to lack of evidence and frequently solitary and most commonly found in the 7 should be an area for future research. They are often flat or sessile and can range greatly in size, but most are greater than 1 cm. A darker, Adenomatous Polyps dysplastic epithelium is seen on the left side of the tissue. Gastric adenomas, or gastric polypoid dysplasia, are true An abrupt transition to normal, nondysplastic epithelium neoplasms and precursors to gastric cancer. Although comcan be seen on the right side (hematoxylin and eosin stain, monly seen in countries with high gastric cancer rates (eg, 100fi magnification). Korea, Japan, and China), they also account for 6% to 10% of all gastric polyps in Western populations. Gastric hyperthey are most commonly found in the antrum but can be plastic polyps are strongly associated with infammatory located anywhere in the stomach. Endoscopically, they are disorders such as chronic gastritis, H pylori gastritis, peroften fat or sessile rather than pedunculated and can range nicious anemia, and reactive or chemical gastritis. As such, it is worthwhile to biopsy the background fat Atrophic gastritis and intestinal metaplasia are frequently mucosa to identify any etiologic factors. In fact, when associated with the development of these polyps, but there H pylori is the culprit, 80% of hyperplastic polyps will is no proven association with H pylori infection. Polyps regress with H pylori eradication, prior to endoscopic that are greater than 2 cm and have villous histology have removal. Tere are 4 types of carcinoids in the stomach, each arising in diferent clinical contexts, and each with distinct prognoses and treatment protocols. This particular tumor underscores the importance of tandem biopsies of the background fat mucosa. Endoscopically, they appear as submucosal mass lesions, sometimes with ulcerations. Histologically, these neuroendocrine tumors appear similar, and biopsies of the B nonpolypoid mucosa are critical in distinguishing tumor type, prognosis, and treatment (Figure 2). The pathogenesis of type I neuroendocrine tumors is as follows: the autoimmune destruction of parietal cells leads to reduced gastric acid production and loss of feedback inhibition of gastrin secretion in the antral G cells. Gastric neuroendocrine polyps (formerly Technically, this represents a reversible hyperplasia but carcinoids). A: Gastric neuroendocrine tumors appear as may progress to malignancy, especially as tumors enlarge. Biopsies of tumors, type I lesions have an excellent prognosis with the flat background mucosa are imperative to classifying exceedingly low rates of metastatic disease. Antrectomy invasive gastric cancer both within the polyp and in synto remove the stimulatory G cells has also proven useful chronous areas of the stomach. Additionally, endoscopic follow-up the setting of multiple endocrine neoplasia 1 syndrome, is required after resection at 6 months (for incompletely Zollinger-Ellison syndrome, or a gastrin-secreting tumor resected polyps or high-grade dysplasia) or 1 year (for all elsewhere in the gastrointestinal tract. Tese Local resection of the neuroendocrine tumor, evaluation polyps result from disordered growth of tissues indigenous of metastatic disease, and resection of the stimulatory to the site. Examples include Peutz-Jeghers polyps and gastrin-secreting tumor (usually found in the small juvenile polyps, as well as hamartomatous polyps without bowel) are the mainstays of therapy. They can arise in any part of the stomor colonic polyps, gastric polyps occur in approximately ach and occur mainly in elderly men (>60 years). Unfortunately, at the of well-developed smooth muscle that is contiguous with time of diagnosis, most of these tumors are already in an the muscularis mucosa. In the small bowel and colon, advanced stage, with extensive metastasis, and are associthese lesions can be diferentiated from juvenile polyps, ated with a poor prognosis. However, gastric syndromic polyps are often Ectopic pancreas is pancreatic tissue lacking anatomic and indistinguishable from nonspecifc gastric hyperplastic vascular continuity with the main body of the pancreatic polyps. Gastric Peutz-Jeghers polyps larger than 1 cm Pyloric Gland Adenomas should be resected endoscopically, and patients should Pyloric gland adenomas are rare neoplasms that demonreceive annual surveillance. They are composed (<1 cm) polyps, surveillance endoscopy is recommended of closely packed, pyloric glandtype tubules with a every 2 to 3 years,60 although it is recognized that small monolayer of cuboidal to low columnar epithelial cells. They often arise in the gastric body with background mucosa, showing features of autoimmune gastritis and Juvenile Polyps and Juvenile Polyposis Syndrome intestinal metaplasia,57,58 and display a female predomiJuvenile polyps are mucosal tumors that consist primarily nance. B: Juvenile polyps are less specific in their and large bowels but may appear more nonspecifc in the histology than Peutz-Jeghers polyps and are sometimes gastric mucosa. This striking example shows characteristic referred to as inflammatory or retention polyps when arborizing smooth muscle (arrows; hematoxylin and eosin unassociated with a syndrome. Juvenile polyps are typically solitary pedunculated lesions in the Cowden Syndrome antrum and range from 3 mm to 20 mm. When found Cowden syndrome is another autosomal dominant, alone, they are believed to be benign incidental lesions, multisystem disorder characterized by hamartomatous unassociated with a syndrome. Just like dominant disorder that carries a lifetime gastric malignancy other clinical-pathologic diagnoses, the importance of risk of greater than 50%. A: Inflammatory polyps are a subset of multiple hamartomatous polyps usually present as polypoid lesions or nodules polyps. There are associated abnormalities of the circumscribed lesions located in the antrum or prepyloric breast (carcinoma), thyroid (follicular carcinoma), and region. B: High-power magnification shows that this genitourinary (endometrial carcinoma) systems. B: lesion is composed of vessels, small spindle cells (circled), these hamartomas are the least specific and may contain and collagen fibers (arrows), as well as an inflammatory mixed tissue types of varying degrees, such as the mixed backdrop with numerous eosinophils (hematoxylin and glands, vessels, and smooth muscle seen in this example eosin stain, 400fi magnification). Transformation neath the surface epithelium, imparting a more nodular of gastrointestinal polyps to malignancy is thought to than polypoid appearance. Given their deep location, be extremely rare; thus, surveillance endoscopy has not these lesions should be further evaluated by endoscopic been recommended by most. Tese histologically unique lesions, arising in the submucosa, were frst described in 1949 by Mesenchymal lesions cover a broad spectrum of mesoVanek as gastric submucosal granulomas with eosinophilic dermally derived tumors. Larger and/or symptomatic lesions may require complete endoscopic resection by an experienced endoscopist. Although these tumors may arise anywhere along the luminal gastrointestinal tract, the most common site is the stomach. Tese lesions are derived from the interstitial cells of Cajal (the pacemaker cells of the gastrointestinal tract), which reside between the inner circular and outer longitudinal layers of the muscularis propria. Although once believed to be a If localized to the stomach, the tumor can be surgically reactive lesion, recent studies have proven that this lesion resected. Leiomyomas Leiomyomas are benign smooth muscle tumors that were The authors have no conficts of interest to disclose. Frequency, location, and age Leiomyomas are typically asymptomatic and found and sex distribution of various types of gastric polyp. Positive predictive value of endoscopic features 90 deemed typical of gastric fundic gland polyps. The histologic distincgland polyps in familial adenomatous polyposis: neoplasms with frequent somatic tion between well-diferentiated leiomyosarcomas and adenomatous polyposis coli gene alterations. Endoscopic management of gastrointestinal hyperechoic foci, and a marginal halo, help to diferentistromal tumors. Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy. Prevalence of fundic gland polyps in a tumors occur synchronously with esophageal granular western European population. Granular cell tumors occur in the proximal tion in patients with hamartomatous fundic polyps. Endoscopically, they are usually found incidentally south-east Scotland: absence of adenomatous polyposis coli gene mutations and a strikingly low prevalence of Helicobacter pylori infection. High-grade dysplasia in sporadic fundic gland polyps: clinically relevant or notfi Despite the fact that more than 90% are asympfundic gland polyps: a case report and review of the literature. Fundic gland polyps and association gastric polyps require further intervention, and histologic with proton pump inhibitor intake: a prospective study in 1,780 endoscopies. The identifcation of such polyps gastric polyps: a retrospective analysis of their frequency, and endoscopic, historequires histologic evaluation and may involve additional logic, and ultrastructural characteristics. Anatomy, histology, embryology, and developmental gland polyp dysplasia is common in familial adenomatous polyposis. Pediatric Gastrointestinal ings of gastric hyperplastic polyps after eradication of Helicobacter pylori: comparison Disease. Disappearance of hyperplastic polyps on diferentiation from small gastrointestinal stromal tumor and leiomyoma. Efect of drug treatment pic pancreas in the stomach: endosonographic detection of malignant change. J on hyperplastic gastric polyps infected with Helicobacter pylori: a randomized, Clin Ultrasound. Histologic types and their relationship to gastric obstruction due to infammatory fbroid polyp.

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Detection of upper gastrointestinal cancer in patients taking antisecretory therapy prior to pregnancy freebies cheap lovegra 100mg line gastroscopy pregnancy portraits purchase lovegra online now. Pharmacological interventions for non-ulcer dyspepsia (Protocol for a Cochrane Review) menopause irregular periods generic 100mg lovegra fast delivery. First line treatment with omeprazole provides an effective and superior alternative strategy in the management of dyspepsia compared to womens health tacoma purchase lovegra 100 mg fast delivery antacid/alginate liquid: A multicentre study in general practice women's health magazine big book of yoga buy lovegra visa. Antisecretory therapy in 1017 patients with ulcerlike or refluxlike dyspepsia in general practice womens health physical therapy order 100mg lovegra with amex. The management of acid-related dyspepsia in general practice: a comparison of an omeprazole versus an antacid-alginate/ranitidine management strategy. Cost-effective treatment of gastro-oesophageal reflux disease a comparison of two therapies commonly used in general practice. Is upper gastrointestinal radiography necessary in the initial management of uncomplicated dyspepsiafi A randomized controlled trial comparing empiric antacid therapy plus patient reassurance with traditional care. A randomised controlled trial of four management strategies for dyspepsia: relationships between symptom subgroups and strategy outcome. Treatment of dyspeptic patients in primary care: early endoscopy or empirical therapy. Does initial management of patients with dyspepsia alter symptom response and patient satisfactionfi Near Patient H pylori testing in primary care: is treatable H pylori related pathology being missedfi Does 'near patient' H-pylori testing in primary care reduce referral for endoscopyfi Cost-effectiveness of initial endoscopy for dyspepsia in patients over the age of 50 years: A randomised controlled trial in primary care. Randomised controlled trial of omeprazole or endoscopy in pateints with persistent dyspepsia: a costeffectiveness analysis. A randomised controlled trial of Helicobacter pylori testing and open access endoscopy for dyspepsia in primary care: preliminary findings. A randomised controlled trial of endoscopy vs no endoscopy in the management of seronegative H pylori dyspspia. Endoscopy for H pylori sero-negative young dyspeptic patients: an economic evaluation based on a randomised trial. A prospective randomised trial of a "test and treat" policy versus endoscopy based management in young Helicobacter pylori positive patients with ulcer-like dyspepsia, referred to a hospital clinic. H-pylori 'test and treat' or prompt endoscopy for dyspeptic patients in primary care. Randomised controlled trial of endoscopy with testing for Helicobacter pylori compared with non-invasive H pylori testing alone in the management of dyspepsia. Benefit of Helicobacter pylori eradication in the treatment of ulcer-like dyspepsia in primary care. Gastroenterology 2001; 120 (5 suppl 1) A50 (260) National Institute for Health and Care Excellence, 2014. Empirical prescribing for dyspepsia: randomised controlled trial of test and treat versus omeprazole treatment. A comparison of the efficacy of the alginate preparation, Gaviscon Advance, with placebo in the treatment of gastro-oesophageal reflux disease. Essai randomise en double insu dune suspension buvable dalginate dans le traitement du pyrosis. Utilisation dune nouvelle forme de topaal dans la symptomatologie douloureuse du reflux gastro-oesophagien. Double-blind comparison of liquid antacid and placebo in the treatment of symptomatic reflux esophagitis. Symptomatic reflux esophagitis: a double-blind controlled comparison of antacid and alginate. A double-blind controlled trial of Gaviscon in patients with symptomatic gastrooesophageal reflux. A comparative crossover study on the treatment of heartburn and epigastric pain: liquid gaviscon and magnesium-aluminium antacid gel. Response of heartburn symptoms to a new cimetidine/alginate combination compared with an alginic acid/antacid. Combined cimetidine-alginate antacid therapy versus single agent treatment for reflux oesophagitis. Double-blind clinical study of an alginate compound vs ranitidine in patients with gastroesophageal reflux disease. Combination of cimetidine and alginic acid: an improvement in the treatment of oesophageal reflux disease. Nizatidine versus placebo in gastroesophageal reflux disease: A 12 week, multicentre, randomized, double-blind study. Cimetidine 800mg twice daily for healing erosions and ulcers in gastroesophageal reflux disease. A comparison of two doses of nizatidine versus placebo in the treatment of reflux oesophagitis. Ranitidine 300 mg twice daily and 150 mg fourtimes daily are effective in healing erosive oesophagitis. Randomized, placebo-controlled comparison of famotidine 20mg bd or 40mg bd in patients with erosive oesophagitis. Treatment of reflux oesophagitis of moderate and severe grade with ranitidine or pantoprazole-comparison of 24 hour intragastric and oesophageal pH. Short-Term Treatment of Refractory Reflux Esophagitis with Different Doses of Omeprazole or Rantidine. Rabeprazole versus ranitidine for the treatment of erosive gastroesophageal reflux disease: a double-blind, randomised clinical trial. Omerpazole and ranitidine in treatment of reflux oesophagitis: double blind comparitive trial. Omeprazole produces significantly greater healing of erosive or ulcerative reflux oesophagitis than ranitidine. Standard-dose lansoprazole is more effective than high-dose ranitidine in achieving endoscopic healing and symptom relief in patients with moderately severe reflux oesophagitis. Comparative Trial of Pantoprazole and Ranitidine in the Treatment of Reflux Esophagitis. Is a proton pump inhibitor necessary for the treatment of lower-grade reflux esophagitisfi Efficacy and tolerability of 20 mg pantoprazole versus 300 mg ranitidine in patients with mild reflux-oesophagitis: a randomized, double-blind, parallel, and multicentre study. Omeprazole (40mg) is superior to rantidine in short-term treatment of ulcerative reflux esophagitis. A placebo-controlled doseranging study of lansoprazole in the management of reflux esophagitis. Comparison of omeprazole and cimetidine in reflux oesophagitis: symptomatic, endoscopic and histological evaluations. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastrooesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Efficacy of omeprazole for the treatment of symptomatic reflux disease without esophagitis. Lansoprazole compared with ranitidine for the treatment of nonerosive gastroesophageal reflux disease. Pantoprazole and omeprazole in the treatment of reflux oesophagitis: a European multicentre study. Double-blind multicentre comparison of omeprazole and ranitidine in the treatment of reflux oesophagitis. Omeprazole is superior to ranitidine plus metoclopramide in the short-term treatment of erosive oesophagitis. Pantoprazole 20mg is effective for the relief of symptoms and healing of lesions in mile reflux oesophagitis. Omeprazole 20mg to 40mg once daily is more effective than ranitidine 300mg to 600mg daily in providing complete relief and endoscopic healing in patients with reflux oesophagitis. Oral pantoprazole for erosive esophagitis: a placebo-controlled, randomized clinical trial. Efficacite comparee du lansoprazole et de lomeprazole dans le traitement de loesophagite peptique. Comparable clinical efficacy and tolerability of 20mg pantoprazole and 20mg omeprazole in patients with grade I reflux oesophagitis. Lansoprazole versus ranitidine dans le traitement de loesophagite peptique par reflux. A double-blind study of pantoprazole and omeprazole in the treatment of reflux oesophagitis: a multicentre trial. Rapid symptom relief in reflux oesophagitis: a comparison of lansoprazole and omeprazole 1996; 10: 75763. Omeprazole (20mg/j) compare a ranitidine (150mg 2 fois/j) dans le traitement de loesophagite par reflux. Double blind comparison of omeprazole (40mg od) versus cimetidine (400mg qd) in the treatment of symptomatic erosive reflux oesophagitis, assessed endoscopically, histologically and by 24 h pH monitoring. Rabeprazole 20mg once daily or 10mg twice daily is equivalent to omeprazole 20mg once daily in the healing of erosive gastro-oesophageal reflux disease. Systematic review of proton pump inhibitors for the acute treatment of reflux oesophagitis. Meta-analysis of randomized controlled trials comparing standard clinical doses of omeprazole and lansoprazole in erosive oesophagitis. Evidence for therapeutic equivalence of lansoprazole 30mg and esomeprazole 40 mg in the treatment of erosive esophagitis. Esomeprazole improves healing and symptom resolution as compared with omeprazole in reflux oesophagitis patients: a randomized controlled trial. Efficacy and tolerability of pantoprazole 40 mg versus 80 mg in patients with reflux oesophagitis. A randomized, double-blind, comparative study of standard-dose rabeprazole and high-dose omeprazole in gastro-oesophageal reflux disease. Does 40 mg omeprazole daily offer additional benefit over 20 mg daily in patients requiring more than 4 weeks of treatment for symptomatic reflux oesophagitisfi Ranitidine controls nocturnal acid breakthrough on omeprazole: a controlled study in normal subjects. Nocturnal recovery of gastric acid secretion with twice-daily dosing of proton pump inhibitors. The usefulness of likelihood ratios in the diagnosis of dyspepsia and gastro-esophageal reflux disease. Acid suppression by famotidine 20mg twice daily or 40mg twice daily in preventing relapse of endoscopic recurrence of erosive esophagitis. Omeprazole 10mg or 20mg once daily in the prevention of recurrence of reflux oesophagitis. Rabeprazole for the prevention of recurrent erosive or ulcerative gastro-oesophageal reflux disease. Rabeprazole for the prevention of pathologic and symptomatic relapse of erosive or ulcerative gastroesophageal reflux disease. Esomeprazole once daily for 6 months is effective therapy for maintaining healeed erosive esophagitis and for controlling gastroesophageal reflux disease symptoms: A randomized, double-blind, placebo-controlled study of efficacy and safety. Comparison between omeprazole and ranitidine in medium-term treatment of reflux oesophagitis. Lansoprazole versus ranitidine in the maintenace treatment of reflux oesophagitis. Prevention of relapse of reflux esophagitis after endoscopic healing: the efficacy and safety of omeprazole compared with ranitidine. Maintenance therapy with pantoprazole 20mg prevents relapse of reflux oesophagitis. Lansoprazole 15mg and 30mg daily in maintaining healing and symptom relief in patients with reflux oesophagitis. Esomeprazole 20mg and lansoprazole 15mg in maintaining healed reflux oesophagitis: Metropole study results. Pantoprazole 20mg is an effective maintenance therapy for patients with gastrooesophageal reflux disease. Review article: the pharmacological inhibition of gastric acid secretion-tolerance and rebound. Marked increase in gastric acid secretory capacity in patients with reflux oesophagitis after a three months period with proton pump inhibitor in conventional dose. Rebound intragastric hyperacidity after abrupt withdrawal of histamine H2 receptor blockade. Rebound hypersecretion after omeprazole and its relation to on-treatment acid suppression and Helicobacter pylori status. The effect if Helicobacter pylori eradication on reflux symptoms in gastroesophageal reflux disease in patients: a randomised controlled trial. Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis. A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Prevention of recurrence of oesophageal stricture, a comparison of lansoprazole and high-dose ranitidine. A randomized blinded comparison of omeprazole and ranitidine in the treatment of chronic esophageal stricture secondary to acid peptic esophagitis. A cost-utility analysis comparing omeprazole with ranitidine in the maintenance therapy of peptic esophageal stricture. On demand therapy with omeprazole for the long-term management of patients with heartburn without oesophagitis a placebo-controlled randomized trial.

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