Journal of clinical gastroenterology
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J. Clin. Gastroenterol. · Mar 1999
ReviewBiliary pancreatitis: a review. Emphasizing appropriate endoscopic intervention.
Gallstones are a common cause of acute pancreatitis. This article reviews acute biliary pancreatitis and includes natural history, noting the serious nature of some cases; pathogenesis, identifying transient obstruction as the primary pathogenetic event; diagnosis, including biochemical parameters and imaging; assessment of severity, underlining the importance of early prognostic signs, organ failure, and local complications; and management. ⋯ Also discussed are additional clinical situations related to biliary pancreatitis in which endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy play a role. Finally, a suggested endoscopic approach to acute biliary pancreatitis is presented along with an algorithm incorporating severity stratification, principles of endoscopic intervention, and concepts of sterile and infected pancreatic necrosis.
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J. Clin. Gastroenterol. · Dec 1998
ReviewOutcomes research, practice guidelines, and disease management in clinical gastroenterology.
The delivery of health care is undergoing dramatic change. Often, patients have come to be viewed as customers and physicians as merely providers. The progressive rise in the cost of medical care has placed a premium on restraint. ⋯ The field of outcomes research has emerged in response to these influences, providing the means to measure the relative effectiveness of different interventions to identify those that provide the most benefit for their cost. At the same time, outcomes research provides a monitoring system to ensure that quality is not sacrificed in the enthusiasm to reduce expenditures. These principles have implications in the practice of clinical gastroenterology.
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J. Clin. Gastroenterol. · Apr 1996
Editorial Review Case ReportsExcluding gastroesophageal reflux disease as the cause of chronic cough.
Gastroesophageal reflux disease (GERD) is recognized to be present in 10-20% of cases of chronic cough. Proving that it is the cause of the cough is more difficult. ⋯ In the commentary following the case history, we review the medical literature to confirm that GERD and cough may each precipitate the other. The role of esophageal pH monitoring in difficult cases of chronic cough is explored; we emphasize the use of pH monitoring while the patient is on therapy to prove or disprove the link.
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J. Clin. Gastroenterol. · Dec 1987
Review Case ReportsAortogastric fistula from hiatal hernia ulcer. A cause of massive upper gastrointestinal bleeding.
An 83-year-old woman with no history of vascular surgery presented with a fatal upper gastrointestinal bleed from an aortogastric fistula secondary to a penetrating gastric ulcer. The fistula was between the thoracic aorta and the gastric ulcer in a hiatus hernia. ⋯ Aortogastric fistula involving the thoracic aorta and a gastric ulcer is rare in the absence of vascular graft surgery or aneurysm. We review the pertinent literature.