The American journal of gastroenterology
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Am. J. Gastroenterol. · Apr 2013
Review Comparative StudyHCV RNA viral load assessments in the era of direct-acting antivirals.
Recent regulatory approvals of the NS3/4A protease inhibitors boceprevir and telaprevir launched a new therapeutic era for hepatitis C virus (HCV) genotype 1 infection. Decisions to shorten, extend, or stop treatment with these direct-acting antiviral (DAA) regimens require accurate quantification of serum HCV RNA levels. To effectively use DAA therapies, clinicians must understand performance characteristics of HCV RNA real-time PCR assays and the clinical significance of HCV RNA that is detectable below the lower limit of quantification. This review summarizes terms used to report HCV RNA viral load results, explains the analytical performance of the PCR assay used in the clinical trials of boceprevir and telaprevir, and compares currently available commercial assays.
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Am. J. Gastroenterol. · Apr 2013
Randomized Controlled TrialMidodrine and clonidine in patients with cirrhosis and refractory or recurrent ascites: a randomized pilot study.
Splanchnic arterial vasodilatation and subsequent activation of anti-natriuretic and vasoconstrictive mechanisms have an important role in cirrhotic ascites. The aim of this study was to evaluate the effects of midodrine, clonidine, and their combination on systemic hemodynamics, renal function, and control of ascites in patients with cirrhosis and refractory or recurrent ascites. ⋯ These results suggest that midodrine, clonidine, and their combination plus SMT improves the systemic hemodynamics without any renal or hepatic dysfunction, and is superior to SMT alone for the control of ascites. However, the combination therapy was not superior to midodrine or clonidine alone.
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Am. J. Gastroenterol. · Mar 2013
Review Meta AnalysisEffect of comorbidity on mortality in patients with peptic ulcer bleeding: systematic review and meta-analysis.
By systematic review and meta-analysis, we sought to assess the impact of comorbidity on short-term mortality in patients with peptic ulcer bleeding (PUB). ⋯ Underlying comorbidity is consistently associated with increased mortality in patients with PUB. The number and type of comorbidities in patients with PUB should be carefully evaluated and factored into initial management strategies.
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Am. J. Gastroenterol. · Feb 2013
Increased risk of pneumonia among patients with inflammatory bowel disease.
Patients with inflammatory bowel disease (IBD) may be at increased risk for infections. We aimed to determine the pneumonia risk in IBD and how specific medications affect this risk. ⋯ Patients with IBD are at increased risk for pneumonia. Medications such as corticosteroids and narcotics are particularly associated with pneumonia in this population. An emphasis upon primary prevention of pneumonia through vaccination and reduction of risk factors is warranted.
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Am. J. Gastroenterol. · Feb 2013
White-matter microstructural changes in functional dyspepsia: a diffusion tensor imaging study.
Recent neuroimaging studies have identified brain microstructural changes in patients with functional gastrointestinal disorders, especially in irritable bowel syndrome. However, whether the microstructure is changed in patients with postprandial distress syndrome (PDS) remains elusive. Therefore, the present study was aimed to examine the white-matter (WM) microstructural changes in patients with PDS. ⋯ Our findings have provided preliminary evidence of WM microstructural changes in patients with PDS. Part of the changes could be accounted for by a higher level of psychosocial distress in the patient group.