The American journal of gastroenterology
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Am. J. Gastroenterol. · Aug 2009
Comparative StudyOutcomes of intra-abdominal fungal vs. bacterial infections in severe acute pancreatitis.
Intra-abdominal infection in severe acute pancreatitis (SAP) has significant morbidity and mortality; however, reports conflict on the outcome of patients with intra-abdominal fungal infection (IFI). We aimed to compare the morbidity and mortality of IFI compared with intra-abdominal bacterial infection (IBI) and no intra-abdominal infection (NII) in patients with SAP. ⋯ Patients with SAP and IFI suffered greater in-hospital morbidity than did patients with IBI alone. Concomitant fungal infection, however, did not increase the in-hospital mortality rate.
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Am. J. Gastroenterol. · Aug 2009
Voltage-gated potassium channels in IB4-positive colonic sensory neurons mediate visceral hypersensitivity in the rat.
Irritable bowel syndrome (IBS) is associated with a state of chronic visceral hypersensitivity, but the underlying molecular mechanisms of visceral hyperalgesia remain elusive. This study was designed to examine changes in the excitability and alterations of voltage-gated K+ currents in subpopulations of colonic dorsal root ganglion (DRG) neurons in a rat model of IBS-like visceral hypersensitivity. ⋯ A new model for chronic visceral hypersensitivity following a diluted AA stimulus in the neonatal period is described. The hypersensitivity may be associated with mast cell hyperplasia in the colon and increased excitability of IB4-positive colonic neurons as a result of suppression of I(A) density and a shift in the inactivation curves of I(A) and I(K) in a hyperpolarizing direction in these cells. This study identifies for the first time a specific molecular mechanism in subpopulations of colonic DRG neurons that underlies chronic visceral hypersensitivity.
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Non-anesthesiologist-administered propfol (NAAP) sedation for endoscopic procedures remains controversial despite the overwhelming evidence that with proper training and patient selection, NAAP is safe and results in improved time to sedation and recovery when compared with standard sedation with a combination of an opioid and benzodiazepine. Emerging data suggest that NAAP also results in an improved psychomotor recovery. Can our patients return to meaningful tasks such as driving with NAAP after recovery in the endoscopy suite?
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Am. J. Gastroenterol. · Jul 2009
Comparative StudyDisparities in emergency department wait times for acute gastrointestinal illnesses: results from the National Hospital Ambulatory Medical Care Survey, 1997-2006.
(i) The aims of this study were to report wait times for visits to US emergency departments (EDs) for acute gastrointestinal illnesses, (ii) to identify whether racial/ethnic disparities exist in wait times, and (iii) to characterize factors associated with delays in physician assessment. ⋯ A significant proportion of visits to US EDs for acute gastrointestinal illnesses are associated with a delay in initial clinical assessment. Hispanic patients waited longer and had a higher frequency of delays compared with other racial/ethnic groups. Future policies should be directed at reducing delays in physician assessment and addressing this healthcare disparity.
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Am. J. Gastroenterol. · Jul 2009
Psychosocial distress and somatic symptoms in community subjects with irritable bowel syndrome: a psychological component is the rule.
Psychosocial factors may drive people with irritable bowel syndrome (IBS) to seek health care, but whether psychological factors are causally linked to IBS is controversial. One hypothesis is that IBS is a heterogeneous syndrome comprising two distinct conditions, one psychological and the other biological. However, it is unclear how many people with IBS in the community have little somatization and minimal psychosocial distress. The aim of our study was to estimate the proportion of people with IBS in a representative US community, who have low levels of somatic and psychological symptoms. ⋯ Psychological factors and somatization are strongly associated with IBS in the community. However, IBS may not be related to low psychological distress and/or somatization.