AL-AZHAR ASSIUT MEDICAL JOURNAL VOL 13, NO 1, JANUREY 2015 SUPPL
|
|
- Alexandrina Harrison
- 6 years ago
- Views:
Transcription
1 AL-AZHAR ASSIUT MEDICAL JOURNAL COMPARATIVE STUDY BETWEEN THE EFFICACY OF REBAMIPIDE, SUCRALFATE AND PANTOPRAZOLE IN TREATMENT OF POST BANDING VARICEAL ULCERS Gamal Mohammad Mohammad Soliman 1,Yasser Amer 2 and Sadek Mostafa 3 Departments of Tropical Medicine 1, General Surgery 2 and Internal Medicine 3 faculty of Medicine - Al- Azhar University ABSTRACT Background: Endoscopic variceal band ligation (EVL) is an effective procedure to control and prevent variceal bleeding in patients with liver cirrhosis. Although EVL has some complications, yet these complications are related to post-evl ulcers. Few data exist regarding therapy of post-ligation ulcer and treatment been mostly empirical with drugs used for peptic ulcer diseases. Aim of the work: is to compare between the efficacy of rebamipide, sucralfate and pantoprazole in treatment of post banding variceal ulcers. Methods: seventy five patients with oesophageal varices eligible for elective band ligation represented the population of the study. The patients were allocated into three groups; rebamipide group, they received rebamipide 100 mg 3 times daily; pantoprazole group, they received pantoprazole 40 mg/day orally at morning; sucralfate group, they received sucralfate 1gm every 6 hours, for 14 days beginning at the next day of band ligation. Subjects underwent EGD 14 days after banding. Primary outcomes included the size and number of ulcers and the subjects' reports of bleeding, dysphagia, chest pain and vomiting. Results: At follow-up endoscopy, the number of patients with post-band ulcers and size of ulcers were similar in the three groups. However, the number of ulcers for each patient is statistically significant less in rebamipide group when compared to pantoprazole and sucralfate (P <.001). Chest pain, dysphagia and vomiting scores were not significantly different. Dysphagia was by far the most common symptom with no case of bleeding was reported in all patients of the studied groups. Conclusion: Rebamipide is effective in decreasing the post banding complication and reducing size of ulcer as well as the number of ulcers with no significant effect on post banding ulcer formation. Rebamipide can be used routinely in settings of post-evl as a good alternative to pantoprazole and sucralfate. Key words: Rebamipide, Pantoprazole, Sucralfate, Endoscopic variceal ligation (EVL), Post banding variceal ulcers. INTRODUCTION Esophageal varices are the major complication of portal hypertension. It is detected in about 50% of cirrhosis patients, and approximately 5 15% of cirrhosis patients show newly formed varices or worsening of varices each year (1). Endoscopic variceal ligation (EVL) is a standard endoscopic procedure in the management of acute variceal bleeding and is beneficial in the primary and secondary prophylaxis of esophageal variceal bleeding (2). EVL is associated with complications such as hemorrhage, chest pain, dysphagia, and odynophagia due to post-evl ulcers in the esophageal mucosa (3). The rubber band causes hemostasis, thrombosis and sloughing of variceal column; it slough off in the following hours, leaving a shallow ulcer behind(4)that heals within 2 3 weeks, allowing the development of fibrosis in the sub mucosa. In case of premature detachment of the rubber band, before variceal thrombosis, marked alterations of the mucosa can be seen with dilated variceal vessels in necrotic areas (5). The behavior of post-ligation ulcer appears benign because of the instrument design which sucks up mucosa and submucosa leading only to the formation of superficial ulcers. They heal by fibrosis, entrapping only the mucosa, and submucosal venous channels, leaving the muscle layer unaffected(6). Few data exist regarding adjuvant therapy for EVL. The few groups who have attempted to determine if adjuvant therapy reduces complications have reported mixed results (7). Rebamipide is one of the gastroprotective drugs able to intervene effectively in the process of ulcer healing and effectively improve the quality of ulcer healing (8).Clinical and experimental data demonstrate that rebamipide accelerates gastric ulcer healing, prevents ulcer relapse, and protects gastric mucosa against acute injury caused by various noxious agents (9). Sucralfate has a significant role in decreasing the rate of occurrence of postbanding ulcers and as well their size (10). Several studies have reported that proton pump inhibitors (PPIs) decrease the size of post-evl ulcers (11, 12). 28 P a g e
2 Gamal Mohammad Mohammad Soliman et al THE AIM OF THIS STUDY is to compare between the efficacy of rebamipide, sucralfate and pantoprazole in treatment of post banding variceal ulcers. PATIENTS AND METHODS Study Design This study is a randomized controlled trial. Study Setting and time; This study was conducted in the endoscopy units of department of Tropical Medicine (Al-Hussein and Sayed Galal Uuniversity Hospitals) in the period from November 2013 to April Inclusion criteria: Patients above the age of 18 years and below age of 65 years presented for elective band ligation of esophageal varices. Exclusion criteria: Patients who had been subjected to injection sclerotherapy sessions or having endoscopically confirmed pre-existing oesophageal ulcers. Patient s ongoing therapy with sucralfate, rebamipide, H2 blockers or proton pump inhibitors. The presence of Barret's esophagus, isolated fundal varices or peptic ulcer disease and previous anti-reflux procedures.diabetic patients, pregnancy, patients with advanced systemic disease as heart failure renal failure or any depleting disease that might affect healing process and\or life expectancy and as well those with suspected malignancy. Allergy to rebamipide, sucralfate, pantoprazole and finally patients who refuse to participate in the trial. The Recruited Patients (75) were randomized into three groups: Group I (n=25) (Rebamipide group): They received rebamipide (Mucosta 100 mg 3 times daily for 14 days beginning at the next day of band ligation). Group II (n=25) (Pantoprazole group): They received pantoprazole, 40 mg/day orally at morning for 14 days beginning at the next day of band ligation). Group III (n=25) (Sucralfate group): This group included 25 patients. They received sucralfate (Gastrofait 1gm every 6 hours for 14 days beginning at the next day of band ligation). Ethical considerations: The objective of the study was explained to the patients who met the eligibility criteria and they were asked to sign a consent form. All the Studied Cases were subjected to the following Complete clinical evaluation;laboratory investigations [To detect the etiology of liver disease, to evaluate the liver function, and to detect the impact of liver disease and portal hypertension on kidney and blood elements]; evaluation of the patients according to Child classification (A, B, C); abdominal ultrasonography and esophagogastroduodenoscopy (EGD) Esophagogastroduodenoscopy: EGD was done to all patients to evaluate the following points and then to conduct the process of esophageal varices band ligation in eligible patients: A. Esophageal varices: to detect number and grade of esophageal varices according to Westby's grading system according to the size at the gastro-esophageal junction into four grades (13): Grade I: Varix is flush with the wall of the esophagus; Grade II: Protrusion of the varix, but not more than half way to the center of the lumen; Grade III: Protrusion of the varix more than half way to the center of the lumen; Grade IV: The varices are so large that they meet at the midline. Also, to detect presence of risky signs e.g.: cherry red spots and red color sign and number of placed bands. B.Portal hypertensive gastropathy (PHG): It's classified, according to consensus statement of Baveno IV meeting into; Mild PHG, mosaiclike pattern; Sever PHG, When mosaic-like pattern is superimposed by any red signs (red point lesions, cherry red spots, and black brown spots) (14).C.Other endoscopic finding. Endoscopic Band Ligation of Oesophageal Varices; the procedure of band ligation was conducted using Saeed multiband ligator shooter then the patients told to come in the predetermined dates for follow up; one week after the banding, two weeks after the first banding. Post-Procedure Follow up and Evaluation One week after the banding: Complete history using a special questionnaire about: 1- Post banding bleeding. 2- Chest pain (no, mild, moderate, sever) whereas. Mild: chest pain that could be tolerated Moderate: could be tolerated in between. Sever: awaken the patient from sleep and need medication 3- Dysphagia (no, mild, moderate, sever) whereas. 29 P a g e
3 AL-AZHAR ASSIUT MEDICAL JOURNAL Mild: dysphagia that could be tolerated Moderate: could be tolerated in between. Sever: couldn t be tolerated and need intervention. 4- Vomiting. 5- Compliance of patients in taking. Two weeks after the first banding: 1. History was taken about post banding complication and compliance as after one week. 2. EGD to assess for: number and grade of varices, number and size of ulcers (measured using an endoscopic measuring wire designed for ERCP to assess length (Wilson-Cook, Winston-Salem,NC) and an open 5-mm biopsy forceps to approximate width) (Shaheen et al., 2005), number of placed bands and other endoscopic finding. Statistical Analysis The data were processed and analyzed using the statistical package for social sciences (SPSS) program. A significant statistical finding is declared if p-value is less then or equal 0.05]. RESULTS This study was conducted on 75 patients eligible for elective band ligation. The studied groups were matched for age & gender. It is apparent that the majority of patients in both groups were males in the 5th decade, male (56%) were more than female (44%). (table 1). Both groups were also matched regarding the aetiology of liver disease and child-pugh classification (table 1), as well as the prebanding status of oesophageal varices (table 2). All patients of both groups were reevaluated clinically with good history taking 1 st week and 2 nd weeks following band ligation to clarify the possible, expected minor complications of band ligation with special stress on chest pain, dysphagia and rebleeding. Dysphagia was by far the most common symptom occurred in 27 patients (36%) being in; 10 patients (40%) of each pantoprazole and sucralfate groups, and less commonly in rebamipide group seven patients (28%). As regard bleeding, no case of bleeding was reported in all patients of the studied groups The difference between the studied groups regarding these complications (1st week and two weeks following band ligation) proved to be statistically insignificant (P-value >0.05). (Table 3) Also, we studied the number of postbanding ulcers in the studied groups as shown in table 4. In rebamipide group,12 patients (85.71%) had a single ulcer, two patients (14.29%) had two ulcers. However in in pantoprazole group the mean of number of all ulcers was 2.27±0.70. The number of single ulcer was two (13.33%), while number of two ulcers was seven (46.67%) and the number of three ulcers was six (40 %). In sucralfate group the number of single ulcer was one (7.14 %), while the number of two ulcers was eight (57.14%) and the number of three ulcers was five (35.71 %). The difference between the studied groups regarding the number of postbanding ulcers was statistically insignificant. During the follow up endoscopy after two weeks we compared the studied groups regarding the mean size of ulcers as shown in table 4. There is no statistically significant difference as regard size of post banding ulcers after the second week between the studied groups, as the mean size of ulcers in rebamipide group was 4.57 mm ±2.4, while in pantoprazole group was 4.85 mm ±1.972 and in sucralfate group was 4.44 mm ± P a g e
4 Gamal Mohammad Mohammad Soliman et al Table 1 Demographic characteristics of the studied groups Parameter Rebamipide Pantoprazole Sucralfate (N=25) (N=25) (N=25) Age (year) (Mean± SD) 51.04± ± ±6.697 Gender Male 12(84.0%) 10 (40.0%) 11 (44.0%) Female 13(52.0%) 15 (60.0%) 14 (56.0%) Smoking 5 (20.0%) 6 (24.0%) 7 (28.0%) History of Hem / Mele 14 (56.0%) 17 (68.0%) 15 (60.0%) Encephalopathy 3 (12.0%) 5 (20.0%) 6(24.0%) Schistosomiasis 5 (20.0%) 8 (32.0%) 7 (28.0%) HBsAg +ve 1 (4.0%) 0 (0.0%) 1 (4.0%) HCV Ab+ve 24 (96.0%) 24 (96.0%) 24 (96.0%) Mixed HCV& HBV 0 (0.0%) 1 (4.0%) 0 (0.0%) Child score (Mean±SD) 8.40± ± ±2.261 A 9 (36.0%) 11 (44.0%) 9 (36.0%) Childs s class B 8 (32.0%) 8 (32.0%) 9 (36.0%) C 8 (32.0%) 6 (24.0%) 7 (28.0%) P Value t p=0.683 χ2 p =0.850 χ2 p =0.803 χ2 p =0.675 χ2 p =0.551 χ2 p =0.518 χ2 p =0.431 χ2 p =0.431 χ2 p =0.431 χ2 p =0.916 χ2 p =0.958 χ2 p =0.978 χ2 p =0.654 Table 2 Upper Endoscopy finding of the patients of the studied groups at the time of presentation EGD (at presentation) No. of columns Grade of OVs RCS No. of bands PHG Gastric Extension II II-III III III-IV Rebamipide(N=25) Groups Pantoprazole Sucralfate (N=25) (N=25) Total (N=75) Chi- Square N % N % N % N % Pvalue IV No Yes Mild Sever No Yes P a g e
5 AL-AZHAR ASSIUT MEDICAL JOURNAL Table 3 Follow up of the studied groups for post banding side effects after one & two weeks of band ligation. Post banding complication Rebamipide(N=25) Groups Pantoprazole Sucralfate Total (N=25) (N=25) (N=75) N % N % N % N % Chi- Square X 2 P- value Chest pain 1 st wk Dysphagia No Mild Moderate No Mild Vomiting No Chest pain 2nd wk Dysphagia Yes No Mild Moderate No Mild Vomiting No Yes Table 4 The number of patients with post-banding ulcers & number of ulcers per patient as well as mean size of the post banding ulcers in both groups Parameter Rebamipide Pantoprazole Sucralfate P Value Number of patients with post-band ulcers 14 (56.0%) 15 (60.0%) 14 (56.0%) Number of ulcers / patients (85.7%) 2 (14.3%) 2(13.3%) 7(46.7%) 1 (7.1%) 3 0 (0.0%) 6(40.0%) 5 (35.7%) 8 (57.2%) 0.001* Mean size of ulcers mm (Mean± SD) 4.57± ± ± P a g e
6 Gamal Mohammad Mohammad Soliman et al DISCUSSION EVL is an effective procedure to control and prevent variceal bleeding, but can be complicated by bleeding from post-evl ulcers (15). It is associated with side effects, including pain from ulceration, dysphagia, odynophagia and post ligation bleeding (7). Shallow ulcerations at the site of each ligation are the rule and rarely bleed. The most worrisome complication was bleeding due to ultimately sloughing of bands caused by inadvertent contact with the endoscope during follow-up endoscopy, for this reason, two week intervals between ligation sessions have been adapted(16). Postligation ulcers are necessary accompaniment of EVL, similar to postsclerotherapy ulcers, they heal by time as follows; by the end of the third day, nearly one half of the varices will have overlying ulcers, after one week, all ligated varices will be replaced by superficial ulcers of the same size; more than one half of them will have been healed within two weeks, and all of them will have been completely healed by the end of the third week (10). These ulcers carry a potential risk of upper gastrointestinal bleeding (in very deep ulcers). In view of their rapid spontaneous healing, it is unclear whether the presence of post-band ulceration requires specific therapy to accelerate the healing process or not (7). Vanbiervliet et al studied bleeding related to post banding ulcers following EVL in 605 cirrhotic patients and they reported that bleeding occurred from 2-29 days with a mean of 13.5 following ligation in 21 patients and they concluded that bleeding related to post banding ulcer is a rare but a severe complication (5). Treatment of post-band ulcers has been mostly empirical with drugs used for peptic ulcer diseases with very few data existing regarding their beneficial effect (7). Nijhawan and Rai randomized 30 subjects undergoing elective EVL to treatment with either sucralfate or placebo. No difference in healing was found between the two groups (17). Conversely, treatment of sclerotherapy ulcers with sucralfate was shown to speed healing in a randomized controlled trial of 45 patients (18). However Lo et al found that the combination of ligation, nadolol and sucralfate (triple therapy) proved more effective than band ligation alone in term of prevention of variceal recurrence and upper gastrointestinal re-bleeding as well as variceal re-bleeding (19). Also, Sakr et al found that sucralfate has a significant role in decreasing the rate of occurrence of variceal post-banding ulcers and as well their size (10). Shaheen et al found that, pantoprazole reduces the size of post-banding ulcers after variceal band-ligation in a randomized controlled trial (7).The double-blind RCT by Shaheen et al (7) was quoted in guidelines to support PPI use post-evl (20, 21). Also, Wahib et al in a study comparing pantoprazole versus placebo inreducing post banding ulcers after variceal band ligation in secondary prophylaxis found that PPI has no significant effect on post banding ulcer formation, but it reduces the ulcer size at follow-up endoscopy (22). However Elsayed in randomized controlled trial (for assessing of PPI after EVL) conducted on 46 patients, showed no statistically significant difference in post banding ulcer s size between both groups (placebo &pantoprazol) (23). Rebamipide a novel mucosal-protective and ulcer-healing drug, is widely prescribed in East Asia (24). Two weeks after band ligation we observed that there was no statistically significant difference in the number of patients with post- band ulcers between the studied groups. In rebamipide and sucralfate groups the number of patients with post- band ulcers14 patients (56%) and in pantoprazole groups 15 patients (56%). These data were in agreement with Wahib et al who reported that 13 patients (52%) in pantoprazole group developed post band ulcers (22). Elsayed also demonstrated that the number of patients who developed post banding ulcers 13 patients (68.4%) of pantoprazole group (23). In contrast, Sakr et al (2011) reported in their study that the number of patients with post-band ulcerswho received sucralfate were 12 (38.7%) and 23(74.2%) in placebo group (10). It was evident in this study that the number of post banding ulcers for each patient was significance in rebamipide group compared to sucralfate and pantoprazole groups (P value <0.001) (table 4). After two weeks of banding the rebamipide group, the number of single ulcer was 12 (85.71%) and the number of two ulcers was two (14.29%).While, the mean was 2.27±0.7 ulcers in the sucralfate group; the number of single ulcer was one (7%), the 33 P a g e
7 AL-AZHAR ASSIUT MEDICAL JOURNAL number of two ulcers was eight (57.14%) and the number of three ulcers was five (35.71%) compared to pantoprazole group where, the number of single ulcer was two (13.33%), the number of two ulcer was seven (46.67%) and the number of three ulcer was six (40%) and this differences were statistically significant. Shaheen et al (7) and El Sayed (23) demonstrated that no significant difference in the number of post banding ulcers in the pantoprazole group and the placebo group. There was no statistically significant difference as regard size of post bandingulcers after the second week between the studied groups, as the mean size of ulcers in rebamipide group it was 4.57mm±2.4 compared to pantoprazole group where it was 4.85mm±1.972 and in sucralfate group was 4.44mm±2.132 (table 25 & figure 34). Our findings were in agreement with Wahib et al (2010) in a randomized controlled trial included 50 patients who were presented for variceal band ligation in secondary prophylaxis. Patients were randomized into two groups, one group received PPI and the other group received a placebo drug also for 14 days beginning at the next day of elective variceal band ligation. They demonstrated that the mean size of ulcers of PPI group was (4.5 mm) compared to (6.72 mm) in the placebo group. Similar findings were documented by other authors 3.7 mm compared to 8.2 mm as reported by Shaheen et al (7) Also, Sakr et al (10) revealed that the mean size of post-banding ulcers in sucralfate group was 2.7 mm ± 1.2. Where, El Sayed (23) found that the mean size of ulcers of drug group was 4.8 mm compared to 5.4 mm in the control group. In this study it seems that rebamipide is effective in decreasing the number of post banding ulcers for each patient after two weeks of post variceal band ligation. However, there were no statistically significant difference between rebamipide and other two drugs (pantoprazole and sucralfate) in reducing size of post-banding ulcers and in decreasing post banding complications as all of them are effective. CONCLUSION Endoscopic variceal band ligation (EVL) is a safe and effective therapeutic and prophylactic method in managing esophageal varices. Although EVL has some complications, yet these complications are minor and transient. Post-banding ulcers are expected; however, they are superficial and rarely bleed. Rebamipide, Pantoprazole and Sucralfate have no significant effect on post banding ulcer formation, but they reduce the ulcer size at follow-up endoscopy. The number of ulcers for each patient is statistically significant less in rebamipide group when compared to Pantoprazole and Sucralfate. REFERENCES 1. Maruyama H, Yokosuka O. Pathophysiology of portal hypertension and esophageal varices. International journal of hepatology. 2012; Tang S-j. Ligation of Esophageal Varices. Video Journal and Encyclopedia of GI Endoscopy. 2013;1(1): Boo GB, Oh JC, Lee BJ, Lee DM, Kim YD, Park CG, et al. [The effect of proton pump inhibitor on healing of post-esophageal variceal ligation ulcers]. The Korean journal of gastroenterology= TaehanSohwagiHakhoe chi. 2008;51(4): Bashir S, Roy P. Review Article Upper Gastrointestinal Bleeding A Review of the Literature (Part 4). Indian Journal for the Practising Doctor. 2008;5(2): Vanbiervliet G, Giudicelli Bornard S, Piche T, Berthier F, Gelsi E, Filippi J, et al. Predictive factors of bleeding related to post banding ulcer following endoscopic variceal ligation in cirrhotic patients: a case control study. Alimentary pharmacology & therapeutics. 2010;32(2): Young MF, Sanowski RA, Rasche R. Comparison and characterization of ulcerations induced by endoscopic ligation of esophageal varices versus endoscopic sclerotherapy. Gastrointestinal endoscopy. 1993;39(2): Shaheen NJ, Stuart E, Schmitz SM, Mitchell KL, Fried MW, Zacks S, et al. Pantoprazole reduces the size of postbanding ulcers after variceal band ligation: a randomized, controlled trial. Hepatology. 2005;41(3): Kangwan N, Park J-M, Kim E-H, Hahm KB. Quality of healing of gastric ulcers: natural products beyond acid suppression. 34 P a g e
8 Gamal Mohammad Mohammad Soliman et al World journal of gastrointestinal pathophysiology. 2014;5(1): Tanigawa T, Watanabe T, Ohkawa F, Nadatani Y, Otani K, Machida H, et al. Rebamipide, a mucoprotective drug, inhibits NSAIDs-induced gastric mucosal injury: possible involvement of the downregulation of 15-hydroxyprostaglandin dehydrogenase. Journal of clinical biochemistry and nutrition. 2011;48(2): Sakr MA, Hamed WAE-A, El Gafaary MM, EL-Folly RF, Manal E-H. Role of Sucralfate in Promoting Healing of Post Band Variceal Ulcer. Advances in Natural Science. 2011;4(2): Kang SH, Yim HJ, Kim SY, Suh SJ, Hyun JJ, Jung SW, et al. Proton pump inhibitor therapy is associated with reduction of early bleeding risk after prophylactic endoscopic variceal band ligation: a retrospective cohort study. Medicine. 2016;95(8). 12. Lo EAG, Wilby KJ, Ensom MHH. Use of Proton Pump Inhibitors in the Management of GastroesophagealVarices. Annals of Pharmacotherapy. 2015;49(2): González-Ojeda A, Cervantes-Guevara G, Chávez-Sánchez M, Dávalos-Cobián C, Ornelas-Cázares S, Macías-Amezcua MD, et al. Platelet count/spleen diameter ratio to predict esophageal varices in Mexican patients with hepatic cirrhosis. World Journal of Gastroenterology: WJG. 2014;20(8): defranchis R. Evolving Consensus in Portal Hypertension Report of the Baveno IV Consensus Workshop on methodology of diagnosis and therapy in portal hypertension. Journal of hepatology. 2005;43(1): Kang SH, Yim HJ, Yoon EL, Suh SJ, Koo JS, Seo YS, et al. LC: Proton Pump Inhibitor Prevents Early Post-Endoscopic Variceal Band Ligation Bleeding in Patients with High Risk Esophageal Varices. 춘 추계학술대회 2013;2013(1):27-8. (KASL). 16. Waterman M, Gralnek IM. Preventing complications of endoscopic hemostasis in acute upper gastrointestinal hemorrhage. Gastrointestinal endoscopy clinics of North America. 2007;17(1): Nijhawan S, Rai R. Does post-ligation oesophageal ulcer healing require treatment? The Lancet. 1994;343(8889): YANG WG, HOU MC, LIN HC, KUO BIT, LEE FY, CHANG FY, et al. Effect of sucralfate granules in suspension on endoscopic varicealsclerotherapy induced ulcer: analysis of the factors determining ulcer healing. Journal of gastroenterology and hepatology. 1998;13(2): Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology. 2001;33(5): Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. AASLD Practice guidelines. Hepatology. 2007;46(3). 21. Sarin SK, Kumar A, Angus PW, Baijal SS, Chawla YK, Dhiman RK, et al. Primary prophylaxis of gastroesophagealvariceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver. Hepatology international. 2008;2(4): Wahib AA., Kilany YF., Sayed FM., et al. Study of efficacy of proton pump inhibitors in reducing post banding ulcers after variceal band ligation in secondary prophylaxis. The New Egptian Journal of Medicine. 2010;41(6): Elsayed SH. Evaluation of the Effect of Proton Pump Inhibitors on Post Endoscopic Variceal Band Ligation Complications. Tropical Medicine department, Benha Faculty of Medicine, : University of Benha Egypt.; Takayama M, Matsui S, Kawasaki M, Asakuma Y, Sakurai T, Kashida H, et al. Efficacy of treatment with rebamipide for endoscopic submucosal dissection-induced ulcers. World J Gastroenterol. 2013;19(34): P a g e
Esophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph
Esophageal Varices Beta-Blockers or Band Ligation Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation? Risk of esophageal variceal
More informationACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis
ACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis Guadalupe Garcia-Tsao, M.D., 1 Arun J. Sanyal, M.D., 2 Norman D. Grace,
More informationCyanoacrylate Glue versus Band Ligation for Acute Gastric Variceal Hemorrhage - A randomized controlled trial at Services Hospital, Lahore
ORIGINAL ARTICLE Cyanoacrylate Glue versus Band Ligation for Acute Gastric Variceal Hemorrhage - A randomized controlled trial at Services Hospital, Lahore ISMAIL HASSAN 1, ASMA SIDDIQUE 2, MUHAMMAD IBRAR
More informationPrimary Prophylaxis against Variceal Hemorrhage Pharmacotherapy vs Endoscopic Band Ligation
Primary Prophylaxis against Variceal Hemorrhage Pharmacotherapy vs Endoscopic Band Ligation Siwaporn Chainuvati, MD Faculty of Medicine Siriraj Hospital Outline Natural history of esophageal varices Which
More informationMichele Bettinelli RN CCRN Lahey Health and Medical Center
Michele Bettinelli RN CCRN Lahey Health and Medical Center Differentiate the types of varices Identify glue preparations utilized when treating gastric varices Review the process of glue administration
More informationEvidence-Base Management of Esophageal and Gastric Varices
Evidence-Base Management of Esophageal and Gastric Varices Rino Alvani Gani Hepatobiliary Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo National
More informationRisk factors for 5-day bleeding after endoscopic treatments for gastroesophageal varices in liver cirrhosis
Original Article Page 1 of 9 Risk factors for 5-day bleeding after endoscopic treatments for gastroesophageal varices in liver cirrhosis Rui Sun*, Xingshun Qi* #, Deli Zou, Xiaodong Shao, Hongyu Li, Xiaozhong
More informationUpper gastrointestinal bleeding in children. Nguyễn Diệu Vinh, MD Department of Gastroenterology
Upper gastrointestinal bleeding in children Nguyễn Diệu Vinh, MD Department of Gastroenterology INTRODUCTION Upper gastrointestinal (UGI) bleeding : arising proximal to the ligament of Treitz in the distal
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute variceal bleeding management of, 251 262 balloon tamponade of esophagus in, 257 258 endoscopic therapies in, 255 257. See also Endoscopy,
More informationVARICEAL BLEEDING. Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta.
VARICEAL BLEEDING Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta Disclosures: None OUTLINE Pathophysiology of portal hypertension Splanchnic
More informationVariceal bleeding is a major cause of morbidity in patients
GASTROENTEROLOGY 2010;139:1238 1245 Equal Efficacy of Endoscopic Variceal Ligation and Propranolol in Preventing Variceal Bleeding in Patients With Noncirrhotic Portal Hypertension SHIV KUMAR SARIN,*,,
More informationGastrointestinal bleeding is one of the most important
Prospective Validation of Baveno V Definitions and Criteria for Failure to Control Bleeding in Portal Hypertension Sun Young Ahn, 1 Soo Young Park, 1 Won Young Tak, 1 Yu Rim Lee, 1 Eun Jeong Kang, 1 Jung
More informationSimon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor
Simon Everett Consultant Gastroenterologist, SJUH, Leeds if this is what greets you in the morning, you probably need to go see a doctor Presentation Audit data and mortality NICE guidance Risk assessment
More informationOn-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding
On-Call Upper GI Bleeding John R Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Upper Gastrointestinal Bleeding 300,000000 hospitalizations/year
More informationVariceal bleeding. Mainz,
Variceal bleeding Mainz, 21.09.2008 Risk of complications 5 years 10 years Ascites 10 % 25 % HCC 10 % 25 % Bleeding < 5 % 5-10 % Enceph. < 5 % < 5 % Typical situation : Mortality 10 % to 40 % Sequence
More informationMANAGEMENT OF DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT OF DYSPEPSIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD) Routine endoscopic investigation of patients of any age, presenting with dyspepsia
More informationChanges in the Clinical Outcomes of Variceal Bleeding in Cirrhotic Patients: A 10-Year Experience in Gangwon Province, South Korea
Gut and Liver, Vol. 6, No. 4, October 2012, pp. 476481 ORiginal Article Changes in the Clinical Outcomes of Variceal Bleeding in Cirrhotic Patients: A 10Year Experience in Gangwon Province, South Korea
More informationMedical Necessity Guidelines: Upper GI Endoscopy: Certain Elective Procedures
Medical Necessity Guidelines: Upper GI Endoscopy: Certain Elective Procedures Effective: October 11, 2017 Clinical documentation and prior authorization required Coverage guideline, no prior authorization
More informationBattle of the Bands: Can You Deny the PPI?
Battle of the Bands: Can You Deny the PPI? Andrea Whitaker, PharmD. PGY1 Pharmacy Practice Resident University Health System, San Antonio, TX Division of Pharmacotherapy, The University of Texas at Austin
More informationCIRROSI E IPERTENSIONE PORTALE NELLA DONNA
Cagliari, 16 settembre 2017 CIRROSI E IPERTENSIONE PORTALE NELLA DONNA Vincenza Calvaruso, MD, PhD Ricercatore di Gastroenterologia Gastroenterologia & Epatologia, Di.Bi.M.I.S. Università degli Studi di
More informationManejo Actual del Sangrado por Varices Gástricas
Manejo Actual del Sangrado por Varices Gástricas Juan Carlos Garcia-Pagán Barcelona Hepatic Hemodynamic Laboratory. Liver Unit. IMDIM. Hospital Clinic. IDIBAPS. Ciberehd. XXIV Congreso de la Asociación
More informationKing Abdul-Aziz University Hospital (KAUH) is a tertiary
Modelling Factors Causing Mortality in Oesophageal Varices Patients in King Abdul Aziz University Hospital Sami Bahlas Abstract Objectives: The objective of this study is to reach a model defining factors
More informationCLINICAL How Should a Hospitalized Patient with Newly Diagnosed Cirrhosis Be Evaluated and Managed?
CLINICAL How Should a Hospitalized Patient with Newly Diagnosed Cirrhosis Be Evaluated and Managed? The Hospitalist. 2016 August;2016(8) Author(s): Raj Sehgal, MD; Joshua Hanson, MD, MPH; Division OF The
More information11/19/2012. Comparison between PPIs G CELL. Risk ratio (95% CI) Patient subgroup. gastrin. S-form of omeprazole. Acid sensitive. coated.
REGULATION OF GASTRIC ACID SECRETION Comparison between PPIs Omeprazole Lansoprazole Rabeprazole Pantoprazole Esomeprazole gastrin G CELL + Acid sensitive Yes T1/2 30-60 minutes Main elimination Enteric
More informationth Annual AISF Meeting 44 th th th, 2011 Rome, February 23 rd -26
44 th 44 th Annual AISF Meeting Rome, February 23 rd -26 th th, 2011 Update on the Baveno Consensus Conference Roberto de Franchis Department of of Clinical Sciences, University of of Milan, Head, Gastroenterology
More informationENDOSCOPIC LIGATION OF ESOPHAGEAL VARICES LONG TERM RESULTS
ENDOSCOPIC LIGATION OF ESOPHAGEAL VARICES LONG TERM RESULTS R. Nikolov, St.Ivan Rilski University Hospital, Clinic of Gastroenterology Sofia, Bulgaria, Medical University Sofia, Bulgaria Contact: R. Nikolov,
More informationDr. LEUNG Lok Hang, Will
Direct access endoscopy booking by family physicians: evaluating a new service model and clinical predictors of positive endoscopy findings at primary care setting Dr. LEUNG Lok Hang, Will Department of
More informationBETA-BLOCKERS IN CIRRHOSIS.PRO.
BETA-BLOCKERS IN CIRRHOSIS.PRO. Angela Puente Sánchez. MD PhD Hepatology Unit. Gastroenterology department Marques de Valdecilla University Hospital. Santander INTRODUCTION. Natural history of cirrhosis
More informationGastroenterology Fellowship Program
Gastroenterology Fellowship Program Outpatient Clinical Rotations I. Overview A. Three Year Continuity Clinic Experience All gastroenterology fellows will be required to have a ½ day continuity clinic
More informationDetection of Esophageal Varices Using CT and MRI
Dig Dis Sci (2011) 56:2696 2700 DOI 10.1007/s10620-011-1660-8 ORIGINAL ARTICLE Detection of Esophageal Varices Using CT and MRI Michael J. Lipp Arkady Broder David Hudesman Pauline Suwandhi Steven A. Okon
More informationEsophageal stricture causes and pattern of presentation at Ibn Sina Specialized Hospital Abstract Introduction: Methods: Results and discussion:
bü z ÇtÄ TÜà väx causes and pattern of presentation at Ibn Sina Specialized Hospital Mohammed Osman El Hassan Gadour 1 and Hayder Hussein Elamin 2 Abstract Introduction: The aim of this study is to evaluate
More informationRadiofrequency Ablation: Stepwise circumferential and focal RFA of Barrett s s esophagus using the HALO System
Radiofrequency Ablation: Stepwise circumferential and focal RFA of Barrett s s esophagus using the HALO System Used abbreviations BE: Barrett s esophagus EC: Early cancer ER: Endoscopic resection HGD:
More informationEditorial Process: Submission:07/25/2018 Acceptance:10/19/2018
RESEARCH ARTICLE Editorial Process: Submission:07/25/2018 Acceptance:10/19/2018 Clinical Outcome and Predictive Factors of Variceal Bleeding in Patients with Hepatocellular Carcinoma in Thailand Jitrapa
More informationThe usual dose is 40 mg daily with amoxycillin 1.5 g (750 mg b.d.) for 2 weeks. Up to 2 g/day of amoxycillin has been used in clinical trials.
Name Gasec - 2 Gastrocaps Composition Gasec-20 Gastrocaps Each Gastrocaps contains: Omeprazole 20 mg (in the form of enteric-coated pellets) Properties, effects Proton Pump Inhibitor Omeprazole belongs
More informationIs pharmacological therapy the best choice for primary prevention of variceal hemmorhaging in patients with hepatic cirrhosis?
Controversies en Gastroenterology Is pharmacological therapy the best choice for primary prevention of variceal hemmorhaging in patients with hepatic cirrhosis? Rolando José Ortega Quiroz, MD, 1 Adalgiza
More informationPeptic ulcer disease Disorders of the esophagus
Peptic ulcer disease Disorders of the esophagus Peptic ulcer disease Burning epigastric pain Exacerbated by fasting Improved with meals Ulcer: disruption of mucosal integrity >5 mm in size, with depth
More informationBarrett s Esophagus. Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI
Barrett s Esophagus Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI A 58 year-old, obese white man has had heartburn for more than 20 years. He read a magazine
More informationUpper Gastrointestinal Bleeding Score for Differentiating Variceal and Nonvariceal Upper Gastrointestinal Bleeding ABSTRACT
44 Original Article Upper Gastrointestinal Bleeding Score for Differentiating Variceal and Jaroon Chasawat Varayu Prachayakul Supot Pongprasobchai ABSTRACT Background: Upper gastrointestinal bleeding (UGIB)
More informationJournal of American Science 2014;10(10)
Platelet Count/Spleen Diameter Ratio, as a Non-Invasive Diagnosis of Esophageal Varices in Egyptian Patients with Liver Cirrhosis Khaled El-Mola 1,Hesham Alshabrawy 3, Mohamed Salah 2,and Al sayed M.Rashed
More informationTools of the Gastroenterologist: Introduction to GI Endoscopy
Tools of the Gastroenterologist: Introduction to GI Endoscopy Objectives Endoscopy Upper endoscopy Colonoscopy Endoscopic retrograde cholangiopancreatography (ERCP) Endoscopic ultrasound (EUS) Endoscopic
More informationPractical Approach to Endoscopic Management for Bleeding Gastric Varices
Review Article http://dx.doi.org/10.3348/kjr.2012.13.s1.s40 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2012;13(S1):S40-S44 Practical Approach to Endoscopic Management for Bleeding Gastric Varices
More informationCost-effectiveness of hepatic venous pressure gradient measurements for prophylaxis of variceal re-bleeding Raines D L, Dupont A W, Arguedas M R
Cost-effectiveness of hepatic venous pressure gradient measurements for prophylaxis of variceal re-bleeding Raines D L, Dupont A W, Arguedas M R Record Status This is a critical abstract of an economic
More informationGI bleeding in chronic liver disease
GI bleeding in chronic liver disease Stuart McPherson Consultant Hepatologist Liver Unit, Freeman Hospital, Newcastle upon Tyne and Institute of Cellular Medicine, Newcastle University. Case 54 year old
More informationGastroenterology. Certification Examination Blueprint. Purpose of the exam
Gastroenterology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified gastroenterologist
More informationVarious Upper Endoscopic Findings of Acute Esophageal Thermal Injury Induced by Diverse Food: A Case Series
CSE REPORT Clin Endosc 2014;47:447-451 Print ISSN 2234-2400 / On-line ISSN 2234-2443 http://dx.doi.org/10.5946/ce.2014.47.5.447 Open ccess Various Upper Endoscopic Findings of cute Esophageal Thermal Injury
More informationCHAPTER 18. PEPTIC ULCER DISEASE, SELF-ASSESSMENT QUESTIONS. 1. Which of the following is not a common cause of peptic ulcer disease (PUD)?
CHAPTER 18. PEPTIC ULCER DISEASE, SELF-ASSESSMENT QUESTIONS 1. Which of the following is not a common cause of peptic ulcer disease (PUD)? A. Chronic alcohol ingestion B. Nonsteroidal antiinflammatory
More informationTitle: The Baveno VI criteria for predicting esophageal varices: validation in real life practice
Title: The Baveno VI criteria for predicting esophageal varices: validation in real life practice Authors: Mafalda Sousa, Sónia Fernandes, Luísa Proença, Ana Paula Silva, Sónia Leite, Joana Silva, Ana
More informationJune By: Reza Gholami
ACG/CAG guideline on Management of Dyspepsia June 2017 By: Reza Gholami DEFINITION OF DYSPEPSIA AND SCOPE OF THE GUIDELINE Dyspepsia was originally defined as any symptoms referable to the upper gastrointestinal
More informationA bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk?
Focus on CME at the University of British Columbia A bleeding ulcer: What can the GP do? By Robert Enns, MD, FRCP Gastrointestinal bleeding is a relatively common disorder affecting thousands of Canadians
More informationEGD Data Collection Form
Sociodemographic Information Type Zip Code Gender Height (in inches) Race Ethnicity Inpatient Outpatient Male Female Birth Date Weight (in pounds) American Indian (Native American) or Alaska Native Asian
More informationD DAVID PUBLISHING. 1. Introduction. Maher Mbarki 1, Helen Sklyarova 1, Krystyna Aksentiychuk 1, Ihor Tumak 2 and Eugene Sklyarov 1
Journal of Pharmacy and Pharmacology (2016) 32-36 doi: 10.17265/232-2150/2016.0.011 D DAVID PUBLISHING Plasma Levels of Leukotriene B and Prostaglandin E2 Correlation with Endoscopic Changes after NSAID
More informationDetection of Esophageal Varices in Liver Cirrhosis Using Non-invasive Parameters
ORIGINAL ARTICLE Detection of Esophageal Varices in Liver Cirrhosis Using Non-invasive Parameters Johana Prihartini*, LA Lesmana**, Chudahman Manan***, Rino A Gani** ABSTRACT Aim: recent guidelines recommend
More informationStem Cell 2017;8(2)
Endoscopic Band Ligation versus Argon Plasma Coagulation in Treatment of Gastric Antral Vascular Ectasia Tarek El-Mahdy Korah, MD; Elsayed Ibrahim Elshayeb, MD; Mohamed Hamdy Badr, MD; Ezzat Mohamed Abdalla,
More informationFaculty Disclosure. Objectives. State of the Art #3: Referrals for Gastroscopy (focus on common esophagus problems) 24/11/2014
State of the Art #3: Referrals for Gastroscopy (focus on common esophagus problems) Dr. Amy Morse November 2014 Faculty: Amy Morse Faculty Disclosure Relationships with commercial interests: Grants/Research
More informationPediatric Gastroenterology
Tropical Gastroenterology 2011;32(4):299 303 Pediatric Gastroenterology Effectiveness of beta blockers in primary prophylaxis of variceal bleeding in children with portal hypertension Tryambak Samanta,
More informationESOPHAGEAL CANCER AND GERD. Prof Salman Guraya FRCS, Masters MedEd
ESOPHAGEAL CANCER AND GERD Prof Salman Guraya FRCS, Masters MedEd Learning objectives Esophagus anatomy and physiology Esophageal cancer Causes, presentations of esophageal cancer Diagnosis and management
More informationLearning Objectives. After attending this presentation, participants will be able to:
Learning Objectives After attending this presentation, participants will be able to: Describe HCV in 2015 Describe how to diagnose advanced liver disease and cirrhosis Identify the clinical presentation
More informationJournal of the Egyptian Society of Parasitology, Vol.45, No.3, December 2015 J. Egypt. Soc. Parasitol. (JESP), 45(3), 2015:
Journal of the Egyptian Society of Parasitology, Vol.45, No.3, December 2015 J. Egypt. Soc. Parasitol. (JESP), 45(3), 2015: 485-492 PLATELET COUNT TO SPLEEN DIAMETER RATIO AND TO SPLEEN AREA RATIO AS PREDICTORS
More informationViral hepatitis and Hepatocellular Carcinoma
Viral hepatitis and Hepatocellular Carcinoma Hashem B. El-Serag, MD, MPH Dan L. Duncan Professor of Medicine Chief, Gastroenterology and Hepatology Houston VA & Baylor College of Medicine Houston, TX Outline
More informationDiagnostic Procedures. Measurement of Hepatic venous pressure in management of cirrhosis. Clinician s opinion
5 th AISF Post-Meeting Course Diagnostic and Therapeutic Invasive Procedures in Hepatology Rome, February 25 th Diagnostic Procedures Measurement of Hepatic venous pressure in management of cirrhosis Clinician
More informationVirtual Mentor American Medical Association Journal of Ethics December 2008, Volume 10, Number 12:
Virtual Mentor American Medical Association Journal of Ethics December 2008, Volume 10, Number 12: 805-809. CLINICAL PEARL Indications for Use of TIPS in Treating Portal Hypertension Elizabeth C. Verna,
More informationCurrent status of hepatic surgery in Korea
Korean J Hepatol. 2009 Dec; 15(Suppl 6):S60 - S64. DOI: 10.3350/kjhep.2009.15.S6.S60 Current status of hepatic surgery in Korea Kyung Sik Kim Department of Surgery, Severance Hospital, Yonsei University
More informationSurgery for Complications of Peptic Ulcer Disease (Definitive Treatment)
Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Amid Keshavarzi, MD UCHSC Grand Round 3/20/2006 Department of Surgery Introduction Epidemiology Pathophysiology Clinical manifestation
More informationORIGINAL ARTICLES LIVER, PANCREAS, AND BILIARY TRACT
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:703 708 ORIGINAL ARTICLES LIVER, PANCREAS, AND BILIARY TRACT Compliance With Practice Guidelines and Risk of a First Esophageal Variceal Hemorrhage in Patients
More informationEosinophilic Esophagitis (EoE)
Eosinophilic Esophagitis (EoE) 01.06.2016 EoE: immune-mediated disorder food or environmental antigens => Th2 inflammatory response. Key cytokines: IL-4, IL-5, and IL-13 stimulate the production of eotaxin-3
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Gastrointestinal bleeding: the management of acute upper gastrointestinal bleeding 1.1 Short title Acute upper GI bleeding
More informationPortal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia
Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia Andrés Cárdenas, MD, MMSc,PhD,AGAF, FAASLD GI/Liver Unit - Hospital Clinic Institut de Malalties Digestives i Metaboliques University
More informationGastro-oesophageal reflux disease and peptic ulcer disease. By: Dr. Singanamala Suman Assistant Professor Department of Pharm.D
Gastro-oesophageal reflux disease and peptic ulcer disease By: Dr. Singanamala Suman Assistant Professor Department of Pharm.D Gastro-oesophageal reflux disease and peptic ulcer disease Learning objectives:
More informationIs Radiofrequency Ablation Effective In Treating Barrett s Esophagus Patients with High-Grade Dysplasia?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 12-2016 Is Radiofrequency Ablation Effective
More informationManagement of dyspepsia and of Helicobacter pylori infection
Management of dyspepsia and of Helicobacter pylori infection The University of Nottingham John Atherton Wolfson Digestive Diseases Centre University of Nottingham, UK Community management of dyspepsia
More informationCarvedilol or Propranolol in the Management of Portal Hypertension?
Evidence Based Case Report Carvedilol or Propranolol in the Management of Portal Hypertension? Arranged by: dr. Saskia Aziza Nursyirwan RESIDENCY PROGRAM OF INTERNAL MEDICINE DEPARTMENT UNIVERSITY OF INDONESIA
More informationEfficacy and Safety of Proton Pump Inhibitors (PPIs) Plus Rebamipide for Endoscopic Submucosal Dissection-induced Ulcers: A Meta-analysis
ORIGINAL ARTICLE Efficacy and Safety of Proton Pump Inhibitors (PPIs) Plus Rebamipide for Endoscopic Submucosal Dissection-induced Ulcers: A Meta-analysis Jun Wang, Xufeng Guo, Chuncui Ye, Shijie Yu, Jixiang
More informationPORTAL HYPERTENSION. Tianjin Medical University LIU JIAN
PORTAL HYPERTENSION Tianjin Medical University LIU JIAN DEFINITION Portal hypertension is present if portal venous pressure exceeds 10mmHg (1.3kPa). Normal portal venous pressure is 5 10mmHg (0.7 1.3kPa),
More informationEsophageal submucosal mass icd 10
Esophageal submucosal mass icd 10 Search 6-6-2011 ICD-10; Risk Adjustment / HCC; Evaluation & Management (E/M). I'm hoping someone can help me with this DX, "soft tissue mass in. Upper gastrointestinal
More informationAcute Upper Gastrointestinal Hemorrhage Surgical Perspective. Dr.J.H.Barnard Dept. of Surgery PAH
Acute Upper Gastrointestinal Hemorrhage Surgical Perspective Dr.J.H.Barnard Dept. of Surgery PAH Introduction: AGH is a leading cause of admissions into ICU. Overall mortality 5-12%, but increases to 40%
More informationMatching study design to research question-interactive learning session
Matching study design to research question-interactive learning session Rahul Mhaskar Assistant Professor Clinical and Translational Science Institute Division and Center for Evidence based Medicine and
More informationGASTROENTEROLOGY Maintenance of Certification (MOC) Examination Blueprint
GASTROENTEROLOGY Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Gastroenterology MOC exam blueprint Based on feedback from physicians that MOC assessments
More informationCauses of Liver Disease in US
Learning Objectives Updates in Outpatient Cirrhosis Management Jennifer Guy, MD MAS Director, Liver Cancer Program California Pacific Medical Center guyj@sutterhealth.org Review cirrhosis epidemiology,
More informationAetiology Of Upper Gastrointestinal Bleeding In North- Eastern Nigeria: A Retrospective Endoscopic Study
ISPUB.COM The Internet Journal of Third World Medicine Volume 8 Number 2 Aetiology Of Upper Gastrointestinal Bleeding In North- Eastern Nigeria: A Retrospective Endoscopic S Mustapha, N Ajayi, A Shehu
More informationOriginal Policy Date
MP 2.04.38 Genetic Testing for Helicobacter pylori Treatment Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return
More informationAre we adequately screening at-risk patients for hepatocellular carcinoma in the outpatient setting?
Rajani Sharma, PGY1 Geriatrics CRC Project, 12/19/13 Are we adequately screening at-risk patients for hepatocellular carcinoma in the outpatient setting? A. Study Purpose and Rationale Hepatocellular carcinoma
More informationHepatitis and pregnancy
Hepatitis and pregnancy Pierre-Jean Malè MD Training Course in Reproductive Health Research WHO Geneva 2008 26.02.2008 Liver disease and pregnancy: three possible etiologic relationship the patient has
More informationTreatment of portal hypertension in the light of the Baveno VI Consensus Conference
r e v I E w A R T I C l e S Curierul medical, December 2015, Vol. 58, No 6 Treatment of portal hypertension in the light of the Baveno VI Consensus Conference E. Tcaciuc Department of Internal Medicine,
More informationChapter 32 Gastroenterology General Pathophysiology General Risk Factors for GI emergencies: Excessive Consumption Excessive Smoking Increased
1 2 3 4 5 6 7 Chapter 32 Gastroenterology General Pathophysiology General Risk Factors for GI emergencies: Excessive Consumption Excessive Smoking Increased Ingestion of Caustic Substances Poor Bowel Habits
More informationNew Techniques. Incidence of Peptic Ulcer. Changing. Contents - with an emphasis on peptic ulcer bleeding. Cause of death in peptic ulcer bleeding
Contents - with an emphasis on peptic ulcer bleeding New Techniques in Treating GI Bleeding Incidence and cause of death Acid suppression Endoscopic hemostasis Prediction of rebleeding and death Second
More informationHigh use of maintenance therapy after triple therapy regimes in Ireland
High use of maintenance therapy after triple therapy regimes in Ireland K Bennett, H O Connor, M Barry, C O Morain, J Feely Department of Pharmacology & Therapeutics Department of Gastroenterology Trinity
More informationFluoroscopy-Guided Endoscopic Removal of Foreign Bodies
CASE REPORT Clin Endosc 2017;50:197-201 https://doi.org/10.5946/ce.2016.085 Print ISSN 2234-2400 / On-line ISSN 2234-2443 Open Access Fluoroscopy-Guided Endoscopic Removal of Foreign odies Junhwan Kim
More informationComparison between Combination of Band ligation and Propranolol with Propranolol alone in Secondary Prophylaxis of Variceal bleed
ORIGINAL ARTICLE APMC 381 Comparison between Combination of Band ligation and Propranolol with Propranolol alone in Secondary Prophylaxis of Variceal bleed Muhammad Hanif, Amir Hussain, Muhammad Aamer,
More informationAnticoagulants are a contributing factor. Other causes are Mallory-Weiss tears, AV malformations, and malignancy and aorto-enteric fistula.
Upper GI Bleeding EMU2018 Dr. Walter Himmel MD Incidence: In non-cirrhotics, the commonest causes are peptic ulcer disease (50%) followed by erosive gastritis. In cirrhotic patients, variceal bleeding
More informationEndoscopic variceal ligation (EVL) is the standard-of-care
G & H C l i n i c a l C a s e S t u d i e s Complete Esophageal Obstruction Following Endoscopic Variceal Ligation Matthew A. Nikoloff, MD Thomas R. Riley, III, MD Ian R. Schreibman, MD Division of Gastroenterology
More informationThe Role of Endoscopy in the Diagnosis and Management of Upper Gastrointestinal Bleeding.
Original Article ISSN (O):2395-2822; ISSN (P):2395-2814 The Role of Endoscopy in the Diagnosis and Management of Upper Gastrointestinal Bleeding. Faroze A. Khan 1, M. H. Raza 2, Vikrant 1 1 Senior Resident,
More informationICU Volume 14 - Issue 2 - Summer Matrix
ICU Volume 14 - Issue 2 - Summer 2014 - Matrix Upper Gastrointestinal Bleeding Authors David Osman, MD Medical Intensive Care Unit Paris-South University Hospitals Assistance Publique-Hôpitaux de Paris
More informationReview Article Self-Expandable Metal Stents in the Treatment of Acute Esophageal Variceal Bleeding
Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2011, Article ID 910986, 6 pages doi:10.1155/2011/910986 Review Article Self-Expandable Metal Stents in the Treatment of Acute
More informationUseful Endoscopic Ultrasonography Parameters and a Predictive Model for the Recurrence of Esophageal Varices and Bleeding after Variceal Ligation
Gut and Liver, Vol. 11, No. 6, November 2017, pp. 843-851 ORiginal Article Useful Endoscopic Ultrasonography Parameters and a Predictive Model for the Recurrence of Esophageal Varices and Bleeding after
More informationJMSCR Vol 04 Issue 08 Page August 2016
www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i8.23 Portal Hypertension in Adults- A Comprehensive
More informationDisclosure. Learning Objectives 4/25/2014. I have no disclosures
Alka Goyal MD Division of Pediatric Gastroenterology Hepatology and Nutrition Children s Hospital of Pittsburgh of UPMC Disclosure I have no disclosures Learning Objectives Diagnosis of Eosinophilic Esophagitis
More informationOriginal Article. Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome
Tropical Gastroenterology 2015;36(1):31 35 Original Article Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome Surinder S Rana 1, Vishal Sharma 1, Deepak
More informationBarrett s Esophagus: What to Do for No Dysplasia, LGD, and HGD?
Barrett s Esophagus: What to Do for No Dysplasia, LGD, and HGD? Nicholas Shaheen, MD, MPH Center for Esophageal Diseases and Swallowing University of North Carolina 1 Outline What are the risks of progression
More informationManagement of HepatoCellular Carcinoma
9th Symposium GIC St Louis - 2010 Management of HepatoCellular Carcinoma Overview Pierre A. Clavien, MD, PhD Department of Surgery University Hospital Zurich Zurich, Switzerland Hepatocellular carcinoma
More informationGASTROINTESTINAL AND ANTIEMETIC DRUGS. Submitted by: Shaema M. Ali
GASTROINTESTINAL AND ANTIEMETIC DRUGS Submitted by: Shaema M. Ali GASTROINTESTINAL AND ANTIEMETIC DRUGS by: Shaema M. Ali There are four common medical conditions involving the GI system 1) peptic ulcers
More information