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Speciality Spotlight
Gastroenterology
- Hawkey CJ, for the Omeprazole Versus Misoprostol for NSAID-Induced Ulcer Management [OMNIUM] Study Group [Univ Hosp, Nottingham, England ; Peninsula Specialist Centre, Kippa Ring, Ausralia; Univ Med School, Lublin, Poland; et al]
Omeprazole Compared with Miso prostol for Ulcers Associated with Nonsteroidal Anti-inflammatory Drugs
N Engl J Med 338: 727-734, 1998
Patients needing NSAIDs on a long term basis tend to develop gastric or duodenal erosions or ulcers. To treat these complications misoprostol in a dose of 200 mG twice daily was compared with 20 mgm of omeprazole on a maintenance basis.
732 patients were thus studied. Higher doses of both drugs were required to control symptoms initially. Reason for the comparing these drugs arose because misoprostol tended to lead to diarrhea and abdominal pain. The study is well controlled. It points out that initial stages of active therapy misoprostol administration produced more side effects, but greater healing. In maintenance both were well tolerated.
- Macdonald CE, Wicks AC, Playford RJ [Leicester Gen Hosp, England]
Ten Years’ Experience of Screening Patients with Barrett’s Oesophagus in a University Teaching Hospital
Gut 41: 303-307, 1997
Medical records from 1984 to 1994 revealed 29,374 upper gastrointestinal endoscopies. Barrett’s oesophageal metaplasia was noted in 409 subjects above 50 years of without sex bias. 379 patients were investigated thus every year; one subject of progressive dysphagia had cancer.
The authors suggest this to be a wasteful procedure if used as a routine.
- Schenk BE, Kuipers EJ, Klinkenberg-Knol EC, et al [ Free Univ Hosp, Amsterdam; ‘t Lange Land Hosp, Zoetermeer, The Netherlands; Bronovo Hosp Den Haag, The Netherlands]
Omeprazole as a Diagnostic Tool in Gastroesophageal Reflux Disease
AM J Gastroenterol 92: 1997-2000, 1997
Gastroesophageal reflux disease [ GERD] can be confused with other disorders associated with retrosternal discomfort eg. Heart burn. If 40 mgm of omeprazole given for 2 weeks relieves symptoms a diagnosis of GERD can be made without recourse to endoscopy.
- Lower Gastrointestinal Problems
Ko CY, Tong J, Lehman RE, et al [ Univ of California, Los Angeles; Univ of California, San Francisco]
Biofeedback is Effective Therapy for Fecal Incontinence and Constipation
Arch Surg 132: 829-834, 1997
Fecal incontinence results from neurogenic causes, sphincter injuries or failure of surgical repair. 25 such patients [21 women and 4 men, median age, 63 years] were taken for study. 17 patients of constipation [ 12 women and 5 men, median age, 50 years] had pelvic floor dysfunction or expulsion weakness.
Retraining the pelvic floor comprised contracting the anal sphincter for five seconds. Of the 25 patients with incontinence 23 improved. The two with pudendal nerve disease did not improve. Of the 17 with constipation 13 showed improvement. The 4 that did not improve exhibited colonic delay or were unable to follow the biofeedback instructions.
Biofeedback thus constitutes an important step in managing rectal dysfunction.
- Karlbom U, Hallden M, Eeg-Olofsson KE, et al [ Univ Hosp, Uppsala, Sweden]
Results of Biofeedback in Constipated Patients : A Prospective study
Dis Colon Rectum 40: 1149-1155, 1997
Paradoxical contraction of the levator any muscle can be a cause of constipation usually psychological and rarely due to neurologic disorders. Exercising this muscle helped 19 of the 28 participants. This treatment was carried out for 3 months.
