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Guillermo J Tearney - One of the best experts on this subject based on the ideXlab platform.
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imaging the Upper Gastrointestinal Tract in unsedated patients using tethered capsule endomicroscopy
Gastroenterology, 2013Co-Authors: Michalina Gora, Jenny Sauk, Robert W Carruth, Drew T Carlton, Amna R Soomro, Mireille Rosenberg, Norman S Nishioka, Guillermo J TearneyAbstract:Endoscopic examination of the Upper Gastrointestinal Tract is costly, inconvenient, and typically requires that the patient be sedated.1 Standard video endoscopy only provides macroscopic information so small, focal biopsies are excised in order to obtain a microscopic tissue diagnosis. Because there are few reliable visible cues for Barrett’s esophagus and dysplasia, crucial diagnostic regions can be missed. In order to overcome these limitations of endoscopy, we have integrated a microscopic imaging technology into a tethered capsule that can be swallowed. This new method, which we term tethered capsule endomicroscopy, provides microscopic information from the entire esophagus as the pill passes through the GI Tract.
Mike G Laukoetter - One of the best experts on this subject based on the ideXlab platform.
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successful closure of defects in the Upper Gastrointestinal Tract by endoscopic vacuum therapy evt a prospective cohort study
Surgical Endoscopy and Other Interventional Techniques, 2017Co-Authors: Mike G Laukoetter, Rudolf Mennigen, Philipp A Neumann, Sameer A Dhayat, Gabriele Horst, Daniel Palmes, Norbert Senninger, Thorsten VowinkelAbstract:Perforations and anastomotic leakages of the Upper Gastrointestinal (GI) Tract cause a high morbidity and mortality rate. Only limited data exist for endoscopic vacuum therapy (EVT) in the Upper GI Tract. Fifty-two patients (37 men and 15 women, ages 41–94 years) were treated (12/2011–12/2015) with EVT for anastomotic insufficiency secondary to esophagectomy or gastrectomy (n = 39), iatrogenic esophageal perforation (n = 9) and Boerhaave syndrome (n = 4). After diagnosis, polyurethane sponges were endoscopically positioned with a total of 390 interventions and continuous negative pressure of 125 mm of mercury (mmHg) was applied to the EVT-system. Sponges were changed endoscopically twice per week. Clinical and therapy-related data and mortality were analyzed. After 1–25 changes of the sponge at intervals of 3–5 days with a mean of 6 sponge changes and a mean duration of therapy of 22 days, the defects were healed in 94.2 % of all patients without revision surgery. In three patients (6 %), EVT failed. Two of these patients died due to hemorrhage related to EVT. Four postinterventional strictures were observed during the follow-up of up to 4 years. Esophageal wall defects of different etiology in the Upper Gastrointestinal Tract can be treated successfully with EVT, considering that indication for EVT should be weighed carefully. EVT can be regarded as a novel life-saving therapeutic tool.
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novel treatment options for perforations of the Upper Gastrointestinal Tract endoscopic vacuum therapy and over the scope clips
World Journal of Gastroenterology, 2014Co-Authors: Rudolf Mennigen, Norbert Senninger, Mike G LaukoetterAbstract:Endoscopic management of leakages and perforations of the Upper Gastrointestinal Tract has gained great importance as it avoids the morbidity and mortality of surgical intervention. In the past years, covered self-expanding metal stents were the mainstay of endoscopic therapy. However, two new techniques are now available that enlarge the possibilities of defect closure: endoscopic vacuum therapy (EVT), and over-the-scope clip (OTSC). EVT is performed by mounting a polyurethane sponge on a gastric tube and placing it into the leakage. Continuous suction is applied via the tube resulting in effective drainage of the cavity and the induction of wound healing, comparable to the application of vacuum therapy in cutaneous wounds. The system is changed every 3-5 d. The overall success rate of EVT in the literature ranges from 84% to 100%, with a mean of 90%; only few complications have been reported. OTSCs are loaded on a transparent cap which is mounted on the tip of a standard endoscope. By bringing the edges of the perforation into the cap, by suction or by dedicated devices, such as anchor or twin grasper, the OTSC can be placed to close the perforation. For acute endoscopy associated perforations, the mean success rate is 90% (range: 70%-100%). For other types of perforations (postoperative, other chronic leaks and fistulas) success rates are somewhat lower (68%, and 59%, respectively). Only few complications have been reported. Although first reports are promising, further studies are needed to define the exact role of EVT and OTSC in treatment algorithms of Upper Gastrointestinal perforations.
Luis A Garciarodriguez - One of the best experts on this subject based on the ideXlab platform.
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risk of Upper Gastrointestinal Tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy interaction with nonsteroidal anti inflammatory drugs and effect of acid suppressing agents
Archives of General Psychiatry, 2008Co-Authors: Francisco J. De Abajo, Luis A GarciarodriguezAbstract:Context Selective serotonin reuptake inhibitors have been reported to increase the risk of Upper Gastrointestinal Tract bleeding. The wide use of these drugs makes such potential risk a public health concern, and identification of factors that may increase or minimize such risk is necessary. Objectives To test the association of selective serotonin reuptake inhibitors and venlafaxine hydrochloride therapy with Upper Gastrointestinal Tract bleeding, to identify subgroups of patients at particularly increased risk, and to explore whether acid-suppressing agents may be effective in minimizing risk. Design Nested case-control study. Setting General practice database from the United Kingdom. Participants One thousand three hundred twenty-one patients with Upper Gastrointestinal Tract bleeding referred to a consultant or hospital and 10 000 control subjects matched for age, sex, and calendar year of the index date. Main Outcome Measure Risk of bleeding associated with selective serotonin reuptake inhibitors and effect of acid-suppressing agents. Results The percentage of current users of selective serotonin reuptake inhibitors (5.3%) or venlafaxine (1.1%) among case subjects was significantly higher than in matched control subjects (3.0% and 0.3%; adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1, and OR, 2.9; 95% CI, 1.5-5.6, respectively). An interaction with nonsteroidal anti-inflammatory drugs (OR, 4.8; 95% CI, 2.8-8.3) was observed, in particular among those not using acid-suppressing agents (OR, 9.1; 95% CI, 4.8-17.3) compared with users of these drugs (OR, 1.3; 95% CI, 0.5-3.3). In addition, an interaction with antiplatelet drugs in nonusers of acid-suppressing agents was suggested (OR, 4.7; 95% CI, 2.6-8.3) compared with users of these drugs (OR, 0.8; 95% CI, 0.3-2.5). Conclusions Antidepressants with a relevant blockade action on the serotonin reuptake mechanism increase the risk of Upper Gastrointestinal Tract bleeding. The increased risk may be of particular relevance when these drugs are associated with nonsteroidal anti-inflammatory drugs. Our study findings also provide evidence that use of acid-suppressing agents limits such increased risk.
Luis Garcia A Rodriguez - One of the best experts on this subject based on the ideXlab platform.
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association between nonsteroidal anti inflammatory drugs and Upper Gastrointestinal Tract bleeding perforation an overview of epidemiologic studies published in the 1990s
JAMA Internal Medicine, 2000Co-Authors: Sonia Hernandezdiaz, Luis Garcia A RodriguezAbstract:Background In the last decades, studies have estimated the Upper Gastrointestinal Tract bleeding/perforation (UGIB) risk associated with individual nonsteroidal anti-inflammatory drugs (NSAIDs). Later analyses have also included the effect of patterns of NSAID use, risk factors for UGIB, and modifiers of NSAID effect. Methods Systematic review of case-control and cohort studies on serious Gastrointestinal Tract complications and nonaspirin NSAIDs published between 1990 and 1999 using MEDLINE. Eighteen original studies were selected according to predefined criteria. Two researchers exTracted the data independently. Pooled relative risk estimates were calculated according to subject and exposure characteristics. Heterogeneity of effects was tested and reasons for heterogeneity were considered. Results Advanced age, history of peptic ulcer disease, and being male were risk factors for UGIB. Nonsteroidal anti-inflammatory drug users with advanced age or a history of peptic ulcer had the highest absolute risks. The pooled relative risk of UGIB after exposure to NSAIDs was 3.8 (95% confidence interval, 3.6-4.1). The increased risk was maintained during treatment and returned to baseline once treatment was stopped. A clear dose response was observed. There was some variation in risk between individual NSAIDs, though these differences were markedly attenuated when comparable daily doses were considered. Conclusions The elderly and patients with a history of peptic ulcer could benefit the most from a reduction in NSAID gastrotoxicity. Whenever possible, physicians may wish to recommend lower doses to reduce the UGIB risk associated with all individual NSAIDs, especially in the subgroup of patients with the greatest background risk.
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risk of hospitalization for Upper Gastrointestinal Tract bleeding associated with ketorolac other nonsteroidal anti inflammatory drugs calcium antagonists and other antihypertensive drugs
JAMA Internal Medicine, 1998Co-Authors: Luis Garcia A Rodriguez, Chiara Cattaruzzi, Maria Grazia Troncon, Luisa AgostinisAbstract:Background Nonsteroidal anti-inflammatory drugs (NSAIDs) cause substantial morbidity and mortality from Upper Gastrointestinal Tract disease. Ketorolac tromethamine has been singled out as an NSAID with a distinct gastrotoxicity profile. Calcium channel blockers, a class of antihypertensive drugs, have also been found to increase the risk of Gastrointestinal Tract bleeding. Methods We identified 1505 patients hospitalized because of Upper Gastrointestinal Tract bleeding and/or perforation, and we randomly sampled 20000 controls in the source population. Results The adjusted relative risk (RR) for Upper Gastrointestinal Tract bleeding and/or perforation in NSAID users compared with nonusers was 4.4 (95% confidence interval [CI], 3.7-5.3). The risk increased with higher daily doses. Ketorolac presented the highest risk (RR, 24.7; 95% CI, 9.6-63.5) and piroxicam ranked second (RR, 9.5; 95% CI, 6.5-13.8). Ketorolac was 5 times more gastrotoxic than all other NSAIDs (RR, 5.5; 95% CI, 2.1-14.4). The excess risk with ketorolac was observed with both oral and intramuscular administration and was already present during the first week of therapy. Among the various antihypertensive drug classes, β-blockers were associated with the lowest relative risk (RR, 1.0; 95% CI, 0.7-1.4), and current use of calcium channel blockers with the highest (RR, 1.7; 95% CI, 1.3-2.1). The association with calcium channel blockers declined when adjusting for various markers of comorbidity (RR, 1.4; 95% CI, 1.1-1.8). Past use of calcium channel blockers was also associated with an increased risk (RR, 1.5; 95% CI, 1.3-1.8). Conclusions The excess risk of major Upper Gastrointestinal Tract complications associated with outpatient use of ketorolac suggests an unfavorable risk-benefit assessment compared with other NSAIDs. More data are required to reduce the uncertainty about the apparent small increased risk of Upper Gastrointestinal Tract bleeding in patients using calcium channel blockers.
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the impact of research quality and study design on epidemiologic estimates of the effect of nonsteroidal anti inflammatory drugs on Upper Gastrointestinal Tract disease
JAMA Internal Medicine, 1992Co-Authors: Paola Bollini, Luis Garcia A Rodriguez, Susanne Perez Gutthann, Alexander M WalkerAbstract:Background.— Considerable differences in the estimates of the risk of Upper Gastrointestinal Tract disease associated with treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) have been observed. We conducted a meta-analysis of epidemiologic studies of Upper Gastrointestinal Tract disease related to NSAIDs to answer the following research questions: Are study characteristics (study design and quality) associated with different estimates of risk, for both aspirin and nonaspirin NSAIDs? Does the risk increase for particular groups of patients, such as women and the elderly? Methods.— Thirty-four studies addressing severe Upper Gastrointestinal Tract disease associated with NSAIDs (including aspirin and nonaspirin NSAIDs) were examined and scored according to a quality checklist that we designed for this review. Results.— Only 44% of the studies controlled for major confounding variables (age and sex). While exposure was. defined as current in 40% and 78% of the studies for nonaspirin NSAIDs and aspirin, respectively, few investigations checked for history of ulcer disease and concurrent diseases or other comedications known to be risk factors for Upper Gastrointestinal Tract bleeding. The overall risk ratio, by means of a random-effects regression model, was 3.0 (95% confidence interval, 1.9 to 4.7). The individual estimates for aspirin and nonaspirin NSAIDs were similar. Both with and without control for quality, cohort studies provided a lower risk ratio estimate than did case-control studies. Conclusions.— The design and quality of the studies appear to be strong independent predictors of the risk estimate; cohort studies were associated with lower risk estimates than case-control studies, and satisfactory studies were associated with lower risk estimates than unsatisfactory studies. ( Arch Intern Med . 1992;152:1289-1295).
Jorgen H Olsen - One of the best experts on this subject based on the ideXlab platform.
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use of selective serotonin reuptake inhibitors and risk of Upper Gastrointestinal Tract bleeding a population based cohort study
JAMA Internal Medicine, 2003Co-Authors: Susanne Oksbjerg Dalton, Christoffer Johansen, Lene Mellemkjaer, Bente Mertz Norgard, Henrik Toft Sorensen, Jorgen H OlsenAbstract:Background Selective serotonin reuptake inhibitors (SSRIs) have been suspected of increasing the risk of bleeding. We examined the risk of Upper Gastrointestinal Tract (GI) bleeding with use of antidepressant medication. Methods All users of antidepressants in the county of North Jutland, Denmark, from January 1, 1991, to December 31, 1995, were identified in the Pharmaco-Epidemiologic Prescription Database of North Jutland. In the Hospital Discharge Register, hospitalizations for Upper GI bleeding were searched among the 26 005 users of antidepressant medications and compared with the number of hospitalizations in the population of North Jutland who did not receive prescriptions for antidepressants. Results During periods of SSRI use without use of other drugs associated with Upper GI bleeding, we observed 55 Upper GI bleeding episodes, which was 3.6 times more than expected (95% confidence interval, 2.7-4.7), corresponding to a rate difference of 3.1 per 1000 treatment years. Combined use of an SSRI and nonsteroidal anti-inflammatory drugs or low-dose aspirin increased the risk to 12.2 (95% confidence interval, 7.1-19.5) and 5.2 (95% confidence interval, 3.2-8.0), respectively. Non-SSRIs increased the risk of Upper GI bleeding to 2.3 (95% confidence interval, 1.5-3.4), while antidepressants without action on the serotonin receptor had no significant effect on the risk of Upper GI bleeding. The risk with SSRI use returned to unity after termination of SSRI use, while the risks were similarly increased during periods of use and nonuse of non-SSRIs. Conclusion Selective serotonin reuptake inhibitors increase the risk of Upper GI bleeding, and this effect is potentiated by concurrent use of nonsteroidal anti-inflammatory drugs or low-dose aspirin, whereas an increased risk of Upper GI bleeding could not be attributed to other types of antidepressants.
