http://ping.fm/mc9wN
Mini Gastric Bypass Surgeon Costa Rica Carlos Quesada
Mini Gastric Bypass Surgeon from Costa Rica, Dr. Carlos Quesada talks about MGB:
Another trial of the treatment of diabetes the Mini-Gastric Bypass was
roughly TWICE as effective as the Sleeve Gastrectomy
http://ping.fm/Zz1mW
Monday, November 09, 2009
Friday, October 30, 2009
My eye doctor, Evan Wolf, MD, PhD was telling me that I had bad eys with lots of complications. I told him my sugar was better, at 5.7 and I said I was hoping that my eyes had improved and he said "We'll see". So he sits down and shines that bright light in my eye so he can look deep inside and he says, "I can't believe this, all the damage you had, is completely gone! It's like you have new eyes. I've NEVER seen that happen before. He was so excited!!
I did have to get a new prescription though, cause now I need a magnifier for up close, no glasses for the tv or computer and then something for far away if I"m driving.
And he took me off the Acetazolamide. The only med I have to take is the Synthroid.
Good news
Cindy T
Alaska
I did have to get a new prescription though, cause now I need a magnifier for up close, no glasses for the tv or computer and then something for far away if I"m driving.
And he took me off the Acetazolamide. The only med I have to take is the Synthroid.
Good news
Cindy T
Alaska
Sunday, October 25, 2009
http://ping.fm/hOojs
Lap Band Less Effective than Stomach Stapling 3
Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial
Level I Evidence: The Lap Band is inferior to the old stomach stapling
Lap Band Less Effective than Stomach Stapling 3
Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial
Level I Evidence: The Lap Band is inferior to the old stomach stapling
Saturday, October 24, 2009
http://ping.fm/qlJV6
Lap Band worse than stomach stapling.
Controlled prospective trial shows the old stomach stapling is better than the band!
;-(
Lap Band worse than stomach stapling.
Controlled prospective trial shows the old stomach stapling is better than the band!
;-(
Wednesday, October 21, 2009
Dr. Rutledge,
Like some of the people I have seen on your videos on you tube, I found your name after typing in failed lap-band. I have had my band for 3 years after I let myself be talked into it by my best friend. The vomiting is awful and has almost put a complete stop to my life for weeks on end as I try to get things under control time and time again. My question is do you ever just remove a lap band without doing the MGB surgery? I feel as though I am done with this and am slowly losing my mind as well as my health.
Thank you and thank you for this site which makes me feel not so alone.
J
Like some of the people I have seen on your videos on you tube, I found your name after typing in failed lap-band. I have had my band for 3 years after I let myself be talked into it by my best friend. The vomiting is awful and has almost put a complete stop to my life for weeks on end as I try to get things under control time and time again. My question is do you ever just remove a lap band without doing the MGB surgery? I feel as though I am done with this and am slowly losing my mind as well as my health.
Thank you and thank you for this site which makes me feel not so alone.
J
The Comparative Dose-Response Effects of Melatonin and Midazolam for Premedication of Adult Patients: A Double-Blinded, Placebo-Controlled Study
Mohamed Naguib, MB, BCh, MSc, FFARCSI, MD*, and Abdulhamid H. Samarkandi, MB, BS, KSUF, FFARCSI{dagger}
Departments of Anesthesia, *University of Iowa College of Medicine, Iowa City, Iowa, and {dagger}King Saud University, Riyadh, Saudi Arabia
Address correspondence and reprint requests to Mohamed Naguib, MD, University of Iowa College of Medicine, Department of Anesthesia, 200 Hawkins Dr., 6JCP, Iowa City, Iowa 52242-1009. Address e-mail to mohamed-naguib@uiowa.edu.
We designed this prospective, randomized, double-blinded, placebo-controlled study to compare the perioperative effects of different doses of melatonin and midazolam.
Doses of 0.05, 0.1, or 0.2 mg/kg sublingual midazolam or melatonin or placebo were given to 84 women, approximately 100 min before a standard anesthetic.
Sedation, anxiety, and orientation were quantified before, 10, 30, 60, and 90 min after premedication, and 15, 30, 60, and 90 min after admission to the recovery room.
Psychomotor performance of the patient was evaluated at these times also, by using the digit-symbol substitution test and Trieger dot test.
Patients who received premedication with either midazolam or melatonin had a significant decrease in anxiety levels and increase in levels of sedation preoperatively compared with control subjects.
Patients in the three midazolam groups experienced significant psychomotor impairment in the preoperative period compared with melatonin or placebo.
After operation, patients who received 0.2 mg/kg midazolam premedication had increased levels of sedation at 90 min compared with 0.05 and 0.1 mg/kg melatonin groups. In addition, patients in the three midazolam groups had impairment of performance on the digit-symbol substitution test at all times compared with the 0.05 mg/kg melatonin group.
Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.
Implications:
Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.
Mohamed Naguib, MB, BCh, MSc, FFARCSI, MD*, and Abdulhamid H. Samarkandi, MB, BS, KSUF, FFARCSI{dagger}
Departments of Anesthesia, *University of Iowa College of Medicine, Iowa City, Iowa, and {dagger}King Saud University, Riyadh, Saudi Arabia
Address correspondence and reprint requests to Mohamed Naguib, MD, University of Iowa College of Medicine, Department of Anesthesia, 200 Hawkins Dr., 6JCP, Iowa City, Iowa 52242-1009. Address e-mail to mohamed-naguib@uiowa.edu.
We designed this prospective, randomized, double-blinded, placebo-controlled study to compare the perioperative effects of different doses of melatonin and midazolam.
Doses of 0.05, 0.1, or 0.2 mg/kg sublingual midazolam or melatonin or placebo were given to 84 women, approximately 100 min before a standard anesthetic.
Sedation, anxiety, and orientation were quantified before, 10, 30, 60, and 90 min after premedication, and 15, 30, 60, and 90 min after admission to the recovery room.
Psychomotor performance of the patient was evaluated at these times also, by using the digit-symbol substitution test and Trieger dot test.
Patients who received premedication with either midazolam or melatonin had a significant decrease in anxiety levels and increase in levels of sedation preoperatively compared with control subjects.
Patients in the three midazolam groups experienced significant psychomotor impairment in the preoperative period compared with melatonin or placebo.
After operation, patients who received 0.2 mg/kg midazolam premedication had increased levels of sedation at 90 min compared with 0.05 and 0.1 mg/kg melatonin groups. In addition, patients in the three midazolam groups had impairment of performance on the digit-symbol substitution test at all times compared with the 0.05 mg/kg melatonin group.
Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.
Implications:
Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.
http://sites.google.com/a/clos.net/mini/melatonin
Melatonin
Anesth Analg 2007; 105:1263-1271
© 2007 International Anesthesia Research Society
ANESTHETIC PHARMACOLOGY
The Clinical Impact of Preoperative Melatonin on Postoperative Outcomes in Patients Undergoing Abdominal Hysterectomy
Wolnei Caumo, MD, PhD*{dagger}, Fernanda Torres, MSc{ddagger}, Nívio L. Moreira, Jr, MD§, Jorge A. S. Auzani, MD§, Cristiano A. Monteiro, MD§, Gustavo Londero, MD§, Diego F. M. Ribeiro||, and Maria Paz L. Hidalgo, MD, PhD||
From the *Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); {dagger}Instituto de Ciências Bsicas da Saúde, Pharmacology Department, UFRGS; {ddagger}Multidisciplinary Group of Development of Biological Rhythms of Universidade de São Paulo; §Registrar of Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); ||Psychiatric Service of Hospital Materno Infantil Presidente Vargas, Hospital de Clínicas de Porto Alegre (HCPA); and ¶Hospital de Clínicas de Porto Alegre (HCPA), Psychiatric Department of School of Medicine, UFRGS, Brazil.
Address correspondence and reprint requests to Dr. Maria Paz Loayza Hidalgo, Castro Alves 167 sala 204, CEP 90430-131 – Porto Alegre, RS, Brazil. Address e-mail to mpaz@cpovo.net.
BACKGROUND: Melatonin has sedative, analgesic, antiinflammatory, antioxidative, and chronobiotic effects. We determined the impact of oral melatonin premedication on anxiolysis, analgesia, and the potency of the rest/activity circadian rhythm.
METHODS: This randomized, double-blind, placebo-controlled study included 33 patients, ASA physical status I–II, undergoing abdominal hysterectomy.
Patients were randomly assigned to receive either oral melatonin 5 mg (n = 17) or placebo (n = 16) the night before and 1 h before surgery.
The analysis instruments were the Visual Analog Scale, the State-Trait Anxiety Inventory, and the actigraphy.
RESULTS:
The number of patients that needed to be treated to prevent one additional patient reporting high postoperative anxiety and moderate to intense pain in the first 24 postoperative hours was 2.53 (95% CI, 1.41–12.22) and 2.20 (95% CI, 1.26–8.58), respectively.
The number-needed-to-treat was 3 (95% CI, 1.35–5.0) to prevent high postoperative anxiety in patients with moderate to intense pain, when compared with 7.5 (95% CI, 1.36–{infty}) in the absence of pain or mild pain.
Also, the treated patients required less morphine by patient-controlled analgesia, as assessed by repeated measures ANOVA (F[1,31] = 6.05, P = 0.02).
The rest/activity cycle, assessed by actigraphy, showed that the rhythmicity percentual of 24 h was higher in the intervention group in the first week after discharge ([21.16 ± 8.90] versus placebo [14.00 ± 7.10]; [t = –2.41, P = 0.02]).
CONCLUSIONS: This finding suggested that
*** preoperative melatonin produced clinically relevant
*** anxiolytic and analgesic effects,
*** especially in the first 24 postoperative hours.
Also, it improved the recovery of the potency of the rest/activity circadian rhythm.
Melatonin
Anesth Analg 2007; 105:1263-1271
© 2007 International Anesthesia Research Society
ANESTHETIC PHARMACOLOGY
The Clinical Impact of Preoperative Melatonin on Postoperative Outcomes in Patients Undergoing Abdominal Hysterectomy
Wolnei Caumo, MD, PhD*{dagger}, Fernanda Torres, MSc{ddagger}, Nívio L. Moreira, Jr, MD§, Jorge A. S. Auzani, MD§, Cristiano A. Monteiro, MD§, Gustavo Londero, MD§, Diego F. M. Ribeiro||, and Maria Paz L. Hidalgo, MD, PhD||
From the *Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); {dagger}Instituto de Ciências Bsicas da Saúde, Pharmacology Department, UFRGS; {ddagger}Multidisciplinary Group of Development of Biological Rhythms of Universidade de São Paulo; §Registrar of Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); ||Psychiatric Service of Hospital Materno Infantil Presidente Vargas, Hospital de Clínicas de Porto Alegre (HCPA); and ¶Hospital de Clínicas de Porto Alegre (HCPA), Psychiatric Department of School of Medicine, UFRGS, Brazil.
Address correspondence and reprint requests to Dr. Maria Paz Loayza Hidalgo, Castro Alves 167 sala 204, CEP 90430-131 – Porto Alegre, RS, Brazil. Address e-mail to mpaz@cpovo.net.
BACKGROUND: Melatonin has sedative, analgesic, antiinflammatory, antioxidative, and chronobiotic effects. We determined the impact of oral melatonin premedication on anxiolysis, analgesia, and the potency of the rest/activity circadian rhythm.
METHODS: This randomized, double-blind, placebo-controlled study included 33 patients, ASA physical status I–II, undergoing abdominal hysterectomy.
Patients were randomly assigned to receive either oral melatonin 5 mg (n = 17) or placebo (n = 16) the night before and 1 h before surgery.
The analysis instruments were the Visual Analog Scale, the State-Trait Anxiety Inventory, and the actigraphy.
RESULTS:
The number of patients that needed to be treated to prevent one additional patient reporting high postoperative anxiety and moderate to intense pain in the first 24 postoperative hours was 2.53 (95% CI, 1.41–12.22) and 2.20 (95% CI, 1.26–8.58), respectively.
The number-needed-to-treat was 3 (95% CI, 1.35–5.0) to prevent high postoperative anxiety in patients with moderate to intense pain, when compared with 7.5 (95% CI, 1.36–{infty}) in the absence of pain or mild pain.
Also, the treated patients required less morphine by patient-controlled analgesia, as assessed by repeated measures ANOVA (F[1,31] = 6.05, P = 0.02).
The rest/activity cycle, assessed by actigraphy, showed that the rhythmicity percentual of 24 h was higher in the intervention group in the first week after discharge ([21.16 ± 8.90] versus placebo [14.00 ± 7.10]; [t = –2.41, P = 0.02]).
CONCLUSIONS: This finding suggested that
*** preoperative melatonin produced clinically relevant
*** anxiolytic and analgesic effects,
*** especially in the first 24 postoperative hours.
Also, it improved the recovery of the potency of the rest/activity circadian rhythm.
Monday, October 19, 2009
http://sites.google.com/a/clos.net/mini/lap-band-less-effective-than-stomach-stapling
Lap Band Less Effective than Stomach Stapling
The Lap Band is advertised as an attractive choice for weight loss. A recent controlled prospective randomized trial shows that the LapBand is not as good as the abandoned "Stomach Stapling!"
Obes Surg. 2009 Aug;19(8):1108-15. Epub 2009 Jun 10.Click here to read Links
Laparoscopic adjustable silicone gastric banding vs laparoscopic vertical banded gastroplasty in morbidly obese patients: long-term results of a prospective randomized controlled clinical trial.
Scozzari G, Farinella E, Bonnet G, Toppino M, Morino M.
Digestive Surgery and Center for Minimal Invasive Surgery, Department of Surgery, University of Turin, C.so A.M. Dogliotti 14, 10126, Turin, Italy.
BACKGROUND: Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity.
METHODS: A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m2) were randomized to LASGB (n=49) or LVBG (n=51) and followed up for a minimum of 7 years.
RESULTS: Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p<0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p<0.05).
Late complication rates were
36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p<0.05),
46.9% vs 43.1% at 5 years (NS), and
55.1% vs 47.1% at 7 years (NS).
Late reoperation rates were
28.6% in LASGBs and 2.0% in LVBGs at 3 years (p<0.001),
38.8% and 2.0% at 5 years (p<0.001), and
46.9% and 7.8% at 7 years (p<0.001).
Excess weight loss in LASGBs was
41.8% at 3 years,
33.2% at 5 years, and
29.9% at 7 years;
excess weight loss in LVBGs was
60.9%,
57%, and
53.1%, respectively (p<0.05).
CONCLUSIONS:
This study demonstrates that
LVBG is significantly more effective than LASGB in terms of
late complications,
late reoperations, and
long-term results on weight loss.
http://sites.google.com/a/clos.net/mini/lap-band-less-effective-than-stomach-stapling
--
Dr. Rutledge
Email: DrR@clos.net
Private Cell Phone 702-215-9550
On the Web=> www.CLOS.Net
Lap Band Less Effective than Stomach Stapling
The Lap Band is advertised as an attractive choice for weight loss. A recent controlled prospective randomized trial shows that the LapBand is not as good as the abandoned "Stomach Stapling!"
Obes Surg. 2009 Aug;19(8):1108-15. Epub 2009 Jun 10.Click here to read Links
Laparoscopic adjustable silicone gastric banding vs laparoscopic vertical banded gastroplasty in morbidly obese patients: long-term results of a prospective randomized controlled clinical trial.
Scozzari G, Farinella E, Bonnet G, Toppino M, Morino M.
Digestive Surgery and Center for Minimal Invasive Surgery, Department of Surgery, University of Turin, C.so A.M. Dogliotti 14, 10126, Turin, Italy.
BACKGROUND: Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity.
METHODS: A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m2) were randomized to LASGB (n=49) or LVBG (n=51) and followed up for a minimum of 7 years.
RESULTS: Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p<0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p<0.05).
Late complication rates were
36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p<0.05),
46.9% vs 43.1% at 5 years (NS), and
55.1% vs 47.1% at 7 years (NS).
Late reoperation rates were
28.6% in LASGBs and 2.0% in LVBGs at 3 years (p<0.001),
38.8% and 2.0% at 5 years (p<0.001), and
46.9% and 7.8% at 7 years (p<0.001).
Excess weight loss in LASGBs was
41.8% at 3 years,
33.2% at 5 years, and
29.9% at 7 years;
excess weight loss in LVBGs was
60.9%,
57%, and
53.1%, respectively (p<0.05).
CONCLUSIONS:
This study demonstrates that
LVBG is significantly more effective than LASGB in terms of
late complications,
late reoperations, and
long-term results on weight loss.
http://sites.google.com/a/clos.net/mini/lap-band-less-effective-than-stomach-stapling
--
Dr. Rutledge
Email: DrR@clos.net
Private Cell Phone 702-215-9550
On the Web=> www.CLOS.Net
http://sites.google.com/a/clos.net/mini/increased-need-for-hospitalization-after-rny-gastric-bypass
Increased Need for Hospitalization after RNY Gastric Bypass
Unbiased Study shows RNY Gastric Bypass Increases Need for Hospitalization after gastric bypass surgery Primarily because of Complications
The rate of hospitalization in the year AFTER RNY was more than double the rate in the year preceding RNY (19% vs 8%, P<.001).
JAMA. 2005 Oct 19;294(15):1918-24.Click here to read Links
Comment in:
JAMA. 2005 Oct 19;294(15):1960-3.
JAMA. 2006 May 24;295(20):2355-6; author reply 2356.
Hospitalization before and after gastric bypass surgery.
Zingmond DS, McGory ML, Ko CY.
Division of General Internal Medicine and Health Services Research, Department of Medicine, The David Geffen School of Medicine at the University of California Los Angeles, Los Angeles 90095-1736, USA. dzingmond@mednet.ucla.edu
CONTEXT:
The use of Roux-en-Y gastric bypass (RYGB) has been reported to be effective in the treatment of obesity and its related comorbidities.
Need for Hospitalization after RYGB is less well understood.
OBJECTIVE:
To determine the rates and indications for inpatient hospital use before and after RYGB.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of Californians receiving RYGB in California hospitals from 1995 to 2004.
MAIN OUTCOME MEASURE: Hospitalization in the 1 to 3 years after RYGB.
RESULTS: In California from 1995 to 2004, 60,077 patients underwent RYGB-11,659 in 2004 alone.
The rate of hospitalization in the year following RYGB was more than double the rate in the year preceding RYGB (19.3% vs 7.9%, P<.001).
Furthermore, in the subset of patients (n = 24,678) with full 3-year follow-up,
a mean of 8.4% were admitted a year before RYGB
while 20.2% were readmitted in the year after RYGB,
18.4% in the second year after RYGB, and
14.9% in the third year after RYGB.
** The most common reasons for admission prior to RYGB were obesity-related problems (eg, osteoarthritis, lower extremity cellulitis), and elective operation (eg, hysterectomy),
** while the most common reasons for admission after RYGB were complications procedure related,
such as ventral hernia repair and gastric revision.
In multivariate logistic regression models predicting 1-year readmission after RYGB, increasing Charlson Comorbidity Index score, and hospitalization in the 3-year period prior to RYGB were significantly associated with readmission within a year.
CONCLUSIONS: Increases in hospital use after surgery appear to be related to RYGB. Payers, clinicians, and patients must consider the not-inconsequential rate of rehospitalization after this type of surgery.
Increased Need for Hospitalization after RNY Gastric Bypass
Unbiased Study shows RNY Gastric Bypass Increases Need for Hospitalization after gastric bypass surgery Primarily because of Complications
The rate of hospitalization in the year AFTER RNY was more than double the rate in the year preceding RNY (19% vs 8%, P<.001).
JAMA. 2005 Oct 19;294(15):1918-24.Click here to read Links
Comment in:
JAMA. 2005 Oct 19;294(15):1960-3.
JAMA. 2006 May 24;295(20):2355-6; author reply 2356.
Hospitalization before and after gastric bypass surgery.
Zingmond DS, McGory ML, Ko CY.
Division of General Internal Medicine and Health Services Research, Department of Medicine, The David Geffen School of Medicine at the University of California Los Angeles, Los Angeles 90095-1736, USA. dzingmond@mednet.ucla.edu
CONTEXT:
The use of Roux-en-Y gastric bypass (RYGB) has been reported to be effective in the treatment of obesity and its related comorbidities.
Need for Hospitalization after RYGB is less well understood.
OBJECTIVE:
To determine the rates and indications for inpatient hospital use before and after RYGB.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of Californians receiving RYGB in California hospitals from 1995 to 2004.
MAIN OUTCOME MEASURE: Hospitalization in the 1 to 3 years after RYGB.
RESULTS: In California from 1995 to 2004, 60,077 patients underwent RYGB-11,659 in 2004 alone.
The rate of hospitalization in the year following RYGB was more than double the rate in the year preceding RYGB (19.3% vs 7.9%, P<.001).
Furthermore, in the subset of patients (n = 24,678) with full 3-year follow-up,
a mean of 8.4% were admitted a year before RYGB
while 20.2% were readmitted in the year after RYGB,
18.4% in the second year after RYGB, and
14.9% in the third year after RYGB.
** The most common reasons for admission prior to RYGB were obesity-related problems (eg, osteoarthritis, lower extremity cellulitis), and elective operation (eg, hysterectomy),
** while the most common reasons for admission after RYGB were complications procedure related,
such as ventral hernia repair and gastric revision.
In multivariate logistic regression models predicting 1-year readmission after RYGB, increasing Charlson Comorbidity Index score, and hospitalization in the 3-year period prior to RYGB were significantly associated with readmission within a year.
CONCLUSIONS: Increases in hospital use after surgery appear to be related to RYGB. Payers, clinicians, and patients must consider the not-inconsequential rate of rehospitalization after this type of surgery.
Monday, October 05, 2009
http://sites.google.com/a/clos.net/mini/h-pylori-and-iron-deficiency-anemia
H. Pylori and Iron Deficiency Anemia
Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
New studies show that treatment of H. Pylori can treat certain forms of Iron Deficiency Anemia
Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.
Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
right arrow Bruno Annibale, MD; Massimo Marignani, MD; Bruno Monarca, MD; Giorgio Antonelli, MD; Adriana Marcheggiano, MD; Gina Martino, MD; Franco Mandelli, MD; Renzo Caprilli, MD; and Gianfranco Delle Fave, MD
2 November 1999 | Volume 131 Issue 9 | Pages 668-672
Background: Iron deficiency anemia is the most common form of anemia worldwide. Recent studies have suggested an association between Helicobacter pylori infection and iron deficiency.
Objective: To investigate the effects of eradicating H. pylori with combination antibiotic therapy on iron deficiency anemia in patients with H. pylori-associated gastritis.
Design: Case series.
Setting: University hospital.
Patients: 30 patients with a long history of iron deficiency anemia in whom H. pylori-associated gastritis was the only pathologic gastrointestinal finding detected.
Intervention: Eradication therapy with two antibiotics and discontinuation of iron replacement therapy.
Measurements: Complete blood count, ferritin levels, and gastroscopy with biopsy to evaluate H. pylori status.
Results: At 6 months, 75% of patients had recovered from anemia (P < 0.001), ferritin values increased from 5.7 ± 0.7 µg/L to 24.5 ± 5.2 µg/L (95% CI, 8.85 to 29.97). After 12 months, 91.7% of patients had recovered from anemia.
Conclusions: Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.
H. Pylori and Iron Deficiency Anemia
Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
New studies show that treatment of H. Pylori can treat certain forms of Iron Deficiency Anemia
Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.
Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
right arrow Bruno Annibale, MD; Massimo Marignani, MD; Bruno Monarca, MD; Giorgio Antonelli, MD; Adriana Marcheggiano, MD; Gina Martino, MD; Franco Mandelli, MD; Renzo Caprilli, MD; and Gianfranco Delle Fave, MD
2 November 1999 | Volume 131 Issue 9 | Pages 668-672
Background: Iron deficiency anemia is the most common form of anemia worldwide. Recent studies have suggested an association between Helicobacter pylori infection and iron deficiency.
Objective: To investigate the effects of eradicating H. pylori with combination antibiotic therapy on iron deficiency anemia in patients with H. pylori-associated gastritis.
Design: Case series.
Setting: University hospital.
Patients: 30 patients with a long history of iron deficiency anemia in whom H. pylori-associated gastritis was the only pathologic gastrointestinal finding detected.
Intervention: Eradication therapy with two antibiotics and discontinuation of iron replacement therapy.
Measurements: Complete blood count, ferritin levels, and gastroscopy with biopsy to evaluate H. pylori status.
Results: At 6 months, 75% of patients had recovered from anemia (P < 0.001), ferritin values increased from 5.7 ± 0.7 µg/L to 24.5 ± 5.2 µg/L (95% CI, 8.85 to 29.97). After 12 months, 91.7% of patients had recovered from anemia.
Conclusions: Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.
http://sites.google.com/a/clos.net/mini/chocalate-and-death-from-heart-attack
Chocolate and Death from Heart Attack
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold
1.
AFP: Chocolate 'cuts death rate' in heart attack survivors
Chocolate 'cuts death rate' in heart attack survivors. By Marlowe Hood (AFP) – Aug 13, 2009. PARIS — Heart attack survivors who eat chocolate two or more ...
www.google.com/.../ALeqM5gxKbyt-iymZ-PS8tgMMyi65kM4Tw - Similar
2.
Health Highlights: Aug. 13, 2009 - US News and World Report
Aug 13, 2009 ... Chocolate Helps Heart Attack Survivors Childhood Radiation Tied to ... that chocolate can help prevent death in heart attack survivors. ...
health.usnews.com/.../health-highlights-aug-13--2009.html - Cached - Similar
3.
Death by Chocolate? Not for Heart Attack Survivors
Aug 14, 2009 ... If you've survived a heart attack, you could dramatically cut your risk of dying from heart disease by eating chocolate two or more times ...
digg.com/.../Death_by_Chocolate_Not_for_Heart_Attack_Survivors - Cached - Similar
4.
Chocolate 'cuts death rate' in heart attack survivors | NowPublic ...
Aug 13, 2009 ... Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to ...
www.nowpublic.com/.../chocolate-cuts-death-rate-heart-attack-survivors - Cached - Similar
5.
Study: Eating Chocolate Reduces Risk of Death in Heart Attack ...
Aug 13, 2009 ... Study: Eating Chocolate Reduces Risk of Death in Heart Attack Survivors, Here's one more reason to eat chocolate: A study finds that eating ...
www.foxnews.com/story/0,2933,539254,00.html - Cached - Similar
6.
Raw Story » Chocolate 'cuts death rate' in heart attack survivors
Aug 13, 2009 ... PARIS (AFP) – Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold ...
rawstory.com/.../chocolate-cuts-death-rate-in-heart-attack-survivors/ - Cached - Similar
7.
Chocolate cuts death risk in heart attack survivors - Health ...
Chocolate cuts death risk in heart attack survivors. ... even indulging in chocolate once a week can nearly halve the risk of death from heart problems. ...
timesofindia.indiatimes.com/.../Chocolate...death...heart-attack.../4896143.cms - Cached - Similar
8.
Chocolate cuts death rate after heart attack - Washington Times
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to those who never ...
www.washingtontimes.com/.../chocolate-found-to-cut-death-rate-after-heart-atta/?... - Cached - Similar
9.
Dark chocolate 'cuts death risk in heart attack survivors'
London, Aug 15 (ANI): A chocolate fix twice a week could be good for heart attacker sufferers, suggests a new study. The research, published in the Journal ...
www.thaindian.com/.../dark-chocolate-cuts-death-risk-in-heart-attack-survivors_100232765.html - Cached - Similar
10.
Study: Chocolate cuts risk of death in heart attack survivors - On ...
Aug 13, 2009 ... Chocolate lovers rejoice: A new study shows a substantial cut in the risk of death from heart disease for heart attack survivors who eat ...
blogs.usatoday.com/.../study-eating-chocolate-cuts-risk-of-heart-disease-for-heart-attack-survivors.html - Cached - Similar
11.
News results for Chocolate and Death from Heart Attack
A Woman's Heart, Eating Chocolate May Reduce Risk of Cardiac Death ... - 1 hour ago
What we are just now learning is that chocolate may also be beneficial to your heart health after a heart attack as well. A joint US-Swedish study recently ...
J Intern Med. 2009 Sep;266(3):248-57.Click here to read Links
Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program.
Janszky I, Mukamal KJ, Ljung R, Ahnve S, Ahlbom A, Hallqvist J.
Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. imre.janszky@ki.se
OBJECTIVES: To assess the long-term effects of chocolate consumption amongst patients with established coronary heart disease.
DESIGN: In a population-based inception cohort study, we followed 1169 non-diabetic patients hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program. Participants self-reported usual chocolate consumption over the preceding 12 months with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registries for 8 years.
RESULTS: Chocolate consumption had a strong inverse association with cardiac mortality. When compared with those never eating chocolate, the multivariable-adjusted hazard ratios were 0.73 (95% confidence interval, 0.41-1.31), 0.56 (0.32-0.99) and 0.34 (0.17-0.70) for those consuming chocolate less than once per month, up to once per week and twice or more per week respectively. Chocolate consumption generally had an inverse but weak association with total mortality and nonfatal outcomes. In contrast, intake of other sweets was not associated with cardiac or total mortality.
CONCLUSIONS: Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI. Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed.
Chocolate and Death from Heart Attack
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold
1.
AFP: Chocolate 'cuts death rate' in heart attack survivors
Chocolate 'cuts death rate' in heart attack survivors. By Marlowe Hood (AFP) – Aug 13, 2009. PARIS — Heart attack survivors who eat chocolate two or more ...
www.google.com/.../ALeqM5gxKbyt-iymZ-PS8tgMMyi65kM4Tw - Similar
2.
Health Highlights: Aug. 13, 2009 - US News and World Report
Aug 13, 2009 ... Chocolate Helps Heart Attack Survivors Childhood Radiation Tied to ... that chocolate can help prevent death in heart attack survivors. ...
health.usnews.com/.../health-highlights-aug-13--2009.html - Cached - Similar
3.
Death by Chocolate? Not for Heart Attack Survivors
Aug 14, 2009 ... If you've survived a heart attack, you could dramatically cut your risk of dying from heart disease by eating chocolate two or more times ...
digg.com/.../Death_by_Chocolate_Not_for_Heart_Attack_Survivors - Cached - Similar
4.
Chocolate 'cuts death rate' in heart attack survivors | NowPublic ...
Aug 13, 2009 ... Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to ...
www.nowpublic.com/.../chocolate-cuts-death-rate-heart-attack-survivors - Cached - Similar
5.
Study: Eating Chocolate Reduces Risk of Death in Heart Attack ...
Aug 13, 2009 ... Study: Eating Chocolate Reduces Risk of Death in Heart Attack Survivors, Here's one more reason to eat chocolate: A study finds that eating ...
www.foxnews.com/story/0,2933,539254,00.html - Cached - Similar
6.
Raw Story » Chocolate 'cuts death rate' in heart attack survivors
Aug 13, 2009 ... PARIS (AFP) – Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold ...
rawstory.com/.../chocolate-cuts-death-rate-in-heart-attack-survivors/ - Cached - Similar
7.
Chocolate cuts death risk in heart attack survivors - Health ...
Chocolate cuts death risk in heart attack survivors. ... even indulging in chocolate once a week can nearly halve the risk of death from heart problems. ...
timesofindia.indiatimes.com/.../Chocolate...death...heart-attack.../4896143.cms - Cached - Similar
8.
Chocolate cuts death rate after heart attack - Washington Times
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to those who never ...
www.washingtontimes.com/.../chocolate-found-to-cut-death-rate-after-heart-atta/?... - Cached - Similar
9.
Dark chocolate 'cuts death risk in heart attack survivors'
London, Aug 15 (ANI): A chocolate fix twice a week could be good for heart attacker sufferers, suggests a new study. The research, published in the Journal ...
www.thaindian.com/.../dark-chocolate-cuts-death-risk-in-heart-attack-survivors_100232765.html - Cached - Similar
10.
Study: Chocolate cuts risk of death in heart attack survivors - On ...
Aug 13, 2009 ... Chocolate lovers rejoice: A new study shows a substantial cut in the risk of death from heart disease for heart attack survivors who eat ...
blogs.usatoday.com/.../study-eating-chocolate-cuts-risk-of-heart-disease-for-heart-attack-survivors.html - Cached - Similar
11.
News results for Chocolate and Death from Heart Attack
A Woman's Heart, Eating Chocolate May Reduce Risk of Cardiac Death ... - 1 hour ago
What we are just now learning is that chocolate may also be beneficial to your heart health after a heart attack as well. A joint US-Swedish study recently ...
J Intern Med. 2009 Sep;266(3):248-57.Click here to read Links
Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program.
Janszky I, Mukamal KJ, Ljung R, Ahnve S, Ahlbom A, Hallqvist J.
Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. imre.janszky@ki.se
OBJECTIVES: To assess the long-term effects of chocolate consumption amongst patients with established coronary heart disease.
DESIGN: In a population-based inception cohort study, we followed 1169 non-diabetic patients hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program. Participants self-reported usual chocolate consumption over the preceding 12 months with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registries for 8 years.
RESULTS: Chocolate consumption had a strong inverse association with cardiac mortality. When compared with those never eating chocolate, the multivariable-adjusted hazard ratios were 0.73 (95% confidence interval, 0.41-1.31), 0.56 (0.32-0.99) and 0.34 (0.17-0.70) for those consuming chocolate less than once per month, up to once per week and twice or more per week respectively. Chocolate consumption generally had an inverse but weak association with total mortality and nonfatal outcomes. In contrast, intake of other sweets was not associated with cardiac or total mortality.
CONCLUSIONS: Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI. Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed.
Monday, September 14, 2009
http://sites.google.com/a/clos.net/mini/female-hair-loss
Female Hair Loss
Semin Cutan Med Surg. 2009 Mar;28(1):19-32.Click here to read Links
Hair loss in women.
Camacho-Martínez FM.
Department of Dermatology, School of Medicine, Hospital Universitario Virgen
Macarena, Seville, Spain. camachodp@medynet.com
Female pattern hair loss (FPHL) is a clinical problem that is becoming more
common in women.
Female alopecia with androgen increase is called female androgenetic alopecia
(FAGA) and without androgen increase is called female pattern hair loss.
The clinical picture of typical FAGA begins with a specific "diffuse loss of
hair from the parietal or frontovertical areas with an intact frontal hairline."
Ludwig called this process "rarefaction."
In Ludwig's classification of hair loss in women, progressive type of FAGA, 3
patterns were described: grade I or minimal, grade II or moderate, and grade III
or severe. Ludwig also described female androgenetic alopecia with male pattern
(FAGA.M) that should be subclassified according to Ebling's or
Hamilton-Norwood's classification. FAGA.M may be present in 4 conditions:
persistent adrenarche syndrome, alopecia caused by an adrenal or an ovarian
tumor, posthysterectomy, and as an involutive alopecia.
A more recent classification (Olsen's classification of FPHL) proposes 2 types:
early- and late-onset with or without excess of androgens in each.
The diagnosis of FPHL is made by clinical history, clinical examination, wash
test, dermoscopy, trichoscan, trichograms and laboratory test, especially
androgenic determinations.
Topical treatment of FPHL is with minoxidil, 2-5% twice daily.
When FPHL is associated with high levels of androgens, systemic antiandrogenic
therapy is needed.
Persistent adrenarche syndrome (adrenal SAHA) and alopecia of adrenal
hyperandrogenism is treated with adrenal suppression and antiandrogens.
Adrenal suppression is achieved with glucocorticosteroids.
Antiandrogens therapy includes cyproterone acetate, drospirenone,
spironolactone, flutamide, and finasteride.
Excess release of ovarian androgens (ovarian SAHA) and alopecia of ovarian
hyperandrogenism is treated with ovarian suppression and antiandrogens.
Ovarian suppression includes the use of contraceptives containing an estrogen,
ethinylestradiol, and a progestogen.
Antiandrogens such as cyproterone acetate, always accompanied by tricyclic
contraceptives, are the best choice of antiandrogens to use in patients with
FPHL.
Gonadotropin-releasing hormone agonists such as leuprolide acetate suppress
pituitary and gonadal function through a reduction in luteinizing hormone and
follicle-stimulating hormone levels.
Subsequently, ovarian steroid levels also will be reduced, especially in
patients with polycystic ovary syndrome.
When polycystic ovary syndrome is associated with insulin resistance, metformin
must be considered as treatment.
Hyperprolactinemic SAHA and alopecia of pituitary hyperandrogenism should be
treated with bromocriptine or cabergoline.
*** Postmenopausal alopecia, with previous high levels of androgens or with
prostatic-specific antigen greater than 0.04 ng/mL, improves with finasteride or
dutasteride.
Although we do not know the reason, postmenopausal alopecia in normoandrogenic
women also improves with finasteride or dutasteride at a dose of 2.5 mg per day.
Dermatocosmetic concealment with a hairpiece, hair prosthesis as extensions, or
partial hairpieces can be useful.
Lastly, weight loss undoubtedly improves hair loss in hyperandrogenic women.
Female Hair Loss
Semin Cutan Med Surg. 2009 Mar;28(1):19-32.Click here to read Links
Hair loss in women.
Camacho-Martínez FM.
Department of Dermatology, School of Medicine, Hospital Universitario Virgen
Macarena, Seville, Spain. camachodp@medynet.com
Female pattern hair loss (FPHL) is a clinical problem that is becoming more
common in women.
Female alopecia with androgen increase is called female androgenetic alopecia
(FAGA) and without androgen increase is called female pattern hair loss.
The clinical picture of typical FAGA begins with a specific "diffuse loss of
hair from the parietal or frontovertical areas with an intact frontal hairline."
Ludwig called this process "rarefaction."
In Ludwig's classification of hair loss in women, progressive type of FAGA, 3
patterns were described: grade I or minimal, grade II or moderate, and grade III
or severe. Ludwig also described female androgenetic alopecia with male pattern
(FAGA.M) that should be subclassified according to Ebling's or
Hamilton-Norwood's classification. FAGA.M may be present in 4 conditions:
persistent adrenarche syndrome, alopecia caused by an adrenal or an ovarian
tumor, posthysterectomy, and as an involutive alopecia.
A more recent classification (Olsen's classification of FPHL) proposes 2 types:
early- and late-onset with or without excess of androgens in each.
The diagnosis of FPHL is made by clinical history, clinical examination, wash
test, dermoscopy, trichoscan, trichograms and laboratory test, especially
androgenic determinations.
Topical treatment of FPHL is with minoxidil, 2-5% twice daily.
When FPHL is associated with high levels of androgens, systemic antiandrogenic
therapy is needed.
Persistent adrenarche syndrome (adrenal SAHA) and alopecia of adrenal
hyperandrogenism is treated with adrenal suppression and antiandrogens.
Adrenal suppression is achieved with glucocorticosteroids.
Antiandrogens therapy includes cyproterone acetate, drospirenone,
spironolactone, flutamide, and finasteride.
Excess release of ovarian androgens (ovarian SAHA) and alopecia of ovarian
hyperandrogenism is treated with ovarian suppression and antiandrogens.
Ovarian suppression includes the use of contraceptives containing an estrogen,
ethinylestradiol, and a progestogen.
Antiandrogens such as cyproterone acetate, always accompanied by tricyclic
contraceptives, are the best choice of antiandrogens to use in patients with
FPHL.
Gonadotropin-releasing hormone agonists such as leuprolide acetate suppress
pituitary and gonadal function through a reduction in luteinizing hormone and
follicle-stimulating hormone levels.
Subsequently, ovarian steroid levels also will be reduced, especially in
patients with polycystic ovary syndrome.
When polycystic ovary syndrome is associated with insulin resistance, metformin
must be considered as treatment.
Hyperprolactinemic SAHA and alopecia of pituitary hyperandrogenism should be
treated with bromocriptine or cabergoline.
*** Postmenopausal alopecia, with previous high levels of androgens or with
prostatic-specific antigen greater than 0.04 ng/mL, improves with finasteride or
dutasteride.
Although we do not know the reason, postmenopausal alopecia in normoandrogenic
women also improves with finasteride or dutasteride at a dose of 2.5 mg per day.
Dermatocosmetic concealment with a hairpiece, hair prosthesis as extensions, or
partial hairpieces can be useful.
Lastly, weight loss undoubtedly improves hair loss in hyperandrogenic women.
http://cme.medscape.com/viewarticle/708355?src=cmemp
From Medscape Medical News CME
Large Waist Size Linked to Asthma in Women CME
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Authors and Disclosures
CME Released: 09/03/2009; Valid for credit through 09/03/2010
* Print This Print This
* Email This Email this
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[ ]
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CME Information
Target Audience
This article is intended for primary care clinicians, pulmonologists, gynecologists, and other specialists who care for women with obesity or asthma.
Goal
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Authors and Disclosures
Laurie Barclay, MD
freelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Brande Nicole Martin
is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California
Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Describe the association between asthma prevalence and body mass index in women.
2. Describe the association between asthma prevalence and severity and waist circumference in women.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Accreditation Statements
For Physicians
MedscapeCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
MedscapeCME designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape News CME has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2009. Term of approval is for 1 year from this date. (This/Each) (element, volume, issue, monograph, tape, web cast, etc) is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of (this/each) (issue, webcast, etc.)
Note: Total credit is subject to change based on topic selection and article length.
AAFP Accreditation Questions
Contact This Provider
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net
CME Released: 09/03/2009; Valid for credit through 09/03/2010
Instructions for Participation and Credit
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit*:
1. Read the target audience, learning objectives, and author disclosures.
2. Study the educational content online or printed out.
3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.
*The credit that you receive is based on your user profile.
Hardware/Software Requirements
MedscapeCME is accessible using the following browsers: Internet Explorer 6.x or higher, Firefox 2.x or higher, Safari 2.x or higher. Certain educational activities may require additional software to view multimedia, presentation or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Macromedia Flash, Adobe Acrobat, or Microsoft PowerPoint.
September 3, 2009 — Large waist size is associated with increased asthma prevalence, even among women considered to have normal body weight, according to results from the California Teachers Study cohort reported online in the August 25 issue of Thorax.
"Obesity is a risk factor for asthma, particularly in women, but few cohort studies have evaluated abdominal obesity which reflects metabolic differences in visceral fat known to influence systemic inflammation," write J. Von Behren, MPH, from Northern California Cancer Center in Berkeley, California, and colleagues. "A study was undertaken to examine the relationship between the prevalence of asthma and measures of abdominal obesity and adult weight gain in addition to body mass index (BMI) in a large cohort of female teachers."
Questionnaires were completed in 1995, 1997, 2000, and 2005. Allowing adjustment for age, smoking, and race/ethnicity, multivariable linear modeling was used to calculate prevalence odds ratios (ORs) for current asthma. At baseline, 11,500 (13%) of 88,304 women studied from the cohort were obese, defined as BMI of more than 30 kg/m2, and 1334 were extremely obese, defined as BMI of more than 40 kg/m2.
The adjusted OR for adult-onset asthma was 1.40 (95% confidence interval [CI], 1.31 - 1.49) for overweight women vs those of normal weight and 3.30 (95% CI, 2.85 - 3.82) for extremely obese women. Even among women with normal BMI, large waist circumference (WC; > 88 cm) was linked to increased prevalence of asthma (OR, 1.37; 95% CI, 1.18 - 1.59).
Compared with obese women whose waist was 88 cm or less, obese women who also had abdominal obesity had a greater risk for asthma (OR, 2.36 vs 1.57). The risk for severe asthma episodes, reflected in urgent medical visits and hospital admissions, was also greater in obese and overweight women.
"This study confirms the association between excess weight and asthma severity and prevalence, and showed that a large waist was associated with increased asthma prevalence even among women considered to have normal body weight," the study authors write. "All measures of obesity were strongly associated with increased asthma prevalence. Even being modestly overweight was associated with higher asthma prevalence in this population."
Limitations of this study include lack of data on several recognized risk factors for asthma, mostly cross-sectional data, reliance on self-report for physician diagnosis of asthma, and possible selection bias or participation bias.
"These findings are particularly troubling because a majority of American adults are now overweight or obese," the study authors conclude. "In the next phase of this study we will prospectively ascertain new asthma cases and will be able to evaluate BMI, waist size and weight change as risk factors for incident asthma in women."
The National Cancer Institute supported this study. The study authors have disclosed no relevant financial relationships.
Thorax. Published online August 25, 2009. Abstract
From Medscape Medical News CME
Large Waist Size Linked to Asthma in Women CME
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Authors and Disclosures
CME Released: 09/03/2009; Valid for credit through 09/03/2010
* Print This Print This
* Email This Email this
processing....
[ ]
[ ]
CME Information
Target Audience
This article is intended for primary care clinicians, pulmonologists, gynecologists, and other specialists who care for women with obesity or asthma.
Goal
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Authors and Disclosures
Laurie Barclay, MD
freelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Brande Nicole Martin
is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California
Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Describe the association between asthma prevalence and body mass index in women.
2. Describe the association between asthma prevalence and severity and waist circumference in women.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Accreditation Statements
For Physicians
MedscapeCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
MedscapeCME designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape News CME has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2009. Term of approval is for 1 year from this date. (This/Each) (element, volume, issue, monograph, tape, web cast, etc) is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of (this/each) (issue, webcast, etc.)
Note: Total credit is subject to change based on topic selection and article length.
AAFP Accreditation Questions
Contact This Provider
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net
CME Released: 09/03/2009; Valid for credit through 09/03/2010
Instructions for Participation and Credit
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit*:
1. Read the target audience, learning objectives, and author disclosures.
2. Study the educational content online or printed out.
3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.
*The credit that you receive is based on your user profile.
Hardware/Software Requirements
MedscapeCME is accessible using the following browsers: Internet Explorer 6.x or higher, Firefox 2.x or higher, Safari 2.x or higher. Certain educational activities may require additional software to view multimedia, presentation or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Macromedia Flash, Adobe Acrobat, or Microsoft PowerPoint.
September 3, 2009 — Large waist size is associated with increased asthma prevalence, even among women considered to have normal body weight, according to results from the California Teachers Study cohort reported online in the August 25 issue of Thorax.
"Obesity is a risk factor for asthma, particularly in women, but few cohort studies have evaluated abdominal obesity which reflects metabolic differences in visceral fat known to influence systemic inflammation," write J. Von Behren, MPH, from Northern California Cancer Center in Berkeley, California, and colleagues. "A study was undertaken to examine the relationship between the prevalence of asthma and measures of abdominal obesity and adult weight gain in addition to body mass index (BMI) in a large cohort of female teachers."
Questionnaires were completed in 1995, 1997, 2000, and 2005. Allowing adjustment for age, smoking, and race/ethnicity, multivariable linear modeling was used to calculate prevalence odds ratios (ORs) for current asthma. At baseline, 11,500 (13%) of 88,304 women studied from the cohort were obese, defined as BMI of more than 30 kg/m2, and 1334 were extremely obese, defined as BMI of more than 40 kg/m2.
The adjusted OR for adult-onset asthma was 1.40 (95% confidence interval [CI], 1.31 - 1.49) for overweight women vs those of normal weight and 3.30 (95% CI, 2.85 - 3.82) for extremely obese women. Even among women with normal BMI, large waist circumference (WC; > 88 cm) was linked to increased prevalence of asthma (OR, 1.37; 95% CI, 1.18 - 1.59).
Compared with obese women whose waist was 88 cm or less, obese women who also had abdominal obesity had a greater risk for asthma (OR, 2.36 vs 1.57). The risk for severe asthma episodes, reflected in urgent medical visits and hospital admissions, was also greater in obese and overweight women.
"This study confirms the association between excess weight and asthma severity and prevalence, and showed that a large waist was associated with increased asthma prevalence even among women considered to have normal body weight," the study authors write. "All measures of obesity were strongly associated with increased asthma prevalence. Even being modestly overweight was associated with higher asthma prevalence in this population."
Limitations of this study include lack of data on several recognized risk factors for asthma, mostly cross-sectional data, reliance on self-report for physician diagnosis of asthma, and possible selection bias or participation bias.
"These findings are particularly troubling because a majority of American adults are now overweight or obese," the study authors conclude. "In the next phase of this study we will prospectively ascertain new asthma cases and will be able to evaluate BMI, waist size and weight change as risk factors for incident asthma in women."
The National Cancer Institute supported this study. The study authors have disclosed no relevant financial relationships.
Thorax. Published online August 25, 2009. Abstract
Monday, September 07, 2009
http://sites.google.com/a/clos.net/mini/80-percent-gastric-bypass-patients-vit-d-defficient
80% of Gastric Bypass patients Vitamin D Defficient
Obes Surg. 2009 May;19(5):590-4. Epub 2008 Oct 11.
Vitamin D status before Roux-en-Y and efficacy of prophylactic and therapeutic doses of vitamin D in patients after Roux-en-Y gastric bypass surgery.
Mahlay NF, Verka LG, Thomsen K, Merugu S, Salomone M.
Saint Vincent Charity Hospital, 2351 East 22nd St., Cleveland, OH, 44115, USA.
BACKGROUND: Literature regarding the effect of Roux-en-Y gastric bypass (RYGBP) on vitamin D level shows contradictory findings.
Our goal was to determine preoperatively vitamin D levels, to evaluate the efficacy of therapeutic and prophylactic doses of vitamin D and to assess the relationship of 25-OH vitamin D level and body mass index (BMI).
METHODS: We conducted a retrospective cross-sectional study of 72 patients who underwent RYGBP from April 2007 to October 2007 in Bariatric Surgery Department at Saint Vincent Charity Hospital.
RESULTS:
Our study demonstrated that ** 80% ** of the obese patients undergoing RYGBP had serum 25-OH vitamin D levels of less than 32 ng/ml.
(many laboratories currently have listed their normal range as 32-150 ng/ml)
Postoperative data show that 45% of these patients continue being vitamin D insufficient despite the treatment.
We demonstrated that a statistically significant inverse correlation between BMI and 25-OH vitamin D levels (r = 0.464, p = 0.01) exists.
I.e. Heavier patients = Lower Vitamin D
CONCLUSION: Our finding strongly supports the need for aggressive monitoring of vitamin D levels for long-term prevention of complications of vitamin D deficiency in gastric bypass patients.
Identifying the factors that predict patient's responses to vitamin D supplementation requires larger-scale studies and further analysis of these tendencies suggested by our findings.
PMID: 18850253 [PubMed - in proces
http://www.ncbi.nlm.nih.gov/pubmed/18850253
80% of Gastric Bypass patients Vitamin D Defficient
Obes Surg. 2009 May;19(5):590-4. Epub 2008 Oct 11.
Vitamin D status before Roux-en-Y and efficacy of prophylactic and therapeutic doses of vitamin D in patients after Roux-en-Y gastric bypass surgery.
Mahlay NF, Verka LG, Thomsen K, Merugu S, Salomone M.
Saint Vincent Charity Hospital, 2351 East 22nd St., Cleveland, OH, 44115, USA.
BACKGROUND: Literature regarding the effect of Roux-en-Y gastric bypass (RYGBP) on vitamin D level shows contradictory findings.
Our goal was to determine preoperatively vitamin D levels, to evaluate the efficacy of therapeutic and prophylactic doses of vitamin D and to assess the relationship of 25-OH vitamin D level and body mass index (BMI).
METHODS: We conducted a retrospective cross-sectional study of 72 patients who underwent RYGBP from April 2007 to October 2007 in Bariatric Surgery Department at Saint Vincent Charity Hospital.
RESULTS:
Our study demonstrated that ** 80% ** of the obese patients undergoing RYGBP had serum 25-OH vitamin D levels of less than 32 ng/ml.
(many laboratories currently have listed their normal range as 32-150 ng/ml)
Postoperative data show that 45% of these patients continue being vitamin D insufficient despite the treatment.
We demonstrated that a statistically significant inverse correlation between BMI and 25-OH vitamin D levels (r = 0.464, p = 0.01) exists.
I.e. Heavier patients = Lower Vitamin D
CONCLUSION: Our finding strongly supports the need for aggressive monitoring of vitamin D levels for long-term prevention of complications of vitamin D deficiency in gastric bypass patients.
Identifying the factors that predict patient's responses to vitamin D supplementation requires larger-scale studies and further analysis of these tendencies suggested by our findings.
PMID: 18850253 [PubMed - in proces
http://www.ncbi.nlm.nih.gov/pubmed/18850253
New Study:
Revision Surgery after RNY Gastric Bypass
Only Leads to 18 lb Weight Loss!
http://ping.fm/WBzVL
One of the common long-term problems with the RNY is weight regain
Revision surgery of the RNY led to only 18 lb weight loss.
Revision Surgery after RNY Gastric Bypass
Only Leads to 18 lb Weight Loss!
http://ping.fm/WBzVL
One of the common long-term problems with the RNY is weight regain
Revision surgery of the RNY led to only 18 lb weight loss.
Higher risk for Adverse Events, especially serious type 1 reactions, with iron dextran therapy than and suggest that iron sucrose (Venofer) carries the lowest risk for hypersensitivity reactions.
Nephrol Dial Transplant. 2005 Jul;20(7):1443-9. Epub 2005 Apr 26.Click here to read Links
Hypersensitivity reactions and deaths associated with intravenous iron preparations.
Bailie GR, Clark JA, Lane CE, Lane PL.
Albany Nephrology Pharmacy (ANephRx) Group, Albany, NY, USA. bailieg@acp.edu
BACKGROUND:
Parenteral iron therapy is an accepted adjunctive management of anaemia in kidney disease.
Newer agents may have fewer severe hypersensitivity adverse events (AE) compared with iron dextrans (ID).
The rate of type 1 adverse events to iron sucrose (IS) and sodium ferric gluconate (SFG) relative to iron dextran is unclear.
We used the US Food and Drug Administration's Freedom of Information (FOI) surveillance database to compare the type 1 adverse events profiles for the three intravenous iron preparations available in the United States.
METHODS: We tabulated reports received by the FOI database between January 1997 and September 2002, and calculated 100 mg dose equivalents for the treated population for each agent.
We developed four clinical categories describing hypersensitivity adverse events (anaphylaxis, anaphylactoid reaction, urticaria and angioedema) and an algorithm describing anaphylaxis, for specific analyses.
RESULTS:
All-event reporting rates were
29.2, 10.5 and 4.2 reports/million 100 mg dose equivalents,
while all-fatal-event reporting rates were 1.4, 0.6 and 0.0 reports/million 100 mg dose equivalents
for Iron Dextran, sodium ferric gluconate (Ferrlecit) and Iron Sucrose (Venofer),
respectively.
Iron dextran had the highest reporting rates in all four clinical categories and the anaphylaxis algorithm.
Sodium ferric gluconate (Ferrlecit) had intermediate reporting rates for urticaria, anaphylactoid reaction and the anaphylaxis algorithm, and a zero reporting rate for the anaphylaxis clinical category.
Iron sucrose (Venofer) had either the lowest or a zero reporting rate in all clinical categories/algorithm.
CONCLUSIONS:
These findings confirm a higher risk for AE, especially serious type 1 reactions, with iron dextran therapy than with newer intravenous iron products and also suggest that iron sucrose (Venofer) carries the lowest risk for hypersensitivity reactions.
Nephrol Dial Transplant. 2005 Jul;20(7):1443-9. Epub 2005 Apr 26.Click here to read Links
Hypersensitivity reactions and deaths associated with intravenous iron preparations.
Bailie GR, Clark JA, Lane CE, Lane PL.
Albany Nephrology Pharmacy (ANephRx) Group, Albany, NY, USA. bailieg@acp.edu
BACKGROUND:
Parenteral iron therapy is an accepted adjunctive management of anaemia in kidney disease.
Newer agents may have fewer severe hypersensitivity adverse events (AE) compared with iron dextrans (ID).
The rate of type 1 adverse events to iron sucrose (IS) and sodium ferric gluconate (SFG) relative to iron dextran is unclear.
We used the US Food and Drug Administration's Freedom of Information (FOI) surveillance database to compare the type 1 adverse events profiles for the three intravenous iron preparations available in the United States.
METHODS: We tabulated reports received by the FOI database between January 1997 and September 2002, and calculated 100 mg dose equivalents for the treated population for each agent.
We developed four clinical categories describing hypersensitivity adverse events (anaphylaxis, anaphylactoid reaction, urticaria and angioedema) and an algorithm describing anaphylaxis, for specific analyses.
RESULTS:
All-event reporting rates were
29.2, 10.5 and 4.2 reports/million 100 mg dose equivalents,
while all-fatal-event reporting rates were 1.4, 0.6 and 0.0 reports/million 100 mg dose equivalents
for Iron Dextran, sodium ferric gluconate (Ferrlecit) and Iron Sucrose (Venofer),
respectively.
Iron dextran had the highest reporting rates in all four clinical categories and the anaphylaxis algorithm.
Sodium ferric gluconate (Ferrlecit) had intermediate reporting rates for urticaria, anaphylactoid reaction and the anaphylaxis algorithm, and a zero reporting rate for the anaphylaxis clinical category.
Iron sucrose (Venofer) had either the lowest or a zero reporting rate in all clinical categories/algorithm.
CONCLUSIONS:
These findings confirm a higher risk for AE, especially serious type 1 reactions, with iron dextran therapy than with newer intravenous iron products and also suggest that iron sucrose (Venofer) carries the lowest risk for hypersensitivity reactions.
http://sites.google.com/a/clos.net/mini/mortality-rate-sleeve-gastrectomy-over-1-per-100
Mortality Rate Sleeve Gastrectomy Over 1 per 100
National Study Mortality Rate Sleeve Gastrectomy Over 1 per 100 (1.4%)!
New Study of All Sleeve Gastrectomies in Germany
Beginning January 1, 2005, the status and outcomes of bariatric surgery were examined in Germany.
Results
The total study contains 3,122 patients.
From January 2006 to December 2007,
144 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study.
The mean body mass index (BMI) of patients undergoing SG was 54.5 kg/m2.
The complication rate after SG was 14.1%, and
the surgical complication rate was 9.4%.
The postoperative mortality rate was 1.4%.
Conclusions
`The complication rate during the first 2 years after SG in Germany is similar to that published in the literature.`
Mortality Rate Sleeve Gastrectomy Over 1 per 100
National Study Mortality Rate Sleeve Gastrectomy Over 1 per 100 (1.4%)!
New Study of All Sleeve Gastrectomies in Germany
Beginning January 1, 2005, the status and outcomes of bariatric surgery were examined in Germany.
Results
The total study contains 3,122 patients.
From January 2006 to December 2007,
144 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study.
The mean body mass index (BMI) of patients undergoing SG was 54.5 kg/m2.
The complication rate after SG was 14.1%, and
the surgical complication rate was 9.4%.
The postoperative mortality rate was 1.4%.
Conclusions
`The complication rate during the first 2 years after SG in Germany is similar to that published in the literature.`
Sunday, September 06, 2009
http://sites.google.com/a/clos.net/mini/high-fructose-corn-syrup-deadly-soup
High-Fructose Corn Syrup: Deadly Soup
Over 10% of Americans' daily calories from fructose.
Fructose accelerates the progression of chronic kidney disease
Fructose causes the Metabolic Syndrome
Beware High Fructose Corn Syrup
Green tea, Carnitine, Quercetin, Soy and other foods/supplements may help
Read on....
High-Fructose Corn Syrup: Deadly Soup
Over 10% of Americans' daily calories from fructose.
Fructose accelerates the progression of chronic kidney disease
Fructose causes the Metabolic Syndrome
Beware High Fructose Corn Syrup
Green tea, Carnitine, Quercetin, Soy and other foods/supplements may help
Read on....
Saturday, September 05, 2009
http://mgb.fm/
From a new MGB patient: "No I have had no previous weight loss surgery. My wife, Teresa, had the MGB on December 12, 2008. I watch her get healthier every day! Sign me up."
From a new MGB patient: "No I have had no previous weight loss surgery. My wife, Teresa, had the MGB on December 12, 2008. I watch her get healthier every day! Sign me up."
http://ping.fm/dsvkH
Band vs Bypass: Easy vs Effective
Prospective Randomized Trial of Laparoscopic Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding
In a high quality new study comparing the band to the RNY bypass the authors conclude that the RNY gets better weight loss but at the expense of more complications
Wouldn't it be great if there was a short simple safe operation that led to excellent weight loss...
Like the Mini (sleeve) Gastric Bypass
Band vs Bypass: Easy vs Effective
Prospective Randomized Trial of Laparoscopic Gastric Bypass Versus Laparoscopic Adjustable Gastric Banding
In a high quality new study comparing the band to the RNY bypass the authors conclude that the RNY gets better weight loss but at the expense of more complications
Wouldn't it be great if there was a short simple safe operation that led to excellent weight loss...
Like the Mini (sleeve) Gastric Bypass
Monday, August 24, 2009
http://sites.google.com/a/clos.net/mini/opioid-sparing-effect-and-post-op-recovery
Opioid-sparing Effect and Post Op Recovery
Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study.
Chen JY, Ko TL, Wen YR, Wu SC, Chou YH, Yien HW, Kuo CD.
Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Clin J Pain. 2009 Jul-Aug;25(6):485-9.
OBJECTIVES: Postoperative ileus (PI) is one of many common complications in major abdominal surgery. Postoperative Ileus results in patient discomfort, increased gastrointestinal leakage, prolonged hospital stay, and increased medical expenses. In this study, we have investigated the morphine-sparing effects of ketorolac and its correlation with the duration of Postoperative Ileus in patients with colorectal surgeries.
METHODS: We collected data from 102 patients who had received elective colorectal resection. The patients were randomly allocated into 2 groups and received intravenous patient-controlled analgesia (IVPCA) morphine (M group) or intravenous patient-controlled analgesia morphine plus ketorolac (M+K group). Time-scale morphine consumption (per 12 h), recovery of bowel functions (the first bowel movement and passage of flatus), pain scores, and opioid-related side effects were then recorded.
RESULTS:
Patients in the morphine plus ketorolac group received 18.3% less morphine than those in the morphine group within 72 postoperative hours.
The maximal opioid-sparing effects of ketorolac appeared in 12 to 24 postoperative hours.
The onset of the first bowel movement and passage of flatus was significantly less in the morphine plus ketorolac group than in the morphine group.
The morphine group showed a 5.25 times greater risk of inducing PI, a result comparable with the morphine plus ketorolac group in colorectal surgery patients.
DISCUSSION:
The addition of ketorolac to intravenous patient-controlled analgesia morphine has demonstrated
a clear opioid-sparing effect and benefits in regards to the shortening of the duration of bowel immobility.
We suggest that adding ketorolac to morphine intravenous patient-controlled analgesia be included in the multimodal postoperative rehabilitation program for the early restoration of normal bowel function.
Opioid-sparing Effect and Post Op Recovery
Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study.
Chen JY, Ko TL, Wen YR, Wu SC, Chou YH, Yien HW, Kuo CD.
Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Clin J Pain. 2009 Jul-Aug;25(6):485-9.
OBJECTIVES: Postoperative ileus (PI) is one of many common complications in major abdominal surgery. Postoperative Ileus results in patient discomfort, increased gastrointestinal leakage, prolonged hospital stay, and increased medical expenses. In this study, we have investigated the morphine-sparing effects of ketorolac and its correlation with the duration of Postoperative Ileus in patients with colorectal surgeries.
METHODS: We collected data from 102 patients who had received elective colorectal resection. The patients were randomly allocated into 2 groups and received intravenous patient-controlled analgesia (IVPCA) morphine (M group) or intravenous patient-controlled analgesia morphine plus ketorolac (M+K group). Time-scale morphine consumption (per 12 h), recovery of bowel functions (the first bowel movement and passage of flatus), pain scores, and opioid-related side effects were then recorded.
RESULTS:
Patients in the morphine plus ketorolac group received 18.3% less morphine than those in the morphine group within 72 postoperative hours.
The maximal opioid-sparing effects of ketorolac appeared in 12 to 24 postoperative hours.
The onset of the first bowel movement and passage of flatus was significantly less in the morphine plus ketorolac group than in the morphine group.
The morphine group showed a 5.25 times greater risk of inducing PI, a result comparable with the morphine plus ketorolac group in colorectal surgery patients.
DISCUSSION:
The addition of ketorolac to intravenous patient-controlled analgesia morphine has demonstrated
a clear opioid-sparing effect and benefits in regards to the shortening of the duration of bowel immobility.
We suggest that adding ketorolac to morphine intravenous patient-controlled analgesia be included in the multimodal postoperative rehabilitation program for the early restoration of normal bowel function.
http://ping.fm/m3mCE?pid=368070&id=1639571519
Xray of MGB by one of our patients that is aradiologist
Xray of MGB by one of our patients that is aradiologist
Wednesday, August 19, 2009
http://ping.fm/tQhW6
Many Normal-Weight Teens Feel Fat, At a time when much of the Western world is focusing on obesity problems, even teens who are at a healthy weight may develop a distorted body image.
Many Normal-Weight Teens Feel Fat, At a time when much of the Western world is focusing on obesity problems, even teens who are at a healthy weight may develop a distorted body image.
http://ping.fm/Z0Dzv
Changes in Weight, Waist Circumference and Compensatory Responses with Different Doses of Exercise among Sedentary, Overweight Postmenopausal Women
Conclusion
In this study of previously sedentary, overweight or obese, postmenopausal women we observed no difference in the actual and predicted weight loss with 4 and 8 KKW of exercise (72 and 136 minutes respectively)
Changes in Weight, Waist Circumference and Compensatory Responses with Different Doses of Exercise among Sedentary, Overweight Postmenopausal Women
Conclusion
In this study of previously sedentary, overweight or obese, postmenopausal women we observed no difference in the actual and predicted weight loss with 4 and 8 KKW of exercise (72 and 136 minutes respectively)
http://ping.fm/njIuG
Why Exercise Won't Make You Thin, "In general, for weight loss, exercise is pretty useless," says Eric Ravussin, chair in diabetes and metabolism at Louisiana State University and a prominent exercise researcher. Many recent studies have found that exercise isn't as important in helping people lose weight as you hear so regularly in gym advertisements or on shows like The Biggest Loser — or, for that matter, from magazines like this one.
Why Exercise Won't Make You Thin, "In general, for weight loss, exercise is pretty useless," says Eric Ravussin, chair in diabetes and metabolism at Louisiana State University and a prominent exercise researcher. Many recent studies have found that exercise isn't as important in helping people lose weight as you hear so regularly in gym advertisements or on shows like The Biggest Loser — or, for that matter, from magazines like this one.
Monday, August 17, 2009
http://sites.google.com/a/clos.net/mini/ulcers-gastritis-and-indigestion
Ulcers Gastritis and Indigestion
1. Dyspepsia (Indigestion) After the Mini-Gastric Bypass (Also see Gastritis, ulcer(s), indigestion, heartburn, acid stomach, upset stomach, unsettled stomach, stomachache ..., also see Bile Reflux, Esophageal Reflux, GERD Gastro Esophageal Reflux Disease...
Example: "I had surgery on April 16th, 2008 in Vegas and I think I have gastritis. What do I need to do?"
Dyspepsia is a pain or an uncomfortable feeling, usually located in the left upper middle part of your stomach. The pain might come and go, and can be made worse by certain foods (i.e. orange juice) and can be made better by Tums, Antacids and foods like Yogurt.
Dyspepsia, Gastritis, ulcer(s), indigestion, heartburn, acid stomach, upset stomach is the most common complication seen after the Mini-Gastric Bypass. It is seen in up to 5% of MGB patients similar to the rates seen in RNY Gastric Bypass (also see: Patel, Felix, Google Ulcer+RNY) patients.
Dyspepsia/Ulcer/Gastritis can lead to devastating complications such as bleeding and/or perforation which can be life threatening.
Because of this patients undergoing MGB should be well educated about the risks of Dyspepsia/Ulcer/Gastritis after MGB and follow advice to institute interventions to decrease the risks of Dyspepsia/Ulcer/Gastritis and to aggressively treat Dyspepsia/Ulcer/Gastritis when it occurs.
I. EDUCATION and AWARENESS
All MGB patients undergo an extensive preoperative education and testing procedure designed to aide them in understanding the risks of Dyspepsia/Ulcer/Gastritis, the interventions to decrease the incidence of Dyspepsia/Ulcer/Gastritis and the treatment of Dyspepsia/Ulcer/Gastritis in MGB post operative patients.
II. PREVENTATIVE MEASURES:
The MGB like the RNY and like Aspirin can increase the risk of Dyspepsia/Ulcer/Gastritis. Fortunately we know a list of factors to avoid to decrease this risk and interventions to recommend that can decrease the incidence of ulcers and gastritis.
Factors Associated with Ulcers/Gastritis
Age
Race
Gender
Heredity
Men have twice the risk of ulcers as women. Gastric ulcers peak at age 55 - 65.
Avoid:
Smoking: Gastric mucosal integrity is maintained by an interplay of some aggressive and defensive factors controlling apoptotic cell death and cell proliferation and smoking potentiates ulcer by disturbing this balance.
Alcohol
Coffee: Coffee consumption has a positive dose-response relation with active H. Pylori infection.
NSAIDS: Aspirin, Advil, Aleve, Ibuprofen and other NSAIDs (Non-steroidal anti-inflammatory drugs)
The use of NSAIDs increases the risk of peptic ulcer 300% to 500%.
Corticosteroids
Bisphosphonates are the primary agents used to treat osteoporosis. Although these agents are generally well tolerated, serious gastrointestinal adverse events, including hospitalization for gastrointestinal bleed, may arise.
Non-nitrogenous
Non-N-containing bisphosphonates:
* Etidronate (Didronel) - 1 (potency relative to that of etidronate)
* Clodronate (Bonefos, Loron) - 10
* Tiludronate (Skelid) - 10
Nitrogenous
N-containing bisphosphonates:
* Pamidronate (APD, Aredia) - 100
* Neridronate - 100
* Olpadronate - 500
* Alendronate (Fosamax) - 500
* Ibandronate (Boniva) - 1000
* Risedronate (Actonel) - 2000
* Zoledronate (Zometa, Aclasta) - 10000
Alendronate and Naproxen Are Synergistic for Development of Gastric Ulcers
David Y. Graham, MD; Hoda M. Malaty, MD, PhD Arch Intern Med. 2001;161:107-110.
Background Both alendronate sodium use and nonsteroidal anti-inflammatory drug use are associated with gastric ulcers. The aim of this study was to investigate whether alendronate and naproxen are synergistic as causes of gastric ulcers.
Methods We performed an endoscopist-blind, randomized, crossover, single-center comparison of 10 mg/d of alendronate sodium, 500 mg of naproxen sodium twice daily, or the combination taken orally for 10 days in volunteers aged 30 years or older. Videoendoscopy was used to evaluate the presence and degree of mucosal damage to the esophagus, stomach, or duodenal bulb before and after each treatment. There was a 1- to 4-week washout between evaluations.
Results Twenty-six healthy volunteers participated (18 women and 8 men), aged 30 to 50 years. Gastric ulcers were present in 2 subjects receiving ** alendronate (8%),** in 3 receiving ** naproxen (12%),** and in 10 receiving ** both (38%) ** (P<.05 for the combination vs either drug alone).
Conclusions Both alendronate and naproxen can cause gastric ulcers. The combination appears synergistic. Alendronate should be used with caution in those who simultaneously require nonsteroidal anti-inflammatory drugs.
COX-2 Selective cyclooxygenase-2 inhibitors (rofecoxib (Vioxx®) and celecoxib ( Celebrex®))
Diet and Ulcer: What You Eat Can Affect the Stomach and Your Gut
FIBER: Higher consumption of fruits and vegetables is associated with lower risk of ulcer
Total dietary fiber intake is inversely associated with the risk of ulcer
FRESH FRUITS AND VEGETABLES:
Grape seed extract may have antioxidative functions that have preventive action in ulcer disease (Grapes and Grape Juice)
Food sourced dietary vitamin C intake may protect against H. Pylori infection and ulcer and gastric cancer
"Emphasize fruits and vegetables. A diet rich in fresh fruits and vegetables, especially those high in vitamin C and beta carotene, has been shown to help protect against" H. Pylori infection and "stomach cancer. Look for deep green and dark yellow or orange fruits and vegetables, such as Swiss chard, bok choy, spinach, cantaloupe, mango, acorn or butternut squash, and sweet potatoes. Also try to eat vegetables from the cabbage family, including broccoli, brussels sprouts and cauliflower. Lycopene, a nutrient found in tomatoes and other red fruits and vegetables such as strawberries and red bell peppers, may be a particularly powerful anti-cancer chemical." From Mayo Clinic .com
FISH OIL:
Fish oil (FO) containing omega-3 polyunsaturated fatty acids may be protective of the stomach lining and prevent gastric ulcers. Fish oil causes a statistically significant increase both in mucus and phospholipid content of the gastric mucosal barrier. Fish oil showed a potent healing-promoting effect on acute gastric erosions and ulcers induced by indomethacin and significantly enhanced the mucus content of the mucosa.
H. pylori and Peptic Ulcer
Helicobacter pylori (H. pylori) is a type of bacteria. Researchers believe that H. pylori is responsible for the majority of peptic ulcers.
"The discovery of Helicobacter pylori, a spiral bacterium which lives in the inhospitable environment of the human stomach, must rank amongst the greatest medical triumphs of the twentieth century. The bacterium was discovered by two Australian doctors, Barry Marshall and Robin Warren in 1982. It took six long years for the medical profession to begin to acknowledge the importance of Marshall and Warren’s work and the first clinical treatment trial was conducted in 1987. Over half the planet’s population is reckoned to be carrying the bacteria and an estimated 5,000,000 cases of gastric cancer and duodenal ulcer occur annually as a result of the infection. From The Institute for Optimum Nutrition"
Helicobacter pylori, Yogurt and Probiotics
Probiotics: Lactobacillus- and Bifidobacterium Yogurt can improve the efficacy of therapy of Helicobacter pylori
"Helicobacter pylori infection, a highly prevalent pathogen, is a major cause of chronic gastritis and peptic ulcer and a risk factor for gastric malignancies. Antibiotics-based H. pylori eradication treatment is 90% effective. However, it is expensive and causes side effects and antibiotic resistance. Probiotics could present a low-cost, large-scale alternative solution to prevent or decrease H. pylori colonization. A literature search of the MEDLINE database (1966-2006) has been performed selecting all in vitro, animal, and human fully published English-language studies dealing with H. pylori and probiotics.
Lactobacillus- and Bifidobacterium-containing yogurt can suppress Helicobacter pylori. In a study of 138 patients were then randomly assigned to either a yogurt-plus-quadruple therapy or a quadruple therapy-only group. The yogurt-plus-quadruple therapy group had a higher H. pylori eradication rate than did the quadruple therapy-only group (intention-to-treat analysis: 90.8% compared with 76.6%, P < 0.05). 4-wk treatment with bacteria in yogurt can decrease H. pylori loads despite antimicrobial resistance, thus improving the efficacy of quadruple therapy in eradicating residual H. pylori.
Consumption of yogurt enriched with probiotics improves the eradication rate of Helicobacter pylori in peptic ulcer patients undergoing quadruple therapy after failed triple therapy, according to a study published in the American Journal of Clinical Nutrition (83, 4:864-69, 2006).
Probiotics had an in vitro inhibitory effect on H. pylori. Animal studies demonstrated that probiotic treatment is effective in reducing H. pylori-associated gastric inflammation. Seven of 9 human studies showed an improvement of H. pylori gastritis and decrease in H. pylori density after administration of probiotics. The addition of probiotics to standard antibiotic treatment improved H. pylori eradication rates (81% vs. 71%, with combination treatment vs. H. pylori-eradication treatment alone; chi(2)test: P=0.03). Probiotic treatment reduced H. pylori therapy-associated side effects (incidence of side effects: 23% vs. 46%, with combination therapy vs. H. pylori-eradication treatment alone; chi(2)test: P=0.04).
Long-term intake of products containing probiotic strains of probiotics may have a favorable effect on H. pylori infection in humans, particularly by reducing the risk of developing disorders associated with high degrees of gastric inflammation."
Other Dietary Factors/Supplements
Green tea,
Red wine,
Flavonoids,
Broccoli sprouts,
Garlic,
Probiotics and
Flavonoids are known to inhibit H. pylori colonization, decrease gastric inflammation by inhibiting cytokine and chemokine release, and repress precancerous changes
Studies have shown that "Red wine/ grapes and green tea are able to prevent H pylori-induced gastric epithelium damage."
Garlic
Capsaicin
Investigations have revealed that chili peppers and "capsaicin" are not the cause for ulcer formation but is a healing and protective agent. In contrast to what might be expected, Capsaicin does not stimulate but inhibits acid secretion. Capsaicin stimulates alkali, mucus secretions and particularly gastric mucosal blood flow which help in prevention and healing of ulcers. Capsaicin acts by stimulating afferent neurons in the stomach and signals for protection against injury. Chili and its pungent ingredient, capsaicin, have been shown to protect against experimental gastric mucosal injury induced by various necrotizing agents such as ethanol and aspirin and stress.
Chili protects against aspirin-induced gastroduodenal mucosal injury in humans.
Capsaicin, the pungent ingredient of chili, has a gastroprotective effect against experimental gastric mucosal injury in animals.
Such an effect has not, however, been documented in humans to date. Eighteen healthy volunteers with normal index endoscopies underwent two studies four weeks apart.
Each subject took 20 g chili orally with 200 ml water in one study and 200 ml water in another study.
In each case this was followed half an hour later by 600 mg aspirin BP with 200 ml water.
Endoscopy was repeated 6 hr later.
Gastroduodenal mucosal damage was assessed by a previously validated scoring system.
The median gastric injury score after chili was 1.5 compared to 4 in the control group (P < 0.05), demonstrating a gastroprotective effect of chili in human subjects.
Dig Dis Sci. 1995 Mar;40(3):580-3. Chili protects against aspirin-induced gastroduodenal mucosal injury in humans.
Yeoh KG, Kang JY, Yap I, Guan R, Tan CC, Wee A, Teng CH. Department of Medicine, National University Hospital, Singapore.
Gastroprotection induced by capsaicin in healthy human subjects.
AIM: To evaluate the gastro-protective effect of capsaicin against the ethanol- and indomethacin (IND)-induced gastric mucosal damage in healthy human subjects.
METHODS: The effects of small doses (1-8 microg/mL, 100 mL) of capsaicin on the gastric acid secretion basal acid output (BAO) and its electrolyte concentration, gastric transmucosal potential difference (GTPD), ethanol- (5 mL 300 mL/L i.g.) and IND- (3x25 mg/d) induced gastric mucosal damage were tested in a randomized, prospective study of 84 healthy human subjects.
The possible role of desensitization of capsaicin-sensitive afferents was tested by repeated exposures and during a prolonged treatment.
RESULTS: Intragastric application of capsaicin protected thestomach as seen by: decreased the gastric Basal Acid Output and enhanced "non-parietal" component, GTPD in a dose-dependent manner.
The stomach was protected from alcoholic damage to the lining of the stomach by a decrease of GTPD evoked by ethanol was inhibited by the capsaicin application, which was reproducible.
Gastric microbleeding induced by IND was inhibited by co-administration with capsaicin, but was not influenced by two weeks pretreatment with a daily capsaicin dose of 3x400 microg i.g.
CONCLUSION: Capsaicin in low concentration range protects against gastric injuries induced by ethanol or IND, which is attributed to stimulation of the sensory nerve endings.
World J Gastroenterol. 2005 Sep 7;11(33):5180-4.Gastroprotection induced by capsaicin in healthy human subjects.
Mózsik G, Szolcsányi J, Rácz I. First Department of Medicine, Medical and Health Center, University of Pécs, Hungary. gyula.mozsik@aok.pte.hu
Melatonin
Consider asking your Dr. about supplemental melatonin 5 milligrams every night and if having dyspepsia trying 5 milligrams three times a day for two weeks.
Melatonin, formed enzymatically from L-tryptophan, has been called "the most versatile and ubiquitous hormone molecule produced not only in all animals but also in some plants."
Melatonin is synthesized not only in the pineal gland, but also in gastrointestinal tract by enterochromaffin cells (EC) and it has a gastro-protective properties.
The enterochromaffin cells of the gastrointestinal (GI) tract secrete 400 times as much melatonin as the pineal gland.
Melatonin has been shown to act by ** scavenging free radicals,** ** protecting gut ** mucosa against various irritants and ** healing of various stomach ** and bowel lesions such as stomatitis, esophagitis, gastritis and peptic ulcer.
Melatonin is abundant in the gastrointestinal tract, has been shown to inhibit gastric acid secretion, augment Gastric Blood Flow and scavenge free radicals, resulting in the attenuation of stress-induced gastric ulcers.
Studies have shown that "nocturnal secretion of melatonin in subjects with asymptomatic infection of H. pylori is higher than in patients with ulcer-like dyspepsia and with duodenal ulcer disease.
** Lower nocturnal secretion of melatonin probably may play role in pathogenesis of upper digestive tract diseases."**
"In animal studies, melatonin protects against GI ulcerations, and randomized clinical trials suggest its efficacy in treating functional dyspepsia and irritable bowel syndrome.
Melatonin administration has been shown to protect against esophageal lesions in animals. Moreover, in a randomized, single-blind clinical trial of subjects with gastroesophageal reflux disease (GERD), the combination of melatonin with other natural supplements was found to be superior to omeprazole, a proton pump inhibitor (PPI)."
The effect of the melatonin on the life span of mice, rats and fruit flies has been studied using various approaches. It has been observed that in various strains of mice long-term administration of melatonin was followed by an increase in the mean life span.
In rats, melatonin treatment increased survival of male and female rats.
Melatonin and its precursor Trptophan significantly attenuate gastric mucosal lesions induced by aspirin. Melatonin and L-tryptophan, accelerate ulcer healing probably via interaction with MT2 receptors; this ulcer healing action is caused by an enhancement by melatonin of the microcirculation at the ulcer margin possibly mediated by COX-derived PG and NO because of overexpression of iNOS and gastrin, which exhibits trophic activity in the gastric mucosa and calcitonin gene related peptide (CGRP), released from sensory nerves, may also contribute to the ulcer healing action of melatonin.
Due to its anti-inflammatory and anti-oxidant properties, melatonin may be one of the most efficient protective factors preventing the development of acute gastric damage and accelerating healing of chronic gastric ulcers probably due to reduction in proinflammatory cytokine production, scavenging of the radical oxygen species and activation of COX-PG and NOS-NO systems as well as stimulating the afferent sensory nerves in the brain-gut axis.
Melatonin in gastroprotection against stress-induced acute gastric lesions and in healing of chronic gastric ulcers.
The degree of gastric damage following to exposition of the mucosa to noxious agents depends upon a balance between the factors promoting this damage and those activating the natural defense mechanisms.
Recent findings, presented in this review, provide evidence that melatonin prevents the formation of acute gastric lesions induced by stress and accelerates healing of chronic gastric ulcers due to increase in the activity of nitric oxide (NO) synthase (NOS)-NO and cyclooxygenase (COX)-prostaglandin E(2) (PGE(2)) systems resulting in the increase of mucosal blood flow and mucosal integrity.
Melatonin is produced and released into the circulation by the pineal gland and, in many times larger amounts, by the gastrointestinal tract.
Due to its anti-inflammatory and anti-oxidant properties, melatonin may be one of the most efficient protective factors preventing the development of acute gastric damage and accelerating healing of chronic gastric ulcers probably due to reduction in proinflammatory cytokine production, scavenging of the radical oxygen species and activation of COX-PG and NOS-NO systems as well as stimulating the afferent sensory nerves in the brain-gut axis.
J Physiol Pharmacol. 2006 Nov;57 Suppl 5:51-66.Melatonin in gastroprotection against stress-induced acute gastric lesions and in healing of chronic gastric ulcers. Konturek SJ, Konturek PC, Brzozowski T. Department of Clinical Physiology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland. mpkontur@cyf-kr.edu.pl
Treatment
Avoid Factors that Increase the Risk of Ulcers/Gastritis (See Above)
Utilize Factors/Supplements that Have Been Shown to Be Gastro-Protective (See Above)
Medical Therapy:
Antacids
(Tums Calcium Carbonate Oral, Adult Min/Max Dose: 400.0mg/5200.0mg
Antacids are attractive for rapid pain relief
Usual Adult Dose for Gastric Ulcer:
1250 to 3750 mg/day in 2 to 4 divided doses. This dose may be increased as needed and tolerated to decrease the abdominal discomfort.
Gaviscon
"In addition to the acid-neutralizing ingredients found in Gaviscon®, all Gaviscon® products contain "alginate". When chewed (Gaviscon tablets) or swallowed (Gaviscon liquid), the combination of the alginic acid and bicarbonate creates a foam barrier or "raft" that floats on the stomach acid. This raft foam barrier helps reduce the number of reflux episodes and provides longer lasting action against "heartburn" than other antacid products." From Gavison.com
* REGULAR-STRENGTH LIQUID
The usual dosage is 1 or 2 tablespoonfuls taken 4 times a day. Do not take more than 8 tablespoonfuls each 24 hours.
* EXTRA-STRENGTH LIQUID
The usual dosage is 2 to 4 teaspoonfuls taken 4 times a day. Do not take more than 16 teaspoonfuls each 24 hours.
* REGULAR AND EXTRA-STRENGTH TABLETS
The usual dosage is 2 to 4 tablets taken 4 times a day. Take the tablets after meals and at bedtime, or as needed. Do not take more than 16 tablets each 24 hours.
Metoclopramide
"Antiemetic use: Metoclopramide is commonly used to treat nausea and vomiting (emesis).
Prokinetic use: Metoclopramide increases peristalsis of the jejunum and duodenum, increases tone and amplitude of gastric contractions, and relaxes the pyloric sphincter and duodenal bulb. These prokinetic effects make metoclopramide useful in the treatment of gastric stasis (e.g. after gastric surgery or diabetic gastroparesis), It is also used in gastroesophageal reflux disease (GERD/GORD)." see Wikpedia Metaclopromide.
The recommended metoclopramide dosage for people being treated for GERD is 10 or 15 mg four times daily.
Proton Pump Inhibitors (PPIs)
Esomeprazole (Nexium®), Lansoprazole (Prevacid®), Omeprazole (Prilosec®), Pantoprazole (Protonix®), Rabeprazole (Aciphex®)
When dyspepsia/ulcer/gastritis occurs following MGB the etiology is almost always a marginal ulcer or gastritis. We routinely recommend Avoiding inciting factors, using gastroprotective supplements (see above) and the use of initial trial of high dose PPI (Proton Pump Inhibitors) usually over the counter Prilosec 20 mg tablets, 2 tabs three times a day for 2 weeks.
Table 1
Proton Pump Inhibitors
Adult Maximum Daily Acute Dose
DRUG
MAXIMUM DOSE
Esomeprazole
(Nexium®)
erosive esophagitis: 40 mg/day
GERD: 20 mg/day
H. pylori eradication: 40 mg/day
Lansoprazole
(Prevacid®)
duodenal ulcer: 15 mg/day
gastric ulcer: 30 mg/day
gastric ulcer associated with NSAIDs: 30 mg/day
GERD: 15 mg/day
H. pylori eradication:
triple therapy – 60 mg/day
dual therapy – 90 mg/day
hypersecretory conditions: 180 mg/day
erosive esophagitis: 30 mg/day
Omeprazole
(Prilosec®)
duodenal ulcer: 20 mg/day
gastric ulcer: 40 mg/day
H. pylori eradication:
triple therapy – 40 mg/day in divided doses
dual therapy – 40 mg/day
hypersecretory conditions: 360 mg/day
GERD, esophagitis: 20 mg/day
upper GI bleeding risk reduction (Zegerid® only): 40 mg/day
Pantoprazole
(Protonix®)
erosive esophagitis associated with GERD: 40 mg/day
hypersecretory conditions: 240 mg/day
Rabeprazole
(Aciphex®)
duodenal ulcer: 20 mg/day
hypersecretory conditions: 120 mg/day
H. pylori eradication: 40 mg/day
GERD: 20 mg/day
erosive esophagitis: 20 mg/day
From MEDICAID DRUG USE REVIEW CRITERIA FOR OUTPATIENT USE
Safety note: A few studies have linked PPIs to a higher risk of pneumonia and infection with a bacterium called C. difficile, and in December 2006 a study found that long–term use of PPIs may be associated with an increased risk of hip fractures. Talk with your doctor about these risks, especially if you must take a PPI over a long period of time.
People aged 65 and over, and people with chronic medical conditions, who take a PPI should get vaccinated against pneumonia and get a flu shot every year.
Bile Reflux Gastritis.
The Mini-Gastric Bypass is a Billroth II Loop Gastrojejunostomy, that is to say the stomach is connected to the side of the small intestine, to the "loop" of small bowel. Many physicians fear the risk that this will lead to a very high incidence of bile reflux gastritis. Bile is a normal part of the digestion in the gut. It is poweful detergent and can irritate the stomach, especially if there is some acid damage to the lining of the stomach from an acid ulcer or gastritis. In most MGB cases anti-ACID therapy resolves the ulcers and gastritis that follows the surgery but in some cases attention to the bile can be helpful as well.
Several treatments have been found to aide in decreaseing the irritaion caused by the detergent bile in the stomach. Lowered recirculation of bile acids results in utilization of cholesterol to synthesize bile acid and reduced fat absorption.
1. Actigall (ursodeoxycholic acid)
which changes bile acid composition. This is less irritating than the patient's own bile acids on the gastric remnant. In a study by Stefaniwsky AB, Tint GS, Speck J, Shefer S, Salen G. "12 patients with symptomatic alkaline (bile) reflux gastritis were treated for 1 mo with placebo and for 1 mo with ursodeoxycholic acid, 1000 mg/day. Before treatment, all patients were symptomatic and manifested epigastric pain, nausea, and bilious vomiting. The gastric mucosa was erythematous, friable, and bile stained, and the histology revealed chronic inflammation. No significant change in symptoms was noted during administration of placebo. In contrast, ursodeoxycholic acid treatment resulted in a profound decrease in the intensity and frequency of pain and almost abolished nausea and vomiting. During bile acid therapy the proportion of ursodeoxycholic acid in gastric bile rose to 50% of total bile acids, whereas cholic and deoxycholic acids decreased and chenodeoxycholic acid remained unchanged."
2. Cholestyramine
Cholestyramine resin adsorbs 90+% of all bile salts tested. The addition of cholestyramine to duodenal contents inhibits their ulcerogenic action of bile in the stomach of rats challenged by bile and acid. "Cholestyramine protects the gastric mucosa from ulceration by blocking the barrier breaking action of bile salts" The recommended maintenance dose for all QUESTRAN powdered products is 2 to 4 packets or scoopfuls daily (8-16 grams anhydrous cholestyramine resin) divided doses. The recommended starting dose is 1 single-dose packet or 1 level scoopful, 1 to 2 times daily.
3. Fiber
Citrucel (cellulose) has been reported as the most active in capturing and inactivating biliary acids: this constitutes a cytoprotective action on the stomach mucosa. In a study by Paniagua M, Piñol F, and Cendan A. "50 patients with bile reflux gastritisreceived cellulose 5 g/day during three months. The results showed that total biliary acids in gastric content decreased at the end of treatment mostly in patients treated with cellulose..." "there was a an excellent response in pain, vomiting and heartburn after cellulose treatment."
4. Aluminum Containing Antacids
Aluminum Containing Antacids can bind bile acids.
Many antacids are available today that contain aluminum hydroxide.
* Aluminum carbonate (Basaljel)
* Aluminum hydroxide (ALternaGEL, Alu-Cap, Alu-Tab, Amphojel, Dialume, Nephrox)
* Aluminum hydroxide/magnesium carbonate (Duracid)
* Aluminum hydroxide/magnesium hydroxide (Alamag, Almacone, Aludrox, Gaviscon Liquid, Gelusil, Kudrox, Maalox, Magalox, Mintox, Mylanta, Rulox)
* Aluminum hydroxide/magnesium hydroxide/calcium carbonate (Tempo)
* Aluminum hydroxide/magnesium trisilicate (Alenic Alka, Gaviscon, Genaton, Foamicon)
5. Sucralfate Carafate
A drug used to treat ulcers. It adheres to proteins at the ulcer site and forms a protective coating over the ulcer. Sucralfate also binds bile acids and may be useful in treat bile reflux gastritis. The recommended adult oral dosage for duodenal ulcer is 1 g four times per day on an empty stomach.
6. Green and Leafy Vegetables
In a study by Kahlon TS, Chiu MC, Chapman MH at Western Regional Research Center, USDA-ARS, Albany, CA found that "relative to cholestyramine, in vitro bile acid binding was for the collard greens, kale, and mustard greens, 13%; broccoli, 10%; Brussels sprouts and spinach, 8%; green bell pepper, 7%; and cabbage, 5%.
"Steam cooking significantly improved the bile acid binding of collard greens, kale, mustard greens, broccoli, green bell pepper, and cabbage compared with previously observed bile acid binding values for these vegetables raw (uncooked).
"Inclusion of steam-cooked collard greens, kale, mustard greens, broccoli, green bell pepper, and cabbage in our daily diet as health-promoting vegetables should be emphasized. These green/leafy vegetables, when consumed regularly after steam cooking, would lower the risk of cardiovascular disease and cancer, advance human nutrition research, and improve public health."
Other Gastroprotective Agents:
Amino Acids:
7. Taurine
Protective effect of taurine against alendronate-induced gastric damage in rats.
Sener G, Sehirli O, Cetinel S, Midillioğlu S, Gedik N, Ayanoğlu-Dülger G. Fundam Clin Pharmacol. 2005 Feb;19(1):93-100.
Alendronate (Fosamax) causes serious gastrointestinal adverse effects.
The aim of this study was to investigate whether taurine, a semi-essential amino acid and an antioxidant, improves the alendronate-induced gastric injury.
Rats were administered 20 mg/kg Alendrolate by gavage for 4 days, either alone or following treatment with Taurine (50 mg/kg, i.p.).
On the last day of treatment, following drug administration, pylorus ligation was performed and 2 h later, rats were killed and stomachs were removed.
Gastric acidity and tissue ulcer index values, lipid peroxidation and glutathione (GSH) levels, myeloperoxidase (MPO) activity as well as the histologic appearance of the stomach tissues were determined.
Chronic oral administration of Alendrolate induced significant gastric damage, increasing lipid peroxidation, MPO activity and collagen content, as well as decreasing tissue GSH levels.
Treatment with Taurine prevented the damage and also the changes in biochemical parameters.
Findings of the present study suggest that Alendrolate induces oxidative gastric damage by a local irritant effect, and that Taurine ameliorates this damage by its antioxidant and/or membrane-stabilizing effects.
Modulation of indomethacin-induced gastric injury by spermine and taurine in rats.
Motawi TK, Abd Elgawad HM, Shahin NN. J Biochem Mol Toxicol. 2007;21(5):280-8.
This study investigated the involvement of neutrophil infiltration, nitric oxide (NO) generation, and oxidative stress in indomethacin-induced ulcer and the possible gastroprotective potentials of taurine, known for antioxidant effects.
Rats were allocated into a normal control group, ulcer control group (received a single dose of indomethacin 40 mg-kg p.o.), and ulcer group pretreated with taurine (250 mg-kg i.p. for three consecutive days before ulcer induction).
6 h after indomethacin administration, and the gastric juice, serum, and mucosal tissue were used for gastric injury evaluation.
Taurine significantly ameliorated the indomethacin-induced gastric lesions in glandular mucosa.
Taurine was able to decrease the elevated levels of gastric myeloperoxidase, conjugated diene, and serum NO. The lowered tissue NO content was markedly elevated by taurine.
The antioxidant action of taurine was illustrated by restoration of the depressed content of glutathione, normalization of the inhibited activities of glutathione reductase, and superoxide dismutase.
These results suggest that taurine confers significant gastroprotection against indomethacin-induced gastric injury
Effect of taurine on ulcerogenic response and impaired ulcer healing induced by monochloramine in rat stomachs.
Kato S, Umeda M, Takeeda M, Kanatsu K, Takeuchi K. Aliment Pharmacol Ther. 2002 Apr;16 Suppl 2:35-43.
BACKGROUND: It is well known that neutrophil-derived hypochlorous acid interacts with ammonia (NH4OH) to generate monochloramine (NH2Cl) and that NH2Cl irritates the gastric mucosa and impairs ulcer healing.
AIM: To examine the effect of taurine, a hypochlorous acid scavenger, on the mucosal ulcerogenic and the impaired healing response induced by NH2Cl in rat stomachs, in comparison with those of methionine and glycine.
METHODS AND RESULTS: Under anaesthesia, oral administration of NH2Cl (120 mmol/L) produced severe lesions in male Sprague-Dawley rat stomachs.
Taurine (10-100 mg/kg) given p.o. 30 min prior to NH2Cl dose-dependently prevented these lesions in response to NH2Cl.
This action was mimicked by methionine (3-30 mg/kg) but not by glycine (10-100 mg/kg).
Under urethane anaesthesia, mucosal exposure to NH4OH (120 mmol/L) caused a marked reduction of potential difference (PD) in the ex vivo chambered stomachs after induction of ischaemia, resulting in severe lesions.
These ulcerogenic and PD responses by NH4OH plus ischaemia were also mitigated by taurine and methionine, but not glycine, applied to the chamber 20 min before the onset of NH4OH plus ischaemia.
Moreover, oral administration of 100% ethanol produced severe haemorrhagic lesions in rat stomachs, all of which rapidly healed within 7 days after lesion induction.
Daily administration of NH2Cl (20 mmol/L) significantly delayed the healing of these lesions, but recovery of this impaired healing response was obtained by concurrent administration of taurine.
Both taurine and methionine showed a potent scavenging effect against NH2Cl in vitro.
CONCLUSIONS: (1) NH2Cl generated either exogenously or endogenously damages the gastric mucosa and impairs the healing response;
(2) taurine exerts a prophylactic effect against the deleterious effects of NH2Cl, mainly due to its scavenging action against NH2Cl; and
(3) this effect of taurine may be useful for treatment of gastritis associated with Helicobacter pylori infection.
Effect of taurine on gastric oxidative stress and hemorrhagic erosion in brain ischemic rats.
Hung CR. Chin J Physiol. 2006 Jun 30;49(3):152-9.
The effect of taurine on gastric hemorrhage and mucosal erosion in the brain ischemia is unknown.
The aim of the research was to study the involvement of gastric oxidative stress in hemorrhagic erosion produced in brain ischemia rats.
The protective effect of taurine on this erosion model was evaluated.
Male Wistar rats were deprived of food for 24 h. Under chloral hydrate -anesthesia, bilateral carotid artery ligation was performed 12, 18 and 21 h after removal of food to obtain 12, 6 and 3 h of brain ischemia duration.
The pylorus and carotid esophagus of rats also were ligated. The stomachs were then irrigated for 3 h with normal saline or simulated gastric juice containing 100 mM HCl plus 17.4 mM pepsin and 54 mM NaCl. The stomach was dissected. Gastric samples were harvested. The rat brain was dissected for examination of ischemia by using triphenyltetrazolium chloride staining method.
Changes in gastric ulcerogenic parameters, such as decreased mucosal GSH level as well as enhanced gastric acid back-diffusion, mucosal lipid peroxide generation, histamine concentration, luminal hemoglobin content and mucosal erosion in gastric samples were measured.
The results indicated that bilateral carotid artery ligation could produce severe brain ischemia in rats.
Moreover, a brain ischemia- duration-dependent exacerbation of various ulcerogenic parameters also was observed in these rats.
Intraperitoneal taurine (0-300 mg/kg) dose-dependently ameliorated gastric oxidative stress and hemorrhagic erosion in brain ischemia rats.
Taken together, brain ischemia could produce gastric oxidative stress and hemorrhagic erosions that was ameliorated by taurine through stimulation of GSH biosynthesis and inhibition of oxidative stress.
Taurine ameliorates water avoidance stress-induced degenerations of gastrointestinal tract and liver. Zeybek A, Ercan F, Cetinel S, Cikler E, Sağlam B, Sener G. Dig Dis Sci. 2006 Oct;51(10):1853-61.
We investigated the role of taurine, is a potent free radical scavenger, on water avoidance stress-induced degeneration of the gastric, ileal, and colonic mucosa and liver parenchyma.
Wistar rats were exposed to chronic water avoidance stress (water avoidance stress group) 2 hr daily for 5 days. After exposing animals to chronic water avoidance stress (water avoidance stress + taurine group), 50 mg/kg taurine was injected IP for 3 days. Control animals received vehicle solution only.
The stomach, ileum, colon, and liver samples were investigated under light microscope for histopathologic changes.
To demonstrate the topography of the luminal mucosa of the stomach, ileum, and colon, scanning electron microscope was used and for hepatocyte ultastructure transmission electron microscope was used. Malondialdehyde (MDA, a biomarker of oxidative damage) and glutathione (GSH, a biomarker of protective oxidative injury) levels were also determined in all tissues.
In the water avoidance stress group, the stomach epithelium showed ulceration in some areas, dilatations of the gastric glands, and degeneration of gastric glandular cells; prominent congestion of the capillaries was apparent.
In the water avoidance stress group, severe vascular congestion was observed along with degeneration of ileal and colonic epithelium.
Prominent vascular congestion and dilated sinusoids, activated Kupffer cells, dilated granular endoplasmic reticulum membranes, and focal pyknotic nuclei were observed in liver parenchyma. MDA levels (stomach, P < 0.01; ileum, colon, and liver P < 0.05) were increased and GSH levels (P < 0.01) were decreased in all tissues in the water avoidance stress group compared with the control group.
The morphology of gastric, ileal, and colonic mucosa and liver parenchyma in the water avoidance stress + taurine group (stomach and ileum, P < 0.05; colon and liver, P < 0.01) showed a significant amelioration when compared to the water avoidance stress group. Increased MDA and decreased GSH levels in the water avoidance stress group were ameliorated with taurine treatment.
Based on the results, taurine supplementation effectively attenuates the oxidative damage of gastrointestinal mucosa and liver because of water avoidance stress induction possibly by its antioxidant effects.
Ulcers Gastritis and Indigestion
1. Dyspepsia (Indigestion) After the Mini-Gastric Bypass (Also see Gastritis, ulcer(s), indigestion, heartburn, acid stomach, upset stomach, unsettled stomach, stomachache ..., also see Bile Reflux, Esophageal Reflux, GERD Gastro Esophageal Reflux Disease...
Example: "I had surgery on April 16th, 2008 in Vegas and I think I have gastritis. What do I need to do?"
Dyspepsia is a pain or an uncomfortable feeling, usually located in the left upper middle part of your stomach. The pain might come and go, and can be made worse by certain foods (i.e. orange juice) and can be made better by Tums, Antacids and foods like Yogurt.
Dyspepsia, Gastritis, ulcer(s), indigestion, heartburn, acid stomach, upset stomach is the most common complication seen after the Mini-Gastric Bypass. It is seen in up to 5% of MGB patients similar to the rates seen in RNY Gastric Bypass (also see: Patel, Felix, Google Ulcer+RNY) patients.
Dyspepsia/Ulcer/Gastritis can lead to devastating complications such as bleeding and/or perforation which can be life threatening.
Because of this patients undergoing MGB should be well educated about the risks of Dyspepsia/Ulcer/Gastritis after MGB and follow advice to institute interventions to decrease the risks of Dyspepsia/Ulcer/Gastritis and to aggressively treat Dyspepsia/Ulcer/Gastritis when it occurs.
I. EDUCATION and AWARENESS
All MGB patients undergo an extensive preoperative education and testing procedure designed to aide them in understanding the risks of Dyspepsia/Ulcer/Gastritis, the interventions to decrease the incidence of Dyspepsia/Ulcer/Gastritis and the treatment of Dyspepsia/Ulcer/Gastritis in MGB post operative patients.
II. PREVENTATIVE MEASURES:
The MGB like the RNY and like Aspirin can increase the risk of Dyspepsia/Ulcer/Gastritis. Fortunately we know a list of factors to avoid to decrease this risk and interventions to recommend that can decrease the incidence of ulcers and gastritis.
Factors Associated with Ulcers/Gastritis
Age
Race
Gender
Heredity
Men have twice the risk of ulcers as women. Gastric ulcers peak at age 55 - 65.
Avoid:
Smoking: Gastric mucosal integrity is maintained by an interplay of some aggressive and defensive factors controlling apoptotic cell death and cell proliferation and smoking potentiates ulcer by disturbing this balance.
Alcohol
Coffee: Coffee consumption has a positive dose-response relation with active H. Pylori infection.
NSAIDS: Aspirin, Advil, Aleve, Ibuprofen and other NSAIDs (Non-steroidal anti-inflammatory drugs)
The use of NSAIDs increases the risk of peptic ulcer 300% to 500%.
Corticosteroids
Bisphosphonates are the primary agents used to treat osteoporosis. Although these agents are generally well tolerated, serious gastrointestinal adverse events, including hospitalization for gastrointestinal bleed, may arise.
Non-nitrogenous
Non-N-containing bisphosphonates:
* Etidronate (Didronel) - 1 (potency relative to that of etidronate)
* Clodronate (Bonefos, Loron) - 10
* Tiludronate (Skelid) - 10
Nitrogenous
N-containing bisphosphonates:
* Pamidronate (APD, Aredia) - 100
* Neridronate - 100
* Olpadronate - 500
* Alendronate (Fosamax) - 500
* Ibandronate (Boniva) - 1000
* Risedronate (Actonel) - 2000
* Zoledronate (Zometa, Aclasta) - 10000
Alendronate and Naproxen Are Synergistic for Development of Gastric Ulcers
David Y. Graham, MD; Hoda M. Malaty, MD, PhD Arch Intern Med. 2001;161:107-110.
Background Both alendronate sodium use and nonsteroidal anti-inflammatory drug use are associated with gastric ulcers. The aim of this study was to investigate whether alendronate and naproxen are synergistic as causes of gastric ulcers.
Methods We performed an endoscopist-blind, randomized, crossover, single-center comparison of 10 mg/d of alendronate sodium, 500 mg of naproxen sodium twice daily, or the combination taken orally for 10 days in volunteers aged 30 years or older. Videoendoscopy was used to evaluate the presence and degree of mucosal damage to the esophagus, stomach, or duodenal bulb before and after each treatment. There was a 1- to 4-week washout between evaluations.
Results Twenty-six healthy volunteers participated (18 women and 8 men), aged 30 to 50 years. Gastric ulcers were present in 2 subjects receiving ** alendronate (8%),** in 3 receiving ** naproxen (12%),** and in 10 receiving ** both (38%) ** (P<.05 for the combination vs either drug alone).
Conclusions Both alendronate and naproxen can cause gastric ulcers. The combination appears synergistic. Alendronate should be used with caution in those who simultaneously require nonsteroidal anti-inflammatory drugs.
COX-2 Selective cyclooxygenase-2 inhibitors (rofecoxib (Vioxx®) and celecoxib ( Celebrex®))
Diet and Ulcer: What You Eat Can Affect the Stomach and Your Gut
FIBER: Higher consumption of fruits and vegetables is associated with lower risk of ulcer
Total dietary fiber intake is inversely associated with the risk of ulcer
FRESH FRUITS AND VEGETABLES:
Grape seed extract may have antioxidative functions that have preventive action in ulcer disease (Grapes and Grape Juice)
Food sourced dietary vitamin C intake may protect against H. Pylori infection and ulcer and gastric cancer
"Emphasize fruits and vegetables. A diet rich in fresh fruits and vegetables, especially those high in vitamin C and beta carotene, has been shown to help protect against" H. Pylori infection and "stomach cancer. Look for deep green and dark yellow or orange fruits and vegetables, such as Swiss chard, bok choy, spinach, cantaloupe, mango, acorn or butternut squash, and sweet potatoes. Also try to eat vegetables from the cabbage family, including broccoli, brussels sprouts and cauliflower. Lycopene, a nutrient found in tomatoes and other red fruits and vegetables such as strawberries and red bell peppers, may be a particularly powerful anti-cancer chemical." From Mayo Clinic .com
FISH OIL:
Fish oil (FO) containing omega-3 polyunsaturated fatty acids may be protective of the stomach lining and prevent gastric ulcers. Fish oil causes a statistically significant increase both in mucus and phospholipid content of the gastric mucosal barrier. Fish oil showed a potent healing-promoting effect on acute gastric erosions and ulcers induced by indomethacin and significantly enhanced the mucus content of the mucosa.
H. pylori and Peptic Ulcer
Helicobacter pylori (H. pylori) is a type of bacteria. Researchers believe that H. pylori is responsible for the majority of peptic ulcers.
"The discovery of Helicobacter pylori, a spiral bacterium which lives in the inhospitable environment of the human stomach, must rank amongst the greatest medical triumphs of the twentieth century. The bacterium was discovered by two Australian doctors, Barry Marshall and Robin Warren in 1982. It took six long years for the medical profession to begin to acknowledge the importance of Marshall and Warren’s work and the first clinical treatment trial was conducted in 1987. Over half the planet’s population is reckoned to be carrying the bacteria and an estimated 5,000,000 cases of gastric cancer and duodenal ulcer occur annually as a result of the infection. From The Institute for Optimum Nutrition"
Helicobacter pylori, Yogurt and Probiotics
Probiotics: Lactobacillus- and Bifidobacterium Yogurt can improve the efficacy of therapy of Helicobacter pylori
"Helicobacter pylori infection, a highly prevalent pathogen, is a major cause of chronic gastritis and peptic ulcer and a risk factor for gastric malignancies. Antibiotics-based H. pylori eradication treatment is 90% effective. However, it is expensive and causes side effects and antibiotic resistance. Probiotics could present a low-cost, large-scale alternative solution to prevent or decrease H. pylori colonization. A literature search of the MEDLINE database (1966-2006) has been performed selecting all in vitro, animal, and human fully published English-language studies dealing with H. pylori and probiotics.
Lactobacillus- and Bifidobacterium-containing yogurt can suppress Helicobacter pylori. In a study of 138 patients were then randomly assigned to either a yogurt-plus-quadruple therapy or a quadruple therapy-only group. The yogurt-plus-quadruple therapy group had a higher H. pylori eradication rate than did the quadruple therapy-only group (intention-to-treat analysis: 90.8% compared with 76.6%, P < 0.05). 4-wk treatment with bacteria in yogurt can decrease H. pylori loads despite antimicrobial resistance, thus improving the efficacy of quadruple therapy in eradicating residual H. pylori.
Consumption of yogurt enriched with probiotics improves the eradication rate of Helicobacter pylori in peptic ulcer patients undergoing quadruple therapy after failed triple therapy, according to a study published in the American Journal of Clinical Nutrition (83, 4:864-69, 2006).
Probiotics had an in vitro inhibitory effect on H. pylori. Animal studies demonstrated that probiotic treatment is effective in reducing H. pylori-associated gastric inflammation. Seven of 9 human studies showed an improvement of H. pylori gastritis and decrease in H. pylori density after administration of probiotics. The addition of probiotics to standard antibiotic treatment improved H. pylori eradication rates (81% vs. 71%, with combination treatment vs. H. pylori-eradication treatment alone; chi(2)test: P=0.03). Probiotic treatment reduced H. pylori therapy-associated side effects (incidence of side effects: 23% vs. 46%, with combination therapy vs. H. pylori-eradication treatment alone; chi(2)test: P=0.04).
Long-term intake of products containing probiotic strains of probiotics may have a favorable effect on H. pylori infection in humans, particularly by reducing the risk of developing disorders associated with high degrees of gastric inflammation."
Other Dietary Factors/Supplements
Green tea,
Red wine,
Flavonoids,
Broccoli sprouts,
Garlic,
Probiotics and
Flavonoids are known to inhibit H. pylori colonization, decrease gastric inflammation by inhibiting cytokine and chemokine release, and repress precancerous changes
Studies have shown that "Red wine/ grapes and green tea are able to prevent H pylori-induced gastric epithelium damage."
Garlic
Capsaicin
Investigations have revealed that chili peppers and "capsaicin" are not the cause for ulcer formation but is a healing and protective agent. In contrast to what might be expected, Capsaicin does not stimulate but inhibits acid secretion. Capsaicin stimulates alkali, mucus secretions and particularly gastric mucosal blood flow which help in prevention and healing of ulcers. Capsaicin acts by stimulating afferent neurons in the stomach and signals for protection against injury. Chili and its pungent ingredient, capsaicin, have been shown to protect against experimental gastric mucosal injury induced by various necrotizing agents such as ethanol and aspirin and stress.
Chili protects against aspirin-induced gastroduodenal mucosal injury in humans.
Capsaicin, the pungent ingredient of chili, has a gastroprotective effect against experimental gastric mucosal injury in animals.
Such an effect has not, however, been documented in humans to date. Eighteen healthy volunteers with normal index endoscopies underwent two studies four weeks apart.
Each subject took 20 g chili orally with 200 ml water in one study and 200 ml water in another study.
In each case this was followed half an hour later by 600 mg aspirin BP with 200 ml water.
Endoscopy was repeated 6 hr later.
Gastroduodenal mucosal damage was assessed by a previously validated scoring system.
The median gastric injury score after chili was 1.5 compared to 4 in the control group (P < 0.05), demonstrating a gastroprotective effect of chili in human subjects.
Dig Dis Sci. 1995 Mar;40(3):580-3. Chili protects against aspirin-induced gastroduodenal mucosal injury in humans.
Yeoh KG, Kang JY, Yap I, Guan R, Tan CC, Wee A, Teng CH. Department of Medicine, National University Hospital, Singapore.
Gastroprotection induced by capsaicin in healthy human subjects.
AIM: To evaluate the gastro-protective effect of capsaicin against the ethanol- and indomethacin (IND)-induced gastric mucosal damage in healthy human subjects.
METHODS: The effects of small doses (1-8 microg/mL, 100 mL) of capsaicin on the gastric acid secretion basal acid output (BAO) and its electrolyte concentration, gastric transmucosal potential difference (GTPD), ethanol- (5 mL 300 mL/L i.g.) and IND- (3x25 mg/d) induced gastric mucosal damage were tested in a randomized, prospective study of 84 healthy human subjects.
The possible role of desensitization of capsaicin-sensitive afferents was tested by repeated exposures and during a prolonged treatment.
RESULTS: Intragastric application of capsaicin protected thestomach as seen by: decreased the gastric Basal Acid Output and enhanced "non-parietal" component, GTPD in a dose-dependent manner.
The stomach was protected from alcoholic damage to the lining of the stomach by a decrease of GTPD evoked by ethanol was inhibited by the capsaicin application, which was reproducible.
Gastric microbleeding induced by IND was inhibited by co-administration with capsaicin, but was not influenced by two weeks pretreatment with a daily capsaicin dose of 3x400 microg i.g.
CONCLUSION: Capsaicin in low concentration range protects against gastric injuries induced by ethanol or IND, which is attributed to stimulation of the sensory nerve endings.
World J Gastroenterol. 2005 Sep 7;11(33):5180-4.Gastroprotection induced by capsaicin in healthy human subjects.
Mózsik G, Szolcsányi J, Rácz I. First Department of Medicine, Medical and Health Center, University of Pécs, Hungary. gyula.mozsik@aok.pte.hu
Melatonin
Consider asking your Dr. about supplemental melatonin 5 milligrams every night and if having dyspepsia trying 5 milligrams three times a day for two weeks.
Melatonin, formed enzymatically from L-tryptophan, has been called "the most versatile and ubiquitous hormone molecule produced not only in all animals but also in some plants."
Melatonin is synthesized not only in the pineal gland, but also in gastrointestinal tract by enterochromaffin cells (EC) and it has a gastro-protective properties.
The enterochromaffin cells of the gastrointestinal (GI) tract secrete 400 times as much melatonin as the pineal gland.
Melatonin has been shown to act by ** scavenging free radicals,** ** protecting gut ** mucosa against various irritants and ** healing of various stomach ** and bowel lesions such as stomatitis, esophagitis, gastritis and peptic ulcer.
Melatonin is abundant in the gastrointestinal tract, has been shown to inhibit gastric acid secretion, augment Gastric Blood Flow and scavenge free radicals, resulting in the attenuation of stress-induced gastric ulcers.
Studies have shown that "nocturnal secretion of melatonin in subjects with asymptomatic infection of H. pylori is higher than in patients with ulcer-like dyspepsia and with duodenal ulcer disease.
** Lower nocturnal secretion of melatonin probably may play role in pathogenesis of upper digestive tract diseases."**
"In animal studies, melatonin protects against GI ulcerations, and randomized clinical trials suggest its efficacy in treating functional dyspepsia and irritable bowel syndrome.
Melatonin administration has been shown to protect against esophageal lesions in animals. Moreover, in a randomized, single-blind clinical trial of subjects with gastroesophageal reflux disease (GERD), the combination of melatonin with other natural supplements was found to be superior to omeprazole, a proton pump inhibitor (PPI)."
The effect of the melatonin on the life span of mice, rats and fruit flies has been studied using various approaches. It has been observed that in various strains of mice long-term administration of melatonin was followed by an increase in the mean life span.
In rats, melatonin treatment increased survival of male and female rats.
Melatonin and its precursor Trptophan significantly attenuate gastric mucosal lesions induced by aspirin. Melatonin and L-tryptophan, accelerate ulcer healing probably via interaction with MT2 receptors; this ulcer healing action is caused by an enhancement by melatonin of the microcirculation at the ulcer margin possibly mediated by COX-derived PG and NO because of overexpression of iNOS and gastrin, which exhibits trophic activity in the gastric mucosa and calcitonin gene related peptide (CGRP), released from sensory nerves, may also contribute to the ulcer healing action of melatonin.
Due to its anti-inflammatory and anti-oxidant properties, melatonin may be one of the most efficient protective factors preventing the development of acute gastric damage and accelerating healing of chronic gastric ulcers probably due to reduction in proinflammatory cytokine production, scavenging of the radical oxygen species and activation of COX-PG and NOS-NO systems as well as stimulating the afferent sensory nerves in the brain-gut axis.
Melatonin in gastroprotection against stress-induced acute gastric lesions and in healing of chronic gastric ulcers.
The degree of gastric damage following to exposition of the mucosa to noxious agents depends upon a balance between the factors promoting this damage and those activating the natural defense mechanisms.
Recent findings, presented in this review, provide evidence that melatonin prevents the formation of acute gastric lesions induced by stress and accelerates healing of chronic gastric ulcers due to increase in the activity of nitric oxide (NO) synthase (NOS)-NO and cyclooxygenase (COX)-prostaglandin E(2) (PGE(2)) systems resulting in the increase of mucosal blood flow and mucosal integrity.
Melatonin is produced and released into the circulation by the pineal gland and, in many times larger amounts, by the gastrointestinal tract.
Due to its anti-inflammatory and anti-oxidant properties, melatonin may be one of the most efficient protective factors preventing the development of acute gastric damage and accelerating healing of chronic gastric ulcers probably due to reduction in proinflammatory cytokine production, scavenging of the radical oxygen species and activation of COX-PG and NOS-NO systems as well as stimulating the afferent sensory nerves in the brain-gut axis.
J Physiol Pharmacol. 2006 Nov;57 Suppl 5:51-66.Melatonin in gastroprotection against stress-induced acute gastric lesions and in healing of chronic gastric ulcers. Konturek SJ, Konturek PC, Brzozowski T. Department of Clinical Physiology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland. mpkontur@cyf-kr.edu.pl
Treatment
Avoid Factors that Increase the Risk of Ulcers/Gastritis (See Above)
Utilize Factors/Supplements that Have Been Shown to Be Gastro-Protective (See Above)
Medical Therapy:
Antacids
(Tums Calcium Carbonate Oral, Adult Min/Max Dose: 400.0mg/5200.0mg
Antacids are attractive for rapid pain relief
Usual Adult Dose for Gastric Ulcer:
1250 to 3750 mg/day in 2 to 4 divided doses. This dose may be increased as needed and tolerated to decrease the abdominal discomfort.
Gaviscon
"In addition to the acid-neutralizing ingredients found in Gaviscon®, all Gaviscon® products contain "alginate". When chewed (Gaviscon tablets) or swallowed (Gaviscon liquid), the combination of the alginic acid and bicarbonate creates a foam barrier or "raft" that floats on the stomach acid. This raft foam barrier helps reduce the number of reflux episodes and provides longer lasting action against "heartburn" than other antacid products." From Gavison.com
* REGULAR-STRENGTH LIQUID
The usual dosage is 1 or 2 tablespoonfuls taken 4 times a day. Do not take more than 8 tablespoonfuls each 24 hours.
* EXTRA-STRENGTH LIQUID
The usual dosage is 2 to 4 teaspoonfuls taken 4 times a day. Do not take more than 16 teaspoonfuls each 24 hours.
* REGULAR AND EXTRA-STRENGTH TABLETS
The usual dosage is 2 to 4 tablets taken 4 times a day. Take the tablets after meals and at bedtime, or as needed. Do not take more than 16 tablets each 24 hours.
Metoclopramide
"Antiemetic use: Metoclopramide is commonly used to treat nausea and vomiting (emesis).
Prokinetic use: Metoclopramide increases peristalsis of the jejunum and duodenum, increases tone and amplitude of gastric contractions, and relaxes the pyloric sphincter and duodenal bulb. These prokinetic effects make metoclopramide useful in the treatment of gastric stasis (e.g. after gastric surgery or diabetic gastroparesis), It is also used in gastroesophageal reflux disease (GERD/GORD)." see Wikpedia Metaclopromide.
The recommended metoclopramide dosage for people being treated for GERD is 10 or 15 mg four times daily.
Proton Pump Inhibitors (PPIs)
Esomeprazole (Nexium®), Lansoprazole (Prevacid®), Omeprazole (Prilosec®), Pantoprazole (Protonix®), Rabeprazole (Aciphex®)
When dyspepsia/ulcer/gastritis occurs following MGB the etiology is almost always a marginal ulcer or gastritis. We routinely recommend Avoiding inciting factors, using gastroprotective supplements (see above) and the use of initial trial of high dose PPI (Proton Pump Inhibitors) usually over the counter Prilosec 20 mg tablets, 2 tabs three times a day for 2 weeks.
Table 1
Proton Pump Inhibitors
Adult Maximum Daily Acute Dose
DRUG
MAXIMUM DOSE
Esomeprazole
(Nexium®)
erosive esophagitis: 40 mg/day
GERD: 20 mg/day
H. pylori eradication: 40 mg/day
Lansoprazole
(Prevacid®)
duodenal ulcer: 15 mg/day
gastric ulcer: 30 mg/day
gastric ulcer associated with NSAIDs: 30 mg/day
GERD: 15 mg/day
H. pylori eradication:
triple therapy – 60 mg/day
dual therapy – 90 mg/day
hypersecretory conditions: 180 mg/day
erosive esophagitis: 30 mg/day
Omeprazole
(Prilosec®)
duodenal ulcer: 20 mg/day
gastric ulcer: 40 mg/day
H. pylori eradication:
triple therapy – 40 mg/day in divided doses
dual therapy – 40 mg/day
hypersecretory conditions: 360 mg/day
GERD, esophagitis: 20 mg/day
upper GI bleeding risk reduction (Zegerid® only): 40 mg/day
Pantoprazole
(Protonix®)
erosive esophagitis associated with GERD: 40 mg/day
hypersecretory conditions: 240 mg/day
Rabeprazole
(Aciphex®)
duodenal ulcer: 20 mg/day
hypersecretory conditions: 120 mg/day
H. pylori eradication: 40 mg/day
GERD: 20 mg/day
erosive esophagitis: 20 mg/day
From MEDICAID DRUG USE REVIEW CRITERIA FOR OUTPATIENT USE
Safety note: A few studies have linked PPIs to a higher risk of pneumonia and infection with a bacterium called C. difficile, and in December 2006 a study found that long–term use of PPIs may be associated with an increased risk of hip fractures. Talk with your doctor about these risks, especially if you must take a PPI over a long period of time.
People aged 65 and over, and people with chronic medical conditions, who take a PPI should get vaccinated against pneumonia and get a flu shot every year.
Bile Reflux Gastritis.
The Mini-Gastric Bypass is a Billroth II Loop Gastrojejunostomy, that is to say the stomach is connected to the side of the small intestine, to the "loop" of small bowel. Many physicians fear the risk that this will lead to a very high incidence of bile reflux gastritis. Bile is a normal part of the digestion in the gut. It is poweful detergent and can irritate the stomach, especially if there is some acid damage to the lining of the stomach from an acid ulcer or gastritis. In most MGB cases anti-ACID therapy resolves the ulcers and gastritis that follows the surgery but in some cases attention to the bile can be helpful as well.
Several treatments have been found to aide in decreaseing the irritaion caused by the detergent bile in the stomach. Lowered recirculation of bile acids results in utilization of cholesterol to synthesize bile acid and reduced fat absorption.
1. Actigall (ursodeoxycholic acid)
which changes bile acid composition. This is less irritating than the patient's own bile acids on the gastric remnant. In a study by Stefaniwsky AB, Tint GS, Speck J, Shefer S, Salen G. "12 patients with symptomatic alkaline (bile) reflux gastritis were treated for 1 mo with placebo and for 1 mo with ursodeoxycholic acid, 1000 mg/day. Before treatment, all patients were symptomatic and manifested epigastric pain, nausea, and bilious vomiting. The gastric mucosa was erythematous, friable, and bile stained, and the histology revealed chronic inflammation. No significant change in symptoms was noted during administration of placebo. In contrast, ursodeoxycholic acid treatment resulted in a profound decrease in the intensity and frequency of pain and almost abolished nausea and vomiting. During bile acid therapy the proportion of ursodeoxycholic acid in gastric bile rose to 50% of total bile acids, whereas cholic and deoxycholic acids decreased and chenodeoxycholic acid remained unchanged."
2. Cholestyramine
Cholestyramine resin adsorbs 90+% of all bile salts tested. The addition of cholestyramine to duodenal contents inhibits their ulcerogenic action of bile in the stomach of rats challenged by bile and acid. "Cholestyramine protects the gastric mucosa from ulceration by blocking the barrier breaking action of bile salts" The recommended maintenance dose for all QUESTRAN powdered products is 2 to 4 packets or scoopfuls daily (8-16 grams anhydrous cholestyramine resin) divided doses. The recommended starting dose is 1 single-dose packet or 1 level scoopful, 1 to 2 times daily.
3. Fiber
Citrucel (cellulose) has been reported as the most active in capturing and inactivating biliary acids: this constitutes a cytoprotective action on the stomach mucosa. In a study by Paniagua M, Piñol F, and Cendan A. "50 patients with bile reflux gastritisreceived cellulose 5 g/day during three months. The results showed that total biliary acids in gastric content decreased at the end of treatment mostly in patients treated with cellulose..." "there was a an excellent response in pain, vomiting and heartburn after cellulose treatment."
4. Aluminum Containing Antacids
Aluminum Containing Antacids can bind bile acids.
Many antacids are available today that contain aluminum hydroxide.
* Aluminum carbonate (Basaljel)
* Aluminum hydroxide (ALternaGEL, Alu-Cap, Alu-Tab, Amphojel, Dialume, Nephrox)
* Aluminum hydroxide/magnesium carbonate (Duracid)
* Aluminum hydroxide/magnesium hydroxide (Alamag, Almacone, Aludrox, Gaviscon Liquid, Gelusil, Kudrox, Maalox, Magalox, Mintox, Mylanta, Rulox)
* Aluminum hydroxide/magnesium hydroxide/calcium carbonate (Tempo)
* Aluminum hydroxide/magnesium trisilicate (Alenic Alka, Gaviscon, Genaton, Foamicon)
5. Sucralfate Carafate
A drug used to treat ulcers. It adheres to proteins at the ulcer site and forms a protective coating over the ulcer. Sucralfate also binds bile acids and may be useful in treat bile reflux gastritis. The recommended adult oral dosage for duodenal ulcer is 1 g four times per day on an empty stomach.
6. Green and Leafy Vegetables
In a study by Kahlon TS, Chiu MC, Chapman MH at Western Regional Research Center, USDA-ARS, Albany, CA found that "relative to cholestyramine, in vitro bile acid binding was for the collard greens, kale, and mustard greens, 13%; broccoli, 10%; Brussels sprouts and spinach, 8%; green bell pepper, 7%; and cabbage, 5%.
"Steam cooking significantly improved the bile acid binding of collard greens, kale, mustard greens, broccoli, green bell pepper, and cabbage compared with previously observed bile acid binding values for these vegetables raw (uncooked).
"Inclusion of steam-cooked collard greens, kale, mustard greens, broccoli, green bell pepper, and cabbage in our daily diet as health-promoting vegetables should be emphasized. These green/leafy vegetables, when consumed regularly after steam cooking, would lower the risk of cardiovascular disease and cancer, advance human nutrition research, and improve public health."
Other Gastroprotective Agents:
Amino Acids:
7. Taurine
Protective effect of taurine against alendronate-induced gastric damage in rats.
Sener G, Sehirli O, Cetinel S, Midillioğlu S, Gedik N, Ayanoğlu-Dülger G. Fundam Clin Pharmacol. 2005 Feb;19(1):93-100.
Alendronate (Fosamax) causes serious gastrointestinal adverse effects.
The aim of this study was to investigate whether taurine, a semi-essential amino acid and an antioxidant, improves the alendronate-induced gastric injury.
Rats were administered 20 mg/kg Alendrolate by gavage for 4 days, either alone or following treatment with Taurine (50 mg/kg, i.p.).
On the last day of treatment, following drug administration, pylorus ligation was performed and 2 h later, rats were killed and stomachs were removed.
Gastric acidity and tissue ulcer index values, lipid peroxidation and glutathione (GSH) levels, myeloperoxidase (MPO) activity as well as the histologic appearance of the stomach tissues were determined.
Chronic oral administration of Alendrolate induced significant gastric damage, increasing lipid peroxidation, MPO activity and collagen content, as well as decreasing tissue GSH levels.
Treatment with Taurine prevented the damage and also the changes in biochemical parameters.
Findings of the present study suggest that Alendrolate induces oxidative gastric damage by a local irritant effect, and that Taurine ameliorates this damage by its antioxidant and/or membrane-stabilizing effects.
Modulation of indomethacin-induced gastric injury by spermine and taurine in rats.
Motawi TK, Abd Elgawad HM, Shahin NN. J Biochem Mol Toxicol. 2007;21(5):280-8.
This study investigated the involvement of neutrophil infiltration, nitric oxide (NO) generation, and oxidative stress in indomethacin-induced ulcer and the possible gastroprotective potentials of taurine, known for antioxidant effects.
Rats were allocated into a normal control group, ulcer control group (received a single dose of indomethacin 40 mg-kg p.o.), and ulcer group pretreated with taurine (250 mg-kg i.p. for three consecutive days before ulcer induction).
6 h after indomethacin administration, and the gastric juice, serum, and mucosal tissue were used for gastric injury evaluation.
Taurine significantly ameliorated the indomethacin-induced gastric lesions in glandular mucosa.
Taurine was able to decrease the elevated levels of gastric myeloperoxidase, conjugated diene, and serum NO. The lowered tissue NO content was markedly elevated by taurine.
The antioxidant action of taurine was illustrated by restoration of the depressed content of glutathione, normalization of the inhibited activities of glutathione reductase, and superoxide dismutase.
These results suggest that taurine confers significant gastroprotection against indomethacin-induced gastric injury
Effect of taurine on ulcerogenic response and impaired ulcer healing induced by monochloramine in rat stomachs.
Kato S, Umeda M, Takeeda M, Kanatsu K, Takeuchi K. Aliment Pharmacol Ther. 2002 Apr;16 Suppl 2:35-43.
BACKGROUND: It is well known that neutrophil-derived hypochlorous acid interacts with ammonia (NH4OH) to generate monochloramine (NH2Cl) and that NH2Cl irritates the gastric mucosa and impairs ulcer healing.
AIM: To examine the effect of taurine, a hypochlorous acid scavenger, on the mucosal ulcerogenic and the impaired healing response induced by NH2Cl in rat stomachs, in comparison with those of methionine and glycine.
METHODS AND RESULTS: Under anaesthesia, oral administration of NH2Cl (120 mmol/L) produced severe lesions in male Sprague-Dawley rat stomachs.
Taurine (10-100 mg/kg) given p.o. 30 min prior to NH2Cl dose-dependently prevented these lesions in response to NH2Cl.
This action was mimicked by methionine (3-30 mg/kg) but not by glycine (10-100 mg/kg).
Under urethane anaesthesia, mucosal exposure to NH4OH (120 mmol/L) caused a marked reduction of potential difference (PD) in the ex vivo chambered stomachs after induction of ischaemia, resulting in severe lesions.
These ulcerogenic and PD responses by NH4OH plus ischaemia were also mitigated by taurine and methionine, but not glycine, applied to the chamber 20 min before the onset of NH4OH plus ischaemia.
Moreover, oral administration of 100% ethanol produced severe haemorrhagic lesions in rat stomachs, all of which rapidly healed within 7 days after lesion induction.
Daily administration of NH2Cl (20 mmol/L) significantly delayed the healing of these lesions, but recovery of this impaired healing response was obtained by concurrent administration of taurine.
Both taurine and methionine showed a potent scavenging effect against NH2Cl in vitro.
CONCLUSIONS: (1) NH2Cl generated either exogenously or endogenously damages the gastric mucosa and impairs the healing response;
(2) taurine exerts a prophylactic effect against the deleterious effects of NH2Cl, mainly due to its scavenging action against NH2Cl; and
(3) this effect of taurine may be useful for treatment of gastritis associated with Helicobacter pylori infection.
Effect of taurine on gastric oxidative stress and hemorrhagic erosion in brain ischemic rats.
Hung CR. Chin J Physiol. 2006 Jun 30;49(3):152-9.
The effect of taurine on gastric hemorrhage and mucosal erosion in the brain ischemia is unknown.
The aim of the research was to study the involvement of gastric oxidative stress in hemorrhagic erosion produced in brain ischemia rats.
The protective effect of taurine on this erosion model was evaluated.
Male Wistar rats were deprived of food for 24 h. Under chloral hydrate -anesthesia, bilateral carotid artery ligation was performed 12, 18 and 21 h after removal of food to obtain 12, 6 and 3 h of brain ischemia duration.
The pylorus and carotid esophagus of rats also were ligated. The stomachs were then irrigated for 3 h with normal saline or simulated gastric juice containing 100 mM HCl plus 17.4 mM pepsin and 54 mM NaCl. The stomach was dissected. Gastric samples were harvested. The rat brain was dissected for examination of ischemia by using triphenyltetrazolium chloride staining method.
Changes in gastric ulcerogenic parameters, such as decreased mucosal GSH level as well as enhanced gastric acid back-diffusion, mucosal lipid peroxide generation, histamine concentration, luminal hemoglobin content and mucosal erosion in gastric samples were measured.
The results indicated that bilateral carotid artery ligation could produce severe brain ischemia in rats.
Moreover, a brain ischemia- duration-dependent exacerbation of various ulcerogenic parameters also was observed in these rats.
Intraperitoneal taurine (0-300 mg/kg) dose-dependently ameliorated gastric oxidative stress and hemorrhagic erosion in brain ischemia rats.
Taken together, brain ischemia could produce gastric oxidative stress and hemorrhagic erosions that was ameliorated by taurine through stimulation of GSH biosynthesis and inhibition of oxidative stress.
Taurine ameliorates water avoidance stress-induced degenerations of gastrointestinal tract and liver. Zeybek A, Ercan F, Cetinel S, Cikler E, Sağlam B, Sener G. Dig Dis Sci. 2006 Oct;51(10):1853-61.
We investigated the role of taurine, is a potent free radical scavenger, on water avoidance stress-induced degeneration of the gastric, ileal, and colonic mucosa and liver parenchyma.
Wistar rats were exposed to chronic water avoidance stress (water avoidance stress group) 2 hr daily for 5 days. After exposing animals to chronic water avoidance stress (water avoidance stress + taurine group), 50 mg/kg taurine was injected IP for 3 days. Control animals received vehicle solution only.
The stomach, ileum, colon, and liver samples were investigated under light microscope for histopathologic changes.
To demonstrate the topography of the luminal mucosa of the stomach, ileum, and colon, scanning electron microscope was used and for hepatocyte ultastructure transmission electron microscope was used. Malondialdehyde (MDA, a biomarker of oxidative damage) and glutathione (GSH, a biomarker of protective oxidative injury) levels were also determined in all tissues.
In the water avoidance stress group, the stomach epithelium showed ulceration in some areas, dilatations of the gastric glands, and degeneration of gastric glandular cells; prominent congestion of the capillaries was apparent.
In the water avoidance stress group, severe vascular congestion was observed along with degeneration of ileal and colonic epithelium.
Prominent vascular congestion and dilated sinusoids, activated Kupffer cells, dilated granular endoplasmic reticulum membranes, and focal pyknotic nuclei were observed in liver parenchyma. MDA levels (stomach, P < 0.01; ileum, colon, and liver P < 0.05) were increased and GSH levels (P < 0.01) were decreased in all tissues in the water avoidance stress group compared with the control group.
The morphology of gastric, ileal, and colonic mucosa and liver parenchyma in the water avoidance stress + taurine group (stomach and ileum, P < 0.05; colon and liver, P < 0.01) showed a significant amelioration when compared to the water avoidance stress group. Increased MDA and decreased GSH levels in the water avoidance stress group were ameliorated with taurine treatment.
Based on the results, taurine supplementation effectively attenuates the oxidative damage of gastrointestinal mucosa and liver because of water avoidance stress induction possibly by its antioxidant effects.
http://ping.fm/oueGj
Eating fatty food appears to take an almost immediate toll on both short-term memory and exercise performance, according to new research on rats and people....
Eating fatty food appears to take an almost immediate toll on both short-term memory and exercise performance, according to new research on rats and people....
Friday, August 14, 2009
http://mgb.fm
5 New Scientific Studies Support the Mini-Gastric Bypass over other Weight Loss Surgery
*** Amazing New Findings! 3 New studies from the International Federation for Surgery of Obesity and Metabolic Diseases show: ***
A 5 year Randomized Controlled Prospective Trial: the Mini-Gastric Bypass better than the RNY gastric bypass.
In another randomized trial, the MGB out performed the lapBand and the Sleeve Gastrectomy in weight loss, quality of life
In another randomized trial of the treatment of diabetes the Mini-Gastric Bypass was roughly TWICE as effective as the Sleeve Gastrectomy
In Studies from ASMBS summer meetings:
New Lap band study showed failure to resolve diabetes in 60% of Diabetics and patients lost less than half of their excess weight.
In another study of 177 patients with type 2 diabetes who underwent RNY gastric bypass, remission of diabetes remained in only 57% at 8 years.
5 New Scientific Studies Support the Mini-Gastric Bypass over other Weight Loss Surgery
*** Amazing New Findings! 3 New studies from the International Federation for Surgery of Obesity and Metabolic Diseases show: ***
A 5 year Randomized Controlled Prospective Trial: the Mini-Gastric Bypass better than the RNY gastric bypass.
In another randomized trial, the MGB out performed the lapBand and the Sleeve Gastrectomy in weight loss, quality of life
In another randomized trial of the treatment of diabetes the Mini-Gastric Bypass was roughly TWICE as effective as the Sleeve Gastrectomy
In Studies from ASMBS summer meetings:
New Lap band study showed failure to resolve diabetes in 60% of Diabetics and patients lost less than half of their excess weight.
In another study of 177 patients with type 2 diabetes who underwent RNY gastric bypass, remission of diabetes remained in only 57% at 8 years.
5 New Scientific Studies Support the Mini-Gastric Bypass over other Weight Loss Surgery
*** Amazing New Findings! 3 New studies from the International Federation for Surgery of Obesity and Metabolic Diseases show: ***
A 5 year Randomized Controlled Prospective Trial: the Mini-Gastric Bypass better than the RNY gastric bypass.
In another randomized trial, the MGB out performed the lapBand and the Sleeve Gastrectomy in weight loss, quality of life
In another randomized trial of the treatment of diabetes the Mini-Gastric Bypass was roughly TWICE as effective as the Sleeve Gastrectomy
In Studies from ASMBS summer meetings:
New Lap band study showed failure to resolve diabetes in 60% of Diabetics and patients lost less than half of their excess weight.
In another study of 177 patients with type 2 diabetes who underwent RNY gastric bypass, remission of diabetes remained in only 57% at 8 years.
*** Amazing New Findings! 3 New studies from the International Federation for Surgery of Obesity and Metabolic Diseases show: ***
A 5 year Randomized Controlled Prospective Trial: the Mini-Gastric Bypass better than the RNY gastric bypass.
In another randomized trial, the MGB out performed the lapBand and the Sleeve Gastrectomy in weight loss, quality of life
In another randomized trial of the treatment of diabetes the Mini-Gastric Bypass was roughly TWICE as effective as the Sleeve Gastrectomy
In Studies from ASMBS summer meetings:
New Lap band study showed failure to resolve diabetes in 60% of Diabetics and patients lost less than half of their excess weight.
In another study of 177 patients with type 2 diabetes who underwent RNY gastric bypass, remission of diabetes remained in only 57% at 8 years.
http://ping.fm/bwsEV Medical Student and MGB Patient talks about MGB and nutrition. On the web: www.clos.net Email: DrR@clos.net Tel: 702-714-0011
Thursday, August 13, 2009
http://ping.fm/XbGvL
Surgeon Specialization
Surgeon specialization was inversely related to mortality rates
That is: More Specialized = Better Outcomes (Fewer Deaths)
Ann Surg. 2009 May;249(5):708-16.Click here to read Links
Comment in:
Ann Surg. 2009 May;249(5):717-8.
The impact of surgeon specialization on patient mortality: examination of a continuous Herfindahl-Hirschman index.
Hall BL, Hsiao EY, Majercik S, Hirbe M, Hamilton BH.
Department of Surgery, John Cochran Veterans Affairs Medical Center, St Louis, Missouri, USA. hallb@ wustl.edu
OBJECTIVE: To examine the effect of surgeon specialization on patient outcomes, controlling for volume.
BACKGROUND: There is great interest in the degree to which surgical specialization affects outcomes, particularly considering drives to measure and reward quality in healthcare. Although surgical specialization has been previously analyzed with respect to outcomes, most studies have treated it as a dichotomous variable based on academic credentials. We treat it here as a continuous variable defined quantitatively by procedural diversity.
METHODS: We used 2002 to 2005 patient data from the National Surgical Quality Improvement Program for the Department of Surgery, Barnes Jewish Hospital, St. Louis, Missouri. To quantitate procedural specialization, Herfindahl-Hirschman indices for surgeons were calculated using billing codes. These indices were calculated according to 3 different levels of procedural aggregation. Using conditional logit models, we examined the relationship between these indices and 30-day postoperative mortality rates.
RESULTS: Surgeon specialization was inversely related to mortality rates after adjusting for case volume when indices were calculated using medium procedural aggregation (odds ratio for mortality = 0.580 per 0.1 unit Herfindahl increase; P = 0.025) or low aggregation (odds ratio for mortality = 0.510 per 0.1 unit Herfindahl increase; P = 0.015). No relationship was observed at the high level of aggregation.
CONCLUSIONS: The procedural concentration component of surgical specialization is correlated with improved mortality rates independently of case volume.
Surgeon Specialization
Surgeon specialization was inversely related to mortality rates
That is: More Specialized = Better Outcomes (Fewer Deaths)
Ann Surg. 2009 May;249(5):708-16.Click here to read Links
Comment in:
Ann Surg. 2009 May;249(5):717-8.
The impact of surgeon specialization on patient mortality: examination of a continuous Herfindahl-Hirschman index.
Hall BL, Hsiao EY, Majercik S, Hirbe M, Hamilton BH.
Department of Surgery, John Cochran Veterans Affairs Medical Center, St Louis, Missouri, USA. hallb@ wustl.edu
OBJECTIVE: To examine the effect of surgeon specialization on patient outcomes, controlling for volume.
BACKGROUND: There is great interest in the degree to which surgical specialization affects outcomes, particularly considering drives to measure and reward quality in healthcare. Although surgical specialization has been previously analyzed with respect to outcomes, most studies have treated it as a dichotomous variable based on academic credentials. We treat it here as a continuous variable defined quantitatively by procedural diversity.
METHODS: We used 2002 to 2005 patient data from the National Surgical Quality Improvement Program for the Department of Surgery, Barnes Jewish Hospital, St. Louis, Missouri. To quantitate procedural specialization, Herfindahl-Hirschman indices for surgeons were calculated using billing codes. These indices were calculated according to 3 different levels of procedural aggregation. Using conditional logit models, we examined the relationship between these indices and 30-day postoperative mortality rates.
RESULTS: Surgeon specialization was inversely related to mortality rates after adjusting for case volume when indices were calculated using medium procedural aggregation (odds ratio for mortality = 0.580 per 0.1 unit Herfindahl increase; P = 0.025) or low aggregation (odds ratio for mortality = 0.510 per 0.1 unit Herfindahl increase; P = 0.015). No relationship was observed at the high level of aggregation.
CONCLUSIONS: The procedural concentration component of surgical specialization is correlated with improved mortality rates independently of case volume.
Monday, August 10, 2009
ICISS: Dr. Rutledge's Contribution to Trauma Carehttp://ping.fm/vBbS7
Dr Rutledge: Inventor of ICISS (ICD based Injury Severity Score)
In 1993 Dr Rutledge published the first article describing
the use of ICD-9 codes as a means of predicting injury severity. (1) At the time the standard means of injury
severity scoring was the consensus derived ISS. Dr Rutledge’s invention was a data derived system
based upon analysis of actual injury outcomes that were quantitated from actual
trauma outcomes.
Although controversial at the time, (criticized by Champion,
MacKenzie and others) now 17 years later the ICISS stands as simple, well validated
and relatively inexpensive means of injury severity scoring, confirming Dr Rutledge’s
initial findings.(2-51)
Now 51 scientific articles later; Dr. Rutledge was right. Its hard changing people's minds.
Dr Rutledge: Inventor of ICISS (ICD based Injury Severity Score)
In 1993 Dr Rutledge published the first article describing
the use of ICD-9 codes as a means of predicting injury severity. (1) At the time the standard means of injury
severity scoring was the consensus derived ISS. Dr Rutledge’s invention was a data derived system
based upon analysis of actual injury outcomes that were quantitated from actual
trauma outcomes.
Although controversial at the time, (criticized by Champion,
MacKenzie and others) now 17 years later the ICISS stands as simple, well validated
and relatively inexpensive means of injury severity scoring, confirming Dr Rutledge’s
initial findings.(2-51)
Now 51 scientific articles later; Dr. Rutledge was right. Its hard changing people's minds.
http://ping.fm/nJcDx
ICISS: Dr. Rutledge's Contribution to Trauma Care
Dr Rutledge: Inventor of ICISS (ICD based Injury Severity Score)
In 1993 Dr Rutledge published the first article describing the use of ICD-9 codes as a means of predicting injury severity. (1) At the time the standard means of injury severity scoring was the consensus derived ISS. Dr Rutledge’s invention was a data derived system based upon analysis of actual injury outcomes that were quantitated from actual trauma outcomes.
Although controversial at the time, (criticized by Champion, MacKenzie and others) now 17 years later the ICISS stands as simple, well validated and relatively inexpensive means of injury severity scoring, confirming Dr Rutledge’s initial findings.(2-51)
Over 10 years ago Dr. Rutledge wrote:
The Journal of Trauma: Injury, Infection, and Critical Care:
January 1998 - Volume 44 - Issue 1 - pp 41-49
Article
The End of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, Ninth Revision-Based Prediction Tool, Outperforms Both ISS and TRISS as Predictors of Trauma Patient Survival, Hospital Charges, and Hospital Length of Stay
Rutledge, Robert MD; Osler, Turner MD; Emery, Sherry PhD; Kromhout-Schiro, Sharon PhD
Collapse Box
Abstract
Introduction: Since their inception, the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS) have been suggested as measures of the quality of trauma care. In concept, they are designed to accurately assess injury severity and predict expected outcomes. ICISS, an injury severity methodology based on International Classification of Diseases, Ninth Revision, codes, has been demonstrated to be superior to ISS and TRISS. The purpose of the present study was to compare the ability of TRISS to ICISS as predictors of survival and other outcomes of injury (hospital length of stay and hospital charges). It was our hypothesis that ICISS would outperform ISS and TRISS in each of these outcome predictions.
Methods: "Training" data for creation of ICISS predictions were obtained from a state hospital discharge data base. "Test" data were obtained from a state trauma registry. ISS, TRISS, and ICISS were compared as predictors of patient survival. They were also compared as indicators of resource utilization by assessing their ability to predict patient hospital length of stay and hospital charges. Finally, a neural network was trained on the ICISS values and applied to the test data set in an effort to further improve predictive power. The techniques were compared by comparing each patient's outcome as predicted by the model to the actual outcome.
Results: Seven thousand seven hundred five patients had complete data available for analysis. The ICISS was far more likely than ISS or TRISS to accurately predict every measure of outcome of injured patients tested, and the neural network further improved predictive power.
Conclusion: In addition to predicting mortality, quality tools that can accurately predict resource utilization are necessary for effective trauma center quality-improvement programs. ICISS-derived predictions of survival, hospital charges, and hospital length of stay consistently outperformed those of ISS and TRISS. The neural network-augmented ICISS was even better. This and previous studies demonstrate that TRISS is a limited technique in predicting survival resource utilization. Because of the limitations of TRISS, it should be superseded by ICISS.
References
1. Rutledge R, Fakhry S, Baker C, Oller D. Injury severity grading in trauma patients: a simplified technique based upon ICD-9 coding. J Trauma 1993;35(4):497-506; discussion 506.
2. Rutledge R. Injury severity and probability of survival assessment in trauma patients using a predictive hierarchical network model derived from ICD-9 codes. J Trauma 1995;38(4):590-7; discussion 597.
3. Osler T, Rutledge R, Deis J, Bedrick E. ICISS: an international classification of disease-9 based injury severity score. J Trauma 1996;41(3):380-6; discussion 386.
4. Rutledge R, Hoyt DB, Eastman AB, Sise MJ, Velky T, Canty T, et al. Comparison of the Injury Severity Score and ICD-9 diagnosis codes as predictors of outcome in injury: analysis of 44,032 patients. J Trauma 1997;42(3):477-87; discussion 487.
5. Osler TM, Cohen M, Rogers FB, Camp L, Rutledge R, Shackford SR, et al. Trauma registry injury coding is superfluous: a comparison of outcome prediction based on trauma registry International Classification of Diseases-Ninth Revision (ICD-9) and hospital information system ICD-9 codes. J Trauma 1997;43(2):253-6; discussion 256.
6. Rutledge R, Osler T. The ICD-9-based illness severity score: a new model that outperforms both DRG and APR-DRG as predictors of survival and resource utilization. J Trauma 1998;45(4):791-799.
7. Osler TM, Rogers FB, Glance LG, Cohen M, Rutledge R, Shackford SR, et al. Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS. J Trauma 1998;45(2):234-7; discussion 237.
8. Rutledge R, Osler T, Kromhout-Schiro S. Illness severity adjustment for outcomes analysis: validation of the ICISS methodology in all 821,455 patients hospitalized in North Carolina in 1996. Surgery 1998;124(2):187-94; discussion 194.
9. Rutledge R, Osler T, Emery S, Kromhout-Schiro S. The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J Trauma 1998;44(1):41-49.
10. Hannan EL, Farrell LS, Gorthy SF, Bessey PQ, Cayten CG, Cooper A, et al. Predictors of mortality in adult patients with blunt injuries in New York State: a comparison of the Trauma and Injury Severity Score (TRISS) and the International Classification of Disease, Ninth Revision-based Injury Severity Score (ICISS). J Trauma 1999;47(1):8-14.
11. West TA, Rivara FP, Cummings P, Jurkovich GJ, Maier RV. Harborview assessment for risk of mortality: an improved measure of injury severity on the basis of ICD-9-CM. J Trauma 2000;49(3):530-40; discussion 540.
12. Hannan EL, Farrell LS, Meaker PS, Cooper A. Predicting inpatient mortality for pediatric trauma patients with blunt injuries: a better alternative. J Pediatr Surg 2000;35(2):155-159.
13. Kim Y, Jung KY, Kim CY, Kim YI, Shin Y. Validation of the International Classification of Diseases 10th Edition-based Injury Severity Score (ICISS). J Trauma 2000;48(2):280-285.
14. Rogers FB, Osler TM, Shackford SR, Martin F, Healey M, Pilcher D, et al. Population-based study of hospital trauma care in a rural state without a formal trauma system. J Trauma 2001;50(3):409-13; discussion 414.
15. Osler TM, Rogers FB, Badger GJ, Healey M, Vane DW, Shackford SR, et al. A simple mathematical modification of TRISS markedly improves calibration. J Trauma 2002;53(4):630-634.
16. Meredith JW, Evans G, Kilgo PD, MacKenzie E, Osler T, McGwin G, et al. A comparison of the abilities of nine scoring algorithms in predicting mortality. J Trauma 2002;53(4):621-8; discussion 628.
17. Stephenson SCR, Langley JD, Civil ID. Comparing measures of injury severity for use with large databases. J Trauma 2002;53(2):326-332.
18. Kuhls DA, Malone DL, McCarter RJ, Napolitano LM. Predictors of mortality in adult trauma patients: the physiologic trauma score is equivalent to the Trauma and Injury Severity Score. J Am Coll Surg 2002;194(6):695-704.
19. Meredith JW, Kilgo PD, Osler TM. Independently derived survival risk ratios yield better estimates of survival than traditional survival risk ratios when using the ICISS. J Trauma 2003;55(5):933-938.
20. Meredith JW, Kilgo PD, Osler T. A fresh set of survival risk ratios derived from incidents in the National Trauma Data Bank from which the ICISS may be calculated. J Trauma 2003;55(5):924-932.
21. Kilgo PD, Osler TM, Meredith W. The worst injury predicts mortality outcome the best: rethinking the role of multiple injuries in trauma outcome scoring. J Trauma 2003;55(4):599-606; discussion 606.
22. Kim Y, Jung KY. Utility of the international classification of diseases injury severity score: detecting preventable deaths and comparing the performance of emergency medical centers. J Trauma 2003;54(4):775-780.
23. Stephenson S, Henley G, Harrison JE, Langley JD. Diagnosis based injury severity scaling: investigation of a method using Australian and New Zealand hospitalisations. Inj Prev 2004;10(6):379-383.
24. Kilgo PD, Meredith JW, Hensberry R, Osler TM. A note on the disjointed nature of the injury severity score. J Trauma 2004;57(3):479-85; discussion 486.
25. Kulla M, Fischer S, Helm M, Lampl L. [How to assess the severity of the multi-system trauma in the emergency-room -- a critical review]. Anasthesiol Intensivmed Notfallmed Schmerzther 2005;40(12):726-736.
26. Clarke JR, Ragone AV, Greenwald L. Comparisons of survival predictions using survival risk ratios based on International Classification of Diseases, Ninth Revision and Abbreviated Injury Scale trauma diagnosis codes. J Trauma 2005;59(3):563-7; discussion 567.
27. Hannan EL, Waller CH, Farrell LS, Cayten CG. A comparison among the abilities of various injury severity measures to predict mortality with and without accompanying physiologic information. J Trauma 2005;58(2):244-251.
28. Deutscher M. The responsibility to protect. Med Confl Surviv 2005;21(1):28-34.
29. Markogiannakis H, Sanidas E, Messaris E, Michalakis I, Kasotakis G, Melissas J, et al. Management of blunt hepatic and splenic trauma in a Greek level I trauma centre. Acta Chir Belg 2006;106(5):566-571.
30. Durham R, Pracht E, Orban B, Lottenburg L, Tepas J, Flint L, et al. Evaluation of a mature trauma system. Ann Surg 2006;243(6):775-83; discussion 783.
31. Clark DE, Ahmad S. Estimating injury severity using the Barell matrix. Inj Prev 2006;12(2):111-116.
32. Pressley JC, Trieu L, Kendig T, Barlow B. National injury-related hospitalizations in children: public versus private expenditures across preventable injury mechanisms. J Trauma 2007;63(3 Suppl):S10-S19.
33. Moore L, Lavoie A, Bergeron E, Emond M. Modeling probability-based injury severity scores in logistic regression models: the logit transformation should be used. J Trauma 2007;62(3):601-605.
34. Bergeron E, Simons R, Linton C, Yang F, Tallon JM, Stewart TC, et al. Canadian benchmarks in trauma. J Trauma 2007;62(2):491-497.
35. Tepas JJ, Leaphart CL, Celso BG, Tuten JD, Pieper P, Ramenofsky ML, et al. Risk stratification simplified: the worst injury predicts mortality for the injured children. J Trauma 2008;65(6):1258-61; discussion 1261.
36. Davie G, Cryer C, Langley J. Improving the predictive ability of the ICD-based Injury Severity Score. Inj Prev 2008;14(4):250-255.
37. Markogiannakis H, Sanidas E, Michalakis I, Manouras A, Melissas J, Tsiftsis D, et al. Predictive factors of operative or nonoperative management of blunt hepatic trauma. Minerva Chir 2008;63(3):223-228.
38. Burd RS, Ouyang M, Madigan D. Bayesian logistic injury severity score: a method for predicting mortality using international classification of disease-9 codes. Acad Emerg Med 2008;15(5):466-475.
39. Diggs BS, Mullins RJ, Hedges JR, Arthur M, Newgard CD. Proportion of seriously injured patients admitted to hospitals in the US with a high annual injured patient volume: a metric of regionalized trauma care. J Am Coll Surg 2008;206(2):212-219.
40. Moore L, Lavoie A, Le Sage N, Bergeron E, Emond M, Abdous B, et al. Consensus or data-derived anatomic injury severity scoring? J Trauma 2008;64(2):420-426.
41. Boufous S, Finch C, Hayen A, Williamson A. The impact of environmental, vehicle and driver characteristics on injury severity in older drivers hospitalized as a result of a traffic crash. J Safety Res 2008;39(1):65-72.
42. Wong SSN, Leung GKK. Injury Severity Score (ISS) vs. ICD-derived Injury Severity Score (ICISS) in a patient population treated in a designated Hong Kong trauma centre. McGill journal of medicine : MJM : an international forum for the advancement of medical sciences by students 2008;11(1):9-13.
43. Tepas JJ, Celso BG, Leaphart CL, Graham D. Application of International Classification Injury Severity Score to National Surgical Quality Improvement Program defines pediatric trauma performance standards and drives performance improvement. J Trauma 2009;67(1):185-8; discussion 188.
44. Glance LG, Osler TM, Mukamel DB, Meredith W, Wagner J, Dick AW, et al. TMPM-ICD9: a trauma mortality prediction model based on ICD-9-CM codes. Ann Surg 2009;249(6):1032-1039.
45. Smartt P, Chalmers D. Searching for ski-lift injury: An uphill struggle? J Sci Med Sport 2009;
46. Cinelli SM, Brady P, Rennie CP, Tuluca C, Hall TS. Comparative results of trauma scoring systems in fatal outcomes. Conn Med 2009;73(5):261-265.
47. Kim J, Shin SD, Im TH, Lee KJ, Ko SB, Park JO, et al. Development and Validation of the Excess Mortality Ratio-adjusted Injury Severity Score Using the International Classification of Diseases 10th Edition. Acad Emerg Med 2009;
48. McDonald G, Davie G, Langley J. Validity of police-reported information on injury severity for those hospitalized from motor vehicle traffic crashes. Traffic Inj Prev 2009;10(2):184-190.
49. Smartt P, Chalmers D. Obstructing the goal? Hospitalisation for netball injury in New Zealand 2000-2005. N Z Med J 2009;122(1288):62-75.
50. Leaphart CL, Graham D, Pieper P, Celso BG, Tepas JJ. Surgical quality improvement: a simplified method to apply national standards to pediatric trauma care. J Pediatr Surg 2009;44(1):156-159.
51. Millham F, Jain NB. Are there racial disparities in trauma care? World J Surg 2009;33(1):23-33.
ICISS: Dr. Rutledge's Contribution to Trauma Care
Dr Rutledge: Inventor of ICISS (ICD based Injury Severity Score)
In 1993 Dr Rutledge published the first article describing the use of ICD-9 codes as a means of predicting injury severity. (1) At the time the standard means of injury severity scoring was the consensus derived ISS. Dr Rutledge’s invention was a data derived system based upon analysis of actual injury outcomes that were quantitated from actual trauma outcomes.
Although controversial at the time, (criticized by Champion, MacKenzie and others) now 17 years later the ICISS stands as simple, well validated and relatively inexpensive means of injury severity scoring, confirming Dr Rutledge’s initial findings.(2-51)
Over 10 years ago Dr. Rutledge wrote:
The Journal of Trauma: Injury, Infection, and Critical Care:
January 1998 - Volume 44 - Issue 1 - pp 41-49
Article
The End of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, Ninth Revision-Based Prediction Tool, Outperforms Both ISS and TRISS as Predictors of Trauma Patient Survival, Hospital Charges, and Hospital Length of Stay
Rutledge, Robert MD; Osler, Turner MD; Emery, Sherry PhD; Kromhout-Schiro, Sharon PhD
Collapse Box
Abstract
Introduction: Since their inception, the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS) have been suggested as measures of the quality of trauma care. In concept, they are designed to accurately assess injury severity and predict expected outcomes. ICISS, an injury severity methodology based on International Classification of Diseases, Ninth Revision, codes, has been demonstrated to be superior to ISS and TRISS. The purpose of the present study was to compare the ability of TRISS to ICISS as predictors of survival and other outcomes of injury (hospital length of stay and hospital charges). It was our hypothesis that ICISS would outperform ISS and TRISS in each of these outcome predictions.
Methods: "Training" data for creation of ICISS predictions were obtained from a state hospital discharge data base. "Test" data were obtained from a state trauma registry. ISS, TRISS, and ICISS were compared as predictors of patient survival. They were also compared as indicators of resource utilization by assessing their ability to predict patient hospital length of stay and hospital charges. Finally, a neural network was trained on the ICISS values and applied to the test data set in an effort to further improve predictive power. The techniques were compared by comparing each patient's outcome as predicted by the model to the actual outcome.
Results: Seven thousand seven hundred five patients had complete data available for analysis. The ICISS was far more likely than ISS or TRISS to accurately predict every measure of outcome of injured patients tested, and the neural network further improved predictive power.
Conclusion: In addition to predicting mortality, quality tools that can accurately predict resource utilization are necessary for effective trauma center quality-improvement programs. ICISS-derived predictions of survival, hospital charges, and hospital length of stay consistently outperformed those of ISS and TRISS. The neural network-augmented ICISS was even better. This and previous studies demonstrate that TRISS is a limited technique in predicting survival resource utilization. Because of the limitations of TRISS, it should be superseded by ICISS.
References
1. Rutledge R, Fakhry S, Baker C, Oller D. Injury severity grading in trauma patients: a simplified technique based upon ICD-9 coding. J Trauma 1993;35(4):497-506; discussion 506.
2. Rutledge R. Injury severity and probability of survival assessment in trauma patients using a predictive hierarchical network model derived from ICD-9 codes. J Trauma 1995;38(4):590-7; discussion 597.
3. Osler T, Rutledge R, Deis J, Bedrick E. ICISS: an international classification of disease-9 based injury severity score. J Trauma 1996;41(3):380-6; discussion 386.
4. Rutledge R, Hoyt DB, Eastman AB, Sise MJ, Velky T, Canty T, et al. Comparison of the Injury Severity Score and ICD-9 diagnosis codes as predictors of outcome in injury: analysis of 44,032 patients. J Trauma 1997;42(3):477-87; discussion 487.
5. Osler TM, Cohen M, Rogers FB, Camp L, Rutledge R, Shackford SR, et al. Trauma registry injury coding is superfluous: a comparison of outcome prediction based on trauma registry International Classification of Diseases-Ninth Revision (ICD-9) and hospital information system ICD-9 codes. J Trauma 1997;43(2):253-6; discussion 256.
6. Rutledge R, Osler T. The ICD-9-based illness severity score: a new model that outperforms both DRG and APR-DRG as predictors of survival and resource utilization. J Trauma 1998;45(4):791-799.
7. Osler TM, Rogers FB, Glance LG, Cohen M, Rutledge R, Shackford SR, et al. Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS. J Trauma 1998;45(2):234-7; discussion 237.
8. Rutledge R, Osler T, Kromhout-Schiro S. Illness severity adjustment for outcomes analysis: validation of the ICISS methodology in all 821,455 patients hospitalized in North Carolina in 1996. Surgery 1998;124(2):187-94; discussion 194.
9. Rutledge R, Osler T, Emery S, Kromhout-Schiro S. The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J Trauma 1998;44(1):41-49.
10. Hannan EL, Farrell LS, Gorthy SF, Bessey PQ, Cayten CG, Cooper A, et al. Predictors of mortality in adult patients with blunt injuries in New York State: a comparison of the Trauma and Injury Severity Score (TRISS) and the International Classification of Disease, Ninth Revision-based Injury Severity Score (ICISS). J Trauma 1999;47(1):8-14.
11. West TA, Rivara FP, Cummings P, Jurkovich GJ, Maier RV. Harborview assessment for risk of mortality: an improved measure of injury severity on the basis of ICD-9-CM. J Trauma 2000;49(3):530-40; discussion 540.
12. Hannan EL, Farrell LS, Meaker PS, Cooper A. Predicting inpatient mortality for pediatric trauma patients with blunt injuries: a better alternative. J Pediatr Surg 2000;35(2):155-159.
13. Kim Y, Jung KY, Kim CY, Kim YI, Shin Y. Validation of the International Classification of Diseases 10th Edition-based Injury Severity Score (ICISS). J Trauma 2000;48(2):280-285.
14. Rogers FB, Osler TM, Shackford SR, Martin F, Healey M, Pilcher D, et al. Population-based study of hospital trauma care in a rural state without a formal trauma system. J Trauma 2001;50(3):409-13; discussion 414.
15. Osler TM, Rogers FB, Badger GJ, Healey M, Vane DW, Shackford SR, et al. A simple mathematical modification of TRISS markedly improves calibration. J Trauma 2002;53(4):630-634.
16. Meredith JW, Evans G, Kilgo PD, MacKenzie E, Osler T, McGwin G, et al. A comparison of the abilities of nine scoring algorithms in predicting mortality. J Trauma 2002;53(4):621-8; discussion 628.
17. Stephenson SCR, Langley JD, Civil ID. Comparing measures of injury severity for use with large databases. J Trauma 2002;53(2):326-332.
18. Kuhls DA, Malone DL, McCarter RJ, Napolitano LM. Predictors of mortality in adult trauma patients: the physiologic trauma score is equivalent to the Trauma and Injury Severity Score. J Am Coll Surg 2002;194(6):695-704.
19. Meredith JW, Kilgo PD, Osler TM. Independently derived survival risk ratios yield better estimates of survival than traditional survival risk ratios when using the ICISS. J Trauma 2003;55(5):933-938.
20. Meredith JW, Kilgo PD, Osler T. A fresh set of survival risk ratios derived from incidents in the National Trauma Data Bank from which the ICISS may be calculated. J Trauma 2003;55(5):924-932.
21. Kilgo PD, Osler TM, Meredith W. The worst injury predicts mortality outcome the best: rethinking the role of multiple injuries in trauma outcome scoring. J Trauma 2003;55(4):599-606; discussion 606.
22. Kim Y, Jung KY. Utility of the international classification of diseases injury severity score: detecting preventable deaths and comparing the performance of emergency medical centers. J Trauma 2003;54(4):775-780.
23. Stephenson S, Henley G, Harrison JE, Langley JD. Diagnosis based injury severity scaling: investigation of a method using Australian and New Zealand hospitalisations. Inj Prev 2004;10(6):379-383.
24. Kilgo PD, Meredith JW, Hensberry R, Osler TM. A note on the disjointed nature of the injury severity score. J Trauma 2004;57(3):479-85; discussion 486.
25. Kulla M, Fischer S, Helm M, Lampl L. [How to assess the severity of the multi-system trauma in the emergency-room -- a critical review]. Anasthesiol Intensivmed Notfallmed Schmerzther 2005;40(12):726-736.
26. Clarke JR, Ragone AV, Greenwald L. Comparisons of survival predictions using survival risk ratios based on International Classification of Diseases, Ninth Revision and Abbreviated Injury Scale trauma diagnosis codes. J Trauma 2005;59(3):563-7; discussion 567.
27. Hannan EL, Waller CH, Farrell LS, Cayten CG. A comparison among the abilities of various injury severity measures to predict mortality with and without accompanying physiologic information. J Trauma 2005;58(2):244-251.
28. Deutscher M. The responsibility to protect. Med Confl Surviv 2005;21(1):28-34.
29. Markogiannakis H, Sanidas E, Messaris E, Michalakis I, Kasotakis G, Melissas J, et al. Management of blunt hepatic and splenic trauma in a Greek level I trauma centre. Acta Chir Belg 2006;106(5):566-571.
30. Durham R, Pracht E, Orban B, Lottenburg L, Tepas J, Flint L, et al. Evaluation of a mature trauma system. Ann Surg 2006;243(6):775-83; discussion 783.
31. Clark DE, Ahmad S. Estimating injury severity using the Barell matrix. Inj Prev 2006;12(2):111-116.
32. Pressley JC, Trieu L, Kendig T, Barlow B. National injury-related hospitalizations in children: public versus private expenditures across preventable injury mechanisms. J Trauma 2007;63(3 Suppl):S10-S19.
33. Moore L, Lavoie A, Bergeron E, Emond M. Modeling probability-based injury severity scores in logistic regression models: the logit transformation should be used. J Trauma 2007;62(3):601-605.
34. Bergeron E, Simons R, Linton C, Yang F, Tallon JM, Stewart TC, et al. Canadian benchmarks in trauma. J Trauma 2007;62(2):491-497.
35. Tepas JJ, Leaphart CL, Celso BG, Tuten JD, Pieper P, Ramenofsky ML, et al. Risk stratification simplified: the worst injury predicts mortality for the injured children. J Trauma 2008;65(6):1258-61; discussion 1261.
36. Davie G, Cryer C, Langley J. Improving the predictive ability of the ICD-based Injury Severity Score. Inj Prev 2008;14(4):250-255.
37. Markogiannakis H, Sanidas E, Michalakis I, Manouras A, Melissas J, Tsiftsis D, et al. Predictive factors of operative or nonoperative management of blunt hepatic trauma. Minerva Chir 2008;63(3):223-228.
38. Burd RS, Ouyang M, Madigan D. Bayesian logistic injury severity score: a method for predicting mortality using international classification of disease-9 codes. Acad Emerg Med 2008;15(5):466-475.
39. Diggs BS, Mullins RJ, Hedges JR, Arthur M, Newgard CD. Proportion of seriously injured patients admitted to hospitals in the US with a high annual injured patient volume: a metric of regionalized trauma care. J Am Coll Surg 2008;206(2):212-219.
40. Moore L, Lavoie A, Le Sage N, Bergeron E, Emond M, Abdous B, et al. Consensus or data-derived anatomic injury severity scoring? J Trauma 2008;64(2):420-426.
41. Boufous S, Finch C, Hayen A, Williamson A. The impact of environmental, vehicle and driver characteristics on injury severity in older drivers hospitalized as a result of a traffic crash. J Safety Res 2008;39(1):65-72.
42. Wong SSN, Leung GKK. Injury Severity Score (ISS) vs. ICD-derived Injury Severity Score (ICISS) in a patient population treated in a designated Hong Kong trauma centre. McGill journal of medicine : MJM : an international forum for the advancement of medical sciences by students 2008;11(1):9-13.
43. Tepas JJ, Celso BG, Leaphart CL, Graham D. Application of International Classification Injury Severity Score to National Surgical Quality Improvement Program defines pediatric trauma performance standards and drives performance improvement. J Trauma 2009;67(1):185-8; discussion 188.
44. Glance LG, Osler TM, Mukamel DB, Meredith W, Wagner J, Dick AW, et al. TMPM-ICD9: a trauma mortality prediction model based on ICD-9-CM codes. Ann Surg 2009;249(6):1032-1039.
45. Smartt P, Chalmers D. Searching for ski-lift injury: An uphill struggle? J Sci Med Sport 2009;
46. Cinelli SM, Brady P, Rennie CP, Tuluca C, Hall TS. Comparative results of trauma scoring systems in fatal outcomes. Conn Med 2009;73(5):261-265.
47. Kim J, Shin SD, Im TH, Lee KJ, Ko SB, Park JO, et al. Development and Validation of the Excess Mortality Ratio-adjusted Injury Severity Score Using the International Classification of Diseases 10th Edition. Acad Emerg Med 2009;
48. McDonald G, Davie G, Langley J. Validity of police-reported information on injury severity for those hospitalized from motor vehicle traffic crashes. Traffic Inj Prev 2009;10(2):184-190.
49. Smartt P, Chalmers D. Obstructing the goal? Hospitalisation for netball injury in New Zealand 2000-2005. N Z Med J 2009;122(1288):62-75.
50. Leaphart CL, Graham D, Pieper P, Celso BG, Tepas JJ. Surgical quality improvement: a simplified method to apply national standards to pediatric trauma care. J Pediatr Surg 2009;44(1):156-159.
51. Millham F, Jain NB. Are there racial disparities in trauma care? World J Surg 2009;33(1):23-33.
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