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Schneider A.R.,Hepatology and Gastroenterological Oncology | Armbruster S.,Hepatology and Gastroenterological Oncology | Mann J.,Association of Bavarian Internists | Von Romer W.,Association of Bavarian Internists | And 2 more authors.
Zeitschrift fur Gastroenterologie | Year: 2012

Objective: Rapidly growing information on adverse gastrointestinal effects of non-steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori (Hp) causes continuous changes in clinical patient management. Decisions on the prevention of gastroduodenal ulcers in individual patients often do not follow guidelines. We aimed to assess the current management of gastroduodenal ulcers by internists in southern Germany. Methods: All 965 members of the Association of Bavarian Internists, a German province with about 8000 internists, were invited to participate in answering a 12-item questionnaire. The questions addressed different clinical scenarios regarding ulcer disease associated with traditional NSAIDs (tNSAIDs), aspirin and Hp. Particularly, we asked for the clinical approach to patients with NSAID-/aspirin-associated ulcers and prophylactic measures before the beginning of a potentially ulcerogenic medication. Results: N = 225 (23.3 %) physicians returned completed questionnaires. In patients with Hp-negative, NSAID-/aspirin-associated ulcers, > 80 % of respondents would initiate long-term proton pump inhibitor (PPI) therapy, whereas 20 % and 17.8 % would prescribe COX-2 selective inhibitors or opiates instead of non-selective NSAIDs and clopidogrel instead of aspirin. The management of Hp-positive ulcers, especially in cases with additional use of aspirin or NSAIDs, was very heterogenous, including Hp-eradication only, eradication + long-term PPI, eradication + clopidogrel or COX-2-inhibitors/ opiates. Conclusion: This survey depicts individual discrepancies in the clinical management of patients receiving NSAIDs and/or aspirin, regarding the prophylaxis of gastroduodenal ulcer disease. © Georg Thieme Verlag KG Stuttgart - New York. Source

Seidl H.,Hepatology and Gastroenterological Oncology | Tuerck J.,Hepatology and Gastroenterological Oncology | Schepp W.,Hepatology and Gastroenterological Oncology | Schneider A.R.,Hepatology and Gastroenterological Oncology
Ultrasound in Medicine and Biology | Year: 2010

Duplex ultrasound is established for the assessment of mesenteric ischemia but potential influences of breathing on mesenteric arterial blood velocity have not been investigated so far. In 100 patients without abdominal diseases (39 men; age 59.4 ± 18.0 years), peak systolic (PSV), end diastolic velocity (EDV) and resistance index (RI) were assessed in the celiac trunk (CT) and the superior mesenteric artery (SMA) by Doppler ultrasound during expiration and deep inspiration. Expiratory PSVs in the CT and the SMA (153.4 ± 42.5 and 145.3 ± 39.5 cm/s) were significantly higher than inspiratory velocities (135.4 ± 36.8 and 131.9 ± 42.2 cm/s, p < 0.0001 and p = 0.0002), with expiratory PSVs exceeding inspiratory PSVs in more than 75% of patients. The mean percentage of PSV-variation was 21.5% ± 15.3% and 24.6% ± 19.1%, respectively. The study demonstrates that breathing may exert considerable periodic effects on splanchnic arterial hemodynamics. We, therefore, recommend that to prevent an underestimation of arterial stenosis, mesenteric Doppler ultrasound should be performed during expiration. (E-mail: arne.schneider@lrz.tum.de). © 2010 World Federation for Ultrasound in Medicine & Biology. Source

Seidl H.,Hepatology and Gastroenterological Oncology | Gundling F.,Hepatology and Gastroenterological Oncology | Pehl C.,Hepatology and Gastroenterological Oncology | Kissler S.,Hepatology and Gastroenterological Oncology | And 2 more authors.
Digestion | Year: 2010

Background: The relationships between contractile activity and transport of intraluminal contents in the human small intestine are not well understood. Aim: To study both phenomena by combined measurements of intraluminal impedance and pressurein the jejunum of healthy subjects. Methods: 12 healthy volunteers (m 4, f 8), mean age 32.3 years (24-49 years), underwent jejunal combined impedance/manometry recordings (six channels at 2-cm intervals). Fasting (one MMC cycle) and postprandial motility were recorded. Results: Intestinal transport differed with the phases of motility. No transport was seen in phase I, regular bolus transport occurred during phase III. The longest duration of transport was observed in late phase II preceding phase III. Irregular and intermittent bolus transport occurred during early phase II and in the postprandial period. Three types of relationship between contractions and bolus transport were identified: transport with single contractions or migrating clustered contractions and transport without contractile activity. The frequency of these events differed with the direction of bolus transport, and a relationship between propagation velocity and bolus presence time was established. Conclusion: Combined simultaneous measurement of intraluminal impedance and manometry is a promising new method to elucidate the relationships between bolus transport and contractile activity in the human small bowel. Copyright © 2010 S. Karger AG, Basel. Source

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