ABSTRACT
BACKGROUND: This study evaluates the relative value of clinical assessment and serum pancreatic enzymes in the discharge management of outpatients undergoing ERCP. METHODS: Two hundred thirty-one patients who underwent ERCP had a detailed clinical assessment performed 2 h after the procedure and blood drawn for amylase and lipase. RESULTS: One-third of the patients who later developed pancreatitis had no pain 2 h after the end of the procedure, whereas an equal number who had no pancreatitis did complain of pain. Values below 276 U/L for amylase and 1000 U/L for lipase were useful in ruling out pancreatitis with negative predictive values of 0.97 and 0.98, respectively. Based on the data of this study a discharge algorithm for outpatients undergoing ERCP is proposed. CONCLUSIONS: In contrast to clinical assessment, which is unreliable, it is possible to stratify patients according to their risk of developing pancreatitis according to their 2-h serum amylase and lipase values. This helps to rationalize the discharge management of outpatients undergoing ERCP at a time when careful utilization of resources, especially the avoidance of unnecessary hospital admissions, becomes increasingly more important.
Subject(s)
Amylases/blood , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Clinical Enzyme Tests , Lipase/blood , Pancreatitis/diagnosis , Pancreatitis/etiology , Abdominal Pain/etiology , Algorithms , Ambulatory Care , Case-Control Studies , Evaluation Studies as Topic , Humans , Patient Discharge , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Time FactorsABSTRACT
Helicobacter pylori infection is quite common. In the United States, prevalence varies considerably with race, nationality, socio-economic status and location of residence. In Western countries, the prevalence of the infection has shown a steady increase with increasing age. H. pylori has been shown to cause chronic gastritis. Most patients infected with H. pylori are asymptomatic and require no therapy. The precise role of the infection in the pathogenesis of peptic ulcer disease is unknown. However, H. pylori infection is associated with a high recurrence rate of both gastric and duodenal ulcers. Eradication of the infection reduces the recurrence rate. Once H. pylori infection is acquired, it usually persists for years, possibly for the patient's lifetime. Although a causative role in gastric cancer has not been proved, evidence suggests an association between H. pylori infection and well-differentiated gastric adenocarcinoma and gastric lymphoma.
