Subject(s)
Colonoscopy , Gastrointestinal Hemorrhage/therapy , Ileal Diseases/therapy , Sclerotherapy/methods , Varicose Veins/therapy , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/diagnosis , Humans , Ileal Diseases/diagnosis , Injections, Intralesional , Middle Aged , Sclerosing Solutions/therapeutic use , Sodium Tetradecyl Sulfate/therapeutic use , Treatment Outcome , Varicose Veins/diagnosisABSTRACT
Liver diseases in the elderly often reflect an age-associated decrease in the capacity to respond to metabolic and infectious insults. Because the geriatric population is growing rapidly, physicians can expect to encounter an increasing number of older patients with liver disease. In this article, the authors discuss the clinical manifestations of the most common liver diseases seen in the geriatric population.
Subject(s)
Liver Diseases , Aged , HumansABSTRACT
BACKGROUND: An increased incidence of reflux esophagitis has been reported after eradication of H. pylori in patients with duodenal ulcer. To determine if H. pylori is associated with lower rates of esophagitis, we studied the prevalence of H. pylori infection in patients with and without reflux esophagitis and a subgroup of patients with concomitant peptic ulcer disease. METHODS: Patients who underwent esophagogastroduodenoscopy and had diagnostic testing for H. pylori over a 30-month period were studied. H. pylori infection was determined by rapid urease testing, gastric histopathology, or serology. Reflux esophagitis was determined by endoscopic and/or histologic criteria. RESULTS: Of 514 patients, 39.5% had H. pylori infection and 22.2% had reflux esophagitis. The prevalence of H. pylori infection in patients with reflux esophagitis was 30.7%, compared with 42.0% in patients without esophagitis (p = 0.039). The odds ratio for esophagitis risk with H. pylori infection was 0.61 (95% CI, 0.39-0.95). Neither patient age nor gender affected H. pylori prevalence. In patients with duodenal ulcer, H. pylori was present in 36.4% of patients with esophagitis and in 69.2% of patients without esophagitis (p = 0.018). The odds ratio for esophagitis with H. pylori infection in these patients was 0.25 (95% CI, 0.09-0.73). CONCLUSIONS: Our study demonstrates that H. pylori infection is significantly less prevalent in patients with reflux esophagitis and may protect against its development. In duodenal ulcer patients, this effect was more dramatic. Further study is required to confirm these findings and elucidate mechanisms underlying possible beneficial effects of H. pylori.
Subject(s)
Gastroesophageal Reflux/microbiology , Helicobacter Infections/epidemiology , Helicobacter pylori , Adult , Aged , Aged, 80 and over , Female , Gastroesophageal Reflux/epidemiology , Humans , Male , Middle Aged , Peptic Ulcer/epidemiology , Peptic Ulcer/microbiology , PrevalenceABSTRACT
Dysphagia due to esophageal metastases from primary breast carcinoma is an unusual entity. In this series of cases, we describe the clinical features of dysphagia due to metastatic esophageal lesions in four patients (with a primary diagnosis of breast cancer made 8-22 yr previously). We provide the first endoscopic ultrasound characterization of metastatic lesions to the esophagus from breast carcinoma. Endoscopic management of these strictures with both bougienage and balloon dilation techniques resulted in esophageal perforation in three of our four patients. We believe that endoscopic ultrasound is helpful in the diagnosis of metastatic breast cancer to the esophagus. However, endoscopic dilation of these strictures should be done gently and only after other treatment options have been carefully considered.
Subject(s)
Breast Neoplasms/pathology , Esophageal Neoplasms/secondary , Aged , Catheterization/adverse effects , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Dilatation/adverse effects , Esophageal Neoplasms/complications , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/therapy , Esophageal Perforation/etiology , Esophageal Stenosis/etiology , Esophageal Stenosis/therapy , Esophagoscopy , Female , Humans , Middle AgedABSTRACT
Ornithine oxoglutarate (OGO) has been previously demonstrated to improve nutrition status in burn and trauma patients. Recently, OGO supplementation was shown to improve nutrition status, ameliorate quality of life, and reduce health care costs when given to elderly patients soon after discharge from the hospital.
