Primary squamous cell carcinoma of the pancreas diagnosed by endoscopic ultrasound-guided fine needle aspiration.

Squamous cell carcinoma of the pancreas is a rare pancreatic malignancy. We describe the case of a female who presented with abdominal pain and was found to have a pancreatic mass on imaging. The diagnosis of pancreatic squamous cell carcinoma was established by endoscopic ultrasound-guided fine needle aspiration of the mass. To the best of our knowledge, this is only the second case report in the medical literature in which endoscopic ultrasound-guided fine needle aspiration was used for a cell-type specific diagnosis of primary pancreatic squamous cell carcinoma.

Sedation, analgesia, and monitoring.

Endoscopic procedures are common and sedation is frequently used to minimize anxiety and discomfort, reduce the potential for physical injury during the procedure, and improve overall patient tolerability and satisfaction. In this article, the authors review the variety of options for sedation and analgesia available to the gastroenterologist or surgical endoscopist.

Clinical trials of pancreatic enzyme replacement for painful chronic pancreatitis--a review.

Painful chronic pancreatitis is a challenging problem for clinicians and patients. Many patients receive a therapeutic trial of pancreatic enzyme supplementation at some point in the course of their disease, but it is unclear what the expected outcome of such a trial should be and whether or not all patients should receive a trial of pancreatic enzymes. We searched PubMed for all studies of pancreatic enzyme supplementation for painful chronic pancreatitis from 1980 to the present. We also searched the references of identified manuscripts and requested additional information from study authors when necessary. Manuscripts were assessed for study design, bias, pain assessment, and pain management protocol. The results are described in full.

Health-related quality of life, somatization, and abuse in Sphincter of Oddi dysfunction.

BACKGROUND: Most of the focus on patients with Sphincter of Oddi dysfunction (SOD) has centered on endoscopic management, and thus little is known about quality of life in these patients. AIMS: We sought to determine what health-related quality of life components are troublesome to patients with SOD and compare to patients with recurrent pancreatitis. METHODS: Using the Brief Symptom Inventory and the SF-12 version 1, as well as proprietary questionnaires, we measured health-related quality of life in patients with biliary SOD and patients with recurrent idiopathic pancreatitis who underwent sphincter of Oddi manometry. RESULTS: Both groups had significantly worse quality of life than nonpatients and both groups somatized. Abuse histories were surprisingly common and similar between both groups. CONCLUSIONS: Health-related quality of life is impaired and abuse histories are common in SOD patients, and similar to patients with recurrent idiopathic pancreatitis. Whether these characteristics are predictors of healthcare seeking remains to be determined.

Gastrointestinal complaints in patients with eating disorders.

BACKGROUND: Patients with eating disorders (EDs) typically have numerous somatic and gastrointestinal complaints. Early referral to treatment may result in improved outcomes. We sought to determine whether patients with EDs were presenting to gastroenterologists or primary care physicians with gastrointestinal complaints early in the disease course, when referral for specialized, comprehensive treatment would be most beneficial. STUDY: Over a 1-year period, we administered a structured interview to a cohort of patients presenting for inpatient ED treatment. We also conducted the same interview on an age-matched cohort of medical students to determine baseline incidences of various gastrointestinal healthcare behaviors. RESULTS: Patients with bulimia nervosa were significantly more likely to seek healthcare for a gastrointestinal complaint before seeking treatment for an ED than were controls. Patients with EDs were significantly more likely to be prescribed medication for the gastrointestinal tract than were controls. CONCLUSION: Gastroenterologists and primary care physicians should employ available instruments to screen young women of low to normal weight with gastrointestinal complaints for possible EDs. Referral to specialized treatment programs should be made promptly when an ED is identified.

Pill Esophagitis.

Pill esophagitis is a preventable cause of morbidity. Simple advice on how and when to take medication could probably prevent most cases of the illness. Avoidance of implicated medications in patients with significant risk factors for developing pill esophagitis could prevent additional cases. When the disease presents despite these preventive measures, the mainstays of treatment are immediate discontinuation of the offending agent and supportive care. If the diagnosis is in question, the principle diagnostic modalities are double-contrast barium esophagogram and esophagogastroduodenoscopy. Medical management of moderate to severe cases includes sucralfate to coat, protect, and promote healing of ulcerated esophageal mucosa, and acid-suppressing therapy if gastroesophageal reflux disease is felt to have played a role in the pathogenesis of the illness. Rare cases may require therapeutic endoscopy or surgical intervention early in the disease course. Late complications include esophageal strictures that may require therapeutic endoscopy or bougienage.