Biomedical subjects
Publications and source records attributed to A I Rogers.
Traditionally, sulfasalazine and corticosteroids have been used to treat Crohn's disease. However, therapy has been expanded to include other drugs, and several newer agents show clinical promise. The authors discuss the therapeutic options now available and describe results of several drug trials. Despite the apparent benefits of newer therapies, caution must be used in choosing appropriate treatment.
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During the past decade it has become evident that colonic mucosal metabolism is more complex than previously suspected. Luminal short-chain fatty acids (SCFAs) are recognized as an essential fuel source for colonocytes, particularly in the distal colon. Their absence may explain the development of diversion colitis; however, this has not been confirmed by clinical trials. The histologic, endoscopic, and metabolic similarities between diversion colitis and ulcerative colitis suggest that a nutritional SCFA deficiency state may play a role in the pathogenesis of these disorders. Diversion colitis and continent urinary diversion, utilizing distal and proximal colon reservoirs, provide in vivo models to study normal colonic mucosa in circumstances of reduced intraluminal SCFA concentrations and altered luminal effluent. Further studies utilizing these models would enhance our understanding of the regional differences in mucosal cell metabolism and adaptability and, hopefully, provide therapeutic alternatives for the management of colonic disorders. The welfare of colonic mucosa, as it relates to SCFA metabolism, awaits another exciting decade of investigation.
When a patient has epigastric pain that worsens 1 to 3 hours after meals, the possibility of peptic ulcer disease should be considered. Completely typical clinical presentations in patients younger than age 50 justify empirical therapy when no physical or laboratory findings suggest a mimicking disorder. Esophagogastroduodenoscopy should be undertaken when response to therapy is incomplete, symptoms recur quickly, or dyspeptic symptoms present for the first time in a patient older than age 50. When gastric ulcers are diagnosed radiographically, endoscopy and biopsy at multiple sites should be done to exclude malignant disease. Intractable duodenal ulcers may necessitate endoscopic biopsy of antral and duodenal mucosa to rule out an associated Helicobacter pylori infection, which may modify therapeutic approaches. Zollinger-Ellison syndrome is rare but should be suspected when ulcer disease presents atypically or aggressively or in families. Diagnosis is not difficult to confirm.
Many agents seem to be equally effective for the treatment of peptic ulcer disease. This is true despite the drugs' varied mechanisms of action, and this observation has caused investigators to shift their focus from aggressive to defensive factors when studying ulcer pathogenesis. Patients with a healed ulcer are always at risk for recurrence, and guidelines are available for management of these patients. Ulcer prevention becomes a crucial issue in intensive care units where critically ill patients have many known risk factors. Maintaining a gastric pH above 4.0 appears to reduce the morbidity and mortality associated with such stress-induced ulcers. Use of nonsteroidal anti-inflammatory drugs increases ulcer risk and complications in the elderly, in women with rheumatoid arthritis, and in smokers and abusers of alcohol. Prophylaxis with the synthetic prostaglandin analogue misoprostol (Cytotec) appears to reduce this risk.
Two hypotheses have been proposed to explain the pathogenesis and cause of the increased subepithelial collagen deposition that occurs in patients with collagenous colitis, a rare disease of unknown cause. One hypothesis considers an inflammatory origin, and the other, a local abnormality of collagen synthesis. An analysis of clinical, endoscopic, and histologic findings from one of our patients and from previously published cases suggests that collagenous colitis is a form of inflammatory bowel disease characterized by localization of the initial injury to the superficial subepithelial zone and with subsequent fibrosis in that area. The data show a spectrum of clinical and histologic changes that represent different stages in the evolution of the inflammatory process.
Ten healthy volunteers took a magnesium and aluminium hydroxide antacid for 4 days, and their urinary acid excretion was measured. During antacid ingestion, blood bicarbonate levels did not change significantly, but there were highly significant rises in urine pH and bicarbonate excretion and falls in the 24 h excretion of titratable acid, ammonium, and net acid; the average change in net acid excretion was 41 +/- 4 mmol (72 +/- 9%) per 24 h. This large reduction in net acid excretion appears to result from neutralisation of more hydrochloric acid than sodium bicarbonate in the gastrointestinal tract rather than from absorption of exogenous alkali. Although metabolic alkalosis does not occur with their use in normal individuals, these antacids should not be termed "non-systemic". They might cause important changes in renal drug handling, solubility of excreted substances, or acid-base status in patients at risk.
Hypercalcemia may be associated with neoplastic disease, either as an epiphenomenon resulting from tumor-produced humoral substances or as a direct consequence of bone involvement. Endoscopic procedures are occasionally performed in this group of patients for both diagnostic and therapeutic purposes. This report reviews the interaction of hypercalcemia and sedative hypnotic drugs and suggests that hypercalcemia might be a risk factor for those patients undergoing endoscopy.
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Explore the source record for details and available documents.
Development of diarrhea in a patient following gastric surgery can be a confusing problem. The clinician is forced to consider and exclude causes that may be independent of the surgery as well as those that are unique to the postgastrectomy state. An orderly approach is mandatory for appropriate workup and management.
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A case of a Meckel's diverticulum is described in a young man presenting with abdominal pain and gastrointestinal bleeding. Methods of arriving at the diagnosis preoperatively are reviewed. A false-negative as well as a true-positive small bowel series and technetium scan were obtained in this case. The factors influencing technetium uptake by a Meckel's diverticulum are reviewed.