PubMed · 6105284
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P Buchmann, G Uhlschmid. 1980-07-12. When are EEA "stapler doughnuts" really complete?. https://doi.org/10.1016/s0140-6736(80)92978-5
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One of the clinician's most difficult tasks is to successfully care for patients with painful and refractory functional gastrointestinal disorders. Because the diagnosis of these disorders is never assured and symptomatic treatments are not always successful, these patients are susceptible to receiving unnecessary, costly, and sometimes risky studies and treatments. This article offers an approach to the diagnosis and care of these patients that emphasizes 1) using a diagnostic strategy that incorporates symptom-based criteria, a screening evaluation, early symptomatic treatment, symptom monitoring, and reassessment; 2) asking several questions during the first visit to assess the psychosocial contributions to the illness; 3) developing an effective patient-physician relationship through empathy, reassurance, education, and a negotiated and realistic treatment plan; and 4) providing the option for psychological consultation and treatment as a way to help the patient better control symptoms. This approach is likely to improve patient and physician satisfaction, adherence to treatment, and clinical outcome.
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.