Lege Artis Medicinae

[PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CLINICAL PRACTICE]

TALLER András

JUNE 21, 2006

Lege Artis Medicinae - 2006;16(06)

[PEG (percutaneous endoscopic gastrostomy) has by now become a widely used method, especially to ensure long-term enteral nutrition. In developed countries nearly 1 in 1000 people have a PEG. Although the use of PEG increases year by year in Hungary, it is still performed too rarely or too late. PEG is an invasive but simple endoscopic technique that may be carried out even at the patient's bed. In cases when the routinely used oral route for oesophago-gastro-duodenoscopy is impossible one of the following alternative ways can be chosen: endoscopy via a laryngoscope, through the opened pharynx, through a large pharyngo-oesophageal fistula or transnasally. These allow the bypassing of stenoses and the placement of PEG. There are few absolute contraindications and complications occur rarely. Early treatment and follow-up of dermatitis is important since it may be the first sign of severe complications. PEG tubes may function for many years with proper maintenance. Feeding via PEG tubes is especially effective in head and neck malignancies or injuries and in neurological disorders. In surgery it can be used for the management of surgical complications or for decompression of the stomach and duodenum. PEG-feeding is common in geriatrics and in paediatrics, sometimes with questionable indications. If used with adequate indications, ethical considerations, wise forethought, and a decision made together with the patient and family, PEG may improve lifespan and quality of life, decrease complications and side effects of the therapy and owing to its cosmetic benefits it facilitates re-socialisation.]

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[WAYS OF PREVENTION OF SEPTIC COMPLICATIONS IN ACUTE PANCREATITIS]

OLÁH Attila

[Similarly to other acute inflammatory responses, the mortality curve of acute pancreatitis has two distinct peaks. The first one, which coincides with a hyperinflammatory phase, is due to the development of an overwhelming systemic inflammatory response syndrome and subsequent multi-organ failure. The second peak of mortality is detected much later, after 14 days from the onset of the disease, when the compensatory antiinflammatory phase results in the infection of the necrotising pancreatic glandular substance. Since no therapy has been shown to efficiently prevent the activation of inflammatory and proteolytic cascades that evoke and sustain the disease, the treatment of acute pancreatitis is basically symptomatic. Beside adequate fluid and volume replacement and pain relief, medical and mechanical support may become necessary if organ failure develops. Recent studies suggest that there are ways to decrease the incidence of infection in pancreatic necrosis, which is usually due to bacterial translocation from the gut. The results of attempts to decrease the frequency of septic complications are controversial. A number of studies support the need of antibiotic prophylaxis but the evidence is weak. Furthermore, the increasingly observed infections by multi-resistant strains of Gram-positive bacteria and Candida species are due to long-term antibiotic use, which strongly questions the grounds for prophylactic antibiotic treatment. Recently, various clinical studies aimed to decrease bacterial translocation in other ways, including probiotic use and enteral feeding. This paper provides a systematic review of the data available in the evidence-based literature on the use of antibiotics and the role of alternative and adjuvant therapy in the treatment of severe acute pancreatitis.]

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[THE ROLE OF OBESITY IN GASTROENTEROLOGICAL DISEASES]

GYÖKERES Tibor, KIRÁLY Ágnes, LAKATOS László, MADÁCSY László

[This paper reviews the current knowledge on the association of obesity and gastrointestinal disorders. While the relationship between obesity and cardiovascular disorders has recently gained wide professional publicity, there are few data on the gastroenterological aspects of obesity. After a discussion on obesity as an epidemic, its international and national prevalence, and public health risks, the most common obesity-related gastrointestinal disorders, their incidence, pathomechanism and consequences are presented by the organ systems affected, including gastrooesophageal reflux disease, fatty liver, gallstone disease, diseases of the pancreas, and colorectal carcinoma. Finally, the means of prevention and treatment are summarized.]

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[Gastroenterologist asks and the children answer]

SZŐNYI László

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