Endoscopic, Deep Mural Implantation of Enteryx for the Treatment of GERD: 6-Month Follow-up of a Multicenter Trial
This prospective, multicenter, single-arm study evaluated the safety and efficacy of the endoscopic implantation of Enteryx, a biocompatible, non-biodegradable liquid polymer for the treatment of GERD.
Eighty-five patients with heartburn symptoms responsive to proton pump inhibitor (PPI) use were enrolled. Inclusion requirements were HRQL score < or = 11 on PPI and > or = 20 off PPI, and 24-hour PH probe with > or = 5% total time at PH < or = 4. Patients with a hiatus hernia > 3 cm, grade 3 or 4 esophagitis, or esophageal motility disorder were excluded. Using a 4-mm needle tipped catheter during standard endoscopy, implants were made in 3-4 quadrants deep into the wall of the cardia. Use of PPI medications, pH-metry, manometry, GERD symptoms, and patient quality of life were assessed over a 6-month follow-up period.
At 6 months, PPI use was eliminated in 74% and reduced by > 50% in 10% of patients. The median HRQL score improved from 24.0 pre-implant (baseline off PPIs) to 4.0 at 6 months (p < 0.001). Mean total esophageal acid exposure time was 9.5% pretherapy and 6.7% at 6 months (p < 0.001). Mean LES length increased from 2.0 cm at baseline to 3.0 cm posttherapy (p = 0.003). There were no clinically serious adverse events. Transient mild-to-moderate chest pain commonly occurred after implantation.
The endoscopic implantation of Enteryx is a safe and effective therapy for eliminating or decreasing the need for PPI medications, improving GERD symptoms and patient quality of life, and decreasing esophageal acid exposure among patients suffering from GERD.
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ABSTRACT: astroesophageal reflux disease (GERD) is very common. Approximately 20% of adult Amer- icans have heartburn at least once a week. The goals of therapy for GERD are to eliminate symptoms, to heal injured esophageal mucosa, and to prevent reflux complications.1 Treatment options for GERD have been highlighted by potent acid suppression with proton pump inhibitors (PPIs) and minimally inva- sive antireflux surgery. Recently, endoscopic therapies for GERD have been introduced. Treatment selection should be individualized and dependent upon underly- ing pathophysiology, anatomy, and clinical presentation coupled with the expected success or limitations of each therapeutic option. This article reviews the pathophysiol- ogy of GERD and the spectrum of clinical presentation, and discusses how these factors affect treatment consider- ations. Medical, surgical, and emerging endoscopic treat- ment options are discussed.
Available from: multiprint.kiev.ua
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ABSTRACT: サルモネラ分離に際してRappaport培地,strontium chlorideブイヨン,strontium seleniteブイヨンおよびselenite Fブイヨンの4種の増菌培地を用い,その成績を比較した.その結果,Rappaport培地にstrontium seleniteブイヨンを併用すると,サルモネラの各種類の分離に最も満足すべき成績がえられた.これらの培地を用いて,下痢を全く伴わない患者,胃腸炎あるいはチフス性疾患の患者3,325名についてサルモネラ保菌率を検査した.その結果,22の血清型に属する189株のサルモネラを分離した.検出率は5.6%である.その血清型は,食中毒の原因と推定されたものから,チフス性疾患の原因菌に至るさまぎまの型が含まれていたが,最も多く分離されたのはS. derbyとS. anatumであった.また,Clonorchis sinensisに感染していた患者は,他の腸寄生虫感染者あるいは非感染者より高率にサルモネラを保有していた The efficiencies of Rappaport medium, strontium chloride, strontium selenite and selenite F broths for enrichment in the isolation of salmonellas from human stools were compared. The study showed that Rappaport medium when used in conjunction with strontium selenite broth gave the most satisfactory result, because they covered the isolation of a wider range of salmonellas. With these media, the carriage rate of Salmonella serotypes of 3,325 hospital patients who were admitted without complaints of diarrhoea or gastroenteritis or enteric fever, were tested. The result revealed that 5.6% of them carried Salmonella serotypes ranging from those that may produce food-poisoning to those which are causal agents of enteric fever. Moreover, patients who were infected with the liver-fluke, Clonorchis sinensis, had a higher carriage rate than those who were infected with other intestinal parasites or non-infected
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