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Showing results for tags 'doctors'.
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Endoscopy Complications Quadruple Rate Reported by Doctors
Jefferson Adams posted an article in Additional Concerns
Celiac.com 11/09/2010 - Each year in the United States, millions of people undergo gastrointestinal (GI) endoscopic procedures. Generally, the procedures have been regarded as safe, with a physician-reported complication rate for endoscopies of just 7%. However, most systems, including the gastroenterology department at Beth Israel, maintain a voluntary, paper-based physician reporting system wherein each gastroenterologist submits a monthly log describing any known complications. To get a better idea of actual numbers based on Emergency Room (ER) visits within two weeks of an endoscopy, Daniel A. Leffler, MD, of Beth Israel Deaconess Medical Center in Boston, set out with a research team to conduct a more in-depth review. Their review of electronic medical records (EMR) showed that complications after endoscopy may be more common than previously thought. Dr. Leffler and his colleagues reviewed over 400 emergency department (ED) visits logged in one hospital's EMR system within two weeks of an endoscopic procedure. They found that nearly one-third of those visits were related to the previous endoscopy. Overall, they looked at records for follow-up visits for 6,383 esophagogastroduodenoscopies and 11,632 colonoscopies. The medical center's electronic reporting system showed 419 ED visits within two weeks of these procedures. The review team determined 32%, or 134 of these visits, to be directly related to the endoscopic procedure. Yet only about 7% of these were reported using the standard physician reporting system, the researchers said (P<0.001). The team also found that 29% of 266 subsequent hospitalizations were directly related to the patients' endoscopic procedure. Most of the ER visits were a result of abdominal pain (47%), gastrointestinal tract bleeding (12%), or chest pain (11%). By looking at actual electronic admission data, rather than relying on the more cumbersome physician reporting data, the research team found "a 1% incidence of related hospital visits within 14 days of outpatient endoscopy, 2- to 3-fold higher than recent estimates." This is important not just from a patient wellness perspective, but from a financial one. According to Medicare standardized rates, the average costs of endoscopic-related complications is $1403 per ED visit, and $10123 per hospitalization. Over the full screening and surveillance program, such complications added an extra $48 to each exam. The team's own words reinforce their conclusions: "Although the overall rate of severe complications, including perforation, myocardial infarction, and death remained low, the true range of adverse events is much greater than typically appreciated." Moreover, "standard physician reporting greatly underestimated the burden of medical care related to endoscopic procedures and unexpected hospital utilization," Leffler and colleagues wrote. With so many cases of celiac disease relying on biopsy via endoscopy, these numbers might be especially interesting to people with celiac disease, in addition to anyone else facing endoscopy in the future. Source: Arch Intern Med 2010; 170(19): 1752-1757- 2 comments
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Celiac.com 07/13/2009 - Doctors are recommending that kids with mental and behavioral disorders, and with low cholesterol be tested for celiac disease. This, after findings from a recent study suggest that low plasma cholesterol levels might have a role in the development and pathogenesis of certain behavioral disorders such as schizophrenia, depression, and obsessional neurosis in people with celiac disease. It is well documented that children with celiac disease face higher rates of certain behavioral disorders such as schizophrenia, depression, and obsessional neurosis. Still, not much is known about the development and pathogenesis of celiac-related mental and behavioral disorders. A team of researchers made up of Italians Luca Mascitelli, M.D., Francesca Pezzetta, M.D., and American Mark R. Goldstein, M.D. set out to investigate the matter. A large scale study of patients aged 6–16 years showed that most people with celiac disease harbored illness of low-grade intensity that was often associated with "decreased psychophysical well-being." Furthermore, a recent study found that adolescents with celiac disease face higher rates of depressive and disruptive behavioral disorders, especially before adopting a gluten-free diet. 2 For some, psychiatric symptoms appear to improve after the patients started a gluten-free diet. Interestingly, children with malabsorption and steatorrhea due to celiac disease often have lower concentrations of blood cholesterol. Moreover, people with celiac disease, but who show no signs of overt cholesterol malabsorption, often show low levels of blood cholesterol, while normal to high cholesterol levels have been shown effective in ruling out celiac disease. Add to that the fact that low cholesterol has been tied to other mental disorders. In particular, a national sample of non-institutionalized, non-African American children of school-age found a statistically significant association between low cholesterol and aggressive behavior. Low cholesterol has also been tied to the onset of conduct disorder during childhood among male criminals. Therefore, they recommend that screening for celiac disease be considered in children and adolescents with mental disorders and low cholesterol. Psychosomatics 50:300-301, May-June
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Celiac.com 01/03/2009 - The development of reliable blood tests for celiac disease have shown the condition to be much more common than previously thought. In fact, the rate of diagnosis has increased sharply in recent years. It’s been well documented that, for most people celiac disease, a gluten-free diet leads to healing of the small intestine, and brings about overall improvements in their quality of life. Current medical wisdom dictates that once a person is diagnosed with celiac disease and experiences an improvement in symptoms by adopting a gluten-free diet, there is little need to undergo follow-up screening unless they experience a clear recurrence of symptoms. Some doctors are beginning to challenge that practice. However, it is also becoming clear that people with celiac disease face a higher risk of risk of developing a number of long-term complications and other autoimmune disorders. The list of such complications and conditions associated with celiac disease is growing rapidly, in particular, autoimmune disease, malignancy, and bone disease. Can these be prevented and outcomes improved? Risk factors that can predict or shape long-term outcomes include genetic make-up, environmental factors, especially gluten consumption and exposure, persistent small intestinal inflammationâ„ damage and nutritional deficiencies. The use of genotyping has yet to establish a clinical role in the long-term management of duodenal biopsy. Symptoms, blood tests, or other non-invasive methods are poor predictors of healing status, or the likelihood of associated complications. This means that long-term management of celiac care might benefit from strategies laying somewhere between regular biopsies for life and simple faith that one is successfully following a gluten-free diet. A team of doctors based in Australia recently set out to conduct a systematic review of the complications and associations of celiac disease, to identify potential risk factors, to define ways of assessing risk factors and to provide a strategy for management. The team was made up of Dr. M. L. Haines, Dr. R. P. Anderson & Dr. P. R. Gibson, and they conducted a review of medical literature going back to 1975. The doctors found that all people with celiac disease should have follow-up exams. They felt a reasonable minimum for all patients would be an initial consultation 1–2 weeks after biopsy diagnosis, review consultation 3–6 months later and subsequent annual reviews assessed on an individual basis. As to whether the follow-up should be done by a specialist, such as a gastroenterologist, or by a general practitioner, a nurse practitioner, or a dietitian, the research team noted that most celiac patients prefer to see a dietitian for follow-up, with a doctor available as needed. The team felt that special attention should be paid to patient adherence to a gluten free diet. The doctors noted the ease of gluten ingestion and pointed out that 6 in 10 patients experience persistent histological changes within an average of two years of undetected gluten exposure. They also noted there are a large number of associated conditions that can be averted by keeping celiac disease under control. They also note that symptoms and blood tests are poor indicators of intestinal damage levels on a cellular level. Such damage can spread from the cellular level to the systemic level over time, leaving people with untreated celiac disease face an elevated risk of developing infection. The researchers noted that people untreated celiac disease have significantly reduced levels of leucocytes, total lymphocytes, and CD3+, CD4+ and CD8+ lymphocytes compared to those with treated celiac disease and to the general population. With so many associated conditions tied to celiac-related intestinal damage, controlling or preventing that damage becomes crucial. They also note that proper monitoring of celiac disease can help to prevent celiac-associated neuro-psychiatric conditions such as anxiety, headaches, behavioral symptoms and depression, which, it is thought may be triggered by impaired availability of tryptophan and disturbances in central serotonergic function. The proper control of celiac disease can help to prevent the development of, or improve, numerous celiac-associated conditions. That proper control means a reliable means to assess patients for follow-up, and the study presents several aspects of a new protocol for treating celiac disease over the course of the patient’s lifetime. Aliment Pharmacol Ther 28, 1042–1066
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Celiac.com 01/30/2009 - Doctors from the Mayo clinic are proposing a new staging system for patients with Refractory Celiac Disease (RCD) after results of a recent study showed that their system offered greater accuracy and improved survival rates over the existing staging system. The new system will rely on the cumulative effect of 5 prognostic factors evaluated at the time of the refractory state diagnosis. Refractory Celiac Disease occurs when both the symptoms and intestinal damage continue or recur, regardless of strict adherence to a gluten-free diet. In Refractory Celiac Disease, the immunophenotype of intraepithelial lymphocytes may be normal and polyclonal (RCD I) or abnormal and monoclonal (RCD II). The goal of this study was describe the clinical characteristics, treatment, and long-term outcome in a large single-center cohort of patients with RCD. The study was conducted by doctors Alberto Rubio–Tapia, Darlene G. Kelly, Brian D. Lahr, Ahmet Dogan, Tsung–Teh Wu, and Joseph A. Murray, all with the Mayo Clinic in Rochester, MN. The research teams assessed and compared clinical characteristics and outcomes in 57 patients with RCD: 42 with RCD I and 15 with RCD II. The team developed a scale that served as the basis for the new staging system. Using Cox regression, they assigned a point score to each of the various prognostic factors. They assigned a score of 0 to patients who showed no Refractory Celiac Disease factors. A score of 1 or 2 was assigned for presence of prognostic factors by rounding each score and taking the sum of all 5 factors for a total score. The team then applied the system to survival rates within the study: Stage I combined patients with a point score of 0 or 1 (n = 27), stage II patients with a point score of 2 or 3 (n = 16), and stage III patients with a point score of 4 (n = 14). Patients with total point scores of 0 (n = 15) or 1 (n = 12), showed overall 5-year survival rates of 93% and 100%, respectively. Patients with a score of 2 (n = 7) or 3 (n = 9) showed 5-year overall survival rates of 80% and 65%, respectively. Patients with a score of 4 (n = 10) or 5 (n = 4), the 5-year cumulative survival rates of 25% and 0%, respectively. For patients in stages I, II, and III, the 5-year cumulative survival rate was 96%, 71%, and 19%, respectively (P < .0001). Fifteen of the 57 patients died within 2 years of being diagnosed with RCD (8 with RCD I and 7 with RCD II). Over the five-year course of the follow-up, the overall survival was 70% for the entire cohort, 80% for RCD I, and 45% for RCD II. Most deaths were a result of refractory celiac disease, or to enteropathy-associated T-cell lymphoma (EATL). Refractory Celiac Disease generally carries a high rate of mortality, and the outcomes for RCD II have been especially poor because of the tendency for EATL to develop. Citing the results, the team is proposing a new staging system based on the cumulative effect of 5 prognostic factors investigated at the time of the refractory state diagnosis Gastroenterology 2009; 136:000–000
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Dr. A Mendes Ant¢nio - Pediatrician Hospital Pedi trico 3000 Coimbra Portugal Jorge Amil Dias, M.D. - Pediatrician Dept. of Pediatrics Hospital S: Joao 4200 Porto Portugal Fax: +351-225025766 E-mail: jamildias@mail.telepac.pt Prof. Paulo Ramalho - Pediatrician Dept. of Pediatrics Hospital S. Maria 1600 Lisboa Portugal Fax +351-1-7978821 Prof. J Salazar de Sousa - Pediatrician Dept. of Pediatrics Hospital S. Maria 1600 Lisboa Portugal Fax +351-1-7978821 Prof. A. Vasconcelos Teixeira Dept. of Gastroenterology Hospital S: Joao 4200 Porto Portugal Fax: 351-2-525766
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Professor Ciaran McCarthy The University College Hospital Galway Galway, Ireland
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Markku Maki, M.D., PhD - Pediatric Gastroenterologist Institute of Medical Technology University of Tampere P.O. Box 607 FIN-33101 Tampere, Finland Tel: +358 31 2157724 Fax: +358 31 2157710 E-mail: llmama@uta.fi Homepage: http://www.uta.fi/~llmama/
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Julio Espinoza, M.D. President of the Gastroenterological Branch of the Chilean Pediatric Society c/o I.N.T.A. Av. J.P. Alessandri #5540 Macul - Santiago - Chile Fax: 56-2-2214030 Ernesto Guiraldes, M.D. - Pediatrician Pediatric Gastroenterology Group Pontificia Universidad Catolica de Chile, Medical School, Santiago, Chile E-mail: eguirald@puc.cl, or eguirald@med.puc.cl Dr. Carlos Quintana, M.D. Gastroenterology Division The Catholic University of Chile Marcoleta 367, Santiago, Chile Tel: 56-2-6332051 Fax: 56-2-6331457
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Alberta Dr. R.N. Fedorak, M.D. - Adult GI University of Alberta Hospitals Edmonton, Alberta, Canada Tel: (403) 492-6941 N.B.Hershfield, M.D. 711 South Tower 3031 Hospital Dr. N.W. Calgary, Alberta T2N 2T9 Tel: (403) 283-6613 Fax: (403) 270-7722 Dr. Lyle McGonigle, M.D. - Pediatrician #730 - 8303 - 112 Street Edmonton, Alberta, Canada Tel: (403) 432-0970 Ontario G. Berezny, M.D. - Gastroenterologist Ottowa, Belleville, Canada Tel: (613) 966 0455 Dr. Phillip Hassard 555 Montreal Rd. Ottawa, Ontario
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Dr. Baert (gastroenterologist) H.Hartkliniek, Kwadestraat 16, 8800 Roeselare Dr. Deprettere (pediatric gastroenterologist) U.Z. Antwerpen, Wilrijkstraat 10, 2650 Edegem Tel: 03/821.30.00 Dr. Devos (pediatric gastroenterologist) Walkurenstraat 39, 8800 Roeselare Dr. Gillis (pediatric gastroenterologist) Stadsomvaart 5, 3500 Hasselt Prof. Hiele (gastroenterologist) U.Z. Gasthuisberg, Herestraat 49, 3000 Leuven Tel: 016/34.42.25 and 016/34.42.18 Dr. Hoffman (pediatric gastroenterologist) U.Z. Gasthuisberg, Herestraat 49, 3000 Leuven Dr. Van Moer (gastroenterologist) Sint Vincentiuskliniek, St. Vincentiusstraat 20 A1, 2000 Antwerpen Tel: 03/285.20.00 Prof. Vandenplas (pediatric gastroenterologist) A.Z.-V.U.B., Laarbeeklaan 101, 1090 Brussel Tel: 02/477.57.81 Dr. Van Itterbeek (pediatric gastroenterologist) Koning Albert 1 laan 69,3010 Kessel-Lo Dr. Van Winckel ( pediatric gastroenterologist) De Pintelaan 185, 9000 Gent
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Maximilian Ledochowski, M.D. Anichstrasse 17, A-6020 Innsbruck, Austria Tel.: ++43-(0)512-561350 Fax: ++43-(0)512-563528-4 E-mail: Maximilian.Ledochowski@uibk.ac.at
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