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If these patients are given antibio- tics buy generic advair diskus on-line asthma definition spirometry, they are more likely to become chronic excre- Giardiasis tors of antibiotic-resistant S advair diskus 250 mcg mastercard asthma definition 600d. Typhoid must be reported to the public health Giardialambliaisaagellate protozoonwhichinfects authorities buy advair diskus 500 mcg on-line asthma treatment new zealand. The diagnosis is conrmed by the pres- Special points in the history ence of trophozoites or cysts in stools or duodenal aspirates. Haemoglobin: if anaemia is present and consider- typhoid, Brucella, Lyme able, it is usually relevant. If iron-decient and there disease (Borrelia burgdorferi) is no overt blood loss, exclude gut malignancy. Leukaemia and infectious Hodgkins), leukaemia mononucleosis are usually associated with abnor- Autoimmune Systemic lupus mal peripheral counts and cell types (remember diseases erythematosus, polyarteritis direct tests for infectious mononucleosis). Eosino- nodosa, systemic vasculitis philia may suggest parasites or polyarteritis nodosa. Erythrocyte sedimentation rate: if over 100mm/h, Rheumatoid disease, Stills check for myeloma and consider polymyalgia rheu- disease (including adult Stills matica or underlying malignancy. Miliary shadowing books, but remember that the cause is more often a rare in miliary tuberculosis and sarcoid. Hilar nodes in manifestation of a common tuberculosis, lymphoma, sarcoid and carcinoma. Go back again and again to take a new history, to re- If the patient is shocked: examine the relevant areas and to repeat selected 5 Treat hypovolaemia with plasma substitutes (e. Other imported pathogens: 7 Consider use of inotropic sympathomimetics (do- nematodes, schistosomes butamine, dopamine or dopexamine) or vasocon- strictor sympathomimetics (norepinephrine). Common sources include intravenous caemic shock unless there is associated adrenal catheters, genitourinary and respiratory tract, and damage (consider performing a short Synacthen test). Coagulase-negative staphylo- cocci isolated from blood cultures may be contami- Antibiotics nants and not clinically signicant, but they are a The choice of antibiotic depends upon the likely common cause of hospital-acquired bacteraemia re- organism and local policies and knowledge of anti- lated to intravenous catheters. If severe infection, Bephenium (Alcopar) (Necator americanus: iron-decient anaemia; Pyrantel Ancylostoma duodenale) malnutrition in children Tetrachloroethylene Eggs or worms in stools Schistosoma Fever and eosinophilia Praziquantel (for both) S. Blood Septicaemia related to vascular catheter for transfusion must be routinely screened. They may then develop symp- toms of malaise, fever, weight loss with features of mildimmunodeciency(e. Clin- tance lies in their ability to cause epidemics (they ical stages are related to prognosis and survival, and occur more frequently than expected in a community can be used to guide treatment. Inuenza viruses primarily cause upper respirato- ry tract infection, typically with fever, headache, mal- Candidiasis aise and myalgia. Secondary bacterial pneumonia, Oral Candida albicans infection is common, present- particularly due to Staphylococcus aureus, is common ingwithtypicalwhite plaquesor mucosalerythema or in the elderly. Topical treatments (nystatin or ampho- Oseltamivir and zanamivir reduce viral replication tericin lozenges) may be effective, but oesophageal by inhibiting viral neuraminidase. They are licensed or genital candidiasis are indications for systemic for use within the rst 48h of the onset of symptoms. Twentypercentofcaseshaveatypicalfeaturesoflobar consolidation, upper zone shadowing or hilar lymph- adenopathy. Adverse reactions are common and intrave- presumptive or denitive diagnosis of any stage 3 or stage 4 conditionb, and/or; nous pentamidine 4mg/kg/day is an alternative. High-dose oxygen and mechanical ventilation may Immunological criteria for diagnosing advanced be required in severe disease. Clinical stage 1 Asymptomatic Persistent generalised lymphadenopathy Clinical stage 2 Moderate unexplained weight loss (< 10% of presumed or measured body weight)l Recurrent respiratory tract infections (sinusitis, tonsillitis, otitis media and pharyngitis) Herpes zoster Angular cheilitis Recurrent oral ulceration Papular pruritic eruptions Seborrhoeic dermatitis Fungal nail infections Clinical stage 3 Unexplained severe weight loss (> 10% of presumed or measured body weight) Unexplained chronic diarrhoea for longer than 1 month Unexplained persistent fever (above 37. Main- Recurrent oral, genital or perianal ulceration is com- tenance therapy with oral or intravenous ganciclovir mon and usually responds to systemic (oral or intra- is continued, although ultimately progression occurs. Herpes zoster Cryptococcal infection Cutaneous dissemination of typical herpes zoster Cryptococcus neoformans is a capsulate yeast widely (p. Primary infection with the protozoon Toxoplasma gondii is usually acquired during childhood by eating infectedcatfaecesorundercookedmeat. Vertical transmission from mother to child Kaposis sarcoma occurs almost exclusively in ho- also occurs and causes fetal abnormalities, including mosexual males, suggesting that an additional sexu- central nervous system abnormalities. Differentiationofcen- acid (to reduce haematological toxicity of pyrimeth- tralnervoussystemlymphomafromToxoplasmagon- amine) and sulfadiazine or clindamycin. Virally encoded The gag (group-specic antigen) gene encodes the proteins are processed and assembled in the cyto- core protein antigens of the virion (intact virus plasm, and then bud from the cell surface as new particle). The env gene encodes the two envelope glycopro- teins, which are cleaved from a larger precursor. A global denition of chronic active hepatitis for resource-limited settings based on clinical and more simple laboratory parameters is under discussion. Most share a conformation that allows them to interact with a hydrophobic site on reverse transcriptase. Usually rest, aspirin gargles and anaesthetic lozenges Examination reveals a tonsillar exudate and palatal for the sore throat are sufcient. If the tonsillar en- petechiae with generalised lymphadenopathy and largement is great and swallowing is difcult or the splenomegaly. A macularpapular rash is common airway threatened (anginose glandular fever usually and more frequent if ampicillin is given for the with severe general symptoms), a short course of sore throat. Mesenteric adenitis with appendicitis steroids (prednisolone 40mg/day for 510 days) rap- may occur. Investigation There is a leucocytosis with an absolute and relative (> 50% of total white cells) increase in mononuclear Tuberculosis cells. Patients withinfectious mononucleosis produce IgM antibodies that bind to and agglutinate red Tuberculosis most commonly causes pulmonary dis- cells from other species, giving rise to a positive Paul ease (p. Rarecomplicationsincludesplenicrupture, tuberculosis, except meningitis, in children and adults. Treatment of drug-resistant tuberculosis, and in particular multi-drug-resistance, Differential diagnosis requiresspecialistexpertiseandclosecollaborationwith The disease may be confused with: Mycobacterium reference laboratories. Transientasymptomaticincreasesinserumtransaminases are very common after starting treatment. Discontinuation is not indicated unless there are symptoms of hepatitis (anorexia, vomiting, hepatomegaly) or jaundice. Steroids are used in life-threatening or widespread tuberculosis in an attempt to reduce acute inammation and allow time for drugs to work. They are usually indicated for pericarditis, extensive pulmonary disease, moderate or severe meningitis, ureteric tuberculosis and pleural effusion. There is no convincing evidence that common viral infections are a risk factor for chronic fatigue syn- Management drome, with the exception of the fatigue that follows A gradual planned increase in exercise is the main less than 10% of EpsteinBarr virus infections.
Mixedstones are associated with anatomical abnormal- Sex ities purchase 500 mcg advair diskus mastercard asthma definition 999, stasis and previous surgery order advair diskus discount asthma symptoms pregnancy. F > M (2:1) Pathophysiology Geography Several different patterns of disease may result from gall- More common in developed world purchase line advair diskus asthma like bronchitis. Aetiology Gallstones may be cholesterol stones (more common in the developed world), pigment stones (more common Clinical features in the Far East) or mixed stones. Normally bile salts and r Impaction of a gallstone in the outlet of the gallblad- lecithin keep the cholesterol soluble, forming micelles. Onset is often after a versely, sudden weight reduction and cholesterol- meal or in the evening, the pain is variable in inten- reducing diets may precipitate gallstones by mo- sity over several hours. Inammation is initially caused by concentrated multiple, small and irregular in shape. Patients develop acute onset of severe griping Complications pain in the right upper quadrant radiating to the right Amucocele occurs when long-standing obstruction oc- subscapularregionandoccasionallytotherightshoul- curs without infection, the bile is resorbed and instead der. Associated features include fever, tachycardia, the epithelium secretes clear mucus. Onexam- tis may lead to empyema (pus-lled gallbladder), per- ination there is abdominal tenderness and guarding in foration with abscess formation and biliary peritonitis the right upper quadrant, which may become gener- (chemical and bacterial). Murphys sign is usu- Investigations ally present (inspiration during right hypochondrial r Full blood count (and investigation for haemolytic palpation causes pain and arrest of inspiration as the anaemia in pigment gallstones). Liver function tests, inamed gallbladder moves downwards and impinges blood cultures, inammatory markers and amylase on the ngers). Management r Patients with asymptomatic gallstones are usually Macroscopy managed conservatively. It may be performed as an Surgical resection is often not feasible due to local spread emergency (severe or complicated acute cholangi- and metastases. Sometimes aggressive segmental resec- tis), early elective (during initial admission for acute tion of the liver and regional lymph nodes is carried out. In acute cholecystitis 90% of patients settle with conser- vative management within 45 days. Ascending cholan- Carcinoma of the bile ducts gitishasamortalityofupto20%inseverecasesrequiring emergency decompression. Carcinoma of the gallbladder is rare, but almost always associated with gallstones. The tumour can arise anywhere in the biliary sys- Aetiology/pathophysiology tem and may be multifocal. It causes obstruction and Unknown, but associated with gallstones and chronic hence dilatation of the proximal ducts. Histologically 90% of tumours are adeno- carcinomas and 10% are squamous carcinomas. Clinical features The usual presentation is progressive obstructive jaun- Clinical features dice. Other symptoms include vague epigastric or right Patients may have a history of gallstone disease. A mass is often palpable in the right upper empyema presenting with biliary colic and a non-tender quadrant. Direct invasion of local structures, especially the liver, is almost invari- Macroscopy/microscopy ableatpresentation. Spreadviathelymphaticsandblood The carcinoma commonly appears as a sclerotic stricture occurs early. The islets of Langerhans are islands of endocrine cells scattered throughout the pancreas. They are clustered Investigations around a capillary network into which they secrete their r Ultrasound may show dilated intrahepatic ducts and hormones. Management Acute pancreatitis Curative treatment is only attempted if the tumour is localised and the patient is t for radical resection. Denition r Carcinoma of the common bile duct is treated by the Acute inammation of the pancreas with variable in- Whipples operation (see page 221). Incidence The remaining biliary tree is anastomosed to a Roux Almost 525 per 100,000 per year and rising. Palliative treatments include insertion of a stent or anas- Age tomosis of a Roux loop of jejunum to a biliary duct in More common >40 years. The prognosis is better for patients with carcinoma of Aetiology the common bile duct who are suitable for a Whipples Biliary tract disease (80%), especially cholelithiasis, gall- operation. Alcoholism is the second most common cause (20% in the United Disorders of the pancreas Kingdom). Causes are as follows: r Obstruction: Gallstones, biliary sludge, carcinoma of the pancreas. Introduction to the pancreas r Drugs/toxins: Alcohol, azathioprine, steroids, diuret- The pancreas has two important functions: the produc- ics. Translocation of gut pancreatitis bacteria can result in local infection and septicaemia. Within 48 hours of admission Shock may result from the release of bradykinin and Age >55 years prostaglandins, or secondary to sepsis. Haemorrhage may cause Grey Turners sign, which is bruising around the left loin and/or Cullens sign, bruising around the umbilicus. The pancreas appears oedematous with grey-white Other investigations are required to assess the sever- necrotic patches. Bacterial infection leads to inamma- ity and to monitor for complications: full blood count, tion and pus formation. Healing results in brosis with clotting screen, urea and electrolytes, liver function tests, calcication. Complications In the most severe cases there is systemic organ failure: Management r Cardiovascularsystem:Shock(hypotension,tachycar- The early management depends on the severity of the dia, arrhythmias). Patients require careful uid balance zymes walled off by compressed tissue), pancreatic using central venous pressure monitoring and uri- abscesses (which may contain gas indicating infection nary catheterisation to allow accurate urine output withgas-formingbacteria)andduodenalobstruction. Prophylactic Investigations broad-spectrumantibioticsaregiventoreducetherisk When supportive clinical features are present the diag- of infective complications. Ascites and persistent obstructive jaundice with conservative management require laparoscopic may occur. Prognosis Investigations Pancreatitis is a serious condition: overall mortality is Serum amylase uctuates, but may be moderately raised 10%. Endoscopic retrograde cholangiopancreatography mayshowscarringoftheductalsystemandevenstonesin the pancreatic duct. Magnetic resonance cholangiopan- Chronic pancreatitis creatography is increasingly being used. Denition Chronic pancreatitis is an inammatory condition that Management results in irreversible morphological change and impair- Precipitating factors especially alcohol need to be re- ment of exocrine and endocrine function.
Psycho-educational monitoring of blood glucose in patients with newly diagnosed type interventions for children and young people with Type 1 diabetes order 100 mcg advair diskus visa asthma definition wikipedia. The effect of continuous glucose effective outpatient intensive education programme for patients monitoring in well-controlled type 1 diabetes order advair diskus 500 mcg overnight delivery asthma wikipedia. Association between smoking and chronic renal failure glucose monitoring devices with conventional monitoring in the in a nationwide population-based case-control study generic 500mcg advair diskus fast delivery asthma. Cigarette smoking and progression of retinopathy and Glucose Monitoring System in children with type 1 diabetes nephropathy in type 1 diabetes. Intervention study for smoking cessation in diabetic patients: review of the literature. Marmara Medical diabetes mellitus: results from a controlled study of an intervention Journal 2005;18(1):13-6. Self- management training program: a randomized trial of diabetes and monitoring of blood glucose as part of a multi-component therapy reduction of tobacco. Risk estimation the management of patients with type 2 diabetes treated with and the prevention of cardiovascular disease. Self-monitoring of blood glucose in patients cessation: randomised trial with six year follow up. Br Med J with type 2 diabetes mellitus who are not using insulin (Cochrane 1999;318(7179):285-8. Physical activity and incidence of diabetes: the Honolulu testing of diabetic patients in the emergency department. Mortality in relation to activity and reduced occurrence of non-insulin-dependent diabetes smoking: 50 years observations on male British doctors. Weight and type 2 diabetes after bariatric surgery: systematic China Da Qing Diabetes Prevention Study: a 20-year follow-up review and meta-analysis. Reduction in the incidence of type 2 diabetes with long-term diabetes outcomes--a systematic review. Overview: jejunoileal bypass in the treatment of morbid Cost-sparing effect of twice-weekly targeted endurance training in obesity. Interventions for being therapy for type 2 diabetes: a randomized controlled trial. Diabetes Res Clin Pract Effect of Lap-Band-induced weight loss on type 2 diabetes mellitus 1998;40(1):53-61. Short-term effects of severe dietary carbohydrate-restriction type I diabetic patients on intensive treatment. Randomized controlled Determinants of Myocardial Infarction Onset Study Investigators. A randomized controlled trial of weight reduction and exercise J Med 2004;117(10):762-74. How effective are lifestyle changes in the prevention Diabetes Care 1997;20(10):1503-11. Importance of weight comparison of learning activity packages and classroom instruction management in type 2 diabetes: review with meta-analysis of for diet management of patients with non-insulin-dependent clinical studies. Long-term effects and costs of brief behavioural dietary cause hypoglycaemia in overnight fasted patients with type 1 intervention for patients with diabetes delivered from the medical diabetes? Improving self-care among older patients with type diabetes to sulfonylurea-induced low blood glucose. The comparison The acute impact of ethanol on glucose, insulin, triacylglycerol,and of four weight reduction strategies aimed at overweight diabetic free fatty acid responses and insulin sensitivity in type 2 diabetes. Effectiveness of medical nutrition therapy provided by hypoglycaemia; implications for Type 1 diabetes. Diabet Med dietitians in the management of non-insulin-dependent diabetes 2004;21(3):230-7. Cost-effectiveness of medical nutrition therapy provided by Intern Med 2008;149(10):708-19. A multicenter randomized controlled trial energy and nutrient intakes and fatty acid composition of serum of motivational interviewing in teenagers with diabetes. Diabetes lipids in patients with recently diagnosed non-insulin-dependent care 2007;30(6):1390-95. Effect Type 1 Diabetes - diagnosis and management of type 1 diabetes in of metabolic control on autonomic function in obese patients with children and young people. Psychological interventions a randomized trial of food provision and monetary incentives. J to improve glycaemic control in patients with type 1 diabetes: Consult Clin Psychol 1993;61(6):1038-45. The Pittsburgh Epidemiology of management of harmful drinking and alcohol dependence in Diabetes Complications Study. Diabet Med Screening for depression in diabetes using the Beck Depression 2005;22(3):243-8. Ann Screening for depressive symptoms: validation of the Center for Intern Med 2004;140(3):211-9. Diabetes Care analysis of the relationship between alcohol consumption and 2008;31(6):1118-9. Alcohol with a meal has no adverse effects on postprandial glucose A Review of Psychology Provision to Adults & Children with homeostasis in diabetic patients. Effects of educational and psychosocial interventions for J Pediatr 1994;125(2):177-88. Motivational Hagedorn insulin in patients with Type 1 diabetes using a treat-to- interviewing improves weight loss in women with type 2 diabetes. Comparison of insulin detemir and control in diabetes: results of a double-blind, placebo-controlled insulin glargine in a basal-bolus regimen, with insulin aspart as trial. Sertraline for prevention of depression recurrence in target noninferiority trial. Persistence of depressive symptoms in diabetic children and adolescents with Type 1 diabetes. Clinical onset distress in unselected type I diabetic patients: effects on and cost-effectiveness of continuous subcutaneous insulin infusion psychological variables and metabolic control. Type 2 diabetes in Type 1 diabetes: meta-analysis of multiple daily insulin injections in children. Factors influencing glycemic control in young people with type Med 2008;25(7):765-74. Diabetologia patients with type 1 diabetes: continuous subcutaneous insulin 2001;44(1):3-15. Pediatr Diabetes Comparing outpatient and inpatient diabetes education for newly 2009;10(1):52-8. Diabetes Care systematic review and meta-analyses of randomized trials of 2009;32(Suppl 1):S13-61.
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Comparison of arterial and venous blood gas values in the initial emergency department evaluation of patients with diabetic keto- Glycemic Management in Adults With Type 1 Diabetes purchase advair diskus 500mcg free shipping asthma knowledge test, p order advair diskus without a prescription asthma treatment 6 year old. Arterial blood gas results rarely inuence emergency physician management of patients with suspected diabetic keto- Adults proven advair diskus 250 mcg asthma definition 64g, p. Point-of-care blood ketone testing: Screen- ing for diabetic ketoacidosis at the emergency department. Use of capillary beta-hydroxybutyrate for the diagnosis of diabetic ketoacidosis at emergency room: Our one-year expe- Appendix 8: Sick-Day Medication List rience. Are blood ketones a better predictor than urine ketones of acid base balance in diabetic ketoacidosis? Point of care blood ketone testing of diabetic patients in the emergency department. Utility of ketone measurement in the prevention, diagnosis Sano, outside the submitted work. Diagnosis and treatment of dia- betic ketoacidosis and the hyperglycemic hyperosmolar state. The diagnosis of diabetic acute complications using the glucose-ketone meter in outpatients at endocrinology department. Epidemiologic characteristics of mortality with dipstick urine tests in the detection of ketone bodies. Hyperosmolar hyperglycemic state: A historic review occur at lower blood glucose levels: Case-control study and a case report of of the clinical presentation, diagnosis, and treatment. Euglycaemic diabetic ketoacidosis in dosis in diabetes mellitus: A three-year experience in Rhode Island. Characteristics of diabetic ketoacidosis in comes of pregnancies complicated by type 1 diabetes: Inuence of continu- older versus younger adults. Effect of physician specialty on out- patients with diabetes: A consensus statement from the American Diabetes Asso- comes in diabetic ketoacidosis. Accuracy and predictive value sion algorithm to treat diabetic ketoacidosis in the emergency department. Diabetic ketoacidosis in adults at Auckland hos- dency unit management on diabetic ketoacidosis patients. J Diabetes Sci Technol 2013;7:1265 sation of insulin therapy is the major precipitating cause of diabetic ketoaci- 74. Pseudo-myocardial infarction in diabetic ketoacidosis tion during diabetic ketoacidosis. Diabetic ketoacidosis precipitated by subacute (De rial hypoxemia and cerebral edema during crystalloid volume loading of patients Quervains) thyroiditis. The ecacy of low-dose versus conven- tional therapy of insulin for treatment of diabetic ketoacidosis. Low-dose continuous insulin therapy for dia- Emergencies in Adults betic ketoacidosis. Diabetes Care Citations identified through Additional citations identified 1995;18:118790. Is a priming dose of insulin neces- N=935 N=11 sary in a low-dose insulin protocol for the treatment of diabetic ketoacidosis? Low-dose insulin infusion in the treatment of dia- betic ketoacidosis: Bolus versus no bolus. The use of an insulin bolus in low-dose insulin infusion for N=714 pediatric diabetic ketoacidosis. Treatment of diabetic ketoacidosis using N=317 N=199 normalization of blood 3-hydroxybutyrate concentration as the endpoint of emer- gency management. Bicarbonate therapy in severe diabetic keto- Full-text screening Citations excluded* acidosis. Potassium balance during treatment of by chapter authors N=105 diabetic ketoacidosis with special reference to the use of bicarbonate. Tonicity balance, and not electrolyte-free water calculations, more accurately guides therapy for acute changes in natremia. Central pontine myelinolysis compli- new or revised cating treatment of the hyperglycaemic hyperosmolar state. Severe hyperglycemia: Effects of rehy- dration on endocrine derangements and blood glucose concentration. Prevention of hypophosphatemia by phosphate infusion during treatment of diabetic ketoacidosis and hyperosmolar coma. Preferred Reporting Items for Systematic Reviews and Meta- Arch Intern Med 1982;142:51720. Can J Diabetes 42 (2018) S115S123 Contents lists available at ScienceDirect Canadian Journal of Diabetes journal homepage: www. A review of medical records of over 2,000 adult patients trolling glycemia in hospital. A proactive approach to glycemic manage- admitted to a community teaching hospital in the United States ment using scheduled basal, bolus and correction (supplemental) insulin (>85% were nonintensive care unit patients) found that hypergly- is the preferred method. The use of correction-only (supplemental) insulin, cemia was present in 38% of patients (1). Of these patients, 26% had which treats hyperglycemia only after it has occurred, should be discour- aged as the sole modality for treating elevated blood glucose levels. Diabetes has been reported to be the fourth most preprandial blood glucose targets should be 5. For critically ill hospitalized people with diabetes, increases in circulating concentrations of stress hormones) or thera- blood glucose levels should be maintained between 6. Hyperglycemia, in turn, causes physiological changes that the assessment and treatment of hypoglycemia. These lead to a complex cycle of wors- ening illness and poor glucose control (3). Therefore, glycemic control and other dia- Will you be able to self-manage your diabetes? Screening for and Diagnosis of Diabetes and Hyperglycemia in Your blood glucose levels may be higher in hospital than your usual target the Hospital Setting range due to a variety of factors, including the stress of your illness, medi- cations, medical procedures and infections. In-hospital hyperglycemia is How often to check your blood glucose dened as any glucose value >7. For hospitalized people Who to contact if you have diculty managing your blood glucose with known diabetes, the glycated hemoglobin (A1C) identies levels. In hospitalized people with newly recognized hyperglycemia, an A1C among those with diabetes Conict of interest statements can be found on page S121. The use of glucose meters with bar coding capability counter-regulatory hormone secretion and the effects of medica- has been shown to reduce data entry errors in medical records (21).
Despite these considerations order advair diskus asthma 6 year old, the preferred method of providing nutrition in acute pancreatitis is elemental jejunal feeding which has been found to be safer than parenteral nutrition with fewer septic complications discount advair diskus on line mild asthma definition. Uncommonly purchase 100mcg advair diskus overnight delivery asthmatic bronchitis yahoo, parenteral nutrition may be necessary if enteral feeding is not tolerated. Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults update 2004. Medical treatments for the maintenance therapy of reflux oesophagitis and endoscopic negative reflux disease. Laparoscopic fundoplication compared with medical management for gastro oesophageal reflux disease: cost effectiveness study. Oesophageal high resolution manometry: moving from research into clinical practice. Aerophagia: Excessive air swallowing demonstrated by esophageal impedance monitoring. Review article: modern technology in the diagnosis of gastro-oesophageal reflux disease Bilitec, intraluminal impedance and Bravo capsule pH monitoring. Caution About Overinterpretation of Symptom Indexes in Reflux Monitoring for Refractory Gastroesophageal Reflux Disease. American Gastroenterological Association Institute Technical Review on the Management of Gastroesophageal Reflux Disease. American Gastroenterological Association Medical Position statement on the management of Gastroesophageal Reflux Disease. Prevalence and risk factors for overlaps between gastroesophageal reflux disease, dyspepsia, and irritable bowel syndrome: a population-based study. Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Mayo Clinic Gastroenterology and Hepatology Board Review Third Edition 2008: 3-20. Gastro-oesophageal reflux disease application of the concept of complete remission. Systematic review: maintenance treatment of gastro-oesophageal reflux disease with proton pump inhibitors taken on-demand. Efficacy of esophageal impedance/pH monitoring in patients with refractory gastroesophageal reflux disease, on and off therapy. Utility of non-endoscopic investigations in the practical management of oesophageal disorders. Caution about overinterpretation of symptom indexes in reflux monitoring for refractory gastroesophageal reflux disease. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence- based consensus. Esophageal Infections and other human immunodeficiency virus-associated esophageal disorders. Overlapping gastroesophageal reflux disease and irritable bowel syndrome: Increased dysfunctional symptoms. American Gastroenterological Association medical position statement on the management of Barretts esophagus. Cost effectiveness of endoscopic screening followed by surveillance for Barretts esophagus: A review. Gastroesophageal reflux disease, Barrett esophagus, and esophageal adenocarcinoma. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. The incidence of deep vein thrombosis in Japanese patients undergoing endoscopic submucosal dissection. Narrow band imaging for characterization of high grade dysplasia and specialized intestinal metaplasia in Barretts esophagus: a meta-analysis. Dysfunctional transforming growth factor-beta signaling with constitutively active notch signaling in Barretts esophageal adenocarcinoma. Canadian Association of Gastroenterology practice guidelines: management of noncardiac chest pain. Efficacy of radiofrequency ablation combined with endoscopic resection for Barretts esophagus with early neoplasia. Risk Factors for Progression of Low-Grade Dysplasia in Patients With Barretts Esophagus. Acceptability and accuracy of a non-endoscopic screening test for Barretts oesophagus in primary care: cohort study. Updated guidelines for the diagnosis, surveillance and therapy for Barretts esophagus. Esophageal adenocarcinoma in Barretts esophagus after endoscopic ablative therapy: a meta-analysis and systematic review. Sleisenger & Fordtrans gastrointestinal and liver disease: Pathophysiology/Diagnosis/Management 2006:871. Oesophageal high-resolution manometry: moving from research into clinical practice. Myotomy for esophageal achalasia - laparoscopic versus peroral endoscopic approach. Reversal of asynchrony between circular and longitudinal muscle contraction in nutcracker esophagus by atropine. Long-Term Esophageal Cancer Risk in Patients With Primary Achalasia: A Prospective Study. Automated analysis of pharyngeal pressure data obtained with high-resolution manometry. Reproducibility and agreement of pharyngeal automated impedance manometry with videofluoroscopy. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. High resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility disorders. The second American Gastroenterological Association technical review on the clinical use of esophageal manometry. Utilizing intraluminal pressure gradients to predict esophageal clearance: a validation study. American Journal of Gastroenterology 2008:103(8):1898-1905 First Principles of Gastroenterology and Hepatology A. The effects of itopride on oesophageal motility and lower oesophageal sphincter function in man.