Principles Of Clinical Gastroenterology

Principles Of Clinical Gastroenterology

Principles Of Clinical Gastroenterology

EDITED BY:

Tadataka Yamada, MD

ASSOCIATE EDITORS:

David H. Alpers, MD

Anthony N. Kalloo, MD

Neil Kaplowitz, MD

Chung Owyang, MD

Don W. Powell, MD

Product Details:

Hardcover: 672 pages

Publisher: Wiley-Blackwell; 1 edition (June 23, 2008)

Language: English

ISBN-10: 1405169109

ISBN-13: 978-1405169103

A Concise, Symptom-Based Textbook for Diagnosis and Decision Making in Clinical Practice

Over the past twenty years, thousands of physicians have come to depend on Yamada’s Textbook of Gastroenterology. Its encyclopaedic discussion of the basic science underlying gastrointestinal and liver diseases as well as the many diagnostic and therapeutic modalities available to the patients who suffer from them was—and still is—beyond compare. This new textbook, Principles of Clinical Gastroenterology, is designed to inform practitioners on the features of the major clinical disorders in gastroenterology and hepatology from the point of view of the clinician observing signs and symptoms of a patient under care and management.

It is a practical guide to diagnosis and decision making in clinical practice and provides a rich source of information on diseases of the gastrointestinal tract and liver. Covering the full range of examinations in gastroenterology and hepatology, with extremely timely chapters on patients with dyspepsia, eating disorders, jaundice, hepatitis, cirrhosis, and on screening, Principles of Clinical Gastroenterology gives you easy access to approaches that a clinician might take to common symptoms and signs presented by patients with such disorders. The chapters include the epidemiology, history, signs and symptoms, diagnosis, treatment, and prognosis of the most commonly encountered disorders in gastroenterology and hepatology.

Contents

Contributors

Preface

1. Clinical decision making; Philip S. Schoenfeld
2. Economic analysis in the diagnosis and treatment of gastrointestinal diseases; John M. Inadomi
3. Psychosocial factors in the care of patients with functional gastrointestinal disorders; Bruce D. Naliboff, Jeffrey M. Lackner, Emeran A. Mayer
4. Approach to the patient with dyspepsia and related functional gastrointestinal complaints; Nicholas J. Talley, Gerald Holtmann
5. Approach to the patient with dysphagia, odynophagia, or noncardiac chest pain; Chandra Prakash Gyawali, Ray E. Clouse
6. Approach to the patient with gastroesophageal reflux disease; Joel E. Richter
7. Approach to the patient with dyspepsia and peptic ulcer disease; Andrew H. Soll, David Y. Graham
8. Approach to the patient with gross gastrointestinal bleeding; Grace H. Elta, Mimi Takami
9. Approach to the patient with occult gastrointestinal bleeding; David A. Ahlquist, Graeme P. Young
10.  Approach to screening for colorectal cancer; Graeme P. Young, James E. Allison
11. Approach to the patient with unintentional weight loss; Andrew W. DuPont
12. Approach to the patient with obesity; Louis A. Chaptini, Steven R. Peikin
13. Approach to the patient with nausea and vomiting; William L. Hasler
14. Approach to the patient with abdominal pain; Pankaj Jay Pasricha
15. Approach to the patient with gas and bloating; William L. Hasler
16. Approach to the patient with acute abdomen; Rebecca M. Minter, Michael W. Mulholland
17. Approach to the patient with ileus and obstruction; Klaus Bielefeldt, Anthony J. Bauer
18. Approach to the patient with diarrhea; Don W. Powell
19. Approach to the patient with suspected acute infectious diarrhea; John D. Long, Ralph A. Giannella
20. Approach to the patient with constipation; Satish S.C. Rao
21. Approach to the patient with abnormal liver chemistries; Richard H. Moseley
22. Approach to the patient with jaundice; Raphael B. Merriman, Marion G. Peters
23. Approach to the patient with ascites and its complications; Guadalupe Garcia-Tsao
24. Approach to the patient with central nervous system and pulmonary complications of end-stage liver disease; Javier Vaquero, Andres T. Blei, Roger F. Butterworth
25. Approach to the patient with acute liver failure; Ryan M. Taylor, Robert J. Fontana
26. Approach to the patient with chronic viral hepatitis B or C; Sammy Saab, Hugo Rosen
27. Approach to the patient with a liver mass; John A. Donovan, Edward G. Grant
28. Approach to gastrointestinal and liver diseases in pregnancy; Willemijntje A. Hoogerwerf
29. General nutritional principles; David H. Alpers, Beth Taylor, Samuel Klein
30. Approach to the patient requiring nutritional supplementation; David H. Alpers, Beth Taylor, Samuel Klein
31. Genetic counseling for gastrointestinal patients; Cindy Solomon, Deborah W. Neklason, Angela Schwab, Randall W. Burt

Index

Sample

Chapter 1 Clinical decision making

What is evidence-based medicine?

David Sackett, the “father” of evidence-based medicine (EBM) stated that EBM is “the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients” [1]. Terms used in this definition can be explained as follows

Conscientious use implies that physicians review articles

about clinical research and apply this information to clinical

decision making.

• Current best evidence from clinical care research implies that physicians systematically appraise the methods and results of clinical research articles using EBM tools. With these tools, physicians can separate the “wheat from the chaff” when reading medical journals and identify poorly designed studies that will produce biased results and should be discarded before being applied to patient care. This chapter will focus on techniques to identify and interpret the best evidence from properly designed research articles.

• Judicious use implies that a physician’s experience and patient’s preferences are crucial components of decision making and that these judgments must be balanced with the data from best evidence.

Judicious use of best evidence is a particularly important concept to understand [2]. Many critics state that the practice of EBM is “cookbook” medicine that devalues the judgment of a clinician and the values of an individual patient. This interpretation is inaccurate. Physicians must consider a patient’s preferences about the potential benefits and side effects and costs of a medication when deciding a specific

treatment. Also, a specific patient may not fit the criteria for enrollment of patients into a randomized controlled trial (RCT). For example, an RCT demonstrated that rifaximin, a nonabsorbable antibiotic, improved bloating in Lebanese patients [3]. Will bloating (and other gastrointestinal symptoms) improve if rifaximin is used in patients with irritable bowel syndrome (IBS) in the United States? If we assume that these results are applicable to patients with IBS in the United States, then is it worthwhile to use a treatment that may only produce a temporary relief of symptoms? What if the patient had a past history of Clostridium difficilecolitis after a course of ciprofloxacin? Would the patient be willing to risk another case of C. difficile colitis? What if the patient does not have insurance and would have to pay $200 for this prescription? These questions are qualitative questions that require clinical judgments on the part of the patient and the physician [4]. Although the best evidence from an RCT [3] may identify an effective treatment for bloating, both physician judgment and patient preferences must also be used for effective clinical decision making. Thus, EBM and a reliance on best evidence is not intended to be “cookbook” medicine [2].

Nevertheless, EBM is a helpful tool for the quantitative aspect of clinical decision making, which arises from a systematic examination of study methodology and study results [2]. The medical literature is expanding at an exponential rate [5], and the time available for reading may be hurried and fragmented. Physicians need tools to build a framework for the rapid evaluation of the methodology and results of published studies, and EBM provides these tools (Tables 1.1 and 1.2). With these frameworks, physicians can rapidly identify well-designed studies that produce accurate and unbiased results and should be applied to patient care. Studies using improper methodology and biased results are quickly identified and ignored.

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