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