Principles of Clinical Gastroenterology

670 Pages·2008·6.94 MB·English

by  Yamada T. (ed.)

9781405169103_1_pre.qxd 3/6/08 1:16 PM Page i
PRINCIPLES OF
Clinical
Gastroenterology
Principles of Clinical Gastroenterology. E dited by Tadataka Yamada
© 2008 Blackwell Publishing. ISBN: 978-1-405-16910-3
9781405169103_1_pre.qxd 3/6/08 1:16 PM Page iii
PRINCIPLES OF
Clinical
Gastroenterology
EDITED BY
Tadataka Yamada,
MD
President, Global Health Program
Bill & Melinda Gates Foundation
Seattle, Washington;
Adjunct Professor
Department of Internal Medicine
Division of Gastroenterology
University of Michigan Health System
Ann Arbor, Michigan, USA
ASSOCIATE EDITORS
David H. Alpers, MD
William B. Kountz Professor of Medicine
Department of Internal Medicine
Division of Gastroenterology
Washington University School of Medicine
St Louis, Missouri, USA
Anthony N. Kalloo, MD
Professor of Medicine
Johns Hopkins University School of Medicine;
Director, Division of Gastroenterology and Hepatology
Johns Hopkins Hospital
Baltimore, Maryland, USA
Neil Kaplowitz, MD
Brem Professor of Medicine and Chief
Division of Gastrointestinal and Liver Diseases
Director, Liver Disease Research Center
Keck School of Medicine
University of Southern California
Los Angeles, California, USA
Chung Owyang, MD
Professor of Internal Medicine
H. Marvin Pollard Collegiate Professor and Chief
Division of Gastroenterology
University of Michigan Health System
Ann Arbor, Michigan, USA
Don W. Powell, MD
The Bassel and Frances Blanton Distinguished Professor of Internal Medicine
Professor, Neuroscience and Cell Biology
Program Director, General Clinical Research Center
Director, Division of Gastroenterology and Hepatology
The University of Texas Medical Branch
Galveston, Texas, USA
A John Wiley & Sons, Ltd., Publication
9781405169103_1_pre.qxd 3/6/08 1:16 PM Page iv
This edition first published 2008, © 2008 by Blackwell Publishing Ltd
Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing
program has been merged with Wiley’s global Scientific, Technical and Medical business to form
Wiley-Blackwell.
Registered office: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex,
PO19 8SQ, UK
Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK
The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
111 River Street, Hoboken, NJ 07030-5774, USA
For details of our global editorial offices, for customer services and for information about how to apply
for permission to reuse the copyright material in this book please see our website at
www.wiley.com/wiley-blackwell.
The right of the author to be identified as the author of this work has been asserted in accordance with
the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior
permission of the publisher.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may
not be available as electronic books.
Designations used by companies to distinguish their products are often claimed as trademarks. All
brand names and product names used in this book are trade names, service marks, trademarks or
registered trademarks of their respective owners. The publisher is not associated with any product or
vendor mentioned in this book. This publication is designed to provide accurate and authoritative
information in regard to the subject matter covered. It is sold on the understanding that the publisher
is not engaged in rendering professional services. If professional advice or other expert assistance
is required, the services of a competent professional should be sought.
The contents of this work are intended to further general scientific research, understanding, and
discussion only and are not intended and should not be relied upon as recommending or promoting a
specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the
author make no representations or warranties with respect to the accuracy or completeness of the
contents of this work and specifically disclaim all warranties, including without limitation any implied
warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications,
changes in governmental regulations, and the constant flow of information relating to the use of
medicines, equipment, and devices, the reader is urged to review and evaluate the information
provided in the package insert or instructions for each medicine, equipment, or device for, among other
things, any changes in the instructions or indication of usage and for added warnings and precautions.
Readers should consult with a specialist where appropriate. The fact that an organization or website is
referred to in this work as a citation and/or a potential source of further information does not mean that
the author or the publisher endorses the information the organization or website may provide or
recommendations it may make. Further, readers should be aware that Internet websites listed in this
work may have changed or disappeared between when this work was written and when it is read. No
warranty may be created or extended by any promotional statements for this work. Neither the
publisher nor the author shall be liable for any damages arising herefrom.
Library of Congress Cataloguing-in-Publication Data
Principles of clinical gastroenterology / edited by Tadataka Yamada ; associate editors,
David H. Alpers...[et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4051-6910-3
1. Gastrointestinal system—Diseases. 2. Liver—Diseases. 3. Gastroenterology.
I. Yamada, Tadataka. II. Alpers, David H.
[DNLM: 1. Gastrointestinal Diseases. 2. Liver Diseases. WI 140 P957 2008]
RC801.P753 2008
616.3’3—dc22
2008000954
ISBN: 978-1-4051-6910-3
A catalogue record for this book is available from the British Library
Set in 9/12pt Palatino/Frutiger by Graphicraft Limited, Hong Kong
Printed in Singapore by COS Printers Pte Ltd
1 2008
9781405169103_1_pre.qxd 3/6/08 1:16 PM Page v
Contents
Contributors, vii
Preface, ix
1 Clinical decision making, 1
Philip S. Schoenfeld
2 Economic analysis in the diagnosis and treatment of gastrointestinal diseases, 14
John M. Inadomi
3 Psychosocial factors in the care of patients with functional gastrointestinal disorders, 20
Bruce D. Naliboff, Jeffrey M. Lackner, Emeran A. Mayer
4 Approach to the patient with dyspepsia and related functional gastrointestinal
complaints, 38
Nicholas J. Talley, Gerald Holtmann
5 Approach to the patient with dysphagia, odynophagia, or noncardiac chest pain, 62
Chandra Prakash Gyawali, Ray E. Clouse
6 Approach to the patient with gastroesophageal reflux disease, 83
Joel E. Richter
7 Approach to the patient with dyspepsia and peptic ulcer disease, 99
Andrew H. Soll, David Y. Graham
8 Approach to the patient with gross gastrointestinal bleeding, 122
Grace H. Elta, Mimi Takami
9 Approach to the patient with occult gastrointestinal bleeding, 152
David A. Ahlquist, Graeme P. Young
10 Approach to screening for colorectal cancer, 170
Graeme P. Young, James E. Allison
11 Approach to the patient with unintentional weight loss, 183
Andrew W. DuPont
12 Approach to the patient with obesity, 191
Louis A. Chaptini, Steven R. Peikin
13 Approach to the patient with nausea and vomiting, 205
William L. Hasler
14 Approach to the patient with abdominal pain, 228
Pankaj Jay Pasricha
15 Approach to the patient with gas and bloating, 255
William L. Hasler
16 Approach to the patient with acute abdomen, 271
Rebecca M. Minter, Michael W. Mulholland
v
9781405169103_1_pre.qxd 3/6/08 1:16 PM Page vi
CONTENTS
17 Approach to the patient with ileus and obstruction, 287
Klaus Bielefeldt, Anthony J. Bauer
18 Approach to the patient with diarrhea, 304
Don W. Powell
19 Approach to the patient with suspected acute infectious diarrhea, 360
John D. Long, Ralph A. Giannella
20 Approach to the patient with constipation, 373
Satish S.C. Rao
21 Approach to the patient with abnormal liver chemistries, 399
Richard H. Moseley
22 Approach to the patient with jaundice, 422
Raphael B. Merriman, Marion G. Peters
23 Approach to the patient with ascites and its complications, 442
Guadalupe Garcia-Tsao
24 Approach to the patient with central nervous system and pulmonary complications of
end-stage liver disease, 467
Javier Vaquero, Andres T. Blei, Roger F. Butterworth
25 Approach to the patient with acute liver failure, 492
Ryan M. Taylor, Robert J. Fontana
26 Approach to the patient with chronic viral hepatitis B or C, 516
Sammy Saab, Hugo Rosen
27 Approach to the patient with a liver mass, 526
John A. Donovan, Edward G. Grant
28 Approach to gastrointestinal and liver diseases in pregnancy, 534
Willemijntje A. Hoogerwerf
29 General nutritional principles, 557
David H. Alpers, Beth Taylor, Samuel Klein
30 Approach to the patient requiring nutritional supplementation, 588
David H. Alpers, Beth Taylor, Samuel Klein
31 Genetic counseling for gastrointestinal patients, 624
Cindy Solomon, Deborah W. Neklason, Angela Schwab, Randall W. Burt
Index, 645
vi
9781405169103_1_pre.qxd 3/6/08 1:16 PM Page vii
Contributors
David A. Ahlquist, MD Louis A. Chaptini, MD Ralph A. Giannella, MD
Professor of Medicine Assistant Professor of Medicine Mark Brown Professor of Medicine
Mayo Clinic College of Medicine; Division of Gastroenterology and Liver Diseases Division of Digestive Diseases
Consultant, Division of Gastroenterology Cooper University Hospital University of Cincinnati College of Medicine
and Hepatology Robert Wood Johnson Medical School Cincinnati, Ohio, USA
Mayo Clinic University of Medicine and Dentistry of New Jersey
Rochester, Minnesota, USA Camden, New Jersey, USA David Y. Graham, MD
Professor of Medicine and Molecular Virology
James E. Allison, MD, FACP, AGAF Ray E. Clouse, MD and Microbiology
Clinical Professor of Medicine Emeritus Professor of Medicine and Psychiatry Michael E. DeBakey Veterans Affairs Medical
University of California, San Francisco; Late of Division of Gastroenterology Center
Division of Gastroenterology Washington University School of Medicine; Baylor College of Medicine
San Francisco General Hospital; Physician, late of Department of Medicine Houston, Texas, USA
Adjunct Investigator, Kaiser Division of Research Barnes-Jewish Hospital
San Francisco, California, USA St Louis, Missouri, USA Edward G. Grant, MD
Professor and Chair
Anthony J. Bauer, PhD John A. Donovan, MD Department of Radiology
Associate Professor of Medicine Assistant Professor of Clinical Medicine Keck School of Medicine
Division of Gastroenterology Division of Gastrointestinal and Liver Diseases University of Southern California
University of Pittsburgh Keck School of Medicine Los Angeles, California, USA
Pittsburgh, Pennsylvania, USA University of Southern California
Los Angeles, California, USA Chandra Prakash Gyawali, MD,
Klaus Bielefeldt, MD, PhD MRCP
Andrew W. DuPont, MD,MSPH Associate Professor of Medicine
Associate Professor of Medicine
Assistant Professor, Internal Medicine Associate Program Director
Division of Gastroenterology
Division of Gastroenterology and Hepatology Division of Gastroenterology
University of Pittsburgh
The University of Texas Medical Branch Washington University School of Medicine
Pittsburgh, Pennsylvania, USA
Galveston, Texas, USA St Louis, Missouri, USA
Andres T. Blei, MD Grace H. Elta, MD William L. Hasler, MD
Professor of Medicine
Professor Professor
Division of Hepatology
Department of Internal Medicine Department of Internal Medicine
Feinberg School of Medicine
Division of Gastroenterology Division of Gastroenterology
Northwestern University
University of Michigan Health System University of Michigan Health System
Chicago, Illinois, USA
Ann Arbor, Michigan, USA Ann Arbor, Michigan, USA
Randall W. Burt, MD Robert J. Fontana, MD Gerald Holtmann, MD, PhD
Professor of Medicine Associate Professor Professor of Medicine
Division of Gastroenterology Department of Internal Medicine University of Adelaide;
University of Utah School of Medicine; Division of Gastroenterology Director, Department of Gastroenterology
Senior Director for Prevention and Outreach University of Michigan Health System and Hepatology
Huntsman Cancer Institute Ann Arbor, Michigan, USA Royal Adelaide Hospital
University of Utah Adelaide, South Australia, Australia
Salt Lake City, Utah, USA Guadalupe Garcia-Tsao, MD
Professor of Medicine Willemijntje A. Hoogerwerf, MD
Roger F. Butterworth, PhD, DSc Section of Digestive Diseases Assistant Professor
Director, Neuroscience Research Unit Yale School of Medicine Department of Internal Medicine
Hôpital Saint-Luc New Haven, Connecticut; Division of Gastroenterology
University of Montreal Veterans Affairs Connecticut Healthcare System University of Michigan Health System
Montreal, Quebec, Canada West Haven, Connecticut, USA Ann Arbor, Michigan, USA
vii
9781405169103_1_pre.qxd 3/6/08 1:16 PM Page viii
CONTRIBUTORS
John M. Inadomi, MD Bruce D. Naliboff, PhD Division of Gastroenterology;
Dean M. Craig Endowed Chair in UCLA Center for Neurovisceral Sciences and Director, Training Program in Gastrointestinal
Gastrointestinal Medicine Women’s Health Epidemiology
Director, GI Health Outcomes, Policy and David Geffen School of Medicine University of Michigan Health System
Economics (HOPE) Research Program University of California, Los Angeles Ann Arbor, Michigan, USA
University of California, San Francisco; Los Angeles, California, USA
Chief, Clinical Gastroenterology Angela Schwab, MS, CGC
San Francisco General Hospital Deborah W. Neklason, PhD Cardiovascular Research Manager
San Francisco, California, USA Research Assistant Professor Intermountain Healthcare
Department of Oncological Sciences Salt Lake City, Utah, USA
Samuel Klein, MD HUnuinvtesrmsiatyn oCfa Unctaehr Institute Andrew H. Soll, MD
William H. Danforth Professor of Medicine and
Salt Lake City, Utah, USA Professor, David Geffen School of Medicine
Nutritional Science
University of California, Los Angeles;
Center for Human Nutrition Pankaj Jay Pasricha, MD Attending Physician, Veterans Affairs Greater
Washington University School of Medicine
Professor of Medicine Los Angeles Healthcare System
St Louis, Missouri, USA
Chief, Division of Gastroenterology Los Angeles, California, USA
and Hepatology
Jeffrey M. Lackner, PsyD Stanford University School of Medicine Cindy Solomon, MS, CGC
Assistant Professor Stanford, California, USA MELARIS Product Manager
University at Buffalo Myriad Genetic Laboratories
The State University of New York Steven R. Peikin, MD Salt Lake City, Utah, USA
Buffalo, New York, USA Professor of Medicine
Division of Gastroenterology and Liver Diseases Mimi Takami, MD
John D. Long, MD Cooper University Hospital Assistant Professor
Associate Professor of Medicine Robert Wood Johnson Medical School Department of Internal Medicine
Section on Gastroenterology University of Medicine and Dentistry of New Jersey Division of Gastroenterology
Wake Forest University School of Medicine Camden, New Jersey, USA University of Michigan Health System
Winston-Salem, North Carolina, USA Ann Arbor, Michigan, USA
Marion G. Peters, MD
John V. Carbone, MD, Endowed Chair in Medicine Nicholas J. Talley, MD, PhD
Emeran A. Mayer, MD
Division of Gastroenterology Chair, Department of Internal Medicine
UCLA Center for Neurovisceral Sciences and
University of California, San Francisco Mayo Clinic Jacksonville
Women’s Health
San Francisco, California, USA Jacksonville, Florida;
David Geffen School of Medicine
Professor of Medicine and Epidemiology
University of California, Los Angeles Satish S.C. Rao, MD, PhD, FRCP Consultant, Division of Gastroenterology
Los Angeles, California, USA Professor of Medicine and Hepatology
Director, Neurogastroenterology and Mayo Clinic College of Medicine
Raphael B. Merriman, MD, MRCPI Gastrointestinal Motility Rochester, Minnesota, USA
Assistant Professor of Medicine University of Iowa Carver College of Medicine
Division of Gastroenterology Iowa City, Iowa, USA Beth Taylor, MS, RD, CNSD
University of California, San Francisco Nutrition Support Specialist
San Francisco, California, USA Joel E. Richter, MD Barnes-Jewish Hospital
Richard L. Evans Chair and Professor St Louis, Missouri, USA
Rebecca M. Minter, MD Department of Medicine
Temple University School of Medicine Ryan M. Taylor, MD, MSc
Assistant Professor
Department of Surgery Philadelphia, Pennsylvania, USA Fellow
UAnninv Aerrsbitoyr ,o Mf Micihcihgiagna,n U HSeAalth System Hugo Rosen, MD, FACP DDeivpiasirotmn eonf tG oafs Itnroteernntaelr oMloegdyicine
Waterman Professor of Medicine and Immunology University of Michigan Health System
Richard H. Moseley, MD Endowed Chair in Liver Research Ann Arbor, Michigan, USA
Division Head, Gastroenterology and Hepatology
Professor University of Colorado Health Sciences Center Javier Vaquero, MD
Department of Internal Medicine
Aurora, Colorado, USA Postdoctoral Research Fellow
Division of Gastroenterology
Neuroscience Research Unit
University of Michigan Health System; Sammy Saab, MD, MPH Hôpital Saint-Luc
Chief, Medical Service Head, Outcomes Research in Hepatology University of Montreal
Veterans Affairs Ann Arbor Associate Professor of Medicine and Surgery Montreal, Quebec, Canada
Healthcare System David Geffen School of Medicine
Ann Arbor, Michigan, USA University of California, Los Angeles Graeme P. Young, MD, FRACP
Los Angeles, California, USA Professor of Gastroenterology
Michael W. Mulholland, MD, PhD Department of Medicine
Professor and Chair Philip S. Schoenfeld, MD, MSEd, Flinders University of South Australia;
Department of Surgery MSc(Epi) Director, Department of Gastroenterology
University of Michigan Health System Associate Professor Flinders Medical Centre
Ann Arbor, Michigan, USA Department of Internal Medicine Adelaide, South Australia, Australia
viii
9781405169103_1_pre.qxd 3/6/08 1:16 PM Page ix
Preface
The Textbook of Gastroenterologywas launched over 20 years basic science underlying these diseases, as well as the many
ago, and from the beginning it was designed to be an encyclo- diagnostic and therapeutic modalities available to the
pedic discussion of all of the disease states encountered in patients who suffer from them.
clinical practice by gastroenterologists, internists, surgeons, We are delighted to have a new publisher, Wiley-Blackwell,
and other clinicians who see patients with gastrointestinal for this edition. Their keen insight into the publishing indus-
and liver disorders. A major component of the Textbookwas a try and the way in which textbooks are utilized today has
section that described the approaches a clinician might take been the basis forcreating the Principles. We are also grateful
to common symptoms and signs presented by patients with for their knowledge of the international world of medicine,
such disorders. This section has proved to be an invaluable which will help us to distribute the contents of the Principles
resource for students, house officers, and practitioners who to a global audience. The editors would like especially to
are not primarily gastroenterologists. To meet the needs of thank Elisabeth Dodds at Wiley-Blackwell, whose commit-
these readers more effectively we have expanded on the con- ment to excellence has contributed materially to the quality of
cept embodied in the chapters comprising that section of the the book. In addition, without the assistance of Alison Brown
Textbook and formatted them into a separate textbook in thePrincipleswould not have been published.
its own right, which we have titled Principles of Clinical Our efforts were especially facilitated by the expert assis-
Gastroenterology. It is designed to inform the reader on the fea- tance of Lori Ennis and Barbara Boughen, who collaborated
tures of the major clinical disorders in gastroenterology and as a team complementing editorial talents with interpersonal
hepatology, from the point of view of the clinician observing skills, to maintain the high quality of the text and deliver the
signs and symptoms of a patient under care and manage- manuscripts in a timely fashion. The editors are indebted to
ment. We hope that the Principleswill be a practical guide to their administrative and secretarial assistants, Patricia Lai,
diagnosis and decision making in clinical practice and pro- Terri Astin, Jennifer Mayes, Sue Sparrow, Patty Poole, Gracie
vide a rich source of information on diseases ofthe gastroin- Bernal-Muñoz, and Maria L. Vidrio.
testinal tract and the liver. Of course, we refer the reader of
the Principles to the Textbook for in-depth discussion of the Tadataka Yamada, MD
ix
9781405169103_4_001.qxd 3/5/08 5:14 PM Page 1
1
Clinical decision making
Philip S. Schoenfeld
What is evidence-based medicine? 1
Critical appraisal of an article about a diagnostic test, 2
Critical appraisal of an article about a therapy, 7
Conclusions, 12
effects and costs of a medication when deciding a specific
What is evidence-based medicine? treatment. Also, a specific patient may not fit the criteria for
enrollment of patients into a randomized controlled trial
David Sackett, the “father” of evidence-based medicine (EBM) (RCT). For example, an RCT demonstrated that rifaximin, a
stated that EBM is “the conscientious and judicious use of nonabsorbable antibiotic, improved bloating in Lebanese
current best evidence from clinical care research in the man- patients [3]. Will bloating (and other gastrointestinal symp-
agement of individual patients” [1]. Terms used in this defini- toms) improve if rifaximin is used in patients with irrit-
tion can be explained as follows. able bowel syndrome (IBS) in the United States? If we assume
• Conscientious use implies that physicians review articles that these results are applicable to patients with IBS in the
about clinical research and apply this information to clinical United States, then is it worthwhile to use a treatment
decision making. that may only produce a temporary relief of symptoms?
• Current best evidence from clinical care researchimplies that What if the patient had a past history of Clostridium difficile
physicians systematically appraise the methods and results colitis after a course of ciprofloxacin? Would the patient be
of clinical research articles using EBM tools. With these tools, willing to risk another case of C.difficilecolitis? What if the
physicians can separate the “wheat from the chaff” when patient does not have insurance and would have to pay $200
reading medical journals and identify poorly designed stud- for this prescription? These questions are qualitative ques-
ies that will produce biased results and should be discarded tions that require clinical judgments on the part of the patient
before being applied to patient care. This chapter will focus and the physician [4]. Although the best evidence from an
on techniques to identify and interpret the best evidence from RCT [3] may identify an effective treatment for bloating, both
properly designed research articles. physician judgment and patient preferences must also be
• Judicious use implies that a physician’s experience and used for effective clinical decision making. Thus, EBM and a
patient’s preferences are crucial components of decision reliance on best evidence is not intended to be “cookbook”
making and that these judgments must be balanced with the medicine [2].
data from best evidence. Nevertheless, EBM is a helpful tool for the quantitative
Judicious use of best evidenceis a particularly important con- aspect of clinical decision making, which arises from a sys-
cept to understand [2]. Many critics state that the practice tematic examination of study methodology and study results
of EBM is “cookbook” medicine that devalues the judgment [2]. The medical literature is expanding at an exponential rate
of a clinician and the values of an individual patient. This [5], and the time available for reading may be hurried and
interpretation is inaccurate. Physicians must consider a fragmented. Physicians need tools to build a framework for
patient’s preferences about the potential benefits and side the rapid evaluation of the methodology and results of pub-
lished 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
Principles of Clinical Gastroenterology. E dited by Tadataka Yamada results and should be applied to patient care. Studies using
© 2008 Blackwell Publishing. ISBN: 978-1-405-16910-3 improper methodology and biased results are quickly identi-
fied and ignored.
1