Terapie nemocí horní části trávicího traktu se odvíjí převážně od anamnestických údajů. V selektovaných případech je indikováno specializované gastroenterologické vyšetření a endoskopie. V terapii nemocí horní části trávicího traktu dominuje léčba inhibující produkci žaludeční kyseliny. Její nasazení a doba podávání vychází z charakteru onemocnění a kontroly vývoje stavu pacienta. U významné části zvláště geriatrických pacientů je indikace pro podávání inhibitorů protonové pumpy nejasná a podávání je zbytečné s teoretickým zvýšením rizika nežádoucích účinků. Přístup k pacientům s chorobami horní části trávicího traktu a cesty k racionální preskripci a způsoby vysazování neindikované terapie jsou zmíněny v přehledovém článku. Korespondenční adresa: doc. MUDr. Radek Kroupa, Ph.D. Interní gastroenterologická klinika LF MU a FN Brno Jihlavská 20, 625 00 Brno e-mail: kroupa.radek@fnbrno.cz
The management of diseases of the upper gastrointestinal tract is based on anamnestic data mainly. In selected cases, specialized gastroenterological examination and endoscopy are indicated. Therapy of upper gastrointestinal tract disorders is usually based on treatment inhibiting gastric acid production. Its initiation and duration of administration are based on the nature of the disease and follow-up of the patient’s condition. In a significant proportion of particularly geriatric patients, the indication for administration of proton pump inhibitors is unclear and their use is unnecessary, with a theoretical increase in the risk of adverse effects. The approach to patients with upper gastrointestinal tract diseases and pathways to rational prescription and ways of de-prescribing of non-indicated therapy are discussed in a review article.
- MeSH
- depreskripce MeSH
- diferenciální diagnóza MeSH
- dyspepsie farmakoterapie MeSH
- gastroezofageální reflux farmakoterapie MeSH
- gastrointestinální krvácení chemicky indukované prevence a kontrola MeSH
- inhibitory protonové pumpy aplikace a dávkování MeSH
- lidé MeSH
- nemoci trávicího systému * diagnóza farmakoterapie MeSH
- senioři MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Background: Degenerative cervical spinal cord compression is becoming increasingly prevalent, yet the MRI criteria that define compression are vague, and vary between studies. This contribution addresses the detection of compression by means of the Spinal Cord Toolbox (SCT) and assesses the variability of the morphometric parameters extracted with it. Methods: Prospective cross-sectional study. Two types of MRI examination, 3 and 1.5 T, were performed on 66 healthy controls and 118 participants with cervical spinal cord compression. Morphometric parameters from 3T MRI obtained by Spinal Cord Toolbox (cross-sectional area, solidity, compressive ratio, torsion) were combined in multivariate logistic regression models with the outcome (binary dependent variable) being the presence of compression determined by two radiologists. Inter-trial (between 3 and 1.5 T) and inter-rater (three expert raters and SCT) variability of morphometric parameters were assessed in a subset of 35 controls and 30 participants with compression. Results: The logistic model combining compressive ratio, cross-sectional area, solidity, torsion and one binary indicator, whether or not the compression was set at level C6/7, demonstrated outstanding compression detection (area under curve =0.947). The single best cut-off for predicted probability calculated using a multiple regression equation was 0.451, with a sensitivity of 87.3% and a specificity of 90.2%. The inter-trial variability was better in Spinal Cord Toolbox (intraclass correlation coefficient was 0.858 for compressive ratio and 0.735 for cross-sectional area) compared to expert raters (mean coefficient for three expert raters was 0.722 for compressive ratio and 0.486 for cross-sectional area). The analysis of inter-rater variability demonstrated general agreement between SCT and three expert raters, as the correlations between SCT and raters were generally similar to those of the raters between one another. Conclusions: This study demonstrates successful semi-automated compression detection based on four parameters. The inter-trial variability of parameters established through two MRI examinations was conclusively better for Spinal Cord Toolbox compared with that of three experts' manual ratings.
- Publikační typ
- časopisecké články MeSH
Impaired gait is one of the cardinal symptoms of degenerative cervical myelopathy (DCM) and frequently its initial presentation. Quantitative gait analysis is therefore a promising objective tool in the disclosure of early cervical cord impairment in patients with degenerative cervical compression. The aim of this cross-sectional observational cohort study was to verify whether an objective and easily-used walk and run test is capable of detecting early gait impairment in a practical proportion of non-myelopathic degenerative cervical cord compression (NMDCC) patients and of revealing any correlation with severity of disability in DCM. The study group consisted of 45 DCM patients (median age 58 years), 126 NMDCC subjects (59 years), and 100 healthy controls (HC) (55.5 years), all of whom performed a standardized 10-m walk and run test. Walking/running time/velocity, number of steps and cadence of walking/running were recorded; analysis disclosed abnormalities in 66.7% of NMDCC subjects. The DCM group exhibited significantly more pronounced abnormalities in all walk/run parameters when compared with the NMDCC group. These were apparent in 84.4% of the DCM group and correlated closely with disability as quantified by the modified Japanese Orthopaedic Association scale. A standardized 10-m walk/run test has the capacity to disclose locomotion abnormalities in NMDCC subjects who lack other clear myelopathic signs and may provide a means of classifying DCM patients according to their degree of disability.
- Publikační typ
- časopisecké články MeSH
