3篇
您的检索式：作者名="Michael D Crowell"
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| 1 | Effect of electrical stimulation of the lower esophageal sphincter in gastroesophageal reflux disease patients refractory to proton pump inhibitors显示文摘AIM: To evaluate the efficacy of lower esophageal sphincter(LES)-electrical stimulation therapy(EST) in a subgroup of patients that reported only partial response to proton pump inhibitors(PPIs) therapy, compared to a group of patient with complete response.METHODS: Bipolar stitch electrodes were laparoscopically placed in the LES and connected to an implantable pulse generator(EndoS tim BV, the Hague, the Netherlands), placed subcutaneously in the anterior abdominal wall. Stimulation at 20 Hz, 215 μsec, 3-8 m Amp in 30 min sessions was delivered starting on day 1 post-implant. Patients were evaluated using gastroesophageal reflux disease(GERD)-HRQL, symptom diaries; esophageal p H and esophageal manometry before and up to 24 mo after therapy and results were compared between partial and complete responders.RESULTS: Twenty-three patients with GERD on LESEST were enrolled and received continuous per-protocol stimulation through 12 mo and 21 patients completed 24 mo of therapy. Of the 23 patients, 16(8 male, mean age 52.1 ± 12 years) had incomplete response to PPIs prior to LES-EST, while 7 patients(5 male, mean age 52.7 ± 4.7) had complete response to PPIs. In the sub-group with incomplete response to PPIs, median(IQR) composite GERD-HRQL score improved significantly from 9.5(9.0-10.0) at baseline on-PPI and 24.0(20.8-26.3) at baseline off-PPI to 2.5(0.0-4.0) at 12-mo and 0.0(0.0-2.5) at 24-mo follow-up(P < 0.05 compared to on-and off-PPI at baseline). Median(IQR) % 24-h esophageal pH < 4.0 at baseline in this sub-group improved significantly from 9.8%(7.8-11.5) at baseline to 3.0%(1.9-6.3) at 12 mo(P < 0.001) and 4.6%(2.0-5.8) at 24 mo follow-up(P < 0.01). At their 24-mo follow-up, 9/11 patients in this sub-group were completely free of PPI use. These results were comparable to the sub-group that reported complete response to PPI therapy at baseline. No unanticipated implantation or stimulation-related adverse events, or any untoward sensation due to stimulation were reported in either group and LES-EST was safely tolerated by both groups. CONCLUSION: LES-EST is safe and effective in controlling symptoms and esophageal acid exposure in GERD patients with incomplete response to PPIs. These results were comparable to those observed PPI responders. | Edy Soffer Leonardo Rodríguez Patricia Rodriguez Beatriz Gómez Manoel G Neto Michael D Crowell | 2016 | World Journal of Gastrointestinal Pharmacology and Therapeutics2016，7，1： | 4 |
| 2 | Measures of patient radiation exposure during endoscopic retrograde cholangiography:Beyond fluoroscopy time显示文摘AIM:to determine whether fluoroscope time is a good predictor of patient radiation exposure during endoscopic retrograde cholangiopancreatography.METHODS:this is a prospective observational study of consecutive patients undergoing endoscopic retrograde cholangiopancreatography in a tertiary care setting.Data related to radiation exposure were collected.The following measures were obtained:Fluoroscopy time(FT),dose area product(DAP)and dose at reference point(DOSERP).Coefficients of determination were calculated to analyze the correlation between FT,DAP and DOSRP.Agreement between FT and DAP/DOSRP was assessed using Bland Altman plots.RESULTS:Four hundred sixty-three data sets were obtained.Fluoroscopy time average was 7.3 min.Fluoroscopy related radiation accounted for 86%of the total DAP while acquisition films related radiation accounted for 14%of the DAP.For any given FT there are wide ranges of DAP and DOSERP and the variability in both increases as fluoroscopy time increases.The coefficient of determination(R2)on the non transformed data for DAP and DOSERP versus FT were respectively 0.416 and0.554.While fluoroscopy use was the largest contributor to patient radiation exposure during endoscopic retrograde cholangiography(ERCP),there is a wide variability in DAP and DOSERP that is not accounted for by FT.DAP and DOSERP increase in variability as FT increases.This translates into poor accuracy of FT in predicting DAP and DOSERP at higher radiation doses.CONCLUSION:DAP and DOSERP in addition to FT should be adopted as new ERCP quality measures to estimate patient radiation exposure. | Toufic Kachaamy Edwyn Harrison Rahul Pannala William Pavlicek Michael D Crowell Douglas O Faigel | 2015 | World Journal of Gastroenterology2015，21，6： | 2 |
| 3 | Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea显示文摘 | Nicholas J Talley Eslie Helen Dennis V.Ann Schettler-Duncan Brian E Lacy Kevin W Olden Michael D Crowell | 2003 | The American Journal of Gastroenterology2003，，11： | 1 |
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