Volume 61 - 1998 - Fasc.4 - Symposium
Controversies in hepatogastroenterology The president's comments
No abstract available
A methodology for consensus conferences
Consensus conference is one of the methods proposed to develop clinical practice guidelines. This method is used when the topic is limited to a small numbers of questions (4 to 6) and when there is a controversy. This process is based on the meeting of a jury which reviews the scientific information provided by the literature and presented by experts. The consensus conference consists of three phases - A preliminary phase during which questions are well defined, experts and jury are choosen by a panel of organizers usually designed by scientific societies. In the jury there are multidisciplinary specialists, generalists practioners and other people such as nurses, economists, ... Experts conduct the review and analysis of the literature. The jury is informed by organizers about the methodology of a consensus conference and about the quality of scientific information available. - The second phase is the plenary session of the consensus conference. It lasts one or two days during which the expert&s texts and presentation are discussed by the jury and a public. - The third phase is the actual meeting of the jury, behind closed doors, during which conclusions and clinical practice guidelines are formulated. Dissemination of these guidelines is one of the major factors determining the impact of the consensus conference. These guidelines are usually mailed directly to the professionals concerned and published in scientific journals and disseminated via professional associations, universities, post graduate training bodies, The impact of the conference is assessed one or two years after and compared by the same method with the results of a preliminary survey before the conference. This process is long and expensive but is increasingly used because of the necessity for physicians to assimilate and to integrate into their daily clinical practice an increasing mass of scientific information.
Is automatic disinfection between each endoscopy mandatory ?
No abstract available
Is antiviral treatment (IFNα and/or Ribavirin) justified in cirrhosis related to hepatitis C virus ?
Aim : to assess the benefit risk ratio of interferon and ribavirin in the treatment of patients with post hepatitis C cirrhosis we summarize the spontaneous over mortality of this disease, and made an overview of the randomized trials and of other controlled studies. Results : in comparison to controls, patients with post hepatitis C cirrhosis have a 17 fold increase risk of dying from a liver disease that a control population, and a 6 fold increase from primary liver cancer. In France the hepatitis C epidemic which start in the sixties explains now the observed dramatic increase in mortality by primary liver cancer, both in men and women. Meta-analysis of randomized trials and controlled retrospective studies showed that interferon treatment is associated with a significant increase in ALT response at the end of the treatment, with a decrease in hepatocellular incidence as well as a decrease in mortality in comparison with controls. Very few data are published concerning ribavirin alone or in combination with interferon in patients with cirrhosis. Preliminary data suggest that this combination during 48 weeks permit to obtain in patients with compensated cirrhosis 20% of sustained virological response. The safety was acceptable but patients with low initial blood cells count must be carefully followed. In conclusion this overview clearly demonstrates a benefit-risk ratio in favor of treatment in patients with post hepatitis C cirrhosis by interferon.
Is it justified to give antisecretory drugs before an endoscopy in case of symptoms suggestive of gastro-oesophageal reflux disease ?
No abstract available
Is surgery the treatment of choice for long term control of gastro-esophageal reflux disease ?
No abstract available.
Results of the GLEM/LOK survey in Belgium
No abstract available
Gastro-intestinal decontamination in acute toxic ingestions
The overall mortality from acute poisoning is less than I % and the challenge for clinicians managing poisoned patients is to identify at an early stage those who are most at risk of developing serious complications and who therefore might potentially benefit from specific measures (decontamination, enhancement of elimination, pharmacological antidotes), in addition to general supportive care; and to avoid unuseful and potentially dangerous interventions in others.
Acute hepatitis due to poisoning
No abstract available.
Gastric motor and sensory function testing
No abstract available
Non ulcer dyspepsia and Helicobacter pylori
No abstract available
