The Dyspepsia Alphabet: DU, GU, GERD, NERD, NUD/FD and UD

The care of patients with dyspepsia may be almost as confusing as the many terms that are used to describe this very common symptom. A symptom-based approach may prove to be ideal for the patient with undiagnosed dyspepsia. This brief overview describes some of the many terms used to describe dyspepsia. Clearly, new treatment algorithms are needed for the care of patients with undiagnosed dyspepsia seen in a primary care setting

A Gastroenterologist’s Perspective of The Medical Management of Patients with Crohn’s Disease and Ulcerative Colitis

Medical therapy in patients with inflammatory bowel disease (IBD) has specific objectives that need to be remembered when considering any form of intervention. These objectives include to improve the quality of life, to improve symptoms, to improve nutrition and reduce the risk of nutritional deficiencies, to reduce the frequency and severity of recurrences, to reduce complications, including the need for surgery, and to cure the disease. Medical therapy potentially helps to achieve all of these objectives for sufferers of IBD, except the last one – until the pathogenesis of the recurrent or continuous episodes of bowel inflammation is better understood, this last objective will remain "a riddle, wrapped in a mystery, inside an enigma"

Impact of PPIs on patient focused symptomatology in GERD

About half of patients with gastroesophageal reflux disease (GERD) have a normal endoscopy, so symptom assessment is the only appropriate outcome measure for these persons. Symptom assessment is also of great importance in persons with erosive esophagitis. There is currently no fully validated questionnaire to compare symptom response to treatment of patients with GERD. The aim of this review is to consider ReQuest™ assessment tool to evaluate esophageal, supra-esophageal, and infra-esophageal symptoms, as well as any modification of the patient’s quality of life. The ReQuest™ may be combined with the Los Angeles classification of esophagitis (LA A–D), to include the normal endoscopic finding in normal endoscopy reflux disease. The ReQuest™ score declines rapidly towards normal with patient treatment with a proton pump inhibitor. A proportion of patients need more than the usual 8 weeks of therapy. For example, in GERD patients with Los Angeles B–D, the ReQuest™ score falls more with pantoprazole 40 mg than with esomoprazole 40 mg after 12 weeks of therapy. Now that the simplified ReQuest in Practice™ is available, this validated brief questionnaire has potential as an instrument for use in GERD patients seen in everyday clinical practice

The European Community and the Requirement of a Republican Form of Government

The European Community - that is, the factual entity composed of three legally separate communities which has been and still is one of the basic concerns of Eric Stein - cannot be understood without taking into account European history after 1933. As an irony of history, the stage for a new beginning was set by the man who destroyed the old Europe and who was the reason that so many academics left the old country for the new world. This new start was not only influenced by the determination of those Europeans who had lived through the darkness to overcome the dangers of rivalry but also by those European-Americans who were able to build the bridges between the old country of liberty and a Europe trying to find new structures. The role played by lawyers, historians and social scientists familiar with both the old world and the emerging new Europe is a story that remains to be written for the benefit of younger generations

European Integration Through Fundamental Rights

The conception of fundamental rights as natural rights of human beings developed in European legal thinking mainly in the seventeenth and eighteenth centuries. John Locke, Jean-Jacques Rousseau, and also Immanuel Kant should be mentioned. But it was in the new world that the principles of fundamental human rights were first put into practice. A little more than ten years after the first American declarations, the Declaration des droits de l\u27homme et du citoyen was adopted in Paris; it remains part of French constitutional law today. But, unlike the development in the United States, the French guarantees could not be enforced by judges. The legislature was seen as the last arbiter of whether or not a specific regulation could be accepted as compatible with the bill of rights. As soon as the legislature had adopted a law, that law could not be challenged. In 1958 a very limited challenge became possible, through the Conseil Constitutionnel, but only before the formal promulgation of the law

A changed climate for mental health care delivery in South Africa

Objective: Traditional health practice was recently mainstreamed in South Africa by the promulgation of the Traditional Health Practitioners Act, No. 35 of 2004. Due to the extent of integration of mental health in the legal definition of traditional health practice, promulgation of this Act also has significant implications for mental health care delivery. This paper explored the documented interface of traditional health practice with mental health care in South Africa over the past almost 50 years. Method: A preliminaryoverview of health literature was done on formal mental health care and traditional alternatives in South Africa since the 1950’s. Important themes were identified as first step in a qualitative approach to identify concepts. Results: The search yielded 143 references, between 1958 and 2004, from articles, case reports, scientific letter, theses and chapters in books. A cross section of 56 references was selected for inclusion in this review of the material. Conclusion: The documentation on the interface betweenthe two parallel systems contribute to establish a context against which the promulgation of the legislation to formally integrate and regulate African traditional health practice in South Africa can be considered. South African policy makers may now have ensured that a multi-faceted, multi-cultural and multi-cosmological context for health and mental health care delivery has come to pass. To health administrators, though, the inclusion of traditional healers into the formal public health system and mental healthmay still prove to be too costly to implement

Acute mental health care and South African mental health legislation Part 1- morbidity, treatment and outcome

Objective: This is the first of three reports on a follow-up review of mental health care at Helen Joseph Hospital (HJH). In this first part, qualitative and quantitative descriptions were made of the services and of demographic and clinical data on acute mental health care users managed at HJH, in a retrospective review of clinical records over a four year period. Objectives for this review were to provide information on mental health care outcome, to do a cost analysis and to establish a quality assurance cycle that may facilitate a cost centre management approach. The operational areas identified were service delivery, teaching, and research. Activities within each area were in-patient care, out-patients and consultation/liaison, under- and postgraduate teaching and self initiated or contract research. Method: The study reviewed the existing mental health care program and activities in context of relevant policy and legislation. Results: Norms from a World Health Organization model for acute mental health care showed that significant staff shortages existed, especially for nursing. A total of 520 users were admitted for in-patient mental health care during the financial year 2007/08. The average length of stay was 15.4 days and ranged from 1 to 85 days. Ninety users (17%) had an extended period of stay of 25 days and more, while 39 users had multiple admissions during the 12 month period. The most common Axis I diagnoses made were schizophrenia n=138 (29%), substance-related conditions n=99 (21%) and bipolar mood disorder n=69 (14%). After discharge, 139 users (27%) were referred back to the HJH out-patient department for follow-up. Conclusion: The information from these reports may be used in the allocation of adequate resources to align this acute unit with its responsibilities according to recent legislation.Key words: Mental health service; Legislation; South Afric

Small Bowel Review - Part II

Significant advances have been made in the study of the small bowel. Part II of this two-part review of the small bowel examines the early development and later ageing of the small bowel; the effect of diabetes, alcohol, radiation and HIV on the small bowel; enteral and parenteral nutrition; the brush border membrane and enterocyte proliferation; and peptide hormones (including transforming growth factors, motilin, peptide YY and cholecystokinin)

Tracking the legal status of a cohort of inpatients on discharge from a 72-hour assessment unit

Scientific Lette