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| 1 | Distinctive aspects of peptic ulcer disease,Dieulafoy'slesion,and Mallory-Weiss syndrome in patients withadvanced alcoholic liver disease or cirrhosis显示文摘AIM:To systematically review the data on distinctive aspects of peptic ulcer disease(PUD),Dieulafoy’s lesion(DL),and Mallory-Weiss syndrome(MWS)in patients with advanced alcoholic liver disease(a ALD),including alcoholic hepatitis or alcoholic cirrhosis.METHODS:Computerized literature search performed via Pub Med using the following medical subject heading terms and keywords:'alcoholic liver disease','alcoholic hepatitis','alcoholic cirrhosis','cirrhosis','liver disease','upper gastrointestinal bleeding','nonvariceal upper gastrointestinal bleeding','PUD',‘‘DL’’,‘‘Mallory-Weiss tear',and'MWS’’.RESULTS:While the majority of acute gastrointestinal(GI)bleeding with a ALD is related to portal hypertension,about 30%-40%of acute GI bleeding in patients with a ALD is unrelated to portal hypertension.Such bleeding constitutes an important complication of a ALD because of its frequency,severity,and associated mortality.Patients with cirrhosis have a markedly increased risk of PUD,which further increases with the progression of cirrhosis.Patients with cirrhosis or a ALD and peptic ulcer bleeding(PUB)have worse clinical outcomes than other patients with PUB,including uncontrolled bleeding,rebleeding,and mortality.Alcohol consumption,nonsteroidal anti-inflammatory drug use,and portal hypertension may have a pathogenic role in the development of PUD in patients with a ALD.Limited data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic patients.The frequency of bleeding from DL appears to be increased in patients with a ALD.DL may be associated with an especially high mortality in these patients.MWS is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism,and is associated with a ALD.Patients with a ALD have more severe MWS bleeding and are more likely to rebleed when compared to non-cirrhotics.Preendoscopic management of acute GI bleeding in patients with a ALD unrelated to portal hypertension is similar to the management of a ALD patients with GI bleeding from portal hypertension,because clinical distinction before endoscopy is difficult.Most patients require intensive care unit admission and attention to avoid over-transfusion,to correct electrolyte abnormalities and coagulopathies,and to administer antibiotic prophylaxis.Alcoholics should receive thiamine and be closely monitored for symptoms of alcohol withdrawal.Prompt endoscopy,after initial resuscitation,is essential to diagnose and appropriately treat these patients.Generally,the same endoscopic hemostatic techniques are used in patients bleeding from PUD,DL,or MWS in patients with a ALD as in the general population.CONCLUSION:Nonvariceal upper GI bleeding in patients with a ALD has clinically important differences from that in the general population without a ALD,including:more frequent and more severe bleeding from PUD,DL,or MWS. | Borko Nojkov Mitchell S Cappell | 2016 | World Journal of Gastroenterology2016，22，1： | 26 |
| 2 | Gastrointestinal bleeding from Dieulafoy's lesion: Clinical presentation, endoscopic findings, and endoscopic therapy显示文摘Although relatively uncommon, Dieulafoy's lesion is an important cause of acute gastrointestinal bleeding due to the frequent difficulty in its diagnosis; its tendency to cause severe, life-threatening, recurrent gastrointestinal bleeding; and its amenability to life-saving endoscopic therapy. Unlike normal vessels of the gastrointestinal tract which become progressively smaller in caliber peripherally, Dieulafoy's lesions maintain a large caliber despite their peripheral, submucosal, location within gastrointestinal wall. Dieulafoy's lesions typically present with severe, active, gastrointestinal bleeding, without prior symptoms; often cause hemodynamic instability and often require transfusion of multiple units of packed erythrocytes. About 75% of lesions are located in the stomach, with a marked proclivity of lesions within 6 cm of the gastroesophageal junction along the gastric lesser curve, but lesions can also occur in the duodenum and esophagus. Lesions in the jejunoileum or colorectum have been increasingly reported. Endoscopy is the first diagnostic test, but has only a 70% diagnostic yield because the lesions are frequently small and inconspicuous. Lesions typically appear at endoscopy as pigmented protuberances from exposed vessel stumps, with minimal surrounding erosion and no ulceration(visible vessel sans ulcer). Endoscopic therapy, including clips, sclerotherapy, argon plasma coagulation, thermocoagulation, or electrocoagulation, is the recommended initial therapy, with primary hemostasis achieved in nearly 90% of cases. Dual endoscopic therapy of epinephrine injection followed by ablative or mechanical therapy appears to be effective. Although banding is reportedly highly successful, it entails a small risk of gastrointestinal perforation from banding deep mural tissue. Therapeutic alternatives after failed endoscopic therapy include repeat endoscopic therapy, angiography, or surgical wedge resection. The mortality has declined from about 30% during the 1970's to 9%-13% currently with the advent of aggressive endoscopic therapy. | Borko Nojkov Mitchell S Cappell | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，4： | 18 |
| 3 | Professional development and teacher learning: Mapping the terrain显示文摘 | Borko H | 2004 | Educational Researcher2004，33，8： | 1 |
| 4 | Under- standing Teacher Education Reform 显示文摘 | Borko Hilda Liston Dan Whitcomb Jennifer A | 2007 | Journal of Teacher Education2007，58，： | 1 |
| 5 | Information Science: What is it?显示文摘 | Borko H | 1968 | American Documentation1968，19，1： | 1 |
| 6 | Self-adapting control pa- rameters in differential evolution: a comparative study on numerical benchmark pro-blems显示文摘 | JANEZ B SASO G BORKO B | 2006 | IEEE Transactions on Evolutionary Comp-utation2006，12，10： | 1 |
| 7 | NCLB and Scientifically-Based Research: Opportunities Lost and Found 显示文摘 | Borko Hilda Liston Dan Whitcomb Jennifer A | 2007 | Journal of Teacher Education2007，58，： | 1 |
| 8 | Stranger than Fiction: Arthur Levine' s Educating School Teach- ers-the Basis for a Proposal 显示文摘 | Borko Hilda Liston Dan Whitcomb Jennifer A | 2007 | Journal of Teacher Edu- cation2007，58，： | 1 |
| 9 | Apples and Fishes: The Debate over Dispositions in Teacher Edu- cation 显示文摘 | Borko Hilda Liston Dan Whitcomb Jennifer A | 2007 | Journal of Teacher Education2007，58，： | 1 |
| 10 | Professional Development and Teacher Learning: Mapping the Terrain 显示文摘 | Borko H | 2004 | Educational Researcher2004，33，8： | 1 |
| 11 | Treatment of varicocele and Male fertility显示文摘 | Breznik R Vlaisavljevic V Borko E | | 0，，03： | 1 |
| 12 | Professional development and teacher learning: Mapping the terrain显示文摘 | BORKO H | 2004 | Educational Researcher2004，33，8： | 1 |
| 13 | Information Science: What is It?显示文摘 | BORKO H | 1968 | American- Documentation1968，19，1： | 1 |
| 14 | Professional Development and Teacher Learning: Mapping the Terrain 显示文摘 | Borko Hilda | 2004 | Educational Researcher2004，3，8： | 1 |
| 15 | Professional development and Teacher Learning:Mapping the Terrain显示文摘 | Borko H | | 0，，08： | 1 |
| 16 | Professional Development and Teacher Learning: Mapping the Terrain 显示文摘 | Borko H | 2004 | Educational Researcher2004，33，8： | 1 |
| 17 | Information Science :What is it? 显示文摘 | Harold Borko | 1968 | American Documentation1968，，1： | 1 |
| 18 | An Education President for the 21st Century 显示文摘 | Hilda Borko Jennie Whitcomb and Dan Liston | 2008 | Journal of Teacher Education2008，，59： | 1 |
| 19 | Student teaching portfolios: A tool for promoting reflective practice 显示文摘 | Borko H Michalec P Timmons M Siddle J | 1997 | Jour- nal of Teaching Education1997，48，5： | 1 |
| 20 | Professional development and teacher learning: Mapping the terrain显示文摘 | Borko H | 2004 | Educational Researcher2004，33，8： | 1 |
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