Help
Subscribe


All of GastroHep is now free access! - Click here to register Read For FREE - Our full range of review articles
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Guido Tytgat Profile of Pete Peterson Profile of Peter Cotton Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Ethical approach to organ support in critically-ill patients with cirrhosis

A study in the latest issue of the Alimentary Pharmacology & Therapeutics considers an ethical approach to organ support in critically-ill patients with cirrhosis.

News image

Increasing numbers of patients are being admitted to hospital with decompensated chronic liver disease in the UK.

A significant proportion will develop complicating extra-hepatic organ dysfunction, but the selection of those who should be admitted to intensive care is complex and challenging.

Alcohol-related liver disease also presents complex ethical dilemmas.

Dr Berry and colleagues from the United Kindgom reviewed the recent survival analyses and explore differences in secondary and tertiary care; to highlight strengths and weaknesses of prognostic models, therapeutic advances and shifts in prognostic expectation. 

The researchers explored the ethical challenges presented by addiction and self- injury in an area of limited resource.

Previously ‘untreatable’ complications are now being managed successfully
Alimentary Pharmacology & Therapeutics

The researchers also searched PubMed for articles discussing ‘cirrhosis’, ‘prognosis’, ‘critical illness’, ‘organ failure’, ‘renal failure’, ‘alcohol’, ‘ethics’ and ‘addiction’.

The team explored particular ethical dilemmas encountered by colleagues.
 
With the findings and outcomes of the study, the prognosis has improved in many cirrhotic complications.

Historically poor outcomes in tertiary care may reflect a more complex patient cohort.

The team observed that previously ‘untreatable’ complications are now being managed successfully.

The doctor's found that estimates of survival are more accurate after a 48-hour period of supportive care.

Physicians are not best placed to make judgments with regard to deservingness, moral responsibility, rationing and access to organ support in cases of acute deterioration related to alcoholism, and the case for denying support must be made on purely medical grounds.
 
Dr Berry's team concludes, "An early, aggressive approach to organ support is justified."

"Further discussions between hepatologists and critical care physicians are required to determine acceptable burden-to-benefit ratios for prolonged intensive care support in young alcoholic patients."

Alimentary Pharmacology & Therapeutics 2012: DOI: 10.1111/apt.12133
26 November 2012

Go to top of page Email this page Email this page to a colleague

 01 April 2015

Advanced search
 01 April 2015 
Mortality rates for upper GI bleeds
 01 April 2015 
Analysis of liver fibrosis
 01 April 2015 
Obeticholic acid in primary biliary cirrhosis
 31 March 2015 
Hepatic fat and gallbladder polyps
 31 March 2015 
HCV-HIV co-infection combination therapy
 31 March 2015 
Placement of nasoenteral feeding tubes
 30 March 2015 
Minimally invasive approach in colorectal procedures
 30 March 2015 
Prevalence of IBD in USA residents of Indian ancestry
 30 March 2015 
Treatment of pediatric IBD
 27 March 2015 
Screening for fecal incontinence
 27 March 2015 
Deep remission in Crohn's disease
 27 March 2015 
Sexual functioning in IBD
 26 March 2015 
Survival of untreated hepatocellular carcinoma
 26 March 2015 
Antimicrobial therapy in cirrhosis with spontaneous bacterial peritonitis
 26 March 2015 
Metformin as a chemopreventive agent for Barrett's
 25 March 2015 
Genetics and Crohn's disease
 25 March 2015 
Mortality in Barrett’s–related T1 esophageal adenocarcinoma
 25 March 2015 
Cytomegalovirus and IBD
 24 March 2015 
Prevention of colorectal cancer after screening
 24 March 2015 
Functional GI disorders and body mass index
 24 March 2015 
Quality of life in children with fecal incontinence
 23 March 2015 
Fibrosis in NAFLD vs NASH
 23 March 2015 
The unmasking of Whipple's disease
 23 March 2015 
Predicting the quality of colon cancer care
 20 March 2015 
Screening for Barrett's esophagus
 20 March 2015 
Interventions for eosinophilic esophagitis
 20 March 2015 
Colorectal cancer risk and genetic variants
 19 March 2015 
Dedicated care for diverticular disease
 19 March 2015 
Hypnotherapy for IBS
 19 March 2015 
Poor mental and physical health in HCV
 18 March 2015 
Practice guidelines for colorectal polyps
 18 March 2015 
Out-of-hours endoscopy for upper GI bleeding
 18 March 2015 
H. pylori eradication and lipids
 17 March 2015 
H. pylori test-and-treat program and gastric cancer
 17 March 2015 
Adalimumab in Crohn’s disease
 17 March 2015 

Low-dose PPIs and GI bleeding in patients receiving aspirin

 16 March 2015 
Cholestasis of pregnancy with HCV
 16 March 2015 
Microscopic colitis
 16 March 2015 
Hybrid therapy for H. pylori
 13 March 2015 
Medicare patients and payments to gastroenterologists
 13 March 2015 
Appendectomy in ulcerative colitis
 13 March 2015 

Racial disparities in gluten-sensitive problems

 12 March 2015 
Predicting IBD in IBS patients
 12 March 2015 
Patient knowledge of IBS
 12 March 2015 
Nonceliac gluten sensitivity
 11 March 2015 

Prediction of malignant bile duct obstruction

 11 March 2015 
NAFLD–related hepatocellular carcinoma
 11 March 2015 
Assessment of eosinophilic esophagitis
 10 March 2015 
Risk for gastroesophageal reflux symptoms
 10 March 2015 
Poor disease course in pediatric ulcerative colitis
 10 March 2015 
Outcomes in Crohn's therapy
 09 March 2015 
Fibre usage in ulcerative colitis in remission
 09 March 2015 
Risk of C. difficile upon hospital admission
 09 March 2015 
Gastric Cancer detection during GI endosocopy
 06 March 2015 
Steroid therapy for eosinophilic esophagitis
 06 March 2015 
Second anti-TNF in IBD
 06 March 2015 
Efficacy of Hep E vaccine
 05 March 2015 
EPHXI polymorphism and esophageal cancer risk
 05 March 2015 
Infliximab and immunosuppressant therapy in ulcerative colitis
 05 March 2015 
Neuroendocrine carcinoma of the colon and rectum

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2015 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us