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Bedell A, Friedlander A. Management of Sexual Dysfunction in Gastrointestinal Disorders. Gastroenterol Clin North Am 2022; 51:815-828. [PMID: 36375998 DOI: 10.1016/j.gtc.2022.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients with gastrointestinal (GI) disorders are at increased risk of sexual dysfunction (SD) due to a combination of biomedical, psychological, social, and interpersonal factors. While most patients desire information on the impact of their GI disorder on sexual function, few providers initiate this conversation. GI providers should routinely assess their patients for SD, validate these concerns, and provide brief education and a referral for evaluation and/or treatment. Treatment of sexual concerns is often multidisciplinary and may involve a sexual medicine physician, pelvic floor physical therapists, and sex therapists.
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Affiliation(s)
- Alyse Bedell
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, MC 3077, Chicago, IL 60637, USA.
| | - Alana Friedlander
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, MC 3077, Chicago, IL 60637, USA; Department of Psychology, Roosevelt University, 430 South Michigan Avenue, Chicago, IL 60605, USA
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Romano L, Pellegrino R, Sciorio C, Barone B, Gravina AG, Santonastaso A, Mucherino C, Astretto S, Napolitano L, Aveta A, Pandolfo SD, Loizzo D, Giudice FD, Ferro M, Imbimbo C, Romano M, Crocetto F. Erectile and sexual dysfunction in male and female patients with celiac disease: A cross-sectional observational study. Andrology 2022; 10:910-918. [PMID: 35419983 PMCID: PMC9324123 DOI: 10.1111/andr.13186] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sexual function is often impaired in patients with chronic illnesses. Several patients with chronic gastrointestinal and liver disorders have been shown to suffer from sexual dysfunction, and celiac disease (CD) is a highly prevalent gastroenterological disorder. AIM The aim of this study was to investigate the sexual function incidence and the risk factors for SD in both male and female CD patients. METHODS Two hundred and eighty-four patients (170 females, 114 males) participated in this cross-sectional, observational study in an anonymous manner. Female sexual function was assessed through the FSFI questionnaire. Male sexual function was assessed through the IIEF-5 questionnaire. Clinical-demographic variables were recorded. We investigated differences in the patient-reported outcomes among the different subgroups and whether there were clinic-demographic predictors of SD in our setting. MAIN OUTCOME MEASURES Prevalence and assessment of sexual dysfunction in CD patients. RESULTS In the female group, 85 subjects (50%) had a total score compatible with sexual dysfunction: 43 (61.42 %) showed low desire, 79 (46.47 %) showed arousal disorder, 66 (38.82 %) lubrication disorder, 84 (49.41 %) inability of obtaining an orgasm. Also, a large proportion of our female patients, 161 (94.70 %), showed sexual discomfort during intercourse. In the male group, 79 patients (62.2%) showed scores compatible with normal erectile function, 8 (7.01%) had mild erectile dysfunction, 24 (21.05%) mild to moderate erectile dysfunction, and 3 (2.63%) presented severe erectile dysfunction. Altered BMI was significantly associated with SD both in male and female patients. Early age at diagnosis was a significant predictor of SD in male CD patients. CONCLUSIONS A significant proportion of CD patients present SD. Early age at diagnosis and high BMI seem to predict SD in this clinical setting. Assessment of sexual function should be part of the initial evaluation of CD patients in order to establish a prompt diagnosis and early treatment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lorenzo Romano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Raffaele Pellegrino
- Hepato-Gastroenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Antonietta Gerarda Gravina
- Hepato-Gastroenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Santonastaso
- Hepato-Gastroenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Caterina Mucherino
- Gastroenterology Unit, "Sant'Anna and San Sebastiano" Hospital, Caserta, Italy
| | - Silvia Astretto
- Gastroenterology Unit, "Sant'Anna and San Sebastiano" Hospital, Caserta, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Achille Aveta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy.,Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - Davide Loizzo
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy.,Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Policlinico "Umberto I" Hospital, University of Rome "La Sapienza", Rome, Italy.,Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology IRCSS, Milan, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Marco Romano
- Hepato-Gastroenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
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Romano L, Granata L, Fusco F, Napolitano L, Cerbone R, Priadko K, Sciorio C, Mirone V, Romano M. Sexual Dysfunction in Patients With Chronic Gastrointestinal and Liver Diseases: A neglected Issue. Sex Med Rev 2021; 10:620-631. [PMID: PMID: 37051954 DOI: 10.1016/j.sxmr.2021.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Normal sexual activity is an important determinant of quality of life. Unfortunately, several chronic health disorders are associated with an impaired sexual function. OBJECTIVE To provide coverage of the current literature on prevalence and pathophysiology of sexual dysfunction in patients with gastrointestinal and liver disorders METHODS: A Comprehensive review of the literature on the prevalence of sexual dysfunction in chronic gastrointestinal and liver disorders, assessing the underlying mechanism (s) was performed. RESULTS Many gastrointestinal disorders, either functional or organic, are associated with some degree of sexual dysfunction. The main pathogenic mechanisms are: (i) the disease itself causing fatigue, anxiety or depression with a potential alteration of self-esteem; (ii) worry of transmitting a potential infectious agent through sexual activity; (iii) alteration of the endocrine mechanisms which are necessary for normal sexual functioning; (iv) chronic pro- inflammatory conditions which may cause endothelial dysfunction and abnormal vascular responses; (v) iatrogenic. CONCLUSION Based on this review, a thorough evaluation of sexual function through validated questionnaires and/or psychological interviews with patients with chronic gastrointestinal disorders should be part of the clinical assessment in order to timely diagnose and possibly treat sexual dysfunction in this clinical setting. L Romano, L Granata, F Fusco, et al. Sexual Dysfunction in Patients With Chronic Gastrointestinal and Liver Diseases: A neglected Issue. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Lorenzo Romano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Lucia Granata
- Dipartimento di Medicina di Precisione, Hepato-Gastroenterology Unit, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Ferdinando Fusco
- Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Rosa Cerbone
- Dipartimento di Medicina di Precisione, Hepato-Gastroenterology Unit, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Kateryna Priadko
- Dipartimento di Medicina di Precisione, Hepato-Gastroenterology Unit, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | | | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Marco Romano
- Dipartimento di Medicina di Precisione, Hepato-Gastroenterology Unit, Università della Campania Luigi Vanvitelli, Napoli, Italy
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Kaufman KR, Coluccio M, Linke M, Noonan E, Babalola R, Aziz R. Alprazolam-induced dose-dependent anorgasmia: case analysis. BJPsych Open 2018; 4:274-277. [PMID: 30083378 PMCID: PMC6066992 DOI: 10.1192/bjo.2018.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sexual dysfunctions are associated with multiple medical and psychiatric disorders, as well as pharmacotherapies used to treat these disorders. Although sexual dysfunctions negatively affect both quality of life and treatment adherence, patients infrequently volunteer these symptoms and clinicians do not pose directed questions to determine their presence or severity. This issue is especially important in psychiatric patients, for whom most common psychotropics may cause sexual dysfunctions (antidepressants, antipsychotics, anxiolytics and mood-stabilising agents). There is limited literature addressing benzodiazepines, and alprazolam in particular. AIMS To report dose-dependent alprazolam anorgasmia. METHOD Case analysis with PubMed literature review. RESULTS A 30-year-old male psychiatric patient presented with new-onset anorgasmia in the context of asymptomatic generalised anxiety disorder, social anxiety, panic disorder with agoraphobia, obsessive-compulsive disorder, major depression in remission, and attention-deficit hyperactivity disorder treated with escitalopram 10 mg q.a.m., gabapentin 1000 mg total daily dose, lisdexamfetamine dimesylate 70 mg q.a.m., nortriptyline 60 mg q.h.s. and alprazolam extended-release 2.5 mg total daily dose. All psychotropic doses had been constant for >6 months excluding alprazolam, which was titrated from 1 mg to 2.5 mg total daily dose. The patient denied any sexual dysfunction with alprazolam at 1 mg q.d. and 1 mg b.i.d. Within 1 week of increasing alprazolam to 2.5 mg total daily dose, the patient reported anorgasmia. Anorgasmia was alprazolam dose-dependent, as anorgasmia resolved with reduced weekend dosing (1 mg b.i.d. Saturday/1.5 mg total daily dose Sunday). CONCLUSIONS Sexual dysfunction is an important adverse effect negatively influencing therapeutic outcome. This case reports alprazolam-induced dose-dependent anorgasmia. Clinicians/patients should be aware of this adverse effect. Routine sexual histories are indicated. DECLARATION OF INTEREST None.
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Affiliation(s)
- Kenneth R Kaufman
- Department of Psychiatry, Department of Neurology, and Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, USA
| | - Melissa Coluccio
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, USA
| | - Michelle Linke
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, USA
| | - Elizabeth Noonan
- Department of Psychology, School of Arts and Sciences, Rutgers University, USA
| | - Ronke Babalola
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, USA
| | - Rehan Aziz
- Department of Psychiatry and Department of Neurology, Rutgers Robert Wood Johnson Medical School, USA
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Kaufman KR, Coluccio M, Sivaraaman K, Campeas M. Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review. BJPsych Open 2017; 3:249-253. [PMID: 29034101 PMCID: PMC5627137 DOI: 10.1192/bjpo.bp.117.005538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/07/2017] [Accepted: 08/23/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Optimal anti-epileptic drug (AED) treatment maximises therapeutic response and minimises adverse effects (AEs). Key to therapeutic AED treatment is adherence. Non-adherence is often related to severity of AEs. Frequently, patients do not spontaneously report, and clinicians do not specifically query, critical AEs that lead to non-adherence, including sexual dysfunction. Sexual dysfunction prevalence in patients with epilepsy ranges from 40 to 70%, often related to AEDs, epilepsy or mood states. This case reports lamotrigine-induced sexual dysfunction leading to periodic non-adherence. AIMS To report lamotrigine-induced sexual dysfunction leading to periodic lamotrigine non-adherence in the context of multiple comorbidities and concurrent antidepressant and antihypertensive pharmacotherapy. METHOD Case analysis with PubMed literature review. RESULTS A 56-year-old male patient with major depression, panic disorder without agoraphobia and post-traumatic stress disorder was well-controlled with escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and alprazolam 1 mg tid prn. Comorbid conditions included complex partial seizures, psychogenic non-epileptic seizures (PNES), hypertension, gastroesophageal reflux disease and hydrocephalus with patent ventriculoperitoneal shunt that were effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam and lansoprazole 30 mg qam. He acknowledged non-adherence with lamotrigine secondary to sexual dysfunction. With lamotrigine 300 mg total daily dose, he described no libido with impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he described becoming libidinous with decreased erectile dysfunction but persistent anejaculation/anorgasmia. When off lamotrigine for 72 h to maximise sexual functioning, he developed auras. Family confirmed patient's consistent monthly non-adherence for 2-3 days during the past year. CONCLUSIONS Sexual dysfunction is a key AE leading to AED non-adherence. This case describes dose-dependent lamotrigine-induced sexual dysfunction with episodic non-adherence for 12 months. Patient/clinician education regarding AED-induced sexual dysfunction is warranted as are routine sexual histories to ensure adherence. DECLARATION OF INTEREST No financial interests. K.R.K. is Editor of BJPsych Open; he took no part in the peer-review of this work. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Kenneth R Kaufman
- , MD, FRCPsych, DLFAPA, FAES, Departments of Psychiatry, Neurology and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Melissa Coluccio
- , BS, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kartik Sivaraaman
- , MD, Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Miriam Campeas
- , BA, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Bor S, Valytova E, Yapali S, Yildirim E, Vardar R. Sexual activity does not predispose to reflux episodes in patients with gastroesophageal reflux disease. United European Gastroenterol J 2014; 2:482-9. [PMID: 25452843 DOI: 10.1177/2050640614550851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/16/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of sexual activity on gastroesophageal reflux disease (GERD) is an under-recognized concern of patients, and one rarely assessed by physicians. OBJECTIVE The objective of this article is to determine the influence of sexual activity on the intraesophageal acid exposure and acid reflux events in GERD patients. METHODS Twenty-one patients with the diagnosis of GERD were prospectively enrolled. Intraesophageal pH monitoring was recorded for 48 hours with a Bravo capsule. All patients were instructed to have sexual intercourse or abstain in a random order two hours after the same refluxogenic dinner within two consecutive nights. Patients were requested to have sex in the standard "missionary position" and women were warned to avoid abdominal compression. The patients completed a diary reporting the time of the sexual intercourse and GERD symptoms. The percentage of reflux time and acid reflux events were compared in two ways: within 30 and 60 minutes prior to and after sexual intercourse on the day of sexual intercourse and in the same time frame of the day without sexual intercourse. RESULTS Fifteen of 21 GERD patients were analyzed. The percentage of reflux time and number of acid reflux events did not show a significant difference within the 30- and 60-minute periods prior to and after sexual intercourse on the day of sexual intercourse and on the day without sexual intercourse, as well. CONCLUSION Sexual activity does not predispose to increased intraesophageal acid exposure and acid reflux events. Larger studies are needed to confirm our findings in patients who define reflux symptoms during sexual intercourse.
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Affiliation(s)
- Serhat Bor
- Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey ; Moscow Gastroenterology Research Institute, Russia
| | - Elen Valytova
- Moscow Gastroenterology Research Institute, Russia ; Ege Reflux Study Group, Izmir, Turkey
| | - Suna Yapali
- Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey ; Moscow Gastroenterology Research Institute, Russia
| | - Esra Yildirim
- Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey ; Moscow Gastroenterology Research Institute, Russia
| | - Rukiye Vardar
- Ege University School of Medicine, Division of Gastroenterology, Izmir, Turkey ; Moscow Gastroenterology Research Institute, Russia
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Tolone S, Docimo G, Del Genio G, Brusciano L, Verde I, Gili S, Vitiello C, D'Alessandro A, Casalino G, Lucido F, Leone N, Pirozzi R, Ruggiero R, Docimo L. Long term quality of life after laparoscopic antireflux surgery for the elderly. BMC Surg 2014. [PMID: 24267446 DOI: 10.1186/1471-2482-13-s2-s10\r1471-2482-13-s2-s10[pii]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. METHODS Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication. RESULTS Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG). CONCLUSIONS In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly.
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Tolone S, Docimo G, Del Genio G, Brusciano L, Verde I, Gili S, Vitiello C, D'Alessandro A, Casalino G, Lucido F, Leone N, Pirozzi R, Ruggiero R, Docimo L. Long term quality of life after laparoscopic antireflux surgery for the elderly. BMC Surg 2013; 13 Suppl 2:S10. [PMID: 24267446 PMCID: PMC3851040 DOI: 10.1186/1471-2482-13-s2-s10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. Methods Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication. Results Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG). There were 114 (36.6%) patients who filled out the SF36 questionnaire (98 in the younger group, rate: 37.4%; 16 in the elderly group, rate: 32.6%) pre- and post-operatively. There was no significant difference between the two age groups regarding preoperative PCS ( 45.6 ± 7.8 in YG vs. 44.2 ± 8.2 in EG; P = 0.51) and MCS ( 48.1 ± 10.7 in YG vs. 46.9 ± 9.2 in EG; P = 0.67). There was no significant difference between the two age groups regarding postoperative PCS (49.8 ± 11.9 in YG and 48.2 ± 9.5 in EG ; P = 0.61 and MCS (48.4 ± 10.7 in YG vs. 50.1 ± 6.9 in EG; P = 0.54). Conclusions In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly.
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Iovino P, Ciacci C. Respiratory physiotherapy in gerd: a proof-of-concept study on the increment of LES pressure. Respir Med 2013; 107:476-7. [PMID: 23266039 DOI: 10.1016/j.rmed.2012.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 11/01/2012] [Accepted: 11/03/2012] [Indexed: 02/07/2023]
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Alonso EC, Román ALS, de Miquel DB. Impacto de la enfermedad inflamatoria intestinal sobre la función sexual. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32 Suppl 2:50-4. [DOI: 10.1016/s0210-5705(09)72606-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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