南京医科大学第二附属医院消化医学中心

江苏省最大的消化内镜诊疗中心，南京医科大学消化内镜研究所．

内科学（消化内科专业）博士＼硕士培养基地．

江苏省唯一的卫生部消化内镜医师培训基地．

If I can help you, please send email to: njxhyxzx@163.com.

本博客将为大家提供大量的本专业信息资源！ 

饮食营养治疗应根据不同类型，给予适当的饮食。养成定时排便的习惯，避免经常服用泻药和灌肠，适当增加体力活动。

(一)痉挛性便秘

1．无粗纤维低渣饮食：先食低渣半流质饮食，禁食蔬菜及水果，后改为低渣软食。

2．适当增加脂肪，脂肪润肠，脂肪酸促进肠蠕动，有利于排便；但不宜过多，应

3．多饮水：饮水及饮料，保持肠道粪便中水分，以利于通便，如早晨饮蜂蜜水等。    

4．进食洋粉制品：洋粉在肠道吸收水分，使粪便软滑，有利排泄。

5．禁食刺激食物：禁止食用酒、浓茶、咖啡、辣椒、咖喱等刺激性食品。

(二)梗阻性便秘

   若为器质性病变引起的，应首先治疗疾病，去除病因；如直肠癌、结肠癌等。若为不完全性梗阻，可考虑给予清流质。饮食仅限于提供部分热能，并最低限度控制食物残渣，以胃肠外营养作为供给热能的主要方式。

(三)无力性便秘

1．含粗纤维饮食：多供给含粗纤维食物，刺激肠道，促进胃肠蠕动，增强排便能力。如粗粮、带皮水果、新鲜蔬菜等。长海医院研制的多纤维素速溶冲剂，口味好，每包20g；含粗纤维7g，每天1～2包温开水冲服并多饮水，临床使用治疗便秘效果满意。

2．多饮水：多饮水及饮料，使肠道保持足够的水分，有利粪便排出。

3．供给B族维生素：多食用含B族维生素丰富食物，可促进消化液分泌，维持和促进肠道蠕动，有利于排便。如粗粮、酵母、豆类及其制品等。

4．多食产气食物：多食易产气食物，促进肠蠕动加快，有利于排便；如洋葱、萝卜、蒜苗等。

5．高脂肪：适当增加高脂肪食物，植物油能直接润肠，且分解产物脂肪酸有刺激肠蠕动作用。如花生、芝麻、核桃及花生油、芝麻油、豆油等，每天脂肪总量可达lOOg。供给润肠通便食物，如洋粉及其制品、银耳羹等。

6．饮食禁忌：禁忌烟酒，及辛辣食物等，因这些食物对通便不利 

胃和十二脂肠溃疡发生部位和症状有所不同，但饮食治疗原则相同，最终目的是促进溃疡愈合，并防止复发。

（一）少量多餐定时定量；每天5～7餐，每餐量不宜多。少量多餐可中和胃酸，减少胃酸对溃疡面的刺激，又可供给营养，有利于溃疡面愈合，对急性消化性溃疡更为适宜。 　　

（二）避免刺激性食物机械性和化学性刺激过强食物应避免，机械性刺激增加对粘膜损伤，破坏粘膜屏障，如粗粮、芹菜、韭菜、雪莱、竹笋及干果类等。化学性刺激会增加胃酸分泌，对溃疡愈合不利，如咖啡、浓茶、烈酒、浓肉汤等。禁忌易产酸食物，如地瓜、土豆、过甜点心及糖醋食品等；易产气食物，如生葱、生蒜、生萝卜、蒜苗、洋葱等；生冷食物，如大量冷饮、冷拌菜等；坚硬的食物，如腊肉、火腿、香肠、蚌肉等；强烈的调味品，如胡椒粉、咖喱粉、芥末、辣椒油等。 　　

（三）选择细软易消化食物　　选择营养价值高，细软易消化的食物，如牛奶、鸡蛋、豆浆、鱼、瘦肉等。经加工烹调使其变得细软易消化、对胃肠无刺激。同时补充足够热能、蛋白质和维生素。营养素比例半流质期为碳水化物55％，蛋白质15％，脂肪30％；流质期为碳水化物60％，蛋白质20％，脂肪20％。　　1．蛋白质：蛋白质对胃酸起缓冲作用，可中和胃酸，但蛋白质在胃内消化又可促进胃酸分泌。应供给足够蛋白质以维持机体需要，每天按1g／kg供给，促进溃疡修复；若有贫血，至少应按1．5g／kg。　　2．脂肪不限量：不需严格限制脂肪，因其可抑制胃酸分泌。适量脂肪对胃肠粘膜没有刺激，但过高可促进胆囊收缩素分泌增加，抑制胃肠蠕动；胃内食物不易进入十二指肠，引起胃胀痛。可供给70～90g／d，应选择易消化吸收乳酪状脂肪，如牛奶、奶油、蛋黄、奶酪等，及适量植物油。　　3．多食碳水化物：既无刺激胃酸分泌作用，也不抑制胃酸分泌，每天可供给300～350g。选择易消化食物，如厚粥、面条、馄饨等。蔗糖不宜过多，因可使胃酸分泌增加，且易胀气。 　　

（四）供给丰富维生素　　选富含B族维生素、维生素A和维生素C的食品；主食以面食为主，出血时应禁食，血止吃流质饮食。

（五）烹调方法溃疡病所吃食物必须切碎煮烂；可选用蒸、煮、汆、软烧、烩、焖等烹调方法，不宜用油煎、炸、爆炒、醋溜、冷拌等方法加工食物。

（六）其他　　进食时应心情舒畅、细嚼慢咽、以利于消化。照顾患者的饮食习惯，配制可口饭菜。供给细软、粗纤维少食物，应注意预防便秘。睡前加餐，对十二指肠溃疡尤为适宜，可减少饥饿性疼痛，有利于睡眠。

                                                                             腹泻的饮食指导

南京医科大学第二附属医院消化医学中心

江苏省最大的消化内镜诊疗中心，南京医科大学消化内镜研究所．

内科学（消化内科专业）博士＼硕士培养基地．

江苏省唯一的卫生部消化内镜医师培训基地．

If I can help you, please send email to: njxhyxzx@163.com.

本博客将为大家提供大量的本专业信息资源！ 

一、饮食治疗目的

预防并纠正水及电解质平衡失调；供给充足营养，改善营养状况。避免机械性及化学性刺激，使肠道得到适当休息，有利于病情早日恢复。

二、饮食治疗原则

(一)急性腹泻饮食治疗

1．急性期禁食：急性水泻期需暂时禁食，使肠道完全休息。必要时由静脉输液，以防失水过多而脱水。

2．清淡流质饮食：不需禁食者，发病初宜给清淡流质饮食。如蛋白水、果汁、米汤、薄面汤等，以咸为主。早期禁牛奶、蔗糖等易产气的流质饮食。有些患者对牛奶不适应，服牛奶后常加重腹泻。

3．根据病情调整饮食：排便次数减少，症状缓解后改为低脂流质饮食，或低脂少渣、细软易消化的半流质饮食，如大米粥、藕粉、烂面条、面片等。

4．饮食选择：腹泻基本停止后，可供给低脂少渣半流质饮食或软食。少量多餐，以利于消化；如面条、粥、馒头、烂米饭、瘦肉泥等。仍应适当限制含粗纤维多的蔬菜水果等，以后逐渐过渡到普食。

5．补充维生素：注意复合维生素B和维生素C补充，如鲜桔汁、果汁、番茄汁、菜汤等。

6．饮食禁忌：禁酒，忌肥肉，坚硬及含粗纤维多的蔬菜、生冷瓜果，油脂多的点心及冷饮等。

(二)慢性腹泻饮食治疗

1．低脂少渣饮食：每天脂肪40g左右，过多不易消化并加重胃肠道负担，刺激胃肠蠕动加重腹泻。故植物油也应限制，并注意烹调方法，以蒸、煮、氽、烩、烧等为主，禁用油煎炸、爆炒、滑溜等。可用食物有瘦肉、鸡、虾、鱼、豆制品等。注意少渣，粗纤维多的食物能刺激肠蠕动，使腹泻加重，当腹泻次数多时最好暂时不吃或尽量少吃蔬菜和水果，可给予鲜果汁、番茄汁以补充维生素；少渣饮食可减少肠蠕动、减轻腹泻，故宜进食细挂面、粥、烂饭等。

2．高蛋白高热能：慢性腹泻病程长，常反复发作，影响食物消化吸收，并造成体内贮存的热能消耗。为改善营养状况，应给予高蛋白高热能饮食，并用逐渐加量的方法，如增加过快，营养素不能完全吸收，反而可能加重胃肠道负担。可供给蛋白质lOOg／d左右，热能10．46～12，55MJ(2500～3000kcal)。

3．禁忌食物：如粗粮、生冷瓜果、冷拌莱等，含粗纤维多的韭菜、芹菜、榨菜等；坚硬不易消化的肉类如火腿、香肠、腌肉等；刺激性食物如辣椒、烈酒、芥末、辣椒粉，以及肥肉、油酥点心等高脂肪食物。

南京医科大学第二附属医院消化医学中心

江苏省最大的消化内镜诊疗中心，南京医科大学消化内镜研究所．

内科学（消化内科专业）博士＼硕士培养基地．

江苏省唯一的卫生部消化内镜医师培训基地．

If I can help you, please send email to: njxhyxzx@163.com.

本博客将为大家提供大量的本专业信息资源！ 

饮食营养治疗应根据不同类型，给予适当的饮食。养成定时排便的习惯，避免经常服用泻药和灌肠，适当增加体力活动。

(一)痉挛性便秘

1．无粗纤维低渣饮食：先食低渣半流质饮食，禁食蔬菜及水果，后改为低渣软食。

2．适当增加脂肪，脂肪润肠，脂肪酸促进肠蠕动，有利于排便；但不宜过多，应

3．多饮水：饮水及饮料，保持肠道粪便中水分，以利于通便，如早晨饮蜂蜜水等。    

4．进食洋粉制品：洋粉在肠道吸收水分，使粪便软滑，有利排泄。

5．禁食刺激食物：禁止食用酒、浓茶、咖啡、辣椒、咖喱等刺激性食品。

(二)梗阻性便秘

   若为器质性病变引起的，应首先治疗疾病，去除病因；如直肠癌、结肠癌等。若为不完全性梗阻，可考虑给予清流质。饮食仅限于提供部分热能，并最低限度控制食物残渣，以胃肠外营养作为供给热能的主要方式。

(三)无力性便秘

1．含粗纤维饮食：多供给含粗纤维食物，刺激肠道，促进胃肠蠕动，增强排便能力。如粗粮、带皮水果、新鲜蔬菜等。长海医院研制的多纤维素速溶冲剂，口味好，每包20g；含粗纤维7g，每天1～2包温开水冲服并多饮水，临床使用治疗便秘效果满意。

2．多饮水：多饮水及饮料，使肠道保持足够的水分，有利粪便排出。

3．供给B族维生素：多食用含B族维生素丰富食物，可促进消化液分泌，维持和促进肠道蠕动，有利于排便。如粗粮、酵母、豆类及其制品等。

4．多食产气食物：多食易产气食物，促进肠蠕动加快，有利于排便；如洋葱、萝卜、蒜苗等。

5．高脂肪：适当增加高脂肪食物，植物油能直接润肠，且分解产物脂肪酸有刺激肠蠕动作用。如花生、芝麻、核桃及花生油、芝麻油、豆油等，每天脂肪总量可达lOOg。供给润肠通便食物，如洋粉及其制品、银耳羹等。

6．饮食禁忌：禁忌烟酒，及辛辣食物等，因这些食物对通便不利

“您捐了吗？”正在流行！

本BLOG

答：TIPS的临床选择

本blog 回答HAPPY朋友关于其病人关于TIPS选择的问题。

问题略。

回答如下：

首先，TIPS的目的：治疗内科治疗安逸控制的出血，顽固性腹水，为肝移植作准备。

其次，适应症：

（1） 非手术治疗失败，同时肝功能很差不能耐受手术。

（2） 顽固性腹水。

（3 ）患者计划做肝移植。

注意：Child-Pugh score是一综合评分，尽管是C，核心还得看门脉压力高导致的出血和腹水是否提示安逸控制和预后差。此外，和病人、家属沟通，权衡“痛苦—收益—风险”非常重要。

问题与争议：

（1）技术条件，国内开展的不过10家，量不多，报道少。西京医院的韩国宏教授在这方面的技术很好。

（2）并发症：肝性脑病，出血在发生等。不少临床医生因此而不喜欢给病人这种建议。

（3）国外最新的认识：

Ligation is the endoscopic treatment of choice in bleeding oesophageal varices; in gastric varices, obturation with cyanoacrylate is preferable. Uncontrolled bleeding should be an indication for a salvage transjugular portosystemic shunt (TIPS).  但是还不少其它问题有争议。

Thabut D,  et al. Best Pract Res Clin Gastroenterol. 2007;

《胃镜操作原则》供初学者分享

(Note: From DXY. Edited by the present bolg)

适当充气，见腔进镜，准确定位，熟练使用角度钮，注意盲区（胃底、贲门口胃侧、十二指肠降段），仔细观察病灶，远近结合，全面观察。注意操作轻柔！！！！！

胃镜操作要领

⑴插镜方法：摆好病人体位，向病人说明如何配合，取得病人合作，争取一次插管成功（反复刺激使插管一次较一次更困难），插管时在25cm处持镜，前端向上弯曲约15°，沿咽后壁滑入食管，恶心时食管狭窄部开放顺势插下，不可强行插入以免引起梨状窝血肿或其它损伤。

⑵入食管后边进镜边充气，部分气体先入胃内，进入胃内即可观察扩张的胃腔，可以节省时间。进食管时粗略观察大的病变，无进镜禁忌（如重度的食管V曲张有活动性出血、使管腔明显狭窄胃镜难以通过者，食管占位病变使管腔明显狭窄等），细小病变退镜时观察及处理。

⑶入幽门时镜头勿接触胃粘膜，减少胃窦刺激。

⑷入降段的方法：内镜靠近十二指肠上角，大角度钮up 至底，小角度钮rigth至底/旋转镜身→出现降段后循腔进 镜。 ⑸观察十二指肠球部，先看前壁、大、小弯侧，最后边滑出边看后壁。 ⑹胃镜和肠镜的不同活检视野：胃镜为左2/3视野，肠镜为左下2/3视野有效。

胃镜观察顺序

（1）食管（上中下）：进镜时粗略观察有无V曲张、溃疡、狭窄、肿物等，如要进一步活检、内镜下治

疗可待退镜时处理。

（2）胃体：进入胃内直下一般即可看

到胃体大弯侧4--6条规则、平行皱襞，是胃体大弯侧标志。此处粘液湖较多；息肉、溃疡、糜烂等

病变发生率极少。

（3）胃窦：可见圆锥形胃窦，半月形胃角，胃角是胃窦定位的标志物。胃角标志小弯侧，对应为大弯

侧。屏幕左、右分别为前、后壁。胃窦圆锥形顶部可见开合状态交替的幽门。 （4）幽门：贴近幽门口，开放时准确较快插入球腔，观察球腔四壁，球腔短而小，进退动作要缓慢。球腔分前后壁、大小弯，十二指肠上角是球腔入降的转折点。（5）降段：环形皱襞，可见十二指肠乳头。入降段方法为镜头靠近十二指肠上角，大角度钮up 至底，小角度钮rigth至底+/镜身轻度顺时旋转/推进少许可。 （6） 观察贲门方法 胃窦部倒镜观察：动作同入降段，倒镜后外拉/旋转可远近、全方位观察。胃底倒镜观察法：退镜到55cm时，旋转+倒镜可观察。

本人体会：1、解剖一定清楚，操作要轻柔！！心要静，忌心浮气燥！！

2、准备工作充分：了解清楚患者状态（一般状态、是否有基础疾病，本次检查的主诉、目的）；作相应的解释、安慰－－虽然简单，但对整个检查的安全，顺利进行很重要！

3、看清每一个角落，不留死角。

4、时刻保持警惕，不能对镜下所见及患者反应千万不想当然。

	南京医科大学第二附属医院消化医学中心 江苏省最大的消化内镜诊疗中心，南京医科大学消化内镜研究所． 内科学（消化内科专业）博士＼硕士培养基地． 江苏省唯一的卫生部消化内镜医师培训基地． The Second Affiliated Hospital of Nanjing Medical University. If I can help you, please send email to: njxhyxzx@163.com.     本博客将为大家提供大量的本专业信息资源！

NIH权威Website_______on digestive diseases

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南京医科大学第二附属医院消化医学中心,江苏省最大的消化内镜诊疗中心，南京医科大学消化内镜研究所．

内科学（消化内科专业）博士＼硕士培养基地．江苏省首家卫生部消化内镜医师培训基地．

 1. Gastroenterology & Endoscopy News - Monthly newspaper that provides clinical news reporting from international, national and regional gastroenterology meetings. It also features original articles, educational reviews, CME monographs and a career opportunities section.

-- http://www.gastroendonews.com/index.html Health: Medicine: Medical Specialties: Gastroenterology

2. University of Chicago Division of Gastroenterology - Information for patients, physicians, and medical professionals about the division, the fellowship, and GI endoscopy. Site includes descriptions of procedures and an article on the latest developments in GI interventional endoscopy.:

-- http://gi.bsd.uchicago.edu/ Health: Medicine: Medical Specialties: Gastroenterology

3. Johns Hopkins Gastroenterology and Hepatology - Comprehensive, highly illustrated, current information on the causes, diagnosis and treatment of digestive diseases, clinical and basic science research at Johns Hopkins.

-- http://hopkins-gi.org/pages/latin/templates/ Health: Conditions and Diseases: Digestive Disorders: Intestinal

4. Ohio Society of Gastroenterology Nurses and Associates - A regional society affiliated with the Society of Gastroenterolgy Nurses and Associates. Includes membership and legislative information, news and resolutions.

-- http://home.fuse.net/bell0039/osgna.html Health: Nursing: Organizations: North America: United States

5. University of Chicago: Section of Gastroenterology - Information on esophageal cancer; of interest to professionals as well as patients.! l

-- http://gi.bsd.uchicago.edu/diseases/colorectandother/esoph.html Health: Conditions and Diseases: Cancer: Gastrointestinal: Esophageal

6. American College of Gastroenterology - Research grants and awards.

-- http://www.acg.gi.org/physicianforum/grants/ Science: Institutions: Research Funding Organizations: Medical

7. Johns Hopkins Pediatric Gastroenterology and Nutrition - The Division specializies in the evaluation and management of gastrointestinal, liver and nutritional disorders from infancy to young adulthood. (Baltimore, Maryland)

-- http://orchid.hosts.jhmi.edu/pedsgi/website/index.cfm Health: Medicine: Medical Specialties: Pediatrics

8. Clinic of Pediatric Gastroenterology and Hepatology - Provides diagnosis and management of the diseases of gastrointestinal tract, liver, and pancreas, as well as teaching students and research.

-- http://www.angelfire.com/ak3/aaaaaa1/index.html Regional: Europe: Bulgaria: Health

9. Gastroenterology: Celiac Disease in Children - Brief outline of celiac (coeliac) disease aimed at health professionals.

-- http://www.mc.vanderbilt.edu/peds/pidl/gi/celiac.htm Health: Child Health: Conditions and Diseases: Digestive Disorders

10. Clinic of Pediatric Gastroenterology, Sofia, Bulgaria - Division of The Department of Pediatrics, Higher Medical School in Sofia. Diagnosis and management of the diseases of gastrointestinal tract, liver and pancreas as well as teaching students and research are the basic activities of our clinic.

-- http://www.angelfire.com/ak3/aaaaaa1/index.html Health: Medicine: Hospitals: Children

11. University of Chicago: Section of Gastroenterology - Information on liver cancer. This site will be of interest to patients and to healthcare professionals.

-- http://gi.bsd.uchicago.edu/diseases/colorectandother/liver.html Health: Conditions and Diseases: Cancer: Gastrointestinal: Liver

12. University of Chicago: Section of Gastroenterology - Information about colorectal cancer and other gastrointestinal diseases and disorders. This site will be of interest to patients as well as health care professionals.

-- http://gi.bsd.uchicago.edu/disea ... ectal/colorect.html Health: Conditions and Diseases: Cancer: Gastrointestinal: Colorectal

13. Commonwealth Association of Paediatric Gastroenterology and Nutrition - Includes calendar of events and meetings, organization structure, member contacts, and education forums.

-- http://www.capgan.org/ Society: Government: Multilateral: Commonwealth: Associations

14. AGA: Gastroenterology Links - General related resources including those of pancreatic cancer offered by the American Gastroenterological Association.

-- http://www.gastro.org/phys-sci/links.html Health: Conditions and Diseases: Cancer: Gastrointestinal: Pancreatic

15. Indian Journal of Gastroenterology - Journal of the Indian Society of Gastroenterology. Abstracts with full text editorials and some feature articles.

-- http://indianjgastro.com/ Regional: Asia: India: Health: Publications

16. Gastroenterology Department - SGH - Contains information about the digestive system. Lists and explains the different types of illness such as abdominal pain and food poisoning and the diagnostics procedures.

-- http://www.sghhealth4u.com.sg/health4u/gastro/ Regional: Asia: Singapore: Health: Conditions and Diseases

17. The Hong Kong Society of Gastroenterology - The main objective of the society is to promote the advancement of gastroenterology.

-- http://www.medicine.org.hk/hksg/ Regional: Asia: Hong Kong: Health: Associations: Professional

18. Gastroenterology Consultants - Provide treatment and preventive counseling to Northern Nevada and California patients. Includes locations, details of services and patient education information.

-- http://www.giconsultants.com/ Regional: North America: United States: Nevada: Health: Physicians and Clinics

19. Hudson Valley Gastroenterology - Dr. Dodd and Dr. Steckman specialize in digestive diseases and nutrition - including intestinal, liver, pancreatic, and gallbladder disorders with in office colonoscopy and upper endoscopy available."

-- http://www.hvgpc.com/ Regional: North America: United States: New York: Regions: Hudson Valley: Health

20. Gastroenterology Associates - Board certified stomach and colon specialists with an out-patient endoscopic center

-- http://www.abilenegastro.com/ Regional: North America: United States: Texas: Localities: A: Abilene: Health

21. Carolina Mountain Gastroenterology - Specializes in disorders of the gastrointestinal tract. Features FAQs, staff and physician profiles, and locations.

-- http://www.caromtngastro.com/ Regional: North America: United States: North Carolina: Metro Areas: Asheville Metro: Health: Physicians and Clinics (1 match)

22. Naperville Gastroenterology - Includes details on the physician, Stephen Holland, MD, and contact information.

-- http://homepage.mac.com/sholland/ Regional: North America: United States: Illinois: Localities: N: Naperville: Health

23. University of Texas-Houston Gastroenterology - Information about the program and the fellowship program.

-- http://www.uth.tmc.edu/schools/med/imed/gastro/ Regional: North America: United States: Texas: Localities: H: Houston: Health

'

24. University of Alabama Division of Gastroenterology - Provides information about the department, research activities, and fellowship information.

-- http://info.dom.uab.edu/gastro/ Regional: North America: United States: Alabama: Localities: B: Birmingham: Health

25. South Bay Gastroenterology and Endoscopy - South Bay Gastroenterology Medical Group and The Endoscopy Center of the South Bay.

-- http://www.southbaygastro.com/ Regional: North America: United States: California: Localities: T: Torrance: Health

26. Chicago Society of Gastroenterology Nurses and Associates - Offers meeting and event schedule, scholarship information, election news, photo gallery, and survey.

-- http://www.csgna.net/ Regional: North America: United States: Illinois: Localities: C: Chicago: Health: Organizations

27. Atlanta South Gastroenterology, P.C. - Private practice of gastrointestinal medicine and liver diseases, located in East Point, Georgia.

-- http://www.mindspring.com/~dmmmd/asg_info.html Regional: North America: United States: Georgia: Localities: E: East Point: Health: Physicians and Clinics

28. Gastroenterology, Prime Medical Net, Professional Resources - A B2B web directory. Offering credible resources to medical professionals in their quest to establish and maintain quality of life for their patients.( l

-- http://www.primemedical.net/gastroentrology.htm Health: Medicine: Medical Specialties: Gastroenterology

29. Ask The Doctor : The Gastroenterology Forum - Interactive medical question and answer format about all gastroenterology conditions. Patient questions are replied to by online doctors. Library and archive of articles on stomach, intestine, liver diseases.

-- http://www.medhelp.org/perl6/gastro/index.htm Health: Conditions and Diseases: Digestive Disorders: Intestinal

30. Old Dominion Society of Gastroenterology Nurses and Associates - Includes list of events, newsletter, and officer list.-

-- http://odsgna.association.com/ Health: Nursing: Organizations: North America: United States

31. ACG Guidelines: Esophageal Cancer - Treatment standards presented by the American College of Gastroenterology in 1999.

-- http://www.acg.gi.org/physicianforum/guides/esocancer.html Health: Conditions and Diseases: Cancer: Gastrointestinal: Esophageal

32. Memphis Gastroenterology and Endoscopy - The first combined office and endoscopy center in the Memphis area.

-- http://www.memphisgastro.com/ Regional: North America: United States: Tennessee: Localities: M: Memphis: Health: Physicians and Clinics

33. MPN Gastroenterology Cartoons - Collection of over 20 gastroenterology cartoons.

http://www.med-psych.net/modules/mylinks/viewcat.php?cid=80 Health: Medicine: Medical Specialties: Gastroenterology

34. Topics in Gastroenterology: IBS - Discusses symptoms,causes,treatment and diet.

-- http://www.naples.net/health/ibs.htm Health: Conditions and Diseases: Digestive Disorders: Intestinal: Irritable Bowel Syndrome

35. Society of Gastroenterology Nurses and Associates - Is dedicated to the safe and effective practice of gastroenterology and endoscopy nursing. Contains membership and scholarship information, news, position statements, resources and newsletter.

-- http://www.sgna.org/ Health: Nursing: Organizations: North America: United States

36. Pediatric Gastroenterology/Nutrition - Statement of purpose and professional biographies of the group's physicians.

-- http://www.urmc.rochester.edu/gchas/div/gi.htm Reference: Education: Colleges and Universities: North America: United States: New York: University of Rochester: Departments and Programs: Medical Center: Divisions and Units

37. Family Practice Notebook - Gastroenterology - Comprehensive database of gastroenterological disorders geared for primary care physicians. It is set up as a "peripheral brain" collection of medical notes.

-- http://www.fpnotebook.com/GI.htm Health: Medicine: Medical Specialties: Gastroenterology

38. Gastroenterology: Irritable Bowel Syndrome - The general features of IBS from the family practice handbook of the University of Iowa.

-- http://www.vh.org/adult/provider ... Chapter05/09-5.html Health: Conditions and Diseases: Digestive Disorders: Intestinal: Irritable Bowel Syndrome

39. Gastroenterology - The spectrum of gastroenterology is quite wide and includes diseases of the esophagus, stomach, small and large intestine (colon), pancreas, bile ducts, gallbladder and liver.

-- http://www.medicine.arizona.edu/gastroenterology/ Reference: Education: Colleges and Universities: North America: United States: Arizona: University of Arizona: Departments: College of Medicine: Department of Medicine

40. Medscape Gastroenterology - A comprehensive site featuring medical journal articles, Free CME, MEDLINE, case reports, medical news, major conference coverage, and drug information.

-- http://www.medscape.com/gastroenterologyhome Health: Medicine: Medical Specialties: Gastroenterology (127)

41. Irritable Bowel Syndrome or just Lactose Intolerance? - A detailed guide about Irritable Bowel Syndrome, adapted from the leaflet produced by The Digestive Disorders Foundation in association with the British Society of Gastroenterology, including symptoms, cure, treatment, diagnosis, and when to seek a doctor. Compare with lactose intolerance.

-- http://www.lactose.co.uk/ibs Health: Conditions and Diseases: Digestive Disorders: Intestinal: Irritable Bowel Syndrome (3 matches)

42. Gastroenterology - Includes staff profiles, clinic overviews and research information.

-- http://www.medicine.dal.ca/dom/c ... s/gastroenterology/ Reference: Education: Colleges and Universities: North America: Canada: Nova Scotia: Dalhousie University: Departments and Programs: Medicine, School of: Medicine, Department of (1)

43. General Practice Notebook - Gastroenterology - Coverage of this medical speciality.

-- http://www.gpnotebook.co.uk/MedwebPage.cfm?ID=1939472391 Health: Medicine: Medical Specialties: Gastroenterology (126)

44. Gastroenterology-Diverticulosis - Resource for medical students offers an overview of diverticulitis of the colon. Read a definition, and research the treatment recommendations

-- http://www.medstudents.com.br/gastro/gastro2.htm Health: Conditions and Diseases: Digestive Disorders: Intestinal: Diverticulitis

45. Gastroenterology - Research interests include inflammatory bowel disease and its effect on bone, mucosal immunology and allergy, nutrition support and interactions between microorganisms and epithelial surfaces.

-- http://www.ccmckids.org/departments/Gastroenterology/gastro.htm Regional: North America: United States: Connecticut: Localities: H: Hartford: Health: Hospitals: Connecticut Children's Medical Center: Departments (1)

46. Baylor College of Medicine Gastroenterology Grand Rounds - Cases presented as unknowns including presentation, evaluation, images, and diagnosis.

-- http://www.bcm.tmc.edu/gastro/VGICC/ Health: Medicine: Medical Specialties: Gastroenterology

47. Gut Feelings: Diseases: Diverticulitis - Gastroenterology resource offers a description of this intestinal disorder. View diagrams, and explore its treatment and prevention methods.

-- http://www.gutfeelings.com/DIVERTICULITIS.HTML Health: Conditions and Diseases: Digestive Disorders: Intestinal: Diverticulitis

48. Liver Diseases - Collection of brief descriptions outlining liver diseases, from Gastroenterology Consultants, PC.

-- http://www.gastro.com/html/liverdisease.shtml Health: Conditions and Diseases: Digestive Disorders: Liver (1)

49. GastroenterologyWeb - Provides information on gastroenterology, hepatology and GI endoscopy written by academic physicians for practicing physicians. Features original articles, videos, cases of interest, job openings and diagnostic challenges.

-- http://www.gastroenterologyweb.com/ Health: Medicine: Medical Specialties: Gastroenterology

50. Irritable Bowel Syndrome (IBS): Examining New Findings & Treatments - Up-to-date information available on: (1) the practical diagnosis of IBS; (2) the role of serotonin (5-HT) in enteric motility, visceral hypersensitivity, and secretion; and (3) 5-HT treatment options for IBS.

-- http://gastroenterology.medscape ... 01/public/goal.html Health: Conditions and Diseases: Digestive Disorders: Intestinal: Irritable Bowel Syndrome: Research (1)

51. Beaumont Hospital, Dublin, Ireland. - Acute 620 bed general hospital specializing in Neurosurgery, Renal and Pancreatic Transplantation, Cochlear Implantation, ENT and Gastroenterology.

-- http://www.beaumont.ie/ Health: Medicine: Hospitals: Europe

52. Gastrotherapy - Concise summaries of the recent developments in gastroenterology and related fields. The information is aimed at primary care physicians.

-- http://www.gastrotherapy.com/ Health: Medicine: Medical Specialties: Gastroenterology

53. Ioannis Koutroubakis's Page - A site for doctors with interest in gastroenterology and for patients with gastrointestinal diseases.

-- http://members.tripod.com/~IoannisKoutroubakis/Koutroubakis.html Regional: Europe: Greece: Health (1)

54. GILinx - Recent medical news and information related to gastroenterology. Information is geared to physicians and is updated daily.

-- http://www.gilinx.com/ Health: Medicine: Medical Specialties: Gastroenterology

55. Axcan Pharma Inc. - Pharmaceutical company which develops and markets treatments for use in the field of gastroenterology. (Nasdaq: AXCA)

-- http://www.axcan.com/ Business: Major Companies: Publicly Traded: A (1)

56. Gastrohep.com - Peer reviewed, subscription site focused on all aspects of gastroenterology, hepatology and endoscopy.

-- http://www.gastrohep.com/ Health: Medicine: Medical Specialties: Gastroenterology

57. Ferring Pharmaceuticals - Manufactures pharmaceuticals within urology, gynaecology, gastroenterology and endocrinology for treatment of bedwetting, pre-term labour, infertility, ulcerative colitis, Crohn's disease and growth disorders.

-- http://www.ferring.com/ Business: Biotechnology and Pharmaceuticals: Pharmaceuticals: Manufacturers

58. atGastroenterology - Specialized search engine focusing on gastroenterology topics.

-- http://atgastroenterology.com/ Health: Medicine: Medical Specialties: Gastroenterology

59. University of Glasgow Department of Medicine and Therapeutics - Specialty clinical and research interests include endocrinology, gastroenterology, cardiovascular disease, hypertension and neurological diseases including stroke and epilepsy.)

-- http://www.medther.gla.ac.uk/ Health: Conditions and Diseases: Neurological Disorders: Epilepsy: Research (1)

60. Diagnosis health - gastroenterology forum - Provides information on specific gastroenterology diseases and procedures. Also provides an online discussion forum on gastroenterology and digestive health.

-- http://www.diagnosishealth.com/gastro1.htm Health: Medicine: Medical Specialties: Gastroenterology

61. University of Glasgow Department of Medicine and Therapeutics - Specialty clinical and research interests include endocrinology, gastroenterology, cardiovascular disease, hypertension and neurological diseases including stroke and epilepsy.

-- http://www.medther.gla.ac.uk/ Health: Conditions and Diseases: Neurological Disorders: Epilepsy: Research (1 match)

62. Gatrosource from AstraZeneca - Information on gastroenterology sponsered by AstraZeneca pharmaceuticals. Information on Nexium, Acid reflux disease, Entocort, Esomeprazole, Budesonide and Gastroesophageal reflux disease.)

-- http://www.gastrosource.com/ Health: Medicine: Medical Specialties: Gastroenterology (127)

63. Petr Kocna - Petr Kocna M.D., Ph.D. Information on the Laboratory of Gastroenterology, image gallery, and personal data.

-- http://www.lf1.cuni.cz/~kocna/gb_home.htm Regional: Europe: Czech Republic: Society and Culture: Personal Pages (1)

64. Hardin MD: Gastroenterology and Digestive Diseases - From the University of Iowa, lists of Internet sources in gastroenterology and digestive diseases, including liver and intestinal diseases (hepatitis, Crohns Disease, irritable bowel syndrome).

-- http://www.lib.uiowa.edu/hardin/md/gastro.html Health: Medicine: Medical Specialties: Gastroenterology

65. Use of Cisapride in Children - A Medical Position Statement of the North American Society for Pediatric Gastroenterology and Nutrition. Discusses the risks and benefits of this medication for treating gastroesophageal reflux and other conditions.

-- http://www.naspghan.org/sub/cisapride.asp Health: Pharmacy: Drugs and Medications: C: Cisapride

66. Princeton Gastroenterology, Associates, P.A. - Gastroenterology practice located in Princeton, New Jersey.

-- http://princetongi.com/ Health: Medicine: Medical Specialties: Gastroenterology

67. Ernak*** Medical Centre - Offers multi-speciality facilities for neonatology, orthopaedics, laproscopic, neurology, gastroenterology and cardiology.

-- http://www.emccochin.com/ Regional: Asia: India: Kerala: Districts: Ernak***

68. University of Pittsburgh Medical Center Division of Gastroenterology and Hepatology - Provides information about the department including research activities and faculty data.

-- http://www.upmc.edu/Gastroenterology/ Health: Medicine: Medical Specialties: Gastroenterology: University and Hospital Departments

69. JAMA Migraine Information Center - Abdominal Migraine: Prophylactic Treatment and Follow-up - Abstract of an article published in the January 1999 issue of the Journal of Pediatric Gastroenterology and Nutrition.

-- http://www.ama-assn.org/special/migraine/library/scan/abdomig.htm Health: Conditions and Diseases: Neurological Disorders: Headaches: Migraine: Abdominal

70. Temple University Gastroenterology - Provides information about the division, patient information, research activities, fellowship program, and links to other sites.

-- http://www.temple.edu/gisection/ Health: Medicine: Medical Specialties: Gastroenterology: University and Hospital Departments

71. Amino Acids - Publishes contributions from all fields of amino acid research: analysis, separation, synthesis, biosynthesis, cross linking amino acids, racemization/enantiomers, modification of amino acids as phosphorylation, methylation, acetylation, glycosylation and nonenzymatic glycosylation, new roles for amino acids in physiology and pathophysiology, biology, amino acid analogues and derivatives, polyamines, radiated amino acids, peptides, stable isotopes and isotopes of amino acids. Applications in medicine, food chemistry, nutrition, gastroenterology, nephrology, neurochemistry, pharmacology, excitatory amino acids are just some topics to be listed.)

-- http://link.springer.de/link/service/journals/00726/tocs.htm Science: Biology: Biochemistry and Molecular Biology: Publications: Journals:

72. Free University of Brussels Gastroenterology and Gastrointestinal Endoscopy - Provides information about the hospital and has links torelated sites.

-- http://minf.vub.ac.be/~leo/ Health: Medicine: Medical Specialties: Gastroenterology: University and Hospital Departments (40)

73. LeBauer Health Care - Clinic offers primary care, cardiology, gastroenterology, pulmonary and critical care medicine. Four offices in the greater Greensboro area.

-- http://www.lebauer.com/ Regional: North America: United States: North Carolina: Metro Areas: Greensboro-Winston-Salem-High Point: Health (1)

74. University of California San Diego, Division of Gastroenterology ; - Provides information about the division, their research activities, and the fellowship program.

-- http://medicine.ucsd.edu/gastro/ Health: Medicine: Medical Specialties: Gastroenterology: University and Hospital Departments (40)

75. Oregon Clinic, P.C. - The Oregon Clinic provides the following services to the Portland metropolitan community: Cardiology, Cardiothoracic Surgery, Gastroenterology, Neurology, Pulmonology, Radiology, Radiation Oncology, Urology

-- http://www.orclinic.com/ Regional: North America: United States: Oregon: Localities: P: Portland: Health (1)

76. Texas A&M College of Medicine/Scott & White Gastroenterology Fellowship - Information about the fellowship program.

-- http://www.sw.org/depts/medicine/gastro/gme/gi_fell.htm Health: Medicine: Medical Specialties: Gastroenterology: University and Hospital Departments (40)

77. The Digestive Disease & Nutrition Center of Westchester, LLP - Specializes in gastroenterology and nutrition which includes colon cancer, polyps, and irritable bowel syndrome. Provides secure patient area and medical information.

-- http://www.rosemarin.salu.net/ Regional: North America: United States: New York: Localities: W: White Plains: Health (1)

78. Mayo Clinic Jacksonville Gastroenterology Department - Information about the department and patient information.

-- http://www.mayo.edu/mcj/gastro/gastrohome.html Health: Medicine: Medical Specialties: Gastroenterology: University and Hospital Departments (40)

79. Keuka Health Care Associates - A medical group practice. Specialists in internal medicine, gastroenterology, gerontology, and podiatry. Includes location information, billing and insurance and contact details.

-- http://www.keukahealth.com/ Regional: North America: United States: New York: Localities: P: Penn Yan (1)

80. Cincinnati Children's Hospital Center of Gastroenterology and Nutrition Department - Provides information about the department and the fellowship program.

-- http://www.cincinnatichildrens.org/departments/22/ Health: Medicine: Medical Specialties: Gastroenterology: University and Hospital Departments (40)

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中华人民共和国卫生部 内镜诊疗技术培训基地建设标准         为规范内镜诊疗管理，提高内镜医师技术水平，保证医疗质量和医疗安全，根据卫生部卫办医发（2006）31号文件，并经卫生部医政司批准，特制定本标准。 一、内镜诊疗技术培训基地专业设置 （1）呼吸科内镜诊疗技术培训基地 包括纤维支气管镜、气管镜等。 （2）消化科内镜诊疗技术培训基地 包括食道镜、胃镜、十二指肠镜、小肠镜、结肠镜等。 （3）普外科内镜诊疗技术培训基地 包括腹腔镜、胆道镜、血管镜等。 （4）妇科内镜诊疗技术培训基地 包括妇科腹腔镜、宫腔镜、输卵管镜、羊水镜等。 （5）骨关节科内镜诊疗技术培训基地 包括关节镜、椎间盘镜等。 （6）泌尿外科内镜诊疗技术培训基地 包括腹腔镜、输尿管肾镜、经皮肾镜、尿道膀胱镜、前列腺电切镜、小儿尿道切开镜等。 （7）心胸血管外科内镜 包括胸腔镜、纵隔镜、血管镜等。 （8）耳鼻喉科、眼科与麻醉科内镜 包括鼻窦镜、咽喉镜、耳镜、眼内镜、泪道内镜等。 （9）神经外科内镜 包括脑室镜等。 二、申报内镜诊疗技术培训基地医疗机构的基本条件 （1） 具备培训条件和能力的三甲医院或医学教学科研机构； （2） 申报专业的内镜诊疗水平在本行政区域内处于领先水平； （3） 有丰富临床经验和较高授课水准的专、兼职师资力量； （4） 配备符合基地建设标准并经技评机构认可的培训及考试设备； （5） 举办过全国或全省专业学术会议，或承担过国家级继续教育项目； （6） 经技术能力评价机构评价合格； （7） 申报专业每年内镜手术量应达到一定例数： 呼吸科: 400例以上 消化科:5000例以上 普外科:500例以上 妇  科: 500例以上 骨关节科: 150例以上 泌尿外科: 800例以上 心胸血管外科: 150例以上 耳鼻喉科、眼科与麻醉科: 1000例以上 神经外科: 50例以上 三、内镜诊疗技术培训基地建设基本标准     总体要求 培训教学场所规划设计科学合理，培训设施及培训专业设备具有国际国内先进水平，有管理机构和专职管理人员，有专、兼职师资队伍，有统一的培训大纲及培训教材，消化科，普外科，心胸血管外科，妇科，泌尿外科，耳鼻喉科、眼科与麻醉科等内镜诊疗技术培训基地必须达到每年培训专业内镜医师200名，骨关节科、呼吸科、神经外科每年培训专业内镜医师100名目标。    基本标准 （一）、场地建设 （1）教学场所 培训基地总建筑面积1000平方米，其中包括：多媒体教室（可容100人以上）、小型会议室2~3间、考核训练室（80平方米以上）、内镜操作模拟训练室（100平方米以上）、模拟（动物）手术室（120平方米以上）、动物准备间、器械消毒间等。 （2） 管理场所 基地管理人员办公用房2~3间等。 （3） 生活场所 培训基地治安状况良好，交通便利，可安排或提供受训人员膳宿，生活设施基本齐备，膳食标准适中。 （二）、组织管理 （1）领导重视 培训基地工作应列入医院全面建设内容，有领导分管培训基地工作，培训基地主要负责人必须是专职，且有相应专业工作经历。 （2）机构落实 根据专业性质和培训要求，每个专业培训基地至少应配备2名专职工作人员。 （3）制度健全 应有相应的工作计划及培训方案和管理制度。 （三）、师资教学能力 （1） 有3~5名符合条件的专职或兼职教学师资； （2） 指导医师需有副高以上专业技术职称，从事本内镜专业临床五年以上，累计独立完成内镜手术200例以上；在国家级学术刊物上发表过有重要影响学术文章，本内镜专业技术达较高水准； （3） 有较丰富的教学经验； （4） 指导医师资质需经技术能力评价机构认可。 （四）、培训设施 （1） 为体现公平、公正原则，确保培训质量，全国内镜医生的培训与考核必须规范统一。全国内镜技术培训基地的教学培训设备器材以及专业内镜集成系统的配置必须经技术评价机构认可。 （2） 多媒体教室应具有会议功能，可举办学术会议和转播临床手术等，需配置电动屏幕、音响、投影、远程教学和转播系统等。 （3） 内镜基本技能训练室为基本技能操作教学训练设置： 普外科、心胸血管外科、妇科、泌尿外科：需配置专用腔镜模拟训练器设备6套以上和其它模拟训练器材。 其它专科：需配备相应的模拟训练器或模型5套以上。 （4） 内镜技术模拟考核室为教学阶段性和培训结束时技能考核设置： 普外科, 消化科, 心胸血管外科, 呼吸科, 妇科, 骨关节科, 耳鼻喉科、眼科与麻醉科：需配置带有触觉反馈和记录评价功能的模拟训练考核系统2套以上； 泌尿外科：需配置腹腔镜模拟训练考核系统和泌尿内镜模拟训练考核系统各一套以上。 （5） 模拟手术室需按标准手术室构建，配有视讯系统，根据专业不同，配置手术床（动物）2~6张，配备相应的专业内镜集成系统（包括吊塔、手术无影灯及常规设备）2-6套； （6） 动物准备室需配置麻醉监护系统； （7） 器械准备室需配置专业内镜器械及常用消耗材料； （8） 处理室需配置器械清洗消毒设备； （9） 小型会议室需配置网络IT系统； （10） 管理人员办公室需配置办公用具和办公设备（包括桌椅、橱柜、计算机、传真、复印设备等）； （11） 会议场所、训练场所、生活场所均应有洗浴设施；会议和训练场所均有空气调节设施。

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 由我公司承建的南京医科大学第二附属医院消化内镜中心手术转播培训系统，日前通过卫生部内镜诊疗技术培训基地的验收。南京医科大学第二附属医院消化内镜中心同时也通过卫生部内镜诊疗技术培训基地的验收，该培训基地是目前江苏唯一通过卫生部验收的内镜诊疗技术培训基地，该基地将行使消化内镜培训和发证职能。

      传统模式的医疗手术观摩和学习主要是组织人员到手术室现场进行学习，或者是对手术情况进行录象作为教学使用。该模式式诸多不足之处：其一，由于手术室空间限制，导致可容纳的参观、观摩的人数较少，效率较低；其二，由于人员杂乱会造成手术室空气污染甚至影响操作医师的注意力；其中，对于重大手术、特殊手术的操作纪录，由于现场录象人员并不了解研究人员或者学生想关注的重点，将使有些部位的视野和视场广度深度不够；另外，由于摄像机屏蔽效果差，当手术中开启射线、电锯等设备时，将受到严重干扰，造成录象效果较差或无法录制。

      我公司的高清手术转播培训系统将克服上述不足：1）可对手术进行高清晰直播，大量的学员或专家不必到手术现场就可以观看手术全程，由于是交互式设备，观摩人员可以随时与手术操作医师进行语言交流和提问。2）由于具有丰富的接口以及多路视频输入，可连接各种内镜、超声等医疗设备。同时采用我公司自行研制的X光机图像转换系统，可将X光机的非标准视频信号直接接入系统，从而实现X光机图像的高清晰显示，实现手术全方位观摩。3） 我公司的高清手术转播培训系统依照军品设计标准，具有多重抗干扰电路和良好的屏蔽，可完全适应手术室环境。

      南京医科大学第二附属医院消化内镜中心手术转播培训系统完全符合《中华人民共和国内镜诊疗技术培训基地建设标准》中培训系统的要求，系统设计合理、经济、超前，操所方便、简单、可靠。可确保传输到示教室的音视频图像清晰、完整，无丢帧和马赛克现象。同时还能将手术影像实时记录下来，作为日后讲学的珍贵资料。

消化内镜示教转播中心                                                            大示教室

培训基地验收　                                                   南医大二附院内镜中心荣誉   

注解“在病人的右边．．．”：

　　　医生，面对病床上的病人，应该站在其右边问病和检查．

　　　这是医学生、进修生、研究生、小医生和大医生接受的基本教育知识和规范。

　　　多到病床边，是医学生、进修生、研究生、小医生和大医生的义务、仁爱。

　　　病床右边，是医学生、进修生、研究生、小医生和大医生共同推进世界临床医学进步的地方。

Less is more!

Our clinic center is an ideal education for 21-century doctors and postgraduates involving practice!

Ralf Keler博士称我首次报道食管记忆合金网状支架

Keller R, Flieger D, Fischbach W, Christl SU.　Self-expanding metal stents for malignant esophagogastric obstruction: experience with a new design covered nitinol stent.　J Gastrointestin Liver Dis. 2007 Sep;16(3):239-43.

全文地址：　http://www.jgld.ro/32007/32007_1.html

该文明确指出，我们首次报道了食管记忆合金网状支架（该支架目前是全世界最常用的食管支架，用于食管肿瘤腔道梗阻治疗）．所引用文献为下面背景介绍的文献．

背景：１９９７年，我们发表研究成果：Fan Z, Dai N, Chen L.　Expandable thermal-shaped memory metal esophageal stent: experiences with a new nitinol stent in 129 patients.　Gastrointest Endosc. 1997 Oct;46(4):352-7.