Cleve Clin J Med

Proton-pump inhibitors for gastric acid-related disease.

Franko TG. Richter JE.
Cleveland Clinic Foundation, OH 44195, USA. frankot@cesmpt.ccf.org
Proton-pump inhibitors are the most effective drugs introduced to date for suppressing gastric acid production. Although they are used to treat the same conditions as histamine type-2 receptor antagonists, they differ from the latter drugs in how they inhibit acid production, and in how they should be given. Initial concerns over potential ill effects of hypergastrinemia due to long-term acid suppression with proton-pump inhibitors have been unfounded.

Evaluating asymptomatic patients with mildly elevated liver enzymes.

Year 1998
Younossi ZM.
Department of Gastroenterology, Cleveland Clinic, USA.
Because elevated liver enzymes are found in 1% to 4% of asymptomatic persons, extensive evaluation of all abnormal tests would expose many patients to undue risks and medical costs. On the other hand, not evaluating minor elevations of liver enzymes could result in missing the early diagnosis of potentially treatable disorders. This review discusses likely causes of elevated aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase levels and provides algorithms for evaluating abnormal liver enzyme values in apparently healthy patients in the primary care setting.