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The need of a gastroprotection must be evaluated on the basis of GI risk factors. High risk patients require gastroprotection with PPIs, while low risk population receives only a small benefit from PPIs prescription; in this setting, the increased risk of CV adverse events, related to the possible interaction between PPI and clopidogrel, suggest the use of

PPIs are demonstrated to be more effective than H2RAs (Ng et al., 2010); however, although to a minor extent, H2RAs (other than cimetidine, because of its hepatic metabolism through CYP2C19) appear to be an alternative option in decreasing risk of gastric and duodenal ulcers (also among antiplatelet-receiving patients) (Lin et al., 2011). H2RAs, because of the low cost and low interaction, could be a good choice in patients with low risk for GI

NSAIDs, Non-Steroidal Anti-Inflammatory Drugs; COX, Cyclooxygenase; GI, GastroIntestinal; CV, CardioVascular; Coxib, selective COX2 inhibitor; *Hp, Helicobacter Pylori*; H2RA, histamine-2 receptor antagonist; PPI, proton pump inhibitor; HCl,

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antiplatelet therapy without gastroprotection.

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**8** 

**Swallowing Disorders** 

*Department of Rehabilitation, University Hospital, Hradec Kralove* 

*University Hospital, Brno* 

*Czech Republic* 

Eva Vanaskova, Jiri Dolina and Ales Hep

*Clinic of Internal Medicine, Gastroenterology,* 

**Related to Vertebrogenic Dysfunctions** 

In recent years, a growing interest in functional gastrointestinal problems can be noticed. In Western Europe, there is prevalence of functional disorders of the gastrointestinal tract in nearly 40% of the population. In Great Britain, 8 to 10% of patients visiting general practitioners have gastrointestinal problems, and approximately 50% of these are functional disorders (Becker & Aroldo, 1990). In the United States, 14% of the population are treated annually for functional gastrointestinal disorders, and in 50 to 70% of patients sent to a

One of the seldom explored disability symptoms related to functional gastrointestinal problems are swallowing dysfunctions that are difficult to verify and quantify. Swallowing problems are often underestimated and attributed to psychological problems or negative mechanical effects of spinal morphological changes. The aim of our overview is to describe in detail the relationship between clinical disability of locomotor system and functional

The digestive tube is one of the systems most affected in terms of functional disorders. Rich gastrointestinal tract innervation of mainly vegetative nerve fibers is closely connected with

Gastrointestinal tract disturbances can be divided into esophageal (chest pain, functional heartburn, functional dysphagia), gastroduodenal (functional dyspepsia, etc.), intestinal disorders (irritable bowel syndrome, functional constipation or diarrhea), functional abdominal pain, biliary disorders, and anorectal disorders. In terms of pathogenesis, functional gastrointestinal motility disorders, visceral hypersensitivity, and intolerance to certain food components have been cited as principal contributing factors. Although musculoskeletal changes occur in approximately 60% of patients with functional bowel disorders, relatively little research has examined vertebrovisceral functional relationships.

gastroenterologist, no significant pathology is detected (Mathias & Clench, 1995).

**2. Functional disorders of the gastrointestinal tract** 

and thereby influences function and activity of the central nervous system.

**1. Introduction** 

dysphagia.

Khurram Z, Chou E, Minutello R, et al. Combination therapy with aspirin, clopidogrel and warfarin following coronary stenting is associated with a significant risk of bleeding. J Invasive Cardiol. 2006;18:162– 4.
