{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:42:30Z","timestamp":1777452150407,"version":"3.51.4"},"reference-count":35,"publisher":"BMJ","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1993,7]]},"abstract":"<jats:p>The insertion of a transjugular intrahepatic portasystemic stent shunt (TIPSS) was evaluated in 22 patients with recurrent upper gastrointestinal haemorrhage related to portal hypertension (bleeding from oesophageal varices 10, gastric varices six, portal hypertensive gastropathy six). TIPSS was successfully performed electively in 15 patients and as an emergency in three patients. Twelve patients have had no further admissions with bleeding after TIPSS. Single episodes of bleeding were noted in six patients after TIPSS associated with shunt thrombosis (two), intimal hyperplasia within the shunt (two), and shunt migration (one). Another patient presented with reaccumulated ascites suggesting poor shunt function but died from massive variceal haemorrhage before further assessment could be performed. There was one death related to the procedure. Two patients developed encephalopathy after TIPSS, in one patient this was controlled by the insertion of a smaller diameter stent within the existing TIPSS. Several complications arose in earlier patients that have not recurred after modification of the initial technique. TIPSS can be life saving and is effective in controlling variceal haemorrhage and rebleeding from oesophageal or gastric varices and portal hypertensive gastropathy. Larger and longer term studies are required, however, to define the role of TIPSS in the overall management of such patients.<\/jats:p>","DOI":"10.1136\/gut.34.7.968","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"968-973","source":"Crossref","is-referenced-by-count":29,"title":["Transjugular intrahepatic portasystemic stent shunting for control of acute and recurrent upper gastrointestinal haemorrhage related to portal hypertension."],"prefix":"10.1136","volume":"34","author":[{"given":"K J","family":"Simpson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Chalmers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D N","family":"Redhead","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N D","family":"Finlayson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I A","family":"Bouchier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P C","family":"Hayes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1993,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1002\/hep.1840060314","article-title":"a randomised trial of vasopressin and vasopresin plus nitroglycerin in the control of active variceal haemorrhage","volume":"6","author":"Gimson, A.E.S.; Westaby, D.; Hegarty, J.; Watson, A.; Williams, R.","year":"1986","unstructured":"Gimson AES, Westaby D, Hegarty J, Watson A, Williams R. a randomised trial of vasopressin and vasopresin plus nitroglycerin in the control of active variceal haemorrhage. Hepatology 1986; 6: 410-13.","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/0016-5085(90)91166-4","article-title":"Randomised double-blind placebo-controlled trial of somatostatin for variceal bleeding. Emergency control and prevention of early variceal rebleeding","volume":"99","author":"Burroughs, A.K.; McCormick, P.A.; Hughes, M.D.; Sprengers, D.; D'Heygele, F.; McIntyre, R.","year":"1990","unstructured":"Burroughs AK, McCormick PA, Hughes MD, Sprengers D, D'Heygele F, McIntyre R. Randomised double-blind placebo-controlled trial of somatostatin for variceal bleeding. Emergency control and prevention of early variceal rebleeding. Gastroenterology 1990; 99: 1388-95.","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1007\/BF01536031","article-title":"Efficacy of balloon tamponade in treatment of bleeding gastric and oesophageal varices. Results in 151 consecutive episodes","volume":"33","author":"Panes, J.; Teres, J.; Bosch, J.","year":"1988","unstructured":"Panes J, Teres J, Bosch J. Efficacy of balloon tamponade in treatment of bleeding gastric and oesophageal varices. Results in 151 consecutive episodes. Dig Dis Sci 1988; 33: 454-9.","journal-title":"Dig Dis Sci"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1002\/hep.1840090219","article-title":"Controlled trial of injection sclerotherapy for active variceal bleeding","volume":"9","author":"Westaby, D.; Hayes, P.C.; Gimson, A.E.S.; Polson, R.J.; Williams, R.","year":"1989","unstructured":"Westaby D, Hayes PC, Gimson AES, Polson RJ, Williams R. Controlled trial of injection sclerotherapy for active variceal bleeding. Hepatology 1989; 9: 274-7.","journal-title":"Hepatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1056\/NEJM198909283211303","article-title":"A comparison of sclerotherapy with staple transection of the oesophagus for the emergency control of bleeding from oesophageal varices","volume":"321","author":"Burroughs, A.K.; Hamilton, G.; Philips, A.; Mezzanotte, G.; McIntyre, N.; Hobbs, K.E.F.","year":"1989","unstructured":"Burroughs AK, Hamilton G, Philips A, Mezzanotte G, McIntyre N, Hobbs KEF. A comparison of sclerotherapy with staple transection of the oesophagus for the emergency control of bleeding from oesophageal varices. N EnglJ7 Med 1989; 321:857-62.","journal-title":"N EnglJ7 Med"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0140-6736(90)91668-Z","article-title":"Meta-analysis of value of propranolol in prevention of variceal haemorrhage","volume":"336","author":"Hayes, P.C.; David, J.M.; Lewis, J.A.; Bouchier, I.A.D.","year":"1990","unstructured":"Hayes PC, David JM, Lewis JA, Bouchier IAD. Meta-analysis of value of propranolol in prevention of variceal haemorrhage. Lancet 1990; 336: 153-6.","journal-title":"Lancet"},{"key":"ref_7","first-page":"137","article-title":"Prevention of recurrent variceal bleeding. Pharmacological measures. Gastro Endosc Clin North","volume":"2","author":"Hayes, P.C.","year":"1992","unstructured":"Hayes PC. Prevention of recurrent variceal bleeding. Pharmacological measures. Gastro Endosc Clin North Am 1992; 2: 137-50.","journal-title":"Am"},{"key":"ref_8","first-page":"1328","article-title":"Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding","volume":"ii:","author":"Terblanche, J.; Bornman, P.C.; Delawir, K.; Jonker, M.A.T.; Campbell, J.A.H.; Wright, J.","year":"1983","unstructured":"Terblanche J, Bornman PC, Delawir K, Jonker MAT, Campbell JAH, Wright J, et al. Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. Lancet 1983; ii: 1328-32.","journal-title":"Lancet"},{"key":"ref_9","first-page":"627","article-title":"Improved survival following injection sclerotherapy for oesophageal varices. Final analysis ofcontrolled trial","volume":"5","author":"Westaby, D.; MacDougall, B.R.D.; Williams, R.","year":"1985","unstructured":"Westaby D, MacDougall BRD, Williams R. Improved survival following injection sclerotherapy for oesophageal varices. Final analysis ofcontrolled trial. Hepatology 1985; 5: 627-31.","journal-title":"Hepatology"},{"key":"ref_10","first-page":"121","article-title":"Prevention of recurrent variceal bleeding: endoscopic techniques. Gastro Endosc Clin North","volume":"2","author":"Westaby, D.","year":"1992","unstructured":"Westaby D. Prevention of recurrent variceal bleeding: endoscopic techniques. Gastro Endosc Clin North Am 1992; 2: 121-50.","journal-title":"Am"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/0016-5085(90)91308-S","article-title":"Propranolol in the prevention of recurrent variceal haemorrhage in cirrhotic patients: a controlled trial","volume":"98","author":"Garden, O.J.; Mills, P.R.; Birnie, G.G.; Murray, G.D.; Carter, D.C.","year":"1990","unstructured":"Garden OJ, Mills PR, Birnie GG, Murray GD, Carter DC. Propranolol in the prevention of recurrent variceal haemorrhage in cirrhotic patients: a controlled trial. Gastroenterology 1990; 98:185-90.","journal-title":"Gastroenterology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"262","DOI":"10.7326\/0003-4819-112-4-262","article-title":"Endoscopic variceal sclerosis compared with distal splenorenal shunt to prevent recurrent variceal bleeding in cirrhosis","volume":"112","author":"Henderson, J.M.; Kutner, M.H.; Millikan, W.J.; Galambos, J.T.; Riepe, S.P.; Scott Brooks, W.","year":"1990","unstructured":"Henderson JM, Kutner MH, Millikan WJ, Galambos JT, Riepe SP, Scott Brooks W, et al. Endoscopic variceal sclerosis compared with distal splenorenal shunt to prevent recurrent variceal bleeding in cirrhosis. Ann Int Med 1990; 112: 262-9.","journal-title":"Ann Int Med"},{"key":"ref_13","first-page":"802","article-title":"Results of a randomized trial of end-toside portacaval shunt and distal splenorenal shunt in alcoholic liver disease","volume-title":"and variceal bleeding. Gastroenterology 1986; 91","author":"Harley, H.A.J.; Morgan, T.; Redeker, A.G.; Reynolds, T.B.; Villamil, F.; Weiner, J.M.","unstructured":"Harley HAJ, Morgan T, Redeker AG, Reynolds TB, Villamil F, Weiner JM, et al. Results of a randomized trial of end-toside portacaval shunt and distal splenorenal shunt in alcoholic liver disease and variceal bleeding. Gastroenterology 1986; 91: 802-9."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/0016-5085(85)90502-5","article-title":"Further report of a prospective randomized trial comparing distal splenorenal shunt with end-to-side portacaval shunt","volume":"88","author":"Langer, B.; Taylor, B.R.; MacKenzie, D.R.; Gilas, T.; Stone, R.M.; Blendis, L.","year":"1985","unstructured":"Langer B, Taylor BR, MacKenzie DR, Gilas T, Stone RM, Blendis L. Further report of a prospective randomized trial comparing distal splenorenal shunt with end-to-side portacaval shunt. Gastroenterology 1985; 88: 424-9.","journal-title":"Gastroenterology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1097\/00000658-197110000-00012","article-title":"A clinical investigation of the portacaval shunt: survival analysis of the therapeutic operation","volume":"174","author":"Jackson, F.C.; Perrin, E.B.; Felix, W.R.; Smith, A.G.","year":"1971","unstructured":"Jackson FC, Perrin EB, Felix WR, Smith AG. A clinical investigation of the portacaval shunt: survival analysis of the therapeutic operation. Ann Surg 1971; 174: 672-701.","journal-title":"Ann Surg"},{"key":"ref_16","first-page":"454","article-title":"Distal splenorenal shunt versus endoscopic sclerotherapy for long-term management of variceal bleeding","volume":"203","author":"W, Dean Warren; JT, Galambos; SP, Riepe; JM, Henderson; WS, Brooks; AA, Salam; etal","year":"1986","unstructured":"Dean Warren W, Galambos JT, Riepe SP, Henderson JM, Brooks WS, Salam AA, etal. Distal splenorenal shunt versus endoscopic sclerotherapy for long-term management of variceal bleeding. Ann Surg 1986; 203: 454-62."},{"issue":"92","key":"ref_17","first-page":"1112","article-title":"Transjugular portal venography and radiologic portacaval shunt: an experimental study","volume":"1969","author":"Rosch, J.; Hanafee, W.N.; Snow, H.","unstructured":"Rosch J, Hanafee WN, Snow H. Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology 1969; 92: 1112-4.","journal-title":"Radiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/0002-9610(71)90147-4","article-title":"Transjugular intraphepatic portacaval shunt: an experimental work","volume":"121","author":"Rosch, J.; Hanafee, W.N.; Snow, H.; Barenfus, M.; Gray, R.","year":"1971","unstructured":"Rosch J, Hanafee WN, Snow H, Barenfus M, Gray R. Transjugular intraphepatic portacaval shunt: an experimental work. AmJ Surg 1971; 121: 588-92.","journal-title":"AmJ Surg"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"821","DOI":"10.2214\/ajr.145.4.821","article-title":"Expandable intrahepatic portacaval shunt stents: early experience in the dog","volume":"145","author":"Palmaz, J.C.; Sibbit, R.R.; Reuter, SR, Garcia; F, Tio; F.O.","year":"1985","unstructured":"Palmaz JC, Sibbit RR, Reuter SR, Garcia F, Tio FO. Expandable intrahepatic portacaval shunt stents: early experience in the dog. AmJ Roentgenol 1985; 145: 821-5.","journal-title":"AmJ Roentgenol"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.2214\/ajr.147.6.1251","article-title":"Expandable intrahepatic portacaval shunt stents in dogs with chronic portal hypertension","volume":"147","author":"Palmaz, J.C.; Garcia, F.; Sibbitt, R.R.; Tio, F.O.; Kopp, D.T.; Schwesinger, W.","year":"1986","unstructured":"Palmaz JC, Garcia F, Sibbitt RR, Tio FO, Kopp DT, Schwesinger W, et al. Expandable intrahepatic portacaval shunt stents in dogs with chronic portal hypertension. AmJ Roentgenol 1986; 147: 1251-4.","journal-title":"AmJ Roentgenol"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1148\/radiology.162.2.3797662","article-title":"Experimental intrahepatic portacaval anastomosis: use of expandable Gianturco stents","volume":"162","author":"Rosch, J.; Uchida, B.T.; Putnam, J.S.; Buschman, R.W.; Law, R.D.; Hershey, A.L.","year":"1987","unstructured":"Rosch J, Uchida BT, Putnam JS, Buschman RW, Law RD, Hershey, AL. Experimental intrahepatic portacaval anastomosis: use of expandable Gianturco stents. Radiology 1987; 162: 481-5.","journal-title":"Radiology"},{"key":"ref_22","first-page":"267","article-title":"Creation of an intrahepatic portosystemic shunt with a Gruntzig balloon catheter","volume":"126","author":"Colapinto, R.F.; Stronell, R.D.; Birth, S.J.; Langer, B.; Blendis, L.M.; Greig, P.D.","year":"1982","unstructured":"Colapinto RF, Stronell RD, Birth SJ, Langer B, Blendis LM, Greig PD, et al. Creation of an intrahepatic portosystemic shunt with a Gruntzig balloon catheter. Can Med Assoc J 1982; 126:267-8.","journal-title":"Can Med Assoc J"},{"key":"ref_23","first-page":"70914","article-title":"Formation ofintrahepatic portosystemic shunts using a balloon dilatation catheter: preliminary clinical experience","volume":"140","author":"Colapinto, R.F.; Stronell, R.D.; Gildiner, M.; Ritchie, A.C.; Langer, B.; Taylor, B.R.","year":"1983","unstructured":"Colapinto RF, Stronell RD, Gildiner M, Ritchie AC, Langer B, Taylor BR, et al. Formation ofintrahepatic portosystemic shunts using a balloon dilatation catheter: preliminary clinical experience. Am J Roentgenol 1983; 140: 70914.","journal-title":"Am J Roentgenol"},{"key":"ref_24","first-page":"40611","article-title":"Der transjugulare intrahepatische portosystemische stent-shunt (TIPSS)","volume":"29","author":"Richter, G.M.; Palmaz, J.C.; Noldge, G.; Rossle, M.; Siegerstetter, V.; Franke, M.","year":"1989","unstructured":"Richter GM, Palmaz JC, Noldge G, Rossle M, Siegerstetter V, Franke M, et al. Der transjugulare intrahepatische portosystemische stent-shunt (TIPSS). Radiologe 1989; 29: 40611.","journal-title":"Radiologe"},{"key":"ref_25","first-page":"153","article-title":"New non-operative treatment for variceal haemorrhage","volume":"i:","author":"Rossle, M.; Richter, G.M.; Noldge, G.; Palmaz, J.C.; Wenz, W.; Gerok, W.","year":"1989","unstructured":"Rossle M, Richter GM, Noldge G, Palmaz JC, Wenz W, Gerok W. New non-operative treatment for variceal haemorrhage [letter]. Lancet 1989; i: 153.","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1148\/radiology.174.3.174-3-1027","article-title":"Transjugular intrahepatic portacaval stent shunt: preliminary clinical results","volume":"174","author":"Richter, G.M.; Noeldge, G.; Palmaz, J.C.; Roessle, M.; Siegerstetter, V.; Franke, M.","year":"1990","unstructured":"Richter GM, Noeldge G, Palmaz JC, Roessle M, Siegerstetter V, Franke M, et al. Transjugular intrahepatic portacaval stent shunt: preliminary clinical results. Radiology 1990; 174:1027-30.","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1001\/jama.1991.03470030090029","article-title":"Percutaneous transiugular portosystemic shunt","volume":"266","author":"Zemel, G.; Katzen, B.T.; Becker, G.J.; Benenati, J.F.; Skip Sallee, D.","year":"1991","unstructured":"Zemel G, Katzen BT, Becker GJ, Benenati JF, Skip Sallee D. Percutaneous transiugular portosystemic shunt. JAMA 1991;266:390-3.","journal-title":"JAMA"},{"key":"ref_28","first-page":"96","article-title":"Transjugular intrahepatic portosystemic stent-shunt (TIPSS): experience with an improved technique","volume":"14","author":"Rossle, M.; Noldge, G.; Pararnau, J.M.; Haag, K.; Sellinger, M.; Wenz, W.","year":"1991","unstructured":"Rossle M, Noldge G, Pararnau JM, Haag K, Sellinger M, Wenz W, et al. Transjugular intrahepatic portosystemic stent-shunt (TIPSS): experience with an improved technique. Hepatology 1991; 14: 96A.","journal-title":"Hepatology"},{"key":"ref_29","first-page":"234","article-title":"Transjugular intra-hepatic porto-caval shunts (ICPS): experimental and clinical study","volume":"14","author":"Vinel, J.P.; Rousseau, H.; Maquin, P.; de Haldat, F.; Blain, F.; Joffre, F.","year":"1991","unstructured":"Vinel JP, Rousseau H, Maquin P, de Haldat F, Blain F, Joffre F, et al. Transjugular intra-hepatic porto-caval shunts (ICPS): experimental and clinical study. Hepatology 1991; 14: 234A.","journal-title":"Hepatology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1148\/radiology.181.3.1947081","article-title":"Percutaneous intrahepatic portosystemic shunt created via a femoral vein approach","volume":"181","author":"JM, La Berge; EJ, Ring; RL, Gordon","year":"1991","unstructured":"La Berge JM, Ring EJ, Gordon RL. Percutaneous intrahepatic portosystemic shunt created via a femoral vein approach. Radiology 1991; 181: 679-81.","journal-title":"Radiology"},{"key":"ref_31","first-page":"304","article-title":"LaBerge JM, Read AE, et al. Using transjugular intrahepatic portosystemic shunts to control variceal bleeding before liver transplantation","volume":"116","author":"Ring, E.J.; Lake, JR, Roberts; JP, Gordon; R.L.","year":"1992","unstructured":"Ring EJ, Lake JR, Roberts JP, Gordon RL, LaBerge JM, Read AE, et al. Using transjugular intrahepatic portosystemic shunts to control variceal bleeding before liver transplantation. American College of Physicians 1992; 116: 304-9.","journal-title":"American College of Physicians"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/S0009-9260(05)80438-6","article-title":"Transjugular intrahepatic portosystemic stent shunt (TIPSS): Early clinical experience","volume":"46","author":"Chalmers, N.; Redhead, D.N.; Simpson, K.J.; Hayes, P.C.","year":"1992","unstructured":"Chalmers N, Redhead DN, Simpson KJ, Hayes PC. Transjugular intrahepatic portosystemic stent shunt (TIPSS): Early clinical experience. Clin Radiol 1992; 46: 166-9.","journal-title":"Clin Radiol"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1055\/s-2007-1018288","article-title":"N-butyl-2cyanoacrylate, a supplement to endoscopic sclerotherapy","volume":"19","author":"Soehendra, N.; Grimm, H.; Nam, V.; Berger, B.","year":"1987","unstructured":"Soehendra N, Grimm H, Nam V, Berger B. N-butyl-2cyanoacrylate, a supplement to endoscopic sclerotherapy. Endoscopy 1987; 19: 221-4.","journal-title":"Endoscopy"},{"key":"ref_34","first-page":"51","article-title":"Effect of prior portasystemic shunt on subsequent liver transplantation","volume":"209","author":"Brems, J.J.; Hiatt, JR, Kleen; AS, Millis; JM, Colonna; JO, Quinones-Baldrich; W.J.","year":"1989","unstructured":"Brems JJ, Hiatt JR, Kleen AS, Millis JM, Colonna JO, Quinones-Baldrich WJ, et al. Effect of prior portasystemic shunt on subsequent liver transplantation. Ann Surg 1989; 209: 51-6."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/0140-6736(91)93125-S","article-title":"Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis","volume":"337","author":"Perez-Ayuso, R.M.; Pique, J.M.; Bosch, J.; Panes, Gonzalez; A, Peres; R.","year":"1991","unstructured":"Perez-Ayuso RM, Pique JM, Bosch J, Panes, Gonzalez A, Peres R, et al. Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis. Lancet 1991; 337: 1431-4.","journal-title":"Lancet"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.34.7.968","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T19:29:51Z","timestamp":1763753391000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.34.7.968"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1993,7]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[1993,7,1]]},"published-print":{"date-parts":[[1993,7]]}},"alternative-id":["10.1136\/gut.34.7.968"],"URL":"https:\/\/doi.org\/10.1136\/gut.34.7.968","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1993,7]]}}}