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W.B. SAUNDERS COMPANY A Division of Harcourt Brace 6 Company The Curtis Center - Independence Square West Philadelphia, Pennsylvania 19106 GASTROENTEROLOGYCLINICS OF NORTH AMERICA September 1998 Editor: Heather Cullen Volume 27, Number 3 ISSN 0889-8553 Production Editor: Julia M. Benson Copyright 0 1998 by W.B. Saunders Company. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information retrieval system, without written permission from the Publisher. The appearance of the code at the top of the first page of an article in this periodical indicates the consent of the W.B. Saunders Company that copies of the article may be made for personal or internal use, or for the personal or internal use of specific clients,for those registered with the Copyright Clearance Center, Inc. (222 Rosewood Drive, Danvers, MA 01923: (978) 750-8400; www.copyright.corn). This consent is given on the condition that the copier pay the stated per-copy fee for that article through the Copyright Clearance Center, Inc. for copying beyond that permitted by Sections 107 or 108 of the US Copyright Law. This consent does not extend to other kinds of copying, such as copying for general distribution, for advertising or promotional purposes, for creating new collective works, or for resale. Absence of the code indicates that the material may not be processed through the Copyright Clearance Center, Inc. The ideas and opinions expressed in Gastroenterology Clinics of North America do not necessarily reflect those of the Publisher. The Publisher does not assume any responsibility for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this periodical. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each drug to be administered to verify the dosage, the method and duration of administra- tion, or contraindications. It is the responsibility of the treating physician or other health care professional, relying on independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. Mention of any product in this issue should not be construed as endorsement by the contributors, editors, or the Publisher of the product or manufacturers’ claims. Gastroenterology Clinics of North America (ISSN 08894553) is published quarterly by the W.B. Saunders Company. Corporate and editorial offices: The Curtis Center, Independence Square West, Philadelphia, PA 191063399. Accounting and circulation offices: 6277 Sea Harbor Drive, Orlando, FL 328874300. Periodicals postage paid at Orlando, FL 32862, and additional mailing offices. Subscription prices are $125.00 per year (US individuals), $153.00 per year (US institutions), $136.00 per year (Canadian individuals), $184.00 per year (Canadian institutions), $161.00 per year (international individuals), and $184.00 per year (international institutions). Foreign air speed delivery is included in all Clinics subscription prices. All prices subject to change without notice. POSTMASTER Send address changes to Gastroenterology Clinics of North America, W.B. Saunders Company, Periodicals Fulfillment, Orlando, FL 328874800. Customer Service: 1-800-6542452 (US). From outside of the US, call 1-407-345-4000. Gastroenterology Clinics ofNorth America is also published in Italian by I1 Pensiero Scientific0 Editore, Rome, Italy; in Portuguese by Interlivros Edicoes Ltda., Rua Commandante Coelho 1085, 21250 Cordovil, Rio de Janeiro, Brazil; and in Spanish by McGraw-Hill Interamericana Editores S.A., P.O. Box 5-237, 06500 Mexico D.F., Mexico. Gastroenterology Clinics of North America is covered in Index Medicus, Excerpta Medica, Current Concepts/Clinical Medicine, Science Citation Index, ISI/BIOMED, and BIOSIS. Printed in the United States of America.

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Page 1: Information for Readers

W.B. SAUNDERS COMPANY A Division of Harcourt Brace 6 Company

The Curtis Center - Independence Square West Philadelphia, Pennsylvania 19106

GASTROENTEROLOGY CLINICS OF NORTH AMERICA September 1998 Editor: Heather Cullen

Volume 27, Number 3 ISSN 0889-8553

Production Editor: Julia M. Benson

Copyright 0 1998 by W.B. Saunders Company. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information retrieval system, without written permission from the Publisher.

The appearance of the code at the top of the first page of an article in this periodical indicates the consent of the W.B. Saunders Company that copies of the article may be made for personal or internal use, or for the personal or internal use of specific clients,for those registered with the Copyright Clearance Center, Inc. (222 Rosewood Drive, Danvers, MA 01923: (978) 750-8400; www.copyright.corn). This consent is given on the condition that the copier pay the stated per-copy fee for that article through the Copyright Clearance Center, Inc. for copying beyond that permitted by Sections 107 or 108 of the US Copyright Law. This consent does not extend to other kinds of copying, such as copying for general distribution, for advertising or promotional purposes, for creating new collective works, or for resale. Absence of the code indicates that the material may not be processed through the Copyright Clearance Center, Inc.

The ideas and opinions expressed in Gastroenterology Clinics of North America do not necessarily reflect those of the Publisher. The Publisher does not assume any responsibility for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this periodical. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each drug to be administered to verify the dosage, the method and duration of administra- tion, or contraindications. It is the responsibility of the treating physician or other health care professional, relying on independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. Mention of any product in this issue should not be construed as endorsement by the contributors, editors, or the Publisher of the product or manufacturers’ claims.

Gastroenterology Clinics of North America (ISSN 08894553) is published quarterly by the W.B. Saunders Company. Corporate and editorial offices: The Curtis Center, Independence Square West, Philadelphia, PA 191063399. Accounting and circulation offices: 6277 Sea Harbor Drive, Orlando, FL 328874300. Periodicals postage paid at Orlando, FL 32862, and additional mailing offices. Subscription prices are $125.00 per year (US individuals), $153.00 per year (US institutions), $136.00 per year (Canadian individuals), $184.00 per year (Canadian institutions), $161.00 per year (international individuals), and $184.00 per year (international institutions). Foreign air speed delivery is included in all Clinics subscription prices. All prices subject to change without notice. POSTMASTER Send address changes to Gastroenterology Clinics of North America, W.B. Saunders Company, Periodicals Fulfillment, Orlando, FL 328874800. Customer Service: 1-800-6542452 (US). From outside of the US, call 1-407-345-4000.

Gastroenterology Clinics ofNorth America is also published in Italian by I1 Pensiero Scientific0 Editore, Rome, Italy; in Portuguese by Interlivros Edicoes Ltda., Rua Commandante Coelho 1085, 21250 Cordovil, Rio de Janeiro, Brazil; and in Spanish by McGraw-Hill Interamericana Editores S.A., P.O. Box 5-237, 06500 Mexico D.F., Mexico.

Gastroenterology Clinics of North America is covered in Index Medicus, Excerpta Medica, Current Concepts/Clinical Medicine, Science Citation Index, ISI/BIOMED, and BIOSIS.

Printed in the United States of America.