bluuebunny/crossref_metadata_2025 huggingface dataset:
Review article: possible beneficial effects of coffee on liver disease and function
Authors: CADDEN I. S. H. , PARTOVI N. , YOSHIDA E. M.
Published: July 2010

Background

Coffee is consumed by 50 percent of Americans every day. After oil, coffee is the second most valuable commodity in the world. In recent years a number of studies have suggested potential health risks associated with coffee consumption; however, the results are controversial. Whilst coffee has been reported to increase cardiovascular risk factors, other investigators have demonstrated its protective effects on diseases ranging from type 2 diabetes to Parkinson's disease. A number of investigators have focused their attention on the relationship between the consumption of coffee and liver disease.

Aim  To examine the published literature to date in an attempt to establish the presence of an hepatoprotective effect of coffee.

Methods  Using PubMed, we identified published studies and review articles relating to the effect of coffee consumption on diseases of the liver.

Conclusion  A number of studies have reported the beneficial effects of coffee on abnormal liver biochemistry, cirrhosis and hepatocellular carcinoma. At the present time the mechanism of this effect remains unclear as does the ‘‘dose’’ required to achieve these benefits.
Incidence and characterization of serum transaminases elevations in pegylated interferon and ribavirin treated patients with chronic hepatitis C
Authors: THURAIRAJAH P. H. , THORBURN D. , HUBSCHER S. , WHITE A. , LAI W. K. , O’DONNELL K. , MUTIMER D.
Published: July 2010

Background

A virological response to pegylated‐interferon and ribavirin is typically associated with a prompt fall in serum transaminases. For some patients, transaminases rise during treatment.

Aim

To assess the frequency and define factors associated with elevations of serum transaminases.

Methods

A total of 169 treated patients were studied. Transaminase elevations were graded by WHO criteria – grade 0: no value > baseline, grade 1: 1–2x baseline, grade 2: 2.1–5x baseline, grade 3: >5x, grade 4: any rise with evidence of liver failure.

Results

60/169 (35%) patients experienced transaminase elevations: 52 grade 1, 6 grade 2, 1 grade 3, 1 grade 4. Overall, end of treatment response and sustained virological response rates were 72% and 55%. Lower rates were observed in the grade 1 elevation group (63% and 40%) compared with patients with grade 0 (79% and 65%) and grade ≥2 elevations (85% and 71%). Grade 1 elevations tended to occur earlier during treatment than grade ≥2 elevations. Transaminase elevations were associated with greater pre‐treatment body weight (P = 0.006), steatosis (P = 0.008) and poorer sustained virological response rates (P = 0.007).

Conclusions

Transaminase elevations during treatment of chronic Hepatitis C virus with pegylated interferon and ribavirin are common but rarely severe. Mild rises may reflect ongoing viral activity in treatment non‐responders. More significant rises are frequently observed despite a virological response, and may be because of an immuno‐modulating effect of interferon in susceptible patients.
Controlled study using wireless capsule endoscopy for the evaluation of the small intestine in chronic refractory pouchitis
Authors: CALABRESE C. , FABBRI A. , GIONCHETTI P. , RIZZELLO F. , MORSELLI C. , LIGUORI G. , POGGIOLI G. , CAMPIERI M. , FEBO G. DI
Published: July 2010

Background

Pouchitis is a common long‐term complication after ileal pouch anal anastomosis for ulcerative colitis. Chronic refractory pouchitis is a treatment‐resistant condition that affects 5–15% of patients.

Aim

To test the hypothesis of a small bowel involvement using wireless capsule endoscopy.

Material and methods

This is a single‐blind, prospective, cohort study. Twenty‐four patients: 16 were patients with chronic refractory pouchitis and eight, with a macroscopically and histologically normal ileal pouch, were considered as control subjects. Diagnosis of pouchitis was confirmed using the pouchitis disease activity index. All subjects were submitted to wireless capsule endoscopy procedure. Within 2 weeks before wireless capsule endoscopy, patients underwent a pouch endoscopy and a small bowel follow‐through. Re‐examination of the colonic surgical and histological specimens was also performed.

Results

One patient with chronic pouchitis was excluded because of incomplete bowel cleaning. At small bowel follow‐through of 16 patients, two subjects (13%) showed only a focal ectasia of the middle ileum and a substenosis of the pouch. At wireless capsule endoscopy all the 15 evaluable patients with chronic pouchitis (100%) showed diffuse lesions from duodenum to ileum consisting of aphthae, erosions, erythema, atrophy, cobblestone, deep/fissural ulcers.

Conclusions

This enteropathy needs further research, and wireless capsule endoscopy could be useful to show involvement of small bowel in patients with chronic pouchitis.
A population‐based study of coeliac disease, neurodegenerative and neuroinflammatory diseases
Authors: LUDVIGSSON J. F. , OLSSON T. , EKBOM A. , MONTGOMERY S. M.
Published: July 2010

Background

It has been suggested that coeliac disease (CD) is associated with several neurological diseases. However, the evidence of such an association is inconclusive as earlier research has often been based on small numbers with retrospective data collection.

Aim

To use Cox regression to examine the risk of neurological disease in individuals with CD.

Methods

Through Swedish national registers we identified some 14 000 individuals with a diagnosis of CD (1964–2003) and 70 000 reference individuals matched for age, sex, calendar year and county.

Results

Coeliac disease was associated with later polyneuropathy [hazard ratio (HR) = 3.4; 95% CI = 2.3–5.1]. We found no statistically significant association between CD and subsequent multiple sclerosis (HR = 0.9; 95% CI = 0.3–2.3), Parkinson’s disease (HR = 1.2; 95% CI = 0.8–1.9), Alzheimer’s disease (HR = 1.5; 95% CI = 0.9–2.6), hereditary ataxia (HR = 1.3; 95% CI = 0.5–3.6), the symptom ataxia (HR = 1.9; 95% CI = 0.6–6.2), Huntington’s disease (HR = 1.7; 95% CI = 0.3–8.6), myasthenia gravis (HR = 0.8; 95% CI = 0.2–3.8) or spinal muscular atrophy (HR = 0.5; 95% CI = 0.1–3.8). Prior polyneuropathy was associated with subsequent CD (odds ratio = 5.4; 95% CI = 3.6–8.2).

Conclusions

The association between CD and polyneuropathy indicates shared risks. We suggest that individuals with polyneuropathy routinely undergo screening for CD. There is no notable association between CD and other neurological outcomes investigated in this study.
The impact of eosinophilia and hepatic necrosis on prognosis in patients with drug‐induced liver injury
Authors: BJÖRNSSON E. , KALAITZAKIS E. , OLSSON R.
Published: July 2010

Background  Drug‐induced liver injury may be immunologically mediated or metabolically induced. Peripheral eosinophilia and liver eosinophilia in suspected drug‐induced liver injury generally supports the role of drug aetiology.

Aim  To assess the importance of eosinophilia and hepatic necrosis on outcome in patients with suspected drug‐induced liver injury.

Methods  We performed search of MEDLINE for case reports on drug‐induced liver injury associated with: amoxicillin/clavulanic acid, carbamazepine, diclofenac, disulfiram, erythromycin, flucloxacillin, halothane, isoniazid, phenytoin, sulindac and trimethoprim/sulfametoxazol.

Results  A total of 570 case reports were retrieved. Mortality/transplantation occurred in 112 (20%). Eosinophilia in peripheral blood was reported in 34% of cases, eosinophilia in liver biopsies in 40%, and hepatic necrosis in 41%. Bilirubin levels were lower in patients with peripheral eosinophilia [5.5 × upper limit of normal (interquartile range 2.9–10) vs. 7.7 (4–17); P = 0.02] and patients with liver eosinophilia [5 × upper limit of normal (2.7–10) vs. 10 (5.4–20); P = 0.003] as compared with those without eosinophilia. Eosinophilia in peripheral blood and eosinophilia in liver biopsies were more common in patients who recovered (37% vs. 15.6%; P = 0.0001 and 48% vs. 18.8%; P < 0.0001, respectively). Hepatic necrosis was present in 24% in the survivors vs. 84% in non‐survivors (P < 0.0001).

Conclusions  In drug‐induced liver injury, a favourable outcome was related to the occurrence of eosinophilia, whereas hepatic necrosis was associated with a poor prognosis.
Review article: the management of steroid dependency in ulcerative colitis
Authors: PORRO G. BIANCHI , CASSINOTTI A. , FERRARA E. , MACONI G. , ARDIZZONE S.
Published: July 2010

Background

Approximately 20% of patients with ulcerative colitis have a chronic active disease often requiring several courses of systemic steroids in order to achieve remission, but followed by relapse of symptoms during steroid tapering or soon after their discontinuation. Although short term control of symptoms can be achieved with steroid treatment, this pattern of drug response, known as steroid‐dependency, leads to important complications of the treatment, while a significant proportion of patients requires colectomy.

Aim

To review the studies currently available specifically evaluating the management of steroid‐dependent ulcerative colitis.

Results

The clinical and biological mechanisms of steroid‐dependency are not well understood compared with those determining steroid‐refractoriness. Very few evidence‐based data are available concerning the management of patients with steroid‐dependent ulcerative colitis. The therapeutic role of aminosalicylates, thiopurines, methotrexate, infliximab, leukocyte apheresis and other drugs in the treatment of steroid‐dependent ulcerative colitis are evaluated.

Conclusions

Outcomes of studies in steroid‐refractory patients may not be applicable to steroid‐dependency. Trials are needed to define the correct approaches and new strategies to ameliorate the therapy of steroid‐dependent ulcerative colitis.
Oral mucosa of coeliac disease patients produces antiendomysial and antitransglutaminase antibodies: the diagnostic usefulness of an in vitro culture system
Authors: CARROCCIO A. , CAMPISI G. , IACONO G. , IACONO O. LO. , MARESI E. , DI PRIMA L. , COMPILATO D. , BARBARIA F. , ARINI A. , DI LIBERTO C. , PIRRONE G. , CRAXÌ A. , DI MARCO V.
Published: July 2010

Background  Antiendomysial (EmA) and antitransglutaminase (anti‐tTG) antibodies are the most specific indirect marker of coeliac disease (CD). It is not known whether the oral mucosa of patients with CD is able to produce these antibodies or not.

Aims  To evaluate the ability of the oral mucosa of patients with CD to produce antibodies in an in vitro culture system.

Patients and methods  Twenty‐eight patients with new diagnosis of CD (15 adults and 13 children) and 14 adult subjects with other diseases (controls) were studied. All underwent oral mucosa biopsy and subsequent EmA and anti‐tTG assays on the mucosa culture medium.

Results  Sensitivity and specificity of EmA and anti‐tTG assayed in the oral mucosa culture medium for CD diagnosis were 54% and 100% and 57% and 100%, respectively. The CD clinical presentation, such as the presence of oral mucosa lesions, did not influence the results of the EmA and anti‐tTG assays in the oral mucosa culture medium. There was an association between positivity of antibodies and greater severity of the oral mucosa lymphocyte infiltration.

Conclusion  This study demonstrates that the oral mucosa contributes to EmA and anti‐tTG production in untreated patients with CD.
Age at onset of inflammatory bowel disease and the risk of surgery for non‐neoplastic bowel disease
Authors: TREMAINE W. J. , TIMMONS L. J. , LOFTUS E. V. , PARDI D. S. , SANDBORN W. J. , HARMSEN W. S. , THAPA P. , ZINSMEISTER A. R.
Published: July 2010

Background  There is conflicting data regarding the response to medical and surgical therapy for inflammatory bowel disease with respect to age at disease onset.

Aim  To determine if the age at onset of Crohn's disease and ulcerative colitis is a risk factor for surgery for non‐neoplastic bowel disease.

Methods  This was a case–control study of patients evaluated between 1998 and 2001. Cases had undergone an initial operation for bowel disease. Controls were matched 1:1 for gender, disease subtype, date of first visit (±2 years), time from diagnosis prior to first visit (±3 years) and duration of follow‐up. Association with age, disease extent, smoking history, medication use and co‐morbidities vs. case/control status was assessed using multiple variable conditional logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CI) for undergoing surgery.

Results  Among 132 Crohn’s patients, older patients had lower odds for surgery (OR per 5 years, 0.86; 95% CI: 0.75–0.98). The rate of surgery for non‐neoplastic bowel disease was not significantly associated with disease distribution, co‐morbidities or cigarette smoking. Among 234 ulcerative colitis patients, the rate of surgery was unrelated to age, disease extent, co‐morbidities or cigarette smoking,

Conclusions  For Crohn’s disease, but not ulcerative colitis, the risk of surgery for non‐neoplastic bowel disease decreases with increasing age at diagnosis, irrespective of disease distribution and history of cigarette smoking.
The Gastro‐oesophageal Reflux Disease Impact Scale: a patient management tool for primary care
Authors: JONES R. , COYNE K. , WIKLUND I.
Published: July 2010

Background  Symptoms of gastro‐oesophageal reflux disease have a substantial impact on patients’ everyday lives.

Aim  To develop and test a short questionnaire to aid patient–doctor communication.

Methods  The Gastro‐oesophageal Reflux Disease Impact Scale was developed from a systematic literature review, focus groups of patients and primary care physicians, and patient cognitive interviews. A psychometric validation study was conducted based on two consultations in new (n = 100) or chronic (n = 105) gastro‐oesophageal reflux disease patients.

Results  The Gastro‐oesophageal Reflux Disease Impact Scale demonstrated internal consistency (Cronbach’s alpha ranged from 0.68 to 0.82), reproducibility (intraclass correlation coefficient in stable patients ranged from 0.61 to 0.72) and construct validity (Spearman correlations with Quality of Life in Reflux and Dyspepsia instrument and Reflux Disease Questionnaire: 0.5–0.8 in both patient groups). Effect sizes in new and chronic gastro‐oesophageal reflux disease patients ranged from 0.9 to 1.5 and 0.32 to 0.42, respectively. Doctors reported altering their treatment decision based on information provided by the Gastro‐oesophageal Reflux Disease Impact Scale in 35% of patients, and 77% of doctors found it to be useful.

Conclusions  The Gastro‐oesophageal Reflux Disease Impact Scale demonstrated good psychometric properties in newly diagnosed gastro‐oesophageal reflux disease patients and those already receiving treatment. This simple communication tool is a useful aid for managing primary care patients with gastro‐oesophageal reflux disease.
Long‐term follow‐up of patients with mild to moderate drug‐induced liver injury
Authors: BJÖRNSSON E. , KALAITZAKIS E. , AV KLINTEBERG V. , ALEM N. , OLSSON R.
Published: July 2010

Aim To evaluate the long‐term prognosis of patients diagnosed with drug‐induced liver injury, and the nature of the liver injury.

Methods Patients with a diagnosis of drug‐induced liver injury between 1994 and 2005 were identified in a university hospital clinic. Patients surviving drug‐induced liver injury‐associated liver failure were excluded.

Results Seventy‐seven cases were identified and those who were alive (69) were invited to attend follow‐up. Of those patients who had died, none had died of liver disease. Of those patients who had survived, 59 were reviewed in the clinic. Patients had a median follow‐up of 48 months. Before the diagnosis of drug‐induced liver injury, nine had a chronic liver disease, four with autoimmune hepatitis, two with non‐alcoholic liver disease, one each with non‐alcoholic fatty liver disease, primary biliary cirrhosis and primary sclerosing cholangitis. There was no evidence of progression of their liver disease during follow‐up. Among 50 patients without a known liver disease prior to the drug‐induced liver injury, 10 had abnormal liver tests. Diagnostic work‐up revealed alternative cause of liver disease in all except three patients (6%), who had asymptomatic abnormal liver tests (but normal bilirubin in all).

Conclusions Chronic abnormalities in liver tests, not explained by an identified liver disease, are very rare in patients previously diagnosed with drug‐induced liver injury. This group of patients did not seem to have a clinically significant liver injury at long‐term follow‐up.
Review article: appropriate use of corticosteroids in Crohn’s disease
Authors: IRVING P. M. , GEARRY R. B. , SPARROW M. P. , GIBSON P. R.
Published: July 2010

Background  Corticosteroids are a well‐established treatment for active Crohn’s disease and have been widely used for decades. It has become apparent, however, that a proportion of patients either fails to respond to corticosteroids or is unable to withdraw from them without relapsing. Furthermore, their use is associated with a range of side effects, such that long‐term treatment carries unacceptable risk.

Aim  To review the evidence regarding the appropriate use of corticosteroids in Crohn’s disease, along with their side effects, safety and alternatives.

Methods  To collect relevant articles, a PubMed search was performed from 1966 to November 2006 using the terms ‘steroid’, ‘corticosteroid’, ‘glucocorticoid’, ‘prednisolone’, ‘prednisone’, ‘methylprednislone’, ‘hydrocortisone’, ‘dexamethasone’ and ‘budesonide’ in combination with ‘Crohn(s) disease’. Relevant articles were reviewed, as were their reference lists to identify further articles.

Results  When used correctly, corticosteroids are a highly effective, well tolerated, cheap and generally safe treatment for active Crohn’ disease. Nevertheless, approximately 50% of recipients will either fail to respond (steroid‐resistant) or will be steroid dependent at 1 year. Newer alternatives to corticosteroids are not, however, without risk themselves and, moreover, are not necessarily available universally.

Conclusions  Steroids are used widely to treat Crohn’s disease, a situation that is unlikely to change in the near future. Accordingly, efforts should be made to ensure that they are used correctly and that their side effects are minimized. Reference is made to recently published guidelines and a simplified ‘users guide’ is presented.
A retrospective analysis of the efficacy and safety of infliximab as rescue therapy in acute severe ulcerative colitis
Authors: LEES C. W. , HEYS D. , HO G. T. , NOBLE C. L. , SHAND A. G. , MOWAT C. , BOULTON‐JONES R. , WILLIAMS A. , CHURCH N. , SATSANGI J. , ARNOTT I. D. R. ,   ON BEHALF OF THE SCOTTISH SOCIETY OF GASTROENTEROLOGY INFLIXIMAB GROUP
Published: July 2010

Background  Forty per cent of patients with acute severe ulcerative colitis will not respond to intravenous corticosteroids and require second‐line medical therapy or colectomy. A recent controlled trial has suggested that infliximab may be effective as rescue therapy.

Aim  To assess the value of infliximab as rescue therapy for acute severe colitis in a retrospective cohort of ulcerative colitis patients in Scotland.

Methods  All patients satisfied Truelove and Witts criteria on admission, failed to respond to intravenous corticosteroids and received infliximab (5 mg/kg) as rescue therapy. Response was defined as need for colectomy at hospital discharge and by 90 days.

Results  A total of 39 patients (median age 31.7 years) were treated. 26/39 (66%) responded, avoiding colectomy during the acute admission, and were followed up for a median of 203 days (Interquartile range = 135.5–328.5). Hypoalbuminaemia was a consistent predictor of non‐response on univariate and multivariate analysis. At day 3 of intravenous steroids, 9/18 (50.0%) with serum albumin <34 g/L had urgent colectomy vs. 1/13 (7.7%) ≥34 g/L (P = 0.02, OR = 12.0, C.I. 1.28–112.7). Two serious adverse events occurred – one death due to Pseudomonas pneumonia, and one post‐operative fungal septicaemia.

Conclusions  Infliximab represents a moderately effective rescue therapy for patients with acute severe ulcerative colitis. Serious adverse events, including death, do occur and should be discussed with patients prior to therapy.
Review article: the genetic basis of haemochromatosis
Authors: GRIFFITHS W. J. H.
Published: July 2010

Background  Since the seminal discovery of the HFE gene a decade ago, considerable further progress in unravelling the genetic basis of haemochromatosis has been made. Novel genes and iron overload phenotypes have been described with potential insights into the molecular pathophysiology of human iron metabolism.

Aim  To review recent key advances in the field of inherited iron overload and assess their impact on clinical practice and on our understanding of iron regulation.

Methods  A PubMed search was undertaken predominantly using ‘haemochromatosis’, ‘HFE’, ‘hepcidin’ and ‘ferroportin’. Illustrative cases were sought.

Results  The impact of HFE mutation analysis on the management of haemochromatosis is significant and allows early accurate diagnosis. HFE is also implicated in the siderosis associated with other liver pathologies. Non‐HFE genes underpinning other forms of haemochromatosis are now recognized and genotype–phenotype interactions result in a spectrum of disease. These novel gene products interact with HFE in a common pathway for iron homeostasis.

Conclusions  Further identification of non‐HFE genes associated with iron homeostasis will enhance our diagnostic certainty of primary haemochromatosis and may explain the variable expression seen in HFE‐related disease. Improving our understanding of the mechanisms of iron regulation may lead to novel therapeutic strategies for the management of iron overload.
Development of a clinical hepatic encephalopathy staging scale
Authors: ORTIZ M. , CÓRDOBA J. , DOVAL E. , JACAS C. , PUJADAS F. , ESTEBAN R. , GUARDIA J.
Published: July 2010

Aim

To develop a scale to assess the severity of hepatic encephalopathy using simple dichotomic items.

Methods

A list of 48 items was created by selecting items that are simple to recognize and categorize; it was applied to thirty‐six cirrhotic in‐patients with episodic encephalopathy, in addition to the adapted‐West‐Haven Criteria and the Glasgow Coma Score. The list underwent an item reduction process and principal component analysis; the metric characteristics were evaluated.

Results

Multiple neurological abnormalities were observed and a Clinical Hepatic Encephalopathy Staging Scale of nine items was constructed. The principal component analysis of the Clinical Hepatic Encephalopathy Staging Scale obtained two factors that explained 77% of the variance. The Clinical Hepatic Encephalopathy Staging Scale exhibited adequate internal consistency and reproducibility. The scores of the Clinical Hepatic Encephalopathy Staging Scale correlated to those of adapted‐West‐Haven Criteria and the Glasgow Coma Score.

Conclusions

This study confirms that the evaluation of multiple neurological manifestations is not necessary to classify hepatic encephalopathy adequately, which can be simply undertaken by an assessment of the patient’s orientation, alertness, ability to respond to commands and to talk. A list of nine items is proposed as a linear scale from normality (Clinical Hepatic Encephalopathy Staging Scale = 0) to deep coma (Clinical Hepatic Encephalopathy Staging Scale = 9).
Red chili induces rectal hypersensitivity in healthy humans: possible role of 5HT‐3 receptors on capsaicin‐sensitive visceral nociceptive pathways
Authors: GONLACHANVIT S. , FONGKAM P. , WITTAYALERTPANYA S. , KULLAVANIJAYA P.
Published: July 2010

Background  Red chili has been reported to modulate visceral hypersensitivity, probably by the action of its active ingredient, capsaicin. The role of 5HT‐3 receptors on capsaicin‐sensitive visceral nociceptive pathways is unknown.

Aim  To test the hypothesis that capsaicin‐containing red chili induces rectal hypersensitivity in healthy humans and 5HT‐3 receptors participate in this effect.

Methods  Eighteen healthy volunteers, each underwent three rectal barostat studies under three conditions: (i) oral placebo; (ii) oral chili (5 g daily × 3 days); and (iii) oral chili with 1‐mg intravenous (i.v.) granisetron, in randomized, double‐blinded, cross‐over fashions. Rectal sensation was evaluated by using a 5‐point Likert scale.

Results  Chili ingestion significantly decreased rectal threshold for first, moderate and severe urgency (18 ± 0.9, 24 ± 1.2, and 38 ± 1.5 mmHg, respectively) compared with placebo (22 ± 0.9, 31 ± 1.3, and 45 ± 1.4 mmHg, respectively, P < 0.01). The threshold for first, moderate and severe urgency after chili with i.v. granisetron was 20 ± 0.9, 28 ± 1.2 and 44 ± 1.3 mmHg, respectively. This is a significant increase compared with chili ingestion without gransisetron (P < 0.05). After placebo ingestion, i.v. granisetron produced no effect on rectal sensation compared with i.v. placebo in 10 healthy volunteers (P > 0.05).

Conclusions  Low‐dose granisetron, a 5HT‐3 receptor antagonist, partially reversed chili‐induced rectal hypersensitivity but had no effect on rectal perception induced only by mechanical balloon distention. This study suggests that 5HT‐3 receptors may be involved in chili‐induced rectal hypersensitivity and potentially participate in the capsaicin‐sensitive nociceptive pathways of the human gut.
Systematic review and meta‐analysis: the incidence and prognosis of post‐infectious irritable bowel syndrome
Authors: THABANE M. , KOTTACHCHI D. T. , MARSHALL J. K.
Published: July 2010

Background  Individual studies suggest that post‐infectious irritable bowel syndrome is common, but symptoms gradually improve.

Aim  To review evidence for an association between intestinal infection and development of irritable bowel syndrome, assess the prognosis of post‐infectious irritable bowel syndrome and explore factors that increase the risk.

Methods  MEDLINE (1966–2007) and EMBASE (1980–2007) databases were searched to identify the studies of post‐infectious irritable bowel syndrome epidemiology. Data were extracted by two independent reviewers. Pooled odds ratios (POR) and corresponding 95% CI for incidence of irritable bowel syndrome were estimated among the exposed and unexposed groups.

Results  Eighteen of 26 studies identified were eligible for inclusion. Intestinal infection was associated with increased odds of developing irritable bowel syndrome at study end (POR = 5.86; 95% CI: 3.60–9.54). In subgroup analysis, the odds of developing irritable bowel syndrome was increased at 3 months (POR = 7.58; 95% CI: 4.27–13.45), 6 months (POR = 5.18; 95% CI: 3.24–8.26), 12 months (POR = 6.37; 95% CI: 2.63–15.40) and 24–36 months (POR = 3.85; 95% CI: 2.95–5.02). Among all studies (controlled and uncontrolled), the pooled incidence of irritable bowel syndrome at study conclusion was 10% (95% CI: 9.4–85.6). Subjects with post‐infectious irritable bowel syndrome were younger and more anxious and depressed than those without post‐infectious irritable bowel syndrome.

Conclusion  The odds of developing irritable bowel syndrome are increased sixfold after acute gastrointestinal infection. Young age, prolonged fever, anxiety and depression are risk factors for post‐infectious irritable bowel syndrome.
Epidemiology of chronic hepatitis B infection in France: risk factors for significant fibrosis – results of a nationwide survey
Authors: CADRANEL J.‐F. , LAHMEK P. , CAUSSE X. , BELLAICHE G. , BETTAN L. , FONTANGES T. , MEDINI A. , HENRION J. , CHOUSTERMAN M. , CONDAT B. , HERVIO P. , PERIAC P. , EUGÈNE C. , MOINDROT H. , GRASSET D. , NOUEL O. , PILETTE C. , SZOSTAK‐TALBODEC N. , CAYLA J.‐M. , SI‐AHMED S. N. , DUMOUCHEL P. , PARIENTE A. , LESGOURGUES B. , DENIS J.
Published: July 2010

Background  Epidemiological data concerning hepatitis B are scarce in France.

Aim  To describe epidemiological, clinical, virological and histological features of HBsAg‐positive patients followed at non‐academic hospitals in France.

Methods  Clinical, biological, virological and histological data of all HBsAg‐positive consecutive patients observed from April 1, 2001 to May 31, 2002 in participating centres were recorded prospectively. Multivariate analyses of factors associated with significant fibrosis and cirrhosis were performed.

Results  Nearly 1166 HBsAg‐positive patients were seen in the 58 centres: 671 males and 495 females from metropolitan France (32%) and from outside metropolitan France (68%); mean age 41 ± 15 years. Twenty‐nine percent of patients were probable HBsAg inactive carriers, while 50% had chronic hepatitis; 43% of these were HBeAg‐positive and 57% HBeAg‐negative. Liver biopsy had been performed in 558 (51%) patients; 205 (17.6%) patients had cirrhosis. By multivariate analysis, factors associated with significant fibrosis were: age >40 years (P < 0.05), HBeAg‐negative status (P < 0.02) and histological activity (P < 0.0001). Factors associated with cirrhosis: age (P < 0.0001), platelet count <150 000/mm3 (P < 0.0001) and viral co‐infection (P < 0.03).

Conclusion  HBV infection represents a significant workload for hepatogastroenterologists at non‐academic hospitals in France.
Options for screening colonoscopy without sedation: a pilot study in United States veterans
Authors: LEUNG J. W. , MANN S. , LEUNG F. W.
Published: July 2010

Background  The direct and indirect costs of sedation limit access to screening colonoscopy amongst United States veterans.

Aim  To determine if offering the option of sedation on‐demand reduces the need for sedation.

Design  A retrospective review of prospectively collected performance improvement data in an open access screening colonoscopy programme.

Setting  Performance improvement programme to minimize the burden of sedation at a single VA Medical Center.

Subjects  44 consecutive veterans who accepted the option of sedation on‐demand. They could choose to have premedications before the start of colonoscopy, or to begin colonoscopy without premedications and receive the medications upon their request during the examination.

Method  Two experienced endoscopists assisted by experienced nurse assistants performed all of the examinations. Insertion of the colonoscope was aided by infusion of warm water through the colonoscope without air insufflation. Medications were administered at the veterans’ request.

Results  Offering the option of sedation on‐demand to 44 consecutive veterans permitted 52% (N = 23) of the veterans to complete screening colonoscopy without any sedation.

Conclusions  This novel approach of sedation on‐demand and water infusion for screening colonoscopy deserves to be further evaluated in a randomized‐controlled study amongst patients undergoing colorectal cancer screening.
The clinical needs of patients with chronic gastrointestinal symptoms after pelvic radiotherapy
Authors: GILLESPIE C. , GOODE C. , HACKETT C. , ANDREYEV H. J. N
Published: July 2010

Background  After radiotherapy for pelvic cancer, gastrointestinal symptoms affecting quality of life are common. How they affect daily living is unknown.

Aim  To investigate the day‐to‐day impact of gastrointestinal symptoms in patients after pelvic radiotherapy.

Methods  New patients referred for gastroenterological evaluation of radiotherapy‐induced symptoms were sent a questionnaire.

Results  Over 15 months, 75 of 100 questionnaires were completed before the gastroenterology appointment by 45 men (median age 70) and 30 women (median age 57) treated for urological (n = 44), gynaecological (n = 27) and gastrointestinal (n = 4) cancers. Time since radiotherapy was 3 years (median) for women and 1.5 years (men). Women experienced 6 (median) symptoms whilst men experienced 4. Having someone listen to problems was often as important as treatment. Urgency, diarrhoea, pain, rectal bleeding, flatulence and bloating were particularly troublesome. 57% women and 33% men were ‘very affected’. Symptoms rarely improved with time and in 33% had been present for more than 2 years. Gastrointestinal symptoms affected quality of life through change of routine (F 37%, M 22%), social limitation (F 17%, M 33%), physical limitations (F 33%, M 16%), emotional difficulties (F 47%, M 18%) and sexual problems (F 30%, M 51%).

Conclusions  Patients experience a high number of physical symptoms for long periods before referral. Clinicians must focus systematically on physical, emotional and psychosexual issues.
Evaluating the cost of sustained virologic response in naïve chronic hepatitis C patients treated à la carte
Authors: BUTI M. , CASADO M. A. , ESTEBAN R.
Published: July 2010

Background

There is a tendency to individualize treatment in chronic hepatitis C patients depending on viral load and rapid clearance of HCV‐RNA.

Aim

To evaluate the cost (€, 2006) per sustained virologic response in naïve patients with therapy à la carte compared with standard combination therapy.

Methods

A decision analysis model was used to compare standard therapy with peginterferon alpha and ribavirin for 24 weeks for genotype (G) 2/3, and 48 weeks for G1 and therapy à la carte with the same drugs but different durations: G1 high viral load for 48 weeks, G1 low viral load with rapid virologic response for 24 weeks, and without rapid virologic response for 48 weeks, and G2/3 with rapid virologic response for 12 weeks, and without rapid virologic response for 24 weeks.

Results

Sustained virologic response was similar in both strategies. The cost per successfully treated patient for standard therapy is €17 812 and for therapy à la carte€12 313. Assuming that 13 309 patients with standard therapy and 14 450 patients with therapy à la carte achieve sustained virologic response, therapy à la carte has an overall cost‐saving of €59.13 million.

Conclusion

Therapy à la carte is a cost‐saving strategy for chronic hepatitis C infection compared to standard therapy, with lower investment requirement per patient to achieve sustained virologic response.
Diagnostic value of serum protein profiling by SELDI‐TOF ProteinChip compared with a biochemical marker, FibroTest, for the diagnosis of advanced fibrosis in patients with chronic hepatitis C
Authors: MORRA R. , MUNTEANU M. , BEDOSSA P. , DARGERE D. , JANNEAU J.‐L. , PARADIS V. , RATZIU V. , CHARLOTTE F. , THIBAULT V. , IMBERT‐BISMUT F. , POYNARD T.
Published: July 2010

Background

FibroTest has been validated for the diagnosis of liver fibrosis in patients with chronic hepatitis C.

Aim

To compare FibroTest with a new proteome‐based model for the prediction of advanced liver fibrosis.

Methods

Sera from 191 consecutive patients with simultaneous liver biopsy and FibroTest on fresh sera were used for retrospective mass spectrometry analysis. A new fibrosis index was constructed combining proteomic peaks, selected on differential expression according to fibrosis stages in logistic regression analyses. The main end point was the diagnosis of advanced fibrosis on liver biopsy.

Results

Eight out of 1000 peaks were selected for the construction of the proteomic index. The area under the receiver operating curve (AUROC) of the proteomic index was 0.88 (95% CI: 0.82–0.92), significantly greater than the FibroTest AUROC of 0.81 (95% CI: 0.74–0.86; P = 0.04); the AUROC of the proteomic and FibroTest combination was 0.88 (95% CI: 0.83–0.92). Seven of the eight selected peaks were highly associated with the FibroTest score, with different patterns of association with the five components of FibroTest.

Conclusions

A proteomic index combining eight peaks had an excellent accuracy value for the diagnosis of advanced fibrosis in patients with chronic hepatitis C. However, despite a statistical significance, the small improvement delivered by proteomics impairs clinical applications because of its cost and its variability compared with the well validated FibroTest.
Cost of gastro‐oesophageal reflux disease to the employer: a perspective from the United States
Authors: BROOK R. A. , WAHLQVIST P. , KLEINMAN N. L. , WALLANDER M.‐A. , CAMPBELL S. M. , SMEEDING J. E.
Published: July 2010

Background

Employers pay more than just salary for their employees. Previous studies have largely focused on direct medical and prescription drug costs of gastro‐oesophageal reflux disease (GERD), and few have reported on total absenteeism costs.

Aims

To examine the annual cost of illness of GERD in an employed US population by benefit category and by place of service for direct medical costs.

Methods

Retrospective data analysis from 2001 to 2004. International Classification of Diseases (ICD)‐9 codes (530.1, 530.10, 530.11, 530.12, 530.19, 530.81, 787.1x, 787.2x or 251.5x) were used to identify employees with and without GERD (the control group). Measures included medical and prescription drug claims, plus indirect costs for sick leave, short‐ and long‐term disability, and workers’ compensation. For a subset of the population, the direct medical claims were analysed by place of service.

Results

Data were available for 267 269 eligible employees of which 11 653 had gastro‐oesophageal reflux disease. GERD was associated with a mean incremental cost of $US3355 per employee of which direct medical costs accounted for 65%, prescription drug costs 17%, and indirect costs 19%. The place of service ‘out‐patient hospital or clinic’ accounted for the largest part (47%) of the difference in medical costs.

Conclusions

GERD is associated with substantial direct and indirect costs, which highlight the importance of managing the disease effectively.
Effects of long‐term cyclo‐oxygenase 2 selective and acid inhibition on Barrett’s oesophagus
Authors: LANAS A. , ORTEGO J. , SOPEÑA F. , ALCEDO J. , BARRIO E. , BUJANDA L. , COSME A. , BAJADOR E. , PARRA‐BLANCO A. , FERRANDEZ A. , PIAZUELO E. , QUINTERO E. , PIQUE J. M.
Published: July 2010

Background

There is an overexpression of cyclo‐oxygenase 2 (COX‐2) in Barrett’s oesophagus (BO).

Aim

To determine the long‐term effect of a COX‐2 inhibitor on cellular mechanisms involved in BO.

Methods

A randomized controlled trial was conducted in BO patients allocated to continue the usual proton pump inhibitor (PPI) alone treatment, or PPI combined with rofecoxib (25 mg/day) for 6 months. Cell proliferation index and COX‐2 expression in BO glands was determined in biopsy specimens at baseline and after treatment. Cell apoptosis, cyclin D1, p53 and vascular endothelial growth factor (VEGF) expression was also explored in a subset of patients. Student‐t test and the U‐Mann–Whitney test were used for quantitative and ordinal variables.

Results

Of 62 patients, 58 completed the study. A higher proportion of patients on rofecoxib + PPI exhibited a decrease in COX‐2 expression compared to those treated with PPI alone, but cell proliferation index was not affected. Unlike PPI alone, rofecoxib + PPI was associated with an increase in the apoptotic cell index, a decrease in p53 cell staining and VEGF expression in mucosal vessels. No effect on low‐grade dysplasia or cyclin D1 was observed.

Conclusions

The addition of rofecoxib to PPI therapy does not affect cell proliferation index in BO cells after 6 months of therapy, but does reduce COX‐2 and VEGF expression and increases cell apoptosis.
The validity of a symptom diary in ratings of dyspepsia measured against a detailed interview: do patients and clinicians agree in their assessment of symptoms?
Authors: MADSEN L. G. , HANSEN J. M. , GRØNVOLD M. , BYTZER P.
Published: July 2010

Background

Patients’ self‐assessment of symptoms is central in drug treatment trials of functional dyspepsia. The validity of such ratings is important.

Aim

To validate a diary for monitoring severity and duration of dyspepsia.

Method

We compared the diary‐cards with two clinicians’ ratings of the patient’s open‐ended responses to the same questions administered by interview. Agreements were evaluated by estimation of the overall agreement and weighted kappa values (Kw).

Results

Forty‐six patients were evaluated. The Kw between the two clinicians rating severity and duration of symptoms were 0.59 and 0.86, respectively. Overall agreement between patients’ diary rating and clinicians’ consensus rating of severity were 52%, and a moderate agreement with Kw of 0.49 was found. For duration of symptoms the overall agreement and Kw were 67% and 0.59, respectively. Qualitative data revealed useful insight in the possible causes of suboptimal agreement between patients and clinicians.

Conclusions

We found a moderate to good agreement between patient and observer ratings, indicating that patients to a reasonable extent interpret severity and duration of dyspeptic symptoms in the same way as do investigators. A ceiling effect of the duration scale indicates suboptimal response categories, which should be adjusted before further use.
Clinical trial: short‐ and long‐term benefit of relaxation training for irritable bowel syndrome
Authors: VAN DER VEEK P. P. J. , VAN ROOD Y. R. , MASCLEE A. A. M.
Published: July 2010

Background

Psychotherapy is effective in treating irritable bowel syndrome, but the effect of relaxation training, a brief psychological group intervention, is not known.

Aim

To determine the efficacy of relaxation training in a large cohort of irritable bowel syndrome patients.

Methods

Ninety‐eight irritable bowel syndrome patients were included in this randomized controlled trial. Forty‐six patients received standard medical care (CON) and 52 received four 90‐min sessions of relaxation training in small groups in addition to standard medical care. Irritable bowel syndrome symptom severity, medical consumption and quality of life were assessed at baseline in patients and in 38 healthy controls and evaluated in patients at 3, 6 and 12 months after intervention.

Results

Irritable bowel syndrome symptom severity was significantly reduced in the relaxation training group compared to CON at 3, 6 and 12 months after treatment (time‐by‐treatment interaction, P = 0.002). The number needed to treat for long‐term improvement was 5. Quality of life had improved (general health, P = 0.017; health change, P = 0.05). Frequency of doctor visits was reduced (P = 0.039).

Conclusions

Relaxation training is a brief group intervention that significantly improves symptom severity, general health perception and medical consumption in irritable bowel syndrome patients immediately after, as well as 6 and 12 months after intervention.
Recurrence of peptic ulcer in uraemic and non‐uraemic patients after Helicobacter pylori eradication: a 2‐year study
Authors: TSENG G.‐Y. , LIN H.‐J. , FANG C.‐T. , YANG H.‐B. , TSENG G.‐C. , WANG P.‐C. , HUNG T.‐L. , DENG Y.‐C. , CHENG Y.‐T. , HUANG C.‐H.
Published: July 2010

Background

The role of Helicobacter pylori in the pathogenesis of peptic ulcer disease in patients with uraemia remains unclear.

Aim

To evaluate the long‐term effect of H. pylori eradication in these patients.

Methods

Uraemic and non‐uraemic patients with peptic ulcer were enrolled in this study. Patients having history of non‐steroidal anti‐inflammatory drugs use or cardiovascular disease that need aspirin use were excluded. After confirmation of H. pylori infection, they received a triple therapy and were followed up for 2 years.

Results

Between September 1999 and December 2005, 34 patients (41%) of the end‐stage renal disease [H. pylori (+) group] and 67 (84%) of the non‐uraemic patients with peptic ulcer disease (PU group) received anti‐H. pylori therapy. After triple therapy, 32 (94%) from the end‐stage renal disease group and 64 (96%) from the peptic ulcer group obtained successful eradication. During the 2‐year follow‐up, three patients in the end‐stage renal disease group were excluded because of the presence of cardiovascular disease and aspirin use in two cases and died of heart failure in one case; two patients in peptic ulcer group refused follow‐up. Finally, 29 uraemic and 62 non‐uraemic patients had achieved the follow‐up. Recurrence of peptic ulcer was more in the end‐stage renal disease group than in the peptic ulcer group with intention‐to‐treat analysis (eight of 32, 25% vs. two of 64, 3%, P = 0.001, OR: 10.0, 95% CI: 1.979–50.540) or per‐protocol analysis (eight of 29, 28% vs. two of 62, 3%, P < 0.001, OR: 11.4, 95% CI: 2.245–58.168).

Conclusions

Peptic ulcer recurrence after H. pylori eradication is higher in end‐stage renal disease patients with peptic ulcer than in peptic ulcer patients without renal disease. Factors aside from H. pylori play an important role in peptic ulcer recurrence in end‐stage renal disease patients.
Review article: yeast as probiotics –Saccharomyces boulardii
Authors: CZERUCKA D. , PICHE T. , RAMPAL P.
Published: July 2010

Background

Probiotics are defined as live micro‐organisms which confer a health benefit on the host. Although most probiotics are bacteria, one strain of yeast, Saccharomyces boulardii, has been found to be an effective probiotic in double‐blind clinical studies.

Aims

To compare the main properties that differentiates yeast from bacteria and to review the properties of S. boulardii explaining its potential benefits as a probiotic.

Methods

The PubMed and Medline databases were searched using the keywords ‘probiotics’, ‘yeast’, ‘antibiotic associated diarrhea’, ‘Saccharomyces boulardii’,‘bacterial diarrhea’ and ‘inflammatory bowel disease’ in various combinations.

Results

Several clinical studies have been conducted with S. boulardii in the treatment and prevention of various forms of diarrhoea. Promising research perspectives have been opened in terms of maintenance treatment of inflammatory bowel diseases. The mechanism of S. boulardii’s action has been partially elucidated.

Conclusion

Saccharomyces boulardii is a strain of yeast which has been extensively studied for its probiotic effects. The clinical activity of S. boulardii is especially relevant to antibiotic‐associated diarrhoea and recurrent Clostridium difficile intestinal infections. Experimental studies clearly demonstrate that S. boulardii has specific probiotic properties, and recent data has opened the door for new therapeutic uses of this yeast as an ‘immunobiotic’.
Clinical trial: levofloxacin‐based quadruple therapy was inferior to traditional quadruple therapy in the treatment of resistant Helicobacter pylori infection
Authors: YEE Y. K. , CHEUNG T. K. , CHU K.‐M. , CHAN C. K. , FUNG J. , CHAN P. , BUT D. , HUNG I. , CHAN A. O. O. , YUEN M. F. , HSU A. , WONG B. C. Y.
Published: July 2010

Background  The efficacy of levofloxacin‐based quadruple therapy in resistant Helicobacter pylori infection is not known.

Aim  To test the efficacy of levofloxacin‐based quadruple therapy and traditional quadruple therapy in resistant H. pylori infection.

Methods  One hundred and two patients with resistant H. pylori infection were randomized to 1 week of either EBAL (esomeprazole 40 mg b.d., bismuth subcitrate 240 mg b.d., amoxicillin 1 g b.d. and levofloxacin 500 mg b.d.) or EBMT (esomeprazole 40 mg b.d., bismuth subcitrate 240 mg b.d., metronidazole 400 mg t.d.s. and tetracycline 500 mg q.d.s.). 13C‐urea breath test was performed at week 12 to assess post‐treatment H. pylori status.

Results  In intention‐to‐treat analysis H. pylori eradication was achieved in 37 of 51 (73%) subjects in EBAL and 45 of 51 (88%) subjects in EBMT groups, respectively (P = 0.046). Per‐protocol eradication rates of EBAL and EMBT groups were 78% and 94%, respectively (P = 0.030). The intention‐to‐treat eradication rate was statistically lower for EBAL than EMBT (56% vs. 90%, P = 0.013) among those who had failed more than one course of eradication therapy. Previous levofloxacin triple therapy did not affect the efficacy of either protocol significantly.

Conclusions  Levofloxacin‐based quadruple therapy was inferior to traditional quadruple therapy for resistant H. pylori infection.