bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of long‐term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn's disease: a prospective, non‐randomized, parallel, controlled study
Authors: YAMAMOTO T. , NAKAHIGASHI M. , UMEGAE S. , KITAGAWA T. , MATSUMOTO K.
Published: July 2010

Background

The impact of enteral nutrition on post‐operative recurrence has not been properly examined.

Aim

To investigate the impact of enteral nutrition using an elemental diet on clinical and endoscopic recurrence after resection for Crohn's disease.

Methods

Forty consecutive patients who underwent resection for ileal or ileocolonic Crohn's disease were studied. After operation, 20 patients continuously received enteral nutritional therapy (EN group), and 20 had neither nutritional therapy nor food restriction (non‐EN group). In the EN group, enteral formula (Elental) was infused through a nasogastric tube in the night‐time, and low fat foods were taken in the daytime. All patients were followed up regularly for 1 year after operation. Ileocolonoscopy was performed at 6 and 12 months after operation.

Results

One patient (5%) in the EN group and seven (35%) in the non‐EN group developed clinical recurrence during 1‐year follow‐up (P = 0.048). Six months after operation, five patients (25%) in the EN group and eight (40%) in the non‐EN group developed endoscopic recurrence (P = 0.50). Twelve months after operation, endoscopic recurrence was observed in six patients (30%) in the EN group and 14 (70%) in the non‐EN group (P = 0.027).

Conclusions

Our long‐term enteral nutritional therapy significantly reduced clinical and endoscopic recurrence after resection for Crohn's disease.
Assessment of dietary nutrients that influence perception of intra‐oesophageal acid reflux events in patients with gastro‐oesophageal reflux disease
Authors: SHAPIRO M. , GREEN C. , BAUTISTA J. M. , DEKEL R. , RISNER‐ADLER S. , WHITACRE R. , GRAVER E. , FASS R.
Published: July 2010

Background

Gastro‐oesophageal reflux disease symptoms are most commonly reported postprandially, suggesting that some diet components are likely to induce symptoms more than others.

Aims

To determine which of the various dietary nutrients is a strong predictive factor for symptom generation in association with an acid reflux event.

Methods

Subjects with typical heartburn symptoms were evaluated by the gastro‐oesophageal reflux disease Symptom Checklist, demographics questionnaire, upper endoscopy and pH testing. During the pH study, patients completed a detailed 24‐h dietary intake record. This included time of meals, description of food components and the amount and type of food preparation.

Results

Fifty gastro‐oesophageal reflux disease patients completed all stages of the study. A total of 112 (78%) symptoms were considered as sensed reflux event. Body mass index did not correlate with having perceived reflux. Patients who consumed more cholesterol, saturated fatty acids and had more percentage calories from fat were significantly more likely to experience a perceived reflux event. Regression analysis and β‐coefficient were specifically significant for cholesterol.

Conclusion

Of all dietary nutrients, cholesterol enhances the most the perception of intra‐oesophageal acid reflux events in patients with gastro‐oesophageal reflux disease.
Systematic review: rebound acid hypersecretion after therapy with proton pump inhibitors
Authors: HUNFELD N. G. M. , GEUS W. P. , KUIPERS E. J.
Published: July 2010

Background

The occurrence and the clinical relevance of rebound acid hypersecretion after discontinuation of proton pump inhibitors is unclear.

Aim

To perform a systematic review of rebound acid hypersecretion after discontinuation of proton pump inhibitors.

Methods

PubMed, Embase and Central were searched up to October 2005 with indexed terms.

Results

Eight studies were included, sample size was 6–32. The studies used both basal and stimulated acid output as parameters to study rebound acid hypersecretion and assessed these at different time points and with variable methods. Five studies (including four randomized studies) did not find any evidence for rebound acid hypersecretion after proton pump inhibitor therapy. Of the remaining three studies, the duration of proton pump inhibitor therapy was the longest and two of these studies were the only to assessHelicobacter pyloristatus of their study subjects. These two studies suggested that rebound acid hypersecretion may occur inH. pylori‐negatives after 8 weeks of proton pump inhibitors.

Conclusions

Studies that have investigated rebound acid hypersecretion after cessation of proton pump inhibitor treatment are heterogenic in design, methods and outcome. There is some evidence from uncontrolled trials for an increased capacity to secrete acid inH. pylori‐negative subjects after 8 weeks of treatment. There is no strong evidence for a clinically relevant increased acid production after withdrawal of proton pump inhibitor therapy.
A randomized double‐blind placebo‐controlled trial of Lactobacillus GG for abdominal pain disorders in children
Authors: GAWROŃSKA A. , DZIECHCIARZ P. , HORVATH A. , SZAJEWSKA H.
Published: July 2010

Background

Functional abdominal pain disorders (FAPD) are common in school‐aged children; however, there is no reliable treatment.

Aim

To determine the efficacy of Lactobacillus rhamnosus GG (LGG) for treating FAPD in children.

Methods

A total of 104 children who fulfilled the Rome II criteria for functional dyspepsia (FD), or irritable bowel syndrome (IBS), or functional abdominal pain (FAP) were enrolled in a double‐blind, randomized controlled trial in which they received LGG (n = 52), or placebo (n = 52) for 4 weeks.

Results

For the overall study population, those in the LGG group were more likely to have treatment success (no pain) than those in the placebo group (25% vs. 9.6%, relative benefit (RB) 2.6, 95% confidence interval (CI): 1.05–6.6, number needed to treat (NNT) 7, 95% CI: 4–123). For children with IBS (n = 37), those in the LGG group were more likely to have treatment success than those in the placebo group (33% vs. 5%, RB 6.3, 95% CI: 1.2–38, NNT 4, 95% CI: 2–36) and reduced frequency of pain (P = 0.02), but not pain severity (P = 0.10). For the FD group (n = 20) and FAP group (n = 47), no differences were found.

Conclusion

The LGG appears to moderately increase treatment success, particularly among children with IBS.
Review article: biological activity markers in inflammatory bowel disease
Authors: DESAI D. , FAUBION W. A. , SANDBORN W. J.
Published: July 2010

Background

Traditionally, inflammatory bowel disease activity is assessed by clinical activity indices that measure clinical symptoms and endoscopic indices that measure endoscopic inflammation. Biological markers are a non‐invasive way of objectively measuring inflammation and can play an adjunctive or primary role in the assessment of disease activity.

Aim

To review the data on biological markers for assessment of disease activity and prediction of relapse in inflammatory bowel disease.

Methods

To collect relevant articles, a PubMed search was performed from 1980 to 2006 using following search terms in combination: inflammatory bowel disease, biomarkers, inflammation, disease activity, relapse, acute phase reactants cytokines, interleukins, adhesion molecules, integrins, calprotectin and lactoferrin.

Results

Biological activity markers can be classified into serological, faecal and miscellaneous categories. Acute phase reactants levels correlate with disease activity and some can be used to help predict relapse. Cytokines and adhesion molecules are elevated in active disease inconsistently. Faecal markers are useful in assessment of disease activity and relapse.

Conclusions

Acute phase reactants and faecal markers are useful to assess the disease activity in clinical practice. More data are required on cytokines and adhesion molecules. C‐reactive protein, erythrocyte sedimentation rate, interleukins and faecal markers may be useful in predicting a relapse.
Consequences of frequent nocturnal gastro‐oesophageal reflux disease among employed adults: symptom severity, quality of life and work productivity
Authors: DUBOIS R. W. , AGUILAR D. , FASS R. , ORR W. C. , ELFANT A. B. , DEAN B. B. , HARPER A. S. , YU H.‐T. , MELMED G. Y. , LYNN R. , SINGH A. , TEDESCHI M.
Published: July 2010

Background

Effects of frequent nocturnal symptoms of gastro‐oesophageal reflux disease (GERD‐FNS) on health‐related quality of life (HRQOL) and work productivity are not well documented.

Aim

To assess symptom severity, production loss, and HRQOL among employed adults with and without GERD‐FNS.

Methods

Using several validated outcome measures in a web survey design, GERD was pre‐specified as GERD Symptom and Medication Questionnaire score >9, and ≥1 episode of heartburn or acid regurgitation during the preceding week. GERD‐FNS patients were those reporting ≥2 symptom‐nights during the previous week; their outcomes were compared with those of patients having minimal or no nocturnal symptoms (GERD‐NNS) and vs. non‐GERD controls.

Results

Data were collected from 1002 GERD patients (476 GERD‐FNS, 526 GERD‐NNS) and 513 controls. Severe symptoms were more common, sleep abnormalities were more frequent (P < 0.0001) and SF‐36 scores lower (P < 0.05, all scores) among GERD‐FNS patients vs. GERD‐NNS patients. GERD‐related work loss was greater among those with GERD‐FNS vs. GERD‐NNS (P < 0.0001). Work loss and functional limitations were more pronounced when comparing GERD‐FNS cases vs. non‐GERD controls.

Conclusion

Employed adults with frequent nocturnal GERD report more severe symptoms, and are associated with impaired sleep, HRQOL and work productivity compared with controls and patients with minimal or no nocturnal symptoms.
The relationship between dosing of alosetron and discontinuation patterns reported by patients participating in a follow‐up programme
Authors: TENNIS P. , ANDREWS E. , HICKMAN P. , MILLER D. , HOLLIS K. , COOK S.
Published: July 2010

Background

Alosetron was reintroduced for treatment of irritable bowel syndrome with a risk management programme in November 2002. Recommended starting dosage was 1 mg/day for 4 weeks. If symptoms remained uncontrolled, dosage could be changed to 2 mg/day.

Aim

To describe alosetron dosages and associated patient characteristics from the Lotronex follow‐up survey programme.

Methods

Patients reported dosages of alosetron at start and regular follow‐up intervals. Analyses were limited to patients with the potential to have at least 1 year of follow‐up (enrolled between 9 December 2002 and 31 December 2003).

Results

At baseline, 75% of 2817 respondents reported starting on 1 mg/day, 17% on 2 mg/day and 8% on other doses. Adherence to recommended starting dosage did not vary by status at end of follow‐up, previous alosetron experience or age. At last reported dose, 50% of respondents were using 1 mg/day; 29% were using 2 mg/day. Discontinuation was not related to baseline doses. Longer times to discontinuation were associated with previous use, symptoms for more than 6 months and dose change throughout follow‐up.

Conclusions

High adherence to recommended dosing at baseline and follow‐up suggests that the risk management programme is encouraging safe use of alosetron, including adherence to dosing recommendations.
Coeliac disease and the risk of fractures – a general population‐based cohort study
Authors: LUDVIGSSON J. F. , MICHAELSSON K. , EKBOM A. , MONTGOMERY S. M.
Published: July 2010

Background

Earlier studies have suggested that untreated coeliac disease may be associated with osteoporosis, but results are contradictory for the risk of long‐term fractures.

Aim

To study the association between coeliac disease and fractures.

Methods

We used Cox regresson to examine the future risk of hip fracture and fracture of any type in more than 13 000 individuals with coeliac disease and 65 000 age‐ and sex‐matched reference individuals in a general population‐based cohort.

Results

During follow‐up, 1365 first hip fractures and 4847 fractures of any type occurred. Coeliac disease was positively associated with subsequent hip fracture (hazard ratio = 2.1; 95% CI = 1.8–2.4) (in children: hazard ratio = 2.6; 95% CI = 1.1–6.2) and fractures of any type (hazard ratio = 1.4; 95% CI = 1.3–1.5) (in children: hazard ratio = 1.1; 95% CI = 1.0–1.2). The absolute excess risk of hip fractures in children with coeliac disease was 4/100 000 person‐years. Incidence ratios for hip fracture in individuals with CD were around two both prior to diagnosis of coeliac disease and afterwards; this risk increase remained 20 years after diagnosis of coeliac disease.

Conclusions

Individuals with coeliac disease, including children with coeliac disease, may be at increased risk of hip fracture and fracture of any type. Coeliac disease may be positively associated with long‐term hip fracture risk.
Systematic review: oral bowel preparation for colonoscopy
Authors: BELSEY J. , EPSTEIN O. , HERESBACH D.
Published: July 2010

Background

There are many published trials of colon cleansing regimens for colonoscopy but no clear consensus regarding relative performance.

Aim

To identify high quality controlled trials comparing two or more bowel preparation regimens and to compare efficacy and tolerability.

Methods

A comprehensive systematic review was carried out to identify candidate studies. Quality appraisal was carried out on all identified studies. Results were meta‐analysed where possible and qualitatively compared if not.

Results

Eighty‐two studies qualified for analysis. Polyethylene glycol and sodium phosphate were the most frequently investigated preparations. There was no significant efficacy difference between the two, but sodium phosphate was better tolerated. Sodium picosulphate/magnesium citrate, a commonly prescribed preparation, was investigated in four studies, with no clear benefit over other regimens demonstrated. Safety was not recognized as a problem in the randomized controlled trials. Published case series demonstrate that sodium phosphate is associated with the highest risk of clinically significant electrolyte disturbances.

Conclusion

Shortcomings in study design limit the value of many of the studies. Based on these results, no single bowel preparation emerges as consistently superior. New preparations are required that combine better efficacy and tolerability, in addition to rigorous new validated study designs, allowing unequivocal comparisons to be made.
Meta‐analysis: ondansetron for vomiting in acute gastroenteritis in children
Authors: SZAJEWSKA H. , GIERUSZCZAK‐BIAŁEK D. , DYLĄG M.
Published: July 2010

Background

Vomiting is a common sympton in children with gastroenteritis, but its treatment remains controversial.

Aim

To investigate potential beneficial effects of ondansetron, compared with placebo or no intervention, in treating vomiting during acute gastroenteritis in children.

Methods

The following electronic databases were searched through August 2006: MEDLINE, EMBASE, CINAHL and The Cochrane Library; additional references were obtained from reviewed articles. Only randomized‐controlled trials (RCTs) were included.

Results

Four RCTs involving 490 patients with vomiting during acute gastroenteritis were included. Combined data from three RCTs (n = 466) showed that ondansetron compared with the control significantly increased the chance for vomiting cessation soon after drug administration [relative risk (RR): 1.3, 95% confidence interval (CI): 1.2–1.5, number needed to treat (NNT): 5, 95% CI: 4–8], but this effect was not observed at 24 h (three RCTs, n = 144, RR 1.2, 95% CI: 0.9–1.7). Ondansetron significantly reduced the risk of intravenous rehydration (two RCTs, n = 359, RR 0.4, 95% CI: 0.3–0.7, NNT 7, 95% CI: 5–14). Outcome measures not significantly different after ondansetron treatment were the need for hospitalization and return emergency department visits.

Conclusions

Despite some clinical benefits, there is insufficient evidence to recommend the routine use of ondansetron for vomiting during acute gastroenteritis in children.
Helicobacter pylori eradication in long‐term proton pump inhibitor users in primary care: a randomized‐controlled trial
Authors: RAGHUNATH A. S. , HUNGIN A. P. S. , MASON J. , JACKSON W.
Published: July 2010

Background  Two‐thirds of proton pump inhibitor prescribing in the UK is for long‐term therapy.

Aim  To determine the impact of eradication in long‐term proton pump inhibitor users infected with Helicobacter pylori.

Methods  A total of 184 H. pylori‐positive patients were randomly assigned to true or placebo eradication therapy. The primary outcome was the change in proton pump inhibitor usage measured by prescriptions; secondary outcomes were changes of proton pump inhibitor doses, dyspepsia symptoms, general practitioner consultations and quality of life measures.

Results  In the year following H. pylori eradication proton pump inhibitor prescriptions fell compared with placebo (−1.7, 95% CI: −2.3 to −1.1, P < 0.001); when adjusted to full‐dose equivalent prescriptions the reduction was more marked (−2.2, 95% CI: −3.0 to −1.4, P < 0.001). Both general practitioner consultations (−1.0, 95% CI: −1.8 to −0.1, P = 0.026) and symptoms measured on the Leeds Dyspepsia Questionnaire (−3.1, 95% CI: −5.3 to −0.9, P = 0.005) were reduced. Quality of life and self‐rating measures also favoured eradication (EQ‐5D: 0.09, P = 0.08 and VAS: 5.6, P = 0.002). The Carlsson and Dent Reflux Questionnaire found no difference between groups (−0.3, P = 0.65), possibly balancing decreased overall symptoms with increased prominence of heartburn in the eradication group.

Conclusions  Helicobacter pylori eradication in infected, long‐term proton pump inhibitor users in primary care reduced both the overall severity of symptoms and use of health care.
Relationship between intragastric acid control and healing status in the treatment of moderate to severe erosive oesophagitis
Authors: KATZ P. O. , GINSBERG G. G. , HOYLE P. E. , SOSTEK M. B. , MONYAK J. T. , SILBERG D. G.
Published: July 2010

Aim  To assess the relationship between the percentage of time intragastric pH >4.0 and healing of erosive oesophagitis.

Methods  In this proof‐of‐concept study, adults with endoscopically verified Los Angeles grade C or grade D erosive oesophagitis were randomly assigned to oral esomeprazole 10 or 40 mg once daily for 4 weeks. On day 5, patients underwent 24‐h pH monitoring. At 4 weeks, erosive oesophagitis healing status was endoscopically assessed. Investigators scored gastro‐oesophageal reflux disease symptoms on a 4‐point scale [none to severe (0–3)] before and 4 weeks after treatment. The percentage of time intragastric pH was >4.0 and healing status were correlated and tested for significance using a Spearman rank correlation (r).

Results  103 patients had evaluable data (mean age, 48.7 years; 65% men). Mean percentages of time with intragastric pH >4.0 on day 5 in patients with healed and unhealed erosive oesophagitis were 61% and 42%, respectively (P = 0.0002), indicating that erosive oesophagitis healing rates were positively related to the percentage of time intragastric pH was >4.0. Greater intragastric acid control correlated with lower final daytime and night‐time heartburn and acid regurgitation symptom scores (r = −0.029, −0.029 and −0.021; P = 0.003, 0.003 and 0.032, respectively).

Conclusion  A positive relationship between intragastric acid control and erosive oesophagitis healing was demonstrated.
Meta‐analysis: randomized controlled trials of clindamycin/aminoglycoside vs. β‐lactam monotherapy for the treatment of intra‐abdominal infections
Authors: FALAGAS M. E. , MATTHAIOU D. K. , KARVELI E. A. , PEPPAS G.
Published: July 2010

Aim  To compare the effectiveness and safety of clindamycin/aminoglycoside with broad‐spectrum β‐lactam monotherapy in patients with intra‐abdominal infections by performing a meta‐analysis of randomized controlled trials (RCTs).

Methods  The relevant 28 RCTS were retrieved from PubMed searches and reviewed by two reviewers independently.

Results  β‐lactam monotherapy was more effective regarding cure of the infection than clindamycin/aminoglycoside (3177 clinically evaluable patients, fixed effects model, OR = 0.67, 95% CI: 0.55–0.81). The same result was found in several subset analyses. There was no difference in all‐cause mortality and attributable‐to‐infection mortality [2382 intention‐to‐treat (ITT) patients, fixed effects model, OR = 1.25, 95% CI: 0.74–2.11 and 1976 ITT patients, OR = 1.19, 95% CI: 0.59–2.41, respectively]. There was no difference regarding overall adverse events and ototoxicity (1460 ITT patients, OR = 1.05, 95% CI: 0.80–1.37, and 1404 ITT patients, OR = 3.22, 95% CI: 0.72–14.45, respectively). However, treatment with clindamycin/aminoglycoside was more likely to be associated with nephrotoxicity compared to β‐lactam (3065 ITT patients, OR = 3.7, 95% CI: 2.09–6.57). Clindamycin/aminoglycoside was less likely to be associated with antibiotic‐associated diarrhoea compared to β‐lactam (3050 ITT patients, OR = 0.68, 95% CI: 0.46–1.00).

Conclusion  The results of our meta‐analysis suggest that β‐lactams are more effective in the treatment of intra‐abdominal infections compared with clindamycin/aminoglycoside.
Cell proliferation of squamous epithelium in gastro‐oesophageal reflux disease: correlations with clinical, endoscopic and morphological data
Authors: MASTRACCI L. , GRILLO F. , ZENTILIN P. , SPAGGIARI P. , DULBECCO P. , PIGOZZI S. , SAVARINO V. , FIOCCA R.
Published: July 2010

Background  The microscopic assessment of squamous epithelium lesions in gastro‐oesophageal reflux disease (GERD) is subjective. The Ki67 nuclear antigen expressed by proliferating cells provides an objective measure of regeneration in the squamous epithelium.

Aim  To evaluate Ki67 expression in GERD patients and controls, in comparison with histological lesions, pH‐metry and endoscopic data.

Methods  Eighty‐seven patients with GERD symptoms and 20 symptom‐free controls underwent endoscopy and 24‐h pH monitoring. Oesophageal biopsies (4 cm, 2 cm and Z‐line) were stained with Ki67/MIB‐1 antibodies; the Ki67‐positive nuclear area was assessed with an image analysis system and expressed as percentage of the whole epithelial area (Ki67‐%).

Results  Ki67‐% was significantly higher in 32 patients with erosive oesophagitis, 44 endoscopy‐negative GERD and 11 patients with functional heartburn than in controls (P = 0.0001). Both controls and patients showed a progressive increase in Ki67‐% from 4 cm to the Z‐line (P < 0.0001). Ki67‐% showed a significant correlation with other conventional histological lesions (P ranged between 0.0151 and <0.0001).

Conclusions  Ki67 evaluation provides quantitative and objective data on squamous epithelium proliferative activity. This marker can be applied in the distinction of endoscopy‐negative GERD from healthy controls.
Intradermal hepatitis B vaccination in patients with advanced chronic renal failure: immunogenicity and follow‐up
Authors: MORAIS E. O. , RESENDE M. R. , OLIVEIRA A. M. , SINKOC V. M. , GARCIA M. T. , ANGERAMI R. N. , DA SILVA L. J.
Published: July 2010

Background

Patients undergoing dialysis usually have a poor response to conventional hepatitis B vaccination.

Aim

To observe the effects of intradermal hepatitis B (HB) vaccination in a 13‐month prospective study of adult patients with end‐stage renal failure. The patients were with or without previous hepatitis B vaccination, but all had antibody titres <10 mUI/mL.

Methods

Patients were allotted to two groups: previous hepatitis B virus vaccination and no previous hepatitis B virus vaccination or anti‐HBs titres <10 mUI/mL. Patients in both groups received 16 i.d. injections of 0.1 mL of hepatitis B virus vaccine over an eight‐week period. Patients had antibody titres assessed before vaccination, 1 month after and every 3 months for a year. Antibody titres ≥10 mUI/mL were considered protective.

Results

Seventy patients completed the protocol. Protective titres were elicited in 82% of each group. Age, time under dialysis, diabetes, smoking and body‐mass index were not associated with seroconversion. Persistent protective titres >12 months occurred in 27 (58.7%). Adverse events were trivial.

Conclusion

Intradermal hepatitis B virus vaccination is an alternative in end‐stage renal failure.
GI Epidemiology: nutritional epidemiology
Authors: KELEMEN L. E.
Published: July 2010

Background

Nutritional epidemiology is the assessment of diet and its relationship to disease aetiology in populations. The choice of dietary assessment method depends on the disease pathology. Events such as cancer that are chronic and complicated by exposure time require methods that capture consumption patterns of populations over a period of years. Although several methods of dietary assessment exist for collecting information on groups of individuals, their application to epidemiologic studies requires an understanding of the effect of variability in nutrient intake, sources of measurement error, and statistical issues unique to the study of nutritional epidemiology.

Aim

This review provides an overview of commonly‐used methods of dietary assessments in epidemiologic studies, and identifies their strengths and limitations and application to epidemiologic study designs. It concludes with a brief discussion of assumptions of nutrient databases and objectives of energy‐adjustment and measurement error correction models.

Conclusions

Nutritional epidemiology has contributed significantly to our understanding of the relationships between diet and disease. Ongoing investigations that further characterize important exposure periods (early life, in utero) and clarify associations within the context of genetic susceptibility will continue to elucidate our understanding of the pathophysiology of complex diseases, and support future recommendations for disease prevention.

Key points

• The choice of dietary assessment depends on the research question and the pathophysiology of the disease.

• Long‐term dietary patterns are most relevant to estimate chronic disease risk.

• Most risk models will need to adjust for total energy.

• Knowledge of potential sources of error in nutritional assessment is essential.

• Statistical methods exist to estimate and correct measurement error.
Meta‐analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy
Authors: JAFRI N. S. , MAHID S. S. , MINOR K. S. , IDSTEIN S. R. , HORNUNG C. A. , GALANDIUK S.
Published: July 2010

Background

Despite numerous guidelines recommending prophylactic antibiotics prior to percutaneous endoscopic gastrostomy, their use remains controversial.

Aim

To conduct a systematic literature review and performed meta‐analyses to determine the benefit of antibiotic prophylaxis for percutaneous endoscopic gastrostomy placement.

Methods

We performed a systematic literature review by searching healthcare databases and grey literature for randomized‐controlled trials of antibiotic prophylaxis against wound infection after percutaneous endoscopic gastrostomy. Relative risks were calculated for individual trials and data pooled using fixed‐effects model. Relative risk reduction, absolute risk reduction and number needed to treat were calculated and are reported with 95% confidence intervals.

Results

Ten randomized‐controlled trials met the inclusion criteria and 1059 cases were pooled. Overall findings indicated that antibiotic prophylaxis resulted in a relative risk reduction of 64% and an absolute risk reduction of 15%. Number needed to treat to prevent one wound infection was 8. Cephalosporin prophylaxis was associated with a relative risk reduction of 64%, absolute risk reduction of 10% and number needed to treat of 10, whereas penicillin‐based prophylaxis was associated with a relative risk reduction of 62%, absolute risk reduction of 13% and number needed to treat of 8.

Conclusions

Antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy is effective in reducing the incidence of percutaneous endoscopic gastrostomy site wound infection. Based on sensitivity analyses, penicillin‐based prophylaxis should be the prophylaxis of choice.
Adalimumab in patients with Crohn’s disease – safety and efficacy in an open‐label single centre study
Authors: SEIDERER J. , BRAND S. , DAMBACHER J. , PFENNIG S. , JÜRGENS M. , GÖKE B. , OCHSENKÜHN T.
Published: July 2010

Aim

To evaluate the efficacy and safety of adalimumab, a human antitumour necrosis factor‐α antibody, in induction and maintenance of remission in patients with Crohn’s disease either refractory or intolerant to infliximab in a single centre cohort.

Methods

Sixteen Crohn’s disease patients received 160 mg adalimumab subcutaneously in week 0, followed by 80 mg every other week. Clinical response was assessed based on Crohn’s disease activity index and laboratory parameters (leukocyte count, C‐reactive protein). In all patients genotyping for CARD15 variants and the +1059G/C polymorphism in the C‐reactive protein gene was performed.

Results

In 10 of 16 patients (63%) treated with adalimumab, remission (CDAI score <150) was induced for at least 8 weeks independent of CARD15 or +1059G/C CRP status. In six of these 10 patients ongoing remission is observed now for more than 24 weeks. Adalimumab significantly decreased C‐reactive protein serum levels and Crohn’s disease activity index. There was one serious complication (fungal pneumonia). Six patients intermittently developed minor dermatological problems resolving after topical therapy. Otherwise, treatment was generally well tolerated.

Conclusion

Adalimumab can induce and maintain remission in patients with moderate to severe Crohn’s disease intolerant or refractory to infliximab. Further experience from larger cohorts is required to evaluate dose regimen and safety profiles in Crohn’s disease therapy.
Review article: the history of acute infectious diarrhoea management – from poorly focused empiricism to fluid therapy and modern pharmacotherapy
Authors: MCMAHAN Z. H. , DUPONT H. L.
Published: July 2010

Background

Acute diarrhoea management has progressed from largely ineffective measures in the early years to a more effective physiologic approach in recent years.

Aim

To review the history of acute diarrhoea management.

Methods

Citations in PubMed were reviewed on ‘acute diarrhoea treatment’ along with an extensive file maintained by the corresponding author.

Results

Freedom from diarrhoea was equated in early military conflicts with bravery and strength where diarrhoea‐free soldiers had the ‘guts’ to fight. Until early 20th century, colonic irrigants, purgatives and emetic drugs were used to help eliminate undesired intestinal contents. Only a few early authorities suggested the need for replacement of fluids and salt, now standard treatment. Drugs aimed at diarrhoea symptom control have been broadly used for more than 100 years. The evolving history of one of those drugs, kaopectate is unappreciated. Once understanding the pathophysiology and infectious aetiology of acute diarrhoea, new oral fluids, pharmacologic agents designed to block specific secretory alterations and anti‐infective drugs have been identified.

Conclusions

Physiologic and antimicrobial approaches to controlling diarrhoea can lead to reduction of stool number and enteric complaints, important in industrialized areas, with the potential for decreasing threat of fatal illness among infants in developing regions.
Interaction between rifaximin and dietary fibre in patients with diverticular disease
Authors: D'INCÀ R. , POMERRI F. , VETTORATO M. G. , DAL PONT E. , DI LEO V. , FERRONATO A. , MEDICI V. , STURNIOLO G. C.
Published: July 2010

Background

Cyclic administration of rifaximin in association with dietary fibre achieves symptomatic relief in uncomplicated diverticular disease (DD) by means of a still undefined mechanism.

Aim

To investigate the effects of a combination of rifaximin and fibre on both hydrogen production by intestinal microflora and oro‐anal transit time.

Methods

In a controlled, double‐blind crossover trial, 64 patients with uncomplicated DD were given bran (20 g/day) and randomly treated with rifaximin (1200 mg/day) or a placebo for 14 days. Evaluation was based on clinical status, breath test, oro‐anal transit time and faecal weight.

Results

The global symptomatic score was significantly reduced after rifaximin (7.1 ± 4.1 to 4.1 ± 3.3; P < 0.005) but not after placebo (6.8 ± 3.8 to 6.1 ± 3.5). Hydrogen production significantly increased after placebo from 198 ± 134 to 267 ± 161 ppm/min, while Rifaximin reduced it from 222 ± 187 to 166 ± 131 ppm/min (P = 0.05). The total oro‐anal transit time decreased from 56.1 ± 28.2 to 51.3 ± 28.0 h in placebo and from 54.4 ± 31.9 to 45.1 ± 32.4 h (P < 0.05) in rifaximin‐treated patients.

Conclusions

The administration of rifamixin improves the benefits of dietary fibre in uncomplicated DD by preventing its bacterial degradation.
Early virological suppression is associated with good maintained response to adefovir dipivoxil in lamivudine resistant chronic hepatitis B
Authors: CHAN H. L.‐Y. , WONG V. W.‐S. , TSE C.‐H. , CHIM A. M.‐L. , CHAN H.‐Y. , WONG G. L.‐H. , SUNG J. J.‐Y.
Published: July 2010

Aim To determine the factors affecting the virological response to adefovir dipivoxil (ADV) among patients with lamivudine resistant chronic hepatitis B.

Methods Chronic hepatitis B virus (HBV) infected patients, who had virological relapse to lamivudine, were switched to ADV monotherapy.

Results Twenty‐six patients were treated by ADV for 23 (12–41) months. At baseline, the median log HBV DNA was 7.70 (4.88–9.01) copies/mL. Six (23%) and 8 (31%) of patients had HBV DNA suppressed to below 1000 copies/mL at month 12 and the last follow‐up, respectively. On linear regression, patients who had higher HBV DNA at baseline and month 6 have higher HBV DNA at month 12. On Cox proportional hazard model, the hazard ratio for each log step increase in HBV DNA at baseline and month 6 for HBV DNA <1000 copies/mL at the last visit was 0.39 (P = 0.010) and 0.47 (P = 0.027), respectively. Alanine aminotransferase, HBV genotype, rtL80 M mutation and log HBsAg did not affect the HBV DNA response.

Conclusions The response of lamivudine‐resistant patients to ADV is suboptimal. Treatment with ADV when HBV DNA is low, and rapid viral suppression at month 6 increases the chance of maintained viral suppression.
Introduction of newer selective cyclo‐oxygenase‐2 inhibitors and rates of hospitalization with bleeding and perforated peptic ulcer
Authors: CHRISTENSEN S. , RIIS A. , NØRGAARD M. , THOMSEN R. W. , SØRENSEN H. T.
Published: July 2010

Background Limited data exist on the impact of the introduction of newer selective cyclo‐oxygenase‐2 inhibitors into clinical practice in 1999 on overall non‐steroidal anti‐inflammatory drug use and hospitalization rates of complicated peptic ulcer disease at the population level.

Aim To examine these issues, we conducted a population‐based study in western Denmark, within a population of 1.2 million.

Methods All patients with perforated (n = 1488) or bleeding peptic ulcer (n = 6017) between 1996 and 2004 were identified in hospital discharge registries. We computed standardized annual hospitalization rates and hospitalization rate ratios using Poisson regression. Data on annual number of prescriptions for non‐steroidal anti‐inflammatory drugs were obtained through population‐based prescription databases.

Results Introduction of newer selective cyclo‐oxygenase‐2 inhibitors was followed by a 44% increase in the annual number of prescriptions for non‐steroidal anti‐inflammatory drugs – almost entirely due to increased use of newer selective cyclo‐oxygenase‐2 inhibitors. Annual standardized hospitalization rates for bleeding peptic ulcer remained stable. Standardized hospitalization rates for perforated peptic ulcer decreased from 17 per 100 000 person‐years in 1996 to 12 per 100 000 person‐years in 2004 (HRR 0.71; 95% CI: 0.57–0.88).

Conclusion Introduction of newer selective cyclo‐oxygenase‐2 inhibitors was followed by substantial increase in overall non‐steroidal anti‐inflammatory drug use and coincided with stable and decreasing hospitalization rates for bleeding and perforated peptic ulcer, respectively.
Review article: acidity and volume of the refluxate in the genesis of gastro‐oesophageal reflux disease symptoms
Authors: SIFRIM D. , MITTAL R. , FASS R. , SMOUT A. , CASTELL D. , TACK J. , GREGERSEN H.
Published: July 2010

Background A number of mechanisms, other than acid reflux, may be responsible for the symptoms of gastro‐oesophageal reflux disease.

Aim To assess the importance of non‐acid reflux mechanisms.

Methods This review is based on presentations and discussion at a workshop, where specialists in the field analysed data relating to these mechanisms.

Results Weakly acidic reflux, pH (4–7), detected with impedance–pHmetry is associated with regurgitation and atypical gastro‐oesophageal reflux disease symptoms. It is not clear whether pepsin and trypsin can elicit symptoms, but bile can elicit heartburn. The magnitude of reflux‐induced oesophageal distension can be determined by high frequency ultrasonography and is not reduced by proton pump inhibition, suggesting that persisting symptoms ‘on’ a proton pump inhibitor may still be due to oesophageal distension by non‐acidic reflux. Exaggerated longitudinal muscle contraction can induce non‐acid‐related heartburn. Preliminary studies showed a positive effect of baclofen, surgery or endoscopic procedures to reduce weakly acidic reflux.

Conclusion Mechanisms other than acid reflux are involved in some of the symptoms of gastro‐oesophageal reflux disease. Controlled outcome studies are needed to clarify their roles and the indications for antireflux procedures in patients with persistent symptoms whilst ‘on’ a proton pump inhibitor.
Prospective randomized trial evaluating ketamine for advanced endoscopic procedures in difficult to sedate patients
Authors: VARADARAJULU S. , ELOUBEIDI M. A. , TAMHANE A. , WILCOX C. M.
Published: July 2010

Background Adequate patient sedation is mandatory for advanced endoscopic procedures such as ERCP and EUS.

Aim To evaluate the effectiveness and safety of ketamine in difficult to sedate patients undergoing advanced endoscopic procedures.

Methods This was a prospective, randomized trial of all patients undergoing ERCP or EUS who were not adequately sedated despite administration of meperidine 50 mg, midazolam 5 mg and diazepam 5 mg. Patients during endoscopy were then randomized to receive either intravenous ketamine (20 mg) every 5 min or continue to receive standard sedation using meperidine and diazepam.

Results Of 175 patients, 82 were randomized to receive ketamine and 93 standard sedatives. Compared with standard sedation, qualitative physician rating (P < 0.0001) and depth of sedation (P < 0.001) were superior in the ketamine group with shorter recovery times (P < 0.0001). Both patient discomfort and sedation‐related technical difficulty were significantly less among patients randomized to receive ketamine (P < 0.0001). More patients in the standard sedation group were crossed‐over to the ketamine group due to sedation failure (35.5 vs. 3.7%, P < 0.0001). Nine patients who received ketamine, developed adverse events that were managed conservatively.

Conclusions Ketamine is a useful adjunct to conscious sedation in patients who are difficult to sedate. Its use results in better quality and depth of sedation with shorter recovery times than patients sedated using benzodiazepines and meperidine alone. Further prospective studies evaluating the effectiveness and safety of ketamine for endoscopic sedation are needed.
Altered intestinal permeability is predictive of early relapse in children with steroid‐responsive ulcerative colitis
Authors: MIELE E. , PASCARELLA F. , QUAGLIETTA L. , GIANNETTI E. , GRECO L. , TRONCONE R. , STAIANO A.
Published: July 2010

Aim To determine if small bowel involvement at diagnosis could predict early relapse in children with ulcerative colitis.

Methods Children with newly diagnosed ulcerative colitis were evaluated prospectively at three time points: within 1 month, 6 months and 1 year after diagnosis. Clinical activity indices were used to measure disease activity. Laboratory studies were performed at each visit and/or at the time of relapse. At diagnosis, all patients underwent colonoscopy and a cellobiose/mannitol small intestinal permeability study. Some children were further investigated with an upper gastrointestinal endoscopy.

Results Thirty‐three patients completed the 1‐year study. Overall, nine patients (27.3%) relapsed within 6 months of diagnosis, one patient (3%) within 1 year, whereas 23 patients (69.7%) did not relapse. The mean clinical activity indices, laboratory parameters, extent of colonic involvement, upper and lower gastrointestinal histological features were not predictive of early relapse. Results of the cellobiose/mannitol small intestinal permeability study were significantly higher in children who relapsed within 6 months compared with children who did not relapse (P < 0.013). The cellobiose/mannitol small intestinal permeability study was abnormal in 77.8% of early relapsers compared with only 8.3% of non‐relapsers.

Conclusion Abnormal small intestinal permeability in children with ulcerative colitis could predict a more relapsing disease.
Rabeprazole‐based eradication therapy for Helicobacter pylori: a large‐scale study in Japan
Authors: KUWAYAMA H. , ASAKA M. , SUGIYAMA T. , FUKUDA Y. , AOYAMA N. , HIRAI Y. , FUJIOKA T. ,   THE JAPAN RABEPRAZOLE STUDY GROUP
Published: July 2010

Background Large‐scale studies of rabeprazole‐based Helicobacter pylori eradication therapy have not been reported in Japan.

Aims To evaluate H. pylori eradication by rabeprazole‐based therapy with reference to antibiotic susceptibility, CYP2C19 genotype, and rabeprazole and clarithromycin dosages.

Methods From 35 centres 479 H. pylori‐positive patients with gastric or duodenal ulcer were randomized to four treatment groups: Group 1 (10 mg rabeprazole + 750 mg amoxicillin + 200 mg clarithromycin twice daily for 7 days); Group 2 (10 mg, 750 mg, 400 mg); Group 3 (20 mg, 750 mg, 200 mg) and Group 4 (20 mg, 750 mg, 400 mg).

Results Eradication rates were 86% (102 of 119), 89% (97 of 109), 91% (106 of 116) and 90% (104 of 115) for Groups 1–4, respectively. The eradication rate was 95% (360 of 379) for clarithromycin‐susceptible strains, and 50% (30 of 60) for clarithromycin‐resistant strains. The eradication rates were 88% (332 of 379) and 96% (77 of 80) in extensive metabolizers and poor metabolizers, respectively.

Conclusions Rabeprazole‐based therapies achieved 50% eradication of clarithromycin‐resistant H. pylori, and even achieved good rates in extensive metabolizers. Accordingly, rabeprazole can be recommended as part of a first‐line proton pump inhibitor‐based triple therapy for H. pylori.
Infliximab for the treatment of ulcerative colitis: outcomes in Oxford from 2000 to 2006
Authors: JAKOBOVITS S. L. , JEWELL D. P. , TRAVIS S. P. L.
Published: July 2010

Background Infliximab has been shown to be of benefit in the treatment of ulcerative colitis but long‐term colectomy rates remain unknown.

Aims To review the rate of colectomy after infliximab for ulcerative colitis and to identify factors that might predict the need for colectomy.

Methods We conducted a retrospective cohort study of patients with active ulcerative colitis treated with infliximab between 2000 and 2006. The primary outcome was colectomy‐free survival. Disease and treatment characteristics and complications were documented.

Results Thirty patients were treated with infliximab for refractory ulcerative colitis. Sixteen (53%) came to colectomy a median of 140 days after their first infusion (range 4–607). There was no difference in colectomy between those receiving infliximab for acute severe ulcerative colitis failing intravenous steroids (8/14) and out‐patients with steroid‐refractory ulcerative colitis (8/16). Only 17% (5/30) achieved a steroid‐free remission after a median follow‐up of 13 months (range 2–72). Univariate analysis showed that a younger age at diagnosis of colitis was significantly associated with an increased rate of colectomy (27.5 years vs. 38.7 years, P = 0.016).

Conclusion Over half the patients studied came to colectomy. Of those avoiding colectomy, only five (17%) sustained a steroid‐free remission.
Systematic review: renal and other clinically relevant outcomes in hepatorenal syndrome trials
Authors: TANDON P. , BAIN V. G. , TSUYUKI R. T. , KLARENBACH S.
Published: July 2010

Background Although reversal of pretransplant renal dysfunction in hepatorenal syndrome reduces post‐transplant complications, the overall impact on morbidity and mortality requires clarification.

Aim To review trials of pharmacologic interventions in hepatorenal syndrome, with specific assessment of trial quality and study endpoints, including patient survival and renal outcome measures.

Methods Literature search and selection was carried out by a single reviewer. Data extraction and quality analysis were carried out by two independent reviewers.

Results Of 848 identified articles, 36 were eligible for inclusion. Twenty‐one were full‐text. Only 19% were randomized‐controlled trials. About 50% of studies included only Type 1 hepatorenal syndrome patients. Serum creatinine, urine output and urine sodium were the most common renal outcome measures. Only 42% defined a primary renal endpoint. About 88% of articles reported mortality rates.

Conclusions Existing literature of pharmacologic agents for use in hepatorenal syndrome is limited by poor study design, including non‐randomization, heterogeneous study populations, lack of power, and limited use of clinically relevant outcomes. There is insufficient information in most trials to judge the impact of pharmacologic therapy on mortality or rates of transplantation. The validity of renal outcome measures as surrogate markers of more clinically relevant endpoints has not been established.
Review article: the role of antibiotics vs. conventional pharmacotherapy in treating symptoms of irritable bowel syndrome
Authors: FRISSORA C. L. , CASH B. D.
Published: July 2010

summary

Background

The concept of augmenting the management of irritable bowel syndrome with antibiotics is evolving, and many questions remain regarding this therapy relative to known and hypothesized irritable bowel syndrome pathophysiology. The clinical evidence of small intestinal bacterial overgrowth as an important aetiology of irritable bowel syndrome continues to accumulate. Clinical symptoms of bacterial overgrowth and irritable bowel syndrome are similar; however, a definitive cause‐and‐effect relationship remains unproven. It is unclear whether motility dysfunction causes bacterial overgrowth or gas products of enteric bacteria affect intestinal motility in irritable bowel syndrome.

Aim

To discusses the efficacy and tolerability of current symptom‐directed pharmacotherapies and of antibiotics in the treatment of irritable bowel syndrome.

Methods

A computerized search of PubMed was performed with search terms ‘IBS’, ‘pharmacotherapy’ and ‘antibiotics’. Relevant articles were selected, and the reference list of selected articles was reviewed to identify additional references.

Results

Antibiotic treatment benefits a subset of irritable bowel syndrome patients. The non‐absorbed antibiotic rifaximin has a favourable safety and tolerability profile compared with systemic antibiotics and demonstrates a therapeutic efficacy comparable with symptom‐based irritable bowel syndrome pharmacotherapies.

Conclusion

Rifaximin is the only antibiotic with demonstrated sustained benefit beyond therapy cessation in irritable bowel syndrome patients in a placebo‐controlled trial. Whether antibiotics can improve quality of life in patients with irritable bowel syndrome warrants further research.