bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of intravenous infusion of ranitidine on intragastric acidity in fasting subjects: comparison with bolus or Gastrojet (pH‐stat‐adjusted) infusion
Authors: THOMSON A. B. R. , KIRDEIKIS P. , SIMON K. , ZUK L. , PINCHBECK B. , WASARAB‐ROLLAND D. , KERSEY K.
Published: July 2010

This study was undertaken in nine fasting healthy volunteers to compare the effect of intravenous continuous infusion versus bolus injection of ranitidine on 12‐h intragastric pH, and to compare the efficacy of these two modes of administration of pH‐stat‐adjusted infusion of ranitidine using the Gastrojet. Each volunteer had three study sessions with 12‐h pH measurements. In the ranitidine infusion treatment arm (RAN‐INF), ranitidine was continually infused intravenously using an IVAC‐pump at a dose of 0.125 mg mg.kg over a 12‐h period. In the ranitidine bolus treatment arm (RAN‐BOL), ranitidine bolus 50 mg was given over 10 min, every 6 h. When ranitidine infusion was given by the pH stat method using the Gastrojet (RAN‐JET), sufficient ranitidine was given to maintain a preset value of pH ≥ 5. The study was analysed with a 3 × 3 Latin square cross‐over design with multiple measurements of each phase of the cross‐over. No difference was found between RAN‐INF and RAN‐BOL in 12‐h or in daytime (10.00–18.00 h) mean pH, median pH, or percentage of pH ≥ 5. Using RAN‐JET, 89.5% of the pH values were ≥ 5, compared with 39.7% and 40.0% with RAN‐INF or RAN‐BOL. RAN‐JET also gave higher (P < 0.05) mean and median 12‐h or daytime pH values, as compared with RAN‐INF or RAN‐BOL. The mean doses of ranitidine given in the 12‐h infusion periods were 100 mg, 109 mg and 112 mg (RAN‐BOL, RAN‐INF and RAN‐JET, respectively). Thus, this superior inhibition of acid inhibition achieved with Gastrojet does not require higher mean doses of ranitidine. These findings cannot necessarily be applied to persons with duodenal ulcer disease or to patients in an intensive‐care unit setting. However, the data do raise the possibility that much greater inhibition of acid inhibition can be achieved by individualizing the dose of ranitidine using the Gastrojet.
The need for long‐term treatment of peptic ulcer
Authors: DOBRILLA G. , ZANCANELLA L. , AMPLATZ S.
Published: July 2010

Some 10% of the population in Western countries will suffer a duodenal ulcer or gastric ulcer at some time in their lives. Although there has been an improvement in the, survival rate of patients with peptic ulcer haemorrhage, the mortality is still approximately 10%. There is evidence to suggest that peptic ulcer disease is a life‐long condition and that ulcers remain active with an unchanged potential for complications such as haemorrhage and perforation. Over the past 15 years anti‐ulcer drugs with different mechanisms of action have been developed, and their use results in complete healing of an ulcer in four to eight weeks. However, most patients experience recurrence of their peptic ulcer after discontinuation of the healing therapy. Studies of continuous H2‐receptor antagonist therapy have shown that recurrence occurs less frequently than in untreated patients, is largely asymptomatic, and is rarely characterized by haemorrhagic complications. Limited data on therapy for the eradication ofHelicobacter pylorisuggest that this may be an alternative approach for selected patients. As protection afforded by H2‐receptor antagonists remains undiminished over the course of several years and is also observed in ulcers which have bled in the past, the implementation of long‐term management with these agents constitutes a rational policy.
Efficacy of continuous therapy for peptic ulcer in controlled clinical trials
Authors: DAMMANN H. G. , WALTER T. A.
Published: July 2010

Long‐term studies have confirmed unequivocally the clinical efficacy of continuous therapy with H2‐receptor antagonists in reducing the incidence of ulcer recurrence. However, studies have also reported varying relapse rates as a result of differences in study design, particularly the frequency of endoscopy and hence the detection of asymptomatic ulcer relapse. Risk factors for ulcer relapse include smoking, stress, previous history of frequent ulcer relapses, duration of disease for more than 10 years and concomitant administration of non‐steroidal anti‐inflammatory drugs. In the prevention of relapse with H2‐receptor antagonists, choice of agents also may influence the rate of relapse. A meta‐analysis of data from direct comparative trials indicates that recurrence rates of duodenal ulcer are significantly lower after one year of treatment with ranitidine (1 50 mg nocte) than with cimetidine (400 mg nocte). It has been claimed that patients with peptic ulcer disease can be successfully managed by intermittent courses of treatment with H2‐receptor antagonists which are taken in response to the development of symptoms. However, high relapse rates (64–100%) have been reported during the first year of follow‐up of patients who were receiving intermittent treatment with H2‐receptor antagonists. High complication rates (haemorrhage 11.4%, perforation 1.2 %) have also been reported over a seven‐year follow‐up, while continuous treatment with H2‐receptor antagonists significantly decreases the risk of haemorrhage in the event of ulcer recurrence.
Review article: infectious diarrhoea
Authors: DuPONT H. L.
Published: July 2010

In this review we will briefly consider the important aetiological agents implicated in acute diarrhoea, the settings where illness most often occurs, the diagnostic approach needed to address proper management, followed by a discussion of therapy.
Mesalamine capsules enhance the quality of life for patients with ulcerative colitis
Authors: ROBINSON M. , HANAUER S. , HOOP R. , ZBROZEK A. , WILKINSON C.
Published: July 2010

Patients with ulcerative colitis tend to be young, potentially at peak lifetime productivity levels, and the disease can be devastating in its effects on the quality of life in these individuals. No treatment for ulcerative colitis can be comprehensively evaluated without careful attention to its impact on such psychosocial issues. The quality of life was evaluated in 374 ulcerative colitis patients using mesalamine capsules at 1 g, 2 g, and 4 g daily versus placebo in an 8‐week, randomized, dose‐response, placebo‐controlled, double‐blind, multicentre trial. Function‐related quality of life parameters were assessed in this study, including five pertinent clinical symptoms and seven general life capabilities. These parameters have been previously shown to be valid, reliable, and responsive to the disease activity of ulcerative colitis. All of the parameters were recorded using a 10‐cm visual analogue scale, except trips to the toilet which were recorded in patients' diaries. The mean change was calculated from baseline and endpoint data. Mesalamine at 2 g and 4 g daily was significantly superior to placebo in improving each of the 12 quality of life parameters (P < 0.05). These results indicate that controlled‐release mesalamine significantly enhances the quality of life for patients with either left‐sided ulcerative colitis or pancolitis.
Effect of propranolol on prevention of first variceal bleed and survival in patients with chronic liver disease
Authors: PLEVRIS J. N. , ELLIOT R. , MILLS P. R. , HISLOP W. S. , DAVIES J. M. , BOUCHIER I. A. D. , HAYES P.C.
Published: July 2010

Background: Propranolol has been shown to be effective in both primary and secondary treatment of variceal haemorrhage; most primary prevention trials have only included patients with large oesophageal varices.

Aim of the study: The aim of this study was to look at the effect of propranolol in the primary prevention of variceal bleeding and its long‐term effects on mortality in unselected patients with chronic liver disease.

Methodology: Three hundred and nineteen patients were included in a double‐blind parallel group study in three centres to receive propranolol 160 mg long‐acting (LA) or placebo. Patients were followed up for a minimum of one year.

Results: There were eleven episodes of variceal bleeding and 38 deaths with no statistically significant difference in bleeding rates between the two treatment groups. Child's group and history of ascites were the most important prognostic factors determining the likelihood of early death and variceal bleeding respectively.

Conclusions: In this study we failed to demonstrate a significant effect of propranolol on first variceal bleeding or in prolonging survival in unselected patients with chronic liver disease. Our results, however, might have been influenced by the low event rate observed in these unselected group of patients and suggest that careful selection of patients who are most likely to benefit from propranolol is important.
Short report: treatment of gastric ulcer with lansoprazole or ranitidine: a multicentre clinical trial
Authors: MICHEL P. , LEMAIRE M. , COLIN R. , BOMMELAER G. , RAMBAUD J. C. , DUPAS J. L. , BIGARD M. A. , VERWAERD J. C.
Published: July 2010

We studied the effectiveness of lansoprazole and ranitidine in promoting gastric ulcer healing in a multicentre double‐blind trial, by comparing the proportion of healed ulcers after 4 and 8 weeks of treatment. One hundred and fifty‐eight patients were randomly given either ranitidine (150 mg each morning and at bedtime) or lansoprazole (30 mg each morning and placebo at bedtime). One hundred and twenty‐eight patients completed the trial (62 taking lansoprazole, 66 taking ranitidine). Fifty‐one (80%) of those treated with lansoprazole and forty‐two (62%) of those treated with ranitidine had healed ulcers at 4 weeks (P < 0.05). Sixty‐one (98%) patients who received lansoprazole and 57 (86%) who received ranitidine had healed ulcers at 8 weeks (P < 0.05). The observed differences were not significant in the intention‐to‐treat analysis. No serious adverse event was reported with lansoprazole.
Review article: drug therapy for reflux oesophagitis
Authors: De BOER W. A. , TYTGAT G. N. J.
Published: July 2010

Gastro‐oesophageal reflux disease is a common disorder and symptoms can be mild to severe. Management of the disease should be individualized. Life‐style changes are important for all patients. Drug therapy is often necessary but only very few patients with severe disease need surgical treatment. The purpose of this article is to focus on drug therapy and to review the clinical trials of all the drugs used for gastro‐oesophageal reflux disease. Thereafter, judged solely on the data derived from these trials, a practical approach to the management of gastro‐oesophageal reflux disease is suggested.
Preservation of gastric antral mucus is associated with failure of eradication of Helicobacter pylori by bismuth, metronidazole and tetracycline
Authors: LOBO A. J. , McNULTY C. A. M. , UFF J. S. , DENT J. , EYRE‐BROOK I. A. , WILKINSON S. P.
Published: July 2010

Methods: Forty‐three patients positive for Helicobacter pylori by histology and culture of antral biopsies (n = 40) or histology alone (n= 3) were investigated. They received either regimen 1‐tripotassium dicitrato bismuthate 120 mg q.d.s. and tetracycline 250 mg q.d.s. for 4 weeks, with metronidazole 200 mg q.d.s. for the first 2 weeks, or regimen 2–omeprazole 20 mg b.d., amoxycillin 500 mg t.d.s., tetracycline 500 mg q.d.s. each for 3 weeks. Gastric antral biopsies were scored (0–3) histologically for mucus depletion, polymorphonuclear and mononuclear cell infiltrate. H. pylori eradication was assessed by biopsy and culture 1 month after the cessation of treatment.

Results: With regimen 1, pre‐treatment mucus depletion was significantly higher where eradication was successful (median score 2) compared to where it was not (median score 1, P < 0.01): there were no differences in the scores for polymorphonuclear or mononuclear cell infiltrates. In patients receiving regimen 2, there were no differences in either mucus depletion or polymorphonuclear or mononuclear cell infiltrate, between those where eradication was successful and those where it was not. Metronidazole minimum inhibitory concentrations rose when eradication with regimen 1 was unsuccessful (median before 0.19 mg/L, median after treatment 16 mg/L; P = 0.04).

Conclusion: Pre‐treatment mucus depletion is identified as a factor affecting H. pylori eradication. Preservation of mucus may facilitate acquisition of metronidazole resistance.
Activity of metronidazole, azithromycin and three benzimidazoles on Giardia lamblia growth and attachment to a human intestinal cell line
Authors: KATELARIS P. H. , NAEEM A. , FARTHING M. J. G.
Published: July 2010

Background: Attachment of Giardia lamblia trophozoites to enterocytes is essential for colonization of the small intestine and is considered a prerequisite for Giardia‐induced enterocyte damage. Inhibition of attachment may therefore have therapeutic potential

Methods: Enterocyte‐like differentiated Caco‐2 cells were used as a biologically appropriate attachment surface to determine the effect of three benzimidazole compounds (albendazole, mebendazole and thiabendazole), azithromycin and metronidazole on Giardia attachment. The results were compared with the ability for each drug to inhibit Giardia growth, measured using [3H]‐thymidine uptake.

Results: The benzimidazoles inhibited Giardia attachment at much lower concentrations than did metronidazole. However, metronidazole was a much more potent inhibitor of growth than any of the benzimidazoles. Azithromycin did not significantly impair Giardia attachment or growth. The benzimidazoles decrease attachment but are less giardiacidal than metronidazole.

Conclusion: This model appears useful for testing potential antigiardial compounds and investigating mechanisms of drug action.
Prednisolone metasulphobenzoate foam retention enemas suppress the hypothalamo‐pituitary‐adrenal axis
Authors: LUMAN W. , GRAY R. S. , PENDEK R. , PALMER K. R.
Published: July 2010

Background: Corticosteroid enemas represent effective treatment for ulcerative proctitis, but absorption into the systemic circulation may have undesirable metabolic consequences. Prednisolone metasulphobenzoate, a lipophobic corticosteroid derivative, is designed to be absorbed poorly through the recto‐sigmoid mucosa, but the effects of foam enema preparations upon the hypothalamo‐pituitary‐adrenal axis have not been examined. Methods: Nine patients suffering from active ulcerative proctitis underwent four weeks of therapy with prednisolone metasulphobenzoate foam enemas. The hypothalamo‐pituitary‐adrenal axis, denned using the modified single‐dose metyrapone test, glucose homeostasis and lipid profiles were studied before and after treatment.

Results: The hypothalamo‐pituitary‐adrenal axis was significantly depressed after the treatment period; mean stimulated plasma Cortisol concentration fell from 384 ± 244 (s.d.) to 288±252 nmol/L, P < 0.02; stimulated mean plasma 11‐deoxyCortisol concentration fell from 677 ± 333 to 407 ± 326 nmol/L, P < 0.01. Mean fasting plasma glucose, insulin, C‐peptide, fructosamine and triglyceride concentration were unchanged, whilst the mean serum cholesterol concentrations rose from 5.6 ± 1.1 to 6.0± 1.2 mmol/L (not significant).

Conclusion: Prednisolone metasulphobenzoate foam enemas have significant systemic and endocrine metabolic effects, which could assume importance with long‐term therapy.
Review article: gastro‐oesophageal reflux and laryngeal symptoms
Authors: FRASER A. G.
Published: July 2010

There is some evidence from clinical, experimental and multiprobe ambulatory pH studies that gastro‐oesophageal reflux is more common in patients with laryngeal symptoms and could potentially play a role in the causation of these symptoms. The proportion of unselected patients with laryngeal symptoms who have gastro‐oesophageal reflux as the primary aetiology may be overestimated in some series. The symptom that has been most evaluated is hoarseness, but even for this symptom the proportion of patients who have significant reflux varies widely. There is even less agreement for other symptoms, and the data on globus sensation remains confused. It is likely that these patients present to ear, nose and throat (ENT) clinics because of the relative insensitivity of the oesophageal mucosa to acid exposure. Given the lack of specificity for routine diagnostic tests for gastro‐oesophageal reflux, it is necessary to perform ambulatory pH monitoring for a secure diagnosis in these patients. Treatment studies have been surprisingly few and inadequate in design. It is suspected that there is a strong placebo response for these symptoms. No clear information on efflcacy can be provided until placebo‐controlled randomised studies are available.
Anaphylactic colonic hypersecretion in cow's milk sensitized guinea‐pigs depends upon release of Interleukin‐1, prostaglandins and mast cell degranulation
Authors: THEODOROU V. , FIORAMONTI J. , JUNIEN J. L. , BUENO L.
Published: July 2010

Methods: The effect of β‐lactoglobulin (β‐LGI) challenge on net water movements into the proximal colon and the role of Interleukin‐1 (IL‐1), prostaglandins and mast cell degranulation on the challenge‐induced net water changes were assessed in vivo using isolated colonic loops in anaesthetized guinea‐pigs immunized to bovine milk.

Results: β‐lactoglobulin challenge infused into the colonic loop during 30 min reversed the net water flux into a net secretion during the period of antigen infusion. Doxantrazole, a mast cell stabilizing agent, administered 120 min before challenge infusion, suppressed challenge‐induced hypersecretion. Similarly recombinant IL‐1 receptor antagonist protein abolished the antigen‐induced colonic secretory effect. Indomethacin, a prostaglandin synthesis inhibitor, administered 20 min prior to antigen infusion, significantly (P < 0.05) reduced, but did not abolish, the challenge‐induced colonic secretory effect.

Conclusions: These results suggest that IL‐1 plays an important role in antigen challenge‐induced colonic hypersecretion which involves mast cell degranulation and prostaglandin release.
Comparison of lansoprazole with omeprazole on 24‐hour pH, acid secretion and serum gastrin in healthy volunteers
Authors: VARANNES S. BRULEY DES , LEVY P. , LARTIGUE S. , DELLATOLAS F. , LEMAIRE M. , GALMICHE J. P.
Published: July 2010

Background: Lansoprazole and omeprazole are proton pump inhibitors which both strongly inhibit acid secretion, resulting in a significant increase in serum gastrin levels. However, no direct comparison of recommended doses (20 mg for omeprazole and 30 mg for lansoprazole) has been reported so far. Our aims were to compare the effects of omeprazole 20 mg/day and lansoprazole 30 mg/day on intragastric acidity and serum gastrin concentration in 12 healthy volunteers.

Methods: The study was double‐blind, randomized and placebo‐controlled with a cross‐over design. On the seventh day of each period, 24‐hour intragastric pH was measured using a combined glass electrode placed in the proximal stomach. The last morning dose of each regimen was taken at the end of 24‐hour pH monitoring; acid output and serum gastrin concentrations were then studied in the fasting state and after stimulation with pentagastrin (maximal acid output) and a meal (post‐prandial gastrin response).

Results: Compared to placebo, both drug regimens induced a sustained increase of 24‐hour intragastric pH and significantly decreased basal and pentagastrin‐stimulated acid secretion. Lansoprazole 30 mg was slightly more effective than omeprazole 20 mg in terms of time spent above pH 3 (P < 0.05). Accordingly post‐prandial gastrin concentrations rose slightly more after lansoprazole than after omeprazole. All other differences were insignificant.

Conclusions: Both lansoprazole 30 mg and omeprazole 20 mg induce potent and long‐lasting acid inhibition, with few minor differences when the two proton pump inhibitors are used at standard doses.
Effective treatment after failure of omeprazole plus amoxycillin to eradicate Helicobacter pylori infection in peptic ulcer disease
Authors: LABENZ J. , RÜHL G. H. , BERTRAMS J. , BÖRSCH G.
Published: July 2010

Methods: Fifty patients with relapsing or complicated Helicobacter pylori positive duodenal (n= 41) or gastric ulcer disease (n= 9) and failure of a combined treatment with omeprazole plus amoxycillin to eradicate H. pylori infection were re‐treated with either oral triple therapy (bismuth subsalicylate, metronidazole, tetracycline) plus ranitidine [group I: n= 22] or high‐dose omeprazole (40 mg b.d. to t.d.s.) plus amoxycillin (1 g t.d.s.) [group II: n= 28].

Results: Patients of group I and II had similar demographic and clinical characteristics. The overall proportion of eradication of H. pylori infection was 81.8% in group I and 78.6% in group II (P= N.S.) as judged from negative bacterial findings by means of an urease test, specific culture and histology after modified Giemsa stain. Ulcer healing was observed in all patients after a maximum duration of 10 weeks. Ten patients on triple therapy and only one patient on omeprazole plus amoxycillin (45.5%vs. 3.6%; P < 0.001) complained of side effects without necessity of discontinuation of the study medication in either group. Twenty patients (group I: n= 10: group II: n= 10) with relapsing duodenal ulcer disease and successful cure were prospectively followed for one year without any evidence of ulcer relapse or H. pylori re‐infection.

Conclusion: Oral triple therapy plus ranitidine or highdose omeprazole plus amoxycillin remain highly effective in eradicating H. pylori infection in patients with peptic ulcer disease and treatment failure of omeprazole/amoxycillin, but the omeprazole enhanced antibiotic monotherapy seems to be superior with regard to side effects. Thus, high‐dose omeprazole/amoxycillin is recommended as the treatment of first choice in these selected patients. Triple therapy should be reserved for patients intolerant of amoxycillin
Short report: evaluation of Helicobacter pylori eradication with bismuth sucrlfate
Authors: REIJERS M. H. E. , NOACH L. A. , TYTGAT G. N. J.
Published: July 2010

Methods: In a pilot study we have evaluated the clinical efficacy of bismuth sucralfate to eradicate H. pylori. Ten consecutive patients with chronic dyspepsia and H. pylori associated gastritis were treated with bismuth sucralfate (220 mg bismuth per tablet, 4 tablets per day for 4 weeks). If a 14C urea breath test immediately after the medication was negative, a gastroscopy was performed one month later to obtain biopsies for culture and histological examination.

Results: Four patients experienced side effects. In none of the ten patients could eradication of H. pylori be demonstrated one month after treatment with bismuth sucralfate.

Conclusion: Bismuth sucralfate is not effective for the treatment of H. pylori infection.
Short report: interferon‐α decreases 14C–aminopyrine breath test values in patients with chronic hepatitis C
Authors: HORSMANS Y. , BRENARD R. , GEUBEL A. P.
Published: July 2010

Objective: To investigate the effect of interferon‐α on cytochrome P‐4 50 dependent microsomal function.

Methods: The 14C‐aminopyrine breath test was performed before, during and after a standard dose of interferon‐α (3 000000 units three times per week) was administered for at least six months (nine patients with chronic hepatitis C).

Results : Mean aminopyrine breath test values obtained during therapy were significantly lower than either pre‐ or post‐treatment, the degree of reduction varying widely between individuals. Pre‐ and post‐treatment aminopyrine breath test values did not differ significantly.

Conclusion: Interferon therapy is associated with a significant and transient inhibition of cytochrome P‐450 activity, which should be taken into account when prescribing concurrent therapy with drugs metabolized by this pathway.
Review article: treatments that impact favourably upon the eradication of Helicobacter pylori and ulcer recurrence
Authors: TYTGAT G. N. J.
Published: July 2010

Healing the gastroduodenal mucosa through Helicobacter pylori eradication leads to a dramatic reduction in gastroduodenal ulcer relapse. Eradication of H. pylori proves to be difficult. Although the organism is sensitive to many antibiotics in vitro, the in vivo eradicating efficacy is often disappointing. This overview summarizes the most commonly used currently‐available eradication schemes and the consequences of successful eradication in peptic ulcer disease.
Omeprazole, bismuth and clarithromycin in the sequential treatment of Helicobacter pylori infection
Authors: NERI M. , SUSI D. , LATERZA F. , DI IORIO P. , SECCIA G. , MEZZETTI A. , CUCCIIRULLO F.
Published: July 2010

Aims: To assess the therapeutic potential of clarithromycin, a new macrolide with high anti‐Helicobacter pylori activity, given with bismuth salts and omeprazole in different regimens aimed at simplifying the treatment of H. piylon‐related gastritis.

Methods: Eighty‐eight patients with proven H. pylori infection and gastritis were treated with one of the following four regimens: omeprazole 40 mg/day for one week (group A. n = 14); omeprazole 40 mg/day for one week followed by clarithromycin 1 g/day for 2 weeks (group B, n = 26); omeprazole 40 mg/day for one week followed by tripotassium dicitrato bismuthate 480 mg/day and clarithromycin 1 g/day, both for two weeks (group C, n = 26); and tripotassium dicitrato bismuthate 480 mg/day and clarithromycin 1 g/day for two weeks (group D, n = 22). Presence of H. pylori, histology and electron microscopy were assessed at entry and four weeks after the end of each treatment.

Results: Omeprazole alone had no effect on H. pylori status. The highest eradication rate was obtained in group C patients (81%), a proportion significantly greater than that observed in group B (50%, P < 0.03) or group D patients (55%, P < 0.05).

Conclusion: Sequential treatment may be a useful option in the treatment of H. pylori‐related gastritis.
Long term treatment with omeprazole 20 mg three days a week or 10 mg daily in the prevention of duodenal ulcer relapse
Authors: PORRO G. BIANCHI , CORINALDESI R. , LAZZARONI M. , BARBARA L. , CAPURSO L. , PAOLUZI P. , MANGIAMELI A. , SABBATINI F. , FRANCESCHI M. , BOLLING E.
Published: July 2010

Background: The aim of this study was to compare omeprazole 10 mg o.m. (daily) with omeprazole 20 mg o.m. on Friday to Sunday inclusive (weekend) in the prevention of duodenal ulcer relapse over a 6‐month period.

Methods: After an open healing phase (4 to 8 weeks) with omeprazole 20 mg o.m., 81 patients entered the follow‐up phase. Forty‐two were randomized in a double‐blind double‐dummy technique, to omeprazole 10 mg o.m., and 39 to omeprazole 20 mg at weekends, At 3 and 6 months or on symptomatic relapse the patients underwent endoscopy with gastric biopsies (quantitative assessment of argyrophilic and gastrin cells), symptom evaluation, and laboratory screening with fasting serum gastrin.

Results: Five patients in the 10 mg group and four in the weekend group were lost to follow‐up. The estimated relapse rates over six months in the two groups receiving 10 mg daily or 20 mg at weekends were 19% and 31%, respectively (95% CI of percentage difference: –33% to 8%; intention‐to‐treat analysis, P = N.S.). During the follow‐up phase, symptoms tended to be milder in the omeprazole 10 mg daily group compared to the weekend group. Gastrin levels increased significantly during the healing phase but then stayed almost constant in the omeprazole 10 mg group, and significantly decreased with weekend treatment. The median number of argyrophilic cells showed a slight but statistically significant increase in the omeprazole 10 mg daily group, but did not change in the weekend group. Both the healing and long‐term therapies were well tolerated.

Conclusions: Our data do not show a clear difference between the two treatment regimens, but there was a tendency towards a lower recurrence rate with omeprazole 10 mg daily compared with 20 mg weekend therapy.
Budesonide enema active haemorrhagic proctitis—a controlled trial against hydrocortisone foam enema
Authors: TARPILA S. , TURUNEN U , SEPPÄLÄ K. , AUKEE S. , PIKKARAINEN P. , ELOMAAS† I. , KARVONENT A‐L. , KÄÄRIÄINEN I. , SIPPONEN P. , TOIVANEN E. , HEIKIUS B. , NIEMELÄ S. , NURMI. H. , TUNTURI‐HIHNALATT H. , BURNHAM W. R. , COWAN R. E. , HINE K. R. , PERSSON T. , SALDES L.
Published: July 2010

Background: The aim was to compare budesonide enema, 2 mg/100 mL (Entocort) and hydrocortisone acetate foam enema, 125 mg (Colifoam) in patients with active haemorrhagic proctitis.

Methods: The trial was a controlled, randomized, investigator‐blind study with two parallel groups. Endoscopy, histology and diary cards were used to assessed the response to therapy. Safety was assessed by laboratory tests and adverse event recording.

Results: Seventy‐two patients were included. Investigations were made before treatment and after 2 and 4 weeks. Both treatment groups showed statistically significant improvement in endoscopic scores but significant differences between the groups were not found. In the hydrocortisone group, plasma cortisol was significantly lowered after 4 weeks compared with budesonide. Bowel habits and quality of life variables did not differ between the treatments. The recorded adverse events were mild or moderate and may have been due to the proctitis.

Conclusions: These results suggest that budesonide enema is as effective as hydrocortisone foam enema, but without the potential for side‐effects associated with suppression of plasma cortisol.
Comparison of a high lipase pancreatic enzyme extract with a regular pancreatin preparation in adult cystic fibrosis patients
Authors: GAN K. H. , HEIJERMAN H. G. M. , GEUS W. P. , BAKKER W. , LAMERS C. B. H. W.
Published: July 2010

Background: Malabsorption due to exocrine pancreatic insufficiency is the main gastrointestinal problem in cystic fibrosis. Despite high doses of pancreatic enzyme supplements it is often not possible to normalize fat absorption. We compared a new high lipase pancreatic enzyme preparation (Pancrease‐HL; Cilag, Brussels, Belgium), containing enteric coated microspheres with 25000 U of lipase, 22 500 U of amylase and 1250 U of protease per capsule, with regular Pancrease capsules, containing 5000 U of lipase, 2900 U of amylase and 330 U of protease per capsule.

Methods: In a randomized double‐blind crossover study, 13 cystic‐fibrosis patients (6 male, 7 female, mean age 2 7.7 years) received either four capsules of Pancrease t.d.s. or one capsule of Pancrease‐HL t.d.s. Patients took 20 mg omeprazole daily to raise intra‐duodenal pH and thus optimize release of enzymes from the enteric coated microspheres.

Results: With four capsules of Pancrease t.d.s., mean fat excretion was 15.4% and mean nitrogen excretion was 19.9% vs. 15.5% fat and 19.9% nitrogen excretion with one capsule Pancrease‐HL t.d.s. Fat and protein energy loss (as a percentage of total daily intake) was 18.3% with Pancrease and 18.2% with Pancrease‐HL. The differences were not statistically significant. Pancrease‐HL was well tolerated, with no difference in abdominal pain or general well‐being scores. The number and average weight of stools passed remained the same.

Conclusions: One capsule of Pancrease‐HL appears to be equivalent to four capsules of regular Pancrease. Treatment with less capsules per day with the same efficacy may facilitate patient compliance.
Polgmeric nutrition as the primary therapy in children with small bowel Crohn's disease
Authors: BEATTIE R. M. , SCHIFFRIN E. J. , DONNET‐HUGHES A , HUGGETT A. C. , DOMIZIO P. , MACDONALD T. T. , WALKER‐SMITH J. A.
Published: July 2010

Background: Recent studies in adults have shown that polymeric (whole protein) diets are as effective as semi‐elemental and elemental formulae for the induction of remission in small bowel Crohn's disease. Whole protein diets are more palatable and cheaper. There have been no studies confirming efficacy in children.

Patients and Methods: We report our experience with seven children with active small bowel Crohn's disease given a casein‐based, polymeric feed rich in TGF‐SbT2 (Specific Polymeric Diet; Nestl–Clintec; Vevey, Switzerland) as complete nutrition for 8 weeks.

Results: Initial and follow‐up assessments were performed. All children showed a significant improvement in disease activity, with C‐reactive protein returning to normal, an increase in serum albumin and a good weight gain. Initial and follow‐up ileal biopsies were assessed and showed reduced mucosal inflammation in six of seven children, with complete healing in two.

Conclusion: In an uncontrolled descriptive study we have shown that a polymeric (whole protein) diet is a therapeutic option for small bowel Crohn's disease in children. By comprehensive follow‐up we have demonstrated clinical and biochemical remission, with an improved endoscopic appearance and a reduction of mucosal inflammation in the terminal ileum.
The eflects of levosulpiride on gastric and gall‐bladder emptying in functional dyspepsia
Authors: ARIENTI V. , CORAZZA G. R. , SORGE M. , BORIANI L. , UGENTI F. , BIAGI F. , MACONI G. , SOTTILI S. , THIEL† D. H. VAN , GASBARRINI G.
Published: July 2010

Background: 50 % of patients with functional dyspepsia have delayed gastric emptying. Levosulpiride is an orthopramide drug that stimulates gastrointestinal motility. Aim of our study was to evaluate the effect of levosulpiride on symptoms and gastric and gall‐bladder emptying, in dyspeptic patients.

Methods: Thirty adult patients, treated for 20 days with levosulpiride (75 mg/day) or placebo, were evaluated in a randomized double‐blind study. Symptoms were assessed by a cumulative index and overall intensity (visual analogue line). Gastric and gall‐bladder emptying were evaluated by epigastric impedance (liquid meal) and real‐time ultrasonography (mixed meal).

Results: Levosulpiride, with respect to placebo, accelerated the mean gastric half‐emptying time of liquids (P < 0.05), gastric emptying (P < 0.001 at 180 min; P < 0.05 at 240 min), and gall‐bladder emptying (P < 0.05 at 60 and 120 min) emptying after a solid‐liquid mixed meal. Both the mean cumulative index (P < 0.05) and the overall intensity (P < 0.025) of dyspeptic symptoms were reduced significantly by levosulpiride.

Conclusions: Our results showed that levosulpiride can be usefully employed in patients affected by functional dyspepsia.
Rapid eradication of Helicobacter pylori infection
Authors: BELL G. D. , POWELL K. U. , BURRIDGE S. M. , BOWDEN A. F. , ATOYEBI W. , BOLTON G. H. , JONES P. H. , BROWN C.
Published: July 2010

Background/aims: Current Helicobacter pylori eradication therapy for peptic ulcer disease usually involves a 2‐week course of either a bismuth preparation or omeprazole in combination with antibiotics. We have studied a shorter, 7‐day course of treatment to assess efficacy and tolerability.

Methods: Four hundred and thirty‐six patients, in three non‐randomized groups, received omeprazole (40 mg mane), amoxycillin (500 mg t.d.s.) and metronidazole (400 mg t.d.s.): 308 patients received the triple combination for 14 days; 80 patients were treated for 7 days; and 48 patients received omeprazole and amoxycillin for 7 days but metronidazole for only 5 days.

Results: Helicobacter pylori was eradicated in 89.5%, 91.1% and 87.5%, respectively (98.3%, 92.9% and 100% of metronidazole‐sensitive isolates and 75.6% and 88.2% of metronidazole‐resistant isolates in the first two groups). Side effects were significantly more frequent in patients who received 14 days (49%) compared with 7 days of treatment (33%); only 8/308 and 1/128 patients, respectively, failed to complete the course.

Conclusions: On the basis of efficacy, tolerability and cost, we conclude that a 7‐day course of the omeprazole (40 mg mane), amoxycillin (500 mg t.d.s.) plus metronidazole (400 mg t.d.s.) combination is effective therapy for the eradication of H. pylori.
Effect of an evening dose of regular and effervescent formulations of ranitidine or cimetidine on intragastric pH in healthy volunteers
Authors: SMOUT A. J. P. M. , JONKMAN J. H. G. , PEETERS P. A. M. , BRUIN† H. DE
Published: July 2010

Aims: To compare the effects on intragastric acidity of a single evening dose of either standard or effervescent formulations of ranitidine (300 mg) or cimetidine (800 mg).

Methods: Twelve healthy subjects were studied, using a four‐period randomized cross‐over design and an ambulatory intragastric pH monitoring technique. The subjects received a standard evening meal at 17.00 hours and one of the H2‐receptor antagonist formulations was given at 23.00 hours.

Results: Both effervescent formulations caused a transient rapid increase in intragastric pH, reaching a maximum at about 3 min after ingestion. After both effervescent formulations a significantly higher pH was measured during the first 45 min after ingestion (P < 0.05), compared to the regular formulations. The onset of action of the H2 receptor antagonists was similar for both formulations of ranitidine and the effervescent cimetidine, but tended to be slower for the regular cimetidine (P= 0.06). Nocturnal intragastric pH was significantly increased by all four formulations, but more effectively so by the two ranitidine formulations. The duration of action (taken as time with pH > 4) of both ranitidine formulations was longer than that of both cimetidine formulations (P < 0.002).

Conclusions: A single evening dose of 300 mg ranitidine produces a stronger decrease of nocturnal gastric acid secretion than 800 mg cimetidine. The effervescent formulations of both drugs offer the advantage of a rapid decrease (within minutes) of intragastric acidity, with preservation of the sustained systemic effect.
The effect of gastritis on human gastric alcohol dehydrogenase activity and ethanol metabolism
Authors: BROWN A. St., J. M. , FIATARONE J. R. , WOOD† P. , BENNETT† M. K. , KELLY P. J. , RAWLINS† M. D. , DAY C. P. , JAMES O. F. W.
Published: July 2010

Background: Gastric mucosal alcohol dehydrogenase (ADH) may decrease the bioavailability of ingested ethanol. Because this enzyme is found in highest concentrations in the superficial gastric mucosa, diffuse abnormalities of this tissue could lead to a decrease in the first pass metabolism of ethanol.

Methods: Thirty‐three adult subjects undergoing routine upper gastrointestinal endoscopy had gastric biopsies performed for assessment of gastric histology and the measurement of gastric ADH activity. Twenty of these subjects underwent separate oral dosing and intravenous infusion of ethanol (0.15 g/kg body weight) in order to determine the first pass metabolism, and hence bioavailability, of ethanol.

Results: Gastric histology was normal in 10 of the biopsies, showed chronic gastritis alone in 13 and significant glandular atrophy (i.e. atrophic gastritis) in a further 10. Gastric ADH activity in specimens with normal gastric histology was significantly higher than those with chronic gastritis (P=0.02), and was further decreased in those specimens with significant atrophy (P < 0.00001). However, no correlation was found between gastric ADH activity and the first pass metabolism of ethanol (r= 0.09, P=0.9).

Conclusions: These results suggest that although gastric ADH activity was decreased in individuals with abnormal gastric mucosa, ethanol bioavailability was not affected by gastric ADH activity. These data support the view that gastric ADH does not play a significant role in the first pass metabolism of alcohol.
Khat chewing delays gastric emptying of a semi‐solid meal
Authors: HEYMANN T. D. , BHUPULAN A. , ZUREIKAT N. E. K. , BOMANJI J. , DRINKWATER C. , GILES P. , MURRAY‐LYON I. M.
Published: July 2010

Background: The leaves of Khat are chewed for their central stimulant effect, but their use may cause anorexia and constipation.

Methods: Gastric emptying of a radio‐labelled semi‐solid meal was measured in 12 healthy volunteers on two occasions a week apart. Subjects chewed either Khat leaves (Catha edulis) or lettuce for 2 h before the study.

Results: Gastric emptying was significantly (P < 0.02 prolonged after chewing Khat compared with lettuce.

Conclusion: The sympathomimetic action of cathinonn in Khat may cause the observed delay in gastric emptying.
Interaction of NSAIDs and Helicobacter pylori on gastrointestinal injury and prostaglandin production: a controlled double‐blind trial
Authors: LAINE L. , COMINELLI F. , SLOANE R. , CASINI‐RAGGI V. , MARIN‐SORENSEN M. , WEINSTEIN W. M.
Published: July 2010

Background: H. pylori and nonsteroidal anti‐inflammatory drugs (NSAIDs) are major causes of gastroduodenal injury in man. We assessed the effect of daily NSAID ingestion on gastric histology and the interaction of H. pylori infection and NSAID ingestion on gross and histological injury and prostaglandin production.

Methods: Fifty‐two healthy volunteers with normal baseline endoscopy were randomly assigned to receive identical‐appearing naproxen 500 mg b.d., etodolac 400 mg b.d., or placebo b.d. for 4 weeks. The number and size of all erosions and ulcers were recorded by endoscopy at weeks 1 and 4. Biopsies taken at baseline, week 1 and week 4 were assessed for H. pylori, histology and gastric prostaglandin E2 production.

Results: No significant changes occurred with treatment in any histological feature in the three study groups or in H. pylori positive or negative subsets. Antral inflammation scores (scale, 0–6) for the NSAID group were: week 0‐1.2 ± 0.3; week 1—1.1 ± 0.3; week 4—1.3 ± 0.3; findings of ‘chemical gastritis’ were not seen. No significant difference in gross gastroduodenal injury (number or total surface area of ulcers or erosions) was seen between H. pylori positive and negative subjects in the three groups at week 1 or 4. Baseline prostaglandin E2 production was significantly higher in H. pylori positive subjects (2398±400 vs. 1064±255 pg/mg protein) and decreased significantly with 1 week of naproxen in H. pylori positive and negative subjects.

Conclusions: NSAID ingestion does not cause diffuse histological injury. Any diffuse histological injury in the gastric mucosa is related to the presence of H. pylori, and this H. pylori‐associated gastritis is not altered by NSAID ingestion. Furthermore, the development of gross gastroduodenal damage with 4 weeks of NSAID use is not influenced by underlying H. pylori infection.
Efficacy of cisapride therapy in functional dyspepsia
Authors: KELLOW J. E. , COWAN H. , SHUTER B. , RILEY J. W. , LUNZER M. R. , ECKSTEIN R. P. , HÖSCHL R. , LAM S.‐K.
Published: July 2010

Aim: To assess the efficacy of cisapride therapy in relieving symptoms of functional dyspepsia.

Methods: After a 2‐week placebo run‐in period, 61 out of 74 patients were eligible to enter a 4‐week double‐blind treatment phase, consisting of treatment with cisapride (10 mg) or placebo tablets t.d.s. Gastric emptying was assessed scintigraphically at entry to the study. Patients were stratified before treatment into those with or without active chronic (Helicobacter pylori) gastritis. Patients were also classified retrospectively into those with ‘reflux‐like’ dyspepsia (n= 29) and those with ‘motility‐like’ dyspepsia (n= 32).

Results: At the end of the active treatment phase, there was a similar significant (P < 0.001) reduction in total symptom score from baseline in both cisapride (8.9±0.5 to 5.8±0.6) and placebo (9.7±0.6 to 5.5±0.6) groups. Scores for heartburn and continual bloating were significantly reduced in the cisapride but not the placebo group; improvement was attributable to patients with normal, rather than delayed, rates of gastric emptying. For continual bloating, significant improvement also occurred in the cisapride subgroup without gastritis, but not in the subgroup with gastritis (mean symptom score reduction 0.48±0.18, P= 0.03). For global evaluation by the investigator and by the patient, the overall improvement rates were not statistically different between cisapride and placebo groups. In those with normal gastric emptying, however, there was a significant (P= 0.01) improvement in general well‐being in the cisapride but not in the placebo group.

Conclusions: We were unable to show major differences in the short‐term efficacy of cisapride and placebo in functional dyspepsia. There were indications, however, of beneficial effects of cisapride over placebo in those with ‘reflux‐like’ dyspepsia, and in those without gastroparesis.
Colonic spreading of a non‐chlorofluorocarbon mesalazine rectal foam enema in patients with quiescent ulcerative colitis
Authors: WILDING I. R. , KENYON C. J. , CHAUHAN S. , HOOPER G. , MARSHALL S. , McCRACKEN J. S. , STAAB H. J. , ARMBRECHT J.
Published: July 2010

Background: Rectal foam enemas provide for drug delivery to the distal colon for treatment of left sided ulcerative colitis. However, currently available formulations contain chlorofluorocarbons which are due to be phased out in the near future. The objective of this study was therefore to determine the degree of dispersion of a newly developed nonchlorofluorocarbon rectal foam preparation in ulcerative colitis patients.

Methods: This was an open label non‐controlled study of a single administration of a mesalazine foam enema (two actuations containing 2 g of mesalazine in approximately 120 mL foam) in 10 patients with quiescent ulcerative colitis. Spreading of the 99mTc‐labelled foam enema was assessed over a 4‐h period by the non‐invasive technique of gamma scintigraphy.

Results: All patients retained the enema for the full 4‐h imaging period. In nine out of the 10 patients, the enema was observed to spread as far as the descending colon and on average 23% of the dose was present in the descending colon at 4 h post‐dose.

Conclusions: The extent of spreading observed in the study supports the use of the formulation in the treatment of left sided ulcerative colitis.
Treatment of diabetic gastroparesis with oral clonidine
Authors: ROSA‐E‐SILVA L. , TRONCON L. E. A. , OLIVEIRA R. B. , IAZIGI N. , GALLO L. , FOSS M. C.
Published: July 2010

Background/Aims: Clonidine, a specific alpha‐2‐adrenergic receptor agonist, has been suggested to improve symptoms of gastroparesis in diabetics with diarrhoea. The aim of this study was to investigate the effects of clonidine on gastric emptying and symptoms suggestive of gastroparesis in patients with long‐standing diabetes mellitus and evidence of autonomic neuropathy.

Methods: Six diabetics with chronic, refractory symptoms of bloating, nausea and vomiting were studied. Gastric emptying of a liquid nutrient meal (250 mL; 430 kcal) was evaluated by scintigraphy and symptoms were scored. Patients were treated with clonidine (median dose: 0.3 mg/day) for 2–12 weeks (median : 4 weeks), after which symptoms and gastric emptying were re‐evaluated. Treatment was then sustained for a median follow‐up period of 7 weeks (range: 2–56 weeks).

Results: Gastric emptying half‐time values in diabetic patients ranged from 16 to 180 min (median: 100 min) and four patients had abnormally delayed emptying before treatment. In all patients, half‐time values decreased during treatment (median : 35 min; range: 14–106 min, P < 0.025 vs. pre‐treatment values) and in three of the four patients with abnormal gastric retention, half‐time values returned to the normal range. During clonidine treatment, a substantial decrease in the score for symptoms was observed (median and range: 7.5; 2–9 vs. 0; 0–9). In four patients, symptoms virtually disappeared, an effect that was maintained throughout follow‐up (6–56 weeks).

Conclusions: These findings suggest that impairment of adrenergic influences on gastrointestinal motility control may play a role in the pathophysiology of diabetic gastroparesis and that clonidine may be a useful alternative for treating patients with this condition.