bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression and cellular localization of COX‐1 and ‐2 in Helicobacter pylori gastritis
Authors: Chan F. K. L. , To K. F. , Ng Y. P. , Lee T. L. , Cheng A. S. L. , Leung W. K. , Sung J. J. Y.
Published: March 2003

Background:

There are conflicting reports on the expression of cyclooxygenase in Helicobacter pylori infection.

Aim:

To evaluate the expression of COX‐1 and COX‐2 in H. pylori gastritis at messenger RNA (mRNA) and protein levels.

Methods:

Endoscopic gastric biopsies were obtained from patients with non‐ulcer dyspepsia. The levels of COX‐1 and COX‐2 mRNA were compared between H. pylori‐infected and uninfected specimens using reverse transcription‐polymerase chain reaction. The immunohistochemical findings were correlated with the cellular localization of cyclooxygenase mRNA using in situ hybridization.

Results:

A total of 40 H. pylori‐infected and 40 uninfected specimens were studied. mRNA of COX‐2 but not COX‐1 was elevated in H. pylori‐infected mucosa. COX‐1 was localized to the mononuclear inflammatory, endothelial and smooth muscle cells in the lamina propria. COX‐2 was barely detectable in uninfected mucosa but was strongly expressed in the foveolar and glandular epithelia in H. pylori gastritis.

Conclusion:

Cyclooxygenase‐1 is expressed in the mononuclear inflammatory, endothelial and smooth muscle cells in the lamina propria irrespective of the H. pylori status. By contrast, H. pylori induces COX‐2 expression in the foveolar and glandular epithelia.
One‐week ranitidine bismuth citrate‐based triple therapy for the eradication of Helicobacter pylori in Hong Kong with high prevalence of metronidazole resistance
Authors: Wong B. C. Y. , Wong W. M. , Wang W. H. , Fung F. M. Y. , Lai K. C. , Chu K. M. , Yuen S. T. , Leung S. Y. , Hu W. H. C. , Yuen M. F. , Lau G. K. K. , Chan C. K. , Lam S. K.
Published: March 2003

Aim:

To compare 1‐week ranitidine bismuth citrate‐based (RBC) triple therapy vs. omeprazole‐based (O) triple therapy for the eradication of Helicobacter pylori infection in Hong Kong with high prevalence of metronidazole resistance.

Methods:

Patients with non‐ulcer dyspepsia and H. pylori infection were randomized to receive either: (i) RBCCM: ranitidine bismuth citrate (pylorid) 400 mg, clarithromycin 250 mg and metronidazole 400 mg; or (ii) OCM: omeprazole 20 mg, clarithromycin 250 mg and metronidazole 400 mg, each given twice daily for 1 week. Endoscopy (CLO test, histology and culture) and 13C‐urea breath test were performed before randomization and 6 weeks after drug treatment.

Results:

A total of 180 patients were randomized. H. pylori eradication rates (intention‐to‐treat, n=180/per protocol, n=166) were 83%/92% for RBCCM and 66%/70% for OCM (P=0.01, intention‐to‐treat and P=0.001, per protocol, respectively). RBCCM treatment was unaffected by metronidazole susceptibility and achieved a significantly higher eradication rate in metronidazole‐resistant cases (89%) than the OCM group (45%, P=0.0064).

Conclusion:

One‐week ranitidine bismuth citrate‐based triple therapy is significantly better than omeprazole‐based triple therapy for the eradication of H. pylori infection, especially in metronidazole‐resistant cases. It is an effective regimen for the eradication of H. pylori infection in regions with a high prevalence of metronidazole resistance.
Impact of Helicobacter pylori resistance to clarithromycin on the efficacy of the omeprazole–amoxicillin–clarithromycin therapy
Authors: Tankovic J. , Lamarque D. , Lascols C. , Soussy C. J. , Delchier J. C.
Published: March 2003

Background:

Helicobacter pylori resistance to clarithromycin is relatively frequent in France and is assumed to be the main cause of failure of the proton pump inhibitor–amoxicillin–clarithromycin (proton pump inhibitor–AC) therapy, which is the first‐line regimen in France.

Aim:

To determine the respective effects of clarithromycin primary and secondary resistances on efficacy of the proton pump inhibitor–AC regimen and to determine whether failures are associated with persistence of the same strain or with emergence of a new one.

Methods:

A total of 123 H. pylori‐infected patients were treated for 7 days with omeprazole 20 mg b.d., amoxicillin 1 g b.d., and clarithromycin 500 mg b.d. Eradication was assessed by breath test in 102 patients. Minimal inhibitory concentrations of clarithromycin were determined by E‐test. Strain genotyping was performed by random amplified polymorphic DNA.

Results:

The pre‐treatment and post‐treatment prevalences of clarithromycin resistance were 19% (23 out of 123) and 69% (nine out of 13), respectively. The rates of eradication were 68% (69 out of 102), 79% (67 out of 85), and 12% (two out of 17) for all, susceptible and resistant strains, respectively. The post‐treatment isolate was available for six patients with a susceptible pre‐treatment isolate and a persistent infection. Resistance emerged in two patients and was associated with persistence of the pre‐treatment strain in one and with selection of a new strain in the other.

Conclusions:

In our hospital, failures of the proton pump inhibitor–AC therapy are related to both clarithromycin primary and secondary resistances, but the emergence of secondary resistance does not explain all of the failures in the initial clarithromycin‐susceptible group. In that group a new strain can emerge after failure.
Increased gastric acid secretion after Helicobacter pylori eradication may be a factor for developing reflux oesophagitis
Authors: Koike T. , Ohara S. , Sekine H. , Iijima K. , Kato K. , Toyota T. , Shimosegawa T.
Published: March 2003

Background:

The role of acid secretion in reflux oesophagitis which may develop after H. pylori eradication is not well known.

Aim:

To investigate the participation of altered gastric acid secretion and the presence of hiatal hernia in the development of reflux oesophagitis after eradication therapy for H. pylori.

Subjects and Methods:

A total of 105 patients with H. pylori infection, but without reflux oesophagitis at the time of eradication therapy, were followed prospectively for 7 months after the clearance of this microorganism. Gastric acid secretion was assessed by endoscopic gastrin test, and the presence of hiatal hernia by endoscopy.

Results:

Reflux oesophagitis developed in 11 out of 105 (10.5%) patients when examined at 7 months after the eradication therapy. The incidence was correlated significantly with the increase in gastric acid secretion after the eradication of H. pylori, and was significantly higher in the patients with hiatal hernia (20%) than in those without it (0%).

Conclusions:

Increased acid secretion after H. pylori eradication is an important risk factor of reflux oesophagitis, especially in patients with hiatal hernia.
Photodynamic therapy and the alimentary tract
Authors: Selvasekar C. R. , Birbeck N. , Mcmillan T. , Wainwright M. , Walker S. J.
Published: March 2003

Photodynamic therapy offers the possibility of relatively selective tumour necrosis and normal tissue healing. It has many potential applications but as yet no clear role. Articles, editorials and case reports published primarily in English and listed in Medline/ISI up to April 2000 or identified by a manual search have been reviewed in an attempt to provide a comprehensive overview of the use of photodynamic therapy in the alimentary tract.

It is concluded that photodynamic therapy can be an effective treatment for superficial pre‐malignant mucosal lesions and early cancers, especially in diffuse disease. Suitable patients include those wishing to avoid surgery, high risk subjects or those in whom other forms of treatment have failed. Superiority over other methods of ablation has not so far been demonstrated. Cheaper and more effective photosensitizers and improved techniques of light delivery are likely to increase the application of photodynamic therapy.
Predictors of failure of Helicobacter pylori eradication with the standard ‘Maastricht triple therapy’
Authors: Perri F. , Villani M. R. , Festa V. , Quitadamo M. , Andriulli A.
Published: March 2003

Background:

Triple therapy with proton pump inhibitor, clarithromycin and amoxicillin has recently been proposed in Maastricht as first‐line treatment for H. pylori infection.

Aim:

To determine predictors of unsuccessful eradication.

Methods:

Two hundred and forty‐eight patients underwent endoscopy with biopsies for rapid urease test, histology and culture with antibiotic susceptibility tests, and 13C‐UBT. All infected patients were given pantoprazole (40 mg b.d.), clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for 1 week. Eradication was assessed by UBT at 4–6 weeks after therapy.

Results:

One hundred and sixty‐two of 248 patients (65%) were infected. Culture was positive in 144 (89%). Prevalence rates of metronidazole, clarithromycin and amoxicillin resistance were 14, 8 and 3%, respectively. Eradication rates (95% CI) were 63% (54.7–70.6) by intention‐to‐treat analysis and 67% (59.4–75.4) by per protocol analysis. Drug compliance was excellent and side‐effects were mild. Age ≥ 45 years (OR: 2.35, CI: 1.30–4.25), smoking (OR: 1.37, CI 1.01–1.87) and high pre‐treatment UBT results (OR: 1.36, CI: 1.08–1.72) were independent predictors of eradication failure. Gender, endoscopic findings, alcohol intake, and clarithromycin and amoxicillin resistance did not predict treatment failure.

Conclusion:

Despite the low prevalence of primary antibiotic resistance in our geographical area, triple therapy with pantoprazole, amoxicillin and clarithromycin achieves low eradication rates. Smoking, age and pre‐treatment UBT results are predictors of potential eradication failure.
Interleukin‐8 increases acetylcholine response of rat intestinal segments
Authors: Plattner V. , Leray V. , Leclair M.‐D. , Aubé A.‐C. , Cherbut C. , Galmiche J. P.
Published: March 2003

Background

: Interleukin‐8 (IL‐8) is a pro‐inflammatory cytokine highly expressed in inflammatory bowel diseases, but whose effects on intestinal motility are unknown.

Aim

: To characterize the role of IL‐8 in the contraction of rat intestinal segments.

Methods

: Contractile response to acetylcholine (ACh 10−6 M) in terminal ileal segments (including mucosa) from Wistar rats was measured before and after incubation (15, 30, 60 or 90 min) with IL‐8 (1 ng/mL), and after 60 min of incubation with different doses of IL‐8 (0, 0.1, 0.5, 1, 10 and 100 ng/mL). The effects of blocking neural transmission with tetrodotoxin (TTX) and inhibiting protein synthesis (cycloheximide) were tested. The contractile response of longitudinal muscle–myenteric plexus preparations (i.e. without mucosa) was measured after 60 min of incubation with 0.1 and 1 ng/mL of IL‐8.

Results

: IL‐8 increased ileal contraction induced by ACh 10−6 M. This augmentation was significant after 60 min of incubation (58%, P=0.01) and persisted after 90 min (18%, P=0.04). A 60‐min incubation period showed a dose‐related effect, beginning at 0.5 ng/mL (30%, P=0.003) and reaching a peak at 1 ng/mL (58%, P=0.01). The same effect was also observed on colonic segments. TTX did not affect the IL‐8 increase of ACh‐induced contractions, which was completely abolished by cycloheximide. IL‐8 had no significant effect on longitudinal muscle–myenteric plexus preparations.

Conclusion

: In vitro, IL‐8 increases contractile response of the ileum to ACh in a dose‐dependent manner. This effect is not neurally mediated, but seems to involve protein synthesis by intestinal mucosa.
Helicobacter pylori infection as a risk factor for gastrointestinal symptoms in patients using aspirin to prevent ischaemic heart disease
Authors: Laheij R. J. F. , Jansen J. B. M. J. , Verbeek A. L. M. , Verheugt F. W. A.
Published: March 2003

Background:

Aspirin use in the secondary prevention of ischaemic heart disease may provoke gastrointestinal discomfort.

Objective:

To register gastrointestinal symptoms and complications in patients with cardiovascular disease using aspirin and to relate these symptoms to infection with H. pylori.

Methods:

Blood samples were obtained from 398 consecutive patients in the Coronary‐Care Unit, University Hospital Nijmegen and analysed for serum antibody levels to H. pylori infection. Questionnaires were sent 2 weeks after discharge to assess gastrointestinal symptoms.

Results:

Questionnaires were returned by 314 patients (79%). A total of 183 out of 314 patients (46%) reported gastrointestinal symptoms. Of 238 patients using 80–100 mg aspirin daily, 145 (61%) recorded gastrointestinal symptoms. Besides aspirin, the use of calcium antagonists was correlated with gastrointestinal symptoms. Of the 128 patients using calcium antagonists, 84 (66%) reported gastrointestinal symptoms. The prevalence of gastrointestinal symptoms in H. pylori‐positive and ‐negative patients using aspirin was 48% and 52%, respectively.

Conclusions:

Two weeks after discharge almost 50% of the patients with cardiovascular disease experienced gastrointestinal symptoms, especially patients using aspirin or calcium antagonists. Patients seropositive for H. pylori and using aspirin or calcium antagonists did not have more gastrointestinal discomfort compared to non‐infected patients.
Reliability and validity of the digestive health status instrument in samples of community, primary care, and gastroenterology patients
Authors: Shaw M. J. , Beebe T. J. , Adlis S. A. , Talley N. J.
Published: March 2003

Aim:

We evaluated a previously reported digestive health status instrument in community, primary care, and gastroenterology practice populations. Multiple types of reliability, validity and responsiveness were assessed to determine the performance of the questionnaire.

Methods:

Study populations included community, primary care and gastroenterology subjects. Psychometric analyses included internal consistency and test–retest reliability, criterion and construct validity, and responsiveness.

Results:

Acceptable internal consistency was seen on all scales in all three populations. Test–retest reliability was excellent in a speciality population with reflux disease. Criterion validity was demonstrated by strong correlation of reflux scale scores and results on 24‐h pH monitoring. Scale scores varied predictably in those receiving gastrointestinal tract imaging and according to diagnosis, indicating construct validity. The reflux scale and pain index were sensitive to change with treatment for reflux disease. Multi‐trait scaling analyses from the community sample revealed a structure equivalent to that reported from a primary care sample.

Conclusions:

The reliability and validity of the digestive health status instrument on multiple measures in multiple settings have been demonstrated. The instrument was responsive to change with treatment for reflux disease. The demonstrated robustness attests to the suitability for future studies and clinical application.
Decreasing oesophageal acid exposure in patients with GERD: a comparison of rabeprazole and omeprazole
Authors: Galmiche J. P. , Zerbib F. , Ducrottè P. , Fournet J. , Rampal P. , Avasthy N. , Humphries T. J.
Published: March 2003

Background:

Rabeprazole has been shown to be more potent and faster than other proton pump inhibitors in in vitro studies and highly effective in decreasing oesophageal acid exposure in patients with gastro‐oesophageal reflux disease (GERD).

Aim:

This study was a multicentre, double‐blind, placebo‐controlled, randomized, parallel‐group comparison of three active treatment regimens utilizing two different proton pump inhibitors, or placebo, administered over 7 days in patients with GERD.

Methods:

Eighty‐two patients with symptomatic GERD were given placebo, rabeprazole 10 mg b.d., rabeprazole 20 mg o.m., or omeprazole 20 mg o.m. for 7 days. Twenty‐four hour oesophageal pH monitoring was performed at baseline and repeated at the conclusion of the treatment period.

Results:

At the end of study, the percentage time (mean ± s.d.) with pH < 4 over a 24‐h period was significantly decreased by the three active regimens but without significant difference between them (9.27 ± 4.77; 2.53 ± 4.27; 2.02 ± 1.71 and 2.91 ± 4.06 for placebo, rabeprazole 10 mg b.d., rabeprazole 20 mg o.m. and omeprazole 20 mg o.m., respectively). Acid exposure was normalized in 90% of patients treated with rabeprazole 10 mg b.d., 95% treated with rabeprazole 20 mg o.m., 78% treated with omeprazole 20 mg o.m., and only 9.5% of patients treated with placebo. Both rabeprazole and omeprazole were well‐tolerated.

Conclusions:

Although rabeprazole 20 mg o.m. showed greater activity numerically, this study demonstrates that rabeprazole 10 mg b.d. and 20 mg o.m. are equivalent to omeprazole 20 mg o.m. in decreasing oesophageal acid exposure.
Epidermal growth factor and its receptor in chronic active gastritis and gastroduodenal ulcer before and after Helicobacter pylori eradication
Authors: Chun Yu Wong B. , Ping Wang W. , Hau Leung So W. , Shin V. Y. , Man Wong W. , Man Yee Fung F. , Shiu Lam Liu E. , Mo Hiu W. , Kum Lam S. , Hin Cho C.
Published: March 2003

Background:

Helicobacteria pylori infection of gastroduodenal mucosa is strongly associated with gastritis and peptic ulcer disease. The aims of the present study were to compare the gastroduodenal mucosal levels of epidermal growth factor (EGF) and its receptor (EGFR) among H. pylori‐negative controls and H. pylori infected patients with chronic active gastritis or gastroduodenal ulcer before and after H. pylori eradication.

Methods:

The protein levels of EGF in mucosal tissues and saliva were determined by a solid‐phase enzyme‐linked immunosorbent assay (ELISA). Repeat transcription‐polymerase chain reaction and the following polymerase chain reaction ELISA were employed to examine the mucosal EGFR mRNA expression.

Results:

Mucosal injury and H. pylori infection increased EGF protein levels and EGFR mRNA expression in the antral mucosa. The concentration of EGF in saliva was not affected by mucosal damage or H. pylori infection. Successful H. pylori eradication normalized the EGFR mRNA back to its basal level 6 weeks after treatment. However, after unsuccessful eradication their high levels in the antrum persisted. All patients experienced ulcer healing after drug treatment, regardless of H. pylori eradication.

Conclusions:

Mucosal damage increased the expression of EGF protein and EGFR mRNA in the gastric mucosa. H. pylori could induce the expression of EGFR but not the EGF in the antral mucosa. The expression of EGFR could be a contributing factor for ulcer healing in patients with H. pylori infection.
Maintenance of Crohn’s disease over 12 months: fixed versus flexible dosing regimen using budesonide controlled ileal release capsules
Authors: Green J. R. B. , Lobo A. J. , Giaffer M. , Travis S. , Watkins H. C. ,   THE FREEDOM INVESTIGATOR GROUP
Published: March 2003

Background:

It may be possible to achieve more effective management of Crohn’s Disease by introducing a flexible dosage regimen sensitive to patients’ needs.

Aim:

Comparison of the efficacy and tolerability of a fixed vs. flexible budesonide controlled ileal release treatment regimen for the prevention and management of relapse in Crohn’s disease patients. Budesonide controlled ileal release is an oral formulation which delivers drug directly to disease sites in the ileum and ascending colon, by preventing more proximal release and absorption.

Methods:

A randomized, double‐blind comparison of a fixed dose of budesonide controlled ileal release (6 mg o.m.) and a flexible dose of budesonide controlled ileal release (3, 6 or 9 mg o.m.) for 12 months, in 143 patients in remission from ileal or ileo–caecal Crohn’s Disease.

Results:

Very low rates of clinical relapse in Crohn’s disease were achieved with budesonide controlled ileal release 6 mg o.m. There was no significant difference between the treatment groups with respect to the survival estimate of percentage of treatment failures (flexible group 15%, fixed group 19%; P=0.61). The average consumed dose of budesonide was comparable in both groups (5.8 mg flexible, 6.0 mg fixed). Similar proportions of patients reported adverse events (flexible 100%, fixed 97%). There were 33 serious adverse events (flexible 19, fixed 14) and 13 withdrawals due to significant adverse events (flexible 9, fixed 4).

Conclusion:

Maintenance treatment with budesonide controlled ileal release 6 mg o.m. is well‐tolerated and is associated with low rates of clinical relapse in stable Crohn’s disease over 12 months. Flexible dosing remains an option for individual patients, but this study has shown no advantage over a standard fixed dosing regimen.
Does the widespread use of proton pump inhibitors mask, complicate and/or delay the diagnosis of Zollinger–Ellison syndrome?
Authors: Corleto V. D. , Annibale B. , Gibril F. , Angeletti S. , Serrano J. , Venzon D. J. , Delle Fave G. , Jensen R. T.
Published: March 2003

Background:

Proton pump inhibitors are potent acid suppressants which, at normal doses, can result in hypergastrinaemia in patients with idiopathic oesophageal reflux disease and in the control of symptoms in most patients with gastrinomas. Therefore, their use could delay or mask the diagnosis of gastrinoma.

Aim:

To investigate whether the widespread use of proton pump inhibitors masks or complicates the diagnosis of gastrinoma.

Subjects and methods:

Data from two centres with different referral criteria for suspected gastrinomas were analysed (Gastroenterology Unit, Rome, Italy and National Institutes of Health, Bethesda, MD, USA). The number of referrals and the number of new patients with gastrinoma diagnosed in the years prior to the widespread use of proton pump inhibitors (1986–1992) were compared with the numbers since proton pump inhibitors became widely available (1993–1998).

Results:

The decrease in referral rate (P=0.0009) and the decrease in the annual rate of gastrinoma diagnosis (P=0.0020) at both centres correlated with the increased use of proton pump inhibitors. At the Italian centre, there was a 62% decrease in annual referrals (P < 0.0001) in the post‐proton pump inhibitor period, relative to the pre‐proton pump inhibitor period, whereas there was an increase in the rate of referral of other gastrointestinal endocrine tumours. The number of new cases of gastrinoma diagnosed decreased by 40%. At the US centre, the referral rate decreased by 28% (P=0.024) in the post‐proton pump inhibitor period. There was also a 43% decrease in the number of new cases diagnosed annually in the post‐proton pump inhibitor period (P=0.0012). There was a 2.6‐fold increase in the post‐proton pump inhibitor period in the percentage of referrals with a false diagnosis of gastrinoma as the cause of hypergastrinaemia (P=0.0040).

Conclusions:

In both referral centres, less patients have been referred with a possible diagnosis of gastrinoma and fewer new patients with gastrinoma have been diagnosed since proton pump inhibitors became widely available. These data support the conclusion that, since proton pump inhibitors have been released, the diagnosis of gastrinoma has been masked and will probably be delayed, with the result that patients with gastrinoma will be diagnosed at more advanced stages in their disease course.
Tegaserod, a 5‐HT4 receptor partial agonist, accelerates gastric emptying and gastrointestinal transit in healthy male subjects
Authors: Degen L. , Matzinger D. , Merz M. , Appel‐Dingemanse S. , Osborne S. , Lüchinger S. , Bertold R. , Maecke H. , Beglinger C.
Published: March 2003

Background:

Serotonin and its type‐4 (5‐hydroxytryptamine4) receptor play a major role in the physiology of the gastrointestinal tract. The effect of intravenous and/or oral tegaserod, a 5‐hydroxytryptamine4 receptor partial agonist, on gastric emptying, small bowel transit and colonic transit has not been studied in detail in humans.

Aim:

To assess the pharmacodynamic effects of repeated oral and intravenous administration of tegaserod on gastric emptying and small intestine and colonic transit.

Methods:

A randomized, placebo‐controlled, double‐blind, three‐way, crossover study of 6 mg oral and 0.6 mg intravenous tegaserod in 12 healthy male subjects was performed. Each treatment arm of the study involved 3 days of twice‐daily administration and 1 day of daily administration of the study drugs.

Results:

In comparison with placebo, oral and intravenous tegaserod significantly increased the gastric emptying rate (P < 0.01), accelerated colonic filling (P < 0.01) and shortened colonic transit at 48 h (P < 0.05). Tegaserod shortened the small intestine transit time by 30% after oral and by 37% after intravenous administration.

Conclusions:

In healthy subjects, tegaserod markedly accelerated gastric emptying and small intestinal transit, and induced a small but significant acceleration of colonic transit. Tegaserod can act as a promotile agent throughout the gastrointestinal tract.
Methicillin‐resistant Staphylococcus aureus infection of percutaneous endoscopic gastrostomy sites
Authors: Hull M. , Beane A. , Bowen J. , Settle C.
Published: March 2003

Background:

Antibiotic prophylaxis for percutaneous endoscopic gastrostomy insertion remains controversial. The bacteriology of peristomal infection following percutaneous endoscopic gastrostomy insertion has been poorly studied, leading to uncertainty regarding the optimum choice of antibiotic for prophylaxis.

Aim:

To investigate the bacteriology of peristomal infection following percutaneous endoscopic gastrostomy insertion and to determine the contribution of methicillin‐resistant Staphylococcus aureus.

Methods:

Nasal and pharyngeal swabs were taken from a consecutive series of patients prior to percutaneous endoscopic gastrostomy insertion over a 6‐month period. Bacterial colonization and infection at the peristomal site were prospectively evaluated at days 2/3 and 7 post‐insertion.

Results:

Thirty‐one patients underwent percutaneous endoscopic gastrostomy insertion (mean age, 68 years; cerebrovascular disease, 52%). Naso‐pharyngeal colonization by methicillin‐resistant Staphylococcus aureus (35%) invariably led to peristomal colonization following percutaneous endoscopic gastrostomy insertion. Peristomal infection occurred in eight (26%) cases (seven (88%) methicillin‐resistant Staphylococcus aureus‐ positive). Peristomal infection was significantly more likely to occur in patients with naso‐pharyngeal methicillin‐resistant Staphylococcus aureus colonization (odds ratio, 10.8; 95% confidence interval, 1.6–70.9).

Conclusions:

Naso‐pharyngeal methicillin‐resistant Staphylococcus aureus colonization invariably predicts peristomal methicillin‐resistant Staphylococcus aureus colonization following percutaneous endoscopic gastrostomy insertion, and is associated with an increased peristomal infection rate. Currently recommended antibiotic prophylaxis regimens may be inappropriate in institutions with significant methicillin‐resistant Staphylococcus aureus colonization rates.
Does the use of immunosuppressive therapy in inflammatory bowel disease increase the risk of developing lymphoma?
Authors: Bebb J. R. , Logan R. P. H.
Published: March 2003

Recent case reports have raised concerns regarding the risks of non‐Hodgkin’s lymphoma in patients with inflammatory bowel disease treated with immunosuppressive agents. This evidence‐based review examines this issue from data derived from the use of immunosuppression in other conditions (and inflammatory bowel disease).

We conclude that, in transplant (cardiac and renal) recipients, immunosuppression increases the risk of non‐Hodgkin’s lymphoma. For non‐transplant patients (with psoriasis and rheumatoid arthritis), debate remains as to whether the observed increase in the incidence of non‐Hodgkin’s lymphoma is due to drug or disease. For inflammatory bowel diseaseper se, population studies show no significant increase in the risk of non‐Hodgkin’s lymphoma, with a relative risk of 1.3 (95% confidence interval, 0.9–1.7) compared to expected rates, and several studies of immuno‐ suppression in inflammatory bowel disease do not appear to confirm a significant rate of lymphoma incidence. Reported cases of lymphoma from single centres should be viewed with caution as evidence of increased risk.

If any association exists, it is likely to be of minimal clinical significance compared to the established and more frequent risks of myelosuppression and infection, and is unlikely to outweigh the benefit of immunosuppression in inflammatory bowel disease.
Upper gastrointestinal evaluation of Chinese patients with non‐cardiac chest pain
Authors: Wong W.‐M. , Lai K. C. , Lau C. P. , Hu W. H. C. , Chen W. H. , Wong B. C. Y. , Hui W. M. , Wong Y. H. , Xia H. H. X. , Lam S. K.
Published: March 2003

Aims:

To test the usefulness of upper gastrointestinal investigations and quality of life assessment in Chinese patients with non‐cardiac chest pain.

Methods:

Seventy‐eight consecutive patients with non‐cardiac chest pain underwent upper endoscopy. Eight patients had upper gastrointestinal pathology (10%). The remaining 70 patients received acid perfusion test, oesophageal manometry and 24‐h ambulatory oesophageal pH (n=65)/manometry (n=61), and the results were compared with those of healthy controls (n=20). Symptoms and quality of life (SF‐36) were assessed by standard validated questionnaire.

Results:

Significant acid reflux symptoms were present in five (5/70, 7%) patients. Abnormal 24‐h oesophageal pH, indicating gastro‐oesophageal reflux, was found in 19 (19/65, 29%) patients. The percentage of simultaneous contractions was higher and the percentage peristalsis was lower in patients with non‐cardiac chest pain when compared with normal subjects by 24‐h ambulatory manometry. Patients with non‐cardiac chest pain had a lower SF‐36 score when compared to controls.

Conclusions:

Typical acid reflux symptoms are uncommon in Chinese patients with non‐cardiac chest pain, but abnormal 24‐h pH results, indicating gastro‐oesophageal reflux, were found in 29% of patients. Ineffective contractions were more frequently found in patients with non‐cardiac chest pain by 24‐h ambulatory manometry, which may have a bearing on the impaired quality of life in such patients. Upper gastrointestinal investigations are useful for the evaluation of Chinese patients with non‐cardiac chest pain.
There are no reliable symptoms for erosive oesophagitis and Barrett's oesophagus: endoscopic diagnosis is still essential
Authors: Avidan B. , Sonnenberg A. , Schnell T. G. , Sontag S. J.
Published: March 2003

Aims:

To evaluate the sensitivity and specificity of different symptoms in erosive reflux oesophagitis and Barrett's oesophagus.

Methods:

The presence of reflux symptoms was compared between a case population of 306 patients with endoscopically determined erosive reflux oesophagitis, 235 patients with biopsy‐proven Barrett's oesophagus and a control population of 198 subjects without reflux disease.

Results:

Heartburn at any time and heartburn at night represented the only two symptoms to be simultaneously sensitive and specific. Symptoms that were induced by various foods, such as fat, tomato, chocolate, citrus or spices, tended to cluster in the same sub‐group of patients. Similarly, heartburn induced by exercise, lying down or bending over tended to occur in the same sub‐groups. The frequency of symptoms was influenced more by the presence of mucosal erosions than by the presence of Barrett's oesophagus. Reflux symptoms occurred more frequently in the presence rather than the absence of Barrett's oesophagus, and in long segment rather than short segment of Barrett's mucosa.

Conclusions:

Endoscopic inspection of the oesophageal mucosa remains the only certain method by which to reliably diagnose erosive reflux oesophagitis and Barrett's oesophagus.
Is clinical remission the optimum therapeutic goal in the treatment of Crohn's disease?
Authors: Arnott I. D. R. , Watts D. , Ghosh S.
Published: March 2003

Currently, the therapeutic end‐point in the treatment of Crohn's disease is the remission of symptoms, but recent data confirm that mucosal inflammation may continue in the absence of symptoms. Furthermore, emerging evidence indicates that such subtle, sub‐clinical mucosal inflammation leads to clinical relapse. The assessment of mucosal inflammation has become easier with the availability of faecal calprotectin assay. Current anti‐inflammatory therapy often leaves low‐grade mucosal inflammation untreated, and therefore recurrent relapses occur. We need to investigate whether the therapeutic end‐point of anti‐inflammatory medications needs to be more rigorous and to aim at complete mucosal healing, confirmed by the normalization of mucosal inflammatory markers such as faecal calprotectin concentrations. Immunosuppressive therapy with azathioprine/ 6‐mercaptopurine currently offers the best mucosal healing treatment with reduction of relapses, but newer biological agents might offer less toxic therapy. Clinical trials to test the feasibility and efficacy of such a paradigm shift in the medical management of Crohn's disease are now warranted.
A double‐blind, randomized, placebo‐controlled trial of essential fatty acid supplementation in the maintenance of remission of ulcerative colitis
Authors: Middleton S. J. , Naylor S. , Woolner J. , Hunter J. O.
Published: March 2003

Background : Essential fatty acid supplementation has been found to ameliorate certain chronic inflammatory diseases. This effect is thought to be mediated through the modulation of eicosanoid synthesis. Pro‐inflammatory eicosanoids have been implicated in ulcerative colitis.

Aim : To investigate the possible therapeutic benefit of essential fatty acids in quiescent ulcerative colitis to reduce the frequency of disease relapse.

Methods : A randomized, double‐blind, placebo‐controlled study was performed with a treatment duration of 12 months. Patients with quiescent disease received either trial medication (gamma‐linolenic acid, 1.6 g, eicosapentaenoic acid, 270 mg, and docosahexaenoic acid, 45 mg, per day) or placebo (sunflower oil, 500 mg/day). The primary end‐point was disease activity, assessed by a previously validated clinical index, sigmoidoscopic appearance and histology.

Results : Sixty‐three patients were randomized, 31 to receive essential fatty acid treatment and 32 to receive placebo. Disease relapse rates were similar at 12 months (placebo, 38%; essential fatty acids, 55%), as were changes in sigmoidoscopic grade from baseline.

Conclusions : The supplementation of the diet with this combination of essential fatty acids does not prolong the period of disease remission of ulcerative colitis.
The burden of illness of non‐cardiac chest pain
Authors: Eslick G. D. , Coulshed D. S. , Talley N. J.
Published: March 2003

Background : Non‐cardiac chest pain is a common condition affecting approximately one‐quarter of the population during their lifetime, but the long‐term economic costs of non‐cardiac chest pain are poorly defined.

Methods : A MEDLINE and Current Contents search was performed from 1991 to 2002 using specific keywords. All major articles on the subject of non‐cardiac chest pain in this period were reviewed and their reference lists searched.

Results : Limited studies suggest that the majority of those with non‐cardiac chest pain do not consult a doctor regarding their symptoms; the drivers of health care seeking are not known. The impact on the quality of life in consulters can be severe, with as many as 36% reporting much lower quality of life levels. The diagnosis of non‐cardiac chest pain can be difficult due to the heterogeneous nature of the condition, with significant overlap of gastro‐oesophageal reflux disease, chest wall syndromes and psychiatric disease, which may drive up the costs of management. The prognosis appears to be good, but there are conflicting results in long‐term studies.

Conclusions : The costs of non‐cardiac chest pain to the health care system are likely to be large and represent a significant proportion of each Western country's health care budget. Further studies are required to determine methods of reducing health care costs.
Effects of enteric‐coated, low‐dose aspirin on parameters of platelet function
Authors: Van Hecken A. , Juliano M. L. , Depré M. , De Lepeleire I. , Arnout J. , Dynder A. , Wildonger L. , Petty K. J. , Gottesdiener K. , De Hoon J. N.
Published: March 2003

Background : Aspirin is widely used as an anti‐thrombotic drug; however, it has been suggested that enteric‐coated formulations of aspirin may be less bioavailable and less effective as anti‐thrombotic agents.

Aim : To assess the effect of a formulation of enteric‐coated, low‐dose (81 mg) aspirin on serum generated thromboxane B2 and platelet aggregation in healthy subjects.

Methods : Twenty‐four subjects participated in a double‐blind, randomized, placebo‐controlled, parallel‐group, multiple‐dose study. Twelve subjects in each of two groups received a daily oral dose of enteric‐coated aspirin (81 mg) or matching placebo for 7 days. Serum thromboxane B2 and platelet aggregation (using 1 mm arachidonic acid and 1 µg/mL collagen as agonists) were measured 1–3 days prior to day 1, on day 1 (prior to therapy) and 4 h after the last dose on day 7.

Results : After seven daily doses of enteric‐coated aspirin, the mean percentage inhibition from baseline of ex vivo generated serum thromboxane B2 was 97.4%, compared with a 7.8% increase after placebo treatment. The mean percentage inhibition of arachidonic acid‐ and collagen‐induced platelet aggregation was 97.9% and 70.9%, respectively, following enteric‐coated aspirin, compared with − 1.0% and 2.7%, respectively, after placebo.

Conclusions : The anti‐platelet effects of multiple, daily, low‐dose aspirin (as assessed by inhibition of serum thromboxane B2 and platelet aggregation) are not adversely affected by enteric coating.
The long‐term effects of cure of Helicobacter pylori infection on patients with atrophic body gastritis
Authors: Annibale B. , Di Giulio E. , Caruana P. , Lahner E. , Capurso G. , Bordi C. , Delle Fave G.
Published: March 2003

Background : Helicobacter pylori infection induces atrophic body gastritis, but the long‐term effect of its cure on body atrophy is unclear.

Aim : To investigate the long‐term effects of H. pylori cure on gastric morpho‐functional parameters in patients with atrophic body gastritis.

Methods : Forty patients with atrophic body gastritis were cured of H. pylori infection. Gastroscopy with biopsies, gastrin and pepsinogen I levels and basal and stimulated acid secretion were evaluated before and 6–12 months after treatment.

Results : At eradication assessment (6–12 months), in eight of the 40 patients, body atrophy was no longer observed, whereas in 32 of the 40 it remained substantially unchanged (2.03 ± 0.12 vs. 1.83 ± 0.15). In the eight patients with reversed body atrophy, gastrinaemia decreased significantly with respect to pre‐treatment values (265 ± 59.9 pg/mL vs. 51.8. ± 6.04 pg/mL), and basal and stimulated acid secretion increased significantly after cure. In the 32 patients still presenting body atrophy, gastrinaemia was similar topre‐treatment values (457 ± 76.04 pg/mL vs. 335.1 ± 58.8 pg/mL). At follow‐up (21–25 and 32–70 months), the eight patients with reversed body atrophy continued with normal gastrinaemia (35.3 ± 10.1 pg/mL vs. 38.5 ± 8.8 pg/mL), but in the 19 patients with continued atrophy, both corporal atrophy and intestinal metaplasia remained substantially unchanged.

Conclusions : Following successful treatment in patients with atrophic body gastritis and H. pylori infection, long‐term histological investigations are crucial in order to detect reversed body damage or to confirm continued body atrophy.
Gastro‐oesophageal reflux disease and Helicobacter pylori infection
Authors: Vakil N. B.
Published: March 2003

Gastro‐oesophageal reflux disease (GERD) and Helicobacter pylori infection are common conditions that frequently coexist. Controversy continues regarding the role of H. pylori infection in GERD. The results of some studies suggest that eradication of H. pylori may increase the risk for developing GERD, and some experts have suggested that chronic H. pylori infection may be of benefit. This article reviews the data on H. pylori infection and GERD and its treatment.
Complementary studies of the gastrointestinal safety of the cyclo‐oxygenase‐2‐selective inhibitor etoricoxib
Authors: Hunt R. H. , Harper S. , Callegari P. , Yu C. , Quan H. , Evans J. , James C. , Bowen B. , Rashid F.
Published: March 2003

Background : Cyclo‐oxygenase‐2‐selective non‐steroidal anti‐inflammatory drugs are intended to preserve cyclo‐oxygenase‐1‐mediated gastroprotection and platelet function, whilst inhibiting cyclo‐oxygenase‐2‐mediated inflammation.

Aim : To assess the gastrointestinal safety of the cyclo‐oxygenase‐2‐selective inhibitor etoricoxib vs. non‐selective non‐steroidal anti‐inflammatory drugs.

Methods : Two randomized, double‐blind, placebo‐ and active‐controlled studies were performed: (i) daily faecal red blood cell loss was measured in 62 subjects receiving etoricoxib (120 mg once daily), ibuprofen (800 mg t.d.s.) or placebo for 28 days; (ii) the incidence of endoscopically detectable gastric/duodenal ulcers was determined in 742 osteoarthritis or rheumatoid arthritis patients receiving etoricoxib (120 mg once daily), naproxen (500 mg b.d.) or placebo over 12 weeks.

Results : In the first study, the between‐treatment ratio of faecal blood loss for etoricoxib vs. placebo (1.06) was not significantly different from unity; however, the ratios for ibuprofen vs. placebo (3.26) and etoricoxib (3.08) were significantly greater than unity (P < 0.001). In the second study, the incidence of ulcers of ≥ 3 mm with naproxen (25.3%) was significantly higher than that with etoricoxib (7.4%) or placebo (1.4%; P < 0.001); the results were similar for ulcers of ≥ 5 mm.

Conclusions : The reduced toxicity of etoricoxib (less faecal blood loss and fewer endoscopically detectable lesions) suggests that use of this drug will may be associated with a reduced incidence of gastrointestinal perforations, ulcers and bleeds.
Tegaserod, a 5‐HT4 receptor partial agonist, decreases sensitivity to rectal distension in healthy subjects
Authors: Coffin B. , Farmachidi J.‐P. , Rueegg P. , Bastie A. , Bouhassira D.
Published: March 2003

Background : Tegaserod reduces the symptoms associated with irritable bowel syndrome, and anti‐nociceptive effects have been demonstrated in animals. Its effect on the rectal sensitivity in humans has not been delineated clearly.

Aim : To evaluate the action of tegaserod on rectal sensitivity in response to distension by means of a reflexological technique based on electrophysiological recordings of the RIII nociceptive reflex.

Methods : A randomized, double‐blind, placebo‐controlled study, performed in 20 healthy women, quantified the effects of slow or rapid rectal distensions on the RIII reflex at baseline and on day 8 following treatment with either placebo or tegaserod (6 mg b.d.).

Results : At baseline, slow distensions performed up to the pain threshold induced gradual inhibitions of the RIII reflex. On day 8, these inhibitory effects were significantly reduced in the tegaserod group, but not in the placebo group (P = 0.0001). The effects of rapid distensions were not significantly modified by tegaserod or placebo. The intensity of subjective pain perception and rectal compliance were not altered by either treatment.

Conclusion : These results suggest that tegaserod reduces the sensitivity to rectal distension in healthy subjects and interacts with the processing of sensory visceral information.
Dorsal column function after epidural and spinal blockade: implications for the safety of walking following low‐dose regional analgesia for labour
Authors: Parry M. G. , Fernando R. , Bawa G. P. S. , Poulton B. B.
Published: March 2003

Walking after regional blockade for labour using low‐dose combinations of bupivacaine and fentanyl is possible due to the maintenance of lower limb motor power. In order to investigate concerns that dorsal column function, important in maintaining balance, is impaired after such techniques, clinical assessment of lower limb proprioception and vibration sense was evaluated in parturients after either low‐dose epidural (n = 30) or spinal blockade (n = 30) for labour analgesia and compared with spinal anaesthesia (n = 30) for elective Caesarean section using a larger total dose of local anaesthetic. Of the patients receiving low‐dose regional labour analgesia 7% (n = 4) had abnormal dorsal column function compared with 97% (n = 29) receiving spinal anaesthesia for Caesarean section (p < 0.001). All patients in the Caesarean section group developed lower limb motor weakness, compared with only 10% (n = 6) in the low‐dose groups (p < 0.001). There were no significant differences between the low‐dose groups with respect to sensory block, motor block or dorsal column function. Overall, 90% of patients receiving low‐dose bupivacaine/fentanyl regional labour analgesia had both normal lower limb motor power and dorsal column function. Assessment of these parameters is recommended before allowing patients to walk after low‐dose regional techniques for labour.
Evaluation of the HemoCue® for measuring intra‐operative haemoglobin concentrations: a comparison with the Coulter Max‐M®
Authors: Lardi A. M. , Hirst C. , Mortimer A. J. , McCollum C. N.
Published: March 2003

We compared haemoglobin concentration values obtained using a portable haemoglobinometer, the HemoCue, in the operating theatre with the results obtained by the Coulter Max‐M in the laboratory. Haemoglobin concentrations were measured on 52 arterial blood samples obtained from 13 patients during aortic surgery, in theatre with the HemoCue and again by the Coulter Max‐M. Twenty routine samples from the laboratory were also analysed by both methods. There was no significant difference between results, with a mean of 10.94 gdl−1 and 10.90 gdl−1 for the HemoCue and Coulter, respectively (p = 0.12, t = −1.99, df = 70). The limits of agreement of the two methods (mean difference ± 2 SD) were −0.37 and +0.45 gdl−1. The coefficients of repeatability of the 20 samples analysed in duplicate on each device were 0.26 gdl−1 and 0.33 gdl−1, respectively. The coefficients of variance were 0.74% (HemoCue) and 0.93% (Coulter). With adequate training and monitoring, the HemoCue provides comparable haemoglobin results for near‐patient testing in theatre.