bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy of the stool antigen test in the diagnosis of Helicobacter pylori infection before treatment and in patients on omeprazole therapy
Authors: Manes G. , Balzano A. , Iaquinto G. , Ricci C. , Piccirillo M. M. , Giardullo N. , Todisco A. , Lioniello M. , Vaira D.
Published: March 2003

Aim:

To evaluate the Helicobacter pylori stool antigen (HpSA) test in the assessment of H. pylori infection and the effect of omeprazole treatment on its accuracy.

Methods:

Study 1: 140 dyspeptic patients were enrolled in the study and defined as H. pylori positive if histology and rapid urease test, or culture alone were positive. HpSA was performed on all patients and 13C‐urea breath test (UBT) on 87. Study 2: 75 patients testing positive using both UBT and HpSA, were given omeprazole 20 mg for 2 weeks (Group A) or omeprazole 40 mg for 2 weeks (Group B), or OAC for 1 week (group C). A Helicobacter pylori stool antigen test was performed on all patients on days 3, 5, 7 and 14 during treatment, and also on days 7 and 14 post‐treatment in groups A and B. UBT was performed in groups A and B on days 7 and 14 during treatment, and days 7 and 14 post‐treatment.

Results:

80/140 patients were H. pylori positive. The sensitivity and specificity of HpSA were 93.8 and 90%, similar to UBT (93.9 and 92.1%). Omeprazole significantly reduced both HpSA and UBT values, resulting in a decreased accuracy. Of 25 patients receiving 20 mg omeprazole, HpSA gave 5 and 6 false negatives after 7 and 14 days treatment respectively, while UBT gave 4 and 7 false negatives after 7 and 14 days treatment. Of 25 patients receiving 40 mg omeprazole, HpSA gave 7 and 9 false negatives after 7 and 14 days of treatment, while UBT gave 8 and 9 false negatives after 7 and 14 days of treatment. Two weeks after stopping omeprazole treatment, the HpSA and UBT were positive in all cases.

Conclusions:

The Helicobacter pylori stool antigen test is valuable in the assessment of H. pylori infection. Short‐term omeprazole treatment decreases the accuracy of both HpSA and UBT in a similar manner.
Involvement of cyclooxygenase‐2 in hyperplastic gastritis induced by Helicobacter pylori infection in C57BL/6 mice
Authors: Xiao F. , Furuta T. , Takashima M. , Shirai N. , Hanai H.
Published: March 2003

Background and aims:

The hyperplastic changes observed in Helicobacter pylori‐associated gastritis have been considered to increase the risk of gastric cancer. The aim of this study was to determine whether cyclooxygenase‐2 is involved in the hyperplastic changes in mice infected with H. pylori.

Methods:

Seven‐week‐old, male C57BL/6 mice (n=40) were inoculated with the Sydney strain of H. pylori. Control mice (n=40) were treated with vehicle only. Half of the infected and control mice were fed an experimental diet containing etodolac (10 mg/kg/day) from 1 week after inoculation until the end of the experiment. The thickness of gastric pits, COX‐2 mRNA and protein levels, and prostaglandin E2 (PGE2) levels in the gastric mucosa were determined before and 12, and 24 weeks after inoculation.

Results:

The thickness of gastric pits, COX‐2 mRNA and protein levels, and PGE2 levels were significantly increased at 24 weeks after inoculation of H. pylori compared with the control groups. Treatment with etodolac resulted in significant decreases in PGE2 production and in the thickness of gastric pits in the infected groups at 24 weeks after inoculation.

Conclusions:

Our findings suggest that COX‐2 is involved in the development of hyperplastic gastritis caused by H. pylori infection via the production of PGE2.
A systematic comparison of triple therapies for treatment of Helicobacter pylori infection with proton pump inhibitor/ ranitidine bismuth citrate plus clarithromycin and either amoxicillin or a nitroimidazole
Authors: Janssen M. J. R. , Van Oijen A. H. A. M. , Verbeek A. L. M. , Jansen J. B. M. J. , De Boer W. A.
Published: March 2003

Background:

Triple therapies with proton pump inhibitor/ranitidine bismuth citrate (RBC), clarithromycin (C) and either amoxicillin (A) or a nitroimidazole (I) are widely accepted as treatment for Helicobacter pylori infection. However, it is not clear which of these antibiotic combinations should be preferred.

Aim:

To evaluate whether there is a difference in efficacy between triple therapies with proton pump inhibitor/RBC, clarithromycin and either amoxicillin or a nitroimidazole.

Methods:

The literature was examined for randomized trials comparing proton pump inhibitor/RBC‐C‐A and proton pump inhibitor/RBC‐C‐I. Studies were grouped according to the type of acid inhibitor used (proton pump inhibitor or RBC) and differences between pooled cure rates were calculated.

Results:

Forty‐seven studies were identified: seven using RBC, 39 using proton pump inhibitor, one using both. RBC‐C‐I was somewhat superior to RBC‐C‐A, although this difference only reached statistical significance in intention‐to‐treat analysis. Overall, proton pump inhibitor‐C‐I and proton pump inhibitor‐C‐A were equally effective, but in nitroimidazole‐susceptible strains, proton pump inhibitor‐C‐I performed better, in nitroimidazole‐resistant strains, proton pump inhibitor‐C‐A performed better. No serious side‐effects were reported and pooled drop‐out rates were equal.

Conclusions:

In general, proton pump inhibitor‐C‐I and proton pump inhibitor‐C‐A are equally effective and therefore other factors such as local prevalence of resistant strains, cost of therapy and options for second‐line treatment should determine which regimen should be preferred. When using RBC, the RBC‐C‐I combination is somewhat superior to RBC‐C‐A.
Ten‐year combination treatment with colchicine and ursodeoxycholic acid for primary biliary cirrhosis: a double‐blind, placebo‐controlled trial on symptomatic patients
Authors: Battezzati P. M. , Zuin M. , Crosignani A. , Allocca M. , Invernizzi P. , Selmi C. , Villa E. , Podda M.
Published: March 2003

Background:

Combined medical treatment may provide further benefit to primary biliary cirrhosis (PBC) patients administered ursodeoxycholic acid (UDCA).

Aim:

To evaluate the long‐term effects of colchicine and UDCA in symptomatic PBC patients.

Patients/methods:

We extended up to 10 years the double‐blind treatment of 44 symptomatic PBC patients originally included in a 3‐year multicentre study comparing UDCA and colchicine (U + C) versus UDCA and placebo (U + P). Outcome measures were death or liver transplantation; incidence of clinically relevant events; clinical and quantitative variables retaining prognostic information.

Results:

Mean follow‐up was 7 ± 3 years. One patient was lost, three withdrew because of jaundice (U + P); two patients stopped colchicine but remained on UDCA. Eleven patients (two for liver‐unrelated reasons, U + P) and six patients (U + C) died, three and two patients, respectively, were transplanted (incidence rate difference, five cases per 100 patient‐years; 95% CI, −1 to 11). Hepatocellular carcinoma developed in one (U + P) and four (U + C) patients (difference, −2; CI, −5 to 1), portal hypertension complications in nine patients from each group (difference, 1; CI, −5 to 6). Trends of serum bilirubin, Mayo score, antipyrine clearance were similar among treatment groups.

Conclusions:

In cirrhotic PBC patients, colchicine does not offer additional benefits to UDCA. In this population, UDCA does not obviate disease progression.
Immune sensitization to food, yeast and bacteria in Crohn’s disease
Authors: Van Den Bogaerde J. , Kamm M. A. , Knight S. C.
Published: March 2003

Background:

Complex food proteins and enteric flora may act as antigenic stimuli in Crohn’s disease. This study assessed the prevalence and magnitude of lymphocyte priming to these antigens in Crohn’s disease.

Methods:

A total of 31 Crohn’s disease patients (median age 42 years, range 25–72 years) and 22 healthy controls (median 29 years, 23–43 years) were studied. Peripheral blood lymphocytes were collected and incubated with antigens in hanging drop culture for 4 days. The antigens tested were cow’s milk, cereals, cabbage group, citrus group, peanut group, Saccharomyces (yeast), Bacteroides, E. coli and Klebsiella. On the 4th day 3H‐thymidine incorporation was measured after a 4‐h pulse. Responses to antigens were considered positive if mean proliferative values were above the 99% confidence interval for background proliferation.

Results:

The mean background and mitogen‐stimulated proliferation did not differ between patients and controls. The mean proliferation to antigens was not above background in controls, but in Crohn’s patients proliferative responses to all food and bacterial antigens were significantly higher than background values. Twenty‐three out of 31 Crohn’s patients and five out of 22 controls (P=0.0003) responded to one or more antigens. Sixteen Crohn’s patients and two controls responded to four or more antigens (P=0.001, Fisher’s exact test).

Conclusion:

The reactivity of peripheral lymphocytes to food, yeast and bacterial antigens, especially multiple antigens, is common in Crohn’s disease. These sensitized lymphocytes may contribute to the inflammatory process.
Balsalazide therapy in ulcerative colitis
Authors: Ragunath K. , Williams J. G.
Published: March 2003

Balsalazide is a 5‐aminosalicylic acid (mesalazine) pro‐drug which has an inert carrier molecule instead of the sulfapyridine moiety of sulfasalazine. It is designed to deliver 5‐aminosalicylic acid to the colonic mucosa without the sulfapyridine‐associated side‐effects encountered with sulfasalazine.

Several studies have confirmed the efficacy and patient tolerance of balsalazide. When compared to mesalazine at equivalent doses, it induced symptomatic and complete remission of acute ulcerative colitis in a greater proportion of patients. In particular, patients with resistant left‐sided disease were shown to have a higher probability of achieving remission. Balsalazide was beneficial in patients with troublesome nocturnal symptoms. It has a similar efficacy in maintaining remission when compared to sulfasalazine and mesalazine. The advantage of balsalazide over other 5‐aminosalicylic acid compounds is its superior patient tolerability with minimal side‐effects.
Effectiveness and safety of nizatidine, 75 mg, for the relief of episodic heartburn
Authors: Paul K. , Redman C. M. , Chen M.
Published: March 2003

Background:

The most frequent cause of episodic heartburn is food and beverage ingestion. Nizatidine, an H2‐receptor antagonist, is currently approved for non‐prescription use in the prevention and relief of heartburn at a dose of 75 mg up to twice a day.

Methods:

Two identical studies were carried out to evaluate the efficacy of nizatidine, 75 mg, compared with placebo in treating heartburn in an ‘at‐home’ setting. The studies were multicentre, multiple‐dose, placebo‐controlled, randomized, parallel group design. A total of 994 subjects were randomized to treatment. Adequate relief of heartburn was assessed at 15, 30 and 45 min and 1, 2 and 3 h following a treatment dose. A subject’s responses with respect to time to relief and attainment of adequate relief were combined into a derived response profile, the sustained adequate relief score. Adverse experiences were noted throughout the study period.

Results:

The individual and combined study results showed that nizatidine, 75 mg, relieved heartburn faster and/or more consistently than placebo. The mean sustained adequate relief score, calculated over a subject’s first four episodes, was 2.43 in the nizatidine‐treated group compared with 2.14 in the placebo group (P < 0.001). Nizatidine‐treated subjects attained sustained adequate relief in a significantly (P < 0.001) larger percentage (75%) of their heartburn episodes than did subjects treated with placebo (66%). No serious adverse experiences were associated with nizatidine treatment.

Conclusion:

Nizatidine, 75 mg, is a safe and effective treatment for episodic heartburn. The results showed that subjects taking nizatidine had heartburn relief that was achieved faster and/or more reliably than did subjects taking placebo.
Lansoprazole in children: pharmacokinetics and efficacy in reflux oesophagitis
Authors: Faure C. , Michaud L. , Khan Shaghaghi E. , Popon M. , Laurence M. , Mougenot J. F. , Hankard R. , Navarro J. , Jacqz‐Aigrain E.
Published: March 2003

Background:

Data on the proton pump inhibitor lansoprazole in paediatric patients are limited.

Aim:

To investigate the pharmacokinetics, optimal dosage and efficacy of lansoprazole in paediatric patients.

Methods:

A 24‐h gastric pH recording and a pharmacokinetic study were performed after 7 days of lansoprazole, 17 mg/m2, in 23 patients with reflux oesophagitis (median age, 3.5 years). Response was defined as pH > 3 for > 65% of the recording. The dosage was doubled in non‐responders. Patients with no response on day 14 were excluded. Responders underwent endoscopy after 4 weeks on the response‐inducing dosage; abnormal findings led to a repeat endoscopy after four additional weeks.

Results:

Nine patients responded to 17 mg/m2 and six to 30.3 mg/m2. On day 7, time with pH > 3 was significantly correlated with the area under the plasma concentration–time curve (P=0.003). The area under the plasma concentration–time curve was significantly greater in the nine responders to 17 mg/m2 than in the 14 other patients. Pharmacokinetic parameters were similar in responders and non‐responders to the higher dose. After 4 weeks, oesophagitis was healed in 80% of responders. Adverse events occurred in three patients and required treatment discontinuation in one.

Conclusions:

Lansoprazole is effective and safe in children. The optimal starting dosage is 30 mg/m2 or 1.4 mg/kg.
Long‐term lansoprazole control of gastric acid and pepsin secretion in ZE and non‐ZE hypersecretors: a prospective 10‐year study
Authors: Hirschowitz B. I. , Simmons J. , Mohnen J.
Published: March 2003

Background:

The majority of patients with Zollinger–Ellison syndrome require lifelong treatment with proton pump inhibitors.

Aims:

To determine the efficacy of lansoprazole control of acid and pepsin secretion over the long term in Zollinger–Ellison syndrome and non‐Zollinger–Ellison syndrome hypersecretors.

Methods:

Sixty‐three hypersecretors (basal acid output > 15 mmol/h), 46 Zollinger–Ellison syndrome and 17 non‐Zollinger–Ellison syndrome, with a total history of 15.4 and 19.2 years, respectively, were entered into a long‐term prospective study using lansoprazole. Sixty‐one were studied every 3 months for 1 year and then every 3–6 months up to 10 years during lansoprazole treatment with endoscopy, serum gastrin and gastric analysis, measuring both basal and stimulated pH and acid and pepsin secretion. Doses were individually optimized and adjusted to keep the basal acid output at < 5 mmol/h in intact patients and < 1 mmol/h in antrectomized Zollinger–Ellison syndrome patients.

Results:

The dose of lansoprazole could not be predicted a priori from pre‐treatment acid or pepsin output, serum gastrin, prior omeprazole dose or diagnosis or prior complications. The median dose was ∼ 80 mg/day, with a wide range from 15 mg every other day to 360 mg/day, and generally stabilized by 12 months. However, as doses were adjusted over time for indications, almost half the patients required higher doses. With adjustments, the basal acid output was maintained in the target range in > 90% of intact patients and in 80% of antrectomized patients. Gastric juice pH increased from ∼ 1.2 before therapy to > 3.4 during therapy. Serum gastrin in Zollinger–Ellison syndrome patients, after excluding five outliers, did not change over the course of therapy, but doubled in non‐Zollinger–Ellison syndrome patients. There were no adverse events due to lansoprazole, and routine laboratory studies remained normal.

Conclusions:

The dose of lansoprazole for hypersecretors cannot be predicted, and thus needs to be optimized empirically on an individual basis. With continued periodic adjustments, almost half the patients required increased doses, while safe dose reduction was possible in only one‐quarter. When individually optimized, lansoprazole proved to be safe and effective in the control of secretion for the treatment of both Zollinger–Ellison syndrome and non‐Zollinger–Ellison syndrome hypersecretors for up to 10 years.
Systematic review: the use of somatostatin or octreotide in refractory diarrhoea
Authors: Szilagyi A. , Shrier I.
Published: March 2003

Background:

Somatostatin and octreotide have multiple effects which make them ideal for treating diarrhoea of different aetiologies. Their use in a variety of conditions with refractory diarrhoea, however, is based on a limited number of studies.

Aim:

We undertook a systematic review of the available English literature to maximize an evidence‐based approach to the treatment of refractory diarrhoea. We tested the hypothesis that efficacy is independent of aetiology.

Methods and results

A Medline and individual article search from 1965 to 2000 was undertaken on the use of somatostatin and octreotide in diarrrhoea. All reports containing at least five subjects were included. The percentage response in case series and randomized controlled trials was compared, and a meta‐analysis of randomized controlled trials where patient level data were provided was carried out. There were 30 publications found (18 case series, 12 randomized controlled trials). The response percentage was 73% overall in case series and 64% in randomized controlled trials (not significant). A meta‐analysis of nine randomized controlled trials revealed significant heterogeneity despite an overall relative risk of 0.5 (95% confidence interval, 0.27–0.91). Subgroup analysis of the largest aetiological groups showed that acquired immunodeficiency syndrome studies were homogeneous, but somatostatin and octreotide were less effective. Post‐chemotherapy studies remained heterogeneous and somatostatin and octreotide were highly effective.

Conclusions

While this review strengthens the consensus guidelines on the use of somatostatin and octreotide for refractory diarrhoea, evidence‐based support requires additional studies.
Clinical and endoscopic characteristics of non‐Helicobacter pylori, non‐NSAID duodenal ulcers: a long‐term prospective study
Authors: Xia H. H.‐X. , Wong B. C. Y. , Wong K. W. , Wong S. Y. , Wong W. M. , Lai K. C. , Hu W. H. C. , Chan C. K. , Lam S. K.
Published: March 2003

Background:

The proportion of duodenal ulcers not associated with Helicobacter pylori infection or the use of non‐steroidal anti‐inflammatory drugs (NSAIDs) is increasing.

Aim:

To identify the clinical and endoscopic characteristics of non‐H. pylori, non‐NSAID duodenal ulcers.

Methods:

Clinical and endoscopic data and H. pylori status were prospectively collected from consecutive patients who underwent upper endoscopy from 1997 to 1999. Patients with duodenal ulcers were identified, and those with non‐H. pylori, non‐NSAID duodenal ulcers were analysed further.

Results:

A total of 11 717 upper endoscopies were performed in 8344 patients. Of these, 1153 (14%) had duodenal ulcers. Of 599 patients with active ulcers and known H. pylori status, 104 (17%) had ulcers not associated with H. pylori or the use of NSAIDs, 393 (66%) had ulcers associated with H. pylori alone, 51 (8.5%) had ulcers associated with the use of NSAIDs alone and 51 (8.5%) had ulcers associated with both. Multivariate logistic regression analysis revealed that the presence of concomitant diseases (odds ratio=15.0; 95% confidence interval, 8.64–25.9; P < 0.001) and the absence of epigastric pain/discomfort (odds ratio=0.52; 95% confidence interval, 0.29–0.91; P=0.022) were independent predictors for non‐H. pylori, non‐NSAID duodenal ulcers.

Conclusions:

Non‐H. pylori, non‐NSAID duodenal ulcers exhibit certain distinct clinical and endoscopic characteristics. The presence of concomitant diseases is an important predictive factor.
Enteric‐release glyceryl trinitrate in active Crohn’s disease: a randomized, double‐blind, placebo‐controlled trial
Authors: Hawkes N. D. , Richardson C. , Ch'Ng C. L. , Green J. T. , Evans B. K. , Williams J. , Rhodes P. , Rhodes J. , Swift G. L. , Thomas G. A. O. , Hawthorne A. B. , Kingham J. G. C. , Mayberry J. F.
Published: March 2003

Background:

Mucosal ischaemia may contribute to the pathogenesis of Crohn’s disease. Microvascular abnormalities have been found in colonic resection specimens, and mucosal levels of constitutive nitric oxide synthase are reduced.

Aim:

To assess the efficacy of a novel, enteric‐release formulation of the nitric oxide donor, glyceryl trinitrate, aimed at increasing the mucosal circulation and relaxing smooth muscle in the affected bowel.

Methods:

The trial was randomized, double‐blind and placebo‐controlled. Baseline disease activity was assessed by a structured symptom diary, with blood tests and a quality of life assessment. Patients with a Crohn’s disease activity index of ≥ 150 and < 450 were randomized to receive 12 weeks of either glyceryl trinitrate (initially 6 mg twice daily, increasing to 9 mg twice daily after 6 weeks) or an identical placebo. Assessments were repeated at 6 and 12 weeks.

Results:

Seventy patients (22 male) entered the study; 34 were given glyceryl trinitrate and 36 placebo. At 12 weeks, there were no differences between the treatment groups in terms of Crohn’s disease activity index, pain, stool frequency, inflammatory markers or quality of life scores.

Conclusions:

Enteric‐release glyceryl trinitrate did not benefit patients with mild to moderately active Crohn’s disease. Whilst ischaemia may contribute to the pathogenesis of Crohn’s disease, our results fail to provide supportive evidence for this hypothesis.
Interaction between azathioprine and aminosalicylates: an in vivo study in patients with Crohn’s disease
Authors: Dewit O. , Vanheuverzwyn R. , Desager J. P. , Horsmans Y.
Published: March 2003

Background:

The inhibition of thiopurine methyltransferase activity, one of the enzymes responsible for azathioprine metabolism, by aminosalicylates has been described in an in vitro study. This could result in a higher risk of bone marrow depression when using the two drugs together.

Aim:

To investigate the in vivo interaction between azathioprine and aminosalicylates in quiescent Crohn’s disease by measuring 6‐thioguanine nucleotide levels, thiopurine methyltransferase activity and the plasma levels of the acetylated metabolite of 5‐aminosalicylic acid.

Methods:

Sixteen patients taking a stable dose of azathioprine, plus sulfasalazine or mesalazine, were enrolled and completed the study. They were not taking any drugs interfering with azathioprine metabolism. Four visits every 4 weeks were held over a 3‐month period. Aminosalicylate administration was withdrawn after the second visit. At each visit, the blood cell count, inflammatory parameters, levels of 6‐thioguanine nucleotide and the acetylated metabolite of 5‐aminosalicylic acid and thiopurine methyltransferase activity were determined.

Results:

After aminosalicylate withdrawal, mean 6‐thioguanine nucleotide levels decreased significantly from 148 pmol (57–357 pmol) to 132 pmol (56–247 pmol) per 8 × 108 red blood cells (P=0.027), without significant changes in thiopurine methyltransferase activity or biological parameters.

Conclusions:

This in vivo study favours the existence of an interaction between azathioprine and aminosalicylates through a mechanism which remains unclear. This drug–drug interaction should be taken into account when using azathioprine and aminosalicylates simultaneously.
Albendazole chemotherapy for AIDS‐related diarrhoea in Zambia—clinical, parasitological and mucosal responses
Authors: Zulu I. , Veitch A. , Sianongo S. , McPhail G. , Feakins R. , Farthing M. J. G. , Kelly P.
Published: March 2003

Background:

Albendazole reduces diarrhoea in African AIDS patients, but it is unclear if the clinical response to treatment reflects pathogen eradication and/or mucosal recovery.

Methods:

Adults with HIV‐related persistent diarrhoea were treated with albendazole 800 mg twice daily for 14 days. Clearance of parasites was evaluated at 3 and 6 weeks by stool microscopy. At baseline and at 6 weeks duodenal biopsies were taken for electron microscopy (EM) and morphometry.

Results:

Ten (7%) of 153 patients had cryptosporidiosis, 54 (37%) had isosporiasis and 23 (16%) had microsporidiosis. By 3 weeks, these protozoa were cleared in 27 (46%) of 59 patients initially positive. By 6 weeks, 34 (39%) of 87 patients experienced complete clinical response, 18 (21%) partial response and 35 (40%) no response. Crypt depth increased by 15% over 6 weeks (P < 0.001), but villous height increased only in patients with complete response (median + 50 μm, interquartile range (IQR) 2–90, compared to patients with partial (+ 4 μm, IQR – 15,41) or no response (− 13 μm, IQR − 62,12; P=0.008)). Fifteen patients died: body mass index < 17.5 kg/m2 and crypt depth < 180 μm independently predicted death.

Conclusions:

Albendazole therapy reduced the burden of protozoal infection and promoted mucosal recovery in patients with a complete clinical response.
Effect of Helicobacter pylori infection and its eradication on nutrition
Authors: Furuta T. , Shirai N. , Xiao F. , Takashima M. , Hanai H.
Published: March 2003

Aims:

To investigate the effects of Helicobacter pylori infection and eradication on nutrition.

Methods:

The body weight, height, blood pressure, gastric juice pH and fasting serum levels of glucose, total protein, albumin, total cholesterol and triglyceride were measured in H. pylori‐positive and H. pylori‐negative subjects, and the effect of eradication of H. pylori on these parameters was determined. The development of gastro‐oesophageal reflux disease after treatment was also examined. Eight patients underwent a pancreatic function test before and after H. pylori eradication therapy.

Results:

The incidence of hypoproteinaemia in H. pylori‐positive subjects was significantly higher than that in H. pylori‐negative subjects. After eradication of H. pylori, the gastric juice pH values were significantly decreased, and the body weight and serum levels of total cholesterol, total protein and albumin were significantly increased. The incidence of hyperlipidaemia significantly increased and that of hypoproteinaemia significantly decreased in the group with eradication. Pancreatic function improved significantly after eradication of H. pylori. No significant changes in these parameters were observed in the group without eradication. Obese patients had a higher risk of the development of gastro‐oesophageal reflux disease after eradication of H. pylori infection.

Conclusions:

The eradication of H. pylori appears to improve some nutritional parameters.
Helicobacter species and hepatobiliary diseases
Authors: Leong R. W. L. , Sung J. J. Y.
Published: March 2003

Helicobacter species, which may colonize the biliary tract, have been implicated as a possible cause of hepatobiliary diseases ranging from chronic cholecystitis and primary sclerosing cholangitis to gall‐bladder carcinoma and primary hepatic carcinomas.

Research in this area has been limited by the lack of a gold standard in the diagnosis of these organisms in bile. Most published data to date have been based on molecular techniques that detect the DNA of Helicobacter species in bile, rather than evidence of viable organisms in bile.

Helicobacter species have not been shown to induce histological injury to the biliary epithelium or liver parenchyma. The strongest association of the presence of these organisms in bile is with cholestatic conditions. This article reviews the literature on this newly developing field as it has evolved historically, taking pertinent methodological issues into account.
Evidence of poor vitamin status in coeliac patients on a gluten‐free diet for 10 years
Authors: Hallert C. , Grant C. , Grehn S. , Grännö C. , Hultén S. , Midhagen G. , Ström M. , Svensson H. , Valdimarsson T.
Published: March 2003

Background : Patients with coeliac disease are advised to keep to a lifelong gluten‐free diet to remain well. Uncertainty still exists as to whether this gives a nutritionally balanced diet.

Aim : To assess the vitamin nutrition status of a series of coeliac patients living on a gluten‐free diet for 10 years.

Methods : Thirty adults with coeliac disease (mean age, 55 years; range, 45–64 years; 60% women), in biopsy‐proven remission following 8–12 years of dietary treatment, were studied. We measured the total plasma homocysteine level, a metabolic marker of folate, vitamin B‐6 and vitamin B‐12 deficiency, and related plasma vitamin levels. The daily vitamin intake level was assessed using a 4‐day food record. Normative data were obtained from the general population of the same age.

Results : Coeliac patients showed a higher total plasma homocysteine level than the general population, indicative of a poor vitamin status. In accordance, the plasma levels of folate and pyridoxal 5′‐phosphate (active form of vitamin B‐6) were low in 37% and 20%, respectively, and accounted for 33% of the variation of the total plasma homocysteine level (P < 0.008). The mean daily intakes of folate and vitamin B‐12, but not of vitamin B‐6, were significantly lower in coeliac patients than in controls.

Conclusions : Half of the adult coeliac patients carefully treated with a gluten‐free diet for several years showed signs of a poor vitamin status. This may have clinical implications considering the linkage between vitamin deficiency, elevated total plasma homocysteine levels and cardiovascular disease. The results may suggest that, when following up adults with coeliac disease, the vitamin status should be reviewed.
Helicobacter pylori eradication therapy improves atrophic gastritis and intestinal metaplasia: a 5‐year prospective study of patients with atrophic gastritis
Authors: Ito M. , Haruma K. , Kamada T. , Mihara M. , Kim S. , Kitadai Y. , Sumii M. , Tanaka S. , Yoshihara M. , Chayama K.
Published: March 2003

Aim : To investigate the effect of the eradication of Helicobacter pylori on histological gastritis.

Methods : Twenty‐six patients with moderate to severe atrophy received successful eradication therapy of H.pylori. Four patients dropped out and 22 were followed up prospectively for 5 years. The grades of gastritis were estimated from gastric biopsy specimens. The grade of intestinal metaplasia was also evaluated by dye‐endoscopy using methylene blue (methylthioninium chloride). The serum levels of pepsinogen, gastrin and anti‐parietal cell antibody were also determined.

Results : The grades of atrophy decreased in patients with successful eradication therapy in the gastric corpus (before vs. 5 years after eradication, 2.09 ± 0.15 vs. 0.91 ± 0.17; P < 0.01) and in the antrum (2.14 ± 0.17 vs. 1.36 ± 0.17; P < 0.01). The levels of intestinal metaplasia were also decreased in the corpus (0.91 ± 0.24 vs. 0.50 ± 0.16; P < 0.05) and in the antrum (1.41 ± 0.20 vs. 1.00 ± 0.16; P < 0.05), which was also demonstrated by the methylene blue (methylthioninium chloride) staining method (33.4 ± 8.2% vs. 23.0 ± 6.5%; P < 0.05). The improvement of corpus atrophy correlated well with the high serum level of pepsinogen I (P = 0.005), but showed no correlation with the levels of anti‐parietal cell antibody.

Conclusions : These results suggest that gastric atrophy and intestinal metaplasia are reversible events in some patients.
Discordance between the degree of osteopenia and the prevalence of spontaneous vertebral fractures in Crohn's disease
Authors: Stockbrügger R. W. , Schoon E. J. , Bollani S. , Mills P. R. , Israeli E. , Landgraf L. , Felsenberg D. , Ljunghall S. , Nygard G. , Persson T. , Graffner H. , Bianchi Porro G. , Ferguson A.
Published: March 2003

Background : A high prevalence of osteoporosis has been noted in Crohn's disease, but data about fractures are scarce.

Methods : The relationship between low bone mineral density and the prevalence of vertebral fractures was studied in 271 patients with ileo‐caecal Crohn's disease in a large European/Israeli study. One hundred and eighty‐one currently steroid‐free patients with active Crohn's disease (98 completely steroid‐naive) and 90 steroid‐dependent patients with inactive or quiescent Crohn's disease were investigated by dual X‐ray absorptiometry scan of the lumbar spine, a standardized posterior/anterior and lateral X‐ray of the thoracic and lumbar spine, and an assessment of potential risk factors for osteoporosis.

Results : Thirty‐nine asymptomatic fractures were seen in 25 of 179 steroid‐free patients (14.0%; 27 wedge, 12 concavity), and 17 fractures were seen in 13 of 89 steroid‐dependent patients (14.6%; 14 wedge, three concavity). The prevalence of fractures in steroid‐naive patients was 12.4%. The average bone mineral density, expressed as the T‐score, of patients with fractures was not significantly different from that of those without fractures (−0.759 vs. −0.837; P=0.73); 55% of patients with fractures had a normal T‐score. The bone mineral density was negatively correlated with lifetime steroids, but not with previous bowel resection or current disease activity. The fracture rate was not correlated with the bone mineral density (P=0.73) or lifetime steroid dose (P=0.83); in women, but not in men, the fracture rate was correlated with age (P=0.009).

Conclusions : The lack of correlation between the prevalence of fractures on the one hand and the bone mineral density and lifetime steroid dose on the other necessitates new hypotheses for the pathogenesis of the former.
Alteration of histological gastritis after cure of Helicobacter pylori infection
Authors: Hojo M. , Miwa H. , Ohkusa T. , Ohkura R. , Kurosawa A. , Sato N.
Published: March 2003

Background : It is still disputed whether gastric atrophy or intestinal metaplasia improves after the cure of Helicobacter pylori infection.

Aim : To clarify the histological changes after the cure of H. pylori infection through a literature survey.

Methods : Fifty‐one selected reports from 1066 relevant articles were reviewed. The extracted data were pooled according to histological parameters of gastritis based on the (updated) Sydney system.

Results : Activity improved more rapidly than inflammation. Eleven of 25 reports described significant improvement of atrophy. Atrophy was not improved in one of four studies with a large sample size (> 100 samples) and in two of five studies with a long follow‐up period (> 12 months), suggesting that disagreement between the studies was not totally due to sample size or follow‐up period. Methodological flaws, such as patient selection, and statistical analysis based on the assumption that atrophy improves continuously and generally in all patients might be responsible for the inconsistent results. Five of 28 studies described significant improvement of intestinal metaplasia.

Conclusions : Activity and inflammation were improved after the cure of H. pylori infection. Atrophy did not improve generally among all patients, but improved in certain patients. Improvement of intestinal metaplasia was difficult to analyse due to methodological problems including statistical power.
Once‐daily, low‐cost, highly effective Helicobacter pylori treatment to family members of gastric cancer patients
Authors: Coelho L. G. V. , Martins G. M. , Passos M. C. F. , Bueno M. L. , Sanches B. S. F. , Lopes L. G. , Miranda C. H. D. , Castro L. P.
Published: March 2003

Background : Helicaobacter pylori eradication in family members of gastric cancer patients is now widely accepted, although problems related to costs and compliance persist.

Aim : To compare the efficacy, tolerability and long‐term re‐infection rates of two once‐daily regimens for the eradication of H. pylori in family members of gastric cancer patients.

Methods : 106 first‐degree family members of gastric cancer patients were recruited and submitted to the 13C‐urea breath test (UBT) to detect H. pylori. If positive, they were randomly allocated to receive a combination of lanzoprazole 30 mg, clarithromycin OD (extended‐release formulation) 500 mg and furazolidone 400 mg, once daily, in the morning, for 7 days (Group A) or the same regimen with only 200 mg furazolidone (Group B). Eradication was confirmed by urea breath test performed 6 weeks after treatment. 13C‐urea breath test was repeated at 944 (784–1258) days after treatment in successfully treated participants to look for re‐infection.

Results : Twenty‐five participants were H. pylori negative and two H. pylori‐positive individuals refused to sign the informed consent and were excluded. Therefore, 79 participants were studied. Forty participants were allocated to Group A and 39 to Group B. All participants completed treatment. Adverse effects, mostly mild, were observed in 18% of Group A and 18% of Group B (N.S.). The intention‐to‐treat eradication rate was 87.5% in Group A and 61.5% in Group B (P = 0.006). The mean annual re‐infection rate was 3%.

Conclusions : The combination of lanzoprazole 30 mg, one tablet of clarithromycin OD (extended release formulation) 500 mg and furazolidone 400 mg, once daily for 7 days, constitutes an inexpensive, safe and effective alternative for anti‐H. pylori therapy in family members of gastric cancer patients.
Early events in proton pump inhibitor‐associated exacerbation of corpus gastritis
Authors: Graham D. Y. , Opekun A. R. , Yamaoka Y. , Osato M. S. , El‐Zimaity H. M. T.
Published: March 2003

Background : Antisecretory therapy may exacerbate Helicobacter pylori corpus gastritis. The rate and mechanism(s) remain unknown.

Aim : To investigate the early events in proton pump inhibitor therapy on antral and corpus H. pylori gastritis.

Methods : Nine H. pylori‐infected volunteers underwent gastric biopsy with jumbo forceps for culture and histology. Histology was scored in the range 0–5 using a visual analogue scale. The depth of inflammation in gastric pits was scored in the range 1–3 (superficial or less than one‐third, one‐third to two‐thirds and greater than two‐thirds of the gastric pit, respectively). Tissue interleukin‐1β and interleukin‐8 levels were measured by enzyme‐linked immunoabsorbent assay. Omeprazole, 20 mg b.d., was given for 6.5 days and biopsies were repeated on day 7.

Results : Proton pump inhibitor therapy resulted in a fall in H. pylori density in the antrum and corpus. Inflammation and tissue levels of interleukin‐8 and interleukin‐1β decreased in the antrum and increased in the corpus mucosa. There was a significant increase in the depth of inflammation to include the proliferative zone in the corpus.

Conclusions : Within 1 week of starting proton pump inhibitor therapy, there was a marked extension of corpus inflammation into the gastric pit and an increase in corpus mucosal interleukin‐1β and interleukin‐8 levels. H. pylori eradication should be considered for all patients receiving long‐term antisecretory therapy.
Effect of oral omeprazole in reducing re‐bleeding in bleeding peptic ulcers: a prospective, double‐blind, randomized, clinical trial
Authors: Kaviani M. J. , Hashemi M. R. , Kazemifar A. R. , Roozitalab S. , Mostaghni A.‐A. , Merat S. , Alizadeh‐Naini M. , Yarmohammadi H.
Published: March 2003

Background : Endoscopic therapies and continuous intravenous omeprazole can decrease the morbidity and duration of hospital stay of patients with high‐risk peptic ulcer.

Aim : To evaluate the role of oral omeprazole in high‐risk bleeders.

Methods : After injection therapy of 160 patients with high‐risk peptic ulcer, 80 received oral omeprazole and 80 received placebo, and all were followed up.

Results : One hundred and forty‐nine patients (71 omeprazole and 78 placebo) completed the study. Eleven patients were excluded from the study. Thirty‐seven (25%) patients had gastric ulcer and 112 (75%) had duodenal ulcer. Fifty‐seven (38%) ulcers showed visible vessels, 80 (54%) showed oozing of blood and 12 (8%) showed a spurting artery. Only one patient died (placebo group). The mean hospital stays were 62.8 ± 28.6 h and 75 ± 39 h in the omeprazole and placebo groups, respectively (P = 0.032). The mean amounts of blood transfused were 1.13 ± 1.36 and 1.68 ± 1.68 bags in the omeprazole and placebo groups, respectively (P = 0.029). The re‐bleeding rate was lower in the omeprazole group than in the placebo group (12 vs. 26, respectively; P = 0.022).

Conclusion : Oral omeprazole is effective in decreasing the hospital stay, re‐bleeding rate and the need for blood transfusion in high‐risk ulcer bleeders treated with endoscopic injection therapy.
Intrathecal diamorphine for analgesia after Caesarean sectionA dose finding study and assessment of side‐effects
Authors: Kelly M. C. , Carabine U. A. , Mirakhur R. K.
Published: March 2003

Eighty women undergoing elective Caesarean section under spinal anaesthesia using hyperbaric bupivacaine 0.5% were randomly allocated to receive, in addition, intrathecal diamorphine 0.125, 0.25 or 0.375 mg or saline. Postoperative morphine requirements, measured using a patient‐controlled analgesia system, were reduced in a dose‐dependent manner by diamorphine. Pain scores were significantly lower at 2 and 6 h following the two larger doses of diamorphine. Less supplemental analgesia was required intra‐operatively if intrathecal diamorphine had been given. The incidences of vomiting and pruritus were also dose‐related. No respiratory rates of less than 14 breath.min−1 were recorded and the incidence of oxygen saturation readings less than 95% and 90% did not differ between groups. There were no adverse neonatal effects. Intrathecal diamorphine in the present study was found to be safe in doses of up to 0.375 mg following Caesarean section. However, minor side‐effects were frequently observed.
Bilateral lingual nerve injury following the use of the laryngeal mask airway
Authors: Majumder S. , Hopkins P. M.
Published: March 2003

We report a 27‐year‐old patient who developed transient bilateral lingual nerve palsy following the use of a laryngeal mask to maintain the airway during a general anaesthetic for arthroscopy of the wrist.
Serum albumin: touchstone or totem?
Authors: Margarson M. P. , Soni N.
Published: March 2003

A decrease in serum albumin concentrations is an almost inevitable finding in disease states, and is primarily mediated in the acute phase by alterations in vascular permeability and redistribution. This change is not disease specific but marked changes that persist are generally associated with a poorer prognosis. Critical appraisal of long‐standing practices and the availability of alternative colloid solutions have led to a reduction in albumin replacement therapy, and a widespread tolerance of lower albumin concentrations in patients. The factors determining serum albumin concentrations, their measurement and the implications of hypoalbuminaemia are reviewed. The clinical value of serum albumin measurement is discussed.
The cuffed oropharyngeal airwayIts clinical use in 100 patients
Authors: Asai T. , Koga K. , Jones R. M. , Stacey M. , Latto I. P. , Vaughan R. S.
Published: March 2003

We studied the efficacy of the cuffed oropharyngeal airway in 100 patients. Insertion of the airway after induction of anaesthesia with propofol was easy in 95 of 100 patients, moderately difficult in four patients and failed in one patient. Complications, such as coughing, gagging or body movement, occurred during induction and insertion in 15 patients. Insertion of the airway was not associated with tachycardia or hypertension. Manual ventilation through the airway was easy in less than 30% of patients immediately after insertion. Manual ventilation became easier after adjusting the position of the patient's head, neck or jaw. During spontaneous breathing, adjustment of the head, neck or jaw was required in 30% of patients. Complete airway obstruction occurred in one patient after insertion of the device and in two patients during maintenance of anaesthesia. The airway was left in place during emergence from anaesthesia in the remaining 97 patients. No complications occurred in 91 patients and coughing occurred in the remaining six patients before or during removal of the airway. No regurgitation, vomiting or laryngospasm occurred in any patient at any time. Therefore, the cuffed oropharyngeal airway has a potential use in anaesthetised patients who are breathing spontaneously.
Tracheal intubation through the intubating laryngeal mask in a patient with a fixed flexed neck and deviated larynx
Authors: Asai T. , Shingu K.
Published: March 2003

Insertion of the conventional laryngeal mask is more difficult or impossible when the patient's head and neck are in either the neutral or flexed position. The intubating laryngeal mask is best inserted when the patient's head is supported by a pillow, without placing the head and neck into the Magill position; therefore, insertion of this modified mask may be less difficult than the conventional mask in the patient with a flexed neck. We report a case of successful insertion of the intubating laryngeal mask and subsequent tracheal intubation through the mask using a fibre‐optic bronchoscope, in a patient with a flexed neck in whom tracheal intubation using several methods had been difficult previously.
Intermediate carePossibilities, requirements and solutions
Authors: Ridley S. A.
Published: March 2003

The inadequate supply of intensive care facilities has focused interest on intermediate care as a means of bridging the gulf between the level of support available in the intensive care unit and the general ward. However, few hospitals have developed intermediate care, in the form of high‐dependency care units, and little information exists concerning the use or potential of such areas. Therefore, this review proposes to cover the definition of intermediate care and to discuss some of the possible reasons why intermediate care is now believed necessary. The capabilities of intermediate care for selected groups of patients and the treatment modalities offered are described. The present provision of high‐dependency care in the United Kingdom is discussed and the methods for estimating the required size of a high‐dependency unit are outlined. The impact of a high‐dependency unit on the workload of the intensive care unit and the potential cost saving of managing such patients in an intermediate care area are illustrated.
The reinforced laryngeal mask in paediatric outpatient dental surgery
Authors: George J. M. , Sanders G. M.
Published: March 2003

One hundred and twenty ASA I and II grade children aged 2–9 years scheduled for outpatient dental extractions under general anaesthesia were studied. They were allocated randomly to one of three groups for airway management: group R had anaesthesia with a reinforced laryngeal mask airway, group L with a standard laryngeal mask airway and group N with a nasal mask. Anaesthesia was induced in all children using halothane in 50% nitrous oxide with oxygen and maintained on halothane in 67% nitrous oxide with oxygen. An Ayre's T‐piece with Jackson‐Rees modification was used. The incidence of airway obstruction was significantly lower and surgical access significantly better with the reinforced laryngeal mask airway when compared with the standard laryngeal mask airway. However, the reinforced laryngeal mask airway was significantly more difficult to insert when compared with the standard laryngeal mask airway. On comparing the reinforced laryngeal mask airway with the nasal mask, there were significantly fewer episodes of airway obstruction, better oxygen saturation, less increase in heart rate and fewer arrhythmias in the reinforced laryngeal mask airway group. Total time for the procedures was the same for all three groups. Thus, the reinforced laryngeal mask airway was found to be a favourable alternative to the standard laryngeal mask airway and nasal mask for paediatric outpatient dental extractions.