bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a novel continuous real time 13C urea breath analyser for Helicobacter pylori
Authors: Shirin H. , Kenet G. , Shevah O. , Wardi Y. , Birkenfeld S. , Shahmurov M. , Bruck R. , Niv Y. , Moss S. F. , Avni Y.
Published: March 2003

Aim:

To evaluate the sensitivity and specificity of a new 13C urea breath test, Oridion BreathID, for the diagnosis of Helicobacter pylori.

Methods:

A total of 97 consecutive symptomatic patients referred for upper endoscopy were included in the ‘pre‐therapy’ part of the study. After endoscopy the patients were analysed for H. pylori by Oridion BreathID. BreathID continuously sampled the subject’s breath for 20 min, and displayed the results on the BreathID screen in real time. Results of the BreathID were compared with the ‘gold standard’ (rapid urease test and histology). We also prospectively tested the validity of BreathID in comparison to isotope ratio mass spectrometry, in 40 patients referred to monitor the efficacy of H. pylori eradication treatment.

Results:

Complete agreement was observed between the ‘gold standard’ and the Breath ID test in 96.9% (94 out of 97) of the patients. The sensitivity and specificity of BreathID were 97.8% and 96.1%, respectively. The correlation between BreathID and isotope ratio mass spectrometry breath test was 100%.

Conclusions:

The Oridion BreathID has comparable sensitivity and specificity to the claims of the currently available urea breath tests. Furthermore, BreathID has the potential advantages of ease of use with minimal medical staff requirement, and real time rapid results (20 min maximum) which may make the BreathID preferable to other urea breath test assays.
Mycobacterium aviumsubsp.paratuberculosisas one cause of Crohn’s disease
Authors: Chamberlin W. , Graham D. Y. , Hulten K. , El‐Zimaity H. M. T. , Schwartz M. R. , Naser S. , Shafran I. , El‐Zaatari F. A. K.
Published: March 2003

A number of theories regarding the aetiology of Crohn’s disease have been proposed. Diet, infections, other unidentified environmental factors and immune disregulation, all working under the influence of a genetic predisposition, have been viewed with suspicion. Many now believe that Crohn’s disease is a syndrome caused by several aetiologies. The two leading theories are the infectious and autoimmune theories. The leading infectious candidate isMycobacterium aviumsubspeciesparatuberculosis(Mycobacterium paratuberculosis), the causative agent of Johne’s disease, an inflammatory bowel disease in a variety of mammals including cattle, sheep, deer, bison, monkeys and chimpanzees. The evidence to supportM. paratuberculosisinfection as a cause of Crohn’s disease is mounting rapidly. Technical advances have allowed the identification and/or isolation ofM. paratuberculosisfrom a significantly higher proportion of Crohn’s disease tissues than from controls. These methodologies include: (i) improved culture techniques; (ii) development ofM. paratuberculosis‐specific polymerase chain reaction assays; (iii) development of a novelin situhybridization method; (iv) efficacy of macrolide and anti‐mycobacterial drug therapies; and (v) discovery of Crohn’s disease‐specific seroreactivity against two specificM. paratuberculosisrecombinant antigens. The causal role forM. paratuberculosisin Crohn’s disease and correlation of infection with specific stratification(s) of the disorder need to be investigated. The data implicating Crohn’s as an autoimmune disorder may be viewed in a manner that supports the mycobacterial theory. The mycobacterial theory and the autoimmune theory are complementary; the first deals with the aetiology of the disorder, the second deals with its pathogenesis. Combined therapies directed against a mycobacterial aetiology and inflammation may be the optimal treatment of the disease.
The Loiano‐Monghidoro population‐based study of Helicobacter pylori infection: prevalence by 13C‐urea breath test and associated factors
Authors: Bazzoli F. , Palli D. , Zagari R. M. , Festi D. , Pozzato P. , Nicolini G. , Masala G. , Fossi S. , Ricciardiello L. , Panuccio D. , Roda E.
Published: March 2003

Objectives:

As part of a cross‐sectional study on cholelithiasis, 1533 out of 1840 residents in Loiano/Monghidoro, a rural area in Northern Italy (792 men, 741 women, age range 28–80 years), agreed to be further evaluated in relation to their Helicobacter pylori status.

Methods:

Each participant performed a 13C‐urea breath test (13C‐UBT) and provided information on sociodemographic, lifestyle and clinical characteristics.

Results:

The 13C‐UBT was positive in 1041 subjects (67.9%; men: 69%; women: 67%) and was positively associated with increasing age (P < 0.001), alcohol consumption (P < 0.01), a higher number of siblings (P < 0.001) and a personal history of peptic ulcer (P < 0.01), but inversely with a nonmanual occupation (P < 0.001). Overall, H. pylori infection was unrelated to smoking, house pets, and a family history of gastroduodenal diseases. The prevalence of H. pylori infection was 72% in subjects reporting one or more dyspeptic symptoms and 65% among asymptomatic participants (P < 0.001); a multivariate analysis showed that only epigastric pain was significantly, although weakly, associated with 13C‐UBT positivity.

Conclusions:

This large population‐based study showed a prevalence of H. pylori infection higher than that reported by serologic surveys in urban areas. Current H. pylori infection was strongly associated with indicators of lower socioeconomic status, alcohol consumption and increasing age. A role of H. pylori infection in determining epigastric pain was suggested.
The pharmacokinetics of the novel promotile drug, tegaserod, are similar in healthy subjects—male and female, elderly and young
Authors: Appel‐Dingemanse S. , Horowitz A. , Campestrini J. , Osborne S. , Mcleod J.
Published: March 2003

Background:

Tegaserod (HTF 919) is a selective 5‐HT4 receptor partial agonist in development for the treatment of irritable bowel syndrome.

Aim:

This study aimed to assess the effect of age and gender on the single‐dose pharmacokinetics of tegaserod.

Methods:

In a parallel‐group, open‐label study, a single dose of tegaserod (12 mg) was administered to four groups of healthy young male, young female, elderly male and elderly female subjects (n=10 per group). Blood samples were collected from 0 to 24 h postdose. Non‐compartmental pharmacokinetics evaluation and statistical analysis (ANOVA and Wilcoxon signed ranks test for tmax) were performed.

Results:

Tegaserod was well tolerated in all groups. There was no effect of age or gender on tmax and Cmax. Gender did not affect AUC0–∞ and AUC0–tz; there was a statistically significant effect of age on these parameters. AUC0–∞ and AUC0–tz in the elderly were greater than in the young (AUC0–∞ ratio 1.37, P < 0.001; AUC0–tz ratio 1.23, P=0.029). This increase in exposure is judged not to be clinically relevant because it is within the variability in the pharmacokinetics parameters of tegaserod and because the dose–response relationship of tegaserod is relatively shallow.

Conclusions:

No dose adjustment for age or gender is recommended in tegaserod therapy.
Effect of interferon therapy on the development of hepatocellular carcinoma in patients with hepatitis C virus‐related cirrhosis: a meta‐analysis
Authors: Papatheodoridis G. V. , Papadimitropoulos V. C. , Hadziyannis S. J.
Published: March 2003

Background:

The role of interferon in the prevention of hepatocellular carcinoma remains controversial.

Aim:

In this meta‐analysis we evaluated the hepatocellular carcinoma incidence in interferon‐treated and ‐untreated patients with hepatitis C virus‐related cirrhosis.

Methods:

Eleven studies with 2178 patients were found to fulfil our inclusion criteria. The pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated from the raw study data.

Results:

Hepatocellular carcinoma development was significantly more frequent in untreated (21.5%) than in interferon‐treated patients (8.2%; OR: 3.0, 95% CI: 2.3–3.9). In the five studies reporting hepatocellular carcinoma incidence in patients with and without sustained response to interferon, hepatocellular carcinoma was detected at a much higher rate in patients without (9%) than with a sustained response (0.9%; OR: 3.7, 95% CI: 1.7–7.8). Moreover, hepatocellular carcinoma developed significantly more frequently in the untreated patients than in the non‐sustained responders (OR: 2.7, 95% CI: 1.9–3.9). The benefit from interferon on hepatocellular carcinoma incidence was not influenced by the study type (prospective or retrospective), the follow‐up duration, or the study origin.

Conclusions:

Interferon therapy significantly reduces the hepatocellular carcinoma risk in patients with hepatitis C virus cirrhosis. Hepatocellular carcinoma development becomes almost negligible among sustained responders, but a reduction in hepatocellular carcinoma incidence is also achieved even in the non‐sustained responders.
High‐dose prolonged combination therapy in non‐responders to interferon monotherapy for chronic hepatitis C
Authors: Di Marco V. , Vaccaro A. , Ferraro D. , Alaimo G. , Rodolico V. , Parisi P. , Peralta S. , Di Stefano R. , Almasio P. L. , Craxì A.
Published: March 2003

Background:

Therapy of chronic hepatitis C non‐ responders to interferon monotherapy with standard doses of interferon plus ribavirin is usually ineffective.

Aim:

To evaluate the efficacy and tolerability of high‐dose prolonged combination retreatment in non‐ responder patients.

Methods:

Patients were retreated for 6 months with 6 MU αIFN on alternate days and 1000 or 1200 mg/day ribavirin. HCV‐RNA negative patients continued therapy for an additional 6 months.

Results:

Forty patients (29 males, mean age 49.7 years, 34 genotype 1b, 11 with F3 fibrosis) were treated. At 6 months, 20 (50%) patients were HCV‐RNA negative but six of them discontinued therapy because of adverse events. A sustained response was achieved in 28% of patients (11/40). A sustained response was more frequent among patients with genotype non‐1b than in those with genotype 1b (67 vs. 21%, P=0.005) and clearance of HCV‐RNA in the first 3 months had a high predictive value for sustained response (100% of sustained responders vs. 24% of non‐responders, P=0.0001).

Conclusions:

High‐dose prolonged combination therapy in non‐responders to IFN monotherapy leads to a higher rate of sustained response than the standard combination regimen. Tolerability may be a rate‐limiting factor. Maximal effectiveness can be predicted in patients with non‐1b genotype and in those who clear HCV‐RNA soon after starting retreatment.
Proton pump inhibitors versus H2‐antagonists: a meta‐analysis of their efficacy in treating bleeding peptic ulcer
Authors: Gisbert J. P. , González L. , Calvet X. , Roqué M. , Gabriel R. , Pajares J. M.
Published: March 2003

Purpose:

To evaluate whether proton pump inhibitors are more effective than H2‐antagonists (H2‐A) for the treatment of bleeding peptic ulcer.

Data sources:

PubMed database until January 2000.

Study selection:

Comparative randomized trials of proton pump inhibitors (omeprazole, lansoprazole, or pantoprazole) vs. H2‐A (cimetidine, ranitidine or famotidine).

Data extraction:

Meta‐analysis combining the odds ratios (OR) of the individual studies in a global OR (Peto method).

Outcomes evaluated:

Persistent or recurrent bleeding, need for surgery, or mortality.

Data synthesis:

Eleven studies fulfilled the inclusion criteria and contained data for at least one of the planned comparisons. Persistent or recurrent bleeding was reported in 6.7% (95% CI: 4.9–8.6%) of the patients treated with proton pump inhibitors, and in 13.4% (95% CI: 10.8–16%) of those treated with H2‐A (OR 0.4; 95% CI: 0.27–0.59) (χ2‐homogeneity test, 18; P=0.09). Surgery was needed in 5.2% (95% CI: 3.4–6.9%) of the patients treated with proton pump inhibitors, and in 6.9% (95% CI: 4.9–8.9%) of the patients treated with H2‐A (OR 0.7; 95% CI: 0.43–1.13). Respective percentages for mortality were 1.6% (95% CI: 0.9–2.9%) and 2.2% (95% CI: 1.3–3.7%) (OR 0.69; 95% CI: 0.31–1.57).

Sub‐analysis:

Five studies evaluated the effect of both therapies given in bolus injections on persistent or recurrent bleeding rate, which was 6% (95% CI: 3.6–8.3%) and 8.1% (95% CI: 5.3–10.9%), respectively (OR, 0.57; 95% CI: 0.31–1.05). Persistent or recurrent bleeding in high risk patients (Forrest Ia, Ib and IIa) occurred in 13.2% (95% CI: 7.9–8%) of the patients treated with proton pump inhibitors and in 34.5% (27–42%) of those treated with H2‐A (OR 0.28; 95% CI: 0.16–0.48). In patients not having endoscopic therapy, persistent or recurrent bleeding was reported, respectively, in 4.3% (95% CI: 2.7–6.7%) and in 12% (95% CI: 8.7–15%) (OR 0.24; 95% CI: 0.13–0.43). Less marked differences were observed in patients having adjunct endoscopic therapy: 10.3% (95% CI: 6.7–13.8%) and 15.2% (11.1–19.3%) (OR 0.59; 95% CI: 0.36–0.97). Moreover, the significance disappeared in this group when a single outlier study was excluded.

Conclusions:

Proton pump inhibitors are more effective than H2‐A in preventing persistent or recurrent bleeding from peptic ulcer, although this advantage seems to be more evident in patients not having adjunct sclerosis therapy. This beneficial effect seems to be similar or even more marked in patients with Forrest Ia, Ib or IIa ulcers. However, proton pump inhibitors are not more effective than H2‐A for reducing surgery or mortality rates. Nevertheless, the data are too scarce and heterogeneous to draw definitive conclusions, and further comparative trials are clearly warranted.
Is a one‐week course of triple anti‐Helicobacter pylori therapy sufficient to control active duodenal ulcer?
Authors: Tepeš B. , Križman I. , Gorenšek M. , Gubina M. , Orel I.
Published: March 2003

Background:

Triple therapy currently forms the cornerstone of the treatment of patients with Helicobacter pylori‐positive duodenal ulcer.

Aim:

To establish whether prolonged antisecretory therapy is necessary in patients with active duodenal ulcer.

Methods:

A total of 77 patients with H. pylori‐positive duodenal ulcer were included in a prospective, controlled, double‐blind study. All patients received a 7‐day treatment with omeprazole 20 mg b.d., clarithromycin 500 mg b.d. and amoxicillin 1000 mg b.d. Patients in the omeprazole group underwent an additional 14‐day therapy with omeprazole 20 mg; patients in placebo group received placebo. Endoscopy was performed upon inclusion in the study and after 3 and 8 weeks.

Results:

Seventy‐four patients were eligible for a per protocol analysis after 3 weeks, and 65 after 8 weeks. After 3 weeks, the healing rate was 89% in the omeprazole group and 81% in the placebo group (P=0.51). After 8 weeks, the ulcer healed in 97% of the patients in the total group (95% CI: 92.7–100%). H. pylori was eradicated in 88% of patients in the omeprazole group and in 91% in the placebo group (P=1.0). No statistically significant differences between the groups were found in ulcer‐related symptoms or in ulcer healing.

Conclusion:

In patients with H. pylori‐positive duodenal ulcer, a 7‐day triple therapy alone is sufficient to control the disease.
Efficacy of ecabet sodium for Helicobacter pylori eradication triple therapy in comparison with a lansoprazole‐based regimen
Authors: Adachi K. , Ishihara S. , Hashimoto T. , Hirakawa K. , Ishimura N. , Niigaki M. , Kaji T. , Kawamura A. , Sato H. , Fujishiro H. , Hattori S. , Watanabe M. , Kinoshita Y.
Published: March 2003

Background

: The cytoprotective agent, ecabet sodium, inhibits urease activity and growth of Helicobacter pylori.

Aim

: To evaluate the efficacy and safety of ecabet sodium‐based eradication of H. pylori infection, compared with a lansoprazole‐based regimen, in a randomized multicentre study.

Subjects and methods

: A total of 120 H. pylori‐positive patients were assigned to one of two treatment regimens for 2 weeks: ecabet sodium 1 g b.d., amoxicillin 500 mg t.d.s. and clarithromycin 400 mg b.d. (EAC: 60 patients); or lansoprazole 30 mg (o.m.) with the same antimicrobial agents (LAC: 60 patients). Cure of infection was assessed by a 13C‐urea breath test 1 month after completion of treatment.

Results

: One patient in the EAC group and two in the LAC group did not complete therapy because of an adverse event, and three did not undergo the 13C‐urea breath test. Cure rates for the intention‐to‐treat, all‐patients‐treated and per protocol analysis in the EAC group were 85%, 86% and 88%, respectively, whereas those in the LAC group were 85%, 88% and 91%. There were no significant differences in cure rate or adverse events between the two regimens.

Conclusions

: Ecabet sodium in combination with amoxicillin and clarithromycin is as effective as lansoprazole‐based eradication therapy for H. pylori.
Acute cholangitis—predictive factors for emergency ERCP
Authors: Hui C.‐K. , Lai K.‐C. , Yuen M.‐F. , Ng M. , Lai C.‐L. , Lam S.‐K.
Published: March 2003

Background:

Acute cholangitis varies in severity from a mild form to severe cases which require urgent biliary decompression.

Aim:

This study was undertaken in order to develop a prognostic scoring system that can be used to predict which patients are likely to require emergency endoscopic retrograde cholangiopancreatogram (ERCP) upon admission.

Methods:

This is a prospective study of 142 consecutive patients with acute cholangitis. Emergency ERCP was performed in patients who did not respond to medical therapy.

Results:

Thirty‐one patients (21.8%) required emergency ERCP. A maximum heart rate of more than 100/min, albumin of less than 30 g/L, bilirubin of more than 50 μmol/L and prothrombin time of more than 14 s on admission were associated with failure of medical treatment and the need for emergency ERCP (P=0.001, < 0.001, 0.006 and 0.004, respectively). By using these four factors in a scoring system, 50.7% of those with a score of one or more required emergency ERCP compared with 1.5% of those with none of the four risk factors (P < 0.001). This scoring system has a sensitivity of 96.8% and a specificity of 59.6%.

Conclusions:

As patients with severe acute cholangitis show a higher mortality, we recommend that emergency ERCP be performed in patients with one or more of the four prognostic factors.
The pharmacological treatment of acute colonic pseudo‐obstruction
Authors: De Giorgio R. , Barbara G. , Stanghellini V. , Tonini M. , Vasina V. , Cola B. , Corinaldesi R. , Biagi G. , De Ponti F.
Published: March 2003

Acute colonic pseudo‐obstruction (Ogilvie’s syndrome) can be defined as a clinical condition with symptoms, signs and radiological appearance of acute large bowel obstruction unrelated to any mechanical cause. Recent reports of the efficacy of cholinesterase inhibitors in relieving acute colonic pseudo‐obstruction have fuelled interest in the pharmacological treatment of this condition. The aim of the present review is to outline current perspectives in the pharmacological treatment of patients with acute colonic pseudo‐obstruction.

The best documented pharmacological treatment of Ogilvie’s syndrome is intravenous neostigmine (2–2.5 mg), which leads to quick decompression in a significant proportion of patients after a single infusion. However, the search for new colokinetic agents for the treatment of lower gut motor disorders has made available a number of drugs that may also be therapeutic options for Ogilvie’s syndrome. Among these agents, the potential of 5‐hydroxytryptamine‐4 receptor agonists and motilin receptor agonists is discussed.
The immunoregulatory cytokine interleukin‐10—a therapy for Crohn’s disease?
Authors: Lindsay J. O. , Hodgson H. J. F.
Published: March 2003

The gastrointestinal tract serves as a barrier between the host and the vast array of foreign antigens that are contained within its lumen. The mucosal immune system must balance two opposing functions: to mount an immune response to pathogens, whilst maintaining tolerance to antigens derived from commensal bacteria and food. This balance is regulated by both cellular interactions and the release of soluble mediators called cytokines. Diseases such as ulcerative colitis and Crohn’s disease are characterized by alterations in the balance of pro‐inflammatory and regulatory cytokines.

Interleukin‐10 is a regulatory cytokine which inhibits both antigen presentation and subsequent pro‐inflammatory cytokine release. In addition, there is evidence that it promotes the formation of antigen‐specific regulatory T‐cell clones. The pivotal role played by interleukin‐10 within the mucosal immune system is demonstrated both by the chronic ileocolitis that develops in gene‐targeted interleukin‐10 knock‐out mice, and by its therapeutic efficacy in several animal models of colitis.

However, trials of daily systemic interleukin‐10 administration in patients with Crohn’s disease have reported only a modest clinical response. Advances in the analysis of functional polymorphisms in the interleukin‐10 gene may allow therapy to be targeted to patients who will respond. Finally, therapeutic strategies utilizing gene therapy may enhance mucosal delivery and increase therapeutic response.
A study of the effects of indometacin on liver mitochondria from rats, mice and humans
Authors: Jacob M. , Bjarnason I. , Rafi S. , Wrigglesworth J. , Simpson R. J.
Published: March 2003

Background:

A part of the mechanism of the gastrointestinal toxicity exhibited by non‐steroidal anti‐inflammatory drugs is believed to involve the uncoupling of mitochondrial oxidative phosphorylation. Most previous uncoupling studies have used rat liver mitochondria. There is little information on the effects of the drugs on mitochondria from other species.

Aim:

To study the effect of indometacin on isolated liver mitochondria from rats, mice and humans.

Methods:

We studied the effects of indometacin on respiration and adenosine triphosphate synthesis by isolated liver mitochondria from rats, mice and humans. Its effects were compared with those of dinitrophenol, a classical uncoupler.

Results:

Indometacin uncoupled oxidative phosphorylation at low concentrations (P < 0.05) and inhibited respiration at high concentrations (P < 0.01) in all three species. Adenosine triphosphate synthesis was, however, more sensitive to dinitrophenol or indometacin at lower concentrations in mouse and human compared to rat liver mitochondria (P < 0.05).

Conclusions:

The current study shows that indometacin acts as an inhibitory uncoupler in human mitochondria. It also demonstrates that the responses of rat, mouse and human mitochondria to indometacin are broadly similar.
A 3.0‐kDa low molecular weight heparin promotes gastric ulcer healing in rats
Authors: Li Y. , Shin V. Y. , Cheuk C. Y. , Liu E. S. L. , Cho C. H.
Published: March 2003

Background:

Previous studies have shown that intragastric administration of unfractionated heparin enhances gastric ulcer healing in rats. As the large molecule of heparin may be partially degraded in the upper gastrointestinal tract, it is likely that fragments of heparin, derived from the unfractionated parent compound, are involved in the anti‐ulcer action in the stomach. Therefore, it is possible that low molecular weight heparin may have a similar ulcer healing effect.

Methods:

Male Sprague–Dawley rats with acetic acid‐induced gastric ulcers were given a 3.0‐kDa low molecular weight heparin (0.6–6.0 mg/kg) intravenously or intragastrically once daily for 4 days. Ulcer healing, mucosal histological changes, angiogenesis and gastric mucus production both in vivo and in vitro were determined. The bleeding time was measured to indicate the anticoagulation activity.

Results:

Both intravenous and intragastric low molecular weight heparin dose dependently accelerated gastric ulcer healing, which was accompanied by a significant increase in mucosal regeneration and proliferation, angiogenesis and mucus content in the stomach. The drug also stimulated the mucus production in MKN‐28 cells. Drug administration by either route did not alter the bleeding time in rats.

Conclusions:

A 3.0‐kDa low molecular weight heparin possesses an ulcer healing effect similar to that of unfractionated heparin in the stomach of the rat. This smaller molecular drug is superior to the unfractionated form, does not affect the coagulation activity and may show better absorption in the gastrointestinal tract.
Spontaneous bacterial peritonitis—diagnosis, treatment and prevention
Authors: Mowat C. , Stanley A. J.
Published: March 2003

Spontaneous bacterial peritonitis is a serious complication of cirrhotic ascites, arising most frequently in those with advanced liver disease. Its development leads to a further reduction in the effective arterial blood volume, and it has a mortality rate equivalent to that of a variceal bleed. However, problems remain with regard to the identification and optimal treatment of spontaneous bacterial peritonitis. Several important studies and consensus documents on the condition have recently been published which aid in the identification of patients at risk and help to guide therapy.

In this review, we discuss these publications and address the issues of diagnosis, treatment and both primary and secondary prophylaxis of spontaneous bacterial peritonitis in the light of recent data.
Impact of intravenous omeprazole on Helicobacter pylori eradication by triple therapy in patients with peptic ulcer bleeding
Authors: Sheu B.‐S. , Chi C.‐H. , Huang C.‐C. , Kao A.‐W. , Wang Y.‐L. , Yang H.‐B.
Published: March 2003

Aim:

To test the impact of intravenous omeprazole on Helicobacter pylori eradication for bleeding peptic ulcers.

Methods:

A total of 175 H. pylori‐infected patients with bleeding peptic ulcers were randomized into either an omeprazole group or a ranitidine group, receiving intravenous omeprazole or ranitidine for 3 days after endoscopy. Afterwards, 1‐week triple therapy was used to eradicate H. pylori for both groups. Six weeks later, either a 13C‐urea breath test or follow‐up endoscopy was performed to assess the success of H. pylori eradication.

Results:

The rebleeding rate was lower in the omeprazole group vs. the ranitidine group (6% vs. 17%, P < 0.05). The H. pylori eradication rate was higher in the omeprazole group (intention‐to‐treat analysis: 83% vs. 66%, P < 0.05; per protocol analysis: 93% vs. 80%, P < 0.05). For patients with duodenal ulcers, the per protocol H. pylori eradication rate of the omeprazole group was higher than that of the ranitidine group (93% vs. 73%, P < 0.05).

Conclusions:

Intravenous omeprazole can decrease the risk of rebleeding of peptic ulcers. For duodenal ulcers, in particular, intravenous omeprazole may even improve the H. pylori eradication rate of the subsequent triple therapy.
Medical decision analysis of endoscopic surveillance of Barrett’s oesophagus to prevent oesophageal adenocarcinoma
Authors: Sonnenberg A. , Soni A. , Sampliner R. E.
Published: March 2003

Background:

Barrett’s oesophagus is associated with an increased risk of the development of oesophageal adenocarcinoma. Endoscopic surveillance every 2–5 years has been recommended to prevent death from adenocarcinoma.

Aim:

To assess the cost‐effectiveness of this strategy.

Methods:

The incremental cost‐effectiveness of surveillance (as compared to no surveillance) was analysed with a computer model of a Markov process.

Results:

Compared to no surveillance, the incremental cost‐effectiveness of bi‐annual endoscopy is $16 695 per life‐year saved. Surveillance is less cost‐effective if the incidence rate of oesophageal adenocarcinoma is low and the 5‐year survival rate is high. For surveillance to be cost‐effective, there should be little reduction in health‐related quality of life following surgical oesophagectomy to prevent death. Moreover, endoscopic surveillance and oesophagectomy need to be efficacious in reliably diagnosing high‐grade dysplasia and preventing deaths from cancer. If such ideal conditions of surveillance are not met, the cost per life‐year saved could rise five‐fold.

Conclusions:

Endoscopic surveillance of patients with Barrett’s oesophagus may be a cost‐effective means to prevent death from oesophageal adenocarcinoma.
Mono, dual and triple moxifloxacin‐based therapies for Helicobacter pylori eradication
Authors: Di Caro S. , Ojetti V. , Zocco M. A. , Cremonini F. , Bartolozzi F. , Candelli M. , Lupascu A. , Nista E. C. , Cammarota G. , Gasbarrini A.
Published: March 2003

Background:

Moxifloxacin is a broad spectrum fluoroquinolone with single daily administration, currently used, above all, for respiratory tract infections.

Aim:

To compare the efficacy of different 1‐week moxifloxacin‐based Helicobacter pylori eradication regimens.

Methods:

One hundred and twenty H. pylori‐positive subjects were randomized to receive moxifloxacin (400 mg/day), moxifloxacin (400 mg/day) and lansoprazole (30 mg/day) or moxifloxacin (400 mg/day), lansoprazole (30 mg/day) and clarithromycin (500 mg b.d.). H. pylori status was reassessed 6 weeks after the end of therapy, and both intention‐to‐treat and per protocol analyses were performed.

Results:

One hundred and nineteen of the 120 patients completed the study. H. pylori eradication was achieved in 22.5% of patients treated with moxifloxacin, in 33.3% of subjects treated with moxifloxacin and lansoprazole and in 90% of patients treated with moxifloxacin, clarithromycin and lansoprazole.

Conclusions:

Mono and dual moxifloxacin‐based therapies are not acceptable for H. pylori eradication; conversely, moxifloxacin‐based triple therapy may be considered as a new, effective, first‐line therapy option.
Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis
Authors: Calvet X. , Sanfeliu I. , Musulen E. , Mas P. , Dalmau B. , Gil M. , Bella M. R. , Campo R. , Brullet E. , Valero C. , Puig J.
Published: March 2003

Background : Helicobacter pylori‐associated peptic ulcer is a frequent complication in cirrhotic patients and its morbidity rate is high. In spite of this, diagnostic methods for H. pylori infection have not been fully evaluated in these patients.

Aim : To evaluate H. pylori diagnostic methods in patients with liver cirrhosis.

Methods : One hundred and one cirrhotic patients were included in the study. Three antral and two corpus biopsies were obtained for rapid urease test of the antral mucosa, and Giemsa stain and immunohistochemistry were performed for both the corpus and antrum. Serology, 13C‐urea breath test and faecal H. pylori antigen determination were also carried out.

Results : Sixty‐two patients were positive and 35 were negative for H. pylori infection; four were indeterminate. The sensitivity and specificity were 90.4% and 100%, respectively, for antral histology, 100% and 100% for gastric body histology, 90.4% and 100% for antral immunohistochemistry, 96.2% and 96.7% for body immunochemistry, 85.7% and 97% for rapid urease test, 83.6% and 55.9% for serology, 96.4% and 97.1% for 13C‐urea breath test and 75.4% and 94.1% for faecal antigen.

Conclusion : The most reliable tests for H. pylori infection in cirrhotic patients were the 13C‐urea breath test and gastric body histology.
Magnesium chloride slows gastric emptying, but does not affect digestive functions
Authors: Geboes K. P. , Maes B. , Luypaerts A. , Evenepoel P. , Rutgeerts P. , Ghoos Y. , Geypens B.
Published: March 2003

Background : An inverse relationship has been established between serum magnesium and serum lipid levels. By means of breath tests, we tested the hypothesis that magnesium inhibits intraluminal lipid digestion and subsequently causes changes in lipid metabolism. We also investigated the influence of the administration of magnesium chloride on protein digestion and gastric emptying.

Methods : Five healthy volunteers performed simultaneous breath tests for gastric emptying and intraluminal lipid digestion, and six others for gastric emptying and protein digestion. Each test was performed in basal conditions and after the intake of 800 mg of magnesium chloride dissolved in water. Breath samples were taken at regular time intervals and analysed for 13CO2 and 14CO2 enrichment in order to calculate gastric emptying and lipid and protein digestion rates.

Results : The oral administration of a single dose of magnesium chloride resulted in a diminished rate of intraluminal lipid and protein digestion. The most pronounced effect of magnesium chloride, however, was a decreased gastric emptying rate of both test meals. After correction for gastric emptying, no differences were noted in intraluminal lipid or protein digestion. Therefore, the lower lipid levels noted after magnesium supplementation are unlikely to be the result of altered lipid assimilation.

Conclusion : Magnesium chloride slows gastric emptying but does not influence lipid digestion.
Consensus report: clinical perspectives, mechanisms, diagnosis and management of irritable bowel syndrome
Authors: Camilleri M. , Heading R. C. , Thompson W. G.
Published: March 2003

This consensus document reviews the current status of the epidemiology, social impact, patient quality of life, pathophysiology, diagnosis and treatment of irritable bowel syndrome. Current evidence suggests that two major mechanisms may interact in irritable bowel syndrome: altered gastrointestinal motility and increased sensitivity of the intestine. However, other factors, such as psychosocial factors, intake of food and prior infection, may contribute to its development. Management of patients is based on a positive diagnosis of the symptom complex, careful history and physical examination to exclude ‘red flags’ as risk factors for organic disease, and, if indicated, investigations to exclude other disorders. Therapeutic choices include dietary fibre for constipation, opioid agents for diarrhoea and low‐dose antidepressants or infrequent use of antispasmodics for pain, although the evidence basis for efficacy is limited or in some cases absent. Psychotherapy and hypnotherapy are the subject of ongoing study. Treatment should be tailored to patient needs and fears. Novel therapies are emerging, and drugs acting on serotonin receptors have proven efficacy and a scientific rationale and, if approved, should be useful in the overall management of patients with irritable bowel syndrome. Patient and physician education, early identification of psychosocial issues and better therapies are important strategies to reduce the suffering and societal cost of irritable bowel syndrome.
Lactose — a potential prebiotic
Authors: Szilagyi A.
Published: March 2003

Lactose maldigestion, which affects a large majority of the world's population, has been mostly linked with uncomfortable symptoms. In addition, dairy consumption is variably blamed or recommended for a number of ill effects. There is, however, emerging evidence that certain lactic acid‐producing bacteria, which selectively consume prebiotics, may be beneficial against some lower intestinal diseases. Lactose maldigestion and lactose should perhaps be re‐evaluated as a potential provider of such a prebiotic. This historical and observational review discusses lactose and argues the opinion that it has prebiotic potential. Moreover, in maldigesters, natural ingestion or lack thereof may be relevant in the pathogenesis of diseases such as colorectal cancer and inflammatory bowel diseases.
Meta‐analysis: combination therapy with interferon‐α 2a/2b and ribavirin for patients with chronic hepatitis C previously non‐responsive to interferon
Authors: Miguel R. San , Guillén F. , Cabasés J. M. , Buti M.
Published: March 2003

Background : The efficacy of interferon‐α plus ribavirin treatment for patients not responding to interferon monotherapy is not well established.

Aim : To assess the efficacy and safety of combination therapy with interferon‐α 2a/2b plus ribavirin by performing a meta‐analysis of randomized clinical trials.

Methods : A systematic search of electronic databases for randomized clinical trials of interferon‐α 2a/2b plus ribavirin was conducted independently by two investigators. Data abstraction was performed. The primary end‐point was a sustained virological response. Estimates of the common odds ratio were calculated using a random effects model.

Results : Of the 127 identified studies, 46 were considered for evaluation and 10 were included (1728 patients). The pooled sustained virological response was 12.6% (95% CI, 9.5–16.3%) for combination therapy vs. 2% (95% CI, 0.9–4.0%) for interferon monotherapy, with a common odds ratio of 5.49. Higher doses of interferon, a longer duration of therapy (48 weeks) and genotypes other than 1 and 4 were associated with an improvement in response. More side‐effects and discontinuations were observed with combination therapy than with interferon monotherapy.

Conclusions : Non‐responders to interferon may benefit from re‐treatment with combination therapy, especially from a 48‐week regimen.
Alimentary diseases in the poor and middle class in London 1773–1815, and in New York poor 1797–1818
Authors: Baron J. H. , Sonnenberg A.
Published: March 2003

Background : Although dyspepsia has been described for thousands of years, few studies have analysed its incidence before the 19th century when peptic ulcer first became a major dyspepsia‐producing disease.

Methods : The incidence of alimentary disease around 1800 was examined in three private practices for the fee‐paying middle class and in five public dispensaries for the poor in London, as well as in one dispensary in New York.

Results : The proportions of attendances for alimentary disorders were identical, 16%, in each of the three groups. Diarrhoea and dysentery were twice as common in the London dispensary than in private practice, presumably because of poor sanitation. Dyspepsia showed a similar incidence in the London dispensary and private practice, but was only half as common in New York. Worms were three times more common in dispensary patients in New York than in London. The incidence of diarrhoea and dyspepsia indicated no significant time trends over 43 years. None of the alimentary causes of death showed peptic ulcer at necropsy, and both haematemesis and intestinal haemorrhage were rare.

Conclusions : Around 1800, the infrequent deaths from alimentary conditions suggested that the ulcer epidemic had not yet started. Instead, it is probable that the dyspepsia was similar to the non‐ulcer dyspepsia of today.
A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis
Authors: Ginsburg P. M. , Ehrenpreis E. D.
Published: March 2003

Background : Mesenteric panniculitis is a rare condition with no standard therapy.

Aim : To assess the safety and efficacy of thalidomide for the treatment of patients with symptomatic mesenteric panniculitis using a newly established clinical disease activity index (Mesenteric Panniculitis Subjective Assessment Score).

Methods : In an open‐label pilot study, five patients with symptomatic mesenteric panniculitis received oral thalidomide, 200 mg nightly, for 12 weeks. The primary end‐point was a reduction in the Mesenteric Panniculitis Subjective Assessment Score by ≥ 20% at 12 weeks or complete remission (absence of symptoms).

Results : Four (80%) of the five patients responded. The median Mesenteric Panniculitis Subjective Assessment Score at baseline was 39 and at week 12 was 25 (average decrease of 44%). One patient achieved complete remission by week 4, which was sustained. At 12 weeks, three (75%) patients experienced a global response, five (100%) patients had a ≥ 20% (range, 29–98%) decrease in erythrocyte sedimentation rate and three (75%) patients had a ≥ 20% (range, 61–93%) decrease in C‐reactive protein. Abdomino‐pelvic computed tomography scans were unchanged in all five patients. There were no serious adverse events.

Conclusions : Thalidomide is safe, well tolerated and efficacious in the treatment of some patients with symptomatic mesenteric panniculitis. Further study is indicated.
Cost‐effectiveness in Canada of intravenous proton pump inhibitors for all patients presenting with acute upper gastrointestinal bleeding
Authors: Enns R. A. , Gagnon Y. M. , Rioux K. P. , Levy A. R.
Published: March 2003

Background: The administration of proton pump inhibitors intravenously after endoscopic treatment of peptic ulcers significantly reduces the recurrence of bleeding.

Aim: To evaluate the incremental cost‐effectiveness in Canada of intravenous proton pump inhibitor before endoscopic therapy to patients presenting with acute upper gastrointestinal bleeding, compared with endoscopic treatment alone.

Methods: From a third‐party payer perspective, we modelled the costs and effectiveness over 60 days of the two approaches using decision analysis. The probabilities of various outcomes, such as re‐bleeding and the need for surgery, were taken from the published literature. We included the costs of intravenous proton pump inhibitor, therapeutic endoscopy, surgical procedures and hospitalizations, all expressed in 2001 Canadian dollars.

Results: In a hypothetical cohort of 1000 patients, the intravenous proton pump inhibitor approach resulted in mean savings of $20 700 with 37 re‐bleeding episodes averted. The investigation of uncertainty resulted in a likelihood of intravenous proton pump inhibitor being cost‐effective of at least 0.73.

Conclusion: It is common in Canada to administer intravenous proton pump inhibitors to patients with upper gastrointestinal bleeding even before endoscopic confirmation of bleeding peptic ulcers. Our results suggest that this approach has a high likelihood of being cost‐effective.
Patients with refractory Crohn's disease or ulcerative colitis respond to dehydroepiandrosterone: a pilot study
Authors: Andus T. , Klebl F. , Rogler G. , Bregenzer N. , Schölmerich J. , Straub R. H.
Published: March 2003

Background : Dehydroepiandrosterone is a steroid hormone used as an ‘over‐the‐counter’ drug in the USA. Treatment with dehydroepiandrosterone was effective in randomized controlled trials in patients with systemic lupus erythematosus. Dehydroepiandrosterone sulphate concentrations are decreased in patients with inflammatory bowel disease. Dehydroepiandrosterone inhibits nuclear factor‐κB and the secretion of interleukin‐6 and interleukin‐12 via the peroxisome proliferator‐activated receptor α.

Aim : A phase II pilot trial was started to evaluate the effect of dehydroepiandrosterone in active inflammatory bowel disease.

Methods : Twenty patients with chronic active inflammatory bowel disease [seven Crohn's disease (Crohn's disease activity index, 242 ± 51; mean ± s.d.); 13 ulcerative colitis (clinical activity index, 7.8 ± 2.1)] took 200 mg dehydroepiandrosterone per day orally for 56 days.

Results : Six of the seven patients with Crohn's disease and eight of the 13 patients with ulcerative colitis responded to treatment, with a decrease in the Crohn's disease activity index of > 70 points and a decrease in the clinical activity index of > 4 points, respectively. Six Crohn's disease patients and six ulcerative colitis patients went into remission (Crohn's disease activity index < 150; clinical activity index ≤ 4). No patient withdrew from the study because of side‐effects.

Conclusions : In a pilot study, dehydroepiandrosterone was effective and safe in patients with refractory Crohn's disease or ulcerative colitis. Adjustment of the dehydroepiandrosterone dosage may further improve the treatment success.
Gallstones — an increasing problem: a study of hospital admissions in England between 1989/1990 and 1999/2000
Authors: Kang J.‐Y. , Ellis C. , Majeed A. , Hoare J. , Tinto A. , Williamson R. C. N. , Tibbs C. J. , Maxwell J. D.
Published: March 2003

Background : The number of operations for cholelithiasis increased from the 1950s to the 1990s.

Aims : To determine the time trends in cholelithiasis for hospital admissions, operations and in‐hospital case fatalities in England between 1989/1990 and 1999/2000, and population mortality rates between 1979 and 1999.

Methods : Hospital Episode Statistics for admissions were obtained from the Department of Health and mortality data were obtained from the Office for National Statistics.

Results : Between 1989/1990 and 1999/2000, age‐standardized hospital admission rates for cholelithiasis increased by 30% for males and 64% for females. The proportions of admissions undergoing an operation declined progressively over the study period. In 1999/2000, the frequency of operation was approximately 50–60% for most age groups, but decreased progressively with advancing age at ≥ 65 years. The proportions of admissions undergoing therapeutic endoscopy increased several‐fold, especially amongst older individuals. Case fatality rates declined. Mortality rates declined from 1979 to 1988, but showed no further change from 1989 to 1999.

Conclusions : There has been a steady increase in admission rates for cholelithiasis over the study period. Whilst the frequency of operation has declined, the proportion of patients undergoing therapeutic endoscopy has increased.
The intubating laryngeal mask
Authors: Parr M. J. A. , Gregory M. , Baskett P. J. F.
Published: March 2003

The use of the intubating laryngeal mask in three patients is described. In two patients for whom tracheal intubation using traditional techniques had failed, the intubating laryngeal mask was used to achieve successful tracheal intubation. The trachea of one of these patients was subsequently re‐intubated for a second procedure using the same technique. A third patient with a cervical spine fracture whose trachea was electively intubated using the intubating laryngeal mask is also presented.
The best view at laryngoscopy using the McCoy laryngoscope with and without cricoid pressure
Authors: Randell T. , Määttänen M. , Kyttä J.
Published: March 2003

The best view obtained by levering the tip of the McCoy laryngoscope blade with or without modified cricoid pressure was studied in 100 patients presenting for general surgery. The airway was assessed pre‐operatively (Mallampati score, thyromental distance, mouth opening, protrusion of the jaw and weight) in an attempt to identify the patients who might benefit from the use of the McCoy laryngoscope. The vocal cords were visible at laryngoscopy with the blade in the neutral position in 32 cases. In the 68 remaining patients the vocal cords were partly visible in 48. The epiglottis only was seen in 18 patients and in two not even the epiglottis could be visualised. Elevation of the blade or modified cricoid pressure improved the view in 38/68 cases and 57/68 cases, respectively (p < 0.001, Wilcoxon signed rank). Using our method of pre‐operative assessment we were unable to identify those patients who might benefit from either manipulation.
EMLA patch for spinal punctureA comparison of EMLA patch with lignocaine infiltration and placebo patch
Authors: Koscielniak‐Nielsen Z. , Hesselbjerg L. , Brushøj J. , Britt Jensen M. , Stens Pedersen H.
Published: March 2003

We have prospectively assessed pain and anxiety of spinal puncture in 180 adult patients randomly allocated to one of three equal groups. On the morning of surgery group 1 had an EMLA patch, whereas group 2 and 3 had placebo patches. Group 2 also had infiltration analgesia with 2 ml lignocaine 2% with adrenaline, immediately before the block. Spinal anaesthesia was performed with 25 gauge sharp needles without introducer or 25,27 gauge blunt needles with 20,22 gauge introducers. Patients assessed the spinal puncture pain on a 10‐cm visual analogue scale immediately after removal of the needle. Pain scores were significantly lower in group 1 (EMLA), median 0.75, than in group 2 (placebo, infiltration analgesia), median 1.75, and group 3 (placebo), median 1.80, p < 0.0001. Pain intensity was less than expected in more patients in the EMLA group than in the other two groups, p = 0.034. However, the decision to accept/reject spinal anaesthesia in the future was not influenced by the pain of lumbar puncture. We conclude that application of an EMLA patch is a simple and effective method to provide adequate analgesia for spinal puncture, which also helps to allay patients' fears of spinal anaesthesia.