bluuebunny/crossref_metadata_2025 huggingface dataset:
Review article: measurement of gall‐bladder motor function in health and disease
Authors: Jazrawi R. P.
Published: March 2003

Normal gall‐bladder (GB) motor function plays an important role in the enterohepatic circulation of bile acids in health, and abnormal GB motor function has serious clinical implications. The old concept that the GB empties gradually during meals and fills between meals is still believed by many. This paper describes the techniques used in the measurement of GB motor function and discusses the information provided by these techniques in health and disease.
Tackling the ‘dyspeptic problem’
Authors: McColl K.E.L.
Published: March 2003

Dyspepsia, and the issue of Helicobacter pylori status, can present significant controversies in clinical management. Both primary physicians and gastroenterologists should be aware of options for the treatment of patients with dyspepsia. This article reviews information gathered about the eradication of H. pylori in non‐ulcer dyspepsia (NUD), therapy for NUD not associated with H. pylori, and whether H. pylori testing should replace routine endoscopy in uncomplicated dyspepsia. The benefits of eradicating H. pylori in NUD include superior, cost‐effective resolution of symptoms, compared to placebo; reduction of ulcer and gastric cancer risk; and removal of risk of certain adverse effects should long‐term proton pump inhibitor therapy become necessary. In patients with normal endoscopy and no evidence of H. pylori, proton pump inhibitor therapy is superior to placebo in controlling symptoms. This benefit is confined to patients with symptoms and/or oesophageal pH‐metry indicative of GORD. Non‐invasive H. pylori testing may be appropriate for younger dyspeptic patients with no alarm symptoms who are not taking non‐steroidal anti‐inflammatory drugs (NSAIDs). In conclusion, eradication of H. pylori is advisable in patients with NUD. Proton pump inhibitor therapy is superior to placebo in NUD patients without H. pylori, especially if symptoms indicate GORD. H. pylori testing may replace endoscopy in young dyspeptics with no alarm symptoms or NSAID use.
The prescribing of acid suppressants prior to the endoscopic diagnosis of Barrett’s oesophagus and oesophagitis
Authors: Todd J. A. , Weston T. , Macdonald T. M. , Johnston D. A. , Dillon J. F.
Published: March 2003

Background:

There has been a dramatic rise in incidences of Barrett’s oesophagus and oesophageal adenocarcinoma. It has been suggested that the introduction and use of acid suppression therapy may be a factor in the rising incidences of Barrett’s oesophagus and oesophageal adenocarcinoma.

Methods:

This was a record linkage study, using a prescribing database and an endoscopy database. Patients who had undergone their first endoscopy during the period 1992–1995 and received the diagnosis of Barrett’s oesophagus or oesophagitis were identified. The prescribing of acid suppressants was compared for the 3 years prior to endoscopy, between those with Barrett’s oesophagus and those with oesophagitis.

Results:

There was no significant difference between the Barrett’s patients and the oesophagitis patients in the proportion that had been exposed to acid suppression therapy (53.4% vs. 51.7%, P=0.704). The mean number of days of prescribing among those who had been exposed to acid suppression therapy was higher in the Barrett’s group (340.5 vs. 237.0 days, P=0.001).

Conclusions:

Patients with Barrett’s oesophagus have received more acid suppressant therapy prior to diagnosis. The reasons for this are not clear. However, 46.6% of Barrett’s patients have not been exposed to acid suppressant therapy.
There are some benefits for eradicating Helicobacter pylori in patients with non‐ulcer dyspepsia
Authors: Des Varannes S. Bruley , Fléjou J. F. , Colin R. , Zaïm M. , Meunier A. , Bidaut‐Mazel C.
Published: March 2003

Background

: The relationship between Helicobacter pylori infection and non‐ulcer dyspepsia is not established.

Aim

: To determine whether eradication of H. pylori might be of benefit in non‐ulcer dyspepsia patients.

Methods

: We randomly assigned 129 H. pylori infected patients with severe epigastric pain, without gastro‐oesophageal reflux symptoms, to receive twice daily treatment with 300 mg of ranitidine, 1000 mg of amoxicillin, and 500 mg of clarithromycin for 7 days and 124 such patients to receive identical‐appearing placebos.

Results

: Treatment was successful (decrease of symptoms at 12 months) in 62% of patients in the active‐treatment group and in 60% of the placebo group (N.S.). At 12 months, the rate of eradication of H. pylori was 69% in the active‐treatment group and 18% in the placebo group (P < 0.001). Complete relief of symptoms occurred significantly more frequently in patients on the active treatment (43%) than in placebo‐treated patients (31%, P=0.048). Within the active‐treatment group, therapeutic success was significantly more frequent in the non‐infected patients (84% vs. 64%, P=0.04).

Conclusions

: Although eradicating H. pylori is not likely to relieve symptoms in the majority of patients with non‐ulcer dyspepsia, a small proportion of H. pylori‐infected patients may benefit from eradication treatment.
Efficacy of oral pancreatic enzyme therapy for the treatment of fat malabsorption in HIV‐infected patients
Authors: Carroccio A. , Guarino A. , Zuin G. , Verghi F. , Berni Canani R. , Fontana M. , Bruzzese E. , Montalto G. , Notarbartolo A.
Published: March 2003

Background:

Nutrient malabsorption is a negative prognostic factor in acquired immunodeficiency syndrome and recent studies have shown that pancreatic insufficiency is a codetermining factor of malabsorption.

Aims:

To evaluate the effectiveness of open‐label oral pancreatic enzyme supplementation therapy in acquired immunodeficiency syndrome patients with fat malabsorption.

Patients and methods:

Twenty‐four consecutive patients with human immunodeficiency virus infection and fat malabsorption were recruited (11 males, 13 females; median age, 9.1 years). Faecal fat loss was evaluated by steatocrit assay at entry to the study (T‐0), after 2 weeks (T‐1) without pancreatic enzyme treatment and after a further 2 weeks (T‐2) of treatment with pancreatic extracts (Creon 10 000 at a dose of 1000 units of lipase per gram of ingested dietary fat). Faecal elastase‐1 and chymotrypsin were assayed at entry.

Results:

Six patients (25%) had abnormally low elastase‐1 and/or chymotrypsin faecal concentration. In all patients, steatocrit values were elevated at both T‐0 and T‐1. Five patients proved intolerant to pancreatic enzyme treatment because of the onset of abdominal pain, and therapy was discontinued. In the 19 patients who concluded the study, steatocrit values during pancreatic enzyme treatment (T‐2) were significantly lower than at entry (P < 0.0001). At T‐2, in eight of 19 patients, steatocrit values were within the normal limit and the frequency of cases cured or improved on pancreatic enzyme therapy (at T‐2) was significantly higher than that observed during the previous study period without enzyme treatment (T‐1) (P < 0.01). A positive significant correlation was found between steatocrit values at entry and the Centers for Disease Control class (P < 0.0005); also, the decrease in steatocrit values during pancreatic enzyme therapy (difference between steatocrit value at T‐2 and steatocrit value at T‐0) positively correlated with the Centers for Disease Control class (P < 0.05).

Conclusions:

This pilot, open‐label study showed that pancreatic enzyme supplementation therapy is highly effective in reducing faecal fat loss in human immunodeficiency virus‐infected patients with nutrient malabsorption. Further double‐blind studies must be undertaken to verify these results and, if they are confirmed, pancreatic enzymes can be added to our weapons in the fight against human immunodeficiency virus‐associated nutrient malabsorption.
Heparin and low‐molecular‐weight heparin (enoxaparin) significantly ameliorate experimental colitis in rats
Authors: Dotan I. , Hershkoviz R. , Karmeli F. , Brazowski E. , Peled Y. , Rachmilewitz D. , Halpern Z.
Published: March 2003

Background and aims:

The anticoagulants, unfractionated heparin and low‐molecular‐weight heparin, demonstrated anti‐inflammatory effects in animal models and in humans. Because of its dual effects, high‐dose heparin was proposed as a therapeutic modality for ulcerative colitis. We investigated whether a low dose of low‐molecular‐weight heparin—enoxaparin (Clexane, Rhône‐Poulenc Rorer, France)—ameliorates the inflammatory response in two models of experimental colitis.

Methods:

Colitis was induced in rats by intrarectal administration of dinitrobenzene sulphonic acid. Enoxaparin (40, 80 and 200 μg/kg) or unfractionated heparin (100, 200 and 400 U/kg) were administered subcutaneously immediately after the induction of damage. Enoxaparin, 80 μg/kg, was also administered after induction of colitis by intrarectal administration of iodoacetamide. Rats were sacrificed 1, 3 or 7 days after induction of injury. Colonic damage was assessed macroscopically and histologically. Mucosal prostaglandin E2 generation, myeloperoxidase and nitric oxide synthase activities and tumour necrosis factor‐α levels in blood were determined.

Results:

Enoxaparin and heparin significantly ameliorated the severity of dinitrobenzene sulphonic acid‐ and iodoacetamide‐induced colitis as demonstrated by a decrease in mucosal lesion area, colonic weight and mucosal myeloperoxidase and nitric oxide synthase activities. The dose–response curve had a bell‐shaped configuration: enoxaparin, 80 μg/kg, and unfractionated heparin, 200 U/kg, were the optimal doses.

Conclusions:

Low‐dose enoxaparin and unfractionated heparin ameliorate the severity of experimental colitis. This effect is related to their anti‐inflammatory rather than anticoagulant properties.
Acid suppression in healthy subjects following lansoprazole or pantoprazole
Authors: Huang J.‐Q. , Goldwater D. R. , Thomson A. B. R. , Appelman S. A. , Sridhar S. , James C. F. , Chiu Y.‐L. , Pilmer B. L. , Keith R. G. , Hunt R. H.
Published: March 2003

Aim:

To compare the effect of lansoprazole, 30 mg once daily, with that of pantoprazole, 40 mg once daily, for the inhibition of gastric acid secretion.

Methods:

Two randomized, single‐blind, two‐way, crossover studies were conducted in 74 healthy male volunteers. Lansoprazole, 30 mg, or pantoprazole, 40 mg, was administered once daily for five consecutive days with at least a 2‐week washout period between regimens. Ambulatory 24‐h intragastric pH was recorded at baseline and on days 1 and 5 of each crossover treatment period.

Results:

On day 1 in both studies, lansoprazole, 30 mg, produced significantly higher mean 24‐h intragastric pH values when compared to pantoprazole, 40 mg (3.78 vs. 3.08, P < 0.001, and 3.97 vs. 3.20, P < 0.001, in the first and second studies, respectively). In both studies, lansoprazole, 30 mg, produced significantly greater proportions of time that the intragastric pH was above 3, 4 and 5 when compared with pantoprazole, 40 mg (P < 0.005 in all comparisons). By treatment day 5 in the first study, lansoprazole, 30 mg, continued to produce a higher mean 24‐h intragastric pH (4.15 vs. 3.91, P=0.014) and a significantly greater percentage of time that the intragastric pH was above 4 (63% vs. 56%, P=0.017) and 5 (41% vs. 30%, P < 0.001) when compared with pantoprazole, 40 mg. In the second study, the effects on intragastric pH were comparable between the two treatment groups. Headache was the most commonly reported adverse experience (nine lansoprazole‐treated subjects, seven in the first study and two in the second study; six pantoprazole‐treated subjects, five in the first study and one in the second study).

Conclusions:

Lansoprazole, 30 mg once daily, produces a faster onset and greater degree of acid inhibition than pantoprazole, 40 mg once daily. The implications for these differences on symptom relief and healing of erosive oesophagitis should be explored.
The cost‐effectiveness of population Helicobacter pylori screening and treatment: a Markov model using economic data from a randomized controlled trial
Authors: Mason J. , Axon A. T. R. , Forman D. , Duffett S. , Drummond M. , Crocombe W. , Feltbower R. , Mason S. , Brown J. , Moayyedi P. ,   (ON BEHALF OF THE LEEDS HELP STUDY GROUP)
Published: March 2003

Background:

Economic models have suggested that population Helicobacter pylori screening and treatment may be a cost‐effective method of reducing mortality from gastric cancer. These models are conservative as they do not consider that the programme may reduce health service peptic ulcer and other dyspepsia costs. We have evaluated the economic impact of population H. pylori screening and treatment over 2 years in a randomized controlled trial and have incorporated the results into an economic model exploring the impact of H. pylori eradication on peptic ulcer disease and gastric cancer.

Methods:

Subjects between the ages of 40 and 49 years were randomly invited to attend their local primary care centre. H. pylori status was evaluated by 13C‐urea breath test and infected individuals were randomized to receive omeprazole, 20 mg b.d., clarithromycin, 250 mg b.d., and tinidazole, 500 mg b.d., for 7 days or identical placebos. Economic data on health service costs for dyspepsia were obtained from a primary care note review for the 2 years following randomization. These data were incorporated into a Markov model comparing population H. pylori screening and treatment with no intervention.

Results:

A total of 2329 of 8407 subjects were H. pylori positive: 1161 were randomized to receive eradication therapy and 1163 to receive placebo. The cost difference favoured the intervention group 2 years after randomization, but this did not reach statistical significance (£11.42 per subject cost saving; 95% confidence interval, £30.04 to – £7.19; P=0.23). Analysis by gender suggested a statistically significant dyspepsia cost saving in men (£27.17 per subject; 95% confidence interval, £50.01 to £4.32; P=0.02), with no benefit in women (– £4.46 per subject; 95% confidence interval, – £33.85 to £24.93). Modelling of these data suggested that population H. pylori screening and treatment for 1 000 000 45‐year‐olds would save over £6 000 000 and 1300 years of life. The programme would cost £14 200 per life year saved if the health service dyspepsia cost savings were the lower limit of the 95% confidence intervals and H. pylori eradication had only a 10% efficacy in reducing mortality from distal gastric cancer and peptic ulcer disease.

Conclusions:

Modelling suggests that population H. pylori screening and treatment are likely to be cost‐effective and could be the first cost‐neutral screening programme. This provides a further mandate for clinical trials to evaluate the efficacy of population H. pylori screening and treatment in preventing mortality from gastric cancer and peptic ulcer disease.
Dyspepsia tolerability from the patients' perspective: a comparison of celecoxib with diclofenac
Authors: Goldstein J. L. , Eisen G. M. , Burke T. A. , Peña B. M. , Lefkowith J. , Geis G. S.
Published: March 2003

Aim:

To compare celecoxib (800 mg/day, n=1997) with diclofenac (150 mg/day, n=1996) on dyspepsia‐related tolerability.

Methods:

In one of the two protocols comprising the Celecoxib Long‐Term Arthritis Safety Study, a randomized double‐blind trial, patients completed the Severity of Dyspepsia Assessment Questionnaire at baseline and at weeks 4, 13, 26 and 52 for the following three scales: Pain Intensity, Non‐Pain Symptoms and Satisfaction with Dyspepsia‐Related Health.

Results:

For the Pain Intensity scale, patients given diclofenac had significantly higher (worsening dyspepsia) mean changes, defined as follow‐up minus baseline, than patients given celecoxib (P < 0.001, at all assessments). The mean changes in the Pain Intensity scale (scale, 2–47; higher score is higher pain intensity) were 0.99 (95% confidence interval (CI): 0.50, 1.48) for celecoxib and 2.76 (95% CI: 2.28, 3.25) for diclofenac at 4 weeks. Satisfaction was superior with celecoxib at all assessments (P < 0.001). At 4 weeks, the mean changes in the Satisfaction scale (scale, 7–35; higher score is higher satisfaction) were 0.02 (95% CI: − 0.26, 0.29) for celecoxib and − 0.72 (95% CI: − 1.00, − 0.45) for diclofenac. Diclofenac patients had significantly higher Non‐Pain Symptoms at 4 weeks (P=0.005).

Conclusions:

Celecoxib, at two to four times the recommended dose, demonstrated a superior dyspepsia‐related tolerability and satisfaction compared with standard dosages of diclofenac.
Effect of cisapride on nocturnal transient lower oesophageal sphincter relaxations and nocturnal gastro‐oesophageal reflux in patients with oesophagitis: a double‐blind, placebo‐controlled study
Authors: Pehlivanov N. , Sarosiek I. , Whitman R. , Olyaee M. , McCallum R.
Published: March 2003

Aim:

To investigate the effect of cisapride, a selective 5‐hydroxytryptamine‐4 receptor agonist, on the frequency of nocturnal transient lower oesophageal sphincter relaxations and oesophageal acid exposure in patients with gastro‐oesophageal reflux disease.

Methods:

In a double‐blind, placebo‐controlled study, 10 patients with gastro‐oesophageal reflux disease (six male and four female; mean age, 54 ± 10.4 years) were randomly assigned to 5‐day treatments with cisapride, 10 mg q.d.s., or placebo, separated by a 2‐day washout period before the treatment crossover. Sleep stages, lower oesophageal sphincter tone and oesophageal pH were monitored overnight at the end of each treatment regimen. Gastric emptying was assessed before treatment.

Results:

Cisapride decreased the frequency of transient lower oesophageal sphincter relaxations during sleep (1.2 ± 0.2/h vs. 2.7 ± 0.5/h with placebo; P=0.004) and oesophageal acid exposure (17.2 ± 9.9% with placebo vs. 7.2 ± 4.2% with cisapride; P=0.4). Cisapride increased lower oesophageal sphincter tone from 12.7 ± 2.8 mmHg with placebo to 16.9 ± 3.9 mmHg (P=0.03), and decreased heartburn episodes and antacid consumption. All patients had normal gastric retention data over 4 h.

Conclusions:

In patients with gastro‐oesophageal reflux disease, cisapride significantly decreased the frequency of transient lower oesophageal sphincter relaxations during sleep and increased lower oesophageal sphincter pressure without changing gastric emptying. We hypothesize, therefore, that 5‐hydroxytryptamine‐4 mechanisms are important in the control of transient lower oesophageal sphincter relaxations in humans.
Does withholding aspirin for one week reduce the risk of post‐sphincterotomy bleeding?
Authors: Hui C.‐K. , Lai K.‐C. , Yuen M.‐F. , Wong W.‐M. , Lam S.‐K. , Lai C.‐L.
Published: March 2003

Background:

Complications of endoscopic sphincterotomy are closely related to the endoscopic technique. To date, there have been no studies to indicate that aspirin increases the risk of bleeding after endoscopic sphincterotomy.

Aim:

To compare the incidence of post‐sphincterotomy bleeding in patients with and without prior aspirin therapy.

Methods:

Eight hundred and four patients were recruited into this retrospective study: 124 patients continued to take aspirin until the day of sphincterotomy (Group 1), 116 patients had their aspirin discontinued for 1 week before sphincterotomy (Group 2) and 564 patients had never taken aspirin (Group 3). The primary outcome analysed was the incidence of post‐sphincterotomy bleeding.

Results:

Sixty‐seven patients (8.3%) developed post‐sphincterotomy bleeding. The incidences of post‐sphincterotomy bleeding in Groups 1, 2 and 3 were 9.7%, 9.5% and 3.9%, respectively. Group 1 showed significantly increased post‐sphincterotomy bleeding when compared with Group 3 (P=0.01), and the risk was also significantly increased when Group 2 was compared with Group 3 (P=0.01). However, there was no significant difference in post‐sphincterotomy bleeding between Groups 1 and 2 (P=0.96).

Conclusions:

Aspirin therapy increased the risk of post‐sphincterotomy bleeding. Withholding aspirin for 1 week before endoscopic sphincterotomy did not seem to decrease the risk of post‐sphincterotomy bleeding.
Inguinal hernia is not a sign of colon cancer: results of a prospective screening trial
Authors: Avidan B. , Sonnenberg A. , Bhatia H. , Aranha G. , Schnell T. G. , Sontag S. J.
Published: March 2003

Background:

It has been suggested that patients with an inguinal hernia harbour an increased risk for colorectal cancer.

Methods:

In a prospective clinical trial, we compared the prevalence of colonic neoplasms in 100 cases with inguinal hernia and 100 controls without inguinal hernia. The number, size, histology type, and the location of all colorectal lesions found during a screening flexible sigmoidoscopy were recorded.

Results:

Not a single case of colorectal cancer was detected in the patients with inguinal hernia pending surgical repair. In the asymptomatic control subjects, one Dukes A and one Dukes B1 colon cancer were detected. Polypectomy was performed in 15% and 17% of the case and control subjects, respectively. During a 5‐year period following the initial screening procedure, none of the case or control subjects was diagnosed with colon cancer.

Conclusions:

The decision for or against performing an endoscopic procedure in a patient with inguinal hernia should be guided by the general principles of screening for colorectal cancer. The mere presence of an inguinal hernia does not automatically increase the risk of colorectal cancer.
Eradication of Helicobacter pylori may reduce disease severity in rheumatoid arthritis
Authors: Zentilin P. , Seriolo B. , Dulbecco P. , Caratto E. , Iiritano E. , Fasciolo D. , Bilardi C. , Mansi C. , Testa E. , Savarino V.
Published: March 2003

Background : A triggering infectious agent has long been postulated in rheumatoid arthritis. Data on the possible role of Helicobacter pylori infection are lacking.

Aim : To assess the effect of H. pylori eradication in patients with rheumatoid arthritis.

Methods : Fifty‐eight adult patients with established rheumatoid arthritis and dyspeptic symptoms were recruited — 28 were H. pylori‐positive and 30 were H. pylori‐negative on the basis of invasive tests. All infected patients were treated successfully. We evaluated the disease activity using clinical and laboratory parameters at baseline and every 4 months during 2 years, and compared the variations in the two subgroups.

Results : H. pylori‐eradicated rheumatoid arthritis patients showed progressive improvement over time (P < 0.0001) of all clinical indices compared with baseline, whereas H. pylori‐negative rheumatoid arthritis patients remained substantially unchanged. After 2 years, H. pylori‐eradicated rheumatoid arthritis patients differed significantly (P < 0.04–0.0001) from patients without H. pylori infection in terms of improvement of all clinical parameters. At the same time point, several laboratory indices (erythrocyte sedimentation rate, fibrinogen, α2‐globulins and antinuclear antibody) showed significantly lower values (P < 0.02–0.0003) in the H. pylori‐eradicated subgroup compared to the H. pylori‐negative subgroup.

Conclusions : Our data suggest that H. pylori infection is implicated in the pathogenesis of rheumatoid arthritis, in that its eradication may induce a significant improvement of disease activity over 24 months. H. pylori eradication seems to be advantageous in infected rheumatoid arthritis patients, but controlled studies are needed.
Systematic review: the effectiveness of budesonide therapy for Crohn's disease
Authors: Kane S. V. , Schoenfeld P. , Sandborn W. J. , Tremaine W. , Hofer T. , Feagan B. G.
Published: March 2003

Aim : To assess the effectiveness and safety of budesonide in comparison to corticosteroids, 5‐aminosalicylic acid (5‐ASA), or placebo for inducing remission of active Crohn's disease and for maintaining remission.

Study selection criteria : Randomized controlled trials comparing budesonide to corticosteroids, 5‐ASA products or placebo were included. Trials had to report on the effectiveness of treatment (defined as decreasing or maintaining Crohn's Disease Activity Index, CDAI, scores ≤ 150) or adverse events.

Data analysis : After assessing the validity of study design and independent, duplicate data extraction from selected trials, summary relative risks (RR) were calculated for each outcome. A test of heterogeneity was also calculated for each outcome using a random effects model.

Results : Budesonide was more likely to induce remission than placebo (RR=1.82, 95% CI: 1.15–2.88) or 5‐ASA (RR=1.73, 95% CI: 1.26–2.39), although only one trial compared budesonide to 5‐ASA products. Although budesonide induced remission less frequently than conventional corticosteroids (RR=0.87, 95% CI: 0.76–0.995), there was no significant difference between conventional corticosteroids and budesonide for inducing remission among patients with a low disease activity (initial CDAI=200–300). Budesonide was significantly less likely to cause corticosteroid‐associated adverse events than conventional corticosteroids (RR=0.65, 95% CI: 0.53–0.80). No significant difference in total adverse events or corticosteroid‐associated adverse events was demonstrated between budesonide and 5‐ASA or placebo.

Conclusion : Budesonide is significantly more effective than placebo or 5‐ASA for inducing remission of active Crohn's disease. Although budesonide is 13% less effective for the induction of remission in active Crohn's disease than conventional corticosteroids, it is less likely to cause corticosteroid‐related adverse effects. Budesonide is ineffective in maintaining remission.
The quality of life in patients with Crohn's disease
Authors: Cohen R. D.
Published: March 2003

Background : Health‐related quality of life studies provide insight into the influence of Crohn's disease on patients' lives, and the potential impact on professional and personal productivity.

Aim : To compare health‐related quality of life in Crohn's disease patients with that in other patients and healthy controls, and between medically and surgically treated Crohn's disease patients, and to correlate health‐related quality of life with Crohn's disease activity.

Methods : An expanded MEDLINE search of full length, English language, adult Crohn's disease studies from January 1966 to September 2000 was performed. The key words utilized were: ‘Quality of Life’, ‘Health Status’ or ‘Health Related Quality of Life’ and ‘Crohn’s' or ‘Inflammatory Bowel Disease’.

Results : A total of 258 articles were identified; 236 subsequently were excluded, leaving 22 for analysis. Compared with Crohn's disease patients, the health‐related quality of life was better in healthy controls and in ulcerative colitis patients (except pre‐colectomy), but similar to or worse than that in many other medical conditions. The health‐related quality of life was directly correlated with Crohn's disease activity, and was worse in active disease than in remission. The health‐related quality of life was improved only in the short term in surgically vs. medically treated Crohn's disease patients.

Conclusions : Health‐related quality of life analysis provides important insights into the impact of Crohn's disease, and should be included in clinical trials. Researchers, clinicians and other health care providers need to be cognizant of the impact of the health‐related quality of life upon patients' lives.
Efficacy of enzyme immunoassay for the detection of Helicobacter pylori antigens in frozen stool specimens: local validation
Authors: Yee Y. K. , Yip K. T. , Que T. L. , Chang K. K. , Li K. F. , Lee C. K. , Wong S. W. , Lau S. F. , Szeto M.L.
Published: March 2003

Aim : To investigate the efficacy of measurement of Helicobacter pylori stool antigen (HpSA) using stored frozen stool specimens, and to assess whether there were factors affecting efficacy in Hong Kong.

Methods : Patients undergoing upper endoscopy at Tuen Mun Hospital were recruited. Stool samples were saved for HpSA testing and questionnaires were completed. Stool samples were frozen immediately upon receipt and stored at − 70 °C until tested. HpSA results were compared with rapid urease test and histology.

Results : One hundred and eighty‐one patients were recruited. One hundred and seventy‐eight patients were suitable for analysis. Eighty‐three were H. pylori positive and 95 were H. pylori negative. The mean duration of storage of the stool samples was 120 days (range, 40–225 days). The sensitivity, specificity and positive and negative predictive values were 84.3%, 97.9%, 97.2% and 88.6%, respectively. In patients with a false negative HpSA test, there was a significant delay in collecting the stool specimen after endoscopy when compared with those with a true positive HpSA test (4.2 vs. 2.3 days; P < 0.05). However, the duration of storage of the specimens was not longer, and consumption of coffee or tea and smoking habits were similar.

Conclusions : HpSA testing showed good sensitivity and specificity, even with frozen stool samples stored for up to 225 days. The efficacy was not affected by coffee, tea or smoking.
Performance characteristics of scintigraphic transit measurements for studies of experimental therapies
Authors: Cremonini F. , Mullan B. P. , Camilleri M. , Burton D. D. , Rank M. R.
Published: March 2003

Background : The intra‐ and inter‐individual reproducibility of gastrointestinal and colonic transit tests require full characterization.

Aims : (i) To characterize the normal values and reproducibility effects of age and gender on the scintigraphic transit of solids in health. (ii) To compare scintigraphic and radio‐opaque marker measurements of colonic transit. (iii) To estimate demonstrable effect sizes for different transit end‐points based on observed variations.

Methods : A scintigraphic gastrointestinal and colonic transit study and the mean colonic transit time were measured using radio‐opaque markers in 37 healthy volunteers; 21 subjects had a repeat scintigraphic test 3 weeks later.

Results : Gastric emptying at 4 h was highly reproducible (coefficient of variation, 4%) on repeat testing. The colonic measurement varied by more than 1 geometric centre unit in 37% of subjects at 24 h and in 26% of subjects at 48 h. There were no age‐ or gender‐related differences in transit. Effect sizes demonstrable with 14 subjects per group were in the range previously shown to be clinically relevant: 25% change in gastric emptying at 4 h; 1.5 geometric centre unit change in colonic transit at 48 h.

Conclusions : These data demonstrate the reproducibility and performance to be expected of transit measurements and are essential for designing studies in experimental therapeutics.
Gut mucosal response to food antigens in Crohn's disease
Authors: Van Den Bogaerde J. , Cahill J. , Emmanuel A. V. , Vaizey C. J. , Talbot I. C. , Knight S. C. , Kamm M. A.
Published: March 2003

Background : Food antigens may contribute to gut inflammation in Crohn's disease.

Aim : To assess in vivo sensitization to food antigens, ascertain whether sensitivity is gut specific, assess food sensitization in vitro, and correlate in vivo changes with histological and blood changes.

Methods : Skin testing and rectal exposure to six food antigens (cereal, cabbage, citrus, milk, yeast and peanut) and control saline were assessed double‐blind by immediate and 3.5‐h laser Doppler blood flowmetry, and rectal biopsies were taken. Peripheral blood lymphocyte proliferation was measured in response to the same antigens.

Results : Ten patients with Crohn's disease and 10 healthy controls were studied. Blood flow increased in 24 of 60 antigen sites in Crohn's disease patients and six of 60 antigen sites in controls (P < 0.0001) after 3.5 h. The Crohn's disease group demonstrated higher rectal blood flow than controls in response to all food antigens, and this was significantly different for the responses to yeast (P = 0.036) and citrus fruits (P = 0.038). Lymphocyte proliferation occurred in 32 of 60 tests in Crohn's disease patients and eight of 60 tests in controls (P < 0.0001). There were no skin responses. Submucosal oedema corresponded to increased mucosal flow.

Conclusions : Crohn's disease patients demonstrate in vivo and in vitro sensitization to food antigens, which is gut specific. Mucosal flowmetry allows the identification of sensitization to gut antigens.
Is your patient taking the medicine? A simple assay to measure compliance with 5‐aminosalicylic acid‐containing compounds
Authors: Shaw I. S. , Jobson B. A. , Silverman D. , Ford J. , Hearing S. D. , Ball D. , Johnson E. , Day A. , Probert C. S. J.
Published: March 2003

Background : Poor compliance with 5‐aminosalicylic acid therapy has been reported amongst patients with inflammatory bowel disease. Currently, there is no easy method to monitor 5‐aminosalicylic acid; however, the chemical similarity between 5‐aminosalicylic acid and salicylate might provide a solution.

Aim : To determine the feasibility of using salicylate levels to monitor compliance with 5‐aminosalicylic acid medication.

Methods : Thirty‐six patients with inflammatory bowel disease, taking maintenance 5‐aminosalicylic acid, provided either a paired serum and urine sample or an intestinal biopsy. Samples were split into two: half were sent to the hospital biochemistry department for salicylate measurement, and half were analysed for 5‐aminosalicylic acid and its metabolite, N‐acetyl‐5‐aminosalicylic acid, using high performance liquid chromatography. Correlation between the results was calculated.

Results : Serum and urine were available for 25 patients. Serum salicylate was undetectable, but urinary salicylate ranged from 31 to 3254 µg/mL. The correlations between urinary salicylate and 5‐aminosalicylic acid and N‐acetyl‐5‐aminosalicylic acid were 0.96 (95% confidence interval, 0.91–0.98) and 0.9 (95% confidence interval, 0.77–0.96), respectively. Sixteen biopsies were available from 13 patients. The 5‐aminosalicylic acid and N‐acetyl‐5‐aminosalicylic acid concentrations were 0.2–657 ng/mg and 1.6–1598 ng/mg, respectively; there was no correlation with bowel salicylate.

Conclusions : The close correlation between 5‐aminosalicylic acid and salicylate levels offers a simple method to assess compliance with 5‐aminosalicylic acid therapy.
Is there an optimal therapeutic regimen for antimitochondrial antibody‐negative primary biliary cirrhosis (autoimmune cholangitis)?
Authors: Gisbert J. P. , Jones E. A. , Pajares J. M. , Moreno‐Otero R.
Published: March 2003

Testing for antimitochondrial antibodies is the most useful laboratory procedure in the diagnosis of primary biliary cirrhosis; nevertheless, 5–10% of patients with typical features of primary biliary cirrhosis do not have detectable antimitochondrial antibodies, their condition being referred to as antimitochondrial antibody‐negative primary biliary cirrhosis or ‘autoimmune cholangitis’. Uncertainty exists whether antimitochondrial antibody‐positive and ‐negative primary biliary cirrhosis represent distinct entities.

We reviewed studies that compared: (i) the clinical, laboratory and histological characteristics of antimitochondrial antibody‐positive and ‐negative primary biliary cirrhosis; (ii) the response to treatment of both conditions; and (iii) the response of autoimmune cholangitis to ursodeoxycholic acid and immunosuppressive therapy. Antimitochondrial antibody‐positive and ‐negative primary biliary cirrhosis were characterized by similar clinical, laboratory and histological abnormalities, clinical course and survival.

Antimitochondrial antibody status did not seem to affect the response to ursodeoxycholic acid. At present, the efficacy of therapies for autoimmune cholangitis has not been established in controlled trials. Of 52 patients with autoimmune cholangitis treated with ursodeoxycholic acid in 13 uncontrolled studies, 83% had serum biochemical improvement. Also, a favourable effect of immunosuppressive drugs occurred in 57% of 54 patients with autoimmune cholangitis in 17 uncontrolled studies. Each of these trials included very few patients and most evaluated the effects of treatment on surrogate markers of disease only.

No marker that consistently distinguished patients who would respond favourably to ursodeoxycholic acid or immunosuppression was apparent. Consequently, treatment is, at present, empirical. However, ursodeoxycholic acid may be given when histology reveals bile duct lesions, whereas immunosuppressive therapy should probably be reserved for patients exhibiting interface hepatitis.
The cuffed oropharyngeal airway for spontaneous ventilation anaesthesiaClinical appraisal in 100 patients
Authors: Brimacombe J. , Berry A.
Published: March 2003

The cuffed oropharyngeal airway is a modified Guedel airway with a distal inflatable cuff and a proximal connector for attachment to an anaesthesia circuit. The purpose of this study was to evaluate this device for spontaneous ventilation anaesthesia in 100 adult patients. Anaesthesia was induced with fentanyl and propofol and maintained with nitrous oxide and isoflurane in oxygen. The device was inserted when anaesthetic depth was judged to be adequate. Adverse airway events and interventions (i.e. manoeuvres performed in order to provide a clear airway) were analysed from video recordings and detailed notes. The position of the device was assessed fibreoptically during spontaneous ventilation. The device provided a clear airway in 98% of patients during manually assisted ventilation, in 100% during spontaneous ventilation and in 100% during emergence. However, 91% of patients required at least one airway intervention at some time. Jaw lift was required for 33% of the time during manually assisted ventilation and 21% of the time during spontaneous ventilation. Most interventions occurred during the first 3 min of either manually assisted or spontaneous ventilation. The incidence of adverse airway events during manually assisted ventilation was 8%, during spontaneous ventilation was 5% and during emergence was 5%. Oxygen saturation briefly fell to between 87 and 89% on six occasions. On fibreoptic assessment, the vocal cords were visible in 29% of patients on fibreoptic assessment and the epiglottis was visible in 90%. Mild sore throat occurred in 4% of patients. We conclude that the cuffed oropharyngeal airway is suitable for spontaneous ventilation anaesthesia and has a low complication rate but that most patients require one or more interventions to provide a clear airway.
Quantifying meaningful changes in pain
Authors: Campbell W. I. , Patterson C. C.
Published: March 2003

One hundred and thirty‐eight nurses were asked to indicate the smallest meaningful reduction in pain from each of four hypothetical pain intensities: 100, 75, 50 and 25, on 100 mm visual analogue scales. The median values for the smallest meaningful reductions in pain were 31, 24, 18 and 10 mm, respectively, representing reductions in pain intensity of 31%, 32%, 36% and 40%, respectively. These tests were repeated in 110 patients before and after they had a lower third molar extraction under general anaesthesia. The patients' expectations of pain relief, pre‐ and postoperatively, were very similar to those observed in the nurses. For each of the four hypothetical pain intensities the median values for meaningful reductions in pain became greater following surgery. The pre‐operative median reductions from the hypothetical pains 100, 75, 50 and 25 mm were 26, 20, 15 and 11 mm (26%, 27%, 29% and 44%), respectively. The corresponding postoperative reductions were 31, 24, 19 and 12 mm (31%, 32%, 38% and 48%). To achieve a meaningful reduction in pain postoperatively in 50% of patients it is necessary to reduce pain as represented by the visual analogue scale, by between 31 and 48%, depending on its initial intensity.
Recurrent respiratory depression after total intravenous anaesthesia with propofol and alfentanil
Authors: Sternlo J. E. G. , Sandin R. H.
Published: March 2003

Since first commented upon by Lamarche in 1984, several cases of recurrent respiratory arrest after alfentanil infusions have been reported. In all these cases the alfentanil infusions have been used to supplement conventional anaesthetic techniques with nitrous oxide and/or inhalational agents and in most cases rather high total alfentanil doses have been administered. We have seen two cases of severe recurrent respiratory depression in healthy patients after relatively minor procedures performed under total intravenous anaesthesia with propofol–alfentanil infusions, air–oxygen ventilation and muscle relaxation, where the alfentanil doses administered were quite small. These cases are presented in detail and compared within a tabulated presentation with the earlier published cases of alfentanil‐related recurrent respiratory depression.
The use of low‐dose mivacurium to facilitate insertion of the laryngeal mask airway
Authors: Chui P. T. , Cheam E. W. S.
Published: March 2003

Ninety patients were assigned randomly in a double‐blind manner to receive 0.9% sodium chloride, mivacurium 0.04 mg.kg−1 or mivacurium 0.08 mg.kg−1 intravenously, followed by propofol 2.5 mg.kg−1. A laryngeal mask airway (LMA) was inserted 90 s later. The LMA was positioned correctly during the first attempt in 87% of patients and this was not significantly altered by the use of mivacurium. However, mivacurium decreased the incidence of swallowing, coughing, movement and laryngospasm (p < 0.05). LMA insertion was graded as easy in 88% of patients who had mivacurium, compared with 50% in patients who had propofol alone (p < 0.05). The conditions during LMA insertion were similar after 0.04 or 0.08 mg.kg−1 of mivacurium. Patients were apnoeic for a mean (SD) time of 0.67 (0.72) min after propofol alone, compared with 1.72 (1.06) min and 3.05 (1.36) min in patients who also received mivacurium 0.04 and 0.08 mg.kg−1, respectively (p < 0.01). Patients who received mivacurium had a lower incidence of postoperative sore throat (24–30% vs. 53%) (p < 0.05). In conclusion, low‐dose mivacurium facilitates LMA insertion and decreases the incidence of postoperative sore throat.
Performance characteristics of a ‘to and fro’ disposable soda lime canister
Authors: Shaw M. , Scott D. H. T.
Published: March 2003

The performance of the Intersurgical disposable soda lime canister was compared to British Pharmacopoeia standards for carbon dioxide absorption and to other carbon dioxide absorber systems. This canister system more than adequately fulfilled the equivalent of the British Pharmacopoeia standard for CO2 absorption. It performed efficiently for over 3 h of continuous use, absorbing 200 mlmin−1 at varying combinations of tidal volume and ventilation rate. Efficiency was not dependent on close matching of tidal volume with canister volume and there was no channelling of gases. Heat was generated by the reaction between soda lime and CO2 and the maximum temperature recorded in the system was 42.1 °C. Under clinical conditions this should pose no threat of thermal injury to the patient.
Neuromuscular interaction between cisatracurium and mivacurium, atracurium, vecuronium or rocuronium administered in combination
Authors: Kim K. S. , Chun Y. S. , Chon S. U. , Suh J. K.
Published: March 2003

We compared the dose–response relationships of cisatracurium, mivacurium, atracurium, vecuronium and rocuronium and examined the interactions of cisatracurium with mivacurium, atracurium, vecuronium and rocuronium in humans by isobolographic and fractional analyses. We studied 180 adult patients during nitrous oxide–fentanyl–propofol anaesthesia. Neuromuscular block was monitored using mechanomyography to detect the twitch response of the ulnar nerve at the wrist. The dose–response curves were determined by probit analysis. The calculated ED50 values and their 95% confidence intervals were 40.9 (38.1–43.7), 49.8 (47.0–52.6), 187.2 (175.1–199.3), 36.6 (34.7–38.5) and 136.4 (129.2–143.6) μg.kg−1 for cisatracurium, mivacurium, atracurium, vecuronium and rocuronium, respectively. Corresponding ED95 values were 57.6 (53.5–61.7), 91.8 (88.1–95.5), 253.1 (238.9–267.3), 52.9 (49.1–56.7) and 288.7 (276.2–301.2) μg.kg−1, respectively. The interaction between cisatracurium and mivacurium, vecuronium or rocuronium was found to be synergistic, but the interaction between cisatracurium and atracurium was found to be additive. Synergy between cisatracurium and vecuronium or rocuronium was greater than between cisatracurium and mivacurium.
The respiratory effects of tramadol in children under halothane anaesthesia
Authors: Bösenberg A. T. , Ratcliffe S.
Published: March 2003

In a randomised double‐blind, placebo‐controlled study, the respiratory effects of intravenous tramadol (1 mg or 2 mgkg−1) were compared with intravenous pethidine 1 mgkg−1 under halothane anaesthesia. Children, ASA 1–2 between 2 and 10 years, presenting for inguinal surgery were studied. Once a steady state for halothane was reached, baseline recordings of end‐tidal carbon dioxide, oxygen saturation, respiratory rate, tidal volume, minute volume, blood pressure and pulse rate were recorded. Intravenous tramadol 1 mgkg−1 (T1) or 2 mgkg−1 (T2) or pethidine 1 mgkg−1 (PE) or placebo (PL) was then given according to a computer‐generated randomisation. Further sets of recordings were taken at 5‐min intervals for 20 min prior to commencement of surgery. The rate of recovery was assessed according to Aldrete scoring and the time and need for further analgesia were noted. The postoperative pain intensity was scored by means of a five‐point verbal rating scale hourly for 6 h. Eighty‐eight children, 22 per group, were studied. The mean age, weight and height were similar in each group. There was a statistically significant difference between the maximum decrease in respiratory rate and increase in end‐tidal carbon dioxide between group PE and groups T1/T2 (p < 0.001). Thirteen episodes of apnoea occurred in the PE group, 11 requiring naloxone. The mean respiratory rate was lowest 5 min after injection in all groups. There was a slow increase in respiratory rate until incision in groups T1 and T2. Respiratory rate remained almost unchanged in PL until incision. The decreases in respiratory rate were reflected by increases in end‐tidal carbon dioxide, the highest being recorded in the PE group. A lower intensity of pain in the first 2 h was noted in the three opioid groups. During the first 6 h, the proportion of patients requiring a further dose of analgesia was highest in PL and lowest in T2. Tramadol appears safe for use in children.
Latex allergy: a strategy for management
Authors: Dakin M. J. , Yentis S. M.
Published: March 2003

Latex is a ubiquitous part of life today. It is a constituent of many household products and medical devices, although not always obvious on examination. The increase in incidence of potentially life‐threatening allergic reactions to latex has been a cause for mounting concern over recent years. Although there have been recent reviews of the general problem of latex allergy, there is little advice available to anaesthetists on how to develop an effective strategy to implement within their own hospitals. The aim of this article is to improve awareness of latex allergy and by describing the development of our strategy to identify and safely manage those at risk in the peri‐operative period, facilitate the process for other departments.