bluuebunny/crossref_metadata_2025 huggingface dataset:
Review article: abdominal bloating and distension in functional gastrointestinal disorders – epidemiology and exploration of possible mechanisms
Authors: AGRAWAL A. , WHORWELL P. J.
Published: July 2010

Background  A sensation of abdominal bloating, sometimes accompanied by an increase in girth (distension), is one of the most common and most intrusive features of functional bowel disorders.

Aim  To conduct a systematic, evidence‐based review of the epidemiology and pathophysiology of abdominal bloating and its relationship to distension.

Methods  The terms bloating, distension, functional bowel, irritable bowel syndrome, constipation and diarrhoea were searched on MEDLINE up to 2006. References from selected articles and relevant abstracts were also included.

Results  Approximately 50% of irritable bowel syndrome patients with bloating also experience an increase in abdominal girth and this is more pronounced with constipation than diarrhoea. Bloating appears to be more frequently associated with visceral hypersensitivity, whereas distension is more often related to hyposensitivity and delayed transit. Although there is little evidence for excessive gas as a cause of bloating, gas infusion studies suggest that handling of gas may be impaired in irritable bowel syndrome and there may also be abnormal relaxation of the anterior abdominal musculature in these patients.

Conclusions  There is unlikely to be a single cause for bloating and distension, which probably have different, but overlapping, pathophysiological mechanisms. Relieving constipation might help distension, but the treatment of bloating may need more complex approaches involving sensory modulation.
Risk factors for non‐adherence to medication in inflammatory bowel disease patients
Authors: D’INCÀ R. , BERTOMORO P. , MAZZOCCO K. , VETTORATO M. G. , RUMIATI R. , STURNIOLO G. C.
Published: July 2010

Background  Inflammatory bowel diseases are chronic conditions requiring medication throughout life to treat the disease and control the risk of relapse and colorectal cancer. Adherence to prescribed drugs is therefore crucial to their management.

Aim  To identify determinants and potential risk factors of non‐adherence in inflammatory bowel disease patients.

Methods  An anonymous 24‐item questionnaire (available online as Supplementary material) was administered to 485 out‐patients attending a tertiary referral centre.

Results  Sixty‐one per cent of the patients reportedly adhered to their treatment. No differences emerged between inflammatory bowel disease and socio‐demographic characteristics other than age, non‐adherence being significantly associated with cases under 40 years (43% vs. 34%, P = 0.041). The most common reasons for non‐adherence vs. adherence were forgetfulness (61% vs. 44%, P = 0.000), disease remission (25% vs. 10%, P = 0.000), recent diagnosis (24% vs. 15%, P = 0.000) and full‐time employment (55% vs. 26%, P = 0.000). Oral therapy was associated with a significantly better adherence than rectal therapy (60% vs. 32%, P = 0.001). Communication affects patient adherence: a significant interaction was found for adherence and patients <40 years who had a good relationship with their doctors.

Conclusions  Risk factors for non‐adherence are younger age, busy working life, recent diagnosis and disease remission. Good communication with the doctor might improve adherence.
The renal safety of bowel preparations for colonoscopy: a comparative study of oral sodium phosphate solution and polyethylene glycol
Authors: SINGAL A. K. , ROSMAN A. S. , POST J. B. , BAUMAN W. A. , SPUNGEN A. M. , KORSTEN M. A.
Published: July 2010

Background  Rare cases of nephrotoxicity have been reported with oral sodium phosphate solution (OSPS).

Aim  To evaluate whether OSPS is associated with changes in renal function.

Methods  A chart review performed on 311 patients who had colonoscopy at the James J. Peters VA Medical Centre prepared with either OSPS (n = 157) or polyethylene glycol (PEG) (n = 154). Patients had a baseline serum creatinine ≤1.5 mg/dL. Effect of bowel preparation on the renal function was evaluated by measuring the absolute change in levels of serum creatinine and the proportion of patients who developed a 50% or more increase above their baseline serum creatinine value.

Results  Oral sodium phosphate solution resulted in a slight increase in serum creatinine from 1.0 ± 0.02 to 1.1 ± 0.02 mg/dL (P = 0.07) and PEG resulted in a small decrease in serum creatinine from 1.1 ± 0.02 to 1.0 ± 0.03 mg/dL (P = 0.03). The absolute change in serum creatinine was slightly higher with OSPS than with PEG (0.04 ± 0.02 vs. −0.05 ± 0.02 mg/dL; P = 0.005). However, the proportion of patients who had a ≥50% increase above their baseline creatinine was similar (OSPS vs. PEG, 5% vs. 3%, P = 0.77).

Conclusions  Oral sodium phosphate solution was associated with a slight increase in serum creatinine, which was not clinically significant. Renal toxicity from OSPS appears to be minimal when used in patients with serum creatinine value <1.5 mg/dL.
Review article: the role of butyrate on colonic function
Authors: HAMER H. M. , JONKERS D. , VENEMA K. , VANHOUTVIN S. , TROOST F. J. , BRUMMER R.‐J.
Published: July 2010

Background Butyrate, a short‐chain fatty acid, is a main end‐product of intestinal microbial fermentation of mainly dietary fibre. Butyrate is an important energy source for intestinal epithelial cells and plays a role in the maintenance of colonic homeostasis.

Aim To provide an overview on the present knowledge of the bioactivity of butyrate, emphasizing effects and possible mechanisms of action in relation to human colonic function.

Methods A PubMed search was performed to select relevant publications using the search terms: ‘butyrate, short‐chain fatty acid, fibre, colon, inflammation, carcinogenesis, barrier, oxidative stress, permeability and satiety’.

Results Butyrate exerts potent effects on a variety of colonic mucosal functions such as inhibition of inflammation and carcinogenesis, reinforcing various components of the colonic defence barrier and decreasing oxidative stress. In addition, butyrate may promote satiety. Two important mechanisms include the inhibition of nuclear factor kappa B activation and histone deacetylation. However, the observed effects of butyrate largely depend on concentrations and models used and human data are still limited.

Conclusion Although most studies point towards beneficial effects of butyrate, more humanin vivostudies are needed to contribute to our current understanding of butyrate‐mediated effects on colonic function in health and disease.
New algorithm for the treatment of gastro‐oesophageal reflux disease
Authors: TYTGAT G. N. , MCCOLL K. , TACK J. , HOLTMANN G. , HUNT R. H. , MALFERTHEINER P. , HUNGIN A. P. S. , BATCHELOR H. K.
Published: July 2010

Background Gastro‐oesophageal reflux disease (GERD) is associated with a variety of typical and atypical symptoms. Patients often present in the first instance to a pharmacist or primary care physician and are subsequently referred to secondary care if initial management fails. Guidelines usually do not provide a clear guidance for all healthcare professionals with whom the patient may consult.

Aim To update a 2002‐treatment algorithm for GERD, making it more applicable to pharmacists as well as doctors.

Methods A panel of international experts met to discuss the principles and practice of treating GERD.

Results The updated algorithm for the management of GERD can be followed by pharmacists, for over‐the‐counter medications, primary care physicians, or secondary care gastroenterologists. The algorithm emphasizes the importance of life style changes to help control the triggers for heartburn and adjuvant therapies for rapid and adequate symptom relief. Proton pump inhibitors will remain a prominent treatment for GERD; however, the use of antacids and alginate‐antacids (either alone or in combination with acid suppressants) is likely to increase.

Conclusion The newly developed algorithm takes into account latest clinical practice experience, offering healthcare professionals clear and effective treatment options for the management of GERD.
Clinical trial: dextofisopam in the treatment of patients with diarrhoea‐predominant or alternating irritable bowel syndrome
Authors: LEVENTER S. M. , RAUDIBAUGH K. , FRISSORA C. L. , KASSEM N. , KEOGH J. C. , PHILLIPS J. , MANGEL A. W.
Published: July 2010

Background  Dextofisopam modulates stimulated activity in animal models of stress, altered bowel motility, and visceral hypersensitivity.

Aim  To evaluate the effects of dextofisopam in men and women with diarrhoea‐predominant or alternating irritable bowel syndrome (IBS) (d‐IBS or a‐IBS).

Methods  In this double‐blind, placebo‐controlled study, patients were randomly assigned to receive dextofisopam 200 mg b.d. or placebo for 12 weeks. The prospectively defined primary endpoint was number of months of adequate overall relief of IBS symptoms. Bowel function was assessed primarily via stool frequency and consistency.

Results  Of 140 enrolled patients, 66 received dextofisopam and 74 placebo; 73% of the patients were women, and 78% had d‐IBS. Dextofisopam was superior to placebo on the primary endpoint (P = 0.033). In d‐IBS patients treated with dextofisopam, both men and women had improved stool consistency, but stool frequency was reduced only in women. Benefit diminished over time on the primary endpoint, but persisted on frequency and consistency. Dextofisopam and placebo had similar rates and types of adverse events, with more events of worsening abdominal pain with dextofisopam (12% vs. 4%) and more headaches with placebo (12% vs. 5%). Constipation was rare.

Conclusion  Dextofisopam should be further evaluated as a new treatment for men and women with d‐IBS and a‐IBS.
Acid‐related oesophageal sensitivity, not dysmotility, differentiates subgroups of patients with non‐erosive reflux disease
Authors: THOUA N. M. , KHOO D. , KALANTZIS C. , EMMANUEL A. V.
Published: July 2010

Background  Patients with non‐erosive reflux disease can experience reflux symptoms with similar frequency and severity as those with erosive reflux disease. Oesophageal motility and acid sensitivity are thought to influence symptom occurrence.

Aim  To compare the effect of infused hydrochloric acid on oesophageal physiology in patients with non‐erosive reflux disease and erosive reflux disease.

Methods  Twelve healthy controls and 39 patients with reflux disease [14 erosive reflux disease, 11 non‐erosive reflux disease with normal (functional heartburn) and 14 non‐erosive reflux disease with excess acid exposure] had hydrochloric acid and saline infused into distal and then proximal oesophagus. Oesophageal contraction amplitude, lower oesophageal sphincter pressure and pain intensity were documented at baseline and during each infusion.

Results  Patients with non‐erosive reflux disease had higher pain sensitivity to acid than those with erosive reflux disease and controls. Proximal acid infusion caused greater pain than distal in patients with non‐erosive reflux disease. Acid and saline sensitivity were more pronounced in patients with functional heartburn. Lower oesophageal sphincter pressure and oesophageal contraction amplitudes were lower in the erosive reflux disease and non‐erosive reflux disease groups, but did not change during infusions.

Conclusions  Patients with non‐erosive reflux disease and, to a lesser extent, patients with erosive reflux disease, are sensitive to acid in the oesophagus, being more sensitive to proximal acid. Hypersensitivity is most marked in functional heartburn patients. This acid sensitivity is not associated with motility change.
A novel partial 5HT3 agonist DDP733 after a standard refluxogenic meal reduces reflux events: a randomized, double‐blind, placebo‐controlled pharmacodynamic study
Authors: CHOUNG R. S. , FERGUSON D. D. , MURRAY J. A. , KAMMER P. P. , DIERKHISING R. A. , ZINSMEISTER A. R. , NURBHAI S. , LANDAU S. B. , TALLEY N. J.
Published: July 2010

Background  DDP733, a selective partial 5HT3 receptor agonist, increases lower oesophageal sphincter pressure in experimental animal models. However, its effect on gastro‐oesophageal reflux or lower oesophageal sphincter pressure in humans remains unknown.

Aim  To evaluate the effect of DDP733 on reflux episodes in healthy volunteers receiving a refluxogenic meal.

Methods  A randomized, double‐blind, placebo‐controlled cross‐over study evaluated the pharmacodynamic effects of DDP733 (0.5, 0.8 and 1.4 mg). Healthy subjects underwent oesophageal manometry and intra‐oesophageal multichannel intraluminal impedance and pH after a refluxogenic meal.

Results  DDP733 0.5 mg significantly (P = 0.013) reduced the rate of reflux episodes after a refluxogenic meal from 10 (±2.2) on placebo to 6 (±1.2) on drug over a 2‐h period. DDP733 0.8 and 1.4 mg had no significant effect on reducing the number of reflux episodes. Significant differences in resting lower oesophageal sphincter pressure and the proportion of time pH was <4 (placebo minus drug) after a refluxogenic meal were not observed. No serious adverse events were reported.

Conclusion  In healthy subjects, the partial 5HT3 agonist DDP733 at a dose of 0.5 mg significantly reduces the rate of reflux events, but did not result in a significant change in lower oesophageal sphincter pressure at 1 h postdosing.
Rapid protection of the gastroduodenal mucosa against aspirin‐induced damage by rabeprazole
Authors: IRANI S. , KREVSKY B. , DESIPIO J. , KIM‐JAFFE J. , MAQBOOL S. , FISHER R. S.
Published: July 2010

Background  The ability of a proton pump inhibitor to reduce or prevent NSAID‐induced gastroduodenal damage during the first 24 h has not been tested.

Aim  To determine, whether oral rabeprazole, administered 5 h before the initiation of therapeutic dosing of aspirin protects the gastroduodenal mucosa.

Methods  Normal subjects were randomized into two groups – one received rabeprazole, 20 mg at 07:00 hours and the other placebo, before initiation of aspirin 650 mg at 12:00 hours, and then q4 h for 3 days. Upper endoscopic examinations were performed on all subjects at baseline, 24 and 72 h after initiation of aspirin. Gastroduodenal mucosal damage was scored.

Results  Thirty subjects were compliant with study medications and underwent three endoscopic examinations. Salicylate concentrations were similar for the placebo and the rabeprazole groups at all times. On rabeprazole, the Lanza scores were significantly lower compared with placebo at 24 h (1.3 ± 0.26 vs. 2.1 ± 0.26, P < 0.05) and at 72 h (1.3 ± 0.29 vs. 2.3 ± 0.28, P < 0.05). Gastric antral erosion counts were less with rabeprazole than placebo at 24 (4.1 ± 1.3 vs. 7.6 ± 2.0, P > 0.05) and 72 h (5.3 ± 1.8 vs. 8.0 ± 1.5; P > 0.05).

Conclusions  Rabeprazole, initiated 5 h before the start of therapeutic dosing with aspirin, decreased Lanza scores and antral erosion counts at 24 h. These findings suggest that prophylaxis with rabeprazole could start concurrently with aspirin administration.
Long‐term use of proton pump inhibitors and vitamin B12 status in elderly individuals
Authors: DEN ELZEN W. P. J. , GROENEVELD Y. , DE RUIJTER W. , SOUVERIJN J. H. M. , LE CESSIE S. , ASSENDELFT W. J. J. , GUSSEKLOO J.
Published: July 2010

Background  Some studies have shown that short‐term use of proton pump inhibitors decreases the absorption of vitamin B12, but the results of studies into long‐term proton pump inhibitor use and vitamin B12 deficiency are inconsistent.

Aim  To investigate whether long‐term proton pump inhibitor use is associated with an abnormal vitamin B12 status in elderly individuals.

Methods  One hundred and twenty‐five long‐term (>3, years) proton pump inhibitor users aged 65, years and above were recruited from general practices. Their 125 partners (who did not use proton pump inhibitors) served as the reference group. Vitamin B12 status was determined by serum levels of vitamin B12 and homocysteine, and mean corpuscular volume.

Results  No differences in mean vitamin B12 levels were observed between the long‐term proton pump inhibitor users and their partners [345 (s.d. 126), pm vs. 339 (s.d. 133), pm, P, =, 0.73], even after adjustment for age, gender, Helicobacter pylori status and C‐reactive protein levels (P, =, 0.87). Four proton pump inhibitor users and three partners had vitamin B12 levels <150, pm (3% vs. 2%, P, =, 1.00). No differences between the groups were observed in homocysteine levels and mean corpuscular volume.

Conclusions  No association between long‐term proton pump inhibitor use and vitamin B12 status was observed. Regular testing for low vitamin B12 levels in elderly patients on long‐term treatment with proton pump inhibitors is therefore not recommended.
Predictive factors for distant recurrence of HCV‐related hepatocellular carcinoma after radiofrequency ablation combined with chemoembolization
Authors: FUKE H. , SUGIMOTO K. , SHIRAKI K. , TANAKA J. , BEPPU T. , YONEDA K. , YAMAMOTO N. , ITO K. , TAKAKI H. , NAKATSUKA A. , YAMAKADO K. , TAKEDA K. , TAKEI Y.
Published: July 2010

Background  Radiofrequency ablation (RFA) therapy for hepatocellular carcinoma has enabled good local control to be possible. However, after successful local control, distant recurrences frequently occur in the remnant liver.

Aim  To identify the predictive factors for distant recurrence after RFA.

Methods  A total of 117 patients with initial non‐advanced hepatocellular carcinoma with HCV who underwent RFA in our hospital were selected for this study. After transcatheter chemoembolization, RFA was performed under real‐time computed tomography‐fluoroscopic guidance. We studied survival rates, local (adjacent to treated tumour) and distant (intrahepatic site distant from the treated tumours) recurrence rates, as well as predictive factors for distant recurrence.

Results  After RFA, survival rates were 98.2% and 64.7% at 1 and 5 years, respectively. Child B patients had a significantly worse survival than Child A. Recurrence rates were 2.4% at 5 years for local, and 17.1% and 76.9% at 1 and 5 years, respectively, for distant. The Kaplan–Meier method revealed significantly high recurrence rates in cases with low albumin levels (Alb < 3.5 g/dL), high aspartate aminotransferase levels (AST > 60 IU/L), high alanine aminotransferase levels (ALT > 60 IU/L), low platelet counts (Plt < 10 × 104/μL), and high alpha‐fetoprotein levels (AFP > 50 ng/mL). On multivariate analysis, low Alb levels and high AST levels were independent predictive factors for distant recurrence.

Conclusions  Although RFA enables good local control for initial hepatocellular carcinoma, distant recurrence is observed at high rates in HCV patients. Low albumin and high AST levels are predictive factors for distant recurrence.
As tests evolve and costs of cancer care rise: reappraising stool‐based screening for colorectal neoplasia
Authors: PAREKH M. , FENDRICK A. M. , LADABAUM U.
Published: July 2010

Background Colorectal cancer screening and treatment are rapidly evolving.

Aims To reappraise stool‐based colorectal cancer screening in light of changing test performance characteristics, lower test cost and increasing colorectal cancer care costs.

Methods Using a Markov model, we compared faecal DNA testing every 3 years, annual faecal occult blood testing or immunochemical testing, and colonoscopy every 10 years.

Results In the base case, faecal occult blood testing and faecal immunochemical testing gained life‐years/person and cost less than no screening. Faecal DNA testing version 1.1 at $300 (the current PreGen Plus test) gained 5323 life‐years/100 000 persons at $16 900/life‐year gained and faecal DNA testing version 2 (enhanced test) gained 5795 life‐years/100 000 persons at $15 700/life‐year gained vs. no screening. In the base case and most sensitivity analyses, faecal occult blood testing and faecal immunochemical testing were preferred to faecal DNA testing. Faecal DNA testing version 2 cost $100 000/life‐year gained vs. faecal immunochemical testing when per‐cycle adherence with faecal immunochemical testing was 22%. Faecal immunochemical testing with excellent adherence was superior to colonoscopy every 10 years.

Conclusions As novel biological therapies increase colorectal cancer treatment costs, faecal occult blood testing and faecal immunochemical testing could become cost‐saving. The cost‐effectiveness of faecal DNA testing compared with no screening has improved, but faecal occult blood testing and faecal immunochemical testing are preferred to faecal DNA testing when patient adherence is high. Faecal immunochemical testing may be comparable to colonoscopy every 10 years in persons adhering to yearly testing.
The spectrum of hepatic functional impairment in compensated chronic hepatitis C: results from the Hepatitis C Anti‐viral Long‐term Treatment against Cirrhosis Trial1
Authors: EVERSON G. T. , SHIFFMAN M. L. , MORGAN T. R. , HOEFS J. C. , STERLING R. K. , WAGNER D. A. , KULIG C. C. , CURTO T. M. , WRIGHT E. C. ,   THE HALT‐C TRIAL GROUP
Published: July 2010

Background The spectrum of functional impairment in patients with compensated chronic hepatitis C is incompletely defined.

Aim To define hepatic impairment by quantitative tests (quantitative liver function tests) and correlate results with disease severity in patients with chronic hepatitis C.

Methods We studied 285 adult patients with chronic hepatitis C prior to treatment in the Hepatitis C Anti‐viral Long‐term Treatment against Cirrhosis Trial; 171 had Ishak fibrosis stages 2–4 (fibrosis) and 114 had stage 5 or 6 (cirrhosis). None had had clinical decompensation. A battery of 12 quantitative liver function test assessed the spectrum of hepatic microsomal, mitochondrial and cytosolic functions, and hepatic and portal blood flow.

Results Twenty‐six to 63% of patients with fibrosis and 45–89% with cirrhosis had hepatic impairment by quantitative liver function test; patients with cirrhosis had the greatest impairment (P‐value ranging from 0.15 to <0.0001). Cholate Cloral, cholate shunt and perfused hepatic mass correlated with cirrhosis, stage of fibrosis (r = −0.51, +0.49, −0.51), varices and variceal size (r = −0.39, +0.36, −0.41). PHM < 95 and cholate shunt >35% identified 91% of patients with medium‐ or large‐sized varices.

Conclusions Hepatic impairment is common in compensated patients with fibrosis or cirrhosis because of chronic hepatitis C. Cholate shunt, and cholate Cloraland perfused hepatic mass, identify patients at risk for cirrhosis or varices.
Review article: restorative proctocolectomy, indications, management of complications and follow‐up – a guide for gastroenterologists
Authors: MCLAUGHLIN S. D. , CLARK S. K. , TEKKIS P. P. , CICLITIRA P. J. , NICHOLLS R. J.
Published: July 2010

Background  Restorative proctocolectomy with ileal pouch‐anal anastomosis is the procedure of choice for the majority of patients with ulcerative colitis who require surgery. Over 2500 patients in the UK have undergone restorative proctocolectomy. It is now increasingly being performed in district general hospitals as well as in specialist inflammatory bowel disease units. Gastroenterologists are increasingly involved in the management of patients following restorative proctocolectomy.

Aim  To provide gastroenterologists with a clear understanding of the investigation and evidence‐based management of complications and the aftercare required in patients who have undergone restorative proctocolectomy.

Results  Following restorative proctocolectomy, most patients have an excellent long‐term functional outcome. Pouchitis, pelvic sepsis and poor function are the most common causes of failure. The development of cancer is rare; nevertheless, long‐term follow‐up is required.

Conclusions  The investigation and management of patients who develop complications require a multidisciplinary team approach to optimize the outcome. Protocols are suggested for investigation and management of patients with complications and for long‐term cancer surveillance.
Clinical trial: renzapride therapy for constipation‐predominant irritable bowel syndrome – multicentre, randomized, placebo‐controlled, double‐blind study in primary healthcare setting
Authors: GEORGE A. M. , MEYERS N. L. , HICKLING R. I.
Published: July 2010

Background Relatively few pharmacological treatment options are available for treating patients with irritable bowel syndrome. New and effective medicines are urgently required.

Aim To identify an appropriate dosage of renzapride (a 5‐HT4receptor full agonist/5‐HT3receptor antagonist) to treat abdominal pain/discomfort in patients with constipation‐predominant irritable bowel syndrome.

Methods In this randomized, placebo‐controlled, phase IIb study in the primary care setting, men and women were randomized to placebo or renzapride (1, 2 or 4 mg/day) for 12 weeks. The primary outcome measure was patient self‐assessed relief of abdominal pain/discomfort during weeks 5–12. Secondary efficacy measures included patients’ assessment of their bowel habits, stool consistency and quality of life.

Results Although there were no statistically significant differences between renzapride and placebo for relief from abdominal pain/discomfort, responder rates in the renzapride treatment groups increased dose dependently, with the 4 mg/day group being consistently numerically greater than placebo. Importantly, a larger numerical treatment difference vs. placebo was observed in women (8% and 12% respectively). Statistically significant improvements in bowel movement frequency and stool consistency were observed in the 4 mg/day group relative to placebo. Renzapride was well tolerated at all doses.

Conclusions This study confirms the gastrointestinal prokinetic effects of renzparide. The data also suggested a potentially beneficial effect on abdominal pain/discomfort in women with constipation‐predominant irritable bowel syndrome.
Review article: nonalcoholic fatty liver disease and hepatitis C virus – partners in crime
Authors: BLONSKY J. J. , HARRISON S. A.
Published: July 2010

Background Both nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CHC) are frequent causes of chronic liver disease. In recent years, there have been significant revelations as regards the relationship between NAFLD and CHC.

Aim To conduct a systematic, evidence‐based review of the epidemiology, pathophysiology and potential treatments of coexistent NAFLD and CHC.

Methods The terms such as hepatitis C, fatty liver, NAFLD, nonalcoholic steatohepatitis and steatosis were searched on PubMed up to January 2008. References from selected articles and pertinent abstracts were also included.

Results Hepatic steatosis affects up to 80% of patients with CHC and is dependent on both viral and host factors. While insulin resistance (IR) is associated with hepatic steatosis and hepatitis C virus, genotype‐specific pathogenic mechanisms have been identified and are currently the focus of intense investigation in the literature. Clinical implications of concurrent NAFLD, CHC and IR include increased disease progression, elevated risk of hepatocellular carcinoma, and decreased response to antiviral therapy.

Conclusions NAFLD and IR are common in patients with CHC virus infection. IR is a driving force in the development of hepatic steatosis. Because of the clinical implications of hepatic steatosis and IR in the setting of CHC, further studies evaluating treatments, which may increase response to antiviral therapy, are needed.
The use of acid‐decreasing medication in veteran patients with gastro‐oesophageal reflux disorder with and without Barrett’s oesophagus
Authors: EL‐SERAG H. B. , WIEMAN M. , RICHARDSON P.
Published: July 2010

Aim  To examine use of acid‐decreasing medications, especially proton pump inhibitors (PPIs), in patients with gastro‐oesophageal reflux disorder (GERD) with and without Barrett’s oesophagus (BO) in a large‐scale study.

Methods  We conducted a retrospective cohort study of patients with newly diagnosed BO (ICD‐9 code 5302) and patients with GERD and no BO (ICD‐9 53081, 5301) in Department of Veterans Affairs (VA) databases. Filled prescriptions for oral PPI and histamine2‐receptor antagonists (H2RA) were identified in the VA Pharmacy Benefit Management database during 365 days following diagnosis. Groups with or without PPI or H2RA were compared in unadjusted and adjusted regression analyses. Chart review was used to validate diagnoses in a subset of patients with and without BO.

Results  We evaluated 7732 patients with BO and 13 457 with GERD and no BO diagnosed between 1/2000 and 12/2002. At least one PPI prescription was filled during the first year following diagnosis in 91.5% of BO and 61.4% of non‐BO patients (P < 0.0001), and one H2RA in 31.7% of BO and 59.4% of non‐BO patients (P < 0.0001), respectively. However, 6.1% of BO patients were prescribed neither. Median duration for PPI filled prescriptions was twice as long for BO (221.7 vs. 106.9 days) compared with non‐BO patients. The ratio of PPI or H2RA filled prescription days to available follow‐up days among BO subjects was 0.66 (122.8 days were not covered with prescription for either), and 0.55 in GERD patients with no BO (165.0 days on neither).

Conclusions  Veterans Affairs patients with BO are 50% more likely to be prescribed a PPI than patients with GERD and no BO. However, on average, PPI prescriptions cover only 60% of follow‐up time for BO patients.
Gastro‐oesophageal reflux, medical resource utilization and upper gastrointestinal endoscopy in patients at risk of oesophageal adenocarcinoma
Authors: VAN SOEST E. M. , DIELEMAN J. P. , STURKENBOOM M. C. J. M. , SIERSEMA P. D. , KUIPERS E. J.
Published: July 2010

Background  Early identification of patients at risk of oesophageal adenocarcinoma (OAC) might improve survival.

Aim  To assess the medical resource utilization in the 3 years before OAC diagnosis as potential markers for early identification and intervention.

Methods  We identified 65 incident OAC within the Integrated Primary Care Information database. For comparison, we randomly selected 260 age‐ and gender‐matched population controls. We abstracted the use of gastric acid inhibitors, general practitioner (GP) and specialist care, and gastroscopies in the 3 years before the detection of OAC.

Results  Approximately 20% of the cases used gastric acid inhibitors in the third and second year before OAC, which increased to almost 50% in the last year, compared to approximately 10% among controls. Only in the 6 months before OAC, the proportion of patients visiting a GP (97%) or specialist (41%) increased compared to controls. Of 13 gastroscopies performed in the 3 years, six (46%) were not suspect for a malignancy.

Conclusions  Only a minority of all OAC patients used acid inhibitors before diagnosis. The use of medical care between cases and controls differed only in the final year before OAC diagnosis. Detection of early neoplastic changes proves to be difficult.
Review article: epidemiology, pathogenesis and potential treatments of paediatric non‐alcoholic fatty liver disease
Authors: BARSHOP N. J. , SIRLIN C. B. , SCHWIMMER J. B. , LAVINE J. E.
Published: July 2010

Background Non‐alcoholic fatty liver disease (NAFLD) is the most common cause of paediatric liver disease. Similar to NAFLD in adults, NAFLD in children is associated with obesity and insulin resistance and requires liver histology for diagnosis and staging. However, significant histological differences exist between adult and paediatric NAFLD to warrant caution in extrapolation of adult data.

Aim To review the available data on the epidemiology, pathogenesis, diagnosis and treatment of paediatric NAFLD.

Methods Relevant articles were identified by Medline searches using the keywords: nonalcoholic fatty liver disease, steatohepatitis, obesity and children.

Results The rise in childhood obesity has been accompanied by an increase in paediatric NAFLD. Age, gender and race/ethnicity are significant determinants of risk, and sex hormones, insulin sensitivity and adipocytokines are implicated in the pathogenesis of paediatric NAFLD. There is no consensus for treatment of NAFLD; however, data suggest that diet, exercise and some pharmacological therapies may be of benefit.

Conclusions To evaluate and effectively treat paediatric NAFLD, the pathophysiology and natural history of the disease should be clarified and non‐invasive methods for screening, diagnosis, and longitudinal assessment developed. Randomized, controlled, double‐blind trials of pharmacological therapies in children with biopsy‐proven disease are necessary.
Health‐economic analysis: cost‐effectiveness of scheduled maintenance treatment with infliximab for Crohn’s disease – modelling outcomes in active luminal and fistulizing disease in adults
Authors: LINDSAY J. , PUNEKAR Y. S. , MORRIS J. , CHUNG‐FAYE G.
Published: July 2010

Background  Infliximab has been shown to be efficacious in moderate‐to‐severe Crohn’s disease (CD).

Aim  To evaluate the cost‐effectiveness of scheduled maintenance treatment with infliximab in luminal and fistulizing CD patients.

Methods  Markov models were constructed to simulate the progression of adult CD patients with and without fistulae during treatment with infliximab (5 mg/kg). Transitions were estimated from published clinical trials of infliximab. Standard care, comprising immunomodulators and/or corticosteroids was used as a comparator. An average weight of 60 kg was used to estimate the dose of infliximab. The costs and outcomes were discounted at 3.5% over 5 years. The primary effectiveness measurement was quality‐adjusted life years (QALYs) estimated using EQ‐5D. One‐way and probabilistic sensitivity analyses were performed by varying the infliximab efficacy estimates, costs and utilities.

Results  The incremental cost per QALY gained was £26 128 in luminal CD and £29 752 in fistulizing CD at 5 years. Results were robust and remained in the range of £23 752–£38 848 for luminal CD and £27 047–£44 206 for fistulizing CD. Patient body weight was the most important factor affecting cost‐effectiveness.

Conclusion  Eight‐week scheduled maintenance treatment with infliximab is a cost‐effective treatment for adult patients suffering from active luminal or fistulizing CD.
Pre‐operative intramuscular ranitidine and cimetidine
Authors: WILLIAMS J. G. , STRUNIN L.
Published: July 2010

A controlled trial was carried out on 120 healthy patients presenting for elective surgery. The patients were divided randomly into three groups, which received respectively, 50 mg ranitidine, 100 mg ranitidine, or 300 mg cimetidine intramuscularly at least 45 minutes before operation. Following induction of anaesthesia, a nasogastric tube was passed, the stomach contents aspirated and analysed for volume and pH. Thirteen per cent of cimetidine‐treated patients had a gastric pH of 2.5 or less, compared to 8% of those given ranitidine 50 mg and 3% of those given ranitidine 100 mg; however, these differences were not statistically significant. No side effects attributable to the administration of either drug were observed. It is concluded that intramuscular administration of ranitidine or cimetidine is an effective method of reducing the number of patients at risk of acid aspiration during anaesthesia. However, neither drug eliminates the risk of acid aspiration in all patients. and thus careful anaesthetic technique to protect the airway remains essential.
Potential hazard of East‐Radcliffe ventilator
Authors: MYERSON K. R.
Published: July 2010

Reports of two hypoxic episodes which occurred during the use of the East Radcliffe PNA 1 ventilator in the ‘complete rebreathing’ mode led to the study of the efficiency of the emergency air entrainment system. The inability of this system to maintain adequate oxygen concentrations during interruption of the fresh gas supply results in the development of a hypoxic gas mixture despite potency of the entrainment valve. The reasons for this, and their clinical implications during intermittent positive pressure ventilation in the ‘complete rebreathing’ mode, are discussed.
Three cases of difficult intubation overcome by the laryngeal mask airway
Authors: BRAIN A. I. J.
Published: July 2010

Three cases of difficult intubation are described in which the problem was overcome by use of the laryngeal mask airway. It is stressed that the anaesthetist should become thoroughly familiar with the technique before attempting to use it in difficult cases.
Allergy, plasma IgE level and anaphylactoid response: a hypothesis
Authors: WATKINS J. , WILD G. , CLARKE R.S.J.
Published: July 2010

Any simple test predictive of immediate hypersensitivity‐like (anaphylactoid) response to anaesthetic agents would be clinically useful. Possession of the traits of allergy or atopy, and of raised plasma IgE levels, all easily established, have previously been reported as predisposing factors. The usefulness of such observations has been limited by the fact that many reactions are not immune and do not involve IgE antibodies. This hypothesis suggests how IgE levels may be widely predictive of other reaction mechanisms and partially explains some of the divergent views on the mechanisms of anaphylactoid response which occur in the literature.
Review of domiciliary consultations for pain relief
Authors: Casale F.F. , Thorogood A.
Published: July 2010

Three hundred consecutive requests for a domiciliary visit for pain relief were reviewed to assess the type of case referred by general practitioners and what treatment was instituted. Two hundred and thirty one (77%) were requested for lumbago/sciatica. In total 179 caudal epidurals and 49 other injections were performed in the patient's home. The safety of the procedures are discussed emphasising careful history taking, physical examination and meticulous attention to injection techniques as 12 patients (7%) were wrongly diagnosed as suffering from lumbago and sciatica from the 231 referred with that diagnosis.
Nitrous oxide solubility in halothane and its effect on the output of vaporizers
Authors: PALAYIWA E. , HAHN C. E. W. , SUGG B. R.
Published: July 2010

The absorption of nitrous oxide in halothane was studied by bubbling nitrous oxide and nitrous oxide/oxygen gas mixtures through a halothane bottle, using 100% oxygen as a control. The gas volume emerging from the halothane bottle was measured each minute, over a period of up to 15 minutes. When oxygen was used as a control gas, the averaged flow rate dropped slightly over the experimental period, due to the cooling of the halothane. However, in the presence of nitrous oxide, the initial flow rate of the gas emerging from the halothane bottle was greatly diminished, but then accelerated rapidly to reach that obtained with oxygen. The results suggested that nitrous oxide dissolved in large quantities in halothane, and the data are consistent with an Ostwald coefficient in excess of 4.0.
Effect of premedication with controlled‐release oral morphine on postoperative pain
Authors: SLOWEY H. F. , REYNOLDS A. D. , MAPLESON W. W. , VICKERS M. D.
Published: July 2010

Thirty five patients presenting for elective total hip replacement were randomly allocated to receive a premedication of 60 or 90 mg controlled‐release oral morphine or 15 mg intramuscular morphine. Postoperative analgesia was assessed using on‐demand intravenous pethidine supplementation requirements. In 15 patients free plasma morphine concentrations were measured. Both 60 and 90 mg controlled‐release oral morphine led to a reduced pethidine requirement compared to the intramuscular group but the reduction was not statistically different.
The management of anaesthesia for patients with cystic fibrosis
Authors: LAMBERTY J. M. , RUBIN B. K.
Published: July 2010

The clinical problems of patients with cystic fibrosis who require anaesthesia are reviewed. The management and the complications of anaesthesia in 77 patients over a 3‐year period are presented. The long term effects of anaesthesia are analysed by a study of the lung function tests of these patients. The results suggest that even multiple procedures, as for instance nasal polypectomy, are not harmful. A method for safe peroperative management is presented.
Intradermal testing and anaphylactoid reactions
Authors: MACDONALD A. R. , EMERY F. M.
Published: July 2010

A patient who exhibited a severe reaction to an intravenous agent on one occasion was given a similar anaesthetic on a subsequent occasion without incident. Intradermal testing was carried out and the results are tabulated and discussed.
Evaluation of the Datex ‘Normac’ anaesthetic agent monitor
Authors: LUFF N. P. , WHITE D. C.
Published: July 2010

The Datex ‘Normac’ infrared anaesthetic agent monitor has been evaluated for accuracy of calibration, stability and speed of response. Accuracy was assessed by comparing with a gas chromatograph calibrated using volumetric standards and was found to be very good for isopurane and enflurane but was slightly less accurate for halothane, due to a low signal: noise ratio. The stability of the instrument was found to be exceptionally good. The response time is dependent on the sampling rate and we found that, in practice, the instrument would record the end expired anaesthetic concentration on patients breathing up to 15 breaths/minute. The instrument is compact and convenient for use in operating theatres.
Fibreoptic bronchoscopic nasotracheal intubation of a neonate with Pierre Robin syndrome
Authors: HOWARDY‐HANSEN P. , BERTHELSEN P.
Published: July 2010

A case of nasotracheal intubation using a fibreoptic bronchoscope and the Seldinger technique is described. A guide wire was passed through the suction channel of the fibrescope after the epiglottis and the vocal cords were seen; the fibrescope was removed and a nasotracheal tube passed over the wire into the trachea.
Intrathecal buprenorphine for postoperative analgesia in the elderly patient
Authors: CAPOGNA G. , CELLENO D. , TAGARIELLO V. , LOFFREDA‐MANCINELLI C.
Published: July 2010

Ninety patients aged 56–85 years scheduled for suprapubic prostatectomy, randomly received intrathecally either bupivacaine 30 mg (group A, n = 30), bupivacaine 30 mg plus buprenorphine 0.03 mg (group B, n = 30) or bupivacaine 30 mg plus buprenorphine 0.045 mg (group C, n = 30). Prolongea postoperative analgesia, minimal disturbance of consciousness and comfortable breathing were common to the groups that received buprenorphine. The higher concentration of buprenorphine improved the quality and duration of analgesia. The only side effects found in the buprenorphine groups were nausea and vomiting in 11 and 14 patients, respectively, in groups B and C. Our study shows that buprenorphine is an effective analgesic, suitable for the management of postoperative pain in elderly patients.
HELLP syndrome and the anaesthetist
Authors: DUFFY B. L.
Published: July 2010

Four pregnant patients are described who had varying signs of pre‐eclampsia plus haemolysis, elevated liver enzymes and a low platelet count. Two of the patients presented without hypertension and all posed considerable diagnostic difficulties, with problems in clinical management. Pregnancy induced hypertension is only one manifestation of a much more diverse pathophysiological process. Anaesthetists need to be aware of these other pregnancy related disorders in order to avoid diagnostic pitfalls and to enable them to provide safely the appropriate general and regional anaesthetic techniques.
Technical advantages of the paramedian approach for lumbar epidural puncture and catheter introduction
Authors: BLOMBERG R. G.
Published: July 2010

The lumbar epidural space of 14 autopsy subjects was examined by epiduroscopy. The aim was to compare the midline and paramedian approaches of locating the space, the estimated risk of accidental dural puncture, the course taken by the epidural catheter after introduction and with special attention to the influence of the dorsomedian connective tissue band. The paramedian needle passed a greater distance within the epidural space before contact with the dura mater and demonstrated a low risk of accidental dural puncture. The catheter passed by the paramedian approach did not cause any tenting of the dura and took a straight cephalad direction in all 14 cases. The midline catheter caused tenting of the dura in all 14 cases and the direction of travel was variable. Differences were statistically significant. Influence of the dorsomedian connective tissue band was greatest on the behaviour of the midline needle and catheter.
Lignocaine 2% with adrenaline for epidural Caesarean section
Authors: NORTON A. C. , DAVIS A. G. , SPICER R. J.
Published: July 2010

A randomised double blind controlled trial of freshly prepared 2% lignocaine with 1/200 000 adrenaline and 0.5% plain bupivacaine was conducted on 60 women undergoing elective Caesarean section. The use of the former enabled epidural blockade to above the T6 dermatome to be established in a significantly shorter time than with bupivacaine (p < 0.005). The quality of sensory blockade and incidence of complications was similar in the two groups. The solutions were of similar potency as measured by the volume required per segment blocked. Motor blockade was more intense with 2% lignocaine with adrenaline (p < 0.03). More neonates had moderately depressed Apgar scores (5–7) at one minute in the lignocaine group but this difference was not statistically significant, and there was no difference in the distribution of Apgar scores at 3 minutes. Lignocaine with 1/200 000 adrenaline is a useful alternative to 0.5% plain bupivacaine when it is desired to establish rapidly epidural blockade for Caesarean section.
Spina bifida occulta and epidural anaesthesia
Authors: McGRADY E. M. , DAVIS A. G.
Published: July 2010

Spina bifida occulta occurs in 5–10% of the population, not all of whom display superficial signs. Attempted epidural puncture at the level of the lesion will almost certainly result in a dural tap. We report a patient who developed a postural headache after Caesarean section under epidural anaesthesia, in whom radiography of the spine later demonstrated spina bifida occulta. This problem has not been described previously, although it is unlikely to be an isolated case.
Systemic air embolism during laser bronchoscopy
Authors: PEACHEY T. , EASON J. , MOXHAM J. , JARVIS D. , DRIVER M.
Published: July 2010

We report a case of massive, fatal, systemic gas embolism which occurred during the course of laser bronchoscopic resection of a bronchial carcinoma. The clinical features of systemic air embolism are discussed.
Costs of replacement of anaesthetic equipment. Projected expenditure for clinical anaesthetic equipment in a teaching health district
Authors: Schofield N. McC.
Published: July 2010

A study was made of all the anaesthetic equipment in clinical use to substantiate estimates of the cost of its replacement on four hospital sites. The years during which replacement was likely to become necessary were estimated from the list compiled and an existing full inventory, together with costs at 1986 prices. The predicted costs for each year until 2000AD were derived. To these were added sums required to make good existing shortfalls and to introduce a moderate amount of equipment incorporating newer technology. The totals showed that the capital currently available in the health district is sufficient only for anaesthetic equipment and requires a substantial increase to replace medical apparatus belonging to all specialties already in routine clinical use. Health authorities must be given detailed projections of these costs.
Is propofol a safe agent in porphyria?
Authors: WEIR P. M. , HODKINSON B. P.
Published: July 2010

A case is presented of the use of a propofol infusion for anaesthesia in a patient with known variegate porphyria. Urinary screening for porphyrins demonstrated a marked increase after this anaesthetic, hut there were no clinical symptoms.