bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dilated intercellular spaces and acid reflux at the distal and proximal oesophagus in patients with non‐erosive gastro‐oesophageal reflux disease
Authors: CAVIGLIA R. , RIBOLSI M. , GENTILE M. , RABITTI C. , EMERENZIANI S. , GUARINO M. P. L. , PETITTI T. , CICALA M. 
Published: July 2010

SummaryBackground  Acid exposure of proximal oesophagus and dilated intercellular space diameters of oesophageal epithelium are relevant in the perception of gastro‐oesophageal reflux.Aim  To explain the relationship between gastro‐oesophageal reflux disease symptoms, acid exposure and intercellular space diameter along the oesophageal epithelium and to assess time‐related variability of intercellular space diameter.Methods  Thirty‐three non‐erosive reflux disease (NERD), six erosive oesophagitis patients and 12 asymptomatic controls underwent oesophageal manometry and 24‐h dual‐channel oesophageal pH‐monitoring following endoscopy. Biopsies were taken 5 cm above the LES and 10 cm below the UES, at comparable levels, as pH sensors. A total of 100 intercellular space diameters per patient/control were measured blindly at transmission electron microscopy. In 15 patients, the investigation was repeated after 1 year.Results  In all NERD patients, acid exposure was higher at mid‐proximal oesophagus (P < 0.01) and mean intercellular space diameters, at distal and mid‐proximal oesophagus, was three‐ and twofold higher (1.5 and 0.82 μm, respectively) compared with controls. Intra‐patient intercellular space diameter values were stable over time, not overlapping with those of controls.Conclusions  Dilation of intercellular space diameter occurs along the distal and proximal oesophageal epithelium in NERD patients and could be responsible for the enhanced perception of proximal acid reflux. This finding appears to be time‐reproducible and to represent a sensitive, histopathological marker of NERD.
Thalidomide in luminal and fistulizing Crohn's disease resistant to standard therapies
Authors: PLAMONDON S. , NG S. C. , KAMM M. A. 
Published: July 2010

SummaryBackground  Thalidomide has been shown to be an effective treatment in Crohn's disease.Aim  To assess the efficacy and tolerability of thalidomide in refractory Crohn's disease patients.Methods  Twenty‐five patients were treated. Retrospective ‘estimated’ Crohn's Disease Activity Indices were assessed at baseline and at the end of follow‐up. Clinical response was defined as symptomatic improvement and a reduction in the ‘estimated’ Crohn's Disease Activity Index of >100 points, ≥50% reduction in draining fistulas or clinical improvement in perianal ulcers. Clinical remission was defined as symptom resolution and an ‘estimated’ Crohn's Disease Activity Index <150, complete fistula closure or complete ulcer healing.Results  Six of eight patients treated for luminal disease responded to thalidomide at a median follow‐up of 12 months (three clinical responses, three clinical remissions). The median reduction in ‘estimated’ Crohn's Disease Activity Index was 212 points (P = 0.005). Nine of 11 patients with active fistulizing disease responded to thalidomide (six responses; three remissions). The four patients treated for both luminal and fistulizing disease had fistula response. Three of them had a response in luminal disease activity. One of two patients with ulcerating perianal disease responded. Twelve patients discontinued treatment because of adverse effects (three sedation; two abdominal pain; one leucopoenia; six neuropathy).Conclusion  Thalidomide is an effective short‐ to medium‐term treatment in selected patients with refractory luminal and fistulizing Crohn's disease. Its long‐term use is limited by toxicity.
GI Epidemiology: nonalcoholic fatty liver disease
Authors: ANGULO P. 
Published: July 2010

SummaryBackground  Nonalcoholic fatty liver disease (NAFLD) is a common diagnosis in clinical practice. Insulin resistance and oxidative stress play an important role in NAFLD development and progression.Aim  To review the data available on the epidemiology and natural history of NAFLD as well as the risk factors for its development and the areas where future research is necessary.Results/Conclusions  NAFLD may affect individuals of any age range and race/ethnicity. NAFLD affects one in three adults and one in ten children/adolescents in the United States. Mortality in patients with NAFLD is significantly higher than in the general population of same age and gender with liver‐related complications being a common cause of death. Liver‐related morbidity and mortality in NAFLD occurs when the disease has progressed to advanced fibrosis and cirrhosis. Further studies are necessary to determine the impact of NAFLD on health‐related quality of life and resources utilization, and to the extent to which preventing the development of the metabolic syndrome would prevent NAFLD development and reduce liver‐related morbidity and mortality. Lifestyle intervention may improve NAFLD, but medications that increase insulin sensitivity and the antioxidant defenses in the liver deserve evaluation in carefully controlled trials.
Patients with irritable bowel syndrome or constipation have an increased risk for ischaemic colitis
Authors: SUH D.‐C. , KAHLER K. H. , CHOI I.‐S. , SHIN H. , KRALSTEIN J. , SHETZLINE M. 
Published: July 2010

SummaryAimsTo estimate the relative risk for ischaemic colitis in patients with and without irritable bowel syndrome or constipation, and to evaluate the role of irritable bowel syndrome and constipation as confounders in the relationship between commonly used gastrointestinal medications and ischaemic colitis.MethodsPatient cohorts were identified with the use of longitudinal MarketScan research databases from 1 January 1999 to 31 December 2002. Patients in each study cohort were matched 1:1 with comparable control patients using a propensity score. A Cox proportional hazards models were used to estimate relative risk for ischaemic colitis.ResultsThe relative risk for ischaemic colitis was 3.17 and 2.78 times higher for patients with irritable bowel syndrome and constipation, respectively, than for those without these disorders. Patients who were taking an antispasmodic, a proton pump inhibitor, or an H2‐antagonist were at increased risk for ischaemic colitis [relative risk with 95% CI 2.73 (1.41–5.39), 2.00 (1.05–3.79), 2.75 (1.22–6.17) respectively]; however, when these results were adjusted for irritable bowel syndrome or constipation, the relative risks were attenuated and no longer statistically significant.ConclusionsPatients with irritable bowel syndrome or constipation demonstrated a two‐ to threefold increased risk for ischaemic colitis. Moreover, irritable bowel syndrome and constipation strongly confounded the relationship between gastrointestinal drug use and the risk for ischaemic colitis, suggesting that etiologic studies of ischaemic colitis risk must account for the presence of irritable bowel syndrome or constipation.
Prognostic value of hepatic venous pressure gradient for in‐hospital mortality of patients with severe acute alcoholic hepatitis
Authors: RINCON D. , LO IACONO O , RIPOLL C , GOMEZ‐CAMARERO J , SALCEDO M , CATALINA M. V , HERNANDO A , CLEMENTE G , MATILLA A , NUÑEZ O , BAÑARES R 
Published: July 2010

SummaryBackgroundHepatic venous pressure gradient (HVPG) has prognostic value in complications and survival of patients with liver cirrhosis. However, the relationship between HVPG and the outcome of acute alcoholic hepatitis (AAH), as well as the specific features of portal hypertension syndrome in this setting, have not been defined.AimsTo evaluate the prognostic value of HVPG and to analyse the degree of portal hypertension and hyperdynamic circulation in patients with severe AAH.MethodsEarly measurements of HVPG were performed in 60 patients with severe AAH, and compared with the haemodynamic findings of 37 and 29 liver transplantation candidates with alcoholic or viral end‐stage cirrhosis respectively.ResultsTwenty‐three patients (38%) died during hospitalization. Portal hypertension and hyperdynamic circulation were more severe in AAH patients. HVPG was greater in non‐survivors [26.9 (7.4) vs. 19.4 (5.2) mmHg,P < 0.001]. Only 4/31 (13%) patients with HVPG ≤ 22 mmHg died from the episode of AAH, vs. 19/29 (66%) patients with HVPG > 22 (P < 0.001). Encephalopathy (OR 9.4; CI 1.4–64.8), Model for End‐Stage Liver Disease (MELD) score > 25 (OR 7.4; CI 1.4–39.9) and HVPG > 22 mmHg (OR 6.7; CI 1.1–39.9) were independently associated to in‐hospital mortality.ConclusionsEarly measurement of HVPG provides important prognostic information on the short‐term outcome of patients with severe AAH. In addition, MELD score also seems to be a strong prognostic factor in these patients.
Perceptions and practices on the management of gastro‐oesophageal reflux disease: results of a national survey comparing primary care physicians and gastroenterologists
Authors: BRETAGNE J.‐F. , HONNORAT C. , RICHARD‐MOLARD B. , SOUFFLET C. , BARTHÉLEMY P. 
Published: July 2010

SummaryBackgroundLiterature comparing generalist and specialist care is accumulating in many disease areas, but very few studies focussed on gastrointestinal diseases and little is known about gastro‐oesophageal reflux disease.AimTo compare the management of gastro‐oesophageal reflux disease (GERD) by French primary care physicians and gastroenterologists.MethodsA postal survey was conducted in a representative sample of French physicians who were asked to complete a questionnaire that consisted of 44 questions relating to their usual medical practice for the diagnostic and therapeutic management of frequent GERD.Results136 primary care physicians and 91 gastroenterologists participated in the survey (54%). Alarm symptoms were identified more frequently by primary care physicians than gastroenterologists, but the appraisal of their seriousness was less acute by primary care physicians than gastroenterologists. Upper endoscopy was prescribed more frequently by gastroenterologists (64% vs. 38%, P < 0.01). Physicians in both groups mainly recommended lifestyle modification. For GERD treatment, most respondents declared using a ‘step‐down’ strategy with proton pump inhibitors, and only slight differences in drug prescription were identified between primary care physicians and gastroenterologists. Both groups of physicians also have similar perception of symptom persistence after treatment, but satisfaction with treatments was slightly higher for gastroenterologists than primary care physicians (7.6 vs. 7.1 on a scale from 0 to 10, P < 0.01).ConclusionsOverall patterns of GERD diagnosis and management are comparable between primary care physicians and gastroenterologists. Both groups perceive that GERD therapy can still be improved.
Treatment of chronic he1patitis C genotype 1 with peginterferon‐ α2a (40 kDa) plus ribavirin under routine clinical practice in Spain: early prediction of sustained virological response rate
Authors: DIAGO M. , OLVEIRA A. , SOLÁ R. , ROMERO‐GÓMEZ M. , MORENO‐OTERO R. , PÉREZ R. , SALMERÓN J. , ENRÍQUEZ J. , PLANAS R. , GAVILÁN J. C. , DEL OLMO J. , URIBARRENA R. , SILLERO C. , BENÍTEZ A. , SÁNCHEZ‐GALDÓN S. , DALMAU B. , ERAÑA L. , MONTORO M. , PORTU J. , GARIJO J. M. , BARNIOL R. , DOMÍNGUEZ A. , ROTA R. , OLCOZ J. L. , ANTÓN M. , PAMPLONA X. , CASANOVAS T. , JIMÉNEZ E. , HUARTE M. , DÍAZ F. , SÁNCHEZ‐RUANO J. , ORIVE M. , MUÑOZ‐SÁNCHEZ M. , ROSET M. 
Published: July 2010

SUMMARYBackground Sustained virological response rates of up to 52% have been obtained with peginterferon α2a (40 kDa) plus ribavirin in patients suffering from chronic hepatitis C genotype 1 in randomized‐controlled trials.Aim To assess early virological response and its clinical utility in predicting an sustained virological response in patients suffering from chronic hepatitis C genotype 1 in routine clinical practice in Spain.Methods Treatment‐naïve patients received pegylated interferon α2a (40 kDa) 180 µg/week plus ribavirin 1000/1200 mg/day for 48 weeks, and were followed for a further 24 weeks. Overall, 475 patients received at least one dose of medication and were included in the efficacy population.Results The overall sustained virological response rate was 48%. Of those with week 12 virological data, 83% had an early virological response. The negative predictive value of an early virological response was 93%.Conclusion If sustained virological response is the goal, a treatment‐decision based on a 12‐week evaluation during routine clinical practice is feasible.
Symptom overlap in patients with upper gastrointestinal complaints in the Canadian confirmatory acid suppression test (CAST) study: further psychometric validation of the reflux disease questionnaire
Authors: VAN ZANTEN S. V. , ARMSTRONG D. , BARKUN A. , JUNGHARD O. , WHITE R. J. , WIKLUND I. K. 
Published: July 2010

SummaryBackground The reflux disease questionnaire (RDQ) is a short, patient‐completed instrument.Aims To investigate the psychometric characteristics of the RDQ in patients with heartburn‐predominant (HB) and non‐heartburn predominant (NHB) dyspepsia.Methods HB (n = 388) and NHB (n = 733) patients were randomized to esomeprazole 40 mg daily or twice daily for 1 week, followed by 3 weeks of esomeprazole 40 mg daily.Results High factor loadings (0.78–0.86) supported the ‘regurgitation’ dimension of the RDQ. Overlapping factor loadings in the ‘heartburn’ and ‘dyspepsia’ dimensions suggested symptom overlap. All dimensions demonstrated high internal consistency (Cronbach’s alpha: 0.79–0.90). Intra‐class correlation coefficients over 4 weeks were good (0.66–0.85). The RDQ showed good responsiveness over 4 weeks of treatment, with high effect sizes (≥0.80). Moderate or large symptom improvements were reported by 90% and 77% of HB and NHB patients, respectively, following treatment. Patients who responded to acid suppression also experienced symptom benefits in all RDQ dimensions.Conclusions The RDQ is reliable, valid and responsive to change in HB and NHB patients. The symptom overlap is important but need not play a major role in determining treatment strategy as both patient groups benefited from proton pump inhibitor treatment.
Cyclooxygenase‐2 selectivity of non‐steroidal anti‐inflammatory drugs and the risk of myocardial infarction and cerebrovascular accident
Authors: ABRAHAM N. S. , EL‐SERAG H. B. , HARTMAN C. , RICHARDSON P. , DESWAL A. 
Published: July 2010

SUMMARYAimTo assess degree of cyclooxygenase‐2 (COX‐2) selectivity of a non‐steroidal anti‐inflammatory drug (NSAID) and risk of myocardial infarction (MI) or cerebrovascular accident (CVA).MethodsPrescription fill data were linked to medical records of a merged VA‐Medicare dataset. NSAIDs were categorized by Cox‐2 selectivity. Incidence of CVA and MI within 180 days of index prescription was assessed using Cox‐proportional hazards models adjusted for gender, race, cardiovascular and pharmacological risk factors and propensity for prescription of highly COX‐2 selective NSAIDs.ResultsOf 384 322 patients (97.5% men and 85.4% white), 79.4% were prescribed a poorly selective, 16.4% a moderately selective and 4.2% a highly selective NSAID. There were 985 incident cases of MI and 586 cases of CVA in >145 870 person‐years. Highly selective agents had the highest rate of MI (12.3 per 1000 person‐years; [95% CI: 12.2–12.3]) and CVA (8.1 per 1000 person‐years; [95% CI: 8.0–8.2]). Periods without NSAID exposure were associated with lowest risk. In adjusted models, highly selective COX‐2 selective NSAIDs were associated with a 61% increase in CVA and a 47% increase in MI, when compared with poorly selective NSAIDs.ConclusionsThe risk of MI and CVA increases with any NSAID. Highly COX‐2 selective NSAIDs confer the greatest risk.
Cochrane systematic review: pegylated interferon plus ribavirin vs. interferon plus ribavirin for chronic hepatitis C
Authors: SIMIN M. , BROK J. , STIMAC D. , GLUUD C. , GLUUD L. L. 
Published: July 2010

SUMMARYBackground About 170 million patients worldwide have chronic hepatitis C. Pegylated interferon plus ribavirin is currently the recommended therapy.Aim To evaluate the beneficial and harmful effects of pegylated interferon plus ribavirin vs. interferon plus ribavirin for chronic hepatitis C infection.Methods We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, Science Citation Index Expanded and contacted pharmaceutical companies and authors of trials (to March 2005).Results We included 18 randomized clinical trials with 4811 patients. Eleven trials (61%) had allocation bias risks and all had assessment bias risk because of lack of blinding. Compared with interferon plus ribavirin, pegylated interferon plus ribavirin had significant beneficial effects on sustained virological response [risk ratio (RR): 0.80; 95% CI: 0.74–0.88]. Data were insufficient to determine impact on long‐term outcomes. Pegylated interferon plus ribavirin significantly increased dose reductions (RR: 1.44; 95% CI: 1.14–1.82) and adverse events including neutropenia (RR: 2.25; 95% CI: 1.58–3.21), thrombocytopenia (RR: 2.28; 95% CI: 1.14–4.54), arthralgia (RR: 1.19; 95% CI: 1.05–1.35), and injection‐site reaction (RR: 2.56; 95% CI: 1.06–6.22).Conclusions Pegylated interferon plus ribavirin compared with interferon plus ribavirin increased the proportion of patients with sustained virological response, but at the cost of more adverse events.
Acute exacerbation of pain in irritable bowel syndrome: efficacy of phloroglucinol/trimethylphloroglucinol – a randomized, double‐blind, placebo‐controlled study
Authors: CHASSANY O. , BONAZ B. , BRULEY DES VARANNES S. , BUENO L. , CARGILL G. , COFFIN B. , DUCROTTÉ P. , GRANGÉ V. 
Published: July 2010

SummaryBackground Abdominal pain is the predominant symptom in irritable bowel syndrome patients. Phloroglucinol and its methylated derivative are antispasmodic agents acting on smooth muscle.Aim To evaluate the efficacy of phloroglucinol/trimethylphloroglucinol on pain intensity during an acute exacerbation of pain of irritable bowel syndrome over a 1‐week period treatment.Methods Irritable bowel syndrome Rome II patients seeking medical advice for an acute exacerbation of abdominal pain were randomized to phloroglucinol/trimethylphloroglucinol (62.2 mg P + 80 mg TMP) two pills three times daily or placebo for 7 days. Patients were included if they had a pain with a minimal intensity of 40 on a 100‐mm visual analogue scale, and if pain occurred at least 2 days during the week previous inclusion.Results Three hundred and seven patients were included by 78 general practitioners. The intent‐to‐treat population included 300 patients, aged of 46.9 ± 14.8 years (73% female). The relative decrease of pain intensity at day 7 was 57.8 ± 31.7% vs. 46.3 ± 34.7% (Δ = 11.5 ± 3.8%, [CI95%: 4.0 ; 19.1], P = 0.0029) and the percentage of patients with at least a 50% decrease of pain intensity was 62% vs. 47% (Δ = 15.3 ± 5.7%, [CI95%: 4.1 ; 26.5], P = 0.0078) in phloroglucinol/trimethylphloroglucinol and placebo groups, respectively.Conclusions A 1‐week phloroglucinol/trimethylphloroglucinol treatment significantly reduces pain intensity in irritable bowel syndrome patients consulting their general practitioners for pain exacerbation.
Fibrosis progression occurs in a subgroup of heavy drinkers with typical histological features
Authors: MATHURIN P. , BEUZIN F. , LOUVET A. , CARRIÉ‐GANNE N. , BALIAN A. , TRINCHET J. C. , DALSOGLIO D. , PREVOT S. , NAVEAU S. 
Published: July 2010

SummaryBackground Studies using consecutive liver biopsies constitute an attractive approach to gaining insight into the pathogenesis of alcoholic liver disease.Aim To analyse histological factors at baseline, which are predictive of fibrosis progression and recurrence of alcoholic hepatitis.Results A total of 193 drinkers underwent consecutive biopsies at an interval of 4 years. At baseline, 20 had normal livers, 135 steatosis, five fibrosis and 33 alcoholic hepatitis. The fibrosis score increased from 1.07 ± 0.07 to 1.7 ± 0.94 (P < 0.001). In multivariate analysis, only steatosis (P = 0.04), alcoholic hepatitis (P = 0.0004) and stage of fibrosis (P < 0.0001) were independent predictive factors of the fibrosis score at the second biopsy. Cirrhosis developed more frequently in patients with steatosis (11%) and alcoholic hepatitis (39%) than in others (0%, P < 0.0001). Alcoholic hepatitis recurred more frequently in patients with alcoholic hepatitis at baseline: 58% vs. 15%, P < 0.0001. In multivariate analysis, alcoholic hepatitis at the first biopsy was the only predictive factor of its recurrence (P < 0.0001).Conclusions In a large cohort of drinkers with consecutive biopsies, steatosis, fibrosis stage and alcoholic hepatitis at baseline were independent predictive factors of fibrosis progression. In terms of mechanisms, we propose a novel concept of multiple hits of alcoholic hepatitis occurring in the same patient.
Temporal trends in new and recurrent oesophageal strictures in a Medicare population
Authors: EL‐SERAG H. B. , LAU M. 
Published: July 2010

SUMMARYBackground  The widespread use of proton pump inhibitors for gastro‐oesophageal reflux disease could result in a decline in new as well as recurrent gastro‐oesophageal reflux disease‐related oesophageal strictures. The temporal trends of strictures have not been examined in population‐based studies.Methods  To examine the temporal trends in strictures, we calculated the age‐adjusted incidence rates of new oesophageal strictures with or without oesophageal dilation in a sample of Medicare beneficiaries between 1992 and 2000. We also examined recurrent dilations recorded at least 3 months after a new stricture or the preceding recurrent stricture.Results  The age‐adjusted rates for strictures accompanied with dilation declined by approximately 11% from 215 per million to 192 per million. New oesophageal strictures with dilation declined as a proportion of all upper endoscopies procedures (from 2.6% to 1.9%). Recurrent dilation within 1 year declined dramatically from 16% (9.5% CI: 12.5–20.3) in 1992 to 8% (95% CI: 4.43–10.62) in 2000. In multivariable proportional hazards model, there was a 30% risk reduction of recurrent oesophageal strictures.Conclusions  This population‐based study indicates that the incidence of new as well as recurrent oesophageal strictures has been declining. In the face of rising incidence of other gastro‐oesophageal reflux disease‐related complications, it is important to understand the explanation of the present observations.
Small bowel mucosal injury is reduced in healthy subjects treated with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy
Authors: GOLDSTEIN J. L. , EISEN G. M. , LEWIS B. , GRALNEK I. M. , AISENBERG J. , BHADRA P. , BERGER M. F. 
Published: July 2010

SUMMARYBackground  Small bowel mucosal injury associated with non‐selective non‐steroidal anti‐inflammatory drugs is being increasingly recognized.Aim  To evaluate the incidence of small bowel injury in healthy subjects receiving celecoxib or ibuprofen plus omeprazole using video capsule endoscopy (VCE).Methods  Subjects with normal baseline VCE were randomly assigned to receive celecoxib 200 mg b.d., ibuprofen 800 mg t.d.s. plus omeprazole 20 mg o.d. or placebo for 2 weeks. The primary end point was mean number of small bowel mucosal breaks per subject. Secondary end points included correlation of faecal calprotectin levels with the primary outcome.Results  After treatment, the mean number of small bowel mucosal breaks per subject and the percentage of subjects with mucosal breaks were 0.7/25.9% for ibuprofen/omeprazole compared with 0.2/6.4% for celecoxib and 0.1/7.1% placebo (both comparisons P < 0.001). There were no significant differences between celecoxib and placebo in any measure. Mean increases in faecal calprotectin levels were higher in subjects receiving ibuprofen/omeprazole compared with celecoxib (P < 0.001), but no correlation was determined between these levels and small bowel mucosal breaks.Conclusions  Among healthy subjects with no baseline endoscopic lesions, celecoxib was associated with significantly fewer small bowel mucosal breaks than ibuprofen/omeprazole as assessed by VCE.