bluuebunny/crossref_metadata_2025_split huggingface dataset:
The microbiological impact of pre‐operative biliary drainage on patients undergoing hepato‐biliary‐pancreatic (HPB) surgery
Authors: JETHWA P. , BREUNING E. , BHATI C. , BUCKLES J. , MIRZA D. , BRAMHALL S. 
Published: July 2010

SUMMARYBackground The merit of pre‐operative biliary drainage in managing hepatic, biliary or pancreatic patients remains unclear with previous studies demonstrating significant increases in bacterobilia.Aims To establish if pre‐operative biliary drainage was associated with (i) a change in bacterial flora, (ii) post‐operative sepsis and (iii) to ascertain if a modification of antibiotic prophylaxis was warranted.Methods Data were collected on 331 patients undergoing hepatic, biliary or pancreatic surgery for malignant obstruction between August 2000 and June 2005. Microbiological data from intra‐operative bile, post‐operative wounds, blood cultures, urine and sputum were analysed. All episodes of pre‐operative endoscopic retrograde cholangiopancreatography (ERCP), stenting and percutaneous drainage were documented.Results One hundred and sixty two patients had ERCP prior to surgery and 154 had surgery only. In comparison to patients who had surgery alone stented patients had significantly increased rates of bacterobilia (40 vs. 85%) and fungobilia (8 vs. 34%, both P < 0.001). Pre‐operative biliary drainage significantly increased post‐operative sepsis, wound infections and prolonged in‐patient stay (P < 0.05). The most common organisms cultured were coliforms and enterococcus with percutaneous transhepatic cholangiography (PTC) highly significant for the development of MRSA sepsis.Conclusions Pre‐operative biliary drainage is associated with a high incidence of bacterobilia and fungal colonization. Pre‐operative biliary drainage should be utilized selectively, with modification of antibiotic prophylaxis according to patient characteristics.
Elastomer implants in faecal incontinence: a blind, randomized placebo‐controlled study
Authors: SIPROUDHIS L. , MORCET J. , LAINÉ F. 
Published: July 2010

AbstractAim To test efficacy and safety of polydimethylsiloxane elastomer implants, a silicone biomaterial, in patients with severe faecal incontinence related to an impaired internal anal sphincter.Methods Subjects were randomized to receive three injections of 2.5 mL of either physiological saline or polydimethylsiloxane elastomer. After local anaesthesia, an 18 gauge, 2.5‐in needle was inserted through the perianal skin and laid down into the intersphincteric space. Treatment (saline or polydimethylsiloxane elastomer) was administered by means of a ratchet gun. Three injections of 2.5 mL each were performed in the area of the internal anal sphincter at 3, 7 and 11 o’clock positions. Main end point was the percentage of subjects in each treatment arm experiencing a successful treatment, defined as a Cleveland Clinic Florida‐Faecal Incontinence score <8, 3 months after treatment. Secondary end points were quality of life scores, weekly number of faecal incontinence episodes, subject acceptance and adverse events rate. Both patients and end point assessments were blinded to treatment.Results 44 women (64.3 ± 9 years) with a baseline Cleveland Clinic Florida‐Faecal Incontinence score ≥8 were enrolled prospectively; 22 received polydimethylsiloxane elastomer and 22 saline treatment. Treatment was well tolerated. At 3 months, the percentage of subjects experiencing a successful treatment was not different between polydimethylsiloxane elastomer and saline groups (23% vs. 27%, respectively, P = 0.73). Moreover, Cleveland Clinic Florida‐Faecal Incontinence score was not significantly different between polydimethylsiloxane elastomer and saline groups (11.7 ± 4.7 vs. 11.4 ± 4.5, respectively, P = 0.79).Conclusions Polydimethylsiloxane elastomer implants cannot be recommended for treatment of severe faecal incontinence related to impaired internal anal sphincter.
A 5‐year prospective study of the late resolution of chronic hepatitis C after antiviral therapy
Authors: ANNICCHIARICO B. E. , SICILIANO M. , AVOLIO A. W. , GRILLO R. L. , BOMBARDIERI G. 
Published: July 2010

SummaryBackground Persistence of hepatitis C virus (HCV) in serum is assured after any course of antiviral therapy that failed to obtain a sustained virological response.Aim To evaluate the long‐term effect on serum HCV‐RNA of a course of pegylated‐interferon and ribavirin therapy that was unable to obtain sustained response.Methods Serum HCV‐RNA was determined at monthly intervals in 68 non‐responders, breakthroughs or relapsers and in 52 naïve controls enrolled in a five‐year study.Results Five genotype 2 or 3 patients (one non‐responder, three breakthroughs, one relapser) cleared HCV‐RNA after the end of therapy or relapse, and remained negative until the end of follow‐up. HCV‐RNA clearance rate in genotype 2 and 3 non‐responders, breakthroughs or relapsers was higher than in controls with the same genotypes (22.7% vs. 0%; log‐rank 9.62; P < 0.002). HCV‐RNA at the end of treatment or at relapse was <105 IU/mL in the five subjects who cleared the virus and <104 IU/mL in four of them. None of genotype 1 or 4 subjects cleared HCV‐RNA during follow‐up.Conclusions Late resolution of HCV infection is possible in genotype 2 or 3 patients with low viral load at the end of therapy or at relapse. In these subjects, HCV‐RNA monitoring is advisable during the first year after therapy.
Persistent small bowel mucosal villous atrophy without symptoms in coeliac disease
Authors: KAUKINEN K. , PERÄAHO M. , LINDFORS K. , PARTANEN J. , WOOLLEY N. , PIKKARAINEN P. , KARVONEN A.‐L. , LAASANEN T. , SIEVÄNEN H. , MÄKI M. , COLLIN P. 
Published: July 2010

SUMMARYBackground  Refractory sprue with malabsorption carries a risk of lymphoma.Aim  To examine whether a good clinical but poor histological response during a strict gluten‐free diet predicts a poor outcome.Methods  The study involved all coeliac patients who showed no histological recovery within 2 years on a strict gluten‐free diet. Small intestinal biopsy and bone mineral density were investigated in 2001 and clinical features were followed up until 2005. The results were compared to those in 18 coeliac patients with a good histological recovery.Results  Thirteen coeliac patients had persistent small intestinal villous atrophy despite maintaining gluten‐free diet. All had demonstrated a good clinical response. Osteoporosis was found in 58% and 22% of the non‐responders and responders, respectively (P = 0.04). In 2005, two of the non‐responders had developed symptomatic refractory sprue, one died of lymphoma and one of carcinoid tumour, and one gastric adenocarcinoma was operated. None of the 18 controls had developed refractory sprue or malignancy. The frequency of histological non‐responsive disease was 1.9%.Conclusions  Persistent villous atrophy in adult coeliac disease, even in the absence of symptoms, carries a risk of subsequent severe complications. The follow‐up biopsy is important in detecting these individuals.
Systematic review: the application of molecular pathogenesis to prevention and treatment of oesophageal adenocarcinoma
Authors: PETERS C. J. , FITZGERALD R. C. 
Published: July 2010

SummaryBackgroundOesophageal adenocarcinoma is an increasingly common cancer with a poor prognosis. It develops in a stepwise progression from Barrett’s metaplasia to dysplasia, and then adenocarcinoma followed by metastasis.AimTo outline the key molecular changes in oesophageal adenocarcinoma and to summarize the chemopreventative and therapeutic strategies proposed.MethodsA literature search was performed to identify appropriate research papers in the field. Search terms included: Barrett’s (o)esophagus, intestinal metaplasia, (o)esophageal adenocarcinoma, molecular changes, genetic changes, pathogenesis, chemoprevention, therapeutic strategies and treatment. The search was restricted to English language articles.ResultsA large number of molecular changes have been identified in the progression from Barrett’s oesophagus to oesophageal adenocarcinoma although there does not appear to be an obligate order of events. Potential chemoprevention strategies include acid suppression, anti‐inflammatory agents and antioxidants. In established adenocarcinoma, targeted treatments under evaluation include receptor tyrosine kinase inhibitors of EGFR and cyclin‐dependent kinase inhibitors, which may benefit a subgroup of patients.ConclusionsAdvances in molecular methodology have led to a greater understanding of the oesophageal adenocarcinoma pathways, which provides opportunities for chemoprevention and therapeutic strategies with a mechanistic basis. More work is required to assess both the safety and efficacy of these new treatments.
Review article: the diagnosis and management of Crohn’s disease in populations with high‐risk rates for tuberculosis
Authors: EPSTEIN D. , WATERMEYER G. , KIRSCH R. 
Published: July 2010

SummaryBackground  Distinguishing Crohn’s disease from intestinal tuberculosis in endemic areas is challenging as both conditions have overlapping clinical, radiological, endoscopic and histological characteristics. Furthermore, high rates of latent tuberculosis confer a considerable risk of reactivation once therapy for established Crohn’s disease is started.Aim  To review current strategies in differentiating these two conditions, and in managing Crohn’s disease, in populations with high rates of tuberculosis.Methods  Literature review and clinical experience.Results  While various clinical, radiological, endoscopic and histological parameters may aid in differentiating Crohn’s disease from intestinal tuberculosis, these remain imperfect and as treatment options differ misdiagnosis has grave consequences. We propose a diagnostic algorithm, based on currently available evidence and experience, to aid in this dilemma. We also discuss approaches to the management of Crohn’s disease, including agents targeting tumour necrosis factor‐α, in patients at risk of developing tuberculosis.Conclusions  A diagnosis of Crohn’s disease in individuals at risk for tuberculosis should only be made after careful interpretation of clinical signs, abdominal imaging and systematic endoscopic and histological assessment. Newer techniques for the diagnosis of latent tuberculosis still need to be validated in this environment, and guidelines on the treatment of latent tuberculosis in this setting require clarification.
Intestinal chemo‐ and mechano‐sensitivity: selective modification of small intestinal sensitivity by lipids
Authors: HAMMER J. , FÜHRER M. 
Published: July 2010

SummaryBackground Intestinal chemo‐nociception is a recently described mechanism of perception of intraluminal stimuli that might involve pathways independent from mechano‐nociception.Aim To investigate whether intraluminal lipids not only modify mechano‐sensitivity, but also influence chemo‐sensitivity.Method Nineteen healthy volunteers ingested an orojejunal tube assembly for mechanical and chemical stimulation of the proximal jejunum. Volume‐controlled distension of a jejunal balloon and capsaicin perfusion were performed during simultaneous infusion of saline or a 10% lipid emulsion. A standard questionnaire evaluated quality and intensity of symptoms induced by intestinal stimulation.Results Balloon volumes to induce perception thresholds were significantly reduced during lipid perfusion (P < 0.05), while balloon pressures remained unaltered (P > 0.05). Saline infusion (2.5 mL/min) did not alter thresholds of perception. Lipid infusion also increased intensity of perception during given distension volumes (P < 0.05). Lipid infusion did neither affect perception quality induced by capsaicin, nor perception thresholds, nor intensity of perception during capsaicin perfusion (P > 0.05). The quality of sensations induced by capsaicin perfusion was similar to sensations during distension, except of sensation of warmth, that was almost exclusively reported during capsaicin perfusion.Conclusions Intraluminal lipids selectively modify intestinal mechano‐perception and do not alter chemo‐perception. Intestinal chemo‐nociception and mechano‐nociception are two mechanisms of intestinal perception that involve distinct sensory pathways.
Role of intra‐oesophageal impedance monitoring in the evaluation of endoscopic gastroplication for gastro‐oesophageal reflux disease
Authors: CONCHILLO J. M. , SCHWARTZ M. P. , SELIMAH M. , SAMSOM M. , ARTS J. , TACK J. , SIFRIM D. , SMOUT A. J. P. M. 
Published: July 2010

SummaryBackground In the evaluation of several endoscopic antireflux procedures, a discrepancy in the degree of improvement between symptoms and objective reflux parameters as measured by pH‐metry has been reported.Aim To assess the additional value of impedance monitoring in the evaluation of endoscopic gastroplication for gastro‐oesophageal reflux disease.Methods Eighteen patients with gastro‐oesophageal reflux disease were treated with three endoscopic gastroplications, and underwent 24 h pH‐impedance monitoring before and 3 months after treatment.Results Total reflux exposure time as assessed by pH‐metry and impedance monitoring was significantly decreased after treatment (P = 0.047 and <0.001, respectively). When assessed with impedance monitoring, the mean number of reflux episodes was significantly decreased after the procedure (82 vs. 56, pre vs. post, P < 0.001). Furthermore, the mean numbers of liquid and acid reflux episodes in patients with symptomatic improvement were significantly reduced after treatment (P = 0.04 and 0.02, respectively). After treatment, mean volume clearance time (s) and mean number of proximal reflux episodes were significantly decreased (P < 0.001 and 0.002, respectively).Conclusions Impedance monitoring can identify the specific effect of endoscopic gastroplication on the different types of reflux episodes with regard to gas–liquid composition and pH, as well as on volume clearance and the proximal extent of the refluxate.
Overlap of gastro‐oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population
Authors: JUNG H.‐K. , HALDER S. , MCNALLY M. , LOCKE III G. R. , SCHLECK C. D. , ZINSMEISTER A. R. , TALLEY N. J. 
Published: July 2010

SummaryBackground  Gastro‐oesophageal reflux disease (GERD) and irritable bowel syndrome may occur more often than expected by chance, but little community data exists and risk factors are unknown.Aim  To determine prevalence and risk factors for overlap of GERD and irritable bowel disease.Methods  Population‐based, cross‐sectional survey was conducted by mailing a valid symptom questionnaire to eligible residents of Olmsted County, MN, aged 30–95 years. Irritable bowel syndrome were defined by Rome III; GERD was defined by weekly or more frequent heartburn and/or acid regurgitation.Results  2298 questionnaires returned (women 52%, 55% response). Irritable bowel syndrome and GERD occurred together more commonly than expected by chance; the prevalence of irritable bowel syndrome–GERD overlap, GERD alone and irritable bowel syndrome alone were 3%, 15% and 5% in men, and 4%, 14% and 10% in women, respectively. Predictors of irritable bowel syndrome–GERD overlap vs. irritable bowel syndrome alone, and separately, GERD alone, were insomnia (OR 1.3, 95% CI: 1.06–1.70; OR 1.5, 95% CI: 1.13–1.90, respectively) and frequent abdominal pain (OR 3.9, 2.2–6.7; OR 1.8, 1.02–3.2, respectively). An additional predictor of irritable bowel syndrome–GERD overlap vs. GERD alone was higher somatization (OR 1.7, 1.1–2.4) and for irritable bowel syndrome–GERD overlap vs. irritable bowel syndrome alone was a higher body mass index (OR 1.0, 1.003–1.07).Conclusions  Irritable bowel syndrome and GERD overlap is common in the population and does not occur by chance.
Portal‐systemic shunting in patients with fibrosis or cirrhosis due to chronic hepatitis C: the minimal model for measuring cholate clearances and shunt
Authors: EVERSON G. T. , MARTUCCI M. A. , SHIFFMAN M. L. , STERLING R. K. , MORGAN T. R. , HOEFS J. C. ,   THE HALT‐C TRIAL GROUP
Published: July 2010

SummaryBackground Measurement of portal inflow and portal‐systemic shunt using cholate clearances could be useful in monitoring patients with liver disease.Aim To examine relationships of cholate clearances and shunt to cirrhosis and varices and to define minimal sampling requirements.Methods Five hundred forty‐eight studies were performed in 282 patients enrolled in the Hepatitis C Antiviral Long‐term Treatment to prevent Cirrhosis (HALT‐C) trial. Stable, non‐radioactive isotopes of cholate were administered intravenously and orally, clearances (Clivand Cloral) were calculated from [dose/area under curve (AUC)] and cholate shunt from [(AUCoral:AUCiv) x (Doseiv:Doseoral) x 100%].Results Cholate Cloraland cholate shunt correlated with prevalences of both cirrhosis and varices (P < 0.0001 for all). Peripheral venous sampling at 5, 20, 45, 60 and 90 min defined the minimal model. Linear regression of cholate shunt determined from five points within 90 min vs. the standard method of 14 points over 3 h yielded slope of 1.0 and intercept 0.5% (r2 = 0.98,P < 0.0001). Results were identical in the 189 validation studies (slope 1.0, intercept 0.5%,r2 = 0.99,P < 0.0001).Conclusions Cholate Cloraland cholate shunt may be useful in monitoring patients with liver disease. The 5‐point model enhances application of cholate Cloraland cholate shunt in the non‐invasive assessment of the portal circulation.
Systematic review: proton pump inhibitor‐associated acute interstitial nephritis
Authors: SIERRA F. , SUAREZ M. , REY M. , VELA M. F. 
Published: July 2010

SummaryBackground  A number of recent case reports and case series suggest that proton pump inhibitors may cause acute interstitial nephritis.Aim  To establish the nature of the relationship (cause or association) between proton pump inhibitor use and development of interstitial nephritis.Methods  Data collection: Two researchers independently searched electronic databases (MEDLINE, EMBASE, GOOGLE, LILACS, COCHRANE) for articles from 1970 to 2006, including all study designs, populations and languages. Two independent reviewers assessed study quality and collected the data. Selection criteria: absence of baseline renal failure, development of interstitial nephritis after proton pump inhibitor exposure, nephritis confirmed by creatinine plus either renal biopsy or recurrence upon reinitiating proton pump inhibitor.Results  Sixty four cases (60% females, mean age 78 years) of proton pump inhibitor‐associated interstitial nephritis were found, 60 included in this review (59 confirmed by renal biopsy, one by recurrence upon reinitiating proton pump inhibitor). The most common symptoms were non‐specific. The mean proton pump inhibitor treatment duration before diagnosing nephritis was 13 weeks, average recovery time was 35.5 weeks, one patient required permanent dialysis, there were no deaths.Conclusion  Proton pump inhibitor‐related interstitial nephritis is rare, idiosyncratic and difficult to predict. It requires a high level of clinical suspicion. While there is not sufficient evidence to establish a causal relationship with certainty, there does appear to be a low‐prevalence association.
Severe gastro‐oesophageal reflux symptoms in relation to anxiety, depression and coping in a population‐based study
Authors: JANSSON C. , NORDENSTEDT H. , WALLANDER M.‐A. , JOHANSSON S. , JOHNSEN R. , HVEEM K. , LAGERGREN J. 
Published: July 2010

SummaryBackgroundThe association between psychiatric disorders and gastro‐oesophageal reflux symptoms is uncertain, and few population‐based studies are available.AimTo examine the association between psychiatric and psychological factors and reflux symptoms.MethodsPopulation‐based, cross‐sectional, case–control study based on two health surveys conducted in the Norwegian county Nord‐Trondelag in 1984–1986 and 1995–1997. Reflux symptoms were assessed in the second survey, including 65 333 participants (70% of the county’s adult population). 3153 subjects reporting severe reflux symptoms were defined as cases and 40 210 subjects without symptoms were defined as controls. Data were collected in questionnaires. Odds ratio with 95% confidence intervals were estimated using unconditional logistic regression, in adjusted models.ResultsSubjects reporting anxiety without depression had a 3.2‐fold (95% CI: 2.7–3.8) increased risk of reflux, subjects with depression without anxiety had a 1.7‐fold (95% CI: 1.4–2.1) increased risk and subjects with both anxiety and depression had a 2.8‐fold (95% CI: 2.4–3.2) increased risk, compared to subjects without anxiety/depression. We observed a weak inverse association between one measure of covert coping and risk of reflux and a weak positive association between another coping measure and risk of reflux.ConclusionsThis population‐based study indicates that anxiety and depression are strongly associated with reflux symptoms, while no consistent association regarding coping and reflux was found.
Meta‐analysis: inosine triphosphate pyrophosphatase polymorphisms and thiopurine toxicity in the treatment of inflammatory bowel disease
Authors: VAN DIEREN J. M. , HANSEN B. E. , KUIPERS E. J. , NIEUWENHUIS E. E. S. , VAN DER WOUDE C. J. 
Published: July 2010

SummaryBackgroundThiopurines are widely used for the treatment of inflammatory bowel disease, but are associated with the development of side effects. It has been suggested that the enzyme inosine triphosphate pyrophosphatase (ITPA) plays a role in the digestion of thiopurines and that defective activity resulting from polymorphisms in the inosine triphosphate pyrophosphatase encoding genes may be associated with thiopurine‐induced side effects. Current studies are controversial regarding this hypothesis.AimTo perform a meta‐analysis and gain more insight into a possible correlation between thiopurine‐induced side effects and ITPA polymorphisms.MethodsWe explored Medline for articles on ITPA polymorphisms and thiopurine toxicity. Studies that compared ITPA polymorphism frequencies among thiopurine‐tolerant and ‐intolerant adult inflammatory bowel disease patients were included in this meta‐analysis.ResultsNine published studies investigated associations between ITPA polymorphisms and thiopurine toxicity. Six studies (with 751 patients included) met our inclusion criteria and were processed in the meta‐analysis. This analysis demonstrates that the ITPA 94C→A polymorphism, is not significantly associated with any of the studied side effect parameters.ConclusionsThis meta‐analysis does not prove a correlation between the development of thiopurine toxicity and the ITPA 94C→A polymorphism. This implies that there is no clinical relevance to determine ITPA polymorphisms in thiopurine‐treated patients.