bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical trial: evaluation of a clinical decision‐support model for upper abdominal complaints in primary‐care practice
Authors: HOROWITZ N. , MOSHKOWITZ M. , LESHNO M. , RIBAK J. , BIRKENFELD S. , KENET G. , HALPERN Z. 
Published: July 2010

SummaryBackground  Gastro‐oesophageal reflux disease (GERD) and dyspepsia affect 25–40% of the general population. In the absence of alarm symptoms, the current recommended policy in young dyspeptic patients is a ‘test and treat’ strategy for Helicobacter pylori; in GERD patients, a therapeutic trial with proton pump inhibitors is the treatment of choice.Aim  To create a short and simple clinical algorithm, for the diagnosis and treatment of patients with upper gastrointestinal complaints.Methods  The clinical usefulness and cost‐effectiveness of the new algorithm were evaluated in a controlled clinical trial, held in primary‐care clinics in Israel. Clinical and economical treatment outcomes were evaluated after 1, 3 and 6 months comparing doctors who used the algorithm (cases) vs. those who did not (controls).Results  78 cases and 54 controls completed the 6 months of follow up. The improvement in symptom severity and quality of life was greater in the cases than in the controls (P < 0.05). General practitioner clinics visits (P = 0.04), gastroenterology clinics visits (P = 0.02) and medication costs (P = 0.004) were all significantly reduced among cases. Controls underwent also more imaging tests (computerized tomography, ultrasound and X‐ray) and endoscopies. The average cost for 6 months’ treatment and follow‐up was $US 199 for cases compared with an average of $US 336 in the control group.Conclusion  The use of a clinical decision‐support tool can facilitate and promote the implementation of management guidelines by general practitioners. The short algorithm presented in the study was found to be useful and easy to apply in clinical practice. Its effectiveness can be further increased by implementing it in computerized medical systems.
A prospective comparative study of five measures of gluten‐free diet adherence in adults with coeliac disease
Authors: LEFFLER D. A. , EDWARDS GEORGE J. B. , DENNIS M. , COOK E. F. , SCHUPPAN D. , KELLY C. P. 
Published: July 2010

SummaryBackground  Increasing numbers of individuals are now being diagnosed with coeliac disease. The only accepted treatment for coeliac disease is lifelong adherence to a strict gluten‐free diet (GFD). Individuals’ ability to adhere to the GFD varies, but systematic studies guiding the assessment of adherence are currently lacking.Aim  We sought to compare the predictive value of self‐report and four serologic tests compared to expert nutritionist evaluation.Methods  In all, 154 individual adults with biopsy‐proven coeliac disease rated their adherence to the GFD on a Likert scale. Serum antibody titres of IgA anti‐tissue transglutaminase, and IgA and IgG anti‐deamidated gliadin peptides were determined. Using anova and ROC analyses, results were compared to a standardized evaluation by an expert nutritionist blinded to the participants’ self‐rated adherence and serology results.Results  All serologic measures as well as participant reported adherence were significantly associated with GFD adherence as assessed by expert nutritionist evaluation. However, on ROC analysis no measure performed satisfactorily. The performance of serologic testing, but not self‐report, improved with increased time on the GFD.Conclusion  Although current serologic tests have very high sensitivities and specificities for the diagnosis of coeliac disease, they cannot replace trained nutritionist evaluation in the assessment of GFD adherence.
Review article: the evidence base for interventions used to maintain remission in Crohn’s disease
Authors: AKOBENG A. K. 
Published: July 2010

SummaryBackground  Crohn’s disease is characterised by recurrent flare‐ups alternating with periods of remission. A number of interventions are currently used in clinical practice to try and maintain remission in Crohn’s disease but the evidence base for some of them may be questionable.Aim  To review the available evidence on interventions, which are currently used to maintain remission in Crohn’s disease.Methods  The Cochrane Library and Medline (Pubmed) were searched for level 1 evidence on specific interventions. Search terms included ‘Crohn’s disease or synonyms’, ‘remission or synonyms’ and the names of specific interventions.Results  Azathioprine, infliximab and adalimumab are effective at maintaining remission in Crohn’s disease. Natalizumab is also effective, but there are concerns about its potential association with progressive multifocal leukoencephalopathy. Long‐term enteral nutritional supplementation, enteric‐coated omega‐3 fatty acids and intramuscular methotrexate may also be effective but the evidence for these is based on relatively small studies. The available evidence does not support the use of oral 5‐aminosalicylates agents, corticosteroids, anti‐mycobacterial agents, probiotics or ciclosporin as maintenance therapy in Crohn’s disease.Conclusion  A better understanding of the evidence base of existing interventions could result in the use of treatments, which are more likely to lead to improved patient outcomes.
Severe symptoms of gastro‐oesophageal reflux disease are associated with cardiovascular disease and other gastrointestinal symptoms, but not diabetes: a population‐based study
Authors: JANSSON C. , NORDENSTEDT H. , WALLANDER M.‐A. , JOHANSSON S. , JOHNSEN R. , HVEEM K. , LAGERGREN J. 
Published: July 2010

SummaryBackground  Few population‐based studies have examined comorbidity in relation to gastro‐oesophageal reflux disease (GERD).Aim  To study the association between cardiovascular disease, diabetes, gastrointestinal symptoms and GERD.Methods  Population‐based, cross‐sectional, case‐control study based on a large Norwegian health survey conducted in 1995–97. Among 65 333 participants, 3153 persons reporting severe reflux symptoms were defined as cases, and 40 210 persons without such symptoms were defined as controls. Data on cardiovascular disease, diabetes, gastrointestinal symptoms and potential confounders were collected through questionnaires. Odds ratios (OR) with 95% confidence intervals (CI) were estimated using unconditional logistic regression, in crude and adjusted models.Results  In the crude models, positive associations were observed between myocardial infarction (OR 1.7, 95% CI 1.4–2.1), angina pectoris (OR 2.5, 95% CI 2.1–2.9) and stroke (OR 1.6, 95% CI 1.2–2.1) and risk of GERD. The associations were attenuated in the adjusted models, but remained significant for angina pectoris (OR 1.9, 95% CI 1.6–2.2). No association was observed between diabetes and GERD. Strong positive associations were seen between all studied gastrointestinal symptoms, i.e. nausea, diarrhoea and constipation, and risk of GERD.Conclusions  This population‐based study indicates that myocardial infarction, angina pectoris, stroke and symptoms of nausea, diarrhoea and constipation are associated with GERD.
Metabolic syndrome is associated with severe fibrosis in chronic viral hepatitis and non‐alcoholic steatohepatitis
Authors: TSOCHATZIS E. , PAPATHEODORIDIS G. V. , MANESIS E. K. , KAFIRI G. , TINIAKOS D. G. , ARCHIMANDRITIS A. J. 
Published: July 2010

SummaryBackground  The prevalence of metabolic syndrome and its possible impact on the severity of liver histological lesions have not been studied prospectively in chronic liver diseases.Aim  To investigate the prevalence of metabolic syndrome in patients with chronic viral hepatitis or non‐alcoholic steatohepatitis, and to determine its associations with histological severity.Methods  We prospectively included 317 patients (hepatitis B e antigen‐negative chronic hepatitis B: 95, chronic hepatitis C: 176, non‐alcoholic steatohepatitis: 46) with liver biopsy. Metabolic syndrome was defined using the Adult Treatment Panel III criteria. Histological lesions were evaluated according to Ishak’s or Brunt’s classification.Results  Metabolic syndrome was present in 10.4% of patients being significantly more prevalent in non‐alcoholic steatohepatitis than in chronic viral hepatitis (41.3% vs. 5.1%, P < 0.001). In chronic viral hepatitis, cirrhosis (stages 5–6) was independently associated with increasing age, higher aspartate aminotransferase and gamma‐glutamyl‐transpeptidase levels, severe necroinflammation and metabolic syndrome (P = 0.016). In non‐alcoholic steatohepatitis, severe fibrosis (stages 3–4) was independently associated with severe necroinflammation and metabolic syndrome (P = 0.033). Presence of metabolic syndrome was not associated with presence or severity of steatosis both in chronic viral hepatitis and in non‐alcoholic steatohepatitis.Conclusion  Metabolic syndrome is more prevalent in non‐alcoholic steatohepatitis than in chronic viral hepatitis; it is associated independently with more severe fibrosis but not with the severity of steatosis, both in chronic viral hepatitis and in non‐alcoholic steatohepatitis.
Clinical trial: the effect of somatostatin vs. octreotide in preventing post‐endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices
Authors: VLACHOGIANNAKOS J. , KOUGIOUMTZIAN A. , TRIANTOS C. , VIAZIS N. , SGOUROS S. , MANOLAKOPOULOS S. , SAVERIADIS A. , MARKOGLOU C. , ECONOMOPOULOS T. , KARAMANOLIS D. G. 
Published: July 2010

SummaryBackground Hepatic venous pressure gradient (HVPG) increases significantly after endoscopic therapy in patients with bleeding oesophageal varices, which may precipitate further haemorrhage. Whether vasoactive drugs can suppress these changes remains unknown.Aim To investigate the efficacy of somatostatin when compared with octreotide in preventing the post‐endoscopic increase in HVPG during acute bleeding and whether the changes affect outcome.Methods Thirty‐three cirrhotics with bleeding varices were randomized to receive somatostatin (n = 17) or octreotide (n = 16) under double‐blind conditions, soon after their admission. HVPG measurements were performed before and immediately after endoscopic treatment.Results In the somatostatin group, postendotherapy HVPG values did not change significantly when compared with pre‐treatment values (18.9 vs. 17.2, P = 0.092). Conversely, in the octreotide group, HVPG increased significantly after endoscopy (18.2 vs. 20.8, P = 0.003). The probability of 6‐week survival without treatment failure was significantly higher in the somatostatin group (P = 0.024). Post‐endoscopic HVPG value was independently associated with 6‐week failure.Conclusions Somatostatin, but not octreotide, effectively prevents the post‐endoscopic increase in HVPG, which may be associated with low probability of treatment failure.
Dietary modifications, nutritional supplements and alternative medicine in paediatric patients with inflammatory bowel disease
Authors: GERASIMIDIS K. , MCGROGAN P. , HASSAN K. , EDWARDS C. A. 
Published: July 2010

SummaryBackground  Data on use of complementary and alternative medicine in children with inflammatory bowel disease are scarce.Aim To assess prevalence, predictors and parental attitude to the use of complementary and alternative medicine in a paediatric population with inflammatory bowel disease in the west of Scotland.Methods  Questionnaire survey encompassing alternative therapists, nutritional supplements and dietary modifications used in the management of inflammatory bowel disease was used. Demographics, disease and treatment data were also collected.Results  86 guardians completed the survey. 61% had used at least one type and 37% were using complementary and alternative medicine recently. The most common types were probiotics (44%) and dairy‐free diet (28%). Higher parental education and young parental age were predictors of complementary and alternative medicine use. An increased number of oral steroid courses and prior use of complementary and alternative medicine for other health reasons were associated with use of alternative therapists. Personal recommendation and to complement conventional medicine were the main reasons for using complementary and alternative medicine. 48% judged complementary and alternative medicine at least partially effective. 86% agreed that doctors should be supportive of use. 89% would give complementary and alternative medicine to their children.Conclusions  Use of complementary and alternative medicine was higher in children with IBD than in adults with the same disease. The gastrointestinal nature of the disease could explain the high use of nutritional supplements and dietary modifications in this survey.
Review article: minimizing tuberculosis during anti‐tumour necrosis factor‐alpha treatment of inflammatory bowel disease
Authors: THEIS V. S. , RHODES J. M. 
Published: July 2010

SummaryBackground  Tumour necrosis factor (TNF)‐alpha inhibitors are a major advance in the management of inflammatory bowel disease but increase the risk for tuberculosis (TB).Aim  To examine the reasons for the increase in the risk for TB and the strategies to reduce it.Methods  PubMed searches were performed using search terms that included TB and each of the current anti‐TNF‐alpha biological agents and also TB and Crohn’s disease.Results  Increased susceptibility to TB, often with extrapulmonary or disseminated disease, occurs following treatment with all anti‐TNF‐alpha biological agents and amounts to a four‐ to 20‐fold increased risk with infliximab. TB usually occurs shortly after anti‐TNF‐alpha initiation suggesting reactivation of latent infection. Animal studies show that TNF‐alpha inhibition impairs inflammatory cell trafficking and granuloma formation. Currently recommended screening for latent TB typically, risk assessment, tuberculin skin testing and chest radiograph used prior to anti‐TNF‐alpha treatment can reduce TB rates by up to 90% but newer screening interferon gamma assays may enhance screening efficacy. Patients positive on screening who are treated with isoniazid and subsequently receive anti‐TNF‐alpha treatment still have approximately 19% risk for TB.Conclusions  Tuberculosis following treatment with TNF‐alpha inhibitors usually results from reactivation of latent disease. Screening reduces the risk substantially but does not completely eliminate it.
The prevalence of and risk factors for erosive oesophagitis and non‐erosive reflux disease: a nationwide multicentre prospective study in Korea
Authors: KIM N. , LEE S. W. , CHO S. I. , PARK C. G. , YANG C. H. , KIM H. S. , REW J. S. , MOON J. S. , KIM S. , PARK S. H. , JUNG H. C. , CHUNG I. S. ,   ‘THE H. PYLORI AND GERD STUDY GROUP’ OF KOREAN COLLEGE OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH
Published: July 2010

SummaryBackground  Prospective nationwide multicentre studies that have evaluated endoscopic findings and reflux symptoms using a well‐designed questionnaire are very rare.Aim  To compare the prevalence rates of and risk factors for erosive oesophagitis and non‐erosive reflux disease (NERD) in the Korean population.Methods  A gastroscopic examination was performed on 25 536 subjects who visited 40 Healthcare Centers for a health check‐up. A gastro‐oesophageal reflux questionnaire and multivariate analysis were used to determine the risk factors for erosive oesophagitis and NERD.Results  2019 (8%) and 996 subjects (4%) had erosive oesophagitis and non‐erosive reflux disease, respectively; only 58% of subjects with erosive oesophagitis had reflux symptoms. Multivariate analysis showed that the risk factors for erosive oesophagitis and NERD differed, i.e. those of erosive oesophagitis were male, a Helicobacter pylori eradication history, alcohol, body mass index ≥25 and hiatal hernia. In contrast, the risk factors for NERD were female, age <40 and ≥60 vs. 40–59 years, body mass index <23 and a monthly income <$1000, glucose ≥126 mg/dL, smoking, a stooping posture at work and antibiotic usage.Conclusions  The prevalence rates of erosive oesophagitis and NERD were 8% and 4%, respectively, in Korean health check‐up subjects. The risk factors for erosive oesophagitis and NERD were found to differ, which indicates that their underlying pathogeneses are distinct.
Comparison of gastric emptying of a nondigestible capsule to a radio‐labelled meal in healthy and gastroparetic subjects
Authors: KUO B. , McCALLUM R. W. , KOCH K. L. , SITRIN M. D. , WO J. M. , CHEY W. D. , HASLER W. L. , LACKNER J. M. , KATZ L. A. , SEMLER J. R. , WILDING G. E. , PARKMAN H. P. 
Published: July 2010

SummaryBackground  Gastric emptying scintigraphy (GES) using a radio‐labelled meal is used to measure gastric emptying. A nondigestible capsule, SmartPill, records luminal pH, temperature, and pressure during gastrointestinal transit providing a measure of gastric emptying time (GET).Aims  To compare gastric emptying time and GES by assessing their correlation, and to compare GET and GES for discriminating healthy subjects from gastroparetics.Methods  Eighty‐seven healthy subjects and 61 gastroparetics enrolled with simultaneous SmartPill and GES. Fasted subjects were ingested capsule and [99mTc]‐SC radio‐labelled meal. Images were obtained every 30 min for 6 h. Gastric emptying time and percentage of meal remaining at 2/4 h were determined for each subject. The sensitivity/specificity and receiver operating characteristic analysis of each measure were determined for each subject.Results  Correlation between GET and GES‐4 h was 0.73 and GES‐2 h was 0.63. The diagnostic accuracy from the receiver operating characteristic curve between gastroparetics and healthy subjects was GET = 0.83, GES‐4 h = 0.82 and GES‐2 h = 0.79. The 300‐min cut‐off time for GET gives sensitivity of 0.65 and specificity of 0.87 for diagnosis of gastroparesis. The corresponding sensitivity/specificity for 2 and 4 h standard GES measures were 0.34/0.93 and 0.44/0.93, respectively.Conclusion  SmartPill GET correlates with GES and discriminates between healthy and gastroparetic subjects offering a nonradioactive, standardized, ambulatory alternative to scintigraphy.
Night‐time and daytime atypical manifestations of gastro‐oesophageal reflux disease: frequency, severity and impact on health‐related quality of life
Authors: DEAN B. B. , AGUILAR D. , JOHNSON L. F. , MCGUIGAN J. E. , ORR W. C. , FASS R. , YAN N. , MORGENSTERN D. , DUBOIS R. W. 
Published: July 2010

SummaryBackground  Respondents with gastro‐oesophageal reflux disease (GERD) report having a variety of atypical manifestations. The relationship between these manifestations and disease severity, night‐time GERD and functioning has not been determined.Aim  To determine if atypical manifestations are related to increased disease severity, night‐time GERD and decreased functioning.Methods  A web survey among US adults was conducted, using a validated GERD screener. Frequency of night‐time and daytime typical symptoms (acid regurgitation and heartburn) and atypical manifestations were assessed. Respondents were classified as night‐time GERD or daytime GERD based on typical symptom frequency. Prevalence of frequent atypical manifestations (≥2 days or nights/week) was assessed.Results  Gastro‐oesophageal reflux disease cases had a higher prevalence of each atypical manifestation (P < 0.05 for all) compared with controls. Night‐time GERD respondents had a higher prevalence of atypical manifestations compared with daytime GERD respondents (P < 0.05 for most manifestations) and the prevalence of atypical manifestations increased with GERD symptom severity (P < 0.05 for most). Those with atypical manifestations reported lower functioning scores (P < 0.05 for most).Conclusions  Respondents with typical GERD symptoms commonly report atypical manifestations, especially those with night‐time symptoms and those with greater underlying GERD severity. Respondents with GERD and atypical manifestations had more impaired functioning than those with typical symptoms only.
Projected impact of colorectal cancer screening with computerized tomographic colonography on current radiological capacity in Europe
Authors: HASSAN C. , LAGHI A. , PICKHARDT P. J. , KIM D. H. , ZULLO A. , IAFRATE F. , MORINI S. 
Published: July 2010

SummaryBackground  The impact of a primary colorectal cancer screening with computerized tomographic colonography on current radiological capacity is unknown. The multispecialty needs for computerized tomographic examinations raise some doubts on the feasibility of a mass colorectal cancer screening with computerized tomographic colonography.Aim  To assess whether the number of available computerized tomographic units in Europe is adequate to cover population screening with computerized tomographic colonography.Methods  A mathematical and a Markov model were, respectively, used to assess the number of computerized tomographic colonography procedures needed to be performed each day in the start‐up and in the steady‐state phases of a colorectal cancer screening programme in Europe. Such outcome was divided for the total number of computerized tomographic machines aged <10 years estimated to be present in the European hospitals.Results  At a simulated 30% compliance, 28 760 130 European people would need to be screened by the 3482 available computerized tomographic units in a 5‐year start‐up period, corresponding to 6.6 CTC/CT unit/day. Assuming a 10‐year repetition of computerized tomographic colonography between 50 and 80 years, the number of computerized tomographic colonography needed to be performed in the steady‐state period appeared to be 4.3/CT unit/day.Conclusions  The current radiological capacity may cover the need for a primary colorectal cancer screening with computerized tomographic colonography in a steady state. On the other hand, a substantial implementation of the current computerized tomographic capacity or a synergistic approach with other techniques seems to be necessary for the start‐up period.
Adipokines and cytokines in non‐alcoholic fatty liver disease
Authors: JARRAR M. H. , BARANOVA A. , COLLANTES R. , RANARD B. , STEPANOVA M. , BENNETT C. , FANG Y. , ELARINY H. , GOODMAN Z. , CHANDHOKE V. , YOUNOSSI Z. M. 
Published: July 2010

SummaryBackground  Several adipocytokines have been implicated in the pathogenesis non‐alcoholic fatty liver disease (NAFLD).Aim  To assess adipocytokines in NAFLD patients and controls.Methods  A total of 95 patients (26 non‐alcoholic steatohepatitis (NASH), 19 simple steatosis (SS), 38 obese controls and 12 non‐obese controls) were included. Fasting serum insulin, glucose, visfatin, resistin, adiponectin, tumour necrosis factor‐α (TNF‐α), interleukin‐8 (IL‐8) and IL‐6 were determined. Univariate and multivariate analyses were used to compare groups and determine associations.Results  Serum TNF‐α and IL‐8 were higher in NAFLD patients when compared with both obese and non‐obese controls. Analysis involving all patients revealed a significant correlation between serum TNF‐α and IL‐8 (P < 6.319e−08), and between IL‐6 and IL‐8 (P < 5.271e−15). Homeostatic model assessment scores negatively correlated with adiponectin in NAFLD (P < 0.0032). Serum visfatin was higher in all three obese groups than in non‐obese controls (P < 0.02, P < 0.002 and P < 0.008). Visfatin in NASH patients was lower than SS and obese controls. Although TNF‐α was associated with NAFLD (P < 0.02), it was interdependent on visfatin. In comparison to SS, four factors were independently associated with NASH: age, alanine aminotransferase, IL‐8 and adiponectin (P < 0.05). Multivariate analysis indicated that TNF‐α was the only independent predictor of fibrosis in NASH (P < 0.0004).Conclusion  These findings support a complex interaction between adipocytokines and the pathogenesis of NAFLD.