bluuebunny/crossref_metadata_2025_split 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

SummaryBackground  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

SummaryBackground  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

SummaryBackground  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

SummaryBackground 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

SummaryBackground 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

SummaryBackground  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

SummaryBackground  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

SummaryBackground  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

SummaryBackground  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

SummaryBackground  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

SummaryBackground  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

SummaryBackground 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

SummaryBackground 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

SummaryBackground  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.