bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in morbidity and mortality from peptic ulcer disease: Tayside versus Scotland
Authors: PENSTON J. G. , CROMBIE I. K. , WAUGH N. R. , WORMSLEY K. G. 
Published: July 2010

SUMMARYRecent studies have shown that the prophylactic use of H2‐receptor antagonists reduces both ulcer recurrence and the risk of ulcer complications. Despite these results, epidemiological studies have failed to show any evidence of an effect of gastric anti‐secretory drugs on complicated ulcer disease in the community.Since 1979, it has been the policy of the gastroenterology department at Ninewells Hospital in Tayside to recommend long‐term, continuous therapy with H2‐receptor antagonists for patients with peptic ulcer; in contrast, prophylactic therapy is less commonly used in the rest of Scotland. The difference in the management of peptic ulcer between Tayside and Scotland presented an opportunity to study the population effects of the widespread use of continuous H2‐receptor antagonists on the morbidity and mortality from ulcer disease. This study compared the trends in hospital admissions, gastric surgery, haemorrhage, perforation and mortality from ulcer disease using data supplied by the Information and Statistics Division of the Common Services Agency, Scottish Health Service, Edinburgh.During the 1980s, hospital admissions for peptic ulcer declined significantly in Tayside, whereas in Scotland there was no obvious downward trend. Gastric surgery for ulcer disease declined throughout Scotland although the fall was significantly steeper in Tayside than in the rest of Scotland. For the population in general, the rate of perforation decreased faster in Tayside than in the rest of Scotland, although the difference was not significant. The rate of admissions for ulcer haemorrhage declined substantially in Tayside whereas there was little change in Scotland as a whole. The decrease in mortality from ulcer disease in all groups except younger females was more marked in Tayside than in Scotland, although the differences were not significant.The magnitude of the differences between Tayside and Scotland, and in particular the consistency of these results across a broad range of indicators of ulcer disease, suggests that the policy of prescribing long‐term, continuous therapy with H2‐ receptor antagonists has reduced both uncomplicated and complicated peptic ulcer in the community in Tayside.
Comparison of two intravenous ranitidine regimens in a homogeneous population of intensive care unit patients
Authors: GEUS W. P. , VINKS A. A. T. M. M. , SMITH S. J. , WESTRA P. , LAMERS C. B. H. W. 
Published: July 2010

SUMMARYPrimed continuous infusion and repeated intravenous injections of ranitidine (daily dose 200 mg) were compared in a homogeneous population of postoperative intensive care unit patients in a randomized fashion. Intragastric pH was measured continuously for 72–96 h with combined glass electrodes positioned in the gastric corpus. Patients whose intragastric acidity fell below pH 4.0 for 70% of a 24‐h period within 48 h after the operation (baseline period) were considered ‘at risk’ of developing stress‐related lesions. From the 26 patients screened, 18 fulfilled this criterion. Nine received the continuous infusion regimen (50 mg bolus+0.125 mg.kg/h) and nine received repeated boluses (50 mg ranitidine every 6 h). A consistent decrease of intragastric acidity was shown in each group by a rise in 24‐h median pH from 1.4 (1.3–1.7; 26th–75th percentile) during the baseline period to 4.2 (1.9–5.4, P < 0.01) for the continuous infusion and from 1.55 (1.1–2.2) to 2.65 (2.1–3.5, P < 0.02) for the repeated boluses during the final 24 h of the therapy period. During that period intragastric pH was maintained above 4 for 52% of time by continuous infusion and for 40% of time for repeated boluses compared with 10.8% (P= 0.01) and 6.2% (P= 0.008) of time, respectively, in the baseline period. In conclusion, although no statistically significant differences between the two regimens could be detected, the continuous infusion regimen tended to show slightly better results in percentages of time that pH values were above 1 to 7, and in median 24–h pH values.
Ranitidine bismuth citrate and aspirin‐induced gastric mucosal injury
Authors: HUDSON N. , MURRAY F. E. , COLE A. T. , TURNBULL G. M. , LETTIS S. , HAWKEY C. J. 
Published: July 2010

SUMMARYThe aim of this study was to investigate the protective action of a new compound, ranitidine bismuth citrate, in the prevention of aspirin‐induced acute mucosal injury to the upper gastrointestinal tract of healthy human volunteers. In a double‐blind randomized three‐way cross‐over study 24 male volunteers received placebo, 900 mg aspirin or 900 mg aspirin and 800 mg ranitidine bismuth citrate at 12‐h intervals for nine doses with a 2‐week wash‐out period between each treatment. The median (interquartile range) number of erosions seen at endoscopy when ranitidine bismuth citrate was given with aspirin (1 [0–4]) was significantly lower than aspirin alone (24 [16–32]) (P < 0.001) and not significantly different from either baseline or placebo (0 [0–2]). These findings were similarly reflected in the effects on microbleeding following the ninth dose: 12.1 (7.1–21.0) μL/10 min following aspirin alone compared to levels with placebo of 1.2 (0.4–2.9), and with aspirin and ranitidine bismuth citrate of 1.6 (0.8–2.6) (P < 0.005). Ranitidine bismuth citrate conferred substantial protection from aspirin‐induced injury to the gastric and duodenal mucosa as determined by both endoscopic assessment and microbleeding rates, reducing injury to placebo levels.
Effect of a 5HT3‐antagonist (ondansetron) on rectal sensitivity and compliance in health and the irritable bowel syndrome
Authors: HAMMER J. , PHILLIPS S. F. , TALLEY N. J. , CAMILLERI M. 
Published: July 2010

SUMMARYIn some patients with the irritable bowel syndrome, rectal urgency and discomfort are major clinical problems and, under experimental conditions, these symptoms are perceived at lesser volumes of rectal distension than they are in asymptomatic controls. Further, a 5‐hydroxytryptamine type‐3 receptor antagonist increased the threshold for rectal discomfort in irritable bowel syndrome. Our aims were, (a) to measure rectal sensation during isobaric distensions of the rectum, and (b) to test the effect of another selective 5HT3antagonist, ondansetron 0.15 mg/kg, on rectal sensitivity, colonic tone, rectal tone and manometric responses. Ten healthy volunteers and five patients with diarrhoea‐predominant irritable bowel syndrome were studied. A multilumen barostatmanometric assembly was placed in the descending colon, and a second barostat balloon was positioned in the rectum. Tone in the wall of the colon and rectum was measured by the barostat balloon volume during a constant pressure clamp, while intraluminal pressures were recorded by manometry; perceived sensations were also recorded before and after the intravenous administration of ondansetron or placebo in blinded fashion. Rectal resistance to stretch was greater and rectal urgency was induced by lower distending pressures in irritable bowel syndrome, however, basal tone in the rectum was similar in health and irritable bowel syndrome. Ondansetron did not change rectal sensitivity (first sensation or urgency) or tone. Rectal distension did not alter tone in the descending colon or colonic manometry; ondansetron did not influence any index of colonic function. We conclude that in diarrhoea‐predominant irritable bowel syndrome there is reduced rectal compliance and the rectum is abnormally sensitive to a pressure stimulus, but this is not altered by 5HT3‐blockade with ondansetron at the dose used.
An investigation into the effect of cimetidine pre‐treatment on raft formation of an anti‐reflux agent
Authors: WASHINGTON N. , WILSON C. G. , WILLIAMS D. L. , ROBERTSON C. 
Published: July 2010

SUMMARYIt is now becoming common practice to co‐administer H2 receptor antagonists and anti‐reflux agents in the treatment of reflux oesophagitis. The mechanism by which anti‐reflux agents achieve flotation requires a small amount of gastric acid to be present in the stomach. This study investigated whether an antireflux agent would remain effective after the decrease in acid secretion produced by a typical clinical dosage regimen of cimetidine (400 mg q.d.s., 7 days). Gastric distribution and residence of a meal and an anti‐reflux agent were assessed in 12 normal subjects using gamma scintigraphy. The area under the gastric and fundal emptying curves demonstrated that Liquid Gaviscon (sodium alginate compound) had a significantly greater gastric residence than the meal, both during the control period and after cimetidine pre‐treatment, and that the majority of the Gaviscon was located in the fundus. The distribution of Gaviscon into the fundus was not affected by cimetidine pre‐treatment. Cimetidine pre‐treatment slightly, but not significantly, increased the time for half the meal and the Gaviscon to empty from the stomach. The results suggest that the mechanism of action of Liquid Gaviscon is not compromised by concurrent H2‐antagonist therapy.
Treatment of active distal ulcerative colitis with immunoglobulin G enemas
Authors: JARLØV A. E. , MUNKHOLM P. , SCHMIDT P. NORDBLAD , LANGHOLZ E. , VESTERGAARD B. FABER , BECH R. MøLSKOV 
Published: July 2010

SUMMARYSeven patients with active distal ulcerative colitis were treated with IgG enemas given as a daily bedtime retention enema for two weeks. Evaluation of effect was assessed by means of sigmoidoscopy with biopsy, measuring acute phase reactants in peripheral blood, and measuring the faecal protein loss. Clinical signs of active disease were registered by the patients on a diary chart. Five patients completed the treatment period, two patients were withdrawn after 7 and 10 days due to deterioration of disease. Four patients did not register any effect, whereas one patient improved clinically. In conclusion, rectally administered IgG did not exert any effect on rectal ulcerative colitis in our study.
Oral budesonide in active Crohn's disease
Authors: LÖFBERG R. , DANIELSSON Å. , SALDE L. 
Published: July 2010

SUMMARYWe studied the efficacy and safety of the topically acting steroid budesonide in an oral preparation for controlled ileal release in an open, uncontrolled trial. Twenty‐one patients with active Crohn's disease localized to the distal ileum, ileocaecal region or ascending colon, entered the trial. The median age was 36 years and the median duration of Crohn's disease was 8 years. The patients received budesonide, in a controlled ileal release preparation, in a dose of 3 mg t.d.s. for 12 weeks, followed by a reduction to 2 mg t.d.s. for 6 weeks and finally to 1 mg t.d.s. for an additional 6 weeks. Primary variables were the modified Crohn's disease activity index (mCDAI), laboratory parameters and plasma cortisol levels. The mean mCDAI at entry was 268 (± 71 s.d.). dropping to 146 (± 91 s.d.) after 4 weeks of treatment and to 122 (± 87 s.d.) after a total of 12 weeks on 3 mg t.d.s. (P < 0.001). Following dose reduction, the mean mCDAI increased after 18 and 24 weeks of treatment. The erythrocyte sedimentation rate also fell significantly during the study period. Eighteen patients responded favourably during the first 12‐week treatment period, and 13 completed the trial. Seven patients were withdrawn due to failure of treatment after reduction of dose, and four of those were treated surgically. No serious side‐effects or significant corticosteroid‐related side‐effects occurred. The mean plasma cortisol levels decreased, but remained within normal range. Four patients were markedly suppressed on the highest dose of budesonide. The controlled ileal release of budesonide seems to be beneficial in active ileal and ileocolonic Crohn's disease without causing important side‐effects.
Cisapride increases gallbladder volume in gallstone patients before and after extracorporeal shock wave lithotripsy
Authors: ZIEGENHAGEN D. J. , HEITZ W. , KRUIS W. , POHL C. , ZEHNTER E. 
Published: July 2010

SUMMARYWe have previously shown that oral cisapride causes a dose‐related increase of fasting gallbladder volume in healthy subjects. The present study investigates the effect of cisapride on gallbladder motility in 16 patients with gallbladder stones: 8 patients had no biliary symptoms, but the other 8 patients with symptomatic gallstone disease were studied before and 6 weeks after extracorporeal shock wave lithotripsy (ESWL). For each study the patients received a single oral dose of 20 mg cisapride; fasting gallbladder volume was measured by ultrasound before, and for 120 minutes after, drug administration. In the 8 asymptomatic patients a mean maximal increase of the fasting volume to 152.7 ± 7.6% of the initial value was observed at a mean 97.5 ± 8.3 minutes after cisapride ingestion. Similarly, in the 8 patients with biliary pain mean fasting volume after cisapride ingestion increased to 141.3 ± 5.7% before ESWL treatment and to 145.0 ± 5.8% after ESWL and 6 weeks of oral litholytic therapy. There were no significant differences between the results in the symptomatic and asymptomatic patients. Our results indicate that cisapride increases the gallbladder volume in gallstone patients regardless of biliary symptoms. Similar volume changes were observed before therapy and after ESWL with bile acid therapy. The therapeutic efficacy of litholytic agents could be diminished by simultaneous cisapride administration.
Regression of columnar lined (Barrett's) oesophagus with continuous omeprazole therapy
Authors: GORE S. , HEALEY C. J. , SUTTON R. , EYRE‐BROOK I. A. , GEAR M. W. L. , SHEPHERD N. A. , WILKINSON S. P. 
Published: July 2010

SUMMARYTwenty‐three adult patients with a columnar lined (Barrett's) oesophagus are being treated with long‐term omeprazole, 40 mg daily. Twelve had never undergone anti‐reflux surgery (Group 1), the other eleven having previously had insertion of an Angelchik anti‐reflux prosthesis (Group 2). Endoscopy was carried out six months before, immediately before and six months, one year and two years into treatment. Multiple and standardized biopsies were taken at each endoscopy. Results from the two groups were similar. During the 6‐month run‐in period there was a statistically non‐significant increase in the linear extent of the columnar mucosa, but this showed a progressive, statistically significant decrease during the two years of treatment. Other evidence for regression of the Barrett's mucosa includes the emergence of large numbers of macroscopic squamous islands within the abnormal mucosa, an increase in the number of microscopic squamous islands, and microscopic squamous encroachment of the abnormal mucosa at the squamocolumnar junction. Histological assessment showed a reduction in the proportion of sulphomucin‐rich intestinal metaplasia, but this only achieved statistical significance in Group 1. The results substantiate the importance of acid in the pathogenesis of Barrett's oesophagus. Omeprazole may have a therapeutic role in bringing about regression of the metaplastic epithelium.
Safety of lansoprazole
Authors: COLIN‐JONES D. G. 
Published: July 2010

SUMMARYThe care with which patients are monitored during clinical trials provides an excellent database to assess the tolerability and safety of drugs. Additional information can be obtained from knowledge of the compound itself, its metabolism and its pharmacological action. Other compounds from the same class can highlight areas that need particular study. All these factors have been used to assess the safety of lansoprazole. Lansoprazole has been administered to 4749 subjects and has been well tolerated. Only 1.2% of patients have been withdrawn from trials because of suspected drug‐related events but there was no pattern and no relationship to drug dosage. Diarrhoea (3.2%) and headache (4.7%) were the most commonly reported adverse events.
Future prospects for proton pump inhibitors
Authors: FRESTON J. W. 
Published: July 2010

SUMMARYFuture prospects for proton pump inhibitors depend on their efficacy and safety relative to H2‐receptor antagonists, the therapeutic standard for acid peptic disorders. As safety concerns diminish, efficacy considerations become more important as these may pertain to cost effectiveness. Comparative, controlled trials show that omeprazole and lansoprazole are somewhat more effective than H2‐blockers in healing duodenal and gastric ulcers, providing faster relief of symptoms. Relapse after cessation of therapy is similar between the two classes. The proton pump inhibitors are substantially more effective in healing lesions and relieving symptoms in patients with reflux oesophagitis, and are particularly effective in cases that have failed to heal after 12 weeks of treatment with H2‐blockers. Relapse rates of oesophagitis are significantly less with prolonged treatment with omeprazole than ranitidine. A proton pump inhibitor combined with amoxicillin is less effective than triple therapy with antibiotics and bismuth in eradicating Helicobacter pylori infections, but is more convenient and associated with fewer side‐effects. Efficacy might be improved by more optimal dosing regimens. Prospects for reversible proton pump inhibitors depend on the balance between their theoretical advantages and their acid inhibition profile which, at present, closely resembles that of H3‐bIockers.
Three months of octreotide treatment decreases gastric acid secretion and argyrophil cell density in patients with Zollinger‐Ellison syndrome and antral G‐cell hyperfunction
Authors: ANNIBALE B. , FAVE G. DELLE , AZZONI C. , CORLETO V. , CAMBONI G. , D'AMBRA G. , PILATO F. P. , BORDI C. 
Published: July 2010

SUMMARY Methods: The effects of three months of treatment with octreotide on gastric acid hypersecretion induced by hypergastrinaemia were investigated in patients with Zollinger‐Ellison syndrome (n= 5) or antral G‐cell hyperfunction (n= 4). Gastric acid secretion, fasting plasma gastrin concentrations and clinical findings were examined, and a morphometrical analysis of oxyntic endocrine cells was performed. Results: Administration of octreotide 100 meg b.d. subcutaneously significantly decreased the volume density of argyrophil cells (P < 0.05) as well as basal and pentagastrin‐stimulated acid secretion (P < 0.05). Although partial or complete loss of inhibition was found in most patients after 3 months, gastrin levels were decreased during the first 2 months of treatment (P < 0.05). Fundic D‐cells were not affected by treatment. Positive correlations were observed between volume density of argyrophil cells and basal acid output (r= 0.65); plasma gastrin and basal acid output (r= 0.74); plasma gastrin concentrations and volume density of argyrophil cells (r= 0.80). Conclusion: These results support the important role of the enterochromamn‐like cell in maintaining acid secretion, and indicate a specific role for octreotide in the therapy of gastric acid hypersecretion associated with hypergastrinaemic diseases.
Effect of eradication of Helicobacter pylori on gastric epithelial cell proliferation
Authors: FRASER A. G. , SANKEY R. SIM. E. A. , DHILLON A. P. , POUNDER R. E. 
Published: July 2010

SUMMARY Background: Helicobacter pylori is associated with B‐type gastritis, duodenal ulcer disease, and possibly gastric carcinoma. The object of this study was to assess the effect of eradication of H. pylori infection on gastric epithelial cell proliferation. Methods: Gastric epithelial cell proliferation was assessed in 22 H. pyloori‐positive duodenal ulcer patients before and 6 weeks after' triple therapy’with bismuth, tetracycline and metronidazole. Cell proliferation was studied either by immunostaining for the proliferating cell nuclear antigen (PCNA) or by a microdissection technique. Results: Eradication was successful in 10 of the 22 H. pylori‐positive patients. Treatment with' triple therapy’resulted in a significant fall in the rate of gastric epithelial cell proliferation; this effect was seen in both the gastric body and antrum. There was a significant correlation between the number of PCNA‐labelled cells and the histological grade of activity (neutrophil inflammation) (r= 0.49, P= 0.02); the same correlation was found for the number of mitoses per gland (r= 0.5, P= 0.02). There was no significant difference in the treatment effect for eradicated or non‐eradicated patients or either the body or antrum. Six patients, who had at least one antral biopsy that showed evidence of focal intestinal metaplasia, had a higher rate of cell proliferation. Conclusions: The reduction in epithelial cell proliferation in the body and antrum after triple therapy is independent of successful eradication of H. pylori, and it may be due to an anti‐inflammatory effect of triple therapy.
Phospholipase A2 activity in gastric juice from patients with active and H. pylori‐eradicated healed duodenal ulcer
Authors: BERSTAD K. , SJÖDAHL R. , BERSTAD A. 
Published: July 2010

SUMMARY Background: Despite the close association between gastric Helicobacter pylori infection and duodenal ulcer. little is known about how this organism may promote mucosal damage. A possibility might be that it produces, or induces the host to release, phospholipases that metabolize the protective layer of phospholipids Methods: Aimed at determination of phospholipase A2 activity and the concentration of choline‐containing phospholipids in gastric juice, aspirates were collected during gastroscopy in 38 consecutive referrals with either active (n= 19) or H. pylori‐eradicated healed duodenal ulcer (n = 19). Results: Gastric juice phospholipase A2 activity was 3.1 times higher in active than in healed duodenal ulcers (P = 0.03). Concurrently, the concentration of choline‐containing phospholipids in the group with active ulcers was less than half compared with the healed group (P = 0.02). Conclusion: The results indicate that phospholipase A2 activity and the concentration of choline‐containing phospholipids in gastric juice are related to H. pylori status and duodenal ulcer disease.
Effect of enprostil on serum gastrin and pepsinogen A and C levels in patients on long‐term treatment with omeprazole
Authors: MEIJER J. L. , ANSEN J. B. M. J. J , BIEMOND I. , KUIJPERS I. J. , LAMERS C. B. H. W. 
Published: July 2010

SUMMARY Background: Treatment of omeprazole induces profound inhibition of gastric acid secretion, resulting in hypergastrinaemia. In rats hypergastrinaemia induced by chronic administration of high doses of omeprazole resulted in ECL‐cell hyperplasia and subsequent carcinoid formation. This finding may limit long‐term therapy in man. The synthetic prostaglandin E2 analogue enprostil not only inhibits gastric acid secretion but also reduces serum gastrin in normal subjects and in peptic ulcer patients. The present study was undertaken to determine whether enprostil reduces serum gastrin in patients on long‐term treatment with omeprazole. Methods: Eight patients with reflux oesophagitis treated with 40 mg omeprazole once daily for at least 3 months received 3 5 μg enprostil t.d.s. during a 5‐day treatment course. Basal and postprandial serum gastrin concentrations and pepsinogen A and C levels were measured on the day before, the first and the final day, and on the day after cessation of treatment. Results: Enprostil significantly (P < 0.05) reduced basal serum gastrin from 65±15 pmol/L to 51 ± 13 pmol/L on the first treatment day, and to 41 ± 9 pmol/L on the final day. Enprostil also significantly (P < 0.05) reduced postprandial integrated serum gastrin from 6173 ± 849 pmol.h/L to 4516 ± 906 pmol.h/L and to 3532 ± 706 pmol.h/L on the first and final treatment days, respectively. On the day after cessation of treatment basal (57± 11 pmol/L) and postprandial integrated serum gastrin concentrations (5766 ± 864 pmol.h/L) were not significantly different when compared to pretreatment values. Enprostil had no significant influence on serum pepsinogens A and C. Conclusion: Short‐term co‐administration of enprostil lowers the serum gastrin levels in patients on long‐term treatment with omeprazole.