bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short Report: omeprazole‐tetracycline combinations are inadequate as therapy for Helicobacter pylori infection
Authors: AL‐ASSI M. T. , GENTA R. M. , GRAHAM D. Y. 
Published: July 2010

SUMMARY Background: Current triple antimicrobial therapies cure Helicobacter pylori infection in 60–90% of cases but are cumbersome. Addition of omeprazole to amoxycillin has been shown to enhance effectiveness when compared to amoxycillin alone Method: We studied omeprazole 20 mg t.d.s. plus tetracycline 500 mg q.d.s. for 14 days (OMP/TCN) and omeprazole 40 mg in the morning plus tetracycline 500 mg q.d.s. along with bismuth subsalicylate tablets 2 q.d.s. (OMP/TCN/BSS) for 14 days. Forty‐four patients (19 OMP/TCN, 25 OMP/TCN/BSS) with H. pylori peptic ulcer disease were studied. H. pylori status was evaluated at least 4 weeks after ending antimicrobial therapy. Results: In the OMP/TCN group cure of H. pylori infection was achieved in 5/19 (26%). Adding bismuth to the regimen improved the results; 4 weeks after ending therapy cure of H. pylori infection was achieved in 12/25 (48%). Conclusions: Neither regimen can be recommended for routine cure of H. pylori infection. Although one cannot predict which antimicrobial therapies will be enhanced by the addition of omeprazole, these data suggest that future studies should evaluate drugs whose effectiveness is compromised by low pH.
Comparative bioavailability of 5‐aminosalicylic acid from a controlled release preparation and an azo‐bond preparation
Authors: CHRISTENSEN L. A. , FALLINGBORG J. , JACOBSEN B. A. , ABILDGAARD K. , RASMUSSEN H. H. , HANSEN S. H. , RASMUSSEN S. N. 
Published: July 2010

SUMMARY Background: Knowledge of the bioavailability of 5‐aminosalicylic acid (5‐ASA, mesalazine) from the different 5‐ASA‐containing drugs is important for rational therapy of inflammatory bowel diseases. Methods: The local and systemic bioavailability of 5‐ASA from a controlled release 5‐ASA preparation (Pentasa—2, 4 or 6 g/day) was investigated and compared with the azo‐bond 5‐ASA preparation olsalazine (Dipenturn—2 g/day) in 13 healthy volunteers during steady state conditions. Results: The therapeutically relevant parameter of 5‐ASA at the rectal level, expressed as the mean concentration in faecal water, showed a significant trend towards higher concentrations with increasing Pentasa dose: 9.2 mmol/L, 19.0 mmol/L and 24.4 mmol/L, respectively. The concentration of olsalazine 2 g/day was 16.0 mmol/L. The concentration of the metabolite N‐acetyl‐5‐aminosalicylic acid (Ac‐5‐ASA) did not rise with increasing Pentasa dose, indicating saturable presystemic acetylating capacity of 5‐ASA. Total urinary excretion of 5‐ASA and Ac‐5‐ASA, as a percentage of the daily ingested 5‐ASA dose, remained constant on the three Pentasa doses, but there was a significant increase in the 5‐ASA fraction. Mean steady state plasma concentrations of 5‐ASA and Ac‐5‐ASA were significantly higher on Pentasa 4 g/day and 6 g/day than on 2 g/day. Values on Pentasa 2 g/day were comparable with those on olsalazine 2 g/day. Conclusions: The study confirmed that 5‐ASA is released from Pentasa in a predictable manner, the amount released increasing with dose. Olsalazine is an excellent generator of 5‐ASA in the colon.
Protective action of diosmectite treatment on digestive disturbances induced by intestinal anaphylaxis in the guinea‐pig
Authors: THEODOROU V. , FIORAMONTI J. , DROY‐LEFAIX M. T. , PLIQUE O. , BUÉNO L. 
Published: July 2010

SUMMARY Methods: Colonic transit time, faecal moisture and intestinal permeability were assessed in guinea‐pigs sensitized intraperitoneally with cow's milk and challenged with an oral administration of β‐lactoglobulin. One group of animals was treated for 1 week with diosmectite (500 mg.kg/day) and another with placebo. A control group was not sensitized but treated with diosmectite. Results: In sensitized animals receiving placebo, challenge with β‐lactoglobulin induced a significant (P < 0.05) decrease in colonic transit time, and increases in faecal moisture and intestinal permeability. These changes were not observed in animals treated with diosmectite. Conclusion: Diosmectite pre‐treatment protects against allergic digestive disturbances induced by antigen administration in guinea‐pigs sensitized to cow's milk.
Flumecinol for the treatment of pruritus associated with primary biliarg cirrhosis
Authors: TURNER I. B. , RAWLINS M. D. , WOOD P. , JAMES O. F. W. 
Published: July 2010

SUMMARY Objective: To determine whether flumecinol (3‐trifluoromethyl‐α‐ethylbenzhydrol, Zixoryn) is effective in ameliorating pruritus of cholestasis, particularly in primary bilary cirrhosis. Methods and Results: 50 patients (46 with primary biliary cirrhosis, PBC) took oral flumecinol 600 mg or identical placebo once weekly for 3 weeks. Patients assessed pruritus by scoring a daily 100 mm visual analogue scale (VAS; 0 = no itch, 100 = severe, continuous, day and night intolerable itch). Quality of life was similarly measured. Patients scored the VAS daily for a 7–day baseline and for a further 21 days. Subjectively, pruritus improved in 13 of 24 on flumecinol and 10 of 26 on placebo (X2= 1.24, P= 0.2 7). Median difference in fall in VAS pruritus score between baseline week (mean score for each individual used) and the last week was 8.0 [95 % confidence interval (CI) –2.1 to 20.81 and for VAS quality of life was 5.0 (95% C1 0.4 to 13.0) both in favour of flumecinol over placebo. Later, 19 patients (all PBC) were randomised to flumecinol 300 mg or placebo daily for 3 weeks. Subjectively, pruritus improved in 7 of 10 on flumecinol and 1 of 9 on placebo (Fisher's exact test, P= 0.02). Median difference in fall in VAS pruritus score was 19.8 mm (95 % CI 3.3 to 40.7 mm) in favour of flumecinol over placebo and for quality of life was 3.5 mm (95 % C1 – 5.9 to 24.9 mm). Flumecinol did not significantly affect liver function tests, antipyrine clearance or serum total bile acids, and was not associated with any significant side‐effects. Conclusion: Flumecinol was safe at the above doses and short term treatment with 300 mg daily, significantly ameliorated pruritus in primary biliary cirrhosis.
Short report: time course of clinical response with fluconazole for Candida oesophagitis in patients with AIDS
Authors: WILCOX C. M. 
Published: July 2010

SUMMARY Background: Although fluconazole is increasingly utilized for the therapy of Candida oesophagitis in patients with AIDS, the time course of response has not been adequately defined. Methods: Over a 48‐month period, all HIV‐infected patients undergoing upper endoscopy at a large city‐county hospital were identified prospectively. Symptomatic patients with endoscopic and histopathologically confirmed Candida oesophagitis in whom oral antifungal therapy had not been received within the past three months were treated in an open‐label fashion with fluconazole 200 mg on the first day followed by 100 mg daily for two weeks. All patients were followed clinically to determine the rapidity of response. Results: Eighteen patients were identified; all but two were male. Candida oesophagitis was graded as severe in 13 patients (72 %). A complete symptomatic response was seen by five days in seven patients (39 %) and by seven days in nine additional patients (cumulative response, 89 %). The two other patients had improved by at least 50% at one week, with a complete symptomatic response seen at two weeks. Conclusions: Our study confirms anecdotal experience suggesting that fluconazole results in a rapid clinical response for Candida oesophagitis in patients with AIDS. Given this rapidity, a one‐week course of empiric treatment with fluconazole for HIV‐infected patients with newly developed esophageal symptoms could be used as an appropriate time period to assess a response prior to further diagnostic evaluation with endoscopy.
Review article: Helicobacter pylori eradication–understandable caution but no excuse for inertia
Authors: PENSTON J. G. 
Published: July 2010

SUMMARYThe long‐term management of patients with peptic ulcer disease is unsatisfactory, as judged by the persistently high levels of haemorrhage, perforation and death from this condition in Western countries. Although ulcer recurrence and complications can be prevented, many patients with peptic ulcer disease fail to receive the benefits of modern therapeutic regimens.In recent years, eradication of Helicobactor pylori has been promoted as a‘cure’for peptic ulcer disease and, while such claims are premature, there can be little doubt that this treatment–when successful– dramatically improves the medium‐term prognosis of ulcer patients. However, in general, clinicians have given this promising therapeutic advance a lukewarm welcome. The aim of this detailed review of the literature is to remove the uncertainty and confusion surrounding many aspects of eradication therapy.Estimates are provided of the eradication rates after either triple therapy or the combination of omeprazole plus amoxycillin, and the sources of variation in published studies are discussed. Problems associated with eradication therapy, including side effects, compliance and re‐infection, are addressed in order to ascertain the extent and clinical significance of each factor. In addition, studies reporting the outcome of patients with peptic ulcer disease after eradication are assessed with reference to both ulcer recurrence and complications. The result of the review is to dissipate much of the scepticism concerning eradication therapy. However, whilst acknowledging the efficacy of eradication therapy, its limitations have also to be recognized. By itself, it does not provide the complete answer to peptic ulcer disease. For some ulcer patients, eradication therapy is the preferred option; for others, prophylactic therapy with H2‐receptor antagonists is more suitable. Guidelines are proposed for the selection of patients for each alternative therapy. The crucial point is that patients with peptic ulcer–excluding the small proportion with a mild form of the disease—require positive, long‐term management consisting of either continuous prophylaxis with H2‐receptor antagonists or the eradication of Helicobacter pylori.
Antidepressant therapy in 138 patients with irritable bowel syndrome: a five‐year clinical experience
Authors: CLOUSE R. E. , LUSTMAN P. J. , GEISMAN R. A. , ALPERS D. H. 
Published: July 2010

SUMMARYBackground: Antidepressant agents may have a therapeutic role in functional gastroenterologic disorders, but controlled investigations in irritable bowel syndrome (IBS) have not provided satisfactory practice recommendations. To help with future study design, we reviewed a five‐year clinical experience with antidepressant agents in out‐patients with IBS. Methods: Presenting features, treatment course, and clinical outcome were determined from a chart review of 138 patients attending a university‐based gastroenterology practice.Results: Patients were treated with up to five antidepressants in separate, consecutive trials if a satisfactory end‐point had not been reached. Tricyclic antidepressants were utilized 130 times, newer antidepressants 39 times, and anxiolytic‐antidepressants 47 times. Improvement and complete remission in bowel symptoms occurred in 89% and 61% of patients, respectively, during antidepressant therapy. Median dosages being prescribed when remission occurred were less than those conventionally used in clinical psychiatry (50 mg/day for several tricyclic antidepressants). Age, gender, symptom duration, and presence of psychological symptoms did not discriminate those who remitted from those who did not, whereas a pain predominant symptom pattern was more commonly associated with symptom remission (P < 0.05 comparing symptom patterns). Symptom remission was more likely during the first antidepressant treatment than with subsequent trials in the group with continued symptoms (P = 0.01), but nearly half of the patients with side effects or no benefit from the first agent who went on to subsequent trials remitted during treatment with an alternative antidepressant.Conclusions: The design of this retrospective review is not capable of determining the efficacy of antidepressants for IBS. Our observations in conjunction with other available data suggest that future trials should employ low daily dosages, carefully assess pain response, include patients with and without active psychiatric symptoms, and utilize a second agent for subjects intolerant or unresponsive to the first.
The effect of tripotassium dicitrato bismuthate on the rat stomach
Authors: WALDUM H. L. , QVIGSTAD G. , MÅVIK R. , BRENNA E. , SYVERSEN U. , SANDVIK A. K. 
Published: July 2010

SUMMARYBackground: Bismuth has been used as symptomatic treatment of dyspepsia for many years. It promotes healing of peptic ulcers and reduces their recurrence. The beneficial effect of bismuth on duodenal ulcer disease is thought to be due to an effect on Helicobacter pylori, although it has a rather weak bactericidal effect on H. pylori in vitro. Eradication of H. pylori in duodenal ulcer patients by a combination of bismuth, tetracycline and metronidazole has been reported to increase the density of somatostatin‐producing D cells in the antrum. A reduced D cell density in the antral mucosa of duodenal ulcer patients could explain their exaggerated gastrin release.Aims/methods: To test the possibility that bismuth could affect the neuroendocrine cells independently of the presence of H. pylori or not. we gave rats a diluted tripotassium dicitrato bismuthate solution by gastric gavage for 14 days.Results: Tripotassium dicitrato bismuthate treatment did not affect maximal pentagastrin‐stimulated acid secretion or histamine release in isolated rat stomachs or the density of argyrophil cells in the oxyntic and antral mucosa. However, it significantly reduced the duodenal concentration of gastrin and calcitonin gene‐related peptide, and the density of G cells in the antrum and duodenum.Conclusion: The effect of tripotassium dicitrato bismuthate on the G cell may be of significance for its beneficial effect on duodenal ulcer disease.
Topical anticolitic efficacy and selectivity of the glucocorticoid budesonide in a new model of acetic acid‐induced acute colitis in the rat
Authors: FABIA R. , ArRAJAB A. , WILLÉN R. , BRATTSAND R. , ERLANSSON M. , SVENSJÖ E. 
Published: July 2010

SUMMARYAims: To study the effect of local or parenteral administration of the glucocorticoid budesonide in the acetic acid‐induced colitis model in the rat.Methods: Colitis was induced in an exteriorized colonic segment by administration of 4% acetic acid for 15 s. Four days later, this colonic segment with colitis was examined using a morphological scoring system, and measurements of myeloperoxidase activity and of plasma exudation into the colonic segment. The experimental colitis showed morphological similarities to human ulcerative colitis, with 3‐fold increase in myeloperoxidase activity and 6‐fold increase in the plasma exudation. Budesonide in different doses administered for 3 days, starting one day after acetic acid instillation, prevented the development of colitis in a dose‐dependent manner. The best effect of budesonide on the morphological score was achieved after local treatment at a dose of 10″5 M twice daily (76% reduction compared with a control colitis group) and parenteral treatment with 0.75 mg/kg (80% reduction). These doses also normalized myeloperoxidase activity and significantly reduced the plasma exudation. The systemic effects of the drug were most pronounced in the group treated with parenteral budesonide. This group showed the greatest reduction in body weight and a significant reduction of the weight of adrenal glands and spleen (as compared to controls). Thymus weight in animals treated systemically was significantly lower than in locally treated animals. In the group treated with local budesonide the weight of adrenals was reduced. However, the weights of spleen and thymus were not reduced and the reduction of the body weight was even less than in the control group.Conclusion: Local treatment with budesonide at a dose of 10−5 M (0.17 mg/kg if completely absorbed, but only 0.03 mg/kg with 15% bioavailability on colonic application) was as effective as parenteral treatment at a dose of 0.75 mg/kg in the attenuation of acetic acid‐induced colitis in the rat, but resulted in minor systemic side‐effects.
Clarithromycin‐amoxycillin therapy for Helicobacter pylori infection
Authors: AL‐ASSI M. T. , GENTA R. M. , KARTTUNEN T. J. , GRAHAM D. Y. 
Published: July 2010

SUMMARYBackground: More convenient therapies are needed to treat Helicobacter pylori infection successfully. Clarithromycin and amoxycillin are effective against H. pylori both in vivo and in vitro. Recent success with a high dose amoxycillin‐metronidazole combination therapy led us to evaluate clarithromycin‐amoxycillin dual therapy for H. pylori infection.Methods: We tested the combination of clarithromycin 500 mg t.d.s. with meals plus amoxycillin 750 mg t.d.s. with meals for 10 days for its effect on H. pylori infection in 29 patients with documented H. pylori peptic ulcers. There were 27 men and 2 women, ranging in age from 23 to 77 years. H. pylori and ulcer status were evaluated at entry and at least 4 weeks after ending antimicrobial therapy. For ulcer healing, ranitidine 300 mg was given each evening for 6 weeks. H. pylori status was determined by CLOtest and histology. Results: H. pylori infection was cured in 86% (95% CI = 78–99%). Compliance averaged 93% by pill count. Ten patients (34%) experienced mild side effects: eight reported dysgeusia and two had mild diarrhoea; none discontinued therapy because of side effects.Conclusion: We conclude that dual therapy with clarithromycin and amoxycillin is a safe and effective alternative regimen for the successful treatment of H. pylori infections.
The outcome of peptic ulcer haemorrhage in relation to consumption of nonsteroidal anti‐inflammatory drugs or aspirin
Authors: CHOUDARI C. P. , ELTON R. A. , PALMER K. R. 
Published: July 2010

SUMMARYAim: To compare the outcome of 76 patients who presented with severe peptic ulcer haemorrhage whilst taking nonsteroidal anti‐inflammatory drugs (NSAIDs) or aspirin with that of 112 patients who were not taking these drugs and who developed peptic ulcer haemorrhage over the same time period.Methods: The two groups of patients were managed identically and endoscopic therapy was attempted in all cases.Results: The group taking NSAIDs or aspirin tended to be older and had a higher prevalence of cardio‐respiratory disease. The severity of bleeding (as assessed by the presence of shock, anaemia and endoscopic stigmata) was similar in the two groups. Outcome in terms of uncontrolled haemorrhage, rebleeding and blood transfusion requirements did not differ significantly in the two groups. The NSAID group had a significantly longer duration of admission, almost certainly attributable to a higher prevalence of co‐morbid diseases.Conclusions: Despite the deleterious effects of NSAIDs and aspirin upon renal and platelet function, the prognosis of peptic ulcer bleeding is not adversely affected by NSAID or aspirin therapy.
Inhibition of 5‐hydroxytryptamine re‐uptake impairs human gall‐bladder emptying
Authors: GORARD D. A. , HEALY J. C. , O'DONNELL L. J. D. , FARTHING M. J. G. 
Published: July 2010

SUMMARYBackground: 5‐Hydroxytryptamine (5‐HT) is an important neurotransmitter in the enteric nervous system. The intrinsic neural plexus of the gall‐bladder resembles the enteric nervous system and similarly contains 5‐HT neurones. The action of 5‐HT on gallbladder motility has been investigated in animals but its effect on the human gall‐bladder in vivo is unknown.Methods: The effect of indirect 5‐HT agonism using paroxetine, a specific inhibitor of neuronal 5‐HT reuptake, on gall‐bladder motility was investigated in 12 healthy volunteers. In a randomized double‐blind crossover design, gall‐bladder motility was assessed after administration of 30 mg paroxetine daily for two days and after placebo. Ultrasonography was used to determine gall‐bladder volumes while fasting and at 5 min intervals following a 250 kcal mixed liquid meal.Results: Fasting gall‐bladder volumes of 21.8 ± 3.2 ml on placebo and 28.0± 3.5 ml on paroxetine were similar. Paroxetine impaired postprandial gall‐bladder emptying. Residual gall‐bladder volume was 10.2 ±2.7 ml with placebo and 17.1±2.7 ml with paroxetine (P < 0.05). Ejection fraction was 57.3 ±7.7% on placebo and 40.9 ± 4.7% on paroxetine (P < 0.05).Conclusion: 5‐HT pathways may participate in the regulation of biliary motility, and this study demonstrates an inhibitory role of 5‐HT in the control of human gall‐bladder emptying.
Meta‐analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome
Authors: POYNARD T. , NAVEAU S. , MORY B. , CHAPUT J. C. 
Published: July 2010

SUMMARYAim: To assess the efficacy of smooth muscle relaxants in the treatment of patients with irritable bowel syndrome, a meta‐analysis of 26 selected double‐blind randomized trials vs. placebo was performed.Methods: Five end‐points were assessed: global assessment, abdominal pain, constipation, abdominal distension and the absence of adverse reactions. Analyses were performed according to the intention‐to‐treat method. For each end‐point, the drug efficacy was assessed by the Der Simonian and Peto methods. When a significant difference was observed, sensitivity analyses were performed by successive stratifications according to the type of drug, the treatment duration, the prevalence of constipated patients, the trial design and the methodological quality.Results: All myorelaxants analysed were significantly better than placebo for the improvement of global assessment (62% improvement rate vs. 35% on placebo, that is 27% improvement rate, P < 0.01) and for pain improvement (64% improvement rate vs. 45% on placebo, that is 19% improvement rate, P < 0.01). No significant differences were observed for constipation and abdominal distension. The percentage of patients with adverse reactions was significantly higher in patients receiving myorelaxants than placebo (6% mean difference, P < 0.01).Conclusion: According to this overview five drugs have proved their clinical efficacy in patients with irritable bowel syndrome, without significant adverse reactions: cimetropium bromide, pinaverium bromide, trimebutine. octilium bromide and mebeverine.
Basal serum gastrin concentrations before and after eradication elicobacter pylori infection measured by sequence specific radioimmunoassays
Authors: WITTEMAN E. M. , VERHULST M. L. , KONING R. W. de , HOPMAN W. P. M. , JANSEN J. B. M. J. 
Published: July 2010

SUMMARYBackground: Helicobacter pylori infection of the antral mucosa is responsible for an increase in basal and stimulated serum gastrin. In the present study we have investigated whether gastritis induced by H. pylori is responsible for abnormalities in the processing of gastrin in dyspeptic patients.Methods: Basal serum gastrin was measured by radioimmunoassay before, 5 weeks, and 1 year after anti‐H. pylori therapy in 73 H. pylori positive functional dyspeptic patients. Three region‐specific antisera were used, specific for the biologically active carboxy‐terminal part, the biologically inactive aminoterminal part of gastrin 1–17, and for the nonsulphated tyrosyl residue in gastrin 1–17.Results: Basal serum gastrin levels were markedly (P < 0.01) decreased 5 weeks and 1 year after successful eradication of H. pylori (n= 39) but not in the patients in whom treatment failed (n= 34). A decline of gastrin was observed for each of the three radioimmunoassays. Conclusion: The decrease of serum gastrin levels in all three radioimmunoassays after a successful eradication of H. pylori does not point to major changes in the processing of gastrin. These results suggest that G‐cells in the antral mucosa are not functionally affected by the inflammation.