bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of omeprazole in Zollinger‐Ellison syndrome: a prospective nine‐year study of efficacy and safety
Authors: METZ D. C. , STRADER D. B. , ORBUCH M. , KOVIACK P. D. , FEIGENBAUM K. M. , JENSEN R. T. 
Published: July 2010

SUMMARYH+, K+‐ATPase inhibitors such as omeprazole are the antisecretory agents of choice for the management of gastric acid hypersecretory states, including the Zollinger‐Ellison syndrome. However, long‐term follow‐up data on the overall efficacy and safety of these agents in large numbers of patients are lacking. In the current study we examined the long‐term efficacy and safety of omeprazole in 116 patients with Zollinger‐Ellison syndrome treated with oral omeprazole at a single centre for up to 114 months (mean ± S.E.M. = 38 ± 3 months). The initial omeprazole maintenance dose was established according to the acute upward dose titration method in 89/116 patients (77%). Gastric acid output was effectively controlled using 60 mg of omeprazole once daily in 41/89 patients (46%) and 22/89 patients (25 %) required twice daily omeprazole therapy. The mean ranitidine equivalent dose for patients who required 60 mg omeprazole once daily (2.5 ± 0.2 g/day) was significantly lower than the mean ranitidine equivalent dose for patients who required more than 60 mg omeprazole once daily (4.3 ± 0.3 g/day). Long‐term omeprazole maintenance therapy was discontinued in 36/116 patients (31%) but in no cases was discontinuation due either to drug‐induced side‐effects or uncontrolled gastric acid output. Fasting serum gastrin levels were significantly elevated above pre‐treatment levels at only one time point during follow‐up and were likely due to tumour growth rather than a drug effect. The final long‐term omeprazole maintenance doses were lower than the initial doses but correlated closely with the preomeprazole basal acid output (r= 0.41, P < 0.001) and ranitidine equivalent dose requirements (r= 0.49, P < 0.001). We conclude that omeprazole effectively and safely controls gastric acid hypersecretion in all patients with Zollinger‐Ellison syndrome for up to nine years without evidence by tachyphylaxis.
Peptic ulcer in the elderly—a double‐blind, short‐term study comparing nizatidine 300 mg with ranitidine 300 mg
Authors: BATTAGLIA G. , MARIO F. DI , VIGNERI S. , SANTO P. DAL , PILOTTO A. , MAZZACCA G. ,   GISU (INTERDISCIPLINARY ULCER STUDY GROUP),   OTHER ITALIAN CENTRES
Published: July 2010

SUMMARYThis was a randomized, double‐blind, multicentre, short‐term study comparing ranitidine and nizatidine at the standard dosages of 300 mg at bedtime. In 49 centres in Italy, all peptic ulcer patients aged over 65 years and with endoscopically documented acute disease were considered eligible for the study. Clinical check‐ups were repeated every 3 weeks, while the endoscopic and biochemical assessments were scheduled at 6 and (in unhealed patients) 12 weeks. Statistics: chi‐squared test, Fisher's exact test, Student t‐test for unpaired data. The study included 170 duodenal ulcer and 75 gastric ulcer patients. Of these, 83/17 duodenal ulcer and 38/75 gastric ulcer patients were treated with nizatidine 300 mg and the remainder with ranitidine 300 mg. The groups were well‐matched for common clinical data. Eight patients dropped out. Healing rates at 6 and 12 weeks were 81.9% and 91.5% for nizatidine‐treated duodenal ulcer patients versus 78.1% and 94.2% for ranitidinetreated duodenal ulcer cases (P: N.S.); 6 and 12‐week healing rates were 76.3% and 89.5% for nizatidinetreated gastric ulcer patients versus 67.6% and 83.8% for ranitidine‐treated gastric ulcer patients (P: N.S.). No slow healing risk factors were found. Only minor adverse events were registered. In conclusion: ranitidine 300 mg and nizatidine 300 mg both proved effective and safe in the treatment of acute peptic ulceration in the elderly.
Effect of intravenous infusion of ranitidine on intragastric acidity in fasting subjects: comparison with bolus or Gastrojet (pH‐stat‐adjusted) infusion
Authors: THOMSON A. B. R. , KIRDEIKIS P. , SIMON K. , ZUK L. , PINCHBECK B. , WASARAB‐ROLLAND D. , KERSEY K. 
Published: July 2010

SUMMARYThis study was undertaken in nine fasting healthy volunteers to compare the effect of intravenous continuous infusion versus bolus injection of ranitidine on 12‐h intragastric pH, and to compare the efficacy of these two modes of administration of pH‐stat‐adjusted infusion of ranitidine using the Gastrojet. Each volunteer had three study sessions with 12‐h pH measurements. In the ranitidine infusion treatment arm (RAN‐INF), ranitidine was continually infused intravenously using an IVAC‐pump at a dose of 0.125 mg mg.kg over a 12‐h period. In the ranitidine bolus treatment arm (RAN‐BOL), ranitidine bolus 50 mg was given over 10 min, every 6 h. When ranitidine infusion was given by the pH stat method using the Gastrojet (RAN‐JET), sufficient ranitidine was given to maintain a preset value of pH ≥ 5. The study was analysed with a 3 × 3 Latin square cross‐over design with multiple measurements of each phase of the cross‐over. No difference was found between RAN‐INF and RAN‐BOL in 12‐h or in daytime (10.00–18.00 h) mean pH, median pH, or percentage of pH ≥ 5. Using RAN‐JET, 89.5% of the pH values were ≥ 5, compared with 39.7% and 40.0% with RAN‐INF or RAN‐BOL. RAN‐JET also gave higher (P < 0.05) mean and median 12‐h or daytime pH values, as compared with RAN‐INF or RAN‐BOL. The mean doses of ranitidine given in the 12‐h infusion periods were 100 mg, 109 mg and 112 mg (RAN‐BOL, RAN‐INF and RAN‐JET, respectively). Thus, this superior inhibition of acid inhibition achieved with Gastrojet does not require higher mean doses of ranitidine. These findings cannot necessarily be applied to persons with duodenal ulcer disease or to patients in an intensive‐care unit setting. However, the data do raise the possibility that much greater inhibition of acid inhibition can be achieved by individualizing the dose of ranitidine using the Gastrojet.
The need for long‐term treatment of peptic ulcer
Authors: DOBRILLA G. , ZANCANELLA L. , AMPLATZ S. 
Published: July 2010

SUMMARYSome 10% of the population in Western countries will suffer a duodenal ulcer or gastric ulcer at some time in their lives. Although there has been an improvement in the, survival rate of patients with peptic ulcer haemorrhage, the mortality is still approximately 10%. There is evidence to suggest that peptic ulcer disease is a life‐long condition and that ulcers remain active with an unchanged potential for complications such as haemorrhage and perforation. Over the past 15 years anti‐ulcer drugs with different mechanisms of action have been developed, and their use results in complete healing of an ulcer in four to eight weeks. However, most patients experience recurrence of their peptic ulcer after discontinuation of the healing therapy. Studies of continuous H2‐receptor antagonist therapy have shown that recurrence occurs less frequently than in untreated patients, is largely asymptomatic, and is rarely characterized by haemorrhagic complications. Limited data on therapy for the eradication ofHelicobacter pylorisuggest that this may be an alternative approach for selected patients. As protection afforded by H2‐receptor antagonists remains undiminished over the course of several years and is also observed in ulcers which have bled in the past, the implementation of long‐term management with these agents constitutes a rational policy.
Efficacy of continuous therapy for peptic ulcer in controlled clinical trials
Authors: DAMMANN H. G. , WALTER T. A. 
Published: July 2010

SUMMARYLong‐term studies have confirmed unequivocally the clinical efficacy of continuous therapy with H2‐receptor antagonists in reducing the incidence of ulcer recurrence. However, studies have also reported varying relapse rates as a result of differences in study design, particularly the frequency of endoscopy and hence the detection of asymptomatic ulcer relapse. Risk factors for ulcer relapse include smoking, stress, previous history of frequent ulcer relapses, duration of disease for more than 10 years and concomitant administration of non‐steroidal anti‐inflammatory drugs. In the prevention of relapse with H2‐receptor antagonists, choice of agents also may influence the rate of relapse. A meta‐analysis of data from direct comparative trials indicates that recurrence rates of duodenal ulcer are significantly lower after one year of treatment with ranitidine (1 50 mg nocte) than with cimetidine (400 mg nocte). It has been claimed that patients with peptic ulcer disease can be successfully managed by intermittent courses of treatment with H2‐receptor antagonists which are taken in response to the development of symptoms. However, high relapse rates (64–100%) have been reported during the first year of follow‐up of patients who were receiving intermittent treatment with H2‐receptor antagonists. High complication rates (haemorrhage 11.4%, perforation 1.2 %) have also been reported over a seven‐year follow‐up, while continuous treatment with H2‐receptor antagonists significantly decreases the risk of haemorrhage in the event of ulcer recurrence.
Mesalamine capsules enhance the quality of life for patients with ulcerative colitis
Authors: ROBINSON M. , HANAUER S. , HOOP R. , ZBROZEK A. , WILKINSON C. 
Published: July 2010

SUMMARYPatients with ulcerative colitis tend to be young, potentially at peak lifetime productivity levels, and the disease can be devastating in its effects on the quality of life in these individuals. No treatment for ulcerative colitis can be comprehensively evaluated without careful attention to its impact on such psychosocial issues. The quality of life was evaluated in 374 ulcerative colitis patients using mesalamine capsules at 1 g, 2 g, and 4 g daily versus placebo in an 8‐week, randomized, dose‐response, placebo‐controlled, double‐blind, multicentre trial. Function‐related quality of life parameters were assessed in this study, including five pertinent clinical symptoms and seven general life capabilities. These parameters have been previously shown to be valid, reliable, and responsive to the disease activity of ulcerative colitis. All of the parameters were recorded using a 10‐cm visual analogue scale, except trips to the toilet which were recorded in patients' diaries. The mean change was calculated from baseline and endpoint data. Mesalamine at 2 g and 4 g daily was significantly superior to placebo in improving each of the 12 quality of life parameters (P < 0.05). These results indicate that controlled‐release mesalamine significantly enhances the quality of life for patients with either left‐sided ulcerative colitis or pancolitis.
Effect of propranolol on prevention of first variceal bleed and survival in patients with chronic liver disease
Authors: PLEVRIS J. N. , ELLIOT R. , MILLS P. R. , HISLOP W. S. , DAVIES J. M. , BOUCHIER I. A. D. , HAYES P.C. 
Published: July 2010

SUMMARY Background: Propranolol has been shown to be effective in both primary and secondary treatment of variceal haemorrhage; most primary prevention trials have only included patients with large oesophageal varices. Aim of the study: The aim of this study was to look at the effect of propranolol in the primary prevention of variceal bleeding and its long‐term effects on mortality in unselected patients with chronic liver disease. Methodology: Three hundred and nineteen patients were included in a double‐blind parallel group study in three centres to receive propranolol 160 mg long‐acting (LA) or placebo. Patients were followed up for a minimum of one year. Results: There were eleven episodes of variceal bleeding and 38 deaths with no statistically significant difference in bleeding rates between the two treatment groups. Child's group and history of ascites were the most important prognostic factors determining the likelihood of early death and variceal bleeding respectively. Conclusions: In this study we failed to demonstrate a significant effect of propranolol on first variceal bleeding or in prolonging survival in unselected patients with chronic liver disease. Our results, however, might have been influenced by the low event rate observed in these unselected group of patients and suggest that careful selection of patients who are most likely to benefit from propranolol is important.
Short report: treatment of gastric ulcer with lansoprazole or ranitidine: a multicentre clinical trial
Authors: MICHEL P. , LEMAIRE M. , COLIN R. , BOMMELAER G. , RAMBAUD J. C. , DUPAS J. L. , BIGARD M. A. , VERWAERD J. C. 
Published: July 2010

SUMMARYWe studied the effectiveness of lansoprazole and ranitidine in promoting gastric ulcer healing in a multicentre double‐blind trial, by comparing the proportion of healed ulcers after 4 and 8 weeks of treatment. One hundred and fifty‐eight patients were randomly given either ranitidine (150 mg each morning and at bedtime) or lansoprazole (30 mg each morning and placebo at bedtime). One hundred and twenty‐eight patients completed the trial (62 taking lansoprazole, 66 taking ranitidine). Fifty‐one (80%) of those treated with lansoprazole and forty‐two (62%) of those treated with ranitidine had healed ulcers at 4 weeks (P < 0.05). Sixty‐one (98%) patients who received lansoprazole and 57 (86%) who received ranitidine had healed ulcers at 8 weeks (P < 0.05). The observed differences were not significant in the intention‐to‐treat analysis. No serious adverse event was reported with lansoprazole.
Review article: drug therapy for reflux oesophagitis
Authors: De BOER W. A. , TYTGAT G. N. J. 
Published: July 2010

SUMMARYGastro‐oesophageal reflux disease is a common disorder and symptoms can be mild to severe. Management of the disease should be individualized. Life‐style changes are important for all patients. Drug therapy is often necessary but only very few patients with severe disease need surgical treatment. The purpose of this article is to focus on drug therapy and to review the clinical trials of all the drugs used for gastro‐oesophageal reflux disease. Thereafter, judged solely on the data derived from these trials, a practical approach to the management of gastro‐oesophageal reflux disease is suggested.
Preservation of gastric antral mucus is associated with failure of eradication of Helicobacter pylori by bismuth, metronidazole and tetracycline
Authors: LOBO A. J. , McNULTY C. A. M. , UFF J. S. , DENT J. , EYRE‐BROOK I. A. , WILKINSON S. P. 
Published: July 2010

SUMMARY Methods: Forty‐three patients positive for Helicobacter pylori by histology and culture of antral biopsies (n = 40) or histology alone (n= 3) were investigated. They received either regimen 1‐tripotassium dicitrato bismuthate 120 mg q.d.s. and tetracycline 250 mg q.d.s. for 4 weeks, with metronidazole 200 mg q.d.s. for the first 2 weeks, or regimen 2–omeprazole 20 mg b.d., amoxycillin 500 mg t.d.s., tetracycline 500 mg q.d.s. each for 3 weeks. Gastric antral biopsies were scored (0–3) histologically for mucus depletion, polymorphonuclear and mononuclear cell infiltrate. H. pylori eradication was assessed by biopsy and culture 1 month after the cessation of treatment. Results: With regimen 1, pre‐treatment mucus depletion was significantly higher where eradication was successful (median score 2) compared to where it was not (median score 1, P < 0.01): there were no differences in the scores for polymorphonuclear or mononuclear cell infiltrates. In patients receiving regimen 2, there were no differences in either mucus depletion or polymorphonuclear or mononuclear cell infiltrate, between those where eradication was successful and those where it was not. Metronidazole minimum inhibitory concentrations rose when eradication with regimen 1 was unsuccessful (median before 0.19 mg/L, median after treatment 16 mg/L; P = 0.04). Conclusion: Pre‐treatment mucus depletion is identified as a factor affecting H. pylori eradication. Preservation of mucus may facilitate acquisition of metronidazole resistance.
Activity of metronidazole, azithromycin and three benzimidazoles on Giardia lamblia growth and attachment to a human intestinal cell line
Authors: KATELARIS P. H. , NAEEM A. , FARTHING M. J. G. 
Published: July 2010

SUMMARY Background: Attachment of Giardia lamblia trophozoites to enterocytes is essential for colonization of the small intestine and is considered a prerequisite for Giardia‐induced enterocyte damage. Inhibition of attachment may therefore have therapeutic potential Methods: Enterocyte‐like differentiated Caco‐2 cells were used as a biologically appropriate attachment surface to determine the effect of three benzimidazole compounds (albendazole, mebendazole and thiabendazole), azithromycin and metronidazole on Giardia attachment. The results were compared with the ability for each drug to inhibit Giardia growth, measured using [3H]‐thymidine uptake. Results: The benzimidazoles inhibited Giardia attachment at much lower concentrations than did metronidazole. However, metronidazole was a much more potent inhibitor of growth than any of the benzimidazoles. Azithromycin did not significantly impair Giardia attachment or growth. The benzimidazoles decrease attachment but are less giardiacidal than metronidazole. Conclusion: This model appears useful for testing potential antigiardial compounds and investigating mechanisms of drug action.
Prednisolone metasulphobenzoate foam retention enemas suppress the hypothalamo‐pituitary‐adrenal axis
Authors: LUMAN W. , GRAY R. S. , PENDEK R. , PALMER K. R. 
Published: July 2010

SUMMARY Background: Corticosteroid enemas represent effective treatment for ulcerative proctitis, but absorption into the systemic circulation may have undesirable metabolic consequences. Prednisolone metasulphobenzoate, a lipophobic corticosteroid derivative, is designed to be absorbed poorly through the recto‐sigmoid mucosa, but the effects of foam enema preparations upon the hypothalamo‐pituitary‐adrenal axis have not been examined. Methods: Nine patients suffering from active ulcerative proctitis underwent four weeks of therapy with prednisolone metasulphobenzoate foam enemas. The hypothalamo‐pituitary‐adrenal axis, denned using the modified single‐dose metyrapone test, glucose homeostasis and lipid profiles were studied before and after treatment. Results: The hypothalamo‐pituitary‐adrenal axis was significantly depressed after the treatment period; mean stimulated plasma Cortisol concentration fell from 384 ± 244 (s.d.) to 288±252 nmol/L, P < 0.02; stimulated mean plasma 11‐deoxyCortisol concentration fell from 677 ± 333 to 407 ± 326 nmol/L, P < 0.01. Mean fasting plasma glucose, insulin, C‐peptide, fructosamine and triglyceride concentration were unchanged, whilst the mean serum cholesterol concentrations rose from 5.6 ± 1.1 to 6.0± 1.2 mmol/L (not significant). Conclusion: Prednisolone metasulphobenzoate foam enemas have significant systemic and endocrine metabolic effects, which could assume importance with long‐term therapy.
Review article: gastro‐oesophageal reflux and laryngeal symptoms
Authors: FRASER A. G. 
Published: July 2010

SUMMARYThere is some evidence from clinical, experimental and multiprobe ambulatory pH studies that gastro‐oesophageal reflux is more common in patients with laryngeal symptoms and could potentially play a role in the causation of these symptoms. The proportion of unselected patients with laryngeal symptoms who have gastro‐oesophageal reflux as the primary aetiology may be overestimated in some series. The symptom that has been most evaluated is hoarseness, but even for this symptom the proportion of patients who have significant reflux varies widely. There is even less agreement for other symptoms, and the data on globus sensation remains confused. It is likely that these patients present to ear, nose and throat (ENT) clinics because of the relative insensitivity of the oesophageal mucosa to acid exposure. Given the lack of specificity for routine diagnostic tests for gastro‐oesophageal reflux, it is necessary to perform ambulatory pH monitoring for a secure diagnosis in these patients. Treatment studies have been surprisingly few and inadequate in design. It is suspected that there is a strong placebo response for these symptoms. No clear information on efflcacy can be provided until placebo‐controlled randomised studies are available.
Anaphylactic colonic hypersecretion in cow's milk sensitized guinea‐pigs depends upon release of Interleukin‐1, prostaglandins and mast cell degranulation
Authors: THEODOROU V. , FIORAMONTI J. , JUNIEN J. L. , BUENO L. 
Published: July 2010

SUMMARY Methods: The effect of β‐lactoglobulin (β‐LGI) challenge on net water movements into the proximal colon and the role of Interleukin‐1 (IL‐1), prostaglandins and mast cell degranulation on the challenge‐induced net water changes were assessed in vivo using isolated colonic loops in anaesthetized guinea‐pigs immunized to bovine milk. Results: β‐lactoglobulin challenge infused into the colonic loop during 30 min reversed the net water flux into a net secretion during the period of antigen infusion. Doxantrazole, a mast cell stabilizing agent, administered 120 min before challenge infusion, suppressed challenge‐induced hypersecretion. Similarly recombinant IL‐1 receptor antagonist protein abolished the antigen‐induced colonic secretory effect. Indomethacin, a prostaglandin synthesis inhibitor, administered 20 min prior to antigen infusion, significantly (P < 0.05) reduced, but did not abolish, the challenge‐induced colonic secretory effect. Conclusions: These results suggest that IL‐1 plays an important role in antigen challenge‐induced colonic hypersecretion which involves mast cell degranulation and prostaglandin release.
Comparison of lansoprazole with omeprazole on 24‐hour pH, acid secretion and serum gastrin in healthy volunteers
Authors: VARANNES S. BRULEY DES , LEVY P. , LARTIGUE S. , DELLATOLAS F. , LEMAIRE M. , GALMICHE J. P. 
Published: July 2010

SUMMARY Background: Lansoprazole and omeprazole are proton pump inhibitors which both strongly inhibit acid secretion, resulting in a significant increase in serum gastrin levels. However, no direct comparison of recommended doses (20 mg for omeprazole and 30 mg for lansoprazole) has been reported so far. Our aims were to compare the effects of omeprazole 20 mg/day and lansoprazole 30 mg/day on intragastric acidity and serum gastrin concentration in 12 healthy volunteers. Methods: The study was double‐blind, randomized and placebo‐controlled with a cross‐over design. On the seventh day of each period, 24‐hour intragastric pH was measured using a combined glass electrode placed in the proximal stomach. The last morning dose of each regimen was taken at the end of 24‐hour pH monitoring; acid output and serum gastrin concentrations were then studied in the fasting state and after stimulation with pentagastrin (maximal acid output) and a meal (post‐prandial gastrin response). Results: Compared to placebo, both drug regimens induced a sustained increase of 24‐hour intragastric pH and significantly decreased basal and pentagastrin‐stimulated acid secretion. Lansoprazole 30 mg was slightly more effective than omeprazole 20 mg in terms of time spent above pH 3 (P < 0.05). Accordingly post‐prandial gastrin concentrations rose slightly more after lansoprazole than after omeprazole. All other differences were insignificant. Conclusions: Both lansoprazole 30 mg and omeprazole 20 mg induce potent and long‐lasting acid inhibition, with few minor differences when the two proton pump inhibitors are used at standard doses.