bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of upper gastrointestinal mucosal damage by standard and delayed‐release indomethacin
Authors: SWIFT G. L , ARNOLD J. , WILLIAMS G. T. , WILLIAMS B. D. , RHODES J. , KHAN F. 
Published: July 2010

SUMMARYForty‐five patients taking long‐term indomethacin and with endoscopic erosions or superficial ulcers in the oesophagus, stomach or duodenal bulb were randomized in a double‐blind study to continue with standard indomethacin or receive a ‘delayed‐release’ formulation. This consisted of microgranules of indomethacin coated with an acrylic resin, Eudragit L, which releases drug in the small intestine. Endoscopy was repeated after 8 weeks and biopsies taken on both occasions. Changes in endoscopic lesions and histological appearances were similar in both groups, although mucosal erythema was less in those given Eudragit L indomethacin. Systemic, rather than topical, effects of indomethacin may therefore be responsible for persistence of gastro‐duodenal mucosal lesions in these patients. There is reason to question the clinical practice of using expensive, delayed‐release preparations.
Dose‐dependent stimulation of gallbladder contraction by intravenous erythromycin in man
Authors: CATNACH S. M. , BALLINGER A. B. , LAW P. A. , NELLANS H. , FAIRCLOUGH P. D. 
Published: July 2010

SUMMARYWe have previously shown that a single oral dose of 500 nig erythromycin causes gallbladder contraction. The effect of intravenous erythromycin on antroduodenal motility is dose‐dependent; < 3 mg/kg body weight stimulates propagated contractions in a fashion similar to motilin while doses > 7 mg/kg cause giant non‐propagated antral contractions not seen with motilin. Using ultrasound, we have examined the effect of differing doses of intravenous erythromycin on gallbladder motility in man. Erythromycin (1 mg/kg) caused fasting gallbladder contraction to 52 % of basal gallbladder volume (P < 0.001), and increased gallbladder emptying following a liquid meal (maximal percentage emptied 75 ± 6.8% vs. 58 ± 9.0% following saline, P < 0.05). Erythromycin (7 mg/kg) however, had no effect on gallbladder fasting or post‐prandial motor activity. We conclude that the effect of erythromycin on gallbladder motility is dose‐dependent, with higher doses having no effect. It is possible that at higher doses erythromycin stimulates other receptors in addition to the motilin receptor, and that the combined effect is different to the stimulation of the motilin receptor alone.
Effect of putative carcinoid mediators on gastric and small bowel transit in rats and the role of 5‐HT receptors
Authors: VALDOVINOS M. A. , THOMFORDE G. M. , CAMILLERI M. 
Published: July 2010

SUMMARYWhereas serotonin and substance P stimulate in‐vivo and in‐vitro myoelectric activity in the small intestine, their effects on transit are unclear. We used a validated in‐vivo transit model in the chloral hydrate‐anaesthetized rat to study the effects of serotonin, substance P and motilin, three putative mediators of carcinoid diarrhoea, on transit through the upper digestive tract. Intra‐arterial serotonin accelerated gastric emptying of a radiolabeled liquid, while motilin accelerated overall upper gastrointestinal transit. Substance P slowed overall upper gastrointestinal transit without altering gastric emptying. The antagonists to serotonin receptor subtypes, R‐zacopride (5‐HT3) and ketanserin (5‐HT2), also accelerated rat gastric emptying of liquids; in contrast, a 5‐HT4agonist, SC53116, resulted in a less pronounced effect on gastric emptying at the dose tested. We conclude that circulating substance P is unlikely to be an important accelerator of transit through the upper digestive tract; in contrast, hyperserotoninaemia significantly accelerates transit through the stomach, and 5‐HT2and 5‐HT3receptor subtypes may play a role in the motor effects of serotonin in the stomach.
Cimetidine improves GERD symptoms in patients selected by a validated GERD questionnaire
Authors: JOHNSSON F. , ROTH Y. , PEDERSEN N.‐E. DAMGAARD , JOELSSON B. 
Published: July 2010

SUMMARYA questionnaire was constructed and validated to improve the accuracy of symptom assessment in diagnosing gastro‐oesophageal reflux disease (GERD). The GERD questionnaire consisted of four questions describing an upward moving, uncomfortable feeling in the chest frequently accompanied by retrosternal burning that is improved with antacids. It was found that if a patient answered yes to all four questions the likelihood was 85% that erosive oesophagitis would be detected on endoscopy or that pathological gastro‐oesophageal reflux on 24‐hour pH‐monitoring would be documented, or both.The GERD questionnaire was used to identify 269 patients with probable GERD who after one week on placebo entered a 2‐week double‐blind placebo‐controlled study which was completed by 251 patients. Cimetidine (400 mg) b.d. was given to 124 patients and placebo to 127 patients. On diary cards the patients noted the number, the mean duration and the mean severity of GERD symptoms episodes. Cimetidine was significantly superior to placebo in increasing the percentage of symptom‐free days, and in reducing the median number of daily symptom episodes.This trial demonstrates that 400 mg cimetidine b.d. is effective in improving GERD symptoms in patients identified by a descriptive, validated GERD questionnaire.
Efficacy of bile acid therapy for gallstone dissolution: a meta‐analysis of randomized trials
Authors: MAY G. R. , SUTHERLAND L. R. , SHAFFER E. A. 
Published: July 2010

SUMMARYTo define better the efficacy of bile acid therapy for dissolution of radiolucent gallstones, we performed a meta‐analysis of published trials from January 1966 to September 1992. Studies were identified using a MEDLINE computer search followed by an extensive manual search. The inclusion criteria used were: randomized trial, radiolucent gallstones in a visualizing gallbladder on oral cholecystography, and complete stone dissolution confirmed by oral cholecystography or ultrasound. Study results were pooled into 6 groups: placebo: high‐ and low‐dose chenodeoxycholic acid (CDCA) (≥10 mg.kg/day and < 10 mg.kg/day); high‐ and low‐dose ursodeoxycholic acid (UDCA) (< 7 mg. kg/day and < 7 mg. kg/day) and combined CDCA plus UDCA. Homogeneity calculations were performed and the percentage of complete stone dissolution calculated for each group with 95% confidence intervals. Of 66 trials identified, 23 comprising 1949 patients met the inclusion criteria. A total of 1062 patients were treated with CDCA, 819 with UDCA and 78 combination therapy. In studies > 6 months' duration, high‐dose UDCA completely dissolved stones in 37.3% of patients (95% C.I. 33–42%), low‐dose UDCA in 20.6%) and high‐dose CDCA 18.2% (95% C.I. 15–21%). Based on only two studies, combination therapy achieved dissolution in 62.8% (95% C.I. 51–74%) of patients. Stones less than 10 mm dissolved significantly more frequently than stones larger than 10 mm. This analysis shows that UDCA in doses greater than 7 mg. kg/day taken for greater than 6 months will dissolve radiolucent gallstones in 38% of patients. The combination of UDCA and CDCA may be more efficacious but this observation is based upon only 78 patients and requires confirmation in further randomized trials.
Two‐week eradication regimen for metronidazole‐resistant Helicobacter pylori
Authors: LOGAN R. P. H. , GUMMETT P. A. , MISIEWICZ J. J. , KARIM Q. N , WALKER M. M. , BARON J. H. 
Published: July 2010

SUMMARYAt present there is no generally accepted treatment regimen for eradicating metronidazole‐resistant Helicobacter pylori. This study determines the eradication rate after treatment with 40 mg omeprazole o.m. and 500 mg amoxycillin q.d.s. for 14 days, with 120 mg tripotassium dicitrato bismuthate q.d.s. for the first week (Days 1–7) and 750 mg ciprofloxacin b.d. for the second week (Days 8–14). Thirty patients (16 male, mean age 45 years, range 16–80 years) with duodenal ulcers (n= 18) or non‐ulcer dyspepsia (n= 2) and metronidazole‐resistant H. pylori detected by histology, culture, in vitro sensitivity tests and a positive 13C‐urea breath test entered the study. Follow‐up was by 13C‐urea breath test at the end of treatment and at 1, 3, 6, and 12 months. Eradication was denned as a negative 13C‐urea breath test at least 1 month after finishing treatment. H. pylori was successfully eradicated in 21/30 (71%) patients (median follow‐up 10.2 months, range 4–12 months). A pre‐treatment ciprofloxacin‐resistant strain was isolated in 1/9 patients in whom eradication failed. Of 30 patients 29 completed the 2‐week regimen; one patient experienced dizziness after 3 days of treatment. The most common side‐effect was increased stool frequency (n= 6). This 2‐week treatment regimen for metronidazole‐resistant H. pylori is well tolerated and achieves an eradication rate of 70%.
Reduction of rectal sensitivity and post‐prandial motility by granisetron, a 5 HT3‐receptor antagonist, in patients with irritable bowel syndrome
Authors: PRIOR A. , READ N. W. 
Published: July 2010

SUMMARYThe effect of granisetron, a specific 5‐hydroxytryptamine 3‐receptor antagonist, on the anorectal responses to rectal distension and a 1000‐calorie meal was assessed in 12 patients with irritable bowel syndrome. Each patient was studied on three occasions, receiving intravenously either 40 mcg/kg granisetron, 160 mcg/kg granisetron or normal saline. Granisetron caused a dose‐dependent reduction in rectal sensitivity, manifested by an increase in the threshold volumes at which the sensations of gas, desire to defecate, urgency and discomfort were perceived. This reached significance for all sensations at the higher dose level (P < 0.01). No significant changes in anal pressures, rectal compliance or distension‐induced motor activity occurred following drug administration. A dose‐dependent reduction in post‐prandial motility was observed following intravenous granisetron and this was highly significant at 160 mcg/kg (P= 0.005). These results suggest that the 5 hydroxytryptamine receptor antagonists may have a therapeutic role in patients with irritable bowel syndrome.
A placebo‐controlled investigation of duodenal ulcer recurrence after withdrawal of long‐term treatment with ranitidine
Authors: PENSTON J. G. , DIXON J. S. , BOYD E. J. S. , WORMSLEY K. G. 
Published: July 2010

SUMMARYNinety‐two patients with duodenal ulcer disease, who had received long‐term continuous treatment with ranitidine for an average of 7.5 years, participated in a double‐blind, placebo‐controlled study to determine whether stopping ranitidine resulted in ulcer recurrence. Patients were randomized to continue with ranitidine (n= 46) or to receive placebo (n= 46) and were followed up for six months. Treatment failure was defined as the first symptomatic recurrence of ulcer. The occurrence of epigastric pain during the follow‐up period was significantly less frequent in the ranitidine group (13%) than in the placebo group (43%) (P= 0.001). At six months, 9% of the ranitidine group had developed ulcer recurrence, compared with 48 % in the placebo group (P< 0.001, logrank test). Multivariate analysis using the Cox proportional hazards model showed that younger age (P= 0.041) and a long history of ulcer disease (P= 0.025) were risk factors for ulcer recurrence but gender, smoking and duration or dose of previous ranitidine treatment were not predictive of relapse during treatment with placebo. In conclusion, withdrawal of ranitidine after more than five years of continuous treatment results in almost half of the patients developing symptomatic ulcer recurrence within six months. Thus, long‐term continuous therapy does not alter the natural history of duodenal ulcer disease. Younger patients and those with a long history of ulcer disease appear to be at increased risk of developing ulcer recurrence if long‐term treatment is withdrawn.
Short report: high‐dose omeprazole and amoxycillin in the treatment of Helicobacter pylori‐associated duodenal ulcer
Authors: COLLINS R. , BEATTIE S. , XIA H. X. , O'MORAIN C. 
Published: July 2010

SUMMARYThirteen consecutive patients with active duodenal ulcer disease were assigned to a treatment schedule with high‐dose omeprazole and amoxycillin. Duodenal ulcer was diagnosed endoscopically in all patients, at which time antral biopsies were taken for culture and histology. All were positive for Helicobacter pylori and histological gastritis. Treatment was for 2 weeks: 80 mg omeprazole daily plus 500 mg amoxycillin syrup t.d.s. in the first week, followed by 40 mg omeprazole daily in the second week. Repeat gastroscopy was performed 4 weeks after completion of treatment in all patients. Duodenal ulcer healing occurred in 4/13 patients. H. pylori eradication was achieved in 2/4 patients with healed ulcers and in 3/9 patients with persistent ulceration. This study suggests that a short period of treatment with high‐dose omeprazole and amoxycillin achieves low rates of ulcer healing and H. pylori eradication.
Short report: octreotide in the treatment of external pancreatic fistulas
Authors: TULASSAY Z. , FLAUTNER L. , VADÁSZ A. , FEHÉRVÁRI I. 
Published: July 2010

SUMMARYThe efficacy of the long‐lasting somatostatin analogue, octreotide, in the treatment of high‐output pancreatic fistulas was investigated in this prospective, open study. Sixteen patients with post‐operative pancreatic fistulas were treated with subcutaneous injections of octreotide 0.1 mg b.d. The output of the fistulas before the somatostatin therapy ranged between 190 and 5 70 ml/day. The therapy was begun on average 17 days following the appearance of the fistula (range 4 to 35 days). The decrease in volume one day after initiation of therapy ranged from 26% to 69%. By the third day of treatment the fistula volume decreased to 0–45% of the initial output. The treatment resulted in the closure of 14 of the 16 fistulas; the time to closure ranging from 3 to 15 days. The results suggest that octreotide is a useful adjuvant agent in the treatment of an external pancreatic fistula.
Short report: Effect of two prokinetic drugs on the electrical and motor activity of the small bowel in dogs
Authors: DEFILIPPI C. , GOMEZ E. 
Published: July 2010

SUMMARYThe effects of trimebutine and domperidone, on the electrical and motor activity of the upper small bowel in dogs, were studied simultaneously by means of a suction electrode and a manometric catheter. Trimebutine, given during phases I and II of the migratory motor complex, was followed by a period of regular spike potentials and contractions; the increased motor activity was significantly greater when the drug was given during phase II. Domperidone, when injected in phase I, was followed by an irregular pattern of spike potentials and contractions of low amplitude. By contrast, activity was not augmented when the drug was given during phase II. We conclude that the effects of drugs, such as trimebutine and domperidone, on the canine small bowel are influenced by the phase of the migratory motor complex.
Short report: prednisolone withdrawal followed by lymphoblastoid interferon in the therapy of adult patients with presumed childhood‐acquired chronic hepatitis B virus infection
Authors: BROOK M. G. , MAIN J. , YAP I. , CHAN G. , KARAYIANNIS P. , CROSSEY M. , THOMAS H. C. 
Published: July 2010

SUMMARYEighteen patients with presumed childhood acquisition of chronic hepatitis B virus infection were initially entered into this randomized controlled trial. Twelve were treated with prednisolone for 4 weeks followed, after a 2‐week gap, by thrice weekly lymphoblastoid a‐interferon for 12 weeks. Two of these had previously acted as untreated controls. Three of the 12 patients (25%) [who were initially hepatitis B virus (HBV) surface antigen (HBsAg),‘e’ antigen (HBeAg) and HBV‐DNA positive] became HBeAg and HBV‐DNA negative during therapy and remained so after 12 months post‐therapy follow‐up. One of these also lost HBsAg. A further two patients lost HBeAg and HBV‐DNA during therapy but relapsed 6 and 9 months later. Two additional patients were HBV‐DNA negative but HBeAg positive at the end of follow‐up. None of the eight untreated control patients seroconverted during an identical follow‐up period. Two further patients were HBsAg and HBeAg positive but HBV‐DNA negative at the start of therapy. These were omitted from the final analysis: both subsequently lost HBeAg. The treatment response was associated with a rise in aspartate aminotransferase, peaking 2–6 weeks after prednisolone withdrawal, loss of HBV‐DNA 0–8 weeks later and subsequent normalization of liver function tests. Treatment was well tolerated.
Anti‐secretory effects and pharmacokinetics of low dose ranitidine
Authors: KOSS M. A. , HOGAN D. L. , LANE J. , STEINBACH J. H. , ISENBERG J. I. 
Published: July 2010

SUMMARYThe purpose of this study was to examine the anti‐secretory effect of low doses of orally administered ranitidine on meal‐stimulated gastric acid secretion and assess its pharmacokinetics. The effect of 20, 40, 60 and 80 mg of ranitidine p.o. and placebo were tested on 5 separate days (Latin square, double‐blind) in 15 healthy males (mean age 35 years). Gastric acid secretion was measured prior to and for 8 h following two sequential mixed liquid meals administered at 4‐h intervals. Venous blood samples were obtained at frequent intervals before and following each dose for determination of plasma ranitidine concentration by high pressure liquid chromatography. Each dose of ranitidine significantly (P < 0.01) decreased the peak and cumulative 4‐h acid secretory responses to the first meal (range 58–93 %), and the 60 and 80 mg doses significantly inhibited the response to the second meal by 31 and 43%, respectively. Total 8‐h meal‐stimulated acid outputs were decreased significantly in a dose‐related manner (range 38–73%). Peak plasma ranitidine occurred approximately 1 h after dosing. Ranitidine tmax, t½ and clearances were independent of dose; however, AUC and C. were dose‐related. Inhibition of acid secretion was related to plasma ranitidine concentration; the mean IC50 was 27 (± 6.4) ng/ml. We conclude that modest doses (equivalent to 7–27% of the daily therapeutic dose) of ranitidine effectively suppress meal‐stimulated gastric acid secretion in a dose‐related manner. If these doses are of clinical efficacy, it may be possible for substantial cost savings to occur.
The management of constipation in adults
Authors: GATTUSO J. M. , KAMM M. A. 
Published: July 2010

SUMMARYThe successful management of constipation depends on defining the patient's symptoms, excluding secondary causes, and characterizing the abnormality of defecation. Constipation without gut dilatation is found commonly in pregnancy, the elderly, and those with the irritable bowel syndrome. In addition, there is a group of patients that has intractable, severe idiopathic constipation. Some have ‘slow transit’ and open their bowels every 1–4 weeks. Others have a defecatory disorder with normal colonic transit. Constipation with gut dilatation is seen in Hirschsprung's disease, idiopathic megarectum and megacolon, chronic intestinal pseudo‐obstruction and Chagas' disease. Constipation can also result from disturbance to the autonomic outflow of the gastrointestinal tract, and colonic function may be also affected by psychological factors. This review article discusses the presentation, investigation and management of patients with constipation.
A prospective randomized study with mineral oil and oral lavage solution for treatment of faecal impaction in children
Authors: TOLIA V. , LIN C.‐H. , SUR Y. FLIT 
Published: July 2010

SUMMARYFaecal impaction with or without encopresis is a very common problem. We performed a randomized, open‐label, prospective study to compare the efficacy and acceptability of the treatment of faecal impaction using either mineral oil or pineapple‐flavoured isotonic intestinal lavage solution containing polyethylene glycol‐3350 (Colyte). Thirty‐six patients over 2 years of age were randomized to receive either mineral oil or flavoured lavage solution. The dose of mineral oil was 2 to 8 tablespoons twice a day for two days (17 patients—Group I) and of lavage solution was 20 ml/kg/h for 4 hours on two consecutive days (19 patients—Group II). The patients were assessed for the presence of abdominal faecal masses, presence and consistency of rectal mass, perineal soiling before and two days after either of the randomly assigned treatment. The patients and parents were asked regarding the compliance with treatment, side‐effects, number of bowel movements after treatment and willingness to try similar treatment if faecal impaction recurred. Patients in the lavage group had more frequent bowel movements, and showed more effective clearance of abdominal and rectal lumps (P < 0.01) at the time of repeat examination at two days. However, they had some vomiting and were less compliant (P < 0.01) when compared to mineral oil patients. We conclude that balanced lavage solution effectively relieves faecal impaction, however, compliance with its use is poorer than that with mineral oil.
Gastric acid suppression is greater during intravenous ranitidine infusion versus bolus injections of famotidine
Authors: HOGAN D. L. , MCQUAID K. R. , KOSS M. A. , CROMBIE D. L. , HUNTER S. , METZ C. , EULER A. R. , ISENBERG J. I. 
Published: July 2010

SUMMARYIt has been proposed that famotidine may be effective in maintaining intragastric pH ≥ 4 for up to 12 h with a single i.v. 20 mg bolus injection and thereby prevent acute stress‐related mucosal haemorrhage, The present study was designed to compare a ranitidine continuous i.v. infusion (6.25 mg/h) vs. famotidine bolus injection (20 mg every 12 h) on 24‐h intragastric pH and gastric acid secretion. Twenty‐eight healthy volunteers (15 males, 13 females; 20–56 years) participated in two 24‐h treatment periods; each test was in random order separated by 7–10 days. After an overnight fast, subjects were intubated and gastric pH and acid secretion measured hourly. Whereas ranitidine maintained gastric pH above 4 for the entire 24‐h period, mean pH steadily decreased to a nadir of 2.9 and 3.7, respectively, 12 h after each famotidine injection (P < 0.01 vs. ranitidine). Furthermore, gastric acid secretion increased to 4.4 ± 1.2 mmol/h 12 h after famotidine injection compared to 1.1±0.3 mmol/h with ranitidine (P < 0.01). We conclude that ranitidine delivered as a continuous i.v. infusion (6.25 mg/h) is superior to bolus famotidine injections (20 mg) at 12‐h intervals in suppressing gastric acid secretion and maintaining an intragastric pH ≥. 4. More frequent famotidine dosing, or delivery by continuous i.v. infusion, may be required to provide prolonged acid suppression.