bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review article: lactose intolerance in clinical practice – myths and realities
Authors: LOMER M. C. E. , PARKES G. C. , SANDERSON J. D. 
Published: July 2010

SummaryBackground  Approximately 70% of the world population has hypolactasia, which often remains undiagnosed and has the potential to cause some morbidity. However, not everyone has lactose intolerance, as several nutritional and genetic factors influence tolerance.Aims  To review current clinical practice and identify published literature on the management of lactose intolerance.Methods  PubMed was searched using the terms lactose, lactase and diet to find original research and reviews. Relevant articles and clinical experience provided the basis for this review.Results  Lactose is found only in mammalian milk and is hydrolysed by lactase in the small intestine. The lactase gene has recently been identified. ‘Wild‐type’ is characterized by lactase nonpersistence, often leading to lactose intolerance. Two genetic polymorphisms responsible for persistence have been identified, with their distribution concentrated in north Europeans. Symptoms of lactose intolerance include abdominal pain, bloating, flatulence and diarrhoea. Diagnosis is most commonly by the lactose hydrogen breath test. However, most people with hypolactasia, if given appropriate advice, can tolerate some lactose‐containing foods without symptoms.Conclusion  In clinical practice, some people with lactose intolerance can consume milk and dairy foods without developing symptoms, whereas others will need lactose restriction.
Mutations in the interferon sensitivity‐determining region (nonstructural 5A amino acid 2209–2248) in patients with hepatitis C‐1b infection and correlating response to combined therapy of pegylated interferon and ribavirin
Authors: YEN Y.‐H. , HUNG C.‐H. , HU T.‐H. , CHEN C.‐H. , WU C.‐M. , WANG J.‐H. , LU S.‐N. , LEE C.‐M. 
Published: July 2010

SummaryBackground  Most reports suggest that mutations in the interferon sensitivity‐determining region (ISDR) correlate with response to conventional interferon‐based therapies in hepatitis C virus‐1b (HCV‐1b) patients. However, the correlation between ISDR region mutations and response to pegylated interferon plus ribavirin therapy in HCV‐1b patients remains unclear.Aim  To assess whether ISDR mutations correlate with response to Peg interferon plus ribavirin therapy in HCV‐1b patients.Patients and methods  Sixty HCV‐1b naive patients who had undergone 6 months of Peg interferon α‐2b plus ribavirin and a 6‐month follow‐up were enrolled. The amino acid sequences of the nonstructural 5A‐interferon‐induced RNA‐dependent protein kinase (NS5A–PKR)‐binding domain were determined by polymerase chain reaction and sequencing.Results  Thirty (50%) patients achieved sustained virological response (SVR). Univariate analysis showed that the proportion of patients with ISDR mutations ≥4 and rapid virological response rate was higher in the sustained virological response group than in the non‐SVR group. Viral load was lower in the SVR group than in the non‐SVR group. Multivariate analysis revealed that ISDR mutations ≥4 and ribavirin ≥14 mg/kg/day were independent predictors of SVR.Conclusion  Mutations of the ISDR correlate with SVR to Peg interferon α‐2b plus ribavirin therapy in HCV‐1b patients.
In vitro comparative study of three pancreatic enzyme preparations: dissolution profiles, active enzyme release and acid stability
Authors: ALOULOU A. , PUCCINELLI D. , SARLES J. , LAUGIER R. , LEBLOND Y. , CARRIÈRE F. 
Published: July 2010

SummaryBackground  Various pancreatic enzyme preparations are used for the treatment of pancreatic insufficiency but their bioequivalence is often unknown.Aim  To determine in vitro the pH‐dependent release and acid resistance of enzymes from three commercially available pancreatin capsules, two containing enteric‐coated (Creon 25000; Eurobiol 25000) and one uncoated (Eurobiol 12500) microspheres.Methods  Dissolution experiments were performed at pH values ranging from 4.0 to 5.8. Lipase, chymotrypsin and amylase activities were measured in the solution as a function of time.Results  Eurobiol 25000 started to release its enzymes significantly at pH 5.0 (t1/2 = 71 min), whereas the enzymes from Creon 25000 were only released at higher pH value (5.4; t1/2 = 49.2 min). Unlike chymotrypsin, lipase and amylase were highly sensitive to acidic conditions at the lowest pH values tested. Both enzymes were also found to be sensitive to proteolytic inactivation at the highest pH values tested. Overall, Eurobiol 25000 released higher amounts of active amylase and lipase than Creon 25000 at the pH values usually found in duodenal contents. The uncoated Eurobiol 12500 preparation was, however, the only one that could immediately release rather high levels of active chymotrypsin and lipase at low pH (4.5).Conclusion  These findings suggest that pH‐sensitive enteric‐coated pancreatin products containing similar amounts of enzymes might not be bioequivalent depending on the pH of duodenal contents.
Empirical rescue therapy after Helicobacter pylori treatment failure: a 10‐year single‐centre study of 500 patients
Authors: GISBERT J. P. , GISBERT J.‐L. , MARCOS S. , JIMENEZ‐ALONSO I. , MORENO‐OTERO R. , PAJARES J. M. 
Published: July 2010

SummaryBackground  Several ‘rescue’ therapies have been recommended to eradicate Helicobacter pylori, but they still fail in >20% of the cases, and these patients constitute a therapeutic dilemma.Aim  To evaluate the efficacy of different ‘rescue’ therapies empirically prescribed during 10 years to 500 patients in whom at least one eradication regimen had failed to cure H. pylori infection.Methods
Design
: Prospective single‐centre study. Patients: Consecutive patients in whom at least one eradication regimen had failed. Intervention: Rescue regimens included: (i) quadruple therapy with omeprazole–bismuth–tetracycline–metronidazole; (ii) ranitidine bismuth citrate–tetracycline–metronidazole; (iii) omeprazole–amoxicillin–levofloxacin; and (iv) omeprazole–amoxicillin‐rifabutin. Antibiotic susceptibility was unknown (rescue regimens were chosen empirically). Outcome: Eradication was defined as a negative 13C‐urea breath test 4–8 weeks after completing therapy.Results  Five hundred patients were included (76% functional dyspepsia, 24% peptic ulcer). Compliance rates with first‐, second‐ and third‐line regimens were 92%, 92%, and 95%, respectively. Adverse effects were reported by 30%, 37%, and 55% of the patients receiving second‐, third‐, and fourth‐line regimens. Overall, H. pylori cure rates with the second‐, third‐, and fourth‐line rescue regimens were 70%, 74%, and 76%, respectively. Cumulative H. pylori eradication rate with four successive treatments was 99.5%.Conclusion  It is possible to construct an overall treatment strategy to maximize H. pylori eradication, on the basis of administration of four consecutive empirical regimens; thus, performing bacterial culture even after a second or third eradication failure may not be necessary.
Systematic review: nutritional therapy in paediatric Crohn’s disease
Authors: DAY A. S. , WHITTEN K. E. , SIDLER M. , LEMBERG D. A. 
Published: July 2010

SummaryBackground At least 25% of individuals diagnosed with Crohn’s disease (CD) have onset of disease in childhood. Almost all children with CD have nutritional impairments, such as weight loss or stunting, at diagnosis or subsequently. Nutritional therapy (exclusive enteral nutrition) is established as a valid and effective treatment in paediatric CD. The advantages of this approach are induction of remission and control of inflammatory changes, mucosal healing, positive benefits to growth and overall nutritional status, and avoidance of other medical therapies.Aim To provide a comprehensive up‐to‐date review of the roles of nutritional therapy in CD and of the data supporting this therapy.Methods A search of PubMed was performed with search terms ‘enteral nutrition’, ‘nutritional therapy’, ‘Crohn disease’ and ‘children’. Relevant articles were selected from this search. In addition, the reference lists of available articles were reviewed for further relevant articles.Results Nutritional therapy offers numerous benefits in the management of CD. Recent work has begun to elucidate the likely mechanisms of this therapy. These include direct mucosal anti‐inflammatory effects and alteration of intestinal microflora.Conclusion Further studies are required to define longer‐term effects of nutritional therapy in patients with CD.
Effect of proton pump inhibitors on markers of risk for high‐grade dysplasia and oesophageal cancer in Barrett’s oesophagus
Authors: HILLMAN L. C. , CHIRAGAKIS L. , SHADBOLT B. , KAYE G. L. , CLARKE A. C. 
Published: July 2010

SummaryBackground It has been shown that the presence on diagnosis of endoscopic macroscopic markers indicates a high‐risk group for Barrett’s oesophagus.Aim To determine whether proton pump inhibitor therapy prior to diagnosis of Barrett’s oesophagus influences markers for risk development of subsequent high‐grade dysplasia/adenocarcinoma.Methods A review of all patients with Barrett’s oesophagus entering a surveillance programme was undertaken. Five hundred and two patients diagnosed with Barrett’s oesophagus were assessed on diagnosis for endoscopic macroscopic markers or low‐grade dysplasia. Subsequent development of high‐grade dysplasia/adenocarcinoma was documented. The relationship between the initiation of proton pump inhibitor therapy prior to the diagnosis of BE and the presence of macroscopic markers or low‐grade dysplasia at entry was determined.Results Fourteen patients developed high‐grade dysplasia/adenocarcinoma during surveillance. Patients who entered without prior proton pump inhibitor therapy were 3.4 times (95% CI: 1.98–5.85) more likely to have a macroscopic marker or low‐grade dysplasia than those patients already on a proton pump inhibitor.Conclusions Use of proton pump inhibitor therapy prior to diagnosis of Barrett’s oesophagus significantly reduced the presence of markers used to stratify patient risk. Widespread use of proton pump inhibitors will confound surveillance strategies for patients with Barrett’s oesophagus based on entry characteristics but is justified because of the lower risk of neoplastic progression.
Mortality rates in patients with Barrett’s oesophagus
Authors: MOAYYEDI P. , BURCH N. , AKHTAR‐DANESH N. , ENAGANTI S. K. , HARRISON R. , TALLEY N. J. , JANKOWSKI J. 
Published: July 2010

SummaryBackground Patients with Barrett’s oesophagus are at increased risk of oesophageal adenocarcinoma. Observational studies have suggested increase in overall mortality also but data are conflicting.Aim To assess the cause of death in patients with Barrett’s oesophagus compared with the general population.Methods Patients with Barrett’s oesophagus were identified retrospectively in four hospitals in Leicestershire, UK using electronic endoscopy and histopathology records from 1997 to 2003. Data on deaths from this cohort of patients were identified through the Office of National Statistics and compared with age– and gender‐adjusted mortality in the Leicestershire region.Results In all, 1272 Barrett’s patients were identified with 245 deaths in this cohort. Overall mortality was found to be increased [male standardized mortality ratio (SMR) = 552, 95% CI = 466–638; female SMR 455, 95% CI = 357–552]. The main disease areas that were responsible for this increase were oesophageal adenocarcinoma (n = 25, male SMR = 2171, 95% CI = 991–3351; female SMR = 1300, 95% CI = 26–2574), bronchopneumonia (n = 70, male SMR = 146, 95% CI = 55–236; female SMR = 436, 95% CI = 272–601) and ischaemic heart disease (n = 51, male SMR = 186, 95% CI = 97–2748; female SMR = 205, 95% CI = 105–306).Conclusions Patients with Barrett’s oesophagus die more commonly of bronchopneumonia and ischaemic heart disease compared with oesophageal adenocarcinoma, and overall mortality in this group may be increased.
Transient elastography to assess hepatic fibrosis in primary biliary cirrhosis
Authors: GÓMEZ‐DOMINGUEZ E. , MENDOZA J. , GARCÍA‐BUEY L. , TRAPERO M. , GISBERT J. P. , JONES E. A. , MORENO‐OTERO R. 
Published: July 2010

SummaryBackground  Liver stiffness measurements may have potential for detecting and monitoring hepatic fibrosis in chronic liver disease.Aim  To study the detection, quantification and progression of hepatic fibrosis in primary biliary cirrhosis by liver stiffness measurements.Methods  Liver stiffness measurements were generated in 80 patients with primary biliary cirrhosis by applying transient elastography; however, as there were 55 with liver biopsy, histological stage (METAVIR) and liver stiffness measurements were compared only in these 55 patients. The efficiency of liver stiffness measurements in predicting stage of fibrosis was determined from the area under receiver operating characteristics curve analysis.Results  Of the 80 patients included, 91, 4% were women and their mean age was 56 ± 12 (s.d.) years. A significant correlation was found (P < 0.05) between histological fibrosis stage (METAVIR) and liver stiffness measurements. The values obtained from area under receiver operating characteristic curve analysis of liver stiffness measurement data were 0.89 for F > 2 and 0.96 for F = 4. Liver stiffness measurements were 9.0 ± 5.3 and 7.9 ± 6.0 kPa for patients followed up more than 5 years and less than 5 years, respectively (P > 0.05).Conclusions  In patients with primary biliary cirrhosis, median values of liver stiffness measurements correlated with histological severity of hepatic fibrosis. Liver stiffness measurements appear to be promising for liver fibrosis detection and quantification, as well as monitoring its progression, in patients with primary biliary cirrhosis. The progression rate of hepatic fibrosis in our primary biliary cirrhosis patients appears to be slow.
Peginterferon alfa‐2a/ribavirin in hepatitis C virus patients nontolerant or nonresponsive to peginterferon alfa‐2b/ribavirin
Authors: RUSTGI V. K. , ESPOSITO S. , HAMZEH F. M. , SHIFFMAN M. L. 
Published: July 2010

SummaryBackground  Peginterferon alfa‐2a/ribavirin treatment resulted in fewer incidences of depression and flu‐like symptoms than that of standard interferon/ribavirin, whereas peginterferon alfa‐2b/ribavirin and standard interferon/ribavirin treatment resulted in similar incidences of these adverse events (AEs).Aim  To assess the efficacy and safety of peginterferon alfa‐2a/ribavirin in genotype 1‐infected patients treated for up to 12 weeks with peginterferon alfa‐2b/ribavirin but not achieving early virologic response (EVR) (non‐EVR) or nontolerant (NT) because of depression, fatigue, flu‐like symptoms, or injection‐site reactions.Methods  Nontolerants were treated for an additional 36 weeks and non‐EVRs for an additional 60 weeks with peginterferon alfa‐2a (180 μg/week)/ribavirin (1000/1200 mg/day). Patients with detectable HCV RNA after 12 weeks were discontinued.Results  Of 25 NTs, 23 (92%) were HCV‐RNA negative after 12 weeks on peginterferon alfa‐2a/ribavirin and 14 (56%) achieved sustained virologic response. Of 32 non‐EVRs to peginterferon alfa‐2b/ribavirin, four (13%) achieved EVR with peginterferon alfa‐2a/ribavirin and one (3%) achieved sustained virologic response. Four non‐EVRs and 0 NTs were withdrawn for AEs; 26 (81%) and 24 (96%), respectively, completed peginterferon alfa‐2a/ribavirin treatment or were withdrawn for insufficient response at week 12. In NTs, depression, fatigue, flu‐like symptoms, and injection‐site reactions declined during treatment.Conclusion  Most patients who did not tolerate peginterferon alfa‐2b/ribavirin because of AEs, and who completed the full 36‐week course of peginterferon alfa‐2a/ribavirin treatment, achieved sustained virologic response.
Clinical trial: interferon alpha‐2b continuous long‐term therapy vs. repeated 24‐week cycles for re‐treating chronic hepatitis C
Authors: MCHUTCHISON J. G. , PATEL K. , SCHIFF E. R. , GITLIN N. , MUR R. E. , EVERSON G. T. , CARITHERS R. L. , DAVIS G. L. , MARCELLIN P. , SHIFFMAN M. L. , HARVEY J. , ALBRECHT J. K. ,   FOR THE INTERNATIONAL HEPATITIS INTERVENTIONAL THERAPY GROUP
Published: July 2010

SummaryBackground  Treatment options are limited for patients with hepatitis C virus who do not experience sustained viral eradication with pegylated interferon and ribavirin therapy.Aim  To compare, in an open‐label, randomized study, long‐term continuous interferon alpha‐2b treatment with repeated 24‐week courses in patients with chronic hepatitis C virus that relapsed after prior interferon monotherapy.Methods  A total of 499 patients received 24 weeks of interferon alpha‐2b, 3 MIU administered 3 TIW. Responders (normal alanine aminotransferase and negative hepatitis C virus ‐RNA, n = 244) were then randomized to continuous interferon therapy (1, 2 or 3 MIU TIW depending on response) or cyclical therapy (3 MIU TIW for 24 weeks per relapse). Mean Knodell inflammation (I + II + III) and necrosis (IV) scores at baseline vs. year 2 were compared.Results  Patients receiving continuous low‐dose therapy vs. cycled therapy had larger reductions in inflammation (−3.9 vs. −3.1) and fibrosis (−0.49 vs. −0.24). Among both groups, the mean change was −3.4 for inflammation and −0.36 for fibrosis. Overall, 73% (95% CI: 67–79) of patients experienced reduced inflammation and 28% (95% CI: 22–34) had reduced fibrosis.Conclusions  Our results suggest hepatitis C virus patients experiencing viral suppression during long‐term maintenance therapy with interferon demonstrate histological improvement. Further prospective trials testing this hypothesis are in progress.
Review article: what do patients with inflammatory bowel disease want for their clinical management?
Authors: WESTWOOD N. , TRAVIS S. P. L. 
Published: July 2010

SummaryBackground  The patient’s perceptions of benefits and risks of treatment differ from those of physicians, yet this topic is rarely explored in ulcerative colitis or Crohn’s disease.Aim  To present a patient’s perspective on care for their colitis, to consider how patients’ views will influence preliminary proposals for standards of care, and to discuss the different priorities of patients and physicians.Methods  Description of an individual patient’s journey from diagnosis of ulcerative colitis to colectomy, compared with priorities proposed by a patient‐based organization (National Association of Colitis and Crohn’s disease).Results  Awareness of colitis in primary care, prompt referral, timely investigation and specialist care if admitted to hospital are shared goals of patients and physicians. Patients are generally prepared to accept higher risks from medical treatment to avoid their undesirable outcomes (especially colectomy) than physicians will on their behalf. There has been little systematic study of this disparity in ulcerative colitis. Under‐reporting the symptom burden, tolerance of treatment side effects, substantial lifestyle changes and willingness to explore any treatment options are characteristic coping strategies. Physicians should be alert to coping strategies, with a willingness to seek second opinions.Conclusion  Perceptions of risk and benefit differ between patients and physicians, and recognition of this difference is a starting point for difficult clinical decision‐making.
Endoscopic feeding tube placement in patients with cancer: a prospective clinical audit of 2055 procedures in 1866 patients
Authors: SHASTRI Y. M. , SHIRODKAR M. , MALLATH M. K. 
Published: July 2010

SummaryBackground  Feeding tube placement in patients with aero‐digestive cancer is challenging because of the distortion and/or obstruction of the upper digestive passage. As a result, many patients may receive intravenous fluids and parenteral nutrition instead of enteral feeds.Aim  To audit all the endoscopic feeding tube placements in large sample of patients to determine difficulties, success, reasons for failures and procedure‐related complications.Methods  Audit of all consecutive feeding tube placements from January 1996 to December 2003 was conducted. Tubes were placed depending on the site of cancer and anticipated duration of feeding: naso‐gastric tubes, naso‐enteral tubes and percutaneous endoscopic gastrostomy. Nutrition support team evaluated these patients. Technical modifications, difficulties, success and complications encountered during the procedure were recorded.Results  Two thousand and fifty‐five attempts were made for feeding tube placements (naso‐gastric tube – 1637, naso‐enteral tube – 177 and percutaneous endoscopic gastrostomy – 241) in 1866 patients. Technical success was achieved in 1969 (96%, 95% CI: 95–97%). Immediate complications occurred in 62 (3%, 95% CI: 2–4%), seven needed hospitalization and one patient died of tumour perforation caused by naso‐gastric tube placement. The technical success and complications rates of the procedures performed by fellows in training were comparable to those performed by attending consultants.Conclusions  Enteral feeding tubes can be placed in almost all patients with cancer using endoscopic techniques. Adequate training of the endoscopy fellows and sufficient care by nutrition support team help achieve high success with few complications.
Correlation between symptoms developed after the oral ingestion of 50 g lactose and results of hydrogen breath testing for lactose intolerance
Authors: BEYERLEIN L. , POHL D. , DELCO F. , STUTZ B. , FRIED M. , TUTUIAN R. 
Published: July 2010

SummaryBackground  Lactase deficiency is a common condition responsible for various abdominal symptoms. Lactose hydrogen breath test is currently the gold standard in diagnosing lactose intolerance.Aim  To assess sensitivity and specificity of symptoms developed after oral lactose challenge.Methods  Intensity of nausea, abdominal pain, borborygmi, bloating and diarrhoea was recorded every 15 min up to 3 h after ingestion of 50 g lactose in patients with positive (i.e. breath H2‐concentration ≥20 p.p.m. above baseline) and negative lactose hydrogen breath test.Results  Between July 1999 and December 2005, 1127 patients (72% females) underwent lactose hydrogen breath test. A positive result was found in 376 (33%). Sensitivity of individual symptoms ranged from 39% (diarrhoea) to 70% (bloating) while specificity ranged from 69% (bloating) to 90% (diarrhoea). A positive lactose hydrogen breath test was found in 21% of patients with one symptom, 40% of patients with two symptoms, 44% of patients with three symptoms, 67% of patients with four symptoms and 82% of patients with five symptoms.Symptom intensity was significantly higher for each symptom in the positive group.Conclusion  Evaluating symptoms developed after ingestion of 50 g lactose can be used as a simple screening test to select patients who need to be referred for lactose intolerance testing.