bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relative effectiveness of somatostatin and octreotide therapy in pancreatic disease
Authors: JENKINS S. A. , BEREIN A. 
Published: July 2010

SUMMARYSomatostatin and octreotide inhibit basal and stimulated pancreatic secretion, stimulate reticuloendothelial system activity, modulate the cytokine cascade and are cytoprotective with respect to the pancreas. These effects of somatostatin and octreotide suggest that both drugs may be useful either in the treatment of pancreatic disorders, or in preventing acute pancreatitis following procedures on the pancreas.In recent years it has become clear that somatostatin is a useful and effective therapy for severe acute pancreatitis and in preventing complications following endoscopic retrograde cholangiopancreatography (ERCP), whereas octreotide has no beneficial effect and may be deleterious in both these indications. The differences in the therapeutic efficacy of somatostatin and octreotide in acute pancreatitis and ERCP appears to be related to their differential effects on sphincter of Oddi motility—the native hormone relaxing, and the analogue increasing, its contractility. Consequently, any beneficial effects of octreotide in both acute pancreatitis and ERCP are offset by the increased contractility of the sphincter of Oddi, which results in retention of activated enzymes within the pancreas and further autodigestion of the gland.Somatostatin and octreotide are equally effective in promoting the closure of pancreatic fistulae. However, the time to closure after commencement of therapy is much more variable and longer in patients treated with subcutaneous octreotide than those receiving intravenous somatostatin, possibly as a result of fluctuations in pancreatic enzyme secretion between consecutive administrations of the hormone.Furthermore, the initial potent inhibitory effect of octreotide on pancreatic secretion is lost after 7 days of continuous subcutaneous administration. Therefore, in terms of cost‐effectiveness, somatostatin would appear to be the treatment of choice for pancreatic fistulae.Octreotide markedly reduces the complication rates after elective pancreatic surgery. It remains to be established whether somatostatin is as effective as octreotide in this indication.
Helicobacter pylorieradication in a clinical setting: success rates and the effect on the quality of life in peptic ulcer
Authors: REILLY T. G. , AYRES R. C. S. , POXON V. , WALT R. P. 
Published: July 2010

SUMMARYBackground: Helicobacter pylorieradication for peptic ulcer has been widely taken up. Evidence for the efficacy of different regimens is often derived from small series in clinical trials but there is little reporting of everyday practice with unselected patients. Freedom from ulcer relapse has been demonstrated, but not whether this equates with clinical success.Methods: We report on a series of 706 patients withH. pyloriinfection who, between January 1991 and April 1995, received eradication therapy followed by assessment of H. pylori status. Two‐hundred and seven of these patients were followed‐up by postal questionnaire, validated by parallel questionnaires to their general practitioners, covering clinical outcome measures.Results: The overall eradication rate was 81.7%, and a 1‐week course of omeprazole plus two antibiotics was significantly better than a 2‐week course of standard triple therapy (85.0% vs. 78.0%,P< 0.05). Amongst 21 first‐time failures, a 7‐day course of a clarithromycin‐containing triple therapy succeeded in 18. The questionnaire replies indicate that, following successfulH. pylorieradication, ulcer patients are less likely to consult with ulcer symptoms (P< 0.0005), take medication (P< 0.0005), require further prescription (P< 0.0005), or lose work‐time because of their ulcer (P< 0.005). They are more likely to have a subjective sense of ulcer cure (P< 0.0005).Conclusions: In addition to clear cost savings, social benefits are now demonstrated whenH. pyloriis eradicated. A well‐tolerated 1 week regimen is genuinely effective in everyday practice.
Addition of metronidazole to omeprazole/amoxycillin dual therapy increases the rate of Helicobacter pylori eradication: a double‐blind, randomized trial
Authors: BELL G. D. , BATE C. M. , AXON A. T. R. , TILDESLEY G. , KERR G. D. , GREEN J. R. B. , EMMAS C. E. , TAYLOR M. D. 
Published: July 2010

SUMMARY Aims: To compare the efficacy, safety and tolerability of an omeprazole/amoxycillin (OA) dual therapy Helicobacter pylori eradication regimen with an omeprazole/amoxycillin/metronidazole (OAM) triple therapy regimen. Methods: In this double‐blind trial, conducted in 19 hospitals, 119 patients with symptomatic duodenal ulcer disease were randomized to receive either 14 days treatment with omeprazole 40 mg daily, amoxycillin 500 mg t.d.s. and placebo followed by a further 14 days’treatment with omeprazole 20 mg daily (n= 59) or 14 days treatment with omeprazole 40 mg daily, amoxycillin 500 mg t.d.s., and metronidazole 400 mg t.d.s., followed by a further 14 days’treatment with omeprazole 20 mg daily (n= 60). H. pylori status was assessed by 13C‐urea breath test at entry and at 4 weeks post‐treatment. Results: H. pylori infection was eradicated in 46% of the OA treated patients and in 92% of the OAM treated patients, a mean difference of 46% (P < 0.0001, 95% CI for the difference: + 30 to + 62). In only one patient was the duodenal ulcer not endoscopically healed after 4 weeks of treatment (OA 100%; OAM 98% healed). There were no significant differences in speed of symptom relief or improvement in symptoms between the two groups. Both regimens were well tolerated, with 96% of patients completing the course, and only one patient withdrawing due to an adverse event. The only side‐effect with a significantly higher incidence in the OAM group was diarrhoea, which occurred in 36% of patients compared to 16% of patients in the OA group (P < 0.05). Conclusions: A regimen consisting of omeprazole 40 mg daily, amoxycillin 500 mg t.d.s. and metronidazole 400 mg t.d.s. for 14 days gives an appreciably higher H. pylori eradication rate than omeprazole and amoxycillin alone, with acceptable tolerability.
Prospective study of fluconazole suspension for the treatment of oesophageal candidiasis in patients with AIDS
Authors: LAINE L. , RABENECK L. 
Published: July 2010

SUMMARY Background: Oesophageal candidiasis is the most common cause of oesophageal symptoms in patients with AIDS. Antifungal therapy, given as a suspension, may be better tolerated than capsules or tablets in children or patients with oesophageal symptoms. We performed a prospective study of the safety and efficacy of fluconazole suspension. Methods: Patients with HIV infection; odynophagia, dysphagia, or retrosternal pain; endoscopic evidence of white plaques or exudate in the oesophagus; and microscopic confirmation of fungal infection on biopsy or brushing specimens were eligible. Patients received fluconazole oral suspension (200 mg loading dose followed by 100 mg q.d.s.). Therapy was continued for 2 weeks after symptom resolution. Repeat endoscopy was performed after completion of therapy. Results: Forty‐two patients enrolled in the study: 40 were male, mean (± s.e.) age was 37 ± 2 years and mean CD4 cell count was 67 ± 14/mm3. One patient was not evaluable because he received amphotericin during the first week of therapy. Symptoms resolved in all 41 evaluable patients; 17 (41%) had resolution by 1 week, 37 (90%) by 2 weeks, and 40 (98%) by 3 weeks. Endoscopic resolution occurred in 35 (95%) of 37 patients who underwent repeat endoscopy. Adverse events (skin rash in 1, nausea/vomiting in 2, elevated liver tests in 2) Ied to early termination of therapy in 5 patients, all of whom had clinical and endoscopic cure. Conclusions: Symptoms resolved in 100% of patients with AIDS and oesophageal candidiasis receiving an oral suspension of fluconazole, and 90% of patients had symptom resolution within 2 weeks. Determining whether the more rapid clinical cure in this study, compared with a previous trial which employed capsules, is related to an additional topical antifungal effect of the suspension, will require further study.
The effects of lintopride, a 5HT‐4 antagonist, on oesophageal motility
Authors: DELVAUX M. , MAISIN J.‐M. , ARANY Y. , ATLAN P. , PRIETO‐CABANIS M.‐J. , CANAL M. , FREXINOS J. 
Published: July 2010

SUMMARYAim: To evaluate the effects of various doses of lintopride, a new 5HT‐4 antagonist with moderate 5HT‐3 antagonist properties, on oesophageal body and lower oesophageal sphincter (LOS) motility in humans.Methods: Eight healthy male volunteers, mean age 22 (19–28) years, without any history of digestive disease or chest pain, were randomized to three doses of lintopride (0.1, 0.3 and 0.5 mg/kg i.v.) and a placebo at 1‐week intervals in a double‐blind, crossover study. Oesophageal motility was recorded continuously for 4 h after each dose, using perfused catheters inserted at the level of the LOS and in the body of the oesophagus, at 5, 10 and 15 cm from the LOS. Peristalsis was studied during 10 wet swallows, at 30‐min intervals (T0–T240min).Results: The LOS basal pressure (23.3 ± 2.0 cmH2O; mean ± s.d.) remained stable after dosing with placebo toT240After lintopride, LOS basal pressure increased significantly vs. placebo (AUCcomparison: 0.1 mg/kg,P= 0.036; 0.3 mg/kg,P= 0.027; 0.5 mg/kg,P= 0.052). In contrast, the duration and extent of LOS relaxation after swallowing was not affected by any of the three doses of lintopride. The amplitude of peristaltic waves in the oesophagus increased significantly atT30after lintopride 0.3 mg/kg (34.5 cmH2O,P= 0.020) and 0.5 mg/kg (32.5 cmH2O,P=‐0.027), atT60after 0.3 mg/kg (48.8 cmH2O,P= 0.0009) and 0.5 mg kg (29.1 cmH2O,P= 0.029) and atT60after 0.3 mg/kg (34.5 cmH2O,P= 0.0018).Conclusions: Lintopride significantly increased the LOS basal tone without affecting LOS physiological relaxation after swallowing. Peristaltic waves were also enhanced by lintopride.
Review article The treatment of lactose intolerance
Authors: SUAREZ F. L. , SAVAIANO D. A. , LEVITT M. D. 
Published: July 2010

SUMMARYWhile about 50 million Americans malabsorb lactose, the colonic metabolism of this disaccharide may prevent the symptomatic state known as lactose intolerance. Elucidation of the clinical importance of lactose malabsorption requires comparison of symptoms after ingestion of lactose with those following an identical appearing lactose‐free control. This paper reviews the extensive literature concerning lactose‐induced symptoms and the value of lactose digestive aids. Poorly controlled studies have suggested that a cup of milk results in appreciable symptoms in the majority of lactase‐deficient subjects. In contrast, controlled trials in unselected lactose malabsorbers of subjects claiming severe lactose intolerance indicate that symptoms from a cup of milk are no greater than that with a lactose‐hydrolyzed control. An increasing fraction of subjects experience symptoms as the lactose load is increased, with the majority having symptoms when the equivalent of 1 L of milk is ingested as a single dose. Further studies are required to determine the tolerance to several cups of milk taken throughout the day. Available digestive aids include pre‐hydrolyzed milk and lactase preparations that can be added to milk (which is then incubated) or ingested with milk. While these products are effective in reducing symptoms, it should be emphasized that there appears to be no need for these preparations when the dosage of milk is limited to one cup per day.
Review article The use of botulinum toxin in the alimentary tract
Authors: ALBANESE A. , BENTIVOGLIO A. R. , CASSETTA E. , VIGGIANO A. , MARIA G. , GUI D. 
Published: July 2010

SUMMARYNew and future indications for the treatment of disorders of the alimentary tract using local injections of botulinum toxin are reviewed. Clinical experience shows that overactive smooth muscle sphincters may be weakened to treat disorders such as achalasia or chronic anal fissure. By contrast, injections placed into the sphincter of Oddi have proven less effective for post‐cholecystectomy pain syndrome. Experimental evidence suggests that food intake may be reduced by weakening the distal stomach with botulinum toxin. This approach may possibly lead to the treatment of obesity. There are some new possible indications for the use of botulinum toxin on the alimentary tract, and infantile hypertrophic pyloric stenosis seems to be the most promising new development.
The efect of indornethacin‐induced gastric rnucosal injury on 24‐h intragastric acidity and plasma gastrin concentration in healthy volunteers
Authors: RADEMAKER J. W. , RAINSFORD K. D. , STETSKO P. I. , JOHNSON D. M. , CHIBA N. , MCDONALD T. M. , HUNT R. H. 
Published: July 2010

SUMMARYAims: To determine the influences of prostaglandin inhibition by indomethacin on 24‐h intragastric acidity and plasma gastrin concentration, related to gastric mucosal injury.Methods:A pre‐ and post‐treatment study design was employed in 10Helicobacter pylorinegative healthy male subjects. All subjects underwent upper gastrointestinal endoscopy at least 3 days before and after 7 days dosing with indomethacin 50 mg t.d.s. Mucosal damage was scored according to the Lanza method, and biopsies were taken forH. pyloristatus and assay of mucosal concentrations of prostaglandin (PG)E2and leukotriene (LT)B4. Before and on the last day of dosing, intragastric acidity was measured by continuous 24‐h pH monitoring, and plasma gastrin levels determined by radioimmunoassay in blood samples collected over the same period.Results:All subjects completed the study and no serious adverse events were reported. The mucosal injury score increased significantly from 0 (0–2) to 3.4 (0–8) (mean and range of values, P < 0.05) after dosing with indomethacin. No differences were observed in 24‐h mean pH or meal stimulated plasma gastrin concentrations. Mucosal PGE2and LTB4were unchanged 8–10 h after the last indomethacin dose.Conclusions: Endogenous prostaglandins do not appear to alter intragastric acidity or gastrin secretion, in contrast to the PGE analogues, whose effects must be more pharmacological than physiological.
Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation
Authors: ASHRAF W. , PARK F. , LOF J. , QUIGLEY E. M. M. 
Published: July 2010

SUMMARYBackground: Psyllium is widely used in the symptomatic therapy of constipation. Its effects on colonic function and their correlation with symptomatic response have not been defined.Methods: After a 4‐week baseline, placebo, run‐in phase, 22 subjects with idiopathic constipation confirmed by prospectively administered stool diaries were randomly assigned to receive either psyllium (5 g b.d., 11 patients) or placebo (11 patients) for 8 weeks, followed by another 4‐week wash‐out, placebo phase. A colon transit study and anorectal manometry were performed at the beginning and at the end of each study phase. Subjects recorded, in diaries, their daily stool frequency, difficulty with defecation and weekly stool weight.Results: Stool frequency increased significantly after 8 weeks of psyllium treatment (3.8 ± 0.4 vs. 2.9 ± 0.1 stools/week,P< 0.05) as did stool weight (665.3 ± 95.8 g vs. 405.2 ± 75.9 g,P< 0.05). Subjects also reported an improvement in stool consistency (stool consistency score: 3.2 ± 0.2 vs. 3.8 ± 0.2,P< 0.05) and pain on defecation (pain score: 2.0 ± 0.4 vs. 2.6. ± 0.5,P< 0.05) on psyllium. Colon transit and anorectal manometry parameters were unchanged on psyllium. Subjects treated with placebo did not show any change in either subjective or objective measures of constipation.Conclusions: Psyllium increases stool frequency and weight and improves stool consistency in idiopathic constipation. These effects are not associated with significant changes in either colonic or rectal motor function. We suggest that the beneficial effects of psyllium in constipation are primarily related to a facilitation of the defecatory process.
Pantoprazole and omeprazole in the treatment of reflux oesophagitis: a European multicentre study
Authors: CORINALDESI R. , VALENTINI M. , BELAÏCHE J. , COLIN R. , GELDOF H. , MAIER C. ,   THE EUROPEAN PANTOPRAZOLE STUDY GROUP
Published: July 2010

SUMMARYBackground: Pantoprazole is a new substituted benzimidazole which inhibits gastric H+,K+‐ATPase.Methods: In this double‐blind, multicentre study, pantoprazole 40 mg once daily was compared with omeprazole 20 mg once daily in the treatment of grade II and III (Savary–Miller) reflux oesophagitis. Endoscopy was repeated after 4 weeks of treatment, and also after 8 weeks in patients unhealed at 4 weeks.Results: The primary efficacy variable was ulcer healing; after 4 weeks, 81/103 (78.6%) patients in the pantoprazole group and 83/105 (79.0%) patients in the omeprazole group had healed completely. After 8 weeks, the cumulative healing rates were 94.2% and 91.4 % in the pantoprazole and omeprazole groups, respectively (P> 0.05 at 4 weeks and 8 weeks). Both groups experienced rapid relief of the key symptoms: heartburn, acid regurgitation and pain on swallowing. The time course of relief of the individual symptoms was similar in both groups after 2 and 4 weeks (P> 0.05). Both treatments were well tolerated, with only three patients withdrawing owing to adverse events.Conclusion: Pantoprazole has been shown to be as effective as omeprazole in the treatment of reflux oesophagitis.
The relationship between the control of pH and healing and symptom relief in gastro‐oesophageal reflux disease
Authors: HUNT R. H. 
Published: July 2010

SUMMARYGastro‐oesophageal reflux disease (GERD) is generally considered to be the result of a motility disorder which permits the abnormal and prolonged exposure of the lumen of the oesophagus to the acidic gastric contents.This view is supported by experimental data, intraoesophageal pH measurement, and the dramatic results of symptom relief and healing seen with effective antisecretory treatment.Oesophageal mucosal injury is determined by the pH of the refluxate and duration of acid exposure. Most patients experience meal‐stimulated reflux during the day and the more severe cases experience 24‐h acid exposure. In contrast to the H2‐receptor antagonists (H2RAs), the proton pump inhibitors (PPIs) are more effective at controlling meal‐stimulated acid secretion when each is given in standard doses. Therefore, the degree and duration of acid suppression throughout 24 h is greater.Treatments which maintain intra‐oesophageal pH > 4 for 96% or more of the 24 h normalize acid exposure and are associated with the highest healing rates. Peptic activity is minimized at or above pH 4. The time above pH 4 is significantly longer with the PPIs than with the H2RAs. Thus, the healing‐time curves for GERD (grades II‐IV) are shifted to the left for the PPIs which heal a significantly greater proportion of patients earlier than the H2RAs or sucralfate.Symptoms in GERD are related to the degree and duration of oesophageal acid exposure. Symptom relief is more rapid and complete with the PPIs than with the H2RAs or other treatments in standard doses.
The role and limitations of H2‐receptor antagonist in the treatment of gastro‐oesophageal refrux disease
Authors: COLIN‐JONES D. G. 
Published: July 2010

SUMMARYGastro‐oesophageal reflux disease (GERD) occurs in up to 44% of adults in the USA. Most individuals do not seek medical help, self‐medicating with antacids. Manifestations of GERD range from symptoms without oesophagitis, which constitute the bulk of patients who self‐medicate, to active oesophagitis and then to complications such as stricture and ulceration. It is the more severe cases who tend to come to the gastroenterologist, but it must be remembered that reflux symptoms are probably around 5–10 times more common than actual oesophagitis. Since acid in the refluxate is responsible for the bulk of the symptoms and mucosal damage, antacids are often used for quick relief—which of course may not be sustained. More prolonged suppression of acid secretion, such as by a histamine H2‐receptor antagonist (H2RA) or a proton pump inhibitor (PPI), is required to give long‐lasting symptomatic relief and heal any inflammatory change.H2‐receptor antagonists inhibit acid secretion with an effect that lasts for 4–8 h with a single dose, decreasing stimulated acid secretion by around 70%. When treating oesophagitis, the H2RAs suffer from the disadvantage of their relatively short duration of action (compared with PPIs), development of tolerance, and incomplete inhibition of acid secretion in response to a meal. Therefore, it is not easy for the H2RAs to achieve optimum conditions for healing the more severe forms of oesophagitis—even very high doses may fail.In mild GERD the H2RAs have been shown to be effective in relieving symptoms. In particular, when there is no oesophagitis, relief of reflux symptoms has been obtained after 4 weeks in almost all cases with a twice daily regimen: and it would seem that the sensitivity of the oesophageal mucosa may be reduced so that symptomatic remission is often obtained for a prolonged period after stopping therapy. In the milder forms of oesophagitis (grades I or II) healing can be achieved with all the H2RAs in 40–60% of cases in 8 weeks. This can be increased, by a substantial increase in dosage, to around 50–70%, but seldom higher than that. This higher dose has cost and compliance considerations. Proton pump inhibitors are required for higher percentage healing and especially for more severe disease.
The role of proton pump inhibitors in the treatment of gastro‐oesophageal reflux disease
Authors: BARDHAN K. D. 
Published: July 2010

SUMMARYEfficacy (healing, symptom relief) and cost‐effectiveness are the principal reasons for the rapidly increasing use of proton pump inhibitors (PPIs) for the management of gastro‐oesophageal reflux disease. Efficacy: Mean healing rates pooled from clinical trials are as follows: on omeprazole (OME) 20 mg vs. H2‐receptor antagonist, H2RA (cimetidine (CIM) 1.6 g or ranitidine (RAN) 300 mg) (eight studies) at 4 weeks, 67% vs. 37%; at 8 weeks, 81% vs. 49%; on lansoprazole (LAN) 30 mg vs. H2RA (three studies), 83% vs. 47% and 91% vs. 63% at 4 and 8 weeks, respectively. The benefit is greatest in severe disease because the H2RAs are disproportionately less effective. Heartburn is more rapidly relieved and in a higher proportion: at 4 weeks, on OME 20 mg vs. H2RA, 77% vs. 47% and on LAN 30 mg vs. H2RA, 81% vs. 46%. Both PPIs are effective in H2RA‐refractory disease, approximately 80% healing occurring in 8 weeks.Relapse rates after healing vary from 2 5 % to 8 5 % at 6 months. Maintenance therapy sustains remissions: relapse at 1 year is, on OME 20 mg vs. RAN 300 mg (2 studies), 12% vs. 79% and 28% vs. 55% (and 38% on OME 10 mg); on LAN 30 mg vs. 10 mg vs. RAN 600 mg, 20% vs. 31% vs. 68%. The effectiveness of the lower dose allows for dose titration. Cost effectiveness: The higher drug costs for the PPIs are offset by their higher efficacy, making their use cost effective, particularly in severe disease.Efficacy and cost effectiveness are likely to further expand the use of PPIs at the expense of H2RAs as increasing numbers of patients with milder disease are treated.
The role of Helicobacter pylori in gastritis and its progression to peptic ulcer disease
Authors: BLASER M. J. 
Published: July 2010

SUMMARY Helicobacter pylori infection is now recognized as the major cause of chronic gastritis throughout the world. A fraction of infected persons develop peptic ulcer disease or gastric cancer, accounting for its clinical significance. The pathophysiology of this infection can be better understood by considering five central concepts—heterogeneity of strains, persistence of infection, immunological down‐regulation, physiological consequences and variability in outcome. Microbial, host and environmental factors must each contribute to the outcome variation.