bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review article: appropriate use of corticosteroids in Crohn’s disease
Authors: IRVING P. M. , GEARRY R. B. , SPARROW M. P. , GIBSON P. R. 
Published: July 2010

SummaryBackground  Corticosteroids are a well‐established treatment for active Crohn’s disease and have been widely used for decades. It has become apparent, however, that a proportion of patients either fails to respond to corticosteroids or is unable to withdraw from them without relapsing. Furthermore, their use is associated with a range of side effects, such that long‐term treatment carries unacceptable risk.Aim  To review the evidence regarding the appropriate use of corticosteroids in Crohn’s disease, along with their side effects, safety and alternatives.Methods  To collect relevant articles, a PubMed search was performed from 1966 to November 2006 using the terms ‘steroid’, ‘corticosteroid’, ‘glucocorticoid’, ‘prednisolone’, ‘prednisone’, ‘methylprednislone’, ‘hydrocortisone’, ‘dexamethasone’ and ‘budesonide’ in combination with ‘Crohn(s) disease’. Relevant articles were reviewed, as were their reference lists to identify further articles.Results  When used correctly, corticosteroids are a highly effective, well tolerated, cheap and generally safe treatment for active Crohn’ disease. Nevertheless, approximately 50% of recipients will either fail to respond (steroid‐resistant) or will be steroid dependent at 1 year. Newer alternatives to corticosteroids are not, however, without risk themselves and, moreover, are not necessarily available universally.Conclusions  Steroids are used widely to treat Crohn’s disease, a situation that is unlikely to change in the near future. Accordingly, efforts should be made to ensure that they are used correctly and that their side effects are minimized. Reference is made to recently published guidelines and a simplified ‘users guide’ is presented.
A retrospective analysis of the efficacy and safety of infliximab as rescue therapy in acute severe ulcerative colitis
Authors: LEES C. W. , HEYS D. , HO G. T. , NOBLE C. L. , SHAND A. G. , MOWAT C. , BOULTON‐JONES R. , WILLIAMS A. , CHURCH N. , SATSANGI J. , ARNOTT I. D. R. ,   ON BEHALF OF THE SCOTTISH SOCIETY OF GASTROENTEROLOGY INFLIXIMAB GROUP
Published: July 2010

SummaryBackground  Forty per cent of patients with acute severe ulcerative colitis will not respond to intravenous corticosteroids and require second‐line medical therapy or colectomy. A recent controlled trial has suggested that infliximab may be effective as rescue therapy.Aim  To assess the value of infliximab as rescue therapy for acute severe colitis in a retrospective cohort of ulcerative colitis patients in Scotland.Methods  All patients satisfied Truelove and Witts criteria on admission, failed to respond to intravenous corticosteroids and received infliximab (5 mg/kg) as rescue therapy. Response was defined as need for colectomy at hospital discharge and by 90 days.Results  A total of 39 patients (median age 31.7 years) were treated. 26/39 (66%) responded, avoiding colectomy during the acute admission, and were followed up for a median of 203 days (Interquartile range = 135.5–328.5). Hypoalbuminaemia was a consistent predictor of non‐response on univariate and multivariate analysis. At day 3 of intravenous steroids, 9/18 (50.0%) with serum albumin <34 g/L had urgent colectomy vs. 1/13 (7.7%) ≥34 g/L (P = 0.02, OR = 12.0, C.I. 1.28–112.7). Two serious adverse events occurred – one death due to Pseudomonas pneumonia, and one post‐operative fungal septicaemia.Conclusions  Infliximab represents a moderately effective rescue therapy for patients with acute severe ulcerative colitis. Serious adverse events, including death, do occur and should be discussed with patients prior to therapy.
Review article: the genetic basis of haemochromatosis
Authors: GRIFFITHS W. J. H. 
Published: July 2010

SummaryBackground  Since the seminal discovery of the HFE gene a decade ago, considerable further progress in unravelling the genetic basis of haemochromatosis has been made. Novel genes and iron overload phenotypes have been described with potential insights into the molecular pathophysiology of human iron metabolism.Aim  To review recent key advances in the field of inherited iron overload and assess their impact on clinical practice and on our understanding of iron regulation.Methods  A PubMed search was undertaken predominantly using ‘haemochromatosis’, ‘HFE’, ‘hepcidin’ and ‘ferroportin’. Illustrative cases were sought.Results  The impact of HFE mutation analysis on the management of haemochromatosis is significant and allows early accurate diagnosis. HFE is also implicated in the siderosis associated with other liver pathologies. Non‐HFE genes underpinning other forms of haemochromatosis are now recognized and genotype–phenotype interactions result in a spectrum of disease. These novel gene products interact with HFE in a common pathway for iron homeostasis.Conclusions  Further identification of non‐HFE genes associated with iron homeostasis will enhance our diagnostic certainty of primary haemochromatosis and may explain the variable expression seen in HFE‐related disease. Improving our understanding of the mechanisms of iron regulation may lead to novel therapeutic strategies for the management of iron overload.
Development of a clinical hepatic encephalopathy staging scale
Authors: ORTIZ M. , CÓRDOBA J. , DOVAL E. , JACAS C. , PUJADAS F. , ESTEBAN R. , GUARDIA J. 
Published: July 2010

SummaryAimTo develop a scale to assess the severity of hepatic encephalopathy using simple dichotomic items.MethodsA list of 48 items was created by selecting items that are simple to recognize and categorize; it was applied to thirty‐six cirrhotic in‐patients with episodic encephalopathy, in addition to the adapted‐West‐Haven Criteria and the Glasgow Coma Score. The list underwent an item reduction process and principal component analysis; the metric characteristics were evaluated.ResultsMultiple neurological abnormalities were observed and a Clinical Hepatic Encephalopathy Staging Scale of nine items was constructed. The principal component analysis of the Clinical Hepatic Encephalopathy Staging Scale obtained two factors that explained 77% of the variance. The Clinical Hepatic Encephalopathy Staging Scale exhibited adequate internal consistency and reproducibility. The scores of the Clinical Hepatic Encephalopathy Staging Scale correlated to those of adapted‐West‐Haven Criteria and the Glasgow Coma Score.ConclusionsThis study confirms that the evaluation of multiple neurological manifestations is not necessary to classify hepatic encephalopathy adequately, which can be simply undertaken by an assessment of the patient’s orientation, alertness, ability to respond to commands and to talk. A list of nine items is proposed as a linear scale from normality (Clinical Hepatic Encephalopathy Staging Scale = 0) to deep coma (Clinical Hepatic Encephalopathy Staging Scale = 9).
Red chili induces rectal hypersensitivity in healthy humans: possible role of 5HT‐3 receptors on capsaicin‐sensitive visceral nociceptive pathways
Authors: GONLACHANVIT S. , FONGKAM P. , WITTAYALERTPANYA S. , KULLAVANIJAYA P. 
Published: July 2010

SummaryBackground  Red chili has been reported to modulate visceral hypersensitivity, probably by the action of its active ingredient, capsaicin. The role of 5HT‐3 receptors on capsaicin‐sensitive visceral nociceptive pathways is unknown.Aim  To test the hypothesis that capsaicin‐containing red chili induces rectal hypersensitivity in healthy humans and 5HT‐3 receptors participate in this effect.Methods  Eighteen healthy volunteers, each underwent three rectal barostat studies under three conditions: (i) oral placebo; (ii) oral chili (5 g daily × 3 days); and (iii) oral chili with 1‐mg intravenous (i.v.) granisetron, in randomized, double‐blinded, cross‐over fashions. Rectal sensation was evaluated by using a 5‐point Likert scale.Results  Chili ingestion significantly decreased rectal threshold for first, moderate and severe urgency (18 ± 0.9, 24 ± 1.2, and 38 ± 1.5 mmHg, respectively) compared with placebo (22 ± 0.9, 31 ± 1.3, and 45 ± 1.4 mmHg, respectively, P < 0.01). The threshold for first, moderate and severe urgency after chili with i.v. granisetron was 20 ± 0.9, 28 ± 1.2 and 44 ± 1.3 mmHg, respectively. This is a significant increase compared with chili ingestion without gransisetron (P < 0.05). After placebo ingestion, i.v. granisetron produced no effect on rectal sensation compared with i.v. placebo in 10 healthy volunteers (P > 0.05).Conclusions  Low‐dose granisetron, a 5HT‐3 receptor antagonist, partially reversed chili‐induced rectal hypersensitivity but had no effect on rectal perception induced only by mechanical balloon distention. This study suggests that 5HT‐3 receptors may be involved in chili‐induced rectal hypersensitivity and potentially participate in the capsaicin‐sensitive nociceptive pathways of the human gut.
Systematic review and meta‐analysis: the incidence and prognosis of post‐infectious irritable bowel syndrome
Authors: THABANE M. , KOTTACHCHI D. T. , MARSHALL J. K. 
Published: July 2010

SummaryBackground  Individual studies suggest that post‐infectious irritable bowel syndrome is common, but symptoms gradually improve.Aim  To review evidence for an association between intestinal infection and development of irritable bowel syndrome, assess the prognosis of post‐infectious irritable bowel syndrome and explore factors that increase the risk.Methods  MEDLINE (1966–2007) and EMBASE (1980–2007) databases were searched to identify the studies of post‐infectious irritable bowel syndrome epidemiology. Data were extracted by two independent reviewers. Pooled odds ratios (POR) and corresponding 95% CI for incidence of irritable bowel syndrome were estimated among the exposed and unexposed groups.Results  Eighteen of 26 studies identified were eligible for inclusion. Intestinal infection was associated with increased odds of developing irritable bowel syndrome at study end (POR = 5.86; 95% CI: 3.60–9.54). In subgroup analysis, the odds of developing irritable bowel syndrome was increased at 3 months (POR = 7.58; 95% CI: 4.27–13.45), 6 months (POR = 5.18; 95% CI: 3.24–8.26), 12 months (POR = 6.37; 95% CI: 2.63–15.40) and 24–36 months (POR = 3.85; 95% CI: 2.95–5.02). Among all studies (controlled and uncontrolled), the pooled incidence of irritable bowel syndrome at study conclusion was 10% (95% CI: 9.4–85.6). Subjects with post‐infectious irritable bowel syndrome were younger and more anxious and depressed than those without post‐infectious irritable bowel syndrome.Conclusion  The odds of developing irritable bowel syndrome are increased sixfold after acute gastrointestinal infection. Young age, prolonged fever, anxiety and depression are risk factors for post‐infectious irritable bowel syndrome.
Epidemiology of chronic hepatitis B infection in France: risk factors for significant fibrosis – results of a nationwide survey
Authors: CADRANEL J.‐F. , LAHMEK P. , CAUSSE X. , BELLAICHE G. , BETTAN L. , FONTANGES T. , MEDINI A. , HENRION J. , CHOUSTERMAN M. , CONDAT B. , HERVIO P. , PERIAC P. , EUGÈNE C. , MOINDROT H. , GRASSET D. , NOUEL O. , PILETTE C. , SZOSTAK‐TALBODEC N. , CAYLA J.‐M. , SI‐AHMED S. N. , DUMOUCHEL P. , PARIENTE A. , LESGOURGUES B. , DENIS J. 
Published: July 2010

SummaryBackground  Epidemiological data concerning hepatitis B are scarce in France.Aim  To describe epidemiological, clinical, virological and histological features of HBsAg‐positive patients followed at non‐academic hospitals in France.Methods  Clinical, biological, virological and histological data of all HBsAg‐positive consecutive patients observed from April 1, 2001 to May 31, 2002 in participating centres were recorded prospectively. Multivariate analyses of factors associated with significant fibrosis and cirrhosis were performed.Results  Nearly 1166 HBsAg‐positive patients were seen in the 58 centres: 671 males and 495 females from metropolitan France (32%) and from outside metropolitan France (68%); mean age 41 ± 15 years. Twenty‐nine percent of patients were probable HBsAg inactive carriers, while 50% had chronic hepatitis; 43% of these were HBeAg‐positive and 57% HBeAg‐negative. Liver biopsy had been performed in 558 (51%) patients; 205 (17.6%) patients had cirrhosis. By multivariate analysis, factors associated with significant fibrosis were: age >40 years (P < 0.05), HBeAg‐negative status (P < 0.02) and histological activity (P < 0.0001). Factors associated with cirrhosis: age (P < 0.0001), platelet count <150 000/mm3 (P < 0.0001) and viral co‐infection (P < 0.03).Conclusion  HBV infection represents a significant workload for hepatogastroenterologists at non‐academic hospitals in France.
Options for screening colonoscopy without sedation: a pilot study in United States veterans
Authors: LEUNG J. W. , MANN S. , LEUNG F. W. 
Published: July 2010

SummaryBackground  The direct and indirect costs of sedation limit access to screening colonoscopy amongst United States veterans.Aim  To determine if offering the option of sedation on‐demand reduces the need for sedation.Design  A retrospective review of prospectively collected performance improvement data in an open access screening colonoscopy programme.Setting  Performance improvement programme to minimize the burden of sedation at a single VA Medical Center.Subjects  44 consecutive veterans who accepted the option of sedation on‐demand. They could choose to have premedications before the start of colonoscopy, or to begin colonoscopy without premedications and receive the medications upon their request during the examination.Method  Two experienced endoscopists assisted by experienced nurse assistants performed all of the examinations. Insertion of the colonoscope was aided by infusion of warm water through the colonoscope without air insufflation. Medications were administered at the veterans’ request.Results  Offering the option of sedation on‐demand to 44 consecutive veterans permitted 52% (N = 23) of the veterans to complete screening colonoscopy without any sedation.Conclusions  This novel approach of sedation on‐demand and water infusion for screening colonoscopy deserves to be further evaluated in a randomized‐controlled study amongst patients undergoing colorectal cancer screening.
The clinical needs of patients with chronic gastrointestinal symptoms after pelvic radiotherapy
Authors: GILLESPIE C. , GOODE C. , HACKETT C. , ANDREYEV H. J. N 
Published: July 2010

SummaryBackground  After radiotherapy for pelvic cancer, gastrointestinal symptoms affecting quality of life are common. How they affect daily living is unknown.Aim  To investigate the day‐to‐day impact of gastrointestinal symptoms in patients after pelvic radiotherapy.Methods  New patients referred for gastroenterological evaluation of radiotherapy‐induced symptoms were sent a questionnaire.Results  Over 15 months, 75 of 100 questionnaires were completed before the gastroenterology appointment by 45 men (median age 70) and 30 women (median age 57) treated for urological (n = 44), gynaecological (n = 27) and gastrointestinal (n = 4) cancers. Time since radiotherapy was 3 years (median) for women and 1.5 years (men). Women experienced 6 (median) symptoms whilst men experienced 4. Having someone listen to problems was often as important as treatment. Urgency, diarrhoea, pain, rectal bleeding, flatulence and bloating were particularly troublesome. 57% women and 33% men were ‘very affected’. Symptoms rarely improved with time and in 33% had been present for more than 2 years. Gastrointestinal symptoms affected quality of life through change of routine (F 37%, M 22%), social limitation (F 17%, M 33%), physical limitations (F 33%, M 16%), emotional difficulties (F 47%, M 18%) and sexual problems (F 30%, M 51%).Conclusions  Patients experience a high number of physical symptoms for long periods before referral. Clinicians must focus systematically on physical, emotional and psychosexual issues.
Evaluating the cost of sustained virologic response in naïve chronic hepatitis C patients treated à la carte
Authors: BUTI M. , CASADO M. A. , ESTEBAN R. 
Published: July 2010

SummaryBackgroundThere is a tendency to individualize treatment in chronic hepatitis C patients depending on viral load and rapid clearance of HCV‐RNA.AimTo evaluate the cost (€, 2006) per sustained virologic response in naïve patients with therapy à la carte compared with standard combination therapy.MethodsA decision analysis model was used to compare standard therapy with peginterferon alpha and ribavirin for 24 weeks for genotype (G) 2/3, and 48 weeks for G1 and therapy à la carte with the same drugs but different durations: G1 high viral load for 48 weeks, G1 low viral load with rapid virologic response for 24 weeks, and without rapid virologic response for 48 weeks, and G2/3 with rapid virologic response for 12 weeks, and without rapid virologic response for 24 weeks.ResultsSustained virologic response was similar in both strategies. The cost per successfully treated patient for standard therapy is €17 812 and for therapy à la carte€12 313. Assuming that 13 309 patients with standard therapy and 14 450 patients with therapy à la carte achieve sustained virologic response, therapy à la carte has an overall cost‐saving of €59.13 million.ConclusionTherapy à la carte is a cost‐saving strategy for chronic hepatitis C infection compared to standard therapy, with lower investment requirement per patient to achieve sustained virologic response.
Diagnostic value of serum protein profiling by SELDI‐TOF ProteinChip compared with a biochemical marker, FibroTest, for the diagnosis of advanced fibrosis in patients with chronic hepatitis C
Authors: MORRA R. , MUNTEANU M. , BEDOSSA P. , DARGERE D. , JANNEAU J.‐L. , PARADIS V. , RATZIU V. , CHARLOTTE F. , THIBAULT V. , IMBERT‐BISMUT F. , POYNARD T. 
Published: July 2010

SummaryBackgroundFibroTest has been validated for the diagnosis of liver fibrosis in patients with chronic hepatitis C.AimTo compare FibroTest with a new proteome‐based model for the prediction of advanced liver fibrosis.MethodsSera from 191 consecutive patients with simultaneous liver biopsy and FibroTest on fresh sera were used for retrospective mass spectrometry analysis. A new fibrosis index was constructed combining proteomic peaks, selected on differential expression according to fibrosis stages in logistic regression analyses. The main end point was the diagnosis of advanced fibrosis on liver biopsy.ResultsEight out of 1000 peaks were selected for the construction of the proteomic index. The area under the receiver operating curve (AUROC) of the proteomic index was 0.88 (95% CI: 0.82–0.92), significantly greater than the FibroTest AUROC of 0.81 (95% CI: 0.74–0.86; P = 0.04); the AUROC of the proteomic and FibroTest combination was 0.88 (95% CI: 0.83–0.92). Seven of the eight selected peaks were highly associated with the FibroTest score, with different patterns of association with the five components of FibroTest.ConclusionsA proteomic index combining eight peaks had an excellent accuracy value for the diagnosis of advanced fibrosis in patients with chronic hepatitis C. However, despite a statistical significance, the small improvement delivered by proteomics impairs clinical applications because of its cost and its variability compared with the well validated FibroTest.
Cost of gastro‐oesophageal reflux disease to the employer: a perspective from the United States
Authors: BROOK R. A. , WAHLQVIST P. , KLEINMAN N. L. , WALLANDER M.‐A. , CAMPBELL S. M. , SMEEDING J. E. 
Published: July 2010

SummaryBackgroundEmployers pay more than just salary for their employees. Previous studies have largely focused on direct medical and prescription drug costs of gastro‐oesophageal reflux disease (GERD), and few have reported on total absenteeism costs.AimsTo examine the annual cost of illness of GERD in an employed US population by benefit category and by place of service for direct medical costs.MethodsRetrospective data analysis from 2001 to 2004. International Classification of Diseases (ICD)‐9 codes (530.1, 530.10, 530.11, 530.12, 530.19, 530.81, 787.1x, 787.2x or 251.5x) were used to identify employees with and without GERD (the control group). Measures included medical and prescription drug claims, plus indirect costs for sick leave, short‐ and long‐term disability, and workers’ compensation. For a subset of the population, the direct medical claims were analysed by place of service.ResultsData were available for 267 269 eligible employees of which 11 653 had gastro‐oesophageal reflux disease. GERD was associated with a mean incremental cost of $US3355 per employee of which direct medical costs accounted for 65%, prescription drug costs 17%, and indirect costs 19%. The place of service ‘out‐patient hospital or clinic’ accounted for the largest part (47%) of the difference in medical costs.ConclusionsGERD is associated with substantial direct and indirect costs, which highlight the importance of managing the disease effectively.
Effects of long‐term cyclo‐oxygenase 2 selective and acid inhibition on Barrett’s oesophagus
Authors: LANAS A. , ORTEGO J. , SOPEÑA F. , ALCEDO J. , BARRIO E. , BUJANDA L. , COSME A. , BAJADOR E. , PARRA‐BLANCO A. , FERRANDEZ A. , PIAZUELO E. , QUINTERO E. , PIQUE J. M. 
Published: July 2010

SummaryBackgroundThere is an overexpression of cyclo‐oxygenase 2 (COX‐2) in Barrett’s oesophagus (BO).AimTo determine the long‐term effect of a COX‐2 inhibitor on cellular mechanisms involved in BO.MethodsA randomized controlled trial was conducted in BO patients allocated to continue the usual proton pump inhibitor (PPI) alone treatment, or PPI combined with rofecoxib (25 mg/day) for 6 months. Cell proliferation index and COX‐2 expression in BO glands was determined in biopsy specimens at baseline and after treatment. Cell apoptosis, cyclin D1, p53 and vascular endothelial growth factor (VEGF) expression was also explored in a subset of patients. Student‐t test and the U‐Mann–Whitney test were used for quantitative and ordinal variables.ResultsOf 62 patients, 58 completed the study. A higher proportion of patients on rofecoxib + PPI exhibited a decrease in COX‐2 expression compared to those treated with PPI alone, but cell proliferation index was not affected. Unlike PPI alone, rofecoxib + PPI was associated with an increase in the apoptotic cell index, a decrease in p53 cell staining and VEGF expression in mucosal vessels. No effect on low‐grade dysplasia or cyclin D1 was observed.ConclusionsThe addition of rofecoxib to PPI therapy does not affect cell proliferation index in BO cells after 6 months of therapy, but does reduce COX‐2 and VEGF expression and increases cell apoptosis.