bluuebunny/crossref_metadata_2025_split huggingface dataset:
Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage: a cost‐effectiveness analysis
Authors: WINSTEAD N. S. , WILCOX C. M. 
Published: October 2008

SummaryBackground Erythromycin is a potent stimulator of gastrointestinal motility. Recent studies have examined the use of intravenous erythromycin to clear the stomach of blood before oesophago‐gastroduodenoscopy (EGD) for acute upper gastrointestinal haemorrhage (UGIH). These studies have shown clinical effectiveness.Aim To evaluate the cost‐effectiveness of this intervention.Methods We sought to determine the cost‐effectiveness of erythromycin before EGD from the payer’s perspective. We found three relevant studies of erythromycin and used these data for the analysis. We obtained costs for intravenous erythromycin and charges for peptic ulcer hospitalization, EGD, surgery, and angiographic embolization. Complication rates were also incorporated from the literature. We implemented a model of health‐related quality of life to measure the impact of the intervention. We created a decision‐analysis tree and performed a probabilistic sensitivity analysis.Results A strategy of erythromycin prior to EGD resulted in a cost‐effective outcome in a majority of trials using willingness‐to‐pay figures of $0, $50 000 and $100 000 (US) per quality‐adjusted life‐year (QALY).Conclusion Because of the implications for cost saving and increase in QALY, we would recommend giving erythromycin prior to EGD for UGIH.
Clinical trial: effects of tegaserod on gastric motor and sensory function in patients with functional dyspepsia
Authors: THUMSHIRN M. , FRUEHAUF H. , STUTZ B. , TOUGAS G. , SALTER J. , FRIED M. 
Published: October 2008

SummaryBackground  Tegaserod, a serotonin receptor type‐4 partial agonist, stimulates gastrointestinal motility and has been shown to increase gastric volumes before and after a meal in healthy volunteers. Its effect on gastric motor and sensory function in patients with functional dyspepsia is unclear.Aim  To evaluate the effects of tegaserod on gastric compliance, accommodation and gastric sensory function in patients with functional dyspepsia and healthy volunteers.Methods Sixteen patients with functional dyspepsia and 12 healthy volunteers were studied on two occasions, each after a 7‐day treatment with either placebo or tegaserod 6 mg b.d. using a double‐blind, randomized, crossover design. After each treatment period a gastric barostat study was performed fasting and during intraduodenal lipid infusion.Results  Tegaserod increased postprandial gastric compliance in functional dyspepsia patients (P = 0.04). Healthy volunteers showed enhanced postprandial gastric compliance after placebo (P = 0.03). Between‐treatment analysis of gastric accommodation revealed a significant increase in intrabag volumes after tegaserod in healthy volunteer (P = 0.04); no difference could be seen in functional dyspepsia patients. Tegaserod had no effect on gastric sensation.Conclusions  Tegaserod enhances postprandial gastric compliance in functional dyspepsia patients and gastric accommodation in healthy volunteers. The improvement of proximal gastric motor function suggests a beneficial role of tegaserod in patients with functional dyspepsia.
No increase in risk of fracture, malignancy or mortality in dermatitis herpetiformis: a cohort study
Authors: LEWIS N. R. , LOGAN R. F. A. , HUBBARD R. B. , WEST J. 
Published: October 2008

SummaryBackground  Dermatitis herpetiformis forms part of the same spectrum of gluten‐sensitive disorders as coeliac disease yet may have different risks of morbidity and mortality.Aims  To quantify the risks of fracture, malignancy and mortality in people with dermatitis herpetiformis compared with the general population.Methods  Using the General Practice Research Database, we identified 846 people with dermatitis herpetiformis and 4225 age‐, gender‐ and practice‐matched controls. We used Cox regression to estimate hazard ratios.Results  Comparing people with dermatitis herpetiformis to the general population, the overall hazard ratio for any fracture was 1.1 (95% CI: 0.77–1.52). The overall hazard ratio for any malignancy was 1.0 (95% CI: 0.73–1.49); there was no increased risk of gastrointestinal (HR: 1.6; 95% CI: 0.67–3.67) or lymphoproliferative cancers (HR: 1.6; 95% CI: 0.44–6.06). A reduction in risk of breast cancer was not statistically significant (HR: 0.19; 95% CI: 0.03–1.39). The hazard ratio for all‐cause mortality was 0.93 (95% CI: 0.70–1.23).Conclusions  Unlike the fivefold increase in risk seen in coeliac disease, we found no increased risk of lymphoproliferative cancer and no increase in fracture, malignancy or mortality in people with dermatitis herpetiformis compared with the general population. It is not clear whether differences in degree of intestinal inflammation or other reasons account for this. Like coeliac disease, dermatitis herpetiformis may protect against breast cancer.
Systematic review: tolerable amount of gluten for people with coeliac disease
Authors: AKOBENG A. K. , THOMAS A. G. 
Published: October 2008

SummaryBackground  The threshold amount of gluten in ‘gluten‐free’ products that can be tolerated by people with coeliac disease is unclear.Aim  To investigate the threshold amount of gluten and the threshold concentration of gluten in food products that can be tolerated by people with coeliac disease.Design  Systematic review of studies published between 1966 and May 2007.Methods  The data sources used were MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and reference lists of retrieved articles. We included studies that evaluated the amount of dietary gluten or the concentrations of gluten in food products that can be tolerated by people with coeliac disease whatever their design, method or language of publication.Results  Thirteen studies (three randomized controlled, one cohort, two crossover, and seven cross‐sectional) met the inclusion criteria. The daily amount of tolerable gluten varied widely between studies. Whilst some patients tolerated an average of 34–36 mg of gluten per day, other patients who consumed about 10 mg of gluten per day developed mucosal abnormalities. The effect of the consumption of ‘gluten‐free’ products with different degrees of gluten contamination was also inconsistent.Conclusions  The amount of tolerable gluten varies among people with coeliac disease. Although there is no evidence to suggest a single definitive threshold, a daily gluten intake of <10 mg is unlikely to cause significant histological abnormalities.
Clinical trial: a randomized controlled cross‐over study of flupenthixol + melitracen in functional dyspepsia
Authors: HASHASH J. G. , ABDUL‐BAKI H. , AZAR C. , ELHAJJ I. I. , EL ZAHABI L. , CHAAR H. F. , SHARARA A. I. 
Published: October 2008

SummaryBackground  Functional dyspepsia is a prevalent condition associated with diminished quality of life (QoL) and high economic burden.Aim  To study the efficacy of a combination of flupenthixol and melitracen (F + M) with anxiolytic and antidepressant properties in functional dyspepsia using a randomized controlled cross‐over design.Methods  Patients met the Rome III criteria for functional dyspepsia and a validated questionnaire was used to exclude those with anxiety or depression. Moreover, patients had to have failed a trial of acid‐suppressive therapy and Helicobacter pylori eradication when positive. End points included subjective global symptom relief and QoL assessed by the Nepean Dyspepsia Index (NDI).Results  Twenty‐five patients (14 females, 11 males; mean age = 34.3 ± 9.9 years) were enrolled and 24 completed the 8‐week study. There was a significant improvement in subjective global symptom relief with F + M vs. placebo (ITT: 73.9% vs. 26.1%, P = 0.001) and a significant drop in the NDI score vs. placebo (ITT: −9.0 ± 11.9 vs. −2.4 ± 8.9, P = 0.03). No difference was noted whether the initial treatment was F + M or placebo. No significant side effects were noted.Conclusions  A combination of F and M is safe and effective in the short‐term treatment of functional dyspepsia. F + M is associated with significant improvement in QoL independent of the presence of anxiety or depression.
A national survey of acute hepatitis E in France
Authors: RENOU C. , MOREAU X. , PARIENTE A. , CADRANEL J.‐F. , MARINGE E. , MORIN T. , CAUSSE X. , PAYEN J.‐L. , IZOPET J. , NICAND E. , BOURLIÈRE M. , PENARANDA G. , HARDWIGSEN J. , GEROLAMI R. , PÉRON J.‐M. , PAVIO N. ,   THE ANGH, FRANCE
Published: October 2008

SummaryBackground  Few data are available on the incidence, risk factors and contamination pathways involved in acute indigenous hepatitis E in developed countries.Aims  To draw up an overall picture of hepatitis E cases, to confirm whether or not the majority of the cases were indigenous and to attempt to identify the risk factors and contamination pathways involved in hepatitis E.Methods  This study was performed in the framework of a national network (ANGH) including 96 participating centres. The 19 centres with at least one case of acute HEV reported a total number of 53 cases.Results  A decreasing South‐to‐North geographic gradient was observed. A nonspecific clinical profile was observed in many cases. Acute hepatitis E was of indigenous origin in 90% of the patients. The most relevant and/or frequent possible risk factors among the 47 indigenous metropolitan cases were water consumption from a personal water supply, uncooked shellfish consumption and the recent acquisition of a pet pig.Conclusions  This national survey confirmed that acute indigenous hepatitis E is an emerging disease in developed countries such as France, and suggests that various risk factors are responsible for acute indigenous hepatitis E contamination in non‐endemic countries.
Safety, tolerability, and efficacy of pegylated‐interferon alfa‐2a plus ribavirin in HCV‐related decompensated cirrhotics
Authors: TEKIN F. , GUNSAR F. , KARASU Z. , AKARCA U. , ERSOZ G. 
Published: October 2008

SummaryBackground  Pretransplantation clearance of hepatitis C virus (HCV)‐RNA reduces the risk of HCV recurrence after transplantation. Furthermore, a sustained virological response could reduce disease progression and slow clinical deterioration in nontransplanted patients.Aim  To evaluate the safety, tolerability and efficacy of pegylated‐interferon (PEG‐IFN) alfa‐2a plus ribavirin therapy in HCV‐related decompensated cirrhotics.Methods  Twenty HCV‐related decompensated cirrhotics (44–67 years, 12 males, six Child–Pugh score A, 14 Child–Pugh score B, all with genotype 1b) were enrolled into the study. Treatment with PEG‐IFN alfa‐2a (135 μg, once a week) plus ribavirin (1000–1200 mg/day) was commenced. A 48‐week treatment was planned in patients who had early virological response.Results  Treatment was stopped in 8 (40%) patients. The remaining 12 (60%) patients completed 48 weeks of therapy; nine (45%) of them obtained end‐of‐therapy virological response and six (30%) of them obtained sustained virological response. Living donor liver transplantation was performed in three (15%) patients. Eight (40%) and six (30%) patients needed to reduce PEG‐IFN alfa‐2a and ribavirin dosages, respectively. No patient died during the follow‐up period.Conclusion  PEG‐IFN alfa‐2a plus ribavirin therapy is safe, tolerable and efficacious in selected HCV‐related decompensated cirrhotics.
Review article: gastrointestinal amyloidosis – clinical features, diagnosis and therapy
Authors: PETRE S. , SHAH I. A. , GILANI N. 
Published: October 2008

SummaryBackground  Amyloidosis is one of the unusual diseases about which a physician may not think when it is affecting the patient. During the last three decades, there has been an enormous progress in the understanding of the chemical nature, classification, pathogenesis, clinical features, diagnostic measures and therapy of this disorder.Aim  To provide an updated review of amyloidosis affecting the gastrointestinal tract.Methods  Review of current medical literature.Results  Amyloid proteins (irrespective of the type) can deposit in various parts of the gastrointestinal tract and liver resulting in symptoms of abdominal pain, dysmotility, diarrhoea, gastrointestinal bleeding, hepatomegaly and even portal hypertension with its associated complications. Definitive diagnosis can only be made by histological examination of the affected organ. Disease modifying treatment with high‐dose chemotherapy followed by autologous stem‐cell transplantation has shown promise. Liver transplantation is an option for a select group of patients.Conclusions  Suspicion of gastrointestinal amyloidosis in patients without known history of amyloidosis is difficult, but should be considered in those older than 30 years with unexplained diarrhoea, weight loss, autonomic dysfunction, malabsorption or proteinuria. While most gastrointestinal complications are managed symptomatically, causal therapy is reserved for a select few from various subtypes of this disorder.
Systematic review: health‐related quality of life (HRQOL) questionnaires in gastro‐oesophageal reflux disease
Authors: CHASSANY O. , HOLTMANN G. , MALAGELADA J. , GEBAUER U. , DOERFLER H. , DEVAULT K. 
Published: October 2008

SummaryBackground  Although gastro‐oesophageal reflux disease (GERD) has a well‐established pathophysiology, the impact of GERD symptoms on the patients’ quality of life can be profound. Therefore, health‐related quality of life (HRQOL) questionnaires have become standard instruments to evaluate the effect of treatment in clinical trials.Aim  To evaluate the reliability, validity and responsiveness of available GERD‐specific HRQOL.Methods  A systematic literature search using the Medical Subject Headings terms: ‘Gastro‐oesophageal reflux’, ‘Heartburn’ and ‘Oesophagitis’ with ‘quality of life’ and ‘questionnaires’ was preformed to identify the available HRQOL questionnaires. To analyse the psychometric properties of the respective tools, the actual guidelines for the use of patient‐reported outcomes in clinical trials were applied.Results  We identified five GERD‐specific HRQOL questionnaires but none of them fulfilled all quality criteria; either they did not meet the actual standards for psychometric properties (HBQOL, GERD‐HRQL, Jasani et al.Aust Fam Physician 1999; 28: 515), or were impracticable to use in clinical trials. The generic and hybrid instruments lack specificity and sensitivity and were not designed for treatment evaluation in GERD patients.Conclusion  There is need for a new evaluative tool in the assessment of HRQOL during GERD therapy.
Review article: current management of metastatic colorectal cancer – the evolving impact of targeted drug therapies
Authors: YAU T. , CHAN P. , Ching CHAN Y. , WONG B. C. Y. , LIANG R. , EPSTEIN R. J. 
Published: October 2008

SummaryBackground  The field of colorectal cancer chemotherapy has been transformed by the advent of molecule‐specific drugs. Combined use of such drugs enhances tumour response rates, but controlled data quantifying the relative efficacy and cost‐effectiveness of different drug combinations on overall survival remain scarce.Aim  To conduct an overview of published clinical trials in advanced colorectal cancer, with the objective of framing provisional approaches to current management.Methods  An NCBI/PubMed search was performed using the strings, ‘colorectal cancer’ (‘metastatic’ or ‘advanced’ or ‘palliative’) and (‘chemotherapy’ or ‘drug therapy’ or ‘targeted’ or ‘target‐specific’ or ‘molecularly‐targeted’).Results  Combinations of target‐specific drugs (with or without the DNA‐alkylating agent oxaliplatin) have substantially enhanced colorectal cancer time to progression over the last decade and have also expedited surgical resection of liver metastases. Disease‐free survival, overall survival and quality of life are favourably influenced.Conclusions  Target‐specific drugs improve palliative efficacy in the setting of advanced colorectal cancer. However, key issues persist as to the cost‐effectiveness of these newer drug treatments, and further controlled trials are needed to resolve this important debate.
MMX mesalazine for the induction of remission of mild‐to‐moderately active ulcerative colitis: efficacy and tolerability in specific patient subpopulations
Authors: LICHTENSTEIN G. R. , KAMM M. A. , SANDBORN W. J. , LYNE A. , JOSEPH R. E. 
Published: October 2008

SummaryBackground  Two phase III studies have evaluated mesalazine (mesalamine) with MMX (Multi Matrix System) technology in patients with active mild‐to‐moderate ulcerative colitis.Aim  To determine the efficacy of MMX mesalazine for the induction of clinical and endoscopic remission in specific subgroups of patients with active, mild‐to‐moderate ulcerative colitis.Methods  Data from two double‐blind, placebo‐controlled trials were analysed (517 out‐patients). Patients were randomized to receive MMX mesalazine [2.4 g/day (once daily or 1.2 g twice daily) or 4.8 g/day (once daily)] or placebo for 8 weeks.Results  The percentages of patients treated with MMX mesalazine, 2.4 or 4.8 g/day, in clinical and endoscopic remission at week 8 were similar and significantly (P < 0.05) greater than placebo in subgroups stratified by disease extent, disease severity and gender and among patients not previously receiving low‐dose 5‐aminosalicylic acid. Among patients transferring directly from prior low‐dose oral 5‐aminosalicylic acid, MMX mesalazine 4.8 g/day was significantly (P = 0.018) more effective than placebo in inducing clinical and endoscopic remission. Efficacy over placebo did not reach significance in patients transferring directly to MMX mesalazine 2.4 g/day.Conclusion  MMX mesalazine is effective in active UC regardless of disease extent, disease severity, gender and previous, low‐dose, 5‐ASA therapy.
Watermelon stomach in systemic sclerosis: its incidence and management
Authors: MARIE I. , DUCROTTE P. , ANTONIETTI M. , HERVE S. , LEVESQUE H. 
Published: October 2008

SummaryBackground  To date, there are no large endoscopic studies in systemic sclerosis (SSc), and both prevalence and characteristics of watermelon stomach in SSc have not been determined.Aims  To determine the prevalence, clinical presentation, endoscopic appearance, therapy success and long‐term outcome in SSc patients with watermelon stomach and make predictions about which SSc patients are at risk for watermelon stomach.Patients and methods  From 1990 to 2008, 264 patients were seen for evaluation of SSc. Data were collected as regards patients’ characteristics, time of watermelon stomach onset, features, therapy and outcome of watermelon stomach.Results  Fifteen SSc patients (5.7%) exhibited watermelon stomach. SSc onset preceded watermelon stomach manifestations in 13 patients (86.7%). Most patients (86.7%) presented with iron‐deficiency anaemia, two other patients experienced gastrointestinal haemorrhage. Gastroscopy disclosed typical ‘watermelon stomach’ characterized by prominent, erythematous stripes, radiating in a spoke‐like fashion from the antrum to the pylorus. All patients received conservative therapy; because of deterioration of watermelon stomach, eight patients (53.3%) underwent endoscopic procedures. During follow‐up, five patients (33.3%) exhibited recurrences of watermelon stomach.Conclusions  Our series indicates that watermelon stomach should be considered when unexplained iron‐deficiency anaemia occurs in SSc patients. Moreover, because watermelon stomach may be the first manifestation of SSc, patients with unexplained watermelon stomach should systematically undergo physical examination and autoantibody testing to detect the underlying SSc.
Benefit of concomitant gastrointestinal and gynaecological evaluation in premenopausal women with iron deficiency anaemia
Authors: VANNELLA L. , ALOE SPIRITI M. A. , COZZA G. , TARDELLA L. , MONARCA B. , CUTERI A. , MOSCARINI M. , DELLE FAVE G. , ANNIBALE B. 
Published: October 2008

SummaryBackground  Iron‐deficiency anaemia (IDA) is common in premenopausal women and menorrhagia is often considered responsible.Aim  To evaluate prospectively the occurrence of bleeding and iron malabsorption related gastrointestinal (GI) diseases likely responsible of IDA in premenopausal women regardless of their menstrual flow.Methods  One hundred and eighty‐seven premenopausal women [median age 39 (20–56) years] irrespective of their menstrual flow underwent gastroscopy with gastric and duodenal biopsies and faecal occult blood test (FOBT). Patients over 50 years, positive 1st degree family history for colonic cancer and/or positive FOBT underwent colonoscopy too.Results  Menorrhagia was present in 67.4% of premenopausal women. A possible GI cause of IDA was found in 129/187 patients; in 65.2% the cause of IDA was possibly related to iron malabsorption diseases. GI bleeding as a cause of IDA was found in seven patients. An exclusive GI cause of IDA was found in 26.7% of premenopausal women, whereas a possible GI cause was observed in 34.2% of menorrhagic premenopausal women. The main risk factor for the presence of likely GI causes was the presence of upper GI symptoms (OR 5.2: 95% CI = 1.6–16.4).Conclusions  Most premenopausal women had a possible upper GI cause of IDA because of diseases related to iron malabsorption. Menorrhagia and a GI cause coexist in one‐third of women with iron‐deficiency anaemia.
Optimized stepwise combination algorithms of non‐invasive liver fibrosis scores including Hepascore in hepatitis C virus patients
Authors: BOURLIERE M. , PENARANDA G. , OUZAN D. , RENOU C. , BOTTA‐FRIDLUND D. , TRAN A. , ROSENTHAL E. , WARTELLE‐BLADOU C. , DELASALLE P. , OULES V. , PORTAL I. , CASTELLANI P. , LECOMTE L. , ROSENTHAL‐ALLIERI M. A. , HALFON P. 
Published: October 2008

SummaryBackground  Non‐invasive liver fibrosis scores such as Hepascore (HS) have been proposed as an alternative to liver biopsy in hepatitis C virus (HCV)‐infected patients.Aim  To validate HS as an alternative to liver biopsy and Fibrotest (FT) and propose five optimized combination algorithms to improve diagnostic accuracy.Methods  The cohort included 467 patients with HCV. There were 274/467 (59%) men, and mean age was 47 ± 12 years.Results  Hepascore area under ROC curves (AUC) for ≥F2, F3F4 and F4 diagnosis were 0.82, 0.84 and 0.90 respectively, in the same range as FT. HS and FT were concordant in 387/467 (82%) for fibrosis staging. Among these patients, 342/387 (88%) were concordant with liver biopsy. AUCs of aspartate aminotransferase (AST) to Platelets Ratio Index (APRI) and Forns for ≥F2 were 0.76 and 0.73 (0.65–0.79) respectively. The algorithm combining APRI and HS had the highest rate of avoided liver biopsies (45%) with a high diagnostic accuracy (91%).Conclusions  Hepascore is an accurate non‐invasive marker for ≥F2 and F4 diagnosis in HCV patients. In a pragmatic approach, a stepwise optimized algorithm combining APRI and FT or HS considerably increases diagnostic accuracy and avoided liver biopsies.