bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term effect of gluten restriction on bone mineral density of patients with coeliac disease
Authors: BAI J. C. , GONZALEZ D. , MAUTALEN C. , MAZURE R. , PEDREIRA S. , VAZQUEZ H. , SMECUOL E. , SICCARDI A. , CATALDI M. , NIVELONI S. , BOERR L. A. , MAURIÑO E. 
Published: October 2003

Aim: To assess the long‐term effect of a gluten‐free diet on bone mineral density of adults with untreated coeliac disease. Methods: Bone mineral density was assessed at baseline and after a mean duration of 37 months of treatment in 25 unselected newly diagnosed coeliac patients. Results: At baseline, osteopenia (>−1 s.d. below normal) was evident in the lumbar spine and total skeleton in 18 (72%) and 21 (84%) patients, respectively. At the end of the study, bone density had increased (mean bone mass Z‐score increase: Z‐score +1.0 for the lumbar spine and +1.1 for total skeleton) in 22 and 23 patients, respectively. Patients who adhered to strict gluten restriction (n=15) demonstrated a similar bone remineralization in the spine than those patients with partial compliance (n=10) (mean Z‐score increase: +1.0, in both areas). A greater mean annual change in Z‐score in the total skeleton was noted in patients who followed strict gluten restriction (0.4±0.1) respect to those with partial compliance (0.3±0.1); however, this difference was not statistically significant. Pre‐menopausal women had significantly greater remineralization that post‐menopausals (P>0.05). Remineralization showed an inverse correlation with the degree of basal osteopenia (r=−0.525; P<0.002). Conclusions: Long‐term treatment with gluten‐free diet produces a significant improvement in bone density in coeliac patients. Remineralization was more pronounced in patients who better comply with gluten‐free diet, in pre‐menopausal women and in patients with the lowest baseline bone mineral density.
Lansoprazole heals erosive reflux oesophagitis in patients with Barrett's oesophagus
Authors: SONTAG S. J. , SCHNELL T. G. , CHEJFEC G. , KURUCAR C. , KARPF J. , LEVINE G. 
Published: October 2003

Background: Barrett's oesophagus is thought to be a complication of severe gastro‐oesophageal reflux. Aim: To determine whether the proton pump inhibitor, lansoprazole, is effective in healing erosive reflux oesophagitis in patients with Barrett's oesophagus. Methods: An 8‐week, randomized, double‐blind study was conducted using patients with both erosive reflux oesophagitis and Barrett's oesophagus. Erosive reflux oesophagitis was defined as grades 2–4 oesophagitis; Barrett's oesophagus, as specialized columnar epithelium obtained by biopsy from the tubular oesophagus; and healing, as a return to grade 0 or 1 oesophageal mucosa (complete re‐epithelialization). One‐hundred and five (105) patients from one centre were randomized to receive either lansoprazole 30 mg daily or ranitidine 150 mg twice daily. Unhealed or symptomatic lansoprazole patients at week 4 were randomized to receive the same 30 mg dose daily or an increased dose of 60 mg daily. Endoscopy was performed at baseline and at weeks 2, 4, 6 and 8. Results: The treatment groups were similar in regards to baseline characteristics, erosive reflux oesophagitis grades and length of Barrett's oesophagus. At each 2‐week interval, lansoprazole patients had significantly greater healing rates and less day and night heartburn and regurgitation than ranitidine patients. There were no significant differences between treatment groups in antacid use, quality of life parameters, or rate of reported adverse events. Median values for fasting serum gastrin levels remained within the normal range for both groups. Conclusion: In patients with both Barrett's oesophagus and erosive reflux oesophagitis, lansoprazole is significantly more effective than ranitidine in relieving reflux symptoms and healing erosive reflux oesophagitis.
Cisapride in functional dyspepsia in general practice. A placebo‐controlled, randomized, double‐blind study
Authors: DE GROOT G. H. , DE BOTH P. S. M. 
Published: October 2003

Background: Functional dyspepsia is recognized as a common disorder in clinical practice. The aim of this study was to determine the efficacy and adverse effects of cisapride compared to a placebo in patients from a general practice with functional dyspepsia (FD). Secondly we investigated whether Helicobacter pylori‐positive FD patients present with specific symptoms and determined the efficacy of cisapride for FD patients with H. pylori. Methods: In a placebo‐controlled double‐blind study, patients were randomized to receive fixed doses of either cisapride (10 mg three times daily) or placebo. Symptoms were evaluated after 2 and 4 weeks of treatment. The selection of FD patients,collection of data, and evaluation of symptoms as well as adverse effects were performed by general practitioners. Dyspeptic patients were referred to the Gastroenterology Department in order to exclude ulcers, oesophagitis, pancreatitis and gallstones. Biopsies of gastric mucosa were taken for histological examination and H. pylori culture. Patients: 121 patients entered this study (61 took cisapride, 60 placebo). There were 113 patients (56 cisapride, 57 placebo) available for analysis of the efficacy and 120 patients (61 cisapride, 59 placebo) for evaluation of adverse effects.In total 102 biopsies were tested for the presence of gastritis by histological examination. There were 30 H. pylori‐positive cultures among 111 patients. Results: After 4 weeks a statistically significant reduction in symptoms was found, but it was similar in the two groups. No symptoms specific for H. pylori‐positive patients were found. There was not a significant difference in the response to cisapride between H. pylori‐positive and H. pylori‐negative patients. The difference in overall (63%) response in the cisapride group and the 44% response in the placebo group did not reach statistical significance. Conclusions: No significant difference was found between placebo and cisapride in the treatment of FD in general practice. H. pylori‐positive patients did not present with specific symptoms nor did they exhibit a different response to cisapride.
Lactulose improves psychometric testing in cirrhotic patients with subclinical encephalopathy
Authors: HORSMANS Y. , SOLBREUX P. M. , DAENENS C. , DESAGER J. P. , GEUBEL A. P. 
Published: October 2003

Background: Therapeutic trials suggest that lactulose is an effective treatment of acute and chronic encephalopathy in cirrhotic patients. Aim and Methods: As it is likely that portal‐systemic shunting and hepatocellular dysfunction are associated with some degree of neurological dysfunction, 14 patients with cirrhosis and documented portal‐systemic shunting, but without detectable encephalopathy, were randomized to treatment with either lactulose 20 g t.d.s., or lactose 20 g t.d.s. as placebo, for a 15‐day period. Monitoring included manually administered and computer‐based psychometric testing, the results of which were correlated with a battery of biochemical and functional parameters. Results: There was no correlation between biochemical or functional parameters and psychometric testing. There was a close correlation between the time required to complete the number connection test and both the number of errors and the duration of errors at sinusoid testing. Lactulose therapy resulted in a significant improvement, assessed by the number connection test and the race track test. Conclusion: Our data suggest that lactulose therapy might improve subclinical hepatic encephalopathy in patients with cirrhosis and portal‐systemic shunting.
Rectal steroids suppress bone formation in patients with colitis
Authors: ROBINSON R. J. , IQBAL S. J. , WHITAKER R. P. , ABRAMS K. , MAYBERRY F. 
Published: October 2003

Background: The aetiology of bone loss in inflammatory bowel disease is multifactorial, but oral corticosteroids are an important contributory factor. Rectally administered steroids are widely used in patients with distal disease, but very little is known about their effect on bone metabolism. The aim of this study was to investigate the effect of a standard course of rectal prednisolone on biochemical markers of bone turnover. Methods: In a longitudinal study of 10 patients, biochemical markers of bone turnover were measured before, during and after treatment with prednisolone metasulphobenzoate (Predfoam, Pharmax Ltd) 20 mg twice daily for 2 weeks. Bone formation markers measured were serum osteocalcin (BGP), bone‐specific alkaline phosphatase (BALP) and procollagen carboxy‐terminal propeptide (PICP). Urinary deoxypyridinoline (dPyr) was measured to assess bone resorption. Results: Disease activity scores improved during treatment (difference in mean Powell–Tuck score=2.3 (±3.1), 95% CI: 0.11–4.48, P=0.04). There was a significant fall in BALP (P=0.02) during treatment, and a rapid but non‐significant fall in BGP (P=0.19). PICP (0.42), and urinary dPyr (0.30) did not change significantly during treatment. Conclusions: Following a standard 2‐week course of rectal prednisolone metasulphobenzoate, we observed a significant fall in bone‐specific alkaline phosphatase activity. These results suggest that bone formation is suppressed in patients with distal colitis treated with pharmacological doses of rectal steroids.
An evaluation of near‐patient testing for Helicobacter pylori in general practice
Authors: JONES R. , PHILLIPS I. , FELIX G. , TAIT C. 
Published: October 2003

Introduction: A knowledge of Helicobacter pylori status is likely to be important in the management of patients presenting in general practice with dyspepsia. Near‐patient testing kits for the detection of the H. pylori antibodies in whole blood, which provide results very quickly, are now available. Aim: To determine the test characteristics of the Helisal Rapid Blood test in general practice and to describe the ways in which general practitioners incorporate the results of H. pylori testing into their management of patients with dyspepsia. Setting: Nine general practices in the United Kingdom. Patients: Consecutive patients presenting with dyspepsia in whom further investigation or referral was considered. Methods: A whole blood fingerstick sample was tested for H. pylori antibodies using the Helisal Rapid Blood test and a venous sample was obtained for subsequent laboratory testing using Helisal Serum and Helico G (ELISA) methods. Results of the three tests were compared and analysed. Clinical data were recorded by the general practitioners. Results: Full serological data were obtained on 123 patients, mean age 44.8 years. The sensitivity and specificity of the Helisal Rapid Blood test, compared with concordant results of the laboratory tests, were 83% and 78%, respectively. The prevalence of H. pylori‐positive patients was 57%, with a positive predictive value of 83% and a negative predictive value of 78%. The results of the test had a significant impact on the clinical management of the patients in the study. Comment: The Helisal Rapid Blood test is a useful and convenient method of improving the clinical care of patients with dyspepsia in general practice.
Effects of octreotide, a somatostatin analogue, on gastric function evaluated by real‐time ultrasonography
Authors: OKAMOTO E. , HARUMA K. , HATA J. , TANI H. , SUMII K. , KAJIYAMA G. 
Published: October 2003

Background: Somatostatin exerts inhibitory effects on physiological functions in the gastrointestinal tract. The actions differ, however, depending on the test meal, dose, and other factors. Aims: To determine by use of ultrasonography and scintigraphy the effect of a somatostatin analog, octreotide, on gastric emptying and antral contraction. Subjects: Twenty healthy men; mean age 23.9 years Methods: Subjects were studied for 7 days, once after subcutaneous injection of octreotide, 50 μg, 5 min before the ingestion of a test meal and once after subcutaneous injection of placebo. Ten subjects received a liquid meal, 10 others received a solid meal. With the liquid meal, gastric emptying was measured 15 min after its ingestion and antral contraction was measured for 15 min by ultrasonography. With the solid meal, gastric emptying was measured both by ultrasonography (n=10) and by simultaneous scintigraphy (n=6), with antral contraction measured by ultrasonography for 5 h after ingestion of the meal. Results and Conclusions: Octreotide given with a liquid or solid meal inhibited gastric emptying in healthy subjects. A significant suppression of antral contraction occurred only with a solid meal.
Review article: critical review of meta‐analyses of randomized clinical trials in hepatogastroenterology
Authors: AUPERIN A. , PIGNON J.‐P. , POYNARD T. 
Published: October 2003

Background: This review attempts to identify meta‐analyses performed in hepatogastroenterology, and to assess their quality and to identify simple criteria of good quality.Methods: Meta‐analyses of randomized clinical trials in hepatogastroenterology published as full papers before 1993 were included. A quality score was defined as the sum of 27 items evaluated in each publication and coded 2 if adequate, 1 if partial and 0 if missing. Quality criteria were identified by discriminant analysis through three groups of meta‐analyses defined by their quality score (poor, middle, high).Results: From 1981 to 1992, 62 publications were identified, including 42% in the last 2 years. Nineteen per cent concerned peptic ulcers, 18% oesophageal varices and 6% digestive cancers. They reported 180 meta‐analyses. The quality score ranged from 14 to 40, the median was 29. Twenty‐five per cent of the studies obtained a score lower than 23 and 25% a score higher than 34. Several stages of meta‐analysis were poorly performed: identification and selection of trials, study of trial quality, data extraction and achievement of sensitivity analyses, subgroup and indirect analyses. Some of them led to biases and questions about the validity of results. Five criteria were significantly associated with high quality: presence of a protocol, assessment of trial quality, only randomized trials pooled, achievement of sensitivity analyses, and peer‐reviewed publication.Conclusions: In hepatogastroenterology, there is an exponential increase in publication of meta‐analyses but their quality is heterogeneous. In particular, the control of the biases has to be better performed.
Randomized study comparing omeprazole plus amoxycillin versus omeprazole plus clarithromycin for eradication of Helicobacter pylori
Authors: SPINZI G. , BORTOLI A. , COLOMBO E. , LESINIGO E. , VENTURELLI R. , TERRUZZI V. , IMPERIALI G. , MINOLI G. 
Published: October 2003

Background: Dual therapy with omeprazole plus amoxycillin or with omeprazole plus clarithromycin has been proposed for eradication of Helicobacter pylori. The main problem is the great variability in the rate of eradication.Methods: A group of 287 consecutive patients with active peptic ulcers and H. pylori infections were admitted to a prospective, randomized, multicentre study, to be given omeprazole 20 mg b.d. plus either amoxycillin 1 g b.d. or clarithromycin 500 mg t.d.s. for 2 weeks. Cure was defined as the absence of H. pylori infection, 4–6 weeks after completing anti‐microbial therapy, assessed by urease activity and histology of antral and body gastric biopsies.Results: The bacteria were eradicated in 68/143 patients (48%) treated with amoxycillin and omeprazole and 70/144 patients (49%) treated with clarithromycin and omeprazole (intention‐to‐treat analysis). The ulcers were healed in 118/127 patients (93%) treated with amoxycillin and in 115/123 (94%) of those treated with clarithromycin. Undesirable effects were rare with both treatments.Conclusions: Combined treatment with omeprazole plus either amoxycillin or clarithromycin produced a high percentage of short‐term healing of ulcers and was well tolerated, but is not useful as first‐line anti‐Helicobacter pylori treatment.
Double‐blind study of the effect of cisapride on constipation and abdominal discomfort as components of the irritable bowel syndrome
Authors: SCHÜTZE K. , BRANDSTÄTTER G. , DRAGOSICS B. , JUDMAIER G. , HENTSCHEL E. 
Published: October 2003

Aim: To study the effect of prokinetic treatment with cisapride in patients with constipation‐predominant irritable bowel syndrome.Patients and methods: Ninety‐six patients were randomly assigned to treatment with either cisapride 5 mg three times daily or placebo three times daily for a period of 12 weeks. The dosage could be doubled after 4 weeks. Presence of the target symptoms abdominal pain, constipation and abdominal bloating was an obligatory criterion for inclusion in the study.Results: After 12 weeks of treatment, 31%, 56% and 27% of the cisapride treated patients were found to be without the three target symptoms (P<0.05). The corresponding percentages for the placebo‐treated patients were 31%, 58% and 19%, respectively, (P<0.05). The visual analogue scale (VAS) symptom scores assessed by the patients for global rating of bowel disease, general well‐being and frequency of stool passage improved significantly within each treatment group (P<0.05). Evaluation of efficacy parameters using intention‐to‐treat analysis showed no statistically significant differences between the groups. Using efficacy analysis, the difficulty of stool passage showed a significantly higher improvement with cisapride (P0.05).Conclusions: These results indicate that cisapride is not superior to placebo in the treatment of constipation and abdominal discomfort as components of irritable bowel syndrome. It may, hovever, be of use in improving the difficulty of stool passage.
Immediate repeat course of amoxycillin, metronidazole and omeprazole to eradicate Helicobacter pylori
Authors: STRÖM M. , SÖRBERG M. , JÖNSSON K.‐Å. 
Published: October 2003

Aim: To investigate a repeat treatment regimen with the same antibiotic combination of amoxycillin and metronidazole in patients with continuing Helicobacter pylori infection.Methods: Eighty‐two patients with severe peptic ulcer disease and concurrent Helicobacter pylori infection were treated with a two week regimen of omeprazole (40 mg once daily), amoxycillin (750 mg t.d.s.) and metronidazole (400 mg t.d.s.). Upper gastrointestinal tract endoscopy was performed before, and approximately 2 months after, completion of antibiotic therapy. Biopsies were taken for rapid urease testing and the histological demonstration of H. pylori infection. Patients with persistent H. pylori infection at follow‐up endoscopy were re‐treated with a second and identical antibiotic treatment course. A subsequent endoscopic examination with accompanying biopsies was performed at least 6 weeks after the second treatment course and after a further 6, 18 and 30 months.Results: Eradication of H. pylori was achieved in 69 patients (84%, 95% CI: 75–90%) after the first treatment. Four patients (4/82=5%) were withdrawn from the study because of side‐effects. All of the remaining nine patients had their H. pylori infection eradicated after the second treatment course (95% CI: 70–100%). Seventy‐eight patients had a follow‐up examination after a median 30 months of the initial eradication of H. pylori, and all but one remained free of infection and none had an ulcer relapse.Conclusions: This study demonstrates that patients with persistent H. pylori infection after completing a primary course of omeprazole (40 mg once daily), amoxycillin (750 mg t.d.s.) and metronidazole (400 mg t.d.s.) will probably respond to a repeat course of treatment with the same antibiotic combination.
Prescribing of nonsteroidal anti‐inflammatory drugs in general practice: determinants and consequences
Authors: HAWKEY C. J. , CULLEN D. J. E. , GREENWOOD D. C. , WILSON J. V. , LOGAN R. F. A. 
Published: October 2003

Aim: To use Prescribing Analysis and Costs data to investigate factors associated with differences in rates of nonsteroidal anti‐inflammatory drug prescribing in Nottingham general practices.Results: Poisson regression analysis revealed that the Age, Sex and Temporary Resident Prescribing Unit Index was the largest identifiable influence; larger practice size and a higher index of deprivation were also significantly associated with lower prescribing, whilst the number of partners was associated with higher levels of prescribing. However, even after correcting for the influence of age, sex and temporary residents, there was an 5.9‐fold variation in rates of prescribing. A similar Poisson regression analysis to identify factors associated with admission to hospital with ulcer bleeding in the elderly over the preceding 57 months identified the rate of nonsteroidal anti‐inflammatory drug (NSAID) prescribing as the only significant influence.Conclusion: The data are compatible with 1 hospital admission per 2823 NSAID prescriptions (95% confidence intervals 2098–8110) and they emphasize the need for strategies to reduce levels of NSAID prescribing.
Review article: COX‐II inhibitors—a new generation of safer NSAIDs?
Authors: DONNELLY M. T. , HAWKEY C. J. 
Published: October 2003

A hundred years after the introduction of aspirin as the first effective anti‐inflammatory drug, problems of tolerability still beset this class of drugs, in particular, gastrointestinal toxicity. Despite this, NSAIDs are among the most widely used and prescribed drugs world‐wide. Many agents have been used to counteract these side‐effects with varying degrees of success and acceptance.Although the central mechanism of NSAID action, reduced prostaglandin production by cyclooxygenase (COX) inhibition, was first described 25 years ago, the recent discovery of a second, inducible form of cyclo‐oxygenase, COX‐2, has stimulated research and interest in producing NSAIDs that are inherently safer whilst maintaining efficacy.Specific COX‐2 inhibitors, the first of which has recently been marketed in the UK, offer real hope as safer NSAIDs and this may be realised when drugs with even greater specificity become available. However, long‐term safety and efficacy need to be demonstrated in clinical practice, and questions remain unanswered about possible physiological roles for COX‐2.Other approaches to improving the safety of NSAIDs, including profound acid suppression and nitric oxide donation, may prove to be as successful in this rapidly changing field.
One‐week triple therapy with omeprazole, amoxycillin and tinidazole for Helicobacter pylori infection: the significance of imidazole resistance
Authors: THIJS J. C. , VAN ZWET A. A. , THIJS W. J. , VAN DER WOUDEN E. J. , KOOY A. 
Published: October 2003

Background: Triple therapy involving a proton pump inhibitor and two antibiotics has been suggested as an effective treatment for Helicobacter pylori infection. The impact of imidazole resistance on the efficacy of such regimens is largely unknown.Methods: One hundred patients with culture proven H. pylori infection were treated with omeprazole 40 mg b.d., amoxycillin 1000 mg b.d., and tinidazole 500 mg b.d. for one week. Pre‐treatment imidazole susceptibility was measured by disk diffusion. Resistance was confirmed by E‐test. Eradication was assessed by endoscopy 6–8 weeks after the end of treatment. In cases of doubt a 13C‐urea breath test was performed. Side‐effects were scored using a semiquantitative scale.Results: H. pylori was eradicated in 95% of the patients with an imidazole‐susceptible strain and in 69% of the patients with a resistant strain (P<0.005). Significant side‐effects were seen in 12%.Conclusion: This proton pump inhibitor triple therapy is a simple, reasonably effective regimen with few significant side‐effects. The efficacy is dependent on the susceptibility of the infecting H. pylori strain.