bluuebunny/crossref_metadata_2025_split huggingface dataset:
A United States multicentre trial of dual and proton pump inhibitor‐based triple therapies for Helicobacter pylori
Authors: LAINE L. , FRANTZ J. E. , BAKER A. , NEIL G. A. 
Published: October 2003

Background:One‐week proton pump inhibitor‐based triple therapies are very popular in the US despite limited US data documenting efficacy. We assessed 1‐week proton pump inhibitor triple therapies for Helicobacter pylori, and compared them to dual antibiotic therapies (to assess benefit of omeprazole) and to omeprazole–amoxycillin (to assess benefit of clarithro‐ mycin) in a large, randomized, US multicentre study.Methods:Healthy subjects who were H. pylori‐positive by rapid serological test and 13C‐urea breath test were randomly assigned to (i) omeprazole (O) 20 mg b.d. + amoxycillin (A) 1 g t.d.s. for 14 days (OA); (ii) A 1 g b.d. + clarithromycin (C) 500 mg b.d. for 7 days (AC); (iii) C 250 mg b.d. + metronidazole (M) 500 mg b.d. for 7 days (CM); (iv) O 20 mg b.d. + C 250 mg b.d. + M 500 mg b.d. for 7 days (MOC); or (v) O 20 mg b.d. + C 500 mg b.d. + A 1 g b.d. for 7 days (OAC). Repeat breath tests were done at 6 weeks to assess H. pylori status.Results:Three hundred and two H. pylori‐positive subjects at 25 centres received medication. Intention‐to‐treat cure rate was significantly higher for OAC (82%) than for MOC (67%), CM (59%), AC (18%) or OA (58%). Per‐protocol cure rates were 85% for OAC and 75% for MOC. Discontinuation of therapy due to a side‐effect occurred in 0–3% of each study group.Conclusions:One‐week twice‐daily triple therapy with omeprazole, amoxycillin and clarithromycin provides the best rate of eradication of the five regimens studied. However, treatment in the US for 7 days may be unable to achieve eradication rates of ≥ 90% with proton pump inhibitor‐based triple therapy.
Clarithromycin, amoxycillin and H2‐receptor antagonist therapy for Helicobacter pylori peptic ulcer disease in Korea
Authors: BREUER T. , KIM J. G. , EL‐ZIMAITY H. M. T. , NIKAJIMA S. , OTA H. , OSATO M. , GRAHAM D. Y. 
Published: October 2003

Background:Effective anti‐Helicobacter pylori therapies with few side‐effects are needed. We previously showed that the regimen of amoxycillin, clarithromycin and an H2‐receptor antagonist was effective in the United States. The current study tested whether this therapy would also be successful in Korea.Methods:Patients with gastric or duodenal ulcers received amoxycillin (750 mg t.d.s.) plus clarithromycin (500 mg t.d.s.) for 2 weeks and nizatidine 300 mg at bedtime for 6 weeks. Endoscopic examinations were performed before treatment and 4 or more weeks after ending antimicrobial therapy. H. pylori status was confirmed by rapid urease testing and histological examination of gastric antrum and corpus biopsies using the Genta stain. Antibiotic resistance was tested using the E‐test method. Cure was defined as no evidence of H. pylori infection 4 or more weeks after ending therapy.Results:Seventy‐two patients (59 males and 13 females; mean age 46 years), including 35 with duodenal ulcers, 30 with gastric ulcers and seven with both, were studied. H. pylori infection was cured in 95.8% (69/72 patients; 95% CI = 88.3–99.1%). Two of the treatment failures had culture data and one had pre‐treatment resistance to clarithromycin. Smoking did not have an adverse effect on therapy. Ten patients (15%) developed side‐effects during treatment, but all were mild and did not require treatment interruption. No case of reinfection was noted during follow‐up.Conclusion:The combination of amoxycillin, clarithromycin and an H2‐receptor antagonist is effective in Korean patients with H. pylori infection.
Misoprostol in the treatment of chronic refractory constipation: results of a long‐term open label trial
Authors: ROARTY T. P. , WEBER F. , SOYKAN I. , McCALLUM R. W. 
Published: October 2003

Background:Misoprostol is known to be effective in stimulating intestinal transit both in healthy individuals and in patients with chronic constipation when evaluated in short‐term trials. The aim of this study was to determine the utility of misoprostol in the long‐term management of patients with chronic refractory constipation.Methods:Eighteen patients were offered misoprostol (600–2400 μg/day) as adjunctive therapy in an open‐ended, non‐blinded trial. All patients were encouraged to continue the drug for a minimum of 4 weeks, after which time the effect on bowel movement patterns was evaluated and continued use of misoprostol was offered to those patients who demonstrated a clinical benefit.Results:Six patients withdrew prior to 4 weeks because of side‐effects. In the 12 patients who continued the treatment and were evaluated at 4 weeks, the mean interval between bowel movement frequency had decreased from a baseline of 11.25 to 4.8 days (P=0.0004). Eight patients continued the long‐term treatment, with sustained response seen in six. In a subset of patients (n=4) the effect of single‐dose misoprostol (400 μg) was evaluated compared to healthy controls (n=5) on post‐prandial segmental colonic motility. Misoprostol augmented the colonic motility response to a meal throughout the colon, and this was significantly greater in the left versus right colonic segments (P < 0.05).Conclusions:Misoprostol can be effective as part of the long‐term medical treatment of patients with chronic refractory constipation, but side‐effects are observed at higher doses and can be a limiting factor. Part of misoprostol's action may be mediated through the augmentation of colonic motility, particularly of the left colon.
Haemodynamic responses to a combination of terlipressin and octreotide in portal hypertensive rats
Authors: MOREAU R. , CAILMAIL S. , VALLA D. , LEBREC D. 
Published: October 2003

Background:An enhancement of the haemodynamic effects of terlipressin by octreotide (and vice versa) may be useful in the treatment of portal hypertension. The aim of this study was to investigate the short‐term effects of terlipressin, octreotide or a combination of these substances on splanchnic and systemic haemodynamics in rats with portal vein stenosis.Methods:Eight rats received an intravenous (i.v.) infusion of isotonic saline (10 μL/min for 15 min). Eight rats received terlipressin first (0.05 mg/kg) and then an i.v. infusion of octreotide (8 μg.h/kg for 15 min) 15 min later. Eight other rats first received an i.v. infusion of octreotide and then terlipressin 15 min later. Splanchnic and systemic haemodynamics (radioactive microsphere method) were measured after saline, after terlipressin or octreotide alone, and after the combined treatments.Results:Terlipressin and octreotide alone significantly decreased portal pressure, portal tributary blood flowand cardiac index. Terlipressin, but not octreotide, significantly increased heptocollateral vascular resistance and arterial pressure. Octreotide administration in rats pre‐treated with terlipressin did not change portal pressure, caused portal tributary blood flow to increase and decreased hepatocollateral vascular resistance; it also decreased arterial pressure but not cardiac index. Terlipressin administration in rats pre‐treated with octreotide further decreased portal pressure, portal tributary blood flow and increased hepatocollateral vascular resistance; terlipressin increased arterial pressure and further decreased cardiac index.Conclusions:In rats with portal vein stenosis, octreotide decreased short‐term splanchnic and systemic vasoconstriction due to terlipressin. In contrast, terlipressin enhanced the splanchnic and systemic vasoconstriction due to octreotide. Thus, the haemodynamic responses to the combination of octreotide and terlipressin depend on the order of administration of these substances.
Effects of a new motilide, ABT‐229, on gastric emptying and postprandial antroduodenal motility in healthy volunteers
Authors: VERHAGEN M. A. M. T. , SAMSOM M. , MAES B. , GEYPENS B. J. , GHOOS Y. F. , SMOUT A. J. P. M. 
Published: October 2003

Methods:ABT‐229 is a recently developed derivative of erythromycin, devoid of antibiotic activity. We studied the effect of ABT‐229 on gastric emptying and postprandial antroduodenal motility in healthy volunteers.Methods:Placebo, 4 and 16 mg ABT‐229 were given as a single oral dose to nine healthy volunteers, in a randomized, 3‐period crossover design. A solid meal (250 kcal) was given twice, 45 min after drug ingestion and 4 h later. Gastric emptying of each meal was studied using the 13C‐octanoic breath test. Antroduodenal motility was recorded during the total 9‐h period.Results:After the first meal, both the 4 and 16 mg doses increased the gastric emptying rate to a similar extent. ABT‐229 stimulated the contractile motility of the antrum dose‐dependently. The half‐emptying time and the lag‐phase of gastric emptying correlated with the number of pressure waves that were propagated over the antrum and the mean amplitude of antral pressure waves. After the second meal no significant effects of ABT‐229 were found.Conclusions:A single dose of the new motilin agonist ABT‐229 strongly increases the gastric emptying rate in healthy volunteers by increasing the strength and length of propagation of antral pressure waves. ABT‐229 has the potential to become a new prokinetic drug.
Review article: treatment of Clostridium difficile infection
Authors: ZIMMERMAN M. J. , BAK A. , SUTHERLAND L. R. 
Published: October 2003

Aim:A systematic review of controlled trials of therapy of Clostridium difficile intestinal infection using methodology described by the Cochrane Collaboration.Methods:Trials were identified by searching computer databases over the years 1978–1996. Trials were included if they were (a) prospective randomized, controlled trials and (b) included patients with symptomatic disease. The primary end‐point was clinical resolution of diarrhoea. Secondary end‐points were clinical relapse and stool clearance of C. difficile and C. difficile toxin.Results:Nine trials (469 patients) satisfying the inclusion criteria were identified. Two trials were placebo controlled. Six trials compared vancomycin to other antibiotics (fusidic acid, bacitracin, teicoplanin and metronidazole). For clinical resolution response rates ranged from 21 (placebo) to 100% (vancomycin). On pooling the trials, no antibiotic showed clear therapeutic superiority. Rates of clinical relapse ranged from 5 to 42%. Only one trial showed significant advantage of one antibiotic over another for prevention of relapse (teicoplanin vs. fusidic acid).Conclusion:The published data are limited, and further studies are required.
A comparison between gastric and oesophageal variceal haemorrhage treated with transjugular intrahepatic portosystemic stent shunt (TIPSS)
Authors: STANLEY A. J. , JALAN R. , IRELAND H. M. , REDHEAD D. N. , BOUCHIER I. A. D. , HAYES P. C. 
Published: October 2003

Background: Transjugular intrahepatic portosystemic stent‐shunts (TIPSS) are becoming widely used in the management of oesophageal variceal haemorrhage (OVH). Their place in the treatment of gastric variceal haemorrhage (GVH), a condition with a traditionally poor prognosis, remains unclear. The aims of our study were to compare portal haemodynamics and patient outcome in patients undergoing TIPSS for either GVH or OVH. Patients and Methods: 106 consecutive patients undergoing TIPSS at our institution for either GVH (32 patients) or OVH (74 patients) were studied. The groups were similar with regard to patient age, aetiology and severity of liver disease and number of procedures carried out as an emergency (34.4% vs. 36.5%). Episodes of shunt insufficiency, rebleeding, encephalopathy and other clinical sequela were recorded. Mean follow‐up was similar in both patient groups (14.2 vs. 12.1 months). Results: Baseline portocaval pressure gradient was lower in patients with GVH compared with those with OVH (13.0±0.9 mmHg vs. 19.0±0.6 mmHg) (P< 0.001). Rates of variceal rebleeding, encephalopathy and shunt insufficiency during follow‐up were similar in both groups and there was no difference in survival. Conclusion: Patients with GVH had markedly lower portocaval pressure gradients than those with OVH, but shunt and clinical complications and survival were similar during follow‐up. TIPSS appears to be an effective treatment for GVH and should be compared with endoscopic or surgical techniques in controlled trials.
NO‐naproxen vs. naproxen: ulcerogenic, analgesic and anti‐inflammatory effects
Authors: DAVIES N. M. , RØSETH A. G. , APPLEYARD C. B. , MCKNIGHT W. , DEL SOLDATO P. , CALIGNANO A. , CIRINO G. , WALLACE J. L. 
Published: October 2003

Background: A novel class of nitric oxide‐releasing nonsteroidal anti‐inflammatory drug (NO‐NSAID) derivatives has recently been described which exert anti‐inflammatory activities but produce significantly less gastrointestinal injury than the parent NSAID from which they are derived. The present studies were performed to determine if a nitroxybutylester derivative of naproxen was less ulcerogenic to the gastrointestinal tract than its parent NSAID, and if it exerted comparable analgesic and anti‐inflammatory properties to the parent NSAID. Methods: The two drugs were compared in an acute gastric injury model, an antral ulcer model and after twice‐daily administration for 18 days (small intestinal damage model). Anti‐inflammatory activity was examined in the carrageenan‐induced paw oedema model, while analgesia was examined in the acetic acid‐induced writhing model. The pharmacokinetic profiles of naproxen vs. NO‐naproxen were compared by HPLC analysis. Results: NO‐naproxen was found to produce significantly less gastric damage despite inducing similar increases in plasma TNFα to naproxen. With chronic administration, small intestinal damage was markedly less with NO‐naproxen than with the parent NSAID. However, NO‐naproxen exerted superior analgesic and comparable anti‐inflammatory effects to naproxen. NO‐naproxen was not completely converted to naproxen, but the reduced plasma levels of the latter was not the underlying reason for reduced gastrointestinal toxicity of NO‐naproxen. Conclusion: NO‐naproxen represents a novel, gastrointestinal‐sparing NSAID derivative with superior analgesic and comparable anti‐inflammatory properties to naproxen.
One‐day intensified lansoprazole‐quadruple therapy for cure of Helicobacter pylori infection
Authors: DE BOER W. A. , VAN ETTEN R. J. X. M. , SCHADE R. W. B. , OUWEHAND M. E. , SCHNEEBERGER P. M. , VAN UNNIK A. J. M. , TYTGAT G. N. J. 
Published: October 2003

Background: Peptic ulcer patients need to be treated with antimicrobials to cure Helicobacter pylori infection. Seven‐day quadruple therapy is the regimen with the highest cure rates. An ultra‐short quadruple therapy was evaluated prospectively. Methods: Forty‐six consecutive H. pylori positive patients (33 had proven ulcer disease) were prescribed lansoprazole 30 mg b.d. on days 1–4, and on day 4 they received in addition tripotassium dicitrato bismuthate 120 mg, tetracycline 250 mg and metronidazole 250 mg at 09.00, 11.00, 13.00, 15.00, 17.00, 19.00, 21.00, 23.00 hours. Repeat endoscopy with biopsies for CLOtest, Giemsa stain and culture was carried out 6 weeks later. Results: Follow‐up was complete. Overall cure rate (all three biopsy‐based tests negative) was 26/46 (57%; 95% CI: 41–71%). Antibiotic sensitivity was available in 42. Thirty‐nine carried a metronidazole sensitive strain and 23/39 (59%) were cured, three carried a resistant strain and therapy failed in all. Three out of four in whom susceptibility was unknown were cured. Metronidazole resistance was induced in 8 out of 16 with a sensitive strain. Only one patient (3%) reported severe side effects. Conclusions: This convenient quadruple regimen showed that a short contact time is sufficient to kill H. pylori in vivo. Since 57% of patients are cured with a 14‐h treatment, a slightly longer treatment duration may increase the cure rate to above 90%.
Efficacy and tolerance of mesalazine suppositories vs. hydrocortisone foam in proctitis
Authors: LUCIDARME D. , MARTEAU P. , FOUCAULT M. , VAUTRIN B. , FILOCHE B. 
Published: October 2003

Background: Topical treatments with steroids or mesalazine are the most effective treatments for idiopathic proctitis.Aim: to compare the efficacy and tolerance of mesalazine suppositories vs. hydrocortisone acetate foam in the treatment of acute proctitis.Patients and methods: 242 patients with active idiopathic proctitis were randomized to receive once daily either one Pentasa suppository (mesalazine 1 g) or 100 mg hydrocortisone (Colofoam) for 14–21 days (until remission). Disease activity and tolerance of the treatments were assessed using a daily questionnaire, by physician assessment, and endoscopy score.Results: Both treatments induced a significant reduction in disease activity. Mesalazine suppositories were significantly more effective than hydrocortisone on rectal blood loss (P=0.002) and mucus (P=0.02) parameters, and on the degree of the decrease in endoscopy score (P=0.02). No significant difference was observed between treatments concerning histology or tolerance.Conclusion: Mesalazine suppositories were as well‐tolerated as hydrocortisone foam, but were more effective for some parameters of disease activity.
Anti‐thyroid drugs decrease mucosal damage in a rat model of experimental colitis
Authors: OREN R. , MAARAVI Y. , KARMELI F. , KENET G. , ZEIDEL L. , HUBERT A. , ELIAKIM R. 
Published: October 2003

Background: Methimazole, an anti‐thyroid drug, was recently found to be useful in the treatment of systemic lupus erythematosus and other autoimmune diseases. Moreover, decreased thyroid hormone production is associated with a variety of immunological manifestations, such as reduced activation of CD4+ cells, increased CD8+ cell activity and reduced soluble IL‐2 receptors. In the present study we examined the effects of methimazole and propylthiouracil on a rat model of experimental colitis.Methods: Colitis was induced by intracolonic administration of 30 mg trinitrobenzene sulphonic acid (TNB). Two weeks prior to induction of colitis, rats were treated by either methimaziole (0.04%) or propylthiouracil (0.01%) in drinking water after a week of free access to water. Rats were sacrificed 48 h or 7 days after induction of colitis. The colon was isolated, rinsed with ice‐cold water and weighed. Damage was assessed both macroscopically and microscopically and myeloperoxidase (MPO) activity determined.Results: All treated rats were hypothyroid as manifested by a significant elevation of thyroid stimulating hormone (TSH), by comparison with the control groups (mean ‐1.82±0.40 versus 0.11±0.02 mmol/L, respectively). The inflammatory response elicited by TNB resulted in severe mucosal damage 48 h after damage induction, which persisted for 7 days. Pre‐treatment with either methimazole 0.04% or propylthiouracil 0.01% significantly decreased mucosal damage macroscopically (lesion area, lesion score and segmental weight) microscopically and also significantly decreased MPO level at both time points (P<0.01).Conclusions: Methimazole and propylthiouracil significantly reduce mucosal damage and colonic weight in a rat model of colitis. The mode by which they do so remains to be studied.
Efficacy and tolerability of a one‐week triple therapy consisting of pantoprazole, clarithromycin and amoxycillin for cure of Helicobacter pylori infection in patients with duodenal ulcer
Authors: LABENZ J. , TILLENBURG B. , WEISMÜLLER J. , LÜTKE A. , STOLTE M. 
Published: October 2003

Background: Previous studies have shown that one‐week triple therapy consisting of omeprazole, clarithromycin and amoxycillin may cure Helicobacter pylori infection in the vast majority of patients. The present study was designed to test the hypothesis that a triple therapy with pantoprazole, clarithromycin and amoxycillin cures the infection in 80% of duodenal ulcer patients infected with H. pylori. Methods: In an open two‐centre study, 60 duodenal ulcer patients were treated with pantoprazole 40 mg b.d., clarithromycin 500 mg b.d. and amoxycillin 1 g b.d. for 1 week. During the second week patients received pantoprazole 40 mg once in the morning. We assessed H. pylori infection before treatment and 4 weeks after cessation of the study medication by a rapid urease test, histology after Warthin–Starry stain and a 13C‐urea breath test. Results: Sixty patients (42 males, mean age 47.4 years) entered the trial. All patients were infected with H. pylori. One patient was withdrawn from the study because of allergy to penicillin and six patients were protocol violators. H. pylori infection was cured in 47 out of 53 patients who completed the trial according to the protocol (89%; 95% CI: 80–97%) and in 49 of 60 patients included in the trial (82%; 95% CI: 72–92%). Four weeks after the last administration of study drugs, 55 out of 60 ulcers had healed (92%). Twenty‐nine patients reported 51 adverse events that were mostly mild to moderate. Conclusions: One‐week triple therapy consisting of pantoprazole, clarithromycin and amoxycillin is a simple and effective approach to the cure of H. pylori infection in patients with duodenal ulcer. In those patients who took the drugs as prescribed the H. pylori cure rate was 89%, with the lower 95% confidence limit being 80%.
Helicobacter pylori serology and the management of young dyspeptics: a UK survey of gastroenterologists and general practitioners with an interest in gastroenterology
Authors: LIM A. G. , MARTIN R. M. , MONTILEONE M. , WALKER A. C. , GOULD S. R. 
Published: October 2003

Aim: To survey the current use of Helicobacter pylori serology for pre‐endoscopy screening and management of young dyspeptics amongst gastroenterologists and general practitioners with an interest in gastroenterology in the United Kingdom.Methods: A postal questionnaire was sent to 536 members of the British Society of Gastroenterology and 164 members of the Primary Care Society in Gastroenterology.Results: Of those who responded (66%), 25% of general practitioners and 17% of gastroenterologists were using H. pylori serology as a screening test for young dyspeptics. General practitioners and gastroenterologists differed in their use of serology to guide management strategies (P<0.0003): general practitioners eradicate infection from sero‐positive patients prior to endoscopy (92%), whilst the majority of gastroenterologists endoscope sero‐positive patients before treatment (55%). More gastroenterologists (89%) would re‐test all or selected patients to assess eradication compared to general practitioners (45%). 106 different drug regimes were being used as first line treatment.Conclusions: H. pylori serology as a pre‐endoscopy screening test for young dyspeptic patients was used by only a fifth of respondents. There were wide variations in attitudes and practice in the way H. pylori serology was used in the management of young dyspeptics. Trials comparing clinical outcome and cost‐effectiveness of different serology‐based strategies are needed.