bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the main oesophageal pathophysiological characteristics between short‐ and long‐segment Barrett's oesophagus
Authors: Zentilin P. , Conio M. , Mele M. R. , Mansi C. , Pandolfo N. , Dulbecco P. , Gambaro C. , Tessieri L. , Iiritano E. , Bilardi C. , Biagini R. , Vigneri S. , Savarino V. 
Published: March 2003

Aim:To assess the oesophageal manometric characteristics and 24‐h pH profiles of patients with both short‐segment and long‐segment Barrett's oesophagus and compare them with those of patients with reflux oesophagitis and controls.Methods:Seventy‐nine patients who had undergone upper digestive endoscopy were recruited: 16 had short‐segment Barrett's oesophagus, 13 had long‐segment Barrett's oesophagus, 25 had grade III oesophagitis according to the Savary–Miller classification and 25 were used as controls. The diagnosis of Barrett's oesophagus was based on the histological detection of specialized intestinal metaplasia, which extended < 3 cm into the oesophagus in patients with short‐segment disease and > 3 cm in patients with long‐segment disease. All subjects underwent oesophageal manometry and basal 24‐h oesophageal pH monitoring.Results:The lower oesophageal sphincter pressure was significantly lower in patients with reflux oesophagitis and short‐segment and long‐segment Barrett's oesophagus than in controls (P=0.0004–0.0001), but there was no difference among the three reflux groups. The peristaltic wave amplitude of patients with long‐segment Barrett's oesophagus was significantly lower than that of controls (P=0.002) and patients with short‐segment Barrett's oesophagus (P=0.02), but was no different from that of patients with reflux oesophagitis. The percentage of non‐propagated wet swallows was significantly higher in patients with reflux oesophagitis and short‐segment and long‐segment Barrett's oesophagus when compared with that of controls (P=0.0004–0.0001). The total percentage of time the oesophagus was exposed to pH < 4.0 was significantly higher in patients with reflux oesophagitis and short‐segment and long‐segment Barrett's oesophagus (P=0.0001) than in controls, and was higher in patients with long‐segment disease than in those with short‐segment disease (P=0.01).Conclusions:Long‐segment Barrett's oesophagus is characterized by a greater impairment of peristaltic wave amplitude and a higher oesophageal acid exposure than is short‐segment Barrett's oesophagus. However, both forms are linked to increased acid reflux.
Prospective audit of gastroscopy under the `three‐day rule': a regional initiative in Italy to reduce waiting time for suspected malignancy
Authors: Parente F. , Bargiggia S. , Bianchi Porro G. 
Published: March 2003

Background:A regional initiative, called the `three‐day rule', has recently been introduced in Italy to facilitate the earlier diagnosis of malignancy. It requires patients with suspected severe diseases to have a diagnostic procedure performed within three working days of referral by a general practitioner.Aim:To assess prospectively the effectiveness and compliance with the three‐day rule for upper digestive malignancies.Methods:We compared patients referred for gastroscopy under the three‐day rule initiative with contemporaneous open access referrals over a 12‐month period at a single large teaching hospital in west Milan. We compared the prevalence of malignancies and other serious non‐neoplastic diseases as well as the waiting times in the two groups. The appropriateness of the indications for each referral was also reviewed by a gastroenterologist blind to the outcome of the test.Results:One hundred and forty‐two patients referred for gastroscopy under the three‐day rule scheme and 767 routine referrals were studied. Significantly more oesophageal/gastric cancers (6% vs. 1%) and serious benign gastrointestinal lesions (grade II–III oesophagitis or peptic ulcer) were diagnosed in three‐day rule patients in comparison with routine referrals (P < 0.05). The rate of inappropriate referral was significantly lower in the three‐day rule group than in the open access group (39% vs. 22%) (P < 0.01). The estimated cost of the three‐day rule scheme (in extra list examinations alone) was 10 780 euros, with about 1198 euros per diagnosis of cancer, but only 229.5 euros per `useful' diagnosis (including peptic ulcer disease and oesophagitis).Conclusions:Significantly more upper gastrointestinal cancers and serious benign diseases can be found within a short period to comply with the three‐day rule scheme. However, some general practitioners appear to over‐interpret alarm symptoms, leading to some inappropriate referrals. Better awareness of appropriate urgent referral criteria is needed in order to ensure that the best use is made of the resources available.
Perceived food and drug allergies in functional and organic gastrointestinal disorders
Authors: Bhat K. , Harper A. , Gorard D. A. 
Published: March 2003

Background:Gastrointestinal symptoms are often due to functional disorders. Many individuals with abdominal symptoms believe they are allergic to or intolerant of various foods.Aim:To assess whether self‐reported allergy is linked to a subsequent functional or organic diagnosis.Methods:One thousand new patients attending a district hospital gastroenterology clinic completed a questionnaire about believed drug and food allergies and foodstuffs thought to worsen symptoms. No attempt was made to confirm patients' self‐reported allergies or intolerances. Final diagnoses were classified as organic or functional.Results:Nineteen per cent of patients reported drug allergies, 14% reported food allergies and 30% identified foods that worsened symptoms. Atopic patients reported more allergies. Forty‐eight per cent of patients had a functional diagnosis. Women were twice as likely as men to have a functional diagnosis. Patients subsequently diagnosed with a functional disorder were more likely than those with organic disease to report drug allergies (odds ratio, 1.92; 95% confidence interval (CI), 1.39–2.65), food allergies (odds ratio, 4.14; 95% CI, 2.73–6.26) or foods that worsened their abdominal symptoms (odds ratio, 3.08; 95% CI, 2.31–4.10). The likelihood of symptoms being functional increased even further if adverse reactions to both drugs and foods were reported. Patients with weight gain were more likely to report food allergy, and those with both features were very likely to have a functional disorder (odds ratio, 4.58; 95% CI, 3.08–6.86).Conclusions:Patients with gastrointestinal symptoms who report drug or food allergies or worsening of symptoms with various foods are more likely to have functional than organic illness. Enquiry about perceived allergies and intolerances may help in the early identification of functional gastrointestinal disorders.
Paroxetine for the treatment of interferon‐α‐induced depression in chronic hepatitis C
Authors: Kraus M. R. , Schäfer A. , Faller H. , Csef H. , Scheurlen M. 
Published: March 2003

SummaryBackground : Psychiatric side‐effects may require dose reduction or premature discontinuation of interferon therapy in chronic hepatitis C. New strategies are needed in order to prevent the premature termination of interferon therapy.Aim : To evaluate prospectively the efficacy and tolerability of antidepressant therapy (paroxetine, a selective serotonin reuptake inhibitor) in patients with chronic hepatitis C treated with interferon‐α who have developed interferon‐induced major depression.Methods : A sub‐group of 14 individuals from 121 consecutively treated hepatitis C patients developed substance‐induced major depression without suicidal ideation during interferon‐α treatment. The individuals in this sub‐group received paroxetine after the occurrence of depression (20 mg daily until termination of interferon therapy). Diagnostic scores for depression (and anger–hostility) were obtained in a repeated measures design (Hospital Anxiety and Depression Scale and Symptom Checklist 90 Items Revised).Results : Eleven of the 14 patients (78.6%) with interferon‐induced major depression were able to complete interferon‐α therapy as scheduled under concomitant paroxetine treatment (three dropouts: insufficient improvement of depression, occurrence of epileptic seizures, paroxetine‐induced nausea/dizziness). Within 4 weeks after the start of paroxetine medication, depression scores declined significantly in all patients.Conclusions : Our data suggest that concomitant therapy with paroxetine is an effective way to treat interferon‐induced depression in patients with chronic hepatitis C.
Azathioprine in paediatric inflammatory bowel disease: an Italian multicentre survey
Authors: Barabino A. , Torrente F. , Ventura A. , Cucchiara S. , Castro M. , Barbera C. 
Published: March 2003

SummaryAim : To assess the efficacy and safety of azathioprine in a paediatric population with inflammatory bowel disease.Patients and methods : One hundred and twenty‐three Italian children treated with azathioprine were studied retrospectively. The treatment duration and causes of its discontinuation, side‐effects and variation in corticosteroid dose were assessed.Results : The mean age at inflammatory bowel disease diagnosis was 9.8 ± 3.6 years, and at the start of azathioprine therapy 11.8 ± 4.3 years. The mean duration of treatment was 19 ± 16 months. Fifty patients (41%) stopped treatment due to surgery (12%), prolonged remission (11%), non‐response (7%), severe side‐effects (7%) and poor compliance (3%). Of the 73 patients (59%) remaining on azathioprine, 11 had never been treated with corticosteroids, 27 were able to stop them and 35 were still on a very low daily dose (91% < 0.3 mg/kg). The difference in the daily corticosteroid dose between the beginning of azathioprine treatment (1 ± 0.6 mg/kg) and the conclusion of the study (0.18 ± 0.16 mg/kg) was statistically significant. Side‐effects were recorded in 48 of the 123 patients (39%), but only eight required discontinuation of azathioprine.Conclusions : Azathioprine was efficacious in 70% of patients, but ineffective in 20% and induced severe toxicity in 7%. Corticosteroids were stopped or markedly reduced in 62% of patients, but they were never given in 9%.
The potential risk factors leading to peptic ulcer formation in autoimmune disease patients receiving corticosteroid treatment
Authors: Luo J.‐C. , Chang F.‐Y. , Lin H.‐Y. , Lu R.‐H. , Lu C.‐L. , Chen C.‐Y. , Lee S.‐D. 
Published: March 2003

SummaryAim : To study the potential risk factors leading to peptic ulcer disease among autoimmune disease patients on corticosteroid treatment.Methods : One hundred and thirty‐eight corticosteroid‐treated autoimmune disease patients were enrolled; their demographic data were recorded and laboratory data were measured. Endoscopy was performed to assess the occurrence of peptic ulcer disease. Helicobacter pylori infection was diagnosed on the basis of rapid urease test and histological examination.Results : Twenty‐eight (20%) of 138 autoimmune disease patients had peptic ulcer disease, including 17 with gastric ulcer, eight with duodenal ulcer and three with gastric ulcer plus duodenal ulcer. Eighty five (62%) had used non‐steroidal anti‐inflammatory drugs and 46 (33%) had H. pylori infection. The majority of peptic ulcer disease subjects showed the following characteristics: age ≥ 60 years; male; smokers; non‐steroidal anti‐inflammatory drug users, particularly the non‐specific cyclo‐oxygenase inhibitors; presence of hyperpepsinogenaemia I; low H. pylori colonization (P < 0.05). Multivariate analysis revealed that an age ≥ 60 years [odds ratio (OR), 6.80; P = 0.001], smoking (OR, 7.94; P = 0.004) and the use of non‐specific cyclo‐oxygenase inhibitors (OR, 4.71; P = 0.030) were the predominant risk factors for the development of peptic ulcer disease among these patients, whereas H. pylori infection showed a protective role (OR, 0.20; P = 0.022).Conclusions : Old age, smoking and the use of non‐specific cyclo‐oxygenase inhibitors are risk factors for peptic ulcer disease in autoimmune disease patients on corticosteroid treatment. H. pylori infection appears to protect against peptic ulcer disease in these patients.
Furazolidone‐based triple ‘rescue therapy’ vs. quadruple ‘rescue therapy’ for the eradication of Helicobacter pylori resistant to metronidazole
Authors: Isakov V. , Domareva I. , Koudryavtseva L. , Maev I. , Ganskaya Z. 
Published: March 2003

SummaryBackground : The optimal treatment of patients with Helicobacter pylori resistant to metronidazole has not been established.Aim : To compare the efficacy of quadruple and furazolidone‐based triple therapy in the eradication of H. pylori resistant to metronidazole.Methods : Duodenal ulcer patients (n = 70) in whom initial eradication therapy failed and who harboured H. pylori strains resistant to metronidazole were randomized to receive one of the following 7‐day regimens: colloidal bismuth subcitrate, 240 mg, tetracycline, 750 mg, and furazolidone, 200 mg, each given twice daily (BTF), or omeprazole, 20 mg b.d., colloidal bismuth subcitrate, 240 mg b.d., tetracycline, 500 mg q.d.s., and metronidazole, 500 mg b.d. (OBTM). H.pylori status was assessed by culture, histology and rapid urease test before treatment and 4–6 weeks after therapy. Susceptibility to metronidazole was assessed by the agar dilution method.Results : H. pylori eradication rates with intention‐to‐treat/per protocol analyses were: BTF, 85.7%/90.9%; OBTM, 74.2%/89.6%. Duodenal ulcers were healed in nine of 10 (90%) patients in the BTF group and in all patients (12/12) (100%) in the OBTM group (P = N.S.). A significantly lower rate of adverse events was observed in the BTF group than in the OBTM group (31.4% vs. 60%, P = 0.03), but there was no difference in terms of discontinuation of treatment (2/35 vs. 6/35, P = N.S.).Conclusions : The 1‐week BTF regimen was as effective as the OBTM regimen, and produced less adverse events. Thus, it may be used in patients in whom resistance of H. pylori to metronidazole is suspected.
Systematic review: patient‐centred endpoints in economic evaluations of gastro‐oesophageal reflux disease
Authors: Vakil N. , Rydén‐Bergsten T. , Bergenheim K. 
Published: March 2003

SummaryAim : To perform a systematic review of the economic literature on gastro‐oesophageal reflux disease to evaluate (a) the use of patient‐centred effectiveness end‐points, or (b) the use of patient‐centred economic end‐points, and the influence of these end‐points on the outcome of the model.Methods : Three electronic databases (EMBASE, BIOSIS and Medline) were used, together with a manual search of meeting abstracts for relevant articles. The quality of the studies was determined by the Drummond criteria.Results : Our initial search identified 179 articles and a manual search revealed 78 abstracts and articles. A total of 47 studies (36 fully published articles and 11 abstracts) met the seven Drummond criteria for inclusion in our evaluation.Conclusions : This systematic review demonstrates that many of the published economic evaluations available today take the perspective of the third‐party payer and focus on pharmaceutical costs relevant to the third‐party payer. Our study also demonstrates that there are a number of costs of illness determinations, such that pharmaceutical costs account for only a small proportion of the total costs of managing gastro‐oesophageal reflux disease. Future economic analyses should consider an evaluation of the patient's desire for complete symptom relief by including cost–utility assessments or willingness to pay data.
Efficacy of quadruple therapy with pantoprazole, bismuth, tetracycline and metronidazole as rescue treatment for Helicobacter pylori infection
Authors: Boixeda D. , Bermejo F. , Martín‐De‐Argila C. , López‐Sanromán A. , Defarges V. , Hernández‐Ranz F. , Milicua J. M. , García‐Plaza A. 
Published: March 2003

SummaryAim : To study the efficacy of a 7‐day quadruple regimen combining pantoprazole, bismuth, tetracycline and metronidazole as rescue treatment for Helicobacter pylori infection after failure of standard triple therapy.Methods : A prospective study was made of 140 patients infected with H. pylori and diagnosed with peptic ulcer or non‐ulcer dyspepsia in whom triple therapy with proton pump inhibitor, clarithromycin and amoxicillin had failed. The patients were treated with quadruple therapy including pantoprazole, 40 mg twice daily, colloidal bismuth subcitrate, 120 mg four times daily, tetracycline, 500 mg four times daily, and metronidazole, 500 mg three times daily, for 7 days. Two months after completion of therapy, a 13C‐urea breath test was performed to confirm eradication.Results : With quadruple therapy, the H. pylori eradication rates were 82% (95% confidence interval (CI), 75–88%) by ‘intention‐to‐treat’ and 85% (95% CI, 79–91%) by ‘per protocol’. No major side‐effects were observed. No differences in eradication success were observed in relation to underlying disease (peptic ulcer: 85% (95% CI, 76–91%) vs. non‐ulcer dyspepsia: 83% (95% CI, 68–93%)) or smoking habits (smokers: 86% (95% CI, 75–93%) vs. non‐smokers: 83% (95% CI, 71–91%)).Conclusion : Quadruple therapy with pantoprazole, bismuth, tetracycline and metronidazole for 7 days is an effective H. pylori eradication treatment for patients in whom standard triple therapy has failed.
Reappraisal of non‐invasive management strategies for uninvestigated dyspepsia: a cost‐minimization analysis
Authors: Ladabaum U. , Chey W. D. , Scheiman J. M. , Fendrick A. M. 
Published: March 2003

SummaryBackground : The benefits of the Helicobacter pylori test‐and‐treat strategy are attributable largely to the cure of peptic ulcer disease while limiting the use of endoscopy.Aim : To reappraise the test‐and‐treat strategy and empirical proton pump inhibitor therapy for the management of uninvestigated dyspepsia in the light of the decreasing prevalence of H. pylori infection, peptic ulcer disease and peptic ulcer disease attributable to H. pylori.Methods : Using a decision analytical model, we estimated the cost per patient with uninvestigated dyspepsia managed with the test‐and‐treat strategy ($25/test; H.pylori treatment, $200) or proton pump inhibitor ($90/month). Endoscopy ($550) guided therapy for persistent or recurrent symptoms.Results : In the base case (25%H. pylori prevalence, 20% likelihood of peptic ulcer disease, 75% of ulcers due to H.pylori), the cost per patient is $545 with the test‐and‐treat strategy and $529 with proton pump inhibitor, and both strategies yield similar clinical outcomes at 1 year. H. pylori prevalence, the likelihood of peptic ulcer disease and the proportion of ulcers due to H.pylori are important determinants of the least costly strategy. At an H. pylori prevalence below 20%, proton pump inhibitor is consistently less costly than the test‐and‐treat strategy.Conclusions : As the H. pylori prevalence, the likelihood of peptic ulcer disease and the proportion of ulcers due to H. pylori decrease, empirical proton pump inhibitor becomes less costly than the test‐and‐treat strategy for the management of uninvestigated dyspepsia. Given the modest cost differential between the strategies, the test‐and‐treat strategy may be favoured if patients without peptic ulcer disease derive long‐term benefit from H.pylori eradication.
Meta‐analysis: the effect of probiotic administration on antibiotic‐associated diarrhoea
Authors: Cremonini F. , Di Caro S. , Nista E. C. , Bartolozzi F. , Capelli G. , Gasbarrini G. , Gasbarrini A. 
Published: March 2003

SUMMARYBackground : Antibiotic‐associated diarrhoea can be attributed in part to imbalances in intestinal microflora. Therefore, probiotic preparations are used to prevent this diarrhoea. However, although several trials have been conducted, no conclusive evidence has been found of the efficacy of different preparations, e.g. Lactobacillus spp. and Saccharomyces spp.Aim : To conduct a meta‐analysis of the data in the literature on the efficacy of probiotics in the prevention of antibiotic‐associated diarrhoea.Methods : A literature search was performed of electronic databases, Abstract Books and single paper references. Data were also obtained from the authors. Only placebo‐controlled studies were included in the search. The Mantel–Haenszel test was used to estimate the relative risk for single studies and an overall combined relative risk, each study being submitted to the Mantel–Haenszel test for homogeneity.Results : Twenty‐two studies matched the inclusion criteria. Only seven studies (881 patients) were homogeneous. The combined relative risk was 0.3966 (95% confidence interval, 0.27–0.57).Conclusions : The results suggest a strong benefit of probiotic administration on antibiotic‐associated diarrhoea, but further data are needed. The evidence for beneficial effects is still not definitive. Published studies are flawed by the lack of a placebo design and by peculiar population features.
Foetal intrauterine growth restrictions with Helicobacter pylori infection
Authors: Eslick G. D. , Yan P. , Xia H. H.‐X. , Murray H. , Spurrett B. , Talley N. J. 
Published: March 2003

SUMMARYBackground : Helicobacter pylori infection has been associated with growth restriction in young children.Aim : To determine whether there is an association between H. pylori infection and intrauterine growth restriction.Methods : Four hundred and forty‐eight consecutive pregnant women (aged 15–44 years), attending for routine examinations in the third trimester, were enrolled. Clinical, demographic and previous obstetric data, as well as smoking history, were collected. At delivery, the weight, height, gender and status of the neonate were recorded; intrauterine growth restriction was defined if the birth weight was below the 10th percentile according to the gestational age for infants born in Australia.Results : Eighty‐nine (20%) women were seropositive for H. pylori. The prevalence of H. pylori was significantly lower in Caucasians (17%) vs. non‐Caucasians (42%, P < 0.0001). There were 34 (7.5%) cases of intrauterine growth restriction (7% Caucasians, 16% Asians, 12% Aborigines and 0% Pacific Islanders). Intrauterine growth restriction was more common in H. pylori‐seropositive women than in H. pylori‐seronegative women [13.5% vs. 6%; odds ratio (OR)=2.41; 95% confidence interval (CI), 1.14–5.08; P=0.018]. A multiple logistic regression model revealed that smoking (OR=3.55; 95% CI, 1.62–7.79; P=0.002), maternal height (OR=0.48; 95% CI, 0.28–0.80; P=0.005) and H. pylori seropositivity (OR=2.59; 95% CI, 1.12–5.95; P=0.025) were all independent risk factors for intrauterine growth restriction.Conclusions : H. pylori infection in pregnant women may affect foetal intrauterine growth.