bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of osmolality in the absorption of a nutrient solution
Authors: Pfeiffer  , Schmidt  , Kaess  
Published: March 2003

Background:Loss of water during enteral nutrition following massive intestinal resection may be severe. Low osmolality of oral rehydration solutions has recently been shown to mediate an increase in water absorption.Aim:To evaluate the effect of osmolality of a nutrient solution on the intraluminal duodenojejunal water flow, and the net absorption rates of total nitrogen and carbohydrate.Methods:Eight healthy volunteers with a mean age of 27 (range 25–29) years participated in the study. Enteral nutrition (17% protein, 59% carbohydrate, 24% lipid plus 5 g/L PEG 4000) was infused (5 mL/min 2.64 kcal/min) into the descending duodenum either as a hypotonic (160 mOsmol/kg) or as an isotonic solution in a random order. Intestinal samples were aspirated 20 and 45 cm distally to the infusion point.Results:Intraluminal water flow rates were significantly lower with the hypotonic solution than with the isotonic solution, both in the duodenum (4.9 ± 0.3 vs. 6.7 ± 0.5 mL/min; P < 0.02) and the upper jejunum (3.0 ± 0.1 vs. 3.9 ± 0.2 mL/min; P < 0.005). The net absorption rates of total nitrogen and carbohydrate were similar with both solutions.Conclusion:Low osmolality of a nutrient solution decreases intraluminal water flow rates in the upper intestine without affecting the absorption rates of total nitrogen and carbohydrate. Compared with an isotonic solution, the use of a hypotonic solution might lower the water loss in patients with extensive short bowel intestinal resection.
Nizatidine in combination with amoxycillin and clarithromycin in the treatment of Helicobacter pylori infection
Authors: Talley  , Full‐Young  , Wyatt  , Adams  , Lau  , Borody  , Tseng‐Shing  , Daskolopolos  , Cheung  , Talley  
Published: March 2003

Background:The efficacy of H2‐antagonists in combination with antibiotics in curing Helicobacter pylori infection remains controversial, and it is uncertain whether double dose H2‐antagonist therapy is superior to standard dose.Aim:To determine the efficacy of two doses of nizatidine in combination with two antibiotics in the treatment of H. pylori.Methods:A randomized controlled trial was conducted in 160 patients comparing nizatidine l50 mg with 300 mg b.d. (standard vs. double dose), in combination with clarithromycin (500 mg) and amoxycillin (1000 mg) b.d. for 14 days, in Australia and Taiwan. Compliance was based on a clinical assessment and pill count. H. pylori status was determined by histology (antrum and corpus) and CLO‐test.Results:Baseline clinical and endoscopic findings were similar in both arms of the study. Based on an intention‐to‐treat analysis, cure of H. pylori was achieved in 78% (95% CI: 70.4–85.4%) in the standard nizatidine dose arm and 70% (95% CI: 61.6–78.2%) in the double dose arm (P = 0.2). Similar cure rates were observed in ulcer and non‐ulcer patient groups. Compliance was excellent in the single and double dose arms (85 and 91%, respectively).Conclusions:The combination of nizatidine in standard or double dose with clarithromycin and amoxycillin is similarly efficacious in curing H. pylori infection.
Evaluation of short‐term low‐dose triple therapy for the eradication of Helicobacter pylori by factorial design in a randomized, double‐blind, controlled study
Authors: Bazzoli  , Zagari  , Pozzato  , Varoli  , Fossi  , Ricciardiello  , Alampi  , Nicolini  , Sottili  , Simoni  , Roda  , Roda  
Published: March 2003

BackgroundStudies demonstrating the efficacy of short‐term low‐dose triple therapies including omeprazole (O), clarithromycin (C) and a nitroimidazole (tinidazole, T) for Helicobacter pylori eradication have largely been open and uncontrolled, and have not assessed antibiotic sensitivity. Simpler regimens using the component drugs have not been evaluated.AimTo evaluate the OCT regimen in a randomized, controlled trial, testing for pre‐ and post‐treatment antibiotic resistance and comparing, in a factorial design, the OCT regimen with simpler combinations of its components.MethodsOne hundred and twenty‐eight patients (68 males, 60 females, age 22–80 years, mean 53 years) with H. pylori gastritis were randomly assigned to one of the following four treatment groups: (C) clarithromycin 250 mg b.d.; (OC) omeprazole 20 mg o.d. + clari‐thromycin 250 mg b.d.; (CT) clarithromycin 250 mg b.d. + tinidazole 500 mg b.d.; (OCT) omeprazole 20 mg q.d.s. + clarithromycin 250 mg b.d. + tinidazole 500 mg b.d. The drugs were administered for 1 week. Medical interview, upper gastrointestinal endoscopy (with four antral and four corpus biopsies) and the 13C‐urea breath test were carried out for all patients prior to and 4 weeks after treatment. Biopsy specimens were used for the urease test, histology, and culture and sensitivities.ResultsAll but one patient completed treatment. Side‐effects were rare and mild in all groups. The eradication rate was 93.8% in group OCT, 59.4% in group CT, 31.3% in group OC and 6.3% in group C. Pre‐treatment metronidazole resistance was 12.8%, clarithromycin 1.1% and, to both antibiotics, 2.1%. In patients with pre‐treatment metronidazole resistance, the eradication rate was 75% in group OCT and 33% in group CT. Post‐treatment resistance to clarithromycin was induced in 28.5% of the failures in group C, but in none of group OC. Resistance to both antibiotics occurred in 22.2% of the failures in group CT and in none of group OCT.Conclusions(i) The high efficacy of the OCT regimen is proved and each of the individual components of the regimen is essential to the result, possibly via a synergistic effect. (ii) Pre‐treatment metronidazole resistance is scarcely relevant to the outcome. (iii) Acquired resistance is essentially nil if omeprazole is part of the regimen.
Efficacy and safety of three 7‐day Helicobacter pylori eradication regimens containing ranitidine bismuth citrate
Authors: Ricciardiello  , Cannizzaro  , D’angelo  , Ederle  , Gerace  , Iaquinto  , Reina  , Scarpulla  , Spadaccini  , Olivieri  , Tosatto  , Fossi  , Pozzato  , Zagari  , Bazzoli  , Roda  
Published: March 2003

Background:This multicentre, randomized study was designed to assess the clinical efficacy, safety and tolerability of three novel 7‐day triple therapies containing ranitidine bismuth citrate (RBC) and two antibiotics.Methods:We studied patients with non‐ulcer dyspepsia and gastritis who were randomly assigned to one of three treatment regimens given for 7 days in a b.d. dosing schedule: RBC 400 mg plus clarithromycin 250 mg and tinidazole 500 mg (RBCCT); RBC 400 mg plus clarithromycin 500 mg and amoxycillin 1 g (RBCCA); RBC 400 mg plus tinidazole 500 mg and amoxycillin 1 g (RBCTA). H. pylori status was determined by CLO‐test, histology and 13C‐urea breath test. A repeat breath test was performed at least 28 days after completion of therapy to assess eradication.Results:One hundred and fifty‐seven patients were eligible for intention‐to‐treat analysis (ITT) and 140 patients completed the study and returned for assessment of eradication. Intention‐to‐treat cure rates were 78% with RBCCT, 71% with RBCCA and 61% with RBCTA. An all‐patients‐treated analysis (APT), performed on evaluable patients, demonstrated eradication rates of 85% with RBCCT, 81% with RBCCA and 70% with RBCTA. No statistically significant difference was found between treatment groups. Twenty‐four patients experienced side‐effects, but in only seven cases was treatment discontinued due to adverse events.Conclusions:A 7‐day course of RBC, clarithromycin and either tinidazole or amoxycillin provides a good rate of H. pylori eradication. Three novel RBC‐based triple therapies proved to be safe and well tolerated, with discontinuations due to side‐effects occurring in less than 5% of cases.
Two‐week course of pantoprazole combined with 1 week of amoxycillin and clarithromycin is effective in Helicobacter pylori eradication and duodenal ulcer healing
Authors: Louw  , Rensburg  , Hanslo  , Grundling H. DeK. , Girdwood  , Marks  
Published: March 2003

Background:Experience with proton pump inhibitor‐based triple therapy is predominantly with omeprazole‐containing regimens.Aim:To investigate the efficacy of a pantoprazole‐based regimen, with either a 1 or 2‐week course of antibiotic co‐therapy, in eradicating H. pylori, healing duodenal ulcers and to assess the antibiotic sensitivity profiles of isolated H. pylori strains.Methods:A single‐blind, multicentre, parallel group comparison of patients with endoscopically proven, H.␣pylori associated, active duodenal ulceration. All patients received pantoprazole, 40 mg b.d. for 2 weeks. Patients were randomized to receive either 1 or 2 weeks of therapy with amoxycillin, 1 g b.d. and clarithromycin 500 mg b.d. Patients were endoscoped at entry, at 14 days and a minimum of 4 weeks after cessation of all therapy. H. pylori status was determined by urease reaction, histological assessment and culture from antral and body biopsies. Antibiotic sensitivity was determined using the agar dilution technique.Results:Sixty‐seven patients were randomized. One week co‐therapy (n = 33): eradication efficacy, ITT = 79% (95% CI: 61–91%); ulcer healing efficacy (at 6‐week visit) = 88% (95% CI: 72–97%). Two‐week co‐therapy (n = 34): eradication efficacy, ITT = 91% (95% CI: 76–98%; ulcer healing efficacy = 88% (95% CI: 73–97%). Both regimens were well tolerated and no primary antibiotic resistance was noted.Conclusion:Pantoprazole‐based triple therapy, with either 1 or 2 weeks of co‐therapy with amoxycillin and clarithromycin, is effective in eradicating H. pylori and healing duodenal ulceration.
The effect of healing oesophagitis on oesophageal motor function as determined by oesophageal scintigraphy and ambulatory oesophageal motility/pH monitoring
Authors: Dougall N. I. M C , Mooney R. B. , Ferguson W. R. , Collins J. S. A. , Mcfarland R. J. , Love A. H. G. 
Published: March 2003

Background:Oesophagitis has been shown by standard manometry to be associated with impaired oesophageal motility, but it remains unclear if this abnormality improves with healing of oesophagitis.Aim:To determine if healing of oesophagitis improves oesophageal motility using solid bolus oesophageal transit scintigraphy and combined ambulatory oesophageal motility/pH monitoring.Methods:Patients with grade II–III oesophagitis underwent ambulatory motility/pH monitoring (using a Konigsberg catheter with four pressure transducers at 5 cm intervals) and solid bolus scintigraphy before and after treatment with omeprazole 20 mg b.d. for 8–14 weeks.Results:Three (11%) of the 28 patients failed to heal. Initial scintigraphy was abnormal in 18 (67%) of 27 patients (one refused scintigraphy). Twenty‐three of the 25 healed patients had repeat studies showing no significant change in the number which were abnormal (16 (64%), P = 1.0) or the overall oesophageal transit time (P = 0.65). Due to intolerance of the technique, only 11 patients had ambulatory motility/pH performed both before and after healing, giving the study 90% power to detect a 5 mmHg increase in peristaltic amplitude. No significant improvement was seen in any motility or pH parameter after healing of oesophagitis.Conclusion:Analysis of oesophageal motility showed no improvement in peristaltic activity after healing of oesophagitis, suggesting that the abnormal motility is either a primary disorder or an irreversible consequence of mucosal damage.
Comparison of 24‐h control of gastric acidity by three different dosages of pantoprazole in patients with duodenal ulcer
Authors: Savarino  , Mela  , Zentilin  , Bisso  , Pivari  , Vigneri  , Termini  , Fiorucci  , Usai  , Malesci  , Celle  
Published: March 2003

BackgroundIt is now clear that the extent to which gastric acid secretion must be suppressed varies with the clinical condition being treated.AimTo assess the 24‐h control of gastric acidity and the individual response variability of three different doses of pantoprazole.MethodsSixty‐four duodenal ulcer patients were recruited for this prospective, randomized, multicentre, double‐blind, parallel‐group study. They were subdivided into three well‐matched groups treated with 20 mg o.m., 40 mg o.m. and 40 mg b.d. of pantoprazole, respectively. Endoscopy and intragastric pH monitoring were performed in each patient before and after 14 days of treatment.ResultsFifty‐five patients were eligible for final analysis (17 treated with 20 mg o.m., 18 with 40 mg o.m. and 20 with 40 mg b.d. pantoprazole). The ulcer crater healed in 94, 88 and 95% of cases, respectively. The three dosages of pantoprazole produced significant increases in gastric pH compared to basal levels (P < 0.0001). There was also a clear dose‐dependent pharmacodynamic effect, which augmented on moving from the lowest dosage of 20 mg o.m. pantoprazole to the highest dosage of 40 mg b.d. (P < 0.01–0.001). The inter‐individual response variability within the three treatment groups was more marked with the dose of 20 mg than with the two higher doses of pantoprazole.ConclusionsAll three doses of pantoprazole we tested are highly effective in decreasing gastric acidity and there is a clear dose‐dependent pharmacodynamic effect on moving from the lowest to the highest dosage. The greatest inter individual variation in the degree of acid inhibition was seen with pantoprazole 20 mg o.m., while the majority of patients responded adequately to the two higher doses of the drug.
A placebo‐controlled trial to assess the effects of 8 days of dosing with rabeprazole versus omeprazole on 24‐h intragastric acidity and plasma gastrin concentrations in young healthy male subjects
Authors: Williams  , Sercombe  , Hamilton  , Pounder  
Published: March 2003

Background:Rabeprazole (LY307640, E3810) is a new, potent, proton pump inhibitor. A single daily 20 mg dose significantly decreases 24‐h intragastric acidity. There are no data currently available directly comparing the effect of rabeprazole on 24‐h acidity with established proton pump inhibitors.Aim:To compare the effects of rabeprazole 20 mg o.m. and omeprazole 20 mg o.m. on 24‐h intragastric acidity and plasma gastrin concentration in a randomized, double‐blind, placebo‐controlled trial, in healthy H. pylori‐negative subjects.Methods:Twenty‐four healthy male volunteers, negative for H. pylori infection by serology and 13C‐urea breath test, were studied on the 1st and 8th day of dosing with either placebo, rabeprazole 20 mg or omeprazole 20 mg, once each morning, in a crossover fashion. On days 1 and 8, hourly intragastric acidity was measured by gastric aspiration for 24 h from 08.00 hours. On day 8, plasma gastrin concentrations were also measured hourly from 08.00 to 24.00 hours, then every 2 h thereafter.Results:A single dose of both rabeprazole and omeprazole significantly decreased 24‐h intragastric acidity compared with placebo. The 24‐h acidity on day 1 was significantly decreased for rabeprazole compared with omeprazole (331 vs. 640 mmol.h/L, P < 0.001), resulting in a significantly higher median 24‐h intragastric pH and longer times at which intragastric pH was>  3 and>  4. On day 8 of dosing, the decrease in 24‐h intragastric acidity was greater with rabeprazole than with omeprazole, but the difference was not statistically significant (160 vs. 218 mmol.h/L, P = 0.1). However, 24‐h plasma gastrin concentration (1687 vs. 1085 pmol.h/L, P < 0.01) and percentage time that intragastric pH was>  3 (69 vs. 59%, P = 0.008) and>  4 (60 vs. 51%, P = 0.03) were significantly greater.Conclusions:Rabeprazole 20 mg once daily has a significantly faster onset of antisecretory activity than omeprazole 20 mg once daily. After 8 days the differences in intragastric pH > 3 and>  4 holding times persisted, but there was no significant difference in 24‐h acidity.
Anti‐diarrhoeal effects of seirogan in the rat small intestine and colon examined in vitro
Authors: MEERVELD B. GREENWOOD‐VAN , TYLER  , KUGE  , OGATA  
Published: March 2003

Background:Seirogan is a beechwood extract composed of guaiacol, creosol and other related phenolic compounds which is widely used as an anti‐diarrhoeal agent in Asia. Abnormalities in water and electrolyte transport are often the cause of diarrhoea, but the mechanism of action of seirogan on small intestinal and colonic mucosal ion transport is unknown.Aim:To examine the effect of seirogan on electrogenic ion transport in vitro.Methods:Sheets of rat jejunum and colon were mounted in Ussing chambers, and transmural potential difference (PD) was used as an electrical marker of changes in mucosal ion transport. Hypersecretory conditions were induced by acetylcholine (ACh).Results:Serosal or mucosal application of seirogan (0.1–100 μg/mL) decreased basal jejunal transmural PD. Pre‐treatment of the tissue with the neurotoxin, tetrodotoxin, did not inhibit the seirogan‐induced changes in basal electrical activity. Seirogan had no effect on basal transmural PD in the ileum and colon. Under ACh‐induced hypersecretory conditions in the small intestine and colon, addition of serosal or mucosal seirogan produced antisecretory effects determined indirectly by measurement of transmural PD.Conclusion:The ability of seirogan to decrease basal transmural PD in the jejunum, and inhibit the ACh‐induced electrical responses, may contribute to its anti‐diarrhoeal action.
Review article: coeliac disease and its management
Authors: PARNELL  , CICLITIRA  
Published: March 2003

Coeliac disease (CD) is a disorder of the small intestine, characterized by villous atrophy, due to an intolerance to dietary gluten in genetically susceptible individuals, which responds to gluten withdrawal. The underlying immunological mechanisms causing the disorder are still being worked out.In recent years a wide range of clinical presentations has become increasingly apparent, as has a lengthening list of associated conditions. Severe malabsorption with steatorrhoea and profound weight loss is seen infrequently, perhaps as a result of earlier diagnosis and the recognition of ‘silent’ and ‘latent’ disease.The prevalence of CD as judged by population screening with, in particular, anti‐endomysial antibodies, appears to be much higher than that found with clinically apparent cases.There are a variety of well recognized complications, the commonest probably being osteopenia and osteoporosis. The marked increased risk of lymphoma can be avoided by a strict gluten‐free diet.Follow‐up of patients needs to be lifelong with prompt investigation of new symptoms and blood test abnormalities.
Protection of human gastric mucosa against aspirin—enteric coating or dose reduction?
Authors: Cole  , Hudson  , Liew  , Murray  , Hawkey  , Heptinstall  
Published: March 2003

Background:Aspirin is widely used for cardiovascular prophylaxis.Aim:To compare the effectiveness of two widely‐used strategies—dose reduction and enteric coating—for the minimization of gastric mucosal injury or toxicity.Methods:Twelve healthy volunteers were studied. On four separate occasions each received, under blinded conditions, five daily doses of plain aspirin 300 mg, plain aspirin 75 mg, enteric‐coated aspirin 300 mg or placebo. Ex vivo prostaglandin E2 synthesis was stimulated by the vortex mixing of gastric mucosal biopsies in Tris saline and measured by radioimmunoassay. Mucosal injury was quantified both by counting erosions and with a visual analogue scale.Results:All three preparations reduced prostaglandin E2 synthesis by day five, by (median) 84% for plain aspirin 300 mg, by 80% for enteric coated aspirin 300 mg and by 63% for plain aspirin 75 mg. There was little mucosal injury prior to the start of each dose and period and no significant change with placebo. Plain aspirin caused a dose‐dependent mucosal injury, with two (median, IQR 0–7) gastric erosions after five days of plain aspirin 75 mg, and 18 (2–26) after five days of plain aspirin 300 mg. With enteric‐coated aspirin 300 mg there were 0 (0–1) gastric erosions (P = 0.003 compared to plain aspirin 300 mg P = 0.11, compared to plain aspirin 75 mg).Conclusion:Enteric coated aspirin reduces acute gastric mucosal injury to placebo levels, despite its inhibition of prostaglandin synthesis. Enteric coating is an appropriate strategy for the prevention of gastric mucosal damage induced by low‐dose aspirin, which warrants systematic clinical evaluation.
Depletion of colonic detoxication enzyme activity in mice with dextran sulphate sodium‐induced colitis
Authors: CLAPPER  , ADRIAN  , PFEIFFER  , KIDO  , EVERLEY  , COOPER  , MURTHY  
Published: March 2003

Background: The increased risk of colonic malignancies in individuals with ulcerative colitis has prompted a search for early biomarkers of disease progression.Aim: To characterize Phase II detoxication enzyme expression during acute and chronic colitis. The mouse model of dextran sulphate sodium (DSS)‐induced colitis represents a relevant system with which to sequentially evaluate the spectrum of biochemical changes associated with colorectal cancer risk.Methods: Acute and chronic colitis were induced in Swiss Webster mice by administering DSS in the drinking water (5%) for 1–4 cycles. Each cycle consisted of 7 days DSS and 14 days of water. The glutathione S‐transferase (GST) activity, γ‐glutamylcysteine synthetase (γ‐GCS) activity and glutathione content of the colonic tissues were determined at various time points throughout the experiment. Alterations in GST isozyme expression were confirmed by Western and Northern blot.Results: GST activity was reduced significantly in the colon by the end of Cycle 1 (84% of control values). Specific activities continued to decrease with subsequent cycles of DSS exposure. By the end of Cycle 4, glutathione levels and γ‐GCS activity had reached 29% and 56% of control, respectively.Conclusions: These data suggest that detoxication enzyme depletion is associated with both acute and chronic colitis and may be an important event in the progression of ulcerative colitis to colon cancer.
High cure rate of Helicobacter pylori infection using tripotassium dicitrato bismuthate, furazolidone and clarithromycin triple therapy for 1 week
Authors: XIAO  , LIU  , HU  , XIA  , TYTGAT  
Published: March 2003

Background:When metronidazole is used in bismuth‐based or proton pump inhibitor‐based triple therapy, the cure rate of Helicobacter pylori is usually high. However, metronidazole‐resistant H. pylori strains, which are increasing in frequency, are a major cause of failed H.␣pylori eradication.Aim:To evaluate the efficacy of non‐metronidazole containing bismuth‐based triple therapy for H. pylori infection.Methods:One‐hundred and eighty H. pylori‐positive patients with endoscopically documented peptic ulcer disease or functional dyspepsia were randomly assigned to one of three 1‐week regimens containing tripotassium dicitrato bismuthate (also called colloidal bismuth subcitrate) 240 mg b.d. and two antibiotics: furazolidone 100 mg b.d. plus clarithromycin 250 mg b.d. (Group A); or clarithromycin 250 mg b.d. plus amoxycillin 1000 mg b.d. (Group B); or furazolidone 100 mg b.d. plus josamycin 1000 mg b.d. (Group C). H. pylori status was assessed by rapid urease test, histology and culture of gastric biopsy specimens taken from both the antrum and corpus, both before and at least 4 weeks after completion of therapy.Results:Thirteen patients dropped out (3 in group A, 5 in group B and 5 in group C). Based on an intention‐to‐treat analysis, the eradication rates achieved in groups A, B and C were 88% (53/60), 58% (35/60) and 77% (46/60), respectively. These differences were significant between groups A and B (P < 0.001), as well as between groups B and C (P < 0.05). Side‐effects occurred in 7 (12%) patients in group A, 3 (5%) in group B and 8 (13%) in group C, and were mild, with the exception of vomiting in one patient (group C) that resulted in withdrawal from the study.Conclusion:One‐week triple therapy, consisting of tripotassium dicitrato bismuthate, low‐dose furazolidone and low‐dose clarithromycin, achieves a high cure rate of H. pylori.