bluuebunny/crossref_metadata_2025_split huggingface dataset:
Herbal medicinal products for non‐ulcer dyspepsia
Authors: Thompson Coon J. , Ernst E. 
Published: March 2003

SummaryBackground : Non‐ulcer dyspepsia is predominantly a self‐managed condition, although it accounts for a significant number of general practitioner consultations and hospital referrals. Herbal medicinal products are often used for the relief of dyspeptic symptoms.Aims : To critically assess the evidence for and against herbal medicinal products for the treatment of non‐ulcer dyspepsia.Methods : Systematic searches were performed in six electronic databases and the reference lists located were checked for further relevant publications. No language restrictions were imposed. Experts in the field and manufacturers of identified herbal extracts were also contacted. All randomized clinical trials of herbal medicinal products administered as supplements to human subjects were included.Results : Seventeen randomized clinical trials were identified, nine of which involved peppermint and caraway as constituents of combination preparations. Symptoms were reduced by all treatments (60–95% of patients reported improvements in symptoms). The mechanism of any anti‐dyspeptic action is difficult to define, as the causes of non‐ulcer dyspepsia are unclear. There appear to be few adverse effects associated with these remedies, although, in many cases, comprehensive safety data were not available.Conclusions : There are several herbal medicinal products with anti‐dyspeptic activity and encouraging safety profiles. Further research is warranted to establish their therapeutic value in the treatment of non‐ulcer dyspepsia.
Effects of rabeprazole, lansoprazole and omeprazole on intragastric pH in CYP2C19 extensive metabolizers
Authors: Saitoh T. , Fukushima Y. , Otsuka H. , Hirakawa J. , Mori H. , Asano T. , Ishikawa T. , Katsube T. , Ogawa K. , Ohkawa S. 
Published: March 2003

SummaryAim : To investigate the inhibitory effects on gastric acid secretion of three proton pump inhibitors, omeprazole, lansoprazole and rabeprazole, using a three‐way crossover design in healthy Helicobacter pylori‐negative,S‐mephenytoin 4′‐hydroxylase (CYP2C19) homo‐ and hetero‐extensive metabolizers.Methods : Eight healthy Japanese male volunteers were enrolled. After the administration of rabeprazole (10 mg/day), lansoprazole (30 mg/day) or omeprazole (20 mg/day), intragastric pH monitoring was commenced from 24 h before the first proton pump inhibitor dose, and continued for days 1–3 after proton pump inhibitor administration. The pH electrode was used for 48 h and changed just before pH monitoring on day 2.Results : For the administration of 10 mg/day rabeprazole, the mean ratios of the 24‐h pH ≥ 3 holding timewere 5.7 ± 1.1%,13.6 ± 2.2%, 35.3 ± 2.7% and 62.8 ± 3.1% for the pre‐treatment day and days 1, 2 and 3, respectively. The same ratios for lansoprazole (30 mg/day) were 5.7 ± 0.7%, 7.4 ± 1.5%, 13.6 ± 3.4% and 26.6 ± 4.9%; the same ratios for 20 mg/day omeprazole were 5.9 ± 0.9%, 6.1 ± 1.2%, 11.4 ± 2.8% and 16.4 ± 4.6%. The mean ratio of the 24‐h pH ≥ 3 holding time of days 1–3 increased significantly compared to the pre‐treatment day (P < 0.01) with the administration of rabeprazole and lansoprazole. The magnitude of inhibition of gastric acid secretion after rabeprazole administration was stronger than that after lansoprazole. A significant elevation of the mean ratio of the 24‐h pH ≥ 3 holding time was demonstrated on days 2 and 3 with omeprazole (P < 0.01).Conclusions : In H. pylori‐negative CYP2C19 extensive metabolizers, rabeprazole (10 mg/day) shows a faster onset of rising intragastric pH and a stronger inhibition of gastric acid secretion than do lansoprazole (30 mg/day) or omeprazole (20 mg/day).
Mechanisms of initiation and perpetuation of gut inflammation by stress
Authors: Hart A. , Kamm M. A. 
Published: March 2003

SummaryInflammatory bowel disease involves an interaction between genetic susceptibility, a host mucosal immune response and the enteric flora. However, the relapsing and remitting course underlines the importance of other modifiers, such as psychological stress. Doctors and patients share the view that stress plays a role in the initiation and perpetuation of disease. Levels of chronic perceived stress have been shown to correlate with symptom relapse and mucosal appearance, and stress management therapy has been shown to be beneficial. Animal models provide further evidence that stress may play a role in disease initiation and reactivation.Elucidation of the gut–brain–immune axis has provided insight into the mechanisms by which stress may result in gut inflammation. Stress can alter intestinal physiological function. Stress can increase gut permeability, increase ion secretion by a mechanism involving neural stimulation or mast cells, increase mucin release and deplete goblet cells. Stress causes parasympathetic activation via a mechanism involving corticotropin releasing factor, ultimately affecting mucosal mast cells. Stress also results in increased bacterial adherence and decreased luminal lactobacilli. As a result of all these changes luminal antigens may gain access to the epithelium, causing inflammation.
Bloating in functional bowel disorders
Authors: Zar S. , Benson M. J. , Kumar D. 
Published: March 2003

SummaryBloating is a frequently reported symptom in functional bowel disorders. It usually occurs in combination with other symptoms, but may also occur in isolation. The severity of bloating tends to worsen during the course of the day and improves overnight. Although frequently considered to be a subjective phenomenon, recent studies have shown that bloating is associated with a measurable increase in abdominal girth.The pathophysiology of bloating remains elusive, but the evidence supports a sensorimotor dysfunction of the bowel. The possible mechanisms include abnormal gas trapping, fluid retention, food intolerance and altered gut microbial flora. Further studies are needed to define the sensorimotor abnormalities associated with bloating, which might be segmental and transient rather than generalized and persistent.The lack of understanding of this symptom is paralleled by a limited availability of therapeutic options. Conventional medications used in functional bowel disorders are not helpful and may indeed worsen the symptoms. In future, new drugs with activity against serotonin and kappa receptors, or novel approaches such as the use of exclusion diets, probiotics and hypnotherapy, may prove to be useful.
Anxiety but not depression determines health care‐seeking behaviour in Chinese patients with dyspepsia and irritable bowel syndrome: a population‐based study
Authors: Hu W. H. C. , Wong W.‐M. , Lam C. L. K. , Lam K. F. , Hui W. M. , Lai K. C. , Xia H. X. H. , Lam S. K. , Wong B. C. Y. 
Published: March 2003

SummaryAims : To study the prevalence of dyspepsia and irritable bowel syndrome and the effects of co‐existing anxiety and depression on health care utilization by a population survey in Chinese.Methods : Ethnic Chinese households were invited to participate in a telephone survey using a validated bowel symptom questionnaire and the hospital anxiety and depression scale. Gastrointestinal symptoms were classified as dyspepsia and irritable bowel syndrome according to the Rome I criteria and gastro‐oesophageal reflux disease by the presence of weekly heartburn or acid regurgitation. The anxiety and depression scores were compared between patients who sought medical attention and those who did not, using multiple logistic regression analysis.Results : One thousand, six hundred and forty‐nine subjects completed the interview (response rate, 62%). The population prevalences of dyspepsia, irritable bowel syndrome and gastro‐oesophageal reflux disease were 18.4%, 4.1% and 4.8%, respectively. Dyspepsia and irritable bowel syndrome were associated with anxiety, depression, medical consultation, sick leave and adverse effects on social life. The degree of anxiety was an independent factor associated with health care‐seeking behaviour in both dyspeptics (P=0.003) and irritable bowel syndrome patients (P=0.036).Conclusions : Irritable bowel syndrome and dyspepsia are associated with anxiety, depression, significant social morbidity, health care utilization and days off work. Anxiety is an independent factor in determining health care utilization in patients with dyspepsia and irritable bowel syndrome.
Hepatic venous pressure gradient measurements to assess response to primary prophylaxis in patients with cirrhosis: a decision analytical study
Authors: Hicken B. L. , Sharara A. I. , Abrams G. A. , Eloubeidi M. , Fallon M. B. , Arguedas M. R. 
Published: March 2003

SummaryBackground: The measurement of the hepatic venous pressure gradient may identify a suboptimal response to beta‐blockers in patients with varices at risk for bleeding. However, the cost‐effectiveness of routine hepatic venous pressure gradient measurements to guide primary prophylaxis has not been examined.Methods: We used decision analysis to evaluate two hepatic venous pressure gradient measurement strategies relative to standard beta‐blocker therapy in a hypothetical cohort of patients with high‐risk varices: (i) hepatic venous pressure gradient measurement 4 weeks after the initiation of beta‐blocker therapy; and (ii) hepatic venous pressure gradient measurement prior to and 4 weeks after the initiation of beta‐blocker therapy. The total expected costs, variceal bleeding episodes and deaths were calculated over a 1‐year time horizon.Results: Beta‐blocker therapy was associated with total costs of $1464, seven variceal bleeding episodes, one variceal bleeding episode‐related death and 15 deaths. One hepatic venous pressure gradient measurement was associated with total costs of $5015, four variceal bleeding episodes, one variceal bleeding episode‐related death and 15 deaths. Two hepatic venous pressure gradient measurements were associated with total costs of $8657, four episodes of variceal bleeding, one variceal bleeding episode‐related death and 15 deaths. Compared with beta‐blocker therapy alone, the incremental costs per variceal bleeding episode prevented and death averted were, respectively, $108 185 and $355 100 (one hepatic venous pressure gradient measurement) and $202 796 and $719 300 (two hepatic venous pressure gradient measurements). The results were sensitive to the time horizon of the analysis, the probability of bleeding whilst on beta‐blockers and the cost of hepatic venous pressure gradient measurement.Conclusion: Hepatic venous pressure gradient measurement to guide primary prophylaxis is an expensive strategy for reducing variceal bleeding or death, especially in patients with limited life expectancy, such as those with advanced, decompensated cirrhosis.
Cyclo‐oxygenase‐2 expression in Barrett's oesophageal carcinogenesis: an immunohistochemical study
Authors: Cheong E. , Igali L. , Harvey I. , Mole M. , Lund E. , Johnson I. T. , Rhodes M. 
Published: March 2003

SummaryBackground : The incidence of Barrett's oesophageal adenocarcinoma is increasing more rapidly than any other malignancy in industrialized countries. Cyclo‐oxygenase‐2 appears to play an important role in gastrointestinal carcinogenesis. Previous studies on cyclo‐oxygenase‐2 expression in Barrett's oesophageal carcinogenesis have utilized tissue samples obtained from different patients. We sought a definitive comparison of cyclo‐oxygenase‐2 expression in the sequence of Barrett's metaplasia–dysplasia–adenocarcinoma within the same patients.Methods : Paraffin‐embedded oesophago‐gastrectomy specimens from 20 patients, containing successive stages of Barrett's metaplasia, high‐grade dysplasia and adenocarcinoma, were analysed for cyclo‐oxygenase‐2 expression by immunohistochemistry.Results : Cyclo‐oxygenase‐2 was constitutively expressed in the basal layers of cells in the adjacent normal squamous oesophageal epithelium, but a higher cyclo‐oxygenase‐2 expression was observed in Barrett's metaplasia. A further increase in cyclo‐oxygenase‐2 expression was detected in high‐grade dysplasia, but cyclo‐oxygenase‐2 was decreased in adenocarcinoma tissue, regardless of its stage or level of differentiation.Conclusions : Cyclo‐oxygenase‐2 expression is progressively increased when squamous oesophageal epithelium develops into Barrett's metaplastic epithelium and then into high‐grade dysplasia, but appears to decrease when adenocarcinoma develops. These findings may be significant for an effective chemo‐prevention strategy with selective cyclo‐oxygenase‐2 inhibitors.
A prospective, comparative study of the para‐aminobenzoic acid test and faecal elastase 1 in the assessment of exocrine pancreatic function
Authors: Sonwalkar S. A. , Holbrook I. B. , Phillips I. , Kelly S. M. 
Published: March 2003

SummaryBackground : The assessment of exocrine pancreatic insufficiency is part of the routine work‐up of patients with persistent diarrhoea or suspected steatorrhoea. Direct and indirect tests for the diagnosis of exocrine pancreatic insufficiency have their drawbacks. Measurement of faecal elastase 1 by enzyme‐linked immunoabsorbent assay is a simple, non‐invasive, robust test for exocrine pancreatic insufficiency.Methods : We performed a prospective comparison of the para‐aminobenzoic acid test and faecal elastase 1 test in 45 patients being investigated for diarrhoea or suspected steatorrhoea. Details of clinical suspicion, imaging and response to treatment were recorded.Results : Exocrine pancreatic function was normal in 20 patients with normal para‐aminobenzoic acid and faecal elastase 1 levels. Eight patients had exocrine pancreatic insufficiency with low para‐aminobenzoic acid and faecal elastase 1 levels, which improved with enzyme supplementation. In 14 of the 15 patients with low or borderline low para‐aminobenzoic acid and normal faecal elastase 1 levels, a non‐pancreatic cause was found; one patient had a false positive para‐aminobenzoic acid test. Two had normal para‐aminobenzoic acid but low faecal elastase 1 levels. One improved with pancreatic supplementation, and imaging revealed chronic pancreatitis. The other had a false positive faecal elastase 1 test related to profuse diarrhoea.Conclusions : Faecal elastase 1 estimation is a simple, non‐invasive, robust test of exocrine pancreatic insufficiency, performed on an out‐patient stool sample. Its diagnostic performance is superior to that of the para‐aminobenzoic acid test in investigating patients with diarrhoea or suspected steatorrhoea.
Randomized controlled study of rabeprazole, levofloxacin and rifabutin triple therapy vs. quadruple therapy as second‐line treatment for Helicobacter pylori infection
Authors: Wong W. M. , Gu Q. , Lam S. K. , Fung F. M. Y. , Lai K. C. , Hu W. H. C. , Yee Y. K. , Chan C. K. , Xia H. H. X. , Yuen M. F. , Wong B. C. Y. 
Published: March 2003

SummaryAim : To test the efficacy of rabeprazole, levofloxacin and rifabutin triple therapy vs. quadruple therapy for the second‐line treatment of Helicobacter pylori infection.Methods : One hundred and nine patients who had failed previous H. pylori eradication were randomized to receive: (i) rabeprazole, 20 mg b.d., rifabutin, 300 mg once daily, and levofloxacin, 500 mg once daily, for 7 days (triple therapy); or (ii) rabeprazole, 20 mg b.d., metronidazole, 400 mg t.d.s., bismuth subcitrate, 120 mg q.d.s., and tetracycline, 500 mg q.d.s., for 7 days (quadruple therapy). Endoscopy and culture were performed before treatment.Results : The clarithromycin (79% vs. 21%, P < 0.001) and metronidazole (89% vs. 40%, P < 0.001) resistance rates were significantly higher in patients with previous exposure than in those with no previous exposure. The intention‐to‐treat and per protocol eradication rates were 91%/91% for the triple therapy group and 91%/92% for the quadruple therapy group. For patients with double resistance to metronidazole and clarithromycin, the eradication rates were 85% (17/20) in the triple therapy group and 87% (13/15) in the quadruple therapy group. Compliance was greater than 95% for both regimens.Conclusion : Rabeprazole, levofloxacin and rifabutin‐based triple therapy and quadruple therapy were equally effective as second‐line treatments for H. pylori infection.
Influence of the selective serotonin re‐uptake inhibitor, paroxetine, on gastric sensorimotor function in humans
Authors: Tack J. , Broekaert D. , Coulie B. , Fischler B. , Janssens J. 
Published: March 2003

SummaryBackground : The role of 5‐hydroxytryptamine in the control of gastric fundus tone in humans is still unknown. Selective 5‐hydroxytryptamine re‐uptake inhibitors act both centrally and peripherally to enhance the availability of physiologically released 5‐hydroxytryptamine.Aim : To study the influence of a selective 5‐hydroxytryptamine re‐uptake inhibitor, paroxetine, on gastric fundus tone, on the perception to gastric distension and on gastric accommodation to a meal.Methods : Sixteen healthy volunteers underwent a gastric barostat study on two occasions, after pre‐treatment with placebo or paroxetine, 20 mg/day. Graded isobaric and isovolumetric distensions were performed and perception was scored by a questionnaire. Subsequently, the amplitude of the gastric accommodation to a mixed liquid meal was also measured.Results : Pre‐treatment with paroxetine did not alter the thresholds for perception and discomfort during isobaric (4.7 ± 2.3 vs. 4.0 ± 2.0 mmHg and 13.3 ± 3.1 vs. 12.7 ± 2.3 mmHg above the minimum intragastric distending pressure, N.S.) and isovolumetric (307 ± 90 vs. 417 ± 114 mL and 772 ± 74 vs. 750 ± 76 mL, N.S.) distensions. Paroxetine significantly enhanced the amplitude of the meal‐induced fundus relaxation (136 ± 51 vs. 255 ± 43 mL, P < 0.05).Conclusions : Pre‐treatment with paroxetine enhances gastric accommodation to a meal. These data suggest that the release of 5‐hydroxytryptamine, probably at the level of the enteric nervous system, is involved in the control of the accommodation reflex in humans, and that paroxetine may be beneficial to patients with impaired post‐prandial fundus relaxation.
Indices of nitric oxide synthesis and outcome in critically ill patients
Authors: Mackenzie I. M. , Garrard C. S. , Young J. D. 
Published: March 2003

We measured the concentrations of serum nitrates/nitrites and plasma cyclic guanosine monophosphate as markers of nitric oxide synthesis in patients with or without septic shock for 5 days following admission to intensive care. We found that nitrate/nitrite concentrations, when corrected for the effect of renal failure, were significantly higher in patients with septic shock, both on admission and in the final samples drawn. In a logistic regression analysis, the rate of change of nitrate/nitrite concentration was associated with survival to day 28 (falling in survivors). The concentration of cyclic guanosine monophosphate when corrected for the confounding effects of renal function and platelet count, was only associated with the septic shock group on admission.
Postoperative residual block after intermediate‐acting neuromuscular blocking drugs
Authors: Hayes A H. , Mirakhur R. K. , Breslin D. S. , Reid J. E. , McCourt K. C. 
Published: March 2003

The frequency and duration of postoperative residual neuromuscular block on arrival of 150 patients in the recovery ward following the use of vecuronium (n = 50), atracurium (n = 50) and rocuronium (n = 50) were recorded. Residual block was defined as a train‐of‐four ratio of <0.8. An additional group of 10 patients received no neuromuscular blocking drugs during anaesthesia. The incidence of postoperative residual neuromuscular block was 64%, 52% and 39% after the use of vecuronium, atracurium and rocuronium, respectively. Similar numbers of patients were not able to maintain a sustained head or leg lift for 5 s on arrival in the recovery ward. The mean [range] times to attaining a train‐of‐four ratio of ≥0.8 after arrival in the recovery ward were 9.2 [1–61], 6.9 [1–24] and 14.7 [1.5–83] min for vecuronium, atracurium and rocuronium, respectively. None of the 10 patients who did not receive neuromuscular blocking drugs had train‐of‐four ratios <0.8 on arrival in the recovery ward. It is concluded that a large proportion of patients arrive in the recovery ward with a train‐of‐four ratio <0.8, even with the use of intermediate‐acting neuromuscular blocking drugs. Although the residual block is relatively short lasting, it may occasionally be prolonged, requiring close observation and monitoring of such patients in the recovery ward.
The effect of swabs soaked in bupivacaine and epinephrine for pain relief following simple dental extractionsin children
Authors: Andrzejowski J. , Lamb L. 
Published: March 2003

SummaryWe studied 133, ASA I or II children, aged 5–12 yearsundergoing general anaesthesia for simple dental extractions. Induction and maintenance of anaesthesia were achieved using sevoflurane in nitrous oxide and oxygen. At the end of surgery, patients had swabs soaked in a trial solution placed over the exposed teeth sockets. The ‘bupivacaine’ group had swabs soaked in bupivacaine 0.25% with epinephrine 1:200 000, the ‘saline’ group had swabs soaked in saline. Pain scores were recorded on a 4‐point scale as follows: 0 = I don't hurt at all; 1 = I hurt a bit; 2 = I hurt a lot; 3 = I hurt the most. Nurse pain assessments and the patient's own scores were recorded at 15 and 30 min following recovery from anaesthesia. The median pain scores (2 at 15 min and 1 at 30 min postoperatively) were the same in both groups.
Calibration of three capnographs for use with helium and oxygen gas mixtures*
Authors: Ball J. A. S. , Grounds R. M. 
Published: March 2003

SummaryCapnography is considered essential in the management of mechanically‐ventilated patients. Helium, as an adjunct to mechanical ventilation, is the subject of renewed interest and used increasingly. However, helium affects the performance of infrared capnometry. We constructed a simple device to generate variable mixtures of helium, oxygen and carbon dioxide within the normal physiological range, and tested the performance of two side‐stream and one in‐line capnographs. We found that addition of helium to the gas mixture caused all three capnographs to underestimate the concentration of carbon dioxide. The underestimation increased as the proportion of helium increased. The maximum underestimation (30%) occurred in a 79:21 helium/oxygen mixture.
Modelling the drainage evolution of a river–shelf system forced by Quaternary glacio‐eustasy
Authors: Meijer X. D. 
Published: March 2003

ABSTRACTThe Quaternary glaciations had a profound impact on the geomorphology and stratigraphy of passive continental margins. The challenge is to resolve the contributions of the main forcing controls relative sea‐level change and sediment flux. The key to answer this question is to understand the interaction between the marine and terrestrial environments, where river dynamics play an essential role. A comprehensible three‐dimensional numerical model is presented in order to investigate quantitatively the behaviour of river–shelf sedimentary systems under glacio‐eustatic conditions. Distinctive features observed in the model results include river avulsion, delta‐lobe switching, incision and knickpoint migration. An important event in the development of the modelled river–shelf system is the establishment of a direct and inextricable link between the drainage basin and the depocentre on the shelf edge, thereby bypassing the exposed shelf. This is termed as ‘drainage connection’. In the model, the timing of drainage connection occurs over a broad interval when the model run is repeated many times with small differences in the initial topography, reflecting the sensitivity of the system to its initial state. It demonstrates the inherent variability in the evolution of a sedimentary system as a consequence of non‐linear behaviour. A statistical approach to modelling is suggested in order to deal with this problem.