bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of acute and chronic alcohol intake on the clinical course and outcome in acetaminophen overdose
Authors: Schiødt F. V. , Lee W. M. , Bondesen S. , Ott P. , Christensen E. 
Published: March 2003

Background:Animal studies on acetaminophen toxicity suggest that chronic alcohol intake affects the outcome adversely, whereas acute alcohol intake seems protective. Few clinical data are available.Methods:We studied 209 consecutive patients with single‐dose acetaminophen overdose. The combined influence of independent variables (gender, age, dose, delay to antidote treatment, chronic and acute alcohol intake and nomogram risk group) on dependent variables (death, development of hepatic encephalopathy and biochemical liver markers) was studied using multiple or logistic regression analysis.Results:Fifty‐seven (27.3%) patients had chronic alcohol intake and 45 (21.5%) patients had acute alcohol intake. Forty‐four (21.1%) patients developed hepatic coma and 20 (43.5%) of these patients died. Chronic alcohol intake was significantly and independently associated with the development of hepatic coma, with a lower prothrombin index, lower platelet count, higher creatinine and higher bilirubin. The relative risks for hepatic coma and death were 5.3 (95% confidence interval, 2.2–12.4) and 1.4 (95% confidence interval, 0.5–3.9), respectively, in the chronic alcohol intake group compared with the no chronic alcohol intake group. Acute alcohol intake was not significantly associated with any of the dependent variables studied.Conclusions:Chronic alcohol intake enhances acetaminophen hepatotoxicity, whereas acute alcohol intake does not affect the clinical course.
Acute effect of clonidine on gastric emptying in patients with diabetic gastropathy and controls
Authors: Huilgol V. , Evans J. , Hellman R. S. , Soergel K. H. 
Published: March 2003

Background:The treatments available for diabetic gastropathy are frequently ineffective. Clinical observations suggest that clonidine, an a‐2 adrenergic agonist, may improve diabetic gastropathy symptoms.Aims:To establish whether a single oral dose of clonidine alters the gastric emptying of a solid meal in 10 patients with diabetic gastropathy and their matched controls. A secondary goal was to compare two methods of analysis of the data from gastric emptying studies.Methods:Clonidine, 0.3 mg, or a matched placebo were administered orally in a double‐blind fashion.Results:Only three of the 10 patients showed an increased gastric residual volume. Gastric emptying rates were comparable in patients and controls. Clonidine had no significant effect on gastric emptying in the controls but increased t1/2 values in the patient group. This effect just reached statistical significance only when calculated by the power exponential method (P=0.05 but not by the linear component model.Conclusions:Delayed gastric emptying is not an invariable characteristic of symptomatic diabetic gastropathy. Clonidine, given as a single dose of 0.3 mg orally, has no gastric prokinetic effects. It may act on gastric afferent innervation or, more likely, at a central site to reduce nausea and vomiting. The analysis of gastric emptying data by the power exponential and the two linear component methods yields equivalent results.
Osteoporosis in inflammatory bowel disease: effect of calcium and vitamin D with or without fluoride
Authors: Abitbol V. , Mary J. Y. , Roux C. , Soulé J. C. , Belaiche J. , Dupas J. ‐L. , Gendre J. P. , Lerebours E. , Chaussade S. ,   The Groupe D'etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID)
Published: March 2003

Background:Previous data have indicated low bone formation as a mechanism of osteoporosis in inflammatory bowel disease. Fluoride can stimulate bone formation.Aim:To assess the effect of fluoride supplementation on lumbar spine bone mineral density in osteoporotic patients with inflammatory bowel disease treated in parallel with calcium and vitamin D.Methods:In this prospective, randomized, double‐blind, parallel and placebo‐controlled study, 94 patients with inflammatory bowel disease (lumbar spine T score below − 2 standard deviations, normal serum 25OH vitamin D), with a median age of 35 years, were included. Bone mineral density was measured by dual‐energy X‐ray absorptiometry. Patients were randomized to receive daily either sodium monofluorophosphate (150 mg, n=45) or placebo (n=49) for 1 year, and all received calcium (1 g) and vitamin D (800 IU). The relative change in bone mineral density from 0 to 12 months was tested in each group (fluoride or placebo) and compared between the groups.Results:Lumbar spine bone mineral density increased significantly in both groups after 1 year: 4.8 ± 5.6% (n=29) and 3.2 ± 3.8% (n=31) in the calcium–vitamin D–fluoride and calcium–vitamin D–placebo groups, respectively (P < 0.001 for each group). There was no difference between the groups (P=0.403). Similar results were observed according to corticosteroid intake or disease activity.Conclusions:Calcium and vitamin D seem to increase lumbar spine density in osteoporotic patients with inflammatory bowel disease; fluoride does not provide further benefit.
Effect of alosetron on left colonic motility in non‐constipated patients with irritable bowel syndrome and healthy volunteers
Authors: Clemens C. H. M. , Samsom M. , Van Berge Henegouwen G. P. , Fabri M. , Smout A. J. P. M. 
Published: March 2003

Background:Alosetron is a 5‐hydroxytryptamine‐3 receptor antagonist reducing symptoms in female patients with diarrhoea‐predominant irritable bowel syndrome, and is known to increase the colonic transit time.Aim:To study the effect of alosetron on left colonic phasic motility in ambulant non‐constipated patients with irritable bowel syndrome and healthy volunteers.Methods:In a double‐blind, randomized, crossover design, 10 patients with irritable bowel syndrome and 12 sex‐ and age‐matched volunteers were treated for two 7‐day periods with alosetron, 4 mg b.d., or placebo b.d. On day 6 of each treatment period, a six‐channel solid‐state manometric catheter was positioned in the left colon and 24 h motility was studied on day 7. The periprandial phasic motility around dinnertime was evaluated in the descending and sigmoid colon. The high‐amplitude propagated contraction frequency and characteristics were calculated.Results:Alosetron appeared to increase the overall periprandial frequency in the sigmoid colon (P=0.043) and the mean amplitude of colonic contractions in the descending colon (P=0.007). The high‐amplitude propagated contraction frequency was higher on alosetron during the second half of the day for patients with irritable bowel syndrome (P=0.002), with increased mean propagation length of high‐amplitude propagated contractions (P=0.001). The stool frequency (P=0.024) and stool consistency score (P=0.002) were decreased by alosetron.Conclusions:The 5‐hydroxytryptamine‐3 receptor antagonist alosetron marginally increased left colonic periprandial phasic motility. Alosetron increased the number and propagation length of high‐amplitude propagated contractions, which were paradoxically accompanied by a decrease in stool frequency and a firming of stool consistency.
Long‐term cisapride treatment improves diabetic gastroparesis but not glycaemic control
Authors: Braden B. , Enghofer M. , Schaub M. , Usadel K.‐H. , Caspary W. F. , Lembcke B. 
Published: March 2003

Background:In patients with diabetic gastroparesis, delayed food delivery to the intestine may become a major obstacle to post‐prandial glycaemic control.Aim:To investigate whether cisapride accelerates gastric emptying in the long term or improves diabetes control in patients with diabetic gastroparesis.Methods:Eighty‐five patients with long‐standing insulin‐dependent diabetes mellitus (glycosylated haemoglobin (HbA1c) > 7.0%), dyspepsia and diabetic neuropathy were tested for impaired gastric emptying of solids by the 13C‐octanoate breath test. Nineteen of these patients with severe diabetic gastroparesis (i.e. t1/2 > 170 min) were randomly treated with 10 mg cisapride t.d.s. (n=9) or placebo (n=10) for 12 months. Thereafter, the breath test, dyspeptic symptoms and HbA1c values were reassessed.Results:Half emptying times in nine patients with diabetic gastroparesis were significantly shortened by cisapride (175 ± 46 min vs. 227 ± 40 min; P < 0.03). Half emptying times in the 10 patients taking placebo did not change (205 ± 37 min vs. 211 ± 36 min, P=0.54). Cisapride significantly reduced dyspepsia (score: 4.1 ± 1.6 vs. 2.0 ± 0.5, P=0.002). HbA1c values after 12 months of treatment were not different (cisapride: 7.7 ± 0.4% vs. 7.6 ± 0.9%, P=0.76; placebo: 7.5 ± 0.6% vs. 7.6 ± 1.5%, P=0.89).Conclusions:Prokinetic treatment with cisapride accelerates gastric emptying of solids and improves dyspeptic symptoms in diabetic gastroparesis. Glycaemic control, however, is not affected by cisapride.
A modification of the quininium resin test for assessing gastric acidity
Authors: Passaro D. J. , Hurwitz A. , Triadafilopoulos G. , Parsonnet J. 
Published: March 2003

Background:Gastric acid is an important defence against enteric infection. Studies investigating the relationship between hypochlorhydria and enteric infections or gastric malignancy have been limited by difficulties in the non‐invasive measurement of gastric acidity.Aim:To develop a blood test for hypochlorhydria based on the quininium resin test.Methods:Quininium resin dissociates to liberate free quinine at pH ≤ 3.5. Ten fasting adult volunteers ingested 100 mg/kg of quininium resin twice: once before (control) and once after acid suppression with rabeprazole (10 mg b.d. for 3 days). Blood and serum samples were collected at baseline and 45, 60, 75, 90 and 120 min after ingestion. Quinine levels were measured fluorometrically from 100 μL samples after simple extraction. Results obtained by the quininium resin test were compared with gastric juice pH measurements.Results:After quininium resin ingestion, mean quinine levels were lower in the acid‐suppressed than in the control condition at all times (P < 0.001). Optimized cut‐off values at 90 min post‐ingestion yielded 95% accuracy rates in both serum and blood. Quininium resin was well tolerated.Conclusions:Using blood or serum, the quininium resin test identifies hypochlorhydria accurately and non‐invasively. This test may be useful in screening for gastric atrophy and in studies investigating hypochlorhydria.
Oral beclometasone dipropionate in the treatment of active ulcerative colitis: a double‐blind placebo‐controlled study
Authors: Rizzello F. , Gionchetti P. , D'Arienzo A. , Manguso F. , Di Matteo G. , Annese V. , Valpiani D. , Casetti T. , Adamo S. , Prada A. , Castiglione G. N. , Varoli G. , Campieri M. 
Published: March 2003

SummaryAim : To evaluate efficacy and safety of oral beclometasone dipropionate (BDP) when added to 5‐ASA in the treatment of patients with active ulcerative colitis.Methods : In a 4‐week, placebo‐controlled, double‐blind study, patients with extensive or left‐sided mild to moderate active ulcerative colitis were randomized to receive oral 5‐ASA (3.2 g/day) plus BDP (5 mg/day) or placebo. Clinical, endoscopic and histologic features, and haematochemical parameters were recorded at baseline and at the end of the study.Results : One hundred and nineteen patients were enrolled and randomly treated with BDP plus 5‐ASA (n = 58) or placebo plus 5‐ASA (n = 61). Both treatment groups showed a statistically significant decrease of disease activity index (DAI) and histology score at the end of treatment (P = 0.001, each). DAI score was lower in the BDP group than in the placebo group (P = 0.014), with more patients in clinical remission in the BDP group (58.6% vs. 34.4%, P = 0.008). Serum cortisol levels significantly decreased in BDP group vs. baseline (P = 0.002), but without signs of pituitary‐adrenal function depletion. A low incidence of adverse events was observed in both groups.Conclusions : Oral BDP in combination with oral 5‐ASA is significantly more effective than 5‐ASA alone in the treatment of patients with extensive or left‐sided active ulcerative colitis.
Gastric mucosal atrophy: interobserver consistency using new criteria for classification and grading
Authors: Rugge M. , Correa P. , Dixon M. F. , Fiocca R. , Hattori T. , Lechago J. , Leandro G. , Price A. B. , Sipponen P. , Solcia E. , Watanabe H. , Genta R. M. 
Published: March 2003

SummaryBackground and aims : Considerable difficulties persist amongst pathologists in agreeing on the presence and severity of gastric atrophy. An international group of pathologists pursued the following aims: (i) to generate an acceptable definition and a simple reproducible classification of gastric atrophy; and (ii) to develop guidelines for the recognition of atrophy useful for increasing agreement among observers.Methods : After redefining atrophy as the ‘loss of appropriate glands’ and examining histological samples from different gastric compartments, three categories were identified: (i) negative; (ii) indefinite; (iii) atrophy, with and without intestinalization. Atrophy was graded on a three‐level scale. Interobserver reproducibility of the classification was tested by κ statistics (general and weighted) in a series of 48 cases.Results : The medians of the general agreement and weighted κ values were 0.78 and 0.73, respectively. The weighted κ coefficients, obtained by cross‐tabulating the evaluation of each pathologist against all others, were, with only one exception, > 0.4 (moderate to excellent agreement).Conclusions : By using the definition of atrophy as the loss of appropriate glands and distinguishing the two main morphological entities of metaplastic and non‐metaplastic types, a high level of agreement was achieved by a group of gastrointestinal pathologists trained in different cultural contexts.
Naloxone treatment for irritable bowel syndrome — a randomized controlled trial with an oral formulation
Authors: Hawkes N. D. , Rhodes J. , Evans B. K. , Rhodes P. , Hawthorne A. B. , Thomas G. A. O. 
Published: March 2003

SUMMARYBackground : Opioids change gut motility and secretion, causing delayed intestinal transit and constipation. Endorphins play a role in the constipation troubling some patients with irritable bowel syndrome; hence naloxone, an opioid antagonist, may have a therapeutic role.Aim : To assess the efficacy and safety of an oral formulation of naloxone in irritable bowel syndrome patients with constipation.Methods : A randomized, double‐blind, placebo‐controlled trial was performed. Patients fulfilling the Rome II criteria for irritable bowel syndrome (constipation‐predominant and alternating types) were randomized to receive 8 weeks of treatment with naloxone capsules, 10 mg twice daily, or identical placebo.Results : Twenty‐eight patients entered the study, which was completed by 25. ‘Adequate symptomatic relief’ was recorded in six of 14 on naloxone and three of 11 on placebo. Whilst the differences were not significant, improvements in severity gradings and mean symptom scores for pain, bloating, straining and urgency to defecate were greater with naloxone than placebo for all parameters. In addition, quality of life assessments improved to a greater extent in patients taking naloxone.Conclusions : Preliminary results suggest that naloxone is well tolerated and beneficial in patients with irritable bowel syndrome and constipation. A larger clinical trial is needed to provide sufficient statistical power to assess efficacy.
Eradication rates of clarithromycin‐resistant Helicobacter pylori using either rabeprazole or lansoprazole plus amoxicillin and clarithromycin
Authors: Murakami K. , Sato R. , Okimoto T. , Nasu M. , Fujioka T. , Kodama M. , Kagawa J. , Sato S. , Abe H. , Arita T. 
Published: March 2003

SummaryBackground : The resistance of Helicobacter pylori to clarithromycin has become one of the primary reasons for eradication failure.Aim : To compare the eradication rates of triple therapy using amoxicillin (A), clarithromycin (C) and rabeprazole (R) or lansoprazole (L) against clarithromycin‐sensitive and clarithromycin‐resistant strains.Methods : Two hundred and ninety‐five patients were randomly divided into four groups and treated for 1 week: 147 cases were treated with RAC, i.e. 49 cases with R20C400 (10 mg R + 750 mg A + 200 mg C, twice daily), 48 cases with R40C400 (20 mg R + 750 mg A + 200 mg C, twice daily) and 50 cases with R40C800 (20 mg R + 750 mg A + 400 mg C, twice daily); 148 cases with treated with LAC (30 mg L + 750 mg A + 200 mg C, twice daily).Results : According to intention‐to‐treat and per protocol analyses, the eradication rates were 88% and 91% with RAC and 78% and 81% with LAC; the eradication rates with R20C400, R40C400 and R40C800 were 94%, 81% and 86%, respectively, in the intention‐to‐treat analysis. In addition, the eradication rates for clarithromycin‐sensitive strains with RAC and LAC were 98% and 89%, respectively, and for clarithromycin‐resistant strains with RAC and LAC were 8.1% and 0%, respectively.Conclusions : The eradication rate was significantly higher with RAC than LAC. The eradication rate for clarithromycin‐resistant strains was low in both groups, and an improved eradication rate could not be achieved by changing the dose of clarithromycin or proton pump inhibitor.
Arthritis treatment in Hong Kong — cost analysis of celecoxib versus conventional NSAIDS, with or without gastroprotective agents
Authors: You J. H. S. , Lee K. K. C. , Chan T. Y. K. , Lau W. H. , Chan F. K. L. 
Published: March 2003

SummaryBackground : Selective cyclo‐oxygenase‐2 inhibitors have been reported to cause fewer gastrointestinal complications when compared with conventional, non‐selective, non‐steroidal anti‐inflammatory drugs (NSAIDs).Aim : To analyse the cost of celecoxib (selective cyclo‐oxygenase‐2 inhibitor) and conventional NSAID regimens for the treatment of osteoarthritis and rheumatoid arthritis from the perspective of a public health organization in Hong Kong.Methods : A decision tree was used to analyse the cost of celecoxib, NSAID alone, NSAID plus histamine2‐receptor antagonist, NSAID plus misoprostol and NSAID plus proton pump inhibitor over 6 months. Model outcomes were no gastrointestinal toxicity, gastrointestinal discomfort, symptomatic ulcer, anaemia with occult bleeding and serious gastrointestinal complications. The clinical probabilities were estimated from clinical trials. Resource utilization for gastrointestinal events was determined locally. Sensitivity analysis was performed.Results : The 6‐month costs per base‐case analysis were as follows: NSAID plus histamine2‐receptor antagonist, HK$1404 (1US$=7.8HK$); celecoxib, HK$1545; NSAID alone, HK$1610; NSAID plus misoprostol, HK$2213; NSAID plus proton pump inhibitor, HK$2857. The model was sensitive to the patients' underlying gastrointestinal risk scores, daily cost of NSAID regimen, risk ratio of NSAID plus histamine2‐receptor antagonist for symptomatic ulcer, daily cost of celecoxib and daily cost of histamine2‐receptor antagonist.Conclusions : Celecoxib appeared to be the least costly alternative in patients with intermediate to high gastrointestinal risk for the treatment of osteoarthritis and rheumatoid arthritis in Hong Kong.
Serotonergic modulators in the treatment of irritable bowel syndrome — influence on psychiatric and gastrointestinal symptoms
Authors: Kilkens T. O. C. , Honig A. , Rozendaal N. , Van Nieuwenhoven M. A. , Brummer R.‐J. M. 
Published: March 2003

SummaryBackground : Both central and peripheral serotonergic modulators are used in the treatment of irritable bowel syndrome. The majority of patients with irritable bowel syndrome presenting to a gastroenterologist demonstrate affective dysregulation. Serotonin may play a regulatory role in both gastrointestinal motility and sensitivity, as well as in affective dysregulation, in irritable bowel syndrome.Aim : To analyse, systematically, randomized controlled trials studying the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome, in order to elucidate baseline irritable bowel syndrome symptomatology and possible differential effects of serotonergic modulation on this symptomatology.Methods : A standardized qualitative analysis was performed of studies investigating the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome using a blind review approach. The studies were ranked according to their total quality score (maximum 100 points).Results : Eleven studies fulfilled the entry criteria, six of which scored above 55 points. An association between gastroenterological and psychiatric changes was present in five of the six studies.Conclusions : The results strengthen the serotonergic association between gastroenterological and psychiatric symptoms. Adjusted guidelines for combined gastrointestinal and psychiatric assessments are recommended in order to further elucidate the serotonergic interaction between gastrointestinal and psychiatric symptoms.
Oral antioxidant supplementation for fatigue associated with primary biliary cirrhosis: results of a multicentre, randomized, placebo‐controlled, cross‐over trial
Authors: Prince M. I. , Mitchison H. C. , Ashley D. , Burke D. A. , Edwards N. , Bramble M. G. , James O. F. W. , Jones D. E. J. 
Published: March 2003

SummaryBackground : We have previously reported, in an uncontrolled trial, an improvement in fatigue scores in patients with primary biliary cirrhosis given oral antioxidant supplementation. We now present data from a controlled trial.Patients and methods : Sixty‐one patients with primary biliary cirrhosis‐associated fatigue were randomized into a double‐blind, placebo‐controlled, cross‐over trial. Participants received 12 weeks each of placebo and antioxidant supplementation (vitamins A, C and E, selenium, methionine and ubiquinone) in random order, separated by a 4‐week washout period. The primary trial outcome (fatigue) was assessed using the Fisk scale. Other symptoms of primary biliary cirrhosis were measured using Likert and visual analogue scales.Results : Forty‐four patients completed both arms of the trial. No significant changes in fatigue were recorded in the active phase of treatment (median improvement in Fisk score, 1; P = 0.61). Small improvements in Fisk scores were recorded during placebo therapy (median improvement, 4; P = 0.03). Neither medication was associated with improvement in any other symptoms related to primary biliary cirrhosis. Adverse effects were more common during active therapy and were mild and self‐limiting. One patient died from unrelated causes during active treatment.Conclusions : Although oral antioxidant supplementation appears to be safe, we could not find any evidence for a beneficial effect on fatigue or other liver‐related symptoms.