bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morning versus evening dosing of lansoprazole 30 mg daily on twenty‐four‐hour intragastric acidity in healthy subjects
Authors: FRASER A. G. , SAWYERR A. M. , HUDSON M. , SMITH M. S. H. , POUNDER R. E. 
Published: October 2003

Background: Morning dosing is usually recommended with proton pump inhibitors, but there are few data from 24‐h intragastric acidity studies comparing times of dosing. Methods: A double‐blind, placebo‐controlled study was performed on the seventh day of dosing to compare the effects of lansoprazole 30 mg given either in the morning or evening on 24‐h intragastric acidity in 32 healthy volunteers. Results: The median integrated 24‐h intragastric acidity on the seventh day of morning dosing with lansoprazole 30 mg was decreased to 36% of the placebo value, compared with 42% for evening dosing. For each daytime meal‐related interval, morning dosing was significantly more effective for controlling acidity, but there was no significant difference between the regimens during the night interval (23.00–08.00 h). Conclusions: These data favour morning dosing of lansoprazole 30 mg for routine use, but patients with mainly nocturnal symptoms may be best treated by evening dosing.
clinical aspects of Helicobacter pylori eradication therapy in peptic ulcer disease
Authors: PENSTON J. G. 
Published: October 2003

Background and aims: Although the role of H. pylori in peptic ulcer disease is no longer in dispute, certain aspects of eradication therapy in this condition have yet to be settled. Uncertainties still surround the relationship between Helicobacter pylori status and ulcer healing, the efficacy of eradication therapy in alleviating acute symptoms and healing ulcers, and the prognosis after eradication with respect to recurrence of symptoms, ulcers and complications. The present literature review, encompassing studies published up to October 1995, specifically addresses these issues. Results: Pooled data show that eradication therapy heals 90% of duodenal ulcers and 85% of gastric ulcers, while individual studies repeatedly confirm that it is more effective at healing ulcers than conventional treatment with anti‐secretory drugs. Recent reports indicate that triple therapy regimens for 1 week, provided they include an anti‐secretory drug, are sufficient to achieve high rates of healing and rapid symptom relief. A detailed analysis of the data, particularly those from studies reporting healing rates in relation to H. pylori status after eradication therapy, provides strong evidence that eradication of H. pylori produces ulcer healing. Follow‐up studies show that ulcer recurrence and complications are rare after eradication treatment in patients with either gastric or duodenal ulcer disease. However, while ulcer symptoms are infrequent during follow‐up, a proportion of patients appear to develop gastrooesophageal reflux after eradication. Conclusions: H. pylori eradication is highly effective in promoting ulcer healing and preventing subsequent ulcer recurrence. These beneficial effects of eradication therapy are observed in patients with either gastric or duodenal ulcers which are associated with H. pylori infection.
Omeprazole versus ranitidine: short‐term triple‐therapy in patients with Helicobacter pylori‐positive duodenal ulcers
Authors: SPADACCINI A. , DE FANIS C. , SCIAMPA G , MASCIULLI V , PANTALEONE U , DI VIRGILI M. , MAGNARINI C. , PIZZICANNELLA G. 
Published: October 2003

Aim: To compare the results of two short triple‐therapy regimens, different only in the antisecretory drugs used, in patients with active duodenal ulcer and Helicobacter pylori infection. Methods: All patients received a combination of clarithromycin 250 mg b.d. and tinidazole 500 mg b.d. for 1 week, in addition to an antisecretory drug: omeprazole 20 mg (50 patients) or ranitidine 300 mg (50 patients) twice daily for 1 week, followed by a single daily dose for a further 3 weeks. Upper gastrointestinal endoscopy, with rapid urease test and histological examination of antral and corpus biopsies, was performed prior to the treatment and at least 2 months after the discontinuation of the antisecretory therapy. Results: Duodenal ulcer healing was documented in all patients at the endoscopic examination after therapy. H. pylori eradication was achieved in 46 of 50 patients (92%, 95% CI=85–99%) in the omeprazole group and in 43 of 50 patients (86%, 95% CI=76–96%) in the ranitidine group; the difference is not significant. Conclusion: Omeprazole or ranitidine, in combination with clarithromycin and tinidazole, are equally effective in the eradication of H. pylori infection and healing of duodenal ulcers.
Differing actions of the acute administration of propranolol and isosorbide‐5‐mononitrate on the portal circulation
Authors: FORREST E. H. , JALAN R. , REDHEAD D. N. , HAYES P. C. 
Published: October 2003

Background: The aim of this study was to clarify the actions of propranolol and isosorbide‐5‐mononitrate upon the portal circulation. Methods: Portal haemodynamics were assessed in 16 patients with transjugular intrahepatic portosystemic stent shunts. A reverse thermodilution catheter was positioned in the portal vein, and portal vein pressure and portal vein flow were measured directly. The effects of propranolol 80 mg and isosorbide‐5‐mononitrate 20 mg over 1 h were determined independently. Results: This demonstrated that propranolol reduced both portal pressure gradient (7.7±2.3 to 5.5±2.1 mmHg, P<0.01) and portal vein flow (925±123 to 597±99 mL/min, P=0.01) significantly, implying a reduction in splanchnic inflow as its main effect. In contrast, isosorbide‐5‐mononitrate tended to increase portal vein flow (814±186 to 911±211 mL/min; P=0.06) whilst reducing portal pressure significantly (108±12 to 92±10 mmHg P=0.014). This suggests a fall in intrahepatic resistance and provides no evidence for baroreceptor‐mediated reflex splanchnic vasoconstriction. Conclusions: These drugs act upon different variables contributing to portal hypertension and so they may have a powerful synergistic effect in combination. Direct measurement of portal vein flow is a valuable method for assessing the pharmacological modulation of portal venous inflow.
Factors affecting dose selection and outcome of cisapride treatment for dyspepsia in primary care
Authors: BRUNNER H. ,   THE AUSTRO‐CIS STUDY GROUP
Published: October 2003

Background: Little is known about the prescribing habits and impact of life style or disease factors on the outcome of cisapride treatment for dyspepsia in primary care. Method: In this large‐scale open, multi‐centre study in Austria, primary care physicians were asked to prescribe cisapride according to the current prescribing guidelines (standard dose, 5 mg t.d.s.; in case of severe symptoms, 10 mg t.d.s.). Symptom severity was rated by the physicians, after 4 weeks of treatment and after another 4 weeks of follow‐up without medication. The global therapeutic result was given by both the physicians and patients. Results: Among the 3912 recruited patients, 60.0% received cisapride 5 mg t.d.s. and 38.5% received 10 mg t.d.s. The dose selection by the physicians was not only influenced by severity of the symptoms (significantly more patients with severe symptoms receiving the higher dosage when compared to those with milder symptoms (P<0.001)), but also other factors were associated with prescription of the higher dose, including heavy smoking, longer pre‐existence of complaints and failing previous treatment. After 4 weeks of treatment, the dyspeptic symptoms improved in about 80% of patients, in both dosage groups. Four weeks after discontinuation of medication, 21% of patients still further improved, while 10% relapsed. The overall therapeutic outcome defined as the percentage of patients with good or excellent results was comparable in both dosage groups and appeared independent of the patient's characteristics, life style or disease factors. However, when only the proportion of ‘excellent’ responders was analysed, this rate significantly decreased the longer the duration of symptoms, the heavier the smoking and with failing previous therapy. This effect was particularly seen with the patients' ratings. Conclusions: Although the open‐study design does not allow evaluation of the contribution of placebo‐effect and calls for cautious interpretation, the data suggest that the use of flexible cisapride doses for management of dyspepsia in primary care results in a good acute and medium‐term outcome, with apparently little dependence on life style and disease factors, at least when assessed by physicians.
Intravenous midazolam as a sedative for colonoscopy: a randomized, double‐blind clinical trial
Authors: YUNO K. , IISHI H. , TATSUTA M. , HIFUMI K. , OMORI M. 
Published: October 2003

Methods: Forty patients, aged between 36 and 60 years, scheduled to undergo colonoscopic removal of colorectal polyps were randomly assigned to receive 0.9% saline solution (n=20) or 0.05 mg/kg body weight of midazolam (n=20) intravenously. Results: Midazolam significantly (P<0.001) increased the tolerance of patients to colonoscopy. It had no significant effect on pulse or systolic blood pressure during endoscopy. Arterial oxygen saturation decreased significantly (P<0.01) during endoscopy in patients pre‐treated with midazolam, but it did not decrease by more than 5%. Conclusions: Intravenous midazolam is useful as a sedative for colonoscopy, but we recommend continuous oxygen saturation monitoring during endoscopy.
Effects of ranitidine bismuth citrate on gastric acid secretion and gastrin release in subjects with and without Helicobacter pylori infection
Authors: CIOCIOLA A. A. , WEBB D. D. , HEATH A. , WALSH J. H. 
Published: October 2003

Background: Ranitidine bismuth citrate is a novel antiulcerant that provides the antisecretory activity of ranitidine and the gastric mucosal protection and antibacterial properties of bismuth. Methods: This randomized, double‐blind, placebo‐controlled study evaluated the effects of single doses of ranitidine bismuth citrate 200 mg, 400 mg and 800 mg and ranitidine hydrochloride 150 mg on gastrin release and suppression of gastric acid secretion, and compared acid secretory profiles and gastrin release between Helicobacter pylori‐negative and‐positive patients. Plasma gastrin concentrations were determined by radioimmunoassay under basal conditions and in response to peptone meal stimulation. Acid secretion was measured under basal conditions and in response to peptone meal stimulation. Presence of H. pylori was determined by both 14C‐urea breath test and ELISA serology. Results: Inhibition of gastric acid output by ranitidine bismuth citrate was both time‐ and dose‐dependent over the 9‐h post‐dose study period. Doses of ranitidine bismuth citrate 400 mg and ranitidine hydrochloride 150 mg, which are equimolar, produced similar suppression of acid output regardless of H. pylori status. Ranitidine bismuth citrate had no effect on plasma gastrin concentrations regardless of H. pylori status. All doses of ranitidine bismuth citrate were well tolerated. Conclusions: Ranitidine bismuth citrate caused time‐and dose‐dependent reductions in meal‐stimulated and between‐meal gastric acid output regardless of H. pylori status. The magnitude of decreased acid secretion was similar with ranitidine bismuth citrate 400 mg and ranitidine hydrochloride 150 mg. Ranitidine bismuth citrate had no effect on plasma gastrin concentrations.
A double‐blind randomized trial of low‐dose versus high‐dose topical anaesthesia in unsedated upper gastrointestinal endoscopy
Authors: MULCAHY H. E. , GREAVES R. R. S. H. , BALLINGER A. , PATCHETT S. E. , RICHES A. , FAIRCLOUGH P. D. , FARTHING M. J. G. 
Published: October 2003

Background: Upper gastrointestinal endoscopy is frequently performed on unsedated subjects. Pharyngeal anaesthesia is thought to improve patient tolerance to the procedure but the optimum dose of anaesthesia is not known. The aim of this study was to assess the benefits of low‐dose vs. high‐dose topical anaesthesia in unsedated gastroscopy. Methods: One hundred and fourteen subjects attending for diagnostic gastroscopy were studied. Patients were randomized to receive either 30 mg or 100 mg of topical pharyngeal lidocaine spray prior to endoscopy in a double‐blind fashion. Subjects completed a questionnaire before and after endoscopy. Results: A similar proportion of patients in each group required intravenous sedation because of discomfort or anxiety during the procedure (P=0.48). The high‐dose group experienced less discomfort during endoscope insertion (P=0.002) and throughout the examination (P=0.01). Overall satisfaction was almost identical in the two groups (P=0.85) and a similar percentage of the high‐dose and low‐dose groups stated that they would request sedation prior to future endoscopy (37 vs. 44%; P=0.48). Further analysis showed that apprehensive patients and younger patients reported relatively high levels of discomfort, and that female subjects were more likely to express a preference for sedation at any future gastroscopy. Conclusion: High‐dose pharyngeal anaesthesia reduces patient discomfort during unsedated upper gastrointestinal endoscopy. However, patient tolerance is also influenced by clinical features, which might be useful in deciding which patients are suitable for this procedure.
A prospective randomized trial of colchicine in prevention of liver cirrhosis in chronic hepatitis B patients
Authors: LIN D.‐Y. , SHEEN I.‐S. , CHU C.‐M. , LIAW Y.‐F. 
Published: October 2003

Background: The clinical course of chronic hepatitis B is variable. Patients with hepatic decompensation, bridging necrosis or an alpha‐fetoprotein level greater than 100 ng/mL during an exacerbation of hepatitis have a high risk of developing cirrhosis. This study was conducted to evaluate the effect of colchicine in the prevention of cirrhosis in such patients. Methods: Patients with risk factor(s) were randomized to receive either colchicine 5 mg/week or no specific treatment, the end point being development of cirrhosis. Results: After a follow up period of 4 years, the treatment group had a marked reduction in exacerbations of acute hepatitis (32% vs. 63%/patient/year, P<0.005). Seven out of 38 patients in the treatment group and 10 out of 27 patients in the control group developed cirrhosis. The calculated cumulative incidence of cirrhosis by the end of first, second, third and fourth years in the treatment group was 8.7, 18.6, 32 and 32%, respectively. The corresponding figures in the control group were 30, 35.5, 46.3 and 73.2%, respectively, with a P‐value of 0.057. Conclusions: The results suggest that colchicine may prevent cirrhosis in chronic hepatitis B patients with risk factor(s), possibly by suppressing exacerbations of hepatitis through an anti‐inflammatory effect.
Feasibility of analysing [13C]urea breath tests for Helicobacter pylori by gas chromatography‐mass spectrometry in the selected ion monitoring mode
Authors: KASHO V. N. , CHENG S. , JENSEN D. M. , AJIE H. , LEE W‐N. P. , FALLER L. D. 
Published: October 2003

Background: The [13C]urea breath test for Helicobacter pylori is nonradioactive, as well as noninvasive, but few clinical laboratories have the expensive isotope ratio mass spectrometer used for analysis. Methods: To demonstrate the feasibility of analysing [13C]urea breath tests with a gas chromatograph‐mass spectrometer routinely used for drug testing, 13CO2 standards for breath tests and breath samples from patients in a multiple‐blind study were analysed. The breath samples were also analysed by isotope ratio mass spectrometry, and the diagnoses were compared with biopsy results. Results: The precision of the enrichment measurements by gas chromatography–mass spectrometry was 1.1 parts per thousand, and the calculated differences in enrichment between standard gases equaled the certified values. The sensitivity (94%), specificity (94%), and percentage agreement (94%) for diagnosis of Helicobacter pylori (n=34) were as high or higher than for analysis of replicate breath samples by isotope ratio mass spectrometry and comparable to the values reported for diagnosis of the bacterium by other currently accepted tests. Conclusions: The study demonstrates that a gas chromatograph–mass spectrometer can be used to analyse [13C]urea breath tests, thus potentially lowering the cost of the test and increasing the number of laboratories that can perform the test.
Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole
Authors: LEWIS S. J. , FRANCO S. , YOUNG G. , O'KEEFE S. J. D. 
Published: October 2003

Background: The dramatic inhibitory effect of proton pump inhibitors on acid secretion has raised concern about possible side‐effects, such as small bowel bacterial overgrowth, which may result in further gut dysfunction. The aim of this study was to assess the effect of proton pump inhibitors on duodenal bacteriology, carbohydrate absorption and bowel habit. Methods: Small bowel bacterial overgrowth and xylose absorption were measured by culture of aspirated duodenal fluid and a combined 1 g 14C‐d‐xylose absorption–metabolism test in 20 patients with peptic ulcer disease. Tests were repeated after 4 weeks of treatment with omeprazole 20 mg daily. Intestinal transit was assessed by recording interdefecatory intervals and stool form. Results: All patients showed an increase in duodenal bacterial counts following treatment, geometric mean counts increasing from 330 to 95000 CFU/mL. The geometric mean of the difference was 290 CFU/mL (95% CI, 110–720 CFU/mL; P<0.0001). No changes were noted in the xylose absorption or metabolism tests. Mean interdefecatory intervals decreased by 32% from 31.7 to 21.6 h, the mean difference being 10.1 h (95% CI, 1.6–18.5 h; P=0.01). The mean stool form index increased from 2.95 to 4.70, mean difference 1.75 (95% CI, 1.10–2.40; P<0.0001), with four patients reporting diarrhoea. Conclusion: The results indicate that conventional treatment for duodenal ulcers with a proton pump inhibitor significantly increases bacterial colonization of the duodenum and the speed of intestinal transit.
Helicobacter pylori eradication using one‐week low‐dose lansoprazole plus amoxycillin and either clarithromycin or azithromycin
Authors: CAMMAROTA G. , TURSI A. , PAPA A. , MONTALTO M. , VENETO G. , CUOCO L. , FEDELI G. , GASBARRINI G. 
Published: October 2003

Aim: To evaluate and compare two 1‐week low‐dose triple therapies based on lansoprazole, amoxycillin and a macrolide in eradicating Helicobacter pylori. Methods: Seventy consecutive patients, suffering from dyspeptic symptoms with H. pylori infection, were randomly allocated to one of two treatment groups: (A) (LAC; n=35) lansoprazole 30 mg once daily, amoxycillin 1000 mg b.d., clarithromycin 250 mg b.d., all for 7 days; and (B) (LAA; n=35) lansoprazole 30 mg once daily and amoxycillin 1000 mg b.d., both for 7 days, plus azithromycin 500 mg once daily for only 3 days. The H. pylori status was evaluated by means of histology and rapid urease test at entry and 8 weeks after treatment. Results: Three patients did not complete the treatment: one in the LAC group was withdrawn owing to severe side‐effects; two patients in the LAA group stopped the treatment prematurely. H. pylori eradication was obtained in 28 of 34 (82%; 95% CI=66–93%) patients in the LAC group and in 20 of 33 (61%; 95% CI=42–77%) patients in the LAA group. The difference is significant (P<0.029). On intention‐to‐treat analysis, the rates of eradication were (28 of 35 patients, 80% in the LAC group and 20 of 35 patients, 57% in the LAA group. Side‐effects occurred in nine (26%) and six (18%) patients in the LAC and LAA groups, respectively. Conclusions: Low‐dose lansoprazole plus amoxycillin and clarithromycin is more effective than low‐dose lansoprazole plus amoxycillin and azithromycin, but it gave a greater incidence of side‐effects.
Tilidine does not affect human sphincter of Oddi motility—a randomized, controlled study
Authors: WEHRMANN T. , RAUSCH D. , SEILER K. U. , BRENNSCHEIDT U. , CASPARY W. F. 
Published: October 2003

Aim:To investigate the effects of intravenous pentazocine and tilidine on sphincter of Oddi motility.Methods:Twenty patients with suspected sphincter of Oddi dysfunction were enrolled in a prospective, double‐blind study. Sphincter of Oddi motility was assessed by means of endoscopic manometry after injection of 0.9% saline, as well as after randomized dosing with either 30 mg pentazocine i.v. (n = 10) or 50 mg tilidine i.v. (n = 10).Results:Pentazocine significantly increased the sphincter of Oddi baseline pressure from 32 ± 21 mmHg (saline) to 41 ± 19 mmHg (P = 0.002), whereas tilidine did not alter the sphincter baseline pressure (34 ± 15 mmHg saline vs. 36 ± 16 mmHg tilidine, P = 0.16). Furthermore, pentazocine increased the phasic sphincter contraction amplitude (108 ± 16 mmHg saline vs. 121 ± 18 mmHg pentazocine, P = 0.004), but tilidine was without any effect (125 ± 24 mmHg saline vs. 125 ± 21 mmHg tilidine, P = 0.93). The phasic sphincter of Oddi contraction frequency and duration were not influenced either by pentazocine or by tilidine.Conclusion:In contrast to 30 mg of pentazocine, 50 mg of tilidine does not affect sphincter of Oddi motility. Therefore, tilidine can be used during endoscopic manometry and for analgesia in pancreatobiliary disease.
The influence of age, gender, Helicobacter pylori and smoking on gastric mucosal adaptation to non‐steroidal anti‐inflammatory drugs
Authors: LIPSCOMB G. R. , CAMPBELL F. , REES W. D. W. 
Published: October 2003

Introduction:Oral NSAIDs cause acute gastric injury that resolves, despite continued administration, by a process known as adaptation. Little is known about the factors that influence this process.Methods:Sixty‐two healthy volunteers were given a 28‐day course of either etodolac 300 mg b.d. (13 subjects), naproxen 500 mg b.d. (23), enteric‐coated diclofenac (10) or effervescent diclofenac 50 mg b.d. (16). All subjects were gastroscoped before and on days 1, 7 and 28 during drug administration, to assess gastric mucosal damage using a modified Lanza scale. Subjects were then divided into three categories: those who adapted completely, those who adapted incompletely and those who showed no adaptation. The proportion of subjects in each group was compared with respect to age, gender, smoking, the presence of Helicobacter pylori, and the NSAID prescribed.Results:Fifty‐nine subjects (median age 25.0 years, range 18–70) developed initial gastric injury to NSAIDs of whom 42 adapted completely, 13 adapted incompletely and four showed no evidence of adaptation. The mean age of subjects was lower in those who adapted (26.8 ± 9.8 years) than those who adapted incompletely (32.5 ± 10.3 years) and those who did not adapt (42.0 ± 15.7 years, P = 0.01). There was no evidence of gender influencing adaptation. Of 17 H. pylori‐positive subjects, a higher proportion had incomplete adaptation, with only nine subjects adapting completely (53% vs. 81%, P = 0.04). Sixteen subjects were smokers, of whom a greater proportion showed no evidence of adaptation (19% vs. 2%, P = 0.03). A smaller proportion of those who took naproxen (48%) adapted completely than those who took enteric‐coated diclofenac (89%), effervescent diclofenac (75%) or etodolac (91%, P = 0.03).Conclusion:Some adaptation occurred in over 90% of subjects after 4 weeks dosing with an NSAID, but adaptation was less frequent in older subjects and in smokers. Complete adaptation occurred less frequently in H. pylori‐positive subjects and in those who were given naproxen.