bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nitrofurantoin quadruple therapy for Helicobacter pylori infection: effect of metronidazole resistance
Authors: Graham D. Y. , Saeed M. A. , Hoffman J. , El‐Zimaity H. M. T. , Kwon D. H. , Osato M. S. 
Published: March 2003

Background:Antibiotic resistance has increasingly been recognized as the major cause of treatment failure for Helicobacter pylori infection. New therapies for patients with metronidazole‐ or clarithromycin‐resistant H. pylori are needed.Aim:To investigate the role of nitrofurantoin quadruple therapy for the treatment of H. pylori.Methods:Patients with confirmed H. pylori infection received nitrofurantoin (100 mg t.d.s.), omeprazole (20 mg b.d.), Pepto‐Bismol (two tablets t.d.s.), and tetracycline (500 mg t.d.s.) for 14 days. Four or more weeks after the end of therapy, outcome was assessed by repeat endoscopy with histology and culture or urea breath testing.Results:Thirty patients were entered, including 25 men and five women; the mean age was 54.9 years. The most common diagnoses were duodenal ulcer (23%) and GERD (18%). The intention‐to‐treat cure rate was 70% (95% CI: 50.6–85%). Nitrofurantoin quadruple therapy was more effective with metronidazole‐sensitive strains (88%; 15 out of 17) than with metronidazole‐resistant strains (33%; three out of nine; P=0.008). Two of the treatment failures had pre‐treatment isolates susceptible to metronidazole, which were resistant after therapy.Conclusions:Because nitrofurantoin quadruple therapy performed inadequately in the presence of metronidazole resistance, we conclude that nitrofurantoin is unlikely to find clinical utility for the eradication of H. pylori.
Induction interferon therapy in naïve patients with chronic hepatitis C: increased end‐of‐treatment virological responses but absence of long‐term benefit
Authors: Hadziyannis A. S. , Papaioannou C. , Spanou F. , Manesis E. K. , Hadziyannis S. J. 
Published: March 2003

Background and aims:The low efficacy of interferon monotherapy and data from viral kinetic studies led us to evaluate the efficacy of interferon administered daily in chronic hepatitis C.Patients and methods:Thirty‐eight naïve patients with chronic hepatitis C and active liver disease randomly received 3 or 5 MU IFN‐α daily for 1 month, followed by the same dose three times a week for 11 months. Results were compared to a three‐times‐a‐week scheme of 3 MU IFN‐α for 1 year.Results:At the end of the induction period, 27 out of 38 (71%) patients had cleared HCV‐RNA with a significantly higher rate in the 5 MU than in the 3 MU group (17 out of 18 or 94% vs. 10 out of 20 or 50%, P=0.003). The end‐of‐treatment virological response rate was 66% (25 out of 38) in the induction groups and 40% (10 out of 25) in the control group (P=0.04). Six months after completion of therapy, the sustained response rate dropped to 29% (11 out of 38) compared to 28% (7 out of 25) in the standard regimen.Conclusions:In chronic hepatitis C, treatment with 5 or 3 MU IFN‐α daily during the first month of a standard IFN regimen leads to significantly increased end‐of‐treatment virological responses, but long‐term responses are similar to those of standard IFN monotherapy.
Economic analysis of four triple regimens for the treatment of Helicobacter pylori‐related peptic ulcer disease in in‐patient and out‐patient settings in Hong Kong
Authors: You J. H. S. , Lee K. K. C. , Ho S. S. S. , Sung J. J. Y. , Kung N. N. S. , Yung M. , Lee C. , Yee G. C. 
Published: March 2003

Background:One‐week triple regimens have been shown to be effective for the treatment of Helicobacter pylori‐related peptic ulcer disease.Aim:To conduct an economic analysis of four triple regimens for the treatment of H. pylori‐related peptic ulcer disease from the perspective of a public health organization in Hong Kong.Methods:Records of 200 patients with H. pylori‐related peptic ulcer disease, who had previously participated in a randomized comparison of ranitidine bismuth citrate (RBC) with amoxicillin and clarithromycin (RAC), omeprazole with amoxicillin and clarithromycin (OAC), RBC with metronidazole and tetracycline (RMT), or, colloidal bismuth subcitrate with metronidazole and tetracycline (BMT) in either in‐patient or out‐patient setting were reviewed.Results:Fifty patients were excluded because of incomplete documentation or lack of peptic ulcer. In the out‐patient group (n=72), the median direct costs of the RAC group (HK $ 5094) were lower those of the BMT (HK $ 5400), RMT (HK $ 5394), or OAC (HK $ 5440) groups, but the difference was significant only between the RAC and BMT groups (P < 0.05). In the in‐patient group (n=78), the median direct costs of the RMT group (HK $ 8524) were significantly lower than those of the OAC (HK $ 13 871) and RAC (HK $ 12 092) groups (P < 0.05), but were similar to those of the BMT group (HK $ 8758).Conclusions:RAC and RMT are the least costly regimens for out‐patient and in‐patient treatment, respectively, of H. pylori‐related peptic ulcer disease in Hong Kong.
Lack of efficacy of ridogrel, a thromboxane synthase inhibitor, in a placebo‐controlled, double‐blind, multi‐centre clinical trial in active Crohn’s disease
Authors: Carty E. , Rampton D. S. , Schneider H. , Rutgeerts P. , Wright J. P. 
Published: March 2003

Background:Thromboxanes are produced in excess and platelets are activated in active Crohn’s disease. Preliminary reports have suggested that ridogrel, a dual thromboxane synthase inhibitor and receptor antagonist, may have therapeutic benefit in patients with inflammatory bowel disease.Aims:To investigate the efficacy of ridogrel in patients with active Crohn’s disease.Patients and methods:This was an international, multicentre, randomized, double‐blind, placebo‐controlled trial of 5 mg/day oral ridogrel for 12 weeks in 85 patients with moderately active Crohn’s disease. Sixty patients were randomized to receive ridogrel, and 25 to placebo. The Crohn’s disease activity index (CDAI) was used to assess disease activity: remission was defined as a CDAI < 150. Changes in clinical condition, as assessed by the Harvey–Bradshaw index, global evaluation by the investigator and the patient, and blood measures of inflammation, were used as secondary outcomes.Results:The patients’ mean (s.d.) CDAI at recruitment was 277 (68) in the ridogrel treated group and 265 (70) in the placebo group. At their final assessment, 20 out of 60 (35%) patients who had been given ridogrel in an intention‐to‐treat analysis and seven out of 25 (28%) patients given placebo were in remission (no significant difference). No significant differences in Harvey– Bradshaw index or global evaluation were noted between patients given ridogrel and those given placebo. Adverse events were similar in both groups.Conclusion:A 5‐mg dose of oral ridogrel was not more effective than placebo in inducing remission in patients with moderately active Crohn’s disease. If thromboxane synthesis and platelet function are to be targeted for the treatment of Crohn’s disease, more potent agents require development and assessment.
Non‐systemic chemotherapy in the treatment of colorectal cancer—portal vein, hepatic arterial and intraperitoneal approaches
Authors: Buecher B. , Bleiberg H. 
Published: March 2003

Loco‐regional chemotherapy, an alternative to systemic chemotherapy in the management of colorectal cancer, has been evaluated in both adjuvant and palliative settings. The rationale for loco‐regional delivery is to achieve higher dose concentrations of drugs at the tumour site or at the most common sites of tumour recurrence, while limiting systemic exposure and associated toxicity.Adjuvant intraportal chemotherapy and palliative hepa‐tic arterial chemotherapy have been most extensively investigated. Intraperitoneal chemotherapy has also been studied as an adjuvant treatment after complete resection of colorectal cancer or cytoreductive surgery in patients with established peritoneal carcinomatosis. The results obtained have been disappointing, and none of these procedures can be considered as a standard therapeutic option today. However, methodological difficulties were encountered in most published studies, and the investigated schedules and doses may not have been optimal.New combinations of cytotoxic drugs and new indications are currently under consideration. Promising results have recently been published for adjuvant intraperitoneal chemotherapy and hepatic arterial chemotherapy following surgical resection of hepatic metastases, but additional well‐designed multicentre phase III trials are needed to determine the true benefits of these treatment modalities and to address the issues of cost and quality of life.
Lack of symptom benefit following presumptive Helicobacter pylori eradication therapy in primary care
Authors: Williams D. , O'Kelly P. , Kelly A. , Feely J. 
Published: March 2003

Background: Helicobacter pylori eradication regimens have failure rates under 10%, however little information is available on the effect of treatment success in reducing the subsequent prescription of anti‐ulcer medications in primary care.Aims:To determine, using a large prescription database in eastern Ireland, the success of presumptive eradication therapy in improving symptoms of dyspepsia in primary care, as judged by a reduction in the subsequent prescription of anti‐ulcer medications.Methods:In a cross‐sectional study, we identified 3847 patients who received a prescription for eradication therapy for Helicobacter pylori, including 826 who were followed for 9–11 months. Those who subsequently received anti‐ulcer medications were deemed failures to obtain symptom relief.Results:For 3847 patients with a median follow‐up of 8 months, the failure rate was 49%. Of 826 patients, followed for a longer period (9–11 months), the overall failure rate was 56% (range 44–62% depending on the eradication regimen used). Age over 65 years (hazard ratio=1.57, 95% confidence interval= 1.29–1.91, P < 0.001), prior use of anti‐ulcer medications (hazard ratio=1.97, 95% confidence interval=1.63–2.37, P < 0.001) and prior use of aspirin/NSAIDs (hazard ratio=1.43, 95% confidence interval=1.18–1.73, P < 0.001) all predicted failure to obtain relief of symptoms of dyspepsia from eradication therapy.Conclusions:Such high failure rates of eradication therapy in reducing the subsequent consumption of anti‐ulcer medications have both clinical and economic implications for the use of eradication therapy for Helicobacter pylori in primary care.
Systematic review of proton pump inhibitors for the acute treatment of reflux oesophagitis
Authors: Edwards S. J. , Lind T. , Lundell L. 
Published: March 2003

Background: Esomeprazole is a new proton pump inhibitor, which has been compared to omeprazole for the treatment of reflux oesophagitis in clinical trials. Aim:To compare the effectiveness of esomeprazole with the recommended dose of proton pump inhibitors in the healing of reflux oesophagitis, using omeprazole as a common comparator.Methods:Systematic review of randomized controlled trials. Extraction and re‐analysis of data to provide ‘intention‐to‐treat’ results. Meta‐analysis using a Fixed Effects model.Results:A meta‐analysis of healing rates of esomeprazole 40 mg compared to omeprazole 20 mg gave the following results: at 4 weeks (relative risk 1.14; 95% CI: 1.10, 1.18) and 8 weeks (RR 1.08; 95%CI: 1.05, 1.10). Other proton pump inhibitors compared to omeprazole 20 mg are as follows: lansoprazole 30 mg at 4 weeks (RR 1.02; 95%CI: 0.97, 1.08) and 8 weeks (RR 1.01; 95%CI: 0.97, 1.06); pantoprazole 40 mg at 4 weeks (RR 0.99; 95%CI: 0.91, 1.07) and 8 weeks (RR 0.98; 95%CI: 0.93, 1.04); rabeprazole 20 mg at 4 weeks (RR 1.00; 95%CI: 0.87, 1.14) and 8 weeks (RR 0.98; 95%CI: 0.91, 1.05).Conclusions:Esomeprazole has demonstrated higher healing rates than omeprazole at 4 and 8 weeks. Other proton pump inhibitors (lansoprazole, pantoprazole and rabeprazole) have not shown higher healing rates when compared with omeprazole.
Safety and efficacy of glucagon as a premedication for upper gastrointestinal endoscopy—a comparative study with butyl scopolamine bromide
Authors: Hashimoto T. , Adachi K. , Ishimura N. , Hirakawa K. , Katsube T. , Kurotani A. , Hattori S. , Kinoshita Y. 
Published: March 2003

Background:Glucagon inhibits digestive motility and is used for endoscopic premedication; however, its effect on cardiopulmonary function during endoscopy has not yet been fully investigated.Aim:To clarify the efficacy and safety of glucagon compared with butyl scopolamine bromide as upper gastrointestinal endoscopy premedication.Methods:Two hundred and forty consecutive patients over 40 years of age, referred for upper gastrointestinal endoscopy, without any complications, were studied. These patients were randomly premedicated with butyl scopolamine bromide (SC group) or glucagon (G group). Time course changes in blood pressure, arterial oxygen saturation, heart rate and the number of retching episodes during endoscopy were examined. The efficacy of glucose tablets after upper gastrointestinal endoscopy to prevent hypoglycaemia caused by glucagon was evaluated. Cardiopulmonary parameters were also examined in 77 complicated patients with glucagon premedication (GC group).Results:A continuous increase in heart rate during upper gastrointestinal endoscopy was observed in the SC group, but not in the G and GC groups. Blood pressure, arterial oxygen saturation and number of retching episodes were not different between the groups. Hypoglycaemia‐related symptoms were frequent in the G group without glucose tablets, but were prevented by the administration of glucose.Conclusions:Glucagon has a weaker effect on cardiopulmonary function during upper gastrointestinal endoscopy than butyl scopolamine bromide. Glucose administration prevents hypoglycaemia‐related symptoms caused by glucagon.
Effect of granisetron on radiation‐induced alterations of colonic motility and fluid absorption in rats
Authors: Picard C. , Ksas B. , Griffiths N. M. , Fioramonti J. 
Published: March 2003

Background:Radiation‐induced diarrhoea is attributed to both mucosal injury and alterations of intestinal motility. Previous reports have indicated that 5‐hydroxytryptamine is released following irradiation, which may contribute to these changes.Aims:To investigate the effects of granisetron (5‐hydroxytryptamine type‐3 receptor antagonist) on colonic motility, fluid absorption and 5‐hydroxytryptamine colonic content following abdominal irradiation (10 Gy) in rats.Methods: In vivo measurements of motility and fluid absorption in the proximal and distal colon, respectively, diarrhoea score and 5‐hydroxytryptamine tissue levels were performed 3 and 7 days after abdominal irradiation. The effects of post‐irradiation granisetron (0.3 mg/kg subcutaneously) were also evaluated.Results:Colonic motility and fluid/Na+ absorption were reduced 3 and 7 days after irradiation. All rats developed diarrhoea (3 days) concomitant with increased colonic mucosal 5‐hydroxytryptamine levels. Granisetron prevented diarrhoea, attenuated decreased colonic motility and reduced 5‐hydroxytryptamine levels on day 3, although fluid absorption was only slightly improved. On day 7, colonic motility and fluid/Na+ absorption were restored in granisetron‐dosed animals.Conclusions:These results indicate that radiation‐induced diarrhoea involves alterations of both colonic motility and fluid/Na+ absorption. 5‐Hydroxytryptamine could be one of the mediators implicated in these alterations, as post‐irradiation dosage with a 5‐hydroxytryptamine type‐3 receptor antagonist improved colonic motility and prevented diarrhoea on day 3.
Efficacy of a motilin receptor agonist (ABT‐229) for the treatment of gastro‐oesophageal reflux disease
Authors: Chen C. L. , Orr W. C. , Verlinden M. H. , Dettmer A. , Brinkhoff H. , Riff D. , Schwartz S. , Soloway R. D. , Krause R. , Lanza F. , Mack R. J. 
Published: March 2003

Background:ABT‐229 is a potent motilin agonist without significant antibiotic activity. It has been shown to improve gastric emptying in humans and to increase lower oesophageal sphincter pressure in cats.Aim:To assess the efficacy of four different doses of ABT‐229 (1.25 mg, 2.5 mg, 5 mg, 10 mg b.d.) compared to placebo in the treatment of gastro‐oesophageal reflux disease, and to determine its safety in patients with gastro‐oesophageal reflux disease.Methods:In a double‐blind, multicentre study, 324 patients with heartburn were randomized to receive four different doses of ABT‐229 or placebo for 8 weeks. The efficacy was evaluated by Patient Symptom Questionnaire, daily diary, endoscopy and global evaluation of efficacy.Results:There were no statistically significant improvement scores for any of the ABT‐229 treatment groups vs. the placebo group in any of the efficacy parameters. Reflux symptom scores were significantly worse after treatment in the dyspeptic group. ABT‐229 appeared to be well tolerated and safe in total daily doses up to 20 mg.Conclusion:ABT‐229 appears to have limited, if any, clinical utility in the treatment of gastro‐oesophageal reflux disease.
Health‐related quality of life among persons with irritable bowel syndrome: a systematic review
Authors: El‐Serag H. B. , Olden K. , Bjorkman D. 
Published: March 2003

SummaryAim : To perform a systematic review of the literature with three objectives: (1) to compare the health related quality of life (HRQoL) of patients with irritable bowel syndrome with that of healthy controls; (2) to compare the HRQoL of irritable bowel syndrome patients to those with other diseases; and (3) to examine therapy‐associated changes in HRQoL of irritable bowel syndrome patients.Methods : Searches of all English and non‐English articles from 1980 to 2001 were performed in Medline and Embase, and two investigators performed independent data abstraction.Results : Seventeen articles met our selection criteria. 13 studies addressed objective no. 1; 11 showed a significant reduction in HRQoL among irritable bowel syndrome patients. Of these, only one study was considered of high quality. Four studies addressed objective no. 2, none of which was considered to be high quality in addressing this objective. Four trials (three of high quality) addressed objective no. 3. One showed that symptomatic improvement with Leupron compared to placebo was accompanied an improvement only in the comparative health domain of the HRQoL. The second study reported significant positive changes in HRQoL after 12 weeks of cognitive behavioural therapy. The third report of two placebo‐controlled studies indicated significant improvement with alosetron on most domains of Irritable Bowel Syndrome Quality of Life Questionnaire.Conclusions : (i) There is reasonable evidence for a decrease in HRQoL in patients with moderate to severe irritable bowel syndrome; however, the data are conflicting regarding the impact of irritable bowel syndrome on HRQoL in population‐based studies of nonconsulters. (ii) HRQoL in irritable bowel syndrome patients is impaired to a degree comparable to other chronic disorders such as GERD and depression. (iii) A therapeutic response in irritable bowel syndrome‐related pain has a corresponding improvement in HRQoL. (iv) Limitations of the literature include focusing on moderate‐severe irritable bowel syndrome in referral centres, and lack of appropriate controls
Long‐term risk of malignancy after treatment of inflammatory bowel disease with azathioprine
Authors: Fraser A. G. , Orchard T. R. , Robinson E. M. , Jewell D. P. 
Published: March 2003

SummaryBackground and aim : Data from renal transplant and rheumatoid arthritis patients suggest that there is an increased risk of malignancy after treatment with azathioprine. Whether this is true for patients with inflammatory bowel disease remains uncertain.Method : A retrospective review of clinical notes was performed.Results : Azathioprine was given to 626 of 2204 patients (855 with Crohn's disease and 1349 with ulcerative colitis). The mean total duration of azathioprine use was 27 months. The mean follow‐up from diagnosis was 13.7 years and the mean follow‐up from the start of azathioprine treatment was 6.9 years. Thirty‐one cancers were observed in 30 patients treated with azathioprine (4.5%) and 77 cancers were observed in 70 patients not treated with azathioprine (4.5%; P=N.S.). Logistic regression analysis (including in the model the age, sex, diagnosis and extent of disease) showed that treatment with azathioprine did not significantly affect the risk of the development of cancer. Eight patients had lymphoma; three had been given azathioprine (P=N.S.). For patients with ulcerative colitis, the number of colorectal cancers (including high‐grade dysplasia) in patients given azathioprine was eight of 355 (2.2%), compared with 28 of 994 (2.8%) for patients not given azathioprine (P=N.S.). The cumulative risk of colorectal cancer or dysplasia/dysplasia‐associated lesion or mass (adjusted to exclude post‐colectomy patients) after 10, 20, 30 and 40 years ofulcerative colitis was 0.4%, 1.3%, 9%and 15.5%, respectively.Conclusion : No increased risk of cancer diagnosis following azathioprine treatment was observed.
Serum bile acids in patients with liver failure supported with a bioartificial liver
Authors: Pazzi P. , Morsiani E. , Vilei M. T. , Granato A. , Rozga J. , Demetriou A. A. , Muraca M. 
Published: March 2003

SummaryBackground : Serum bile acids are increased in liver failure, but the composition of the bile acid pool in this condition has not been studied in detail. This information is of interest because of dihydroxy bile acid toxicity.Methods : We measured serum bile acids by gas chromatography–mass spectrometry in 13 patients with fulminant liver failure and five patients with acute‐on‐chronic liver failure. Furthermore, serum bile acids were analysed in the same patients after 6 h of treatment with a bioartificial liver, consisting of a hollow‐fibre cartridge with microcarrier‐attached porcine hepatocytes and a charcoal column.Results : Pre‐bioartificial liver serum bile acids demonstrated a high dihydroxy/trihydroxy ratio and were higher in patients with acute‐on‐chronic liver failure than in those with fulminant liver failure (452.8 ± 98.6 vs. 182.1 ± 39.7 µmol/L; P < 0.05). Bioartificial liver treatment decreased significantly serum bile acids in patients with fulminant liver failure (−38.8%) and acute‐on‐chronic liver failure (−35.8%), with a decreased dihydroxy/trihydroxy ratio. In vitro, porcine hepatocytes in the bioreactor cleared most conjugated bile acid species from pooled patient plasma.Conclusions : Acute liver failure is associated with very high serum levels of toxic bile acids that could contribute to the pathogenesis of the syndrome. Bioartificial liver treatment reduces both serum bile acid concentrations and the hydrophobicity of the bile acid pool.