bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intestinal metaplasia and gastric carcinogenesis
Authors: Leung W. K. , Sung J. J. Y. 
Published: March 2003

SummaryGastric intestinal metaplasia, an intermediate step in Correa's cascade of gastric carcinogenesis, is generally regarded as a pre‐malignant lesion. Epidemiological studies suggest that patients with intestinal metaplasia have more than a 10‐fold increased risk of developing gastric cancer. Within the subclassification of intestinal metaplasia, incomplete or type III intestinal metaplasia appears to be associated with even higher malignant potential. The topographical distribution of intestinal metaplasia may also have prognostic implications. Certain genetic and epigenetic alterations have been demonstrated in gastric intestinal metaplasia which straddle into gastric cancer. These findings suggest that genetic changes occur early in the multistep gastric carcinogenesis process. Unlike Barrett's oesophagus and colonic polyp, which have well‐defined surveillance guidelines, there is no widely accepted surveillance programme for gastric intestinal metaplasia. An annual surveillance programme may allow early detection of gastric cancer, which theoretically may improve survival. It remains elusive whether the treatment of Helicobacter pylori infection may reverse gastric intestinal metaplasia or reduce the subsequent risk of cancer development. Further controlled studies with longer follow‐up are needed to resolve this controversy. The role of chemo‐prophylactic agents, e.g. cyclo‐oxygenase‐2 inhibitor, should be investigated.
The role of the gut flora in health and disease, and its modification as therapy
Authors: Hart A. L. , Stagg A. J. , Frame M. , Graffner H. , Glise H. , Falk P. , Kamm M. A. 
Published: March 2003

SummaryThe gut flora is a vast interior ecosystem whose nature is only beginning to be unravelled, due to the emergence of sophisticated molecular tools. Techniques such as 16S ribosomal RNA analysis, polymerase chain reaction amplification and the use of DNA microarrays now facilitate rapid identification and characterization of species resistant to conventional culture and possibly unknown species. Life‐long cross‐talk between the host and the gut flora determines whether health is maintained or disease intervenes. An understanding of these bacteria–bacteria and bacteria–host immune and epithelial cell interactions is likely to lead to a greater insight into disease pathogenesis. Studies of single organism–epithelial interactions have revealed the large range of metabolic processes that gut bacteria may influence. In inflammatory bowel diseases, bacteria drive the inflammatory process, and genetic predisposition to disease identified to date, such as the recently described NOD2/CARD15 gene variants, may relate to altered bacterial recognition. Extra‐intestinal disorders, such as atopy and arthritis, may also have an altered gut milieu as their basis. Clinical evidence is emerging that the modification of this internal environment, using either antibiotics or probiotic bacteria, is beneficial in preventing and treating disease. This natural and apparently safe approach holds great appeal.
The treatment of irritable bowel syndrome
Authors: Thompson W. G. 
Published: March 2003

SUMMARYThe efforts of clinical researchers, lay organizations and pharmaceutical companies have increased the public profile of irritable bowel syndrome and made it a respectable diagnosis. Diagnostic symptom criteria encourage a firm clinical diagnosis, which is the foundation of a logical management strategy. This begins with education. Reassurance that no structural disease threatens should be tempered with the reality that symptoms are likely to recur over many years. Patients expect diet and lifestyle advice, even if this is not specific to irritable bowel syndrome. Only a few of those with irritable bowel syndrome see doctors, and even fewer see specialists. Therefore, the treating physician should ascertain the reason for the visit, the patient's fears and the presence of any comorbid illness, such as depression, that might require treatment in its own right. No drug treatment is useful for all of the symptoms of irritable bowel syndrome, and many patients require no drug at all. If used, drugs should target the predominant symptom. Alosetron, a 5‐HT3 antagonist, is effective in treating women with irritable bowel syndrome who also have diarrhoea. Tegaserod, a 5‐HT4 agonist, is useful for women with irritable bowel syndrome who are constipated. Most patients with irritable bowel syndrome need psychological support. Reassurance, discussion and relaxation techniques can be provided by the family doctor. Difficult psychopathology may require referral to a mental health professional, and the gastroenterologist can settle diagnostic uncertainties. In all cases, successful treatment depends on a confident diagnosis and the strength of the doctor–patient relationship.
Meta‐analysis: ribavirin‐induced haemolytic anaemia in patients with chronic hepatitis C
Authors: Chang C. H. , Chen K. Y. , Lai M. Y. , Chan K. A. 
Published: March 2003

SUMMARYAim : To use meta‐analysis to study the risk of anaemiarelated to ribavirin therapy for chronic hepatitisC.Methods : The MEDLINE database up to January 2001 was searched for randomized controlled trials of ribavirin (monotherapy or combined with interferon) for chronic hepatitis C. The outcomes evaluated were withdrawal from the study due to anaemia, ribavirin dosage reduction due to a decrease in haemoglobin and haemoglobin levels below 10 g/dL.Results : Based on 17 studies, the overall risk difference (ribavirin vs. no ribavirin) for anaemia was 0.09 [95% confidence interval (CI), 0.04–0.13]. Two Asian studies reported risk differences of 0.29 and 0.22, greater than the pooled risk difference of 0.07 (95% CI, 0.03–0.12) for 15 non‐Asian studies. The risk associated with 1 g or more of ribavirin per day was higher (risk difference, 0.09; 95% CI, 0.04–0.14) than that for 0.8 g of ribavirin per day (risk difference, 0.01; 95% CI, − 0.04–0.06).Conclusions : Chronic hepatitis C patients treated with 1 g or more of ribavirin per day were at a higher risk of developing anaemia. Reported risks were higher among Asian studies, which may be due to differences in study entrance criteria, dosage titration strategy or ethnic vulnerability.
Dynamics of Helicobacter pylori infection in early childhood in a high‐risk group living in Germany: loss of infection higher than acquisition
Authors: Rothenbacher D. , Bode G. , Brenner H. 
Published: March 2003

SUMMARYBackground : The dynamics of Helicobacter pylori infection in early childhood are not yet well understood.Aim : To conduct a prospective study in a population of children known to be at high risk of H. pylori infection to elucidate the incidence and loss of infection in childhood.Methods : Asymptomatic Turkish children [aged 1 (n = 56 children), 2 (n = 55 children) and 4 years (n = 69 children)] at baseline, on whom participating paediatricians had performed routine health screening examinations between September 1997 and October 1998, were included in the study. A follow‐up was performed about 1 year later. The infection status was defined by means of an antigen‐based stool assay.Results : In total, for 137 of 180 (76%) children, follow‐up information was available. At baseline examination, the prevalence of infection in children with follow‐up information was 27%[95% confidence interval (CI), 20–35%]. The incidence of H. pylori infection amongpreviously uninfected children was 7% (95% CI, 3–14%) and the loss of infection among previously infected children was 35% (95% CI, 20–54%) during follow‐up.Conclusions : This prospective cohort study in a high‐risk group of children living in Germany showed that H. pylori colonization may often not persist at an early age. Furthermore, the use of penicillins and macrolides may be associated with the loss of infection at an early age.
Thiopurine methyltransferase activity and the use of azathioprine in inflammatory bowel disease
Authors: Ansari A. , Hassan C. , Duley J. , Marinaki A. , Shobowale‐Bakre E. ‐M. , Seed P. , Meenan J. , Yim A. , Sanderson J. 
Published: March 2003

SummaryBackground : Azathioprine therapy is discontinued in one‐third of patients with inflammatory bowel disease because of toxicity or a lack of clinical response. Patients with thiopurine methyltransferase (TPMT) deficiency are intolerant to azathioprine, whilst carriers are at increased risk of side‐effects.Aim : To evaluate the importance of TPMT activity in the management of azathioprine therapy in inflammatory bowel disease.Methods : Clinical response, adverse effects and haematological parameters were determined and correlated with TPMT enzyme activity and genotype in 106 patients with inflammatory bowel disease.Results : Ninety‐six patients had high TPMT activity, and 10 had intermediate activity. Nineteen patients (18%) were intolerant to azathioprine. Fifteen (16%) of those with high TPMT activity were intolerant, compared with five (50%) with intermediate activity [odds ratio (OR), 5.4; 95% confidence interval (CI), 1.5–19.8]. Complete remission was achieved in 63% of cases, and complete or partial remission in 79%. Interestingly, very high TPMT activity (> 14 units/mL red blood cells) was significantly associated with non‐response, irrespective of the time on azathioprine (OR, 0.21; 95% CI, 0.07–0.68). TPMT gene mutations correlated with TPMT activity.Conclusions : Inflammatory bowel disease patients with intermediate TPMT activity have an increased risk of azathioprine toxicity. Conversely, very high TPMT activity predicts treatment failure. TPMT genotype predicted TPMT phenotype in this study.
Prophylactic lamivudine prevents hepatitis B reactivation in chemotherapy patients
Authors: Lim L. L. , Wai C. T. , Lee Y. M. , Kong H. L. , Lim R. , Koay E. , Lim S. G. 
Published: March 2003

SummaryBackground : Chronic hepatitis B virus carriers receiving chemotherapy develop a high hepatitis B virus reactivation rate (38–53%) with a high mortality (37–60%). Few studies have characterized the efficacy of lamivudine in the treatment of chemotherapy‐induced hepatitis B virus reactivation.Aim : To determine whether lamivudine prophylaxis reduces chemotherapy‐induced hepatitis B virus reactivation and mortality.Methods : The medical records of all hepatitis B surface antigen‐positive patients with malignancy treated with chemotherapy since 1995 at the National University Hospital of Singapore were identified, and divided into those who received lamivudine prophylaxis before chemotherapy (P) and those who did not (NP).The parameters examined included gender, age, malignancy type, steroid usage, number of chemotherapy courses and regimens, follow‐up duration and hepatitis B virus status. The outcome measures were hepatitis B virus reactivation (abrupt rise of serum alanine aminotransferase to > 200 IU/L) and reactivation death. Patients with primary hepatoma or liver metastasis were excluded.Results : Thirty‐five patients were identified: 16 in the P group and 19 in the NP group. The baseline characteristics of the two groups were similar. Seven of the 19 patients in the NP group and none of the 16 patients in the P group developed reactivation (36.8% vs. 0%, P=0.009). Six of the seven patients in the NP group who developed reactivation received lamivudine at that time, but five died (mortality, 71.4%), whilst no patient in the P group died from reactivation (P=0.064).Conclusions : Prophylactic lamivudine appears to prevent hepatitis B virus reactivation and its associated mortality in patients treated with chemotherapy. This should be confirmed with prospective studies.
Clinical effectiveness of a new antacid chewing gum on heartburn and oesophageal pH control
Authors: Collings K. L. , Rodriguez‐Stanley S. , Proskin H. M. , Robinson M. , Miner P. B. 
Published: March 2003

SummaryBackground : Oesophageal acid neutralization with antacids depends on the duration of oesophageal antacid exposure and acid neutralizing capacity. A gum that releases antacid as it is chewed could take advantage of both mechanisms to enhance heartburn relief.Methods : Twenty‐four subjects were crossed over to four regimens: placebo, chewable antacid tablets (1000 mg CaCO3), lower dose gum (600 mg CaCO3) and higher dose gum (900 mg CaCO3). A dual pH probe was placed, subjects ate a standardized provocative meal and self‐dosed once as needed. Symptoms were recorded every 15 min using visual analogue and Likert scales.Results : Symptoms: Both gums decreased heartburn compared to placebo for 120 min. Higher dose gum decreased heartburn more than chewable antacids up to 120 min post‐dose. pH: Active chewable antacid and gums immediately increased oesophageal pH, with significant improvement 15–30 min post‐dose.Summary: (i) both gums promptly decreased heartburn and elevated oesophageal pH; (ii) both gums provided sustained relief for 120 min; (iii) antacid gums provided faster and more prolonged symptom relief and pH control than chewable antacids.Conclusions : Calcium carbonate gum effectively neutralizes oesophageal acidity and relieves symptoms following a meal, and is superior to chewable antacids in terms of the duration of heartburn relief.
Pharmacokinetics of budesonide controlled ileal release capsules in children and adults with active Crohn's disease
Authors: Lundin P. D. P. , Edsbäcker S. , Bergstrand M. , Ejderhamn J. , Linander H. , Högberg L. , Persson T. , Escher J. C. , Lindquist B. 
Published: March 2003

SummaryBackground : Systemic glucocorticosteroid therapy is effective in Crohn's disease, but is associated with side‐effects. Budesonide has high topical anti‐inflammatory activity, but considerably lower systemic activity than other oral glucocorticosteroids.Aim : To evaluate the systemic exposure to budesonide (controlled ileal release capsules) in children and adults with active Crohn's disease, and to assess the suppression of plasma cortisol.Methods : In an open label study, patients (eight children and six adults) with active Crohn's disease received 9 mg budesonide (Entocort capsules) orally once daily for 7 days. Plasma concentrations were determined on the seventh day of administration, and pharmacokinetic parameters were calculated. For reference, 0.5 mg budesonide was given intravenously separately. Plasma cortisol levels were compared with the pre‐treatment baseline values.Results : Systemic exposure to budesonide (AUC0−24 h) after 1 week of oral administration was 41 ± 21 nmol/L × h (mean ± s.d.) in children and 35 ± 20 nmol/L × h in adults. The estimated systemic availability in children was 9 ± 5% and in adults 11 ± 7%. The mean plasma cortisol (AUC0−24 h) decreased by 64 ± 18% in children and by 50 ± 27% in adults.Conclusions : The systemic exposure, systemic availability and cortisol suppression after oral administration of 9 mg budesonide were similar in children and adults with active Crohn's disease. Budesonide was well tolerated and no clinically important safety‐related findings were identified.
A rapid‐release 50‐mg tablet‐based 13C‐urea breath test for the diagnosis of Helicobacter pylori infection
Authors: Wong W. M. , Lam S. K. , Lai K. C. , Chu K. M. , Xia H. H. X. , Wong K. W. , Cheung K. L. , Lin S. K. , Wong B. C. Y. 
Published: March 2003

SummaryBackground : Recently, a rapid‐release 100‐mg 13C‐urea tablet with citrate supplement (Diabact UBT) showed excellent performance in a European population.Aim : To investigate the accuracy of a 50‐mg tablet‐based 13C‐urea breath test protocol.Methods : Consecutive dyspeptic patients referred for upper endoscopy were recruited. 13C‐Urea breath test was performed using a 50‐mg 13C‐urea tablet (Diabact UBT) and compared with the gold standard (rapid urease test and histology). Baseline, 10‐min, 20‐min and 30‐min breath samples were collected in all cases. The cut‐off values at each measurement interval were determined by three standard deviations above the mean excess δ13CO2 excretion of Helicobacter pylori‐negative patients.Results : Two hundred patients (150 before therapy and 50 after therapy) were available for analysis, with a mean age of 48.4 years, and 99 patients (50%) were H. pylori positive. The sensitivity and specificity of the 50‐mg tablet‐based 13C‐urea breath test at 10 min, 20 min and 30 min were 100% and 98%, 100% and 100%, and 100% and 98%, respectively.Conclusion : A 20‐min, 50‐mg tablet‐based 13C‐urea breath test (Diabact UBT) protocol is highly accurate for the diagnosis of H. pylori infection.
Non‐erosive reflux disease (NERD) — acid reflux and symptom patterns
Authors: Martinez S. D. , Malagon I. B. , Garewal H. S. , Cui H. , Fass R. 
Published: March 2003

SummaryBackground: Recent reports suggest that patients with non‐erosive reflux disease (NERD) treated with anti‐reflux medications show lower symptom improvement rates than patients with erosive oesophagitis treated with the same medications.Aim: To determine the acid reflux and symptom patterns of patients with NERD in comparison with those with erosive oesophagitis and Barrett's oesophagus, and to identify different NERD subgroups.Methods: One hundred and forty‐nine consecutive patients seen for classic heartburn symptoms were evaluated for the study. Oesophageal mucosal injury was assessed by upper endoscopy and classified by Hetzel–Dent criteria. Patients with Hetzel–Dent grades 0–1 were considered to have NERD. The extent of oesophageal acid exposure was determined by ambulatory 24‐h oesophageal pH monitoring.Results: Seventy‐one patients were found to have NERD, 36 erosive oesophagitis and 42 Barrett's oesophagus. Compared with patients with erosive oesophagitis (75%) and Barrett's oesophagus (93%), those with NERD (45%) were significantly less likely to have an abnormal pH test (P = 0.0001). Patients with Barrett's oesophagus had the highest mean number of acid reflux events (210 ± 17.7), compared with those with erosive oesophagitis (139.7 ± 15.2) and NERD (95.3 ± 9.4) (P = 0.0001); however, the rate of perceived acid reflux events was similar and very low in all groups (NERD, 3.6%; erosive oesophagitis, 2.9%; Barrett's oesophagus, 2.17%). NERD‐positive patients (abnormal pH test) had a similar extent of oesophageal acid exposure to those with erosive oesophagitis. NERD‐positive patients were more likely to demonstrate a symptom index greater than 75% than NERD‐negative patients (normal pH test) (61.9% vs. 10.5%; P = 0.0001). In the NERD‐negative group, those with a negative symptom index reported having heartburn at pH < 4 only 12.7% of the time, compared with 70.7% of the time in those with a positive symptom index, despite a similar mean number of heartburn episodes.Conclusions: Patients with NERD commonly demonstrate a negative pH test. Acid reflux characteristics and symptom patterns suggest a heterogeneous group of patients.
Efficacy and safety of single‐triple capsules of bismuth biskalcitrate, metronidazole and tetracycline, given with omeprazole, for the eradication of Helicobacter pylori: an international multicentre study
Authors: O'Morain C. , Borody T. , Farley A. , De Boer W. A. , Dallaire C. , Schuman R. , Piotrowski J. , Fallone C. A. , Tytgat G. , Mégraud F. , Spénard J. 
Published: March 2003

SummaryBackground : The high prevalence of Helicobacter pylori resistance to metronidazole demands treatments more effective than standard bismuth‐based triple therapy against these strains.Aim : To evaluate the H. pylori eradication rate in both metronidazole‐sensitive and ‐resistant strains following quadruple therapy using single‐triple capsules of bismuth biskalcitrate, metronidazole and tetracycline, given with omeprazole.Methods : One hundred and seventy valid patients with duodenal ulcer, gastric ulcer or non‐ulcer dyspepsia were treated in eight centres located in five countries. H. pylori was confirmed at baseline using 13C‐urea breath test, histology and/or culture. Patients received three single‐triple capsules q.i.d. and omeprazole, 20 mg b.d., for 10 days. Each capsule contained bismuth biskalcitrate, 140 mg (as 40 mg Bi2O3 equivalent), metronidazole, 125 mg, and tetracycline, 125 mg. 13C‐Urea breath test was repeated at least 4 and 8 weeks post‐treatment.Results : Overall eradication rates were 93% (158/170) by modified intention‐to‐treat analysis and 97% (142/146) by per protocol analysis. Eradication rates were 93% (40/43) and 95% (38/40) for strains resistant to metronidazole and 95% (82/86) and 99% (75/76) for strains sensitive to metronidazole by modified intention‐to‐treat and per protocol analysis, respectively.Conclusion : This omeprazole–bismuth biskalcitrate–metronidazole–tetracycline 10‐day regimen is a very effective and well‐tolerated treatment, which overcomes metronidazole resistance.
Effect of frequent consumption of a Lactobacillus casei‐containing milk drink in Helicobacter pylori‐colonized subjects
Authors: Cats A. , Kuipers E. J. , Bosschaert M. A. R. , Pot R. G. J. , Vandenbroucke‐Grauls C. M. J. E. , Kusters J. G. 
Published: March 2003

SummaryBackground : Several studies have reported inhibitory effects of lactic acid bacteria on bacterial pathogens.Aim : To test whether a drink containing Lactobacillus casei strain Shirota inhibits Helicobacter pylori growth.Methods : The in vitro growth inhibition of H. pylori was studied when L. casei was added to plates previously inoculated with H. pylori reference strain NCTC 11637. In an intervention study, 14 H. pylori‐positive subjects were given Yakult drink (108 colony‐forming units/mL L. casei) thrice daily during meals for 3 weeks. Six untreated H. pylori‐positive subjects served as controls. H. pylori bacterial loads were determined using the 13C‐urea breath test, which was performed before and 3 weeks after the start of L. casei supplementation.Results : In vitro, L. casei inhibits H. pylori growth. This effect was stronger with L. casei grown in milk solution than in DeMan–Rogosa–Sharpe medium. No growth inhibition was shown with medium inoculated with lactic acid, Escherichia coli strain DH5α or uninoculated medium. Filtration of L. casei culture before incubation with H. pylori completely abolished the inhibitory effect. Urease activity decreased in nine of the 14 (64%) subjects with L. casei supplementation and in two of the six (33%) controls (P = 0.22).Conclusions : Viable L. casei are required for H. pylori growth inhibition. This does not result from changes in lactic acid concentration. In addition, a slight, but non‐significant, trend towards a suppressive effect of L. casei on H. pylori in vivo may exist.
The pharmacological properties and clinical use of valdecoxib, a new cyclo‐oxygenase‐2‐selective inhibitor
Authors: Alsalameh S. , Burian M. , Mahr G. , Woodcock B. G. , Geisslinger G. 
Published: March 2003

SummaryCyclo‐oxygenase‐2‐selective inhibitors produce less gastric damage than conventional non‐steroidal anti‐inflammatory drugs. Valdecoxib is a new orally administered cyclo‐oxygenase‐2‐selective inhibitor, recently approved for use in osteoarthritis, rheumatoid arthritis and primary dysmenorrhoea in the USA. The drug has been evaluated in more than 60 clinical studies involving more than 14 000 patients and healthy volunteers. The analgesic efficacy of valdecoxib at a dose of 10 mg once daily in both osteoarthritis and rheumatoid arthritis is superior to that of placebo and similar to that of traditional non‐steroidal anti‐inflammatory drugs. Valdecoxib is effective in single doses of up to 40 mg for the alleviation of acute menstrual pain and has a rapid onset of action (within 30 min) and a long duration of analgesia (up to 24 h). Valdecoxib is well tolerated and has safety advantages compared with traditional non‐steroidal anti‐inflammatory drugs in terms of less gastrointestinal toxicity and a lack of an effect on platelet function. The incidence of adverse effects involving the kidney (fluid retention, oedema and hypertension) is similar to that of non‐selective, non‐steroidal anti‐inflammatory drugs.