bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptomatic and endoscopic duodenal ulcer relapse rates 12 months following Helicobacter pylori eradication treatment with omeprazole and amoxycillin with or without metronidazole
Authors: BELL G. D. , BATE C. M. , AXON A. T. R. , TILDESLEY G. , MARTIN J. L. , TAYLOR M. D. , RICHARDSON P. D. I. 
Published: October 2003

Aim: To determine the effect of Helicobacter pylori eradication with omeprazole and amoxycillin, with or without metronidazole, on the 12‐month course of duodenal ulcer disease. Methods: In a randomized, double‐blind study, conducted in 19 hospitals, 105 H. pylori positive duodenal ulcer patients were healed and symptom‐free following either omeprazole dual therapy (omeprazole 40 mg o.m.+amoxycillin 500 mg t.d.s., OA, eradication rate 46%, n=52) or omeprazole triple therapy (omeprazole 40 mg o.m.+amoxycillin 500 mg t.d.s.+metronidazole 400 mg t.d.s., OAM, eradication rate 92%, n=53) for 2 weeks, followed by 2 weeks of omeprazole 20 mg o.m. and a 12‐month untreated follow‐up period, after which time all patients were endoscoped. Endoscopic and symptomatic relapse rates, and effect on H. pylori status measured using 13C‐urea breath test, were determined. Results: During the 12‐month untreated follow‐up period, the life‐table endoscopic relapse rates were 12% (95% CI: 2–22%) and 2% (95% CI: 0–6%) for OA and OAM patients, respectively. By 12 months, life‐table symptomatic relapse rates were 22% (95% CI: 13–37%) and 19% (95% CI: 8–30%) for OA and OAM, respectively. In the 12 months untreated follow‐up period, 2/69 (3%, 95% CI: 0–7%) patients rendered H. pylori negative had an endoscopic relapse at the end of the 12‐month follow‐up period, compared with 5/31 (16%, 95% CI: 3–29%) patients remaining H. pylori positive (P=0.03 between H. pylori positive and negative groups). Twelve of 69 (17%, 95% CI: 8–26%) patients rendered H. pylori negative relapsed symptomatically, compared with 9/31 (29%, 95% CI: 13–45%) patients remaining H. pylori positive (P= N.S. between groups). There was a significant improvement in epigastric pain (P=0.0001), nausea and vomiting (P<0.05) between entry to the study and 1, 6 and 12 months post‐treatment for both treatment groups. Conclusions: OAM eradicates H. pylori in significantly more patients than OA, but successful H. pylori eradication with either OAM or OA predisposes to low endoscopic and symptomatic relapse rates for duodenal ulcer patients when followed up for 12 months.
The safety and efficacy of ranitidine bismuth citrate in combination with antibiotics for the eradication of Helicobacter pylori
Authors: WYETH J. W. , POUNDER R. E. , DUGGAN A. E. , O'MORAIN C. A. , SCHAUFELBERGER H. D. , DE KOSTER E. H. , RAUWS E. A. J. , BARDHAN K. D. , GILVARRY J. , BUCKLEY M. J. M. , GUMMETT P. A. , LOGAN R. P. H. 
Published: October 2003

Background: Ranitidine bismuth citrate is a novel salt of ranitidine and a bismuth citrate complex. It has intrinsic antisecretory and anti‐Helicobacter pylori activity, but monotherapy rarely eradicates H. pylori infection in man. Aim: A pilot study to investigate rates of H. pylori eradication achieved by co‐prescription of ranitidine bismuth citrate with antibiotics, and to identify several regimens which would merit further investigation. Method: One hundred dyspeptic patients infected with H. pylori were randomly allocated to treatment with ranitidine bismuth citrate 800 mg b.d. plus either amoxycillin, metronidazole, clarithromycin, cefuroxime axetil, tetracycline, tetracycline plus metronidazole or clarithromycin plus tetracycline for 14 days. Eradication of infection was assessed using the 13C‐urea breath test 4 weeks after the end of treatment. Results: In a per protocol analysis eradication of H. pylori ranged between 22 and 100%; the intention‐to‐treat eradication rates ranged between 15 and 92%. No adverse events were specifically attributed to ranitidine bismuth citrate. Conclusion: Co‐prescription therapy, using ranitidine bismuth citrate and one or more antibiotics, is suitable for further investigation in large‐scale clinical trials in patients infected with H. pylori.
Low‐dose famotidine and ranitidine as single post‐prandial doses: a three‐period placebo‐controlled comparative trial
Authors: REILLY T. G. , SINGH S. , COTTRELL J. , MANN S. G. , STAUFFER L. , WALT R. P. 
Published: October 2003

Background: Low‐dose H2‐receptor antagonists are available without prescription for the self‐medication of dyspepsia. Methods: To investigate the relative abilities of low doses of famotidine and ranitidine to raise intragastric pH after a single post‐prandial evening dose, 25 healthy volunteers completed a three‐period cross‐over trial of famotidine 10 mg, ranitidine elixir 75 mg and placebo. A standard meal was given at 18.30 h and drug or placebo at 19.30 h to subjects fasted for 5.5 h. Intragastric pH was recorded with nasogastric electrodes from 18.00 to 07.30 h by GastrograpH II recorder. Results: The geometric mean area under the pH–time curve for the 5–9 h post‐dose period was 1.49 pH units/h following placebo, 3.43 pH units/h following famotidine 10 mg (agent/placebo ratio 2.3; P< 0.001, ANOVA) and 2.6 pH units/h following ranitidine 75 mg (1.75; P<0.001). The geometric mean area under the pH–time curve ratio of famotidine 10 mg to ranitidine 75 mg was 1.32 (P<0.016). Median pH over the 5–9 h period was 1.1 following placebo, 2.7 following famotidine 10 mg (P<0.05 by comparison with placebo) and 1.9 following ranitidine 75 mg (P<0.05); comparison of median pH showed no significant difference between the active drugs. The percentage of pH values greater than 3.0 for the period 0–12 h post‐dose was 9.7% following placebo, 30.0% following famotidine 10 mg (P<0.05) and 24.9% following ranitidine 75 mg (P<0.05); there was no significant difference between the active drugs. Conclusions: We conclude that both famotidine 10 mg and ranitidine 75 mg significantly raise intragastric pH when given as single post‐prandial doses. Famotidine 10 mg may have a greater effect than ranitidine elixir 75 mg over the 5–9‐h period after dosing.
The palatability of five colonic lavage solutions
Authors: DIAB F. H. , MARSHALL J. B. 
Published: October 2003

Background: Many patients dislike the taste and saltiness of polyethylene glycol–electrolyte colonic lavage solutions. Several commercially available lavage solutions have been introduced with reduced salt content or flavouring added in an attempt to improve palatability and to encourage patient compliance. Aim: To determine which of the commercially available lavage solutions are the most palatable. Methods: A taste test of the five commercially available lavage solutions was performed by two groups of subjects: (a) adult patients scheduled to undergo colonoscopy (n=50) and (b) adult family members of patients scheduled to undergo colonoscopy and hospital volunteers (n=50). Subjects sampled all five products and were asked to grade the taste and saltiness, and to rank them in their overall order of preference. Results: Similar findings were observed in the two groups of subjects. Colyte‐Flavored, Cherry‐NuLytely, NuLytely and GoLytely had similar median taste scores and a similar frequency of taste scores labelled as ‘unacceptable’ (8–11%); these four products ranked ahead of plain Colyte (which had a 25% frequency of taste scores labelled as ‘unacceptable’). However, in the ranking phase of the study, about three‐quarters of the subjects preferred a flavoured lavage solution to an unflavoured one. Colyte‐Flavored and Cherry‐NuLytely rated almost equal. Twenty‐two per cent of subjects rated an unflavoured lavage solution (generally NuLytely or GoLytely) as their first choice. This included a subset of subjects who disliked the flavoured solutions and greatly preferred an unflavoured product. Conclusions: Four of the five commercially available products studied received similar taste scores. However, in the direct comparison phase of the study, a majority of subjects expressed a preference for a flavoured lavage solution. On the other hand, about one in five subjects expressed a dislike for the available flavoured solutions and preferred an unflavoured one.
Xanthine oxidase activity is not increased in the colonic mucosa of ulcerative colitis
Authors: REYNOLDS P. D. , RHENIUS S. T. , HUNTER J. O. 
Published: October 2003

Aim: To measure urate and xanthine by high‐performance liquid chromatography in mucosal biopsies from patients with ulcerative colitis and controls. Results: Reactive oxygen metabolite activity was demonstrated by a cystine to cysteine ratio of 0.24±0.08 in the control biopsies compared with 1.79±0.25 in ulcerative colitis. The product to substrate ratio (urate to xanthine) for xanthine oxidase and mucosal urate concentrations were not different between ulcerative colitis patients and controls. Xanthine oxidase activity after incubation of homogenized biopsies was 0.451 (±0.175) nmol.min/mg protein in ulcerative colitis patients compared with 2.585 (±0.823) nmol.min/mg protein in controls (P<0.01). Conclusion: These results suggest that xanthine oxidase may not be the major source of superoxide formation in ulcerative colitis.
Clinical response after transjugular intrahepatic portosystemic stent shunt insertion for refractory ascites in cirrhosis
Authors: FORREST E. H. , STANLEY A. J. , REDHEAD D. N. , McGILCHRIST A. J. , HAYES P. C. 
Published: October 2003

Background: Transjugular intrahepatic portosystemic stent shunts (TIPSS) have been used successfully to reduce portal pressure in the context of variceal haemorrhage. Recent interest has focused on the possible use of TIPSS to manage refractory ascites. Aim: To study the effect of TIPSS insertion in 18 patients with refractory ascites. Results: Response rates were 33.3%, 50%, 33.3% and 26.7% at 1 week, 4 weeks, 3 months and 6 months, respectively. Overall mortality was 50% with a new or worsening encephalopathy rate also of 50%. Patients with lower serum bilirubin and serum creatinine prior to TIPSS insertion had greater response at 1 and 4 weeks, respectively. There was no improvement in either liver or renal function after TIPSS insertion by standard laboratory tests, although serum sodium increased in the responders after 1 month. Conclusion: TIPSS improves refractory ascites in only a minority of patients, and is associated with high encephalopathy and mortality rates.
management of patients with non‐responsive coeliac disease
Authors: O'MAHONY S. , HOWDLE P. D. , LOSOWSKY M. S. 
Published: October 2003

A substantial minority of patients with coeliac disease (estimated at anything between 7 and 30%) fail to respond to treatment with a gluten‐free diet. Non‐responsiveness may be primary, that is when the patient fails to respond to treatment following initial diagnosis, or secondary, when a patient who has previously had a documented response to gluten exclusion becomes non‐responsive to therapy. The commonest cause of non‐responsiveness is continued gluten ingestion, either voluntary or inadvertent. Other causes to be considered include intolerances to dietary constituents other than gluten (e.g. milk, soya), pancreatic insufficiency, enteropathy‐associated T‐cell lymphoma and ulcerative jejunitis. There is some evidence that ulcerative jejunitis is, in fact, a manifestation of lymphoma.The most important steps in the management of the non‐responsive coeliac patient are (a) to determine whether the patient is indeed coeliac, (b) to exclude lymphoma and (c) to establish the cause of the non‐responsiveness. In those coeliac patients with no demonstrable cause for non‐responsiveness, a variety of therapeutic stratagems (mostly based on small, uncontrolled studies) have been described; these include elimination diets, dietary supplementation with zinc and copper, and pharmacological therapy in the form of steroids, azathioprine and cyclosporin. In a minority of non‐responsive patients, the clinical course is characterized by a rapid decline, and total parenteral nutrition is required.None of the therapies described above has been subjected to rigorous controlled studies. The precise mechanisms of non‐responsiveness in coeliac patients need to be unravelled before rational therapeutic approaches can be established.
The effect of a non‐absorbable fat substitute, sucrose polyester, on gastrointestinal function
Authors: KELLY S. M. , HUNTER J. O. 
Published: October 2003

Objectives: To assess the effects of a single dose of a non‐absorbable fat substitute, sucrose polyester, on gastrointestinal function. Methods: The effects of 50 g of sucrose polyester taken as a single drink on gastric emptying, small bowel transit time (SBTT), whole gut transit time (WGTT) and faecal weight compared with a control fat were examined in double‐blind studies. The effect of sucrose polyester on gallbladder ejection fraction and gastrointestinal hormones was also assessed. Results: Sucrose polyester was found to accelerate gastric emptying significantly (98.33±71.0 vs. 112.92±82.0 min, P=0.042) but to slow SBTT (153.75±36.25 vs. 128.75±47.39 min, P=0.006). A trend to faster WGTT (37.47±15.61 vs. 46.63±20.65 h) and increased faecal weight was observed (453.33±122.05 vs. 395.0±107.85 g/48 h), but this did not reach statistical significance. There was a striking reduction in gallbladder ejection fraction with sucrose polyester (21.69±25.32 vs. 45.27±27.67%), P=0.039) and a corresponding significant decrease in the release of cholecystokinin. Lower levels of motilin and enteroglucagon were also observed. Conclusions: Sucrose polyester has significant effects on gastrointestinal transit, gallbladder contraction and gastrointestinal hormones. These effects can be explained on the basis of decreased luminal products of digestion and may have implications for the widespread use of sucrose polyester as a fat substitute.
Effervescent and standard formulations of ranitidine—a comparison of their pharmacokinetics and pharmacology
Authors: WATSON R. G. P. , JOHNSTON B. T. , THAM T. C. K. , KERSEY K. 
Published: October 2003

Background: An effervescent formulation of ranitidine may be absorbed faster and achieve a faster onset of action than conventional tablet form. The aim of this study was to compare the effects of effervescent formulations of ranitidine with equivalent dose standard tablets, in terms of intragastric pH and plasma pharmacokinetics in the initial 6 h following dosing. Methods: Fifteen fasting healthy males, aged 18–31 (mean 29) years, were each randomly given, at weekly intervals, 150 mg standard and effervescent ranitidine and 300 mg standard and effervescent ranitidine. Ambulatory gastric pH was performed and plasma drug levels measured at regular intervals. Results: Plasma ranitidine levels increased more rapidly with both effervescent formulations compared with standard tablets as indicated by mean area under curve (AUC) at 1 h (P<0.001). However, the pH profiles produced by all four treatments were similar with a steep rise in pH at 40–60 min to give a sustained level of pH 7 for the following 5 h. The effervescent formulations produced a transient rise in pH immediately following dosing, and for 300 mg this rise was significantly different at 10–20 min compared with the standard tablet (median pH 4.75 vs. 2.3, P<0.05). Conclusions: Plasma drug levels increase more rapidly following effervescent ranitidine. Effervescent and standard formulations of 150 and 300 mg are all equally effective in producing gastric pH 7 after 1 h. However, effervescent formulations produce an early transient rise in pH which may be of clinical benefit.
Review article: methotrexate in gastroenterology—dangerous villain or simply misunderstood?
Authors: TANG H. , NEUBERGER J. 
Published: October 2003

Methotrexate has a place in the treatment of an increasing number of diseases. Its emerging role in the treatment of primary biliary cirrhosis and inflammatory bowel disease still requires further evaluation.Its toxicity profile is wide and is affected by a variety of factors. Hepatotoxicity from long‐term use in patients with psoriasis and rheumatoid arthritis holds particular concern for the physician. Appropriate monitoring guidelines for hepatotoxicity can only be made after careful evaluation of available data and consideration of cost‐to‐benefit models.
Review article: β3‐adrenoceptor agonists—future anti‐inflammatory drugs for the gastrointestinal tract?
Authors: ANTHONY A. 
Published: October 2003

The β3‐adrenoceptor is now a recognized sub‐type of β‐adrenoceptor and is the principle adrenoceptor responsible for lipolysis in rat adipocytes. The receptor is also found in the gastrointestinal tract where β3‐adrenoceptor agonists are both spasmolytic and potent inhibitors of experimental non‐steroidal anti‐inflammatory drug (NSAID)‐induced gastric and small intestinal ulcers. There is evidence to suggest that the underlying mechanism of protection involves enhancement of mucosal blood flow, possibly as a result of relaxation of vascular and non‐vascular smooth muscle.This review examines some possible therapeutic applications for β3‐adrenoceptor agonists in ulcero‐inflammatory disorders of the gastrointestinal tract where an altered blood flow state is a component of the underlying pathogenic process.
5‐amino salicylic acid absorption and metabolism in ulcerative colitis patients receiving maintenance sulphasalazine, olsalazine or mesalazine
Authors: STRETCH G. L. , CAMPBELL B. J. , DWARAKANATH A. D. , YAQOOB M. , STEVENSON A. , MORRIS A. I. , RHODES J. M. 
Published: October 2003

Background: All 5‐aminosalicylic acid (5‐ASA) preparations are potentially nephrotoxic, but there has been concern that newer delivery systems may increase this risk, either because of altered absorption or altered metabolism. Previous studies of 5‐ASA absorption and excretion have usually either been performed in healthy controls or have only examined short‐term therapy. 5‐ASA and N‐acetyl‐5‐ASA have therefore been measured in blood samples, and N‐acetyl‐5‐ASA in urine samples, from patients with ulcerative colitis on long‐term maintenance with different 5‐ASA preparations and compared with sensitive markers of renal damage. Methods: Patients receiving mesalazine (Asacol) (n=13), sulphasalazine (n=12) or olsalazine (Dipentum) (n=8), all at doses within the recommended range were studied. Six‐hour and trough serum concentrations of 5‐ASA and N‐acetyl‐5‐ASA and 24‐h urinary excretion of N‐acetyl‐5‐ASA were measured by high‐performance liquid chromatography. Results: Absorption of 5‐ASA, assessed as 24‐h excretion of N‐acetyl‐5‐ASA expressed as molar % of ingested dose, was greater in patients receiving mesalazine, 23.25±10.65% (mean±s.d.; n=13), than those receiving sulphasalazine (11.16±10.52%, n=12; P=0.003) or olsalazine (9.70±3.89%, n=8; P<0.002). The ratio of 5‐ASA:N‐acetyl‐5‐ASA in the serum 6 h after dose was also greater with mesalazine (1.02±0.44, mean±s.d.) than sulphasalazine (0.54±0.44, P<0.02) or olsalazine (0.38±0.44, P<0.005). Urinary markers of tubular damage were increased in four of 33 patients, but showed no correlation with concentration of 5‐ASA or N‐acetyl‐5‐ASA in serum and N‐acetyl‐5‐ASA in urine, nor with lifetime dose or average daily dose of 5‐ASA. Conclusions: In patients with ulcerative colitis receiving maintenance 5‐ASA therapy there was greater absorption and less acetylation of 5‐ASA from mesalazine (Asacol) compared with sulphasalazine or olsalazine, but no evidence from this study that this resulted in increased nephrotoxicity.
Treatment of reflux oesophagitis of moderate and severe grade with ranitidine or pantoprazole—comparison of 24‐hour intragastric and oesophageal pH
Authors: ARMBRECHT U. , ABUCAR A. , HAMEETEMAN W. , SCHNEIDER A. , STOCKBRÜGGER R. W. 
Published: October 2003

Background:Proton pump inhibiting drugs strongly decrease gastric acid secretion and have proven more effective in the treatment of reflux oesophagitis than H2‐receptor antagonists.Methods:In a double‐blind randomized trial, 24 patients with oesophagitis grade II (n=15) and III (n=9) were treated for 4 weeks with either ranitidine 150 mg b.d. (n=13) or pantoprazole 40 mg o.m. (n=11). Before the trial and on the last day of medication, 24‐h intra‐, gastric pH and oesophageal pH profiles were performed. Healing was assessed by endoscopy.Results:Pantoprazole increased median gastric pH from 1.7 to 3.9. Virtually no change in gastric pH was seen in the ranitidine group. Pantoprazole reduced the fraction time of pH < 4 in the oesophagus from 21% to 3% (P=0.0005), and the median number of refluxes from 206 to 56 (P=0.022). Oesophageal acid exposure was not decreased by ranitidine. Healing of the oesophagitis was seen in 6/11 cases after pantoprazole and in 3/13 cases after ranitidine (N.S.)Conclusion:In patients with oesophagitis of moderate and severe grade, pantoprazole 40 mg o.m. decreases intragastric acidity and gastro‐oesophageal acid reflux more effectively than ranitidine 150 mg b.d.
Controlled trial of oral 5‐aminosalicylic acid for the prevention of early relapse in Crohn's disease
Authors: FRANCHIS R. DE , OMODEI P. , RANZI T. , BRIGNOLA C. , ROCCA R. , PRADA A. , PERA A. , VECCHI M. , PIANO M. DEL , FERRARA A. , BELLOLI C. , PIODI L. , FRAMARIN L. , ASTEGIANO M. , RICCIOLI F. A. , MEUCCI G. 
Published: October 2003

BackgroundRecent data indicate that 5‐aminosalicylic acid (5‐ASA) is most effective in preventing relapse of Crohn's disease in patients with a short duration of remission before enrolment.AimTo evaluate the efficacy of oral 5‐ASA treatment, started immediately after achieving steroid‐induced remission, in preventing clinical relapses of Crohn's disease.MethodsPatients with active Crohn's disease, achieving remission on steroids, were randomized to oral 5‐ASA 3 g/day or placebo, while steroids were tapered over 6 weeks. The trial was terminated after interim analysis showed a slightly higher relapse rate in the 5‐ASA group, and the calculated probability of seeing a statistically significant difference by completing the study was minimal.ResultsFinal analysis included 117 patients (58 taking 5‐ASA and 59 taking placebo; follow‐up 9.2 ± 6.5 months). Cumulative relapse rates at 6 and 12 months were 34% and 58% in 5‐ASA patients and 31% and 52% in placebo patients, respectively (rate difference + 0.095; 95% CI = −0.085– + 0.274). Subgroups analysis showed that 5‐ASA was equally ineffective in patients with ileal, colonic or ileocolonic disease.ConclusionsContrary to previous results, in our study early introduction of treatment with oral 5‐ASA did not prevent relapse in Crohn's disease patients treated with steroids to induce remission.