bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a new ultrashort triple therapy for Helicobacter pylori disease
Authors: Trevisani  , Sartori  , Galvani  , Ruina  , Caselli  , Verdianelli  , Abbasciano  
Published: March 2003

Background:1‐week proton pump inhibitor‐based triple therapies are considered the most effective and convenient drug combinations for curing Helicobacter pylori infection. Short therapies, lasting less than 1 week have been investigated rarely.Aim:To assess the efficacy and tolerability of a 3‐day lansoprazole triple therapy after 1 day of lansoprazole pre‐treatment.Methods:Seventy H. pylori‐positive (rapid urease test and histology) patients received LAzT3 regimen (lanzoprazole 30 mg b.d. and azithromycin 500 mg o.m. for 3 days; tinidazole 2000 mg o.m. on day 1 and 1000 mg o.m. on days 2–3) after 1 day of lansoprazole pre‐treatment. Patients with active ulcer received lansoprazole 30 mg o.m. for an additional 4 weeks. Follow‐up gastroscopy was carried out 4–6 weeks after completion of therapy. Eradication was defined as negative histology and rapid urease test.Results:Four patients failed to attend the follow‐up endoscopy. One patient complained of minor side‐effects. H. pylori was eradicated in 57 of 66 patients suitable for evaluation, with a per‐protocol cure rate of 86.3% (95%CI: 76–94%), and an intention‐to‐treat cure rate of 81.4% (95%CI: 70–90%).Conclusions:This new ultrashort triple therapy including lansoprazole, azithromycin and tinidazole seems to be effective in eradicating H. pylori. It is safe and well‐tolerated, and may be taken into consideration as a valid alternative to the better known and widely used 1‐week proton pump inhibitor‐based triple therapies.
Plaunotol prevents indomethacin‐induced gastric mucosal injury in rats by inhibiting neutrophil activation
Authors: MURAKAMI  , OKAJIMA  , HARADA  , ISOBE  , LIU  , JOHNO  , OKABE  
Published: March 2003

Background:Activated neutrophils play a critical role in indomethacin‐induced gastric mucosal injury.Aim:To investigate the effect of plaunotol, an anti‐ulcer agent, on neutrophil activation in vitro and its effect on gastric mucosal injury and gastric accumulation of neutrophils in rats given indomethacin.Methods:Human monocytes and neutrophils were isolated from the peripheral blood of healthy volunteers. We examined the effect of plaunotol on neutrophil elastase release, production of O2−, intracellular calcium concentration and expression of adhesion molecules CD11b and CD18 in activated neutrophils in vitro. The effect of plaunotol on TNF‐α production by monocytes stimulated with endotoxin also was investigated in vitro. The effect of plaunotol (100 mg/kg, p.o.) on gastric mucosal injury and neutrophil accumulation was investigated in male Wistar rats given indomethacin (30 mg/kg, p.o.).Results:Plaunotol inhibited the fMLP‐induced release of neutrophil elastase from activated neutrophils, as well as the opsonized zymosan‐induced production of O2− by neutrophils. Plaunotol significantly inhibited increased levels of intracellular calcium, a second messenger of neutrophil activation, in vitro. The fMLP‐induced increases in CD11b and CD18 expression were also inhibited by plaunotol in vitro. Plaunotol inhibited monocytic production of TNF‐α, a potent activator of neutrophils. Both gastric mucosal injury and gastric neutrophil infiltration in rats given indomethacin were significantly inhibited by the oral administration of plaunotol.Conclusions:Plaunotol inhibits indomethacin‐induced gastric mucosal injury, at least in part by inhibiting neutrophil activation.
Expression of endothelial cell‐derived nitric oxide synthase (eNOS) is increased during gastric adaptation to chronic aspirin intake in humans
Authors: FISCHER  , BECKER  , BOKNIK  , HUBER  , LÜSS  , NEUMANN  , SCHMITZ  , DOMSCHKE  , KONTUREK  
Published: March 2003

Background: Gastric adaptation to aspirin is well‐documented. However, the mechanisms underlying the reduction of aspirin‐induced mucosal damage despite continued ingestion of the drug remain poorly understood.Methods: Eight healthy volunteers who received aspirin 1 g b.d. for 14 days were compared with eight placebo‐dosed controls. Gastroscopy with mucosal biopsy was performed, and gastric mucosal blood flow was measured before and following 3, 7 and 14 days of aspirin treatment. At the same time points, tissue concentration and the content of prostaglandin E2 in the gastric juice were determined and expression of endothelial cell‐derived nitric oxide synthase (eNOS) in mucosal biopsies was measured using Western blot analysis.Results: Aspirin‐induced mucosal damage that reached a maximum on day 3, declining significantly by day 14. Concomitantly, mucosal blood flow significantly increased on day 3 and returned to initial values on day 14. Aspirin intake led to a significant decrease in prostaglandin E2 concentration in the gastric mucosa and in gastric juice during the whole period of aspirin consumption. eNOS expression started to increase on day 7 in oxyntic mucosa and on day 3 in antral mucosa, reaching its highest values at the end of the consumption of aspirin.Conclusions: The human gastric mucosa adapts to prolonged aspirin intake, and this is accompanied by an increase in mucosal blood flow and reduced prostaglandin synthesis. Increase of mucosal eNOS expression might compensate for reduced prostaglandin synthesis and be responsible for gastric adaptation to chronic aspirin intake in humans.
Efficacy of a 1‐week regimen of ranitidine bismuth citrate in combination with metronidazole and clarithromycin for Helicobacter pylori eradication
Authors: HOFFMAN  , KATZ  , CAVE  
Published: March 2003

Background: In order to improve the efficacy and simplicity of the FDA‐approved regimen of ranitidine bismuth citrate (RBC) and clarithromycin dual therapy, we added an inexpensive antibiotic (metronidazole), changed the dosage scheme to twice daily dosing, and decreased the duration of therapy to 1 week.Methods: This was an open label study in which subjects with previously untreated Helicobacter pylori infection documented by serology or endoscopy and confirmed by the 13C‐urea breath test received a 1‐week course of RBC 400 mg b.d., metronidazole 500 mg b.d. and clarithromycin 500 mg b.d. A repeat breath test was performed 4–6 weeks after completing therapy.Results: Forty‐seven out of 50 subjects completed the protocol. Intention‐to‐treat and per protocol cure rates were 86% and 91%, respectively. The regimen was well tolerated. Study drugs were stopped in two patients due to side‐effects. The most common side‐effect was self‐limited diarrhoea.Conclusion: Twice daily RBC‐based triple therapy with metronidazole and clarithromycin for 1 week is well tolerated and effective in eradicating H. pylori infection.
Ecabet sodium, a novel locally‐acting anti‐ulcer agent, protects the integrity of the gastric mucosal gel layer from pepsin‐induced disruption in the rat
Authors: KINOSHITA  , ENDO  , YASOSHIMA  , SAITO  , YAMASAKI  , CHISHIMA  , NARITA  
Published: March 2003

Background: Ecabet sodium, a novel non‐systemic anti‐ulcer agent, possesses high affinity to gastric adherent mucus, which plays an important role in the protection of the gastric epithelium against acid and pepsin.Aim: To assess the effect of ecabet on pepsin‐induced degradation of the structure of the mucus gel layer.Methods: Everted sacs of rat stomach were incubated in HCl solution containing pepsin with or without ecabet. Pepsin‐induced release of the cleaved peptides and hexosamine from the sacs was determined. Changes in the molecular size of glycoproteins in the adherent mucus (using gel filtration methods) and in the morphology of the epithelium (using both light and scanning electron microscopy) were also examined.Results: Ecabet reduced the pepsin‐induced release of peptides and hexosamine, depending on its content in the adherent mucus. Pepsin treatment partially lowered the molecular weight of native glycoproteins in the adherent mucus, caused exfoliation of the epithelial cells, and degraded the network‐like ultrastructure of the mucus layer, giving it a lumpy, globular appearance. Ecabet prevented both the pepsin‐induced molecular size shift in mucus glycoproteins, and morphological alteration of the epithelium, including ultrastructural derangement of the mucus gel layer.Conclusion: Ecabet protects the polymeric structure of mucus glycoproteins from proteolytic degradation by pepsin, and thus maintains integrity of the gastric mucus gel layer.
A non‐toxic analogue of a coeliac‐activating gliadin peptide: a basis for immunomodulation?
Authors: Biagi  , Ellis  , Parnell  , Shidrawi  , Thomas  , O’reilly  , Corazza  , Ciclitira  
Published: March 2003

Background: A‐gliadin residues 31–49 (peptide A) binds to HLA‐DQ2 and is toxic to coeliac small bowel. Analogues of this peptide, which bind to DQ2 molecules but are non‐toxic, may be a potential route to inducing tolerance to gliadin in patients with coeliac disease.Methods: Toxicity was investigated with small bowel organ culture in six patients with untreated coeliac disease, four with treated coeliac disease and six controls. Analogue peptides comprised alanine substituted variants of peptide A at L31 (peptide D), P36 (E), P38 (F), P39 (G) and P42 (H).Results: Peptides D and E were toxic in biopsies from some patients. Peptides F, G and H were not toxic.Conclusions: Peptide F, which binds to DQ2 more strongly than peptide A, is not toxic in patients with coeliac disease in‐vitro; this could be an initial step towards investigation of the induction of tolerance to gliadin in patients affected by coeliac disease.
Randomized controlled comparison of nitroimidazoles for the eradication of Helicobacter pylori and relief of ulcer‐associated and non‐ulcer dyspepsia
Authors: GODDARD  , LOGAN  , LAWES  , SPILLER  
Published: March 2003

Background: A combination of omeprazole, clarithromycin and either metronidazole or tinidazole is commonly used for Helicobacter pylori eradication. Metronidazole is considerably cheaper than tinidazole but the two have not previously been compared in a randomized trial.Methods: One hundred and twenty dyspeptic H. pylori‐positive patients with endoscopically defined peptic ulcer [DU (n = 65), GU (n = 12)] or non‐ulcer dyspepsia (NUD, n = 43) were randomized to receive a 1‐week course of twice daily omeprazole 20 mg, clarithromycin 250 mg and either metronidazole 400 mg (OCM) or tinidazole 500 mg (OCT) in a double‐blind fashion. Eradication of H. pylori, safety and side‐effects of treatment, dyspeptic symptom score and consumption of antisecretory drugs were assessed at 6 weeks and 1 year after treatment.Results: H. pylori eradication was successfully achieved in 57/60 (95%, ITT analysis) of patients receiving OCT and 58/60 (97%, ITT analysis) receiving OCM. Both regimens had similar side‐effect profiles, which accounted for only one patient withdrawal. All patients remained uninfected (as assessed by 14C‐urea breath test) at 1‐year follow‐up, but major symptom improvements and decreased antisecretory drug use were only seen in patients with DU (P < 0.0001).Conclusions: Treatment with OCM is as effective as the more expensive OCT at eradicating H. pylori. H. pylori eradication results in long‐term relief of dyspeptic symptoms and reduced antisecretory consumption only in patients with DU, and not in those with NUD.
Delay of gastric emptying by duodenal intubation: sensitive measurement of gastric emptying by the paracetamol absorption test
Authors: MEDHUS  , SANDSTAD  , BREDESEN  , HUSEBYE  
Published: March 2003

Aims: To examine the influence of duodenal intubation on gastric emptying measured by the paracetamol absorption test using a new algorithm developed to estimate emptying parameters, and to determine the sensitivity of this test.Methods: A caloric liquid meal with paracetamol as marker of emptying was administered orally to eight healthy volunteers during phase I and phase II of the migrating motor complex (MMC) and without intubation on 3 separate days, and to 10 patients with partial gastrectomy.Results: Healthy subjects: With duodenal tube, time until 25% of the meal had emptied (t25%) was 24 ± 7 (phase I, P < 0.02) and 21 ± 6 min (phase II, P < 0.02) compared with 14 ± 4 min for meal intake without intubation. Time until 50% of the meal had emptied (t50%) was 45 ± 8 (phase I, P < 0.001) and 35 ± 8 min (phase II, P < 0.02) compared with 26 ± 9 min for meal intake without intubation. Intraduodenal instillation of 10–20 mL of the liquid meal was reliably detected. Patients: In 9 out of 10 patients with partial gastrectomy t25% was below the lower limit of the range for healthy controls, and t25% detected accelerated emptying with a higher degree of sensitivity than the commonly applied pharmacokinetic parameters Cmax and Tmax.Conclusions: A duodenal tube delays gastric emptying of a caloric liquid meal. The paracetamol absorption test emerges as a sensitive method suitable for detecting both delayed and accelerated gastric emptying of caloric liquid meals.
Survey on repeat prescribing for acid suppression drugs in primary care in Cornwall and the Isles of Scilly
Authors: Boutet R. , Wilcock M. , Mackenzie I. 
Published: March 2003

Background: Repeat prescriptions for acid suppression therapy represent an important burden on health care resources.Aim: To determine the prevalence of acid suppression therapy and its indications by general practitioners (GPs) in a larger sample of practices than previous studies.Method: Practices in Cornwall and the Isles of Scilly were invited to identify the number of patients on repeat prescription for acid suppression drugs in their practice, to review the indication for treatment in a sample of 50 patients, and to indicate the mode of review of these patients.Results: Out of 77 practices, 42 (55%) participated in the study. Overall, 5% of patients were authorized to receive a repeat prescription for acid suppression drugs. Repeat rates varied between practices, from 1.68% to 11.11%. Repeat rates increased with age and were higher in men than in women. Only 41% of patients had a proven diagnosis of gastro‐oesophageal reflux disease or peptic ulcer. A review of notes was the most frequent way (36%) stated by GPs to review acid suppression therapy.Conclusion: The repeat rate found in our study was higher than that found in previous studies. A high proportion of older patients in Cornwall, as well as a continuing increase in the prescription of acid suppression drugs, may account for these results.
Octreotide in refractory functional epigastric pain with nutritional impairment—an open study
Authors: Ducrotte  , Maillot  , Leroi  , Lalaude  , Colin  , Denis  
Published: March 2003

Aim: To test the therapeutic efficacy of octreotide administered subcutaneously for the relief of chronic refractory epigastric pain severe enough to provoke nutritional impairment.Subjects and methods: Seventeen patients were enrolled in an open trial. Epigastric pain had lasted from 1 to 8 years (median: 5 years), following anti‐reflux surgery in eight patients. Median weight loss was 10% (range 10–15). The initial dose of octreotide was 50 μg b.d, adjusted during the follow‐up visits which were scheduled for months 1, 3, 6, 8, 10, 12 and every 3 months. At each visit, overall symptomatic improvement, frequency and intensity of symptoms were checked on a 10‐cm visual analogic scale.Results: At month 1, a progressive improvement of pain intensity was reported in 15 of the 17 patients, while octreotide was a therapeutic failure in two. In four out of 15, the daily dose of octreotide was increased to 100 μg b.d. In these 15 patients, median follow‐up was 7 months (3–27). The symptomatic benefit was maintained in each patient at month 3, with a median weight gain of 3.5 kg.2–5 An attempt to stop octreotide led to recurrence of symptoms in 2–3 days which were as intense as before the treatment. The 11 patients followed‐up for at least 6 months reported persistent improvement of symptoms with octreotide and a median weight gain of 4 kg.3–7 Four patients were followed up for more 11–27 months: octreotide was withdrawn gradually in two who remained asymptomatic. Six of the 17 patients experienced minor side‐effects, but none developed biliary sludge.Conclusions: This open study suggests that octreotide could be a promising alternative treatment when all others fail in refractory chronic functional epigastric pain severe enough to limit food intake and to induce nutritional impairment. These results must be tested by a placebo‐controlled study.
The safety of proton pump inhibitors in pregnancy
Authors: Nielsen  , Sørensen  , Thulstrup  , Tage‐Jensen  , Olesen  , Ekbom  
Published: March 2003

Aim: To assess the safety of proton pump inhibitors during pregnancy.Methods: Fifty‐one pregnant women exposed to proton pump inhibitors around the time of conception or during pregnancy were compared with 13 327 controls without exposure to any prescribed drug in a population‐based study based on The Pharmaco‐Epidemiological Prescription Database of North Jutland and the Danish Hospital Discharge Registry.Results: Three babies with malformations were found among 38 women exposed to proton pump inhibitors from 30 days before conception to the end of the first trimester. No cases of stillbirth were recorded. Crude relative risks of malformation, low birth weight and preterm delivery were 1.6 (95% CI: 0.5–5.1), 1.8 (95% CI: 0.2–13.0) and 2.3 (95% CI: 0.9–6.0), respectively.Conclusions: In this population‐based follow‐up study, we found no substantially elevated risk in terms of malformations, low birth weight or number of preterm deliveries in pregnancies exposed to proton pump inhibitors. However, further monitoring is warranted in order to establish or rule out a potential association between the use of proton pump inhibitors and increased risk of either cardiac malformations or preterm birth.
The effects on intragastric acidity of per‐gastrostomy administration of an alkaline suspension of omeprazole
Authors: Sharma  , Vasudeva  , Howden  
Published: March 2003

Background: It may be difficult to administer proton pump inhibitors via gastrostomy. Previous studies have examined the effect of intact proton pump inhibitor granules in orange juice. This study examined the effect of an alkaline suspension of omeprazole (simplified omeprazole suspension (SOS)) on 24‐h intragastric acidity.Methods: Six men with an established gastrostomy had a baseline 24‐h intragastric pH study using methodology we have previously described. They then received 20 mg SOS o.d. for 7 days and had a repeat pH study at the end of this period. Four of the patients then received 20 mg SOS with 30 cc of liquid antacid (Mylanta, TM) per gastrostomy o.d. for a further 7 days and then underwent a third pH study.Results: SOS raised mean pH from 2.2 to 4.1. Intragastric pH was above 3, 4 and 5 for 35, 28 and 17% of the 24‐h period at baseline, respectively; corresponding values after SOS were 63, 51 and 39%, respectively. Addition of liquid antacid to SOS did not further increase its pH‐controlling effect.Conclusions: We found a statistically significant effect of o.d. SOS on intragastric pH when administered via gastrostomy. We found no additional benefit of administering SOS with liquid antacid.
Laser assisted ratio analyser 13C‐urea breath testing, for the detection of H. pylori: a prospective diagnostic European multicentre study
Authors: Van Der Hulst  , Lamouliatte  , Megraud  , Pounder  , Stolte  , Vaira  , Williams  , Tytgat  
Published: March 2003

Background: Novel technology based on laser optogalvanic spectroscopy called the LARA (Laser Assisted Ratio Analyser) system was developed to measure 12C/13C ratios in breath samples using stable 13C isotopes, to detect Helicobacter pylori infection.Aim: To determine the sensitivity and specificity of the 13C‐LARA‐urea breath test in the detection of H. pylori infection in a prospective European multicentre trial; FDA‐and EMEA‐approved.Methods: Consecutive dyspeptic patients underwent diagnostic gastroscopy with biopsies for culture and histopathology, to detect H. pylori infection (gold standard). Subsequently, the LARA‐urea breath test was performed using either a system without a cold trap (part I) or a system with a cold trap (part II). In both instances baseline, 30‐min and 60‐min breath samples were collected. The optimum cut‐off level for 12C/13C ratios was determined by Receiver Operator Characteristics analysis.Results: In part I, 544 out of 604 patients were evaluable (low CO2: 47; withdrawn: 13). 284 out of 544 patients (52%) were H. pylori‐positive according to the gold standard. The sensitivity of the LARA‐urea breath test was 95% and the specificity 94%. In part II, 257 out of 272 were evaluable (low CO2: 14; withdrawn: 1). Sensitivity and specificity were 93% and 96%, respectively.Conclusion: The LARA‐technology represents an accurate and non‐invasive testing system for the detection of H. pylori infection. Its major advantages are the use of stable 13C isotope, the high throughput of samples and the easy means of collecting, storing and transporting the samples, thus making the system convenient to both patient and clinician.
Comparison of two different formulations of botulinum toxin A for the treatment of oesophageal achalasia
Authors: Annese  , Bassotti  , Coccia  , D’Onofrio  , Gatto  , Repici  , Andriulli  ,   THE GISMAD ACHALASIA STUDY GROUP
Published: March 2003

Background: Intrasphincteric injection of botulinum toxin has been reported as a safe and effective alternative treatment in oesophageal achalasia, especially in high‐risk and elderly patients.Aim: To compare two formulations of botulinum toxin in the management of achalasia.Patients and methods: We randomly compared the efficacy and safety of 100 U of Botox (Allergan, Irvine, USA) and 250 U of Dysport (Ipsen, Milan, Italy), injected through a sclerotherapy needle at the level of the lower oesophageal sphincter, in 78 consecutive patients with achalasia. Symptom score, oesophageal manometry and 24 h pH‐metry were recorded (before and 1 month after therapy). Symptom score was also obtained 6 months after treatment.Results: One month after treatment, the effects of the toxin on symptoms and oesophageal tests were similar for both formulations. Lower oesophageal sphincter pressure decreased from 31 ± 12 to 18 ± 5 mmHg after Botox, and from 35 ± 9 to 18 ± 10 after Dysport. At the end of the follow‐up period (6 months), symptom score decreased from 5 ± 1.2 to 1.2 ± 0.8 after Botox and from 5.2 ± 1.5 to 1.5 ± 1 after Dysport. Moreover, the percentages of patients who failed to respond to treatment (10% and 17.5%) and who relapsed during follow‐up (12% and 24%) did not differ significantly. No patient complained of reflux symptoms after treatment, although abnormal acid exposure was documented in two subjects.Conclusions: Both formulations of botulinum toxin have comparable efficacy in the treatment of oesophageal achalasia, for up to 6 months of follow‐up.