bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn's disease
Authors: Dejaco C. , Harrer M. , Waldhoer T. , Miehsler W. , Vogelsang H. , Reinisch W. 
Published: December 2004

SummaryBackground : Antibiotics and thiopurines have been employed in the management of fistulizing Crohn's disease, although evidence of their efficacy is rare.Aim : To evaluate, in a prospective, open‐label study, the influence of antibiotics and azathioprine on the clinical outcome of perianal fistulas in patients with Crohn's disease.Methods : Fifty‐two patients entered the study, starting with an 8‐week regimen of ciprofloxacin (500–1000 mg/day) and/or metronidazole (1000–1500 mg/day). Seventeen patients had already received daily azathioprine (2–2.5 mg/kg) at enrolment, whereas in 14 patients azathioprine was initiated after 8 weeks of antibiotic treatment. Outcome was evaluated by Fistula Drainage Assessment and the Perianal Disease Activity Index at weeks 8 and 20.Results : Overall, 26 patients (50%) responded to antibiotic treatment, with complete healing in 25% of patients at week 8. The Perianal Disease Activity Index decreased significantly from 8.4 ± 2.9 to 6.0 ± 4.0 (P < 0.0001). At week 20, the outcome was assessed in 49 patients (94%), 29 of whom (59%) had received azathioprine. Response was noted in 17 of the 49 patients (35%), with complete healing in nine patients (18%). Patients who received azathioprine were more likely to achieve a response (48%) than those without immunosuppression (15%) (P = 0.03). The Perianal Disease Activity Index was closely associated with treatment response and perianal disease activity.Conclusion : Antibiotics are useful to induce a short‐term response in perianal Crohn's disease, and may provide a bridging strategy to azathioprine, which seems to be essential for the maintenance of fistula improvement.
Antibiotic treatment of small bowel bacterial overgrowth in patients with Crohn's disease
Authors: Castiglione F. , Rispo A. , Di Girolamo E. , Cozzolino A. , Manguso F. , Grassia R. , Mazzacca G. 
Published: December 2004

SummaryBackground : Small bowel bacterial overgrowth is common in Crohn's disease but its treatment is not clearly defined. Metronidazole and ciprofloxacin are effective antibiotics in active Crohn's disease.Aim : To investigate the efficacy of metronidazole and ciprofloxacin in the treatment of bacterial overgrowth in patients with Crohn's disease.Patients and methods : We performed the lactulose breath test in 145 consecutive patients affected by Crohn's disease. Patients positive to the lactulose breath test underwent a glucose breath test to confirm the overgrowth. These patients were randomized in two treatment groups: metronidazole 250 mg t.d.s. (Group A) and ciprofloxacin 500 mg b.d. (Group B), both orally for 10 days. The glucose breath test was repeated at the end of treatment. The clinical outcome after therapy was also recorded.Results : Bacterial overgrowth was present in 29 patients (20%). Breath test normalization occurred in 13 out of 15 patients treated by metronidazole and in all 14 patients treated by ciprofloxacin (P = ns). In both groups antibiotic treatment induced an improvement of intestinal symptoms: bloating (Group A 85% and Group B 83%), stool softness (44% and 50%), and abdominal pain (50% and 43%).Conclusions : Small bowel bacterial overgrowth is a frequent condition in Crohn's disease which can be effectively treated by metronidazole or ciprofloxacin.
Glucocorticoid receptor expression in inflammatory bowel disease: evidence for a mucosal down‐regulation in steroid‐unresponsive ulcerative colitis
Authors: Raddatz D. , Middel P. , Bockemühl M. , Benöhr P. , Wissmann C. , Schwörer H. , Ramadori G. 
Published: December 2004

SummaryBackground : Glucocorticoids (GC) play a major role in the attenuation of inflammation. Glucocorticoid receptor (GR) expression is an important determinant of steroid sensitivity.Aims : To investigate whether GR mRNA expression is altered in inflammatory bowel disease, and whether GR mRNA expression correlates with disease activity and may predict response to GC therapy.Methods : Mucosal biopsies were taken from 33 patients with ulcerative colitis, 21 with Crohn's disease and 11 controls. Peripheral blood mononuclear cells were isolated from 24 ulcerative colitis and 18 Crohn's disease patients and 11 controls. GR mRNA was measured by quantitative reverse transcriptase polymerase chain reaction (RT‐PCR), and correlated to endoscopic findings, clinical activity and outcome of GC therapy. In a subset of subjects GR localisation was shown by immunohistochemistry.Results : In patients with inflammatory bowel disease GR expression was not different from controls. However, GR was decreased in biopsies from ulcerative colitis patients with impaired GC response. The inhibitory subtype GRβ was expressed 100–1000 times lower than GRα. GR immunoreactivity was identified in immune and epithelial cells except for colonic crypts.Conclusion : In inflammatory bowel disease systemic and mucosal GR mRNA expression is not altered. However, in ulcerative colitis patients, low mucosal GR expression may predict the outcome of GC therapy. The low expression of GRβ challenges its role in steroid refractoriness in inflammatory bowel disease.
Empirically derived symptom sub‐groups correspond poorly with diagnostic criteria for functional dyspepsia and irritable bowel syndrome. A factor and cluster analysis of a patient sample
Authors: Eslick G. D. , Howell S. C. , Hammer J. , Talley N. J. 
Published: December 2004

SummaryAim : To determine how clusters (groups) of patients with respect to symptoms compare with a clinical diagnosis in patients with irritable bowel syndrome and non‐ulcer dyspepsia.Methods : All patients who attended a gastroenterology practice at Nepean Hospital were included in the study. All patients received the previously validated Bowel Disease Questionnaire, and were independently assessed by the gastroenterologist. Factor analysis and a k‐means cluster analysis were completed.Results : The study population comprised 897 patients [320 males (36%) and 577 females (64%)]. Factor analysis identified nine symptom factors: (1) diarrhoea; (2) constipation; (3) dysmotility; (4) dyspepsia/reflux; (5) nausea/vomiting; (6) bowel; (7) meal‐related pain; (8) weight loss; and (9) abdominal pain. A k‐means cluster analysis identified seven distinct subject groups, which included an undifferentiated group: (1) diarrhoea; (2) meal‐related pain; (3) abdominal pain; (4) faecal indicators; (5) nausea/vomiting/weight loss; and (6) constipation. The majority of irritable bowel syndrome patients fitted into two cluster groups [diarrhoea (25%) and constipation (20%)], whereas those with non‐ulcer dyspepsia predominantly fitted into the undifferentiated cluster (34%) and the nausea/vomiting cluster (18%).Conclusion : This study supports the concept of symptom subgroups, including the subdivision of patients into diarrhoea‐ and constipation‐predominant irritable bowel syndrome.
Chemoprevention of colorectal cancer
Authors: Courtney E. D. J. , Melville D. M. , Leicester R. J. 
Published: December 2004

SummaryColorectal cancer is a disease with a high mortality at present, due to the late stage at which many cases present. Attention is therefore focusing on preventative strategies for colorectal cancer given that polyps appear to be identifiable and treatable precursor lesions of this disease. Endoscopic polypectomy has been shown to reduce the incidence of colorectal cancer and there is a good case for endoscopic screening of the general population. However, this will require a large amount of manpower and resources and its success will also depend on the overall compliance of the population.Epidemiological studies have shown that individuals reporting a regular intake of aspirin and other non‐steroidal anti‐inflammatory drugs have a reduced risk of developing colorectal polyps and cancer. Similarly, a number of natural substances, such as calcium and folate, when supplemented regularly in the diet, have also been linked to a possible decreased incidence of colorectal cancer. This has led to the concept of using such agents to reduce the number of cases of colorectal cancer. In this article, we review the current evidence for the use of these and other agents for the chemoprevention of colorectal cancer, together with theories as to their possible mechanisms of action.
The ageing bowel and intolerance to aspirin
Authors: Newton J. L. , Johns C. E. , May F. E. B. 
Published: December 2004

SummaryAspirin has a role in the prevention of cardiovascular and cerebrovascular disease, Alzheimer's dementia and several cancers. Encouraging all 50 year olds to take low‐dose aspirin doubles their chances of living a healthy life into their nineties. The widespread use of aspirin, however, is limited as many older subjects are currently unable to take aspirin because of gastrointestinal side‐effects.This review explores why gastrointestinal events occur with aspirin use and how a net benefit from prophylactic aspirin might be achieved in older subjects. It is suggested that, by understanding the age‐related changes in upper gastrointestinal physiology and the mechanisms by which aspirin leads to the risk reductions associated with its use, it may be possible to direct interventions to improve tolerability in older subjects. This would allow greater numbers of older subjects to gain the benefits associated with aspirin use.
A comparison of hepatitis C treatment and outcomes at academic, private and Veterans' Affairs treatment centres
Authors: Jensen D. M. , Cotler S. J. , Lam H. , Harb G. , Shillington A. 
Published: December 2004

SummaryBackground : Currently, there is a lack of published data examining hepatitis C treatment practices in different care settings.Aim : To provide data describing treatment practices for patients with hepatitis C virus infection in actual clinical practice, and to examine clinical outcomes in patients treated with interferon alpha‐2b/ribavirin combination therapy in academically affiliated centres, private treatment centres and Veterans' Affairs treatment centres.Methods : This multi‐centre, retrospective, cohort study of 231 patients examined hepatitis C virus treatment practices in patients receiving interferon alpha‐2b from January 1997 to May 2001 and explored outcomes in academically affiliated, private and Veterans' Affairs centres.Results : Differences in treatment practice and use of diagnostic procedures were found. Genotype testing was under‐utilized in non‐academic sites (academic centres, 79.2%; private centres, 33.7%; Veterans' Affairs centres, 35.9%; P < 0.001). Liver biopsies were performed less often in private sites (academic centres, 95.8%; private centres, 80.0%; Veterans' Affairs centres, 92.2%; P < 0.01). End‐of‐treatment viral response (academic centres, 40.0%; private centres, 31.3%; Veterans' Affairs centres, 17.2%; P < 0.05) was lower than that found in published trial data. Multivariate analysis revealed genotype 1 as the single significant predictor of treatment failure (P < 0.01).Conclusions : Outside of the academic setting, there is significantly less diagnostic work‐up performed prior to the initiation of hepatitis C virus therapy. This suggests a need for a standardization of care across treatment settings.
Rabeprazole 10 mg twice daily is superior to 20 mg once daily for night‐time gastric acid suppression
Authors: Shimatani T. , Inoue M. , Kuroiwa T. , Horikawa Y. 
Published: December 2004

SummaryBackground : Insufficient acid suppression is one of the main causes of proton pump inhibitor‐refractory gastro‐oesophageal reflux disease.Aim : To achieve more potent and long‐lasting acid suppression, different dosage regimens of rabeprazole were compared in relation to the CYP2C19 genotype status.Methods : In a cross‐over study, 18 healthy Helicobacter pylori‐negative males (six homozygous extensive metabolizers, six heterozygous extensive metabolizers and six poor metabolizers) were given rabeprazole 10 mg once daily, 20 mg once daily or 10 mg twice daily, or water only (baseline data), for 7 days each. On day 7 of each regimen, 24‐h intragastric pH‐metry was performed.Results : No significant differences were observed in median pH values and pH > 4 holding time ratios between rabeprazole 10 mg once daily and 20 mg once daily. However, with rabeprazole 10 mg twice daily, these parameters were significantly higher than those with 20 mg once daily. The potency of acid suppression by rabeprazole was influenced by the CYP2C19 genotype status. The differences were somewhat significant but not large. The incidence of nocturnal acid breakthrough was lowest with rabeprazole 10 mg twice daily.Conclusions : Rabeprazole 10 mg twice daily, not 20 mg once daily, should be administered to achieve more potent and long‐lasting acid suppression.
High‐dose intravenous proton pump inhibition following endoscopic therapy in the acute management of patients with bleeding peptic ulcers in the USA and Canada: a cost‐effectiveness analysis
Authors: Barkun A. N. , Herba K. , Adam V. , Kennedy W. , Fallone C. A. , Bardou M. 
Published: December 2004

SummaryBackground : The efficacy of high‐dose intravenous proton pump inhibition has recently been shown, yet its cost‐effectiveness remains poorly studied.Aim : To assess the cost‐effectiveness of this approach separately for American and Canadian health care settings.Methods : A validated decision model included patients with bleeding ulcers after successful endoscopic haemostasis. Probabilities were determined from the literature, and charges and lengths of stay from national databases. A third‐party payer perspective was adopted over a 30‐day time horizon.Results : Re‐bleeding rates were 5.9% for patients who received high‐dose intravenous proton pump inhibition and 22.9% for those who did not. Hospitalization costs for patients with and without re‐bleeding were US$11 802 and US$7993, and CAN$5220 and CAN$2696, respectively. High‐dose intravenous proton pump inhibition was more effective and less costly than the alternative of not administering it. The cost‐effectiveness ratios for high‐dose and no high‐dose intravenous proton pump inhibition were US$9112 and US$11 819 (CAN$3293 and CAN$4284 for the Canadian case), respectively. Sensitivity and threshold analyses showed that the results were robust across a wide range of clinically relevant assumptions.Conclusion : In the USA and Canada, administering high‐dose intravenous proton pump inhibition for 3 days is both more effective and less costly than not doing so for patients with bleeding ulcers after successful endoscopic haemostasis.
Sequential treatment for Helicobacter pylori does not share the risk factors of triple therapy failure
Authors: De Francesco V. , Zullo A. , Margiotta M. , Marangi S. , Burattini O. , Berloco P. , Russo F. , Barone M. , Di Leo A. , Minenna M. F. , Stoppino V. , Morini S. , Panella C. , Francavilla A. , Ierardi E. 
Published: December 2004

SummaryBackground : Predicting factors for the outcome of conventional Helicobacter pylori triple therapy have been identified. Of these, the presence of the CagA gene is a strong predictor of successful treatment. Our preliminary data show that this factor becomes irrelevant when sequential therapy is used.Aim : To identify predicting factors for the outcome of H. pylori eradication using two therapeutic schemes (triple and sequential) of equal duration (10 days).Methods : Ninety‐six patients with H. pylori infection were randomly assigned to receive one of the following therapeutic schemes: group A: rabeprazole (20 mg b.d.) plus amoxicillin (1 g b.d.) for 5 days, followed by rabeprazole (20 mg b.d.) plus tinidazole (500 mg b.d.) and clarithromycin (500 mg b.d.) for a further 5 days; group B: rabeprazole (20 mg b.d.) plus amoxicillin (1 g b.d.) and clarithromycin (500 mg b.d.) for 10 days. Age, sex, smoking, endoscopic and histological findings, and CagA and VacA status were considered as candidates for a model of multivariate analysis which used therapeutic outcome as the dependent variable. CagA and VacA status were assessed by polymerase chain reaction on DNA isolated from gastric antral specimens.Results : The sequential scheme was significantly more effective than prolonged triple therapy (P < 0.05). Smoking (P < 0.001) and the absence of the CagA gene (P < 0.05) were significantly associated with the failure of triple therapy, but the effectiveness of sequential treatment was not predicted by these factors.Conclusion : Our data suggest that sequential therapy is not affected by bacterial and host factors which have, until now, predicted the outcome of conventional eradication treatments.
Monitoring methotrexate‐induced hepatic fibrosis in patients with psoriasis: are serial liver biopsies justified?
Authors: Aithal G. P. , Haugk B. , Das S. , Card T. , Burt A. D. , Record C. O. 
Published: December 2004

SummaryBackground : Reports that up to 26% of subjects with psoriasis develop cirrhosis have led to a recommendation of serial liver biopsies after each cumulative dose of 1500 mg of methotrexate.Aim : To evaluate the progression of liver injury in patients with psoriasis and the impact of monitoring by liver biopsy on their management.Methods : One hundred and twenty‐one liver biopsies from 66 subjects (aged 11–79 years) with psoriasis, receiving a median cumulative dose of 3206 mg of methotrexate over a period of 280.5 weeks, were evaluated.Results : The assessment of advanced fibrosis according to the Ishak system (≥ 4) correlated perfectly with that of the Scheuer system (≥ 3) and poorly with that of the Roenigk scale (≥ 3b) (r2 = 1.0 and 0.31, respectively). Two of 24 pre‐treatment biopsies showed advanced fibrosis and both subjects were heavy drinkers. The cumulative probabilities of advanced fibrosis (Ishak ≥ 4) were 0%, 2.6%, 2.6%, 8.2% and 8.2% at cumulative doses of 1500, 3000, 4500, 5000 and 6000 mg, respectively. None of the subjects developed cirrhosis during follow‐up or discontinued therapy on the basis of liver biopsy findings.Conclusions : Advanced hepatic fibrosis with low‐dose methotrexate therapy is much less frequent than previously reported. Pre‐treatment or monitoring liver biopsies in accordance with the current guidelines have little impact on patient management.
Effects of capsaicin on the sensorimotor function of the proximal stomach in humans
Authors: Lee K.‐J. , Vos R. , Tack J. 
Published: December 2004

SummaryBackground : Capsaicin‐sensitive afferents have been implicated in the control of visceral sensorimotor functions.Aim : To study the effects of capsaicin on the sensorimotor function of the proximal stomach in humans.Methods : In 10 healthy subjects, a gastric barostat was used to study the effect of saline or capsaicin‐containing red pepper sauce on the sensitivity to gastric distension and on gastric accommodation to a meal.Results : The administration of capsaicin was accompanied by a relaxation of the proximal stomach. After capsaicin, the compliance of the proximal stomach was increased and higher perception scores were reached for the same distending pressures. Dosing with capsaicin significantly decreased the pressures and corresponding wall tensions at the discomfort threshold. Gastric accommodation to a meal was not altered by capsaicin.Conclusion : The acute administration of capsaicin decreases proximal gastric tone, inhibits phasic contractility of the proximal stomach and increases sensitivity to proximal gastric distension. These data suggest the involvement of vanilloid receptor 1 in the modulation of gastric sensorimotor function in humans.
Double‐blind, randomized controlled study to assess the effects of lansoprazole 30 mg and lansoprazole 15 mg on 24‐h oesophageal and intragastric pH in Chinese subjects with gastro‐oesophageal reflux disease
Authors: Wong W. M. , Lai K. C. , Hui W. M. , Lam K. F. , Huang J. Q. , Hu W. H. C. , Wong N. Y. H. , Lam C. L. K. , Xia H. H. X. , Chan A. O. O. , Lam S. K. , Wong B. C. Y. 
Published: December 2004

SummaryBackground : Previous studies have suggested that the acid secretory capacity of the Chinese population is lower than that of the Western population.Aim : To compare the effect of lansoprazole 30 mg and 15 mg once daily on the 24‐h oesophageal and intragastric pH profiles in Chinese patients with gastro‐oesophageal reflux disease.Methods : Forty‐four patients (male to female ratio, 27 : 17; mean age, 53 years; 55% with oesophagitis) with gastro‐oesophageal reflux disease were randomized to receive lansoprazole 30 mg or 15 mg once daily for 4 weeks. Measurement of the 24‐h oesophageal and intragastric pH, gastro‐oesophageal reflux disease symptoms and quality of life was performed at baseline and during the last week of each dosing period.Results : Lansoprazole 30 mg maintained an intragastric pH > 4 for 10.5 h vs. 9.6 h for lansoprazole 15 mg (P = 0.44). The percentage total time at oesophageal pH < 4 was similar for lansoprazole 30 mg and 15 mg (2.0% vs. 2.3%, P = 0.30). The proportion of patients with complete cure of heartburn and acid regurgitation and the quality of life assessment were similar for lansoprazole 30 mg and 15 mg. Both dosages of lansoprazole were well tolerated and the compliance was 100% in both groups.Conclusion : Lansoprazole dosages of 30 mg and 15 mg once daily provide a satisfactory decrease for oesophageal acid exposure and are equally effective for the treatment of gastro‐oesophageal reflux disease in the Chinese population.
Prevalence and characteristics of familial hepatocellular carcinoma caused by chronic hepatitis B infection in Hong Kong
Authors: Chan A. O. O. , Yuen M. F. , Lam C. M. , Fong C. Y. , Wong B. C. Y. , Lai C. L. 
Published: December 2004

SummaryBackground : Hepatitis B virus infection is an important aetiological factor for hepatocellular carcinoma. Clusters of hepatocellular carcinoma have been observed in families infected with hepatitis B virus.Aim : To investigate the prevalence and characteristics of hepatocellular carcinoma associated with familial hepatitis B virus in Hong Kong.Methods : Hepatitis B virus patients were screened for familial hepatocellular carcinoma using a standardized questionnaire. The clinical features of patients with familial hepatocellular carcinoma were compared with those of 118 patients with sporadic hepatocellular carcinoma attending the clinic during the same period.Results : A total of 5080 patients were interviewed. Validation of the questionnaire indicated that the reliability was high. There were 22 families with familial hepatocellular carcinoma, giving a prevalence of 4.3 families/1000 hepatitis B virus carriers. The mean age of onset was 48.5 ± 13 years in familial hepatocellular carcinoma and 62 ± 11 years in sporadic hepatocellular carcinoma (P = 0.005). The ages of onset were 59 ± 11, 40 ± 10 and 18 ± 4 years in the first, second and third generations, respectively (P < 0.0001), suggesting an anticipation phenomenon. Familial hepatocellular carcinoma patients were more likely to present with pain (70% vs. 10%, P < 0.0001), but not on routine screening (14% vs. 52%, P < 0.0001), than sporadic hepatocellular carcinoma patients.Conclusion : The prevalence of familial hepatocellular carcinoma is significant in Hong Kong. These patients show specific clinical features when compared with patients with sporadic hepatocellular carcinoma.