bluuebunny/crossref_metadata_2025_split huggingface dataset:
Double‐blind placebo‐controlled multicentre studies of rebamipide, a gastroprotective drug, in the treatment of functional dyspepsia with or without Helicobacter pylori infection
Authors: Talley N. J. , Riff D. S. , Schwartz H. , Marcuard S. P. 
Published: March 2003

Background:Functional dyspepsia is a problem that is difficult to treat in clinical practice.Aim:To evaluate the efficacy and safety of rebamipide (a cytoprotective drug) in functional dyspepsia.Methods:Patients with functional dyspepsia (n=557) were divided a priori into two studies by Helicobacter pylori status, and enrolled in a 2‐week baseline evaluation period. Ninety‐nine patients with Helicobacter pylori and 173 patients without Helicobacter pylori, continuing to have at least moderate upper abdominal pain or discomfort, were randomly assigned to rebamipide 100 mg, rebamipide 200 mg or placebo, three times a day, in a double‐blind design for 8 weeks.Results:There was significant improvement of individual symptom scores from baseline in all the treatment arms. No significant improvement of individual symptom scores was observed in either rebamipide group at the end of the studies compared to placebo, although the belching score was significantly reduced in the rebamipide 100 mg and 200 mg groups at week 2 (P=0.017 and P=0.012, respectively) in the Helicobacter pylori‐positive patients. The ratio of patients who requested usage of the study medication again was greater in the rebamipide 100 mg (85%) and 200 mg (96%, P=0.020) groups compared with the placebo group (72%) among Helicobacter pylori‐positive patients. There were no serious study medication related adverse events.Conclusions:Rebamipide was not superior to placebo in terms of individual symptoms at the end of treatment.
Control of intragastric acidity with over‐the‐counter doses of ranitidine or famotidine
Authors: Hamilton M. I. , Sercombe J. , Pounder R. E. 
Published: March 2003

Background:Histamine H2‐receptor antagonists are available over the counter for the treatment of heartburn.Aim:To compare the effects of low doses of ranitidine and famotidine on intragastric acidity in a three‐way crossover study.Methods:Healthy subjects (12 male, 12 female) were dosed on three occasions with single oral doses of placebo, ranitidine, 75 mg, and famotidine, 10 mg, 1 h after lunch. The pH of gastric aspirates was then measured for 20 h. Subjects ate standard meals and snacks. Analysis of variance was used to determine the statistical significance of differences in acidity (mmol/L) during the day (12.30–22.30 hours) and night (22.30–08.30 hours).Results:Ranitidine and famotidine were superior (P < 0.05) to placebo in decreasing acidity for daytime and night‐time intervals. There were no significant differences in mean gastric acidity between ranitidine and famotidine during the daytime (11.37 mmol/L vs. 13.42 mmol/L, respectively) and night‐time (23.57 mmol/L vs. 24.74 mmol/L, respectively). Intragastric acidity after ranitidine was significantly lower than that after famotidine in the first 2.5‐h period following dosing (4.32 mmol/L vs. 9.28 mmol/L; P < 0.05).Conclusions:Lunchtime doses of ranitidine and famotidine decreased acidity during day‐ and night‐time periods. The effect of ranitidine was significantly greater for the first 2.5 h after dosing.
Effects of NSAIDs on cryoprobe‐induced gastric ulcer healing in rats
Authors: Tibble J. , Sigthorsson G. , Caldwell C. , Palmer R. H. , Bjarnason I. 
Published: March 2003

Background:Failure of ulcer healing may be critically important to the development of serious gastrointestinal complications in patients on long‐term NSAIDs.Aim:To determine the effect of indometacin, celecoxib, a cyclooxygenase‐2‐specific inhibitor, and nabumetone, a pro‐drug, on ulcer healing rates in the rat.Methods:Gastric ulcers were induced using a cryoprobe. An NSAID or a vehicle control was administered to groups of eight rats for 3 or 6 days (2 mg/kg indometacin, 9 mg/kg celecoxib or 40 mg/kg nabumetone). The ulcer area was measured and epithelial proliferation at the ulcer margins was measured histochemically. The effect of the drugs on intestinal prostaglandin levels was also assessed.Results:The mean ulcer sizes in the four groups on day 3 were comparable. On day 6, control animals and those receiving nabumetone showed significant ulcer healing (P < 0.02), while the mean ulcer sizes in the indometacin (P < 0.01) and celecoxib (P < 0.02) groups were significantly larger than those in the control group. Higher doses of nabumetone (160 mg/kg), however, impaired healing. Intestinal prostaglandins were reduced (P < 0.01) only in indometacin‐treated animals. The epithelial proliferation index was significantly lower among indometacin‐ (P=0.02) and celecoxib‐treated (P=0.03) animals compared to controls at day 3.Conclusions:Celecoxib and indometacin both decreased the epithelial proliferative response and delayed healing of cryoprobe‐induced gastric ulcers. In contrast, nabumetone impaired ulcer healing only at very high doses.
Dysfunction of oesophageal motility in Helicobacter pylori‐infected patients with reflux oesophagitis
Authors: Wu J. C. Y. , Lai A. C. W. , Wong S. K. H. , Chan F. K. L. , Leung W.‐K. , Sung J. J. Y. 
Published: March 2003

Background: Helicobacter pylori infection has been suggested to be protective against gastro‐oesophageal reflux disease. However, a significant proportion of patients with gastro‐oesophageal reflux disease are infected by H. pylori.Aim:To study oesophageal motor function in H. pylori‐infected patients with reflux oesophagitis.Methods:Patients with erosive reflux oesophagitis were recruited prospectively for stationary oesophageal manometry and 24‐h ambulatory oesophageal pH monitoring. H. pylori status was determined by biopsy urease test. Non‐reflux volunteers were recruited as controls.Results:Seventy‐four patients with erosive oesophagitis (34 H. pylori‐positive, 40 H. pylori‐negative) and 48 non‐reflux patient controls (22 H. pylori‐positive, 26 H. pylori‐negative) were recruited. There was no difference in severity of oesophagitis (median grade, 1; P=0.53) or oesophageal acid exposure (total percentage time oesophageal pH < 4, 7.6% vs. 6.8%; P=0.57) between H. pylori‐positive and H. pylori‐negative groups. Compared to H. pylori‐negative patients, H. pylori‐positive patients had significantly lower basal lower oesophageal sphincter pressure (12.2 mmHg vs. 15.3 mmHg; P=0.03) and amplitude of distal peristalsis (56.9 mmHg vs. 68.4 mmHg; P=0.03). Ineffective oesophageal motility (14% vs. 7%; P=0.02) and failed oesophageal peristalsis were also significantly more prevalent in H. pylori‐positive patients.Conclusions:Among patients with a similar degree of reflux oesophagitis, H. pylori‐infected patients have more severe oesophageal dysmotility and lower oesophageal sphincter dysfunction. Oesophageal motor dysfunction probably plays a dominant role in the development of gastro‐oesophageal reflux disease in patients with H. pylori infection.
Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open‐access endoscopy system: a prospective observational study based on the Maastricht guidelines
Authors: Manes G. , Balzano A. , Marone P. , Lioniello M. , Mosca S. 
Published: March 2003

Aim:To test the appropriateness of referrals for upper gastrointestinal endoscopy in Campania, Italy, using the criteria of the Maastricht Consensus.Patients:Patients undergoing endoscopy during a 1‐week period in 21 Endoscopy Services were considered prospectively. The reasons for endoscopy were dyspeptic symptoms, history of peptic ulcer and assessment after treatment. The age, sex, symptoms, history of peptic ulcer (previous endoscopic or radiographic examinations and treatment), endoscopic diagnosis and H. pylori status were recorded. The indications for endoscopy were evaluated according to the Maastricht guidelines.Results:Two hundred and sixteen of 706 patients presented with reflux symptoms, 430 with dyspeptic symptoms, 38 with alarm symptoms and 22 with atypical symptoms. Endoscopy was normal in 376 cases (53.2%); duodenal ulcer was found in 219, gastric ulcer in 45, oesophagitis in 82 and gastric cancer in six. All patients with cancer were older than 45 years, and four presented with alarm symptoms. In 398 cases (56%), endoscopy was considered not to be indicated: 250 patients with a previous diagnosis of ulcer without a change in symptoms, 38 patients in order to confirm eradication and 110 patients younger than 45 years with dyspepsia without alarm symptoms.Conclusions:A large number of endoscopic examinations could be avoided by following the guidelines of the Maastricht Consensus. In order to reduce endoscopic workload, strategies for educating physicians should be pursued.
A double‐blind comparison of balsalazide, 6.75 g, and sulfasalazine, 3 g, as sole therapy in the management of ulcerative colitis
Authors: Mansfield J. C. , Giaffer M. H. , Cann P. A. , Mckenna D. , Thornton P. C. , Holdsworth C. D. 
Published: March 2003

Background:Sulfasalazine is accepted therapy for active ulcerative colitis, but side‐effects and intolerance are common. Balsalazide is an azo‐bonded pro‐drug which also releases 5‐aminosalicylic acid into the colon, but uses an inert carrier molecule.Aim:To compare the safety and efficacy of sul‐ fasalazine, 3 g, with balsalazide, 6.75 g, in the initial daily treatment of mild to moderate ulcerative colitis.Methods:A randomized, multicentre, double‐blind, parallel group study was performed, with a treatment duration of 8 weeks. Patients on previous maintenance treatment were excluded. The trial medication was the sole treatment for the colitis. Efficacy was assessed by patient diaries, symptom assessment, sigmoidoscopic appearance and histology.Results:Fifty patients were recruited: 26 allocated to the balsalazide group and 24 to the sulfasalazine group. More patients withdrew due to adverse events in the sulfasalazine group (nine patients vs. one patient in the balsalazide group, P=0.004). Improvement occurred in both groups, with a tendency to a faster response with balsalazide. Of the patients taking balsalazide, 61% achieved clinical and sigmoidoscopic remission.Conclusions:Balsalazide, 6.75 g, is effective as the sole treatment for patients with mild to moderately active ulcerative colitis, with significantly fewer withdrawals due to side‐effects than in a similar group of patients taking sulfasalazine, 3 g.
Transient lower oesophageal sphincter relaxations—a pharmacological target for gastro‐oesophageal reflux disease?
Authors: Hirsch D. P. , Tytgat G. N. J. , Boeckxstaens G. E. E. 
Published: March 2003

The oesophago‐gastric junction functions as an anti‐reflux barrier preventing increased exposure of the oesophageal mucosa to gastric contents. Failure of this anti‐reflux barrier results in gastro‐oesophageal reflux disease, and may lead to complications such as oesophagitis, Barrett’s oesophagus and eventually oesophageal carcinoma.Recent studies have suggested that transient lower oesophageal sphincter relaxation is the main mechanism underlying gastro‐oesophageal reflux. It involves a prolonged relaxation of the lower oesophageal sphincter, mediated by a vago‐vagal neural pathway, synapsing in the brainstem.Several drugs, such as atropine, baclofen and loxiglumide, have been shown to reduce the rate of transient lower oesophageal sphincter relaxations and concomitantly the number of reflux episodes. These findings illustrate that transient lower oesophageal sphincter relaxations may represent a potential new target for the pharmacological treatment of gastro‐oesophageal reflux disease.It is possible that the reduction in the number of transient lower oesophageal sphincter relaxations may also contribute to the beneficial effect of fundoplication and new endoscopic anti‐reflux procedures. It should be emphasized, however, that other factors, such as low lower oesophageal sphincter pressure, the presence of a hiatal hernia and impaired oesophageal peristalsis, are also of great importance. Therefore, whether the targeting of transient lower oesophageal sphincter relaxations is the ‘golden bullet’ in anti‐reflux therapy remains to be proven, as evidence of an effective control of gastro‐oesophageal reflux in reflux patients is still lacking.
Effects of meal consistency and ingested fluid volume on the intragastric distribution of a drug model in humans—a magnetic resonance imaging study
Authors: Faas H. , Steingoetter A. , Feinle C. , Rades T. , Lengsfeld H. , Boesiger P. , Fried M. , Schwizer W. 
Published: March 2003

Background:Controlled delivery of drugs to the small intestine in relation to emptying of an ingested meal is important in various pathophysiological conditions. We investigated the effects of different food consistencies and the amount of co‐ingested liquid on the intragastric distribution of a contrast marker.Methods:Five healthy subjects received four meals (each 650 kcal: A, mashed potato with 100 mL water; B, rice with 100 mL water; C, hamburger meal with 100 mL water; D, hamburger meal with 300 mL water). A capsule filled with gadolinium tetra‐azacyclododecane tetra‐acetic acid solution (as contrast marker) was ingested following meal termination, and its intragastric distribution was assessed by magnetic resonance imaging.Results:Initially, marker distribution was confined to the fundus, and subsequently extended along the inner curvature of the stomach. The maximum distribution volume of the marker was lower in meal A than in meal B (P < 0.05). No differences in marker distribution were observed when the hamburger meal was given with 100 or 300 mL water.Conclusions:The intragastric distribution kinetics of the marker gadolinium tetra‐azacyclododecane tetra‐acetic acid appeared to depend on meal consistency, but not on the amount of water co‐ingested. Three‐dimensional magnetic resonance imaging allows detailed analysis of the intragastric distribution of a drug model in relation to meal emptying and intragastric meal distribution.
Effects of antacid formulation on postprandial oesophageal acidity in patients with a history of episodic heartburn
Authors: Robinson M. , Rodriguez‐Stanley S. , Miner P. B. , McGuire A. J. , Fung K. , Ciociola A. A. 
Published: March 2003

Background:Heartburn self‐treatment with antacids is extremely common. If the oesophagus is the primary site of antacid action, chewable antacids might raise the oesophageal pH more effectively than swallowable tablets.Aim:To establish a model to assess postprandial acid reflux and to compare the onset and duration of action on oesophageal pH of different antacid formulations.Methods:Twenty subjects with a history of episodic heartburn underwent eight pH monitoring sessions each for 5.5 h postprandially. One hour after consuming a meal consisting of chilli, cheese, raw onions and cola, subjects received 750 mg, 1500 mg and 3000 mg of either chewable or swallowable CaCO3 tablets, an effervescent bicarbonate solution or placebo. Oesophageal and gastric pH data were collected.Results:Mean intra‐oesophageal pH remained lower than baseline for more than 1 h (pH range 5–5.5) postprandially, indicating reflux of somewhat acidic intragastric contents into the oesophagus. The onset of action on oesophageal pH was similar for all antacids (30–35 min). The duration of action on pH varied: chewable tablets and effervescent bicarbonate had relatively long durations of action (oesophagus, 40–45 min; stomach, 100–180 min); swallowable tablets had little effect.Conclusions:The meal model used in this study dependably produced acidic gastro‐oesophageal reflux. Antacids increased oesophageal pH independent of gastric pH, demonstrating that chewing antacids controls oesophageal acidity more effectively than swallowing antacid tablets.
Helicobacter pylori, parietal cell antibodies and autoimmune gastropathy in type 1 diabetes mellitus
Authors: De Block C. E. M. , De Leeuw I. H. , Bogers J. J. P. M. , Pelckmans P. A. , Ieven M. M. , Van Marck E. A. E. , Van Hoof V. , Máday E. , Van Acker K. L. , Van Gaal L. F. 
Published: March 2003

Background:Fifteen to 20% of type 1 diabetic patients exhibit parietal cell antibodies (PCA), which are associated with autoimmune gastritis, hypochlorhydria, iron deficiency and pernicious anaemia.Aim:To examine whether Helicobacter pylori infection could explain the high prevalence of PCA and autoimmune gastropathy in diabetes. If so, H. pylori eradication could prevent autoimmune gastritis.Methods:In 229 type 1 diabetics (M/F: 135/94; age: 41 ± 12 years) PCA were measured. H. pylori infection was assessed by serology, urea breath test in all and by histology (updated Sydney system) in 88 subjects. Pentagastrin tests were performed in 42 patients.Results:Sixty‐nine patients were PCA‐positive. H. pylori infection was present in 72 patients and was negatively associated with HLA‐DQA1*0103‐B1*0603 (OR=0.12, P=0.015) and positively with DQA1*0501‐B1*0201 (OR=1.9, P=0.032). PCA‐positivity was linked to HLA‐DQA1*0501‐B1*0301 (OR=3.9, P=0.017). A link between H. pylori and PCA was observed when PCA‐positivity was defined as a titre ≥ 1/20 (OR=2.0, P=0.03), but not if ≥ 1/40 was the cut‐off point. PCA‐positivity, but not H. pylori infection, was associated with iron deficiency anaemia (OR=2.7, P=0.008), pernicious anaemia (OR= 33.5, P < 0.0001), hypochlorhydria (OR=12.1, P=0.0008) and autoimmune gastritis (OR=12.5, P < 0.0001).Conclusions:The HLA‐bound susceptibility of H. pylori and PCA differed. PCA‐positivity but not ongoing H. pylori infection is associated with autoimmune gastritis. Low titres of PCA might reflect H. pylori infection rather than autoimmune gastropathy.
One‐week omeprazole, furazolidone and amoxicillin rescue therapy after failure of Helicobacter pylori eradication with standard triple therapies
Authors: Wong W. M. , Wong B. C. Y. , Lu H. , Gu Q. , Yin Y. , Wang W. H. , Fung F. M. Y. , Lai K. C. , Xia H. H. X. , Xiao S. D. , Lam S. K. 
Published: March 2003

Aim:To test the efficacy of omeprazole, furazolidone and amoxicillin triple therapy for the treatment of Helicobacter pylori infection after failure of standard first‐line therapy recommended by the Asia‐Pacific Consensus on the management of H. pylori infection.Methods:Patients with failed H. pylori eradication received omeprazole, 20 mg, furazolidone, 100 mg, and amoxicillin, 1 g, all twice daily for 1 week. Endoscopy (CLO test, histology and culture) was performed before treatment. Post‐treatment H. pylori status was determined by 13C‐urea breath test 6 weeks later.Results:Fifty patients were recruited. Resistance to metronidazole, clarithromycin and both drugs was in the range of 50–64%, 60–75% and 40–50%, respectively, after failure of first‐line therapy. Amoxicillin resistance was not found. The intention‐to‐treat and per protocol H. pylori eradication rates were 52% and 53%, respectively. Patients with double resistance to metronidazole and clarithromycin showed the lowest eradication rate (38%), which was significantly lower than that of patients with sensitive strains (88%). Side‐effects were minimal and compliance was excellent (98%).Conclusions:One‐week omeprazole, furazolidone and amoxicillin rescue therapy achieved a high eradication rate in strains sensitive to metronidazole and clarithromycin. This is a cheap and safe rescue regimen when guided by pre‐treatment sensitivity testing.
Prospective study of the ability of histamine, serotonin or serum chromogranin A levels to identify gastric carcinoids in patients with gastrinomas
Authors: Bashir S. , Gibril F. , Ojeaburu J. V. , Asgharian B. , Entsuah L. K. , Ferraro G. , Crafa P. , Bordi C. , Jensen R. T. 
Published: March 2003

Background:Chronic hypergastrinaemia causes gastric enterochromaffin cell proliferation and carcinoid tumours. The only reliable means to diagnose enterochromaffin cell changes/carcinoids is by biopsy.Aim:To assess whether serum histamine, chromogranin A or serotonin and urinary N‐methylimidazoleacetic acid or 5‐hydroxyindoleacetic acid correlate with advanced enterochromaffin cell changes or gastric carcinoids in patients with gastrinomas.Methods:Consecutive patients (n=145) had the above assays and endoscopy with gastric biopsies.Results:Lower N‐methylimidazoleacetic acid and chromogranin A levels (P < 0.0001) occurred in disease‐free patients. In patients with active disease, the fasting serum gastrin levels correlated (P < 0.0001) with both chromogranin A and N‐methylimidazoleacetic acid levels. Chromogranin A (P=0.005), but not N‐methylimidazoleacetic acid, serotonin, 5‐hydroxyindoleacetic acid or histamine levels, correlated with the enterochromaffin cell index. Carcinoids, but not advanced enterochromaffin cell changes only, were associated with higher chromogranin A and N‐methylimidazoleacetic acid levels.Conclusions:Serum chromogranin A levels and urinary N‐methylimidazoleacetic acid levels, but not serum histamine or serotonin or urinary 5‐hydroxyindoleacetic acid, correlate with the presence of gastric carcinoids. However, no assay identified patients with advanced enterochromaffin cell changes only with high sensitivity/specificity. Thus, N‐methylimidazoleacetic acid and chromogranin A levels are unable to identify patients with advanced changes in enterochromaffin cells and therefore neither can replace routine gastric biopsies.
Sequential intravenous/oral antibiotic vs. continuous intravenous antibiotic in the treatment of pyogenic liver abscess
Authors: Ng F. H. , Wong W. M. , Wong B. C. Y. , Kng C. , Wong S. Y. , Lai K. C. , Cheng C. S. , Yuen W. C. , Lam S. K. , Lai C. L. 
Published: March 2003

SummaryAim : Pyogenic liver abscesses result in substantial morbidity and mortality. Antimicrobial regimens using sequential intravenous/oral therapy may reduce the length of hospital stay. In this retrospective analysis, the efficacy of continuous intravenous antibiotic therapy (group I) vs. sequential intravenous/oral antibiotic therapy (group II) was studied in patients with pyogenic liver abscess.Methods : One hundred and twelve consecutive patients (55 in group I and 57 in group II) with pyogenic liver abscess were analysed. Clinical response, length of hospital stay and relapse rates were examined.Results : Group II had a significantly shorter duration of intravenous antibiotic treatment (3.2 weeks vs. 5.9 weeks, P < 0.01) and a shorter length of hospital stay (28 days vs. 42 days, P < 0.01) when compared to group I. Oral antibiotics were prescribed for a median duration of 2.9 weeks in group II after discharge. No relapse occurred within 6 weeks after the completion of treatment in both groups. The cost of therapy was significantly lower in group II than in group I by 33%.Conclusions : A sequential intravenous/oral antibiotic regime is a safe and effective treatment for pyogenic liver abscess. This reduces the cost of therapy and the length of hospital stay.