bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential effects of baclofen on lower oesophageal sphincter pressure and proximal gastric motility in humans
Authors: Lee K.‐J. , Vos R. , Janssens J. , Tack J. 
Published: July 2003

SummaryBackground: The γ‐aminobutyric acid receptor type B agonist, baclofen, inhibits transient lower oesophageal sphincter relaxations by influencing a vagal pathway. Although post‐prandial proximal gastric function, which is vagally mediated, is important in the occurrence of transient lower oesophageal sphincter relaxations, the effects of baclofen on post‐prandial proximal gastric motility in humans remains undetermined.Aim: To determine the effects of baclofen on post‐prandial lower oesophageal sphincter function and proximal gastric motility in healthy subjects.Methods: In 11 healthy volunteers, a barostat bag and an oesophageal manometric catheter with a sleeve were simultaneously positioned; 40 mg of oral baclofen or placebo was then given in a randomized, double‐blind manner. Subsequently, the intragastric bag volume, oesophageal and lower oesophageal sphincter pressure and oesophageal pH were recorded during the 90 min before and 120 min after a meal.Results: During the post‐prandial period, unlike the fasting period, baclofen decreased the rate of transient lower oesophageal sphincter relaxations and increased the basal lower oesophageal sphincter pressure compared with placebo. However, the meal‐induced decrease in the tone and phasic contractility of the fundus was not affected by baclofen.Conclusion: The γ‐aminobutyric acid receptor type B agonist, baclofen, has a potent effect on post‐prandial lower oesophageal sphincter motility without altering post‐prandial proximal gastric motility, suggesting differential effects of baclofen on different signals of gastrointestinal vagal afferents.
Current therapeutic options for gastric antral vascular ectasia
Authors: Sebastian S. , O'Morain C. A. , Buckley M. J. M. 
Published: July 2003

SummaryGastric antral vascular ectasia, or ‘watermelon stomach’, is a rare but important cause of gastrointestinal blood loss and anaemia, which has characteristic endoscopic and histological features. The pathogenesis of this condition remains unclear; however, many associated disorders have been documented. Various medical, surgical and endoscopic therapeutic modalities have been attempted with variable success. Leading contenders for the therapeutic modality of choice include hormonal therapy, endoscopic Nd:YAG laser and argon plasma coagulation. Randomized controlled trials to identify the ideal treatment method are lacking at present.
Studies of compliance with delayed‐release mesalazine therapy in patients with inflammatory bowel disease
Authors: Shale M. J. , Riley S. A. 
Published: July 2003

SummaryBackground: Non‐compliance with maintenance mesalazine therapy may be a risk factor for relapse in inflammatory bowel disease, but the prevalence and determinants of non‐compliance are unknown.Aim: To study the prevalence and determinants of non‐compliance in patients with inflammatory bowel disease.Methods: Out‐patients receiving delayed‐release mesalazine were studied. Compliance was determined by direct enquiry and by analysis of urine samples for 5‐aminosalicylic acid/N‐acetyl‐5‐aminosalicylic acid. Potential determinants of compliance were assessed.Results: Ninety‐eight patients were studied. Forty‐two patients (43%) reported taking < 80% of their prescribed dose. Logistic regression revealed the independent predictors of non‐compliance to be three‐times daily dosing [odds ratio (OR), 3.1; 95% confidence interval (CI), 1.8–8.4] and full‐time employment (OR, 2.7; 95% CI, 1.1–6.9). Urine from 12 patients (12%) contained no detectable 5‐aminosalicylic acid/N‐acetyl‐5‐aminosalicylic acid, and 18 patients (18%) had levels below those expected. Depression was the only independent predictor of complete non‐compliance (OR, 10.5; 95% CI, 1.8–79.0), and three‐times daily dosing was the only independent predictor of partial non‐compliance (OR, 3.7; 95% CI, 1.8–8.9). Self‐reporting correctly identified 66% of patients judged to be non‐compliant on urinary drug measurement.Conclusions: Non‐compliance with maintenance mesalazine therapy is common in patients with inflammatory bowel disease. Three‐times daily dosing and full‐time employment are predictors of partial non‐compliance, whilst depression is associated with complete non‐compliance. Self‐reporting detects most non‐compliant patients.
High variation of tioguanine absorption in patients with chronic active Crohn's disease
Authors: Deibert P. , Dilger K. , Fischer C. , Hofmann U. , Nauck S. , Stoelben S. , Kreisel W. 
Published: July 2003

SummaryBackground : Tioguanine (thioguanine) has been suggested as a therapeutic alternative for patients with Crohn's disease resistant or intolerant to azathioprine or mercaptopurine. However, pharmacokinetic data on tioguanine in inflammatory bowel disease are missing.Aim: To determine the disposition of three different 40 mg tablet preparations of tioguanine in patients with Crohn's disease.Methods : Six patients with chronic active Crohn's disease were included in a randomized, cross‐over, single‐dose study. Pharmacokinetic analysis was based on plasma concentrations of tioguanine during 6 h after dosing. Tioguanine was measured by a validated high‐pressure liquid chromatographic method.Results : The areas under the curve (AUC) varied 4–7‐fold between patients. In two patients, tioguanine was not detected in plasma following the intake of one of the three tablets; another patient did not absorb tioguanine in two of the three different preparations. No significant differences were found in the AUC and Cmax values between the three tablets. In all patients, there was a second peak in plasma concentration following a meal 3 h after drug administration.Conclusions : The absorption of tioguanine is highly variable in patients with Crohn's disease, which may be responsible for treatment failure. Therapy with tioguanine may be improved by monitoring tioguanine nucleotides as a surrogate parameter of efficacy.
Does gall‐bladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain?
Authors: Delgado‐Aros S. , Cremonini F. , Bredenoord A. J. , Camilleri M. 
Published: July 2003

SummaryBackground : Patients with suspected functional biliary pain often undergo cholecystectomy if a decreased gall‐bladder ejection fraction (GBEF < 35%) is demonstrated by cholecystokinin cholescintigraphy. However, the validity of GBEF in predicting which patients will have symptomatic relief following cholecystectomy is unclear.Aim : To determine whether patients with suspected functional biliary pain with decreased GBEF have a better symptomatic outcome after cholecystectomy than those with normal GBEF.Methods : Systematic review and meta‐analysis of the published literature through MEDLINE and EMBASE databases.Results : We included nine studies with a total of 974 patients with suspected functional biliary pain; 362 patients underwent cholecystectomy. Most studies assessed outcome by direct patient interview. Mean ages across the studies ranged from 35 to 47 years; 78% of all patients were female. Mean duration of follow‐up after surgery ranged from 1 to 2.5 years. After cholecystectomy, 94% of the patients with reduced GBEF had a positive outcome compared to 85% among those with normal GBEF. The pooled Mantel–Haenszel odds ratio for positive outcome was 1.37 (95% confidence interval 0.56–3.34), P = 0.56.Conclusion : These data do not support the use of GBEF to select patients with suspected functional biliary pain for cholecystectomy. Prospective randomized trials are required if this practice is to be evidence‐based.
Coeliac disease presenting with symptoms of irritable bowel syndrome
Authors: Shahbazkhani B. , Forootan M. , Merat S. , Akbari M. R. , Nasserimoghadam S. , Vahedi H. , Malekzadeh R. 
Published: July 2003

SummaryBackground : Coeliac disease may easily mimic symptoms which are parts of the criteria used for diagnosing irritable bowel syndrome.Aim : To find the frequency of coeliac disease among patients diagnosed as irritable bowel syndrome.Methods : During a period of one year, irritable bowel syndrome patients referred to a university clinic in Tehran were studied. For each patient, an asymptomatic sibling was enrolled as control. Serological tests for coeliac disease were performed in all patients and controls. If positive, duodenal biopsy was performed to confirm the diagnosis. Patients subsequently diagnosed as coeliac disease were placed on a gluten free diet and re‐evaluated after 6 months.Results : One hundred and five cases of irritable bowel syndrome and 105 controls were enrolled. Coeliac disease was diagnosed in 12 of the irritable bowel syndrome patients and none of the controls. Eleven coeliac disease patients adhered to a gluten free diet. After 6 months, all 11 patients had significant improvement in symptoms and three were totally asymptomatic. Six allowed repeated endoscopy after 6 months of gluten free diet, of which five showed improvement in histological findings.Conclusions : Coeliac disease is a common finding among patients labelled as irritable bowel syndrome. In this sub‐group, a gluten free diet may lead to a significant improvement in symptoms. Routine testing for coeliac disease may be indicated in all patients being evaluated for irritable bowel syndrome.
Preliminary evaluation of an injectable anal sphincter bulking agent (Durasphere) in the management of faecal incontinence
Authors: Davis K. , Kumar D. , Poloniecki J. 
Published: July 2003

SummaryBackground : It has been previously shown that ‘bulking’ of internal anal sphincter defects may provide an effective method to treat patients with faecal incontinence, but the benefit wears off with time.Aim : To assess the efficacy of a larger molecule, bulking agent (Durasphere) over the short‐ and long‐term in patients with an internal anal sphincter defect refractory to conservative management.Patients : Eighteen patients (nine male, nine female) with a mean age of 60 years were recruited. All patients had persistent faecal leakage/soiling.Methods : Durasphere was injected in the submucosal plane to restore anal canal symmetry. All patients had anorectal physiology, endoanal ultrasound, continence grading, patient satisfaction and quality of life scores assessed at 1, 3, 6 and 12 months.Results : The mean follow‐up is 28.5 months. Changes from baseline were not statistically significant up to 6 months. At 12 months there was significant improvement in the continence grading (P = 0.003), patient satisfaction (P = 0.053) and all quality of life subscales: lifestyle (P = 0.004), coping (P = 0.011), depression (P = 0.024) and embarrassment (P = 0.059). Anorectal physiological parameters apart from the maximum tolerable rectal volume at 12 months (P = 0.036) showed no significant improvement.Conclusions : Anal sphincter bulking with Durasphere is safe and effective in the short term as well as the longer term. More importantly, there is no evidence of attenuation of effect over time.
The long‐term effect of Helicobacter pylori eradication therapy on symptoms in dyspeptic patients with fundic atrophic gastritis
Authors: Kamada T. , Haruma K. , Hata J. , Kusunoki H. , Sasaki A. , Ito M. , Tanaka S. , Yoshihara M. 
Published: July 2003

SummaryAim : To investigate whether curing Helicobacter pylori infection improves symptoms over the long‐term in Japanese patients with nonulcer dyspepsia and fundic atrophic gastritis.Methods : Ninety H. pylori‐positive dyspeptic patients with fundic atrophic gastritis were enrolled in this study. We performed a randomized double‐blind placebo‐controlled trial comparing triple therapy (n = 45) with that of placebo alone (n = 45). Inflammation and mucosal atrophy were scored according to the Updated Sydney System. Symptoms were scored on a scale of 0 to 3 for six items. Fasting samples of gastric juice were taken before endoscopy, and gastric pH was determined. Serum gastrin and pepsinogen levels were measured, and body mass index was determined. These patients were followed up for 3 years, and all measures were evaluated both before and after therapy.Results : Significant improvement in dyspeptic symptoms and gastritis scores, significant decrease in gastric pH, and significant increase in body mass index were found after 3 years eradication in nonulcer dyspepsia patients treated successfully for H. pylori infection. There were no significant changes in the placebo group.Conclusion : Our study shows that eradicating of H. pylori results in significant long‐term reduction in symptoms of nonulcer dyspepsia with fundic atrophic gastritis.
Economic analysis of celecoxib versus diclofenac plus omeprazole for the treatment of arthritis in patients at risk of ulcer disease
Authors: Lee K. K. C. , You J. H. S. , Ho J. T. S. , Suen B. Y. , Yung M. Y. , Lau W. H. , Lee V. W. Y. , Sung J. Y. , Chan F. K. L. 
Published: July 2003

SummaryAim : To evaluate the economic impact of celecoxib therapy vs. diclofenac plus omeprazole therapy for the treatment of arthritis in Chinese patients with a high risk of bleeding, from the perspective of a public health organization in Hong Kong.Methods : The medical records of 287 Chinese arthritic patients with a history of bleeding ulcers who had previously participated in a randomised study of celecoxib 200 mg twice daily and extended‐release diclofenac 75 mg twice daily plus 20 mg of omeprazole daily for 6 months were reviewed.Results : Compared to the diclofenac plus omeprazole group, the average total direct cost per patient in the celecoxib group showed a significant reduction of 11%, from $HK 10 915 (range $HK 10 915–57 899) to $HK 9714 (range $HK 9714–89 770) (P < 0.0001) (1 $US = 7.8 $HK). The median direct medical cost for routine management in the celecoxib group was significantly lower (11%) than that for the diclofenac plus omeprazole group [$HK 10 915 (range 10 915–28 048) vs. $HK 9714 (range $HK 6946–26 179) (P < 0.0001)]. In patients who experienced recurrent bleeding, the celecoxib group showed a significantly higher median cost of management of recurrent bleeding than the diclofenac plus omeprazole group [$HK 8466 (range 572–29 851) vs. $HK 23 210 (range $HK 12 318–65 823)] (P = 0.036).Conclusions : Celecoxib therapy appears to cost less compared with diclofenac plus omeprazole for treatment of arthritis in Chinese patients with a high risk of bleeding.
Antibiotic prophylaxis for percutaneous endoscopic gastrostomy — a prospective, randomised, double‐blind trial
Authors: Ahmad I. , Mouncher A. , Abdoolah A. , Stenson R. , Wright J. , Daniels A. , Tillett J. , Hawthorne A. B. , Thomas G. 
Published: July 2003

SummaryBackground : Peristomal infection can sometimes complicate percutaneous endoscopic gastrostomy (PEG) placement. Antibiotic prophylaxis has, in some studies, been shown to reduce the incidence. However, the use of prophylaxis varies widely, possibly because the design and findings of the studies have differed, making their relevance to clinical practice difficult to interpret.Aim : To determine the efficacy of antibiotics, either prophylaxis or concurrent antibiotics at the time of the procedure, in reducing peristomal infection after PEG insertion in the context of a study designed to reflect current practice.Methods : One hundred and forty‐one patients undergoing PEG placement were randomised to group one to receive either a single dose of 750 mg of intravenous cefuroxime (n = 50) or placebo (n = 51) 30 min before PEG insertion. Forty patients who, for various reasons, were already receiving antibiotics were allocated to group two. The peristomal site was evaluated on day 3, 5 and 7 following insertion. Erythema and exudate were scored on a scale from 0 to 4; induration was scored on a scale of 0–3. A maximum combined score of 8 or higher or the presence of pus was criteria for infection. The primary outcome measure was the occurrence of a peristomal wound infection at any time within one week of PEG insertion.Results : Peristomal wound infection was significantly reduced in patients who received antibiotics either as a single dose of cefuroxime [one of 33 (3%)], or in those on antibiotics for prior indications [one of 36 (3%)], compared with placebo [six of 33 (18%)], P = 0.04 and 0.03, respectively.Conclusion : Antibiotics, either prophylaxis or concurrent, reduce the incidence of peristomal wound infection after PEG placement.
What is the long‐term outcome of the different subgroups of functional dyspepsia?
Authors: Heikkinen M. , Färkkilä M. 
Published: July 2003

SummaryBackground : Functional dyspepsia is often a long‐lasting disorder that accounts for substantial healthcare costs. It has been classified into subgroups assuming that it can guide management of dyspepsia.Aim : To evaluate the clinical significance of subgrouping functional dyspepsia in a long‐term perspective study.Methods : Consecutive patients with dyspepsia identified by general practitioners were investigated. Those patients with functional dyspepsia (n = 201) were enrolled in this study. Initially, patients were divided into five subgroups (ulcer‐like, dysmotility‐like, reflux‐like, unspecified, and irritable bowel syndrome‐like). Patients' medical histories were reviewed after 6–7 years, and the number and outcome of repeated investigations were analysed. At the end of follow‐up, patients filled in a questionnaire similar to that at baseline, and were invited for gastroscopy.Results : Only 2% of patients developed peptic ulcer during follow‐up, none of them were in the ulcer‐like subgroup. When referrals to hospital and examinations during follow‐up were registered, no statistically significant differences existed between subgroups. Patients with reflux‐like dyspepsia made fewer revisits than others (P = 0.02), but had used antidyspepsia drugs during the previous year more often (P = 0.036). Stability of the subgroups over time was poor.Conclusions : Functional dyspepsia is a long‐lasting disorder with a very good prognosis. Subgroups of functional dyspepsia play only a minor role in prediction of the long‐term outcome, and their usefulness in clinical practice is also hampered by subgroup instability over time.
Infliximab for refractory ulcerative colitis or indeterminate colitis: an open‐label multicentre study
Authors: Gornet J.‐M. , Couve S. , Hassani Z. , Delchier J.‐C. , Marteau P. , Cosnes J. , Bouhnik Y. , Dupas J.‐L. , Modigliani R. , Taillard F. , Lemann M. 
Published: July 2003

SummaryBackground : The efficacy of infliximab in ulcerative colitis (UC) and indeterminate colitis has been poorly assessed and preliminary results are conflicting.Methods : The records of 30 patients treated with infliximab for ulcerative colitis (n = 19) or indeterminate colitis (n = 11) were reviewed. Infliximab was given because of steroid resistance (n = 18), dependence (n = 5) or intolerance (n = 7); five patients had failed on cyclosporin; 19 patients had a severe flare‐up.Results : Median duration of follow‐up was 10 months. In 28 patients with active disease, the response rate was 75% at day 7, with 43% having a complete remission, and 50% at month 1, with 32% having a complete remission. Among the 22 responders, the probability of relapse was 73% at month 6. The probability of complete remission without steroids, taking into account the re‐treatment for relapse (n = 11), was 57% (95% confidence interval (CI): 45% to 69%) at month 6. The probability of colectomy was 33% (95% CI: 23% to 43%) at month 12. In indeterminate colitis, response rate was only 50% at day 7 and 30% at month 1. Concomitant use of antimetabolite agents was associated with better results.Conclusions : Infliximab was able to induce a rapid response in some patients with UC or indeterminate colitis refractory to conventional treatment. Long‐term results were less favourable, with frequent relapses, and about one‐third of the patients required a colectomy.
Food allergy to wheat: identification of immunogloglin E and immunoglobulin G‐binding proteins with sequential extracts and purified proteins from wheat flour
Authors: Battais F. , Pineau F. , Popineau Y. , Aparicio C. , Kanny G. , Guerin L. , Moneret‐Vautrin D. A. , Denery‐Papini S. 
Published: July 2003

SummaryBackground Cereal‐associated allergy is particularly considered a serious problem, because cereals are essential in our daily diet. Wheat proteins are classified into albumins, globulins and prolamins (insoluble gliadins and glutenins).Objectives Our objectives were to study the involvement in food allergy to wheat of these different protein types by using purified fractions and to identify those binding IgE and IgG antibodies.Methods Sera were obtained from 28 patients with food allergy to wheat. Albumins/globulins, gliadins and glutenins were obtained by sequential extraction based on differential solubility; α‐, β‐, γ‐ and ω‐gliadins and low molecular weight (LMW) and high molecular weight (HMW) glutenin subunits were purified by chromatography. IgE binding to these extracts and fractions were analysed by radioallergosorbent test (RAST), and immunoblotting; IgG binding was detected by enzyme‐linked immunosorbent assay (ELISA).Results In RAST, 60% of sera were shown to have specific IgE antibodies against α‐, β‐gliadins and LMW glutenin subunits, 55% to γ‐gliadins, 48% to ω‐gliadins and 26% to HMW glutenins. Immunoblotting analysis confirmed results obtained in RAST concerning LMW and HMW glutenin subunits and showed that 67% of patients have IgE antibodies to the albumin/globulin fraction.Conclusion Results obtained in the different tests showed common features and in agreement with other studies indicated the presence of numerous allergens in food allergy to wheat; α‐, β‐, γ‐ and ω‐gliadins, LMW glutenin subunits and some water/salt‐soluble proteins appeared as major IgE binding allergens, whereas HMW glutenins were only minor allergens. The same type of antigenic profile against gliadins and glutenins was observed with IgG antibodies. Important sequence or structural homologies between the various gliadins and LMW glutenin subunits could certainly explain similarity of IgE binding to these proteins.