bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute cholangitis—predictive factors for emergency ERCP
Authors: Hui C.‐K. , Lai K.‐C. , Yuen M.‐F. , Ng M. , Lai C.‐L. , Lam S.‐K. 
Published: March 2003

Background:Acute cholangitis varies in severity from a mild form to severe cases which require urgent biliary decompression.Aim:This study was undertaken in order to develop a prognostic scoring system that can be used to predict which patients are likely to require emergency endoscopic retrograde cholangiopancreatogram (ERCP) upon admission.Methods:This is a prospective study of 142 consecutive patients with acute cholangitis. Emergency ERCP was performed in patients who did not respond to medical therapy.Results:Thirty‐one patients (21.8%) required emergency ERCP. A maximum heart rate of more than 100/min, albumin of less than 30 g/L, bilirubin of more than 50 μmol/L and prothrombin time of more than 14 s on admission were associated with failure of medical treatment and the need for emergency ERCP (P=0.001, < 0.001, 0.006 and 0.004, respectively). By using these four factors in a scoring system, 50.7% of those with a score of one or more required emergency ERCP compared with 1.5% of those with none of the four risk factors (P < 0.001). This scoring system has a sensitivity of 96.8% and a specificity of 59.6%.Conclusions:As patients with severe acute cholangitis show a higher mortality, we recommend that emergency ERCP be performed in patients with one or more of the four prognostic factors.
The pharmacological treatment of acute colonic pseudo‐obstruction
Authors: De Giorgio R. , Barbara G. , Stanghellini V. , Tonini M. , Vasina V. , Cola B. , Corinaldesi R. , Biagi G. , De Ponti F. 
Published: March 2003

Acute colonic pseudo‐obstruction (Ogilvie’s syndrome) can be defined as a clinical condition with symptoms, signs and radiological appearance of acute large bowel obstruction unrelated to any mechanical cause. Recent reports of the efficacy of cholinesterase inhibitors in relieving acute colonic pseudo‐obstruction have fuelled interest in the pharmacological treatment of this condition. The aim of the present review is to outline current perspectives in the pharmacological treatment of patients with acute colonic pseudo‐obstruction.The best documented pharmacological treatment of Ogilvie’s syndrome is intravenous neostigmine (2–2.5 mg), which leads to quick decompression in a significant proportion of patients after a single infusion. However, the search for new colokinetic agents for the treatment of lower gut motor disorders has made available a number of drugs that may also be therapeutic options for Ogilvie’s syndrome. Among these agents, the potential of 5‐hydroxytryptamine‐4 receptor agonists and motilin receptor agonists is discussed.
The immunoregulatory cytokine interleukin‐10—a therapy for Crohn’s disease?
Authors: Lindsay J. O. , Hodgson H. J. F. 
Published: March 2003

The gastrointestinal tract serves as a barrier between the host and the vast array of foreign antigens that are contained within its lumen. The mucosal immune system must balance two opposing functions: to mount an immune response to pathogens, whilst maintaining tolerance to antigens derived from commensal bacteria and food. This balance is regulated by both cellular interactions and the release of soluble mediators called cytokines. Diseases such as ulcerative colitis and Crohn’s disease are characterized by alterations in the balance of pro‐inflammatory and regulatory cytokines.Interleukin‐10 is a regulatory cytokine which inhibits both antigen presentation and subsequent pro‐inflammatory cytokine release. In addition, there is evidence that it promotes the formation of antigen‐specific regulatory T‐cell clones. The pivotal role played by interleukin‐10 within the mucosal immune system is demonstrated both by the chronic ileocolitis that develops in gene‐targeted interleukin‐10 knock‐out mice, and by its therapeutic efficacy in several animal models of colitis.However, trials of daily systemic interleukin‐10 administration in patients with Crohn’s disease have reported only a modest clinical response. Advances in the analysis of functional polymorphisms in the interleukin‐10 gene may allow therapy to be targeted to patients who will respond. Finally, therapeutic strategies utilizing gene therapy may enhance mucosal delivery and increase therapeutic response.
A study of the effects of indometacin on liver mitochondria from rats, mice and humans
Authors: Jacob M. , Bjarnason I. , Rafi S. , Wrigglesworth J. , Simpson R. J. 
Published: March 2003

Background:A part of the mechanism of the gastrointestinal toxicity exhibited by non‐steroidal anti‐inflammatory drugs is believed to involve the uncoupling of mitochondrial oxidative phosphorylation. Most previous uncoupling studies have used rat liver mitochondria. There is little information on the effects of the drugs on mitochondria from other species.Aim:To study the effect of indometacin on isolated liver mitochondria from rats, mice and humans.Methods:We studied the effects of indometacin on respiration and adenosine triphosphate synthesis by isolated liver mitochondria from rats, mice and humans. Its effects were compared with those of dinitrophenol, a classical uncoupler.Results:Indometacin uncoupled oxidative phosphorylation at low concentrations (P < 0.05) and inhibited respiration at high concentrations (P < 0.01) in all three species. Adenosine triphosphate synthesis was, however, more sensitive to dinitrophenol or indometacin at lower concentrations in mouse and human compared to rat liver mitochondria (P < 0.05).Conclusions:The current study shows that indometacin acts as an inhibitory uncoupler in human mitochondria. It also demonstrates that the responses of rat, mouse and human mitochondria to indometacin are broadly similar.
A 3.0‐kDa low molecular weight heparin promotes gastric ulcer healing in rats
Authors: Li Y. , Shin V. Y. , Cheuk C. Y. , Liu E. S. L. , Cho C. H. 
Published: March 2003

Background:Previous studies have shown that intragastric administration of unfractionated heparin enhances gastric ulcer healing in rats. As the large molecule of heparin may be partially degraded in the upper gastrointestinal tract, it is likely that fragments of heparin, derived from the unfractionated parent compound, are involved in the anti‐ulcer action in the stomach. Therefore, it is possible that low molecular weight heparin may have a similar ulcer healing effect.Methods:Male Sprague–Dawley rats with acetic acid‐induced gastric ulcers were given a 3.0‐kDa low molecular weight heparin (0.6–6.0 mg/kg) intravenously or intragastrically once daily for 4 days. Ulcer healing, mucosal histological changes, angiogenesis and gastric mucus production both in vivo and in vitro were determined. The bleeding time was measured to indicate the anticoagulation activity.Results:Both intravenous and intragastric low molecular weight heparin dose dependently accelerated gastric ulcer healing, which was accompanied by a significant increase in mucosal regeneration and proliferation, angiogenesis and mucus content in the stomach. The drug also stimulated the mucus production in MKN‐28 cells. Drug administration by either route did not alter the bleeding time in rats.Conclusions:A 3.0‐kDa low molecular weight heparin possesses an ulcer healing effect similar to that of unfractionated heparin in the stomach of the rat. This smaller molecular drug is superior to the unfractionated form, does not affect the coagulation activity and may show better absorption in the gastrointestinal tract.
Spontaneous bacterial peritonitis—diagnosis, treatment and prevention
Authors: Mowat C. , Stanley A. J. 
Published: March 2003

Spontaneous bacterial peritonitis is a serious complication of cirrhotic ascites, arising most frequently in those with advanced liver disease. Its development leads to a further reduction in the effective arterial blood volume, and it has a mortality rate equivalent to that of a variceal bleed. However, problems remain with regard to the identification and optimal treatment of spontaneous bacterial peritonitis. Several important studies and consensus documents on the condition have recently been published which aid in the identification of patients at risk and help to guide therapy.In this review, we discuss these publications and address the issues of diagnosis, treatment and both primary and secondary prophylaxis of spontaneous bacterial peritonitis in the light of recent data.
Impact of intravenous omeprazole on Helicobacter pylori eradication by triple therapy in patients with peptic ulcer bleeding
Authors: Sheu B.‐S. , Chi C.‐H. , Huang C.‐C. , Kao A.‐W. , Wang Y.‐L. , Yang H.‐B. 
Published: March 2003

Aim:To test the impact of intravenous omeprazole on Helicobacter pylori eradication for bleeding peptic ulcers.Methods:A total of 175 H. pylori‐infected patients with bleeding peptic ulcers were randomized into either an omeprazole group or a ranitidine group, receiving intravenous omeprazole or ranitidine for 3 days after endoscopy. Afterwards, 1‐week triple therapy was used to eradicate H. pylori for both groups. Six weeks later, either a 13C‐urea breath test or follow‐up endoscopy was performed to assess the success of H. pylori eradication.Results:The rebleeding rate was lower in the omeprazole group vs. the ranitidine group (6% vs. 17%, P < 0.05). The H. pylori eradication rate was higher in the omeprazole group (intention‐to‐treat analysis: 83% vs. 66%, P < 0.05; per protocol analysis: 93% vs. 80%, P < 0.05). For patients with duodenal ulcers, the per protocol H. pylori eradication rate of the omeprazole group was higher than that of the ranitidine group (93% vs. 73%, P < 0.05).Conclusions:Intravenous omeprazole can decrease the risk of rebleeding of peptic ulcers. For duodenal ulcers, in particular, intravenous omeprazole may even improve the H. pylori eradication rate of the subsequent triple therapy.
Medical decision analysis of endoscopic surveillance of Barrett’s oesophagus to prevent oesophageal adenocarcinoma
Authors: Sonnenberg A. , Soni A. , Sampliner R. E. 
Published: March 2003

Background:Barrett’s oesophagus is associated with an increased risk of the development of oesophageal adenocarcinoma. Endoscopic surveillance every 2–5 years has been recommended to prevent death from adenocarcinoma.Aim:To assess the cost‐effectiveness of this strategy.Methods:The incremental cost‐effectiveness of surveillance (as compared to no surveillance) was analysed with a computer model of a Markov process.Results:Compared to no surveillance, the incremental cost‐effectiveness of bi‐annual endoscopy is $16 695 per life‐year saved. Surveillance is less cost‐effective if the incidence rate of oesophageal adenocarcinoma is low and the 5‐year survival rate is high. For surveillance to be cost‐effective, there should be little reduction in health‐related quality of life following surgical oesophagectomy to prevent death. Moreover, endoscopic surveillance and oesophagectomy need to be efficacious in reliably diagnosing high‐grade dysplasia and preventing deaths from cancer. If such ideal conditions of surveillance are not met, the cost per life‐year saved could rise five‐fold.Conclusions:Endoscopic surveillance of patients with Barrett’s oesophagus may be a cost‐effective means to prevent death from oesophageal adenocarcinoma.
Mono, dual and triple moxifloxacin‐based therapies for Helicobacter pylori eradication
Authors: Di Caro S. , Ojetti V. , Zocco M. A. , Cremonini F. , Bartolozzi F. , Candelli M. , Lupascu A. , Nista E. C. , Cammarota G. , Gasbarrini A. 
Published: March 2003

Background:Moxifloxacin is a broad spectrum fluoroquinolone with single daily administration, currently used, above all, for respiratory tract infections.Aim:To compare the efficacy of different 1‐week moxifloxacin‐based Helicobacter pylori eradication regimens.Methods:One hundred and twenty H. pylori‐positive subjects were randomized to receive moxifloxacin (400 mg/day), moxifloxacin (400 mg/day) and lansoprazole (30 mg/day) or moxifloxacin (400 mg/day), lansoprazole (30 mg/day) and clarithromycin (500 mg b.d.). H. pylori status was reassessed 6 weeks after the end of therapy, and both intention‐to‐treat and per protocol analyses were performed.Results:One hundred and nineteen of the 120 patients completed the study. H. pylori eradication was achieved in 22.5% of patients treated with moxifloxacin, in 33.3% of subjects treated with moxifloxacin and lansoprazole and in 90% of patients treated with moxifloxacin, clarithromycin and lansoprazole.Conclusions:Mono and dual moxifloxacin‐based therapies are not acceptable for H. pylori eradication; conversely, moxifloxacin‐based triple therapy may be considered as a new, effective, first‐line therapy option.
Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis
Authors: Calvet X. , Sanfeliu I. , Musulen E. , Mas P. , Dalmau B. , Gil M. , Bella M. R. , Campo R. , Brullet E. , Valero C. , Puig J. 
Published: March 2003

SummaryBackground : Helicobacter pylori‐associated peptic ulcer is a frequent complication in cirrhotic patients and its morbidity rate is high. In spite of this, diagnostic methods for H. pylori infection have not been fully evaluated in these patients.Aim : To evaluate H. pylori diagnostic methods in patients with liver cirrhosis.Methods : One hundred and one cirrhotic patients were included in the study. Three antral and two corpus biopsies were obtained for rapid urease test of the antral mucosa, and Giemsa stain and immunohistochemistry were performed for both the corpus and antrum. Serology, 13C‐urea breath test and faecal H. pylori antigen determination were also carried out.Results : Sixty‐two patients were positive and 35 were negative for H. pylori infection; four were indeterminate. The sensitivity and specificity were 90.4% and 100%, respectively, for antral histology, 100% and 100% for gastric body histology, 90.4% and 100% for antral immunohistochemistry, 96.2% and 96.7% for body immunochemistry, 85.7% and 97% for rapid urease test, 83.6% and 55.9% for serology, 96.4% and 97.1% for 13C‐urea breath test and 75.4% and 94.1% for faecal antigen.Conclusion : The most reliable tests for H. pylori infection in cirrhotic patients were the 13C‐urea breath test and gastric body histology.
Magnesium chloride slows gastric emptying, but does not affect digestive functions
Authors: Geboes K. P. , Maes B. , Luypaerts A. , Evenepoel P. , Rutgeerts P. , Ghoos Y. , Geypens B. 
Published: March 2003

SummaryBackground : An inverse relationship has been established between serum magnesium and serum lipid levels. By means of breath tests, we tested the hypothesis that magnesium inhibits intraluminal lipid digestion and subsequently causes changes in lipid metabolism. We also investigated the influence of the administration of magnesium chloride on protein digestion and gastric emptying.Methods : Five healthy volunteers performed simultaneous breath tests for gastric emptying and intraluminal lipid digestion, and six others for gastric emptying and protein digestion. Each test was performed in basal conditions and after the intake of 800 mg of magnesium chloride dissolved in water. Breath samples were taken at regular time intervals and analysed for 13CO2 and 14CO2 enrichment in order to calculate gastric emptying and lipid and protein digestion rates.Results : The oral administration of a single dose of magnesium chloride resulted in a diminished rate of intraluminal lipid and protein digestion. The most pronounced effect of magnesium chloride, however, was a decreased gastric emptying rate of both test meals. After correction for gastric emptying, no differences were noted in intraluminal lipid or protein digestion. Therefore, the lower lipid levels noted after magnesium supplementation are unlikely to be the result of altered lipid assimilation.Conclusion : Magnesium chloride slows gastric emptying but does not influence lipid digestion.
Consensus report: clinical perspectives, mechanisms, diagnosis and management of irritable bowel syndrome
Authors: Camilleri M. , Heading R. C. , Thompson W. G. 
Published: March 2003

SummaryThis consensus document reviews the current status of the epidemiology, social impact, patient quality of life, pathophysiology, diagnosis and treatment of irritable bowel syndrome. Current evidence suggests that two major mechanisms may interact in irritable bowel syndrome: altered gastrointestinal motility and increased sensitivity of the intestine. However, other factors, such as psychosocial factors, intake of food and prior infection, may contribute to its development. Management of patients is based on a positive diagnosis of the symptom complex, careful history and physical examination to exclude ‘red flags’ as risk factors for organic disease, and, if indicated, investigations to exclude other disorders. Therapeutic choices include dietary fibre for constipation, opioid agents for diarrhoea and low‐dose antidepressants or infrequent use of antispasmodics for pain, although the evidence basis for efficacy is limited or in some cases absent. Psychotherapy and hypnotherapy are the subject of ongoing study. Treatment should be tailored to patient needs and fears. Novel therapies are emerging, and drugs acting on serotonin receptors have proven efficacy and a scientific rationale and, if approved, should be useful in the overall management of patients with irritable bowel syndrome. Patient and physician education, early identification of psychosocial issues and better therapies are important strategies to reduce the suffering and societal cost of irritable bowel syndrome.
Lactose — a potential prebiotic
Authors: Szilagyi A. 
Published: March 2003

SUMMARYLactose maldigestion, which affects a large majority of the world's population, has been mostly linked with uncomfortable symptoms. In addition, dairy consumption is variably blamed or recommended for a number of ill effects. There is, however, emerging evidence that certain lactic acid‐producing bacteria, which selectively consume prebiotics, may be beneficial against some lower intestinal diseases. Lactose maldigestion and lactose should perhaps be re‐evaluated as a potential provider of such a prebiotic. This historical and observational review discusses lactose and argues the opinion that it has prebiotic potential. Moreover, in maldigesters, natural ingestion or lack thereof may be relevant in the pathogenesis of diseases such as colorectal cancer and inflammatory bowel diseases.
Meta‐analysis: combination therapy with interferon‐α 2a/2b and ribavirin for patients with chronic hepatitis C previously non‐responsive to interferon
Authors: Miguel R. San , Guillén F. , Cabasés J. M. , Buti M. 
Published: March 2003

SUMMARYBackground : The efficacy of interferon‐α plus ribavirin treatment for patients not responding to interferon monotherapy is not well established.Aim : To assess the efficacy and safety of combination therapy with interferon‐α 2a/2b plus ribavirin by performing a meta‐analysis of randomized clinical trials.Methods : A systematic search of electronic databases for randomized clinical trials of interferon‐α 2a/2b plus ribavirin was conducted independently by two investigators. Data abstraction was performed. The primary end‐point was a sustained virological response. Estimates of the common odds ratio were calculated using a random effects model.Results : Of the 127 identified studies, 46 were considered for evaluation and 10 were included (1728 patients). The pooled sustained virological response was 12.6% (95% CI, 9.5–16.3%) for combination therapy vs. 2% (95% CI, 0.9–4.0%) for interferon monotherapy, with a common odds ratio of 5.49. Higher doses of interferon, a longer duration of therapy (48 weeks) and genotypes other than 1 and 4 were associated with an improvement in response. More side‐effects and discontinuations were observed with combination therapy than with interferon monotherapy.Conclusions : Non‐responders to interferon may benefit from re‐treatment with combination therapy, especially from a 48‐week regimen.
Alimentary diseases in the poor and middle class in London 1773–1815, and in New York poor 1797–1818
Authors: Baron J. H. , Sonnenberg A. 
Published: March 2003

SummaryBackground : Although dyspepsia has been described for thousands of years, few studies have analysed its incidence before the 19th century when peptic ulcer first became a major dyspepsia‐producing disease.Methods : The incidence of alimentary disease around 1800 was examined in three private practices for the fee‐paying middle class and in five public dispensaries for the poor in London, as well as in one dispensary in New York.Results : The proportions of attendances for alimentary disorders were identical, 16%, in each of the three groups. Diarrhoea and dysentery were twice as common in the London dispensary than in private practice, presumably because of poor sanitation. Dyspepsia showed a similar incidence in the London dispensary and private practice, but was only half as common in New York. Worms were three times more common in dispensary patients in New York than in London. The incidence of diarrhoea and dyspepsia indicated no significant time trends over 43 years. None of the alimentary causes of death showed peptic ulcer at necropsy, and both haematemesis and intestinal haemorrhage were rare.Conclusions : Around 1800, the infrequent deaths from alimentary conditions suggested that the ulcer epidemic had not yet started. Instead, it is probable that the dyspepsia was similar to the non‐ulcer dyspepsia of today.
A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis
Authors: Ginsburg P. M. , Ehrenpreis E. D. 
Published: March 2003

SummaryBackground : Mesenteric panniculitis is a rare condition with no standard therapy.Aim : To assess the safety and efficacy of thalidomide for the treatment of patients with symptomatic mesenteric panniculitis using a newly established clinical disease activity index (Mesenteric Panniculitis Subjective Assessment Score).Methods : In an open‐label pilot study, five patients with symptomatic mesenteric panniculitis received oral thalidomide, 200 mg nightly, for 12 weeks. The primary end‐point was a reduction in the Mesenteric Panniculitis Subjective Assessment Score by ≥ 20% at 12 weeks or complete remission (absence of symptoms).Results : Four (80%) of the five patients responded. The median Mesenteric Panniculitis Subjective Assessment Score at baseline was 39 and at week 12 was 25 (average decrease of 44%). One patient achieved complete remission by week 4, which was sustained. At 12 weeks, three (75%) patients experienced a global response, five (100%) patients had a ≥ 20% (range, 29–98%) decrease in erythrocyte sedimentation rate and three (75%) patients had a ≥ 20% (range, 61–93%) decrease in C‐reactive protein. Abdomino‐pelvic computed tomography scans were unchanged in all five patients. There were no serious adverse events.Conclusions : Thalidomide is safe, well tolerated and efficacious in the treatment of some patients with symptomatic mesenteric panniculitis. Further study is indicated.