bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impaired bioavailability of vitamin A in adults and children with persistent diarrhoea in Zambia
Authors: Kelly P. , Musuku J. , Kafwembe E. , Libby G. , Zulu I. , Murphy J. , Farthing M. J. G. 
Published: March 2003

Background:We have previously demonstrated a strong relationship between low serum retinol concentration and mortality in Zambian AIDS patients with diarrhoea, but were unable to detect any benefit from oral micronutrient supplementation.Aim:To test the hypothesis that this is related to impaired availability of vitamin A, we analysed serum retinol concentration changes over 6 h following oral mega‐dose therapy (60, 120 or 180 mg retinol).Methods:Twenty‐four men without diarrhoea, 15 adults with persistent diarrhoea and 11 children (six girls, five boys) with persistent diarrhoea were studied.Results:Men with persistent diarrhoea had lower baseline serum retinol concentrations (median 0.39 μmol/L, interquartile range 0.21–0.56) than controls (median 1.16 μmol/L, interquartile range 0.84–1.47; P=0.0003). After 60 mg retinol, the rise in serum retinol in HIV seropositive controls (median 0.63 μmol/L, interquartile range 0.35–0.77) did not differ significantly from that observed in HIV seronegative controls (median 0.35 μmol/L, interquartile range – 0.04–0.56; P=0.20). Increasing the dose to 120 mg or 180 mg retinol did not enhance the increase in serum retinol concentration. The increase in serum retinol was less in adults with persistent diarrhoea (median 0.25 μmol/L, interquartile range 0.04–0.35) and in children (median 0.11 μmol/L, interquartile range 0.04–0.46) than in men without diarrhoea (median 0.44 μmol/L, interquartile range 0.26–0.74; P=0.03). Adults and children with diarrhoea had greater losses of retinol in urine over a 24‐h period than controls, but less than 1% of the ingested dose was excreted.Conclusions:These results suggest that persistent diarrhoea in this population is associated with reduced bioavailability of retinol. Further work is required to determine the metabolic fate of therapeutic doses of retinol and to determine appropriate replacement strategies for HIV infected individuals.
The effect of cholecystokinin antagonism on postprandial lower oesophageal sphincter function in asymptomatic volunteers and patients with reflux disease
Authors: Trudgill N. J. , Hussain F. N. , Moustafa M. , Ajjan R. , D'Amato M. , Riley S. A. 
Published: March 2003

Background:Postprandial acid reflux is thought to be mediated by the increase in transient lower oesophageal sphincter relaxations (TLOSR) frequency and fall in lower oesophageal sphincter (LOS) pressure seen after ingestion of a meal. Studies in animals and healthy volunteers suggest that cholecystokinin (CCK) may play a role.Aim:To study the role of CCK in postprandial LOS function using the CCK antagonist loxiglumide.Subjects:10 asymptomatic volunteers (7 male, 20–29 years) and 9 patients with symptomatic gastro‐oesophageal reflux (4 male, 33–66 years).Methods:Oesophageal, LOS and gastric pressure and oesophageal pH readings were recorded for 1 h before and 2 h after intragastric infusion of a 200 kCal, 300 mL long chain triglyceride meal. Each subject underwent two studies and received intravenous loxiglumide or placebo infusion in randomized order.Results:During placebo infusion, postprandial LOS pressure fell [volunteers: 17 (9–31) to 7 (1–19) mmHg (P < 0.01), patients: 15 (6–26) to 9 (2–21) mmHg (P=0.02)] and TLOSR frequency increased [volunteers: 0 (0–1) to 2 (0–7) per hour (P=0.01), patients: 0 (0–3) to 2 (0–10) per hour (P=0.03)]. Loxiglumide infusion attenuated the postprandial fall in LOS pressure and the postprandial increase in TLOSR frequency [volunteers: 0 (0–3) per hour (P=0.04 vs. placebo), patients: 0 (0–2) per hour (P=0.03 vs. placebo)], but it had only modest effects on postprandial acid exposure [volunteers: placebo 45 (0–1725) vs. loxiglumide 0 (0–443) seconds (N.S.), patients: placebo 60 (0–3442) seconds vs. loxiglumide 31 (0–1472) seconds (N.S.)].Conclusions:Loxiglumide inhibits TLOSR and attenuates the fall in LOS pressure following a meal, but has only modest effects on postprandial gastro‐oesophageal acid reflux.
Citric acid‐enhanced Helicobacter pylori urease activity in vivo is unrelated to gastric emptying
Authors: Shiotani A. , Saeed A. , Yamaoka Y. , Osato M. S. , Klein P. D. , Graham D. Y. 
Published: March 2003

Background:In a previous study, the use of a citric acid test meal produced a rapid dose‐dependent increase in urease activity that was significantly greater than that resulting from a pudding meal, ascorbic acid or sodium citrate. The mechanism was hypothesized to be related to the ability of citric acid to delay gastric emptying and possibly to enhance intragastric distribution of the urea.Objective:To compare the effects of sodium citrate, two doses of citric acid and a pudding meal on gastric motor function.Method:Eleven normal healthy volunteers were investigated using non‐invasive techniques to measure gastric emptying and gastric motility. We evaluated gastric emptying using the Meretek 13Ceebiscuit solid phase gastric emptying breath test, which employs a 340‐calorie biscuit containing 200 mg of the edible 13C‐blue–green alga Spirulina platensis, after the administration of test meals of pudding, 2 g and 4 g of citric acid and 2 g of sodium citrate. Electrogastrograms (Digitrapper EGG) were also recorded for 30 min before and 180 min after the test meal.Results:Gastric emptying, as assessed by the half‐time (T1/2), was delayed similarly with the pudding (136.8 ± 9 min) and with 4 g of citric acid (144.5 ± 7 min) (P > 0.7). Sodium citrate (108.7 ± 6 min) and 2 g of citric acid (110.1 ± 6 min) had similar effects on gastric emptying (P=0.986), and were significantly less effective in delaying gastric emptying (P < 0.01) compared to pudding or 4 g of citric acid. The electrogastrograms remained normal and there were no differences among meals and no relation with the gastric emptying results.Conclusions:The increased intragastric urea hydrolysis associated with citric acid test meals cannot be attributed to delayed gastric emptying. Changes in the intragastric distribution of urea or a direct effect of citric acid on the bacteria (e.g. via the cytoplasmic protein, UreI) are more likely to be responsible.
Effect of oral iron supplementation on oxidative stress and colonic inflammation in rats with induced colitis
Authors: Carrier J. , Aghdassi E. , Platt I. , Cullen J. , Allard J. P. 
Published: March 2003

Background:Iron supplementation may increase disease activity in ulcerative colitis, possibly through the production of reactive oxygen species from the Fenton reaction.Aim:To assess the effects of two doses of oral iron on intestinal inflammation and oxidative stress in experimental colitis.Methods:Colitis was induced in rats by giving 5% dextran sulphate sodium in drinking water for 7 days. First, using a 2 × 2 factorial design, rats with or without dextran sulphate sodium received the regular diet or a diet containing iron 3%/kg diet. Second, rats with dextran sulphate sodium‐induced colitis were supplemented with iron 0.3%/kg diet and compared with rats on dextran sulphate sodium and regular diet. The body weight change, histological scores, colon length, rectal bleeding, plasma and colonic lipid peroxides, colonic glutathione peroxidase and plasma vitamin E and C were measured. Faecal analysis for haem and total, free and ethylenediaminetetra‐acetic acid‐chelatable iron was also performed.Results:Iron 3% and iron 0.3% increased the activity of dextran sulphate sodium‐induced colitis, as demonstrated by higher histological scores, heavier rectal bleeding and further shortening of the colon. This was associated with increased lipid peroxidation and decreased antioxidant vitamins. Faecal iron available to the Fenton reaction was increased in a dose‐dependent manner.Conclusions:Iron supplementation taken orally enhanced the activity of dextran sulphate sodium‐induced colitis and is associated with an increase in oxidative stress.
Helicobacter pylori eradication is superior to ulcer healing with or without maintenance therapy to prevent further ulcer haemorrhage
Authors: Sharma V. K. , Sahai A. V. , Corder F. A. , Howden C. W. 
Published: March 2003

Background: Helicobacter pylori eradication decreases ulcer recurrence and should prevent recurrent ulcer haemorrhage.Aim:By meta‐analysis, to compare treatment of H. pylori infection with other approaches to prevent recurrent ulcer haemorrhage and, by cost minimization analysis, to determine the least costly strategy.Methods:We searched for randomized, controlled trials comparing treatment of H. pylori infection with ulcer healing alone or with maintenance therapy in preventing recurrent ulcer haemorrhage. We calculated the relative and absolute risk reductions and numbers needed to treat.Results:Treatment of H. pylori infection decreased recurrent bleeding by 17% (numbers needed to treat=6) compared with ulcer healing treatment alone. Compared with ulcer healing treatment followed by maintenance therapy, recurrent bleeding was decreased by 4% (numbers needed to treat=25). Decision model‐based cost minimization analysis demonstrated that treatment of H. pylori infection was the least costly strategy unless the incidence of complicated recurrences after treatment was over 6%, or the cost of confirming eradication was over $741.Conclusions:Treatment of H. pylori infection is superior to ulcer healing treatment with or without maintenance therapy in preventing recurrent ulcer haemorrhage. All patients with ulcer bleeding should be tested for H. pylori infection and appropriately treated if positive.
Does intravenous ondansetron affect gastric emptying of a solid meal, gastric electrical activity or blood hormone levels in healthy volunteers?
Authors: Netzer P. , Gaia C. , Lourens S. T. , Reber P. , Wildi S. , Noelpp U. , Ritter E. P. , Ledermann H. , Lüscher D. , Varga L. , Kinser J. A. , Büchler M. W. , Scheurer U. 
Published: March 2003

Background:In previous studies, tropisetron has been shown to accelerate gastric emptying of a solid meal. However, it is uncertain whether other specific 5‐hydroxytryptamine‐3 receptor antagonists, such as ondansetron, also have a gastroprokinetic effect in humans.Aim:To evaluate the effect of ondansetron on gastric half‐emptying time (T1/2) of a solid meal, gastric myoelectrical activity and hormone levels in 14 healthy volunteers.Methods:In a placebo‐controlled, randomized, crossover study, we investigated the effects of ondansetron (8 mg intravenously) on the gastric emptying of solids (by scintigraphy), gastric myoelectrical activity (by electrogastrography) and the post‐prandial release of cholecystokinin, gastrin, human pancreatic polypeptide, gastric inhibitory polypeptide, vasoactive intestinal polypeptide, motilin, substance P and galanin.Results:The average T1/2 values were 86 min and 85.5 min without lag time (P=0.082) and 92 min and 93 min with lag time (P=0.158) for the placebo and ondansetron treatments, respectively. The average T1/2 of female volunteers was significantly longer than that of male volunteers. The dominant gastric electrical frequency and hormone plasma concentrations were not altered by ondansetron.Conclusions:Ondansetron did not affect the gastric emptying of solids, the dominant gastric electrical frequency or the plasma concentrations of the analysed gastrointestinal peptides.
Haemodynamic effects of acute and chronic administration of low‐dose carvedilol, a vasodilating β‐blocker, in patients with cirrhosis and portal hypertension
Authors: Tripathi D. , Therapondos G. , Lui H. F. , Stanley A. J. , Hayes P. C. 
Published: March 2003

Background:Carvedilol is a non‐selective vasodilating β‐blocker with weak α1 receptor antagonism. Recent studies have demonstrated its potential as a portal hypotensive agent.Aim:To assess the haemodynamic effects and patient tolerability of the acute and chronic administration of low‐dose carvedilol.Methods:Haemodynamic measurements were performed in ten cirrhotic patients before and 1 h after the administration of 12.5 mg oral carvedilol. The study was repeated 4 weeks after daily administration of 12.5 mg carvedilol.Results:After acute administration of carvedilol, there was a 23% reduction in the hepatic venous pressure gradient from 16.37 ± 2.14 to 12.56 ± 3.91 mmHg (P < 0.05), with significant falls in the heart rate, mean arterial pressure and cardiac output. Chronic administration resulted in a further fall in the hepatic venous pressure gradient from a baseline of 16.37 ± 0.71 to 9.27 ± 1.40 mmHg (P < 0.001) with the mean arterial pressure being unaffected. The drug was well tolerated with only one patient experiencing asymptomatic hypotension.Conclusions:The results show that low‐dose carvedilol is an extremely potent portal hypotensive pharmacological agent, and is worthy of further investigation in large randomized trials to assess its effect in preventing variceal haemorrhage.
The effect of regular medication on the outcome of paracetamol poisoning
Authors: Schmidt L. E. , Dalhoff K. 
Published: March 2003

SummaryBackground : Patients admitted with paracetamol overdose frequently receive one or more types of regular medication that may affect the outcome of the paracetamol intoxication.Aim : To describe the use of regular medication in patients with paracetamol poisoning and to evaluate its effects on morbidity and mortality.Methods : Seven hundred and thirty‐seven consecutive patients admitted with paracetamol poisoning were studied and the use of regular medication was recorded. The relative risk of hepatic encephalopathy, death or liver transplantation, severe hepatic dysfunction and severe hepatocellular injury was evaluated by multivariate analysis.Results : Regular medication was received by 332 patients (45%). Medication with benzodiazepines (105 cases), antidepressants (100 cases), neuroleptics (75 cases), paracetamol (58 cases), oral contraceptives (51 cases), beta‐agonists (40 cases), opioid analgesics (32 cases) and anticonvulsants (27 cases) predominated. Regular medication with opioid analgesics was associated with a high incidence of hepatic dysfunction (odds ratio, 5.39; 95% confidence interval, 1.13–25.8). No significant findings were demonstrated for benzodiazepines, antidepressants, neuroleptics, paracetamol, oral contraceptives, beta‐agonists or anticonvulsants in the multivariate analysis.Conclusions : Regular medication with psychotropic medication, analgesics, oral contraceptives, beta‐agonists or anticonvulsants was frequent in patients admitted with paracetamol poisoning. Medication with opioid analgesics was associated with a significantly increased incidence of hepatic dysfunction, whereas the other medications did not appear to affect the outcome of the paracetamol intoxication.
Octreotide enhances the accelerating effect of erythromycin on gastric emptying in healthy subjects
Authors: Athanasakis E. , Chrysos E. , Zoras O. J. , Tsiaoussis J. , Karkavitsas N. , Xynos E. 
Published: March 2003

SummaryBackground : Erythromycin exhibits gastrokinetic properties through cholinergic pathways. Reports regarding the action of octreotide on gastric emptying are conflicting.Aim : To assess: (i) the hypothesis that serotonin receptors are involved in the accelerating effect of erythromycin on gastric emptying; and (ii) any modification of the gastrokinetic action of erythromycin induced by octreotide.Subjects and methods : Gastric emptying of a standard meal was estimated in 20 healthy subjects by scintigraphy on three different occasions in a double‐blind, placebo‐controlled manner and in random order: (i) after placebo; (ii) after 200 mg of intravenous erythromycin; and (iii) after 200 mg of intravenous erythromycin following pre‐treatment with either 4 mg of intravenous ondansetron (10 subjects) or 50 µg octreotide.Results : Erythromycin significantly accelerated gastric emptying in all subjects by abolishing the lag phase. Pre‐treatment with ondansetron abolished the accelerating effect of erythromycin by restoring the emptying times to placebo levels. Octreotide significantly enhanced the accelerating effect of erythromycin by reducing both the lag and post‐lag phases of gastric emptying.Conclusions : Serotonin receptors are involved in the accelerating effect of erythromycin on gastric emptying. This effect seems to be enhanced by pre‐treatment with octreotide, possibly as a result of the modification of the gastrointestinal hormonal environment.
Biological agents in the treatment of Crohn's disease
Authors: Caprilli R. , Viscido A. , Guagnozzi D. 
Published: March 2003

SUMMARYThe main aim of the management of Crohn's disease is to reduce inflammation. Current approaches with corticosteroids, immunosuppressive agents, mesalazine and antibiotics have limited therapeutic benefit for many patients. Considerable progress has been made with regard to our knowledge of the basic mechanisms of the disease, which is associated with immunological imbalance characterized by an excess of pro‐inflammatory cytokines.Recent advances in bio‐technology have led to the development of many new therapeutic agents, so‐called biological agents, which selectively target single key processes involved in the pathogenesis of the disease. A growing number of biological agents are under investigation in both randomized controlled trials and uncontrolled studies. The aim of this review is to provide the clinician with an insight into the randomized controlled trials published in the literature on the use of biological agents in the treatment of Crohn's disease.
Azathioprine or methotrexate in the treatment of patients with steroid‐dependent or steroid‐resistant ulcerative colitis: results of an open‐label study on efficacy and tolerability in inducing and maintaining remission
Authors: Paoluzi O. A. , Pica R. , Marcheggiano A. , Crispino P. , Iacopini F. , Iannoni C. , Rivera M. , Paoluzi P. 
Published: March 2003

SummaryBackground : The role of azathioprine and methotrexate in inducing and maintaining remission in patients with ulcerative colitis is still controversial.Aim : To evaluate the efficacy and tolerability of these two drugs in a series of patients with steroid‐dependent or steroid‐resistant active ulcerative colitis.Methods : Forty‐two patients were treated with a daily dose of azathioprine (2 mg/kg) and, if intolerant or not responding, with methotrexate (12.5 mg/week intramuscularly), and their efficacy was established by clinical, endoscopic and histological examinations at 6 months. Patients achieving clinical remission continued with treatment and were followed up.Results : Of the 42 patients on azathioprine, 10 experienced early side‐effects requiring withdrawal from treatment, 22 (69%) achieved complete remission, six (19%) achieved improvement and four (12%) obtained no substantial benefit. Methotrexate, administered to eight patients intolerant to and two patients resistant to azathioprine, induced complete remission in six patients (60%) and improvement in four (40%). During follow‐up, a larger number of patients on azathioprine relapsed in comparison with patients on methotrexate [16/28 (57%) vs. 2/10 (20%), respectively; P < 0.05]. Only minor side‐effects wereobserved on both treatments.Conclusions : Azathioprine is effective in patients with steroid‐dependent or steroid‐resistant ulcerative colitis. Methotrexate seems to be a good alternative in patients intolerant to or not responding to azathioprine.
Racial differences in the frequency of symptoms and complications of gastro‐oesophageal reflux disease
Authors: Spechler S. J. , Jain S. K. , Tendler D. A. , Parker R. A. 
Published: March 2003

SummaryBackground : A number of reports have suggested that there are substantial racial differences in the frequency of gastro‐oesophageal reflux disease and its complications, but few studies have compared directly the frequency of this disorder amongst different racial groups.Aim : To explore the racial differences in the frequency of gastro‐oesophageal reflux disease and its complications.Methods : We reviewed endoscopy reports and medical records for data on race and complications of gastro‐oesophageal reflux disease in 2477 consecutive patients who had endoscopic examinations at the general endoscopy unit of an academic hospital. In addition, we prospectively interviewed 129 out‐patients attending general medical clinics in the hospital and in an Asian community health centre in Boston to obtain data on race and gastro‐oesophageal reflux disease symptoms.Results : One or more gastro‐oesophageal reflux disease complications (peptic oesophageal ulcer, stricture or Barrett's oesophagus) were observed in 267 of 2174 white patients (12.3%), seven of 249 black patients (2.8%), one of 21 West Asian patients (4.8%) and none of 33 East Asian patients seen at the general endoscopy unit (P < 0.001); 34.6% of whites, 46.1% of blacks and 2.6% of East Asian patients interviewed claimed that they had heartburn (P < 0.01), but the term ‘heartburn’ was understood by only 34.6%, 53.8% and 13.2% of whites, blacks and East Asians, respectively (P < 0.01).Conclusions : Asian patients in Boston infrequently complain of heartburn, whereas heartburn is commonly reported by both white and black patients. Many patients do not understand the meaning of the term heartburn, however, and so physicians should be cautious when using the term during patient interviews. Complicated gastro‐oesophageal reflux disease appears to be predominantly a disorder of whites.
Fluorescence in situ hybridization vs. epsilometer test for detection of clarithromycin‐susceptible and clarithromycin‐resistant Helicobacter pylori strains in gastric biopsies from children
Authors: Feydt‐Schmidt A. , Rüssmann H. , Lehn N. , Fischer A. , Antoni I. , Störk D. , Koletzko S. 
Published: March 2003

SummaryAim : To compare the results of culture and epsilometer test with fluorescence in situ hybridization for the detection of Helicobacter pylori and the presence of clarithromycin‐susceptible and clarithromycin‐resistant strains in antral biopsies from children.Methods : Antral biopsies from 149 unselected children were investigated prospectively; 15 had previously received anti‐H. pylori therapy. H. pylori status was defined by histology, rapid urease test and 13C‐urea breath test. Fluorescence in situ hybridization was applied on fresh tissue with probes specific for the clarithromycin‐susceptible wild type and three clarithromycin‐resistant mutants. Susceptibility to clarithromycin was tested by epsilometer test in two laboratories.Results : Culture and fluorescence in situ hybridization gave negative results in all 66 H. pylori‐negative children (specificity, 100%). Of 83 infected children, cultures were successful in 75 (90%), epsilometer test in 71 (86%) and fluorescence in situ hybridization in 77 (93%). Eleven children (13%) showed discrepant results between the applied methods, indicating mixed infection. Clarithromycin‐resistant isolates were identified in 16 of 73 previously untreated children.Conclusions : Primary resistance to clarithromycin is common (22%) in H. pylori isolates from children living in Germany. Fluorescence in situ hybridization is an excellent, fast method for the detection of H. pylori and clarithromycin‐resistant mutants in gastric biopsies. Multiple biopsies identify mixed infections, indicating that clarithromycin‐resistant and clarithromycin‐ susceptible strains are not evenly distributed within the stomach.