bluuebunny/crossref_metadata_2025_split huggingface dataset:
An increasing dose of omeprazole combined with amoxycillin cures Helicobacter pylori infection more effectively
Authors: MIEHLKE S. , MANNES G. A. , LEHN N. , HELE C. , STOLTE M. , BAYERDÖRFFER E. 
Published: October 2003

Background: The combination of omeprazole and amoxycillin has demonstrated effectiveness with very few side‐effects in the treatment of H. pylori infection, however cure rates have varied widely. The present study addresses the question as to the extent to which the cure rate of H. pylori infection depends on the size of the daily omeprazole dose, and investigates other patient‐related factors that influence treatment success.Methods: In a randomized, controlled and investigator‐blinded trial, 163 hospitalized patients with H. pylori‐associated gastritis were treated with 20 mg omeprazole once daily in the morning, 20 mg omeprazole b.d., 40 mg omeprazole b.d. or 60 mg omeprazole b.d. for 14 days. In addition, all patients received 1000 mg amoxycillin b.d. on days 5–14. Endoscopic and histological examinations were performed prior to treatment, at the end of treatment and 4 weeks after completion of treatment.Results: H. pylori infection was cured in 18 of 40 (45%, 95% CI: 29–62%), in 22 of 39 (56.4%, 95% CI: 40–72%), in 25 of 38 (65.8%, 95% CI: 49–80%), and in 33 of 40 (82.5%, 95% CI: 67–93%) patients, respectively, (P<0.001). Side‐effects leading to discontinuation of treatment occurred in only 1.2%.Conclusion: The daily dose of omeprazole is an important factor for the success of dual therapy comprising omeprazole and amoxycillin in curing H. pylori infection. Cure of H. pylori infection correlates positively and significantly with the size of the daily omeprazole dose. The combination of high‐dose omeprazole and amoxycillin is an effective and well‐tolerated regimen for the treatment of H. pylori‐associated diseases.
The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress
Authors: FRANCIS C. Y. , MORRIS J. , WHORWELL P. J. 
Published: October 2003

Background: The clinical assessment and investigation of irritable bowel syndrome would be greatly facilitated by the introduction of a simple, easy to use severity scoring system. Such a system, developed in our department over a number of years, has been submitted to validation in a total of 141 patients and 40 healthy controls.Methods: The system, incorporating pain, distension, bowel dysfunction and quality of life/global well‐being, was assessed for its ability to reliably score patients previously classified as mild, moderate or severe. The reproducibility and sensitivity to change of the system was also assessed.Results: The maximum achievable score was 500. Mild, moderate and severe cases were indicated by scores of 75 to 175, 175 to 300 and >300 respectively. Controls scored below 75 and patients scoring in this range can be considered to be in remission. There was a highly significant difference between controls and patients as a whole (P=0.0001) as well as significant differences (P<0.01) between all severity categories. Scores repeated within 24 h were very reproducible and sensitivity to change was also extremely good (P<0.001) with a change of 50 reliably indicating improvement.Conclusion: These results suggest that this scoring system should prove to be a valuable instrument in helping to meet the many challenges offered by irritable bowel syndrome.
Effect of oral pancreatic enzyme administration on digestive function in healthy subjects: comparison between two enzyme preparations
Authors: DOMÍNGUEZ‐MUÑOZ J. E. , BIRCKELBACH U. , GLASBRENNER B. , SAUERBRUCH T. , MALFERTHEINER P. 
Published: October 2003

Background: Intraduodenal proteases exert a negative feedback on pancreatic secretion.Aim: To investigate the effect of two pancreatic enzyme preparations (enteric‐coated tablets, and capsules with enteric‐coated microtablets) on postprandial pancreatic and bile acid secretion, gastroduodenal motility and release of gastrin and pancreatic polypeptide in healthy humans.Methods: Twenty healthy males were studied on two different days one week apart. After an overnight fast a nine‐lumen motility tube was positioned with the distal tip at the Treitz angle. On each study day, 30 min after an interdigestive migrating motor complex‐phase III, a semi‐liquid test meal was given either alone (n=20) or with enzymes (3 tablets (n=10) or 2 capsules with microtablets (n=10); 40000 U lipase and 2000 proteases) in a randomized order, and the study continued over 2 h. Motility was continuously recorded with four ports in the antrum and three in the duodenum, using a low‐compliance pneumohydraulic perfusion system. Secretion of human‐specific pancreatic elastase and bile acids was measured by a standard duodenal intubation perfusion technique. Plasma concentrations of gastrin and pancreatic polypeptide were measured by specific radioimmunoassays.Results: Postprandial pancreatic secretion was significantly reduced by administration of microtablets (median 82 mg/2 h vs. 70 mg/2 h, P<0.02) but not by tablets (median 59 mg/2 h vs. 58 mg/2 h, N.S.). No changes were observed in bile acid secretion, antroduodenal motility or release of gastrin and pancreatic polypeptide.Conclusions: Oral administration of pancreatic enzymes at normal therapeutic doses significantly inhibits postprandial pancreatic secretion in healthy humans, when capsules with enteric‐coated microtablets are given. Exogenous pancreatic enzymes have no significant effect on bile acid secretion, gastroduodenal motility and hormone release.
Lansoprazole 15 and 30 mg daily in maintaining healing and symptom relief in patients with reflux oesophagitis
Authors: HATLEBAKK J. G. , BERSTAD A. 
Published: October 2003

Background: In patients with reflux oesophagitis, endoscopic healing and symptom relief are considered important treatment goals in long‐term care.Aim: To compare the effect of lansoprazole 15 and 30 mg daily on maintaining endoscopic healing and symptom relief in patients with moderate reflux oesophagitis.Patients and methods: In a single‐centre, double‐blind randomized clinical trial, 103 patients with grade 1 or 2 reflux oesophagitis who were endoscopically healed and asymptomatic after lansoprazole 30 mg daily for 12 weeks, were randomized to maintenance therapy with either lansoprazole 15 mg or 30 mg o.m. Endoscopy was repeated after 3, 6 and 12 months, and symptom relief assessed after 3, 6, 9 and 12 months. Relapse of oesophagitis or symptoms were considered end‐points.Results: After 12 months, 14/50 patients (28%) receiving lansoprazole 15 mg daily had suffered an endoscopic relapse compared to 8/53 patients (15%) treated with lansoprazole 30 mg daily. A life table analysis showed no statistically significant difference between the two groups (P=0.086). Significantly more patients were kept in complete symptomatic remission in the 30 mg group (P<0.01). In the 15 mg group, 23/50 (46%) had suffered either an endoscopic or symptomatic relapse on completion of the study, compared to 12/53 (23%) in the 30 mg group. A life table analysis showed this difference to be statistically significant (P=0.010). Lansoprazole 15 and 30 mg daily were equally well tolerated.Conclusion: No statistically significant differences were found in endoscopic relapse rate or occurrence of adverse events, while lansoprazole 30 mg proved superior to 15 mg in maintaining patients in symptomatic relief and combined endoscopic and symptomatic remission.
Recurrence of duodenal ulcer after Helicobacter pylori eradication is related to high acid output
Authors: HARRIS A. W. , GUMMETT P. A. , PHULL P. S. , JACYNA M. R. , MISIEWICZ J. J. , BARON J. H. 
Published: October 2003

Background: Helicobacter pylori eradication reduces the recurrence of duodenal ulcers. It is unclear why duodenal ulcers rarely recur in the absence of reinfection with H. pylori or NSAID treatment.Methods: Basal, gastrin‐releasing peptide‐ and pentagastrin‐stimulated peak acid outputs in patients with ulcer relapse after H. pylori eradication were measured, and compared with patients without ulcer relapse after H. pylori eradication.Results: Pentagastrin‐stimulated peak acid output was significantly higher in H. pylori‐positive patients with duodenal ulcers than in H. pylori‐negative controls, and fell significantly after H. pylori eradication. In H. pylori‐negative patients with recurrent duodenal ulcers, pentagastrin‐stimulated peak acid output was significantly higher than in controls and similar to H. pylori‐positive patients with duodenal ulcers.Conclusions: These findings suggest that duodenal ulcer relapse after eradication of H. pylori may be related to high pentagastrin‐stimulated peak acid output. In this subset of patients with duodenal ulcers, maintenance anti‐secretory treatment may be necessary to prevent relapse.
Review article: update on the role of transjugular intrahepatic portosystemic stent‐shunt (TIPSS) in the management of complications of portal hypertension
Authors: STANLEY A. J. , REDHEAD D. N. , HAYES P. C. 
Published: October 2003

In the 8 years since its introduction into clinical practice, initial enthusiasm for the transjugular intrahepatic portosystemic stent‐shunt (TIPSS) has been tempered by a more critical appraisal of its role in the management of portal hypertension. TIPSS has established its role as a rescue procedure for variceal haemorrhage uncontrolled by endoscopic means and as a treatment for ectopic or recurrent variceal bleeding. Randomized trials comparing TIPSS with endoscopic methods in the secondary prophylaxis of oesophageal variceal haemorrhage have shown reduced rebleeding after TIPSS but no effect on survival. Its exact role in this situation awaits further assessment, including quality of life and cost analyses, and consideration of the current limited availability of the technique.Experience of TIPSS in patients with refractory ascites or hepatorenal syndrome has been disappointing. Little data currently exist, but results of further randomized studies comparing TIPSS with paracentesis for refractory ascites are awaited. Ideally these should be multicentre studies, and should include quality of life data for this poor prognostic group.Development of shunt insufficiency remains a major problem and occurs in ≈50% patients at 1 year. The need for continued shunt surveillance by Doppler sonography and direct portography is the major limitation of TIPSS, but hopefully the development of covered stents will address this problem.
One‐week low‐dose triple therapy for Helicobacter pylori is sufficient for relief from symptoms and healing of duodenal ulcers
Authors: LABENZ J. , IDSTRÖM J.‐P. , TILLENBURG B. , PEITZ U. , ADAMEK R. J. , BÖRSCH G. 
Published: October 2003

Aim: To test the hypothesis that 1‐week low‐dose triple therapy for H. pylori is sufficient for relief from dyspeptic symptoms and healing of duodenal ulcers. Methods: Fifty‐nine out‐patients with duodenal ulcers and positive rapid urease test participated in this randomized, double‐blind, two‐centre study. All patients were treated for 1 week with omeprazole 20 mg b.d., clarithromycin 250 mg b.d. and metronidazole 400 mg b.d. In a double‐blind fashion, patients were then randomly treated for another 3 weeks with either omeprazole 20 mg once daily or an identical‐looking placebo. Patients were investigated endoscopically before treatment for H. pylori, after 2 weeks and after 4 weeks. H. pylori infection was assessed by a 13C‐urea breath test at the time of enrolment and 4 weeks after cessation of any study medication. Results: Fifty‐two patients were included in the ‘all patients treated’ analysis of efficacy. The overall H. pylori cure rate was 96% (95% CI=87–100%), with no difference between the treatment groups. After 2 weeks duodenal ulcer healing was confirmed in 91% (95% CI=80–100%) of patients treated with omeprazole and in 76% (95% CI=60–91%) in the placebo group (P=0.14). After 4 weeks all ulcers had healed. Relief from dyspeptic symptoms and adverse events (13.8 and 16.7%) did not differ between the treatment groups. Conclusions: One‐week low‐dose triple therapy consisting of omeprazole, clarithromycin and metronidazole is a highly effective and well‐tolerated approach to the cure of H. pylori infection in patients with a duodenal ulcer. Our data suggest that continuation of antisecretory drug therapy beyond anti‐H. pylori therapy is actually excessive regarding relief from dyspeptic symptoms and healing of duodenal ulcers.
A one‐week quadruple eradication regimen for Helicobacter pylori in routine clinical practice
Authors: VAUTIER G. , SCOTT B. B. 
Published: October 2003

Background: The addition of omeprazole to 1 week of standard triple therapy (tripotassium dicitrato bismuthate, tetracycline and metronidazole) has given a 98% eradication rate in 54 patients at 4–6 weeks in a research setting. We report the result of a similar 1‐week regimen in 52 patients in routine clinical practice assessed at a mean of 8 months. Methods: Fifty‐two patients with peptic ulcer disease and antral biopsies containing Helicobacter pylori sensitive to metronidazole were given a 7‐day course of treatment: omeprazole 20 mg b.d., tetracycline 500 mg q.d.s. and tripotassium dictitrato bismuthate chelate tablets 120 mg q.d.s., with metronidazole 400 mg five times daily for the last 3 days only. Completeness of eradication was assessed by a 13C‐urea breath test at 4–26 months (mean 8 months). Results: Forty‐eight patients (92%) had a negative breath test. Three patients vomited on the last day of the course, otherwise the treatment was well tolerated with the expected minor side‐effects of tongue discoloration, nausea and unpleasant taste. Conclusions: The efficacy of a modified 1‐week standard triple therapy with omeprazole is confirmed and shown to be almost as effective in routine clinical practice as a similar regimen in a research setting.
Review article: the dietary management of Crohn's disease
Authors: KING T. S. , WOOLNER J. T. , HUNTER J. O. 
Published: October 2003

Enteral feeding has been shown to be as effective as primary therapy for Crohn's disease, but it requires high patient motivation, may be unpalatable and is expensive. However, in adolescents with growth failure and when corticosteroid therapy is contra‐indicated or has failed, it may become the treatment of choice. Furthermore, dietary therapy allows circumvention of the adverse side‐effects of repeated courses of steroids.A number of different hypotheses have been proposed to explain the effect of enteral feeds but none has reached universal acceptance. Prospective trials suggest that the exclusion of whole protein is not necessary. Comparison of feeds with differing composition suggests that a low fat content increases efficacy and various explanations have been offered. The reduction of colonic bacterial load may also be important.Because symptoms of Crohn's disease may be provoked by eating, there is a risk of falsely attributing symptoms to specific foodstuffs. However, in many individuals foods can be identified which affect disease activity, and their exclusion leads to prolongation of disease remission. Dietetic supervision during food testing is important to avoid detrimental effects on nutrient and micronutrient intake.
Antiemetic activity of ondansetron in acute gastroenteritis
Authors: CUBEDDU L. X. , TRUJILLO L. M. , TALMACIU I. , GONZALEZ V. , GUARIGUATA J. , SEIJAS J. , MILLER I. A. , PASKA W. 
Published: October 2003

Background: The mechanism of nausea and vomiting associated with gastroenteritis is unknown. The role of 5‐HT3 receptors in emesis associated with gastroenteritis was investigated in paediatric patients. Methods: A randomized, double‐blind, placebo‐controlled, parallel‐group study was conducted in three groups of 12 patients each, receiving either a single i.v. dose of ondansetron (0.3 mg/kg), metoclopramide (0.3 mg/kg) or placebo (sterile saline). Food was restricted and oral rehydration was administered for 4 h. Results: During 0–24 h, the number of emetic episodes experienced was significantly greater (P=0.048) with placebo (mean=5) than ondansetron (mean=2) and the proportion of patients experiencing no emesis was significantly greater (P=0.039) with ondansetron (58%) than placebo (17%). A numerical difference, in favour of ondansetron, was observed between ondansetron and metoclopramide groups for both of the above parameters. Fewer treatment failures were observed with ondansetron (17%) than placebo (33%) and metoclopramide (42%). More diarrheal episodes were observed in the groups receiving anti‐emetic treatment. All three treatments were well tolerated. Conclusions: Ondansetron, a 5HT3 receptor antagonist, was significantly superior to placebo in preventing emesis associated with acute gastroenteritis, in paediatric patients. Therefore, serotonin, acting through 5HT3 receptors, may play a role in this form of emesis.
In vivo effects of the 5‐HT3 antagonist alosetron on basal and cholera toxin‐induced secretion in the human jejunum: a segmental perfusion study
Authors: BEARCROFT C. P. , ANDRÉ E. A. , FARTHING M. J. G. 
Published: October 2003

Background:5‐hydroxytryptamine type 3 receptor antagonists have been shown to reduce fluid and electrolyte secretion or promote absorption in experimental models of small intestinal secretion. The aim of this study was to compare the effects of a single dose (4 mg) of the 5‐hydroxytryptamine type 3 receptor antagonist alosetron and placebo on jejunal fluid and electrolyte movement in humans under basal conditions (n=7) and following cholera toxin‐induced secretion (n=5) in a randomized, double‐blind, crossover design over two separate study periods.Methods:One hour after oral alosetron or placebo, jejunal intubation was performed. A 30 cm segment of jejunum, isolated by two occluding balloons, was exposed to 15 μg of purified cholera toxin for 2 h prior to triple lumen perfusion with a plasma electrolyte solution containing []> 14C]‐polyethylene glycol as a non‐absorbable volume marker. In the basal study, intestinal perfusion was performed without exposure to cholera toxin. Collection and analysis of the effluent from the jejunal segment allowed fluid and electrolyte movement to be calculated.Results:Alosetron treatment increased basal jejunal fluid absorption (median 5.1 mL/cm/h [interquartile range 4.2 to 7.1] compared with placebo (3.8 [3.6 to 4.3] P=0.028, two sided Wilcoxon matched pairs signed rank test)). However, following establishment of a secretory state by cholera toxin, alosetron failed to significantly promote absorption or reduce secretion (0.3 [−1.2 to 1.2] compared to placebo (−4.3 [−7.7 to −1.3] P=0.14)). Adverse events during the study, which included anorexia, nausea, dizziness and loose bowel movements, were not considered to be clinically important. There were no clinically significant changes in laboratory parameters.Conclusion:The 5‐hydroxytyptamine type 3 receptor antagonist, alosetron increased basal fluid absorption in normal human small intestine but failed to have a beneficial effect in cholera toxin‐induced secretion.
Correction of aplastic anaemia complicating paroxysmal nocturnal haemoglobinuria: absence of eradication of the PNH clone and dependence of response on cyclosporin A administration
Authors: STOPPA Anne Marie , VEY Norbert , SAINTY Danielle , ARNOULET Christine , CAMERLO Jacques , CAPPIELLO Maria Antonietta , GASTAUT Jean Albert , MRANINCHI Dominique 
Published: October 2003

Paroxysmal nocturnal haemoglobinuria (PNH) is defined as a somatic mutation of a clonal population of stem cells. Consequently, when aplastic anaemia (AA) occurs in patients with a history of PNH, allogeneic bone marrow transplantation is considered as the only effective treatment. The impact of immunosuppressive therapy has not been reported in this situation. We present observations of three PNH patients who developed AA and were effectively treated with cyclosporin A (CSA).Because of lack of improvement with other treatments, CSA alone was given at a dose of 5–10 mg/kg/d. Complete response (CR) was obtained in two patients after 6 and 24 months respectively. A partial response (PR) was observed in the third patient after 12 months. Transient elevated LDH and haemosiderinuria persisted in all cases. DAF and MIRL deficiency were still documented in the two patients in CR.Two patients (one CR, one PR) ceased CSA therapy after 12 months and relapsed within 3–6 months. CSA was reinitiated and led to platelet recovery in one patient after 6 months.The persistence of the abnormal PNH clone is coherent with the hypothesis that CSA does not act directly on the PNH clone but probably acts through regulation of the inhibitory effects of immunocompetent cells on haemopoiesis.These observations suggest that patients suffering from severe AA complicated PNH should not be excluded from immunosuppressive therapy.
Treatment of newly‐diagnosed acute myelogenous leukaemia in patients aged 80 years and above
Authors: DELIMA MARCOS , GHADDAR HABIB , PIERCE SHERRY , ESTEY ELIHU 
Published: October 2003

In order to assess outcome following treatment of acute myeloid leukaemia (AML) in patients aged 80 years and above, we have studied 33 patients aged ≥80 years treated between 1980 and 1994; 29 of these received treatment. The median age was 82 years (range 80–89). Three patients received daunorubicin (≥60mg/m2 daily × 3) alone or with low‐dose ara‐C, two patients received ‘3+7’ with post‐treatment GM‐CSF; 24 patients had higher doses of ara‐C, generally with anthracyclines or fludarabine, and in nine cases with G or GM‐CSF.The median survival of the treated patients was 3–4 weeks and only two were alive after 1 year (at 66 and 79 weeks). Complete remission (CR) occurred in 9/29 (31%). Only one of the nine remains alive in remission, at 76 weeks after the date of CR, whereas the other eight died in remission or had disease recurrence at a median of 11 weeks (range 5–37 weeks) after CR. The median survival of the four untreated patients was 10 weeks (range 3–38). Patients aged ≥80 had, on average, worse outcomes than those observed in patients aged 70–79.Our results confirm that currently available chemotherapy is generally not indicated in patients aged 80 or over with AML.
Isolation and characterization of cysteine proteinase in thrombotic thrombocytopenic purpura
Authors: Kelton John G. , Moore Jane C. , Warkentin Theodore E. , Hayward Catherine P. M. 
Published: October 2003

Thrombotic thrombocytopenic purpura (TTP) is an uncommon disorder characterized by thrombocytopenia, schistocytic haemolytic anaemia, fever, neurologic lesions, and renal failure. A platelet aggregating factor has been postulated to be responsible for this disorder, but its precise identity remains debated. Two different groups of investigators have provided evidence that the platelet aggregating factor is a cysteine proteinase. We have suggested that it was calpain, whereas others have suggested that it was cathepsin L. To help resolve this issue, we have studied the platelet activating activity found in the acute serum samples from 10 different TTP patients as well as purified calpain and cathepsin L. The TTP activity was measured functionally (platelet serotonin release assay and casein lysis assay) and antigenically (immunodepletion using anti‐calpain and anti‐cathepsin L antibodies and antigenic analysis using SDS PAGE). The TTP serum parallelled the activity of the purified calpain and had optimal pH activity of 7.5. The purified cathepsin L activity had optimal activity at low pH (5.5) and activity was no longer measurable at pH 7.5. Similarly, a specific cathepsin L inhibitor (Z‐Phe‐Phe‐CHN2) had no effect on the activity of the TTP samples nor on purified calpain, but it did abolish the activity of purified cathepsin L. The platelet activating activity of the TTP samples was detectable in the microparticle pellet following ultracentrifugation of TTP serum, and could be immunodepleted using antibodies to calpain but not to cathepsin L.These studies indicate that the microparticle‐associated platelet activating factor in TTP corresponds to calpain.