bluuebunny/crossref_metadata_2025_split huggingface dataset:
Costs of Managing Helicobacter pylori‐Infected Ulcer Patients after Initial Therapy
Authors: Griffiths Robert I. , Rabeneck Linda , Guzman Gladys , Cromwell David M. , Strauss Michael J. , Robinson John W. , Winston Bradley , Li Theodore , Graham David Y. 
Published: March 2003

AbstractBackground.The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated for peptic ulcer disease and Helicobacter pylori infection.Materials and Methods.A decision‐analytic model was used to compare (1a) urease breath testing (UBT) for assessment of H. pylori status versus (1b) observation without further testing or treatment, among patients who were symptom‐free following initial antimicrobial and antisecretory therapy for endoscopically demonstrated ulcer and H. pylori infection; and (2a) UBT versus (2b) repeat endoscopy with H. pylori testing, and versus (2c) repeat antimicrobial and antisecretory therapy without further testing, among patients who remained symptomatic following initial therapy.Results.Among patients who were symptom free after initial therapy, 6.1% receiving UBT had symptomatic ulcer at one year, compared to 18.2% of those simply observed. The expected first‐year cost per symptom‐free patient following initial therapy was $591 for UBT compared to $480 for observation. Among patients with persistent symptoms after initial therapy, 21% receiving repeat therapy had symptomatic ulcer at one year, compared to 23.8% receiving repeat endoscopy, and 23.3% receiving UBT. Corresponding medical costs per patient were, respectively, $766, $1787 and $1122.Conclusions.The optimal approach to managing patients following initial treatment for ulcer and H. pylori infection depends on symptom status following initial therapy. For symptomatic patients, the preferred approach is to prescribe a repeat course of antimicrobial and antisecretory therapy. For patients without symptoms following initial therapy, UBT is the preferred approach because it is associated with a threefold lower risk of symptomatic ulcer at one year, although it costs an additional $110 per patient, compared with observation.
Correlation Between Helicobacter pylori Infection, Gastric Inflammation and Serum Homocysteine Concentration
Authors: Leung Wai K. , Ma P. K. , Choi Paul C. L. , Ching Jessica Y. L. , Ng Alex C. W. , Poon Peter , Woo K. S. , Sung Joseph J. Y. 
Published: March 2003

AbstractBackground.  Epidemiological studies have suggested a link between chronic Helicobacter pylori infection and ischemic heart disease but the underlying mechanism remains elusive. We hypothesized that H. pylori‐associated chronic gastritis causes impairment of absorption of vitamin cofactors that are essential in the metabolism of homocysteine and results in hyperhomocysteinemia.Materials and Methods.  Forty‐nine dyspeptic patients were studied. H. pylori infection was defined by rapid urease test and histology. Fasting serum homocysteine level, which was measured by a validated commercial fluorescence polarization immunoassay, was correlated with H. pylori infection statuses and gastric histology. H. pylori‐infected patients were followed up for 24 weeks post eradication for changes in serum homocysteine concentration.Results.  Univariate analyses showed that serum homocysteine level correlated with increasing age (p < .001), male sex (p = .003) and smoking habit (p = .025). There was no significant difference in serum homocysteine levels between H. pylori infected and uninfected subjects (median 10.5 vs. 10.2 µmol/l). After successful eradication of the bacterium, there was no significant reduction in homocysteine level. Moreover, there was no correlation between homocysteine level and gastric histology including H. pylori density, activity and inflammation scores, presence of atrophy or intestinal metaplasia.Conclusions.  The postulated link between H. pylori infection and ischemic heart disease, if it actually exists, is unlikely to be mediated through hyper‐homocysteinemia.
Guidelines in the Management of Helicobacter pylori Infection in Japan
Authors: Asaka Masahiro , Satoh Kiichi , Sugano Kentaro , Sugiyama Toshiro , Takahashi Shin‐ichi , Fukuda Yoshihiro , Ota Hiroyoshi , Murakami Kazushige , Kimura Ken , Shimoyama Takashi 
Published: March 2003

ABSTRACTBackground.In preparation of the approval of Helicobacter pylori therapy by the Japanese national health system, the board of directors of the Japanese Society for Helicobacter Research decided to prepare guidelines on the diagnosis and treatment of H. pylori infection for physicians in routine medical practice.Methods.A guidelines preparation committee was formed and six meetings were held. Then, in December 1999, a consensus meeting was held in Kobe to obtain the opinions of general practitioners as well as experts from Europe, North America, and Asia.Results. Helicobacter pylori eradication therapy is recommended in gastric or duodenal ulcer patients. Helicobacter pylori eradication therapy is recommended or gastric mucosa associated lymphoid tissue (MALT) lymphoma but it should be done at specialist institutions. The significance of H. pylori eradication therapy is still under evaluation in patients with hyperplastic polyps, chronic atrophic gastritis, non‐ulcer dyspepsia and in patients after endoscopic mucosal resection of gastric cancer and after gastrectomy for gastric cancer. When diagnosing H. pylori infection, at least one of the tests requiring endoscopic biopsy (e.g. rapid urease test, histology, or culture) and tests not requiring biopsy (e.g. measurement of H. pylori antibody or urea breath test) should be used. Multiple tests are recommended to increase the accuracy. The drugs of first choice currently covered by the national health insurance system in Japan are: lansoprazole (30 mg) 1 capsule twice daily, amoxicillin (250 mg) 3 capsules twice daily, and clarithromycin (200 mg) 1–2 tablets twice daily. These three drugs should be administered after breakfast and dinner for 1 week.Conclusion.These guidelines are intended for utilization in routine medical practice after the Japanese national health system begins to cover the management of H. pylori infection.
Immune Response to a 26‐kDa Protein, Alkyl Hydroperoxide Reductase, in Helicobacter pylori‐Infected Mongolian Gerbil Model
Authors: Yan Jing , Kumagai Toshiko , Ohnishi Makoto , Ueno Ichiro , Ota Hiroyoshi 
Published: March 2003

ABSTRACTBackground.The host immune response is thought to play an important role in the outcome of Helico‐bacter pylori infection. The successful development of the H. pylori‐infected Mongolian gerbil model that mimics human disease has enabled study of the antibody response against H. pylori antigens.Materials and Methods.Serum samples from ulcer and carcinogenesis models of H. pylori‐infected gerbils were used to screen for H. pylori antigens that cause a humoral immune response in the infected hosts. H. pylori alkyl hydroperoxide reductase (AhpC) is one such antigen on which we report here. The tsaA gene encoding AhpC was amplified by PCR from H. pylori ATCC 43504 strain, cloned into pMALTM‐c2 expression vector and expressed in Escherichia coli. Maltose‐binding protein fusion protein (MBP‐AhpC) was purified by a MBP affinity column. Using purified recombinant AhpC protein as an antigen, the antibody response and changes of antibody levels against AhpC in the gerbil models were studied by Western blotting and ELISA.Results.Antibody against AhpC was negative in the early stages of infection, and became positive in the gerbils with the emergence of gastric diseases such as chronic active gastritis, gastric ulcer and gastric cancer. The antibody levels (ELISA) increased gradually over time and were higher in gerbils with gastric ulcer than that in gerbils without ulcers.Conclusions.Use of the gerbil model that mimics human H. pylori infection is likely to provide insights into the role of H. pylori‐specific antigens possibly related to the subsequent development of gastric diseases.
Effects of Selective Cyclooxygenase‐2 Inhibitor and Non‐Selective NSAIDs on Helicobacter pylori‐Induced Gastritis in Mongolian Gerbils
Authors: Bhang Choon Sang , Lee Hak Sung , Kim Sung Soo , Song Ho Jin , Sung Yong Jick , Kim Jin Il , Chung In Sik , Sun Hee Sik , Park Doo Ho , Lee Youn Soo 
Published: March 2003

AbstractBackground. It is still a point of controversy whether Helicobacter pylori‐infected patients are more likely to develop mucosal damage while taking NSADIs. Selective cyclooxygenase (COX‐2) inhibitors may be associated with less severe gastric mucosal damage than conventional NSAIDs, but this association is undefined in H. pylori‐induced gastritis. The aim of this study was to evaluate the effects of selective COX‐2 and nonselective NSAIDs on H. pylori‐induced gastritis.Methods. After intragastric administration of indomethacin, NS‐398 or vehicle alone, once daily for 5 days in H. pylori‐infected and uninfected Mongolian gerbils, we evaluated gastric mucosal damage, inflammatory cell infiltration and prostaglandin E2 (PGE2) concentration. We investigated whether H. pylori infection induced the COX‐2 expression.Results. In H. pylori‐uninfected groups, the indomethacin‐treated group showed the highest mucosal damage score and the lowest PGE2 concentration. There was no difference in mucosal damage scores and PGE2 concentration between NS‐398 and vehicle‐alone treated group. In H. pylori‐infected groups, there was no difference in mucosal damage scores, irrespective of the type of drugs administered. The indomethacin‐treated group showed the lowest PGE2 concentration, similar to that of the NS‐398 and vehicle‐alone treated groups, both without H. pylori infection. Gastric neutrophil and monocyte infiltration scores were higher in H. pylori‐infected groups than in uninfected groups. However, there was no difference in these scores according to the type of drugs administered, within H. pylori‐infected or uninfected groups. COX‐2 protein expression was observed in H. pylori‐infected Mongolian gerbils but not in uninfected ones.Conclusions. Our animal study showed that H. pylori infection induced COX‐2 expression and increased prostaglandin concentration. Administration of NSAIDs decreased the prostaglandin concentration, but did not increase mucosal damage in H. pylori‐induced gastritis. Selective COX‐2 inhibitors, instead of conventional NSIADs, had no beneficial effect on preventing mucosal damage in H. pylori‐induced gastritis.
Enhanced Expression of Transcription Factor E2F in Helicobacter pylori‐infected Gastric Mucosa
Authors: Isomoto Hajime , Furusu Hisashi , Shin Masashi , Ohnita Ken , Miyazaki Masanobu , Omagari Katsuhisa , Mizuta Yohei , Murase Kunihiko , Inoue Ken‐ichiro , Murata Ikuo , Koji Takehiko , Kohno Shigeru 
Published: March 2003

AbstractObjective. Helicobacter pylori is implicated in gastric carcinogenesis through increased gastric epithelial cell turnover. In fact, high proportions of proliferating and apoptotic epithelial cells are found in H. pylori‐infected gastric mucosa. E2F, a transcription factor, induces coordinated transactivation of a set of genes involved in cell cycle progression. The aim of this study was to investigate the expression of E2F in H. pylori‐infected gastric mucosa and examine the correlation between such expression and gastric epithelial cell proliferation and apoptosis.Methods. Twenty‐five patients with H. pylori‐associated gastritis (HAG) and 13 control subjects negative for H. pylori were examined. E2F expression was studied in situ by Southwestern histochemistry, a method used to localize transcription factors. Labeled double‐stranded oligo‐DNA with specific consensus sequence for E2F binding sites was reacted with frozen sections from antral biopsy specimens obtained at endoscopy. Gastric epithelial cell proliferation was assessed by immunostaining of proliferating cell nuclear antigen (PCNA), while apoptosis was detected by terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick end labeling (TUNEL). The percentages of epithelial cells with nuclear staining for PCNA and E2F were expressed as a positivity index (PI). The percentage of TUNEL‐positive epithelial cells was defined as apoptotic index.Results. E2F was expressed in the nuclei of gastric epithelial cells within gastric pits. E2F PI in H. pylori‐infected gastric mucosa was significantly higher than that in noninfected. Expression of E2F correlated well with PCNA‐positive epithelial cells. We also demonstrated colocalization of PCNA with E2F expression in the same epithelial cells. Apoptotic index was also high in H. pylori‐infected mucosa, and correlated with E2F PI.Conclusion. Our results demonstrated a significant increase in the expression of E2F in H. pylori‐infected mucosa, which correlated with both the percentages of PCNA‐ and TUNEL‐positive cells. Our results suggest that enhanced E2F expression in gastric mucosa may be involved in H. pylori‐related gastric carcinogenesis through accelerated cell turnover.
Accuracy of Office‐Based Immunoassays for the Diagnosis of Helicobacter pylori Infection in Children
Authors: Day Andrew S. , Sherman Philip M. 
Published: March 2003

AbstractBackground. Rapid non‐invasive diagnostic tests that can reliably document the presence or absence of Helicobacter pylori infection are urgently required. The aim of this study was to determine the accuracy of two immunoassays (Flex‐Sure and MedMira), developed for use outside the laboratory setting by practitioners, in the setting of a low prevalence of H. pylori infection.Methods. Serum samples collected in four previous studies (n = 349) were employed to detect the presence of H. pylori‐specific immunoglobulin G, compared to previous results obtained using endoscopic biopsies, serology, flow cytometry, and urease breath testing. Serum samples included 52 obtained from adults (parents and grandparents of symptomatic children), 123 sera collected from children and adolescents undergoing diagnostic upper endoscopy for upper gastrointestinal tract symptoms, and 174 samples drawn from children in the primary care setting with or without recurrent abdominal pain.Results. Overall, 16% of subjects were infected by the gastric pathogen. Both the specificity (%) and negative predictive value (%) of the two tests were high (FlexSure: 91 and 92; Medmira: 97 and 94, respectively). In adults, both tests also demonstrated high sensitivity (83% and 86%) and positive predictive values (79% and 83%, respectively). However, in children where the prevalence of infection was 12% (37 of 297 subjects), the sensitivity (59% and 71%) and positive predictive values (55% and 88%, respectively) of the immunoassays were lower.Conclusions. These findings indicate that, in the setting of a low prevalence of H. pylori infection, the MedMira office‐based test provides satisfactory results and utility. However, the low positive–predictive value of the FlexSure kit may limit applicability of this test in children.
Improvement of Reflux Symptoms 3 Years After Cure of Helicobacter pylori Infection: A Case‐Controlled Study in the Japanese Population
Authors: Miwa Hiroto , Sugiyama Yuriko , Ohkusa Toshifumi , Kurosawa Akihiko , Hojo Mariko , Yokoyama Tetsuji , Hamada Tsutomu , Basyuda Hisashi , Sato Nobuhiro 
Published: March 2003

AbstractBackground. Development of reflux esophagitis is one of the adverse effects that cause concern in relation to curative treatment of Helicobacter pylori infection. However, recent studies present a rather negative association between curative treatment and development of reflux esophagitis or reflux symptoms. Therefore, this issue has remained controversial. Accordingly, we investigated the long‐term adverse effects of H. pylori eradication treatment in special reference to development of reflux symptoms.Patients and Methods. We conducted a case controlled study by mailing structured questionnaires on past (before curative treatment or 3 years previously) and current status. A case was an endoscopically confirmed peptic ulcer patient with confirmed cure of the infection after eradication treatment 3 years previously and a control was one who had not undergone the eradication treatment during the same period. We studied 241 pairs who matched for age, gender, and type of ulcer disease (GU, DU or GDU). Of these pairs, 81.3% were male and the mean age was 52.6 ± 9.6 year (range 23–76).Results. The rates of patients with improved reflux symptoms in the case and control groups were 65.4% and 30.4%, respectively, with the rate being significantly greater in the case group. On the contrary, the rates of those with worsened reflux symptoms were similar (5.1% and 7.6%). Regarding general events, the rate of patients with decreased frequency of hospital visits and of those who regularly used antiacid medications were significantly decreased in the case group. Furthermore, the case group experienced significantly fewer hospital admissions for various diseases in this 3‐year period. However, a significantly greater number of case group patients than control subjects gained weight.Conclusion. Reflux symptoms as well as general well‐being were significantly improved after cure of H. pylori infection.
Epidemiology and diagnosis of Helicobacter pylori infection
Authors: Mitchell Hazel , Mégraud Francis 
Published: March 2003

AbstractThere have been no major breakthroughs in the field of epidemiology and diagnosis of Helicobacter pylori infection over the last year, thus for this reason, these two topics will be treated in the same chapter.Information on the incidence of infection, as in the study of Malaty et al. are now being published from long‐term cohort follow‐ups. The route of transmission of H. pylori remains controversial, with circumstantial evidence for infection via exposure to animals, contaminated water supplies and oral reservoirs being reported.The value of citric acid to improve urea breath test (UBT) results has been documented. A novel stool test has been released on the market and we are awaiting more information, while detection of antibodies in urine gave satisfactory results.However, the most interesting data comes from the study of McColl et al. who clearly proved on a large sample and a 1‐year follow‐up that the ‘test and treat’ strategy using UBT, as proposed in the Maastricht Consensus Report, is definitely the method to use.
Self‐Care and Breast Cancer Recovery
Authors: Seegers Cathy , Walker B. Lee , Nail Lillian M. , Schwartz Anna , Mudgett Lorrie Larsen , Stephen Sharon 
Published: March 2003

PURPOSE
: This study identified self‐care behaviors used by women during and after radiation therapy for early‐stage breast cancer.
DESCRIPTION OF STUDY
: Interviews with 23 women 7 months post‐radiation therapy for breast cancer were analyzed for descriptions of self‐care. The interviews were part of the final data collection in a longitudinal study investigating experiences post‐treatment.
RESULTS
: Self‐care behaviors reported most frequently were establishing a good support network, living life to the fullest despite illness, regulating feelings, managing stress, and taking responsibility for one's own health. Results suggest that breast cancer patients have many needs that continue to require attention post‐radiation therapy, making self‐care an important consideration throughout recovery.
CLINICAL IMPLICATIONS
: Quality of self‐care may make a significant difference to women after treatment for breast cancer. Healthcare providers can promote self‐care by encouraging patients to conserve energy, to engage in relationships, and to maintain a positive outlook and by suggesting activities that help patients cope, adapt, and manage symptoms during and after treatment.
A Review
Authors: Brown David W. , French Michael T. , Schweitzer Maurice E. , McGeary Kerry Anne , McCoy Clyde B. , Ullmann Steven G. 
Published: March 2003

PURPOSE: The authors provide a review of the economic evaluation literature of breast cancer screening and identify important trends and gaps in the literature. OVERVIEW: Healthcare resources are limited and economic evaluation plays a critical role in resource allocation, healthcare policy, and clinical decisions. Many economic evaluations of medical practice, however, are unreliable and do not use appropriate analytic techniques. Three important trends were observed. First, two economic evaluation methods are dominant. Second, a wide range of cost estimates exists across studies. Third, a lack of standardization exists across studies with regard to basic economic evaluation principles. These findings should be considered when conducting future research, analyzing economic evaluations of breast cancer screening, and developing clinical guidelines. CLINICAL IMPLICATIONS: Concerns about cost containment in healthcare make it necessary for physicians and clinical administrators to take an active role in resource allocation decisions at the clinical level. For instance, the recent debate on the proper age to begin annual mammography screening involves both resource allocation and clinical issues. Thus, it is important for physicians and clinical administrators to be familiar with the economic evaluation literature of breast cancer screening, economic evaluation methodology, and the associated shortcomings of published estimates.
Patient and Caregiver Perceptions of Cancer Pain Control
Authors: Rushton Patricia , Brown Sherry 
Published: March 2003

objectives: This study measured the perceptions of cancer patients and caregivers in Utah concerning knowledge about and adequacy of pharmacologic cancer pain control.materials and methods: A descriptive survey was sent to a stratified random sample of adult cancer patients obtained from the Utah Tumor Registry. Questionnaires asked cancer patients and caregivers about their knowledge of pain control and about perceptions of the adequacy of pharmacologic cancer pain management.results: The study had a 52% response rate (259 of 500) after two mailings. Eighty‐five percent (219 of 259) of the respondents stated that they had no cancer pain. With the first mailing, a “no pain” response was not offered as an option. When the researchers realized that this might be a possible response, a second mailing was sent, which may be the reason for the high response rate.conclusions: Cancer literature indicates that much cancer pain is not effectively controlled. The majority of the respondents of this study reported no pain. Because this result is different than that reported in the literature, it may indicate that education of healthcare providers, patients, and families can improve cancer pain management and control. It may also indicate an inability of the study to obtain data from those patients having cancer pain. This study should be repeated with a focused population of advanced stage cancer patients with types of cancer typically producing high levels of cancer pain.