bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic value of a gastroenterology consultation in irritable bowel syndrome
Authors: Ilnyckyj A. , Graff L. A. , Blanchard J. F. , Bernstein C. N. 
Published: December 2004

SummaryBackground : Functional patients comprise the largest group in gastroenterology practice. Pharmacological therapy of irritable bowel syndrome is disappointing. One treatment strategy for irritable bowel syndrome emphasizes the physician's role; the physician is promoted as the therapeutic modality.Aim : To determine the therapeutic value of the contemporary approach to irritable bowel syndrome by examining health care utilization and patient morbidity.Methods : We performed an observational study over 4 years using an administrative database and morbidity scales. Health care utilization was assessed for 2 years pre‐ and post‐intervention. Patient morbidity was assessed at baseline and 1 and 2 years post‐intervention. The participants included 70 irritable bowel syndrome patients referred by primary physicians. A structured consultation was performed, establishing a positive diagnosis of irritable bowel syndrome and providing disease conceptualization.Results : Health care utilization for gastrointestinal diagnoses increased in the year prior to the intervention and declined immediately after to baseline; psychiatric and other visits remained unchanged for 4 years. Pain was reduced but other morbidity persisted.Conclusions : A consultation itself is a therapeutic intervention in irritable bowel syndrome with regard to its impact on societal economic burden. It is associated with a durable decrease in illness‐specific health care utilization. It may not address all aspects of irritable bowel syndrome; multiple domains of morbidity demonstrated persistent distress.
Effect of treatment of Helicobacter pylori on the prevention of gastroduodenal ulcers in patients receiving long‐term NSAIDs: a double‐blind, placebo‐controlled trial
Authors: Lai K. C. , Lau C. S. , Ip W. Y. , Wong B. C. Y. , Hui W. M. , Hu W. H. C. , Wong R. W. M. , Lam S. K. 
Published: December 2004

SummaryBackground : There is controversy as to whether Helicobacter pylori and non‐steroidal anti‐inflammatory drugs interact to cause peptic ulcers.Aim : To study whether the eradication of H. pylori in patients on long‐term non‐steroidal anti‐inflammatory drug therapy prevents the development of ulcers.Methods : Patients infected with H. pylori whilst receiving long‐term non‐steroidal anti‐inflammatory drug therapy, but with no ulcers at baseline endoscopy, were randomized to receive either triple antibiotic therapy (metronidazole 300 mg, clarithromycin 250 mg and amoxicillin 500 mg, given four times daily; n = 70) or placebo (n = 70) for 2 weeks. Non‐steroidal anti‐inflammatory drugs were continued throughout the study period. Endoscopy was repeated 12 weeks after the end of treatment. The development of ulcers was compared between the two groups.Results : Endoscopy at 12 weeks revealed peptic ulcer development in five [7%; 95% confidence interval (CI), 2–16] of the patients who received triple therapy and in six (9%; 95% CI, 3–18) of those who received placebo (P = 1.00). No significant difference in the development of ulcers was found between patients with persistent H. pylori infection (7/80; 9%; 95% CI, 4–17) and those with the eradication of H. pylori (4/52; 8%; 95% CI, 2–19) (P = 1.00).Conclusions : The eradication of H. pylori in patients receiving long‐term treatment with non‐steroidal anti‐inflammatory drugs did not prevent ulcer development. However, because the rate of ulcer development was low, a study with a larger sample size is required to confirm this finding.
Bile composition in inflammatory bowel disease: ileal disease and colectomy, but not colitis, induce lithogenic bile
Authors: Pereira S. P. , Bain I. M. , Kumar D. , Dowling R. H. 
Published: December 2004

SummaryBackground : Inflammatory bowel disease is a risk factor for gall‐bladder stones, but there is controversy about the composition of these stones and whether such patients develop lithogenic bile.Methods : In 54 gallstone‐free inflammatory bowel disease patients and 13 non‐inflammatory bowel disease patients with cholesterol‐rich gallstones, we measured the biliary cholesterol saturation indices, nucleation times and bilirubin concentrations, and determined the bile acid composition and molecular species of phosphatidylcholine, in gall‐bladder bile.Results : Patients with Crohn's colitis or ulcerative colitis had less saturated bile (mean cholesterol saturation index, 0.9) and longer nucleation times (median, 21 days) than those with ileal Crohn's disease (1.5; 14 days) or those who had undergone colectomy (1.6; 5 days). In patients with ileal Crohn's disease, the mean biliary bilirubin concentration was two‐ to three‐fold higher than that in the other groups, and was associated with a decrease in the percentage of biliary deoxycholate and an increase in the percentage of ursodeoxycholate, compared with disease controls, but phosphatidylcholine species were similar.Conclusions : Patients with small bowel Crohn's disease, or who have undergone colonic resection, have supersaturated bile and an increased risk of cholesterol gallstone formation. In patients with ileal disease, the presence of high biliary bilirubin concentrations and low percentage of deoxycholic acid may also favour the formation of mixed, pigment‐rich, gallstones.
Antibiotic‐associated diarrhoea and Clostridium difficile> in the community
Authors: Beaugerie L. , Flahault A. , Barbut F. , Atlan P. , Lalande V. , Cousin P. , Cadilhac M. , Petit J.‐C. ,   FOR THE STUDY GROUP
Published: December 2004

SummaryBackground : Clostridium difficile is the main cause of nosocomial infectious diarrhoea and the causative agent of antibiotic‐associated colitis. The involvement of C. difficile infection in antibiotic‐associated diarrhoea in the community is poorly documented.Methods : We studied prospectively 266 adult out‐patients in the Paris (France) area who were prescribed a 5–10‐day course of antimicrobial chemotherapy. Stools were screened for C. difficile before and 14 days after the start of treatment by standard culture, toxigenic culture and testing for the cytopathic effect of toxin B. Patients were requested to note daily stool frequency and consistency. Diarrhoea was defined as the passage of at least three loose stools per day.Results : Forty‐six (17.5%) of the 262 assessable patients had diarrhoea during the study period. Diarrhoea was mild and self‐limited in all patients, and lasted for only 1 day in 65.6% of cases. C. difficile was isolated before and after treatment from one patient, who did not develop diarrhoea. C. difficile was detected only on day 14 in 10 patients (3.8%). The isolate was toxin producing in seven patients. Four of these seven patients had mild self‐limited diarrhoea. Toxin‐producing C. difficile was isolated significantly more frequently from patients who had diarrhoea than from those who were diarrhoea free (8.7% vs. 1.4%, P = 0.02).Conclusion : The acquisition of toxin‐producing C. difficile appears to be frequent during antimicrobial chemotherapy in the community [estimated rate of 2700 (1150–5400) cases per 100 000 exposures to antibiotics]. However, C. difficile is not the main agent of mild antibiotic‐associated diarrhoea in out‐patients.
Determination of the reduction in gastric acidity necessary to prevent pathological oesophageal reflux in patients with gastro‐oesophageal reflux disease treated with a proton pump inhibitor
Authors: Gardner J. D. , Sloan S. , Miner P. B. , Robinson M. 
Published: December 2004

SummaryBackground : In subjects with gastro‐oesophageal reflux disease treated with a gastric antisecretory agent, the extent to which gastric acidity needs to be reduced to prevent pathological oesophageal acid exposure is not known.Methods : Gastric and oesophageal pH were measured in 26 healthy subjects and in 59 subjects with gastro‐oesophageal reflux disease. In 27 of the subjects with gastro‐oesophageal reflux disease, pH was also recorded on days 1, 2 and 8 of treatment with 20 mg omeprazole and 20 mg rabeprazole in a randomized, two‐way, cross‐over fashion.Results : Receiver operating characteristic analysis was used to determine values for the integrated oesophageal acidity and time oesophageal pH≤4 that gave optimal cut‐off points for distinguishing between normal and pathological oesophageal reflux. Using these cut‐off points, we found that the probability of no pathological oesophageal reflux (Y) could be best fitted by an exponential equation, Y = a(e–bX) + c, where a, b and c are constants and X is the value of the integrated gastric acidity. There was close agreement between the predicted and observed percentages of subjects with pathological oesophageal reflux during different days of treatment.Conclusions : In subjects with gastro‐oesophageal reflux disease treated with a proton pump inhibitor, the value of the integrated gastric acidity can predict the likelihood of pathological oesophageal reflux.
The 4G/4G genotype of the 4G/5G polymorphism of the type‐1 plasminogen activator inhibitor (PAI‐1) gene is a determinant of penetrating behaviour in patients with Crohn's disease
Authors: Sans M. , Tàssies D. , PellisÉ M. , Espinosa G. , Quintó L. , Piqué J. M. , Reverter J. C. , Panés J. 
Published: December 2004

SummaryBackground : Crohn's disease is a heterogeneous disorder with polygenic inheritance.Aim : To assess the effect of the 4G/5G polymorphism of the type‐1 plasminogen activator inhibitor (PAI‐1) gene, the major inhibitor of fibrinolysis, on Crohn's disease susceptibility and phenotype.Methods : One hundred and fifty‐seven patients with Crohn's disease and 350 controls were included prospectively. Medical records were reviewed to determine changes in the Crohn's disease phenotype. The 4G/5G polymorphism was assessed by polymerase chain reaction techniques.Results : The frequencies of the 4G/4G, 4G/5G and 5G/5G genotypes were similar in patients with Crohn's disease and controls. The 4G/4G genotype (P < 0.0001; odds ratio, 4.84) and male sex (P = 0.009; odds ratio, 2.63) were independent risk factors for penetrating behaviour in Crohn's disease. Most Crohn's disease patients had a non‐penetrating phenotype at diagnosis. The probability of development of a penetrating phenotype within 5 years of diagnosis was higher in patients with the 4G/4G genotype (72% vs. 19%, P < 0.0001).Conclusions : The 4G/4G genotype of the PAI‐1 gene does not influence Crohn's disease susceptibility, but increases by five‐fold the probability of penetrating behaviour. Most patients with the 4G/4G genotype have a non‐penetrating phenotype at diagnosis, but develop a penetrating behaviour within 5 years. Genotyping the 4G/5G polymorphism may be useful for the identification of a sub‐group of patients with aggressive Crohn's disease, who might benefit from specific therapy.
Longevity of silicone and polyurethane catheters in long‐term enteral feeding via percutaneous endoscopic gastrostomy
Authors: Sartori S. , Trevisani L. , Nielsen I. , Tassinari D. , Ceccotti P. , Abbasciano V. 
Published: December 2004

SummaryBackground : As percutaneous endoscopic gastrostomy (PEG) is often used for many months or years, the longevity of the feeding tubes plays an important role in the global outcome and costs of PEG.Aim : A retrospective study to evaluate the longevity of silicone and polyurethane PEG catheters.Methods : The records of 297 patients who were fed via PEG for over 90 days were evaluated. The material of the PEG catheter, duration of follow‐up, local complications, need to remove PEG because of tube deterioration or local complications and time from PEG placement to PEG removal were recorded and compared.Results : Two hundred and twenty‐eight patients had polyurethane and 69 had silicone PEG catheters. The follow‐up ranged from 116 to 3207 days for the polyurethane group and from 98 to 1861 days for the silicone group. No differences were observed in either local complications or PEG removal because of local complications. Tube deterioration causing PEG removal occurred in 36 of the 228 polyurethane PEG catheters and in 25 of the 69 silicone PEG catheters (P = 0.0005). Tube deterioration occurred significantly earlier in the 25 silicone catheters than in the 36 polyurethane catheters. The mean time from PEG placement to PEG removal was 287 days (95% confidence interval, 239–335) for silicone tubes and 573.9 days (95% confidence interval, 425–723) for polyurethane tubes (P = 0.0024).Conclusion : Polyurethane PEG catheters seem to be more resistant to deterioration than silicone PEG catheters, and at present they should be preferred for long‐term enteral feeding via PEG.
High‐dose azathioprine in children with inflammatory bowel disease
Authors: Fuentes D. , Torrente F. , Keady S. , Thirrupathy K. , Thomson M. A. , Walker‐Smith J. A. , Murch S. H. , Heuschkel R. B. 
Published: December 2004

SummaryBackground:  Azathioprine is widely used as maintenance therapy in children with moderate to severe inflammatory bowel disease (IBD). There is no data on safety at higher doses and its impact on growth and surgical morbidity in children.Methods:  This retrospective cohort study included all children treated with azathioprine and diagnosed with IBD between 1996–2001. Outcome measures included indications for azathioprine use, adverse‐effects and reasons for treatment discontinuation. Height and weight at diagnosis, treatment onset and current follow‐up was recorded, and Z scores for height standardised for time.Results:  107 children received azathioprine at 3 mg/kg. 61% had Crohn's disease and 83% started azathioprine within 2 years of diagnosis. Only 2/107 children had to stop azathioprine because of persistent adverse effects and 16/107 required surgery. There was a trend toward better growth in a group of children with Crohn's disease following treatment with high dose azathioprine therapy (P = 0.08).Conclusions: Azathioprine is a safe and well‐tolerated maintenance therapy at 3 mg/kg for children with IBD. The prevalence of surgery and growth failure in a cohort of children with moderate to severe IBD appears less than previously reported. In children with Crohn's disease, growth velocity may be maximised by an emphasis on nutritional therapy and the use of high dose azathioprine.
The impact of gastrointestinal symptoms on health status in patients with cardiovascular disease
Authors: Laheij R. J. F. , Van Rossum L. G. M. , Krabbe P. F. M. , Jansen J. B. M. J. , Verheugt F. W. A. 
Published: December 2004

SummaryBackground : Drugs for the management of cardiovascular disease may provoke gastrointestinal discomfort and complications.Aim : To evaluate whether upper gastrointestinal symptoms affect the health status of patients with cardiovascular disease.Methods : Two weeks after discharge, 958 consecutive patients, who had been admitted to the Coronary Care Unit of the University Hospital Nijmegen between January and September 2001, were sent a questionnaire for the evaluation of gastrointestinal symptoms and health status.Results : The questionnaire was returned by 632 patients (66%), with 334 patients (53%) reporting gastrointestinal symptoms. The self‐rated health status (mean and 95% confidence interval), evaluated by visual analogue scale, was 70 (68–72) for patients without and 61 (59–63) for patients with gastrointestinal symptoms (P = 0.001). Patients with gastrointestinal symptoms reported significantly higher rates of problems with mobility (50% vs. 37%), self‐care (19% vs. 10%), usual activities (70% vs. 52%), pain/discomfort (96% vs. 38%) and anxiety/depression (41% vs. 20%) when compared with those without gastrointestinal symptoms.Conclusion : Upper gastrointestinal symptoms strongly impaired the health status of patients with cardiovascular disease.
Induction interferon and ribavirin for re‐treatment of chronic hepatitis C patients unresponsive to interferon alone
Authors: Sievert W. , Batey R. , Mollison L. , Pianko S. , Mcdonald J. , Marinos G. , Reed W. , Warner S. , Bowden S. , De Solom R. , Bhathal P. ,   FOR THE AUSHEP INVESTIGATORS
Published: December 2004

SummaryBackground : The optimal treatment for hepatitis C patients unresponsive to interferon is unclear. High‐dose induction interferon may enhance early viral clearance, whilst ribavirin reduces relapse; in combination, they may improve sustained virological response rates.Aim : To compare the efficacy and safety of re‐treatment with interferon induction, with or without ribavirin, in interferon non‐responders.Methods : We randomized 218 biochemical interferon non‐responders to 10 MU interferon α2b daily for 4 weeks, followed by 5 MU thrice weekly for 48 weeks plus ribavirin (II + R), or to the same interferon regimen plus placebo (II + P). All patients were viraemic at entry.Results : The sustained virological response in the II + R group was 39%[95% confidence interval (CI), 30–48%], compared with 16% (95% CI, 9–23%) in the II + P group (P < 0.002). The study drug was discontinued for intolerable symptoms during induction in 9% of the II + R group and in 5% of the II + P group. By logistic regression, a sustained virological response was more likely following II + R treatment (odds ratio, 4.4; 95% CI, 2.1–9.7) and less likely in patients with genotype 1 or 4 (odds ratio, 0.16; 95% CI, 0.07–0.36).Conclusion : High‐dose induction interferon plus ribavirin is well tolerated and effective for patients unresponsive to interferon alone.
Impact of moderate alcohol consumption on histological activity and fibrosis in patients with chronic hepatitis C, and specific influence of steatosis: a prospective study
Authors: HÉzode C. , Lonjon I. , Roudot‐Thoraval F. , Pawlotsky J.‐M. , Zafrani E.‐S. , Dhumeaux D. 
Published: December 2004

SummaryAim : To evaluate the effects of minimal to moderate alcohol consumption on the severity of histological lesions in patients with chronic hepatitis C.Methods : Daily alcohol intake (none, 1–20, 21–30, 31–50 g/day) and histological activity and fibrosis were recorded in 260 patients with chronic hepatitis C.Results : The proportion of patients with moderate (A2) or marked (A3) activity increased gradually from 53.8% in abstinent patients to 86.5% for an intake between 31 and 50 g/day (P = 0.003). In multivariate analysis, age > 40 years, alcohol intake between 31 and 50 g/day and moderate or severe steatosis were independently related to histological activity. The proportion of patients with moderate (F2) or marked (F3) fibrosis or cirrhosis (F4) gradually increased from 29.0% in abstinent patients to 67.6% for an intake between 31 and 50 g/day (P < 0.001). Multivariate analysis also showed that alcohol intake between 31 and 50 g/day, moderate or severe steatosis and histological activity were independently related to fibrosis. The deleterious effect of alcohol intake on histological lesions differed according to gender.Conclusions : This study demonstrates that both activity and fibrosis gradually increase according to the amount of alcohol ingested, and that even moderate alcohol consumption, as low as 31–50 g/day in men and 21–50 g/day in women, may aggravate histological lesions in patients with chronic hepatitis C.
Reflux symptoms in general practice: diagnostic evaluation of the Carlsson–Dent gastro‐oesophageal reflux disease questionnaire
Authors: Numans M. E. , De Wit N. J. 
Published: December 2004

SummaryBackground : Amongst primary care patients with dyspeptic symptoms, those with reflux‐like symptoms or gastro‐oesophageal reflux disease are expected to benefit most from empirical proton pump inhibitor therapy. Recognition of this patient group, however, is difficult. The Carlsson–Dent gastro‐oesophageal reflux disease questionnaire was developed to justify the selection of primary care patients for empirical proton pump inhibitor treatment.Aim : To evaluate the diagnostic test characteristics of the Carlsson–Dent questionnaire in a primary care population.Methods : A prospective, open‐label, multi‐centre diagnostic prevalence study was conducted amongst primary care adults with reflux symptoms. All patients completed the questionnaire and underwent gastroscopy. If no abnormalities were found, the patients were prescribed 2 weeks of treatment with omeprazole (20 mg daily). Receiver operating characteristic curve analysis was used to determine the overall discriminative value of the questionnaire. Diagnostic test characteristics of both the cut‐off score (total diagnostic score) in the questionnaire and the physician's provisional classification were measured using oesophagitis and omeprazole treatment success as the reference tests.Results : Of the 536 patients included, 515 underwent endoscopy. No abnormalities were found in 286 (55%). Omeprazole treatment success occurred more frequently in patients with a total diagnostic score of > 7 and oesophagitis II–IV in patients with a total diagnostic score of > 9. The diagnostic test characteristics of the questionnaire were comparable with those of the physician's provisional classification. The area under the receiver operating characteristic curve did not exceed 0.65. Kappa values for observer agreement with the gold standard were far below 0.4.Conclusion : The diagnostic performance of this version of the Carlsson–Dent questionnaire was poor. It equalled the physician's clinical judgement and therefore its value for clinical use is limited.
A summary of Food and Drug Administration‐reported adverse events and drug interactions occurring during therapy with omeprazole, lansoprazole and pantoprazole
Authors: Labenz J. , Petersen K. U. , Rösch W. , Koelz H. R. 
Published: December 2004

SummaryBackground : Pantoprazole is claimed to have a lower potential for drug interaction than other proton pump inhibitors.Aim : To estimate the frequency of adverse events and drug interactions reported to the Food and Drug Administration in patients receiving omeprazole, lansoprazole or pantoprazole.Methods : The study involved a search of the Food and Drug Administration's database for adverse events and drug interactions with omeprazole, lansoprazole or pantoprazole as primary or secondary suspect drug. An estimate of the amount of drug dispensed during the adverse event collection period (from US drug launch) was obtained from the International Medical Statistics health database.Results : Of the suspected drug interactions recorded, vitamin K antagonist interactions, although rare, were the most common. The frequency of vitamin K antagonist interactions was 0.09 per million packages for omeprazole and 0.11 per million packages for lansoprazole and pantoprazole. Interactions with benzodiazepines or phenytoin were even rarer, being reported in less than 10 patients on each proton pump inhibitor.Conclusion  The frequency of reported drug interactions was low for omeprazole, lansoprazole and pantoprazole and vitamin K antagonist interactions were by far the most common. These potentially important drug interactions, although rare, were no less frequent on pantoprazole than on omeprazole or lansoprazole, suggesting a class effect.