bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of alverine citrate on cat intestinal mechanoreceptor responses to chemical and mechanical stimuli
Authors: ABYSIQUE  , LUCCHINI  , ORSONI  , MEI  , BOUVIER  
Published: March 2003

Background:Alverine citrate is commonly used in the treatment of painful affections of the colon.Aim:To determine whether alverine citrate acts on the vagal sensory endings.Methods:Unitary recordings were performed at the level of the vagal fibres in the nodose ganglion of anaesthetized cats using extracellular glass microelectrodes, and the patterns of response to chemical and mechanical stimuli applied to identified vagal intestinal mechanoreceptors were studied.Results:The intestinal mechanoreceptors located at the endings of type C vagal fibres responded mainly to mechanical stimuli (distension and contraction), but also responded to chemical substances (cholecystokinin and substance P). The most conspicuous effect of alverine (2 mg/kg) was that it significantly inhibited the pattern of vagal activity produced in response to either cholecystokinin (5–10 μg/kg), substance P (5–10 μg/kg) or phenylbiguanide (5–10 μg/kg), a 5‐HT3 receptor agonist. On the other hand, the unitary vagal response to the mechanical distension was slightly enhanced by alverine, as was any spontaneous activity present.Conclusions:Based on the present data, alverine citrate can be said to decrease the sensitivity of the intestinal mechanoreceptors, which is consistent with its previously established anti‐spasmodic effects.
The importance of clarithromycin dose in the management of Helicobacter pylori infection: a meta‐analysis of triple therapies with a proton pump inhibitor, clarithromycin and amoxycillin or metronidazole
Authors: Huang J.‐Q. , Hunt R. H. 
Published: March 2003

Background: It is not clear which dose of clarithromycin (500 mg b.d. or 250 mg b.d.) is more effective for Helicobacter pylori eradication in proton pump inhibitor‐based triple therapies.Methods: We undertook a meta‐analysis of the effect of 7‐day triple therapies consisting of a proton pump inhibitor (P), and clarithromycin (C) and amoxycillin (A) or metronidazole (M). A meta‐analysis of all clinical trials performed in an adult population and published in English up to March 1998 was undertaken. Studies with doses of clarithromycin 500 mg b.d. or 250 mg b.d. only were included.Results: A total of 82 studies (31 papers and 51 abstracts) involving 110 treatment arms and 6123 patients were analysed that met the predetermined inclusion and exclusion criteria. In the PAC combination, the pooled eradication rate in patients treated with clarithromycin 500 mg b.d. was 89.5% (95% CI: 86.9–92.0%) by per protocol analysis and 86.6% (95% CI: 81.0–89.3%) by intention‐to‐treat analysis. These rates are significantly higher than those achieved with clarithromycin 250 mg b.d. (83.3% by per protocol and 78.2% by intention‐to‐treat analysis, both P < 0.0001). This difference was confirmed in head‐to‐head comparative studies. In the PMC regimen, clarithromycin 500 mg b.d. eradicated 90.8% (95% CI: 87.0–94.5%) of the infections compared to 88.5% (95% CI: 85.5–91.5%) in patients treated with clarithromycin 250 mg b.d. by per protocol analysis (P = 0.082). The corresponding rates by intention‐to‐treat analysis for clarithromycin 500 mg b.d. and 250 mg b.d. was 88.3% and 86.7%, respectively (P = 0.259).Conclusions: Seven‐day triple therapies with a proton pump inhibitor, clarithromycin and amoxycillin or metronidazole are highly effective treatments for the eradication of H. pylori. Clarithromycin 500 mg b.d. should be used in these combinations to achieve the best first treatment results, which can minimize the subsequent development of bacterial resistance to clarithromycin and metronidazole.
Effects of ranitidine bismuth citrate on Helicobacter pylori motility, morphology and survival
Authors: Worku M. L. , Sidebotham R. L. , Karim Q. N. 
Published: March 2003

Aim: The effects of the anti‐ulcer agents ranitidine bismuth citrate (RBC), ranitidine hydrochloride (R) and colloidal bismuth citrate (BC), on Helicobacter pylori motility, morphology and survival were examined to determine whether the clinical effectiveness of RBC might be linked to a specific action that inhibits bacterial motility.Methods: H. pylori from patients with duodenal ulcer or non‐ulcer dyspepsia were exposed to RBC and BC at bismuth concentrations ranging from 12.5 to 50 μg/mL, and R at ranitidine concentrations ranging from 12.5 to 50 μg/mL for a brief period (< 15 min), 6 h and 24 h. Bacterial motility was assessed with a Hobson BacTracker, bacterial morphology by transmission electron microscopy, and growth inhibition by counting colony‐forming units.Results: H. pylori motility was diminished with RBC and BC but not R. However, the effect of RBC was markedly greater than that of BC at each bismuth concentration and time of exposure tested: (i) brief exposure to RBC/bismuth 50 μg/mL but not to BC, resulted in a significant loss of motility without loss of viability or change in cell morphology, and (ii) bacteria were immobilized, and lost viability after exposure to RBC/bismuth 50 μg/mL for 24 h but not to BC. Morphological destruction caused by RBC differed from that by BC: after 24 h exposure to the highest concentration tested, cell fragmentation and flagella detachment occurred more frequently with BC than RBC, but the latter produced greater disruption of intracellular structures.Conclusions: RBC suppresses growth of H. pylori, and has a specific inhibitory effect on the bacterial motor mechanism. These pharmacological actions are likely to contribute to the clinical effectiveness of the agent.
Two‐week dual vs. one‐week triple therapy for cure ofHelicobacter pyloriinfection in primary care: a multicentre, randomized trial
Authors: Calvet X. , López‐Lorente M. ‐T. , Cubells M.‐J , Barè M , Gálvez E. , Molina E. ,   for the Sabadell Primary Care Study Group
Published: March 2003

Background: One‐week triple therapy has been suggested to be superior to two‐week omeprazole‐clarithromycin therapy for the cure ofHelicobacter pyloriinfection. However, direct comparisons of the two treatments are scarce.Aim: To compare triple with dual therapy forH. pyloriinfection in the primary care setting.Methods: One hundred and forty‐five patients with duodenal ulcer andH. pyloriinfection were randomized to receive omeprazole 20 mg b.d. and clarithromycin 500 mg t.d.s. for 14 days (OC14 group, 69 patients) or omeprazole 20 mg b.d., clarithromycin 500 mg b.d. and amoxycillin 1 g b.d. for 7 days (OCA7 group, 76 patients). Eradication was evaluated by the13C‐urea breath‐test.Results: Intention‐to‐treat analysis showed a cure rate of 48% (95% CI: 36–60%) in the OC14 group, and 71% (95% CI: 59–80%) in the OCA7 group (P=0.0004). Per protocol analysis showed cure rates of 51% (95% CI: 38–63%, 33/65 patients) and 82% (95% CI: 70–90%, 54/66 patients), respectively (P=0.0001). There were no significant differences in compliance or side‐effects.Conclusion: One‐week twice‐daily triple therapy is superior to 2‐week dual therapy, but the cure rate in primary care was far below 90%.
Post‐prandial ranitidine is superior to post‐prandial omeprazole in control of gastric acidity in healthy volunteers
Authors: Khoury  , Katz  , Castell  
Published: March 2003

Background: Episodic heartburn is a common problem, affecting over 40 million Americans. Although omeprazole provides excellent acid suppression when used daily, the use of omeprazole as on‐demand therapy for episodic symptoms has not been extensively studied.Aim: To compare the onset and duration of post‐prandial gastric acid suppression by omeprazole (10 and 20 mg) or ranitidine (75 and 150 mg) taken as single doses in healthy volunteers.Methods: Twenty‐four healthy volunteers (14 male, 10 female, mean age 33.4 years, range 18–56 years) were given ranitidine (RAN) 75 mg or 150 mg vs. omeprazole (OME) 10 mg or 20 mg when pH returned to below 2 after breakfast, in a randomized open label crossover design, with a washout of at least 2 days between medications. Intragastric pH was monitored for 6 h. The time between drug ingestion and rise of gastric pH > 3 and 4, and total time pH remained > 3 and 4 during the 6 h post drug, was compared between groups using two way ANOVA and Wilcoxon matched pairs test.Results: The median time needed to pH > 4 was 204.5 min for RAN 75 mg, 186 min for RAN 150 mg and > 360 min for both OME 10 and 20 mg (P < 0.001 between the four groups). The median time that pH remained > 4 was 93 min for RAN 75 mg, 143.5 min for RAN 150 mg and 0 min for both OME 10 and 20 mg (P < 0.001 between the four groups). Both doses of RAN were significantly superior to both doses of OME, although no significant difference was found between the high and the low doses of either drugs. Similar results were found for pH > 3.Conclusion: Ranitidine 75 or 150 mg provides more rapid increase in gastric pH to > 3 and > 4 compared to omeprazole 10 or 20 mg when taken at the end of the post‐prandial period. These data suggest that ranitidine may be more effective for episodic post‐prandial heartburn than omeprazole.
Economic analysis of step‐wise treatment of gastro‐oesophageal reflux disease
Authors: Sonnenberg  , Inadomi  , Becker  
Published: March 2003

Background: To expose patients with gastro‐oesophageal reflux disease (GERD) to the least amount of medication and to reduce health expenditures, it is recommended that their treatment is started with a small dose of an antisecretory or prokinetic medication. If patients fail to respond, the dose is increased in several consecutive steps or the initial regimen is changed to a more potent medication until the patients become asymptomatic. Although such treatment strategy is widely recommended, its impact on health expenditures has not been evaluated.Methods: The economic analysis compares the medication costs of competing medical treatment strategies, using two different sets of cost data. Medication costs are estimated from the average wholesale prices (AWP) and from the lowest discount prices charged to governmental health institutions. A decision tree is used to model the step‐wise treatment of GERD. In a Monte Carlo simulation, all transition probabilities built into the model are varied over a wide range. A threshold analysis evaluates the relationship between the cost of an individual medication and its therapeutic success rate.Results: In a governmental health care system, a step‐wise strategy saves on average $916 per patient every 5 years (range: $443–$1628) in comparison with a strategy utilizing only the most potent medication. In a cost environment relying on AWP, the average savings amount to $256 (–$206 to +$1561). The smaller the cost difference between two consecutive treatment steps, the longer one needs to follow the patients to reap the benefit of the small cost difference. However, even a small cost difference can turn into tangible cost savings, if a large enough fraction of GERD patients responds to the initial step of a less potent but also less expensive medication.Conclusions: The economic analysis suggests that a step‐wise utilization of increasingly more potent and more expensive medications to treat GERD would result in appreciable cost savings.
Interferon alfa‐2b alone or in combination with ketoprofen as treatment for interferon‐naive chronic hepatitis C patients
Authors: Fabris  , Tositti  , Negro  , Marranconi  , Infantolino  , Rassu  , De Lalla  
Published: March 2003

Background: Non‐steroidal anti‐inflammatory drugs may amplify the anti‐viral effect of α‐interferon in vitro but in vivo data are still controversial.Aim: To test the hypothesis that ketoprofen may increase the rate of response to α‐interferon of chronic hepatitis C patients.Methods: Fifty patients with chronic hepatitis C who had never received α‐interferon were randomly assigned to receive 3–8 MU of α2b‐interferon, three times weekly for 6 months, alone or in association with ketoprofen at a dose of 200 mg/day five times weekly. The virological response to treatment (undetectable HCV RNA in serum) was evaluated after 3 months and at the end of treatment, and 6 and 12 months after therapy withdrawal.Results: One patient under combination therapy stopped the ketoprofen for persisting epigastric pain. Complete response under treatment was observed in 15 out of 24 (62.5%) patients receiving α2b‐interferon alone and in 14 out of 26 (53.8%) patients under combination therapy (P=N.S.). One year after the end of treatment, a sustained response was seen in 4 out of 24 (16.2%) patients treated with α2b‐interferon and in 5 out of 26 (19.2%) patients having received the combination (P=N.S.).Conclusion: Administration of ketoprofen does not increase either the primary or the sustained response to α2b‐interferon therapy of interferon‐naive chronic hepatitis C patients.
The effect of Helicobacter pylori eradication therapy on gastric antral myoelectrical activity and gastric emptying in patients with non‐ulcer dyspepsia
Authors: Miyaji  , Azuma  , Ito  , Abe  , Ono  , Suto  , Ito  , Yamazaki  , Kohli  , Kuriyama  
Published: March 2003

Background: Dysmotility of the gastroduodenal region and delayed gastric emptying have been considered to play roles in non‐ulcer dyspepsia (NUD). Helicobacter pylori‐induced inflammation of the gastric mucosa may affect gastric motility.Aim: To evaluate the effects of H. pylori eradication therapy on gastrointestinal motility and symptoms in NUD patients.Methods: Forty‐six NUD patients were examined for gastric emptying, antral myoelectrical activity, H. pylori infection, and symptom scores. In H. pylori‐positive NUD patients, gastric emptying, antral myoelectrical activity, and symptom scores were also analysed 2 months after cure of H. pylori infection.Results: Sixty‐seven per cent of NUD patients were H. pylori‐positive. Both abnormal gastric emptying and antral myoelectrical activity were observed in NUD patients. H. pylori‐positive NUD patients were divided into three groups according to their gastric emptying: the delayed group, the normal group, and the rapid group. In the delayed and rapid gastric emptying groups, the emptying and symptom scores were improved significantly by eradication. There was no improvement in symptom scores in the normal gastric emptying NUD group by the eradication therapy.Conclusions: Disturbed gastric emptying and antral myoelectrical activity play roles in NUD. H. pylori‐induced disturbed gastric emptying may cause some NUD symptoms. Gastric emptying and symptom scores are improved by H. pylori eradication therapy in NUD patients with disturbed gastric emptying; H. pylori eradication therapy is effective in H. pylori‐positive NUD patients with disturbed gastric emptying.
Management of Helicobacter pylori‐related gastrointestinal diseases by general practitioners in Italy
Authors: Maconi  , Tosetti  , Miroglio  , Parente  , Colombo  , Sainaghi  , Bianchi Porro  
Published: March 2003

Aims: To investigate the diagnostic approach to and management of Helicobacter pylori infection at primary care level in Italy 2 years after the Maastricht consensus report.Methods: A total of 100 randomly selected general practitioners (GPs) answered a 12‐item multiple‐choice questionnaire, personally delivered and collected by non‐medical staff.Results: In 25% of cases, GPs preferred a prompt referral of dyspeptic patients to the specialist. The favourite diagnostic test for H. pylori infection was gastroscopy with biopsies (55%), followed by standard and office‐based serology (24% and 18%, respectively), and 13C urea breath test (5%). H. pylori‐eradication was prescribed in patients with peptic ulcer, reflux oesophagitis and functional dyspepsia by 64%, 43% and 66% of GPs, respectively. Only 7% of GPs adopted a test‐and‐treat approach. Proton pump inhibitor‐based triple therapies were used by almost all physicians. In peptic ulcer disease, most of GPs re‐tested patients in order to confirm H. pylori eradication (50% by gastroscopy with biopsies and 30% by serology only 2 months after therapy).Conclusions: Uncertainty seems to persist among Italian GPs concerning the indications for H. pylori treatment, the use of diagnostic tests, and patient follow‐up. In contrast, no doubts exist regarding the first choice eradication regimens. This survey suggests that further efforts should be made to spread scientific knowledge and guidelines on H. pylori diagnosis and management in primary care in Italy.
Onset of action during on‐demand treatment with Maalox suspension or low‐dose ranitidine for heartburn
Authors: Faaij  , Van Gerven  , Jolivet‐Landreau  , Masclee  , Vendrig  , Schoemaker  , Jacobs  , Cohen  
Published: March 2003

Aim:To compare the onset of action of the local antacid Maalox and the systemic H2‐antagonist ranitidine, during ‘on demand’ ambulant treatment of a single heartburn episode, using a randomized, parallel group, double‐blind, double‐dummy design.Methods:Subjects with self‐perceived heartburn without known gastrointestinal disease or interfering treatments were selected with questionnaires. The study was performed unsupervised, whenever heartburn required medication. An electronic patient diary gave instructions when to take study medication, and provided visual analogue scales and five‐item relief ratings for heartburn, at frequent time intervals activated by an alarm‐clock.Results:After a study of the natural history of heartburn and the feasibility of the study procedures in 23 patients, 49 subjects took Maalox and 45 ranitidine. Half of these experienced meaningful heartburn relief within 19 min after Maalox, and within 70 min after ranitidine. One hour after intake, the average heartburn relief score was 3.43 in the Maalox group and 3.04 in the ranitidine group (3 means ‘slight improvement’ and 4 ‘strong improvement’). Heartburn was similar in both groups after 3 h.Conclusions:Maalox provides faster relief of heartburn than ranitidine. Heartburn can be assessed frequently and reliably under ambulant conditions using an electronic patient diary.
Furazolidone combination therapies for Helicobacter pylori infection in the United States
Authors: Graham  , Osato  , Hoffman  , Opekun  , Anderson  , El‐Zimaity  
Published: March 2003

Background:Antibiotic resistance has begun to impair the ability to cure Helicobacter pylori infection.Aim:To evaluate furazolidone as a component of combination therapies for treatment of H. pylori infection in the United States.Methods:Patients with active H. pylori infection received furazolidone combination therapy for 14 days (furazolidone 100 mg and tetracycline 500 mg t.d.s.; omeprazole 20 mg o.d. in the morning and, depending on the pre‐treatment antimicrobial susceptibility pattern, 500 mg of metronidazole or clarithromycin t.d.s.).Results:A total of 27 patients received the metronidazole containing combination (cure rate 100%) and seven received the clarithromycin combination (cure rate 86%). Overall the cure rates for intention‐to‐treat was 97% (95% CI: 85% to 100%). The single failure took the clarithromycin containing combination for only 2 days (per protocol cure rate = 100%). Side‐effects were common and led to discontinuation of therapy in 26% of patients. An attempt to eliminate metronidazole and clarithromycin and use furazolidone, tetracycline, and lansoprazole b.d. produced an unsatisfactory cure rate of 72%.Conclusion:Furazolidone combination therapy appears to be effective. Additional studies with different antimicrobial combinations and duration of therapy are warranted.
Efficacy of a multistep strategy for Helicobacter pylori eradication
Authors: Gasbarrini  , Ojetti  , Armuzzi  , Branca  , Canducci  , Torre E. Sanz , Candelli  , Pastorelli  , Anti  , Fedeli  , Fadda  , Pola  , Gasbarrini  
Published: March 2003

Background: Helicobacter pylori eradication therapies do not achieve 100% success rates. Antibiotic resistant strains are among the major causes of failure. Current recommendations concerning the management of treatment failures are not fully clear.Aim:To evaluate the efficacy of a multi‐step therapeutic strategy in a large group of infected patients.Methods:A total of 2606 H. pylori‐positive patients were administered tinidazole, clarithromycin and a proton pump inhibitor for 1 week. Patients with continuing infection were then given a second 1‐week course of amoxycillin, clarithromycin and ranitidine bismuth citrate. Patients still infected after the second course underwent upper gastrointestinal endoscopy with H. pylori culture, and then received a 1‐week quadruple proton pump inhibitor‐bismuth based scheme established on H. pylori antibiotic sensitivity.Results:After the first step, eradication was achieved in 2063 out of 2413 patients [86% per protocol analysis (PP); 79% intention‐to‐treat analysis (ITT)]. First‐step failures (350 out of 2413; 14.5% PP) showed second‐step eradication rates of 82% (271 out of 329 patients, PP; 77% ITT). The specific quadruple therapy for second‐step failures (58 out of 329, 18% PP) achieved 77% (30 out of 39 patients, PP) or 52% (ITT) success. This algorithm led to overall eradication rates of 99% (PP) or 91% (ITT).Conclusions:This multi‐step strategy succeeded in a high percentage of H. pylori infected patients. Given the lack of precise guidelines on treatment failures, assessing H. pylori sensitivity to antibiotics only after failure of the second treatment could be suggested in clinical practice.
A meta‐analysis of short versus long therapy with a proton pump inhibitor, clarithromycin and either metronidazole or amoxycillin for treating Helicobacter pylori infection
Authors: Calvet  , García  , López  , Gisbert  , Gené  , Roque  
Published: March 2003

Background:Although triple therapies with a proton pump inhibitor, clarithromycin and either amoxycillin or metronidazole are the most widely accepted treatment for Helicobacter pylori infection, there is no consensus on how long treatment should be maintained for.Aim:To evaluate whether increasing the length of triple therapies beyond 7 days improves treatment efficacy.Methods:An extensive search of the literature was performed. Reports of randomized trials comparing different lengths of therapy were selected. Short (7‐day) vs. long (10/14‐day) therapies were compared, and three‐way comparison of 7‐day vs. 10‐day, 10‐day vs. 14‐day and 7‐day vs. 14‐day therapies was performed. Meta‐analysis was conducted using conventional shareware (Review Manager 4.0). The Peto Odds Ratio using a fixed model analysis was calculated for each comparison.Results:Thirteen studies were identified. Pooled 10‐ to 14‐day therapies achieved better results than 7‐day schedules. In head‐to‐head comparisons, only 14‐day therapies were significantly better than 7‐day treatments. Improvement in cure rates ranged from 7 to 9%. Comparisons of 7‐day vs. 10‐day and 10‐day vs. 14‐day also showed a non‐significant trend towards better cure rates with longer therapies.Conclusions:Fourteen‐day, proton pump inhibitor‐based triple therapy achieves better results than 7‐day schedules. Additional data are necessary to evaluate 10‐day therapies.