bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of 5‐HT3 antagonism on postprandial gastric volume and symptoms in humans
Authors: Kuo B. , Camilleri M. , Burton D. , Viramontes B. , McKinzie S. , Thomforde G. , O'Connor M. K. , Brinkmann B. H. 
Published: March 2003

Background:Alosetron reduces symptoms of dyspepsia, but the physiological basis for the symptomatic benefit is unclear.Aim:To assess 5‐HT3 antagonism on postprandial gastric volume and symptoms after ingestion of maximum tolerable volume of a liquid meal.Methods:In 36 healthy volunteers, we assessed effects of placebo, 0.5 and 1 mg b.d. alosetron on fasting and postprandial gastric volumes (using single photon emission computed tomography) and symptoms based on 100 mm VAS, 30 min after maximum volume ingested.Results:The 5‐HT3 antagonist reduced postprandial symptoms (aggregate score: P < 0.05), nausea (P < 0.001), and tended to reduce bloating (P=0.08). Both 0.5 and 1 mg alosetron reduced nausea (P < 0.025); 1 mg alosetron reduced aggregate symptoms (P < 0.05) and bloating (P < 0.05). Effects on pain (P=0.19) and fullness (P=0.14) were not statistically significant. There were no significant effects of the 5‐HT3 antagonist on volume of meal tolerated or on SPECT‐measured fasting or postprandial gastric volumes.Conclusion:5‐HT3 antagonism reduces aggregate symptoms, nausea and bloating after a liquid meal without increase in gastric volumes, suggesting a role for 5‐HT3 in afferent functions in healthy humans during the postprandial period.
Serum pepsinogen and gastrin levels in HIV‐positive patients: relationship with CD4+ cell count and Helicobacter pylori infection
Authors: Fabris P. , Pilotto A. , Bozzola L. , Tositti G. , Soffiati G. , Manfrin V. , De Lalla F. 
Published: March 2003

Background:The relationship between serum parameters of gastric function and Helicobacter pylori infection in human immunodeficiency virus (HIV)‐positive patients is almost unknown.Aims:To investigate in HIV‐infected patients: (i) the relationship between serum gastrin and serum pepsinogens over the progressive phases of HIV‐related disease; (ii) the impact of H. pylori infection on gastrin and pepsinogen serum levels and its relation to antral histology; (iii) the prevalence of parietal cell autoantibodies.Methods:Fifty‐nine HIV‐positive patients were studied by upper endoscopy plus gastric antral biopsy. Serum samples were tested for gastrin, pepsinogen A, pepsinogen C and parietal cell autoantibodies.Results:In patients without overt acquired immunodeficiency syndrome (AIDS), or with a CD4+ count of > 100 × 106 cells/L, mean serum levels of gastrin and pepsinogen C were higher than in subjects with AIDS or with a CD4+ count of < 100 × 106 cells/L (P < 0.01). Only one patient was found to be positive for parietal cell autoantibodies. H. pylori infection was associated with increased values of gastrin and pepsinogen C only in HIV‐positive patients without AIDS or with a CD4+ count of > 100 × 106 cells/L. Atrophy was more frequent in patients with overt AIDS than in those without overt AIDS (57% vs. 33%, P=N.S.), and/or in patients with a CD4+ count of < 100 × 106 cells/L than in those with a CD4+ count of > 100 × 106 cells/L (62% vs. 26%, P < 0.05).Conclusions:HIV‐positive patients without overt AIDS have increased serum levels of gastrin and pepsinogen C compared with HIV‐positive patients with overt AIDS.
Ranitidine, 75 mg, over‐the‐counter dose: pharmacokinetic and pharmacodynamic effects in children with symptoms of gastro‐oesophageal reflux
Authors: Orenstein S. R. , Blumer J. L. , Faessel H. M. , McGuire J. A. , Fung K. , Li B. U. K. , Lavine J. E. , Grunow J. E. , Treem W. R. , Ciociola A. A. 
Published: March 2003

Background:The use of over‐the‐counter antacids has increased in children under the age of 12 years, and has been followed by an apparent increase in the use of over‐the‐counter histamine‐2 receptor antagonists. However, the pharmacokinetic and pharmacodynamic effects of over‐the‐counter histamine‐2 receptor antagonists in the paediatric population are largely unknown.Aim:To evaluate the pharmacokinetics and pharmacodynamics of a single dose of the over‐the‐counter histamine‐2 receptor antagonist, ranitidine, 75 mg, in children with symptoms of gastro‐oesophageal reflux disease.Methods:Children aged between 4 and 11 years with symptoms of heartburn suspected to be due to gastro‐oesophageal reflux disease were recruited at six clinical centres. Following a single dose of either oral ranitidine, 75 mg (n=19), or placebo (n=10), recording of intragastric pH and serial blood sampling were carried out for 6 h.Results:The estimated pharmacokinetic parameters of ranitidine, 75 mg, were as follows: the median Cmax value of 477 ng/mL occurred within a median of 2.5 h after dosing, and the median half‐life was 2.0 h. The intragastric pH began to rise approximately 30 min after dosing with ranitidine to a peak of pH ˜ 4. The pH in the ranitidine group remained higher than that in the placebo group throughout the 6‐h evaluation period. Adverse events were generally mild.Conclusions:Ranitidine, 75 mg, significantly increased the intragastric pH in children aged 4–11 years. The pharmacokinetic and pharmacodynamic profiles were similar to those in adults. Ranitidine, 75 mg, appears to be effective for the control of intragastric acidity for 5–6 h in children aged 4–11 years.
Extra‐intestinal manifestations associated with irritable bowel syndrome: a twin study
Authors: Svedberg P. , Johansson S. , Wallander M.‐A. , Hamelin B. , Pedersen N. L. 
Published: March 2003

Background:Little is known about the role of genetic and environmental factors in irritable bowel syndrome. Various extra‐intestinal manifestations are more prevalent in cases than in controls. Genetic effects may be important in the liability to develop functional bowel disorders.Aims:To evaluate the associations of irritable bowel syndrome with several disorders co‐morbid with the condition, using both a case–control design and a co‐twin control design.Methods:A sample of 850 Swedish twin pairs, aged 18–85 years, was contacted for a telephone interview. Through a diagnostic algorithm, 72 unrelated cases of irritable bowel syndrome and 216 age‐ and gender‐matched controls were identified. Fifty‐eight twin pairs discordant for irritable bowel syndrome were evaluated in co‐twin analyses.Results:Renal problems (odds ratio (OR)=3.3; confidence interval (CI), 1.3–8.2), obesity (OR=2.6; CI, 1.0–6.4), underweight in the past (OR=2.4; CI, 1.1–6.4), gluten intolerance (OR=9.0; CI, 1.4–60.1), rheumatoid arthritis (OR=3.2; CI, 1.1–9.4) and poor self‐rated health (OR=1.8; CI, 1.0–3.2) were significantly associated with irritable bowel syndrome. In the co‐twin analyses, the only factors maintaining significance were renal and recurrent urinary tract problems.Conclusions:The association between irritable bowel syndrome and renal and urinary tract problems does not reflect a genetic or familial mediation. Eating disorders in childhood represent a familial–environmental influence on irritable bowel syndrome, whereas the association with rheumatoid arthritis and perhaps gluten intolerance probably reflects genetic mediation.
Peptic ulceration in general practice in England and Wales 1994–98: period prevalence and drug management
Authors: Kang J.‐Y. , Tinto A. , Higham J. , Majeed A. 
Published: March 2003

Background:Little is known about the burden of peptic ulcer in the community.Aims:To examine recent time trends in the period prevalence of peptic ulceration and its drug management, in England and Wales.Methods:For each year between 1994 and 1998, information on patients with a diagnosis of peptic ulceration was extracted from the General Practice Research Database.Results:The annual age‐standardized period prevalence of peptic ulceration decreased from 3.3/1000 in 1994 to 1.5/1000 in 1998 for men, and from 1.8/1000 to 0.9/1000 for women. This decline was more evident among younger people, and among males registered with practices located in the most deprived electoral wards compared to those located in the least deprived. The proportion of patients receiving H2 receptor antagonists declined from 68% in 1994 to 41% in 1998. In contrast, the proportion prescribed proton pump inhibitors rose from 46% to 66%.Conclusions:Over a 5‐year period, the period prevalence of peptic ulceration has decreased markedly, especially among younger people and those from more deprived areas.
Premature discontinuation of interferon plus ribavirin for adverse effects: a multicentre survey in ‘real world’ patients with chronic hepatitis C
Authors: Gaeta G. B. , Precone D. F. , Felaco F. M. , Bruno R. , Spadaro A. , Stornaiuolo G. , Stanzione M. , Ascione T. , De Sena R. , Campanone A. , Filice G. , Piccinino F. 
Published: March 2003

SUMMARYBackground: Interferon‐α plus ribavirin therapy for chronic hepatitis C is associated with adverse effects that lead to therapy discontinuation in up to 27% of patients in randomized controlled trials.Aim: To examine the causes and predictive factors for therapy discontinuation in patients treated in current clinical practice.Methods: We retrospectively enrolled 441 consecutive patients, scheduled to receive interferon‐α + ribavirin for chronic hepatitis C, in five centres. Patients had been treated with 3 or 6 MU interferon‐α three times a week plus ribavirin, 800–1200 mg daily, for 6 or 12 months.Results: One hundred and eight [24.5%; confidence interval (CI), 20.5–28.8%] patients failed to finish combination therapy because of adverse events. The discontinuation rate was higher during the first 6 months of treatment; anaemia was an important cause (36.1% of discontinuations); unexplained lipothymia resulted in discontinuation in 11 patients. Female gender [hazard ratio (HR) = 1.85; CI, 1.17–2.92], an interferon‐α dose > 15 MU/week (HR = 1.79; CI, 1.12–2.86) and no previous interferon‐α treatment (HR = 1.63; CI, 1.04–2.57) were independent factors associated with discontinuation. The simultaneous presence of these factors identified patients at high risk for discontinuation [odds ratio (OR) = 10; CI, 3.98–25.13].Conclusions: The study identified some predictive factorsfor adverse event‐related discontinuation, which may improve the safety profile and effectiveness of interferon‐α + ribavirin combination therapy in chronic hepatitis C.
Stool antigen assay (HpSA) is less reliable than urea breath test for post‐treatment diagnosis of Helicobacter pylori infection
Authors: Bilardi C. , Biagini R. , Dulbecco P. , Iiritano E. , Gambaro C. , Mele M. R. , Borro P. , Tessieri L. , Zentilin P. , Mansi C. , Vigneri S. , Savarino V. 
Published: March 2003

SummaryBackground : The diagnostic yield of the stool antigen test (HpSA) in evaluating the results of Helicobacter pylori eradication therapy is controversial, but many studies have used only the 13C‐urea breath test (13C‐UBT) as a gold standard which has greatly reduced their relevance.Aim : To compare the reliability of HpSA and 13C‐UBT in patients post‐treatment using biopsy‐based methods as reference tests.Methods : A total of 100 consecutive dyspeptic patients (42 male and 58 female; mean age, 56 ± 18 years) were enrolled in our study. All patients were H. pylori positive on the basis of at least two biopsy‐based methods, and underwent 1 week of treatment with various triple therapies. They were again endoscoped 4 weeks after completing therapy and six biopsyspecimens were taken from the gastric antrum and corpus for rapid urease test, histology and culture. HpSA and 13C‐UBT were also performed within 3 days of the second endoscopy.Results : On the basis of biopsy‐based tests, infection was eradicated in 77 patients but continued in 23. Three false negatives were observed with HpSA and two with 13C‐UBT. In contrast, the number of false positives was significantly higher (P < 0.01) with HpSA than with 13C‐UBT (nine vs. one), confirming the lower specificity of the former test. The overall accuracy of HpSA was 88% vs. 97% for 13C‐UBT (P < 0.02).Conclusions : HpSA has lower diagnostic value than 13C‐UBT in the evaluation of the outcome of anti‐H. pylori therapy. 13C‐UBT remains the first‐line diagnostic method to monitor eradication results. The use of HpSA should be reserved for those settings in which 13C‐UBT is not available.
Acute and chronic pancreatitis — diseases on the rise: a study of hospital admissions in England 1989/90–1999/2000
Authors: Tinto A. , Lloyd D. A. J. , Kang J.‐Y. , Majeed A. , Ellis C. , Williamson R. C. N. , Maxwell J. D. 
Published: March 2003

SummaryBackground: The number of hospital admissions for acute and chronic pancreatitis increased in Britain from the 1960s to the 1980s.Aims: To determine time trends in acute and chronic pancreatitis for hospital admissions from 1989/90 to 1999/2000, mortality from 1979 to 1999, and various indices of alcohol consumption.Methods: Hospital Episode Statistics for admissions were obtained from the Department of Health and mortality data from the Office for National Statistics. Alcohol consumption data were obtained from the General Household Survey.Results: Between 1989/90 and 1999/2000, age‐standardized hospital admission rates for acute pancreatitis increased by 43%, whilst those for chronic pancreatitis rose by 100%. The proportions of admissions requiring surgical operations increased for acute pancreatitis, but declined for chronic pancreatitis. Case fatality rates for acute pancreatitis declined, but mortality statistics showed no significant change. The proportion of women who drank more than 14 units of alcohol a week also increased.Conclusions: There has been a steady increase in admission rates for both acute and chronic pancreatitis over the study period, and these conditions will become an increasingly important part of the workload of the gastroenterologist.
Haemochromatosis
Authors: Whittington C. A. , Kowdley K. V. 
Published: March 2003

SummaryHereditary haemochromatosis is the prototype disease for primary iron overload. The disorder is very common, especially amongst subjects of Northern European extraction. It is characterized by an autosomal recessive mode of inheritance, and most cases are homozygous for the C282Y mutation in the HFE gene. Haemochromatosis is now recognized to be a complex genetic disease with probable significant environmental and genetic modifying factors. The early diagnosis of individuals at risk for the development of haemochromatosis is important, because survival and morbidity are improved if phlebotomy therapy is instituted before the development of cirrhosis. The cost‐effectiveness and utility of large‐scale screening for haemochromatosis have been questioned given that many individuals with the homozygous C282Y mutation do not have iron overload or end‐organ damage. However, the use of phenotypic tests, such as serum transferrin‐iron saturation, for initial screening avoids the problem of the identification of non‐expressing homozygotes. Liver biopsy remains important in management to determine the presence or absence of cirrhosis, particularly amongst patients with serum ferritin levels greater than 1000 ng/mL or elevated liver enzymes. Those with non‐HFE haemochromatosis who cannot be identified on genotypic testing should have a liver biopsy to establish diagnosis. Patients with end‐stage liver disease may develop liver failure or primary liver cancer, and liver transplantation may be required. Liver transplantation for haemochromatosis is associated with a poorer outcome compared with other indications because of infections and cardiac complications.
An evaluation of the clinical implications of acid breakthrough in patients on proton pump inhibitor therapy
Authors: Nzeako U. C. , Murray J. A. 
Published: March 2003

SummaryBackground : Some patients with gastro‐oesophageal reflux disease continue to experience symptoms despite therapy with proton pump inhibitors. One recently proposed cause is the occurrence of nocturnal acid breakthrough.Aim : To investigate the relationship between acid breakthrough occurrence (nocturnal and daytime) and refractory symptoms among patients with gastro‐oesophageal reflux disease on proton pump inhibitors.Methods : Fifty‐two consecutive patients with persistent symptoms of gastro‐oesophageal reflux disease despite proton pump inhibitor therapy underwent 24‐h pH study at the Mayo Clinic between January 1 and November 10, 1999. Relevant data were extracted and analysed.Results : Fifty‐two patients, 18 males and 34 females, were eligible for the study. The mean age was 53 ± 2.2 years. Thirty‐seven patients (71%) had nocturnal acid breakthrough, and 36 (69%) had daytime acid breakthrough. Sixty per cent of patients experienced both nocturnal and daytime acid breakthrough, whereas 19% had neither. Among those with nocturnal and daytime acid breakthrough, only 36% and 33% of symptoms, respectively, were associated with gastro‐oesophageal reflux episodes. The proportion of patients with symptoms and the mean symptom scores were not significantly different between those with and without acid breakthrough.Conclusions : Gastric acid breakthrough occurs nocturnally and during the daytime in patients on proton pump inhibitor therapy. With less than 36% of refractory symptoms associated with gastro‐oesophageal reflux, gastric acid breakthrough cannot explain symptom refractoriness to proton pump inhibitor therapy in a significant majority of patients evaluated by 24‐h pH study.
Baclofen decreases acid and non‐acid post‐prandial gastro‐oesophageal reflux measured by combined multichannel intraluminal impedance and pH
Authors: Vela M. F. , Tutuian R. , Katz P. O. , Castell D. O. 
Published: March 2003

SummaryBackground : Omeprazole controls acid but not non‐acid reflux. The GABA B agonist baclofen decreases acid reflux through the inhibition of transient lower oesophageal sphincter relaxations (TLESRs) and should similarly decrease non‐acid reflux. Using combined multichannel intraluminal impedance and pH (MII/pH), we compared acid and non‐acid reflux after placebo and baclofen.Methods : Nine healthy volunteers and nine heartburn patients underwent two 2‐h studies of combined MII/pH in right lateral decubitus after a refluxogenic meal in random order: on placebo and after baclofen 40 mg p.o. Tracings were analysed for acid and non‐acid reflux episodes, re‐reflux and symptoms in the heartburn patients.Results : In normal subjects baclofen significantly reduced the median number of episodes of acid (7 vs. 1, P = 0.02), non‐acid (2 vs. 0, P = 0.005), and all reflux combined (10 vs. 2, P = 0.006); re‐reflux was not reduced (0 vs. 0, P = N.S.). In heartburn patients, baclofen significantly decreased the median number of episodes of acid (15 vs. 6, P = 0.004), non‐acid (4 vs. 2, P = 0.003), re‐reflux (2 vs. 0, P = 0.02), and all reflux combined (23 vs. 8, P = 0.004); it also reduced the median number of acid‐related (9 vs. 1, P = 0.008) and non‐acid‐related (1 vs. 0, P = 0.04) symptoms.Conclusions : Baclofen reduces post‐prandial acid and non‐acid reflux and their associated symptoms. GABA B agonists may have a role in treating GERD.
Thiopurine methyltransferase genotype distribution in patients with Crohn's disease
Authors: Reuther L. O. , Sonne J. , Larsen N. , Dahlerup J. F. , Thomsen O. O. , Schmiegelow K. 
Published: March 2003

SummaryBackground : Inter‐individual response to azathioprine is partly due to inter‐individual variation in the thiopurine methyltransferase (TPMT) activity. The TPMT genotype, which reflects the TPMT activity, has previously been studied in healthy Caucasians, with the most common variant allele being TPMT*3A. TPMT genotyping in adult patients with Crohn's disease has never been performed systematically.Aim : To determine the TPMT genotype distribution in adult patients with Crohn's disease.Methods : One hundred and twenty randomly selected Danish patients (64 females and 56 males) with azathioprine‐dependent Crohn's disease were included, and a polymerase chain reaction assay was used for TPMT genotyping. The patients were genotyped for the low‐level genotype G460→A and A719→G transitions.Results : One hundred and nine patients (90.3%; 95% confidence interval, 84.1–95.3) had a wild‐type/ wild‐type genotype, whereas 10 patients (8.3%; 95% confidence interval, 4.1–14.8) had one non‐functional mutant allele and one patient (0.8%; 95% confidence interval, 0.02–4.6) had two non‐functional mutant alleles. Only the TPMT*3A variant allele was found.Conclusions : The study showed a TPMT genotype distribution amongst adult Danish patients with Crohn's disease which was similar to the distribution of TPMT variant alleles normally found in healthy Caucasians.
Treatment of active Crohn's disease with onercept (recombinant human soluble p55 tumour necrosis factor receptor): results of a randomized, open‐label, pilot study
Authors: Rutgeerts P. , Lemmens L. , Van Assche G. , Noman M. , Borghini‐Fuhrer I. , Goedkoop R. 
Published: March 2003

SummaryBackground : Monoclonal antibodies to the pro‐inflammatory cytokine tumour necrosis factor‐α have shown efficacy in treating Crohn's disease, but can be immunogenic. Soluble tumour necrosis factor‐binding proteins are being studied as potential alternative anti‐tumour necrosis factor agents in Crohn's disease.Aim : To investigate the safety and efficacy of onercept, a recombinant form of the natural human soluble p55 tumour necrosis factor receptor, in the treatment of patients with active Crohn's disease.Methods : In a pilot study, 12 patients with active Crohn's disease were randomized to receive onercept at either 11.7 or 50 mg three times weekly for 2 weeks. Patients were followed up for 6 months after the end of treatment.Results : The Crohn's disease activity index decreased rapidly during treatment in both groups. Seven responses (Crohn's disease activity index decrease of 100 points) were observed over the first 6 weeks of the study, including five remissions (Crohn's disease activity index decrease of 150 points). Improvement was sustained for 2–4 months after stopping treatment. Treatment was well tolerated. No patients developed antibodies to onercept.Conclusions : Neutralizing the activity of tumour necrosis factor‐α with its soluble p55 receptor may be valuable in the treatment of patients with Crohn's disease. Larger placebo‐controlled trials are indicated.
Attitudes of patients and anaesthetists to informed consent for specialist airway techniques*
Authors: Bray J. K. , Yentis S. M. 
Published: March 2003

SummaryWe investigated the attitudes of 96 patients and 163 anaesthetists to the need for obtaining informed consent before specialist airway techniques. Participants were asked to score six questions using a numerical scale, as to whether they thought consent was necessary before specific procedures, particularly in relation to fibreoptic intubtion used for teaching or maintaining skills. Significant differences in opinion were found between patients and anaesthetists despite a wide range of views. Overall, patients felt that specific consent was required for non‐routine techniques, whilst anaesthetic respondents felt this was unnecessary, even if teaching. We conclude that guidance in obtaining consent is needed to support anaesthetists wishing to practice or teach fibreoptic intubation.