bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative efficacy of new investigational agents against Helicobacter pylori
Authors: Osato M. S. , Reddy S. G. , Piergies A. A. , Bochenek W. J. , Testa R. T. , Graham D. Y. 
Published: March 2003

Background:Emergence of antibiotic resistant Helicobacter pylori has necessitated the identification of alternate therapies for the treatment of this infection.Aim:To assess the in vitro efficacy of two investigational agents: DMG‐MINO CL 344 (a N,N‐dimethylglycylamido derivative of minocycline), and davercin, a cyclic carbonate of erythromycin A as compared to older antibiotics (clarithromcyin, azithromycin, minocycline, tetracycline, ofloxacin, ciprofloxacin, cefixime) against clinical isolates of H. pylori.Methods:Testing was performed using the agar dilution method approved by the NCCLS subcommittee on antimicrobial susceptibility testing, Helicobacter pylori working group. Under these guidelines, Mueller–Hinton agar containing 5% aged sheep blood was used. All incubations were done under CampyPak Plus conditions for 72 h at 37 °C. The drug concentrations in the agar ranged from 0.016 to 16 μg/mL. Twenty‐one clarithromycin‐resistant and 16 clarithromycin‐susceptible clinical isolates of H. pylori obtained from patients with duodenal ulcer were used. H. pylori ATCC 43504 was used as the control in all determinations.Results:Against clarithromycin susceptible isolates, all antimicrobial agents except the fluoroquinolones were highly effective. Against clarithromycin‐resistant H. pylori, the MIC50/MIC90 values showed that the tetracyclines and cefixime were the most efficacious agents. The fluoroquinolones and macrolides were ineffective. Macrolide cross‐resistance was detected.Conclusion:Macrolide cross‐resistance prevents the use of this entire class of antimicrobials when clarithromycin resistance is present. Tetracyclines and cefixime are possible alternative agents for the treatment of H. pylori infection in these patients.
In‐vitro cyclosporin sensitivity of proliferating lymphocytes is predictive of in‐vivo therapeutic response in ulcerative colitis
Authors: McCormack G. , O'Donoghue D. , Baird A. 
Published: March 2003

Background:The efficacy of cyclosporin in the management of ulcerative colitis is recognized. Not all patients respond to this treatment. Existing clinical and laboratory parameters are of little use in identifying those most likely to respond.Aims:To determine whether in‐vitro sensitivity to cyclosporin as measured by a lymphocyte proliferation assay is predictive of in‐vivo response to therapy.Methods:The study comprised seven responders with ulcerative colitis, seven non‐responders, and 14 healthy matched controls. A lymphocyte proliferation assay was carried out in the presence of a range of concentrations of cyclosporin and a dose–response curve constructed for each subject. The IC50 value, the concentration of cyclosporin that resulted in 50% inhibition of proliferation, was calculated for each subject. IC50 values for responders, non‐responders and controls were compared using a Mann–Whitney test.Results:There was a wide range of values obtained for the study group as a whole. IC50 values for non‐responders were significantly higher than those of responders (P < 0.05).Conclusions:There is a population‐wide variation of in‐vitro sensitivity to cyclosporin. This is reflected in in‐vivo sensitivity as measured by clinical response to cyclosporin treatment. Future therapeutic strategies need to address this inherent variability of individual response to therapy.
Occurrence and relapse of bleeding from duodenal ulcer: respective roles of acid secretion and Helicobacter pylori infection
Authors: Capurso G. , Annibale B. , Osborn J. , D'Ambra G. , Martino G. , Lahner E. , Delle Fave G. 
Published: March 2003

Background: Helicobacter pylori infection, gastric acid hypersecretion and NSAID consumption may cause peptic ulcer.Aim:To investigate the respective roles of H. pylori and acid secretion in bleeding duodenal ulcer.Patients and methods:A total of 99 duodenal ulcer patients were referred for evaluation of acid secretion: seven with Zollinger–Ellison Syndrome; 14 with hypersecretory duodenal ulcer, defined by the coexistence of elevated basal acid output and pentagastrin acid output; and 78 duodenal ulcer patients with normal acid output. All non‐Zollinger–Ellison Syndrome patients were H. pylori‐positive and cured of infection. All patients were followed‐up for a 36‐month period, to assess the occurrence of bleeding episodes.Results:Twenty‐nine patients had at least one bleeding episode in the 4 years before the study. Bleeding was more frequent in males and in patients on NSAIDs. The mean basal acid output was not higher among bleeders. In the 21 patients (14 hypersecretory duodenal ulcer, seven Zollinger–Ellison Syndrome) with basal acid output > 10 meg/h and pentagastrin acid output > 44.5 meg/h, the risk of bleeding was higher (OR 6.5; 95% CI: 2–21). In the follow‐up period, three out of 83 (3.3%) non‐Zollinger–Ellison Syndrome patients had a H. pylori‐negative duodenal ulcer with bleeding. The risk of bleeding after H. pylori cure was not higher in hypersecretory duodenal ulcer patients (P > 0.3), nor among patients with previous bleeding episodes (P > 0.2).Conclusions:In H. pylori‐positive duodenal ulcer patients, the coexistence of elevated basal acid output and pentagastrin acid output leads to a sixfold increase in the risk of bleeding. After H. pylori cure, gastric acid hypersecretion is not a risk factor for bleeding. However, duodenal ulcer recurrence with bleeding may occasionally occur in patients cured of H. pylori, even if acid output is normal.
Healthcare resource utilization in the management of oesophageal adenocarcinoma
Authors: Soni A. , Sonnenberg A. 
Published: March 2003

Objective:To study the natural history of oesophageal adenocarcinoma in terms of utilization of the healthcare resources and associated medical costs.Methods:All 29 patients treated at the University of New Mexico Health Center between 1 January 1992 and 1 December 1998 for an oesophageal adenocarcinoma were included in the study. For each individual patient, all medical resources utilized, facility costs, and physician fees were retrieved from the computerized databases of the collection departments.Results:During the progress of the disease, the same type of diagnostic or therapeutic procedure became necessary a number of times, and patients underwent, on average, three (range one to eight) upper gastrointestinal endoscopies, five (range one to 11) computerized tomography scans, 35 (five to 143) X‐ray examinations, and 28 (three to 46) radiation therapies or 39 (10 to 74) chemotherapies. The large variation in the numbers of resources utilized was also reflected by a corresponding variation in total healthcare costs. The mean cost per patient was $48 127, ranging between $13 454 and $139 721. Facility costs comprised 88% of all costs compared to physician fees which comprised 12%. The largest cost items, in declining order, were physician encounters ($16 916), radiation plus chemotherapy ($9909 plus $4891, respectively), and pharmacy prescriptions ($7565).Conclusions:The prolonged disease process and the many diagnostic and therapeutic procedures result in complications, side‐effects, inconclusive tests, or failed therapies that all markedly increase the use of healthcare resources. Because such outcomes are the rule rather than the exception, the management of oesophageal adenocarcinoma is expensive.
Characteristics of patients with irritable bowel syndrome recruited from three sources: implications for clinical trials
Authors: Longstreth G. F. , Hawkey C. J. , Mayer E. A. , Jones R. H. , Naesdal J. , Wilson I. K. , Peacock R. A. , Wiklund I. K. 
Published: March 2003

Background:Variation in the characteristics of irritable bowel syndrome patients recruited for clinical trials from different sources could affect their response and the generalizability of trial results.Aim:To describe and compare the characteristics of three different groups of irritable bowel syndrome patients recruited into a ‘mock clinical trial.’Methods:We enrolled 245 irritable bowel syndrome patients from three sources: (i) 121 from British primary practitioners; (ii) 72 from California newspaper advertisements; and (iii) 52 from a California gastroenterologist’s practice. We obtained demographic, clinical, and Hospital Anxiety and Depression (HAD) Scale data.Results:Most patients were young to middle‐aged women; the majority reported symptoms for > 5 years in all three groups. Subject characteristics varied among the groups. Typically, primary care patients were anxious, smokers and daily alcohol drinkers who had sought care recently for irritable bowel syndrome and tried antispasmodic drugs. Their symptoms were intermediate in severity between those of the other two groups. Advertisement subjects were the oldest, most highly educated, most often depressed, and were least likely to have sought care recently for symptoms, which were almost uniformly only moderate in severity. Gastroenterologist patients tended to be anxious and had nearly all sought care recently for symptoms, which were the most severe and most likely to include all three pain‐related Rome I criteria.Conclusion:Recruitment methodology affects important characteristics of an irritable bowel syndrome study group.
Effect of Helicobacter pylori eradication on expression of cyclin D2 and p27 in gastric intestinal metaplasia
Authors: Yu J. , Leung W. K. , Ng E. K. W. , To K. F. , Ebert M. P. A. , Go M. Y. Y. , Chan W. Y. , Chan F. K. L. , Chung S. C. S. , Malfertheiner P. , Sung J. J. Y. 
Published: March 2003

Background and aims:Cyclins and cyclin‐dependent kinase inhibitors play a crucial role in the control of cell cycle transitions. Enhanced expression of cyclin D2 and reduced expression of p27kip1 (p27) have been implicated in the pathogenesis of cancer. Because intestinal metaplasia has been regarded as a pre‐malignant lesion, we investigated the expression of cyclin D2 and p27 in Helicobacter pylori‐associated chronic gastritis with and without intestinal metaplasia, and followed the changes after H. pylori eradication.Methods:Expression of cyclin D2 and p27 was studied by immunohistochemistry in 59 patients (including 35 patients with intestinal metaplasia) and in 10 gastric cancer patients. Among them, 29 H. pylori‐infected patients had serial gastric biopsies taken before and at 1‐year after eradication of H. pylori.Results:Expression of cyclin D2 was significantly higher in gastric cancers when compared to their adjacent non‐tumour tissues (median score 3 vs. 1, P=0.015). Over‐expression of cyclin D2 was detected in H. pylori‐associated chronic gastritis and intestinal metaplasia, which was reduced after eradication of the organism (median score 2 vs. 1, P=0.037 in chronic gastritis; median score 2 vs. 0, P=0.008 in intestinal metaplasia). While the normal gastric mucosa showed strong p27 expression, five of the 10 gastric cancer tissues exhibited reduced p27 expression (P=0.039). Diminished p27 expression was also seen in intestinal metaplasia, which was restored 1‐year after H. pylori eradication (eight out of 16 vs. one out of 16, P=0.018). Reduced expression of p27 was frequently associated with increased cyclin D2 expression in H. pylori‐associated intestinal metaplasia (P=0.02).Conclusion:Over‐expression of cyclin D2 and reduced expression of p27 are closely linked to H. pylori‐associated intestinal metaplasia. Eradication of H. pylori infection reverses the aberrant expression of cyclin D2 and p27 in intestinal metaplasia.
Review article: herbal treatment in gastrointestinal and liver disease—benefits and dangers
Authors: Langmead L. , Rampton D. S. 
Published: March 2003

Herbal medicines are now used by up to 50% of the Western population, in a substantial minority of instances for the treatment or prevention of digestive disorders. Although most indications for the use of such remedies are anecdotally or traditionally derived, controlled trials suggest some benefits for ginger in nausea and vomiting, liquorice extracts in peptic ulceration, Chinese herbal medicine in irritable bowel syndrome, opium derivatives in diarrhoea and senna, ispaghula and sterculia in constipation. Herbal preparations contain many bioactive compounds with potentially deleterious as well as beneficial effects.There is clearly a need for greater education of patients and doctors about herbal therapy, for legislation to control the quality of herbal preparations, and in particular for further randomized controlled trials to establish the value and safety of such preparations in digestive and other disorders.
Review article: current therapeutic options for radiation proctopathy
Authors: Hong J. J. , Park W. , Ehrenpreis E. D. 
Published: March 2003

Radiation proctopathy is a common unfortunate complication following radiation therapy of pelvic malignancies. Symptoms of chronic radiation procto‐ pathy include haematochezia, urgency, constipation, tenesmus, diarrhoea and rectal pain.Currently, a wide variety of pharmacological options, endoscopic cautery techniques and surgical procedures have been proposed for the treatment of chronic radiation proctopathy. Although these have been proposed primarily as treatment for rectal bleeding, the control of other symptoms has been noted with some of these agents. Pharmacological options include 5‐aminosalicylic acid preparations, coticosteroid enemas, sucralfate (oral, enemas), formalin, short chain fatty acid enemas, oestrogen/progesterone, hyperbaric oxygen, antioxidants, sodium pentosan polysulphate and miso‐prostol rectal suppositories. Of these, sucralfate and formalin therapy appear to be effective for bleeding control. Misoprostol rectal suppositories and oral sucralfate may be useful in the prevention of acute and chronic symptoms of radiation proctopathy.Endoscopic cautery techniques have included the use of Nd:YAG laser and argon laser for coagulation of bleeding neovascular telangiectasias. Argon plasma coagulation offers a safe non‐contact method of delivering haemostasis which has proven to be particularly useful in targeting difficult to reach lesions tangentially.Surgery is generally reserved for severe refractory cases involving ongoing haemorrhage, obstruction, stricture formation, fistulas and perforation.Given that formal randomized placebo‐controlled studies are lacking for most treatments, the management of these patients is often challenging and unclear. Hence, there is a need for more research and education on radiation proctopathy.
Involvement of the corporal mucosa and related changes in gastric acid secretion characterize patients with iron deficiency anaemia associated with Helicobacter pylori infection
Authors: Capurso G. , Lahner E. , Marcheggiano A. , Caruana P. , Carnuccio A. , Bordi C. , Delle Fave G. , Annibale B. 
Published: March 2003

Background:Recent studies have reported an association between iron deficiency anaemia and Helicobacter pylori. Helicobacter pylori could cause iron deficiency anaemia by altering iron absorption. We observed that most patients with Helicobacter pylori infection and iron deficiency anaemia present a chronic superficial pangastritis.Aim:To investigate whether Helicobacter pylori‐positive patients with iron deficiency anaemia have peculiar histological and functional features when compared with non‐anaemic Helicobacter pylori‐positive subjects.Patients:Fifty‐one patients with iron deficiency anaemia, in whom chronic superficial Helicobacter pylori gastritis was the only gastrointestinal finding, and 103 non‐anaemic Helicobacter pylori‐positive controls were included in the study. Thirty‐seven patients were randomly matched with 37 controls of the same sex and age.Methods:Gastroscopy, with antral (n=3) and body (n=3) biopsies, was performed. Gastrin and pepsinogen I levels and antiparietal cell antibodies were evaluated. Intragastric pH was also measured.Results:Gastritis involved the corporal mucosa in 90% of patients compared to 42.7% of controls (P < 0.0001). The mean inflammatory score in the gastric body was significantly higher among patients than in controls (2.2 vs. 0.6; P=0.012). Gastrin was significantly higher in patients than in controls (mean 60.2 vs. 29 pg/mL; P=0.0069). Intragastric pH was higher in patients than in controls (median 5.7 vs. 2; P=0.0026).Conclusions:These data suggest that patients with iron deficiency anaemia and Helicobacter pylori infection have a peculiar pattern of gastritis with corporal involvement and related changes in intragastric pH.
Evaluation of the cost‐effectiveness of Helicobacter pylori eradication triple therapy vs. conventional therapy for ulcers in Japan
Authors: Ikeda S. , Tamamuro T. , Hamashima C. , Asaka M. 
Published: March 2003

Background: Helicobacter pylori eradication triple therapy with a combination of lansoprazole, amoxicillin and clarithromycin was approved in Japan in September 2000.Aim:To compare the cost‐effectiveness of this eradication therapy with conventional histamine‐2 receptor antagonist therapy in Japan.Methods:We established two Markov models for gastric and duodenal ulcers. The model design was based on the Japanese H. pylori eradication guideline and a specialist’s opinions, and the model inputs were obtained from a literature review. The models predict the direct medical costs, number of disease‐free days and cost per disease‐free day for 5 years.Results:In the gastric ulcer model, the expected total costs of eradication and conventional therapies per patient were ¥169 719 and ¥390 921, respectively; the expected numbers of disease‐free days were 1454 days and 1313 days, respectively. In the duodenal ulcer model, the expected total costs were ¥134 786 and ¥324 689, respectively; the expected numbers of disease‐free days were 1503 days and 1387 days, respectively. The sensitivity analyses showed that the results of the base case analysis were robust.Conclusions:This eradication therapy is less costly and more effective than conventional therapy for the treatment of gastric and duodenal ulcers in a Japanese medical setting.
One‐week regimens containing ranitidine bismuth citrate, furazolidone and either amoxicillin or tetracycline effectively eradicate Helicobacter pylori: a multicentre, randomized, double‐blind study
Authors: Lu H. , Zhang D.‐Z. , Hu P.‐J. , Li Z.‐S. , Lu X.‐H. , Fang X.‐C. , Xiao S.‐D. 
Published: March 2003

Background:The metronidazole resistance of Helicobacter pylori strains has increased rapidly.Aim:To evaluate the efficacy and safety of new 1‐week regimens containing ranitidine bismuth citrate, furazolidone and either amoxicillin or tetracycline.Methods:One hundred and twenty patients with H. pylori‐positive inactive duodenal ulcer or non‐ulcer dyspepsia diagnosed by endoscopy were recruited randomly to receive one of two regimens for 7 days: ranitidine bismuth citrate, 350 mg b.d., furazolidone, 100 mg b.d., and either amoxicillin, 1000 mg b.d. (n=60), or tetracycline, 500 mg b.d. (n=60). H. pylori infection was identified by rapid urease testing and histology. 13C‐Urea breath test was performed to evaluate the cure of H. pylori infection at least 4 weeks after completion of triple therapy.Results:The eradication rates of H. pylori by ranitidine bismuth citrate–furazolidone–amoxicillin and ranitidine bismuth citrate–furazolidone–tetracycline regimens were 82% and 85% (P > 0.05), respectively, by intention‐to‐treat analysis, and 85% and 91% (P > 0.05), respectively, by per protocol analysis. Adverse effects were mild in both ranitidine bismuth citrate–furazolidone–amoxicillin and ranitidine bismuth citrate–furazolidone–tetracycline groups.Conclusions:One‐week regimens containing ranitidine bismuth citrate, furazolidone and amoxicillin or tetracycline are well tolerated and effective for the eradication of H. pylori.
Intestinal anti‐inflammatory activity of morin on chronic experimental colitis in the rat
Authors: Gálvez J. , Coelho G. , Crespo M. E. , Cruz T. , Rodríguez‐Cabezas M. E. , Concha A. , Gonzalez M. , Zarzuelo A. 
Published: March 2003

Background:Morin, a bioflavonoid with antioxidant properties, shows intestinal anti‐inflammatory activity in the acute phase of the trinitrobenzenesulphonic acid model of rat colitis.Aim:To assess the anti‐inflammatory activity of morin in the chronic stages of trinitrobenzenesulphonic acid‐induced rat colitis.Methods:Rats were rendered colitic by a single colonic instillation of 30 mg of the hapten trinitrobenzenesulphonic acid dissolved in 0.25 mL of 50% ethanol. A group of colitic animals was given morin orally at doses of 25 mg/kg daily. Animals were sacrificed every week for 4 weeks. Colonic damage was evaluated macroscopically and microscopically. Different biochemical markers of colonic inflammation were also assayed, including myeloperoxidase activity, leukotriene B4 and interleukin‐1β synthesis, glutathione and malonyldialdehyde levels and nitric oxide synthase activity.Results:The administration of morin facilitated tissue recovery during the 4 weeks following colonic insult with trinitrobenzenesulphonic acid, as demonstrated macroscopically and microscopically, as well as biochemically by a reduction in myeloperoxidase activity. The intestinal anti‐inflammatory effect of morin was accompanied by a significant reduction in colonic leukotriene B4 and interleukin‐1β levels, improvement in colonic oxidative stress and inhibition of colonic nitric oxide synthase activity.Conclusions:Morin exerts a beneficial anti‐inflammatory effect in the chronic phase of trinitrobenzenesulphonic acid‐induced rat colitis through the down‐regulation of some of the mediators involved in the intestinal inflammatory response, including free radicals, cytokines, leukotriene B4 and nitric oxide.
Over‐the‐counter H2‐receptor antagonists do not compromise intragastric pH control with proton pump inhibitors
Authors: Tutuian R. , Katz P. O. , Ahmed F. , Korn S. , Castell D. O. 
Published: March 2003

Background:Proton pump inhibitors effectively suppress intragastric acid. Nocturnal acid breakthrough occurs on any dosing regimen of oral proton pump inhibitors. Histamine2‐receptor antagonists (H2RA) suppress intragastric acidity independently of meals and help to control nocturnal acid breakthrough. Because proton pump inhibitors require an acid intragastric milieu for activation, nocturnal dosing of H2RA might decrease the effect of proton pump inhibitors taken in the morning by decreasing their gastric‐acid‐driven activation.Aim:Assess intragastric acid control on omeprazole, 20 mg, taken every morning, after variable dosing of over‐the‐counter famotidine, 10 mg.Methods:Twelve Helicobacter pylori‐negative, healthy volunteers received omeprazole, 20 mg, every morning before breakfast for 15 days. Baseline studies on omeprazole, 20 mg, in the morning, were done on day 7. On nights between days 8–9, 11–12 and 14–15, famotidine, 10 mg at bedtime, and 10 mg at bedtime and/or at 05.30 h, was given in a three‐way, crossover, double‐blind randomized design. Intragastric pH monitoring was performed on days 9, 12 and 15, starting at 08.00 h.Results:Percentage times intragastric pH < 4 on omeprazole, 20 mg, in the morning of the day after receiving famotidine, 10 mg, at bedtime (58.6 ± 4.8); at 05.30 h (54.1 ± 5.1); or at bedtime and at 05.30 h (54.3 ± 5.0) did not differ significantly (P=0.65) from percentage times intragastric pH on day 7 of omeprazole, 20 mg, in the morning (49.5 ± 5.1).Conclusion:Concerns over inhibition of next‐day daytime proton‐pump inhibitor effect should not preclude use of nocturnal H2RAs in patients with gastro‐oesophageal reflux disease.