bluuebunny/crossref_metadata_2025_split huggingface dataset:
Induction of cyclooxygenase‐2 in mesothelial cells in peritonitis caused by perforated ulcers – an immunohistochemical study in humans
Authors: Tatsuguchi A. , Sakamoto C. , Fukuda Y. , Wada K. , Akamatsu T. , Tsukui T. , Miyake K. , Futagami S. , Kishida T. , Yamanaka N. , Kobayashi M. 
Published: March 2003

Summary Background: Increasing evidence suggests that mesothelial cells contribute to the control of inflammation in the peritoneal cavity by secreting prostaglandins. A study has shown that cyclo‐oxygenase (COX)‐2 knockout mice die partly as a result of peritonitis. Aim: To investigate the expression and location of COX in peritonitis associated with peptic ulcer perforation. Methods: Gastric and duodenal tissues were collected intraoperatively from nine and four patients, respectively, and immunohistochemical staining for COX‐1 and COX‐2 was performed. Results: Histologically, all patients had severe peritonitis around the perforation sites, into which many inflammatory cells and fibroblasts had infiltrated, and reactive mesothelial cells exhibited hyperplastic change. The COX‐1 protein was not detected, whereas COX‐2 was abundant in reactive mesothelial cells near the perforation site and disappeared away from the site. Macrophages and fibroblasts around the perforation site also revealed immunostaining for COX‐2. Conclusions: Our results showed that COX‐2 protein is induced in mesothelial cells, as well as in macrophages and fibroblasts, in inflamed peritoneal tissues associated with peptic ulcer perforation, suggesting involvement of COX‐2 in tissue repair.
Manometric and hormonal changes after distal partial gastrectomy
Authors: Yamashita Y. , Inoue H. , Ohta K. , Yoshida K. , Miyahara E. , Hirai T. , Toge T. , Adrian T. E. 
Published: March 2003

Summary Background: Alkaline oesophagitis attributable to duodenal mechanisms may induce oesophageal carcinogenesis in a rat reflux model. Aim: To investigate the mechanism of the regurgitation after distal partial gastrectomy. Methods: Oesophageal manometry was used in 16 patients before and after distal partial gastrectomy with reconstruction by Bilroth methods. Serum concentrations of four gastrointestinal hormones were measured by radioimmunoassay in 10 gastrectomy patients and nine healthy volunteers before and after a standardized meal. Results: The lower oesophageal sphincter pressure was reduced to 83% after surgery. The amplitude and duration of the peristaltic waves tended to be increased, and the velocity tended to be less after surgery (amplitude 120%, duration 114%, velocity 88%). Interrupted waves appeared more frequently after surgery. The manometric changes in gastrectomized patients are considered to be disadvantageous relative to regurgitation. After surgery, gastrin and pancreatic polypeptide were completely abolished postprandially, whereas cholecystokinin and neurotensin were significantly increased. Conclusion: The hormonal changes should have a suppressive effect on the lower oesophageal sphincter. Both the manometric and the hormonal changes may exacerbate reflux oesophagitis after distal partial gastrectomy.
Review article: hepatobiliary complications associated with total parenteral nutrition
Authors: Angelico M. , Guardia P. Della 
Published: March 2003

SummaryParenteral nutrition is often associated with hepatobiliary complications. Hepatic steatosis, intrahepatic cholestasis and biliary sludge are the most frequent. Cholestasis predominates in infants, steatosis in adults, and biliary sludge in both. Other less frequent complications are steatohepatitis and gallstones. All hepatobiliary complications are more likely to occur after extended periods of total parenteral nutrition, and are prevented by the concomitant consumption of nutrients by the enteral route. The pathogenic causes are multiple and only partially known. They include lack of gastrointestinal stimuli for biliary secretion and gall‐bladder motility, abnormalities in bile acid metabolism, the presence of sepsis, and the potentially unfavourable effects of individual components in the total parenteral nutrition formulae, including an excess of calories. Each potential mechanism and its clinical relevance is discussed in this review.
The cost of diagnosing Helicobacter pylori infection
Authors: Vakil N. 
Published: March 2003

Non‐invasive testing and treatment for Helicobacter pylori has been recommended for dyspeptic patients in primary care and a number of recent studies have demonstrated the cost‐effectiveness of this approach. As the prevalence of H. pylori infection declines, the positive and negative predictive values of individual tests will change. Cost‐effectiveness is important in determining the appropriate test in individual populations. Recent studies have shown that the stool antigen test and the urea breath test have high sensitivity and specificity in the detection of H. pylori infection before and after therapy.Cost‐effectiveness studies have shown that when the prevalence of H. pylori infection is low or intermediate, serological tests have relatively poor accuracy compared with the stool test or the urea breath test. In populations with low or intermediate prevalence (<60%) these tests should be preferred to ELISA serology or office‐based whole‐blood test or serology. This is particularly true when the prevalence of H. pylori infection is less than 30% as is seen in many developed countries. When the prevalence of H. pylori infection is high (>60%), low‐cost antibody tests are cost‐effective.
Time course of serum hepatitis C virus‐RNA during chronic hepatitis C treatment accurately predicts the type of response
Authors: Calleja J. L. , Albillos A. , Rossi I. , Moreno R. , Domper F. , MartÍnez J. L. , EscartÍn P. 
Published: March 2003

Aim:To establish the value of alanine aminotransferase normalization and hepatitis C virus‐RNA clearance as predictors of sustained virological response in naïve and relapser chronic hepatitis C patients on mono or combination therapy.Methods:A total of 282 hepatitis C patients were studied: 98 naïves on interferon, and 64 naïves and 75 relapsers on interferon plus oral ribavirin; 45 patients were excluded. Drugs were administered at standard doses for 12 months. Alanine aminotransferase and hepatitis C virus‐RNA were determined at baseline and at weeks 4, 12, 24, 48, and at 72 and 96 weeks after completion of therapy.Results:The rate of sustained response was greater (P < 0.05) in naïves and relapsers on combination therapy (33% and 48%, respectively) than in naïves on interferon alone (16%). Hepatitis C virus‐RNA significantly decreased from baseline by week 4 in naïves on interferon and relapsers on combination therapy and by week 12 in naïves on combination therapy. Alanine aminotransferase levels paralleled viremic load in naïves on interferon, yet in patients on combination therapy, alanine aminotransferase normalized independently of the virological response. During treatment, the main factor associated with sustained response was hepatitis C virus‐RNA clearance by week 4 in naïves on interferon and relapsers on combination therapy, and by week 24 in naïves on combination therapy.Conclusion:Clearance of viraemia constitutes the best predictor of a sustained response to therapy, but needs to be measured at patient‐specific times.
Adverse drug reactions in patients with gastroenterological diseases: does age increase the risk?
Authors: Dormann H. , Krebs S. , Muth‐Selbach U. , Criegee‐Rieck M. , Radespiel‐TrÖger M. , Levy M. , Hahn E. G. , Brune K. , Schneider H. T. 
Published: March 2003

Background:It has been claimed that the risk of adverse drug reactions increases with age. However, only limited data exist for disease‐group specific risks and none for patients with liver and gastrointestinal diseases.Aims:To determine the incidence and characteristics of adverse drug reactions and the physicians’ awareness of adverse drug reactions.Methods:During a 7‐month period, a prospective survey of 532 male patients (158 aged 65 years or older; 30%) was conducted on a hepatogastroenterological ward of a tertiary‐care university hospital, using intensive bedside and computer‐assisted drug surveillance methods.Results:No difference was found in the overall rate of adverse drug reactions between older and younger patients (25.9% vs. 24.2%) during 6213 treatment days. However, a significantly higher risk for developing adverse drug reactions could be shown for the elderly with biliary tract diseases (P < 0.01). Independently of age, patients suffering from gastric ulcers, acute episodes of pancreatitis, cholangitis or inflammatory bowel diseases were at high risk of adverse drug reactions. Adverse drug reaction‐associated mortality was encountered in four elderly and none of the younger patients. Secondary pharmacological effects and drug toxicity were the main types of adverse drug reactions for both age groups. Although 75.3% of the adverse drug reactions were predictable, only 37.5% of all adverse drug reactions were recognized by the staff physicians.Conclusion:In hepatogastroenterological patients, advancing age was not associated with an overall increased risk of adverse drug reactions except for patients with biliary tract diseases. In the elderly, adverse drug reactions were more severe and carried higher mortality. Guidelines and educational programs should be developed to increase the awareness of adverse drug reactions and their prevention, especially in high risk patients and, thus, to improve patient outcomes.
Evaluation of a novel continuous real time 13C urea breath analyser for Helicobacter pylori
Authors: Shirin H. , Kenet G. , Shevah O. , Wardi Y. , Birkenfeld S. , Shahmurov M. , Bruck R. , Niv Y. , Moss S. F. , Avni Y. 
Published: March 2003

Aim:To evaluate the sensitivity and specificity of a new 13C urea breath test, Oridion BreathID, for the diagnosis of Helicobacter pylori.Methods:A total of 97 consecutive symptomatic patients referred for upper endoscopy were included in the ‘pre‐therapy’ part of the study. After endoscopy the patients were analysed for H. pylori by Oridion BreathID. BreathID continuously sampled the subject’s breath for 20 min, and displayed the results on the BreathID screen in real time. Results of the BreathID were compared with the ‘gold standard’ (rapid urease test and histology). We also prospectively tested the validity of BreathID in comparison to isotope ratio mass spectrometry, in 40 patients referred to monitor the efficacy of H. pylori eradication treatment.Results:Complete agreement was observed between the ‘gold standard’ and the Breath ID test in 96.9% (94 out of 97) of the patients. The sensitivity and specificity of BreathID were 97.8% and 96.1%, respectively. The correlation between BreathID and isotope ratio mass spectrometry breath test was 100%.Conclusions:The Oridion BreathID has comparable sensitivity and specificity to the claims of the currently available urea breath tests. Furthermore, BreathID has the potential advantages of ease of use with minimal medical staff requirement, and real time rapid results (20 min maximum) which may make the BreathID preferable to other urea breath test assays.
The Loiano‐Monghidoro population‐based study of Helicobacter pylori infection: prevalence by 13C‐urea breath test and associated factors
Authors: Bazzoli F. , Palli D. , Zagari R. M. , Festi D. , Pozzato P. , Nicolini G. , Masala G. , Fossi S. , Ricciardiello L. , Panuccio D. , Roda E. 
Published: March 2003

Objectives:As part of a cross‐sectional study on cholelithiasis, 1533 out of 1840 residents in Loiano/Monghidoro, a rural area in Northern Italy (792 men, 741 women, age range 28–80 years), agreed to be further evaluated in relation to their Helicobacter pylori status.Methods:Each participant performed a 13C‐urea breath test (13C‐UBT) and provided information on sociodemographic, lifestyle and clinical characteristics.Results:The 13C‐UBT was positive in 1041 subjects (67.9%; men: 69%; women: 67%) and was positively associated with increasing age (P < 0.001), alcohol consumption (P < 0.01), a higher number of siblings (P < 0.001) and a personal history of peptic ulcer (P < 0.01), but inversely with a nonmanual occupation (P < 0.001). Overall, H. pylori infection was unrelated to smoking, house pets, and a family history of gastroduodenal diseases. The prevalence of H. pylori infection was 72% in subjects reporting one or more dyspeptic symptoms and 65% among asymptomatic participants (P < 0.001); a multivariate analysis showed that only epigastric pain was significantly, although weakly, associated with 13C‐UBT positivity.Conclusions:This large population‐based study showed a prevalence of H. pylori infection higher than that reported by serologic surveys in urban areas. Current H. pylori infection was strongly associated with indicators of lower socioeconomic status, alcohol consumption and increasing age. A role of H. pylori infection in determining epigastric pain was suggested.
The pharmacokinetics of the novel promotile drug, tegaserod, are similar in healthy subjects—male and female, elderly and young
Authors: Appel‐Dingemanse S. , Horowitz A. , Campestrini J. , Osborne S. , Mcleod J. 
Published: March 2003

Background:Tegaserod (HTF 919) is a selective 5‐HT4 receptor partial agonist in development for the treatment of irritable bowel syndrome.Aim:This study aimed to assess the effect of age and gender on the single‐dose pharmacokinetics of tegaserod.Methods:In a parallel‐group, open‐label study, a single dose of tegaserod (12 mg) was administered to four groups of healthy young male, young female, elderly male and elderly female subjects (n=10 per group). Blood samples were collected from 0 to 24 h postdose. Non‐compartmental pharmacokinetics evaluation and statistical analysis (ANOVA and Wilcoxon signed ranks test for tmax) were performed.Results:Tegaserod was well tolerated in all groups. There was no effect of age or gender on tmax and Cmax. Gender did not affect AUC0–∞ and AUC0–tz; there was a statistically significant effect of age on these parameters. AUC0–∞ and AUC0–tz in the elderly were greater than in the young (AUC0–∞ ratio 1.37, P < 0.001; AUC0–tz ratio 1.23, P=0.029). This increase in exposure is judged not to be clinically relevant because it is within the variability in the pharmacokinetics parameters of tegaserod and because the dose–response relationship of tegaserod is relatively shallow.Conclusions:No dose adjustment for age or gender is recommended in tegaserod therapy.
Effect of interferon therapy on the development of hepatocellular carcinoma in patients with hepatitis C virus‐related cirrhosis: a meta‐analysis
Authors: Papatheodoridis G. V. , Papadimitropoulos V. C. , Hadziyannis S. J. 
Published: March 2003

Background:The role of interferon in the prevention of hepatocellular carcinoma remains controversial.Aim:In this meta‐analysis we evaluated the hepatocellular carcinoma incidence in interferon‐treated and ‐untreated patients with hepatitis C virus‐related cirrhosis.Methods:Eleven studies with 2178 patients were found to fulfil our inclusion criteria. The pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated from the raw study data.Results:Hepatocellular carcinoma development was significantly more frequent in untreated (21.5%) than in interferon‐treated patients (8.2%; OR: 3.0, 95% CI: 2.3–3.9). In the five studies reporting hepatocellular carcinoma incidence in patients with and without sustained response to interferon, hepatocellular carcinoma was detected at a much higher rate in patients without (9%) than with a sustained response (0.9%; OR: 3.7, 95% CI: 1.7–7.8). Moreover, hepatocellular carcinoma developed significantly more frequently in the untreated patients than in the non‐sustained responders (OR: 2.7, 95% CI: 1.9–3.9). The benefit from interferon on hepatocellular carcinoma incidence was not influenced by the study type (prospective or retrospective), the follow‐up duration, or the study origin.Conclusions:Interferon therapy significantly reduces the hepatocellular carcinoma risk in patients with hepatitis C virus cirrhosis. Hepatocellular carcinoma development becomes almost negligible among sustained responders, but a reduction in hepatocellular carcinoma incidence is also achieved even in the non‐sustained responders.
High‐dose prolonged combination therapy in non‐responders to interferon monotherapy for chronic hepatitis C
Authors: Di Marco V. , Vaccaro A. , Ferraro D. , Alaimo G. , Rodolico V. , Parisi P. , Peralta S. , Di Stefano R. , Almasio P. L. , Craxì A. 
Published: March 2003

Background:Therapy of chronic hepatitis C non‐ responders to interferon monotherapy with standard doses of interferon plus ribavirin is usually ineffective.Aim:To evaluate the efficacy and tolerability of high‐dose prolonged combination retreatment in non‐ responder patients.Methods:Patients were retreated for 6 months with 6 MU αIFN on alternate days and 1000 or 1200 mg/day ribavirin. HCV‐RNA negative patients continued therapy for an additional 6 months.Results:Forty patients (29 males, mean age 49.7 years, 34 genotype 1b, 11 with F3 fibrosis) were treated. At 6 months, 20 (50%) patients were HCV‐RNA negative but six of them discontinued therapy because of adverse events. A sustained response was achieved in 28% of patients (11/40). A sustained response was more frequent among patients with genotype non‐1b than in those with genotype 1b (67 vs. 21%, P=0.005) and clearance of HCV‐RNA in the first 3 months had a high predictive value for sustained response (100% of sustained responders vs. 24% of non‐responders, P=0.0001).Conclusions:High‐dose prolonged combination therapy in non‐responders to IFN monotherapy leads to a higher rate of sustained response than the standard combination regimen. Tolerability may be a rate‐limiting factor. Maximal effectiveness can be predicted in patients with non‐1b genotype and in those who clear HCV‐RNA soon after starting retreatment.
Proton pump inhibitors versus H2‐antagonists: a meta‐analysis of their efficacy in treating bleeding peptic ulcer
Authors: Gisbert J. P. , González L. , Calvet X. , Roqué M. , Gabriel R. , Pajares J. M. 
Published: March 2003

Purpose:To evaluate whether proton pump inhibitors are more effective than H2‐antagonists (H2‐A) for the treatment of bleeding peptic ulcer.Data sources:PubMed database until January 2000.Study selection:Comparative randomized trials of proton pump inhibitors (omeprazole, lansoprazole, or pantoprazole) vs. H2‐A (cimetidine, ranitidine or famotidine).Data extraction:Meta‐analysis combining the odds ratios (OR) of the individual studies in a global OR (Peto method).Outcomes evaluated:Persistent or recurrent bleeding, need for surgery, or mortality.Data synthesis:Eleven studies fulfilled the inclusion criteria and contained data for at least one of the planned comparisons. Persistent or recurrent bleeding was reported in 6.7% (95% CI: 4.9–8.6%) of the patients treated with proton pump inhibitors, and in 13.4% (95% CI: 10.8–16%) of those treated with H2‐A (OR 0.4; 95% CI: 0.27–0.59) (χ2‐homogeneity test, 18; P=0.09). Surgery was needed in 5.2% (95% CI: 3.4–6.9%) of the patients treated with proton pump inhibitors, and in 6.9% (95% CI: 4.9–8.9%) of the patients treated with H2‐A (OR 0.7; 95% CI: 0.43–1.13). Respective percentages for mortality were 1.6% (95% CI: 0.9–2.9%) and 2.2% (95% CI: 1.3–3.7%) (OR 0.69; 95% CI: 0.31–1.57).Sub‐analysis:Five studies evaluated the effect of both therapies given in bolus injections on persistent or recurrent bleeding rate, which was 6% (95% CI: 3.6–8.3%) and 8.1% (95% CI: 5.3–10.9%), respectively (OR, 0.57; 95% CI: 0.31–1.05). Persistent or recurrent bleeding in high risk patients (Forrest Ia, Ib and IIa) occurred in 13.2% (95% CI: 7.9–8%) of the patients treated with proton pump inhibitors and in 34.5% (27–42%) of those treated with H2‐A (OR 0.28; 95% CI: 0.16–0.48). In patients not having endoscopic therapy, persistent or recurrent bleeding was reported, respectively, in 4.3% (95% CI: 2.7–6.7%) and in 12% (95% CI: 8.7–15%) (OR 0.24; 95% CI: 0.13–0.43). Less marked differences were observed in patients having adjunct endoscopic therapy: 10.3% (95% CI: 6.7–13.8%) and 15.2% (11.1–19.3%) (OR 0.59; 95% CI: 0.36–0.97). Moreover, the significance disappeared in this group when a single outlier study was excluded.Conclusions:Proton pump inhibitors are more effective than H2‐A in preventing persistent or recurrent bleeding from peptic ulcer, although this advantage seems to be more evident in patients not having adjunct sclerosis therapy. This beneficial effect seems to be similar or even more marked in patients with Forrest Ia, Ib or IIa ulcers. However, proton pump inhibitors are not more effective than H2‐A for reducing surgery or mortality rates. Nevertheless, the data are too scarce and heterogeneous to draw definitive conclusions, and further comparative trials are clearly warranted.
Is a one‐week course of triple anti‐Helicobacter pylori therapy sufficient to control active duodenal ulcer?
Authors: Tepeš B. , Križman I. , Gorenšek M. , Gubina M. , Orel I. 
Published: March 2003

Background:Triple therapy currently forms the cornerstone of the treatment of patients with Helicobacter pylori‐positive duodenal ulcer.Aim:To establish whether prolonged antisecretory therapy is necessary in patients with active duodenal ulcer.Methods:A total of 77 patients with H. pylori‐positive duodenal ulcer were included in a prospective, controlled, double‐blind study. All patients received a 7‐day treatment with omeprazole 20 mg b.d., clarithromycin 500 mg b.d. and amoxicillin 1000 mg b.d. Patients in the omeprazole group underwent an additional 14‐day therapy with omeprazole 20 mg; patients in placebo group received placebo. Endoscopy was performed upon inclusion in the study and after 3 and 8 weeks.Results:Seventy‐four patients were eligible for a per protocol analysis after 3 weeks, and 65 after 8 weeks. After 3 weeks, the healing rate was 89% in the omeprazole group and 81% in the placebo group (P=0.51). After 8 weeks, the ulcer healed in 97% of the patients in the total group (95% CI: 92.7–100%). H. pylori was eradicated in 88% of patients in the omeprazole group and in 91% in the placebo group (P=1.0). No statistically significant differences between the groups were found in ulcer‐related symptoms or in ulcer healing.Conclusion:In patients with H. pylori‐positive duodenal ulcer, a 7‐day triple therapy alone is sufficient to control the disease.
Efficacy of ecabet sodium for Helicobacter pylori eradication triple therapy in comparison with a lansoprazole‐based regimen
Authors: Adachi K. , Ishihara S. , Hashimoto T. , Hirakawa K. , Ishimura N. , Niigaki M. , Kaji T. , Kawamura A. , Sato H. , Fujishiro H. , Hattori S. , Watanabe M. , Kinoshita Y. 
Published: March 2003

Background: The cytoprotective agent, ecabet sodium, inhibits urease activity and growth of Helicobacter pylori.Aim: To evaluate the efficacy and safety of ecabet sodium‐based eradication of H. pylori infection, compared with a lansoprazole‐based regimen, in a randomized multicentre study.Subjects and methods: A total of 120 H. pylori‐positive patients were assigned to one of two treatment regimens for 2 weeks: ecabet sodium 1 g b.d., amoxicillin 500 mg t.d.s. and clarithromycin 400 mg b.d. (EAC: 60 patients); or lansoprazole 30 mg (o.m.) with the same antimicrobial agents (LAC: 60 patients). Cure of infection was assessed by a 13C‐urea breath test 1 month after completion of treatment.Results: One patient in the EAC group and two in the LAC group did not complete therapy because of an adverse event, and three did not undergo the 13C‐urea breath test. Cure rates for the intention‐to‐treat, all‐patients‐treated and per protocol analysis in the EAC group were 85%, 86% and 88%, respectively, whereas those in the LAC group were 85%, 88% and 91%. There were no significant differences in cure rate or adverse events between the two regimens.Conclusions: Ecabet sodium in combination with amoxicillin and clarithromycin is as effective as lansoprazole‐based eradication therapy for H. pylori.