bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and efficacy of pantoprazole 40 mg daily as relapse prophylaxis in patients with healed reflux oesophagitis—a 2‐year follow‐up
Authors: Van Rensburg C. J. , Honiball  , Van Zyl J. H. , Grundling H. DE K. , Eloff  , Spies  , Simjee  , Theron  , Fischer  , Louw  
Published: March 2003

Background: Pantoprazole is a benzimidazole derivative which selectively inhibits the proton pump H+, K+‐ATPase, necessary for the final step in gastric acid secretion.Aim: To assess safety and efficacy of oral pantoprazole (40 mg o.d.) used as a prophylaxis against relapse in patients with healed reflux oesophagitis during an open‐label, 2‐year study.Methods: Outpatients (n=157) with healed stage II or III reflux oesophagitis (Savary–Miller classification) were enrolled into a long‐term, multicentre maintenance study. Endoscopy was performed at entry into the study, after 12 and 24 months, or when disease‐specific symptoms occurred on more than three consecutive days. Symptoms were assessed at 3‐monthly intervals. Endoscopically confirmed relapses (at least stage I) were evaluated as treatment failures.Results: Of the 178 adverse events, experienced by 88 (56%) patients (intention‐to‐treat population), 12 (7%) were assessed by the investigators as possibly related to the study medication. Median serum gastrin levels increased from a baseline of 46 ng/L to 90 ng/L, reaching a plateau after 9 months. For the intention‐to‐treat population the endoscopic remission rates after 12 and 24 months were 87% and 76%, respectively (Life‐Table survival analysis, Kaplan–Meier).Conclusion: Pantoprazole 40 mg proved to be safe and efficacious during a 2‐year prophylaxis treatment in patients with healed reflux oesophagitis.
One‐year follow‐up of newly diagnosed irritable bowel syndrome patients
Authors: RuigÓmez  , Wallander  , Johansson  , RodrÍguez L. A. GarcÍA 
Published: March 2003

Background: Irritable bowel syndrome is the most common functional gastrointestinal disorder seen by general physicians.Methods: We followed up a population‐based cohort of newly diagnosed irritable bowel syndrome patients aged 20–79 years, to examine patterns of treatment, comorbidity and healthcare utilization. We used the UK General Practice Research Database as the source population. Individuals with other gastrointestinal diseases, cancer and pregnant women were not included. There were 2956 patients in our final cohort.Results: Irritable bowel syndrome patients were mainly young and middle‐aged; only 12% were 60 years or older. The majority of patients were women (74%). There were no marked differences in terms of use of healthcare services or comorbidity status in the year before irritable bowel syndrome diagnosis as compared to the year after. Fourteen per cent of irritable bowel syndrome patients received no drug treatment at all. Among those treated, the first choice was an antispasmodic. Elderly patients (> 60 years old) were more likely to receive drug treatment. Females had a slightly higher probability of being treated than men, except for the category of anti‐diarrhoeal drugs.Conclusion: This study has shown that irritable bowel syndrome patients are mainly young and female. We also found that treatment pattern varied according to age and gender. Elderly patients and females were at a higher risk of receiving drug treatment.
The effect of omeprazole dosing on the isolation of Helicobacter pylori from gastric aspirates
Authors: Williams  , Sercombe  , Lawson  , Slater  , Owen  , Pounder  
Published: March 2003

Background: Animal experiments suggest that omeprazole dosing increases shedding of Helicobacter into the gastric lumen, and hence into gastric juice.Aim: To assess the effect of omeprazole dosing on the yield of H. pylori from gastric aspirates of infected volunteers.Methods: Six serial nasogastric aspirates, three before and three during dosing with omeprazole 40 mg b.d., were obtained for culture from 10 H. pylori infected volunteers and one uninfected volunteer. To reduce contamination, samples were diluted 1:10 with Maximum Recovery Diluent (MRD; pH 7.0) or HCl‐KCl buffer (pH 2.2) prior to culture on Columbia and Dent’s agar.Results: Undiluted gastric juice cultures were rapidly overgrown by upper respiratory tract flora. HCl‐KCl dilution resulted in isolation of H. pylori from 77% of infected subject aspirates before, and 67% of aspirates during dosing with omeprazole. The yields were significantly lower with MRD dilution, 47% and 10%, respectively. Omeprazole dosing significantly decreased the yield after MRD dilution, but not after HCl‐KCl dilution.Conclusions: Decreasing intragastric acidity, by dosing with omeprazole, decreases the isolation of H. pylori from routinely processed gastric aspirates. In vitro acidification of gastric aspirates, by HCl‐KCl dilution, increases the isolation of H. pylori both before and during omeprazole dosing.
Improvement in pain and bowel function in female irritable bowel patients with alosetron, a 5‐HT3 receptor antagonist
Authors: Camilleri  , Mayer  , Drossman  , Heath  , Dukes  , Mcsorley  , Kong  , Mangel  , Northcutt  
Published: March 2003

Background: No currently available treatment provides consistent relief of irritable bowel syndrome. Colonic sensory and motor function are modulated partly through 5HT3‐receptors.Aim: To evaluate effects of the 5HT3‐receptor antagonist, alosetron, in irritable bowel syndrome.Methods: Randomized, double‐blind, placebo‐controlled, dose‐ranging (1, 2, 4, 8 mg b.d. alosetron), 12‐week trial in 370 patients with diarrhoea‐predominant or alternating constipation and diarrhoea irritable bowel syndrome. Weekly measurement of adequate relief was the key end‐point; other irritable bowel syndrome symptoms were collected daily using an electronic phone system.Results: Alosetron (1 mg or 2 mg b.d.) significantly (P < 0.05 vs. placebo) increased the proportion of females, but not males, reporting adequate relief. Stool consistency, frequency and percentage days with urgency improved over placebo (P < 0.05) within the first month with all doses of alosetron, and persisted throughout the trial with all doses in female patients. With 1 mg b.d. alosetron, females had improved stool consistency and urgency within the first week, and adequate relief and improved stool frequency within the first 2 weeks. There was no consistent improvement in bowel function among male patients.Conclusion: In female irritable bowel syndrome patients with predominant diarrhoea or alternating constipation and diarrhoea, alosetron is effective in treatment of abdominal pain and discomfort and bowel‐related symptoms.
Effect of naproxen on the hamster gastric antrum: ulceration, adaptation and efficacy of anti‐ulcer drugs
Authors: Fitzpatrick  , Sakurai  , Le  
Published: March 2003

Background: Various animal models of non‐steroidal anti‐inflammatory drug (NSAID)‐induced gastric ulceration exist. These models have limitations, which make them less relevant to the human situation.Aim: To develop a more simple and more relevant model of NSAID‐induced gastric ulceration and adaptation.Methods: Gastric ulceration was evaluated following the orogastric administration of naproxen (80 mg/kg b.d.) to hamsters. The effects of misoprostol and famotidine on gastric acid secretion and ulceration were also determined. Gastric adaptation was evaluated by proliferating cell nuclear antigen (PCNA) immunohistochemistry, in hamsters given naproxen for 3 weeks. Antral resistance to acute injury by NSAIDs and ethanol was also determined in these animals.Results: Naproxen caused primarily gastric antral ulceration, which decreased from day 3 to day 21. This gastric adaptation was accompanied by an increase in PCNA positive cells, particularly on days 7 and 14. The adapted gastric antral mucosa was resistant to acute damage by various agents. Misoprostol (1 or 100 μg/kg) prevented antral ulceration, without affecting gastric acid secretion. Despite decreasing acid output by>  90%, famotidine (30 mg/kg) failed to prevent ulceration.Conclusion: The administration of naproxen (80 mg/kg b.d.) to hamsters is a simple, reliable and relevant method for evaluating NSAID‐induced gastric antral ulceration and adaptation.
Pantoprazole, amoxycillin and either azithromycin or clarithromycin for eradication of Helicobacter pylori in duodenal ulcer
Authors: Včev  , Štimac  , Ivandić  , Včeva  , Takač  , Pezerović  
Published: March 2003

Background:Studies have shown that 1‐week triple therapy consisting of a proton pump inhibitor, amoxycillin and clarithromycin may cure Helicobacter pylori infection in the majority of patients.Aim:To establish whether pantoprazole plus amoxycillin in association with either azithromycin or clarithromycin is useful in curing H. pylori infection in patients with a duodenal ulcer.Methods:One hundred and ten patients with active duodenal ulcers and H. pylori infection were treated with pantoprazole (days 1–7, 40 mg b.d.; days 8–28 40 mg o.d.) plus amoxycillin 1 g b.d. for the first 7 days. Patients were randomly assigned to receive either azithromycin 500 mg o.d. for the first 6 days (PAAz group; n=55) or clarithromycin 500 mg b.d. for the first 7 days of treatment (PAC group; n=55). H. pylori status was determined by urease test and histology before the treatment, and again 4 weeks after cessation of any medication.Results:One hundred and three patients completed the study. H. pylori infection was eradicated in 78% (39/50) of patients in the PAAz group (ITT analysis: 71%, 95% CI: 61–83%) vs. 81% (43/53) of patients in the PAC group (ITT analysis: 78%, 95% CI: 69–90%) (N.S.). All ulcers had healed.Conclusion:Our study shows that 1‐week triple therapy with pantoprazole, amoxycillin and either azithromycin or clarithromycin is not satisfactory (<80% ITT H. pylori eradication rate).
Five‐day regimens containing ranitidine bismuth citrate plus high‐dose clarithromycin and either amoxycillin or tinidazole for Helicobacter pylori infection
Authors: Cammarota  , Cannizzaro  , Ojetti  , Cianci  , Pastorelli  , Armuzzi  , Gentiloni  , Gasbarrini  , Pirozzi  , Gasbarrini  
Published: March 2003

Background:Ranitidine bismuth citrate (RBC)‐based triple therapies for a period of 7 days have proved to be an effective treatment for Helicobacter pylori.Aim:To investigate the eradication efficacy, safety profile and patient compliance of two RBC‐based triple therapies given for 5 days.Methods:Eighty H. pylori‐positive patients with dyspeptic symptoms, referred to us for gastroscopy, were consecutively enrolled in this prospective, randomized, open‐label study. These patients were randomly assigned to receive a 5‐day course of RBC 400 mg b.d. plus clarithromycin 500 mg b.d. and either tinidazole 500 mg b.d. (RBCCT group) or amoxycillin 1 g b.d. (RBCCA group). The H. pylori status was assessed by means of histology and rapid urease test at entry, and by 13C‐urea breath test 8 weeks after the completion of treatment.Results:All enrolled patients completed the study. Thirty‐seven of 40 patients treated with RBCCT (both PP and ITT analysis: 93%; 95% CI: 80–98%) and 35 of 40 in the RBCCA group (both PP and ITT analysis: 88%; 95% CI: 73–96%) returned H. pylori‐negative. Slight or mild side‐effects occurred in 4/40 patients (10%) in the RBCCT group and in 5/40 (12%) in the RBCCA group.Conclusions:This is the first study demonstrating the efficacy of RBC‐based triple therapies given for only 5 days. RBC regimens containing high‐dose clarithromycin and either amoxycillin or tinidazole prove to be well tolerated, safe and preserve good eradication rates even when administered for a shorter than conventional duration.
Recurrent symptoms and gastro‐oesophageal reflux disease in patients with duodenal ulcer treated for Helicobacter pylori infection
Authors: Vakil  , Hahn  , McSorley  
Published: March 2003

Background:Eradication of Helicobacter pylori has been shown to prevent relapse of endoscopically detected duodenal ulcers. There is controversy regarding symptom improvement after therapy. Some studies have suggested that a substantial number of patients remain symptomatic after eradication therapy. Other studies suggest that gastro‐oesophageal reflux disease (GERD) may develop as a result of H. pylori eradication.Aim:To determine the relationship between symptoms and H. pylori eradication and to determine whether H. pylori eradication results in symptoms or endoscopic findings of GERD.Methods:Two hundred and forty‐two patients with endoscopically documented duodenal ulcer disease and evidence of H. pylori infection by rapid urease testing and histology were studied in four randomized, placebo‐controlled, double‐blind trials of H. pylori eradication therapy. All patients underwent symptom assessment and endoscopy with biopsy before therapy and 1 and 6 months after completing therapy. The rapid urease test and histology were used to determine H. pylori status. Interviewers were blinded to H. pylori status after eradication and were unaware of the endoscopic findings (interviews were performed prior to repeat endoscopy).Results:The presence of epigastric pain was significantly associated with persistent H. pylori infection 1 month after therapy (odds ratio 2.3, 95% CI: 1.02–5.2; P=0.041), as was nausea (OR 7.1, 95% CI: 0.93–55.6; P=0.029). The presence of epigastric pain was significantly associated with ulcer relapse at 6 months (OR 7.5, 95% CI: 3.6–15.7; P < 0.001) as was nausea (OR 5.1, 95% CI: 1.7–16.0; P=0.002). Heartburn was not associated with eradication of H. pylori or ulcer relapse. New onset reflux symptoms were reported by 17% (17 of 101 patients) at 6 months and were not significantly different in patients with (15%) and without (22%) persistent H. pylori infection (P=0.47). Erosive oesophagitis was present at endoscopy in one of the 17 cases that developed new heartburn.Conclusions:One month after completion of therapy, the presence of epigastric pain or nausea is associated with persistent infection and these symptoms at 6 months are suggestive of duodenal ulcer relapse. The incidence of GERD is not increased in patients who have eradication of H. pylori.
Personal review: is profound acid inhibition safe?
Authors: Waldum  , Brenna  
Published: March 2003

Inhibitors of gastric acid secretion, particular proton pump inhibitors, are effective drugs in the treatment and prophylaxis of acid‐related diseases. Proton pump inhibitors are therefore prescribed widely, often for minor complaints.Gastric acidity kills swallowed microorganisms, and acid secretion must be of biological importance because it is maintained in phylogenesis. Acid secretion is controlled by feedback mechanisms, mainly via gastrin. A decrease in acidity always causes an increase in plasma gastrin. The trophic effect of gastrin leads to hyperplasia and neoplasia of the enterochromaffin‐like (ECL) cell. ECL cell derived tumours in man were previously regarded as rare, and also as rather benign. It is now clear that the ECL cell gives rise to a significant proportion of gastric carcinomas. Moreover, ECL cell carcinoids secondary to hypergastrinaemia may develop into highly malignant tumours.Treatment with a proton pump inhibitor is followed by rebound acid hypersecretion and decreased efficiency of H2‐blockers, thus such treatment may induce a type of physical dependence. It is therefore reasonable to be cautious and not to treat younger (< 50 years) patients for long periods of time with profound inhibitors of gastric acid secretion. Chromogranin A in the blood is a sensitive marker of the ECL cell mass, and it could be used to survey patients on long‐term proton pump inhibitors.
The osmotic laxative magnesium sulphate activates the ileal brake
Authors: Vu  , Nouwens  , Biemond  , Lamers  , Masclee  
Published: March 2003

Background:Alterations in gastrointestinal motility and hormone secretion, especially activation of the ileal brake, have been documented in malabsorption.Aim:To investigate whether artificially‐induced accelerated small intestinal transit activates the ileal brake mechanism.Methods:Eight healthy volunteers (four female, four male; age 21 ± 3 years) participated in four experiments: (a) meal with either oral magnesium sulphate (MgSO4) or placebo; and (b) fasting with either oral MgSO4 or placebo. Antroduodenal motility was recorded by perfusion manometry. Duodenocaecal transit time was determined by the lactulose H2 breath test. Gall‐bladder volume was measured by ultrasound at regular intervals, and blood samples were drawn for determination of cholecystokinin and peptide YY (RIA). Twenty‐four hour faecal weight and fat excretion were determined.Results:MgS04 significantly accelerated duodenocaecal transit time and increased faecal fat and weight in all subjects. MgSO4 significantly delayed the reoccurrence of phase III and affected antroduodenal motility during fasting but not after meal ingestion. Postprandial gall‐bladder relaxation and postprandial peptide YY release were significantly increased during the MgSO4 experiment compared to placebo.Conclusions:The osmotic laxative MgS04 accelerates intestinal transit both in the fasting and fed state. MgS04 activates the ileal brake mechanism only in the fed state, with peptide YY release and inhibition of gall‐bladder emptying.
Anti‐Helicobacter pylori activity of Chinese tea: in vitro study
Authors: Yee Yuk‐Kei , Koo Marcel Wing‐Leung 
Published: March 2003

Background:Chinese tea has an antibacterial activity against a wide range of bacteria. However, its activity against Helicobacter pylori has not been reported.Method:In this study the anti‐Helicobacter pylori effects of a Chinese tea (Lung Chen tea), and two tea catechins, epigallocatechin gallate and epicatechin and their minimum inhibitory concentrations (MICs) were examined. The effect of Lung Chen on metronidazole resistance was also studied using the E‐test.Results:Lung Chen, epigallocatechin gallate and epicatechin all inhibited the growth of H. pylori. The MIC90 for Lung Chen was 0.25–0.5% (w/w) and that of epigallocatechin gallate and epicatechin were 50–100 and 800–1600 μg/mL, respectively. Epigallocatechin gallate is probably the active ingredient responsible for most of the anti‐H. pylori activity of Chinese tea. Lung Chen did not reverse metronidazole resistance.Conclusions:Chinese tea has anti‐H. pylori activity in a daily consumed concentration, and epigallocatechin gallate is probably the active ingredient responsible for the action.
Failure of oesophageal acid control in candidates for Barrett's oesophagus reversal on a very high dose of proton pump inhibitor
Authors: Fass  , Sampliner  , Malagon  , Hayden  , Camargo  , Wendel  , Garewal  
Published: March 2003

Background:Normalization of oesophageal acid exposure using high dose proton pump inhibitors in patients who are candidates for ablation therapy has been suggested to be essential for successful Barrett's reversal. However, the success rate for achieving pH normalization has not been determined.Methods:Patients with Barrett's oesophagus (2–6 cm in length) who were found to be eligible for ablation therapy using multipolar electrocoagulation were included in this prospective study. Patients underwent an upper endoscopy to determine Barrett's length and other anatomic characteristics. Biopsies were obtained to rule out dysplasia. Subsequently, patients were treated with omeprazole 40 mg b.d. Twenty‐four hour oesophageal pH monitoring was performed after a mean period of 8.4 ± 0.6 days of therapy.Results:Twenty‐five patients were enrolled into the study. The pH test was abnormal in four (16%) of the study subjects. An additional two (8%) patients had abnormal supine percentage time with pH less than 4. There was no significant difference in oesophageal acid control between patients with long vs. short segment Barrett's oesophagus. Elderly (> 60 years) patients tended to have less acid control than younger (≤ 60 years) patients.Conclusions:Failure of oesophageal acid control in candidates for Barrett's oesophagus reversal on very high dose of proton pump inhibitor is not uncommon. Our study suggests that ambulatory 24‐h oesophageal pH monitoring should be considered in all candidates for Barrett's reversal who are treated with high dose proton pump inhibitor to ensure normalization of oesophageal acid exposure.
The effects of smoking and indomethacin on small intestinal permeability
Authors: Suenaert  , Bulteel  , Den Hond  , Hiele  , Peeters  , Monsuur  , Ghoos  , Rutgeerts  
Published: March 2003

Background:Smoking modulates inflammatory bowel disease, protecting from ulcerative colitis on the one hand and worsening the course of Crohn’s disease on the other. This influence might occur through changes in intestinal permeability, because permeability is increased in most patients with Crohn’s disease.Aim:To study the influence of smoking on small intestinal permeability and its increase induced by indomethacin.Methods:50 smokers and 50 nonsmokers underwent a 51Cr‐EDTA basal permeability test and the same test after challenge with indomethacin 125 mg p.o.Results:Small intestinal permeability was the same in smokers (median 1.22%; IQR 1.00–1.58) and nonsmokers (1.24%; 0.94–1.66). Basal small intestinal permeability was lower in females (1.09%; 0.87–1.33) than in males (1.48%; 1.18–1.88). Indomethacin challenge increased permeability by 110% (71–141) in smokers, vs. 156% (78–220) in the nonsmokers (P=0.04).Conclusion:Smoking reduces the effect of NSAID on small intestinal permeability. It is therefore unlikely that the adverse effect of smoking on Crohn’s disease is related to its influence on intestinal permeability.
Gastric acidity and acid breakthrough with twice‐daily omeprazole or lansoprazole
Authors: Katz  , Hatlebakk  , Castell  
Published: March 2003

Background:In patients with severe gastro‐oesophageal reflux disease (GERD), proton pump inhibitors are being used increasingly in twice‐daily regimens to improve control of gastric acidity. Few data exist to compare the ability of the most‐often used proton pump inhibitors, omeprazole and lansoprazole, to control gastric acid at twice‐daily dosage regimens. Nocturnal acid breakthrough, defined as gastric pH < 4.0 continuously for > 60 min, may compromise treatment goals in patients with GERD.Aim:To compare the effects of omeprazole 20 mg b.d. or lansoprazole 30 mg b.d. on gastric acidity and the relative ability of each dosage regimen to prevent acid breakthrough.Methods:In a crossover pharmacodynamic study, 20 healthy volunteers (10 male, 10 female, mean age 38 years) were given omeprazole 20 mg b.d. or lansoprazole 30 mg b.d. for 7 days each, in a randomized manner. Each dosage regimen was separated by a minimum 7‐day period where no medication was administered. On day 7 of each regimen, 24‐h intragastric pH‐metry was performed. The percentage of time for which gastric pH was below 4.0 and 3.0, the occurrence of daytime and nocturnal acid breakthrough, and the duration of action of each regimen were compared. Non‐parametric statistics for paired data were used.Results:The percentage time for which gastric pH was below 4.0 was significantly lower with omeprazole 20 mg b.d. (median 14.8%) than with lansoprazole 30 mg b.d. (median 24.2; P=0.0372). Fourteen subjects showed more effective acid control when taking omeprazole; these were significantly more often H. pylori‐negative patients compared with those for whom acid control was better on lansoprazole (P < 0.001). Nocturnal acid breakthrough occurred in seven patients (35%) on omeprazole and in 10 (50%) on lansoprazole (N.S.).Conclusion:In healthy volunteers, twice‐daily dosing of omeprazole 20 mg b.d. appears to be significantly more effective than lansoprazole 30 mg b.d. in controlling gastric acidity. The clinical importance of such a difference remains to be defined in GERD patients.