bluuebunny/crossref_metadata_2025_split huggingface dataset:
The diagnosis of coeliac disease
Authors: Abdulkarim A. S. , Murray J. A. 
Published: December 2004

SummaryCoeliac disease is a chronic inflammatory condition associated with small intestinal injury that results in the malabsorption of different nutrients. The damaging factor is gluten present in wheat, barley and rye. The diagnosis relies on the clinical picture of the patient, serological markers for coeliac disease, characteristic findings of small intestinal biopsy and, eventually, clinical improvement on a gluten‐free diet. Our strategies for the diagnosis of coeliac disease have changed dramatically within the last 10 years. The advent of serological markers with high sensitivity and specificity is changing our understanding of the disease and its prevalence. Treatment includes a life‐long gluten‐free diet to prevent the recurrence of symptoms and other potential consequences. Most coeliac disease remains under‐diagnosed; the utilization of more accurate serological tests and a greater awareness of its many presentations will aid its identification.
Therapy of osteoporosis in patients with Crohn's disease: a randomized study comparing sodium fluoride and ibandronate
Authors: Von Tirpitz C. , Klaus J. , Steinkamp M. , Hofbauer L. C. , Kratzer W. , Mason R. , Boehm B. O. , Adler G. , Reinshagen M. 
Published: December 2004

SummaryBackground : Osteoporosis is a frequent complication in Crohn's disease. Although the efficacy of both sodium fluoride and aminobisphosphonates in postmenopausal osteoporosis has been investigated in long‐term therapy studies, no long‐term results are available regarding the effect of these agents in the management of osteoporosis in patients with Crohn's disease.Methods : Eighty‐four patients with Crohn's disease and pathological bone mineral density findings were randomized to receive either vitamin D3 (1000 IU) and calcium citrate (800 mg) daily (group A) or sodium fluoride (25 mg b.d., group B) or intravenous ibandronate (1 mg every 3 months, group C) in addition to daily calcium/vitamin D substitution. On admission to the study and after 12 and 27 months, patients underwent dual‐energy X‐ray absorptiometry and radiological examination of the spine.Results : Sixty‐eight patients completed the 1‐year observation period and were available for the intention‐to‐treat analysis. No new vertebral fractures were diagnosed. In group A, lumbar bone density increased by 2.6% (P = 0.066, N.S.), in group B by 5.7% (P = 0.003) and in group C by 5.4% (P = 0.003). Therapy with sodium fluoride was associated with an increase in osteocalcin (N.S.), whereas administration of ibandronate was associated with a decrease in the resorption parameter, carboxy‐terminal cross‐linked type‐I collagen telopeptide (P < 0.05). Both sodium fluoride and ibandronate resulted in significant decreases in the serum concentration of osteoprotegerin after 9 months (P < 0.001).Conclusions : The findings of the present study show that both sodium fluoride and ibandronate are effective in combination with calcium and vitamin D substitution in the management of osteopenia and osteoporosis in patients with Crohn's disease. Both agents are safe and well tolerated, and induce continuous increases in lumbar bone density.
The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40 000 subjects
Authors: Hungin A. P. S. , Whorwell P. J. , Tack J. , Mearin F. 
Published: December 2004

SummaryAim : To determine the prevalence, symptom pattern and impact of the irritable bowel syndrome, across eight European countries, using a standardized methodology.Methods : A community survey of 41 984 individuals was performed using quota sampling and random digit telephone dialling to identify those with diagnosed irritable bowel syndrome or those meeting diagnostic criteria, followed by in‐depth interviews.Results : The overall prevalence was 11.5% (6.2–12%); 9.6% had current symptoms, 4.8% had been formally diagnosed and a further 2.9%, 4.2% and 6.5% met the Rome II, Rome I or Manning criteria, respectively. Bowel habit classification varied by criteria: 63% had an ‘alternating’ bowel habit by Rome II vs. 21% by self‐report. On average, 69% reported symptoms lasting for 1 h, twice daily, for 7 days a month. Irritable bowel syndrome sufferers reported more peptic ulcer (13% vs. 6%), reflux (21% vs. 7%) and appendectomy (17% vs. 11%), but not hysterectomy, cholecystectomy or bladder procedures. Ninety per cent had consulted in primary care and 17% in hospital; 69% had used medication. Irritable bowel syndrome substantially interfered with lifestyle and caused absenteeism.Conclusions : Irritable bowel syndrome is common with major effects on lifestyle and health care. The majority of cases are undiagnosed and the prevalence varies strikingly between countries. Diagnostic criteria are associated with varying prevalences and bowel habit sub‐types. This limits their utility in clinical practice and the transferability of research findings using them.
High eradication rates of Helicobacter pylori with a new sequential treatment
Authors: Zullo A. , Vaira D. , Vakil N. , Hassan C. , Gatta L. , Ricci C. , De Francesco V. , Menegatti M. , Tampieri A. , Perna F. , Rinaldi V. , Perri F. , Papadìa C. , Fornari F. , Pilati S. , Mete L. S. , Merla A. , Potì R. , Marinone G. , Savioli A. , Campo S. M. A. , Faleo D. , Ierardi E. , Miglioli M. , Morini S. 
Published: December 2004

SummaryBackground : Eradication rates of Helicobacter pylori with standard triple therapy are disappointing, and studies from several countries confirm this poor performance.Aim : To assess the eradication rate of a new sequential treatment regimen compared with conventional triple therapy for the eradication of H. pylori infection.Methods : One thousand and forty‐nine dyspeptic patients were studied prospectively. H. pylori‐infected patients were randomized to receive 10‐day sequential therapy [rabeprazole (40 mg daily) plus amoxicillin (1 g twice daily) for the first 5 days, followed by rabeprazole (20 mg), clarithromycin (500 mg) and tinidazole (500 mg) twice daily for the remaining 5 days] or standard 7‐day treatment [rabeprazole (20 mg), clarithromycin (500 mg) and amoxicillin (1 g) twice daily]. H. pylori status was assessed by histology, rapid urease test and 13C‐urea breath test at baseline and 6 weeks or more after completion of treatment.Results : Higher eradication rates were found with the sequential regimen compared to the standard regimen (intention‐to‐treat: 92% vs. 74%, P < 0.0001; per protocol: 95% vs. 77%, P < 0.0001). Higher eradication rates were also seen in patients with peptic ulcer disease and non‐ulcer dyspepsia. In both treatments, compliance was similar (> 90%), as was the rate of side‐effects, which were mild.Conclusions : This 10‐day sequential treatment regimen achieves high eradication rates in peptic ulcer disease and non‐ulcer dyspepsia.
Stool antigen for the diagnosis of Helicobacter pylori infection in cirrhosis: comparative usefulness of three different methods
Authors: Calvet X. , Quesada M. , Roselló M. , Salceda F. , Sanfeliu I. , Dalmau B. , Gil M. 
Published: December 2004

SummaryBackground : Helicobacter pylori infection may lead to peptic ulcer disease, and causes significant morbidity in patients with cirrhosis. The measurement of H. pylori antigens in human stools has been proposed as a valuable, non‐invasive, diagnostic tool. A number of tests have recently been commercialized. However, very few data are available on their reliability in patients with cirrhosis.Aim : To evaluate the usefulness of three new tests — HpSA (Meridian Diagnostics Inc., Cincinnati, OH, USA), Simple H. pyl (OPERON S.A., Zaragoza, Spain) and FemtoLab H. pylori (Connex, Martinsried, Germany) — in the diagnosis of H. pylori infection in cirrhotic patients.Methods : H. pylori infection was determined in 79 cirrhotic patients (48 men, 31 women; age range, 29–82 years; mean, 62 ± 11 years) by concordance of histology and urea breath test. The sensitivity, specificity and positive and negative predictive values of each stool test were calculated.Results : According to the reference method, the sensitivities of HpSA, Simple H. pyl and FemtoLab H. pylori immunoassays were 76%, 87% and 78%, respectively, and their specificities were 93%, 62% and 79%, respectively.Conclusions : Faecal tests are non‐invasive and easy‐to‐perform tools for the diagnosis of H. pylori infection. However, their sensitivity and specificity seem to be non‐optimal in patients with cirrhosis.
The prophylactic use of a proton pump inhibitor before food and alcohol
Authors: O'leary C. , McCarthy J. , Humphries M. , Shanahan F. , Quigley E. 
Published: December 2004

SummaryBackground : Patients report that the prophylactic consumption of a proton pump inhibitor minimizes gastrointestinal symptoms expected to be provoked by late‐night food and alcohol consumption. The efficacy of this practice has not been studied formally.Aim : To perform a randomized, double‐blind, placebo‐controlled trial of a single dose of lansoprazole (30 mg) taken prior to a large meal and alcohol consumption.Methods : Study subjects were recruited randomly from local primary care and hospital physicians. Each participant (n = 56; 37 male, 19 female; mean age, 38 years) completed questionnaires before and after the meal. Approximately 90 min prior to the provocative meal, participants were witnessed taking either placebo or 30 mg lansoprazole. Bar tokens were dispensed to permit the accurate quantification of alcohol consumption (mean, 15 units).Results : Forty per cent of subjects reported significant reflux symptoms. For the entire group, there was no significant difference between lansoprazole and placebo. Post‐prandial reflux was more frequent in those consuming > 15 units of alcohol (13/26, 50%) compared with those consuming < 15 units (7/30, 24%; P < 0.05). In the group who consumed > 15 units of alcohol, lansoprazole was associated with a lower rate of heartburn (5/15, 33%) compared with placebo (8/11, 73%; P < 0.05).Conclusion : A single dose of a proton pump inhibitor prior to indulgence was only associated with reduced heartburn in those consuming > 15 units of alcohol.
Response, relapse and mucosal immune regulation after infliximab treatment in fistulating Crohn's disease
Authors: Agnholt J. , Dahlerup J. F. , Buntzen S. , Tøttrup A. , Nielsen S. Lyhne , Lundorf E. 
Published: December 2004

SummaryBackground : Infliximab reduces mucosal inflammation in some, but not all, patients with Crohn's disease.Aim : To monitor clinical data and changes in mucosal cytokine levels after infliximab treatment to identify differences between responders and non‐responders.Methods : Twenty‐six patients with fistulating Crohn's disease received three infliximab infusions at weeks 0, 2 and 6. Follow‐up was for 1 year and included clinical examination, colonoscopy, ano‐rectal ultrasound and magnetic resonance imaging. Biopsies were taken at weeks 0, 8, 26 and 52. Cell cultures were established and analysed for tumour necrosis factor‐α, interferon‐γ and interleukin‐10 levels, and related to clinical status and fistula healing.Results : Eleven of 15 patients (73%) with active disease (Crohn's disease activity index > 150) obtained remission (Crohn's disease activity index < 150) at 8 weeks. In in vitro cell cultures, there was reduced tumour necrosis factor‐α and interleukin‐10 production at week 26, with the latter persistent throughout the study period. When the disease deteriorated or relapsed, there was increased interferon‐γ production in in vitro cell cultures. Fistula healing was associated with reduced production of interferon‐γ, tumour necrosis factor‐α and interleukin‐10.Conclusions : Infliximab down‐regulates mucosal immune activation in Crohn's disease. Monitoring of mucosal cytokine levels after infliximab treatment by whole biopsy cultures may be useful as interleukin‐10, tumour necrosis factor‐α and interferon‐γ production are different in responders and at relapse.
Eradication of Helicobacter pylori increases nocturnal intragastric acidity during dosingwith rabeprazole, omeprazole, lansoprazole and placebo
Authors: Williams M. P. , Usselmann B. , Chilton A. , Sercombe J. , Nwokolo C. U. , Pounder R. E. 
Published: December 2004

SummaryBackground : The eradication of Helicobacter pylori decreases the antisecretory activity of omeprazole and lansoprazole. Rabeprazole is a potent proton pump inhibitor that may not be affected as greatly by H. pylori status.Aim : To compare the effect of H. pylori eradication on intragastric acidity and plasma gastrin during dosing with lansoprazole, omeprazole, rabeprazole and placebo.Methods : Twenty‐four healthy H. pylori‐infected volunteers were studied on day 7 of dosing with placebo, lansoprazole 30 mg, omeprazole 20 mg and rabeprazole 20 mg, before and at least 5 weeks after H. pylori eradication. On each occasion, the 24‐h intragastric acidity was measured by gastric aspiration. Plasma gastrin concentrations were measured hourly from 08.00 to 13.00 h.Results : Sixteen subjects completed the study. For all three drugs and placebo, H. pylori eradication increased intragastric acidity, particularly nocturnal acidity, and decreased plasma gastrin. There were no differences between the three drugs with respect to 24‐h acidity, percentage of time pH > 4 or 5‐h plasma gastrin, either before or after H. pylori eradication. Before eradication, the percentage nocturnal time at pH > 3 was significantly greater during rabeprazole than during lanso‐prazole dosing.Conclusions : The increase in intragastric acidity seen after H. pylori eradication during dosing with proton pump inhibitors is a drug–class effect, particularly affecting nocturnal acid control. This is related to increased spontaneous intragastric acidity after H. pylori eradication.
A rapid, low‐dose, 13C‐urea tablet for the detection of Helicobacter pylori infection before and after treatment
Authors: Gatta L. , Vakil N. , Ricci C. , Osborn J. F. , Tampieri A. , Perna F. , Miglioli M. , Vaira D. 
Published: December 2004

SummaryBackground : A new urea breath test (UBT) has been described which uses a tablet formulation of 13C‐urea with citric acid and allows breath sampling to be performed as early as 10 min after ingestion of the tablet.Aim : To assess the diagnostic accuracy of tablet‐based 13C‐UBTs (50 and 100 mg 13C‐urea) before and after Helicobacter pylori eradication treatment, compared with an endoscopy gold standard and a conventional 13C‐UBT (75 mg 13C‐urea).Methods : Two hundred dyspeptic patients underwent endoscopy, followed by tablet‐based 13C‐UBTs (50 and 100 mg 13C‐urea) and a conventional 13C‐UBT (75 mg 13C‐urea). H. pylori‐infected patients were prescribed treatment and asked to return 4–6 weeks after the end of therapy for repeat endoscopy and 13C‐UBTs.Results : One hundred and thirteen patients were infected with H. pylori. The sensitivity and specificity of the conventional 13C‐UBT were both 100%; the sensitivity and specificity of the 100‐mg tablet‐based 13C‐UBT were 100% and 98.85%, respectively. For the 50‐mg tablet‐based 13C‐UBT, cut‐off values of the difference over baseline of between 1.65 and 3.15 provided a sensitivity and specificity of 100%. At follow‐up, the sensitivity and specificity of the conventional and 100‐mg tablet‐based 13C‐UBTs were both 100%. For the 50‐mg tablet‐based 13C‐UBT, cut‐off values of the difference over baseline of between 1.49 and 1.56 gave a sensitivity and specificity of 100%.Conclusions : New 10‐min 13C‐UBTs using tablet formulations of 13C‐urea with citric acid are reliable for the assessment of H. pylori status pre‐ and post‐treatment.
Role of immunosuppression in the development of quinolone‐resistant Escherichia coli spontaneous bacterial peritonitis and in the mortality of E. coli spontaneous bacterial peritonitis
Authors: Cereto F. , Molina I. , González A. , Del Valle O. , Esteban R. , Guardia J. , Genescà J. 
Published: December 2004

SummaryBackground : Norfloxacin decreases the incidence of spontaneous bacterial peritonitis in cirrhotics, but promotes the appearance of quinolone‐resistant Escherichia coli.Aim : To define the characteristics of quinolone‐resistant E. coli spontaneous bacterial peritonitis.Methods : E. coli‐positive ascitic fluid cultures were identified during a 6‐year period. Data on quinolone‐sensitive and quinolone‐resistant E. coli spontaneous bacterial peritonitis were compared.Results : One hundred and two E. coli‐positive ascitic fluid cultures were detected. Cirrhotics accounted for 67 cases. Spontaneous bacterial peritonitis was found in 47 of the 67 (70%) cases [35 (74%) caused by quinolone‐sensitive and 12 (26%) caused by quinolone‐resistant E. coli]. Norfloxacin prophylaxis was higher in the quinolone‐resistant group (92% vs. 6%, P < 0.001). Compared with patients with quinolone‐sensitive E. coli spontaneous bacterial peritonitis, those with quinolone‐resistant E. coli spontaneous bacterial peritonitis showed a higher prevalence of associated immunosuppressive factors (immunosuppressive drugs, human immunodeficiency virus infection or cancer) (92% vs. 20%, P < 0.001). Steroid therapy was independently associated with quinolone‐resistant E. coli spontaneous bacterial peritonitis (odds ratio, 49; 95% confidence interval, 3.4–699; P = 0.004). The Child–Pugh score (P = 0.03), immunosuppression (P = 0.02) and renal failure (P = 0.01) were independent predictors of E. coli spontaneous bacterial peritonitis‐related mortality.Conclusions : Associated immunosuppression is an important co‐factor for the development of quinolone‐resistant E. coli spontaneous bacterial peritonitis and for E. coli spontaneous bacterial peritonitis‐related mortality.
Non‐alcoholic fatty liver disease
Authors: Alba L. M. , Lindor K. 
Published: December 2004

SummaryNon‐alcoholic fatty liver disease is a clinicopathological condition that comprises a wide spectrum of liver damage, ranging from simple steatosis to steatohepatitis, advanced fibrosis and cirrhosis. Non‐alcoholic steatohepatitis represents only a stage within the spectrum of non‐alcoholic fatty liver disease and is defined pathologically by the presence of steatosis together with necro‐inflammatory activity. The true prevalence of non‐alcoholic fatty liver disease is unknown, but it is estimated that it affects 10–24% of the general population in different countries. The diagnosis of non‐alcoholic fatty liver disease is based upon convincing evidence of absent or minimal alcohol consumption, compatible histological changes in liver biopsy and the exclusion of other liver diseases. The natural history of non‐alcoholic fatty liver disease remains to be defined. Patients with pure steatosis on liver biopsy follow a relatively benign course, whereas patients with histological necro‐inflammatory changes and/or fibrosis may progress to end‐stage liver disease. An initial step in the treatment of non‐alcoholic fatty liver disease is the management of associated conditions, such as obesity, diabetes mellitus and hyperlipidaemia. Non‐alcoholic fatty liver disease patients with steatohepatitis and/or fibrosis on liver biopsy may benefit from investigational pharmacological therapy. Patients with decompensated cirrhosis from non‐alcoholic fatty liver disease may be candidates for liver transplantation.
Cost‐effectiveness analysis of therapeutic strategies for patients with chronic hepatitis C previously not responding to interferon
Authors: San Miguel R. , Mar J. , Cabasés J. M. , GuilléN‐Grima F. , Buti M. 
Published: December 2004

SummaryBackground: The efficacy of combination therapy in patients with chronic hepatitis C previously not responding to interferon monotherapy is lower than that in naive patients, and there has been no economic evaluation in this population.Aim: To develop a cost‐effectiveness analysis of therapeutic regimens with interferon‐alpha and ribavirin in previous interferon non‐responders.Methods: A Markov simulation model was used to project the clinical and economic outcomes of five different therapeutic strategies, including a ‘no treatment’ alternative, using the health care system perspective. The efficacy data for the different doses and durations were obtained from a previously performed meta‐analysis. A sensitivity analysis was performed to test the robustness of the model, analysing changes in different variables.Results: Applying a 3% discount rate, the standard patient on combination therapy for 12 months showed increases of 0.80 years and 1.55 quality‐adjusted life years, when compared with the ‘no treatment’ strategy. This option led to an incremental cost‐effectiveness ratio of 11 767 euros per year of life gained and 6073 euros per quality‐adjusted life year.Conclusions: Combination therapy with interferon plus ribavirin is cost‐effective in previous interferon non‐responders and is within the range of some well‐accepted medical interventions in our health care system.
Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia
Authors: Koloski N. A. , Talley N. J. , Huskic S. S. , Boyce P. M. 
Published: December 2004

SummaryBackground : The drivers of conventional and, especially, alternative health care use for irritable bowel syndrome and functional dyspepsia are not clear.Aim : To determine the predictors of conventional and alternative health care use for irritable bowel syndrome and functional dyspepsia.Methods : Two hundred and seven subjects with irritable bowel syndrome or functional dyspepsia, identified from a previous population survey, were included in the study. Individuals with irritable bowel syndrome/functional dyspepsia were defined as consulters (n = 103) if they had visited their doctor for gastrointestinal symptoms more than once in the past year. Controls (n = 100) did not report having any abdominal pain. Subjects were given structured interviews to assess the Diagnostic and Statistical Manual – version IV (DSM‐IV) and International Classification of Disorders – version 10 (ICD‐10) psychiatric diagnosis for anxiety, depression, somatization or any psychiatric diagnosis, aspects of health care use and symptom factors.Results : About one‐half (n = 103, 49.8%) of community subjects with irritable bowel syndrome/functional dyspepsia had sought conventional care for gastrointestinal symptoms in the past 12 months. Lifetime rates for alternative health care use for gastrointestinal symptoms were 20.8% (n = 43). Independent predictors of conventional health care use were more frequent abdominal pain, greater interference of gastrointestinal symptoms with work and activities and a greater satisfaction with the physician–patient relationship. Being female independently predicted alternative health care use.Conclusions : Psychological morbidity did not predict conventional or alternative health care use for gastrointestinal symptoms. Other factors were more important.