bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of ornidazole and clarithromycin resistance on eradication of Helicobacter pylori in peptic ulcer disease
Authors: Lehmann  , Drewe  , Terracciano  , Beglinger  
Published: March 2003

Background:Clarithromycin and nitroimidazoles such as metronidazole and ornidazole are among the most frequently used antibiotics for curing Helicobacter pylori infection. However, controversial data exist on whether their in vitro resistance has a negative impact on treatment outcome.Methods:Patients with H. pylori positive active peptic ulcer disease were randomly assigned to receive lansoprazole 30 mg o.d., amoxycillin 1 g b.d. and ornidazole 500 mg b.d. (LAO) or lansoprazole 30 mg o.d., amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. (LAC) for 2 weeks. Pre‐treatment resistance to ornidazole and clarithromycin was assessed by Epsilometer (E‐) test. Four weeks after completion of treatment, patients underwent a 13C urea breath test to assess H. pylori status.Results:Data from 80 patients with active peptic ulcer disease and positive H. pylori status were analysed. The prevalence of primary drug resistance was 25% for metronidazole and 7.5% for clarithromycin. In patients treated with LAO, effective treatment was achieved in 87% of metronidazole‐susceptible, but only 30% of metronidazole‐resistant strains (P < 0.01). In the LAC group, therapy was successful in 81% of clarithromycin‐susceptible strains, whereas treatment failed in all patients with primary clarithromycin resistance (n = 3).Conclusion:Resistance against nitroimidazoles significantly affects treatment outcome in H. pylori eradication therapy.
Effect of gastric acid suppression on 13C‐urea breath test: comparison of ranitidine with omeprazole
Authors: Savarino  , Bisso  , Pivari  , Zentilin  , Bilardi  , Dulbecco  , Mele  , Tracci  , Vigneri  
Published: March 2003

Background:The assessment of the effect of H2 antagonists on the results of the urea breath test has produced controversial results.Aim:To assess whether standard doses of both omeprazole and H2 blockers can adversely influence the accuracy of the urea breath test.Methods:Sixty dyspeptic patients with ascertained Helicobacter pylori infection were recruited for this prospective, open study. They were randomized to receive either omeprazole 20 mg at 08:00 hours (n = 30) or ranitidine 300 mg at 22:00 hours (n = 30) for 14 days. The urea breath test was performed at baseline, on day 14, while patients were still taking the antisecretory drugs, and on day 21, 1 week after their cessation. Duplicate breath samples were collected after ingestion of 75 mg 13C‐urea + citric acid. A δ value > 5‰ was considered positive.Results:On day 14 the median δ values had declined, but not significantly (P = 0.07) compared to baseline (13.79 vs. 22.39) with omeprazole, while they had increased (P = 0.27) with ranitidine (27.21 vs. 19.46). On the same day there were five out of 30 (17%) and five out of 28 (18%) false‐negative results in the omeprazole and ranitidine groups, respectively. All these cases became positive again on day 21. However, in eight cases treated with omeprazole and 13 treated with ranitidine, there was an increase of 14‐day δ values compared to baseline.Conclusions:Our study shows that both omeprazole and ranitidine at standard doses are able to negatively affect the results of the urea breath test. Their adverse effect resolves within 7 days of drug cessation and therefore the withdrawal of these drugs 7 days before testing seems to be sufficient to avoid false‐negative results. The surprising finding that both antisecretory drugs reduce δ values in one group and increase them in another group of patients deserves further study.
Dyspepsia workload in urban general practice and implications of the British Society of Gastroenterology Dyspepsia Guidelines (1996)
Authors: Bodger  , Eastwood  , Manning  , Daly  , Heatley  
Published: March 2003

Aim:To define the characteristics of patients consulting with active dyspeptic symptoms in urban general practice, and to consider the implications of applying the British Society of Gastroenterology Dyspepsia management guidelines.Design:Prospective observational study over a period of 12 months.Setting:Two multipartner, two‐centre general practices in the City of Leeds (UK) with a combined target population of 11 011 registered patients.Subjects:A total of 340 patients consulting with active dyspeptic symptoms (52% male; mean age 53 years, range 16–89 years).Results:Of the practice population, 3% consulted with dyspepsia (first‐time consulter: 19%; previous consulter not yet investigated: 30%; previously investigated: 51%). Of 168 undiagnosed patients, 43% had upper abdominal pain (dysmotility‐like symptoms in 42%), 35% had reflux symptoms, 22% had mixed symptoms, 12% had ‘alarm’ symptoms and 18% had a history of NSAID use. Patients < 45 years old with simple dyspepsia accounted for 32% of undiagnosed cases. A fifth of the workload was in dealing with undiagnosed dyspeptics over 45 years old. One per cent of the population would require endoscopy if all undiagnosed cases either > 45 years or with complicated dyspepsia were investigated. Of 172 previously investigated patients, 29% had negative tests, 25% had ‘minor’ findings, and 45% had evidence of acid‐peptic disease. Patients with duodenal ulcer disease accounted for 12% of the total workload.Conclusions:A knowledge of the characteristics of patients consulting with dyspepsia in primary care should allow the adaptation of guidelines, to ensure advice is relevant to local case mix and compatible with local resources.
Comparative palatability of 22 liquid antacids
Authors: Temple  , Nahata  
Published: March 2003

Objective:To compare the palatability, acid neutralizing capability, and costs of different antacids.Methods:Volunteers between the ages of 18 and 60 years were given 22 antacids. All antacids were given during a 4‐h period in two groups of 11 antacids each. Subjects sampled each antacid in a manner similar to wine tasting and rated each antacid on its smell, taste, texture and aftertaste using a scale of 1–9; 1 being the worst and 9 the best.Results:A total of 73 adults completed the study. Mylanta Lemon Twist and Mylanta Cherry Crème were the most palatable antacids; however, overall the palatability of all the antacids was poor. Maalox MS Cool Mint and ES Gaviscon were the least palatable. The extra strength antacids had the most acid neutralizing capability, and thus would require smaller doses. Amphogel was the most costly antacid per mEq of acid neutralized. Age and gender did not affect the palatability scores.Conclusion:Although the regular strengths of Mylanta Lemon Twist and Mylanta Cherry Crème were the most palatable, the extra strength versions of these products have twice the acid neutralizing capability and thus, half the volume is required for each dose. Therefore, these agents may be the antacids of choice.
Effects of dietary fibre and olestra on regional apparent viscosity and water content of digesta residue in porcine large intestine
Authors: Mcrorie  , Brown  , Cooper  , Givaruangsawat  , Scruggs  , Boring  
Published: March 2003

Background:Increased consumption of non‐digested, non‐absorbed substrates, such as dietary fibre, can lead to an increase in colonic transit rate and stool output. The effects of dietary fibre and olestra on the consistency and water content of digesta residue within the large bowel were not known.Aim:The aim of this study was to determine the effects of dietary fibre and olestra on regional dehydration and apparent viscosity of digesta residue throughout the large bowel.Methods:Seventy‐eight pigs were fed diet alone (control) or supplemented with 40 g/day or 80 g/day dietary fibre or olestra and sacrificed 24, 48, 96 or 192 h after initiation of dosing. The large bowel was removed, divided into 13 segments, and the digesta residue/stool was analysed for apparent viscosity (peak force for extrusion) and percentage water content.Results:In control animals, digesta residue occurred as a continuum, from liquid in the cecum (87.9% water) to solid in the rectum (71.5% water). The relatively small decrease in percentage water content (16.4%) resulted in a marked increase in mean apparent viscosity (liquid = 87 g peak force; solid=3919 g peak force). Dietary fibre increased the percentage water content of digesta residue throughout the large bowel. In contrast, olestra decreased the percentage water content of digesta residue in the mid and distal large bowel. At 40 g/day, dietary fibre showed a significant (P < 0.05) digesta residue/stool softening effect for all time points, beginning at 24‐h (single dose). Olestra 40 g/day did not significantly soften digesta residue/stool until 48 h (2 doses, P < 0.05), and was not different from control at 96 h. At 80 g/day, both dietary fibre and olestra significantly (P < 0.01) softened digesta residue/stool at all time points. There were no liquid or oily stools at any dose or time‐point.Conclusions:Relatively small changes in water content result in large changes in digesta residue/stool apparent viscosity. Dietary fibre increased digesta residue/stool water content throughout the bowel, resulting in softer digesta residue/stool. In contrast, olestra decreased stool water content, yet had a similar stool softening effect compared to dietary fibre.
The impact of antibiotic resistance on the efficacy of three 7‐day regimens against Helicobacter pylori
Authors: Savarino  , Zentilin  , Pivari  , Bisso  , Mele M. Raffaella , Bilardi  , Borro  , Dulbecco  , Tessieri  , Mansi  , Borgonovo  , De Salvo  , Vigneri  
Published: March 2003

Background:Antibiotic resistance affects the success of anti‐Helicobacter pylori therapies and varies greatly from country to country.Aim:To compare the efficacy of three short‐term triple regimens in relation to H. pylori primary resistance in our region.Methods:We enrolled 210 H. pylori‐positive dyspeptic patients for this randomized, open, parallel‐group study. Three arms of 70 patients each received the following 1‐week regimens: (1) ranitidine bismuth citrate 400 mg b.d. + clarithromycin 250 mg b.d. + metronidazole 500 mg b.d. (RCM); (2) bismuth subcitrate 240 mg b.d. + amoxycillin 1000 mg b.d. + metronidazole 500 mg b.d. (BAM); (3) omeprazole 20 mg o.d. + clarithromycin 250 mg b.d. + metronidazole 500 mg b.d. (OCM). H. pylori was assessed by CLO‐test and histology before and 4 weeks after therapy. Antibiotic resistance was assessed by E‐test.Results:On intention‐to‐treat analysis RCM was more effective than OCM (84% vs. 69%; P < 0.03) and BAM (84% vs. 63%; P < 0.004). MIC determination was successful in 117 out of 210 patients (55%); metronidazole resistance was present in 52 out of 117 patients (44%) and clarithromycin resistance was present in 17 out of 117 patients (14%). Excellent cure rates were achieved when strains were sensitive to both antibiotics (100% with RCM and BAM and 90% with OCM), whereas RCM was superior to OCM (P=0.009) and BAM (P=0.001) with respect to overall resistant strains (94% vs. 57% and 38%, respectively).Conclusions:One‐week RCM is the best regimen to eradicate H. pylori in our geographical area. This seems to be linked to the better ability of RCM compared to OCM and BAM in overcoming the high prevalence of H. pylori resistance to both metronidazole and clarithromycin in our region.
High prevalence of Helicobacter pylori infection with dual resistance to metronidazole and clarithromycin in Hong Kong
Authors: Wang  , Wong  , Mukhopadhyay  , Berg  , Cho  , Lai  , Hu  , Fung  , Hui  , Lam  
Published: March 2003

Background:Metronidazole resistance is a common problem in most Asian countries, and clarithromycin has been widely used in Hong Kong.Aim:To determine the prevalence of Helicobacter pylori strains resistant to metronidazole and clarithromycin in Hong Kong and to assess the effect on eradication rates. Also to determine the genetic mutation in relation to phenotypic divergence in clarithromycin‐resistant strains.Methods: H. pylori were cultured from gastric biopsies obtained from 87 patients during upper endoscopy. Minimal inhibitory concentrations of metronidazole and clarithromycin were determined by Etest and agar dilution methods. Mutations in clarithromycin‐resistant strains were identified by polymerase chain reaction and restriction analysis. Random amplified polymorphic DNA fingerprinting was performed on clarithromycin‐resistant and susceptible isolates.Results:The prevalences of H. pylori strains resistant to metronidazole and clarithromycin were 49.4% and 10.8%, respectively, in Hong Kong. Dual resistance to metronidazole and clarithromycin were found in 7.2% of patients. The agreement between E‐test and agar dilution methods was determined by error‐rate bound analysis as 95.4% for metronidazole and 100% for clarithromycin. Dual resistant strains reduced the eradication rate to 66.7%. Among clarithromycin‐resistant strains tested, all were due to A2144G point mutation in 23S rRNA gene. Random amplified polymorphic DNA fingerprinting suggested various phenotypically mixed populations.Conclusions:The prevalence of metronidazole‐resistant H. pylori strains remained static whilst the prevalence of clarithromycin‐resistant strains was not rare in Hong Kong. An alarming 7.2% of patients were resistant to both the antimicrobials, which had a definite impact on treatment success. All cases of resistance to clarithromycin were due to A2144G mutation in 23S rRNA of H. pylori.
Abnormal contractile properties of rectal smooth muscle in chronic ulcerative colitis
Authors: Cook T. A. , Brading A. F. , Mortensen N. J. MCC. 
Published: March 2003

Background:Patients with ulcerative colitis have abnormal rectal motility.Aim:To compare the contractile properties of rectal smooth muscle from patients with ulcerative colitis and controls.Methods:Rectal smooth muscle strips from patients undergoing resection for ulcerative colitis or cancer (control) were mounted in an organ bath. The effects of carbachol (receptor–mediated) and potassium (causes membrane depolarization) were studied. Acetylcholinesterase histochemistry was performed and nerve counts compared.Results:Ulcerative colitis (n=41) and control (n=34) strips contracted in response to potassium and carbachol. Mean (S.E.M.) maximum response to potassium in the control and ulcerative colitis groups was 1.07 (0.06) g/mg and 1.02 (0.09) g/mg tissue, respectively (P=N.S.). EC50s (concentrations required to give 50% of maximal response) were 75 (1) mM and 73 (1) mM, respectively (P=N.S.). Although maximum responses to carbachol were similar, 2.12 (0.12) g/mg and 1.95 (0.12) g/mg tissue (P=N.S.), ulcerative colitis strips exhibited an increased sensitivity to carbachol, EC50s: 5.05 × 10–6  (0.55 × 10–6) M vs. 8.36 × 10–6 (0.88 × 10–6) M, P=0.002). There was no significant difference in nerve counts between the tissues, as assessed by staining for acetylcholinesterase.Conclusions:Ulcerative colitis tissue has an increased sensitivity to carbachol and this is not due to denervation; it may result from increased calcium release from intracellular stores since contraction due to membrane depolarization is not altered. Modulation of this pathway could potentially be used to alter rectal motility in patients with ulcerative colitis.
Nitric oxide mediates a therapeutic effect of nicotine in ulcerative colitis
Authors: Green J. T. , Richardson C. , Marshall R. W. , Rhodes J. , Mckirdy H. C. , Thomas G. A. O. , Williams G. T. 
Published: March 2003

Background:Ulcerative colitis is a condition of nonsmokers in which nicotine is of therapeutic benefit.Aims:To examine thein vitroeffect of nicotine on colonic smooth muscle activity and the role of nitric oxide (NO) as a mediator.Methods:Nicotine, 1–10 μM, was administered to strips of circular muscle from the distal sigmoid colon of 9 patients with active ulcerative colitis and 18 with colorectal cancer. The effect of electrical field stimulation (EFS) was examined before nicotine was added. Finally L‐NAME, a NO synthetase inhibitor, was added before nicotine was administered again.Results:Muscle strips developed similar spontaneous resting tone. In response to EFS, ulcerative colitis tissue developed lower tensions than the controls. Nicotine significantly reduced the resting tone and peak tension after EFS, with a greater effect in controls. With L‐NAME, peak tensions were increased more in ulcerative colitis than controls, and nicotine produced a much smaller reduction.Conclusions:Nicotine reduces circular muscle activity, predominantly through the release of nitric oxide—this appears to be ‘up‐regulated’ in active ulcerative colitis. These findings may explain some of the therapeutic benefit from nicotine (and smoking) in ulcerative colitis and may account for the colonic motor dysfunction in active disease.
The effects of tegaserod (HTF 919) on oesophageal acid exposure in gastro‐oesophageal reflux disease
Authors: Kahrilas P. J. , Quigley E. M. M. , Castell D. O. , Spechler S. J. 
Published: March 2003

Background:Tegaserod (HTF 919), a 5‐HT4 receptor partial agonist, has prokinetic effects that might be useful in decreasing acid reflux in gastro‐oesophageal reflux disease (GERD).Methods:To investigate the potential clinical utility of tegaserod in GERD, a five‐period crossover study (balanced Latin square) was designed to evaluate the efficacy of 4 b.d. doses of tegaserod vs. placebo. Four‐hour manometry (1 h fasting and 3 h postprandial) with continuous recording of lower oesophageal sphincter pressure and distal oesophageal pH, was performed at the end of each 2‐week treatment period in 19 patients with mild‐to‐moderate GERD. Recordings were scored for mean lower oesophageal sphincter pressure, number of transient lower oesophageal sphincter relaxations, and distal oesophageal acid exposure.Results:Tegaserod (1 mg/day and 4 mg/day) caused a more than 50% decrease in acid exposure in the postprandial period in patients with abnormal acid exposure, although only the 1 mg/day tegaserod treatment elicited statistically significant decreasing (P < 0.05) for the entire treatment group (percentage time for which pH < 4: placebo=13%; 1 mg/day dose=5%; 4 mg/day dose=8%). A decreased number of reflux episodes was demonstrated with both the 1 mg/day and 4 mg/day tegaserod doses. There was no apparent effect on mean lower oesophageal sphincter pressure, whilst transient lower oesophageal sphincter relaxations frequency decreased in the 1–2.5 h post‐dose.Conclusions:Tegaserod in a dose of 1 mg/day causes a significant decrease in postprandial oesophageal acid exposure. The reduction in oesophageal acid exposure with tegaserod treatment may result from enhanced oesophageal acid clearance, improved gastric emptying, and/or reduced transient lower oesophageal sphincter relaxations.
A randomized controlled trial to assess alendronate‐associated injury of the upper gastrointestinal tract
Authors: Marshall J. K. , Rainsford K. D. , James C. , Hunt R. H. 
Published: March 2003

Background:Aminobisphosphonates are recommended for postmenopausal osteoporosis but have been associated with injury to the upper gastrointestinal tract.Aim:To conduct a randomized controlled trial, to assess the endoscopic damage caused by alendronate and its effect on gastric mucosal prostaglandin synthesis.Methods:Seventy‐six healthy volunteers age 40–60 years, with normal baseline endoscopy were randomly assigned to treatment with: (A) ASA 650 mg q.d.s.; (B) alendronate 10 mg o.d.; or (C) placebo o.d. for 14 days. Mucosal injury scores on day 14 of treatment were reported by a blinded endoscopist. Gastric biopsies were analysed for prostaglandin E2 (PGE2) concentration by radioimmunoassay.Results:Oesophageal injury did not differ among treatment groups. Gastric ulcers developed in five out of 26 subjects given ASA, two out of 25 given alendronate, and none of 25 given placebo. The mucosal damage scores for the alendronate group exceeded those for the placebo group in the gastric body but not at other sites. Injury scores for ASA exceeded those for placebo in the duodenum, antrum, body, and fundus. The mean change in log10[PGE2] (ng/mg protein) was − 0.07 for placebo, − 0.80 for ASA, and + 0.62 for alendronate (differences not significant).Conclusions:Alendronate is associated with injury and ulceration of the gastric mucosa. This effect was not associated with any significant change in gastric mucosal PGE2 levels.
Identifying responders to acid suppression in dyspepsia using a random starting day trial
Authors:   THE DANISH DYSPEPSIA STUDY GROUP:, Bytzer P. , Hansen J. M. , Rune S. , Bonnevie O. , Breinstrup H. , Funch‐Jensen P. , Matzen P. , Meineche‐Schmidt V. , Schaffalitzky De Muckadell O. B. 
Published: March 2003

Background:Functional dyspepsia is a heterogeneous condition and a uniform response to drug treatment is not likely. This may be the reason for the general failure of acid suppression in clinical trials in these patients. It may be more rewarding to identify true responders to drug treatment by a single subject trial.Aim:To develop and to test a novel single subject trial design (random starting day trial) in dyspeptic patients.Patients and methods:A total of 301 dyspeptic patients entered a 16‐day trial. All patients received placebo for the first 4 days and switched to omeprazole at a randomized and blinded day between day 5 and day 14. Response was defined as a sustained ≥ 50% decrease in symptom score occurring in relation to drug shifting.Results:Spontaneous response varied between 0.3% and 10.6% per day, uniformly distributed over time. Overall, 53–61% of patients with organic dyspepsia had a symptom response in relation to shifting to active treatment, compared to only 23% of patients with functional dyspepsia. The only predictor of response was symptoms suggesting gastro‐oesophageal reflux.Conclusions:A random starting day trial may be a valuable tool to identify response to acid suppression in dyspeptic patients.
Autonomic nervous regeneration in acetic acid‐induced ulcer from the viewpoint of synapse formation – effect of basic fibroblast growth factor and sofalcone in the rat
Authors: Nakamura M. , Kishikawa H. , Ishii H. , Kumagai N. , Tsuchimoto K. 
Published: March 2003

Summary Background: Monoclonal antibodies against GAP43 and synaptophysin, markers of regenerated nerves, have recently become available. Aim: To investigate the regeneration of the autonomic nerves after acetic acid treatment, as well as the effect of recombinant basic fibroblast growth factor (bFGF‐CS23) and sofalcone on reinnervation. Methods: Ulcers were induced by the direct application of 100% acetic acid to the serosal surface of the rat fundic stomach. Some rats were treated with bFGF‐CS23 or sofalcone every 12 h after the acetic acid treatment. The immunohistochemical location of GAP43 and synaptophysin was observed by confocal laser microscopy, and the uptake sites of 14C‐sofalcone were observed by autoradiography. Results: Both GAP43 and synaptophysin immuno‐reactivities surrounding microvessels were weak in the control group, whereas in the acetic acid‐treated group, these immunoreactivities were increased. Treatment with bFGF‐CS23 and sofalcone increased these immunoreactivities. The binding sites of sofalcone coincided with the location of regenerated nerves and surface mucous cells. The progenitors of the autonomic nerves were more abundant than expected. Conclusion: Both bFGF and sofalcone seem to stimulate nerve regeneration.