bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antiinflammatory actions of cat’s claw: the role of NF‐κB
Authors: Sandoval‐Chacón  , Thompson  , Zhang  , Liu  , Mannick  , Sadowska‐Krowicka  , Charbonnet  , Clark  , Miller  
Published: March 2003

Background: Uncaria tomentosa is a vine commonly known as cat’s claw or ‘uña de gato’ (UG) and is used in traditional Peruvian medicine for the treatment of a wide range of health problems, particularly digestive complaints and arthritis.Purpose:The aim of this study was to determine the proposed anti‐inflammatory properties of cat’s claw. Specifically: (i) does a bark extract of cat’s claw protect against oxidant‐induced stress in vitro, and (ii) to determine if UG modifies transcriptionally regulated events.Methods:Cell death was determined in two cell lines, RAW 264.7 and HT29 in response to peroxynitrite (PN, 300 μM). Gene expression of inducible nitric oxide synthase (iNOS) in HT29 cells, direct effects on nitric oxide and peroxynitrite levels, and activation of NF‐κB in RAW 264.7 cells as influenced by UG were assessed. Chronic intestinal inflammation was induced in rats with indomethacin (7.5 mg/kg), with UG administered orally in the drinking water (5 mg/mL).Results:The administration of UG (100 μg/mL) attenuated (P < 0.05) peroxynitrite‐induced apoptosis in HT29 (epithelial) and RAW 264.7 cells (macrophage). Cat’s claw inhibited lipopolysaccharide‐induced iNOS gene expression, nitrite formation, cell death and inhibited the activation of NF‐κB. Cat’s claw markedly attenuated indomethacin‐enteritis as evident by reduced myeloperoxidase activity, morphometric damage and liver metallothionein expression.Conclusions:Cat’s claw protects cells against oxidative stress and negated the activation of NF‐κB. These studies provide a mechanistic evidence for the widely held belief that cat’s claw is an effective anti‐inflammatory agent.
Is maintenance therapy always necessary for patients with ulcerative colitis in remission?
Authors: ARDIZZONE  , PETRILLO  , IMBESI  , CERUTTI  , BOLLANI  , BIANCHI PORRO  
Published: March 2003

Background: The efficacy of sulphasalazine and mesalazine in preventing relapse in patients with ulcerative colitis is well known. It is less clear how long such maintenance should be continued, and if the duration of disease remission is a factor that affects the risk of recurrence.Aim: To determine whether the duration of disease remission affects the relapse rate, by comparing the efficacy of a delayed‐release mesalazine (Asacol, Bracco S.p.A., Milan, Italy) against placebo in patients with ulcerative colitis with short‐ and long‐duration of disease remission.Methods: 112 patients (66 male, 46 female, mean age 35 years), with intermittent chronic ulcerative colitis in clinical, endoscopic and histological remission with sulphasalazine or mesalazine for at least 1 year, were included in the study. Assuming that a lower duration of remission might be associated with a higher relapse rate, the patients were stratified according to the length of their disease remission, prior to randomization into Group A (Asacol 26, placebo 35) in remission from 1 to 2 years, or Group B (Asacol 28, placebo 23) in remission for over 2 years, median 4 years. Patients were treated daily with oral Asacol 1.2 g vs. placebo, for a follow‐up period of 1 year.Results: We employed an intention‐to‐treat analysis. In Group A, whilst no difference was found between the two treatments after 6 months, mesalazine was significantly more effective than placebo in preventing relapse at 12 months [Asacol 6/26 (23%), placebo 17/35 (49%), P = 0.035, 95% Cl: 48–2.3%]. In contrast, in Group B no statistically significant difference was observed between the two treatments, either at 6 or 12 months [Asacol 5/28 (18%), placebo 6/23 (26%), P = 0.35, 95% Cl: 31–14%] of follow‐up. Patients in group B were older, and had the disease and remission duration for longer, than those in Group A.Conclusions: Mesalazine prophylaxis is necessary for the prevention of relapse by patients with ulcerative colitis in remission for less than 2 years, but this study casts doubt over whether continuous maintenance treatment is necessary in patients with prolonged clinical, endoscopic and histological remission, who are at very low risk of relapse.
Prospective evaluation of ranitidine bismuth citrate‐based triple therapy for the treatment of Helicobacter pylori infection
Authors: MÖNKEMÜLLER  , HIRSCHOWITZ  
Published: March 2003

Background: There is a need for effective and inexpensive therapy for Helicobacter pylori with good patient compliance.Aim: To evaluate a simplified twice daily schedule for treating H. pylori.Methods: Patients infected with H. pylori (positive by CLO‐ and 13C‐urea breath tests [UBT]) and not previously treated with anti‐H. pylori therapy were treated with ranitidine bismuth citrate (RBC) and two inexpensive antibiotics (metronidazole, tetracycline) twice daily for 14 days in an open‐label study. Eradication was established by a negative UBT 4 weeks after ending therapy.Results: Twenty men and 30 women (age 54 ± 14 years, range 26–74) were included in the study. Five patients were prematurely withdrawn (side‐effects 2, took additional antibiotics 2 and surgery 1) and one patient was lost to follow‐up; therefore, 44 (88%) patients completed the H. pylori eradication protocol. Per protocol (PP) cure rate was 82% (36/44 patients, 95% CI: 68–95%), and intention‐to‐treat cure rate was 72% (36/50 patients, 95% CI: 58–82%). Five patients (10%) developed side‐effects during therapy, most commonly nausea (3 patients). Four weeks after the end of treatment, 78% (PP) of patients were symptomatically improved.Conclusions: A 2‐week course of twice‐daily RBC‐based triple therapy was well tolerated, eradicated H. pylori in 72% (ITT) and 82% (PP) of patients, respectively, and relieved symptoms in 78%.
Head‐to‐head comparison of 1‐week triple regimens combining ranitidine or omeprazole with two antibiotics to eradicate Helicobacter pylori
Authors: SAVARINO  , ZENTILIN  , BISSO  , PIVARI  , MELE  , MELA  , MANSI  , VIGNERI  , TERMINI  , CELLE.  
Published: March 2003

Background: Triple therapies containing omeprazole and ranitidine have been shown to be equivalent in eradicating H. pylori infection, but have been assessed either separately or head‐to‐head, only in small trials.Aim: To carry out a large randomized controlled study comparing omeprazole and ranitidine combined with two antibiotic combinations for 1 week.Methods: Three hundred and twenty H. pylori‐positive patients were randomly subdivided into four equal‐sized groups and received one of the following treatments: OAM = omeprazole 20 mg b.d. + amoxycillin 1 g b.d. + metronidazole 500 mg b.d.; RAM = ranitidine 300 mg b.d. + amoxycillin 1 g b.d. + metronidazole 500 mg b.d.; OAC = omeprazole 20 mg b.d. + amoxycillin 1 g b.d. + clarithromycin 250 mg t.d.s.; RAC=ranitidine 300 mg b.d. + amoxycillin 1 g b.d. + clarithromycin 250 mg t.d.s. The assessment of H. pylori status was performed before and 4 weeks after the end of therapy by means of CLO‐test and histology. H. pylori infection was considered to be eradicated when both tests were negative.Results: OAM and RAM eradicated H. pylori in 89% and 85% of cases on per protocol (P = 0.48) and in 77% and 75% of cases on intention‐to‐treat analyses (P = 0.71). OAC and RAC eradicated H. pylori in 67% and 70% of cases on per protocol (P = 0.68) and in 57% and 64% of cases on intention‐to‐treat analyses (P = 0.41). In contrast, there was significant difference between OAM and OAC (P < 0.01) and between RAM and RAC (P < 0.05). Side‐effects occurred in 15%, 10%, 17% and 16% of patients with respect to the above four subgroups.Conclusions: Omeprazole and ranitidine combined with two antibiotics for 1 week are equally effective in the eradication of H. pylori infection, and these results question the role of profound acid suppression in the eradication of the bacterium.
Famotidine versus omeprazole in combination with clarithromycin and metronidazole for eradication of Helicobacter pylori—a randomized, controlled trial
Authors: Gschwantler  , Dragosics  , Schütze  , Wurzer  , Hirschl  , Pasching  , Wimmer  , Klimpfinger  , Oberhuber  , Brandstätter  , Hentschel  , Weiss  
Published: March 2003

Background: One‐week low‐dose triple therapy is currently considered the gold standard regimen for treatment of Helicobacter pylori infection. However, the mechanisms involved in the synergy between antibiotics and proton pump inhibitors are controversial.Aims: To test the hypothesis that acid suppression represents the crucial mechanism by which the antibacterial activity of antibiotics can be enhanced, and to assess the impact of primary resistance on treatment outcome.Methods: One hundred and twenty patients with H. pylori infection and duodenal ulcer, gastric ulcer or non‐ulcer dyspepsia were randomly assigned to a 1 week course of either famotidine 80 mg b.d., clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. (FCM group; n = 60) or omeprazole 20 mg o.d., clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. (OCM group; n=60). Gastroscopy was performed at baseline and 5 weeks after completion of treatment. H. pylori status was assessed by biopsy urease test, histology and culture.Results: In the intention‐to‐treat analysis, eradication of H. pylori was achieved in 47 of 60 patients (78%; 95% CI: 66–88%) in the FCM group, compared to 44 of 60 patients (73%; 95% CI: 60–84%) in the OCM group (N.S.). Using per protocol analysis, eradication therapy was successful in 47 of 52 patients (90%; 95% CI: 79–97%) treated with FCM and 44 of 57 patients (77%; 95% CI: 64–87%) treated with OCM (N.S.). Primary metronidazole resistance was present in 27% and primary clarithromycin resistance in 8% of strains. Overall per protocol eradication rates in strains susceptible to both antibiotics and strains with isolated metronidazole resistance were 93% and 84%, respectively. No patient with clarithromycin resistance responded to treatment.Conclusions: High‐dose famotidine and omeprazole, combined with clarithromycin and metronidazole, are equally effective for eradication of H. pylori. In 1‐week low‐dose triple therapy, metronidazole resistance has no major impact on eradication rates whereas clarithromycin resistance is associated with a poor treatment outcome.
Review article: proteinase‐activated receptors — novel signals for gastrointestinal pathophysiology
Authors: Vergnolle  
Published: March 2003

Proteinase‐activated receptors (PARs) have the common property of being activated by the proteolytic cleavage of their extracellular N‐terminal domain. The new NH2‐terminus acts as a ‘tethered ligand’ binding and activating the receptor itself. Four members of this family have been cloned, three of which are activated by thrombin (PAR‐1, PAR‐3 and PAR‐4) while the fourth (PAR‐2) is activated by trypsin or mast cell tryptase.In physiological or pathophysiological conditions, the gastrointestinal tract is exposed more than other tissues to proteinases (digestive enzymes, proteinases from pathogens or proteinases from inflammatory cells) that can activate PARs. Since PARs are highly expressed throughout the gastrointestinal tract, the study of the role of PARs in these tissues appears to be particularly important.It has already been shown that PAR‐2 activation induces calcium mobilization and eicosanoid production in enterocytes as well as changes in ion transport in jejunal tissue segments. PAR‐2 activation also causes calcium mobilization and stimulates amylase release from pancreatic acini. Moreover, both PAR‐1 and PAR‐2 activation can alter the gastrointestinal motility. In inflammatory or allergic conditions, the proteinases that constitute the major agonists for PARs (thrombin, trypsin and mast cell tryptase) are usually released. The activation of PARs by these proteinases might contribute to the gastrointestinal disorders associated with these pathologies.A complete understanding of the role of PARs in the gastrointestinal tract will require the development of selective receptor antagonists that are not yet available. Nonetheless, the use of PAR agonists has already highlighted new potential functions for proteinases in the gastrointestinal tract, thus the control of PAR activation might represent a promising therapeutic target.
Predictive factors of outcome of intensive intravenous treatment for attacks of ulcerative colitis
Authors: Carbonnel  , Gargouri  , Lémann  , Beaugerie  , Cattan  , Cosnes  , Gendre  
Published: March 2003

Background:Intensive intravenous treatment remains the first line therapy of severe, uncomplicated attacks of ulcerative colitis.Aim:To predict the failure of intensive intravenous treatment by combining clinical and laboratory parameters with endoscopy findings.Methods:Retrospective study conducted in a tertiary care referral centre. Failure of intensive intravenous treatment was defined as colectomy before day 30, intravenous cyclosporin, or death. Predictive factors of outcome were assessed using univariate and multivariate prognostic analysis.Results:Between January 1990 and May 1997, 85 consecutive patients were treated with intensive intravenous treatment for non‐response to oral corticosteroids (n=59) and/or severe attack of ulcerative colitis (n=26). There were 41 successes and 44 failures (including 1 death, 13 cyclosporin and 30 colectomies before day 30). Multivariate prognostic analysis found that the presence of Truelove and Witts’ criteria (P=0.018), an attack that had lasted more than 6 weeks (P=0.001), and severe endoscopic lesions (P=0.007) were associated with an increased risk of failure. Patients with severe endoscopic lesions and Truelove and Witts’ criteria, or an attack of more than 6 weeks had a failure rate of 85–86%.Conclusion:Clinical, laboratory and endoscopic findings can predict the risk of failure of intensive intravenous treatment. A prospective study is required to confirm these results.
The omeprazole test is as sensitive as 24‐h oesophageal pH monitoring in diagnosing gastro‐oesophageal reflux disease in symptomatic patients with erosive oesophagitis
Authors: Fass  , Ofman  , Sampliner  , Camargo  , Wendel  , Fennerty  
Published: March 2003

Background:Ambulatory 24‐h oesophageal pH monitoring and a short course of high dose omeprazole can be used as diagnostic modalities for GERD. However, comparative studies of the diagnostic accuracy and reliability of both strategies have not been performed.Aim:To compare the omeprazole test to ambulatory 24‐h oesophageal pH monitoring in diagnosing GERD in symptomatic patients using endoscopically proven erosive oesophagitis as a gold standard.Methods:Patients with heartburn underwent an upper endoscopy. Only those with erosive oesophagitis were included in the study. Subsequently, patients underwent ambulatory 24‐h oesophageal pH monitoring and an ‘omeprazole test.’ Daily symptoms were recorded during the first week (baseline) and repeated during the second week on therapy (omeprazole 40 mg in the morning and 20 mg in the evening).Results:Thirty‐five patients were included in the study. The omeprazole test was significantly more sensitive in diagnosing GERD than total acid contact time on 24‐h oesophageal pH monitoring (83% vs. 60%; P < 0.03). However, the sensitivity of the pH test increased to 80% after adding patients with a positive symptom index, and patients with abnormal acid exposure in the supine or erect positions despite normal total acid contact time. Patients with a normal pH test were significantly younger (49 ± 2.6 years) than those with abnormal test (59 ± 1.8; P=0.002).Conclusions:In this study an omeprazole test was at least as sensitive as ambulatory 24‐h oesophageal pH monitoring in diagnosing GERD in patients with erosive oesophagitis.
High incidence of reflux oesophagitis after eradication therapy for Helicobacter pylori: impacts of hiatal hernia and corpus gastritis
Authors: Hamada  , Haruma  , Mihara  , Kamada  , Yoshihara  , Sumii  , Kajiyama  , Kawanishi  
Published: March 2003

Background:Although several recent studies have shown that the eradication of Helicobacter pylori provokes reflux oesophagitis, the results are conflicting.Aim:To investigate the prevalence of reflux oesophagitis in patients after eradication of H. pylori and consider its association with hiatal hernia and corpus gastritis.Methods:A total of 286 patients who underwent H. pylori eradication therapy and 286 age‐ and disease‐matched H. pylori‐positive controls who did not undergo eradication therapy were followed prospectively. All patients and controls underwent endoscopy at 1‐year intervals or when upper gastrointestinal symptoms recurred. The presence of hiatal hernia and histology of the gastric corpus were evaluated at the time of initial endoscopy.Results:The estimated prevalence of reflux oesophagitis within 3 years was 18% after eradication therapy and 0.3% without therapy. Patients who developed reflux oesophagitis after therapy had a greater prevalence of hiatal hernia (P=0.0008) and more severe corpus gastritis (P=0.0005) before therapy. Cumulative prevalence of reflux oesophagitis was 26% in patients with hiatal hernia, 7.7% in those without hiatal hernia, 33% in those with corpus atrophic gastritis and 13% in those without corpus atrophic gastritis. When patients had both hiatal hernia and corpus gastritis, the prevalence of reflux oesophagitis was 37%. The newly developed reflux oesophagitis was classified as mild in 35 out of 36 (97%) patients who developed reflux oesophagitis after eradication therapy.Conclusions:Eradication of H. pylori increased the prevalence of reflux oesophagitis in our patient group. The presence of hiatal hernia and corpus gastritis are closely related to the development of reflux oesophagitis after H. pylori eradication therapy.
Alosetron, a 5‐HT3 receptor antagonist, delays colonic transit in patients with irritable bowel syndrome and healthy volunteers
Authors: Houghton  , Foster  , Whorwell  
Published: March 2003

Background:Alosetron is a potent and selective 5‐HT3 receptor antagonist, which has been shown to be beneficial in the treatment of female patients with non‐constipated irritable bowel syndrome.Aims:To investigate the effect of alosetron on whole gut, small bowel and colonic transit in patients with irritable bowel syndrome (Study 1) and healthy volunteers (Study 2).Subjects:Thirteen patients with irritable bowel syndrome and 12 healthy volunteers.Methods:Both studies were randomized, double‐blind, placebo‐controlled with a two‐way crossover design, in which each subject received alosetron (2 mg b.d. administered orally) or placebo for 8 days. Mean whole gut transit was determined from the excretion of radio‐opaque markers; small bowel transit was determined from rise in breath hydrogen after a meal; and colonic transit and segmental transit were evaluated from abdominal X‐ray. In addition, colonic transit was calculated by subtracting small bowel transit time from whole gut transit time.Results:Alosetron increased colonic transit time by prolonging left colonic transit in both patients with irritable bowel syndrome and controls. This resulted in a tendency for the whole gut transit to be delayed in irritable bowel syndrome patients (P=0.128), which was confirmed in controls (P=0.047).Conclusion:Alosetron delays colonic transit by prolonging left colonic transit. These results add to the body of evidence suggesting that alosetron should have a therapeutic role in patients with non‐constipated irritable bowel syndrome.
Effects of alosetron on gastrointestinal transit time and rectal sensation in patients with irritable bowel syndrome
Authors: Thumshirn  , Coulie  , Camilleri  , Zinsmeister  , Burton  , Van Dyke  
Published: March 2003

Background:Alosetron, a 5‐HT3‐receptor antagonist, relieves abdominal pain and improves bowel function in non‐constipated, female patients with irritable bowel syndrome. 5‐HT3 antagonists delay colonic transit, increase colonic compliance, and increase small intestinal water absorption.Aim:To evaluate the effects of alosetron on gastrointestinal and colonic transit, rectal compliance and rectal sensation in irritable bowel syndrome.Methods:A double‐blind, placebo‐controlled, two‐dose study of alosetron was performed in 25 non‐constipated irritable bowel syndrome patients, with paired studies before and after 4 weeks of treatment with placebo (n=5), 1 mg alosetron (n=10) or 4 mg (n=10) alosetron b.d. Gastrointestinal and colonic transit were measured by scintigraphy. Rectal compliance and sensation were assessed by rectal balloon distention with a barostat.Results:There was a trend (P=0.06) for 1 mg alosetron to increase rectal compliance (median pressure at half maximum volume 11 mmHg after alosetron vs. 15.6 mmHg before alosetron). The 1 mg b.d. alosetron dose non‐significantly retarded proximal colonic transit. Alosetron and placebo reduced sensory scores relative to baseline values; none of the changes induced by alosetron was significant relative to placebo.Conclusions:Alosetron had no significant effect on gastrointestinal transit or rectal sensory and motor mechanisms in non‐constipated irritable bowel syndrome patients in this study. Alosetron’s effects on colonic sensorimotor function and central sensory mechanisms deserve further evaluation.
Proton pump inhibitors: better acid suppression when taken before a meal than without a meal
Authors: Hatlebakk J. G. , Katz P. O. , Camacho‐Lobato L. , Castell D. O. 
Published: March 2003

Background:Proton pump inhibitors including omeprazole and lansoprazole inhibit gastric acid secretion by selectively and non‐competitively inactivating the H+, K+ ATPase molecules of the parietal cell, but possibly only those that are actively secreting acid. This might imply that stimulation of acid secretion by a meal is necessary for optimal inhibition of gastric secretion.Aim:To quantify and compare the effect on daytime gastric acidity of omeprazole 20 mg or lansoprazole 30 mg daily taken 15 min before breakfast, with that of the same drug taken without a meal.Methods:Twenty‐one healthy volunteers were randomized to receive either omeprazole or lansoprazole. They were given the drug for two separate periods of 7 days in randomized order and at least 7 days apart. During one period the study medication was taken before breakfast; during the other it was taken at the same hour, but with no meal until 12:00 hours. Lunch was standardized. On day 7, intragastric pH‐metry was performed, starting at 08:00 hours. Tracings were analysed for the 8‐h period from 08:00 hours until 16:00 hours with regard to percentage time for which gastric pH was below 4.0 and 3.0, and median gastric pH. Tracings were also analysed after removing the 1 h breakfast period, to exclude the buffering effect of the meal.Results:When taking the drug with breakfast, the median percentage time for which gastric pH < 4.0 was 17.2 (interquartile range 4.6–45.5), compared with 42.0 (interquartile range 31.4–48.8) when taken without food (P=0.01). Fifteen subjects had better control of gastric acidity when the medication was taken with breakfast. A pH threshold of 3 and median pH showed similar differences. When the breakfast period was removed, the differences were no longer statistically significant.Conclusions:When therapy with omeprazole or lansoprazole is indicated, medication should be taken before a meal for optimal control of daytime gastric acidity.