摘要:

SUMMARYVirtually all duodenal ulcers (DUs) and the vast majority of gastric ulcers (GUS) are the consequence ofHelicobacter pylori‐associated inflammation. In DUs, the inflammation is maximal in the antrum and is associated with gastric metaplasia in the bulb. Gastrin homeostasis is disturbed byH. pylorigastritis and there is robust acid secretion. Successful eradication of the infection cures the ulcer diathesis. Amalgamated figures for ulcer relapse per year inH. pylori‐positive DUs are>60% compared with 2.6% forH. pylori‐negative DU patients. The corresponding figures for GU are>50% forH. pylori‐positive and 2.0% forH. pylori‐negative individuals. This striking difference in relapse rate persists, as the re‐infection rate in the developed world is<1 % per year. Recurrent bleeding in bleeding‐prone DUs is essentially abolished after cure of the infection.Proton pump inhibitors (PPIs) are increasingly used in eradication regimens. PPIs have intrinsic antimicrobial activity.MICs for lansoprazole (LAN) are lower than for omeprazole (OME). Two weeks of triple therapy (bismuth, tetracycline, imidazole) has, on average, a superior eradication efficacy (± 90%) compared with dual therapy (PPI, amoxycillin or clarithromycin) (± 80%). When a combination of PPI and two antibiotics has been used, results comparable to triple therapy have been reported. However, the side‐effects profile and patient acceptability of PPI plus one or two antibiotic regimens are better than for traditional triple therapy. To date, published results with LAN‐antibiotic combinations are limited, but may be expected to be comparable to those obtained wi

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00782.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYBackground/aims: CurrentHelicobacter pylorieradication therapy for peptic ulcer disease usually involves a 2‐week course of either a bismuth preparation or omeprazole in combination with antibiotics. We have studied a shorter, 7‐day course of treatment to assess efficacy and tolerability.Methods: Four hundred and thirty‐six patients, in three non‐randomized groups, received omeprazole (40 mg mane), amoxycillin (500 mg t.d.s.) and metronidazole (400 mg t.d.s.): 308 patients received the triple combination for 14 days; 80 patients were treated for 7 days; and 48 patients received omeprazole and amoxycillin for 7 days but metronidazole for only 5 days.Results:Helicobacter pyloriwas eradicated in 89.5%, 91.1% and 87.5%, respectively (98.3%, 92.9% and 100% of metronidazole‐sensitive isolates and 75.6% and 88.2% of metronidazole‐resistant isolates in the first two groups). Side effects were significantly more frequent in patients who received 14 days (49%) compared with 7 days of treatment (33%); only 8/308 and 1/128 patients, respectively, failed to complete the course.Conclusions: On the basis of efficacy, tolerability and cost, we conclude that a 7‐day course of the omeprazole (40 mg mane), amoxycillin (500 mg t.d.s.) plus metronidazole (400 mg t.d.s.) combination is effective therapy for the eradicatio

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00349.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYA peptic ulcer is a lesion in which acid and pepsin are essential components of pathogenesis. Regardless of type of patient or the setting in which the ulcer presents, the basic pathogenetic scheme is the same. The primary event is disruption of mucosal integrity. In the presence of acid and pepsin, such disruption of integrity leads to an ulcer. While rarely sufficient by itself to cause ulceration, the presence of acid is a necessary cofactor.The causes of disruption of mucosal integrity include nonsteroidal anti‐inflammatory drugs (NSAIDs),Helicobacter pyloriand critical illness. With the latter, tissue ischaemia may be the primary event, leading to back‐diffusion of H+ions through increased membrane permeability. Impaired mucosal buffering then leads to intramural acidosis and cell death. Risk factors for bleeding peptic ulcer in the intensive care unit (ICU) include severe trauma, sepsis, respiratory failure, and coagulopathy.Potential roles for decreasing gastric acidity in the treatment of bleeding peptic ulcer include cessation of active bleeding, prevention of rebleeding in hospital and primary prevention of bleeding. Most published studies dealing with the first two situations suggest no benefit with antisecretory therapy. However, the optimal pH for clot and platelet function may be ± 7.0. Can such pH levels be maintained with antisecretory agents such as the proton pump inhibitors? Are the published trials adequate to demonstrate any benefit from antisecretory agents?Primary prevention of bleeding ulcer in the outpatient setting includes avoidance of NSAIDs, use of antisecretory agents and eradication ofH. pylori. Antacids, antisecretory therapy and sucralfate have each been shown to reduce the incidence of bleeding ulcer in ICU patients. Which regimens are the most effective? Which are the safest? Does prevention of bleeding improve surv

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00783.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYA few years ago, patients with bleeding peptic ulcers were referred to the surgeon if the bleeding did not stop. Today we have two promising new approaches to prevent emergency surgery. One is endoscopic intervention, the other is the pharmacological approach of blocking the proton pump.The endoscopical techniques of adrenaline injection, fibrin‐‘glue’ injection, polidocanol injection and heat coagulation can stop active bleeding in over 90% of cases. Pharmacologically, proton pump inhibitors can quickly achieve the optimal pH condition for support of the physiological cascade of haemostasis.The aim is to keep the intragastric pH above 6.0 for a few days. For the first time this aim can be achieved quickly and reliably by infusion of proton pump inhibitors. The optimal form of application is continuous infusion. Repeated bolus injections do not give optimal results. The optimal dosing was found to be the continuous infusion of 8 mg/h omeprazole or pantoprazole after an initial loading dose of 40

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00784.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYUsing 24‐h pH monitoring, we studied the optimal dose and mode of administration of lansoprazole (LAN) injection in healthy adult male volunteers in three tests of antisecretory effect. We followed this with a dosefinding study, using the drug's suppressive effect on increased gastric acid secretion due to surgical stress as the indicator. Finally, we conducted a pilot study to determine the optimal mode of administration and efficacy of the drug in patients with haemorrhage from the upper gastrointestinal tract.Twenty‐four‐hour intragastric pH monitoring established the order of potency of the different regimens: LAN 30 mg b.d.>LAN 15 mg bed.: and LAN 30 mg b.d., intravenous drip infusion = LAN 30 mg b.d., bolus injection.Lansoprazole 30 mg b.d. appeared to be slightly more effective than LAN 15 mg b.d. in suppressing increased gastric acid secretion due to post‐operative stress and in haemostasis in patients with upper gastrointestinal bleeding. No severe adverse effects were observed in eithe

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00785.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYBackground: Gastric mucosal alcohol dehydrogenase (ADH) may decrease the bioavailability of ingested ethanol. Because this enzyme is found in highest concentrations in the superficial gastric mucosa, diffuse abnormalities of this tissue could lead to a decrease in the first pass metabolism of ethanol.Methods: Thirty‐three adult subjects undergoing routine upper gastrointestinal endoscopy had gastric biopsies performed for assessment of gastric histology and the measurement of gastric ADH activity. Twenty of these subjects underwent separate oral dosing and intravenous infusion of ethanol (0.15 g/kg body weight) in order to determine the first pass metabolism, and hence bioavailability, of ethanol.Results: Gastric histology was normal in 10 of the biopsies, showed chronic gastritis alone in 13 and significant glandular atrophy (i.e. atrophic gastritis) in a further 10. Gastric ADH activity in specimens with normal gastric histology was significantly higher than those with chronic gastritis (P=0.02), and was further decreased in those specimens with significant atrophy (P<0.00001). However, no correlation was found between gastric ADH activity and the first pass metabolism of ethanol (r= 0.09,P=0.9).Conclusions: These results suggest that although gastric ADH activity was decreased in individuals with abnormal gastric mucosa, ethanol bioavailability was not affected by gastric ADH activity. These data support the view that gastric ADH does not play a significant role in the first pass metabolism of alcoho

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00352.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYBackground: A case study reporting the efficacy of oral vancomycin in a patient with chronic idiopathic constipation prompted this prospective trial of oral vancomycin in eight female patients (aged 21–61 years) with severe constipation resistant to the action of dietary fibre.Methods: The trial was divided into two consecutive 14‐day periods. During the first period, each patient was given ispaghula, 3.5 g twice a day, and during the subsequent period they took 250 mg vancomycin t.d.s.per os, as well as the fibre supplement. During both periods they collected stools and recorded daily bowel symptoms (stool frequency, straining, stool consistency, subjective stool volume) in a diary. At the end of each period whole gut transit time and the breath hydrogen response to a standard meal, giving oro‐caecal transit time, were measured along with gastrointestinal symptoms which were assessed on visual analogue scales.Results: Vancomycin caused a significant improvement in stool frequency, consistency, ease of defecation and the amount of stool patients felt they produced (allP<0.05), but objective measures of daily stool weight and whole gut or oro‐caecal transit time were not significantly different. Basal breath hydrogen levels were higher after vancomycin treatment in seven out of eight patients. One patient experienced a complete remission of symptoms when she took vancomycin and remains in remission after 14 months. This patient showed no elevation in basal breath hydrogen level.Conclusion: Although this study does not support the use of vancomycin for most patients with constipation, the results suggest that modification of the intraluminal flora may be of value in the treatment of the occasional case of idiopathic const

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00353.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYAim and methods: To study the effect of 45 g lactose, 30 g lactulose and 10 mg bisacodyl on gastrointestinal transit in 30 healthy volunteers by metal detector and Hinton marker method. The first set of measurements were performed under standard conditions. In a second stage, transit was slowed to twice the original value by loperamide to simulate constipation conditions.Results: Bisacodyl drastically accelerated small and large intestinal transit. Colonic transit was shortened to 23 % and to 31% of control values, without and with loperamide. Bisacodyl increased stool weight and decreased stool consistency in all persons. Lactulose marginally shortened small intestinal transit (P= 0.08) but significantly increased stool weight and decreased stool consistency. The accelerating effect of lactose on small intestinal transit was abolished by loperamide. Lactose did not influence colonic transit, stool weight or stool consistency. Results of metal detector and Hinton marker method corresponded well (r=0.75), the metal detector method measuring slightly shorter transit times than the Hinton marker method.Conclusions: With the dose chosen in this trial, lactose did not have any laxative effect in lactose tolerant persons. Laxative effect was mild with lactulose and most pronounced with bisacodyl.

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00354.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYBackground and aims: Due to the need for new principles for the treatment of Crohn's disease and due to the documented immunomodulatory effects of interferon alpha, the tolerability and effect(s) of interferon alpha‐2b (Introna) in active Crohn's disease were examined in a pilot study.Methods: Five patients with active Crohn's disease (activity index (CDAI) scores of 235–517), were treated with interferon alpha‐2b for 12 weeks.Results: All patients tolerated the treatment, but developed influenza‐like symptoms, which were fully controlled by paracetamol. Two patients obtained partial remission with a decline in activity index scores of 39% and 50%. The activity of 2′, 5′‐oligoadenylate synthetase, which together with two other interferon‐induced proteins, neopterin and β2‐microglobulin were increased during treatment, indicated clearly anin vivouptake of interferon. Sedimentation rate, C‐reactive protein, orosomucoid, albumin, specific inflammatory markers: soluble interleukin‐2 α‐receptors (sIL‐2R) and intercellular adhesion molecule‐1 (ICAM‐1) did not show any changes before or after treatment.Conclusion: Future multicentre investigations are required to evaluate the clinical effect of interferon alpha‐2b tr

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00355.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYBackground: The leaves of Khat are chewed for their central stimulant effect, but their use may cause anorexia and constipation.Methods: Gastric emptying of a radio‐labelled semi‐solid meal was measured in 12 healthy volunteers on two occasions a week apart. Subjects chewed either Khat leaves (Catha edulis) or lettuce for 2 h before the study.Results: Gastric emptying was significantly (P<0.02 prolonged after chewing Khat compared with lettuce.Conclusion: The sympathomimetic action of cathinonn in Khat may cause the observed delay in gastric empty

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00356.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY