摘要:

SUMMARYThe pathogenesis of portal hypertension remains poorly understood. Similarly, pharmacological manipulation for the prevention and treatment of variceal haemorrhage has not fulfilled the promise of the 1980s. This article reviews current concepts in the pathophysiology of portal hypertension and considers pharmacotherapy for the treatment of variceal bleeding.

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00567.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYOver the past 20 years we have moved from a situation in which we had no therapy for alcoholic liver disease, through a period when any therapy we had was purely empirical, to an era where we have specific therapies for different aspects of this disease based upon sound pathogenic principles. In this short review, an attempt has been made to summarize these advances in the understanding of the pathogenesis of alcoholic liver disease. In particular, they explain why patients with severe acute alcoholic hepatitis continue to deteriorate in hospital despite withdrawal from alcohol, why they respond to corticosteroids, why only a small percentage of patients develop cirrhosis, and why propylthiouracil may offer Protection.

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00568.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYThis study compared the relative effectiveness of a standard pancreatic enzyme supplement (‘Creon’, Duphar) and a new preparation (‘Pancrease HL’, Cilag) containing about 3 times the lipase and more than 5 times the protease activity. Capsule dosage was adjusted to a ratio of approximately 3:1. Fat balances showed that absorption of fat did not change significantly on conversion to the new high‐lipase product, and the coefficient of absorption of total energy was similarly maintained. The coefficient of protein absorption was significantly enhanced with the high enzyme preparation (P<0.01), which may explain the reported subjective improvement in stool odour. No adverse effects were recorded. Patient acceptability of the new compound was high; the great reduction in the number of capsules required at each meal was cited by all patients as the reason for their p

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00569.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYThe mechanisms of hypergastrinaemia during H2‐receptor antagonist therapy remain unclear. In addition, the effect of food stimulation in conditions of hypergastrinaemia is poorly understood. These effects may be important when considering long‐term therapy with potent acid inhibitory agents. To investigate this we studied the effect of H2‐receptor antagonist therapy on basal and meal‐stimulated plasma gastrin concentrations in 9 patients with pentagastrin fast gastric achlorhydria associated with pernicious anaemia. The subjects received in double‐blind randomized fashion 28‐day courses of 300 mg ranitidine q.d.s. and placebo, with one‐month wash‐out between. The fasting and peptone meal‐stimulated gastrin concentrations were studied on the final day of each course of treatment. The median fasting gastrin concentrations (ng/L) were similar following placebo (1100, range 25–2100), and 300 mg ranitidine q.d.s. (1075, range 15–2600) and both markedly elevated when compared with our laboratory's normal range of 0—100. Despite the elevated basal levels the pernicious anaemia patients still showed a further increase in response to the peptone meal. Their median peak percentage rise over basal in response to the meal was similar following placebo (96%, range 0–375) and 300 mg ranitidine q.d.s. (100%, range 25–425) (bothP<0.02 c.f. basal).This study shows that: (a) in hypergastrinaemia in pernicious anaemia subjects, meal stimulation leads to a marked and prolonged increase in plasma gastrin concentrations; (b) H2‐receptor antagonists have no effect on plasma gastrin in the neutral stomach and this is consistent with their gastrin effect being entirely

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00570.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYTwenty‐five patients with systemic sclerosis and severe gastro‐oesophageal reflux disease were treated with 20–80 mg omeprazole daily for up to 5 years. Efficacy of treatment was assessed by symptom score, by endoscopic and histopathological surveillance of the oesophageal and gastric mucosa, and by laboratory screening including serum gastrin concentration.Statistically significant relief of symptoms and healing of oesophagitis confirmed the efficacy of this treatment. However, complete healing of oesophagitis was not achieved in half of the patients due to residual gastro‐oesophageal acid reflux. Repeated adjustments of the maintenance dose of omeprazole may be needed for this group of patients. From the safety point‐of‐view, nothing was observed to discourage the long‐term use of omeprazole in this grou

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00571.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYThis study was designed to compare the effectiveness of single doses of either Liquid Gaviscon or Algicon Suspension in the suppression of food and acid reflux into the oesophagus after a test meal in volunteers.After the pH electrode and gamma detector were positioned 5 cm above the cardia, the volunteers received a refluxogenic radiolabelled meal. The subjects then remained untreated, or thirty minutes later they were given a dose of unlabelled Algicon Suspension, or Liquid Gaviscon and a recording was made for a minimum of 3 hours. Allocation to the treatment group was randomized with the cross‐overs performed 1 week apart.Liquid Gaviscon suppressed gastro‐oesophageal reflux of both food and acid whereas only an insignificant reduction in reflux was seen after Algicon Suspension. The oesophageal pH remained below 4 for 3.21 ± 0.92% (S.E.M.) of the recording period in the control study, 0.88 ± 0.33 after Gaviscon and 2.91 ± 0.68 after Algicon. The reflux of food was reduced from 17070 ± 103± 4713 ± 103counts in the control study to 224 ± 103± 93 ± 103counts after the Gaviscon and 16080 ± 103± 7131 ± 103counts after Algicon. The suppression of reflux by Liquid Gaviscon was significantly better than that produced by Alg

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00572.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYErythromycin is a prokinetic agent for the lower oesophageal sphincter, the stomach, the gallbladder and the small bowel, acting directly on motilin receptors. Its effect on pressure activity of the human colon has not been investigated. Eight healthy volunteers were studied on 2 occasions and given intravenous or oral erythromycin, or placebo in a single‐blind, randomized crossover study. Sigmoid pressure activity was measured using a 4‐lumen water perfused system placed sigmoidoscopically at 50, 45, 30 and 15 cm from the anal verge. The pressures were analysed for activity index (mmHg.min) for the 35 cm colonic study segment using dedicated software. No significant difference was found in the activity index following oral erythromycin (500 mg) or placebo, or following intravenous erythromycin 1.8 mg/kg or placebo. A further 8 subjects were studied in a single‐blind crossover study to determine the effect of oral erythromycin (500 mg) b.d. on colonic transit, measured with radio‐opaque markers and a single abdominal X‐ray. Mean or segmental colonic transit times were not statistically significantly different (Student's pairedt‐test) in the subjects on placebo or erythromycin. This lack of effect of erythromycin on the distal large intestine may indicate the absence of receptors for motilin in that part

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00573.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYA multicentre, randomized, double‐blind, placebo‐controlled study was conducted to evaluate the efficacy and safety of ranitidine 150 mg and 300 mg in 342 patients with erosive oesophagitis. Treatment was given four times daily, and continued for 12 weeks or until healing (that is, normal or only erythematous mucosa). Erosive oesophagitis healing rates, as determined by endoscopy, were significantly greater in ranitidine‐treated patients by 4 weeks compared with those of placebo‐treated patients. By 12 weeks, erosive oesophagitis healing rates were 83 and 81% for ranitidine‐treated patients (150 and 300 mg, respectively) and 58% for placebo‐treated patients (P± 0.001, ranitidine vs. placebo). Symptomatic relief was achieved within 24 hours after starting either dosage of ranitidine. Heartburn frequency (P<0.001) and severity (P<0.001), as well as antacid consumed per week (P<0.001), were reduced in both ranitidine groups in comparison with placebo. Healing rates and symptom relief were similar in the two ranitidine groups. Both dosages of ranitidine were well tolerated. Ranitidine (150 mg) given four times daily appears to be as effective as 300 mg ranitidine given four times daily in patients with moderate to severe oesophag

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00574.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYThe combination of a histamine H2‐receptor antagonist and a muscarinic receptor antagonist has been reported to result in greater suppression of intragastric acidity than either agent alone. The present randomized, double‐blind, multicentre trial compared the effects of the oral combination of 150 mg ranitidine b.d. plus 50 mg pirenzepine b.d. with 150 mg ranitidine b.d. plus placebo pirenzepine b.d. in the treatment of patients with reflux oesophagitis. All 157 patients had symptoms of gastro‐oesophageal reflux with endoscopically confirmed oesophageal erosions (Savary and Miller grades I‐III). After four weeks of treatment, healing rates were 32/75 (43%) in the combined treatment group and 34/76 (45%) in the group receiving ranitidine alone. After eight weeks, the cumulative healing rates had increased to 48/72 (67%) and 51/75 (68%), respectively. More patients receiving ranitidine plus pirenzepine had complete relief of day‐ and night‐time heartburn after four weeks compared with those receiving ranitidine alone (day: 59% vs. 38%,P= 0.02; night: 69% vs. 52%,P= 0.04). After eight weeks, symptom relief was comparable in both groups. Clinical adverse effects were reported by nine patients receiving ranitidine and by 19 patients receiving the combination. It is concluded that combining ranitidine with pirenzepine does not aid the healing of reflux oesophagitis but does improve symptom relief at

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00575.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYSecretory diarrhoea is a major cause of morbidity and mortality worldwide. However, there is no biologically relevant test system in man for assessing new anti‐diarrhoeal therapies prior to clinical trial. We have used highly purified cholera toxin in combination with the triple lumen jejunal perfusion technique to establish a subclinical model of cholera in man. Cholera toxin was administered either by mouth with sodium bicarbonate or directly into a 30 cm‘open’ or‘closed’(isolated between two inflated balloons) jejunal segment in healthy adult volunteers. Both oral dosing and direct delivery into an‘open’ jejunal segment failed to produce consistent secretion of water and electrolytes. In contrast 15 μg or 25 μg of cholera toxin elicited secretion of water and sodium 3 h after instillation into the balloon occluded‘closed’ jejunal segment (P<0.05 vs. controls). The rate of secretion was constant over the maximal period studied (4.5 h) and was similar to that reported in human cholera. None of the subjects experienced troublesome diarrhoea. We believe this model offers a relevant test system for assessing anti‐diar

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00576.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY