摘要:

SUMMARYThe treatment of pancreatic steatorrhoea can often be improved by attention to the pathophysiological and pharmacological principles involved. Factors influencing the efficacy of pancreatic enzyme replacement include physiological characteristics of the individual patient and pharmaceutical characteristics of the supplement. Different patients may be best suited by different preparations and there is no overall ‘best buy’. The new enteric‐coated microsphere formulations are often most effective, but also more expensive than conventional preparations. Adjunctive H2‐blockade can help appropriately selected patients with resistant steatorrhoea. Knowledge of the underlying cause may guide the choice of supplement and its dose, but trials of different regimens may prove necessary. Successful management, particularly of malnourished patients, involves optimization of dietary fat intake in addition to enzyme repl

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00644.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYThe use of acute human models of gastric mucosal injury has been stimulated by a need to understand more fully the problems of non‐steroidal anti‐inflammatory drugs but such models have other applications. None is ideal and they all share certain drawbacks. For none of them has a precise relationship to clinical events been established and they have all tended to be employed on a population of young healthy subjects who are not those at greatest clinical risk. Of individual methods mucosal potential difference is an indirect measure which is too often affected by other influences to be acceptable as a measure of mucosal injury when used alone, although it has some value as an adjunct to other measurements. Assay of DNA in gastric washings is a suitable technique for quantifying desquamation of gastric epithelial cells occurring in response to acute injury; on present evidence its significance is much more difficult to assess in the context of continuing challenge over several days. By contrast, measurement of microbleeding is more suitable for quantifying injury over several days of NSAID ingestion; little bleeding is recorded with a single acute challenge. Endoscopy can demonstrate macroscopic lesions which result from mucosal injury—injury which is quantified more easily and sensitively by measurements of cellular exfoliation or bleeding. Paradoxically, endoscopy's strength has been to underline the scientific weakness of acute models because it shows that it is rare for ulcers, which are the lesions of clinical concern to develop in these st

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00645.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYThis study examined the effects of transmural nerve stimulation, acetylcholine, adrenoceptor agonists and several peptides on the contractility of strips of human gallbladderin vitro.Acetylcholine caused concentration‐related contractions of the tissues and the sensitivity to acetylcholine was similar in gallbladders with mild and severe chronic cholecystitis. Noradrenaline and adrenaline relaxed gallbladder strips, probably via β2‐adrenoceptor stimulation. Transmural nerve stimulation always caused contractions, but in the presence of atropine inhibitory responses were demonstrable and these were antagonized by propranolol. There was no evidence of non‐adrenergic inhibitory neural responses. Of the peptides tested, only cholecystokinin octapeptide (CCK‐OP), gastrin, pentagastrin, substance P and caerulein caused contractions. Responses to CCK‐OP, gastrin and pentagastrin were antagonized by dibutyryl cyclic GMP. Hormones which had no effect upon human gallbladder strips included motilin, secretin, bombesin, neurotensin, glucagon, vasopressin, VIP and somatostatin. Considerable differences therefore exist between human tissues and those from experimental animals with respect to the direct actions of neural and hormonal stimuli on gallbladder con

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00646.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYNon‐steroidal anti‐inflammatory drugs (NSAIDs) damage the gastric mucosa, and an important part of this effect is probably due to inhibition of prostaglandin synthesis. We have therefore studied various drugs for their ability to reduce prostaglandin and thromboxane formation by human isolated gastric mucosa. The overall relative potencies for inhibiting the endogenous production of PGE, 6‐keto‐PGF1αand thromboxane B2by mucosal pieces was generally: indomethacin = naproxen>ibuprofen>piroxicam; diflunisal, the prodrug sulindac, and the analgesic paracetamol usually had small or variable effects. This rank order was mainly similar to the inhibition of gastric microsomal PGE2formation from exogenous arachidonic acid, the relative potencies being: indomethacin>naproxen>ibuprofen = piroxicam = diflunisal; again sulindac and paracetamol had little or no effect. The relative propensity of NSAIDs to cause gastric mucosal damage is controversial, but aspirin and indomethacin may be worst, and ibuprofen seems to be among the safest. Potency as an inhibitor of prostaglandin synthesis correlates better with the reported propensity for damage than does potency dose. For reasons that are given in the discussion, this may indicate that gastric mucosal damage by NSAIDs with short or moderate half‐lives is due largely to locally absorbed drug. Whereas inhibition of prostaglandin synthesis is probably the major cause of the damage, the simultaneous reduction of thromboxane formation might be advantageous for gastric mucosal integrity. Various implications arise from our hypotheses concerning the design of anti‐inflam

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00647.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYIn a double‐blind crossover study, lower oesophageal sphincter pressure (LOSP) and distal oesophageal motility were studied in eight healthy volunteers following a single intravenous dose of omeprazole or placebo. Lower oesophageal sphincter pressure was determined before and at intervals up to 120 min after intravenous administration of 40 mg omeprazole or placebo. No effects on LOSP or distal oesophageal motility were observe

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00648.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYNinety‐five patients with healed gastric ulcers were treated with ranitidine 150 mg at night plus either Caved‐S two tablets twice daily, or an identical placebo preparation. Treatment was continued for 2 years: the recurrence rate after 1 year was 12.5% for single therapy and 19% for combined therapy, and 30 and 40% respectively after 2 years (differences not significant). No serious side‐effects were encountered, but patients found the combination therapy difficult to take, and it conferred no clinical advantage. In a 3 month follow‐up after stopping maintenance therapy, 11% of the patients had a symptomatic ulcer recurrence. It is therefore recommended that elderly patients with gastric ulceration should remain on maintenance therapy f

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00649.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYThe splanchnic and systemic haemodynamic effects of a single sublingual dose of nifedipine (slow calcium channel blocker) in nine patients with cirrhosis of the liver and portal hypertension were studied. Nifedipine produced a significant reduction in the mean arterial blood pressure (98±53vs. 86±5 mmHg,P<0.05) but did not alter the mean heart rate, portal venous pressure or total liver blood flow. The systemic antihypertensive effect of nifedipine can be achieved without altering liver blood‐flow in patients with chronic liver disease and portal hypertens

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00650.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYThe effect of nicardipine on basal and pentagastrin‐stimulated gastric acid secretion in normal volunteers was investigated. When compared with saline, an intravenous infusion of nicardipine caused a significant decrease in peak acid output (from 37.8 mmol hour−1to 28.8 mmol hour−1;P= 0.04) and a small reduction in aspirate volume. Nicardipine had no significant action on basal acid output or volume of aspirate. Proteolytic activity in both the basal and stimulated periods was unaffected by nicardipine as were serum gastrin concentrations. Although calcium channel blocking agents are theoretically antisecretory the present study suggests they are unlikely to have clinically useful therapeutic ac

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00651.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYExperiments were performed to investigate the effect of two α2‐adrenoreceptor agonists, clonidine and lidamidine, and a specific α2‐adrenoreceptor antagonist, idazoxan, on gastric emptying and mouth to caecum transit time (MCTT) of a radiolabelled meal in 27 healthy male subjects. Lidamidine (20 mg p.o.) and clonidine (0.3 mg p.o.), given alone had no significant effect on gastric emptying or MCTT suggesting that the anti‐diarrhoeal action of clonidine and lidamidine are unlikely to be explained by a slowing of small intestinal transit. Idazoxan (20 mg p.o.) reversed the effect of clonidine in 10 subjects, who showed a delay in MCTT after taking clonidine, but did not alter MCTT under basal conditions. These results suggest that although the sympathetic nervous system can influence upper gastrointestinal motility by an action on α2‐adrenoreceptors, this action does not exert a tonic influence on upper gastrointestinal motility under basal

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00652.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY