摘要:

SUMMARYAntibiotics have an important place in the management of gastrointestinal disease. Recent studies have demonstrated efficacy in acute bacterial gastroenteritis caused by salmonellae and campylobacteriaceae, shigellae and enterotoxigenic strains ofE coli(ETEC). Tetracycline remains effective in cholera.Antibiotic resistance is widespread amongst the enteric pathogens and can quickly spread during epidemics of infective diarrhoeas. It is important that antibiotics are reserved for the treatment of serious infections lest their effectiveness in these conditions be lost.Campylobacter pyloriappears to be an important cause of chronic active gastritis and is amenable to treatment with antibiotics and bismuth salts. The role ofC. pyloriin the pathogenesis of peptic ulcer disease is not yet established but there is mounting evidence that antibiotic treatment will have a place in the treatment of this common condition. The effect of antibiotics on the normal intestinal microflora can have serious consequences. It is a major cause of resistance in urinary tract pathogens, can result in outbreaks of hospital infection with resistant organisms and frequently results inC. difficileassociated diarrhoea.

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00219.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYAn Eudragit‐L coated oral 5‐aminosalicylic acid (5‐ASA; mesalazine) product (Mesasal), has been formulated to deliver 5‐ASA to the distal small intestine and colon for the treatment of inflammatory bowel disease. The purpose of this study was to compare the pharmacokinetic profile of this product to sulphasalazine (SASP; Salazopyrin) and to assess the pharmacokinetics of a suppository 5‐ASA dosage form.Twelve healthy volunteers randomly received four single doses of 5‐ASA delivering formulations not less than 1 week apart. (a) Mesasal tablets, 2 × 250 mg, fasting; (b) Mesasal tablets, 2 × 250 mg, fed; (c) Salazopyrin tablets, 3 × 500 mg (corresponding to 576 mg 5‐ASA), fasting; and (d) Mesasal suppository, 1 × 500 mg, fasting. Plasma 5‐ASA and acetyl‐5‐ASA (Ac‐5‐ASA) concentrations were followed for 48 h and urine and faecal concentrations for 72 h.Mesasal tablets (fasting) produced a greater area under the concentration–time curve (AUC), peak and time to peak for both plasma 5‐ASA and Ac‐5‐ASA than Salazopyrin. Median urinary recovery values were 21.7% for Salazopyrin and 35.5% for Mesasal (fasting) (P<0.01). This means that the systemic absorption was higher after Mesasal than after Salazopyrin. The total faecal recovery values were 38.3 and 26.5%, respectively (NS). Except for a delay of 1.5–3 h in the time to peak of 5‐ASA and Ac‐5‐ASA plasma levels, the pharmacokinetics of Mesasal tablets were essentially the same in fasting or fed subjects. Suppository administration of 5‐ASA resul

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00220.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYTwenty patients with active Crohn's disease, the majority refractory to conventional therapy, were treated with rifampicin, ethambutol, isoniazid, and pyrazinamide or clofazamine for 9 months. After this period, 10 were in remission (Crohn's disease activity index<150). Of the 10 not in remission, three had been at 6 months, but had relapsed on treatment. Nine of 10 patients on steroids at the beginning were off steroids at 9 months. Six patients came to surgery during the period, five for stricture formation without evidence of florid Crohn's disease outside the strictured segment. Three young patients with severe Crohn's disease facing total colectomy were spared surgery. No serious drug‐related side‐effects were encountered. The results of this pilot study suggest that controlled trials of antimycobacterial chemotherapy, using four or more of the best agents available, are worthy of assessment in Crohn's dise

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00221.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYThe literature was searched for clinical trials evaluating the use of 300 mg ranitidine daily in the acute treatment of gastric ulcer. All available trials were examined, and the results compared between countries to determine the extent of any geographical variation in ulcer healing rates. Published placebo studies in gastric ulcer were also reviewed for comparison. Sixty‐six publications were inspected to determine the trial design, country of origin, gastric ulcer healing rates, determined endoscopically, and details of patient demography.Overall worldwide healing rates for ranitidine treatment were 63% at week 4 and 86% at week 8 (n= 2349 and 2256 respectively), compared with 34% at week 4 and 52% at week 8 for placebo (n= 790 and 231 respectively). Statistically significant differences were found between the healing rates for individual countries at week 4 (P<0.001) and week 8 (P<0.001). However, after exclusion of the results from Japan (35%,n= 278) and Yugoslavia (97%,n= 32) at week 4, and from Japan (80%,n= 467) and France (65%,n= 52) at week 8, the healing rates from the remaining countries were not statistically different from one another. The limited data available in relation to age, sex and smoking habits, or placebo healing rates contributed little to explaining these aberrant results.It is concluded that there is variation in gastric ulcer healing rates between countries, but only results from Japan seem to be out of line with the rest of the worl

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00222.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYSix patients with short intestine (jejunal length 25–70 cm) on long‐term parenteral nutrition, needing 4–5 L of intravenous fluid daily, were given octreotide (a somatostatin analogue, SMS 201–995) to investigate whether it would reduce beneficially their secretory diarrhoea (3.6–6.9 kg/day). They consumed the same diet for 2 control days, followed by 2 test days. Octreotide was given intravenously, initially in a dose of 50 μg b.d. through the central feeding line. There was a significant reduction of daily stomal output (0.5–5.0 kg) and daily sodium and potassium output; however there was no significant change in energy absorption. The response to octreotide was greatest in those patients who absorbed least nutrients. A dose increase to 100 μg t.d.s. gave no further measurable benefit though the patients found it smoothed‐out the post‐prandial rise in stomal output. Two patients were continued on long‐term octreotide therapy, which allowed for a daily reduction in intravenous fluid of 1 and 1.5 L. Octreotide's anti‐secretory effect was found to have been maintained when it was retested in one patient after a year

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00223.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYThe effect of 60 mg oral omeprazole daily for 9 days on intrinsic factor and gastric acid secretion was studied in eight healthy volunteers. Gastric secretion studies were performed during saline and 0.1 M HCl perfusion before and after omeprazole administration. During dosing with omeprazole, basal gastric acid output diminished by 94%, and pentagastrin‐stimulated acid output by 97%. Basal, peak and steady‐state stimulated intrinsic factor output were unaffected by omeprazole. It is concluded that high oral doses of omeprazole suppress gastric acid secretion to very low levels but they do not affect intrinsic factor secretion. Intrinsic factor secretion was also unaffected by profound hypochlorhyd

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00224.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYWe have studied the effect of tripotassium dicitrato bismuthate on the peptic activity of gastric juice, both basal and pentagastrin‐stimulated, from five healthy volunteers using porcine pepsin solution as a control. Tripotassium dicitrato bismuthate showed no inhibition of the proteolytic activity of either the pure porcine or the human pepsin in the gastric juice. The ulcer healing efficacy of tripotassium dicitrato bismuthate is unlikely to be related to a gastric anti‐protease eff

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00225.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYTrimebutine maleate and metoclopramide increase small bowel motility. The present manometric study of the human normal interdigestive duodeno‐jejunal motility demonstrated two different pharmacological effects in 15 healthy volunteers. Trimebutine constantly induced a premature phase 3 activity (0.81 ± 0.4 min after a 100‐mg intravenous injection) with patterns similar to spontaneous phase 3. Metoclopramide increased the motility index (contractile activity) during phase 2 without inducing a premature phase 3. No significant variations in plasma motilin concentration were noticed after either trimebutine or metoclopramide. The pancreatic polypeptide concentration rose significantly after metoclopramide injec

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00226.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYIn previous studies it has been suggested that activation of cellular immunity may have a role in controlling the activity of chronic non‐A, non‐B liver disease. We conducted a pilot study of therapy with a bovine thymus extract for 6 weeks in 15 consecutive patients with chronic non‐A, non‐B hepatitis, most of them sporadic cases. Treatment induced immunomodulation, and in five patients a significant but transient diminution in aminotransferase levels was observed associated with increments in several parameters of cellular immunity. This suggests that a longer administration of this or other related compounds, or treatment with a more potent immunomodulating agent, might be effective in these p

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00227.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYH2‐receptor antagonists have been shown to be effective in the suppression of nocturnal acidity. This double‐blind, randomized, crossover Latin‐square study of 24‐h intragastric pH in 12 normal volunteers investigated the effect of large single‐dose administration of misoprostol on intragastric acidity. Efficacy of 800 μg misoprostol h.s., 600 μg h.s., 400 μg h.s. and 800 μg after supper was compared to placebo and 200 μg misoprostol q.d.s. Twenty‐four hour mean pH ± s.d. was placebo 2.1 ± 0.3, misoprostol 200 μg q.d.s. Twenty‐four hour mean pH ± s.d. was placebo 2.1 ± 0.3, misoprostol 200 μg q.d.s. 2.2 ± 0.3, 800 μg p.m. 2.6 ± 1.1, 400 μg h.s. 2.6 ± 0.7, 600 μg h.s. 2.6 ± 0.4, 800 μg h.s. 2.6 ± 0.5. The effect of misoprostol on gastric acidity was short and limited to the nocturnal period. Only misoprostol 800 μg and 600 μg reduced 24‐h

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00228.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY