摘要:

SUMMARYThe value of dietary alteration and the nutritional management of Crohn's disease is assessed in this review.Lactose restriction, low‐fat diets and low‐residue diets may be of value in specifically indicated clinical situations. A fibre‐rich, unrefined carbohydrate diet has not been shown to alter the course of the disease, and the value of ‘exclusion diets’remains to be confirmed in controlled, prospective studies.Nutritional insufficiency of varying degrees is common in Crohn's disease and can be corrected by the efficient use of enteral diets (usually with polymeric preparations) or intravenous nutritional support. Growth retardation in adolescents with Crohn's disease can usually be improved by enteral nutrition.Nutritional support of various kinds may be of value in the management of local complications of Crohn's disease; sub‐acute obstruction, anal, perianal and rectal lesions, fistulas and ileostomy complications, and the management of bile acid‐induced diarrhoea.The use of nutrition as ‘primary therapy; in Crohn's disease is considered. Theoretical reasons why nutritional support and bowel rest may possibly induce remission of the disease are discussed. The evidence to date suggests that intravenous nutrition and bowel rest may not be effective in inducing a primary remission of the disease, and the possible value of elemental diets and polymeric diets in this respect are assessed. Further prospective controlled studies of elemental diets as primary therapy in Crohn's disea

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00023.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYThe relationship between drug‐induced suppression of intragastric acidity and the rate of duodenal ulcer healing was examined using data for a single drug, ranitidine, from 156 clinical trials involving 16362 patients together with data on acid suppression from 37 studies of intragastric acidity in 630 subjects. In these studies ranitidine was given in doses ranging from 150 mg to 1200 mg per day administered in 9 different dosage regimens. The overall percentage of patients whose duodenal ulcers healed at 2 and 4 weeks on the different regimens was highly correlated with the percentage suppression of 24‐hour intragastric acidity induced by different regimens. Thus the therapeutic benefit of a given ranitidine dosage regimen in healing duodenal ulcers relates directly to its antisecretory eff

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00024.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYLansoprazole (AG 1749) is a novel substituted benzimidazole which inhibits gastric acid secretion by blocking H+, K+‐ATPase. This randomized, double‐blind multicentre trial studied the dose–response relationship of lansoprazole on ulcer healing and compared it with ranitidine in 314 out‐patients with endoscopically assessed, symptomatic duodenal ulcer. Cumulative healing rates with Lansoprazole 7.5, 15, and 30 mg o.m. were 48, 59, and 74% at 2 weeks and 75, 84, and 95 % at 4 weeks, respectively (intention‐to‐treat); the difference of the healing rates between 7.5 and 30 mg groups was significant (P<0.001).Corresponding healing rates for 300 mg ranitidine nocte were 51 and 89 %. Pain relief was similar in all treatment groups. Lansoprazole was well tolerated. During a follow‐up of 6 months relapse rates after lansoprazole 7.5, 15, and 30 mg were 21, 29, and 22%, respectively; the relapse rate after ranitidine 300 mg was 20%. In conclusion, lansoprazole provides faster healing of duodenal ulcer than ranitidine and a similar relapse pattern. For further trials in peptic ulcer disease a daily dose of lansoprazole 30 mg o.m. i

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00025.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYThe effects of systemic administration of α2‐adrenoceptor agonists on migrating myoelectric complexes and castor oil‐induced diarrhoea of the small intestine were studied in conscious rats. Castor oil (1 mg/kg, intraduodenally) disrupted the migrating myoelectric complexes and induced irregular spiking activity with sporadic bursts of myoelectric activity. This change of motility pattern was present concomitant with diarrhoea 1–2 h after instillation of castor oil and during the whole period of diarrhoea. Pre‐treatment with clonidine (5–10 μg/kg i.v.) or oxymetazoline (5.6–11.2 μg/kg i.v.), a peripherally active α2‐agonist, inhibited the irregular spiking induced by castor oil and no diarrhoea occurred during the experimental period of 6 h. Thus, the antidiarrhoeal action of peripherally acting α2‐adrenoceptor agonists such as oxymetazoline, may be of clinical value in the tr

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00026.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYPlasma alcohol concentration following oral ingestion of 0.3 g/kg of alcohol (ethyl alcohol), one hour after an evening meal, was measured in four groups of 12 healthy subjects. Each group had a control study and a repeat study after 7 days dosing with either placebo or an H2‐receptor antagonist (300 mg ranitidine nocte, 800 mg cimetidine nocte, or 40 mg famotidine nocte). There was no significant difference between the control and post‐dosing studies in the integrated 4‐h plasma alcohol concentration, peak plasma alcohol concentration, or time to reach peak alcohol concentration. This study shows that post‐prandial alcohol absorption after 0.3 g/kg of alcohol is not affected by ranitidine, cimetidine or fam

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00027.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYWater and solute absorption from three experimental hypotonic oral rehydration solutions (HYPO‐ORS; sodium 45, 60 and 75 mmol/L, glucose 90 mmol/L), the World Health Organization recommended ORS (WHO‐ORS; sodium 90 mmol/L, glucose 111 mmol/L), and the British National Formulary recommended ORS (BNF‐ORS; sodium 35 mmol/L, glucose 200 mmol/L), have been assessed by perfusion studies in cholera toxin‐induced secreting rat intestine. Net water absorption was greatest from the most hypotonic solution (HYPO‐45;P<0.05). UK‐ORS prevented net water secretion and WHO‐ORS promoted moderate net water absorption. Net sodium secretion was seen with all solutions but was least from WHO‐ORS and greatest with BNF‐ORS (P<0.01). Glucose absorption was similar from BNF‐ORS, WHO‐ORS and HYPO‐45 and in each case was greater than glucose absorption from HYPO‐60 and HYPO‐75 (P<0.05). These results suggest that net water and sodium absorption from ORS may be enhanced if osmolality is reduced by dec

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00028.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYIn a prospective study, eight young healthy subjects (five with an activeH. pyloriinfection in the antral mucosa) were treated with a course of tripotassium dicitrato bismuthate, amoxycillin and metronidazole. The triple therapy eradicated infection when assessed 20–24 weeks later by antral biopsy (urease, histology, and13C urea breath test [4 out of 5 subjects]). Twenty‐four hour intragastric acidity and plasma gastrin concentration were measured before treatment, and 4–6 weeks and 20–24 weeks post‐treatment. Treatment did not affect acidity in either theH. pylori‐positive orH. pylori‐negative groups, nor did it affect the plasma gastrin profile in theH. pylori‐negative group. Eradication ofH. pyloriinfection in five subjects caused a drop of the median integrated 24‐hour plasma gastrin concentration from 558 pmol. h/L before treatment to 307 and 289 pmol.h/L at 4–6 and 20–24 weeks post‐treatment, respectively. It is concluded thatH. pyloriinfection is associated with 24‐hour hypergastrinaemia, and that in apparently healthy subjects normal gastric physiology can be restored by era

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00029.x

出版商:Blackwell Publishing Ltd    

年代:1991

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 bowel and colon for the treatment of inflammatory bowel disease. The purpose of this study was to compare the pharmacokinetic profile of this product at steady‐state between healthy volunteers and two different patient groups with inflammation of either the small or the large bowel.Two carefully selected groups of patients, nine with Crohn's disease restricted to the small intestine and ten with total ulcerative colitis and one group of ten healthy volunteers received two 250 mg Mesasal tablets three times daily for 10 days to reach steady‐state. Plasma 5‐ASA and acetyl‐5‐ASA concentrations were followed for 48 h and urinary excretion for 72 h.There was a great variation in most pharmacokinetic parameters within each group and no significant differences were noticed between the groups. The location of the inflammatory process probably does not influence the pharmacokinetics of 5‐ASA in any significant way in patients with either Crohn's disease in the small bowel or total

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00030.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYRoxatidine acetate is a new histamine H2‐antagonist of about twice the potency of ranitidine on a weight‐for‐weight basis. Two hundred and thirty‐two patients participated in a double‐blind randomized trial of duodenal ulcer healing comparing 300 mg ranitidine nocte with 150 mg roxatidine nocte. Endoscopy was repeated fortnightly to 4 weeks in each of four participating centres. Usual exclusion criteria applied but NSAID users were allowed. There were no important demographic differences between treatment recipients. Three analyses were used: protocol (dropouts and violators not included), intention‐to‐treat I (dropouts considered failures), and intention‐to‐treat II (dropouts considered failures, but violators outcome included). Healing rates differed markedly (but not significantly) with each analysis. After 2 weeks of treatment ulcers had healed in 51% versus 45% using the intention to treat I analysis with roxatidine and ranitidine, respectively; by the protocol analysis the healing proportions were 60% and 55%. These differences between treatments were not significant. After 4 weeks of treatment healing rates ranged from 71% to 83% on roxatidine and between 69% and 84% on ranitidine depending on the analysis. Differential healing proportions of smokers and non‐smokers were nonsignificant (83% vs. 79%). Both drugs were well tolerated and adverse events were similar with each agent. Roxatidine should prove as effective as ranitidine for acute duode

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00031.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

SUMMARYTwenty‐fourHelicobacter pylori(H. pylori)‐positive patients were treated for 28 days with either 20 mg omeprazole o.m. (n= 12) or 40 mg omeprazole o.m. (n= 12). Clearance (absence ofH. pyloriat the end of or shortly after treatment) and eradication (absence ofH. pylori1 month after cessation of treatment) were assessed using the14C‐urea breath test. Observed clearance and eradication were: 20 mg omeprazole 3/12 and 0/12; 40 mg omeprazole 6/12 and 1/12 respectively. The effect onH. pyloriis probably due to the change in gastric pH from acid to neutral, however it is insufficient to recommend the inclusion of omeprazole in regimens aimed at eradicatingH. p

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1991.tb00032.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY