摘要:

SUMMARYThe present review examines the evidence for the existence of an asymptomatic variant of duodenal ulcer disease, as well as its clinical significance and therapeutic implications. Asymptomatic duodenal ulcers have definitely been shown to occur only in patients treated with nonsteroidal anti‐inflammatory drugs (NSAIDs) and in patients who have previously suffered from ulcer disease, especially if the latter have been subjected to gastric surgery or are receiving long‐term continuous (maintenance) treatment with drugs. It seems likely (although conclusive evidence is not yet available) that NSAID‐associated asymptomatic duodenal ulcers are predisposed to haemorrhage or perforation and should therefore be healed and kept in remission. Asymptomatic duodenal ulcers discovered during maintenance treatment appear to be clinically innocuous and do not therefore indicate therapeutic failure, nor require modification of th

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00503.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYFifty‐seven patients who developed asymptomatic recurrence of duodenal ulceration during maintenance treatment with ranitidine were followed up to assess the risk of developing symptoms or complications of ulcer disease. The risk of development of symptomatic ulcer recurrence was 4% in the first year of follow‐up during continuous maintenance treatment, irrespective of whether or not the asymptomatic ulcer had been actively treated (by doubling the dose of ranitidine used for maintenance therapy). The asymptomatic duodenal ulceration during maintenance treatment did not predispose to complications such as haemorrhage or perforation. It seems, therefore, that patients receiving maintenance treatment for duodenal ulceration do not require endoscopic re‐examination unless symptoms have recurred, because the asymptomatic recurrences of duodenal ulceration occurring during maintenance treatment are clinically benign, usually heal spontaneously if maintenance treatment is continued, and do not require active medical interve

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00504.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYEleven patients with active proctitis or proctosigmoiditis completed one month's treatment with tripotassium dicitrato bismuthate enemas administered at night. Symptoms, sigmoidoscopic appearances, and the histological grade of acute inflammation were assessed at the commencement of therapy and after one month. An overall score of these features showed improvement in 9 of 11 patients, which encourages further investigation of bismuth in controlled trials for patients with inflammatory bowel disease.

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00505.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYWe measured 4‐aminosalicylic acid (4‐ASA) levels in faecal water by in‐vivo equilibrium dialysis during oral ingestion of drug by two different dose protocols (A and B). In Protocol A, 5 normal subjects ingested 3 g of 4‐ASA as the free acid and 20 mg of metaclopromide per day. On Day 5, small dialysis sacs filled with dextran 40 were ingested and the oral drug was continued until the sacs were retrieved from the stool. Protocol B followed the same format except that 3 g of 4‐ASA was ingested twice daily and metaclopromide was omitted. In both protocols concentrations of 4‐ASA andN‐acetylated 4‐ASA in sac contents were measured by HPLC. In‐vitro dialysis studies showed bi‐directional equilibrium was reached within 120 min. During Protocol A, intraluminal concentrations of total 4‐ASA ranged from 14.0 to 32.2 mmol/L with a mean of 20.6 mmol/L. With Protocol B, total 4‐ASA levels ranged from 20.1 to 41.3 mmol/L with a mean of 33.9 mmol/L. From 90 to 99% of the drug in the dialysates wasN‐acetylated. These concentrations of total 4‐ASA are similar to those of 5‐ASA after ingestion of therapeutic doses of sulphasalazine or absorption‐resistant formulations of 5‐ASA. Thus, oral 4‐ASA could have a role in the trea

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00506.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYThe efficacy of omeprazole therapy (40 mg daily) in H2‐blocker refractory severe reflux oesophagitis (Grade II‐IV; Savary and Miller classification) was investigated in 61 patients. Mean duration of reflux disease and preceding H2‐antagonist treatment were 4.3 years and 15 months, respectively. Healing rates at 4, 8 and 12 weeks were 48%, 80% and 92%, respectively. There was a correlation between severity of oesophagitis and duration of omeprazole therapy necessary for healing. Three patients (5%) required higher dosages than 40 mg for healing. Symptomatic responses paralleled healing. It is concluded that omeprazole is a highly effective drug for severe reflux oesophagitis not responding to H2‐blocker treatment and that 40 mg daily is the optim

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00507.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYEnprostil is a synthetic dehydro‐prostaglandin E2with gastroduodenal ulcer‐healing and mucosal‐protective properties. One hundred and three healthy volunteers were randomized to receive capsules of enprostil 35 μg b.d. (the clinically recommended dose), enprostil 70 μg b.d., or placebo b.d. All underwent endoscopic assessment of the gastroduodenal mucosa, scored using a 0–4 scale, at baseline and on Days 3, 7, 14, 21 and 28 of dosing. Mean and median maximum scores demonstrated a dose response, and the mean maximum scores were statistically significantly higher for both enprostil groups on each endoscopy day when compared with placebo. The majority of enprostil‐treated subjects had petechial haemorrhages. The proportion of volunteers with small white‐based mucosal breaks (erosions) was significantly higher for the fundus in the enprostil 70‐μg group on Days 21 and 28 when compared with placebo, but there were no significant differences between treatment groups for any area on the other study days. T

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00508.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYThe comparative efficacy of two alginate‐containing anti‐reflux preparations (Gaviscon, Algicon) was assessed in a single blind crossover study of 20 patients with gastro‐oesophageal reflux disease. The clinical efficacy study was preceded by two studies in healthy volunteers to assess the intragastric effects of Algicon and Gaviscon by pH measurement, endoscopic visualization and gamma scintigraphy.Algicon and Gaviscon were shown to form a raft in the fasting and fed human stomach, with Algicon alone having a potent antacid effect below and within the raft. Both Algicon and Gaviscon liquids significantly reduced the frequency and severity of reflux symptoms from baseline when given at their recommended doses (10 ml and 20 ml four times daily, respectively). There were no significant differences between Algicon and Gaviscon, although 12 patients preferred Algicon (vs5 for Gaviscon) for control of reflux symptoms. It was concluded that both Algicon and Gaviscon were effective for the symptomatic control of gastro‐oesophageal reflux

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00509.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYA dose‐response study was performed with three doses of colestipol, using postprandial serum bile acid levels to assess bile acid sequestering activity in 40 volunteers with asymptomatic hyperlipidaemia. Subjects who entered the study had total serum cholesterol concentrations greater than 220 mg/dl and triglyceride concentrations less than 200 mg/dl. They were randomly assigned to one of four parallel treatment groups: (a) placebo b.d., colestipol (as Colestid hydrochloride granules) 2.5 g b.d., (c) colestipol 5 g b.d., and (d) colestipol 7.5 g b.d. Subjects were maintained on a constant repeating solid diet throughout the 6‐day study period, and colestipol was ingested 30 min before breakfast and dinner. No drug was administered on Days 1–3; baseline (pre‐treatment) serum bile acid concentration profiles were determined on Day 3. The above treatments were given on Days 4–6, and total serum

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00510.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYIn a randomly allocated, double‐blind, endoscopically controlled study, 98 patients with gastric ulcers were treated with either (a synthetic prostaglandin of E2‐like structure) enprostil 70 μg b.d. or 150 mg ranitidine b.d. The healing rates at 4, 8 and 12 weeks were enprostil 57, 91 and 94% and for ranitidine 55, 88 and 98%, respectively. Following ulcer healing, half the patients were followed for 1 year without treatment and the others were given 70 μg enprostil nocte. Endoscopy was repeated in both groups after 6 and 12 months or if dyspeptic symptoms returned. The recurrence rate without maintenance at 6 and 12 months, following ranitidine therapy, was 67 and 75%, and after enprostil therapy 50 and 61%, respectively. On maintenance enprostil, the recurrence rates were 28 and 40%. Forty‐seven per cent of patients who completed maintenance treatment had a proven ulcer recurrence within 6 months of stopping therapy. Diarrhoea was a common sideeffect of enprostil therapy. Seven patients were withdrawn because of diarrhoea or abdomin

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00511.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYThe aim of this study was to compare the effects upon gastric secretion of therapeutic doses of aminophylline, with doxofylline, a new xanthine derivative proposed for the treatment of chronic asthma.Twelve patients with endoscopically‐proven healed duodenal ulcer were studied twice under double‐blind conditions in cross‐over experiments. In a 1‐hour infusion, six patients received either 240 mg aminophylline i.v. or 200 mg doxofylline i.v., and six received either 240 mg aminophylline i.v. or 400 mg doxofylline i.v.Compared with basal gastric secretion, for the hour after the infusion 240 mg aminophylline i.v. stimulated gastric acid output by a mean 213% (P<0.01) and mean pepsin output by 129% (P<0.01). Intravenous doxofylline did not stimulate a significant increase of either acid or pepsin output (200 mg: acid output + 4%, pepsin output + 10%; 400 mg: acid output + 25%, pepsin output + 27%).These findings suggest that doxofylline, unlike aminophylline, has a low secretagogue activity and it may be more suitable for asthmatic patients with peptic ulcer

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1990.tb00512.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY