摘要:

SUMMARYGastro‐oesophageal reflux disease may result from a host of factors. Medical therapy has largely been aimed at neutralizing acid or decreasing acid production but improvement of upper‐gastrointestinal motility may prove to be a valuable treatment modality as well. This paper reviews the current state of knowledge of the pathogenesis of reflux disease and concentrates upon promotility treatment with domperidone, metoclopramide and cisapr

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00197.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00198.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYCyclosporin is a potent immunosuppressant, which has gained recent interest as a possible treatment for Crohn's disease. Chronic nephrotoxicity, however, has recently been demonstrated as a result of early treatment with high initial cyclosporin doses. We report the effect of a 3‐month treatment with low‐dose cyclosporin (5–7.5 mg kg−1day−1) in 11 chronically active, therapy‐resistant Crohn's disease patients. Eight of the 11 patients (72%) improved according to a clinical grading score and the Dutch Activity Index whereas 9/11 (82%) improved according to the Crohn's Disease Activity Index (P<0.05) after 1 month. Three patients were withdrawn despite clinical improvement. One developed arterial hypertension, one dropped out and one required surgical treatment due to a small bowel stricture. Five patients (45%) completed the treatment period with improved clinical scores. After tapering‐off, two patients (18%) were better at follow‐up. No serious side‐effects were encountered and it is concluded that low‐dose cyclosporin treatment should be further investigated

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00199.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYA pilot study was performed to assess the role of cyclosporin in the management of severe inflammatory bowel disease. Twelve patients with Crohn's disease and 12 with ulcerative colitis were admitted to hospital with a severe attack. They were treated with an intravenous regimen of corticosteroids for 5 days followed by oral therapy. In addition, they received a 6‐week course of oral cyclosporin, initially 15 mg kg−1day−1reduced to 7.5 mg kg−1day−1. In comparison with historical controls, the addition of cyclosporin to standard corticosteroid therapy appeared to have no benefit. Adverse effects were common but minor. The expression of Class II molecules on the inflamed epithelium was rapidly reversed by cyclosporin therapy which may indicate a potential therapeutic benefit over longer period

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00200.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYIntraluminal pH was measured simultaneously in the stomach and duodenal bulb with six small, glass electrodes tied together at 1.5‐cm intervals. Ten patients with duodenal ulcer disease were studied under fasting conditions and for 3 h after a standard liquid meal on three occasions: day 1, before treatment; day 8, when the proton pump blocker omeprazole had been taken in a daily dose of 30 mg for 7 days consecutively, including the day of the pH study; day 9, 24 h after the last dose of omeprazole. Mean hydrogen ion activity and the percentage of time with pH below 3 was calculated from the digital pH data sampled at a frequency of 1 per second from each electrode.On day 8, five of the patients were permanently anacidic (pH>4) in the stomach and duodenum, while the food‐stimulation broke off anacidity for shorter periods in the other five patients. The pH pattern in the duodenal bulb was markedly altered in all patients with disappearance of the typical pH fluctuations, and a decrease in the time that the pH was below 3 from a median value of 30% before treatment to 0% in seven patients and close to 0% in three patients. On day 9, a large patient‐to‐patient variation was observed in gastric pH: three patients were still anacidic, four were markedly suppressed, but three patients reached near pre‐treatment acidity. Duodenal bulb acidity was still decreased significantly on day 9 in all patients, with post‐prandial pH below 3 for less than 5% of the time, compared with 30% befor

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00201.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYFour agents, which could delay intestinal transit, were tested in six short‐bowel patients (jejunal length 30–120 cm) on long‐term nutritional/ electrolyte replacement therapy. Intestinal transit time of a liquid test meal and nutrient, water and sodium absorption were measured during a control study and with each test agent on separate days. Soy polysaccharide tended to increase transit time, but decreased the absorption of water, sodium and nutrients. Codeine phosphate and loperamide caused inconsistent and clinically unimportant changes. Octreotide, a long‐acting analogue of somatostatin, delayed transit and increased water, sodium and calorie absorption from the meal. Octreotide appears to have the potential to reduce the need for electrolyte and nutritional supplements in patients with the short‐bowel

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00202.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYA randomized, double‐blind, clinical trial was undertaken to compare 150 mg ranitidine b.d. with 300 mg ranitidine nocte in the treatment of reflux oesophagitis. Endoscopy data were evaluable for 336 patients after 8 weeks of treatment. At this time 75% of patients who received 150 mg ranitidine b.d., and 73% of those who received 300 mg nocte, had healed or showed endoscopic improvement to grade I oesophagitis. At 12 weeks these rates had increased to 89 and 88%, respectively. Oesophageal biopsies from 258 patients at 8 weeks showed histological improvement in 44 and 47% of those treated with 150 mg ranitidine b.d. and 300 mg ranitidine nocte, respectively. After 12 weeks histological improvement was apparent in 57 and 54% of biopsies from each group, respectively. Symptom severity and frequency was reduced to a similar extent by both treatments. Adverse events were reported by 15 patients. A 300–mg bedtime dose of ranitidine was found to be a well‐tolerated, effective alternative to twice daily treatment in reflux oesopha

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00203.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYThe safety and efficacy of Claversal (coated, oral 5‐aminosalicylic acid (5‐ASA) 0.75 g/day) and sulphasalazine 1.5–2.0 g/day were compared for the maintenance treatment of ulcerative colitis in a 1‐year double‐blind trial. Three hundred and thirty‐four patients, whose disease was controlled on a stable dose of sulphasalazine (1.5–2.0 g/day) for a 1‐month pre‐trial, entered the study. On entry, patients were assigned in a random manner to continue sulphasalazine or to switch to coated 5‐ASA. One hundred and thirty‐one patients in the coated 5‐ASA group and 142 on sulphasalazine were analysed for efficacy.No significant difference was observed between treatments with respect to the cumulative rate of relapse. Over the 12 months, 30 (28%) of the coated 5‐ASA patients versus 29 (23%) of those treated with sulphasalazine had an exacerbation of their disease (log rank testP= 0.7011).The incidence of drug‐related adverse events and subsequent withdrawals was similar. The high incidence of side‐effects usually associated with sulphasalazine was not observed, probably due to the fact that this population was tolerant of sulphasalazine pre‐trial. Of the 37 patients who reported adverse events with previous sulphasalazine therapy, however, only two (8%)of the 24 experienced those events when randomized to coated 5‐ASA while five (38%) of the 13 who continued on sulphasalazine reported those same events. Coated 5‐ASA is a safe, effective therapy for maintain

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00204.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYThe effect of increasing doses (15 mg, 30 mg and 60 mg) of the substituted benzimidazole, AG‐1749, on gastric acid secretion and fasting serum gastrin concentration has been studied after repeated administration to healthy volunteers.AG‐1749 produced a dose‐dependent and profound decrease in basal and stimulated gastric acid secretion in all volunteers, with almost total suppression at the highest dose. The extent of inhibition increased between Day 2 and Day 8 with the 15 and 30 mg doses of AG‐1749. The inhibitory effect of AG‐1749 appears to be fully reversible as control levels of acid output were reached 7 days after drug withdrawal.Seven days’dosing with 60 mg AG‐1749 induced a more than threefold increment of fasting serum gastrin concentration, but this increase was still within the normal range. Seven days after cessation of dosing, fasting serum gastrin concentration returned to a p

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00205.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

SUMMARYSix asymptomatic, non‐smoking men with endoscopically proven duodenal ulcer disease received single nocturnal doses of placebo, 40 mg famotidine and 300 mg ranitidine each for 1 week prior to serial measurement of pH, peptic activity and serum gastrin concentrations over 24 h and of acid output. The intragastric pH fluctuated between 1.53 and 5.07 when subjects were given placebo but within 2 h of taking famotidine or ranitidine it rose to 5.57 or higher; the effect lasted for 12 h from midnight. Peptic activity fell during famotidine and ranitidine treatment and the decline was somewhat greater 8–15 h after using famotidine. Serum gastrin levels did not change materially with any treatment. The study shows the equivalent effect of standard bed‐time doses of famotidine and ranitidine on intragastric pH, acid output and serum gastrin concentrations in asymptomatic men with duodenal ulcer di

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1989.tb00206.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY