ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00540.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYIn recent years a number of different strategies for managing patients with peptic ulcer disease have become available. The present review discusses the relative merits of each form of treatment. Intermittent treatment (whether given in response to symptoms or as a prophylactic regimen prescribed seasonally or at weekends) fails to prevent ulcer recurrence and leaves patients at risk of haemorrhage and perforation. Anti‐Helicobacter pyloritherapy, although useful in certain circumstances, cannot be recommended for all patients with ulcer disease because of side effects and, in any case, requires further assessment of efficacy. Gastric surgery reduces ulcer recurrence and complications, but operations which have a low incidence of side effects are associated with higher rates of ulcer recurrence, particularly when patients are followed up for more than 10 years. Long‐term continuous maintenance treatment with H2‐receptor antagonists for 5 or more years effectively prevents ulcer recurrence in the majority of patients and significantly reduces the risk of ulcer complications. In addition, maintenance treatment has proved to be safe and is well tolerated by patients.Maintenance treatment with H2‐receptor antagonists is the preferred option for the management of patients with peptic ulcer

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00541.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYPrednisolone metasulphabenzoate, a steroid with poor colonic absorption, was coated with the pH‐dependent acrylic resin Eudragit S, as a means of delivering an orally administered preparation to the proximal colon. The therapeutic potential of delivering this steroid with potentially less systemic side‐effects to the proximal colon was assessed in extensive ulcerative colitis. Plasma and urine prednisolone profiles in 6 healthy volunteers confirmed minimal absorption from Eudragit S‐coated prednisolone metasulphabenzoate compared to prednisolone acetate: peak plasma prednisolone concentrations 29 ± 21 ng/mlvs.570 ± 185 ng/ml (P<0.01), area under curve measurements 204 ± 214vs.2724 ± 1236 ng.h/ml (P<0.01). Prednisolone metasulphabenzoate coated with Eudragit S (30–60 mg daily) was then administered for 12 weeks to 12 patients with colonoscopically proven extensive ulcerative colitis in relapse. Symptoms, sigmoidoscopic appearances and rectal histological abnormalities all improved during therapy. Complete clinical remission occurred in 7 patients, a partial response in 2 patients and no response in 3 patients. Cortisol responses to tetracosactrin demonstrated no significant adrenal suppression following treatment. Eudragit S‐coated prednisolone metasulphabenzoate may be a useful treatment for extensive ulcerative colitis, without risk of systemic steroid

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00542.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYThe new long‐acting somatostatin analogue octreotide (SMS 201–995) was investigated for its influence on segretatagogue‐stimulated human exocrine pancreatic secretion. Eighteen healthy volunteers participated in the study. During duodenal intubation with a background stimulation of either secretin 1 U.kg/h or secretin 1 U. kg/h + ceruletide, 120 ng.kg/h, octreotide was infused at doses of 5, 20 and 80μg/h in a placebo‐controlled randomized double‐blind crossover trial. Duodenal juice samples were collected in 10‐min intervals, and amylase, trypsin, chymotrypsin, and bicarbonate were measured in the individual fractions.During secretin stimulation, amylase was inhibited between 41 and 59%, trypsin between 28 and 72%, chymotrypsin between 55 and 70%, and bicarbonate between 0 and 31% with 5, 20 and 80μg/h octreotide. During secretin and ceruletide stimulation, amylase was significantly inhibited by 84%, 78%, 81%, trypsin by 76%, 55%, 52%, chymotrypsin by 77%, 55%, 60%, and bicarbonate by 25%, 11%, 19% with 5, 20, and 80μg/h octreotide, respectively (all decreasesP<0.05).The long‐acting somatostatin analogue octreotide was confirmed to be a potent inhibitor of stimulated human exocrine pancreatic secretion. The near maximal inhibitory potency of octreotide was achieved at a dose of only 5μg/h. This finding may be of value in the planning of therapeutic studie

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00543.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYThe clinical tolerance to three 5‐aminosalicylic acid (5‐ASA) releasing preparations (mesalazine, olsalazine and balsalazide) was assessed in a consecutive series of 43 patients with inflammatory bowel disease who were intolerant to sulphasalazine. The relative contributions to the side‐effects of sulphasalazine made by its two components, 5‐ASA and sulphapyridine, were also assessed in these patients. Thirty‐nine (91%) patients were able to tolerate at least one of the three 5‐ASA preparations. Only four (9%) patients were intolerant to all preparations, having adverse reactions previously experienced with sulphasalazine and presumably related to 5‐ASA rather than sulphapyridine. The clinical tolerance to mesalazine (63%), olsalazine (70%) and balsalazide (70%) was similar, and tolerance to one drug only was found in nine (18%) patients. The commonest adverse reactions associated with 5‐ASA preparations were gastrointestinal. Diarrhoea was a problem in five patients during treatment with olsalazine and three each while on mesalazine and balsalazide. Allergic reactions from 5‐ASA preparations were uncommon; of ten patients with rash following sulphasalazine only one developed a rash with mesalazine. The results of this study indicate that the vast majority of patients with inflammatory bowel disease can be managed with at least one of these four 5‐ASA containing preparations and that the side‐effects of sulphasalazine are multifactorial in aetiology, some being due to the parent molecule, and some to one of its two metabolites, 5

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00544.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYAn assessment was made of the efficacy of aβ‐galactosidase, obtained fromAspergillus nigerand added to intact milk, in decreasing lactose malabsorption and intolerance. Sixteen adult patients with malabsorption and intolerance to this sugar were studied in a double‐blind crossover studyvs.placebo. A 5‐hour hydrogen breath test was used to assess malabsorption of lactose contained in 400 ml milk. When compared with placebo, the addition of exogenous lactase to intact milk caused a statistically significant reduction in the maximum breath H2concentration (P<0.01) and in the cumulative H2excretion (P<0.005). In the same way, the cumulative index for gastrointestinal intolerance was significantly lower (P<0.005) after the ingestion of lactase‐added milk. This study demonstrates that enzyme replacement therapy, withβ‐galactosidases obtained fromAspergillus niger, is effective in decreasing lactose malabsorption and its consequent intolerance in adult subjects with lactase

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00545.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYThe effects of indomethacin and ibuprofen on gastrointestinal mucosal integrity were studied in conventional and germ‐free rats. Only ibuprofen induced significant gastric erosion formation in both conventional and germ‐free animals, demonstrating that the presence of micro‐organisms is not required in this form of damage. Both indomethacin and ibuprofen caused significant intestinal damage and blood loss in germ‐free animals. However, in the conventional counterparts, damage due to indomethacin was enhanced whereas that induced by ibuprofen was not. The results from the present work would suggest that non‐steroidal anti‐inflammatory drugs such as indomethacin, which are secreted largely in the bile, unlike ibuprofen, may act in concert with bacteria and the constituents of bile to induce, in part, intestinal damage and

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00546.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYThe ethinyloestradiol (EO2) component of oral contraceptive steroids is extensively conjugated with sulphate by the gut wall. The ability of gastrointestinal mucosa to conjugate EO2has been examinedin vitroin samples of mucosa taken from normal women as well as from women with coeliac disease. The percentage conjugation per mg dry weight for normal tissue (n= 11) was 17.1 ± 6.4 (mean ± s.d.) while in untreated coeliac tissue (n= 6) the figure was 6.3 ± 3.6% (P<0.01). In tissue from patients with treated coeliac disease (n= 5) the figure was 12.1 ± 3.2%.Thus the ability of intestinal mucosa to conjugate ethinyloestradiol was significantly reduced in patients with coeliac disease, and restored towards normal following treatment. However, in patients with coeliac disease the pharmacokinetics of ethinyloestradiol were not significantly different from normal contr

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00547.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYLansoprazole (AG 1749/CG 4801) is an inhibitor of gastric acid secretion by blocking H+,K+‐ATPase. In this 2:1 randomized, double‐blind, multicentre trial lansoprazole 30 mg am was compared to 40 mg famotidine nocte in 264 out‐patients suffering from uncomplicated duodenal ulcer. After 2 weeks of treatment ulcer healing was confirmed endoscopically in a significantly higher proportion (P= 0.027) of patients treated with lansoprazole (94/174 = 54.0%) compared to patients receiving famotidine (35/90 = 38.9%). Cumulative healing rates after 4 weeks were 91.4% for the lansoprazole group and 83.3% for the famotidine group (P= 0.065). Pain relief and decrease of concomitant antacid consumption during treatment were comparable in both groups. Both compounds were well tolerated. Rates of recurrent duodenal ulcer in the 6 months after trial treatment were 45/158 (28.5%) after lansoprazole, and 18/69 (26.1%) after famot

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00548.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SUMMARYAssessment of intragastric urease activity by the13C‐urea breath test was performed before and after one day of dosing with either De‐Noltabs (tripotassium dicitrato bismuthate, one tablet 1 q.d.s.), Pepto‐Bismol liquid (bismuth salicylate 30 ml q.d.s.), or Roter tablets (bismuth subnitrate, one tablet q.d.s.) in twelveHelicobacter pylori‐positive patient volunteers. There was a significant decrease in the excess of13CO2after one day of dosing with each of the three bismuth compounds, but analysis of variance could detect no difference between the effects of the three compounds.Systemic absorption of bismuth following oral dosing with either Pepto‐Bismol or Roter is minimal, yet both compounds have a suppressive effect onH. pylorisimilar to that of De‐Noltab. This study suggests that the action of all three bismuth compounds is within the gastric lumen, and that systemic absorption of bismuth is not necessary for activity again

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1992.tb00549.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY