ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00600.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYβ‐Adrenoceptor blockers always change splanchnic haemodynamics in cirrhotic patients. Azygous blood flow, as a measure of collateral circulation including that through varices, is always reduced, but the effects on portal pressure, whether measured directly or by the wedged hepatic venous pressure, are variable. The initial correlations between a 25% reduction of resting pulse rate and similar percentage reduction in the wedge‐free hepatic venous gradient, has not been reproduced in subsequent studies. Therefore, to study the effect of changes in haemodynamic indices and the likelihood of variceal bleeding, direct measurements of such indices need to be made in clinical trials. At present there are no haemodynamic or clinical factors which can be used to select patients who will have a good therapeutic response to propranolol other than those documented in the first clinical trial of propranolol for the prevention of variceal re‐bleeding from Paris. Thus the hypothesis that β‐adrenoceptor blockers may lessen the incidence of bleeding in cirrhotics, by partially reducing portal pressure or flow or both, needs testing in further clinical studies. The selection criteria of the first clinical trial of propranolol in Paris need to be confirmed. Two subsequent trials, in which patients were not selected but in which many patients had similar clinical characteristics to the Paris patients, could not confirm a therapeutic effect of propranolol. No fatal complications due to propranolol administration have been reported in cirrhotic patients. Complications are reversible. Pharmacological treatment including β‐adrenoceptor blockade appears ideal for trials of primary prevention of variceal bleeding. Some preliminary results including use in decompensated cirrhotics are encouraging. However, as for trials for prevention of re‐bleeding, the design and analysis of such trials needs careful evaluation to take into account the outcome of patients who discontinue medication, whether due to simple non‐compliance or due to side‐effects, and also the influence of abstinence from alcohol on ble

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00601.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYIntragastric pH was measured continuously from 1800 to 1200 hours the following day in 22 duodenal ulcer patients and in eight gastric ulcer patients, all of whom had been admitted as emergencies with acute upper gastrointestinal haemorrhage. The effects of intravenous cimetidine or ranitidine were compared with no treatment. In patients with duodenal ulcer, median intragastric pH was 1.8 (range 1.0–4.9) in the group receiving no treatment. In the cimetidine group (400 mg, 6‐hourly,n= 8) median pH was 4.7 (range 1.5–7.7) and after ranitidine (50 mg, 6‐hourly,n= 10) it was 3.8 (range 1.2–7.8). The pH remained above 4.0 for 67% of the recording time with cimetidine, 47% with ranitidine and for only 3% with placebo. Intragastric pH in gastric ulcer patients without treatment was higher (median 3.4, range 1.0–6.9) than in duodenal ulcer patients with treatment. Both H2antagonists raised intragastric pH in patients with gastric ulcer and maintained a gastric pH of>4.0 for at least 50% of the time. Presently recommended i.v. doses of cimetidine and ranitidine do not consistently maintain gastric pH above 4.0 for long periods in patients with peptic ulc

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00602.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYEighteen patients with duodenal, gastric or jejunal ulcers, resistant to at least 3 months treatment with histamine H2‐receptor antagonists, singly or in combination with other anti‐ulcer drugs, were treated with 40 mg omeprazole once daily for up to 8 weeks. All ulcers healed, the majority within two weeks. After ulcer healing patients were given maintenance therapy with high doses of cimetidine or ranitidine. Of 15 patients on maintenance therapy with H2‐receptor antagonists, 12 (80%) developed a relapse after a period ranging from 3 to 52 weeks. Two patients were lost to follow‐up. After re‐healing on 40 mg omeprazole, two patients were given 20 mg omeprazole daily as maintenance therapy but relapses occurred again after 14 and 26 weeks respectively. After re‐healing on 40 mg omeprazole, these two patients and one additional patient received maintenance therapy with 40 mg omeprazole daily. At present these three patients have been relapse‐free for periods varying from 16 to 52 weeks. No side effects were registered during treatment with omeprazole. It is therefore concluded that omeprazole is highly effective in healing refractory peptic ulcers and that omeprazole maintenance therapy may be useful for preventi

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00603.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYEight patients with active uncomplicated Crohn's disease, who were resistant to or intolerant of conventional treatment, were treated for 6 weeks with oral cyclosporin (mean dose 8.2 mg kg−1day−1). Seven of the eight patients responded to treatment with cyclosporin by symptomatic improvement, weight gain and a return of serum C‐reactive protein concentration towards normal. All patients relapsed on stopping cyclosporin. No serious side‐effects were encountered. This favourable early experience justifies further trials using cyclosporin for active Crohn's

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00604.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYPlasma samples of seven patients with gut and pancreatic endocrine tumours who have been on long‐term treatment with a long‐acting somatostatin analogue (SMS 201‐995) were investigated for endogenous antibodies to the peptide by incubation with radiolabelled SMS 201–995. The duration of treatment with the somatostatin analogue was between 9 and 26 months and the dose from 100 to 300μg day−1. In none of the patients could antibodies to SMS be detected. The effect of this somatostatin analogue is unlikely to be impaired by formation of endogenous antibodies, even after long‐te

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00605.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYThe acetyl moiety in aspirin (acetyl salicylic acid: ASA) is considered to play a major part in the pathogenesis of ASA‐induced mucosal injury. At equivalent salicylate doses and pH values, the induction of acute gastric mucosal haemorrhagic erosions in rats by ASA and choline magnesium trisalicylate (CMT), a new non‐acetylated salicylate, with and without the potentiating damaging effect of taurodeoxycholic acid (TDCA) were compared. Test solutions were administered byper oralintubation to five groups of fasting Sprague–Dawley rats (n= 24). Gastric mucosa were examined after 4 hours and mucosal injury assessed by a lesion‐scoring system. The incidence and severity (median lesion scores with quartiles) of the lesions were 83% and 13 (7:20) respectively for ASA (128 mg kg−1) compared with 17% and 0 (0:0) for CMT (128 mg kg−1) (P<0.001 andP<0.001). TDCA increased mucosal damage to 100% and 29 (20:34) for ASA compared with 30% and 0 (0:4) for CMT (P<0.001) and P<0.001). Serum salicylate levels (median values of 1.4 for ASA and 1.5 mmol litre−1for CMT) were not significantly different. It is concluded that replacing the acetyl moiety in ASA with choline and magnesium moieties reduces the ASA‐induced mucosal injury, without affecting blood salicylate

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00606.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYPlasma concentrations of cimetidine and ranitidine were measured after oral administration (n= 5 for cimetidine,n= 5 for ranitidine) or intravenous administration (n= 6 for cimetidine,n= 4 for ranitidine) in habitual smokers, once when cigarettes were smoked and again on a separate day when cigarettes were prohibited. After oral administration plasma concentrations of both drugs rose more rapidly and peak plasma concentrations were achieved earlier when cigarettes were smoked. However, plasma concentrations of the drugs subsequent to the peak were significantly lower when cigarettes were smoked. Cigarette smoking had no effect on plasma blood concentrations of either drug when administered intravenously. In eight healthy smokers cigarette smoking increased the gastric emptying of a liquid test meal by 28% compared with non‐smoking control rates. In habitual smokers cigarette smoking alters the blood concentrations of antisecretory drugs in a manner which appears attributable to an increase in the rate of gastric emptying. The observed changes in drug disposition may contribute to the loss of gastric secretory inhibition observed in duodenal ulcer patients who are smoker

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00607.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYIn a randomized double‐blind study, two groups of eight healthy volunteers received either placebo or omeprazole 40 mg o.m. for 14 days. Fasting plasma gastrin concentration and peak acid output in response to a maximal intravenous dose of pentagastrin were measured before, during and after the 14 days of treatment. Omeprazole caused a 68% (mean) decrease in the peak acid output when measured 24 hours after the last dose, with a simultaneous increase in the fasting plasma gastrin concentration. When measured 1, 2, 3 and 8 weeks after cessation of treatment, there was no significant difference in the peak acid output between the two groups. The study demonstrates that there is no increase in the acid production capacity after 2 weeks of treatment with omeprazole. Thus it would appear that the rise in the plasma gastrin concentration during short‐term treatment with omeprazole does not induce parietal cell hypertrophy or hyperpla

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00608.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SUMMARYPrepyloric and duodenal ulcers have some common characteristics: gastric acid secretion is increased and there is an association with blood group O. Many, therefore, have considered prepyloric ulcers to be a variety of duodenal ulcer disease. From an anatomical point of view, however, prepyloric ulcers are clearly gastric ulcers. After proximal selective vagotomy, the recurrence rate is very high, amounting to more than 30% in 5 years; this is significantly higher than the rate for duodenal ulcers. Better results are obtained in prepyloric ulcers, if vagotomy is combined with a drainage procedure. In recent years, some evidence, primarily from Scandinavia, has accumulated indicating that prepyloric ulcers are more resistant to treatment with histamine H2‐receptor antagonists than duodenal ulcers or ulcers located in other parts of the stomach. In addition, the recurrence rate is particularly high in prepyloric ulcers. One must, however, consider that not only have all of these studies included relatively small numbers of patients, but also the prepyloric ulcer healing rates in other studies were similar to those observed for both duodenal ulcers and ulcers located elsewhere in the stomach. Prospective studies with large numbers of patients are, therefore, necessary before a clear‐cut conclusion can be reached.There are several reasons why prepyloric ulcers could be more resistant to treatment. Impaired gastric emptying, duodeno‐gastric reflex or choric gastritis, especially in conjunction withCampylobacter pyloriinfection, must be considered. At present one can only speculate on the validity of any of these hypot

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1987.tb00653.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY