Showing papers in "Scandinavian Journal of Gastroenterology in 1988"
TL;DR: The higher healing rate for omeprazole was also accompanied by a significantly faster and more substantial improvement in reflux symptoms, and there were no adverse events or clinically significant changes in the laboratory values attributable to the trial medication.
Abstract: One hundred and fifty-two patients with endoscopically verified erosive and/or ulcerative esophagitis entered a double-blind, randomized study comparing 20 mg omeprazole given once daily and ranitidine 150 mg twice daily. The efficacy and safety of 4 to 8 weeks' treatment were studied. Macroscopic healing of esophagitis was defined as complete epithelialization of all esophageal erosive and/or ulcerative lesions. One hundred and forty-four patients completed the first 4 weeks of treatment in accordance with the protocol. The healing rate was 67% in the omeprazole group and 31% in the ranitidine group (p less than 0.0001). The corresponding figures after 8 weeks' treatment were 85% and 50%, respectively (p less than 0.0001). The higher healing rate for omeprazole was also accompanied by a significantly faster and more substantial improvement in reflux symptoms. In the patient's own overall evaluation of symptoms, these had resolved in 51% of the omeprazole-treated patients already at the end of the 1st week of treatment, compared with 27% of those given ranitidine (p = 0.009). Both omeprazole and ranitidine were well tolerated, and there were no adverse events or clinically significant changes in the laboratory values attributable to the trial medication.
274 citations
TL;DR: The morphological features of campylobacter-associated gastritis represent the immune response of the mucosa to C. pylori, and they are concluded that the inflammation gradually abates following eradication of the bacteria.
Abstract: The histological features of non-autoimmune chronic gastritis are consistent with those of a local immune response by the gastric mucosa. If Campylobacter pylori is causative in this condition, then the immune response will be in part specific for this organism. Antibodies to C. pylori are present in the gastric juice of infected patients. Coating of mucosal C. pylori by antibody in vivo can be demonstrated by immunohistochemistry, and a neutrophil infiltrate (active gastritis) is associated with coating by opsonising antibodies. Gastric mucosa from patients with C. pylori produces specific immunoglobulin in vitro, and this antibody production correlates with the plasma cell infiltrate seen in these patients. Lymphoid follicles in gastric mucosa, implying local antigenic stimulation, are a specific feature of campylobacter-associated gastritis. The inflammation gradually abates following eradication of the bacteria. We conclude that the morphological features of campylobacter-associated gastritis represen...
245 citations
TL;DR: The results support the view that adiposity is associated with both sliding pause hernia and reflux oesophagitis and that hiatus hernia plays a role in the development of refluxOesophageal reflux.
Abstract: In a prospective study in 1224 patients referred for upper alimentary endoscopy, reflux oesophagitis was found in 195 (16%) of the patients and hiatus hernia in 249 (20%). In patients with reflux oesophagitis a coexisting hiatus hernia was found in 68%. The weight-for-height index (W/H1.8), which expresses the degree of overweight, was significantly higher both in patients with hiatus hernia and in the patients with reflux oesophagitis, indicating an overweight of approximately 5% in both groups. The overweight was most pronounced in oesophagitis grades 1 and 2, whereas in patients with severe oesophagitis (grade 3) body weight was normal, possibly owing to weight loss caused by dysphagia and excessive regurgitation. The results support the view that adiposity is associated with both sliding hiatus hernia and reflux oesophagitis and that hiatus hernia plays a role in the development of reflux oesophagitis.
178 citations
TL;DR: A seven-day procedure including marker intake for 6 days and a single radiograph on day 7 was found to be a simple method to differentiate between rapid, normal and prolonged transit, and seems convenient for clinical use in diagnostic as well as therapeutic studies of colonic transit.
Abstract: Gastrointestinal transit time (GITT) and segmental colonic transit times were studied in 56 healthy subjects by repeated daily ingestion of 10 radiopaque markers followed by abdominal x-ray. A seven-day procedure including marker intake for 6 days and a single radiograph on day 7 was found to be a simple method to differentiate between rapid, normal and prolonged transit. Addition of 20 distinguishable markers on day 6 helped to describe transit profiles. Healthy women had longer GITT than men (median 2.4 and 1.9 days, respectively) measured as mean 50% excretion time for the ingested doses of markers. For comparisons with patients percentiles for transit were calculated. In constipated patients the 7-day method demonstrated prolonged GITT as well as transit dysfunction in separate colonic segments. The method seems convenient for clinical use in diagnostic as well as therapeutic studies of colonic transit.
168 citations
TL;DR: Observations clearly demonstrate pathological alterations which in the cellular level induced by Cp with the result of a disrupted mucosal barrier of the stomach and the duodenum.
Abstract: There is now substantial evidence that Campylobacter pylori (Cp) is able to colonize the gastroduodenal mucosa and is responsible for active chronic gastritis, its role in duodenitis, gastric ulceration and duodenal ulceration is still under debate. Cp has a lot of characteristics which are prerequisites for a pathogen: the typical S-shape, the corkscrew-like movement and the powerful urease and protease enzymes. These features allow a rapid movement through the mucous layer to permit access to the apical membranes of the surface mucous cells. There they adhere directly to the membranes and induce several ultrastructural alterations: degeneration of microvilli, depletion of mucous granules and an increase in sialic-acid rich glycoproteins in the apical part of the cytoplasma. Cp weakens the tight-junction complex and is found between the cells and sometimes intracellularly. Cp is phagocytized by invading polymorphonuclear leukocytes and causes an intense inflammatory response. These observations clearly d...
147 citations
TL;DR: No strong evidence of a therapeutic effect of smoking after ulcerative colitis onset on this illness's clinical course is found, but smoking before disease onset may affect the clinical severity of this illness.
Abstract: We assessed the effect of smoking on the clinical course of ulcerative colitis in 209 subjects by comparing disease severity in smokers and non-smokers as measured by yearly number of hospitalizations for ulcerative colitis treatment and the need for a colectomy. Hospitalization for ulcerative colitis treatment occurred less frequently in persons who smoked after disease onset, but the colectomy rate in persons who smoked after disease onset and non-smokers was similar. Both hospitalization and colectomy for treatment of ulcerative colitis occurred more frequently among smokers who quit before disease onset. Furthermore, hospitalization and colectomy occurred most frequently in the heaviest smokers who quit before disease onset. We found no strong evidence of a therapeutic effect of smoking after ulcerative colitis onset on this illness's clinical course, but smoking before disease onset may affect the clinical severity of this illness.
144 citations
TL;DR: To study the impact of starch malabsorption on fecal short-chain fatty acid concentrations, 11 healthy volunteers consumed a controlled diet rich in starch for 2 4-week periods and received the glucosidase inhibitors acarbose and placebo.
Abstract: To study the impact of starch malabsorption on fecal short-chain fatty acid concentrations, 11 healthy volunteers consumed a controlled diet rich in starch for 24-week periods. They received the glucosidase inhibitor acarbose (Bay g 5421) in one of the study periods and placebo in the other. Stool wet weight increased by 68% and stool dry weight by 57% with acarbose. The fecal concentration (umol/g wet weight) of n-butyrate (+58%) rose significantly when acarbose was added to the diet. The fecal excretion (mmol/day) of total short-chain fatty acids (+95%) and of their constituents acetate (+97%) and n-butyrate (+182%) was significantly higher when starch malabsorption was induced by acarbose.
135 citations
TL;DR: This study indicates that a part of the intestinal SCFA may originate from polypeptides, which apparently are the major source of those SCFA only found in small amounts in the healthy colon.
Abstract: Rasmussen HS, Holtug K, Mortensen PB. Degradation of amino acids to short-chain fatty acids in humans. An in vitro study. Scand J Gastroenterol 1988, 23, 178–182Short-chain fatty acids (SCFA) originate mainly in the colon through bacterial fermentation of polysaccharides. To test the hypothesis that SCFA may originate from polypeptides as well, the production of these acids from albumin and specific amino acids was examined in a faecal incubation system. Albumin was converted to all CZCS-fatty acids, whereas amino acids generally were converted to specific SCFA, most often through the combination of a deamination and decarboxylation of the amino acids, although more complex processes also took place. This study indicates that a part of the intestinal SCFA may originate from polypeptides, which apparently are the major source of those SCFA (isobutyrate, valerate, and isovalerate) only found in small amounts in the healthy colon. Moreover, gastrointestinal disease resulting in increased proteinous material ...
122 citations
Journal Article•
TL;DR: Histopathologic findings, number of previous operations, and symptomatic status prior to operation did not appear to affect the subsequent risk of recurrence, but the margin of clearance at operation appeared to affect further recurrence.
Abstract: The prospect of recurrence following surgery for Crohn's disease (CD) poses an important and difficult problem in routine clinical practice. Out of the 1247 CD patients registered in the OMGE multinational inflammatory bowel disease survey, a high proportion came to surgery. A detailed study has been undertaken of 154 patients (77 who did recur matched with 77 who did not recur) who had undergone surgery for CD. An assessment was made which established a 'risk factor' (RF) for each item of patient information. Findings indicated the risk of recurrence to be higher in patients under 20 years both at onset of disease (RF, 2.2:1) and at time of their operation (RF, 2.7:1) and in patients with distal colonic Crohn's disease (RF, 1.8:1). Histopathologic findings, number of previous operations, and symptomatic status prior to operation did not appear to affect the subsequent risk of recurrence. The margin of clearance at operation appeared to affect further recurrence. Amongst patients with 10cm or more margin of clearance (i.e. histopathologically normal bowel) only 21% recurred during follow-up, versus 50% in those with a smaller margin of clearance.
116 citations
TL;DR: The gut may be a reservoir or source of bacterial peptides that could promote an inflammatory response should they cross the 'mucosal barrier', and pronase-sensitive bioactive factors have been demonstrated in human rectal dialysates from normal subjects and patients with Crohn's disease.
Abstract: Chadwick VS, Mellor DM, Myers DB, Selden AC, Keshavarzian A, Broom MF, Hobson CH. Production of peptides inducing chemotaxis and lysosomal enzyme release in human neutrophils by intestinal bacteria in vitro and vivo.Low molecular weight (MI 200-1500) N-formylated peptides that stimulate many leucocyte functions, including chemotaxis and lysosomal enzyme release, have previously been isolated from Escherichia coli cultures. We have used high-performance liquid chromatography and bioassay techniques to study production of such peptides by intestinal bacteria in vitro and their activity in intestinal luminal contents, obtained by in vivo dialysis methods. Bioactivity was detected in culture supernatants of all 11 species of bacteria so far investigated, was resistant to digestion with amino-peptidase, but was destroyed by carboxypeptidase, confirming that bioactive moieties were amino-terminal-blocked peptides. By similar isolation procedures, pronase-sensitive bioactive factors have been demonstrated in hum...
116 citations
TL;DR: The results indicate that the examination of a fairly small number of specimens from the main body of the stomach may be sufficient for assessing the frequency of endocrine cells in the oxyntic mucosa of individual patients.
Abstract: The oxyntic mucosa of the human stomach harbors at least five different endocrine cell types (ECL cells, A-like or X cells, somatostatin cells (D), enterochromaffin (EC) cells, and D1 or P cells). Little is known about their functional roles, and of the hormones they produce only somatostatin has been identified. The relative frequency and regional distribution of the different endocrine cell populations were studied in 13 adults with no manifest gastrointestinal disease. From each of them at least three biopsy specimens were taken at seven fixed locations within the oxyntic mucosa. The specimens were examined for the different endocrine cell types by means of immunocytochemistry (staining with antisera against chromogranin A, 5-hydroxytryptamine, and somatostatin) and silver staining techniques (demonstration of argyrophil cells by the methods of Grimelius or Sevier-Munger). Chromogranin-positive cells included all endocrine cells identified by the other staining techniques. Grimelius-positive cells incl...
TL;DR: The results suggest that the degenerative changes produced in gastric mucus gel by C. pylori may be a contributing factor in the pathogenesis of gastritis and peptic ulcer.
Abstract: The role of Campylobacter pylori in weakening the mucus component of the gastric mucosal barrier was investigated. The extracellular material elaborated by C. pylori, cultured from antral mucosal biopsy specimens of patients undergoing gastroscopy, caused a rapid degradation of mucus glycoprotein polymer to glycopeptides comparable in size to those produced by the action of pepsin. Viscosity measurements showed that incubation of C. pylori filtrate with gastric mucus led to a gradual loss in mucus viscosity, which at the end of 48 h decreased by 36%. The C. pylori filtrate also had a detrimental effect on the ability of mucus to retard the diffusion of H+. After 12 h of incubation the permeability of mucus to H+ increased by 10%, whereas a 32% increase in permeability was observed after 48 h. The results suggest that the degenerative changes produced in gastric mucus gel by C. pylori may be a contributing factor in the pathogenesis of gastritis and peptic ulcer.
TL;DR: This review summarizes the historical contradictions and inconsistencies that form the labile arguments advocating neutralization or inhibition of secretion of gastric acid for the prevention or treatment of gastroduodenal ulcers and suggests additional pharmacologic targets toward which new gastroprotective drugs can be directed.
Abstract: This review summarizes the historical contradictions and inconsistencies that form the labile arguments advocating neutralization or inhibition of secretion of gastric acid for the prevention or treatment of gastroduodenal ulcers. Re-evaluation of old concepts is needed in the wake of recognition that even the most potent antisecretory agents do not change the natural history of ulcer disease; that is, the recurrence is high after termination of treatment. New biochemical, functional, and structural targets are listed for pharmacologic intervention in ulcer disease. As a supplement or alternative to the antisecretory agents, we should now consider prosecretory agents (for example, for bicarbonate and mucus secretion) and antioxidants (for example, free radical scavengers). Gastroduodenal motility, smooth muscle, the vascular endothelial cell, and the basement membrane seem to represent additional pharmacologic targets toward which new gastroprotective drugs can be directed even though the biochemical mech...
TL;DR: The abnormal flora may be indigenous to subjects predisposed to Crohn's disease, suggesting a direct or indirect relationship between the abnormal faecal flora and Crohn’s disease.
Abstract: The obligate anaerobic faecal floras of patients with Crohn's disease, their first-degree relatives, and healthy control subjects were compared. The flora of Crohn's patients contained more anaerobic gram-positive coccoid rods and gram-negative rods than that of healthy subjects; on this basis patients and healthy subjects formed two clusters with minor overlap. Nine of 26 children of Crohn's patients were also included within the Crohn's disease cluster. During 5 to 7 years of follow-up study 3 of them presented with remitting abdominal pain, diarrhoea, or weight loss, and in 1 of them Crohn's disease was diagnosed; none of the 17 children with a normal flora showed symptoms possibly due to Crohn's disease. It is concluded that the abnormal flora may be indigenous to subjects predisposed to Crohn's disease, suggesting a direct or indirect relationship between the abnormal faecal flora and Crohn's disease.
TL;DR: Cimetidine was found to be more effective than both placebo and antacid in relieving pain and nausea but not bloating and with regard to the number of patients who improved in general well-being.
Abstract: Patients with dyspepsia of unknown origin were randomly allocated to a controlled double-blind study to examine the symptomatic effect of cimetidine and antacid especially on the relief of pain, nausea, and bloating. Two hundred and twenty-two patients with no previous history of peptic ulcer disease and no evidence of other organic causes of dyspepsia were treated for 6 weeks with placebo, cimetidine, or antacid. The results showed that cimetidine was superior to both placebo and antacid in relieving pain and nausea but not bloating. Certain background factors, such as epigastric pain and symptoms relieved by solid food, had a significant positive influence on the outcome of treatment. When the impact of background factors was taken into account, cimetidine was found to be more effective than both placebo and antacid also with regard to the number of patients who improved in general well-being.
TL;DR: An epidemiologic study of coeliac disease in a geographically defined area of Sweden showed that the prevalence was 95.5/10(5) inhabitants aged 15 years or more and an especially high incidence of associated thyroid disease was observed.
Abstract: An epidemiologic study of coeliac disease in a geographically defined area of Sweden showed that the prevalence was 95.5/105 inhabitants aged 15 years or more. The highest prevalence, 178/105 inhabitants, was found in the age group 65–74 years. The lowest prevalence, 39/105 inhabitants, was found in patients aged 15–24 years. Among the associated diseases an especially high incidence of associated thyroid disease was observed: thyrotoxicosis occurred in 5.0% and hypothyroidism in 5.8% of the patients.
TL;DR: The results indicate that the chemical nature of the meal and not the volume per se is a significant factor determining postprandial mesenteric hyperaemia.
Abstract: Transcutaneous Doppler ultrasound was used to measure superior mesenteric artery blood flow in 12 healthy volunteers in the fasting state and serially for 1 h after the ingestion of isocaloric and isovolaemic carbohydrate, fat, and protein liquid meals. The superior mesenteric artery blood flow increased significantly within 5 min of the end of each meal. The maximal responses were not significantly different but were reached at different times: carbohydrate, 64% at 15 min; fat, 60% at 30 min; and protein, 57% at 45 min. The response to the fat meal was significantly slower than the response to the carbohydrate, and the response to protein was slowest of all. In a further group of 20 fasted normal subjects no significant change in superior mesenteric artery blood flow occurred after drinking 400 ml of distilled water at room temperature. In seven of these subjects, drinking 400 ml of distilled water at 4°C also did not affect mesenteric blood flow. These results indicate that the chemical nature of the me...
TL;DR: At the present state the combination of bismuth salts and antibiotics has achieved the highest eradication rates of Cp and thus lowest relapse rates of DU, and Antibiotics seem to be an indispensable factor in the antimicrobial treatment of C p associated diseases.
Abstract: Since the recognition and first culture of Campylobacter pylori (Cp) the hypothesis of a pathogenic role has been strengthened by numerous investigations. Its close association with active chronic gastritis and even active duodenitis, and the disappearance of these pathologic conditions with antimicrobial treatment suggest a pathogenic role for Cp in active chronic gastritis. The close association of antral gastritis with duodenal ulcer (DU) suggests that Cp associated active chronic gastritis may be an important precondition for the development of DU. Therapy studies so far using either bismuth, antibiotics, or a combination of both could demonstrate that the healing of DU ulcer was closely related to the clearance of Cp and healing of gastritis. Relapse of DU was closely associated with reappearance of Cp and active chronic gastritis. At the present state the combination of bismuth salts and antibiotics has achieved the highest eradication rates of Cp and thus lowest relapse rates of DU. Antibiotics therefore seem to be an indispensable factor in the antimicrobial treatment of Cp associated diseases.
TL;DR: An ELISA system, using an acid extractable cell surface C. pylori antigen, has been used to detect anti-C.
Abstract: An ELISA system, using an acid extractable cell surface C. pylori antigen, has been used to detect anti-C. pylori antibodies in 176 endoscoped patients. The antibody concentration was related to histological diagnosis and colonisation with Campylobacter-like organisms. The criteria for sero-positivity was determined from the median antibody concentration in a group of 368 non-endoscoped control patients. The specificity and sensitivity of the sero-diagnostic assay for histological gastritis in antral biopsies was 83.0% and 95.6% respectively. The positive (79.3%) and negative predictive values (94.3%) indicate that such a sero-diagnostic assay could be used to screen patients prior to endoscopy.
TL;DR: Several experimental models of hetero-species or -topic recombinants between epithelial and mesenchymal anlagen are described to elucidate the respective roles of these tissue components in morphogenesis, epithelial differentiation, and hormone-elicited responses.
Abstract: The complex morphogenetic events and the concomitant structural and functional differentiation of intestinal progenitor cells are dependent on tissue interactions. Several experimental models of hetero-species or -topic recombinants between epithelial and mesenchymal anlagen are described. They enabled us to elucidate the respective roles of these tissue components in morphogenesis, epithelial differentiation, and hormone-elicited responses. Among the mechanisms of tissue interactions, the possible mediation of permissive and instructive information via the extracellular matrix is postulated. Arguments in favor of this are provided by the observation of compositional changes in matrix molecules during intestinal development and differentiation. On the other hand, in vitro experimental data emphasize the role of actual contacts between epithelial and mesenchymal cell populations and the importance of the mesenchyme for basement membrane formation.
TL;DR: Bacterial overgrowth was demonstrated in three diabetic subjects and motility abnormalities are nonspecific and are unlikely to play a major role in the pathogenesis of diabetic diarrhea.
Abstract: Diarrhea is a common symptom in long-standing diabetes. The pathogenesis of this diarrhea remains obscure, although it appears to be related to the development of autonomic neuropathy, which may cause several abnormalities including altered gut motility. We studied fasting gastrointestinal motility for a mean of 210 min in a group of 12 type-II diabetics with diarrhea. All patients had peripheral neuropathy and symptoms of autonomic neuropathy. Their motor activity was compared with that of a group of six normal volunteers. In addition, gastrointestinal transit time was assessed by the hydrogen breath test. The presence of bacterial overgrowth was assessed by the hydrogen breath test and culture of jejunal secretions. The diabetics showed grossly disordered motor activity. There was a complete absence of phase-III activity in two patients. Most phase III's commenced in the distal duodenum or jejunum. The phase-III component was often of short duration at each recording site. There was increased velocity of propagation between sites. Continuous phase-II activity was noted in some patients. Antral activity was absent or reduced during phase II. Gastrointestinal transit time was significantly prolonged in the diabetics. Bacterial overgrowth was demonstrated in three diabetic subjects. These motility abnormalities are nonspecific and are unlikely to play a major role in the pathogenesis of diabetic diarrhea.
TL;DR: A significantly larger proportion of the ingested 5-ASA was excreted in faeces after intake of azo compounds as compared with slow-release compounds, indicating fast absorption proximally in the intestine and little availability to the colon.
Abstract: Time-related urinary excretion and faecal excretion of 5-ASA and acetyl-5-ASA were measured in eight healthy volunteers after a single oral dose of the azo compounds sulphasalazine and olsalazine, the slow release compounds Pentasa, Asacol and Salofalk, and plain 5-ASA. After ingestion of both azo compounds and slow-release compounds, urinary excretion of 5-ASA was markedly delayed and reduced, and faecal excretion was enhanced. At all points of time, there was a significant, but not very marked difference in urinary excretion of 5-ASA after ingestion of the azo compounds and the slow-release compounds, in favour of the azo compounds. A significantly larger proportion of the ingested 5-ASA, moreover, was excreted in faeces after the intake of azo compounds as compared with slow-release compounds.
TL;DR: The possibility that the extracellular matrix helps maintain normal parenchymal cell function and that alteration of the matrix underlies the loss of hepatocellular function that occurs in acute inflammation is considered.
Abstract: Sustained expression of liver-specific function by hepatocytes in culture requires a basement membrane-like matrix as the culture substratum. Individual components of the matrix cannot substitute for the complex. The implications of these findings for the intact liver include the possibility that the extracellular matrix helps maintain normal parenchymal cell function and that alteration of the matrix underlies the loss of hepatocellular function that occurs in acute inflammation. Moreover, the low level of DNA synthesis by hepatocytes on the complex substratum, in contrast to that of cells cultured on collagen, suggests that extracellular matrix also modulates hepatocyte proliferation.
TL;DR: Resectable mesenteric lymph node metastases did not affect the 5-year survival of patients with small-bowel carcinoids as compared with the tumours confined to the bowel wall.
Abstract: Clinical data about 104 patients with gastrointestinal carcinoids emphasized the heterogeneous nature of these tumours in different organs. The sites of the primary tumours were the stomach in 12 (11%), the duodenum in 3 (3%), the small bowel in 48 (45%), the appendix in 28 (26%), the colon in 6 (6%), and the rectum in 6 cases (6%). Gastric carcinoids were multiple in 4 (33%) and small-bowel carcinoids in 11 cases (23%). None of the gastric, duodenal, or rectal carcinoids had generated metastases, as contrasted to 34 (72%) small-bowel carcinoids. Twelve patients had symptoms of the carcinoid syndrome caused by hepatic metastases from ileal (11) or appendiceal (1) primary tumours. At least two patients with duodenal carcinoids had Zollinger-Ellison syndrome produced by the tumours. The cumulative 5-year survival rate was 91–100% for gastric, appendiceal, and rectal carcinoids, 77% for small-bowel carcinoids, and 33% ror colonic carcinoids. Resectable mesenteric lymph node metastases did not affect the 5-ye...
Journal Article•
TL;DR: The risk to life rose steeply after the age of 50, possibly reflecting low rates of diagnostic accuracy, and the clinical presentation of appendicitis was quite different in those over 50.
Abstract: This study aimed to discover whether the disease spectrum in elderly patients (50 years and over) differed from that in other ages, and to compare patient presentation, progress and outcome between different age groups. In all, a total of 2406 patients from the OMGE series who were aged 50 and over were studied. Cholecystitis was the commonest disease category, commoner even than NSAP and appendicitis. Obstruction was more than three times as common in the elderly patients. One in four obstruction cases eventually proved to be due to an undiagnosed hernia. Cancer rates rose to 24% in patients over 70; whilst vascular causes accounted for 2.3% of patients over 50. As regards outcome, the risk to life rose steeply after the age of 50, possibly reflecting low rates of diagnostic accuracy. The clinical presentation of appendicitis was quite different in those over 50. Patients over 50 years with acute abdominal pain should be viewed differently from other younger patients, with special care being taken to look for hernia, cancer, and vascular disease. Educational material should also be reviewed to reflect the different features of the elderly patient. It is clear that further data on elderly patients are urgently required.
TL;DR: The incidence of ulcerative colitis in the three counties that compose Western Norway was registered in a prospective study during the years 1984 and 1985, giving a mean annual incidence of 14.8 per 100,000 patients.
Abstract: The incidence of ulcerative colitis (UC) in the three counties that compose Western Norway was registered in a prospective study during the years 1984 and 1985. Both inpatients and outpatients were included. Five hundred and fifty general practitioners and 12 hospitals participated in the study. A total of 239 patients were diagnosed in this area with 807,000 inhibitants, giving a mean annual incidence of 14.8 per 100,000. For patients between 30 and 35 years of age the age-specific incidence rate was 31.2. The M/F sex ratio was 1.10. Familial occurrence of inflammatory bowel disease was found in 11% of the patients. Patients with rectal involvement only constituted 35% of the patients.
TL;DR: The present study supports the existence of a subgroup of cimetidine responders among patients with NUD characterized by symptoms suggestive of gastroesophageal reflux disease in the absence of confirmatory objective evidence.
Abstract: The effect of cimetidine and placebo was examined in 123 patients with non-ulcer dyspepsia (NUD) by means of a 12-day multi-crossover model with 5 regular interchanges between cimetidine and placebo. The evaluation of effect in individual patients was based on the number of times cimetidine was associated with less symptoms than the preceding or following placebo period. If cimetidine had no effect, the probability of being defined as a cimetidine responder was 25%. In general, cimetidine was associated with less symptoms than placebo (p < 0.0001). Forty patients were identified as cimetidine responders (R) and the remaining patients were termed non-responders (NR). Symptoms compatible with gastroesophageal reflux were significantly more frequent in R than in NR, whereas the opposite was true for symptoms of the irritable colon syndrome. The ability of symptoms selected by stepwise logistic regression to predict response to cimetidine showed at best a sensitivity of 75% and a specificity of about 65%. No ...
TL;DR: Fasting gastrin concentrations were moderately increased in the beginning and normalized at the end of each 24-h period during treatment with daily doses of 20-80 mg omeprazole, with a relationship between degree of acid inhibition and fasting gastrin concentration observed.
Abstract: We have studied the relationship between reduction of gastric acid secretion and fasting plasma gastrin concentrations during once daily omeprazole treatment. Healthy subjects were given omeprazole for 5 days in daily doses of 5, 10, 20, 40, or 80 mg. Acid secretion and fasting gastrin concentration were measured 6 h (maximal omeprazole effect) and 24 h (minimal omeprazole effect) after the fifth omeprazole dose. Omeprazole in doses lower than 20 mg daily did not suppress pentagastrin-stimulated acid secretion in all subjects 6 h after dosing on the 5th day. Doses of 20–80 mg omeprazole, however, significantly reduced acid secretion 24 h after the fifth dose, the range being 36–76%. A relationship between degree of acid inhibition and fasting gastrin concentration was observed. However, acid secretion needed to be reduced by more than 80% before gastrin levels were clearly affected. This degree of acid inhibition was only achieved 6 h after administration of omeprazole in doses of 20 mg and higher. The in...
TL;DR: The data suggest that in 3-h and 12-h cerulein-induced pancreatitis the oxygen-derived free radicals mediate the increased lipid peroxidation in pancreatic tissue and the depletion of the scavenger enzyme SOD may be responsible for such a disturbance of lipid metabolism.
Abstract: Conscious rats were treated with a supramaximal dose of 5.10(-6)g.kg-1.h-1 of cerulein for periods of 3 and 12 h. In both groups of animals typical features of acute oedematous pancreatitis were proved by biochemical and histologic examinations. The most important finding of our study was the decrease of superoxide dismutase (SOD) activity in pancreatic tissue, accompanied by a slight increase of this scavenger enzyme in serum of rats stimulated with cerulein during 3 h. Parallelly, evident elevation of malondialdehyde (MDA) concentration in pancreatic tissue was noted. After the 12-h infusion of cerulein we were not able to detect any SOD activity in pancreatic tissue, whereas this activity appeared in ascitic fluid of tested animals. Further increase of MDA concentration in pancreatic tissue, in comparison with 3-h pancreatitis, was found. These data suggest that in 3-h and 12-h cerulein-induced pancreatitis the oxygen-derived free radicals mediate the increased lipid peroxidation in pancreatic tissue. We think that the depletion of the scavenger enzyme SOD may be responsible for such a disturbance of lipid metabolism.
TL;DR: In this article, it was shown that increased catalytic activities of this enzyme as well as above-normal concentrations of immunoreactive phospholipase A2 have been detected in sera of patients suffering from acute pancreatitis.
Abstract: Acute pancreatitis is an autodigestive disease, in which digestive enzymes produced by the pancreas destroy the gland. Opie and Meakins [29] proposed that it is trypsin that causes the tissue injury. However, it seems more probable that phospholipase A2 might be the enzyme responsible for autodigestion in acute pancreatitis [26]. Accordingly, increased catalytic activities of this enzyme [33] as well as above-normal concentrations of immunoreactive phospholipase A2 [27] have been detected in sera of patients suffering from acute pancreatitis.