1,721,518 research outputs found
Meta-analysis: remission and response from control arms of randomized trials of biological therapies for active luminal Crohn's disease.
No full text1. Aliment Pharmacol Ther. 2008 Jun;27(12):1210-23. Epub 2008 Mar 14.
Meta-analysis: remission and response from control arms of randomized trials of
biological therapies for active luminal Crohn's disease.
Tinè F, Rossi F, Sferrazza A, Orlando A, Mocciaro F, Scimeca D, Olivo M, Cottone
M.
Divisione di Gastroenterologia, Azienda Ospedaliera V. Cervello, Palermo, Italy.
[email protected]
BACKGROUND: Remission and response are the main outcomes to evaluate the efficacy
of new treatments for Crohn's disease (CD).
AIM: To explain variation of remission and response rates in active luminal CD.
METHODS: We studied control patients from trials of biological therapies through
articles retrieved by MEDLINE search (from 1997 to 2007) and by bibliography
review. Thousand nine hundred and thirteen control patients from 28 trials were
identified; data were extracted by three independent observers and pooled by
DerSimonian and Laird random effect model; factors influencing remission and
clinical response were explored by metaregression for aggregated data.
RESULTS: The pooled control rates of remission and response were 17% and 33%,
respectively, both with significant heterogeneity among studies (P < 0.0001). At
metaregression, the time of primary outcome evaluation was associated with
remission, whereas the trial's criteria for defining response and publication
year were predictors of response. CDAI score, CRP levels or other clinical
variables related with disease activity or concomitant medications were not
significant factors.
CONCLUSIONS: Populations used as 'add-on' treatment comparator in trials of
biological therapies for active luminal CD are poorly characterized and outcomes
are heterogeneous. Planning of future trials will require better description of
patients and concomitant therapies, blinding of outcome assessors and homogeneous
criteria of outcome definition
Comparison of omeprazole, metronidazole and clarithromycin with omeprazole/amoxicillin dual-therapy for the cure of Helicobacter pylori infection
Get PDFIn this randomized, multicenter trial, we evaluated the effectiveness and side effect profile of a modified omeprazole-based triple therapy to cure Helicobacter pylori infection. The control group consisted of patients treated with standard dual therapy comprising omeprazole and amoxicillin. One hundred and fifty-seven H. pylori infected patients with duodenal ulcers were randomly assigned to receive either a combination of omeprazole 10 mg, clarithromycin 250 mg and metronidazole 400 mg (OCM) given three times daily for 10 days (n = 81),or a combination of omeprazole 20 mg and amoxicillin 1 g (OA) given twice daily for 14 days (n = 76). Prior to treatment and after 2 and 6 weeks, gastric biopsies from the antrum and corpus were obtained for histology and H. pylori culture. H. pylori infection was cured in 97.4% after OCM and in 65.8% after OA in the per-protocol analysis (p < 0.001) (intention-to-treat analysis: 93.4% and 63.2%, respectively). H. pylori was successfully cultured in 122 patients (77%). The overall rate of metronidazole resistance was 19.7% (24/122), no primary resistance to clarithromycin or amoxicillin was found. In the OCM group, all patients infected with metronidazole-sensitive H. pylori strains (n = 51) and those infected with strains of unknown susceptibility to metronidazole (n = 14)were cured (100%), while 77% (10/13) of those harboring metronidazole-resistant. strains were cured of the infection (p = 0.36). Side effects leading to premature termination of treatment occurred in 2.5% of the patients in the OCM group and in 1.4 % of the OA group. We conclude that combined treatment with omeprazole, clarithromycin and a higher dose of metronidazole is highly effective in curing H, pylori infection, Helicobacter pylori omeprazole and that this regimen remains very effective in the presence of metronidazole resistant strains
Prevalência de Hérnia hiata deslizamento nos pacientes com esofagite erodida submetidos à endoscopia digestiva alta no HU-UFSC.
Get PDFTrabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Departamento de Clínica Médica
Efficacy of 6-mercaptopurine treatment after azathioprine hypersensitivity in inflammatory bowel disease
No full textAIM:To investigate the efficacy of 6-mercaptopurine
(6-MP) in cases of azathioprine (AZA) hypersensitivity
in patients with inflammatory bowel disease.
METHODS: Twenty nine previously confirmed Crohn’s
disease (CD) (n = 14) and ulcerative colitis (UC)
(n = 15) patients with a known previous (AZA)
hypersensitivity reaction were studied prospectively.
The 6-MP doses were gradually increased from 0.5
up to 1.0-1.5 mg/kg per day. Clinical activity indicies
(CDAI/CAI), laboratory variables and daily doses of
oral 5-ASA, corticosteroids, and 6-MP were assessed
before and in the first, sixth and twelfth months of
treatment.
RESULTS: In 9 patients, 6-MP was withdrawn in the
first 2 wk due to an early hypersensitivity reaction.
Medication was ineffective within 6 mo in 6 CD
patients, and myelotoxic reaction was observed in two.
Data were evaluated at the end of the sixth month in
12 (8 UC, 4 CD) patients, and after the first year in 9
(6 UC, 3 CD) patients. CDAI decreased transiently at
the end of the sixth month, but no significant changes
were observed in the CDAI or the CAI values at the
end of the year. Leukocyte counts (P = 0.01), CRP
(P = 0.02), and serum iron (P = 0.05) values indicated
decreased inflammatory reactions, especially in the UC
patients at the end of the year, making the possibility
to taper oral steroid doses.
CONCLUSION: About one-third of the previously AZAintolerant
patients showed adverse effects on taking
6MP. In our series, 20 patients tolerated 6MP, but it
was ineffective in 8 CD cases, and valuable mainly in
ulcerative colitis patients
Assessment of the cardiac safety of prucalopride in healthy volunteers: a randomized, double-blind, placebo- and positive-controlled thorough QT study
No full textSystematic investigation of gastrointestinal diseases in China (SILC): validation of survey methodology
Get PDFBackground: Symptom-based surveys suggest that the prevalence of gastrointestinal diseases is lower in China than in Western countries. The aim of this study was to validate a methodology for the epidemiological investigation of gastrointestinal symptoms and endoscopic findings in China. Methods: A randomized, stratified, multi-stage sampling methodology was used to select 18 000 adults aged 18-80 years from Shanghai, Beijing, Xi'an, Wuhan and Guangzhou. Participants from Shanghai were invited to provide blood samples and undergo upper gastrointestinal endoscopy. All participants completed Chinese versions of the Reflux Disease Questionnaire (RDQ) and the modified Rome II questionnaire; 20% were also invited to complete the 36-item Short Form Health Survey (SF-36) and Epworth Sleepiness Scale (ESS). The psychometric properties of the questionnaires were evaluated statistically. Results: The study was completed by 16 091 individuals (response rate: 89.4%), with 3219 (89.4% of those invited) completing the SF-36 and ESS. All 3153 participants in Shanghai provided blood samples and 1030 (32.7%) underwent endoscopy. Cronbach's alpha coefficients were 0.89, 0.89, 0.80 and 0.91, respectively, for the RDQ, modified Rome II questionnaire, ESS and SF-36, supporting internal consistency. Factor analysis supported construct validity of all questionnaire dimensions except SF-36 psychosocial dimensions. Conclusion: This population-based study has great potential to characterize the relationship between gastrointestinal symptoms and endoscopic findings in China.Xiaoyan Yan, Rui Wang, Yanfang Zhao, Xiuqiang Ma, Jiqian Fang, Hong Yan, Xiaoping Kang, Ping Yin, Yuantao Hao, Qiang Li, John Dent, Joseph Sung, Duowu Zou, Saga Johansson, Katarina Halling, Wenbin Liu and Jia H
Difficulties encountered when treating coeliac disease : from molecule to miracle cure?
Get PDFDietary treatment of coeliac disease should be based on a sound theoretical knowledge of the different immunogenicities of various cereal grains, an appreciation of the limitations of the current Codex Alimentarius recommendations and an understanding of the factors that limit dietary compliance in many patients. The expertise of dieticians, nutritional chemists, gastroenterologists and clinical pharmacists should be made readily available to coeliac patients, to coeliac societies and to coeliac self-help groups. Various enzymatic and pharmacological modalities that may be used to treat coeliac disease in the future are highlighted as potential ways to improve quality of life in these patients in whom the coeliac diet often promotes poor compliance or may lead to significant social alienation.peer-reviewe
General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care.
Get PDFBACKGROUND: Irritable bowel syndrome is a common condition in general practice. It occurs in 10 to 20% of the population, but less than half seek medical assistance with the complaint.
METHODS: A questionnaire was sent to the 406 GPs listed on the West Sussex Health Authority Medical List to investigate their views of this condition and whether they felt hypnotherapy had a place in its management
RESULTS: 38% of general practitioners responded. The achieved sample shared the characteristics of target sample. Nearly half thought that irritable bowel syndrome (IBS) was a "nervous complaint" and used a combination of "the placebo effect of personal care," therapeutic, and dietary advice. There is considerable divergence in the perceived effectiveness of current approaches. Over 70% thought that hypnotherapy may have a role in the management of patients with IBS; though the majority (68%) felt that this should not be offered by general practitioners. 84% felt that this should be offered by qualified hypnotherapist, with 40% feeling that this should be offered outside the health service.
CONCLUSIONS: General practitioners vary in their perceptions of what constitutes effective therapy in IBS. They are willing to consider referral to a qualified hypnotherapist
Coeliac disease: where are we in 2014?
Get PDFPresents up-to-date information on coeliac disease, with recommendations on whom to test and how to test them, and how to manage patients once they are diagnosed.
Summary
Background
Coeliac disease (CD) is an autoimmune condition affecting at least 1% of the population, many of whom remain undiagnosed. It is characterised by chronic inflammation of the small-intestinal mucosa and triggered by eating gluten. It is challenging to diagnose because of the many and varied ways in which it may present.
Discussion
Primary care practitioners have a crucial role in improving rates of CD diagnosis, and in the ongoing care of patients with CD. A blood test for coeliac-specific antibodies will identify most patients who need to undergo duodenal biopsy to make the diagnosis. Management encompasses supporting patients with adherence to the gluten-free diet and conducting a CD-focused clinical review every 1–2 years
Prevalença de la infecció pel virus de la hepatitis B i C en pacients amb malaltia inflamatòria intestinal. Impacte del tractament immunosupressor en l’evolució de l’hepatopatia
Get PDFINTRODUCCIÓ: Hi ha molt poca informació a la literatura mèdica que suggereix que existeix una alta prevalença de la infecció pel virus hepatitis B (VHB) i C (VHC) en malalts amb malaltia inflamatòria intestinal (MII). El seu coneixement és important per la possibilitat de reactivació viral relacionada amb el tractament immunosupressor. HIPÒTESI: La infecció per VHB i C és més freqüent en la MII que en la població general de referència. El tractament immunosupressor pot reactivar la infecció per VHB i C. OBJECTIUS: Avaluar: 1) La prevalença d'infecció per VHB i C en pacients amb MII de diferents àrees geogràfiques d'Espanya. 2) L'efecte del tractament immunosupressor i els fàrmacs biològics sobre l'evolució de la infecció per VHB i C. METODOLOGIA: Estudi 1: inclusió de 2076 pacients amb MII, als quals s'avalua l'existència d'infecció per VHB i C mitjançant tècniques analítiques estàndard (ELISA i PCR). Es van registrar els factors relacionats amb la MII i la infecció. Estudi 2: Inclusió de 162 pacients amb MII i infecció per VHB i / o C i que van rebre tractament immunosupressor per la MII. Es van registrar variables clíniques i analítiques relacionades amb la reactivació. Tots dos són estudis multicèntrics amb registre electrònic (www.repentina.com). Per a l’anàlisi de resultats es van utilitzar tests univariants (2 i test de t Student) i multivariants (regressió logística i model de risc proporcional de Cox). RESULTATS: Estudi 1: El 9.7% de pacients amb colitis ulcerosa (CU) i malaltia de Crohn (MC) van presentar positivitat de marcadors d'infecció pel VHB i C actual o passada (CU: HBsAg 0.8 % , anti-HBc 8 % , anti-VHC 1.3 % ; MC: HBsAg 0.6 % , anti-HBc 7.1 % , anti-VHC 2.3 % ). El 12% de pacients amb MII van presentar marcadors de vacunació eficaç. En l’anàlisi multivariant, l'edat, la història familiar d'hepatitis i la MII moderada-greu, es van relacionar de manera significativa amb el VHB, mentre que les transfusions i l'ús d'antibiòtics ho van fer amb el VHC. Estudi 2: Un 36% de pacients van presentar disfunció hepàtica (DH) relacionada amb el VHB, un 66% dels quals van presentar insuficiència hepàtica. L’anàlisi multivariant va demostrar que l’únic factor relacionat amb la DH per VHB va ser l'ús simultani de 2 o més immunosupressors. En canvi només un 15.7% dels pacients amb VHC van presentar DH. CONCLUSIONS:Estudi 1: El pacients amb MII presenten una prevalença d’infecció pels VHB i VHC similar a la de la població general de referència, i aquesta és més baixa del que prèviament s’havia publicat. L’escassa relació de la infecció pel VHC i VHB amb els procediments invasius i ingressos hospitalaris suggereix que aquestes infeccions rarament s’adquireixen en l’àmbit hospitalari al nostre país. Es detecta un baix percentatge de vacunació eficaç pel VHB, el que obliga a intensificar els programes de vacunació en aquests pacients. Estudi 2: La DH en pacients amb MII tractats amb immunosupressors, és més freqüent i greu en els pacients amb infecció pel VHB que en el pacients amb infecció pel VHC. La immunosupressió combinada va ser l’únic factor predictiu independent de reactivació pel VHB.Background: Limited information suggests the existence of a high prevalence of hepatitis B (HBV) and C virus (HCV) in inflammatory bowel disease (IBD). Hypothesis: HBV and HCV infection is more common in IBD than in the general population. Immunosuppressants can reactivate these infections.Objectives: To asses: 1) the prevalence of HBV and HCV in IBD, in a nationwide study, and to evaluate associated risk factors. 2) the influence of immunosuppressants on the course of HBV and HCV in IBD.Methods: Study 1: inclusion of 2076 IBD patients, which evaluates the existence of HBV and HCV using ELISA and PCR. Factors related to IBD and to infection were registered. Study 2: Inclusion of 162 IBD patients with HBV and HCV infection and immunosuppressants. Registration of clinical and laboratory variables related to reactivation. Both are multicentre studies with electronic data base (www.repentina.com). The results are analyzed by univariate and multivariate analysis. Results: Study 1: Present and / or past HBV and HCV infection was found in 9.7 % of IBD patients (HBsAg 0,6-0,8% / antiHBc 7-8% / anti-HCV 1.3-2.3%). Effective vaccination was present in 12 % of patients. In multivariate analysis, age, family history of hepatitis and moderate-to-severe IBD were significantly associated with HBV, whereas transfusions and antibiotics were significantly associated with HCV. Study 2: Liver dysfunction (LD) was observed in 36% HBsAg positive patients, 66% of whom developed hepatic failure. In contrast LD in HCV was observed in 15.7% of HCV-RNA positive patients. Treatment with ≥2 immunosuppressants was an independent predictor of HBV reactivation.Conclusions: Study 1: Prevalence of HBV and HCV infection in IBD is similar to that of the general population and lower than that in previously published series. This fact, in addition to the lack of association with invasive procedures, suggests the existence of adequate preventive measures in centres attending to these patients. The low percentage of effective vaccination makes it mandatory to intensify B virus vaccination in IBD. Study 2: LD in patients with IBD treated with immunosuppressants is more frequent and severe in those with HBV than in HCV carriers and is associated with combined immunosuppression
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