Helicobacter pylori and gastric acid output in peptic ulcer disease

Helicobacter pylori is associated with peptic ulcer, and a causal relationship has been postulated. We investigated the association betweenHelicobacter pylori and gastric acid output. Two hundred forty-one patients were studied: 173 with duodenal ulcer, 51 with gastric ulcer (41 corpus, 10 prepyloric), and 17 with combined gastric and duodenal ulcer. In 194 patients (80%),Helicobacter pylori could be demonstrated histologically from gastric antral biopsies. The presence or absence ofHelicobacter pylori was not influenced by age, sex, or use of tobacco or analgesics. Patients with duodenal ulcer or combined gastric and duodenal ulcer had similar gastric acid outputs irrespective of the presence or absence ofHelicobacter pylori. However, gastric ulcer patients withHelicobacter had higher basal and maximal acid outputs when compared to patients withoutHelicobacter (mean basal output: 4.1 mmol/hr vs 2.4,P<0.05; mean maximal output 19.5 mmol/hr vs 14.4,P<0.05). AlthoughHelicobacter pylori is associated with both gastric ulcer and duodenal ulcer, its significance may be different in the two diseases.     

Reliability and interobserver variability of ultrasonographic measurement of gastric emptying rate

Scintigraphy and real-time ultrasound are valid techniques to measure parameters of gastric emptying. However, scintigraphy involves exposure to ionizing radiation, while the precision of real-time ultrasound has not been previously evaluated. The objectives of the present study were to determine the inter observer and day-to-day variability of liquid gastric emptying rate measured by real-time ultrasonography in healthy volunteers and to compare the gastric emptying rate of males and females. Twenty healthy volunteers had ultrasonographic measurement of gastric emptying rate after ingestion of 300 ml beef broth. Nine subjects had a concurrent assessment by a second observer. Nine subjects had two studies performed on different days by the same sonographer. TheT1/2 for 20 subjects was 24.77±6.84 min with no difference between the half-emptying time for males (25.89±6.99 min) and females (24.02±6.94 min). The Pearson and intraclass correlation coefficients for observations made by two observers were 0.83 and 0.625, with a difference due to observer of 2.37 min±5.26 (NS). The test-retest reliability across successive days was 0.136, representing considerable day-to-day variability within subjects. The variability between subjects was also large, explaining up to 79% of the total variance. We conclude that ultrasound is a useful method to evaluate gastric emptying with good interobserver agreement. Due to substantial day-to-day variability, sample sizes larger than previously suggested are required to demonstrate clinically important changes in gastric emptying rate in clinical trials.Gervais Tougas was supported by the Medical Research Council of Canada and the Canadian Association of Gastroenterology-Merck Research Fellowship.     

Macroscopic lesions in dysplasia and carcinoma complicating ulcerative colitis

Visible changes associated with dysplasia or carcinoma have been assessed in 62 colectomy specimens from patients with ulcerative colitis. In 34 colectomy specimens with one or more carcinomas, there were 51 visible carcinomas and 65 macroscopic dysplastic lesions; only one carcinoma was found in flat mucosa. Among 28 specimens with microscopic dysplasia but no carcinoma, eight contained no visible dysplastic lesion, and the remaining 20 contained a total of 40 polypoid or elevated dysplastic areas. In 32 operative specimens removed for long-standing chronic colitis without dysplasia or carcinoma, nine contained visible inflammatory polypoid lesions. On radiological or endoscopic examination of the colon in long-standing colitis close attention should be given to the identification and biopsy of polyps, elevated nodular areas or plaques, strictures, and isolated ulcers. It is likely that colectomy specimens with visible polypoid or elevated dysplastic lesions will contain a carcinoma more often than those removed for dysplasia in flat mucosa.     

Hepatic iron stores and markers of iron overload in alcoholics and patients with idiopathic hemochromatosis

Liver iron concentrations were determined in 60 alcoholics with liver disease of varying severity, 15 patients with untreated idiopathic hemochromatosis, and 16 control subjects with biliary tract disease. Mean liver iron concentrations (g/100 mg dry weight) were significantly greater in the alcoholics (156.4±7.8 (sem);P<0.05) and in patients with idiopathic hemochromatosis (2094.5±230.7;P<0.01) than in control subjects (53.0±7.0). Liver iron concentrations of >140 g/100 mg were found in 17 alcoholics (29%) and in all 15 patients with idiopathic hemochromatosis. Liver iron concentrations >1000 g/100 mg were found in all patients with idiopathic hemochromatosis but in none of the alcoholics. In the alcoholics no relationship existed between liver iron concentrations and the amount of alcohol consumed daily, the length of the drinking history, the amount of beverage iron consumed daily, or the severity of the liver disease. Serum ferritin concentrations reflected iron stores in patients with hemochromatosis and in alcoholics with minimal liver disease. However, in alcoholics with significant liver disease serum ferritin concentrations did not reflect iron stores accurately, although with normal values iron overload is unlikely. Serum iron concentration and percentage saturation of total iron-binding capacity were of little value in assessing iron status in either alcoholics or patients with hemochromatosis. Measurement of the liver iron concentration clearly differentiates between alcoholics with significant siderosis and patients with idiopathic hemochromatosis.R. W. Chapman was Watson-Smith Fellow of the Royal College of Physicians of London.     

Effect of indomethacin and misoprostol on fasted gallbladder volume and meal-induced gallbladder contractility in humans

Impaired gallbladder contractility is a prerequisite for gallstone formation in animal models. Prostaglandins are important mediators of gallstone formation and may affect gallbladder contractility in animals. The aim of this study was to evaluate the effect of indomethacin, an inhibitor of prostaglandin synthesis, and misoprostol, a synthetic prostaglandin, on gallbladder contractility in man. Seven male volunteers (18–33 years old, mean age 23 years) were studied under blinded conditions after an overnight fast, during control periods and following ingestion of indomethacin 125 mg (75 mg at 10PM, 50 mg at 630AM) or misoprostol 800 g (400 g at 10 PM, 400 g at 630 AM) orally. Gallbladder residual volume was determined by real-time ultrasonography before and 10, 20, 30, 40, and 50 min after ingestion of a standard liquid fatty meal stimulus. Fasting gallbladder volume (milliliters) was similar in all three periods [control 20.8 (1.6);indomethacin 20.8 (2.9); misoprostol 18.3 (1.6)]. The fatty meal stimulus caused prompt contraction, resulting in minimum residual volume of 7.5 (1.4) ml in the control period. Pretreatment with misoprostol or indomethacin did not affect the minimum volume obtained compared with control period [misoprostol: 5.8 (1.4) ml; indomethacin 5.9 (1.3) ml)]. Thus administration of indomethacin and misoprostol had no effect on fasting gallbladder volume or gallbladder contractility in humans as assessed by ultrasonography.     

Omeprazole inhibits nocturnal and pentagastrin-stimulated gastric secretion in Man

The effect of omeprazole on the overnight and pentagastrin-stimulated gastric secretion of acid and pepsin have been studied in healthy male volunteers. After treatment with omeprazole, 30 mg or 60 mg daily for one week, overnight secretion of acid was reduced by 48 and 73%, respectively. During stimulation with pentagastrin, a single dose of 40 mg omeprazole reduced acid output by 98%, while after 80 mg, secretion of acid and pepsin was completely abolished. Omeprazole is one of the most potent gastric secretory inhibitors available at present, with potential for use in the therapy of ulcer disease.     

Aging-Associated Endothelial Dysfunction in Humans Is Reversed by

Summary One hundred and twenty women, aged between 18 and 90 years, with a history of at least four episodes of symptomatic urinary tract infection in the preceding 12 months, were randomized in an open, prospective study to prophylactic treatment with cefaclor 250 mg at bedtime or macrocrystalline nitrofurantoin 50 mg at bedtime for 12 months. Ninety-seven (49 taking cefaclor, 48 taking macrocrystalline nitrofurantoin) were assessed for efficacy; 80% of these were symptomatically improved and remained abacteriuric during the period of prophylaxis. Symptomatic attacks while patients were taking prophylaxis occurred at least five times less often than before prophylaxis had started. Seventy percent of the patients continued in an improved condition after having stopped prophylaxis. All 120 patients were assessed for adverse events; these were twice as frequent in patients taking macrocrystalline nitrofurantoin (20% vs. 10%), but only 11 patients (three taking cefaclor, eight taking macrocrystalline nitrofurantoin) withdrew from the study. Due to the small numbers of patients experiencing adverse events, these differences are not statistically significant. No significant changes in haematological or biochemical parameters were found during or after the end of the 12-month course. The 22 patients assessable for efficacy who had a non-obstructive radiological abnormality responded as well to prophylaxis as those with no detectable abnormality. Long-term, low-dose prophylaxis with a suitable antimicrobial agent is highly effective management for patients with recurrent urinary tract infections, and can appropriately be provided by the family doctor. Prophylaxis given for 1 year gives better results than when given for 6 months.

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Studie zum Vergleich Cefaclor in niedriger Dosierung und makrokristallinem Nitrofurantoin zur Prävention rezidivierender Harnwegsinfektionen

Zusammenfassung 120 Frauen mit mindestens vier Episoden einer symptomatischen Harnwegsinfektion in den vergangenen 12 Monaten wurden in einer offenen, prospektiven Studie für eine 12-monatige Prophylaxe mit 250 mg Cefaclornocte oder 50 mg makrokristallinem Nitrofurantoinnocte randomisiert. Für die Auswertung standen 97 Frauen (49 nahmen Cefaclor und 48 makrokristallines Nitrofurantoin) zur Verfügung. 80% waren symptomatisch gebessert oder blieben für die Zeit der Prophylaxe ohne Rezidive. Symptomatische Schübe traten während der Prophylaxe mindestens 5mal seltener auf als vor Beginn der Prophylaxe. 70% der Patientinnen waren nach Absetzen der Prophylaxe noch in gebessertem Zustand. Alle 120 Frauen wurden hinsichtlich Nebenwirkungen beurteilt. Bei Frauen, die makrokristallines Nitrofurantoin einnahmen, waren Nebenwirkungen zweimal so häufig (20% gegenüber 10%); aus der Studie schieden aber nur 11 Frauen aus, 3 unter Cefaclor und 8 unter makrokristallinem Nitrofurantoin. Diese Unterschiede sind wegen der kleinen Zahlen von Frauen mit Nebenwirkungen nicht statistisch signifikant. In den hämatologischen oder biochemischen Parametern fanden sich während oder nach dem Ende der 12-monatigen Prophylaxephase keine Veränderungen. Die 22 Frauen, die nicht-obstruktive röntgenologische Veränderungen aufwiesen und für Wirksamkeit auswertbar waren, hatten auf die Prophylaxe ebenso gut angesprochen wie Frauen ohne erkennbare anatomische Abweichung. Eine Langzeitprophylaxe mit einem geeigneten Antibiotikum in niedriger Dosierung ist eine hochwirksame Maßnahme für Patienten mit rezidivierenden Harnwegsinfektionen und kann durch den Hausarzt adäquat verordnet werden.

     

A comparative trial of low dose cefaclor and macrocrystalline nitrofurantoin in the prevention of recurrent urinary tract infection

Summary One hundred and twenty women, aged between 18 and 90 years, with a history of at least four episodes of symptomatic urinary tract infection in the preceding 12 months, were randomized in an open, prospective study to prophylactic treatment with cefaclor 250 mg at bedtime or macrocrystalline nitrofurantoin 50 mg at bedtime for 12 months. Ninety-seven (49 taking cefaclor, 48 taking macrocrystalline nitrofurantoin) were assessed for efficacy; 80% of these were symptomatically improved and remained abacteriuric during the period of prophylaxis. Symptomatic attacks while patients were taking prophylaxis occurred at least five times less often than before prophylaxis had started. Seventy percent of the patients continued in an improved condition after having stopped prophylaxis. All 120 patients were assessed for adverse events; these were twice as frequent in patients taking macrocrystalline nitrofurantoin (20% vs. 10%), but only 11 patients (three taking cefaclor, eight taking macrocrystalline nitrofurantoin) withdrew from the study. Due to the small numbers of patients experiencing adverse events, these differences are not statistically significant. No significant changes in haematological or biochemical parameters were found during or after the end of the 12-month course. The 22 patients assessable for efficacy who had a non-obstructive radiological abnormality responded as well to prophylaxis as those with no detectable abnormality. Long-term, low-dose prophylaxis with a suitable antimicrobial agent is highly effective management for patients with recurrent urinary tract infections, and can appropriately be provided by the family doctor. Prophylaxis given for 1 year gives better results than when given for 6 months.

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Studie zum Vergleich Cefaclor in niedriger Dosierung und makrokristallinem Nitrofurantoin zur Prävention rezidivierender Harnwegsinfektionen

Zusammenfassung 120 Frauen mit mindestens vier Episoden einer symptomatischen Harnwegsinfektion in den vergangenen 12 Monaten wurden in einer offenen, prospektiven Studie für eine 12-monatige Prophylaxe mit 250 mg Cefaclornocte oder 50 mg makrokristallinem Nitrofurantoinnocte randomisiert. Für die Auswertung standen 97 Frauen (49 nahmen Cefaclor und 48 makrokristallines Nitrofurantoin) zur Verfügung. 80% waren symptomatisch gebessert oder blieben für die Zeit der Prophylaxe ohne Rezidive. Symptomatische Schübe traten während der Prophylaxe mindestens 5mal seltener auf als vor Beginn der Prophylaxe. 70% der Patientinnen waren nach Absetzen der Prophylaxe noch in gebessertem Zustand. Alle 120 Frauen wurden hinsichtlich Nebenwirkungen beurteilt. Bei Frauen, die makrokristallines Nitrofurantoin einnahmen, waren Nebenwirkungen zweimal so häufig (20% gegenüber 10%); aus der Studie schieden aber nur 11 Frauen aus, 3 unter Cefaclor und 8 unter makrokristallinem Nitrofurantoin. Diese Unterschiede sind wegen der kleinen Zahlen von Frauen mit Nebenwirkungen nicht statistisch signifikant. In den hämatologischen oder biochemischen Parametern fanden sich während oder nach dem Ende der 12-monatigen Prophylaxephase keine Veränderungen. Die 22 Frauen, die nicht-obstruktive röntgenologische Veränderungen aufwiesen und für Wirksamkeit auswertbar waren, hatten auf die Prophylaxe ebenso gut angesprochen wie Frauen ohne erkennbare anatomische Abweichung. Eine Langzeitprophylaxe mit einem geeigneten Antibiotikum in niedriger Dosierung ist eine hochwirksame Maßnahme für Patienten mit rezidivierenden Harnwegsinfektionen und kann durch den Hausarzt adäquat verordnet werden.

     

The atrioventricular delay of cardiac resynchronization can be optimized hemodynamically during exercise and predicted from resting measurements

BACKGROUND: Atrioventricular (AV) optimization of cardiac resynchronization therapy (CRT) is typically calculated at rest. However, patients often become symptomatic during exercise. OBJECTIVE: In this study, we use acute noninvasive hemodynamics to optimize the AV delay of CRT during exercise and investigate whether this exercise optimum can be predicted from a three-phase resting model. METHODS: In 20 patients with CRT, we adjusted the sensed AV delay while the patient exercised on a treadmill up to a heart rate of 100 bpm to identify the hemodynamically optimal value. Separately, at rest, by pacing with three different configurations and calculating the sensed-paced difference, we calculated an "expected" value for the exercise optimum. RESULTS: It was possible to perform AV delay optimization while a patient exercised. The resting three-phase model correlated well with the actual exercise optimal AV delay (r = 0.85, mean difference +/- standard deviation [SD] = 3.7 +/- 17 ms). Simply using measurements made at rest during atrial-sensed pacing showed a poorer correlation with exercise (r = 0.64, mean difference +/- SD = 2.2 +/- 24 ms). The three-phase resting model allows improved exercise hemodynamics to be achieved. Programming according to the three-phase resting model yields an exercise blood pressure of only 0.5 mmHg (+/-1.4 mmHg; P = NS) less than the true exercise optimum, whereas programming the resting sensed optimum yields an exercise blood pressure of 1.4 mmHg (+/-2.2 mmHg, P = .02) less than the true optimum. CONCLUSIONS: Using acute noninvasive hemodynamics and a protocol of alternations, it is possible to optimize the AV delay of cardiac resynchronization devices even while a patient exercises. In clinical practice, the exercise optimum AV delay could be determined from three phases of resting measurements, without performing exercise.