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Biomedical subjects

C W Howden

Publications and source records attributed to C W Howden.

At least 73 records · Page 4Linked to original sources
PubMed1997

Randomized controlled trial of rectal tube placement for the management of abdominal distension following colonoscopy.

BACKGROUND: Traditionally, endoscopists have sought to provide maximum comfort for patients undergoing colonoscopy but may have been less concerned with the level of patient discomfort following the procedure. The aim of this study was to examine the effectiveness of rectal tube placement for abdominal decompression following colonoscopy in an effort to limit patient discomfort. METHODS: We conducted a prospective, single-blind, randomized controlled trial in 67 consecutive men undergoing elective colonoscopy. At the end of the procedure, patients were randomized to rectal tube placement or standard management without tube placement. Patients were evaluated by standardized criteria 30 minutes after completion of colonoscopy, and again 24 hours later. RESULTS: Thirty patients were randomized to rectal tube placement and 37 served as controls. The two groups were well matched with respect to age, duration of colonoscopy, quality of bowel preparation, prevalence of diverticulosis, frequency of polypectomy, and degree of difficulty in colonoscopy. At 30 minutes after colonoscopy, patients' overall satisfaction rating (mean +/- SD) from a 10-point scale was 9.1 +/- 3.2 in treated patients and 5.7 +/- 3.9 in controls (p < 0.05; 2-tailed unpaired t test). CONCLUSION: Placement of a rectal tube at the conclusion of colonoscopy reduces patient discomfort, and improves satisfaction.

Abdomen↗
PubMed1997

Outcomes of routine testing of liver enzymes in institutionalized geriatric patients.

This study sought to identify any benefit of routine liver function tests (LFTs) in chronically ill, geriatric patients and to assess which patients require evaluation for abnormal LFT levels. A retrospective chart review was carried out on 268 consecutive patients (M:F = 1.2, mean age 77 years, range 61-98 years) presenting for acute care from a long-term care facility. All were without jaundice, right upper quadrant pain, pruritus, bruising, or signs of chronic liver disease. The degree of LFT abnormality (aspartate aminotransferase, alanine aminotransferase, total bilirubin, or alkaline phosphatase) during admission was compared to the clinical diagnosis at the time of discharge. The most common diagnoses were pneumonia, urinary tract infection, and peripheral or coronary disease in 186 (60%). Thirty-seven patients (14%) had elevated LFT levels on admission. The levels normalized within 2 days in 26 of these patients, 25 of whom had a history of vascular disease (96%). Of the 11 remaining patients, 4 had coexistent vascular disease (36%), and 5 had LFT levels twice normal (none with vascular disease) and underwent abdominal ultrasound. One patient had a common bile duct stone successfully extracted. Enzyme abnormalities were due to hepatitis B or medication use in 10 of 11 patients. No patient had liver biopsy. All but one of the 268 patients were discharged without further evaluation. Over one year of follow up, no patient returned for a liver-related problem. Based on these findings, only those patients with LFT levels that are twice normal and which do not normalize within 2 days warrant further evaluation. Transient LFT abnormalities may be due to decreased liver perfusion.

Aged↗
PubMed1997

Candida splenic abscess in the absence of obvious immunodeficiency.

Focal hepatosplenic candidiasis has been increasingly recognized as a variant of disseminated candidiasis in immunocompromised patients. It rarely presents as Candida splenic abscess. Its occurrence in non-leukemic patients is quite rare. A patient with diabetes mellitus and previously undiagnosed sickle cell trait presented with upper gastrointestinal bleeding. Candida splenic abscess was diagnosed. She was successfully treated with percutaneous drainage and fluconazole. The clinical presentation, diagnosis, and treatment of Candida splenic abscess is reviewed, and its relationship to diabetes mellitus and sickle cell disease without major immunodeficiency is discussed.

Abscess↗
PubMed1997

Optimizing the pharmacology of acid control in acid-related disorders.

Clinical evidence supports the relationship between acid suppression and healing of duodenal ulceration and reflux esophagitis. In contrast to H2-receptor antagonists which suppress acid secretion by inhibiting the initial stimulation of the parietal cell, proton pump inhibitors directly inhibit hydrogen ion secretion and can, therefore, better provide the degree and duration of intragastric pH elevation necessary for the optimal management of duodenal ulceration and reflux esophagitis. Clinical studies have shown that proton pump inhibitors, such as omeprazole and lansoprazole, provide more rapid healing and higher healing rates for both duodenal ulcers and reflux esophagitis than do H2-receptor antagonists.

Antacids↗
PubMed1997

Randomized, controlled comparison of two forms of preparation for screening flexible sigmoidoscopy.

OBJECTIVE: There is a paucity of data regarding the optimal form of bowel preparation for flexible sigmoidoscopy. Most endoscopists recommend enemas. A simpler preparation that is easy, acceptable, and that reduces patient encounter time would be desirable, and might be cost-effective. Our objective in this study was to evaluate a simple oral form of preparation for screening flexible sigmoidoscopy. METHODS: In this randomized, single-blind, controlled trial, we compared two forms of preparation in consecutive male patients referred for screening flexible sigmoidoscopy. The oral preparation consisted of one bottle of magnesium citrate and two "Dulcolax" tablets on the evening before flexible sigmoidoscopy. This was compared with the standard form of preparation, namely, two Fleet's enemas given on arrival at the endoscopy suite. Thirty-seven patients received the oral preparation [mean age, 62.8 +/- 8.9 (SD) yr]; 33 received enemas (mean age, 65.2 +/- 7.3 yr). Endoscopists were blinded to the preparation. RESULTS: Mean time between arrival and starting flexible sigmoidoscopy was 36 +/- 22 (SD) min for patients on oral preparation, and 62 +/- 25 min for patients receiving enemas (p < 0.0001). Mean times performing flexible sigmoidoscopy were 10 +/- 3 min and 13 +/- 4 min, respectively (p = 0.004). Mean patient satisfaction score (range 0-13) was higher for patients given the oral preparation (11.4 +/- 1.8) than for patients receiving enemas (9.6 +/- 2.4) (p = 0.001). Fifteen patients randomized to receive the oral preparation had previous flexible sigmoidoscopy with an enema preparation; all preferred the oral form. Mean technical difficulty (range 1-10) was 3 +/- 2.2 for patients given the oral preparation and 4.9 +/- 3.1 for patients receiving the enema preparation (p = 0.01). Polyps were identified in 10/37 patients who received the oral preparation and in 3/33 patients who received enemas (p = 0.05). Quality of colon preparation was judged "good" in 29, "fair" in four, and "poor" in four, among the 37 patients given the oral form; corresponding values for 33 patients given enemas were 16, 10, and 7 (p = 0.03). CONCLUSION: Patient acceptance, encounter time, technical ease, and quality of colon preparation were significantly better with the oral form of colon preparation than with the standard Fleet enema preparation.

Administration, Oral↗
PubMed1997

Nonencapsulated, intact omeprazole granules effectively suppress intragastric acidity when administered via a gastrostomy.

UNLABELLED: Because of its acid-labile nature, omeprazole is usually administered as encapsulated enteric-coated granules. The gelatin capsule and acid-resistant coating are essential for effective drug absorption and optimal bioavailability. OBJECTIVE: This study tested the effectiveness of nonencapsulated, intact omeprazole granules in suppressing intragastric acidity when administered through a gastrostomy. METHODS: Fourteen male patients with established gastrostomies underwent a baseline 24-h intragastric pH monitoring study while off any acid-suppressing medication. Via the gastrostomy, they then received 7 days of dosing with 20 mg omeprazole as intact granules in orange juice. Twenty-four-hour intragastric pH monitoring was repeated on the seventh day. RESULTS: Mean intragastric pH during the baseline study was 1.8 (+/- SD 0.7). This pH increased to 4.9 +/- 0.8 with omeprazole granules (p < 0.0001). Median intragastric pH rose from 1.3 to 5.3 (p < 0.0001). During the baseline study, intragastric pH was above 3 for 21.2 +/- 14.1%, above 4 for 14.9 +/- 11.0%, and above 5 for 9.5 +/- 8.4% of the 24-h recording period. Corresponding values after 7 days of omeprazole were 80 +/- 15.1%, 72.5 +/- 16.3%, and 59.1 +/- 16.6% (p < 0.0001 for each comparison with pretreatment values). CONCLUSION: Omeprazole effectively suppresses intragastric acidity when given through a gastrostomy tube as nonencapsulated, intact granules.

Aged↗
PubMed1996

Clinical expressions of Helicobacter pylori infection.

Helicobacter pylori infection is very common both in the United States and internationally. However, clinical manifestations of this infection vary markedly among different individuals. Apart from gastritis, which may be asymptomatic, patients may develop peptic ulceration or a gastric neoplasm. However, these patients represent a minority of patients infected with H. pylori. This article aims to review the different possible consequences of H. pylori infection.

Adenocarcinoma↗
PubMed1995

The rationale for continuous maintenance treatment of reflux esophagitis.

Reflux esophagitis is a chronic process associated with frequent episodes of relapse in many patients. In addition, the disease may be progressive in at least some patients. Erosion of the esophageal mucosa precedes the development of some of the complications of the condition. There is accumulating evidence that continuous treatment of patients with erosive esophagitis effectively maintains symptomatic remission and absence of esophageal erosions. Whether such treatment will prevent the development of complications has not yet been demonstrated. We investigated a number of questions concerning the natural history and complications of erosive esophagitis and the need for maintenance treatment for patients with severe manifestations of disease as well as the impact of continuous maintenance treatment on the natural history of reflux esophagitis and its complications.

Chronic Disease↗
PubMed1995

A systematic review of the association between Barrett's esophagus and colon neoplasms.

OBJECTIVE: Patients with Barrett's esophagus may be at increased risk of colon neoplasms, including cancer. However, different studies of this have yielded conflicting results. The objective of this analysis was to review all existing published data in an attempt to determine whether there is such an association and, if so, to estimate the level of risk. METHODS: We have reviewed all of the published studies examining the prevalence of colon neoplasms in patients with Barrett's esophagus. We have compared these with a cohort of patients drawn from the general population and participating in colorectal cancer screening programs. RESULTS: The prevalence of colon cancer in patients with Barrett's esophagus was 7.6% compared with 1.6% in the control group. The pooled odds ratio for colon cancer in Barrett's esophagus was 5.19 (p < 0.0001). In a small subgroup analysis, the odds ratio for colon cancer in patients identified as having Barrett's esophagus with specialized columnar epithelium was 8.71 (p < 0.0001). CONCLUSIONS: We conclude that patients with Barrett's esophagus have an increased risk of colon cancer. This may be particularly true in those patients with specialized columnar epithelium.

Barrett Esophagus↗
PubMed1995

Critical issues in the pathophysiology and management of peptic ulcer disease.

OBJECTIVE: To discuss some of the critical issues in the pathophysiology and management of peptic ulcer disease. OPINION: Peptic ulcer disease has multiple causes, although gastric acid has traditionally been considered the primary aggressive factor. Helicobacter pylori infection is established as a major causative factor, but some aspects of the mechanisms by which H. pylori causes peptic ulceration remain unclear. Treatment with proton pump inhibitors (PPIs) is the most effective means of healing peptic ulcers. In addition to healing a higher proportion of ulcers than H2-receptor antagonists, PPIs provide faster healing and relief of symptoms. The ability of PPIs to produce effective and sustained inhibition of gastric acid secretion suggests that they may also become the treatment of choice for gastric ulcers caused by non-steroidal anti-inflammatory drugs. However, eradication of H. pylori infection is more effective than maintenance therapy with antisecretory agents in reducing the rate of recurrence of peptic ulcers initially healed using antisecretory therapy. H. pylori eradication is therefore the optimal, and almost certainly the most cost-effective, approach to the long-term management of patients with peptic ulcer disease. Despite the fact that 90-95% of patients with demonstrable duodenal ulceration are probably infected with H. pylori, it is recommended that, in routine clinical practice, infection is diagnosed before eradication therapy is instituted. H. pylori testing 4-6 weeks after the completion of eradication therapy is also recommended to check that the infection has been successfully cured. For routine clinical practice, the highly sensitive and specific rapid urease test is probably the most useful diagnostic approach. The most appropriate H. pylori eradication regimen remains to be defined. However, 1-2 weeks of treatment with a combination of a PPI and two antimicrobial agents achieves eradication rates in excess of 90%, which are similar to those attained using standard triple therapy, but with the advantage of better patient compliance and greater tolerability. Preliminary evidence also suggests that H. pylori eradication prevents the recurrence of peptic ulcer bleeding, although further studies are required. CONCLUSION: H. pylori eradication by 1-2 weeks' treatment with a combination of a PPI and two antimicrobial agents appears to be the optimal (and probably the most cost-effective) approach to the long-term management of patients with peptic ulcer disease, and represents a major advance in the management of such patients.

Antacids↗
PubMed1994

Appropriate acid suppression in the treatment of acid-related conditions.

Gastric acid is involved in the pathogenesis of duodenal ulcer, gastric ulcer and gastro-oesophageal reflux disease. Although levels of acid secretion may not be abnormally high in patients with these conditions, pharmacological suppression of acid secretion is associated with healing of mucosal defects and maintenance of healing in the long term. In the case of duodenal ulcer, this was demonstrated before the understanding of the importance of Helicobacter pylori infection. There is a considerable body of published work examining the pharmacological effectiveness of antisecretory drugs in suppressing gastric acid secretion, as well as their therapeutic efficacy in terms of healing ulcers or oesophageal erosions. These two parameters have been significantly correlated in each of the three conditions listed above. The purpose of this article is to review the mathematical relationships established between suppression of gastric acid secretion and healing rates of duodenal ulcer, gastric ulcer and gastro-oesophageal reflux disease.

Anti-Ulcer Agents↗
PubMed1994

Appropriate acid suppression for optimal healing of duodenal ulcer and gastro-oesophageal reflux disease.

Comparisons of the effectiveness of treatments for healing duodenal ulcer are essential to determine optimal management strategies for both economic analysis and quality-of-life evaluation. Differences are usually made on the basis of the proportion of ulcers healed at varying time intervals. It has been shown by meta-analysis that healing of duodenal ulcers with antisecretory drugs is directly correlated to the degree of acid suppression. More recently, sophisticated meta-analysis of 24-hour intragastric acidity data and clinical trials of antisecretory drugs has demonstrated that the optimal degree and duration of gastric acid suppression for healing duodenal ulcer can be achieved by an aggregate time above pH 3 of 18-20 hours/day. These conditions predict 100% ulcer healing at 4 weeks. Antisecretory drug regimens that approach these criteria should achieve faster healing than other agents, with a concomitant acceleration of symptom resolution. Regression analysis was performed on the healing-time curves for each drug class to determine the rate of ulcer healing per week. The mean proportion of ulcers healed, irrespective of treatment duration, was highest for omeprazole, which also provided a significantly faster rate of duodenal ulcer healing than all other drug classes (p < 0.001). It has recently been shown that healing of erosive oesophagitis with antisecretory drugs is directly correlated with both the duration of acid suppression over the 24-hour period (p < 0.05) and the elevation of intra-oesophageal pH above 4. Furthermore, oesophageal acid exposure time can be normalized by maintaining the intra-oesophageal pH above 4 for at least 96% of the 24-hour period.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1994

Intestinal permeability in patients with Crohn's disease and their first-degree relatives.

OBJECTIVE: To measure small intestinal permeability in a group of patients with Crohn's disease in clinical remission and their apparently healthy first-degree relatives. METHODS: Administration of 51Cr-labeled EDTA and subsequent measurement of its excretion in a 24-h urine collection. RESULTS: Excretion of 51Cr-EDTA was not elevated in either the patients or in first-degree relatives. CONCLUSION: Intestinal permeability to 51Cr-EDTA is not raised in patients with Crohn's disease in clinical remission or in their healthy first-degree relatives.

Chromium Radioisotopes↗