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Biomedical subjects

D C Metz

Publications and source records attributed to D C Metz.

At least 37 records · Page 2Linked to original sources
PubMed2000

Oral and intravenous dosage forms of pantoprazole are equivalent in their ability to suppress gastric acid secretion in patients with gastroesophageal reflux disease.

OBJECTIVE: The aim of this study was to assess the ability of pantoprazole to maintain gastric acid suppression in patients with gastroesophageal reflux disease who are switched from an oral (p.o.) to an intravenous (i.v.) dosage form. METHODS: A total of 65 patients with gastroesophageal reflux disease were administered either 40 or 20 mg of p.o. pantoprazole daily for 10 days, then were switched to either a matching dose of i.v. pantoprazole or to placebo for 7 days. Acid output (basal and maximal) was measured at the end of the p.o. treatment period and on the first and last days of i.v. therapy. In the primary efficacy analysis, the acid output values at the end of the p.o. pantoprazole treatment were compared with those at the end of the i.v. treatment. Safety was monitored by periodic vital sign measurements, clinical laboratory evaluations, ophthalmic examinations, electrocardiograms, and reports of adverse events. The data were tested by an analysis of covariance and by Wilcoxon signed rank and t tests. RESULTS: Maximal acid output (mean +/- SD) in the 40 mg and 20 mg pantoprazole group after p.o. treatment was 6.5 +/- 5.6 mEq/h and 14.5 +/- 15.5 mEq/h, respectively; whereas, at the end of the i.v. treatment period, the values were 6.6 +/- 6.3 mEq/h and 11.1 +/- 10.2 mEq/h, respectively. In patients given i.v. placebo, acid output was significantly (p < 0.05) increased to 29.2 +/- 13.0 mEq/h by day 7. Both p.o. and i.v. pantoprazole dosage forms had similar favorable safety and tolerability profiles. CONCLUSIONS: The p.o. and i.v. formulations of pantoprazole (40 and 20 mg) are equivalent in their ability to suppress gastric acid output. The i.v. form of pantoprazole offers an alternative for gastroesophageal reflux disease patients who are unable to take the p.o. formulation.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2000

Appropriate timing of the 14C-urea breath test to establish eradication of Helicobacter pylori infection.

OBJECTIVE: The aim of this study was to determine the performance characteristics of the 14C-urea breath test (UBT) performed 2 wk after the completion of therapy for Helicobacter pylori using a 4 to 6 wk study as the gold standard. METHODS: Patients with active Helicobacter pylori infection at four medical centers received proton pump inhibitor-based triple or quadruple therapy for 10-14 days. Patients underwent the 14C-UBT 2 and 4-6 wk after the completion of therapy. A positive test was defined as 14CO2 excretion of >200 dpm, a negative test as <50 dpm, and an equivocal test as >50 but <200 dpm. Performance characteristics of the 2-wk UBT were calculated using the 4 to 6-wk result as a gold standard. RESULTS: Eighty-five patients were enrolled and 82 patients (mean +/- SD age, 62 +/- 15 yr; 15 women) completed the protocol. Four patients had equivocal UBT results and were excluded from the analysis. Of the 78 patients, 68 (87%) had a negative 4 to 6-wk UBT. The 2-week UBT yielded a sensitivity of 90% (95% confidence interval 72-100%), specificity of 99% (97-100%), and accuracy of 97% (93-100%). In patients with a persistently positive UBT, 14CO2 excretion at 2 wk was significantly lower than at 4-6 wk after therapy (p = 0.03). CONCLUSIONS: A UBT performed 2 wk after therapy yielded results comparable to 4 to 6 wk testing. Further studies to evaluate the optimal time of confirmatory testing in the age of more effective proton pump inhibitor-based triple therapies are warranted.

Breath Tests↗
PubMed2000

A survey of internal medicine residents' knowledge about Helicobacter pylori infection.

OBJECTIVE: Despite recently published national guidelines, many physicians have only limited knowledge about Helicobacter pylori infection. We conducted this study to assess internal medicine residents' knowledge about H. pylori. METHODS: Two hundred and nineteen residents in seven accredited internal medicine training programs completed a self-administered questionnaire on personal demographics and practices related to testing for-and treating-H. pylori infection. RESULTS: Noon conferences (82%), ward teaching (66%), journals (70%), and sponsored symposia (27%) were their major sources of H. pylori-related information. Forty-eight percent had used office-based tests for the infection. Testing for (and treatment of) Helicobacter pylori infection was recommended by 97% (97%) for newly diagnosed duodenal ulcer, but by only 61% (63%) for a past history of duodenal ulcer. Many recommended testing in unproven conditions and might not have offered treatment to an infected patient. A proton pump inhibitor-based triple-drug regimen was the treatment of first choice of 55%; 20% recommended proton pump inhibitor-based dual regimens. Sixty-six percent and 80%, respectively, underestimated the rates of resistance to clarithromycin and metronidazole. In the absence of gastrointestinal symptoms, 22% would have ordered Helicobacter pylori testing but only 33% of these would undergo treatment if positive. CONCLUSIONS: Internal medicine residents usually test for Helicobacter pylori infection in appropriate conditions, but may not always treat the infection when the result is positive. Most use efficacious treatment regimens although many have inaccurate knowledge of resistance rates, which may adversely influence prescribing. Education should focus on practical issues surrounding Helicobacter pylori testing and treatment such as those contained in the American College of Gastroenterology's 1998 practice guidelines.

Adult↗
PubMed2000

Potential uses of intravenous proton pump inhibitors to control gastric acid secretion.

Proton pump inhibitors are the most effective agents for suppressing gastric acidity and are the preferred therapy for many acid-related conditions. While proton pump inhibitors have been accessible in intravenous formulations in several European countries, they have been available only as oral drugs in the United States. In the near future, the proton pump inhibitor pantoprazole is likely to become available in an intravenous formulation for American patients. Potential uses for intravenous proton pump inhibitors include treatment of Zollinger-Ellison syndrome and peptic ulcers complicated by bleeding or gastric outlet obstruction, as well as prevention of stress ulcers and acid-induced lung injury. These intravenous proton pump inhibitors are also likely to be beneficial to patients undergoing long-term maintenance with oral proton pump inhibitors who cannot take oral therapy for a period of time. Intravenous pantoprazole is especially distinguished in its lack of clinically relevant drug interactions, and it requires no dosage adjustment for patients with renal insufficiency or with mild to moderate hepatic dysfunction. Both omeprazole and pantoprazole are well tolerated in both oral and intravenous forms. Although further studies are needed to define their roles clearly, the availability of intravenous formulations of proton pump inhibitors will certainly assist with the treatment of gastric acid-related disorders.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2000

Stool testing for Helicobacter pylori infection: yet another noninvasive alternative.

A prospective, multicenter study was performed in 11 European centers to evaluate the accuracy of stool testing for active Helicobacter pylori (H. pylori) infection, using the HpSA ELISA antigen assay. The accuracy of this test was assessed in a large number of patients both before and after treatment by comparing results with a rigidly defined gold standard consisting of gastric antral and body biopsies with normal and special stains, as well as culture and rapid urease testing. The accuracy of the stool test was also compared with the currently accepted best noninvasive test, the carbon-13 urea breath test. Five hundred and one treatment naive patients (276 men, mean age 52 yr) were tested after endoscopy (491 patients had evaluable results). The sensitivity and specificity of the stool test were 94.1% (the 95% confidence interval was 90.6-96.6%) and 91.8% (87.3-95.1%), respectively. Pretreatment sensitivity and specificity for breath testing were similar (95.3% [92.2-97.5%] and 97.7% [94.8-99.3%], respectively). One hundred and seven infected patients were reassessed 4 wk after undergoing therapy for H. pylori infection. The posttreatment sensitivity and specificity of the HpSA assay was also excellent, although the confidence intervals were significantly wider because of the smaller number of patients (90% [68.3-98.9%], and 95.3% [88.5-98.7%], respectively). Posttreatment sensitivity and specificity for urea breath testing were also similar (90% [68.3-98.8%] and 98.9% [93.8-100%], respectively). Intercenter variability of test results did not reach statistical significance with either testing method. The authors concluded that HpSA stool testing is a reliable and easy-to-use method for diagnosing H. pylori infection in both treatment naïve and posttreatment patients that compares well with carbon-13 urea breath testing. They site specific advantages of the HpSA assay to include: 1) a more simple sampling method (only one stool specimen is required); 2) the lack of a requirement for trained personnel at the testing site; and 3) there is no need for expensive equipment.

Antigens, Viral↗
PubMed1999

Helicobacter pylori and gastroesophageal reflux disease.

The nature of the relationship between Helicobacter pylori (Hp) infection and gastroesophageal reflux disease (GERD) remains unclear. This article reviews the current body of knowledge regarding the association between these two common entities. The authors examine the potential interactions of Hp and GERD from epidemiologic and pathophysiologic viewpoints and summarize and critique the prevalence and eradication studies that have been performed to date. Special consideration is given to the possible effects that long-term use of proton pump inhibitors may have on Hp gastritis.

Gastroesophageal Reflux↗
PubMed1999

Dyspepsia and heartburn.

Dyspepsia and heartburn are the two cardinal symptoms of foregut dysfunction. When confronting such a problem, that physician must first learn to discern between the two, because treatment can be quite different for the conditions presenting with these symptoms. This article details the approach to work-up and treatment of patients presenting with dyspepsia or heartburn.

Diagnosis, Differential↗
PubMed1999

Diagnosis of non-Zollinger-Ellison syndrome, non-carcinoid syndrome, enteropancreatic neuroendocrine tumours.

The diagnosis of entero-neuropancreatic tumours different from Zollinger-Ellison syndrome and carcinoid syndrome require an high index of suspicion and even when they are associated to virulent syndromes such as VIPoma or insulinoma syndrome the mean delay in diagnosis is of 4 years. Symptomatic hypoglycaemia due to inappropriate insulin release from insulinoma and watery diarrhoea leading to dehydration caused by elevated circulant vaso-intestinal peptide levels are present in the 90% and 100% of the patients at presentation of the respective syndrome. Somatostatinoma syndrome has a far more subtle presentation and it tends to present much later during the disease course. The diagnosis is based on the presence of gallstones, diabetes, weight loss, diarrhoea and steatorrhoea. Growth hormone releasing factor neuroendocrine tumours (GRFoma) present with acromegaly and account for less than 2% of the acromegalic patients in which the growth hormone is from an ectopic source located in the pancreas. The Cushing's syndrome diagnosis due to rare ectopic neuroendocrine tumour adrenocorticotropic hormone secretion can be made only with selective angiography, whereas non-functional and pancreatic polypeptide producing neuroendocrine tumours (PPoma) present without any symptoms. Finally, multiple endocrine neoplasia type one occurs more commonly with somatostatinoma or GRFoma, conversely patients with multiple endocrine neoplasia type one can develop insulinoma (20%) or PPoma (60%).

Diagnosis, Differential↗
PubMed1998

Comparison of rapid office-based serology with formal laboratory-based ELISA testing for diagnosis of Helicobacter pylori gastritis.

Accurate and cost-effective diagnosis of Helicobacter pylori gastritis has taken on major importance. Several serologic tests for the diagnosis of H. pylori infection are commercially available. We compared the performance of the FlexSure HP rapid IgG antibody test with the conventional HM-CAP ELISA to evaluate whether qualitative office-based serology is reliable enough to replace formal laboratory-based testing. We assessed H. pylori status by concordance in 100 consecutive patients with antral biopsy, rapid urease, and 1 microCi[14C]urea breath tests. Both antibody tests had good sensitivity and specificity (>86%). Concordance between the two antibody tests occurred in 87/93 patients (94%). Based on our data, the office-based FlexSure HP performed equally well as the laboratory-based formal ELISA and may be a better choice for initial serologic diagnosis in untreated patients.

Antibodies, Bacterial↗
PubMed1998

Giant gastric ulcers and risk factors for gastroduodenal mucosal disease in orthotopic lung transplant patients.

Giant gastric ulcers are defined as ulcers with a diameter greater than 3 cm. Previously they have not been described in lung transplant recipients. We report a high incidence of symptomatic giant gastric ulcers and identify the risk factors for ulcer development in these patients. We examined the records of all 95 patients who had undergone lung transplantation at our institution from November 1991 to July 1995. Fourteen of the patients who underwent lung transplantation developed symptoms that required esophagogastroduodenoscopy. Three of these patients (21%) were found to have giant gastric ulcers. The relative risk of giant gastric ulcer in symptomatic patients undergoing endoscopy after lung transplantation is over 40 times that of population controls. The patients who developed giant gastric ulcers, despite H2 antagonist use, had all received bilateral lung transplantation and had received nonsteroidal antiinflammatory drugs, cyclosporine, and high-dose intravenous corticosteroids. The risk of developing giant gastric ulcers is significantly increased in patients who have undergone bilateral orthotopic lung transplantation. Clinicians should be made aware of this complication in order to avoid use of ulcerogenic medications in this population. Avoidance of these medications could potentially minimize the risk of this complication.

Female↗
PubMed1998

AccuStat whole blood fingerstick test for Helicobacter pylori infection: a reliable screening method.

Helicobacter pylori antibody testing is accurate for diagnosing untreated patients. Rapid serum testing is as accurate as formal enzyme-linked immunosorbent assay (ELISA) testing. As whole blood fingerstick tests may become the diagnostic method of choice if they are of similar accuracy, 51 patients were studied who had not taken antibiotics, bismuth, sucralfate, or proton pump inhibitors. Concordance between C-14 Urea Breath Testing and HM-CAP ELISA testing served as the study standard for H. pylori diagnosis. Rapid antibody testing was performed with the AccuStat whole blood (Boehringer Mannheim, Mannheim, Germany) and FlexSure HP (Smith Kline Diagnostics, San Jose, CA) serum tests. Antral biopsy for CLO testing and histological evaluation with thiazine staining were available for 18 (35.3%) and 20 patients (39.2%), respectively. Nineteen of 50 patients (38%) were infected. (One patient had discordant tests and was excluded.) FlexSure HP and AccuStat were each positive in 18 (36%) and 19 patients (38%) with sensitivity, specificity, and positive and negative predictive values of 89.5% and 89.5%, 96.8% and 93.5%, 94.4% and 89.5%, and 93.8% and 93.5%, respectively. There were two false-negative FlexSure HP and AccuStat tests and three false-positive tests--1 FlexSure and 2 AccuStat results. CLO test and histology concurred in every case tested. We conclude that both rapid antibody tests are accurate and suitable for screening patients not previously treated for H. pylori infection. Since the AccuStat has preserved diagnostic strength, is less costly, takes less time, and is less labor intensive, whole blood testing is the screening test of choice.

Adult↗
PubMed1998

Helicobacter colonization of the biliary tree: commensal, pathogen, or spurious finding?

The authors hypothesized that Helicobacter species may be present in the bile and gallbladder wall of patients with chronic cholecystitis who live in a region with a high prevalence of gallbladder cancer. They attempted to identify such species by obtaining both bile and resected gallbladder tissue from 46 patients who underwent cholecystectomy. Tissue specimens were stained with hematoxylin and eosin as well as other stains used specifically for the identification of Helicobacter species, and culture was attempted using specialized media on samples from tissue and bile. Unfortunately, the authors were unable to culture any Helicobacter species, and the yield from histopathology was also poor with silver stains identifying curved bacteria suggestive, but not diagnostic, of Helicobacter species in only two cases. Molecular techniques were more successful. DNA was extracted from both tissue and bile and amplified by polymerase chain reaction (PCR) using a specific primer. The amplicons they identified were then compared with known Helicobacter proteins using a Southern blot approach. PCR amplification was relatively successful with 9 of 23 gallbladder samples and 13 of the 23 bile samples coming up positive for Helicobacter species using two specific primers. These specimens were also positive by Southern blot hybridization. The cloning and sequencing of the 16S ribosomal RNA amplicons in eight cases verified true Helicobacter origin with a phylogenetic analysis showing greater than 99.3% similarity. Five of the amplicons clustered with H. bilis, two with Flexispira rappini, and one with H. pullorum. The authors concluded that despite their being unable to identify organisms directly, the stringent PCR technique with amplicon sequencing confirmed that Helicobacter species could be identified within the bile and gallbladder tissue of patients with chronic cholecystitis in a region with high incidence of gallbladder cancer. They indicated that further studies are needed to ascertain whether similar species have a causative role in the development of gallbladder cancer.

Bile↗
PubMed1997

Studies on the interrelation between Zollinger-Ellison syndrome, Helicobacter pylori, and proton pump inhibitor therapy.

BACKGROUND & AIMS: The interrelation between Helicobacter pylori infection and proton pump inhibitor therapy in patients with Zollinger-Ellison syndrome is unknown. The aim of this study was to evaluate the influence of these factors on parameters of Zollinger-Ellison syndrome. METHODS: Prevalence of H. pylori was determined by biopsy and antibody testing in 84 patients. The influence of H. pylori status on clinical and laboratory parameters of Zollinger-Ellison syndrome was evaluated. Seroconversion after surgery was assessed retrospectively in infected patients. RESULTS: The prevalence of H. pylori exposure was 23% (10% with active infection). Acid output was higher in H. pylori-negative patients, but other clinical and biochemical parameters did not differ. Parameters were also similar for patients determined to be H. pylori positive by histology or antibody testing alone. Seroconversion rates did not differ between those rendered or not rendered disease free despite a significant reduction in acid output. CONCLUSIONS: H. pylori infection is not a risk factor for peptic ulceration in patients with Zollinger-Ellison syndrome. The prevalence is lower than in the general population and much lower than for patients with idiopathic peptic ulcer disease. Long-term omeprazole therapy in H. pylori-positive patients with Zollinger-Ellison syndrome may-lead to a reduction in parietal cell mass.

Adolescent↗
PubMed1997

Device choice and experience level in endoscopic foreign object retrieval: an in vivo study.

BACKGROUND: Successful foreign object retrieval may depend on device choice and the experience level of the endoscopist, although these factors have not been systematically evaluated. METHODS: In anesthetized pigs, the ability to retrieve foreign objects (metal tack, button disc battery, wooden toothpick) placed endoscopically into the stomach was assessed. Seven university medical center gastroenterology attending physicians (5 clinical and 2 basic science research [BSR]), and 4 fellows-in-training participated. The devices used were the Roth retrieval net, rat tooth forceps, Dormia basket, polypectomy snare, and radial jaw forceps. The time to retrieve each object into an esophageal overtube within a 5 minute maximum was measured. RESULTS: Only the Roth net and Dormia basket were successful in retrieving the button disc battery, although the Roth net was superior (100% vs 27%, Fisher p < 0.025). All devices were equally successful at retrieving the tack (82% to 100%, p = NS). The snare was significantly faster than the Roth net (p < 0.05). For the tack, there was significantly fewer difficulties encountered with the snare than the Roth net (Fisher p < 0.03). The Roth net was incapable of retrieving the toothpick; the other devices were equally successful (91% to 100%). The clinical attendings had a significantly higher success rate (95%) than the fellows (82%, chi squared p < 0.05) or combined fellows/BSR attendings (80%, p < 0.02), and were significantly faster than the fellows (p < 0.0002) or the fellows/BSR attendings (p < 0.0003). CONCLUSIONS: The Roth net is the best device for retrieving smooth objects such as the button disc battery. For sharp objects, such as the tack and toothpick, best results were achieved with the snare, although the forceps were also effective. More experienced endoscopists had higher success rates and faster retrieval times. Both device choice and the experience level of the endoscopists have an impact on successful foreign object retrieval.

Animals↗