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H M Spiro

Publications and source records attributed to H M Spiro.

At least 55 records · Page 3Linked to original sources
PubMed1983

H2-blockers: how safe and how effective?

Worldwide clinical experience has shown the short-term use of H2-blockers is safe and effective. They speed the healing of acute endoscopically proven duodenal ulcer with few important side effects. Curious differences in placebo response and reported efficacy from country to country deserve explanation, but do not blur the overall benefit from H2-blockers or the general satisfaction of patients and physicians. While it seems likely that a concerned physician and a dedicated patient could achieve the same results without such therapy, the major clinical advantage of H2-blockers lies in the speed and ease with which they relieve symptoms and hasten healing of the ulcer crater. Indeed, it could be argued that such therapy should not be restricted to the patient with a "proven" duodenal ulcer, and that patients with symptoms who might have "Moynihan's disease" (dyspepsia without a crater) deserve therapy without further diagnostic endeavors. Long-term therapy is still under judgment for both safety and efficacy. Controlled clinical trials suggest that H2-blockers prevent the recurrence of endoscopically proven duodenal ulcer at an impressive rate, while the recurrence rate of duodenal ulcer in patients taking placebo has been appalling. Many thoughtful physicians now argue that the patient with a duodenal ulcer ought to remain on maintenance therapy after the ulcer has healed. There is a problem, however, in the "selection" bias of the controlled trial; only patients with a proven ulcer crater have been entered into such studies and therefore they represent a subset, however important, of patients with dyspepsia and peptic ulcer symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Cimetidine↗
PubMed1982

Duodenal ulcer.

Explore the source record for details and available documents.

Duodenal Ulcer↗
PubMed1982

Inflammatory bowel disease and pregnancy.

Inflammatory bowel disease (IBD) commonly affects women of childbearing age, leading to concerns about the effects of the disease on fertility and pregnancy, the effect of pregnancy on the disease, and the diagnosis and treatment of IBD in the pregnancy women. The literature regarding these issues is reviewed, and a representative case report is discussed. Ulcerative colitis has no effect on fertility. Crohn's disease appears to be associated with an increased risk of infertility. "Subfertility," a temporary inability to conceive associated with chronic disease activity, is perhaps a more suitable description. There have been no studies regarding infertility and males with IBD, although sulfasalazine has recently been reported to cause reversible infertility in men. Ulcerative colitis is not associated with a higher spontaneous abortion rate than the general population, although it is not clear whether certain subgroups of patients have a higher rate of abortion. A similar conclusion has been reached for Crohn's disease, although reported abortion rates of 10-25% are somewhat higher than the general population. Approximately 30-50% of pregnant women with ulcerative colitis have exacerbations during their pregnancy or postpartum, a figure that is applicable to Crohn's disease as well, and which is no different than a control population of nonpregnant women with IBD. Patients with active ulcerative colitis at conception have a higher incidence of disease exacerbation than those with quiescent disease. Postpartum recurrences are more frequent in Crohn's disease, occurring in up to 40% of patients, but respond to standard medical therapy. Women who have had an ileostomy for ulcerative colitis consistently and successfully carry pregnancy to term. There is no data regarding women who have had an ileostomy for Crohn's disease. The approach to the women with abdominal pain during pregnancy is reviewed, including the use of radiographic procedures. No amount of radiation exposure can be considered safe, but the judicious use of standard radiographic tests when considered necessary for the health of the mother appear to be associated with little risk for the fetus. The medial treatment of IBD during pregnancy is the same as that for the nonpregnant patient. Despite animal data to the contrary, the bulk of human data suggests that steroids, when used to treat a variety of conditions including IBD, pose little risk to the human fetus. Similarly, despite the theoretical risk of kernicterus, sulfasalazine appears to be a safe drug even when used during the third trimester of pregnancy.U

Abortion, Spontaneous↗
PubMed1982

Cimetidine and duodenal ulcer: an analysis of methodologic problems in randomized controlled trials.

The double-blind placebo-comparison randomized clinical trials (RCTs) of cimetidine in the treatment of duodenal ulcer (DU) are examples of good, well-designed clinical trials. With the publication of the first United States RCT in 1978, which reported superiority for cimetidine for only 2 weeks of treatment, grounds for healthy skepticism arose. We undertook a methodologic review of the 16 RCTs published in English through 1980 testing cimetidine in endoscopically documented DU to ascertain if methodologic problems could explain the disparate results. The lack of a clinical classification of disease severity, the failure to consider the additional effect of iatrotherapy (the healing effect of the investigator), the failure to separate duodenitis from ulceration and to note transitions--change in duodenitis and change in ulcer size, and the failure to calculate beta error statistics for "negative" RCTs are important methodologic problems that could explain the disparate results. Future RCTs of therapy in DU should address these issues.

Cimetidine↗
PubMed1981

Hydrogen peroxide colitis: a report of three patients.

We have seen three patients with acute ulcerative colitis after hydrogen peroxide enemas. The colitis is probably the result of the explosive entrance of gas into the loose connective tissues of the mucosa and submucosa of the rectum and sigmoid. Fortunately, it is transitory in nature, but it should be distinguished from ulcerative, ischemic, or pseudomembranous colitis.

Adult↗
PubMed1981

Therapy of esophageal stricture: a review of 84 patients.

The course of patients with stricture of the esophagus is variable. Operation is effective, but preoperative trials of dilatation are often inadequate. We reviewed the records of 84 patients with esophageal stricture of various causes of assess efficacy of operative and nonoperative management. Sixty-five percent of patients were successfully treated with serial bouginage alone and 35% required operation, with an overall mean follow-up of 59.6 months. Sixty-eight percent of 37 patients with reflux-induced stricture were successfully treated with bouginage, whereas 32% required operation. Eighty-five percent of patients with stricture from nasogastric tubes of esophageal surgery wre successfully treated with dilatation, but 67% of those with corrosive stricture needed operation. Although surgical therapy is effective and generally safe on the management of esophageal stricture, we estimate that two-thirds of patients with stricture can be treated satisfactorily with nonoperative dilatation. Bouginage should be tried as the initial therapy in patients with reflux-induced, postoperative, or tube-related stricture of the esophagus.

Adolescent↗
PubMed1980

The effectiveness of panendoscopy on diagnostic and therapeutic decisions about chronic abdominal pain.

To evaluate the impact of panendoscopy on diagnosis and management, we asked several gastroenterologists to state their diagnoses, management plans, and confidence in these plans before performing endoscopy in patients with chronic abdominal or thoracic pain; and to repeat the same decisions after endoscopy. To evaluate acceptance of the procedure, patients were later interviewed about their discomfort during its performance. To check the way that changes in diagnosis may have affected patient management, we formed six diagnostic groups that roughly correspond to differing treatments. The postendoscopic diagnostic groupings revealed two unsuspected cancers and disagreed with the original classification in 38 (45%) of 84 patients. Dramatic or substantial changes in management occurred in 37 (44%) patients, but often did not correspond to changes in diagnosis. Conversely, management was often unchanged despite alterations in diagnosis. Patients expressed about equal preferences for barium meal as for panendoscopy, and 75% would have agreed to a repeat endoscopy without hesitation. Although the ultimate benefits of postendoscopy management changes were not ascertained, we believe that these results support the use of panendoscopy in patients with persistent and unexplained symptoms.

Abdomen↗