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J H Iser

Publications and source records attributed to J H Iser.

14 recordsLinked to original sources
PubMed1994

Low dose, short duration therapy for the eradication of Helicobacter pylori in patients with duodenal ulcer.

OBJECTIVE: To study the efficacy and acceptability of low dose, short duration triple therapy in eradicating Helicobacter pylori from patients with duodenal ulcer. DESIGN: A prospective study of 105 patients with H. pylori associated duodenal ulcer presenting consecutively to a regional Melbourne general hospital and a local private endoscopy clinic. INTERVENTIONS: Patients were treated with H2-antagonists (if required), followed by two weeks of triple therapy consisting of colloidal bismuth subcitrate (Denol) one tablet four times daily between meals, tetracycline hydrochloride 250 mg four times daily and metronidazole 400 mg twice daily. Four weeks, and again 12 months after treatment, patients were assessed by gastroscopy and antral biopsy for ulceration and H. pylori as measured by rapid urease test. Side effects of treatment were documented. RESULTS: Four patients withdrew because of drug side effects. Of 101 patients completing treatment, H. pylori was eradicated in 91 (90%, or 87% of total). Eight of the 10 patients in whom initial treatment failed received one or more further courses of triple therapy, with H. pylori being eradicated in five. Mild nausea occurred in 6% and possible candida infection in 3%. Of 68 patients who were reassessed after 12 months, 66 were still clear of H. pylori but, in four, small superficial ulcers were present. Two patients were positive for H. pylori, one with and one without ulceration, giving an H. pylori recurrence rate of 3% and an ulcer recurrence rate of 7%. CONCLUSIONS: This particular regimen of triple therapy was highly effective, safe and acceptable and could be offered to all patients with H. pylori associated duodenal ulcer.

Adult↗
PubMed1982

Outcome of chenodeoxycholic acid (CDCA) treatment in 125 patients with radiolucent gallstones. Factors influencing efficacy, withdrawal, symptoms and side effects and post-dissolution recurrence.

Of 125 patients with radiolucent gallstones in functioning gallbladders treated with chenodeoxycholic acid (CDCA) between 1971 and 1977, 47 showed complete gallstone dissolution--an overall efficacy of 38%. However, a retrospective analysis of factors governing efficacy carried out in 1976 showed that in patients with stones less than 15 mm in diameter, treated with greater than 13 mg CDCA kg-1 day-1 for not less than one year who developed unsaturated bile (n = 27), efficacy rose to 78% complete and 93% partial plus complete gallstone dissolution. The usefulness of this selection/management approach was then confirmed prospectively in 42 comparable patients selected for treatment since 1977, efficacy (complete gallstone dissolution) reached 76%. The median duration of treatment for complete gallstone dissolution was 7.5 months for stones less than 5 mm in diameter, 12.0 for 5-10 mm stones; 22.0 for 10-15 mm stones and 28.5 for the only two patients (of 26) with large (greater than 15 mm) stones who ultimately showed complete gallstone dissolution. Seventy-eight patients withdrew from therapy, 21 within 6 months of starting CDCA (before their first follow-up cholecystogram): the remaining 57 withdrew because of: complications of gallstones (11 patients), inadequate treatment (dose and/or duration, 20 patients), inappropriate selection or unsuitable stones (19 patients) and resistance to CDCA (7 patients). Diarrhea, although common, was usually mild or transient. Biliary colic and non-specific dyspepsia tended to improve during therapy. To date, gallstone recurrence has been detected in 14 patients (30%), 3 months to 5 years after discontinuing treatment with CDCA.

Adolescent↗
PubMed1981

Chenodeoxycholic acid: a review of its pharmacological properties and therapeutic use.

Chenodeoxycholic acid (chenic acid; CDCA) is 1 of the 3 major biliary bile acids in man. When administered in pharmacological doses it causes a decrease in cholesterol saturation of bile, which in turn may lead to gradual dissolution of cholesterol gallstones. The stone dissolution rate during CDCA therapy has varied considerably from about one-third of patients overall to 80 to 90% in a highly selected group of patients. Radiolucent gallstones in a functioning gallbladder are absolute requirements. CDCA is well tolerated; diarrhoea (sometimes requiring dosage reduction) is the only frequent side effect. Although hepatotoxicity has occurred in certain animal species, and slight hypertransaminasaemia has occurred in some patients, definite liver damage has not been observed in man. CDCA is considered contraindicated in pregnancy, and in those patients with the complications from gallstones which require immediate surgery. Care should be taken in patients with liver disease. The only other proven agent for dissolving gallstones is the 7 beta-epimer of CDCA, ursodeoxycholic acid (UDCA). Preliminary results show that UDCA is as effective as CDCA, but at one-half to two-thirds the dose, without causing diarrhoea. Further studies need to be done with both CDCA and UDCA to improve criteria for selection of patients most likely to respond, and to establish optimum schedules for dosage and duration of treatment.

Animals↗
PubMed1978

Resistance to chenodeoxycholic acid (CDCA) treatment in obese patients with gall stones.

In most patients with radiolucent gall stones who were given chenodeoxycholic acid (CDCA) in doses of 13-15 mg/kg body weight/day the bile became unsaturated in cholesterol, and their gall stones dissolved. The patients whose stones did not dissolve were significantly heavier and fatter than the responders, which suggested that obese patients might be "resistant" to the effects of CDCA. To test this hypothesis, 32 consecutive patients presenting for medical treatment of gall stones had their ideal body weight (IBW) and estimated body fat mass calculated. The eight most obese and the eight least obese patients were then selected, and their fasting bile lipid responses to CDCA 13-15 mg/kg/day were measured. The very obese patients were also given larger doses, and any changes in bile lipid composition were studied in relation to subsequent gall-stone dissolution.Before treatment the obese patients had a higher mean biliary cholesterol saturation index than the non-obese patients, and this difference was maintained during treatment with the normal dose of CDCA: the bile in the obese patients remained supersaturated while that in the non-obese became unsaturated with cholesterol. When the obese patients were given larger doses of CDCA their bile ultimately became unsaturated in cholesterol. Gall stones dissolved partially or completely in five of the eight non-obese patients after 6-18 months of 13-15 mg CDCA/kg/day, but none of the obese patients showed any response after comparable periods of treatment with this standard dose. With increased doses and unsaturated bile, however, three of the obese patients showed partial gall-stone dissolution after 3-12 months' treatment and one showed complete gall-stone dissolution after three years' treatment.These results suggest that when giving CDCA to patients with gall stones, larger than normal doses (some 18-20 mg/kg/day) should be prescribed. Alternatively the lipid composition of the patients' bile should be monitored by duodenal intubation and the CDCA dose increased until the bile becomes unsaturated in cholesterol.

Adult↗
PubMed1977

Speed of change in biliary lipids and bile acids with chenodeoxycholic acid--is intermittent therapy feasible?

To see whehter intermittent chenodeoxycholic acid (CDCA) therapy is a potential alternative to continous treatment for gallstone dissolution, the speed of change in bile lipid composition was studied after starting and stopping CDCA therapy. In addition, the relationship between bile lipid composition and the proportions of the bile acids was examined. Bile-rich duodenal fluid was collected twice in the first week and then at approximately weekly intervals for four to six weeks, from six gallstone patients starting 13-15 mg CDCA.kg BW-1 day-1 and from another group of six patients whose treatment was stopped after gallstone dissolution. After starting treatment, the mean biliary cholesterol saturation index (based on criteria of Hegardt and Dam, 1971) decreased from 1-49 +/- SEM 0-17 to 0-92 +/- 0-13 at three weeks and 0-88 +/- 0-10 at four weeks, by which time bile lipid composition had become relatively constant. In patients whose treatment was stopped, bile reverted to its supersaturated state within one week, changing from an on-treatment mean saturation index of 0-74 +/- 0-10 to 1-15 +/- 0-15 in six to eight days after withdrawing CDCA. The proportion of conjugated CDCA in the biliary bile acids increased from 27-9 +/- 2-5% to 60-5 +/- 4-2% within four days and to 80-7 +/- 6-2% by four weeks after starting CDCA. When treatment was stopped, the proportion of CDCA reverted to pretreatment levels by two to three weeks. The saturation index was significantly related (P less than 0-001) to the percent of conjugated CDCA present, such that when the proportion of CDCA exceeded 70%, bile was almost invariably unsaturated. Since the mean time taken for bile to become unsaturated was not shorter than the time taken for bile to revert to its supersaturated state, it seems that intermittent treatment would not be adequate to maintain an unsaturated bile and is, therefore, unlikely to be as effective as continuous treatment in dissolving gallstones.

Adult↗
PubMed1975

Chenodeoxycholic acid treatment of gallstones. A follow-up report and analysis of factors influencing response to therapy.

We treated 70 patients with gallstones with chenodeoxycholic acid over 3 1/2 years and analyzed the factors influencing the outcome of therapy. This treatment was unsuccessful in 11 patients with radiopaque gallstones and in seven with nonfunctioning gallbladders, but 64 per cent with radiolucent gallstones treated for six months or more showed partial or complete gallstone dissolution, and of those whose bile became unsaturated with cholesterol, 100 per cent had evidence of dissolution. In patients with partial or complete gallstone dissolution, the mean post-treatment biliary cholesterol saturation index--0.78 +/- 0.04 (S.E.M.)--was significantly less (P less than 0.001), and the dose of chenodeoxycholic acid (14.4 +/- 1.0 mg per kilogram of body weight per day) significantly more (P less than 0.025) than in those whose gallstones did not change (1.15 +/- 0.04 and 10.6 +/- 1.2 respectively). In patients with radiolucent gallstones, the dose of chenodeoxycholic acid should be based on body weight; 14 to 15 mg per kilogram of body weight per day effectively lowers the saturation index and dissolves gallstones.

Adult↗
PubMed1975

Hepatic bile acid transport: effect of conjugation and position of hydroxyl groups.

The hepatic transport of five bile acids was studied in the bile-fistula rat. Pairs of labeled bile acids were injected simultaneously into the portal vein as a sharp pulse and the secretion of radiolabel in bile was measured over the nex 15 min. Six bile acid pairs were tested, and it was found that both conjugation and the number and disposition of hydroxyl groups influenced hepatic transport. Taurocholic acid was transported most efficiently, followed in order by glycocholic acid, cholic acid, deoxycholic acid, and chenodeoxycholic acid. Sampling aortic blood immediately after portal vein injection of labeled bile acid pairs demonstrated differential rates of hepatic extraction. In every comparison, the bile acid that was more efficiently extracted by the liver had a faster overall transport rate. This suggests that the differing rates of biliary secretion are, at least in part, determined by the efficiency of hepatic uptake.

Animals↗
PubMedDate not supplied

The hepatic transport of taurocholic acid in the rat: development of a mathematical model.

1. The transport of taurocholic acid from portal blood to bile was studied in the anaesthetized rat by injecting a radiolabelled pulse of bile acid. 2. The transport process was very rapid, 50% of the dose being secreted within 5 min, and the total dose within 15 min. 3. The transport process had a large capacity. The secretory profile was little modified by a 500-fold increase in the injected dose. 4. The transport process was modelled with both analogue and digital computers. The simplest model which fitted the data comprised rapid uptake from portal blood, slow transport across the cell and rapid secretion into bile. The digital computer simulation suggested that this model is not unique, but will require further testing.

Animals↗