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Biomedical subjects

M J Langman

Publications and source records attributed to M J Langman.

At least 73 records · Page 4Linked to original sources
PubMed1991

Post-cimetidine surveillance for up to ten years: incidence of carcinoma of the stomach and oesophagus.

The long-term effects of cimetidine on the occurrence of gastric and oesophageal cancer were assessed in a prospective cohort study of 9928 patients who had been prescribed cimetidine. They were first identified between 1978 and 1980, and cancer registrations and deaths were identified among them over a period of up to 10 years. One hundred and eleven cancers were identified after the start of cimetidine treatment: 71 were adenocarcinomas of the stomach, 27 were carcinomas of the cardia and/or oesophagus (22 adenocarcinomas, five unknown histology) and the remaining 13 tumours were squamous cell cancers of the oesophagus. Only six patients presented with early gastric cancers. Over a period of eight years the ratio of observed to expected (O/E) gastric cancer deaths has fallen from 10.7 (p < 0.001) to 1.2 (NS). The O/E ratio of oesophageal cancer deaths also fell over the first six years of study, from 5.4 (p < 0.01) to 1.4 (NS) but it has risen slightly in years 7 and 8 to 3.7 (p < 0.05). These findings do not suggest that there is an increased risk of developing oesophageal or gastric cancer from cimetidine treatment, and are generally consistent with cimetidine being used inadvertently to treat the early symptoms of gastric and oesophageal cancer. The slight rise in oesophageal cancer deaths in years 7 and 8 was unexpected and will be the subject of further observation.

Adenocarcinoma↗
PubMed1990

Effect of ranitidine and indomethacin on nocturnal gastric acidity in normal subjects.

To assess the effect of indomethacin on gastric acidity and to identify a potential pharmacodynamic interaction between indomethacin and ranitidine, we measured nocturnal acidity on half-hourly aliquots of gastric contents from 10 volunteers on the seventh day of four dosing regimens given in a randomized double-blind manner. These were indomethacin (50 mg t.d.s.) and ranitidine (300 mg in the evening) together or alone with matching placebos. Median nocturnal acidity on placebo was 41.7 mmol/L (range 67.6-25.1 mmol/L) and was 39.8 mmol/L (63.1-24.0 mmol/L) on indomethacin (N.S.). During ranitidine dosing it was 0.4 mmol/L (21.3-0.0 mmol/L) without and 0.8 mmol/L (43.7-0.0 mmol/L) with concurrent indomethacin, representing 99 and 98% decreases in gastric acidity (P less than 0.01) compared with placebo. Indomethacin did not increase overnight gastric acidity and did not influence the suppression of acidity produced by ranitidine. It is unlikely that the ulcerogenic potential of indomethacin is explicable by an effect on gastric acidity.

Adult↗
PubMed1990

Duodenal ulcer and refined carbohydrate intake: a case-control study assessing dietary fibre and refined sugar intake.

An association between duodenal ulceration and a low fibre intake and a high refined carbohydrate diet has been reported. We therefore compared the current diet, smoking habits, social class, and possible other risk factors of 78 patients with duodenal ulcer and a community control group matched for age and sex. Logistic regression for matched sets was used to calculate the relative risks for successive quintiles of dietary fibre and sugar intake before and after adjustment for total calorie intake and for the possible confounding effect of other known risk factors. Relative risks did not differ materially or consistently for total dietary fibre or for the cereal moiety whether adjusted or not for calorie intake. By contrast, relative risks tended to be reduced with high vegetable fibre intake and with low refined sugar intake. After controlling for smoking and social class, both of which were associated with ulcer disease, and for relative weight (Quetelet's index), the relation between ulcer disease and low refined sugar intake persisted, while that with high vegetable fibre intake was reduced. The results of this study indicate that a lack of cereal or total fibre intake plays no part in duodenal ulcer development but that a low refined sugar intake may be a protective factor.

Adult↗
PubMed1989

Epidemiologic evidence on the association between peptic ulceration and antiinflammatory drug use.

Adverse effects associated with nonsteroidal antiinflammatory drug treatment are reported more commonly to regulatory authorities than the adverse effects of any other form of treatment. Epidemiologic evidence in general suggests a doubling or quadrupling of the risk of ulcer complications or death in recipients of such treatment. The risk appears to be related to increasing age, but no other associated factor has yet been identified. It is uncertain whether individuals with preexisting ulcer are at special risk or whether treatment predisposed equally to ulcer and ulcer complications, and there is no clear evidence that the nature of the disability leading to nonsteroidal antiinflammatory drug treatment influences the risk of gastrointestinal complications.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

Audit of mortality in upper gastrointestinal bleeding.

The outcome in 1017 patients with haematemesis and malaena referred to two major hospitals in Nottingham within a 2-year period has been prospectively evaluated. Ninety one (9%) patients died during the time period under consideration and all but four were found to have been over 60 years of age. There were 13 (14%) deaths following rebleeding, of whom 5 (5%) could have been potentially avoided by alterations in management. Some improvement of mortality might result from intensive-care facilities with better management of transfusions and earlier detection of rebleeding allowing earlier endoscopy or surgery. The majority of patients (81%), however, died from concomitant disease which was exacerbated by gastrointestinal haemorrhage or bleeding developed in patients with an already existing end-stage disease. These results show that a reduction of mortality in patients with gastrointestinal bleeding is hampered by the high number of poor-risk patients. The rise in the proportion of elderly patients with this disorder seems to continue.

Age Factors↗
PubMed1989

[Smoking and inflammatory bowel diseases].

In a case-control study 142 patients with Crohn's disease, 189 patients with ulcerative colitis and matched community controls were questioned about their smoking habits. When assessed by smoking habits before the onset of disease, patients with Crohn's disease were four times as likely to have been smokers than their matched controls. In contrast, patients with ulcerative colitis were ten times less likely to have been smokers compared with their matched controls. There was no confounding by social class or alcohol intake differences. The contrasting nature of these associations suggests that there might be an aetiological role for smoking in inflammatory bowel disease.

Adult↗
PubMed1988

Aspirin and bleeding peptic ulcers in the elderly.

A case-control study was performed to determine whether aspirin confers a similar risk of bleeding from gastric or duodenal ulcers in the elderly as non-aspirin, non-steroidal anti-inflammatory drugs. The intake of analgesics in 230 patients with bleeding ulcers aged 60 and over and in hospital and community controls matched for age and sex was examined. Those who had taken aspirin were between two and three times more likely to be admitted to hospital with bleeding ulcers. This increased risk was not accounted for by aspirin taken for indigestion or by concurrent use of non-aspirin, non-steroidal anti-inflammatory drugs. A similar effect was not seen for paracetamol. When aspirin and other non-steroidal anti-inflammatory drugs were considered together the overall risk attributed to the drugs suggested that these drugs may be responsible for over a third of admissions for bleeding peptic ulcers in the elderly.

Aged↗
PubMed1988

Ulcer complications and nonsteroidal anti-inflammatory drugs.

Rates of ulcer perforation, hospital admission, and death are usually regarded as the best available measures of the frequency of severe peptic ulcer disease. Overall admission rates have tended to decline, which almost certainly reflects the widespread adoption of effective outpatient therapy. The overall incidence of ulcer perforation and death may also have fallen. However, at least in Europe, and in the United Kingdom in particular, there may be differences between the young and the elderly; rates of perforation and death in the young appear to be declining, whereas they are rising or static in the elderly. Although there are various interpretations for these changing patterns, data for the United Kingdom suggest that during the last 15 to 20 years some unidentified factor or factors began to influence the rates of severe peptic ulcer disease among the elderly. At least part of this change may reflect increasingly frequent prescribing of nonsteroidal anti-inflammatory drugs (NSAIDs). In the United Kingdom, most adverse drug reactions attributable to NSAIDs are gastrointestinal and are usually serious. Bleeding and perforation are common, may occur in the absence of warning symptoms, and are associated with a high mortality rate. In some countries, other factors, including smoking and diet, may be equally important. It is difficult to determine the relative contribution of each factor, though the widespread perception that the gastrointestinal tolerance of NSAIDs is poor, particularly in the elderly, may be well founded. About half the prescriptions for non-aspirin NSAIDs in the United Kingdom are for patients over 60 years of age. About one quarter of all cases of upper gastrointestinal bleeding in the elderly are likely caused by NSAIDs and are associated with a death rate of 10 percent or possibly higher. Although the absolute risk of a serious gastrointestinal complication may be low, perhaps one in several thousand NSAID prescriptions, the total burden of disease is high because of the multimillion NSAID prescriptions issued yearly.

Adult↗
PubMed1988

Ulcer and ulcer complications from non-steroidal anti-inflammatory drugs: what is the risk?

Gastroenterologists believe that non-steroidal anti-inflammatory drugs (NSAIDs) cause dyspepsia, may cause ulcers to develop de novo and cause ulcer bleeding and perforation. Regulatory authorities are aware that NSAID-associated adverse events are reported more often than for any other drug class, and that gastrointestinal events are most common and often serious. A case-control study in the UK indicates that those who use NSAIDs may be between two and four times as liable to gastrointestinal bleeding and probably perforation as non-users, particularly if elderly. It has further been suggested that the chances of dying of ulcer complications are very high in NSAID users. By contrast, studies in the USA conducted prospectively and post-marketing surveillance in the UK have appeared to show little risk. Differences may be partially, if not completely, explained by the variable methodologies employed. Dispute also exists about the rank order and significance of toxic effects among the various agents.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1988

Smoking and sugar intake are separate but interactive risk factors in Crohn's disease.

Previous studies have consistently found strong positive associations between refined sugar intake and Crohn's disease (CD) and recently between smoking and CD. As refined sugar intake and smoking are themselves associated we have enquired about smoking and added sugar intake (AS) and smoking in CD using a postal questionnaire sent to 104 CD patients and 153 community controls. Smoking and AS were associated with one another. After adjusting for AS, smoking showed a significant association with CD with a relative risk of 1.8. After adjusting for smoking habit, AS was also strongly associated with CD in never and exsmokers and in a dose response pattern, with the relative risks for no AS, less than 50 g/day and greater than 50 g/day being respectively 1.0, 1.8, and 4.6 (chi 2 = 12.1; p less than 0.005). No association between CD and AS was evident in smokers. The AS relationship was supported by a separate association between frequency of confectionery consumption and CD. These findings indicate that while smoking and AS are individually associated with CD combined exposure results in no further increase in risk, suggesting that they may operate through a common mechanism.

Adolescent↗
PubMed1988

Antisecretory drugs. Safe and effective?

Surveillance of takers of the antisecretory drug cimetidine has failed to reveal any disturbing trends. This pattern is reassuring but the difficulties of detecting drug-induced disease mimicking ordinary community complaints deserve emphasis. Experience since the surveillance study began has not revealed any disturbing trends. Observed mortality rates have fallen to match population expectation, both for ordinary disease and for cancer. The pattern is generally reassuring and suggests that significant drug-induced disease is not being missed. Nevertheless the ability of this or any other surveillance study to detect drug-induced illness mimicking ordinary disease is likely to be low.

Anti-Ulcer Agents↗
PubMed1988

H2 antagonists in the treatment of upper gastrointestinal bleeding.

It is plausible that, for pharmacologic and physiologic reasons, antisecretory treatment reduces the chances of rebleeding from gastric and duodenal ulcers and thereby reduces operation and death rates. Currently available evidence is not strong enough to confirm this, in part because trials have been too small to detect any differences present, and perhaps in part because drug doses have been too low to achieve the desired antisecretory potential.

Clinical Trials as Topic↗