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Biomedical subjects

P M Kleveland

Publications and source records attributed to P M Kleveland.

At least 19 recordsLinked to original sources
PubMed2000

[Palliative endoscopic stent drainage of non-operable malignant biliary obstruction].

BACKGROUND: Endoscopic stenting is the treatment of choice for inoperable malignant biliary obstruction. The standard plastic stents in use, however, tend to clog with time. MATERIAL AND METHODS: We report the patient survival and stent patency rates in two separate groups of patients treated endoscopically for malignant biliary strictures on the basis of a retrospective review of patient medical records. The first group of 27 patients was treated with small caliber polyethylene stents in 1997. The second group of ten selected patients with fairly good life expectancy was treated with self-expandable wallstents due to early plastic stent occlusion in 1998. RESULTS: The median stent patency and patient survival of patients treated with plastic stents was 11 and 14 weeks, respectively. Early stent occlusion occurred in seven patients. The median stent patency and patient survival of the patients treated with wallstents were 25 and 32 weeks, respectively. Late stent occlusion due to tumour ingrowth occurred in two patients. INTERPRETATION: The last generation of self-expandable wallstent is endoscopically easy to insert and represents a valuable supplement to standard plastic stenting. Due to high cost, however, metal stents should preferably be offered patients with early plastic stent occlusion and estimated good life expectancy.

Adult↗
PubMed1998

[Treatment of Helicobacter pylori infection].

The article presents information gained from a survey among Norwegian hospitals in March 1997 concerning their treatment of infections with Helicobacter pylori. Altogether 52 hospitals answered the questionnaire. A combination of proton pump inhibitors, metronidazole and clarithromycin was used by 59% as first choice and urea quick test (94%) and urea breath test (42%) as the primary diagnostic procedures, whereas serology was in little use (17%). Besides ordinary ulcer disease, indications for treatment were: ulcer induced by non-steroid anti-inflammatory drugs (79%), gastrooesophageal reflux (37%), non-ulcer dyspepsia (14%) and cancer prophylaxis (14%). The gastro group at the Department of Pharmacotherapeutics at the University of Oslo invited specialists from all health regions to discuss indications for treatment of H pylori, the diagnosis and the role of general practitioners. The extensive use of clarithromycin might be doubtful due to development of resistance. Indications for treatment of H pylori other than ulcer disease and mucosa associated lymphoid tissue lymphoma are still uncertain. Uncritical use of serological tests in primary care should be discouraged. At present there is no uniform strategy for the diagnosis and treatment of H pylori infection, and a coordinated strategy between general practitioners and specialists is needed.

Antacids↗
PubMed1998

[Children and adolescents with ulcerative colitis and Crohn disease].

The diagnosis and treatment of children and young people with ulcerative colitis and Crohn's disease follows the same guidelines as for adults, but several important and unique problems related to the diseases in young age groups deserve attention. Since ulcerative colitis and Crohn's disease are relatively rare at a young age, there is often a lack of awareness among people in general, parents and general practitioners. There is therefore often an unnecessarily long delay before the young patient is seen by a general practitioner and then referred to a specialist centre where the diseases can be properly diagnosed, evaluated and treated. Chronic gastrointestinal symptoms caused by inflammatory bowel disease at an age where physical and mental growth are at a peak could result in serious negative effects not only on young patients' physical and mental development, but also on their self-esteem. The diseases adversely affect the quality of life of many young patients and their families and are a source of anxiety, emotional, behavioural, and psychological morbidity. Patients' organisations can help by providing additional information and support through special groups for young patients with inflammatory bowel disease.

Adolescent↗
PubMed1997

[A simple method for endoscopic placement of a nasojejunal feeding tube].

The aim of this paper is to describe a simple, nonsurgical method for endoscopic placement of a nasojejunal feeding tube. A stylet inserted in the tube facilitates nasogastric intubation. A thread on the tip of the tube is grasped with a biopsy forceps inserted through an endoscope, and the tube can be placed in the distal part of the duodenum under direct endoscopic inspection. By means of a guide wire the tube can be pushed further to the desired position in the upper part of the jejunum. The endoscope can now be removed while pressure is exerted on the stylet, thus preventing the tube from dislocating. By this method, oral-nasal transfer of the tube is avoided, the tube is placed in the upper jejunum under direct endoscopic inspection, and the stylet inserted in the tube facilitates intubation and prevents it from dislocating when the endoscope is withdrawn.

Endoscopes, Gastrointestinal↗
PubMed1997

In single doses ranitidine effervescent is more effective than lansoprazole in decreasing gastric acidity.

BACKGROUND: A rapid and reproducible decrease of gastric acidity is preferable in patients with penetrating/perforating peptic ulcers and in on-demand treatment of some patients with dyspepsia. The present study was done to compare the effect of single doses of ranitidine effervescent with that of the proton pump inhibitor lansoprazole. METHOD: Twelve healthy young volunteers were studied by 11-h intragastric continuous pH recording after the intake of ranitidine 150 or 300 mg effervescent tablets or lansoprazole 30 mg capsules. Trial medications were taken with 200 mL water, and the subjects remained fasting apart from 250 mL fluid at 4 h. RESULTS: Ranitidine effervescent, both 150 and 300 mg, induced a rapid and persisting increase in gastric pH in most of the subjects, whereas a single dose of lansoprazole 30 mg did not affect intragastric pH in five of the twelve subjects. CONCLUSION: The histamine H2-blocker ranitidine given as an effervescent formulation is superior to the proton pump inhibitor lansoprazole in inducing a rapid decrease of gastric acidity.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1997

Relationship between the efficacy of amoxicillin and intragastric pH for the treatment of Helicobacter pylori infection.

BACKGROUND: Proton pump inhibitors are reported to enhance the efficacy of antibiotics in the treatment of Helicobacter pylori infection. An elevated intragastric pH is considered to be an important factor for this increased antimicrobial efficacy. The aim of this study was to assess the effect of different doses of lansoprazole on 24-hour intragastric pH and to correlate the effect of amoxicillin on the cure rate for H. pylori infection with the intragastric pH obtained during lansoprazole treatment. PATIENTS AND METHODS: Thirty-six duodenal ulcer patients who tested positively for H. pylori as assessed by a rapid urease test, culture, and histological evaluation were allocated randomly to dual treatment with amoxicillin, 3 gm/day, and lansoprazole in different doses ranging between 30 and 180 mg/day for 2 weeks. A 24-hour intragastric pH measurement was taken in all patients on the fifth day of treatment. H. pylori status was determined by culture and histological workup 6 weeks after cessation of the amoxicillin-lansoprazole medication. RESULTS: The H. pylori infection was treated successfully in 19 of 32 patients who completed the dual therapy (per protocol, 59.4%). The median intragastric pH in patients who were treated successfully was 4.4 (95% confidence interval [CI] = 3.7-4.7), as compared to 4.0 (95% CI = 3.5-4.5) in patients who were not treated successfully (p = .47, Wilcoxon's rank sum test). The median percentage of time that the intragastric pH exceeded 4 was not different in the two groups (p = .77). Administration of lansoprazole in doses exceeding 30 mg induced only a moderate additional increase in intragastric pH. CONCLUSIONS: Profound inhibition of gastric acid secretion seems not to be necessary to improve the effect of amoxicillin on the cure rate for H. pylori infection in patients with duodenal ulcers.

Adult↗
PubMed1995

[Damages to the large intestine induced by non-steroidal anti-inflammatory agents].

Non-steroidal anti-inflammatory drugs can cause side effects in the large bowel. We describe two cases which illustrate some of the aspects associated with this problem, and briefly outline the different types of side effects encountered, and possible pathogenetic mechanisms. It is emphasized that non-steroidal anti-inflammatory drugs can cause exacerbation of quiescent colitis in patients with inflammatory bowel disease. The use of these drugs in such patients should be very restrictive. Non-steroidal anti-inflammatory drugs can also precipitate de novo colitis. They are also associated with collagenous colitis, non-gangrenous ischemic colitis, complications to diverticular disease, and ulceration of the colon.

Adult↗
PubMed1995

The natural course of peptic ulcer disease and its predictors.

BACKGROUND: Little is known about today's natural course of peptic ulcer disease (PUD). METHODS: A follow-up study based on a structured telephone interview was attempted in 728 patients with an endoscopic diagnosis of peptic ulcer in 1980-84. RESULTS: Seven patients (1%) died because of PUD during the 8- to 10-year follow-up period. Of the 441 interviewed patients 15.2% had experienced no further clinical manifestations of PUD, 10.9% had had bleeding and 0.7% perforation, and 17.5% had been operated on. The operated patients reported fewer symptoms (p < 0.01) during the last 2 weeks before the interview than those not operated on. On an average the unoperated patients had had symptoms and had used histamine-2-receptor antagonists (H2RA) 12 and 10 weeks per year, respectively. Long-term treatment with H2RA was reported by 18%. More than one-third (36%) of the unoperated patients stated that the symptoms had had a significant negative impact on their lives. Age at onset of disease and index ulcer, family history, use of anti-inflammatory drugs and alcohol, bleeding, and another chronic disease were found to be significant predictors of the course. CONCLUSION: In more than one-third of the patients with PUD the course is still burdened with many symptoms and complications.

Adolescent↗
PubMed1995

Effect of the histamine-2 agonist impromidine on stem cell proliferation of rat oxyntic mucosa.

BACKGROUND: The trophic effect of gastrin on the histamine-containing enterochromaffin-like cell is pronounced but on the stem cell of the oxyntic mucosa it is only modest. In the rat, gastrin stimulates acid secretion mainly by releasing histamine from enterochromaffin-like cells. This study was designed to test the hypothesis that the trophic effect of gastrin on stem cells is also mediated by histamine released from the enterochromaffin-like cell. METHODS: We stimulated rats with the histamine-2 agonist impromidine. Impromidine, 0.2 mg/h, was given for 2 days by subcutaneously implanted osmotic minipumps, and the trophic effect on stem cells was assessed by incorporation of tritiated thymidine. RESULTS: The plasma gastrin concentrations were 33.9 (9.4) pM and 27.3 (6.0) pM, and the stem cell labelling index values were 5.92 (1.94) and 8.09 (3.78) in the controls and impromidine-stimulated animals, respectively (mean value (SD)). These differences were not statistically significant. CONCLUSION: The present study provides no evidence that histamine-2 receptors mediate a trophic effect on the stem cell of the rat oxyntic mucosa.

Animals↗
PubMed1994

[Symptomatic gallstones in a patient with heart transplantation. A serious and little observed adverse reaction of cyclosporine A].

A 53 year old male patient developed symptomatic cholelithiasis shortly after a heart transplantation following postinfarction heart failure. The patient was both initially cholecystectomized and later endoscopically treated for recurrent biliary pain and multiple concrements in the choledochus. He did not present any of the known predisposing risk factors for developing biliary stones. The possible role of cyclosporine in inducing biliary stones is discussed.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1993

Review article: the use of gastric acid-inhibitory drugs--physiological and pathophysiological considerations.

All vertebrates secrete gastric acid. Acid denatures the proteins in the food and thus makes them more accessible to proteolytic enzymes, and it kills swallowed micro-organisms. Gastric acid plays an important pathogenetic role in peptic ulcer disease and reflux oesophagitis. In these diseases, drugs that inhibit secretion of gastric acid will heal the lesions and suppress the symptoms. However, both reflux oesophagitis and peptic ulcer tend to recur when the acid-inhibitory treatment is stopped. Therefore, these patients often require long-term treatment with acid-inhibitors. In this overview the potential risks of long-term profound inhibition of acid secretion, raising the pH above 4 for a considerable time, resulting in reduced killing of micro-organisms and secondary hypergastrinaemia, are discussed. Gastrin regulates both the function (production and release of histamine) and growth of the enterochromaffin-like (ECL) cell. Hitherto, the role that this cell plays in gastric carcinogenesis appears to have been underestimated.

Animals↗
PubMed1993

The intensity and variability of symptoms in dyspepsia.

During the waiting time for upper gastrointestinal endoscopy 165 patients with dyspepsia completed a questionnaire and a diary for daily measurements of the symptoms pain, heartburn, and global complaints. 23 patients (14%) had peptic ulcer disease (PUD), 18 oesophagitis (11%), and the rest were labelled nonulcer dyspepsia (NUD). NUD was further subdivided into ulcer-like, reflux-like, dysmotility, and essential NUD by means of predefined symptom profiles. 39 (24%) patients were on H2 receptor antagonist treatment. In general, the intensity of the daily symptoms was rather low, and except for a higher rating of heartburn in oesophagitis, there were no significant differences between PUD, oesophagitis, and NUD--treated or untreated. NUD patients with reflux-like dyspepsia had significantly more heartburn than the group with essential NUD; otherwise there were no differences between the subgroups of NUD. The individual daily ratings for abdominal pain, heartburn, and global symptoms varied by an average standard deviation of 64%, 97% and 47% of the mean values, respectively, and were independent of treatment or diagnoses. There was an approximately 40% probability that two successive days had different levels of symptoms. Only 10% of the patients showed stable symptoms, and the patients were completely symptom-free for 20% of the observation period. Symptoms in dyspepsia patients disclosed low intensity and high variability in this study. Such factors may be important sources of bias in clinical trials.

Adolescent↗
PubMed1992

Can NSAIDs cause acute biliary pain with cholestasis?

Two patients had many acute episodes of biliary pain with elevated liver function tests 12-48 h after the last ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) (including paracetamol) alone or in combination with codeine. One had known intolerance to NSAIDs, but paracetamol had not been previously incriminated in the pathogenesis of the attacks. In this patient the combined use of paracetamol and codeine probably also increased the severity of the episodes. We conclude that in some patients in whom endoscopic cholangiography is normal, biliary pain and abnormal liver function tests could be the result of NSAIDs. A thorough drug history is required in such cases.

Acetaminophen↗
PubMed1992

Cimetidine on-demand in dyspepsia. Experience with randomized controlled single-subject trials.

Double-blind randomized controlled trials in single subjects (N of 1 RCTs) have demonstrated a beneficial symptomatic effect of cimetidine in reflux- or ulcer-like non-ulcer dyspepsia (NUD). However, spontaneous fluctuations in symptoms reduce the validity of such trials when performed as continuous trials with fixed dosages. This study was carried out to identify individual responders to cimetidine in NUD, peptic ulcer disease, and oesophagitis and to confirm the beneficial average effect of cimetidine in these clinical entities. We evaluated N of 1 multi-crossover trial designs, which compare the effects of single doses of cimetidine and placebo taken on-demand for symptomatic relief. Each trial consisted of six cimetidine (400 mg or 800 mg) and six placebo tablets randomized in successive pairs. The symptomatic effect of each tablet was measured 1/2-6 h after the intake. Outcomes were assessed by individual p values and confidence intervals. A minimal clinically important difference was defined, to assess the clinical significance as demonstrated by the confidence intervals. Thirteen of 25 patients (52%) with reflux- and ulcer-like NUD obtained individual p values below 0.20. Similarly, 7 of 9 patients (78%) with oesophagitis and 6 of 12 patients (50%) with peptic ulcer obtained such p values. On the basis of the 80% confidence intervals the corresponding numbers of subjects with clinically significant effect were six (NUD), three, and three. The combined data showed a significantly better effect of cimetidine than of placebo (p less than 0.0001) in each of the three diagnostic groups studied. Cimetidine taken on-demand may have a rapid symptom-relieving effect in dyspepsia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Relationship between endoscopic hiatus hernia and gastroesophageal reflux symptoms.

Little is known about the relationship between hiatus hernia (HH) and gastroesophageal reflux symptoms (GERS). Nine hundred and thirty patients submitted to gastroscopy because of symptoms completed a self-administered questionnaire. Fourteen per cent showed esophagitis (ES) and 17% HH. Forty-nine per cent of the patients with HH had endoscopic ES, and 60% of those with ES had HH. The severity of ES was dependent (p less than 0.05) on both the presence and the size of HH. After exclusion of patients with peptic ulcer and malignancy, patients with and without HH and ES were compared with regard to the presence of single symptoms and a weighted GERS score based on symptoms proven to be typical for ES. Only borderline differences were found between patients with ES and HH and those with ES and no HH. The former group, however, presented with significantly (p less than 0.001) more GERS than the patients with HH only. Nevertheless, the patients with HH as the only pathologic finding had significantly (p less than 0.01) more GERS than the patients with no major endoscopic abnormality. This study indicates a close association between HH and gastroesophageal reflux disease and supports the clinical significance of an endoscopically detected HH.

Adult↗
PubMed1991

The symptomatic effect of 1-day treatment periods with cimetidine in dyspepsia. Combined results from randomized, controlled, single-subject trials.

Before endoscopy a double-blind, randomized, controlled, single-subject trial comparing the symptomatic effect of 1-day treatment periods with cimetidine and placebo was conducted in patients with dyspepsia. Results from 339 patients were analysed. The trial lasted 12 days and consisted of 6 treatment days with 400 mg cimetidine three times daily and 6 days with placebo three times daily. The order of the treatments was randomized within six pairs, and a randomization test based on daily measures of global symptoms provided individual p values. Aggregation of the measures from all subjects showed that cimetidine alleviated the symptoms significantly better than placebo in peptic ulcer disease (PUD) (p less than 0.0001), oesophagitis (p less than 0.001), and non-ulcer dyspepsia (NUD) (p less than 0.0001). Twenty-seven per cent of the patients with PUD, 26% of those with oesophagitis, and 12% of the patients with NUD obtained individual p values of less than 0.10 and were defined as responders. The best predictors of the response to cimetidine in NUD were age above 40 years, heartburn or acid regurgitations being the worst symptom, and night pains relieved by food, milk, or antacids. In conclusion, the applied single-subject trial confirmed the overall symptomatic effect of cimetidine in dyspepsia and identified individual responders among patients with NUD with a clinically reasonable profile. The low proportion of responders among patients with PUD or oesophagitis suggests that the model has a low sensitivity for identification of individual responders and that the single-subject trial design in dyspepsia needs further refinement.

Adult↗