Sonographically visible intrahepatic bile ducts in healthy elderly.
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Aged↗
Biomedical subjects
S Massarrat
Publications and source records attributed to S Massarrat.
Efficacy of tetracycline and metronidazole alone or with ranitidine on the healing of duodenal ulcer and eradication of Helicobacter pylori. A randomized controlled multicenter study. Tetra-Metro-Ran Study Group.
In almost all eradication regimens, which contain antibiotics and bismuth derivatives, the administration of acid suppressing drugs for 4-6 weeks is recommended for healing of duodenal ulcer. The aim of this multicenter double blind study is to elucidate the effect of two classic antibiotics tetracycline (CAS 60-54-8) and metronidazole (CAS 443-48-1) alone or combined with ranitidine (CAS 66357-35-5) on the healing of duodenal ulcer and eradication of Helicobacter Pylori. Patients with duodenal ulcer were randomized to two treatment groups: group A received either ranitidine 4 x 150 mg or tetracycline 4 x 500 mg or metronidazole 3 x 250 mg for 2 weeks. Group B received 4 x placebo + tetracycline and metronidazole as in group A for 2 weeks. A final endoscopy was performed after 8 weeks. Four biopsy specimens were obtained from the antrum (two) and corpus (two) for both urease test and hematoxylin stain for detection of H. pylori. Out of 201 patients entering the study 156 completed the study (78 in A and 78 in B). The healing rate of duodenal ulcer was 98.7% in group A and 97.5 in group B. The eradication rate was only 33.3% in group B but 64% in group A (p < 0.001), when additionally ranitidine was given. The present study shows that treatment with the two antibiotics tetracycline and metronidazole alone results in a very low H. pylori eradication, but almost complete healing of duodenal ulcer after 8 weeks. Prolonged administration of antisecretory drugs in eradication regimens containing two antibiotics is not necessary for duodenal ulcer healing. However, the addition of H2-receptor antagonists or proton pump inhibitors to antibiotics increases the eradication rate.
Anti-Bacterial Agents↗
Risk factors in patients with refractory peptic ulcer.
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Anti-Ulcer Agents↗
Peptic ulcer disease, irritable bowel syndrome and constipation in two populations in Iran.
OBJECTIVE: To determine the prevalence of peptic ulcer disease, irritable bowel syndrome (IBS) and chronic constipation in two Iranian populations (pastoral nomads and industrial labourers) with different life styles, and to evaluate the risk factors associated with these diseases. SUBJECTS: A total of 455 randomly selected pastoral nomads and 492 industrial labourers (all male) aged between 35-55 years. METHODS: Demographic and social data were obtained by interviews. An upper gastrointestinal tract endoscopy was performed and biopsy specimens were taken from subjects complaining of abdominal symptoms and randomly selected asymptomatic subjects. A urease test was performed on antral specimens. Serum pepsinogen I concentrations and Helicobacter pylori antibody titres were measured by radioimmunoassay and immunoglobulin (Ig) G enzyme-linked immunosorbent assay tests, respectively. RESULTS: Serum pepsinogen I concentrations were similar in both nomads and industrial labourers, and the percentage with positive antibody titres for H. pylori was high in both populations (86.3 and 91% in nomads and industrial labourers, respectively). Industrial labourers were twice as likely to have duodenal ulcer (P < 0.05) than nomads. The prevalence of duodenal ulcer disease and gastric ulcer was 4.6 and 0.6% in nomads and 10.3 and 0.4% in industrial labourers, respectively. The prevalence of IBS was similar in nomads (3.1%) and industrial labourers (3.6%). Fewer nomads (1.4%) than industrial labourers (3.3%) had chronic constipation. Logistic regression analysis showed that being an industrial labourer, or smoker and having undergone previous non-gastric surgery were risk factors for duodenal ulcer disease. When the variable 'urease test' was included in the logistic regression analysis, smoking, a positive urease test and the quantity of fruit eaten per week were associated risk factors. The risk factors associated with IBS were the use of analgesics and back pain. The only risk factor associated with chronic constipation was being an industrial labourer. CONCLUSIONS: Industrial labourers were twice as likely to have duodenal ulcer disease as nomads. The prevalence of IBS and chronic constipation in the two male Iranian populations was lower than that found in western countries. Duodenal ulcer disease was associated with H. pylori colonization but not with a positive serum antibody titre for H. pylori. H. pylori colonization of the antral mucosa and smoking are causative factors for duodenal ulcer disease and fruit intake is possibly an associated factor.
Adult↗
Effect of triple therapy or amoxycillin plus omeprazole or amoxycillin plus tinidazole plus omeprazole on duodenal ulcer healing, eradication of Helicobacter pylori, and prevention of ulcer relapse over a 1-year follow-up period: a prospective, randomized, controlled study.
OBJECTIVES: Triple therapy and amoxycillin plus omeprazole are the two most widely recommended regimens for the eradication of Helicobacter pylori. However, no controlled studies with a large number of cases are available for the reliable comparison of these two regimens. The aim of this controlled, randomized, prospective study was to compare the effect of these two regimens and a further regimen for metronidazole-resistant patients on duodenal ulcer healing, H. pylori eradication, and prevention of ulcer relapse. METHODS: Patients (n = 144) with proven duodenal ulcer (DU) were randomized to one of the three following regimens: group A, omeprazole (2 x 40 mg) plus amoxycillin (4 x 500 mg) for 2 wk; group B, triple therapy: bismuth nitrate (4 x 375 mg) plus metronidazole (4 x 250 mg) and tetracycline (4 x 500 mg) daily for 2 wk and ranitidine (150 mg) for the first week and bismuth nitrate (4 x 375 mg) alone for a further 2 wk; group C, omeprazole (20 mg) plus amoxycillin (4 x 500 mg) and tinidazole (2 x 500 mg) for 2 wk. RESULTS: A total of 46 patients in group A, 39 in group B, and 43 in group C completed the study. One patient in group A and three in group B did not tolerate the regimens and dropped out of the study. Control endoscopy was performed 8 wk after the start of treatment and when symptoms appeared (up to 1 yr after the start of treatment). In subjects who completed the study, both the healing rate of DU in group B (97% compared with 74 and 73% in A and C, respectively, p < 0.02) and the H. pylori eradication rate in group B (85 compared with 35%, p < 0.0001 in A and 58%, p < 0.02, in C) were significantly higher than in groups A and C. The symptomatic ulcer relapse during the 1-yr follow-up in patients with initially healed ulcers was similar in all groups (18, 16, and 19% in A, B, and C, respectively). The predictor of healing using logistic regression analysis was night pain (p < 0.05). The predictor of H. pylori eradication was sex (p < 0.05). CONCLUSION: The 2-wk triple therapy plus an additional 2-wk treatment with the bismuth derivative (without a prolonged administration of acid suppressing drugs) seems to be an effective and economic treatment not only for the eradication of H. pylori but also for the healing of acute DU. The higher incidence of side effects found after triple therapy compared with the other two regimens was tolerated by the patients.
Adult↗
Changes in total pepsin activity and pepsinogen I in human sera under stimulation and inhibition of gastric acid secretion.
The levels of total pepsin activity and pepsinogen I in sera were first studied in 10 healthy volunteers undergoing stimulation of gastric acid secretion at random on 4 different days with a) a maximum dose (6 micrograms/kg) of pentagastrin, b) ranitidine injection 5 minutes before maximal pentagastrin stimulation, c) ranitidine injection 1 hr before maximal pentagastrin stimulation, or d) sham feeding. In a further 10 healthy volunteers the levels of total pepsin activity and pepsinogen I were studied over 5 days by short-term oral intake of ranitidine. The total pepsin activity and pepsinogen I increased significantly in the sera after maximum-dose pentagastrin, but not after sham feeding. The increase could be completely prevented by ranitidine given only 1 hour before pentagastrin stimulation. The total pepsin activity and pepsinogen I decreased significantly after brief oral intake of ranitidine. It can be concluded that the measurement of total pepsin activity and pepsinogen I in the sera could serve as a rough parameter for testing the effectiveness of potential agents inhibiting gastric secretion.
Adult↗
Ten versus 28 days of cimetidine treatment for duodenal ulcer in Iran. Evidence for the need for risk-oriented individual treatment of ulcer patients.
A clinical trial involving 100 duodenal ulcer patients was performed at the Shiraz Medical School in Iran, in which the known risk factors that influence the healing of duodenal ulcers in West Germany were examined. The patients were randomly allocated to groups receiving 2 x 400 mg cimetidine daily for 10 days (group I) or 28 days (group II). In addition, antacid was taken if pain occurred. Probable prognostic risk factors were noted, such as: age, sex, duration of ulcer history, duration of the present ulcer relapse, smoking habit, nocturnal pain, radiation of pain to the back, history of ulcer bleeding and use of analgesics. The number of ulcers, ulcer size, ulcer depth, bulbar deformity and narrowing were determined endoscopically. Follow-up examinations were performed in 89 patients 4 weeks after the start of treatment. The ulcers were healed in 20 out of 43 patients in group I (46%), and in 29 out of 46 in group II (63%) (p = 0.11). Statistical analyses were performed in both group combined to investigate unfavorable factors for healing. Following univariate analysis the following factors were prognostically unfavorable: bulb deformity (p = 0.003), radiation of pain to the back before treatment (p = 0.045), number of cigarettes smoked per day (p = 0.046). The patients with non-healed ulcers had more days with pain during treatment (p = 0.045). Using logistic regression analysis, the following prognostic factors were significant: number of cigarettes smoked per day (p = 0.03), radiation of pain to the back (p = 0.036), and bulb deformity (p = 0.048).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Variation of total pepsin activity in sera with age and under different stimulations of gastric acid secretion.
The total pepsin activity in sera was measured in 660 outpatients endoscopically proven to be free of gastroduodenal lesions. A small but significant increase of total pepsin activity with age in females older than 50 years was observed. Total serum pepsin activity increased after stimulation of gastric acid secretion. This increase was small after a meal and vagal stimulation by sham feeding, but higher after maximal stimulation with Pentagastrin. Its amount, which is in general rather small and probably not relevant for clinical evaluation of gastric acid secretion, depends on the proportion of cases with high gastric secretory capacity. This might clarify the discrepancy in the results obtained by previous authors.
Adult↗
Irradiation-induced duodenal ulcer disease refractory to ranitidine: healing by omeprazole.
In two patients duodenal ulcer refractory to high dose H2-blocker treatment started several months after irradiation therapy following right nephrectomy because of renal adenocarcinoma. Established antiulcer drugs like ranitidine, famotidine, sucralfate, pirenzepine, and antacids alone or in combination were unable to control ulcer pain and failed to induce ulcer healing. Initiation of omeprazole treatment at dosages to produce complete achlorhydria were necessary for ulcer healing and maintenance therapy. We suggest that (a) irradiation may cause duodenal ulcer disease indistinguishable from idiopathic duodenal ulcer; (b) radiation-induced ulcers in the duodenal bulb are refractory to various antiulcer drugs but may heal after administration of omeprazole in dosages that completely suppress acid secretion.
Aged↗
Risk factors for healing of duodenal ulcer under antacid treatment: do ulcer patients need individual treatment?
In order to identify the risk factors affecting the healing of duodenal ulcer, a clinical trial with effective dose of antacid was carried out in 53 patients. Duration of ulcer history, number of relapses, duration of the last and present relapse, number, duration and severity of pain attacks in the present ulcer relapse, pain radiation to back, vomiting, appetite, smoking habit, intake of analgesics and previous haemorrhage were registered. Number of ulcers, ulcer depth, bublar narrowing, erosions, duodenitis at initial endoscopy and healing of ulcer were assessed by one endoscopist. Basic and peak acid output were measured. The extent of duodenitis on the site opposite the ulcer was determined by histological examination. Sixty per cent of the duodenal ulcers were healed after three weeks. By univariate analysis, the following factors affect the healing; pain radiation to back and pain duration during treatment (p less than 0.001), multiple or deep ulcers, narrowing of duodenal bulb (p less than 0.01), number of pain attacks and poor appetite (p less than 0.05). By the stepwise logistic regression model, the following factors were selected as predictors for healing of duodenal ulcer with 76% correct classification: pain radiation to back (p = 0.002), deep ulcer (p = 0.013), multiple ulcers (p = 0.028). Number of cigarettes/day (p less than 0.007) and male sex (p = 0.036). By this model, the prediction of healing could be accurately assessed in 78% in a new sample. Individual treatment should be carried out on the basis of these factors.
Aluminum Hydroxide↗
Increased gastric secretory capacity in smokers without gastrointestinal lesions.
The relationship between smoking and gastric secretory capacity was studied in 201 25-40 year old healthy subjects with normal laboratory data and no gastrointestinal lesions. Basal acid output (BAO) and peak acid output (PAO) were determined in all, and basal and stimulated pepsin outputs were measured in 85 participants. The accuracy of the patients' statements was checked by urinary nicotine assay. Basal acid output and PAO were significantly higher in male smokers (n = 55) than in male non-smokers (n = 49). In women PAO in smokers (n = 38) was higher than in non-smokers (n = 59). Female smokers (n = 38) had a higher pepsin output than female non-smokers (n = 23). Eight variables were considered in relation to BAO and PAO: age, height, weight, alcohol abuse, smoking habits, duration of smoking habit, number of cigarettes per day, and the product of years of smoking multiplied by daily number of cigarettes. The daily number of cigarettes X years of smoking was most closely correlated with BAO and PAO by stepwise multiple linear regression analysis. It was concluded that smoking is related to increased gastric acid capacity.
Adult↗
Serum pepsin activity as a parameter of gastric acid secretion.
Serum pepsin activity was measured in 359 patients with various gastric diseases, the serum protein themselves serving as substrate. In 332 out of 359 patients, BAO and PAO, and in 173 of these patients, pepsin activity, were determined in gastric juices. In 102 patients, serum pepsin activity was measured before, and 45 and 90 minutes after, pentagastrin stimulation. In 71 out of these 102 patients, pepsinogen I was measured simultaneously by RIA. There was good correlation between stimulated serum pepsin activity and maximal pepsin output (r = 0.63), as well as BAO (r = 0.67) and PAO (r = 0.77). The higher the PAO, the greater the increase in pepsin activity in the sera after pentagastrin stimulation. The increase in pepsinogen I under stimulation was smaller in the sera than pepsin activity. There was a slightly better correlation of PAO with stimulated serum pepsin activity than with pepsinogen I (r = 0.76 versus 0.62). The measurement of pentagastrin-stimulated pepsin activity in sera, as a very simple and inexpensive method, permits the screening, with an overall accuracy of more than 75%, of achlorhydrics (stimulated pepsin activity less than 30 micrograms thyrosine/24 hours/ml serum), acid secretors (greater than 80 micrograms thyrosine/24 hours/ml serum) and hypersecretors (PAO greater than 35 mmol HCl/hours, greater than 120 micrograms thyrosine/24 hours/ml serum).
Achlorhydria↗
The role of certain habits and various diseases in the occurrence of gastritis.
Four biopsy specimens of antral and body mucosa were taken from the greater and lesser curvature of the stomach in 557 Germans and 46 Turks with no gastric or duodenal lesions. The age-adjusted gastritis score in each area was related to various habits and clinical diagnoses. In contrast to the Germans the Turks had advanced antral gastritis at an early age which did not progress with age. Patients of low social class were more prone to antral gastritis than academics and civil servants. Hypertension was associated with a lower incidence of antral gastritis. Patients who had had a cholecystectomy had advanced gastritis in antral and body mucosa as compared with those with gallstones but intact gallbladders. The incidence of fundic gastritis was higher in patients with degenerative joint disease than in the controls. It is concluded that alcohol, nicotine, drug abuse and various diseases do not play an important role in the frequency of occurrence of gastritis.
Adolescent↗
[Long-term prevention of duodenal ulcer with cimetidine. Effect of the rhythm of ingestion and drug compliance on the incidence of recurrence].
The long term effect of 400 mg cimetidine ingested at various times on ulcer recurrence and drug compliance was investigated in 66 patients with severe course of duodenal ulcer, now healed. Patients were randomised in 3 treatment groups: group A (n = 29) received 400 mg cimetidine in the evening, group B (n = 23) 200 mg both morning and evening, group C (n = 14) no treatment. Follow up examinations were at 3 month intervals. Ulcer recurrence was observed in 10 out of 14 patients in group C and in 12 out of 52 patients of groups A and B within the first 6 months. Due to the highly significant difference between the treated and untreated groups (P less than 0.001) the control group was discontinued. The recurrence rate after 12 months was identical in groups A and B (51 and 52%). Comparison of patients with and without recurrences showed no differences as regards length of history, maximal acid secretion, cimetidine compliance or endoscopic findings such as duodenitis, circular constriction of the bulbus or antral erosions. However, it was noticeable that smokers with 63% recurrent ulceration had a worse prognosis than the non-smokers with 37% (P = 0.06).
Adult↗
[(Incidence of gallstone disease in autopsy material and outpatients from West Germany) ].
The incidence of cholelithiasis and rate of cholecystectomy has been studied in three differently selected groups: first, in 3842 autopsies during the years 1969-1977, second, in 6564 patients who underwent to x-ray examination during 1970-1974 for various reasons; third in 163 patients aged over 50 years referred for reasons other than abdominal discomfort. The incidence of dyspeptic symptoms was registered in the patients of the last group. The rate of cholelithiasis and cholecystectomy in the first group corresponds well to that in the second group. In men and women over 60 years, who had been referred to the outpatients clinic for reasons not related to abdominal pain, the rate of cholelithiasis was 33% and 42% respectively. This finding corresponds to that of the first and second group. There was no difference in the incidence of dyspeptic symptoms among the patients of the last group with and without cholelithiasis. The results suggests that in the old patients the incidence of silent gallstones increases, but that the rate of cholecystectomy did not.
Adult↗
Effect of low dose of cimetidine on gastric potentials difference and acetylsalicylic acid-induced change.
Cimetidine in a low dose of 10 mg given intravenously increases significantly the gastric potential difference (GPD) without any inhibitory effect on gastric acid secretion. The increase of GPD after 200 mg cimetidine is higher than after 10 mg. While the high dose of cimetidine prevents the acetylsalicylic acid (ASA)-induced GPD drop, cimetidine in a dose of 10 mg is not able to protect this change. Nevertheless the low dose of cimetidine may have a clinical significance and should be evaluated by clinical studies.
Adult↗
Factors affecting the healing rate of duodenal and pyloric ulcers with low-dose antacid treatment.
In 80 patients with duodenal ulcer, the effects of various factors--symptoms, endoscopic findings, and peak acid output (PAO)--on the healing rate were studied during eight weeks of outpatient therapy with low-dose antacid (neutralising capacity less than 50 mmol HCl/d). Fifty-six per cent of the ulcers healed. The following unfavourable factors were found to cause a significant delay in ulcer healing: a long duration of pain in the last ulcer relapse and the present period of ulcer pain, smoking, stenosis of the duodenal bulb, and a high PAO. Multiple regression analysis showed that three factors (duration of the present ulcer pain, smoking, and stenosis of the duodenum) had a significant influence on healing rate. According to the results obtained with this method, the patients with no or only one unfavourable factor (n = 35) had the best healing rate: 80%, compared with patients who had two (n = 31) or three (n = 14) unfavourable factors. The healing rate of the latter two groups was 41% and 28%, respectively (p less than 0.001). A prognostic score based on these three factors represents the severity of duodenal-ulcer disease with regard to the healing process under placebo-like doses of antacid.
Adult↗