PubMed Health⌕ Search

Biomedical subjects

T Rokkas

Publications and source records attributed to T Rokkas.

At least 37 records · Page 2Linked to original sources
PubMed1995

Eradication of Helicobacter pylori reduces the possibility of rebleeding in peptic ulcer disease.

A close relationship has been found between Helicobacter pylori and peptic ulcer disease. Furthermore, eradication of H. pylori is associated with low recurrence rates. The aim of the present study was to examine whether eradication of H. pylori has any impact on the complications of ulcers, such as bleeding. Thirty-one patients hospitalized for duodenal ulcer bleeding, undergoing conservative treatment and with a previous history of bleeding, comprised the group studied. All patients had emergency endoscopy, and tests for H. pylori proved to be positive in all. After discharge, patients were given omeprazole 20 mg daily for 4 weeks for ulcer healing, which was achieved in all patients (100%). After this, patients were randomized to receive either omeprazole 20 mg t.i.d. alone (group O, n = 15) or the combination of omeprazole 20 mg t.i.d. + amoxicillin 500 mg q.i.d. (group O + A, n = 16) for 2 weeks. Endoscopy was performed 4 weeks after treatment ended to check for eradication of H. pylori and again when rebleeding or symptomatic relapse occurred. Groups O and O + A were similar in age, sex, smoking habits, and NSAID use. The follow-up period was 12 months for both groups. Eradication was achieved in 2 of 15 (13.3%) patients in group O and in 13 of 16 (81.3%) patients in group O + A (p < .001). Five patients rebled during follow-up. All of them belonged to group O and were patients in whom eradication had failed. In contrast, none of group O + A had rebleeding (p = 0.18).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Primary peristalsis is the major acid clearance mechanism in reflux patients.

This study examined the clearance of gastric acid from the oesophagus in ambulant patients with gastro-oesophageal reflux. Eighteen patients with proved reflux disease were studied, nine with (group 1) and nine without (group 2) endoscopic oesophagitis. Oesophageal pressure and pH were recorded over 24 hours. Pressures were measured by a probe with five sensors: a 5 cm long sensor in the lower oesophageal sphincter, three sensors in the body of the oesophagus, and one at the pharynx to detect swallowing. Oesophageal pH was monitored 5 cm above the lower oesophageal sphincter. Manometric activities were classified as either peristaltic or ineffective. The latter included simultaneous, non-transmitted, and low amplitude peristaltic contractions. A reflux episode was defined as starting when pH fell to less than 4 and ending when the pH rose to 5. When the rise to pH 5 took place in three or more discrete steps after motor responses to gastro-oesophageal reflux, the pH steps were labelled as initial change (I), middle changes (M), and last change (L). A total of 595 episodes of gastro-oesophageal reflux and 1626 associated motor events were analysed. Of these, 1331 (81.9%) were classed as primary peristaltic activity, 174 (10.7%) as primary ineffective activity, 46 (2.8%) as secondary peristaltic activity, and 75 (4.6%) as secondary ineffective activity. There were no significant differences in initial change (p > 0.05), middle changes (p > 0.05), and last change (p > 0.05) between group 1 and group 2. In all patients, the successive changes of pH in response to motor activity were significantly different (p = 0.0001) between initial, middle, and last changes. Last change was significantly higher when compared with initial (p=0.001) and middle changes (p<0.001). Primary oesophageal peristalsis was the most frequent motor response to gastro-oesophageal reflux. The last motor activity during reflux showed the greatest change in pH.

Adult↗
PubMed1994

Bronchoalveolar lavage findings in a young adult with idiopathic pulmonary haemosiderosis and coeliac disease.

Idiopathic pulmonary haemosiderosis is a rare disease of unknown autoimmune aetiology, mainly affecting children and adolescents. A variety of coexisting autoimmune diseases have been described, including coeliac disease. We describe the case of a man, aged 19 yrs, presenting with a one year history of recurrent haemoptysis. Gluten and gliadin antibodies were positive, and the jejunal biopsy revealed villous atrophy consistent with the diagnosis of coeliac disease. Bronchoalveolar lavage fluid analysis showed a mean haemosiderin score (Golde index) of 240, and a local suppressor/cytotoxic profile on immunocytology. Both clinical and immunological improvement was obtained after a month of gluten-free diet. These immunological findings provide new insight into the pathogenesis of this disease.

Adult↗
PubMed1993

Small polyps found at sigmoidoscopy: are they significant?

In this study we prospectively examined the significance of small polyps found at screening flexible sigmoidoscopy and studied in particular, the possibility that hyperplastic polyps in the rectosigmoid can serve as potential markers for neoplastic polyps proximal to this area. During the last three years we performed sigmoidoscopy on 1500 patients. One hundred and five patients (7%) had one or more polyps in the rectosigmoid. Exclusion criteria were polyps of > 1 cm in size, a history of bleeding, inflammatory bowel disease or past polypectomy. After excluding 30 patients, 75/1500 (5%) patients with small polyps remained in the study. All these patients were submitted to total colonoscopy with removal of all polyps found. Histopathology showed that 45/75 (60%) patients had hyperplastic polyps and 30/75 (40%) had at least one adenomatous polyp. Among the 45 patients with hyperplastic polyps at flexible sigmoidoscopy, 16 (35.5%) had a more proximal adenomatous polyp. Nine of the 30 patients (30%) who had at least one adenomatous polyp in the rectosigmoid were found to have them more proximally. We conclude that a) size alone is not an accurate predictor of the histology of the polyp, b) because small polyps, either hyperplastic or adenomatous, in the rectosigmoid indicate a risk for adenomatous polyps more proximally, all patients with small polyps found during flexible sigmoidoscopy should be submitted to total colonoscopy.

Adenoma↗
PubMed1993

Pancreatic duct width: its significance as a diagnostic criterion for pancreatic disease.

The significance of main pancreatic duct width in the diagnosis of pancreatic disease, was studied in 338 endoscopic retrograde pancreatographies. Two hundred and forty patients referred for suspected biliary disease had normal pancreatograms (Group 1), 60 had pancreatic carcinoma (Group 2) and 38 had a history and pancreatogram compatible with chronic pancreatitis (Group 3). After categorizing patients by decade, in group 1 the effect of aging on the pancreatic duct width in the head, body and tail (F5,234 > 3.71, p < 0.003) was pronounced, especially after the fifth decade. There was a significant difference between groups 1, 2 and 3 in terms of the width of the main pancreatic duct in all three parts of the pancreas (F2,325 > 42.24, p < 0.001). The upper range of normal pancreatic duct width was 8.0 mm, 4.0 mm and 2.4 mm in the head, body and tail, respectively. Abnormal ductograms were wider than the normal ranges in the head, body and tail of the pancreas in 14%, 49% and 59% (p < 0.001) of the patients, respectively. Establishing normal ranges of the pancreatic duct width may help in the diagnosis of pancreatic disease. Measurements in the body and tail, as compared with the head, are a more sensitive indicator of pancreatic duct dilation.

Adult↗
PubMed1992

Acid perfusion and edrophonium provocation tests in patients with chest pain of undetermined etiology.

During the last five years, 672 patients were referred to our esophageal investigation unit; 110 patients (16.3%) of these presented with chest pain of undetermined etiology (CPUE) alone. Since the nature of this pain is intermittent and rarely present during the diagnostic study, acid perfusion and intravenous edrophonium tests were added as provocative tests after baseline esophageal manometry. Following completion of the motility studies, 24-hr pH study was performed to detect gastroesophageal reflux (GER). Twenty-nine patients (26.4%) had positive acid perfusion (APT) test whereas 26 patients (23.6%) had positive edrophonium test (ET). In the group of patients with positive acid perfusion test, 12/29 (41.3%) had GER, 8/29 (27.5%) had both motility disorder and GER, 2/29 (6.8%) had motility disorder, and 7/29 (24.1%) had normal esophageal motility and 24-hr pH studies. In the other group, 13/26 (50%) had motility disorder and 13/26 (50%) had both motility disorder and GER. There were no significant differences between the two tests as far as reproducibility of symptoms was concerned. We conclude that ATP and ET showed the esophageal origin of CPUE in half of our patients and therefore in a substantial percentage of patients the esophageal origin of chest pain will remain very difficult to prove.

Adult↗
PubMed1991

Detection of an increased incidence of early gastric cancer in patients with intestinal metaplasia type III who are closely followed up.

Because early gastric cancer is associated with a much better prognosis than advanced disease, its diagnosis is important. Over a 12 year period (1976-87), a progressive increase in the incidence of early gastric cancer was observed. Twenty four of the 718 (3.3%) consecutive gastric resections for gastric cancer in this period were in patients with early gastric cancer. Six of the 24 were diagnosed in the first six year period (1976-81) and 18 in the second six year period (1982-87) (p less than 0.01). This increase was observed during the prospective phase of the study, when all patients diagnosed on initial biopsy specimen as showing type III intestinal metaplasia underwent follow up endoscopy and biopsy at six to 12 month intervals. Eleven of the 18 with early gastric cancer detected in this period were diagnosed as a direct result of this follow up. We conclude that early gastric cancer can be diagnosed with increasing frequency if patients with type III intestinal metaplasia are closely followed endoscopically.

Follow-Up Studies↗
PubMed1990

Postheparin plasma diamine oxidase in health and intestinal disease.

In animals, the distribution of the enzyme diamine oxidase is confined, almost exclusively, to the small bowel mucosa. In humans, plasma diamine oxidase is at or below assay detection limits but can be liberated into the circulation from binding sites in the intestine by i.v. heparin. Therefore, the authors wished to see if diamine oxidase could be released by a low and safe dose of heparin (5000 U) and if the resultant area under the concentration-time curve would provide a noninvasive marker of segmental intestinal disease. In 17 control subjects, the mean area under the curve (following administration of 5000 U i.v. heparin) was 35.9 +/- 5.0 (SEM) mU.L-1.2 h-1; in 6 individuals studied on two separate occasions, postheparin plasma diamine oxidase profiles were reproducible (r = 0.98; p less than 0.001). The longitudinal distribution of diamine oxidase in the gastrointestinal tract, measured in 12 gastric, 16 jejunal, 6 ileal, and 18 colonic biopsies, was similar in humans to that found in animals. In patients with normal peroral biopsies, there was a linear relationship between jejunal mucosal and postheparin plasma diamine oxidase activities (r = 0.84; p less than 0.01). The areas under the curve in controls were then compared with those in patients with segmental intestinal diseases: 21 with ileal disease with or without colonic Crohn's disease (10 unoperated and 11 with ileal resection), 7 with non-Crohn's ileal resection, 8 with ulcerative colitis, 10 with untreated and 7 with treated celiac disease (6 studied before and after a gluten-free diet), and 5 studied during total parenteral nutrition and again after resumption of oral feeding. The results in the 18 ileectomized patients were subdivided into those with major (arbitrarily greater than 75 cm) and minor (less than 75 cm) resections. Areas under the curve were markedly reduced in nonresected Crohn's patients (6.0 +/- 1.79 mU.L-1.2 h-1; p less than 0.001 vs. controls), correlating inversely, in a first-order relationship, with disease activity (r = 0.82; p less than 0.001) and returning toward normal in 4 patients achieving disease remission. Low areas under the curve in total parenteral nutrition patients (4.5 +/- 0.9; p less than 0.001) were also reversible on resumption of oral feeding. However, areas under the curve were not significantly lower in patients with limited ileal resection (less than or equal to 75 cm), with celiac disease (untreated and treated), or ulcerative colitis than in controls.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1990

Effect of intestinal diamine oxidase (DAO) depletion by heparin on mucosal polyamine metabolism.

The aim of this study was to examine the relative importance of the enzymes ornithine decarboxylase (ODC) and diamine oxidase (DAO) in intestinal polyamine metabolism in normal rats. To study this we measured jejunal and ileal DAO and ODC activities and polyamine levels 2 h after injecting, in non-fasting male Wistar rats, either normal saline (controls) or a large dose of i.v. heparin to deplete intestinal mucosal DAO stores. We found that heparin significantly reduced mean DAO activity (p less than 0.001). As a result putrescine levels increased significantly in both jejunum (p less than 0.02) and ileum (p less than 0.01). Heparin-induced DAO depletion had no significant effect on spermine and spermidine levels at either site. The increased putrescine was associated with reduced ODC activity in both jejunum (p less than 0.01) and ileum (p less than 0.05). ODC activity correlated negatively with putrescine (p less than 0.001). These results suggest that (i) in normal rats, DAO is more important than ODC in regulating mucosal putrescine levels and (ii) putrescine exerts feedback inhibition of ODC.

Amine Oxidase (Copper-Containing)↗
PubMed1990

Is the intestine the sole source of heparin-stimulated plasma diamine oxidase? Acute effects of jejunectomy, ileectomy and total enterectomy.

The assumption that the intestine is the sole/major source of post-heparin diamine oxidase (DAO) has been tested only once by Kobayashi et al. in 1969. In this study we tested whether the intestine is indeed the sole/major source of post-heparin plasma DAO and furthermore we studied the relative contribution of jejunum and ileum to post-heparin plasma DAO. We measured non-fasting plasma DAO before and every 15 min for 2 h after i.v. heparin (4,000 U/kg BW) and compared the resultant areas under the concentration-time curves (AUCs: mU/l X 2 h) in unoperated controls, jejunectomised, ileectomised and totally enterectomised (from gastro-oesophageal to colorectal junctions) male Wistar rats. Total enterectomy virtually abolished the post-heparin rise in plasma DAO, the mean AUC falling from 55.3 +/- (SEM) 10.2 in controls to 2.1 +/- 1.1 after enterectomy (p less than 0.001). The mean AUCs after jejunectomy and ileectomy were 25.6 +/- 5.5 and 10.75 +/- 2.42, respectively. Therefore in acute jejunal and ileal resection the AUCs were 2.1 and 5.4 times, respectively, lower than those seen in the controls (p less than 0.02 and p less than 0.001). The difference in mean AUC values between jejunectomy and ileectomy groups was also statistically significant (p less than 0.05). We conclude that total enterectomy abolishes the post-heparin rise in circulating DAO activity, confirming that the intestine is the major source of post-heparin plasma DAO. The ileum contributes more than the jejunum to this post-heparin rise in plasma enzyme activity.

Amine Oxidase (Copper-Containing)↗
PubMed1990

Aminoguanidine blocks intestinal diamine oxidase (DAO) activity and enhances the intestinal adaptive response to resection in the rat.

The aim of this study was to assess the effect inhibiting diamine oxidase (DAO) activity on intestinal adaptation after 80% proximal small bowel resection in the rat. Aminoguanidine (AG), a DAO inhibitor, was administered subcutaneously (25 mg kg-1 day-1) to rats for 11 days after small bowel transection (n = 6) or resection (n = 6). Two additional groups of animals (n = 6) served as transection or resection controls and received normal saline subcutaneously for the same period. On day 12 after operation, the animals were sacrificed, mucosal homogenates prepared from the ileal remnants (or from the control ileum), analysed for DAO and ornithine decarboxylase (ODC) activities, and the concentrations of the polyamines putrescine, spermidine, spermine, and the indices of mucosal mass (wet weight, protein and DNA) measured. The results were expressed both per unit length intestine and per milligram mucosal DNA. AG treatment completely inhibited DAO activity in both the transection control and resected rats. In the AG-treated resection group, inhibition of DAO activity was accompanied by increases (p less than 0.005) in all three indices of mucosal mass (wet weight, protein and DNA per centimetre intestine), putrescine concentrations (p less than 0.05) and ODC activity per centimetre intestine (p less than 0.001) when compared with the saline-treated resection controls. The results of this study suggest that inhibition of the putrescine-degrading enzyme, DAO, enhances the adaptive response to intestinal resection. Therefore, DAO may play a major role in regulating adaptive intestinal mucosal growth. Furthermore, inhibition of DAO activity could be important therapeutically in patients with the short bowel syndrome.

Adaptation, Physiological↗
PubMed1989

Tumours of the pancreas as a sequel to abdominal irradiation.

Two cases of tumours arising in or near the pancreatic head are reported in patients previously treated with abdominal irradiation for testicular tumours. These are only the third and fourth such cases to be reported and they suggest that second cancers may develop as a result of abdominal irradiation for malignant disease.

Abdomen↗
PubMed1988

Non-ulcer dyspepsia and short term De-Nol therapy: a placebo controlled trial with particular reference to the role of Campylobacter pylori.

This double blind randomised study tested the effectiveness of colloidal bismuth subcitrate (De-Nol) in non-ulcer dyspepsia (NUD) and if any benefit is associated with clearance of Campylobacter pylori (C pylori) from the gastric mucosa. Sixty six patients with dyspepsic symptoms, normal abdominal ultrasound, and upper GI endoscopy, were randomly allocated to placebo or De-Nol for eight weeks. Antral biopsies were taken for bacteriological and histological examination, and endoscopies and clinical questionnaires were administered before and after treatment. Fifty two patients (25 on De-Nol and 27 on placebo) completed the trial. De-Nol cleared C pylori from 10 of the 12 C pylori positive patients (83.3%), whereas placebo did not clear C pylori from any of the eight C pylori positive patients (p less than 0.01). In patients receiving De-Nol gastritis improved (p less than 0.01) and symptomatic response was better (p less than 0.001) compared with placebo. In the placebo group seven of the 19 C pylori negative patients became positive: this was associated with significant deterioration of symptoms, a phenomenon not seen in the De-Nol treated group.

Adolescent↗
PubMed1988

Collagenous colitis with rapid response to sulphasalazine.

A case of collagenous colitis in a young female with a rapid response to sulphasalazine both symptomatically and histologically is reported. This is only the third such response to be reported. In most published accounts, collagenous colitis fails to respond to treatment and runs a very prolonged course.

Adult↗
PubMed1988

Bismuth: effects on gastritis and peptic ulcer.

The healing properties of colloidal bismuth subcitrate (CBS) on peptic ulcer are well established and several studies have shown that healing with CBS is associated with a lower relapse rate than that produced by H2-receptor antagonists. The recent observation that CBS is effective against Campylobacter pylori has shed light on this because recent studies have shown that eradication of C. pylori by CBS leads to resolution of the associated gastritis and this may explain the low relapse rates. CBS is also effective in C. pylori positive patients with non ulcer dyspepsia (NUD) in whom clearance of these organisms from the stomach is associated with significant improvement of the associated gastritis and symptoms.

Cimetidine↗
PubMed1988

Ambulatory esophageal pH recording in gastroesophageal reflux: relevance to the development of esophagitis.

In a group of 60 patients with symptomatic gastroesophageal reflux (GER), we carried out upper gastrointestinal (GI) endoscopy and 24-h ambulatory esophageal pH monitoring to assess the relationship between acid reflux and esophagitis. The results of 24-h pH measurement were compared with those of 15 asymptomatic control subjects who were studied with ambulatory 24-h esophageal pH monitoring only. Thirty-two patients (53.3%) had a normal esophagus macroscopically, and 28 patients (46.7%) had some degree of esophagitis. There was no significant difference between the two groups with and without esophagitis, regarding male:female ratio, age, and duration of symptoms. The group with esophagitis was more symptomatic (p less than 0.001) than the group without, and differed significantly in relation to all pH variables, i.e., number of GER episodes per hour, duration of mucosal exposure to acid (pH less than 4), and number of GER episodes requiring more than 5 min to clear per hour for the upright, supine, and 24-h periods, compared with the control group (p less than 0.001) and the group without esophagitis (p less than 0.001). In the group with esophagitis, comparison of the above pH variables in the upright and supine periods showed significantly higher values in the upright than in the supine period for the total number of reflux episodes per hour (p less than 0.001) and the number of episodes greater than 5 min/h (p less than 0.05). We conclude that the presence of esophagitis is related to both frequency and duration of GER episodes. Our findings also stress the importance of daytime acid exposure in the pathogenesis of esophagitis.

Adolescent↗