Gut
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Randomized Controlled Trial Multicenter Study Clinical Trial
Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis.
Platelet activating factor (PAF) is believed to amplify the activity of key mediators of the systemic inflammatory response syndrome (SIRS) in acute pancreatitis, resulting in multiorgan dysfunction syndrome. We tested the hypothesis that a potent PAF antagonist, lexipafant, could dampen SIRS and reduce organ failure in severe acute pancreatitis. ⋯ The high incidence of organ failure within 72 hours of the onset of symptoms undermined the primary hypothesis, and power calculations for future studies in severe acute pancreatitis will need to allow for this. Lexipafant had no effect on new organ failure during treatment. This adequately powered study has shown that antagonism of PAF activity on its own is not sufficient to ameliorate SIRS in severe acute pancreatitis
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Randomized Controlled Trial Clinical Trial
A double blind, randomised, controlled trial of glutamine supplementation in parenteral nutrition.
To determine whether the inclusion of 20 g free glutamine as part of the nitrogen source of parenteral feeds reduces length of hospital stay or mortality. ⋯ The benefit from glutamine supplementation of parenteral feeds as used in this trial has not been proved. Supplementation may have advantages in surgical patients and in haematological malignancy. Further trials are required.
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Randomized Controlled Trial Clinical Trial
Does oesophageal motor function improve with time after successful antireflux surgery? Results of a prospective, randomised clinical study.
There is a continuing debate whether motor abnormalities associated with gastro-oesophageal reflux disease (GORD) are primary phenomena or occur as a consequence of repeated injury caused by inflammation. To get new insights into mechanisms involved, patients were studied before and three years after effective and durable reflux control induced by two types of fundoplications. ⋯ Despite adequate and durable reflux control after fundoplication in patients with chronic GORD, no change was found in oesophageal motor function with time. The higher contraction amplitude and decreased frequency of failed primary peristalsis seen in patients having a total fundic wrap were thus most likely due to a mechanical outflow obstruction in the gastro-oesophageal junction. These results could therefore be interpreted in favour of the hypothesis that GORD is pathogenetically linked to a primary defect in oesophageal motor function.
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Randomized Controlled Trial Comparative Study Clinical Trial
Assessment of residual gastric volume and thirst in patients who drink before gastroscopy.
Before endoscopy patients undergo an uncomfortable fluid fast to reduce the risk of gastric acid aspiration and to ensure good endoscopic views are obtained. However, fluids rapidly leave the stomach and thus a long fluid fast before endoscopy may not be required. ⋯ It is safe for elective day cases to drink a significant volume of water two hours before endoscopy and this alleviates symptoms of thirst.
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Randomized Controlled Trial Comparative Study Clinical Trial
Role of Helicobacter pylori in ulcer healing and recurrence of gastric and duodenal ulcers in longterm NSAID users. Response to omeprazole dual therapy.
The relation between Helicobacter pylori infection and non-steroidal anti-inflammatory drug (NSAID)-associated peptic ulcers remains unclear; in particular, it is not known whether H pylori plays a part in the healing and recurrence of these ulcers. ⋯ H pylori eradication does not confer any significant advantage on the healing of gastric and duodenal ulcers associated with longterm NSAID use. It remains to be established with certainty whether eradication may be helpful in the reduction of recurrence in a specific subset of NSAID associated ulcer.