Scandinavian journal of gastroenterology. Supplement
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Non-ulcer dyspepsia (NUD) is a poorly defined heterogenous condition less well suited for the conventional randomized and placebo controlled parallel type trials. We have designed a multi cross-over model (MCO-model) with the facility of providing information about drug responses in individual patients. A pilot study suggested that the model may identify individual cimetidine responders among patients with dyspepsia. Preliminary findings from an ongoing study in patients with NUD supports the existence of a subgroup of cimetidine responders characterized by gastroesophageal reflux symptoms and possibly an increased basal acid secretion.
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Scand. J. Gastroenterol. Suppl. · Jan 1985
Clinical TrialControlled trials in gastrodyspepsia: a methodological aspect.
Non-ulcer dyspepsia (NUD) is a poorly defined condition that is not very suitable for conventional randomised double-blind studies. A multi cross-over model (MCO-model) has been designed allowing identification of individual drug responders with a defined degree of certainty. The model involves regular interchanges between periods with active drug and placebo, and the evaluation is based on the number of times the active drug is associated with fewer symptoms than the preceding or following placebo period (X-score). ⋯ The effect of cimetidine in patients with NUD has been studied using a variant of the MCO-model including 6 treatment periods of 2 or 4 days' duration. So far, the conclusion that the MCO-model is able to identify individual cimetidine responders among patients with NUD appears to be justified. The preliminary findings furthermore suggest that cimetidine responders among patients with NUD are characterised rather by symptoms suggestive of reflux esophagitis than by hypersecretion of acid.
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Problems of infections in the intensive care unit (ICU) center on patients admitted because of sepsis, patients with compromised host defenses and patients subject to invasive procedures. The mortality rate in septic shock is high, 47% in our own study. Escherichia coli was found in half the cases. ⋯ Use of corticosteroids and cimetidine may impair defence mechanisms. The use and abuse of antibiotics is vital to the successful control and treatment of infections in the ICU. Infection has been quoted as the most important single factor which determines the outcome of the intensive care patient.
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Scand. J. Gastroenterol. Suppl. · Jan 1984
Role of local secretory and motility changes in the pathogenesis of experimental duodenal ulcer.
Changes in gastric acid and pepsin secretions do not fully account for the duodenal ulcerogenic effect of cysteamine or propionitrile in the rat. We investigated the role of pancreatic and biliary secretions as well as motility changes in the duodenum. Bypass of bile to the jejunum and/or ablation of pancreatic secretion or drainage of these secretions through chronic duodenal fistula aggravated the cysteamine-induced duodenal ulcers. ⋯ An increased and dopamine-sensitive myoelectric activity caused by cysteamine or propionitrile was recorded in the proximal duodenum, indicating a state of hypermotility. Indeed, a decreased quantity of bilirubin was recovered through the chronic fistula in the proximal duodenum, suggesting an impaired delivery of bile to the ulcer area after cysteamine administration. Thus, duodenal hypermotility probably prevents the proper mix and neutralization of gastric acid and duodenal (mucosal, biliary and pancreatic) secretions, predisposing to ulceration in the proximal duodenum.
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Scand. J. Gastroenterol. Suppl. · Jan 1984
Comparative StudyDiversion of bile and pancreatic secretion in the rat and its effect on cysteamine-induced duodenal and peptic ulcer development under maximal acid secretion.
In this investigation we assess whether diversion of bile and pancreatic secretion protects rats from ulceration under maximal acid secretion as it does in cysteamine-induced ulcers. The rats were divided into a cysteamine-group (Cy) comprising 16 rats and a secretagogue group (PC) with 18 white male rats. Half of the animals of each group were submitted to the diversion-operation (division of the duodenum distally from the pylorus, jejuno-duodenostomy and entero-y-anastomosis), Cy2 and PC2 respectively. ⋯ Furthermore in PC1 group 34 gastric ulcers were found in 7 rats and only 4 ulcers in the PC2 group. It is therefore concluded, that the diversion operation provided protection against cysteamine-induced duodenal ulcers (p less than 0.01) and ulcer formation under maximal acid stimulation in the duodenum (p less than 0.02) as well as in the rat stomachs (p less than 0.05). In the PC group the restraint haltering of the animals promoted presumably a stress situation with bile reflux in the non-operated whereas in the operated animals (PC2) reflux did not occur.