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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Scand. J. Gastroenterol. Suppl. · Jan 1984
The ulcer risk in reflux preventive gastric operations. An experimental study.
The ulcer risk of duodenogastric antireflux operations following gastric resection was analyzed experimentally in 162 rats. After gastric resection a Roux-Y gastrojejunostomy or jejunal transposition of various length were done. 10 month postoperatively a follow-up was performed consisting of endoscopy, analysis of gastrin and gastric secretion, gastric emptying tests and histamine stimulation. A high incidence of stomal ulceration was found, which was directly related to the length of the interposed jejunal segment. ⋯ The aetiology of these ulcers seems to be acid related, because all reflux-free stomachs showed a very low pH. Reflux preventive operations are demonstrated to be a modification of the Mann-Williamson experiment. They should be used carefully or avoided.
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In 62 patients the late results of isoperistaltic jejunal interposition in reconstructive ulcer surgery are analyzed 1.5 to 9.5 years postoperatively (mean 3.1 years); a follow up was possible in 58 patients. 38 (65.5%) had a Visick I or II result; 16 (28%) a fair result (Visick III) and 4 a poor result (Visick IV). 12 of the 58 followed up patients developed a jejunal stomal ulceration in the mean time. These ulcerations were mostly (60%) asymptomatic, superficial and nonbleeding. The histology of the gastric remnant remained unchanged in the most patients and didn't show any benefit of bile diverting operation. ⋯ Similar reports are found in the literature. Even an additional vagotomy doesn't prevent the ulcer formation sufficiently in every case. In conclusion reflux-preventive jejunal interposition is shown to be heavily ulcer-prone, it should be used in reconstructive ulcer surgery very carefully only with short (15 cm) segments and additional vagotomy.
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Scand. J. Gastroenterol. Suppl. · Jan 1984
ReviewFactors that might influence the outcome of studies on the aetiology and epidemiology of acute pelvic inflammatory disease.
An overview is presented of the various factors that might influence the outcome of aetiological and epidemiological studies of pelvic infections in women. Some diversities of opinion in these respects might be explained by i.a. inprecise definitions, lack of simple and specific diagnostic methods, differences in patient selection and laboratory techniques.