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
Bile diversion from the duodenum: its effect on gastric and pancreatic function.
The effect of diverting bile from the duodenum in four dogs by cholecysto-jejunostomy was studied using a double-marker perfusion technique. During digestion of a liquid meal, acid secretion increased from 0.8 mmol H+/min to 1.48 mmol H+/min (p less than 0.05, paired t test); there was an associated rise in serum levels of gastrin 120 minutes after feeding (p less than 0.001, paired t test). ⋯ There was no significant change in the rate at which the liquid meal emptied from the stomach after bile diversion but the pH of duodenal contents was lower during the later stages of digestion. These changes may explain the reported increase of peptic ulcer after diverting bile from the duodenum and the procedure should not be considered unless the consequences of acid hypersecretion and pancreatic inhibition have been anticipated.
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Scand. J. Gastroenterol. Suppl. · Jan 1984
Effect of pentobarbital anesthesia and bile acids on cysteamine-induced duodenal and gastric ulcers in rats.
Cysteamine given three times within 8 h produced severe duodenal and gastric ulcers in female SIV rats. A pentobarbital anesthesia during the first 10 h prevented gastric ulcer formation without affecting duodenal ulcer. ⋯ Treatment with somatostatin significantly reduced the intensity of duodenal ulcer. The inhibition of cysteamine-induced gastric ulcer formation by pentobarbital does not seem to be due to a possible inhibition of duodenogastric reflux but more likely to an inhibition of central nervous stress reactions by anesthesia.