[Reflux esophagitis--a therapeutic problem].
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Biomedical subjects
Publications and source records attributed to A Rydning.
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To determine survival and the risk factors of death in primary biliary cirrhosis, data from 52 symptomatic and 13 asymptomatic patients were analyzed. The mean follow-up time was 6.3 years (range, 0.4-23 years). The average length of survival was 18 years for the symptomatic and 8.4 years for the asymptomatic patients. By a univariate analysis, ascites, presence of esophageal varices, gastrointestinal bleeding, jaundice, hepatomegaly and the logarithms of albumin and bilirubin were all associated with a poor prognosis. A multivariate analysis of the clinical features showed that the presence of bleeding from esophageal varices and the logarithm of bilirubin were the only predictors for poor prognosis. The survival of the symptomatic patients is longer than reported previously, while the life expectancy for the asymptomatic patients seems no better than for the symptomatic group.
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In the search for pathogenetic mechanisms behind EPC, intragastric bile acids were measured in 60 patients with non-ulcer dyspepsia (NUD) and grade 2 or 3 erosive prepyloric changes (EPC) and in 20 control subjects. Intragastric bile acid concentrations tended to be higher in the control subjects than in the EPC patients, but the difference did not reach statistical significance. The results neither support nor disprove the hypothesis that bile acid-induced mucosal damage may be involved in the pathogenesis of EPC.
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A randomized, double-blind, placebo-controlled trial was conducted to determine the efficacy of a low-dose aluminum-magnesium antacid regimen (Link one tablet q.i.d.) (total neutralizing capacity 120 mmol HCl/day) in combination with a high- or a low-fiber diet in ulcer healing and relief of symptoms in patients with benign gastric ulcer. After 6 wk, the ulcer healed in 28 (67%) of the 42 patients treated with antacids compared with 11 (25%) of the 44 patients treated with placebo (p less than 0.001). Antacids were also significantly more effective than placebo in the relief of symptoms. The dietary treatment did not significantly influence ulcer healing or ulcer symptoms. Constipation was more frequently seen with the low- than with the high-fiber diet (p less than 0.01). No significant side effects from antacids were recorded.
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Fasting and postprandial intragastric bile acid concentrations were determined in healthy subjects and in patients with gastric and duodenal ulcer. The results showed great interindividual variation and wide overlapping between groups. Mean bile acid concentrations, fasting and postprandially, were significantly higher in patients with gastric ulcer than in healthy subjects. The differences between gastric and duodenal ulcer patients and between duodenal ulcer patients and healthy subjects were not significant. Fiber-enriched wheat bran reduced bile acid concentrations significantly in patients with gastric ulcer disease.
Eighty patients with active duodenal ulcer were randomized to a diet poor or rich in fiber for a treatment period of 4 weeks. In addition, all patients received one antacid tablet (Link, 1.1 g) four times a day (total neutralizing capacity, 120 mmol HCl/day). The ulcer healed in 27 (67.5%) of the 40 patients in the high-fiber group, compared with in 24 (60%) of the 40 patients in the low-fiber group (p less than 0.5). Ulcer symptoms did not differ significantly between groups during the 4-week treatment period. No serious side effects were recorded. Constipation, the most frequently registered side effect, was seen in 11 (27.5%) of the patients in the low-fiber group, compared within 4 (10%) in the high-fiber group (chi-square = 4.0; p less than 0.05). Patients with unhealed ulcer after 4 weeks' treatment received ranitidine instead of antacids. While they were receiving ranitidine treatment, no significant differences in healing rates were seen between the two dietary groups.
The effect of physiological doses of guar gum (Guarem), 5 g, and fiber-enriched wheat bran (Fiberform), 10.5 g, on gastric emptying was studied by two different methods in healthy subjects: by a simple isotope localization monitor placed over the upper part of the abdomen and by gamma camera. The fiber preparations were added to a semisolid meal consisting of wheatmeal porridge and juice, using technetium-99 DTPA as a marker. The gamma camera showed no effect of fiber on gastric emptying. The isotope localization monitor, however, indicated that Fiberform prevented a postprandial accumulation of the meal within the upper part of the stomach. The simple isotope localization monitor cannot be recommended for measurements of gastric emptying.
Diets modify gastric function in various ways. Fibre influences acidity, pepsin and bile acid concentrations both in vitro and in vivo. Both animal studies and clinical studies in humans give reason to believe that a diet rich in fibre may protect against the development of peptic ulceration.
The effect of a fiber-enriched wheat bran product, Fiberform, and a guar gum, Guarem, on gastric juice acidity, pepsin, and bile acid concentration was studied in vitro. Fiberform had a slight acid-binding capacity. The fiber preparation did not bind pepsin. Both products bound bile acids. With Fiberform the amount of bile acids bound was proportional to the amount of fiber and most pronounced at low pH and high bile acid concentration.
The effect of a fiber-enriched wheat bran product, Fiberform, and a guar gum preparation, Guarem, on postprandial intragastric juice acidity and pepsin and bile acid concentrations was studied in healthy subjects. Fiber-enriched wheat bran prolonged significantly the meal-induced elevation of pH and decrease in pepsin. Both fiber products reduced postprandial intragastric bile acid concentration.
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