Search PubMed⌕ Search

Biomedical subjects

A T Axon

Publications and source records attributed to A T Axon.

At least 163 records · Page 9Linked to original sources
PubMed1990

Reflux gastritis in the intact stomach.

Gastric biopsy specimens from patients who have undergone gastric surgery frequently exhibit foveolar hyperplasia, oedema, vasodilatation and congestion, and a paucity of inflammatory cells as consequences of entero-gastric reflux. Similar, albeit generally milder, changes were found in 47 of 316 (15%) non-surgical patients undergoing endoscopy for dyspeptic symptoms. To relate these changes to bile reflux or other potential gastric irritants the total bile acid concentration was measured in samples of fasting gastric juice, and the use of a symptom questionnaire ascertained the patients' cigarette consumption, use of non-steroidal anti-inflammatory drugs (NSAIDs), and alcohol intake. When patients with reflux gastritis were compared with normal controls (n = 91), significant increases in associated peptic ulceration and NSAID use were found in the group with reflux, but no increases in bile acid concentrations. Indeed, only one patient had evidence of duodenogastric reflux. It is concluded that most cases of "reflux gastritis" in the intact stomach are not due to reflux of bile. Our findings indicate an important pathogenic role for long term NSAID use, in what might be usefully termed type C or "chemical" gastritis.

Adolescent↗
PubMed1990

Serum bactericidal resistance of faecal Escherichia coli and bactericidal competence of serum from patients with ulcerative colitis.

A microtitre method was developed to screen Escherichia coli from 48 patients with ulcerative colitis and 25 controls for serum resistance. Bactericidal resistance was indicated by a change in colour of indicator due to acid production by viable organisms and quantitated by a change in absorbance. The method clearly differentiated between organisms confirmed as resistant or sensitive by conventional techniques. Twenty four (50%) disease and 14 (56%) control E coli specimens showed serum resistance. Bactericidal competence of sera from patients with ulcerative colitis was assessed by incubating sensitive E coli with sera from 10 patients with ulcerative colitis and pooled normal serum. All sera effectively reduced viable counts to less than 6% of original inoculum. This study shows that serum samples from patients with ulcerative colitis are bactericidally competent and that there is no increase in the number of serum resistant E coli in patients with ulcerative colitis.

Bacteriological Techniques↗
PubMed1989

Ascorbic acid in the human stomach.

Ascorbic acid, the reduced form of vitamin C, may protect against gastric cancer. Accordingly, this study assessed the variability of ascorbic acid and vitamin C in the gastric juice of 77 patients with dyspepsia. There was a vitamin C concentration gradient from gastric juice down to plasma in subjects with normal gastric mucosa, but not in those with chronic gastritis. Patients with chronic gastritis had significantly lower gastric concentrations of vitamin C and ascorbic acid, and ascorbic acid concentrations were especially low in subjects with hypochlorhydria. The presence of the concentration gradient suggests that a mechanism for the secretion of vitamin C into the stomach exists. This is compromised by chronic gastritis. The very low ascorbic acid concentrations in hypochlorhydria may be a consequence of oxidation by bacterial nitrite. Those patients who by the Correa model are at greatest risk for gastric cancer have the lowest gastric levels of ascorbic acid.

Adult↗
PubMed1989

Lactulose/mannitol test: an ideal screen for celiac disease.

A lactulose/mannitol (La/Ma) test was compared with a standard cellobiose/mannitol test (Ce/Ma) in 17 patients with newly diagnosed celiac disease and 12 healthy controls. The mean La/Ma test was 0.163 (SEM 0.076) in celiacs and 0.016 (SEM 0.002) in controls. The mean Ce/Ma test was 0.132 (SEM 0.024) in celiacs and 0.014 (SEM 0.002) in controls (p less than 0.001). There is no significant difference between the new La/Ma test and the Ce/Ma test. Eighty-two patients referred to a general gastroenterology clinic with symptoms or signs of celiac disease performed a La/Ma test. A jejunal biopsy was indicated in 44 of these. In this selected group the sensitivity was 89%, specificity 54%, and negative predictive value of 95%. The La/Ma test fulfills the criteria of a screening test; it is sensitive, of low cost, and simple to perform, and it has the advantage of a simple enzyme assay and does not cause diarrhea in patients with hypolactasia. It can, therefore, be used in screening large patient populations.

Adolescent↗
PubMed1989

Does the endoscope control head need to be disinfected between examinations?

An evaluation was made of the incidence of contamination of endoscope control heads during gastroduodenoscopy and colonoscopy, and of the efficacy of a simple disinfection technique. Contamination of the control heads occurred in 4 out of 17 examinations. Scrubbing in detergent followed by wiping with swabs impregnated with 70% isopropyl alcohol and 2% chlorhexidine achieved adequate disinfection of artificial heavy contamination of the control head. The endoscope control head represents a potential source of cross-infection and should not be neglected in any cleaning procedure.

1-Propanol↗
PubMed1989

Vitamin C in the human stomach: relation to gastric pH, gastroduodenal disease, and possible sources.

Fasting gastric juice pH and concentrations of vitamin C in gastric aspirate and plasma were measured in 73 patients undergoing endoscopy. Vitamin C concentrations were significantly lower in those with hypochlorhydria (pH greater than 4; n = 23) compared with those with pH less than or equal to 4 (p less than 0.005) and there was a significant correlation between gastric juice and plasma concentrations (p = 0.002). Patients with normal endoscopic findings had significantly higher intragastric concentrations of vitamin C than those with gastric cancer (p less than 0.001), pernicious anaemia (p less than 0.005), gastric ulcer (p less than 0.01), duodenal ulcer (p less than 0.05), or after gastric surgery (p less than 0.01). There was a strong trend (0.05 less than p less than 0.1) towards lower intragastric concentrations of vitamin C in patients with chronic atrophic gastritis. In vitro, vitamin C concentrations remained stable in acidic but fell significantly over 24 hours in alkaline gastric aspirate. Gastric secretory studies in five volunteers showed that vitamin C concentrations increased significantly after intramuscular pentagastrin. These findings suggest that the low fasting levels of vitamin C in hypochlorhydric gastric juice may be caused by chemical instability and that vitamin C may be secreted by the human stomach.

Adult↗
PubMed1989

Cellobiose/mannitol sugar test--a sensitive tubeless test for coeliac disease: results on 1010 unselected patients.

The cellobiose/mannitol (Ce/Ma) test is a non-invasive technique for investigating intestinal permeability. In coeliac disease there is a decreased absorption of small molecules and paradoxically increased absorption of large molecules. The simultaneous administration of cellobiose and mannitol as two probe molecules allows the permeability of the small bowel mucosa to be studied, eliminating extraneous factors such as gastric emptying, and incomplete urine collection. One thousand and ten patients presenting to a gastroenterology clinic with symptoms, signs, or biochemical indices compatible with coeliac disease had a Ce/Ma test. Eight hundred and seventeen had a normal test and of these 197 had a jejunal biopsy showing 148 normal mucosa, two coeliac disease, 43 non-specific abnormalities, four giardiasis. One hundred and ninety three had an abnormal test; of these 132 had a jejunal biopsy showing 62 normal mucosa, 48 coeliac disease, and 22 other abnormalities. Considering those who had jejunal biopsies, the sensitivity of the test for coeliac disease is 96%, specificity 70%, the predictive value of the positive 36%, and predictive value of the negative 99%. Eleven per cent of the patients with a 'false positive' test had abnormalities in the jejunal biopsy or a diagnosis which could explain the abnormal permeability.

Celiac Disease↗
PubMed1989

Campylobacter pylori--therapy review.

Although Campylobacter pylori is sensitive to many antibiotics in vitro, few are effective in vivo. Furthermore, treatment regimens which successfully clear the organism in vivo are associated with high recurrence rates when assessed one month following treatment. On the other hand, 85% of those individuals who are C. pylori negative 1 month after the cessation of therapy remain negative at 12 months and the infection can be considered to be eradicated. Treatment with certain bismuth salts appears to be the most useful monotherapy, eradicating the organism in approximately 19% whilst dual therapy with bismuth plus ampicillin or tinidazole is more effective, eradicating infection in 32% and 78% respectively. Preliminary data suggest that triple therapy with bismuth, amoxicillin and metronidazole, or bismuth, tetracycline and metronidazole eradicates the infection in over 90%.

Antacids↗
PubMed1989

Endoscopic retrograde cholangiopancreatography in chronic pancreatitis. Cambridge classification.

This article reviews the use of endoscopic retrograde cholangiopancreatography in chronic pancreatitis and discusses the endoscopic and radiologic techniques necessary for good pancreatography, the indications for its use, and the complications that may arise from it. The Cambridge classification is dealt with in detail together with the abnormalities found in chronic pancreatitis. There is also a short section describing methods of endoscopic therapy in chronic pancreatitis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1989

Ulcerative colitis: prolonged remission following azathioprine-induced pancytopenia.

The patient reported here has had prolonged remission following a chronic relapsing course of ulcerative colitis requiring frequent use of systemic steroids. All inflammatory bowel disease symptoms resolved after treatment with azathioprine, which was associated with the development of pancytopenia. The patient remains in clinical, sigmoidoscopic, and histological remission 56 months after receiving azathioprine.

Adult↗
PubMed1988

Adhesive Escherichia coli in inflammatory bowel disease and infective diarrhoea.

The clinical features of ulcerative colitis and Crohn's disease are similar to those of infections of the bowel, although their cause is uncertain. Many bacteria that cause intestinal diseases adhere to the gut mucosa, and adhesion of pathogenic Escherichia coli is resistant to D-mannose. The adhesive properties of isolates of E coli were assessed by assay of adhesion to buccal epithelial cells with mannose added. The isolates were obtained from patients with inflammatory bowel diseases (50 with a relapse of ulcerative colitis, nine with ulcerative colitis in remission, 13 with Crohn's disease, and 11 with infectious diarrhoea not due to E coli) and 22 controls. The median index of adhesion to buccal epithelial cells (the proportion of cells with more than 50 adherent bacteria) for E coli from patients with ulcerative colitis in relapse was significantly higher (43%) than that for controls (5%) and patients with infectious diarrhoea (14%). The index was not significantly different among isolates from patients with ulcerative colitis in relapse, Crohn's disease (53%), and ulcerative colitis in remission (30%). If an index of adhesion of greater than 25% is taken as indicating an adhesive strain 86% of isolates of E coli from patients with inflammatory bowel disease were adhesive compared with 27% from patients with infective diarrhoea and none from controls. The adhesive properties of the isolates from patients with inflammatory bowel disease were similar to those of pathogenic intestinal E coli, raising the possibility that they may have a role in the pathogenesis of the condition; the smaller proportion of adhesive isolates in patients with infective diarrhoea due to other bacteria suggests that the organism may be of primary importance rather than arising secondarily.

Bacterial Adhesion↗
PubMed1988

Highly selective vagotomy and duodenal ulcers that fail to respond to H2 receptor antagonists.

A study was conducted to see whether patients with duodenal ulcers that failed to heal in response to H2 receptor antagonists had a higher incidence of recurrent ulceration after highly selective vagotomy than patients whose ulcers healed with these drugs. Between 1977 and 1983, 157 patients had a highly selective vagotomy for uncomplicated duodenal ulcer; in 57 patients the ulcer had failed to heal despite treatment with H2 receptor antagonists (refractory group), 19 patients had developed recurrent ulceration while receiving maintenance treatment, 67 patients had remained healed while taking H2 receptor antagonists but suffered frequent relapses when treatment was stopped, and 14 patients had not been given these drugs before operation. The overall incidence of recurrent ulceration was 6% after two years and 11% after five years of follow up. In the refractory group, however, the incidence of recurrent ulceration was 18% at two years and 34% after five years, whereas the incidence of recurrence was only 1.5% at two years and 3% after five years in patients whose ulcers had healed with H2 receptor antagonists. Resistance to H2 receptor antagonists was not related to preoperative basal or peak acid output but was related to cigarette smoking. Factors associated with recurrent ulceration after highly selective vagotomy were basal acid outputs before and after operation, cigarette smoking, and the surgeon who performed the operation. Duodenal ulcers that fail to respond to H2 receptor antagonists represent a more severe ulcer diathesis, for which highly selective vagotomy is less effective.

Adolescent↗
PubMed1988

The mutagenic activity of gastric juice.

The mutagenic activity of fasting gastric juice was assessed in 123 patients including 18 with normal endoscopic findings, 53 peptic ulceration, 9 gastric cancer, 12 pernicious anaemia and 31 patients who had undergone peptic ulcer surgery in the past. Significant mutagenic activity was detected in 96 (78%). Marked variations in mutagenic activity were noted both within and between the patient groups and no significant differences were detected. No correlation was found between mutagenic activity and patient age or sex, gastric pH, bile acid concentrations or bacterial counts, intestinal metaplasia on gastric mucosal biopsy, or intragastric nitrite. About 30% of gastric juice samples showed evidence of a cytotoxic activity towards the Salmonella tester strains in the mutation assay. Preliminary studies on other body fluids showed the presence of significant mutagenic activity in fasting saliva, bile and plasma. These findings demonstrate widespread human exposure to potentially genotoxic substances.

Age Factors↗
PubMed1988

Iopamidol as contrast medium in endoscopic retrograde pancreatography: a prospective randomised comparison with diatrizoate.

In a prospective double-blind comparison of contrast media for retrograde pancreatography, 85 consecutive patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) were randomised to receive either the non-ionic medium, iopamidol (Niopam) or the ionic medium, meglumine diatrizoate (Urografin). The quality of pancreatograms obtained was assessed "blindly" using a specially devised scoring system, and patients were observed for clinical and biochemical evidence of acute pancreatitis following ERCP. Pancreatogram scores were similar in the "Niopam" and "Urografin" groups. No patients developed clinical evidence of acute pancreatitis. Eighteen hours after ERCP median increments in serum amylase and lipase in the "Niopam" group were significantly lower and hyperamylasemia and hyperlipasemia significantly less frequent than in the "Urografin" group. Niopam may be a safer contrast medium than Urografin for retrograde pancreatography, particularly in patients in whom the risk of acute pancreatitis is high. However, in view of its relatively high cost, further direct clinical evidence of reduced toxicity is required before Niopam can be recommended for routine use at ERCP.

Cholangiopancreatography, Endoscopic Retrograde↗