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Biomedical subjects

B T Cooper

Publications and source records attributed to B T Cooper.

At least 37 records · Page 2Linked to original sources
PubMed1996

Lansoprazole versus ranitidine in the maintenance treatment of reflux oesophagitis.

AIMS: To assess the relative efficacies of lansoprazole 15 mg once daily, lansoprazole 30 mg once daily and ranitidine 300 mg b.d. in the maintenance treatment of reflux oesophagitis for 12 months. METHODS: Multicentre, out-patient, double-blind, parallel group, prospectively randomized clinical trial. Patients with grade 0, asymptomatic oesophagitis after 8 weeks of treatment with lansoprazole 30 mg once daily were randomized to receive lansoprazole 30 mg once daily (L30) (n = 75), lansoprazole 15 mg once daily (L15) (n = 86) or ranitidine 300 mg b.d. (R600) (n = 74) for 12 months. Endoscopy was repeated at 6 and 12 months, and symptomatic assessment was made every 3 months. Efficacy was primarily assessed by the time to endoscopically confirmed relapse (oesophagitis grade > or = 1) and the proportion of patients who relapsed during the 12-month study period. Severity of symptoms were secondary efficacy measures. RESULTS: For all patients randomized with at least one post-baseline endoscopy (intent-to-treat principle) both lansoprazole 15 mg (P < 0.001) and lansoprazole 30 mg (P < 0.001) were significantly superior to ranitidine 600 mg with respect to time to endoscopic relapse. There was no difference between the lansoprazole groups (P = 0.11). There was evidence of relapse in 27 of 86 (31.4%), 15 of 75 (20.0%) and 50 of 74 (67.6%) of the patients treated with lansoprazole 15 mg and 30 mg and ranitidine 600 mg, respectively. Patients receiving treatment with either lansoprazole dosages experienced significantly less severe heartburn and regurgitation than those patients treated with ranitidine. There were no differences between the treatment groups with respect to the severity or incidence of adverse events. No clinically significant laboratory changes were observed in any of the treatment groups. Serum gastrin levels were elevated in all treatment groups, and most markedly in those patients receiving lansoprazole, but there was no significant difference between the treatments. Morphological and immunohistochemical examination of the gastric biopsies revealed no clinically relevant changes from baseline in any of the treatment groups. CONCLUSION: Both lansoprazole 15 mg and lansoprazole 30 mg once daily are significantly more effective than high-dose ranitidine in maintaining reflux oesophagitis in remission.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

Small intestinal permeability to mannitol and lactulose in the three ethnic groups resident in west Birmingham.

BACKGROUND/AIMS: Asymptomatic residents of tropical countries have differences in small intestinal morphology and permeability compared with residents of temperate zones. The aim of this study was to investigate small intestinal permeability and morphology in three ethnic groups resident in Birmingham, UK. METHODS: 28 white patients, 101 Indian (Indian subcontinent), and 49 Afro-Caribbean adult patients with dyspepsia had endoscopic distal duodenal biopsies and a hyperosmolar lactulose/mannitol permeability test. Twenty normal white subjects had the permeability test. RESULTS: Lactulose/mannitol excretion ratios (LMER) were: white subjects 0.022 (median), white patients 0.022, Indians 0.031, Afro-Caribbeans 0.033. Differences between the immigrant groups and the two white groups were significant (p < 0.001); 33% of Indians and 45% of Afro-Caribbeans had LMER outside the range of the white groups. Afro-Caribbeans born in the UK had significantly lower LMER than those born abroad (p < 0.05); a similar trend was seen in Indians. Villous height/mucosal thickness ratios, calculated from small intestinal biopsy specimens, were lower in the immigrant groups and correlated inversely with LMER (r = 0.28; p < 0.05). Time resident in the tropics also correlated inversely with LMER. CONCLUSIONS: There were significant differences in small intestinal permeability and morphology between immigrants resident in a Western country and the native white population. The data suggested that these differences were related to environmental factors.

Adolescent↗
PubMed1995

Effect of water-loading on the performance of polyethylene glycol as a marker of small intestinal permeability.

1. Polyethylene glycol has been used extensively to measure small intestinal permeability in vivo. However, polyethylene glycol seems to traverse the intestinal mucosa in much greater quantities than sugar molecules of equivalent M(r). In addition, the recovery of the lowest M(r) polymers of administered polyethylene glycol has been found to be both low and unreliable. 2. To compare the behaviour of a range of polyethylene glycol polymers with sugar probes in vivo, a combined polyethylene glycol/mannitol/lactulose probe was administered sequentially to healthy individuals in the fasted state and under conditions of water-loading. Timed hourly urine collections were made for 6 h. 3. Mannitol and lactulose recoveries were all within the normal range and were unaffected by co-administration of water. The lactulose/mannitol recovery ratios did not vary significantly over the 6 h collection period. In contrast, the recovery of total polyethylene glycol was significantly greater when subjects were water-loaded. Furthermore, proportionally greater quantities of polyethylene glycol M(r) 370 than M(r) 854 were recovered towards the end of the collection period than at the start. 4. Our results show that, in contrast to lactulose and mannitol, excretion of low-medium M(r) polyethylene glycol polymers is highly dependent on co-administration of water. Furthermore, the differential rate of excretion of the low compared with the high M(r) polyethylene glycol polymers suggests that the volume of distribution of the individual polymers may vary with M(r), and smaller polyethylene glycol molecules may undergo considerable renal tubular reabsorption.

Adult↗
PubMed1995

Long term continuous omeprazole treatment of patients with Barrett's oesophagus.

BACKGROUND: The metaplastic columnar epithelium in Barrett's oesophagus has malignant potential. AIM: To determine whether decreasing acid reflux leads to regression of Barrett's epithelium. METHOD: Twenty-four patients with Barrett's oesophagus were treated with omeprazole 20 mg o.m. in an open, prospective study; 11 were treated for 12 months, and 13 for 24 months. Another group of 17 patients with Barrett's oesophagus was treated with an H2-receptor antagonist in standard dosage for 12-36 (mean 23) months. Patients were assessed endoscopically. RESULTS: No evidence of significant shortening of the length of Barrett's oesophagus was seen in any patient treated for 12 or 24 months with omeprazole. Similarly, no shortening of the length of Barrett's oesophagus was seen in any patient treated with an H2-receptor antagonist. However, 6 of 11 patients treated with omeprazole for 12 months, and 7 of 13 treated for 24 months, developed macroscopic squamous islands visible below the squamo-columnar junction. This was not seen in any patient treated with an H2-receptor antagonist. CONCLUSION: Although there can be reappearance of squamous epithelium in Barrett's oesophagus of some patients during treatment with omeprazole 20 mg o.m. over 12-24 months, a significant shortening of the columnar lined segment is not seen.

Adult↗
PubMed1995

Endoscopy and computed tomography in the diagnosis and follow up of oesophageal leiomyoma.

Leiomyoma of the oesophagus, although the commonest benign oesophageal tumour, is still rare compared with malignant tumours of the oesophagus. Leiomyomas of the oesophagus are usually diagnosed on barium swallow or histological examination after section. Five cases of leiomyoma of the oesophagus are reported where diagnosis was made by the combination of barium swallow, upper gastrointestinal endoscopy, and computed tomography and all but one patient were followed up for one to four years. The endoscopic biopsy specimens were non-specific in all five patients but none showed any evidence of malignancy. None of the five patients had a history of dysphagia. This paper describes a conservative approach to medical treatment in asymptomatic oesophageal leiomyoma rather than surgical excision as commonly published. It also emphasises the importance of negative endoscopic pinch biopsy specimens and the role of computed tomography in the diagnosis of oesophageal leiomyoma.

Biopsy, Needle↗
PubMed1995

Symptomatic cardiomyopathy as a presentation in Whipple's disease.

A patient presenting with congestive cardiac failure and anaemia underwent investigation which led to the diagnosis of Whipple's disease, associated with dilated cardiomyopathy. Conventional antibiotic therapy for Whipple's disease resulted in resolution of the traditional features of Whipple's disease and a marked improvement in the patient's heart failure.

Aged↗
PubMed1994

24 hour ambulatory oesophageal pH monitoring in uncomplicated Barrett's oesophagus.

The aim of this study was to compare acid reflux in 16 patients with uncomplicated Barrett's oesophagus with 37 patients with reflux oesophagitis and 10 control subjects of comparable age. All patients had 24 hour ambulatory pH monitoring within one week of endoscopy. The controls differed significantly from the other groups in all indices of reflux but there was no difference between the Barrett's oesophagus patients and the reflux oesophagitis patients in any index of reflux over the total 24 hour period. Barrett's oesophagus patients differed significantly, however, with respect to the percentage time pH < 4 and the number of reflux episodes of > five minutes during the supine period when compared with patients with grade I reflux oesophagitis, but not when compared with patients with grade II and III reflux oesophagitis. Barrett's oesophagus patients with associated grade II reflux oesophagitis had more reflux than those with no oesophagitis or grade I reflux oesophagitis. Within each disease group patients > or = 50 years had more acid reflux than patients < 50 years. The severity of acid reflux in patients with uncomplicated Barrett's oesophagus was no greater than in patients with reflux oesophagitis of comparable age. It seems probable that other factors must be important in the development of Barrett's oesophagus.

Ambulatory Care↗
PubMed1994

Benign intracranial hypertension during prednisolone treatment for inflammatory bowel disease.

Benign intracranial hypertension (BIH, pseudotumour cerebri) is a rare condition with unknown aetiology although hormonal influences have been implicated. It occurs spontaneously, particularly in young obese women, and is associated with several drug treatments including corticosteroids. Two young adult women are described in whom headache and papilloedema in association with raised intracranial pressure occurred during prednisolone treatment for inflammatory bowel disease. This provides further evidence of the risk of BIH during corticosteroid treatment and has not been described before in adults with this condition. Advice is given to gastroenterologists to use corticosteroids with caution in adults, particularly young, fertile female patients. The treatment of a severe relapse of colitis in a patient who has had one episode of steroid related BIH remains a dilemma.

Adult↗
PubMed1994

Phytase activity in the human and rat small intestine.

Phytate is the major storage form of phosphorus in seeds and so is a common dietary constituent. Excessive ingestion of undegraded phytates can cause mineral deficiencies in humans. In addition, phytic acid is antineoplastic in animal models of both colon and breast carcinoma. There have been no previous studies quantifying phytase activity in the human small intestine although it is present in animals. Small intestinal phytase and alkaline phosphatase activity and distribution was measured in vitro in mucosal homogenates from two human small intestinal specimens obtained from transplant donors. Rat intestine was also studied for comparison. Phytase activity was found in human small intestine at low values (30 times less than that in rat tissue and 1000-fold lower than alkaline phosphatase in the same tissue). The activity was greatest in the duodenum and lowest in the ileum. In conclusion, the normal human small intestine has very limited ability to digest undegraded phytates. Although this may have adverse nutritional consequences with respect to metabolic cation imbalances, the presence of undigested phytate in the colon may protect against the development of colonic carcinoma.

6-Phytase↗
PubMed1993

Diffusion of polyethylene glycol-400 across lipid barriers in vitro.

1. Polyethylene glycol has been used extensively as a probe to measure passive small-intestinal permeability in vivo. However, there has been some uncertainty as to its suitability for use as an indicator of the permeation of water-soluble molecules across the intestinal wall because it seems to traverse the mucosa in much greater quantities than sugar molecules of equivalent M(r). 2. We have measured the permeation of polyethylene glycol-400 and lactulose from aqueous solution across pure lipid solvents in vitro. We found considerable transport of polyethylene glycol-400 across chloroform (1.03 g h-1 m-2) but no movement across petroleum ether. 3. However, in a separate experiment in which phospholipid (egg lecithin) was dissolved in the petroleum ether, permeation of polyethylene glycol-400 did occur (0.13 g h-1 m2), implying interaction of polyethylene glycol-400 with the phospholipid. No permeation of lactulose was seen in any of the experiments. 4. Our results suggest that, because of its interaction with lipid solvents, polyethylene glycol-400 is unsuitable as a probe to measure passive intestinal permeability in vivo.

Diffusion↗
PubMed1991

A comparison of roxatidine and ranitidine for the acute treatment of duodenal ulcer.

Roxatidine acetate is a new histamine H2-antagonist of about twice the potency of ranitidine on a weight-for-weight basis. Two hundred and thirty-two patients participated in a double-blind randomized trial of duodenal ulcer healing comparing 300 mg ranitidine nocte with 150 mg roxatidine nocte. Endoscopy was repeated fortnightly to 4 weeks in each of four participating centres. Usual exclusion criteria applied but NSAID users were allowed. There were no important demographic differences between treatment recipients. Three analyses were used: protocol (dropouts and violators not included), intention-to-treat I (dropouts considered failures), and intention-to-treat II (dropouts considered failures, but violators outcome included). Healing rates differed markedly (but not significantly) with each analysis. After 2 weeks of treatment ulcers had healed in 51% versus 45% using the intention to treat I analysis with roxatidine and ranitidine, respectively; by the protocol analysis the healing proportions were 60% and 55%. These differences between treatments were not significant. After 4 weeks of treatment healing rates ranged from 71% to 83% on roxatidine and between 69% and 84% on ranitidine depending on the analysis. Differential healing proportions of smokers and non-smokers were non-significant (83% vs. 79%). Both drugs were well tolerated and adverse events were similar with each agent. Roxatidine should prove as effective as ranitidine for acute duodenal ulcer treatment.

Adult↗
PubMed1991

Coeliac disease and malignancy of the duodenum: diagnosis by endoscopy, successful treatment of the malignancy, and response to a gluten free diet.

A patient presented with subtotal villous atrophy and a malignant duodenal tumour of uncertain histogenesis. He was successfully treated by resection and chemotherapy and the small bowel mucosa recovered on a gluten free diet. The tumour was diagnosed at upper gastrointestinal endoscopy when barium studies and abdominal computed tomography were normal, thus making this one of the earliest coeliac malignancies diagnosed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Small bowel morphology in British Indian and Afro-Caribbean subjects: evidence of tropical enteropathy.

Distal duodenal biopsy specimens taken from 30 white, 35 Indian, and 20 Afro-Caribbean residents of West Birmingham during routine endoscopy for dyspepsia, were assessed by dissecting microscopy and morphometry. Finger-shaped villi were significantly less frequent in the Indian and Afro-Caribbean subjects than in the white subjects when assessed by dissecting microscopy (p less than 0.005), and both immigrant groups had decreased mucosal thickness (p less than 0.01), villous height (p less than 0.001), villous:crypt ratios (p less than 0.01) and enterocyte height (p less than 0.05) compared with the white group. In the Indian subjects, villous height and villous:crypt ratios correlated significantly with the time since the last visit to the Indian subcontinent (p less than 0.005). Serum alkaline phosphatase values were significantly higher in the Indian subjects compared with the whites (p less than 0.02), and serum globulins were increased in both the Afro-Caribbean and Indian subjects (p less than 0.01). There were no correlations between morphometric indices and body habitus or biochemical or haematological indices and the long term effect of the morphological changes is not clear.

Adolescent↗
PubMed1988

Acute upper gastrointestinal haemorrhage in patients aged 80 years or more.

We report a series of 103 admissions of patients aged 80 years or more with acute upper gastrointestinal haemorrhage to one hospital over a four-year period. A cause was eventually found during 81.5 per cent of admissions and of these, 57 per cent had bled from chronic peptic ulcers. After 64 per cent of admissions, the patient received a blood transfusion and in 25 per cent, the blood transfusion exceeded 5 units. Nine patients had surgery for peptic ulcer during admission but no operations were performed in patients with other causes of upper gastrointestinal haemorrhage. Patients with peptic ulcer, when compared to patients with other causes for haemorrhage, were more likely to have symptoms of upper gastrointestinal disease before presentation. They were also more likely to continue to bleed, to bleed again, to require surgery, and to die as a consequence of haemorrhage. Eighteen admissions (17.5 per cent) ended with death but in only 11 (10.5 per cent) did the patient die directly because of haemorrhage. Nine of these bled from a peptic ulcer, one from oesophageal varices and one from an unknown cause. Patients who died from haemorrhage, when compared to all others, were more likely to have bled from a peptic ulcer and to have significant co-existing disease, to have ingested non-steroidal antiinflammatory drugs or aspirin before admission, to have raised blood urea level and low systolic blood pressure at admission and to have required blood transfusion of more than 5 units. Our study has shown that upper gastrointestinal haemorrhage secondary to peptic ulceration is a serious and often fatal condition in the elderly. Identification and effective monitoring of those at particular risk of death may be essential if mortality is to be reduced.

Acute Disease↗