Letter: Unusual complication of use of Sengstaken-Blakemore tube.
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Alcoholism↗
Biomedical subjects
C J Hawkey
Publications and source records attributed to C J Hawkey.
Non-steroid anti-inflammatory drug associated ulcer: epidemiology, causation and treatment.
Epidemiological evidence consistently indicates that aspirin or non-aspirin non-steroidal anti-inflammatory drug use is associated with the occurrence of gastric ulceration, gastric and ulcer bleeding, and ulcer death. Evidence on duodenal ulcer occurrence conflicts, possibly because of differences in study populations. A wide range of mechanisms could explain the occurrence of non steroidal-induced damage. These include inhibition of bicarbonate secretion, effects on mucus formation, and vascular actions. Not all effects are dependent on cyclo-oxygenase inhibition. Short-term studies in humans provide indications of likely therapeutic effects, but cannot demonstrate clinical efficiency. Although anti-secretory drugs and prostaglandins can protect patients against the development of duodenal or gastric ulcers, but not both, there is no clinical evidence which bears upon the critical issue of protection against complications.
Anti-Inflammatory Agents, Non-Steroidal↗
NSAIDs and COX-2 inhibitors: what can we learn from large outcomes trials? The gastroenterologist's perspective.
Many studies have shown that a variety of strategies, including the use of cyclooxygenase-2 (COX-2) inhibitors, or co-prescription of misoprostol or proton pump inhibitors, result in reduced endoscopic damage and ulceration compared with non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) alone. Questions have been raised as to whether this would translate into improved clinical outcomes. Consequently, several studies have investigated whether use of COX-2 inhibitors (Vioxx Gastrointestinal Outcomes Research [VIGOR] and the Celecoxib Long-Term Arthritis Safety Assessment Study [CLASS] studies) or co-prescription with misoprostol (MUCOSA) would reduce the event rate of clinically significant ulcers. These studies have shown an approximate halving of such events. They have raised the possibility that use of low dose aspirin may compromise these benefits and appear to have shown differences between (at least some) COX-2 inhibitors and (at least some) NSAIDs with regard to myocardial infarction. Among the lessons learned from this experience are the need to define closely the outcomes of interest and possibly to concentrate on ulcer complications, the need for adequately powered studies, and the fact that endoscopic studies broadly predict outcomes. However, there are differences in the estimated rates of reduction. It is not self evident whether outcomes studies or endoscopic studies give a truer estimate of risk. A helpful development would be more standardized gastrointestinal assessment at the time of ulcer complications and this could be achieved if studies were done in countries with well-developed primary care systems.
Animals↗
New treatments in inflammatory bowel disease.
Salicylates and steroids remain the mainstay of treatment for inflammatory bowel disease. New formulations which attempt to lower the rates of side effects are under evaluation. The value of azathioprine has been established in ulcerative colitis and cyclosporin has been shown to be of value. Dietary therapy in Crohn's disease has been the focus of a large amount of research and benefits have been demonstrated. New therapies including bioengineered drugs are anticipated.
Anti-Bacterial Agents↗
A case of pica and iron deficiency anaemia in Nottingham.
Pica is the persistent eating of a non-nutritional substance (as defined by the American Psychiatric Association) and is often associated with iron deficiency. Current literature leaves uncertain whether pica causes iron deficiency via its proposed effect on iron absorption or, conversely, whether iron deficiency causes pica. We report the case of a young girl from Nottingham who we believe developed pica secondary to her iron deficiency anaemia. To determine that her pica was not affecting gastrointestinal iron absorption we carried out iron absorption studies first under pica and then under normal dietary conditions.
Adolescent↗