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Biomedical subjects

C O'Moráin

Publications and source records attributed to C O'Moráin.

13 recordsLinked to original sources
PubMed1998

Lack of effect of treating Helicobacter pylori infection in patients with nonulcer dyspepsia. Omeprazole plus Clarithromycin and Amoxicillin Effect One Year after Treatment (OCAY) Study Group.

BACKGROUND: It is uncertain whether treatment of Helicobacter pylori infection relieves symptoms in patients with nonulcer, or functional, dyspepsia. METHODS: We conducted a double-blind, multicenter trial of patients with H. pylori infection and dyspeptic symptoms (moderate-to-very-severe pain and discomfort centered in the upper abdomen). Patients were excluded if they had a history of peptic ulcer disease or gastroesophageal reflux disease and had abnormal findings on upper endoscopy. Patients were randomly assigned to seven days of treatment with 20 mg of omeprazole twice daily, 1000 mg of amoxicillin twice daily, and 500 mg of clarithromycin twice daily or with omeprazole alone and then followed up for one year. Treatment success was defined as the absence of dyspeptic symptoms or the presence of minimal symptoms on any of the 7 days preceding the 12-month visit. RESULTS: Twenty of the 348 patients were excluded after randomization because they were not infected with H. pylori, were not treated, or had no data available. For the remaining 328 patients (164 in each group), treatment was successful for 27.4 percent of those assigned to receive omeprazole and antibiotics and 20.7 percent of those assigned to receive omeprazole alone (P=0.17; absolute difference between groups, 6.7 percent; 95 percent confidence interval, -2.6 to 16.0). After 12 months, gastritis had healed in 75.0 percent of the patients in the group given omeprazole and antibiotics and in 3.0 percent of the patients in the omeprazole group (P<0.001); the respective rates of H. pylori eradication were 79 percent and 2 percent. In the group given omeprazole and antibiotics, the rate of treatment success among patients with persistent H. pylori infection was similar to that among patients in whom the infection was eradicated (26 percent vs. 31 percent). There were no significant differences between the groups in the quality of life after treatment. CONCLUSIONS: In patients with nonulcer dyspepsia, the eradication of H. pylori infection is not likely to relieve symptoms.

Adolescent↗
PubMed1998

Diagnosis of gluten-sensitive enteropathy: is exclusive reliance on histology appropriate?

OBJECTIVE: Coeliac disease is a prevalent disorder but frequently remains undiagnosed because of varied modes of clinical presentation. In this study, methods for the detection of coeliac disease were evaluated in a clinical practice setting. METHODS: Small intestinal histology, IgA anti-endomysial and IgG anti-gliadin antibody tests were performed on 441 unselected, consecutive patients under investigation for small intestinal disease. Response to treatment and other clinical events were monitored over the ensuing years. RESULTS: Untreated coeliac disease was diagnosed in 97 patients and was excluded in 344. At clinical presentation, the endomysial antibody test was positive in 84 of the 97 untreated coeliac patients (sensitivity 87%) and negative in 340 of the 344 non-coeliac patients (specificity 99%). A typical histological lesion was found in 83 of the 97 coeliac patients (sensitivity 86%) but was absent in all 344 non-coeliacs (specificity 100%). The sensitivity of the gliadin antibody test was 69% and the specificity was 71%. CONCLUSIONS: In unselected patients attending a gastroenterology clinic, small bowel histology and endomysial antibody serology show similar predictive value in the diagnosis of coeliac disease. These results emphasize that a combination of clinical, histological and serological criteria are required for effective diagnosis of this disorder. Exclusive reliance on histology or serology will result in failure to make a diagnosis in a significant proportion of patients.

Adolescent↗
PubMed1993

Eradication of Helicobacter pylori in patients with non-ulcer dyspepsia.

Non-ulcer dyspepsia is an unsatisfactory term, as it describes a spectrum of conditions. The term is used for patients who have a normal upper endoscopy, macroscopically, but who have persistent upper gastrointestinal symptoms. Patients with non-ulcer dyspepsia respond to a wide variety of treatments, and there is a strong placebo response. Fifty per cent of these patients are shown to have Helicobacter pylori present if biopsy specimens are taken at endoscopy. Previous studies suggest that H. pylori eradication improves patients' symptoms. In a study from our unit we have shown that, in the short term, patients' symptoms improved with treatment, independent of H. pylori status. However, at 1-year follow-up, prolonged improvement of symptoms was observed only in patients in whom the organism had been eradicated.

Dyspepsia↗
PubMed1991

Helicobacter pylori infection in elderly dyspeptic patients.

The association between Helicobacter pylori (HP) and gastritis is well established. As there is evidence that HP infection increases with age we reviewed the clinicopathological records of 119 consecutive patients aged 65-85 years (mean 71.1 years) on whom gastroscopy had been performed for dyspeptic symptoms. All patients had two antral biopsies--one was assessed for histological evidence of gastritis and the other was independently assessed for evidence of HP infection. Thirty-six patients (30%) had duodenal ulceration, of whom 32 (89%) had an associated HP-positive gastritis. Forty-nine patients (41%) had antral gastritis without ulceration, of whom 38 (78%) were HP positive and 11 (22%) were HP negative. Ninety-one per cent of HP-negative gastritis patients had a history of recent ingestion of non-steroidal anti-inflammatory drugs (NSAID) compared with 29% of HP-positive gastritis patients. Ten patients (8%) had normal antral mucosa but had evidence of reflux oesophagitis (one of these patients was HP-positive). Nineteen patients (16%) had normal antral mucosa and normal endoscopic findings and one of these was HP positive. We conclude that HP infection is associated with the majority of cases of symptomatic gastritis in elderly patients. HP-positive gastritis is associated with the majority of duodenal ulcers. The most important cause of HP-negative gastritis is NSAID ingestion.

Age Factors↗
PubMed1991

Short report: the effect of omeprazole on Helicobacter pylori and associated gastritis.

Twenty-one patients with endoscopically confirmed duodenal ulceration, who had failed to heal with an H2-antagonist, were given omeprazole 20 mg o.m. for four weeks. Four antral biopsies from each patient were taken at endoscopy before, at the end of, and four weeks after treatment. Rapid urease test, culture, histopathology and transmission electron microscopy were carried out on these biopsies to determine the presence of Helicobacter pylori and improvement of gastritis. After four weeks of treatment, duodenal ulceration was healed in 16 (79%) of the patients; H. pylori was not detected by culture in 11 (50%) of the patients, and the associated gastritis improved in 12 (54%) patients. Four weeks after cessation of treatment the organism was cultured from antral biopsies of 18 (86%) of the patients and all of these had gastritis. Omeprazole treatment healed duodenal ulceration, improved gastritis temporarily, and suppressed but did not eradicate H. pylori.

Adult↗
PubMed1988

Effect of treatment on Campylobacter pylori in peptic disease: a randomised prospective trial.

This study investigated the effect of colloidal bismuth subcitrate and cimetidine on Campylobacter pylori in peptic disease. In 74% of 135 patients with peptic disease diagnosed at endoscopy C pylori was detected before treatment. Compared with cimetidine, colloidal bismuth subcitrate significantly decreased the incidence of C pylori after six weeks of treatment (p less than 0.001). In the colloidal bismuth subcitrate group, subsequent healing of the lesion was correlated with the clearance of C pylori, unlike in the cimetidine group. C pylori was strongly associated with the presence of histological gastritis, which was decreased by colloidal bismuth subcitrate (p less than 0.001).

Adult↗
PubMed1984

Elemental diet as primary treatment of acute Crohn's disease: a controlled trial.

Acute exacerbations of Crohn's disease are usually treated with prednisolone or potentially more toxic immunosuppressive drugs or by surgery. In pilot studies replacing the normal diet by a protein free elemental diet also induced remission. A controlled trial was therefore conducted in which 21 patients acutely ill with exacerbations of Crohn's disease were randomised to receive either prednisolone 0.75 mg/kg/day or an elemental diet (Vivonex) for four weeks. Assessment at four and 12 weeks showed that the patients treated with the elemental diet had improved as much as and by some criteria more than the steroid treated group. Elemental diet is a safe and effective treatment for acute Crohn's disease.

Acute Disease↗
PubMed1984

Reversible male infertility due to sulphasalazine: studies in man and rat.

Sulphasalazine treatment for inflammatory bowel disease in man causes oligospermia, reduced sperm motility and an increased proportion of abnormal forms. On withdrawal of sulphasalazine these effects are found to be reversible and 15 pregnancies occurred at a median of 2.5 months after stopping sulphasalazine therapy. Seminal plasma concentrations of acid phosphatase fructose and PGE2 as well as the hormone profiles of patients on sulphasalazine for three months were found to be within normal limits. Sulphasalazine fed to male Sprague Dawley rats caused a dose dependent and reversible infertility with a significant reduction in litter size. Rats fed the metabolite sulphapyridine also had a reduced litter size when mated, while those fed the metabolite 5'aminosalicylic acid and a polymer of 5'aminosalicylic acid did not. It seems likely that the sulphapyridine moiety of sulphasalazine is responsible for the infertility seen, the effect being mediated at a late stage in sperm maturation.

Adult↗
PubMed1982

Nitrous oxide decreases motility of human neutrophils in vitro.

The effect of 80 per cent nitrous oxide on motility of human neutrophils obtained from six volunteers was studied in vitro. In every case, random migration through the pores of 3 micrometer-millipore filter paper, was reduced (mean value 16 per cent). Chemotaxis toward casein also was reduced in every case (mean value 22 per cent). These results contrast with a previous study in which mean rates of migration were found to increase following exposure to 2 per cent halothane.

Cell Movement↗
PubMed1979

Halothane does not inhibit human neutrophil function in vitro.

Various indices of function of neutrophils from normal healthy volunteers have been examined after in vitro exposure to halothane. Random free movement on glass was unaffected, but random migration through millipore filters was slightly increased. There was no significant change in migration in response to casein chemotaxis. Phagocytosis, degranulation and the enhanced non-mitochondrial respiration associated with phagocytosis were unaffected. Electron-microscopic appearance at 30 s after exposure to latex particles was normal in all respects.

Cell Movement↗