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Biomedical subjects

M Osnes

Publications and source records attributed to M Osnes.

At least 55 records · Page 3Linked to original sources
PubMed1991

Ranitidine for non-ulcer dyspepsia. A clinical study of the symptomatic effect of ranitidine and a classification and characterization of the responders to treatment.

Seven Norwegian centres recruited 61 female and 54 male patients with non-ulcer dyspepsia (NUD). Their mean age was 40 years. After 6 weeks' double-blind alternating treatment with 150 mg ranitidine twice daily and placebo, 1 week of each alternative (part I), an effect score (Xs) and an efficacy index (Ei) were calculated. Ranitidine was significantly superior to placebo for symptomatic relief (p less than 0.01). Twenty-eight, 49, and 38 patients were Xs-classified as 'responders', 'unclassified', and 'nonresponders' to ranitidine, respectively. The symptomatic effect was impressive in the responder group and moderate but significant also in the unclassified group. The nonresponders had a significantly unfavourable effect of ranitidine compared with placebo. The Xs-classified responders and unclassified continued single-blind treatment with ranitidine for 4 weeks (part II) and were reclassified as 'new responders/nonresponders'. The new responders received single-blind treatment with placebo until relapse or maximum 8 weeks (part III). Parts II and III verified the good Xs classification of responders to ranitidine treatment. The overall effect of ranitidine in patients with NUD was due to good symptomatic effect in a subpopulation characterized by meal-related heartburn and/or regurgitation, large body mass index, first-degree relatives with gastrointestinal diseases, a relatively low frequency of gastrointestinal symptoms per week, and absence of soft stools.

Adult↗
PubMed1991

Gastrointestinal bleeding: dyspeptic symptoms and clinical course in relation to use of non-steroidal antiinflammatory drugs.

To study the symptoms of NSAID-associated gastroduodenal bleeding, 94 patients (median age 71 years, range 19-90), were included in a prospective, clinical trial where hematemesis or melena from gastroduodenal ulceration or haemorrhagic/erosive gastritis were the inclusion criteria. NSAID use within one month was studied in relation to subjective symptoms prior to admission and to clinical course of the episode. Significantly fewer of the NSAID users (n = 54) than the non-users (n = 40) had experienced prior peptic ulceration or dyspeptic symptoms. Otherwise, no differences were seen between users and non-users, as regards pre-admission epigastric pain, heartburn or nausea. Also, the clinical course was similar in the two groups. We also found sporadic and regular NSAID use to be similar in this respect. These data do not support the alleged masking of ulcer symptoms by NSAIDs in bleeding ulcers.

Adult↗
PubMed1990

Digital ambulatory manometry of the small intestine in healthy adults. Estimates of variation within and between individuals and statistical management of incomplete MMC periods.

A new technique for ambulatory manometry of the small intestine with digital storage of signals is presented. Postprandial motility after a 1700-kJ meal and nighttime fasting motility were recorded in 19 healthy young adults. A comprehensive statistical approach was worked out to illuminate the statistical properties of fasting motility data from long-term studies. Separate quantifications of the variation within and between individuals are presented for the migrating motor complex (MMC). The overall mean for the MMC period was 107 min, with incomplete periods included as censored data. Standard deviation within individuals was 49 min, and standard deviation between individuals 16 min. Presented in the same manner, phase III in the proximal jejunum lasted 5.3 min, with standard deviations of 1.5 and 1.1 min, respectively. The propagation velocity of phase III in the distal duodenum was 10.8 cm/min, with standard deviations of 3.7 and 4.1 cm/min, respectively. Fed-state lasted 324 +/- 110 min (mean +/- SD), and adjusted fed-state, an alternative definition proposed in this study, 290 +/- 80 min. This variance component model, extended to handle censored data, provides a useful statistical approach for the analyses of the MMC. The MMC period proved to be less suitable for quantitative comparisons because of dominating intraindividual variance. Comparisons presented indicate that discrepancies in reference values depend, to a great extent, on the statistical methods applied.

Adult↗
PubMed1990

NSAID-associated gastroduodenal damage: does famotidine protection extend into the mid- and distal duodenum?

Eighteen healthy volunteers were included in a cross-over, double-blind study where 500 mg naproxen b.d. was given for 1 week with 20 mg famotidine b.d., 40 mg nocte or placebo. Endoscopic evaluation of the gastroduodenal mucosa was performed before and after each treatment period, with separate evaluation of the mid- and distal duodenum. 51Cr-EDTA-permeability tests were done to study effects on the mid- and distal gut, and, in addition, symptom registration was performed. The mucosal damage was significant in all treatment periods, and a statistically significant reduction was seen with 20 mg famotidine b.d. for erosive lesions in the stomach/duodenal bulb region as well as for the sum of damage score in the mid- and distal duodenum. The reduction was considerable in a few subjects with extensive duodenal damage. The reduction was considerable in a few subjects with extensive duodenal damage. Intestinal permeation increased significantly in all periods, and was not reduced by famotidine. Symptoms were modest and equal in all periods.

Adult↗
PubMed1990

51Cr-ethylenediaminetetraacetic acid absorption test. Effects of naproxen, a non-steroidal, antiinflammatory drug.

Eighty volunteers were studied to determine the effects of 750 or 1000 mg naproxen daily for a week on intestinal permeability, by means of the 51Cr-ethylenediaminetetraacetic acid (EDTA) absorption test. With 750 mg naproxen (n = 42) the median urinary excretion increased from 2.44% to 3.51% (p less than 0.01), and with 1000 mg (n = 38) from 2.26% to 3.39% (p less than 0.01). When the individual pretreatment absorption was included in the analysis, a statistically significant difference was found between the two doses (19% and 68% median increase as a percentage of base line, respectively (p = 0.04)). Similar results were found in 27 subjects who were given both doses of naproxen. Intraduodenal instillation of the test dose in 18 subjects showed that gastric absorption was negligible, and no correlation was found with upper endoscopy findings, changes in orocoecal transit time, or reported symptoms.

Adult↗
PubMed1990

Gastroduodenal lesions induced by naproxen. An endoscopic evaluation of regional differences and natural course.

Gastroduodenal endoscopic findings were studied in 65 healthy volunteers receiving 750 mg or 1000 mg naproxen for 1 or 2 weeks. Separate registration of the mid- and distal duodenum showed that mucosal toxicity can be demonstrated even distally to the duodenal bulb. The lesions were closely correlated to the findings in the stomach and duodenal bulb, though generally somewhat less extensive. Whereas a difference between 750 mg and 1000 mg naproxen was demonstrated in an intraindividual comparison (n = 26; median sum of visual analogue scale score in the stomach/duodenal bulb, 129 mm and 183 mm, respectively; p less than 0.05), no difference was seen in two parallel groups (n = 32 and 33). In the stomach and duodenal bulb, a significant aggravation of mucosal lesions was seen from 1 to 2 weeks in 16 subjects. Healing was complete in 10/12 subjects after 3 weeks, independent of the extent of the initial damage.

Adolescent↗
PubMed1990

Visual analogue scales for endoscopic evaluation of nonsteroidal anti-inflammatory drug-induced mucosal damage in the stomach and duodenum.

The use of visual analogue scales in the evaluation of mucosal lesions may reduce sample size requirements in clinical trials, but they may be complex to use, and adding guide points may reduce their informative value. We found that two investigators with differing levels of endoscopic experience reached comparable conclusions in 4 clinical trials (738 scores), and their scores were highly correlated, with similar dispersion characteristics. With guide texts along the scales, thus avoiding points on the actual scales, no tendency towards accumulation was seen in 1449 scores. These results encourage the use of visual analogue scales in endoscopic studies.

Adolescent↗
PubMed1989

[Campylobacter pylori. Determination of gastric colonization and its clinical relevance].

While evidence suggesting a statistical association between Campylobacter pylori and chronic active antral gastritis is convincing, the role which the organism may play in the pathogenesis of this condition and in the case of peptic ulcer remains to be elucidated. The development of safe, non-invasive diagnostic tests suitable for population studies greatly facilitates this investigative process. This article presents a brief review of currently available methods of diagnosing C pylori colonization in the stomach and discusses their possible application in the field of clinical gastroenterology.

Campylobacter↗
PubMed1989

Optimal assessment of gastrointestinal side effects induced by non-steroidal anti-inflammatory drugs. Endoscopic lesions, faecal blood loss, and symptoms not necessarily correlated, as observed after naproxen and oxindanac in healthy volunteers.

Gastrointestinal side effects caused by naproxen and oxindanac (a developmental non-steroidal anti-inflammatory drug) were compared by combined endoscopy and determination of faecal blood loss in 16 healthy male volunteers in a randomized, double-blind, crossover study. Individual daily faecal blood loss was determined by means of 51Cr-labelled erythrocytes. Gastroduodenoscopy was performed before and after administration of naproxen, 750 mg/day, and oxindanac, 600 mg/day, for 1 week each. A washout period of at least 3 weeks was inserted between drug periods. Visual analogue scales (VAS) were used for endoscopic assessment of lesions and subjective complaints. Mean faecal blood loss increased from a base line 0.48 ml/24 h to 1.59 ml/24 h with naproxen (p less than 0.01) and from 0.56 ml/24 h to 1.31 ml/24 h with oxindanac (p less than 0.01). VAS scores for gastroduodenal lesions increased significantly with both drugs. Naproxen caused a significantly greater increase than oxindanac (p less than 0.05). There was no correlation between gastrointestinal blood loss and endoscopic findings. Subjective symptoms were correlated to faecal blood loss with naproxen, but not to endoscopic findings. No such correlations were observed for oxindanac. Naproxen caused a significant prolongation of bleeding time (p less than 0.01), whereas the increase caused by oxindanac was not significant (p = 0.09).

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

Non-steroidal anti-inflammatory drug-induced disease in the distal ileum and large bowel.

Non-steroid, anti-inflammatory drug (NSAID)-induced lesions in the gut are common, but so far most focus has been placed on the gastroduodenal mucosa. However, an increasing number of reports describe deleterious effects on the distal gut as well. Findings range from asymptomatic mucosal inflammation to stricture and obstruction, perforations, and major hemorrhages. Induction and exacerbation of inflammatory bowel disease has also been noted for most of the commercially available NSAIDs. Although final proof of a causal relationship is lacking, the indices present strongly suggest such a connection. The mechanism is largely unknown, although inhibition of cyclooxygenase with subsequent depletion of endogenous prostanoid synthesis has been suggested as a mediator. If surgery can be avoided, stopping the NSAID therapy is often sufficient to obtain lasting remission. The main point is knowledge of this facet of NSAID use, so that the pertinent drug history is obtained. Determination of the distal gut effects should probably also be included in the evaluation of present and future NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

Comparison of the gastrointestinal side effects of naproxen formulated as plain tablets, enteric-coated tablets, or enteric-coated granules in capsules.

We studied the gastrointestinal side effects of three formulations of naproxen in 18 healthy male volunteers. In a Latin-square design crossover study, the subjects received 500 mg naproxen twice daily for 7 days as plain tablets, enteric-coated tablets, or enteric-coated granules in capsules. The 51Cr-EDTA absorption test was performed before and at the end of each drug period, to evaluate changes in the distal gut. The test dose was instilled distally in the duodenum to prevent lesions in the stomach from interfering with the evaluation. Upper endoscopy was performed at the same intervals, scoring changes in the middle and distal duodenum separately from findings in the stomach and duodenal bulb. The nature and severity of adverse effects were recorded for each treatment period. Non-parametric methods were used for statistical evaluation. All drugs induced a significant increase in 51Cr-EDTA absorption, but we did not detect any difference between the three formulations. All formulations were associated with a significant increase in all the endoscopic findings monitored. Enteric-coated tablets induced significantly less lesions than enteric-coated granules in the stomach and duodenal bulb, and an advantage over plain tablets was indicated. No difference was seen in the middle and distal duodenum. The proximal endoscopic scores were not correlated to those found in the middle and distal duodenum. Evaluation of the small and large bowel should probably be included in clinical studies of NSAIDs, but our findings suggest that the importance of transfer of mucosal lesions to the distal gut by enteric coating may have been overemphasized.

Adult↗
PubMed1989

Juxtapapillary duodenal diverticula predispose to common bile duct stones.

In an endoscopic study of 107 patients with suspected common bile duct calculi, 26 were found at retrograde cholangiography to have juxtapapillary diverticula (JPD). Over 80% of these patients had common bile duct calculi, compared with only 52% among those without any JPD (p less than 0.01).

Adult↗
PubMed1989

Beta-glucuronidase activity in the bile of gallstone patients both with and without duodenal diverticula.

Patients with juxtapapillary duodenal diverticula have an increased occurrence of calcium bilirubinate gallstones. One possible hypothesis to explain this observation is enzymatic deconjugation of bilirubin conjugates in the bile. Beta-glucuronidase of human or bacterial origin may lead to deconjugation of the bilirubin glucuronides in bile. This, in turn, may increase the amounts of unconjugated, water-insoluble bilirubin which can precipitate as calcium bilirubinate, the main component of brown pigment stones. In this study we compared gallstone patients with and without duodenal diverticula treated with endoscopic papillotomy. Increased occurrence of bacteria producing beta-glucuronidase (p less than 0.01) and increased activity of bacterial beta-glucuronidase (pH 7.0) in the bile itself (p less than 0.01) were found in patients with duodenal diverticula. When the activity of the enzyme at pH 4.5, the optimum of the human enzyme, was measured, no such difference was found. The results support the hypothesis of bacterial glucuronidase as an etiologic factor in pigment gallstone disease in patients with duodenal diverticula. The high activity of bacterial enzyme found in the bile in some patients without diverticula suggests bacteria as an etiologic factor, independent of the presence of diverticula.

Aged↗
PubMed1989

The duodenal bacterial flora in the region of papilla of Vater in patients with and without duodenal diverticula.

Small-intestinal bacterial overgrowth may be one etiologic factor in pigment gallstone disease, previously shown to be prevalent in patients with juxtapapillary duodenal diverticula. In this study the bacterial microflora in the duodenum was examined in 52 patients admitted for endoscopic retrograde cholangiography, 27 with and 25 without duodenal diverticula. Endoscopic sampling was done with a microbiology specimen brush. The reproducibility of the method was good. Presence of gas in the anaerobic cultivation media corresponded closely to growth of Enterobacteriaceae, with a sensitivity of 90% and a specificity of 98%. Gas production in thioglycollate medium with 1% glucose is proposed as a simple criterion of bacterial overgrowth. Patients with diverticula had significantly higher total numbers of bacteria in the duodenum than patients without diverticula (p less than 0.01). Enterobacteriaceae and fecal streptococci dominated the flora in patients with diverticula, and gram-positive cocci were most frequently isolated from patients without diverticula.

Aged↗
PubMed1989

Sucralfate for prevention of naproxen-induced mucosal lesions in the proximal and distal gastrointestinal tract.

To study the protective effect of Sucralfate on Naproxen-induced mucosal lesions, 16 healthy, male volunteers were given Naproxen 500 mg b.i.d. together with Sucralfate 2 g b.i.d. or placebo in a double-blind, crossover study. Drug periods were 1 week, with a 3-week wash out in between. Mucosal lesions in stomach and duodenum were assessed by upper endoscopy before and after each drug period, using a visual analogue with separate scoring of mid- and distal duodenal lesions. 51Cr-EDTA absorption tests were performed to demonstrate possible changes in distal gut permeability. In addition, subjective symptoms were registered. Both drug periods induced significant lesions in the stomach and duodenum. Statistically speaking, fewer changes were found in the stomach and duodenal bulb after Sucralfate co-administration, whereas no significant reduction of lesions was seen in the distal duodenum. The 51Cr-EDTA absorption was increased in both periods, indicating deleterious effects to distal parts of the gut, but our results did not demonstrate Sucralfate-mediated protection from these changes. Symptoms were modest, and equal in the two periods. We conclude that Sucralfate may offer protection in the gastric and proximal duodenal mucosa, but no such protective effect was seen distally to the duodenal bulb.

Absorption↗
PubMed1989

Cimetidine tablets or suspension for the prevention of gastrointestinal mucosal lesions caused by non-steroidal, anti-inflammatory drugs.

We compared the protection offered by cimetidine 400 mg b.i.d. as tablets or suspension vs. placebo, in Naproxen-induced gastrointestinal damage in 17 healthy males. Upper endoscopy was performed before and after each drug period, with separate evaluation of duodenal mucosa distal to the duodenal bulb. 51Cr-EDTA absorption tests were done to assess distal mucosal integrity, and symptoms were registered. All regimens caused a significant increase in mucosal damage (p less than 0.01). Cimetidine tablets gave a significantly lower damage score than placebo for gastritis/duodenitis and hemorrhagic lesions in the stomach/duodenal bulb, and for the sum of scores in both scoring regions (p = 0.02). Cimetidine suspension was not significantly different from placebo for any of the endoscopic parameters. The 51Cr-EDTA absorption was significantly increased after all drug periods. However, there was no difference between the three drug combinations. Symptoms reported were mild and equal in the three groups. Cimetidine tablets offered protection against Naproxen-induced mucosal damage, primarily in the stomach and duodenal bulb, but lacked any effect on permeability changes. Cimetidine suspension was not significantly different from placebo in any respect.

Absorption↗