Search PubMed⌕ Search

Biomedical subjects

R Stockbrügger

Publications and source records attributed to R Stockbrügger.

At least 19 recordsLinked to original sources
PubMed2005

Survival of the probiotic, L. plantarum 299v and its effects on the faecal bacterial flora, with and without gastric acid inhibition.

INTRODUCTION: Probiotic bacteria have to survive passage through the gastrointestinal tract. In this placebo-controlled double-blind study, the effect of Lactobacillus plantarum 299v on the faecal flora was studied with and without gastric acid inhibition. METHODS: Thirty-two healthy volunteers were given pantoprazole (40 mg/day) or placebo for 3 weeks from week 2 until week 4. In addition, from week 3 until week 4, L. plantarum 299v in an oatmeal-fermented drink (10(9) CFU/ml) was given twice daily to both groups. From each healthy volunteer, faecal samples were collected at the end of week 1, 2, 4 and 8 (4 weeks after cessation of L. plantarum 299v and pantoprazole/placebo). Several aerobically and anaerobically growing bacteria were counted and short chain fatty acid concentrations were determined. RESULTS: In both the pantoprazole and the placebo group, median lactobacilli counts increased significantly in week 4 compared to week 1 (from log 4.5 to 8.0 CFU/g faeces in pantoprazole and from log 4.2 to 7.7 CFU/g faeces in placebo group) and decreased significantly in week 8 (to log 4.5 CFU/g faeces in pantoprazole and log 4.3 CFU/g faeces in placebo group). These lactobacilli were identified as L. plantarum 299v. No significant differences were observed in all other bacterial counts and short chain fatty acid concentrations. CONCLUSIONS: The comparable increase of faecal lactobacilli counts in both the pantoprazole and the placebo-treated group demonstrates that L. plantarum 299v survives passage through the gastrointestinal tract irrespective of gastric acidity. The increment of the intra-gastric pH in combination with L. plantarum 299v did not modulate bacterial composition and/or the production of short chain fatty acids.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Inflammatory bowel disease versus irritable bowel syndrome: a hospital-based, case-control study of disease impact on quality of life.

BACKGROUND: Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are intestinal diseases perceived differently by patients and doctors: the former is considered essentially as an 'organic' disease (i.e. an illness in which the role of stress or psychological factors is at best secondary to the disease itself), whereas the latter is acknowledged as a 'functional' disorder (i.e. illness thought to be more in the 'mind' than in the body of the patient). Accordingly, the respective impact of the two diseases on patients' health-related quality of life (HRQOL) is perceived to be very different. We aimed to compare the relative impact of the disease on HRQOL, psychological profile and perceived burden of stressful life events in two groups of outpatients suffering from IBS and IBD and attending our outpatient department at an Italian university hospital. Eighty patients with IBD (26 with ulcerative colitis and 54 with Crohn disease) and 85 controls with IBS formed the patient samples of the study. METHODS: Three questionnaires were given to the patients while they were attending the outpatient department because of their previously diagnosed disease, namely the SF-36 (a generic well-validated tool for measuring HRQOL), the SCL-90 (for assessing the psychological profile of patients), and the Holmes & Rahe schedule (for the assessment of stressful life experiences). The results were then compared by means of analysis of variance (ANOVA) and Bonferroni-adjusted t test, when appropriate. RESULTS: HRQOL appeared to be similarly reduced in both disease groups (SF-36 overall mean value: 58.2 +/- 16.1 in IBS patients versus 56.4 +/- 22.3 in IBD patients: P > 0.05) in comparison with normative Italian data. Furthermore, the overall severity of psychological symptoms was not statistically different between patients suffering from IBD versus IBS, as shown by SCL-90 mean scores of 0.89 + 0.45 versus 0.83 +/- 0.48, respectively (P > 0.05). On the contrary, the severity of recent stressful life experiences was perceived to be higher by IBS than by IBD patients (mean SRE score: 110.8 = 110.2 versus 61.6 +/- 78.8; P < 0.05). CONCLUSION: Our study supports the notion that, at least in referral centres, patients with IBS show health-related quality of life, psychological distress and recent occurrence of stressful life events of severity at least comparable with age-matched IBD patients.

Adult↗
PubMed2003

Probiotics in gastroenterology: indications and future perspectives.

Nowadays. there is a growing interest in probiotics as a safe way of changing the intestinal bacterial flora. Probiotics may have potential in several gastroenterological conditions, especially when the intestinal flora has been disturbed. Most scientific evidence is available for diarrhoea patients treated with Lactobacillus GG, Lactobacillus reuteri or Saccharomyces boulardii. Meta-analyses have shown an overall reduction in the risk of antibiotic-associated diarrhoea during treatment with probiotics, and benefits have also been demonstrated for patients with rota-virus-associated diarrhoea. Patients with inflammatory bowel disease, an inflammatory disorder characterized by a change in the intestinal flora, are another important target group for which probiotics may be beneficial. It has been claimed that in ulcerative colitis and Crohn disease patients, lactobacilli, S. boulardii and Escherichia coli reduce relapses. but most studies were not placebo-controlled. A reduction in relapses has also been demonstrated in pouchitis patients treated with a multispecies probiotic. Irritable bowel syndrome might be another clinical indication for probiotic therapy, but results of clinical trials performed in these patients are inconsistent. Additionally, probiotics may improve lactose absorption. Helicobacter pylori eradication and constipation. Finally, in animal models of colorectal cancer, treatment with probiotics reduces the prevalence of this disease, and in humans the amount of genotoxic substances in faeces has been reduced. In conclusion, the results of studies on the effects of probiotics in gastrointestinal conditions are encouraging. but well-designed placebo-controlled studies are warranted before recommendations for therapeutic or preventive use can be given. Many issues still have to be resolved, including optimal dose and duration of treatment, selection of and differences between the several available probiotic strains, and, importantly, their mechanisms of actions have to be elucidated.

Colorectal Neoplasms↗
PubMed2001

Is type III intestinal metaplasia an obligatory precancerous lesion in intestinal-type gastric carcinoma?

This retrospective study was performed to assess whether type III intestinal metaplasia is an obligatory precancerous lesion of intestinal-type gastric carcinoma and to determine its possible use as a marker of enhanced cancer risk. From 48 consecutive patients with gastric cancer who underwent a gastrectomy over a 3-year period (mean age 72.0 years; 29 M/19 F), at least two sections from antrum, corpus and tumour-surrounding mucosa were obtained for the examination of presence and subtypes of intestinal metaplasia (IM). It was found that 77.1% of the carcinomas were of the intestinal type and 22.9% of the diffuse type. The intestinal-type was more often found in males (P = 0.01); the mean age at diagnosis in this type was higher than in the diffuse cancer group (P = 0.004). There was a high prevalence of total IM in both the intestinal (75.7%) and diffuse group (88.9%). Type I IM was predominant in antrum and corpus of patients from both groups. Type III IM was only found among patients with intestinal-type carcinoma. However, its prevalence was rather low (26.3%). Therefore the absence of this lesion in patients with other risk factors cannot be used as an argument for lowering the degree of surveillance and its presence seems to be sufficient indication for long-term follow-up.

Aged↗
PubMed2001

Quality of health care in inflammatory bowel disease: development of a reliable questionnaire (QUOTE-IBD) and first results.

OBJECTIVES: As inflammatory bowel disease is a chronic disorder, usually with an early onset in life, quality of care plays an important role for patients. The aim of this study was to develop a questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease. METHODS: Ten generic questions were already available because the questionnaire is based on an existing instrument. Patients with inflammatory bowel disease in seven countries were involved in the development of additional disease-specific items. Validation and first field testing of the total questionnaire (QUOTE-IBD) was performed in The Netherlands. RESULTS: A total of 380 patients cooperated in the development of 13 disease-specific items, with high internal reliability (Cronbach's alpha = 0.83). Another 162 patients were involved in validating and testing of the QUOTE-IBD, which consists of 23 items in total. Pearson's correlation coefficient between QUOTE-IBD and visual analog scale scores of health care items was 0.55. Intraclass correlation coefficient of two assessments was 0.64. First testing showed that patients gave relatively poor marks to some part of health care services, such as providing information about extraintestinal complaints and the psychological as well as physical approach to complaints. CONCLUSIONS: A short, valid, reliable questionnaire was developed to measure the opinions of patients with inflammatory bowel disease on quality of health care. The QUOTE-IBD can be used for identification of areas for improvement, with the aim of optimizing health care in inflammatory bowel disease.

Europe↗
PubMed2001

Epidemiological aspects of irritable bowel syndrome in Europe and North America.

The epidemiology of irritable bowel syndrome (IBS) in Europe and North America was analyzed from published material. The percentage of the population of Western civilisation with IBS symptoms is between 10 and 15% in most studies. The proportion of a Western population visiting a doctor for IBS symptoms is around 5%. The prevalence of IBS and the proportion of consulters do not seem to depend on age in an adult population. The female-to-male ratio of IBS in the population is close to 2. It is higher in IBS consulters in primary care and may be as high as 3 or 4 in tertiary referral centers. At least in patients from these centers, the number of physician visits and colonoscopies is considerable. Most of the consulters get a drug prescription.

Colonic Diseases, Functional↗
PubMed2000

Influence of quality of care on quality of life in inflammatory bowel disease (IBD): literature review and studies planned.

Inflammatory bowel disease (IBD) is a chronic disorder with an early onset in life. Therefore, it is reasonable to assume that IBD patients are in considerable need of health care. The quality of life of IBD patients is reported to be impaired. Whether optimizing the quality of health care for these patients may positively influence their quality of life is a question that has been raised often during recent years. This review of the literature on health care research discusses different concepts regarding the quality of care assessment in chronic disease, stresses the need to see things from the patient's perspective, and provides recommendations to optimize health care research. The two most important conclusions that can be drawn are that: (1) the relationship between quality of health care and quality of life in IBD is one that is certainly worth studying; and (2) when developing a means to assess patient data on quality of care, it is essential to involve patients from the very start.

Journal Article↗
PubMed1999

Differential features of gastric cancer patients, either Helicobacter pylori positive or Helicobacter pylori negative.

BACKGROUND: Helicobacter pylori infection is associated with an increased risk of gastric cancer. In Helicobacter pylori negative patients, factors different from those in Helicobacter pylori positive patients may be involved in gastric carcinogenesis. METHODS: Thirty-nine recently diagnosed consecutive patients with gastric cancer were investigated. Gastric biopsies were obtained for detection of Helicobacter pylori (by immunohistochemistry), non-Helicobacter pylori flora (by modified Giemsa and culture) and histological assessment according to the Sydney classification by Haematoxylin-Eosin staining. In serum samples, Helicobacter pylori antibodies were determined by IgG enzyme-linked immunosorbent assay, IgA enzyme-linked immunosorbent assay, and Western blotting. Furthermore, serum gastrin, pepsinogen A and C and plasma chromogranin A were determined. RESULTS: Helicobacter pylori was detected by immunohistochemistry in 53.8%, by IgG in 56.4%, by IgA in 33.3%, and by Western blotting in 74.4% of the 39 patients. Ten patients (25.6%) were negative by both histology and serology. Non-Helicobacter pylori flora was detected in 27 of the 39 patients (69.2%) with a similar frequency in Helicobacter pylori positive and negative patients. Helicobacter pylori positivity was found significantly more often in diffuse than intestinal type carcinoma patients (p < 0.05). Elevated gastrin levels and antrum-sparing atrophic gastritis were more frequent in Helicobacter pylori negative than in Helicobacter pylori positive patients (p < 0.05). CONCLUSIONS: In 10 out of 39 gastric cancer patients, no evidence of previous or current Helicobacter pylori infection could be demonstrated. Non-Helicobacter pylori was found in 69.2% of patients regardless of the Helicobacter pylori status. Further studies are needed to establish the contribution of non-Helicobacter pylori flora as well as antrum-sparing atrophic gastritis with hypergastrinaemia to the development of gastric cancer.

Aged↗
PubMed1998

Prevalence of gastric metaplasia in the duodenal bulb and distribution of Helicobacter pylori in the gastric mucosa. A clinical and histopathological study in 96 consecutive patients.

BACKGROUND: Consecutive untreated patients with duodenal ulcer (n = 49) or gastric ulcer (n = 47) were compared with regard to the presence of gastric metaplasia in the duodenal bulb, gastric distribution of Helicobacter pylori and histopathological findings to assess differences which may contribute to either duodenal ulcer or gastric ulcer development. METHODS: Serial sections of corpus, antral and duodenal mucosal biopsies were stained by haematoxylin-eosin stain for histopathological evaluation, immunohistochemistry for the detection of Helicobacter pylori, and duodenal biopsies alone by the PAS/Alcian blue stain to assess the presence of gastric metaplasia in the duodenal bulb. RESULTS: Helicobacter pylori was found in 81.6% of duodenal ulcer and in 83.0% of gastric ulcer patients. In duodenal ulcer and gastric ulcer patients, Helicobacter pylori was found in 79.6% and 79.5% of corpus, 77.6% and 72.3% of antral, and 16.7% and 20.0% of duodenal bulb biopsies, respectively. In duodenal ulcer patients, the density of Helicobacter pylori was significantly lower in corpus compared to antrum biopsies (p < 0.001). Furthermore, the Helicobacter pylori density was higher in corpus of gastric ulcer than of duodenal ulcer patients. Inflammatory scores followed the density of Helicobacter pylori infection. In the duodenal bulb of both duodenal ulcer and gastric ulcer patients, the occurrence and extent of gastric metaplasia were comparable. Gastric metaplasia was present in 5 out of 8 Helicobacter pylori positive duodenal biopsies of duodenal ulcer patients and in 3 out of 9 Helicobacter pylori positive duodenal biopsies of gastric ulcer patients. CONCLUSIONS: No evidence was found for a role of gastric metaplasia in the differential pathogenesis of duodenal ulcer or gastric ulcer. Differences in the gastric topography of Helicobacter pylori density and inflammatory scores between duodenal ulcer and gastric ulcer may contribute to differences in development and presentation of both peptic ulcer conditions.

Adult↗
PubMed1997

Evaluation of immunohistochemistry for the detection of Helicobacter pylori in gastric mucosal biopsies.

A reliable diagnosis of Helicobacter pylori is important in clinical practice and research. To evaluate sensitivity, specificity and inter-observer variation of three histological staining methods for the diagnosis of intragastric H. pylori bacterial flora, four observers assessed the presence of H. pylori in a test set of pairs of gastric biopsies taken from 40 patients during GI-endoscopy. Histological slides of one biopsy of each patient (formalin-fixed and paraffin-embedded) were stained with a Modified Giemsa (MG), the Warthin-Starry (WS), and an immunohistochemical method (IMM) using purified polyclonal H. pylori antiserum (DAKO B471). As a standard, bacterial culture was performed on the adjacent biopsy, using the four quadrants method. Special attention was paid to the presence of non-H. pylori bacterial flora. Twenty out of 40 specimens were H. pylori-positive by culture. Using culture as a standard, sensitivity for H. pylori was 90.0+/-10.0% with MG, 70.0+/-14.1% with WS, and 83.8+/-11.1% with IMM stain. Specificity was 53.8+/-19.3%, 82.5+/-9.6% and 90.0+/-0.0%, respectively. Of 37, 14 and eight false positive scores by all observers for MG, WS and IMM, respectively, non-H. pylori flora was cultured from 17, six, and four of the corresponding adjacent biopsies. Non-H. pylori flora may account for overdiagnosis of H. pylori in gastric biopsies. Kappa values for the variance between the four observers were 0.28 for MG, 0.57 for WS, and 0.83 for IMM. Immunohistochemical staining for H. pylori is highly specific and has a low inter-observer variation. We advise that in situations where gastric histology is the main diagnostic tool, IMM should be used for the detection of H. pylori.

Azure Stains↗
PubMed1997

Helicobacter pylori and non-Helicobacter pylori bacterial flora in gastric mucosal and tumour specimens of patients with primary gastric lymphoma.

There is an association between Helicobacter pylori (H. pylori) and gastric mucosa-associated lymphoid tissue (MALT) and MALT lymphoma. Histologically, mainly non-specific stains are used to detect H. pylori, such as haematoxylin-eosin (HE) or modified Giemsa (MG). In this study, both a MG and a specific immunohistochemical stain (IMM) for H. pylori (Dako B471) were performed on sequential slides of resected material containing tumour and non-tumorous gastric mucosa from patients with primary gastric lymphoma (n = 52). Special attention was paid to the presence of non-H. pylori bacterial flora diagnosed by a positive MG (according to form and localization) and a subsequently negative IMM. On all slides, bacterial density was scored semiquantitatively (grades 0, 1, 2, 3). In total, 32 (61.5%) patients were H. pylori positive using IMM and 34 (65.4%) were non-H. pylori positive using MG. In 24 out of the 34 patients, the non-H. pylori flora consisted mainly of cocci in combination with rods in 15 patients, mostly in minor quantities; in another 10 patients, high numbers of both cocci and different types of rods were present. Most non-H. pylori bacteria were localized superficially, although in 22 patients minor quantities of non-H. pylori were also seen in the glandular lumina. After all of the patients had been analysed, no differences in the density of H. pylori and of non-H. pylori flora were found. Only when comparing patients who had a small-cell lymphoma with those who had a large-cell lymphoma was a significantly higher density of H. pylori found in the corpus mucosa of large-cell lymphomas and a higher prevalence of non-H. pylori was found in tumours, in antrum or corpus, of patients with large-cell lymphomas. In conclusion, with joint evaluation using MG and a H. pylori-specific immunohistochemical stains, the proportion of H. pylori-positive gastric lymphoma patients was lower than in most previous studies but other bacteria were found in a relatively high proportion. The role of the non-H. pylori intragastric bacterial flora identified in this study has to be further elucidated in the aetiopathogenesis of primary gastric lymphoma.

Adult↗
PubMed1997

Ongoing gastric acid inhibition is a confounding factor in Helicobacter pylori diagnosis.

BACKGROUND: Eradication of Helicobacter pylori by antibiotics in combination with gastric acid inhibition can result in overgrowth of non-H. pylori bacterial flora. This may confound the histological detection of H. pylori at eradication control if non-specific staining methods are used. OBJECTIVE AND METHODS: In 18 patients treated with amoxycillin (2 weeks) and omeprazole (6 weeks), endoscopically obtained gastric juice was cultured and two biopsies of corpus, antrum and duodenum were taken before and after eradication therapy (with gastric acid inhibition still going on) for culture and for histology to assess the intragastric bacterial flora. By histology, modified Giemsa (MG) and an H. pylori-specific immunohistochemical stain (IMM) were evaluated. RESULTS: Median pH of gastric juice was 1.5 (n = 18) before and 7 (n = 17) after eradication therapy, when patients were still on omeprazole. After therapy, culture showed a significant decrease (P < 0.05) in mean amount of H. pylori in corpus, antral and duodenal biopsies and a significant increase of non-H. pylori flora (P < 0.05) in gastric juice, corpus, antral and duodenal mucosa. With culture as a standard, 16 and 4 biopsy specimens were scored falsely positive for H. pylori by MG and IMM, respectively, and H. pylori was not detected in 23 and 13 biopsy specimens when culture was H. pylori-positive. CONCLUSION: Because of the possible presence of non-H. pylori flora after eradication therapy, the use of IMM is recommended in this situation for the histological detection of H. pylori, especially in those patients with ongoing gastric acid inhibitory therapy.

Amoxicillin↗
PubMed1996

[Relationship between duodenal diverticuli, gallstones and duodenal and pancreaticobiliary disorders].

OBJECTIVE: To determine the relationship between duodenal diverticula and the prevalence of bile duct stones, and between duodenal diverticula and pancreatic pathology and/or duodenal inflammation. DESIGN: Retrospective descriptive study. SETTING: Department of Internal medicine, Division of Gastroenterology/Hepatology, University Hospital Maastricht. METHODS: The medical records were reviewed of 273 consecutive patients in whom an endoscopic retrograde cholangiopancreatography (ERCP) had been performed for the first time during the period 1991-1992. Clinical data such as previous history of cholecystectomy and ERCP findings such as presence of a duodenal diverticulum, its location (juxtapapillary or circumpapilary), and possible concomitant pancreaticobiliary disorders and/or duodenal inflammation were evaluated. RESULTS: Duodenal diverticula were present in 49 out of 273 patients (18%(: 30 patients with a juxtapapillary, 18 patients with a circumpapillary duodenal diverticulum and one patient with both types. A history of cholecystectomy was not reported more frequently in patients with a diverticulum than in those without. At the time of ERCP investigation, gallbladder stones were not diagnosed more frequently in diverticulum patients. A significantly higher prevalence of common bile duct stones was found in diverticulum patients than in those without (53% versus 22%, p = 0.001). Pancreatic pathology was not related to the presence of duodenal diverticula (p = 0.441). Furthermore. duodenitis and duodenal ulcers were significantly more prevalent in diverticulum patients than in those without (18% versus 7% for duodenitis, p = -0.049; 14% versus 2% for duodenal ulcers, p = 0.001). CONCLUSIONS: Duodenal diverticula were not only associated with common bile duct stones, but were also related to duodenitis and duodenal ulcers. Pancreatic pathology appeared not to be related to duodenal diverticula.

Adult↗
PubMed1996

Influence of oropharyngeal flora and specimen pretreatment on the recovery of Helicobacter pylori.

The recovery of Helicobacter pylori was studied in vitro in the presence of different concentrations of oropharyngeal flora. The effect on the bacterial yield of Helicobacter pylori and oropharyngeal flora of washing biopsies once, twice or thrice before culture was then studied in biopsies taken from 35 patients. A low rate of recovery of low Helicobacter pylori concentrations (< or = 10(3) cfu/ml) was related to the presence of relatively high oropharyngeal flora concentrations (> or = 10(4) cfu/ml). After three washings a decrease in oropharyngeal flora between 10-fold and 100-fold cfu/biopsy was observed in seven patient samples. In another three specimens a more than 100-fold reduction in cfu/biopsy was observed. In the case of Helicobacter pylori, a 60-fold decrease in log cfu/biopsy was observed in only one patient. Pretreatment of the specimens by washing of the biopsies improved the recovery of small amounts of Helicobacter pylori in 10 of 28 patients. For optimal detection of Helicobacter pylori in gastric mucosal biopsies, washing of the specimens in addition to the use of selective media is recommended.

Biopsy↗
PubMed1996

Omeprazole inhibits growth of gram-positive and gram-negative bacteria including Helicobacter pylori in vitro.

The antibacterial effects of omeprazole (100, 200 and 300 mg/L) were assessed using bacterial growth curves. A dose-related permanent inhibition was seen with actively growing Gram-positive cocci. A reduced and only temporary effect was observed with Gram-negative bacilli. After 1 day the bacterial count of Helicobacter pylori in the presence of omeprazole 200 mg/L was reduced from 10(4) cfu/mL for the control to zero. No synergic or antagonistic interaction of omeprazole with amoxycillin or doxycycline was observed for Escherichia coli and Enterococcus faecalis.

Anti-Ulcer Agents↗
PubMed1989

[Lambliasis: a cause of malabsorption and diarrhea?].

Multiple biopsies from the lower duodenum were obtained during endoscopy of 171 patients with dyspepsia, diarrhoea and/or suspected malabsorption. Histological evidence of lambliasis was obtained in six (3.5%). Antibiotic treatment with metronidazole, 250 mg two or three times daily for seven to 11 days (which had to be repeated in two cases), improved symptoms in four. In most of the patients "functional upper-abdominal symptoms" had been diagnosed after extensive examinations. In case of unclear upper-abdominal symptoms, chronic or chronic-recurrent diarrhoea and/or malabsorption lambliasis should be considered and histological examination of the duodenal mucosa undertaken.

Adult↗