Alan B. R. Thomson

Oral Budesonide for Active Crohn's Disease

Background Corticosteroids are the most efficacious drugs for inducing remission in active Crohns disease, but their benefits are frequently offset by serious side effects. Budesonide is a corticosteroid with high topical antiinflammatory activity but low systemic activity because of extensive hepatic metabolism. We investigated the efficacy and safety of an oral controlled-ileal-release preparation of budesonide in patients with active Crohns disease involving the ileum or ileum and proximal colon. Methods In a double-blind, multicenter trial, 258 patients were randomly assigned to receive placebo or one of three doses of budesonide -- 3, 9, or 15 mg daily. The primary outcome measure was clinical remission, as defined by a score of 150 or less on the Crohns disease activity index. Results After eight weeks of treatment, remission occurred in 51 percent of the patients in the group receiving 9 mg of budesonide (95 percent confidence interval, 39 to 63 percent), 43 percent of those receiving 15 mg (95 ...

World Gastroenterology Organization Practice Guidelines for the Diagnosis and Management of IBD in 2010

Inflammatory bowel disease (IBD) represents a group of idiopathic, chronic, inflammatory intestinal conditions. Its two main disease categories are: Crohns disease (CD) and ulcerative colitis (UC), which feature both overlapping and distinct clinical and pathological features. While these diseases have, in the past, been most evident in the developed world, their prevalence in the developing world has been gradually increasing in recent decades. This poses unique issues in diagnosis and management which have been scarcely addressed in the literature or in extant guidelines. Depending on the nature of the complaints, investigations to diagnose either form of IBD or to assess disease activity will vary and will also be influenced by geographic variations in other conditions that might mimic IBD. Similarly, therapy varies depending on the phenotype of the disease being treated and available resources. The World Gastroenterology Organization has, accordingly, developed guidelines for diagnosing and treating IBD using a cascade approach to account for variability in resources in countries around the world.

Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin

Background : Aspirin is valuable for preventing vascular events, but information about ulcer frequency is necessary to inform risk‐benefit decisions in individual patients.

Hepatocellular carcinoma (HCC): a global perspective

Peter Ferenci (chair) (Austria) Michael Fried (Switzerland) Douglas Labrecque (USA) J. Bruix (Spain) M. Sherman (Canada) M. Omata (Japan) J. Heathcote (Canada) T. Piratsivuth (Thailand) Mike Kew (South Africa) Jesse A. Otegbayo (Nigeria) S.S. Zheng (China) S. Sarin (India) S. Hamid (Pakistan) Salma Barakat Modawi (Sudan) Wolfgang Fleig (Germany) Suliman Fedail (Sudan) Alan Thomson (Canada) Aamir Khan (Pakistan) Peter Malfertheiner (Germany) George Lau (Hong Kong) F.J. Carillo (Brazil) Justus Krabshuis (France) Anton Le Mair (The Netherlands)

Canadian Helicobacter Study Group Consensus Conference: Update on the Approach to Helicobacter Pylori Infection in Children and Adolescents – an Evidence-Based Evaluation

As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of 14 topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The goal was to update guidelines based on the best available evidence using an established and uniform methodology to address and formulate recommendations for each topic. The degree of consensus for each recommendation is also presented. The clinical issues addressed and recommendations made were: population-based screening for H. pylori in asymptomatic children to prevent gastric cancer is not warranted; testing for H. pylori in children should be considered if there is a family history of gastric cancer; the goal of diagnostic interventions should be to determine the cause of presenting gastrointestinal symptoms and not the presence of H. pylori infection; recurrent abdominal pain of childhood is not an indication to test for H. pylori infection; H. pylori testing is not required in patients with newly diagnosed gastroesophageal reflux disease; H. pylori testing may be considered before the use of long-term proton pump inhibitor therapy; testing for H. pylori infection should be considered in children with refractory iron deficiency anemia when no other cause has been found; when investigation of pediatric patients with persistent or severe upper abdominal symptoms is indicated, upper endoscopy with biopsy is the investigation of choice; the 13C-urea breath test is currently the best noninvasive diagnostic test for H. pylori infection in children; there is currently insufficient evidence to recommend stool antigen tests as acceptable diagnostic tools for H. pylori infection; serological antibody tests are not recommended as diagnostic tools for H. pylori infection in children; first-line therapy for H. pylori infection in children is a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics (clarithromycin plus amoxicillin or metronidazole); the optimal treatment period for H. pylori infection in children is 14 days; and H. pylori culture and antibiotic sensitivity testing should be made available to monitor population antibiotic resistance and manage treatment failures.

World Gastroenterology Organisation Global Guidelines: probiotics and prebiotics October 2011.

Review Team: Juan-R. Malagelada, MD (Spain) (Chair), Franco Bazzoli, MD (Italy), Guy Boeckxstaens, MD (Belgium), Danny De Looze, MD (Belgium), Michael Fried, MD (Switzerland), Peter Kahrilas, MD (USA), Greger Lindberg, MD (Sweden), Peter Malfertheiner, MD (Germany), Graciela Salis, MD (Argentina), Prateek Sharma, MD (USA), Daniel Sifrim, MD (UK), Nimish Vakil, MD (USA), and Anton Le Mair, MD (The Netherlands)

Endothelium-Dependent Relaxation in Aorta of BB Rat

The study was undertaken to determine whether the phenomenon of endothelium-dependent relaxation was impaired in the spontaneously diabetic BB Wistar rat. Endothelium-dependent relaxation in the aorta of overtly diabetic animals was compared with that in nondiabetic BB rats. The relaxative responses were elicited in vitro to acetylcholine (−8.0 to −5.5 log M) and histamine (−7.0 to −3.0 log M) after precontraction with norepinephrine (−6.0 log M). The maximum relaxations produced by both acetylcholine and histamine expressed as percentages of the contractions to norepinephrine were significantly lower in diabetic than in nondiabetic rats. Scanning electron microscopy revealed that in diabetic BB rats there was consistent evidence of swollen cells, raised nuclei, and sloughing of nuclei in endothelial cells of the aorta. In nondiabetic animals these features were not evident. These findings suggest the presence of a functional and morphological defect in endothelial cells in the aorta of the BB rat.

World Gastroenterology Organisation global guidelines: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis.

Review Team, Douglas R. LaBrecque, MD, FACP (chair, USA), Zaigham Abbas, MD, MBBS, FCPS, FRCP, FRCPI, FACP, FACG, AGAF (Pakistan), Frank Anania, MD, FACP, AGAF (USA), Peter Ferenci, MD (Austria), Aamir G. Khan, MD (Pakistan), Khean-Lee Goh, MBBS, FRCP (Glasgow, London), MD, FACG, FASGE (Malaysia), Saeed S. Hamid, MD (Pakistan), Vasily Isakov, MD, PhD, AGAF (Russia), Maribel Lizarzabal, MD, PhD (Venezuela), Manuel M. Peñaranda, MD (Colombia), Juan F.R. Ramos, MD (Mexico), Shiv Sarin, MD, DM (India), Davor Stimac, MD (Croatia), Alan B.R. Thomson, MD (Canada), Muhammed Umar, MD, MBBS, MCPS, FCPS (PAK), FACG (USA), FRCP (L), FRCP (G), ASGE-M (USA), AGAF (USA) (Pakistan), Justus Krabshuis, (France), and Anton LeMair, MD (Netherlands)

Canadian Helicobacter pylori Consensus Conference

These guidelines were created to dispel confusion and provide guidance about how the isolation of Helicobacter pylori infection has led to new opportunities and initiatives to improve patient care. The guidelines are designed for practical application in management decisions, but must remain flexible and amenable to change with new information. Updated versions of the recommendations are anticipated. Although it is now clear that H pylori is a major gastrointestinal pathogen, the extent of the clinical consequences posed by this microorganism has yet to be fully defined.These guidelines were created to dispel confusion and provide guidance about how the isolation of Helicobacter pylori infection has led to new opportunities and initiatives to improve patient care. The guidelines are designed for practical application in management decisions, but must remain flexible and amenable to change with new information. Updated versions of the recommendations are anticipated. Although it is now clear that H pylori is a major gastrointestinal pathogen, the extent of the clinical consequences posed by this microorganism has yet to be fully defined.

Stanniocalcin: a novel protein regulating calcium and phosphate transport across mammalian intestine

Stanniocalcin (STC) is an anti-hypercalcemic glycoprotein hormone previously identified in the corpuscles of Stannius in bony fish and recently in the human genome. This study undertook to express human STC in Chinese hamster ovary (CHO) cells and to determine its effects on calcium and phosphate absorption in swine and rat intestine. Unidirectional mucosal-to-serosal ( J m→s) and serosal-to-mucosal ( J s→m)45Ca and32P fluxes were measured in vitro in duodenal tissue in voltage-clamped Ussing chambers. Addition of STC (10-100 ng/ml) to the serosal surface of the duodenum resulted in a simultaneous increase in calcium J m→s and J s→mfluxes, with a subsequent reduction in net calcium absorption. This was coupled with an STC-stimulated increase in phosphate absorption. Intestinal conductance was increased at the highest dose of STC (100 ng/ml) in swine tissue. The addition of STC to the mucosal surface had no effect on calcium and phosphate fluxes. STC at doses of 10-1,000 ng/ml had no effect on short-circuit current in any region of the rat intestine. In conclusion, human recombinant STC decreases the absorption of calcium and stimulates the absorption of phosphate in both swine and rat duodenum. STC is a novel regulatory protein that regulates mammalian intestinal calcium and phosphate transport.