2-15 UPDATE IN GASTROENTEROLOGY
Annals Int. Med. February 1, 1997; 126: 221-25 reported from Univ. Of Kansas, Kansas City.

1. A Comparison of Five Maintenance Therapies for Reflux Esophagitis.
Omeprazole (Prilosec- a proton-pump inhibitor) was more effective than ranitidine (Zantac-a H2 blocker) alone or cisapride (Propulsid- a gastrointestinal prokinetic agent) alone in maintaining remission in patients with erosive esophagitis. Omeprazole alone was almost as effective as omeprazole-cisapride combined. NEJM 1995; 333: 1106-10.

2. Accuracy of Invasive and Noninvasive Tests to Diagnose Helicobacter pylori Infection.
The C13 urea breath test and measurement of serum IgG H pylori antibody titers had sensitivity and specificity similar to invasive tests. Gastroenterology 1995; 109: 136-41

3. Effect of Acid Suppression of Efficacy of Treatment of Helicobacter pylori Infection.
Omeprazole, when added to triple antibacterial therapy (bismuth, metronidazole, and tetracycline), eradicated H pylori in 98% of patients vs 83% of those receiving antimicrobial therapy alone. Lancet 1995; 345: 817-20

4. A Comparison of Symptoms after the Consumption of Milk or Lactose-hydrolyzed Milk by People with Self-reported Severe Lactose Intolerance.
When lactose intake was limited to 240 mL of milk per day gastrointestinal symptoms were likely to be negligible in patients who had identified themselves as severely lactose intolerant. NEJM 1995; 333: 1-4

5. Aspirin and the Risk of Colon Cancer in Women
The relative risk for developing colon cancer decreased to 0.7 after 10 years of aspirin use and to 0.6 after 20 years. Maximum risk reduction was in those taking 4 to 6 aspirin tablets per week. NEJM 1995; 333: 609-14.

6. An Oral Preparation of Mesalamine as Long-term Maintenance Therapy for Ulcerative Colitis.
Mesalamine (Asacol; Pentasa; Rowasa), a 5-amino salicylic acid analogue, safely and effectively maintained remission in patients with quiescent ulcerative colitis. Annals Int. Med. 1996; 124: 204-11

7. Prophylaxis against Gallstone Formation with Ursodeoxycholic Acid in Patients Participating in a Very-low-calorie Diet Program.
Gallstones develop in 10% to 25% of patients who rapidly lose weight through very low calorie diets (eg, 520 Kcal/d). Ursodeoxycholic acid 600 mg/d prevented gallstone formation. Annals Int. Med. 1995; 122: 899-905

8. Early Antibiotic Treatment in Acute Necrotizing Pancreatitis.
Infectious complications are a major cause of death in patients with necrotizing pancreatitis (sepsis caused by E coli and staph the most common cause).

Treatment with intravenous cefuroxime (Ceftin) reduced morbidity and mortality. Lancet 1995; 346: 663-67

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