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The potential protective properties of esaprazole on the gastric mucosa following administration of aspirin were evaluated by measurement of the potential difference across the gastric mucosa. Twelve patients with non-ulcer dyspepsia were admitted to the study and were divided into two groups of six patients each. In association with a randomized double-blind scheme the two groups of patients underwent two tests, with placebo and esaprazole 600 or 900 mg. After 30 min of basal recording of the potential difference, patients received either esaprazole or placebo i.v. and recording was continued for a further 30 min. Afterwards, 600 mg of unbuffered aspirin was instilled into the stomach through a nasogastric tube and the potential difference was measured for 60 min. Esaprazole 600 mg did not prevent the fall in the potential difference across the gastric mucosa caused by aspirin. A higher dose of esaprazole, however, did significantly (p≤0.05) reduce the fall. These results suggest that esaprazole exerts a dose-dependent cytoprotective effect on the gastric mucosa in man.

A double-blind, double-dummy controlled study to compare the clinical efficacy and gastric tolerability of salsalate and piroxicam in the treatment of rheumatoid arthritis was performed. A total of 23 patients were treated with 1.5 g salsalate twice daily and 20 with 20 mg piroxicam (after the evening meal) for 4 weeks. Patients were submitted to gastroscopy at the start and end of treatment; only patients who presented a normal baseline gastroscopy were admitted to the trial. At the end of the planned treatment period, a statistically significant improvement of all clinical variables was observed in both treatment groups, the difference between the two drugs not being statistically significant. Five of 20 (25%) piroxicam treated patients and only 2/19 (11%) salsalate treated patients showed gastric lesions at final endoscopy. No relationship was found between dyspeptic symptoms and endoscopic lesions. The results show that salsalate and piroxicam have equal efficacy in relieving arthritic symptoms, but salsalate causes fewer gastric lesions.

The effectiveness of cimetropii bromidum (10 or 20 mg i.v.) as premedication for upper gastro-intestinal tract endoscopy was examined and compared with that of placebo in a double-blind crossover study involving 160 patients. The drug effects were assessed from the degree of opening of the pyloric sphincter and the endoscopist's rating of drug performance. The study showed that the effects of cimetropii bromidum differed highly significantly (p < 0·0001) from those of placebo, on either count. No adverse effects were noted.

The potentially damaging gastric and duodenal effects of dipyrone, a nonnarcotic analgesic agent, were evaluated in three phases in comparison to placebo and paracetamol. Three groups of 12 healthy adult volunteers were treated in a double-blind study, according to a cross-over, randomization sequence, using the double-dummy technique, for two 15-day periods, with dipyrone 3 g/day and placebo (group I), dipyrone 1.5 g/day and placebo (group II), and dipyrone 1.5 g/day and paracetamol 1.5 g/day (group III). An esophagogastroduodenoscopy was performed at the beginning and end of each treatment period. In the first treatment group, grade-3 and 4 mucosal lesions were found after dipyrone administration (3 g/day) in 3 of 12 (25%) subjects (multiple antral erosions, gastric ulcer and duodenal ulcer, 1 case each), whereas grade-2 mucosal lesions (antral erosions) were detected in 1 of 12 cases (8%) after the corresponding placebo treatment. The difference between the two treatments, however, was not statistically significant (p > 0.05). Only in the gastric ulcer case were subjective symptoms reported (feeling of hunger). At the 1.5-g/day dose (groups II and III), dipyrone produced no gastroduodenal lesions, the endoscopic results showing no appreciable difference between dipyrone and either placebo (p = 0.54) or paracetamol (p = 0.99). No subjective symptoms were reported in any of these subjects. Dipyrone, administered for 2 weeks, has effects on the gastric and duodenal mucosa comparable to those of paracetamol and placebo, though noticeable damage is detectable at a dosage of 3 g/day.

Crohn’s disease (CD) and ulcerative colitis (UC) are the two main clinical subtypes of inflammatory bowel disease (IBD), a common complex disease with a frequency in Western populations of about 1 in 1000.1 A strong genetic susceptibility to IBD is supported by several epidemiological studies,2 and the existence of both specific and common susceptibility genes for CD and UC has been postulated.3 Several candidate loci for IBD have been identified following whole genome scans in different populations (reviewed in Bonen & Cho4). Among these, a locus in the pericentromeric region of chromosome 16 denoted IBD1 5 was found consistently in linkage to CD in several independent studies4 and in a large collaborative study by the IBD International Genetics Consortium.6 Most of these studies, with few exceptions,7 reported negative or non-significant linkage of the same locus to UC. Allelic variants of single nucleotide polymorphisms (SNPs) in the CARD15 gene, located in the IBD1 region, have since been demonstrated to confer susceptibility to CD, but not to UC in several populations8–10 (also reviewed in Bonen & Cho4). In a previous study, we reported positive non-parametric linkage (NPL) scores in the IBD1 region in both our CD and UC families,11 with the highest scores occurring at markers D16S419 and D16S514, respectively. Marker D16S419 is located approximately 5 cM away from CARD15 , while D16S514 is located almost 20 cM away on chromosome 16q. To follow up on these results, we typed 10 additional microsatellite markers in the chromosome 16 region of positive linkage in a total of 90 Italian IBD families, and repeated the linkage analysis after excluding 26 families with previously reported CARD15 SNP susceptibility alleles. The observation of a broad region of positive NPL scores in our UC families …

Accurate assessment of intestinal complications of Crohn's disease (CD) is extremely important, both in clinical practice and in trials. The accuracy of radiographic and ultrasonographic diagnosis of internal fistulae and abscesses complicating CD is still debated and requires further investigation. We compared ultrasonography (US) and contrast radiography in detecting intestinal fistulae and abscesses complicating CD.A prospective study was carried out on 625 consecutive CD patients who underwent complete evaluation of the intestinal tract by means of colonoscopy and double contrast barium enema, small bowel enteroclysis, and abdominal ultrasound (US). Computed tomography (CT) was also carried out in cases of severe CD with clinical suspicion of septic complications. The accuracy of US, barium radiology, and CT in detecting internal fistulae and abscesses was assessed by comparing results with intraoperative findings in 128 consecutive patients who underwent operation immediately after diagnostic workup.Internal fistulae and intra-abdominal abscesses were identified intraoperatively in 56 (43.7%) and 26 (20.3%) patients, respectively. Diagnostic accuracy of US and x-ray studies in detecting internal fistulae was comparable (85.2% vs 84.8%), with sensitivity of 71.4% for US and 69.6% for x-ray studies, and specificity of 95.8% for both. Combination of radiographic techniques and US significantly improved diagnostic accuracy in detection of internal fistulae. In severe cases of CD with clinical suspicion of septic complications such as abdominal mass or fever, the accuracy of US, barium studies, and CT was 88.5%, 80.3%, and 77%, respectively (p = ns). The presence of abscesses was correctly detected in 90.9% of cases by means of US and in 86.4% by CT (p = ns), although accuracy was higher for CT (91.8%) than for US (86.9%) because of false positive results in US studies.Despite the fact that barium radiology is widely considered the method of choice in detection of internal fistulae, accuracy is not entirely satisfactory. Comparable accuracy was found for US and CT. The combination of barium and US studies, or the sole use of US in more CD patients with more severe disease, can reliably detect most internal fistulae and abscesses.