29 results on '"Loft DE"'
Search Results
2. PARTIAL MALROTATION ASSOCIATED WITH PSEUDO‐OBSTRUCTION OF THE SMALL BOWEL
- Author
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Singh, G, primary, Hershman, MJ, additional, Loft, DE, additional, Payne‐James, J, additional, Shorvon, PJ, additional, Lovell, D, additional, Misiewicz, JJ, additional, and Menziesgow, N, additional
- Published
- 1993
- Full Text
- View/download PDF
3. Barrett's surveillance is worthwhile and detects curable cancers. A prospective cohort study addressing cancer incidence, treatment outcome and survival.
- Author
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Aldulaimi DM, Cox M, Nwokolo CU, Loft DE, Aldulaimi, David M, Cox, Mark, Nwokolo, Chuka U, and Loft, Duncan E
- Published
- 2005
- Full Text
- View/download PDF
4. Partial malrotation associated with pseudo-obstruction of the small bowel
- Author
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Singh G, Mj, Hershman, Loft DE, J Jason Payne-James, Pj, Shorvon, Lovell D, Jj, Misiewicz, and Menzies-Gow N
- Subjects
Intestines ,Adolescent ,Rotation ,Ileal Diseases ,Intestinal Pseudo-Obstruction ,Humans ,Female - Abstract
Intestinal pseudo-obstruction is defined as a syndrome in which there are signs and symptoms of intestinal obstruction without an actual obstructing lesion. In many cases it is associated with other disease entities but may be idiopathic. We report a case associated with partial malrotation of the gut which has not been described in the literature before.
5. Comparison of 2 three-day Helicobacter pylorieradication regimens with a standard one week regimen: A randomized, investigator-blind study
- Author
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Grimley, CE, Penny, A, O'Sullivan, M, Shebani, M, Lismore, JR, Cross, R, Illing, RC, Loft, DE, and Nwokolo, CU
- Published
- 1998
- Full Text
- View/download PDF
6. Pigmentary changes in pernicious anaemia: an important but under-recognized phenomenon.
- Author
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Sherley-Dale AC, Goulding JM, Leithead J, Loft DE, and Ahmed I
- Subjects
- Humans, Hyperpigmentation drug therapy, Male, Middle Aged, Time Factors, Treatment Outcome, Anemia, Pernicious complications, Hyperpigmentation etiology, Vitamin B 12 therapeutic use, Vitamin B Complex therapeutic use
- Published
- 2011
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7. Revalidation for gastroenterologists, with or without sedation!
- Author
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Loft DE, Harris AW, and Barrison IG
- Abstract
From 16 November 2009, all doctors require a license to practise in the UK. Revalidation encompasses relicensing and recertification. This article focuses on recertification for gastroenterologists. Revalidation should not be viewed as a threat, and for the vast majority of doctors it should be straightforward, with the aim of demonstrating safe doctors, while keeping to a minimum time spent on exhaustive data collection. Specialty specific standards for physician medicine are ready to be endorsed by the General Medical Council and the first revalidations will be introduced around 2011. Subspecialty specific standards for gastroenterology are under evaluation and in the early stages of consultation., Competing Interests: Competing interests: None.
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- 2010
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8. Radiation exposure to personnel performing endoscopic retrograde cholangiopancreatography.
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Naidu LS, Singhal S, Preece DE, Vohrah A, and Loft DE
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- Cholangiopancreatography, Endoscopic Retrograde statistics & numerical data, Humans, Occupational Exposure adverse effects, Radiation Dosage, Radiation Protection, Risk Assessment, Risk Factors, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Occupational Diseases etiology, Personnel, Hospital
- Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) relies on the use of ionising radiation but risks to operator and patient associated with radiation exposure are unclear. The aim of this prospective study was to estimate the radiation dose received by personnel performing fluoroscopic endoscopic procedures, mainly ERCP., Methods: Consecutive procedures over a two month period were included. The use of thermoluminescent dosimeters to measure radiation exposure to the abdomen, thyroid gland, and hands of the operator permitted an estimation of the annual whole body effective dose equivalent., Results: During the study period 66 procedures (61 ERCP) were performed and the estimated annual whole body effective dose equivalent received by consultant operators ranged between 3.35 and 5.87 mSv. These values are similar to those received by patients undergoing barium studies and equate to an estimated additional lifetime fatal cancer risk between 1 in 7000 and 1 in 3500. While within legal safety limits for radiation exposure to personnel, these doses are higher than values deemed acceptable for the general public., Conclusions: It is suggested that personnel as well as patients may be exposed to significant values of radiation during ERCP. The study emphasises the need to carefully assess the indication for, and to use measures that minimise radiation exposure during any fluoroscopic procedure.
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- 2005
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9. Controversial topics in surgery: gastro-oesophageal reflux disease.
- Author
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Dehn T and Loft DE
- Subjects
- Gastroesophageal Reflux complications, Gastroesophageal Reflux drug therapy, Helicobacter Infections complications, Helicobacter pylori, Humans, Laparoscopy methods, Patient Selection, Proton Pump Inhibitors, Treatment Outcome, Gastroesophageal Reflux surgery
- Published
- 2005
10. A blinded, randomized comparison of a novel, low-dose, triple regimen with fleet phospho-soda: a study of colon cleanliness, speed and success of colonoscopy.
- Author
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Chilton AP, O'Sullivan M, Cox MA, Loft DE, and Nwokolo CU
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- Adolescent, Adult, Aged, Aged, 80 and over, Anthraquinones adverse effects, Citrates, Double-Blind Method, Female, Humans, Isotonic Solutions adverse effects, Male, Middle Aged, Organometallic Compounds, Phosphates adverse effects, Picolines adverse effects, Premedication, Senna Extract, Sennosides, Anthraquinones administration & dosage, Cathartics adverse effects, Colonoscopy, Isotonic Solutions administration & dosage, Phosphates administration & dosage, Picolines administration & dosage
- Abstract
Background and Study Aims: A clean colon is essential for an efficient examination. The aim of this study was to compare a novel low-dose, low volume triple regimen with Fleet Phospho-soda., Methods: A blinded, experienced colonoscopist examined 132 consecutive patients randomly allocated to receive either a triple regimen consisting of senna syrup (sennoside B), Picolax (sodium picosulphate), and Klean Prep (polyethylene glycol 3350), or Fleet Phospho-soda (sodium dihydrogen phosphate and disodium phosphate dodecahydrate). The colonoscopist recorded cleanliness according to a scoring system (1-very clean to 4-solid stools), and time taken to reach the caecum., Results: In the triple regimen group (n = 81), 73% scored 1 or 2 compared with 57% in the Fleet Phospho-soda group (n = 51, p = 0.037 Mann-Whitney U-test). Examination to caecum was achieved in 95% of the triple regimen group and 89% of the Fleet Phospho-soda group. Among those examined as far as the caecum, the time to reach the caecum was 11 minutes (range 5-50) in the triple regimen group compared with 16 minutes (range 5-65) in the Fleet Phospho-soda group (p = 0.08, Mann-Whitney U-test). Patient tolerability was not assessed in this study., Conclusions: This novel triple regimen produces a cleaner colon than Fleet Phospho-soda, is associated with a trend towards a quicker and more efficient colonic examination, and is also 30% cheaper per patient.
- Published
- 2000
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11. Comparison of two 3-day Helicobacter pylori eradication regimens with a standard 1-week regimen.
- Author
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Grimley CE, Penny A, O'sullivan M, Shebani M, Lismore JR, Cross R, Illing RC, Loft DE, and Nwokolo CU
- Subjects
- 2-Pyridinylmethylsulfinylbenzimidazoles, Adult, Aged, Aged, 80 and over, Amoxicillin administration & dosage, Biopsy, Bismuth administration & dosage, Breath Tests, Clarithromycin administration & dosage, Drug Administration Schedule, Drug Therapy, Combination, Female, Humans, Lansoprazole, Male, Metronidazole administration & dosage, Middle Aged, Omeprazole administration & dosage, Omeprazole analogs & derivatives, Penicillins administration & dosage, Peptic Ulcer microbiology, Ranitidine administration & dosage, Ranitidine analogs & derivatives, Treatment Outcome, Anti-Bacterial Agents administration & dosage, Anti-Ulcer Agents administration & dosage, Helicobacter Infections drug therapy, Helicobacter pylori, Peptic Ulcer drug therapy
- Abstract
Background: The duration of Helicobacter pylori eradication regimens has decreased to 1 week with cure rates of over 90%. This can be attributed to the use of triple drug regimens including potent inhibitors of gastric acid secretion and clarithromycin. There is no theoretical reason why shorter regimens should not be possible., Aim: To compare two 3-day, low-dose, twice daily regimens with 1 week of omeprazole 20 mg b.d., clarithromycin 250 mg b.d., and metronidazole 400 mg b.d. (OCM) METHODS: Outpatients referred for gastroscopy were screened by biopsy urease test. H. pylori-positive patients were randomized to receive either lansoprazole 30 mg b.d., tri-potassium dicitrato bismuthate one tablet b.d., clarithromycin 250 mg b.d., and amoxycillin 1 g b.d. for 3 days (LTdbCA), or ranitidine bismuth citrate 400 mg b.d., clarithromycin 250 mg b.d. and amoxycillin 1 g b.d. for 3 days (RbcCA) or omeprazole 20 mg b.d., clarithromycin 250 mg b.d. and metronidazole 400 mg b.d. for 1 week (OCM). They were not pre-treated with a gastric acid inhibitor. After 8 weeks, H. pylori status was assessed by 13C urea breath test., Results: 974 out of 1114 patients referred for gastroscopy were screened by biopsy urease test. 140 patients were not screened either because they were anticoagulated or for technical reasons. 334 patients were H. pylori-positive: 154 were excluded mostly because of allergy to penicillin and personal reasons but 180 were randomized to treatment All regimens were well tolerated. For LTdbCA (n=60), RbcCA (n=59), and OCM (n=61) the H. pylori cure rates (95% CI) were 23% (12-34), 14% (5-23) and 87% (79-95), respectively, using intention-to-treat analysis and 25% (14-36), 15% (6-24) and 88% (80-96), respectively, if analysed per protocol. OCM was significantly superior to LTdbCA and RbcCA (P < 0.001) but there was no significant difference between regimens LTdbCA and RbcCA., Conclusions: OCM is an extremely effective H. pylori eradication regimen. The 3-day regimens tested both have poor cure rates. Pre-treatment with a proton pump inhibitor, higher doses or more frequent dosing may be necessary to increase the cure rate of short duration regimens. However, this could make them less acceptable than the H. pylori eradication regimens currently available.
- Published
- 1999
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12. Helicobacter pylori-associated antibodies in patients with duodenal ulcer, gastric and oesophageal adenocarcinoma.
- Author
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Grimley CE, Holder RL, Loft DE, Morris A, and Nwokolo CU
- Subjects
- Antigens, Bacterial analysis, Bacterial Proteins analysis, Bacterial Toxins analysis, Humans, Prospective Studies, Seroepidemiologic Studies, Adenocarcinoma microbiology, Antibodies, Bacterial analysis, Duodenal Ulcer microbiology, Esophageal Neoplasms microbiology, Helicobacter pylori immunology, Stomach Neoplasms microbiology
- Abstract
Objective: To associate Helicobacter pylori-associated antibodies with clinical disease in groups of patients with duodenal ulcer, gastric adenocarcinoma, oesophageal adenocarcinoma and normal mucosa., Design: Prospective observational sero-epidemiology study. Identification of consecutive in-patients with duodenal ulcer, gastric adenocarcinoma, oesophageal adenocarcinoma and normal mucosa. Analyses of sera for antibodies to whole H. pylori, Cag A and Vac A antigens using ELISA and Western blot. Statistical analyses., Setting: Walsgrave Hospital, Coventry, a district general hospital that serves a population of 350,000., Participants: Consecutive in-patients with an endoscopic diagnosis of duodenal ulcer (n = 31), gastric adenocarcinoma (n = 31), oesophageal adenocarcinoma (n = 40) and normal mucosa (n = 46)., Main Outcome Measures: A profile of antibodies was constructed for each patient group and between-group comparisons were made. A logistic regression model determined the H. pylori-associated antibody that could best predict a patient's diagnosis. A discriminatory power for each antibody was calculated., Results: Whole H. pylori, Cag A and Vac A antibodies are found more commonly in duodenal ulcer patients when compared to oesophageal adenocarcinoma (P < 0.003) and normal mucosa patients (P < 0.015). Similarly, gastric adenocarcinoma patients have antibodies to whole H. pylori, Cag A and Vac A more frequently than oesophageal adenocarcinoma (P< 0.002) and normal mucosa patients (P < 0.006). Vac A antibodies discriminate between duodenal ulcer/gastric adenocarcinoma and oesophageal adenocarcinoma/normal mucosa patients (odds ratio 5.56, log likelihood -90.06, P < 0.001) more effectively than Cag A antibodies (odds ratio 4.17, log likelihood -91.88, P < 0.001)., Conclusions: Similar profiles of H. pylori-associated antibodies are seen in patients with duodenal ulcer and gastric adenocarcinoma, confirming that virulent H. pylori are involved in the pathogenesis of both diseases. Antibodies to Vac A could be used to identify patients at increased risk of developing H. pylori-associated disease.
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- 1999
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13. The diagnosis of gluten sensitivity and coeliac disease--the two are not mutually inclusive.
- Author
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Loft DE, Nwokolo CU, and Ciclitira PJ
- Subjects
- Biopsy, Celiac Disease pathology, Diagnosis, Differential, Humans, Immunoglobulin A, Intestine, Small pathology, Celiac Disease diagnosis
- Abstract
The traditional definition of coeliac disease is inadequate because it includes only patients with abnormal small intestinal morphology. Gluten sensitivity is a systemic disorder whose common factor is an immune response to gluten in the context of the susceptible 'coeliac' HLA haplotype and possibly environmental triggers. Gluten sensitivity embraces traditional coeliac disease as well as subjects with normal small bowel morphology including latent coeliac disease, dermatitis herpetiformis, and symptomatic gluten intolerance. The diagnosis of gluten sensitivity and coeliac disease are not mutually inclusive. Small intestinal biopsy and clinical criteria are essential in diagnosing classical coeliac disease. IgA endomysial antibody is valuable in identifying gluten sensitivity and has particular value as a screening test. Serology should include total IgA levels to exclude selective IgA deficiency, a potential cause of false negative IgA endomysial antibody. A combination of histology, serology and clinical criteria will identify most cases of coeliac disease and gluten sensitivity.
- Published
- 1998
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14. A case of obstructive jaundice.
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Griffith JF, Bera SK, and Loft DE
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- Adult, Aneurysm, False diagnostic imaging, Cholangiopancreatography, Endoscopic Retrograde, Humans, Male, Multiple Trauma complications, Tomography, X-Ray Computed, Ultrasonography, Aneurysm, False complications, Aneurysm, False diagnosis, Cholestasis, Intrahepatic etiology, Hepatic Artery
- Published
- 1997
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15. Early and late effects of low-dose famotidine, ranitidine or placebo on pentagastrin-stimulated gastric acid secretion in man.
- Author
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Grimley CE, West JM, Loft DE, Cottrell J, Mann SG, Stauffer L, and Nwokolo CU
- Subjects
- Administration, Oral, Adult, Analysis of Variance, Anti-Ulcer Agents administration & dosage, Anti-Ulcer Agents therapeutic use, Cross-Over Studies, Famotidine administration & dosage, Famotidine therapeutic use, Female, Helicobacter pylori drug effects, Histamine H2 Antagonists administration & dosage, Humans, Infusions, Intravenous, Male, Middle Aged, Pentagastrin administration & dosage, Pentagastrin adverse effects, Peptic Ulcer drug therapy, Ranitidine administration & dosage, Ranitidine therapeutic use, Treatment Outcome, Anti-Ulcer Agents pharmacology, Famotidine pharmacology, Gastric Acid metabolism, Histamine H2 Antagonists pharmacology, Ranitidine pharmacology
- Abstract
Background: There are no published comparative studies on the effect of low-dose H2-antagonists on pentagastrin-stimulated gastric acid secretion., Methods: Twenty-four healthy subjects were dosed with either famotidine 10 mg, ranitidine 75 mg or placebo in a balanced three-period cross-over design. The subjects were studied in groups of 12, simultaneously, under identical controlled environmental conditions. Gastric juice was aspirated in 15-min aliquots during sub-maximal (0.6 microgram.h/kg) intravenous pentagastrin stimulation in the third and fourth hours (early period) and the eighth and ninth hours (late period) after oral dosing. The hydrogen ion (H+) content of gastric juice was measured ex vivo, by titrating to pH7 known volumes of gastric aspirate against 0.1 M sodium hydroxide, using a versatile microprocessor-controlled auto-titration unit. Gastric acid output during the period of interest was calculated by adding the hydrogen ion content of 15-min aliquots collected during that period. The geometric mean of the cumulative pentagastrin-stimulated gastric acid output during the early and late periods was determined for the subjects dosed with either famotidine, ranitidine or placebo. Comparisons were performed by ANOVA., Results: During the early period (2-4 h post-dose), When the subjects were given placebo, mean gastric acid output was 46.6 mmol, decreasing by 76% to 11.3 mmol (P < 0.001) when treated with famotidine and by 76% to 11.1 mmol (P < 0.001) when treated with ranitidine. During the late period (7-9 h post-dose), when the subjects were dosed with placebo, mean gastric acid output was 41.2 mmol, decreasing by 38% to 25.7 mmol (P < 0.001) when treated with famotidine and by 27% to 30.0 mmol (P = 0.007) when treated with ranitidine. The difference between the inhibitory effects of famotidine and ranitidine on gastric acid output were non-significant during either period., Conclusions: Low-dose famotidine and ranitidine, intended for over-the-counter use, inhibit stimulated gastric acid secretion profoundly in the third and fourth hours after an oral dose. Modest effects are still detectable up to 9 h after dosing.
- Published
- 1996
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16. An easy test for coeliac disease using human umbilical vein endothelial cells.
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Usselmann B and Loft DE
- Subjects
- Biopsy, Celiac Disease diagnosis, Humans, Sensitivity and Specificity, Celiac Disease prevention & control, Endothelium, Vascular cytology, Mass Screening methods, Umbilical Veins
- Published
- 1996
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17. Palliation of malignant dysphagia by ethanol induced tumour necrosis.
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Nwokolo CU, Payne-James JJ, Silk DB, Misiewicz JJ, and Loft DE
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- Adult, Aged, Aged, 80 and over, Deglutition Disorders etiology, Esophageal Neoplasms complications, Ethanol administration & dosage, Female, Humans, Injections, Intralesional, Male, Middle Aged, Necrosis chemically induced, Stomach Neoplasms complications, Deglutition Disorders drug therapy, Esophageal Neoplasms drug therapy, Ethanol therapeutic use, Palliative Care, Stomach Neoplasms drug therapy
- Abstract
Thirty two patients (74 (43-93) years; median, (range)) with dysphagia because of inoperable, unresectable or recurrent oesophagogastric carcinoma were treated by ethanol induced tumour necrosis (ETN). Endoscopic injection of absolute alcohol was performed using a variceal injector needle, with 0.5-1 ml aliquots injected retrogradely from distal to proximal tumour margin. Dilatation to 12 mm was used only if the endoscope would not traverse the stricture. In patients with total occlusion, injection into the proximal tumour was followed by a repeat endoscopy 3-7 days later. Dysphagia was graded from 0 = no dysphagia to 4 = total dysphagia. The significance of changes in the dysphagia grade after ETN were assessed using the Wilcoxon rank sum test. Results (median (range)) were as follows: stricture length = 5.0 cm (1-15). Dysphagia grade before treatment was 3 (2-4) improving after first treatment to 1 (0-3), p < 0.003. Best dysphagia grade achieved was 1 (0-3) and interval between treatments was 28.5 days (4-170). The volume of ethanol injected = 10 ml (1.5-29) and survival after first treatment was 93 days (6-660). The number of treatment sessions required to achieve best grade = 1 (1-3). There were no treatment complications. ETN significantly improves dysphagia. Results of palliation are similar to those of laser therapy, but can be achieved quickly and safely on a day case basis in most patients and at a small proportion of the cost.
- Published
- 1994
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18. Lack of evidence of neurotoxicity following 8 weeks of treatment with tripotassium dicitrato bismuthate.
- Author
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Nwokolo CU, Fitzpatrick JD, Paul R, Dyal R, Smits BJ, and Loft DE
- Subjects
- Administration, Oral, Adolescent, Adult, Aged, Anti-Ulcer Agents administration & dosage, Bismuth urine, Electromyography drug effects, Evoked Potentials, Visual drug effects, Humans, Magnetic Resonance Imaging, Middle Aged, Neural Conduction drug effects, Organometallic Compounds administration & dosage, Prospective Studies, Psychomotor Performance drug effects, Anti-Ulcer Agents adverse effects, Bismuth adverse effects, Brain drug effects, Nervous System drug effects, Organometallic Compounds adverse effects
- Abstract
Objective: To search for evidence of subclinical neurotoxicity in patients treated with tripotassium dicitrato bismuthate., Design: Prospective, controlled, triplicate study using urinary bismuth concentration, magnetic resonance imaging (MRI), nerve conduction studies, visual evoked response and a battery of 10 neuropsychological screening tests., Setting: Out-patient clinics, Walsgrave Hospital, Coventry, UK., Subjects: Fourteen dyspeptic patients; 8 (treatment group) treated with tripotassium dicitrato bismuthate one tablet q.d.s and 6 (control group) treated with ranitidine 150 mg b.d. for 8 weeks., Main Outcome Measures: Changes in urinary bismuth, MRI, nerve conduction studies, visual evoked response, and neuropsychological tests performed before, immediately after and 8 weeks after the cessation of treatment., Results: In the treatment group the median (range) urinary bismuth concentration was 1 (1-12) ng/ml before treatment, increased to 560 (140-1300) immediately after treatment (P < 0.01, Wilcoxon Rank Sum test) and was still significantly elevated (23 (7-53) ng/ml) 8 weeks after the cessation of treatment. In the patient who recorded the highest urinary bismuth, a high intensity signal appeared in the globus pallidus immediately after treatment and was still present (though diminished in intensity) 8 weeks after the cessation of treatment. This isolated MRI finding was not associated with evidence of subclinical neurotoxicity. No changes in the MRI, nerve conduction studies, visual evoked response and neuropsychological tests were observed among the other patients studied., Conclusions: Bismuth accumulation occurs in patients receiving a conventional course of treatment with tripotassium dicitrato bismuthate but this is not associated with significant changes in the nervous system.
- Published
- 1994
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19. Partial malrotation associated with pseudo-obstruction of the small bowel.
- Author
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Singh G, Hershman MJ, Loft DE, Payne-James J, Shorvon PJ, Lovell D, Misiewicz JJ, and Menzies-Gow N
- Subjects
- Adolescent, Female, Humans, Rotation, Ileal Diseases complications, Intestinal Pseudo-Obstruction complications, Intestines abnormalities
- Abstract
Intestinal pseudo-obstruction is defined as a syndrome in which there are signs and symptoms of intestinal obstruction without an actual obstructing lesion. In many cases it is associated with other disease entities but may be idiopathic. We report a case associated with partial malrotation of the gut which has not been described in the literature before.
- Published
- 1993
20. Morphometric analysis of intestinal mucosa. V. Quantitative histological and immunocytochemical studies of rectal mucosae in gluten sensitivity.
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Ensari A, Marsh MN, Loft DE, Morgan S, and Moriarty K
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- CD3 Complex analysis, Celiac Disease diet therapy, Cell Count, Humans, Image Processing, Computer-Assisted, Immunohistochemistry, Intestinal Mucosa chemistry, Lymphocytes pathology, Plasma Cells pathology, Prospective Studies, Rectum chemistry, T-Lymphocytes immunology, Celiac Disease pathology, Intestinal Mucosa pathology, Rectum pathology
- Abstract
To study changes in rectal mucosa that might be attributable to the effects of gluten, rectal biopsy specimens from untreated and treated gluten sensitised subjects were analysed morphometrically and by immunohistochemical techniques and were compared with a series of disease control mucosae. Although morphometry showed increased populations of plasma cells, lymphocytes, and mast cells in the mucosae of untreated patients, which were reduced (except for mast cells) by dietary gluten restriction, immunohistochemical techniques were far more sensitive in defining these changes. There were highly significant increases in CD3+ and gamma delta+ lymphocytes within both the lamina propria and the epithelium while neutrophils (CD15+ cells) were not at all prominent. Activated (CD25+) lymphocytes expressing interleukin (IL)-2 receptors were increased in lamina propria, usually subjacent to basal lamina, although a few IL-2R+ intraepithelial lymphocytes were found: other IL-2R+ cells were deemed to be macrophages (CD68+). These results clearly indicate that in untreated, gluten sensitised subjects the rectal mucosa shows a lymphoplasmacytoid reaction that is responsive to gluten restriction. The absence of neutrophilia suggests that this lesion is not a conventional inflammatory type proctitis, but rather one presumed to be induced by gluten antigen(s) present in the faecal stream--that is, a cell mediated form of response.
- Published
- 1993
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21. Early experience with the Bower percutaneous endoscopic gastrostomy tube.
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Payne-James JJ, Kapadia S, Loft DE, and Silk DB
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- Adolescent, Adult, Aged, Aged, 80 and over, Endoscopy, Gastrointestinal standards, Female, Follow-Up Studies, Gastrostomy instrumentation, Gastrostomy standards, Humans, Male, Middle Aged, Endoscopy, Gastrointestinal methods, Gastrostomy methods
- Abstract
Percutaneous endoscopic insertion of gastrostomy tubes is a technique becoming more widely used in the UK. It allows insertion of a gastrostomy tube without laparotomy, under local anaesthesia and sedation, and so operative insertion may eventually become a rarity. We report on our successful early experience with a new gastrostomy tube (Bower PEG) which does not require endoscopy if eventual removal is required, and describe the methods of insertion and removal.
- Published
- 1992
22. Symptomatic cervical oesophageal ectopic (heterotopic) gastric mucosa treated with omeprazole.
- Author
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Payne-James JJ, Loft DE, Mears T, and Lovell D
- Subjects
- Endoscopy, Digestive System, Female, Humans, Middle Aged, Choristoma drug therapy, Esophageal Neoplasms drug therapy, Gastric Mucosa, Omeprazole therapeutic use
- Abstract
A 60-year-old female patient with a 3-year history of nausea underwent oesophagogastroduodenoscopy. Red lesions were found in the cervical oesophagus: one of 2 cm and the other less than 1 cm. These lesions were biopsied and the larger lesion showed typical gastric mucosa. Following 40 mg/day omeprazole for 3 days all symptoms disappeared. Treatment was stopped after the patient remained symptom-free for 4 weeks.
- Published
- 1991
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23. Rectal gluten challenge and diagnosis of coeliac disease.
- Author
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Loft DE, Marsh MN, and Crowe PT
- Subjects
- Celiac Disease immunology, Humans, Rectum, Time Factors, Celiac Disease diagnosis, Glutens administration & dosage, Lymphocyte Activation drug effects
- Published
- 1990
- Full Text
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24. Epidemiological survey of coeliac disease and inflammatory bowel disease in first-degree relatives of coeliac patients.
- Author
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Shah A, Mayberry JF, Williams G, Holt P, Loft DE, and Rhodes J
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- Adolescent, Adult, Aged, Celiac Disease genetics, Child, Child, Preschool, Colitis, Ulcerative epidemiology, Female, Humans, Infant, Inflammatory Bowel Diseases genetics, Male, Middle Aged, Prevalence, Risk Factors, Celiac Disease epidemiology, Inflammatory Bowel Diseases epidemiology
- Abstract
One hundred and sixty-two of 182 patients with coeliac disease provided satisfactory details of family size and the prevalence of coeliac disease and inflammatory bowel disease among their first-degree relatives. Patients ranged in age from 11 months to 79 years with a mean age of 41 (+/- 23) years. Twenty patients had at least one first-degree relative with coeliac disease: a total of 25 of 861 relatives were affected (prevalence = 2904/100,000) compared with an expected 0.9 cases (prevalence = 100/100,000; p less than 0.001). Six relatives had inflammatory bowel disease (prevalence = 697/100,000) compared with an expected 1.3 cases (prevalence = 150/100,000; p less than 0.001). Five of these had ulcerative colitis, and one had Crohn's disease. The relative risk of ulcerative colitis is, therefore, five times greater for first-degree relatives of people with coeliac disease than for the general population (95 per cent confidence interval, 4.7-7.2). There is a clear association between coeliac disease and ulcerative colitis, which may point to factors involved in the aetiology of colitis.
- Published
- 1990
25. Studies of intestinal lymphoid tissue. X-observations on granular epithelial lymphocytes (gEL) in normal and diseased human jejunum.
- Author
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Marsh MN, Leigh RJ, Loft DE, Garner GV, and Gordon DB
- Subjects
- Adolescent, Adult, Aged, Epithelial Cells, Humans, Intestinal Mucosa cytology, Jejunum pathology, Lactoglobulins pharmacology, Lymphocytes cytology, Lymphoid Tissue cytology, Middle Aged, Celiac Disease pathology, Jejunum cytology, Lymphoid Tissue pathology
- Abstract
A proportion of epithelial lymphocytes in various mammalian species is characterised by cells containing cytoplasmic granules. We have studied the total number of granular lymphocytes within surface and crypt epithelium of jejunal mucosae (per 10(4) micron2 muscularis mucosae) from six groups of subjects, comprising (i) young healthy volunteers (ii) family relatives of known coeliac patients, patients with gastrointestinal disorders associated with either (iii) normal or (iv) "flat" mucosae, and groups of (v) untreated and (vi) treated patients with coeliac disease. There was no difference in the absolute number of gEL between the three control groups with normal mucosal architecture, the proportion of granular to total EL per unit of tissue varying between 30-40%. In untreated coeliac mucosae, there was a significantly increased population of gEL, compared with the same control groups (p less than 0.001): the ratio of granular to total EL approximated 65%, and did not differ from flat-control mucosae in which the proportion of gEL was 55%. On withdrawal of gluten, the absolute number of gEL fell significantly in comparison with the untreated coeliac group (p less than 0.05). To further evaluate the effect of gluten challenge, granular lymphocytes were monitored during a five-day period in groups of treated coeliac patients orally challenged with increasing doses (500-3000 mg) of a peptic-tryptic digest of gluten. A significant rise in the absolute number of granular lymphocytes occurred at 12 h, but without any deterioration in mucosal architecture.
- Published
- 1988
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26. Oesophageal ulcer caused by warfarin.
- Author
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Loft DE, Stubington S, Clark C, and Rees WD
- Subjects
- Drug Administration Schedule, Female, Humans, Middle Aged, Ulcer chemically induced, Warfarin administration & dosage, Esophageal Diseases chemically induced, Warfarin adverse effects
- Abstract
Oesophageal injury is a well recognized complication of certain oral medications but warfarin has not been implicated previously. We present a case of an oesophageal ulcer occurring in a patient with mitral regurgitation taking warfarin, and demonstrate a delayed oesophageal tablet transit time.
- Published
- 1989
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27. Humoral response to wheat protein in patients with celiac disease and enteropathy associated T cell lymphoma.
- Author
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Loft DE and Marsh MM
- Subjects
- Antibody Formation, Humans, T-Lymphocytes, Celiac Disease immunology, Gliadin immunology, Lymphoma immunology, Plant Proteins immunology
- Published
- 1986
- Full Text
- View/download PDF
28. Coeliac sprue: a centennial overview 1888-1988.
- Author
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Marsh MN and Loft DE
- Subjects
- Antibody Formation, Celiac Disease history, Celiac Disease physiopathology, History, 19th Century, History, 20th Century, Humans, Immunity, Cellular, Celiac Disease immunology, Glutens immunology
- Published
- 1988
- Full Text
- View/download PDF
29. Studies of intestinal lymphoid tissue. XII. Epithelial lymphocyte and mucosal responses to rectal gluten challenge in celiac sprue.
- Author
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Loft DE, Marsh MN, Sandle GI, Crowe PT, Garner V, Gordon D, and Baker R
- Subjects
- Adult, Aged, Capillary Permeability drug effects, Female, Humans, Intestinal Mucosa blood supply, Intestinal Mucosa pathology, Male, Mast Cells ultrastructure, Microscopy, Electron, Middle Aged, Rectum drug effects, Celiac Disease pathology, Glutens pharmacology, Intestinal Mucosa drug effects
- Abstract
The immunopathologic, structural, and functional changes within rectal mucosa of known celiac sprue subjects were quantitated during local challenge with a peptic-tryptic digest of gluten. In the celiac sprue patients challenged with 2 g of digest, major effects occurred in lamina propria, submucosa, and local microvasculature. The lamina propria swelling was biphasic, starting 1-2 h after challenge with widespread extravascular deposition of fibrinogen, indicative of increased microvascular permeability, receding by 24 h postchallenge. A rapid fall in mast cells together with granule discharge suggested their involvement in this response. The late-phase swelling (48-72 h) was preceded by a rapid influx of neutrophils and basophils, the latter showing evidence of degranulation beyond 72 h. Reestablishment of vessel lumina, a rise in mast cells, and loss of neutrophils indicated tapering of the inflammatory cellular cascade by 96 h. Lymphocytes, first seen to enter the lamina by 2 h postchallenge, increased progressively, thereby resulting in substantial infiltration between 36 and 96 h. A marked rise in epithelial lymphocytes, maximal at 6-8 h, waned by 24 h. Volumes of surface and crypt epithelium remained constant throughout. In another challenge series with 4 g of gluten digest, electrical potential difference across rectal mucosa decreased significantly 12 h postchallenge, but the associated decreases in net sodium and chloride absorptive fluxes were insignificant. It is concluded that rectal mucosa is sensitized to gluten in celiac sprue disease and thus offers a promising and convenient in vivo substrate for investigative and diagnostic purposes.
- Published
- 1989
- Full Text
- View/download PDF
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