24 results on '"M. H. Giaffer"'
Search Results
2. Improved maintenance of remission in ulcerative colitis by balsalazide 4 g/day compared with 2 g/day
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C. A. Rodrigues, C. D. Holdsworth, J. H. Baron, A. M. Hoare, R. J. Polson, Peter McIntyre, S. Manjunatha, M. H. Giaffer, I. G. Barrison, P. C. Thornton, John E. Lennard-Jones, and G. S. R. Davies
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Gastroenterology ,Drug Administration Schedule ,law.invention ,chemistry.chemical_compound ,Double-Blind Method ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Colitis ,Mesalamine ,Aged ,Aged, 80 and over ,Chemotherapy ,Dose-Response Relationship, Drug ,Hepatology ,medicine.diagnostic_test ,business.industry ,Sigmoidoscopy ,Middle Aged ,Balsalazide ,medicine.disease ,Ulcerative colitis ,Phenylhydrazines ,Sulfasalazine ,Clinical trial ,Aminosalicylic Acids ,Dose–response relationship ,chemistry ,Colitis, Ulcerative ,Female ,business - Abstract
The efficacy of two doses of balsalazide for the maintenance of remission in patients with ulcerative colitis was compared in a double-blind multicentre trial. Sixty-five patients received a 2 g daily dose, and 68 a 4 g dose. The patient groups were similar at entry for sex, age, and disease distribution. Clinical assessment was carried out at 3-monthly intervals, with sigmoidoscopy, rectal biopsy, and blood tests on entry and at 26 and 52 weeks. Clinical relapse over twelve months was significantly less common on the 4 g dose (36%), than on the 2 g dose (55%), P less than 0.01. There were eight withdrawals on 2 g daily and 13 on 4 g daily, six and nine respectively being mainly due to gastrointestinal intolerance. It is concluded that balsalazide is a well-tolerated drug, and is effective for the maintenance of remission in patients with ulcerative colitis, the optimal dose being greater than 2 g daily. more...
- Published
- 2007
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Catalog
3. A double-blind comparison of balsalazide, 6.75 g, and sulfasalazine, 3 g, as sole therapy in the management of ulcerative colitis
- Author
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P. C. Thornton, D. Mckenna, John C. Mansfield, M. H. Giaffer, C. D. Holdsworth, and P. A. Cann
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medicine.medical_specialty ,Hepatology ,Management of ulcerative colitis ,business.industry ,Gastroenterology ,Balsalazide ,medicine.disease ,Ulcerative colitis ,law.invention ,Surgery ,Clinical trial ,chemistry.chemical_compound ,Randomized controlled trial ,chemistry ,law ,Sulfasalazine ,Internal medicine ,medicine ,Pharmacology (medical) ,Colitis ,Adverse effect ,business ,medicine.drug - Abstract
Background: Sulfasalazine is accepted therapy for active ulcerative colitis, but side-effects and intolerance are common. Balsalazide is an azo-bonded pro-drug which also releases 5-aminosalicylic acid into the colon, but uses an inert carrier molecule. Aim: To compare the safety and efficacy of sul- fasalazine, 3 g, with balsalazide, 6.75 g, in the initial daily treatment of mild to moderate ulcerative colitis. Methods: A randomized, multicentre, double-blind, parallel group study was performed, with a treatment duration of 8 weeks. Patients on previous maintenance treatment were excluded. The trial medication was the sole treatment for the colitis. Efficacy was assessed by patient diaries, symptom assessment, sigmoidoscopic appearance and histology. Results: Fifty patients were recruited: 26 allocated to the balsalazide group and 24 to the sulfasalazine group. More patients withdrew due to adverse events in the sulfasalazine group (nine patients vs. one patient in the balsalazide group, P=0.004). Improvement occurred in both groups, with a tendency to a faster response with balsalazide. Of the patients taking balsalazide, 61% achieved clinical and sigmoidoscopic remission. Conclusions: Balsalazide, 6.75 g, is effective as the sole treatment for patients with mild to moderately active ulcerative colitis, with significantly fewer withdrawals due to side-effects than in a similar group of patients taking sulfasalazine, 3 g. more...
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- 2002
- Full Text
- View/download PDF
4. Labelled leucocyte scintigraphy in inflammatory bowel disease: clinical applications
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M H Giaffer
- Subjects
Leucocyte scintigraphy ,medicine.medical_specialty ,Pathology ,Colorectal cancer ,Scintigraphy ,Gastroenterology ,Inflammatory bowel disease ,Technetium Tc 99m Exametazime ,Crohn Disease ,Sepsis ,Internal medicine ,Oximes ,Leukocytes ,medicine ,Humans ,Radionuclide Imaging ,Crohn's disease ,medicine.diagnostic_test ,business.industry ,Medical screening ,Indium Radioisotopes ,Organotechnetium Compounds ,Inflammatory Bowel Diseases ,medicine.disease ,Ulcerative colitis ,Endoscopy ,business ,Research Article - Published
- 1996
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5. Quantitative assessment of overall inflammatory bowel disease activity using labelled leucocytes: a direct comparison between indium-111 and technetium-99m HMPAO methods
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W B Tindale, C. D. Holdsworth, John C. Mansfield, and M. H. Giaffer
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Adult ,Male ,Adolescent ,chemistry.chemical_element ,Scintigraphy ,Technetium ,Inflammatory bowel disease ,Feces ,Technetium Tc 99m Exametazime ,Computer analysis ,Oximes ,Leukocytes ,medicine ,Quantitative assessment ,Humans ,Radionuclide Imaging ,Aged ,medicine.diagnostic_test ,business.industry ,Indium Radioisotopes ,Gastroenterology ,Organotechnetium Compounds ,Middle Aged ,Inflammatory Bowel Diseases ,medicine.disease ,chemistry ,Female ,Faecal excretion ,business ,Nuclear medicine ,Technetium-99m ,Research Article - Abstract
The ideal imaging method in inflammatory bowel disease would reliably detect inflammation, identify the correct intestinal location, and assess the severity of the disease. The aim of this study was to compare scintigraphic methods of quantifying overall disease activity using both indium-111 (111In) and technetium-99M (99mTc) HMPAO labelled leucocyte scans. The four day faecal excretion of 111In was measured after 111In scintigraphy in 24 patients known to have inflammatory bowel disease. The same patients also underwent 99mTc HMPAO scanning. The scans were performed 10 days or less apart with no changes in treatment between scans. Bowel activity on the 99mTc HMPAO scans was assessed using a computer based method (scan score) and a visual grading method in a further 54 99mTc HMPAO. The results showed a close correlation between inflammatory activity defined by faecal 111In excretion and the scan score generated from the computer analysis of the 99mTc HMPAO image (Spearman rank correlation: rs = 0.78; p < 0.001). Accurate information to localise inflammatory activity could be obtained by simple visual assessment of both types of scan images, although image quality was superior with 99mTc HMPAO. Qualification of disease activity from 99mTc HMPAO images by visual grading was associated with a large variability, only 69% of scans had similar scores when graded by three observers. Computer generated image analysis was more reproducible. In conclusion, in inflammatory bowel disease 99mTc HMPAO scintigraphy and faecal 111In excretion correlated well. Either method can quantify and localise the inflammation. As 99mTc HMPAO scanning provides a quicker result, with a lower radiation dose, and avoids faecal collection, it may be the preferred method. more...
- Published
- 1995
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6. Controlled trial of oligopeptide versus amino acid diet in treatment of active Crohn's disease
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C. D. Holdsworth, M. H. Giaffer, and John C. Mansfield
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Male ,medicine.medical_specialty ,Complete protein ,Gastroenterology ,law.invention ,Enteral Nutrition ,Technetium Tc 99m Exametazime ,Crohn Disease ,Randomized controlled trial ,law ,Internal medicine ,Oximes ,Leukocytes ,medicine ,Humans ,Amino Acids ,Radionuclide Imaging ,Food, Formulated ,chemistry.chemical_classification ,Oligopeptide ,Crohn's disease ,business.industry ,Therapeutic effect ,Organotechnetium Compounds ,medicine.disease ,Amino acid ,Intestines ,Clinical trial ,Treatment Outcome ,Parenteral nutrition ,chemistry ,Immunology ,Female ,business ,Oligopeptides ,Research Article - Abstract
Elemental diets are effective in inducing remission in active Crohn's disease, but how they exert this therapeutic effect is unclear. In a previous study a whole protein containing diet proved less effective than one in which food antigens were excluded, suggesting that exclusion of food antigens from the gut was a possible mechanism. This study was designed to test whether an oligopeptide diet of hydrolysed proteins was as effective as an amino acid based diet. These diets were equally antigen free but with different nitrogen sources. Forty four patients with active Crohn's disease were randomised in a controlled trial of amino acid versus oligopeptide diet. The feeds were given by nasogastric tube in equicaloric quantities and were the sole form of nutrition. Treatment was continued for four weeks although failure to improve by day 10 resulted in withdrawal. Quantitative leucocyte scintigraphy was used to investigate the effect of diet treatment on gut inflammation. Clinical and nutritional responses to treatment were also measured. Sixteen patients entered remission (including withdrawal of corticosteroids), six patients could not tolerate the nasogastric tube, and 22 patients failed to respond. The two diets were equally effective. Patients who responded had a rapid drop in clinical index of disease activity and a major reduction in the bowel uptake of leucocytes on scintigraphy. The oligopeptide and amino acid based enteral feeds were equally effective at inducing remission in active Crohn's disease. With both diets clinical improvement was accompanied by a reduction in intestinal inflammation. more...
- Published
- 1995
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7. Background Subtraction: A New Approach to the Assessment of Disease Activity in Crohn's Disease Using99mTc-HMPAO-Labelled Leucocytes
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C. D. Holdsworth, M. H. Giaffer, and W. B. Tindale
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medicine.medical_specialty ,Pathology ,Gastroenterology ,Disease activity ,Excretion ,Feces ,Technetium Tc 99m Exametazime ,Crohn Disease ,Internal medicine ,Oximes ,Active disease ,Image Processing, Computer-Assisted ,Leukocytes ,medicine ,Humans ,Platelet ,Radionuclide Imaging ,Crohn's disease ,business.industry ,Indium Radioisotopes ,Albumin ,Organotechnetium Compounds ,medicine.disease ,99mTc-HMPAO ,Standard technique ,Subtraction Technique ,business - Abstract
A computer-based technique for the quantification of abnormal bowel uptake in Crohn's disease has been developed and compared with pre-existing clinical, laboratory and scintigraphic methods of assessment. The standard technique for labelling leucocytes with 99mTc-HMPAO is applied. Images were obtained at 40, 120 and 240 min after the injection of radiolabelled leucocytes. The count in the bowel area after subtracting background activity corrected to the injected dose and image acquisition times is the 'scan score', an objective measure of disease activity. The scan score is significantly higher in patients with clinically active disease (mean 82.1 +/- SEM 13.6) than in those with quiescent disease (24.7 +/- 7.0) (p < or = 0.005). Optimum separation between active and quiescent disease is achieved with a threshold scan score of 20. The scan score was comparable in small bowel disease (73.3 +/- 16.2), large bowel (94.4 +/- 33) and disease at both locations (94.1 +/- 19.2). The scan score correlated favourably with Crohn's Disease Activity Index (rs = 52, p < or = 0.0001), Harvey & Bradshow Simple Index (rs = 0.4, p < or = 0.001), serum C-reactive protein (rs = 0.72, p < or = 0.001), serum alpha acid glycoprotein (rs 0.67, p < or = 0.001), haemoglobin (rs = 0.66, p < or = 0.001), platelet count (rs = 0.47, p < or = 0.006), albumin (rs = 0.61, p < or = 0.0001) and faecal 111Indium excretion (rs = 0.78, p < or = 0.001), but not with the ESR (rs = 0.22, p < or = 0.4).(ABSTRACT TRUNCATED AT 250 WORDS) more...
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- 1994
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8. Quantification of disease activity in Crohn's disease by computer analysis of Tc-99m hexamethyl propylene amine oxime (HMPAO) labelled leucocyte images
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W B Tindale, C. D. Holdsworth, S Senior, D C Barber, and M. H. Giaffer
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Adult ,Male ,medicine.medical_specialty ,Pathology ,chemistry.chemical_element ,Disease ,Technetium ,Scintigraphy ,Gastroenterology ,Disease activity ,Technetium Tc 99m Exametazime ,Computer analysis ,Crohn Disease ,Internal medicine ,Oximes ,Image Processing, Computer-Assisted ,Leukocytes ,medicine ,Humans ,Radionuclide Imaging ,Aged ,Crohn's disease ,medicine.diagnostic_test ,business.industry ,Albumin ,Organotechnetium Compounds ,Middle Aged ,medicine.disease ,Intestines ,Intestinal Absorption ,chemistry ,Erythrocyte sedimentation rate ,Acute Disease ,Female ,business ,Research Article - Abstract
The reliability and clinical applications of computerised image analysis measurement of bowel uptake of Tc-99m HMPAO labelled leucocytes has been examined as a measure of disease activity in Crohn's disease. In 54 studies carried out on 33 patients with established Crohn's disease, the mean 'scan score', a quantitative assessment of image intensity, was 82.1 SEM (13.6), in patients with clinically active disease compared to 24.7 (7.0) in those with quiescent disease, p < or = 0.0005. A significant correlation was found between the scan score and Crohn's Disease Activity Index (rs = 0.52, p < 0.0001), and Harvey and Bradshaw Simple Index (rs = 0.4, p < 0.004). A low scan score correctly identified seven patients whose raised Crohn's Disease Activity Index incorrectly indicated active disease because symptoms used in calculation of the index were not caused by active inflammation. Of the laboratory measurements, the scan score correlated with the haemoglobin (rs = 0.66, p < 0.0001), albumin level (rs = -0.6, p < 0.0001), C-reactive protein (rs = 0.7, p < 0.0001), alpha-acid glycoprotein (rs = 0.57, p < 0.001), and platelet count (rs = 0.47, p < or = 0.006), but not with the erythrocyte sedimentation rate (rs = 0.2, p < or = 0.25). The scan score was raised in all patients who had clinically active disease but normal laboratory tests. The results of this study indicate that the scan score provides an objective indicator of disease activity in Crohn's disease which may be superior to clinical indices, and also to laboratory tests which although objective are often normal in the presence of active disease. more...
- Published
- 1993
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9. Antibodies to Saccharomyces cerevisiae in patients with Crohn's disease and their possible pathogenic importance
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A Clark, C D Holdsworth, and M. H. Giaffer
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Adult ,Male ,Immunoglobulin A ,Saccharomyces cerevisiae ,Coeliac disease ,Immunoglobulin G ,Pathogenesis ,Crohn Disease ,medicine ,Humans ,Antibodies, Fungal ,Aged ,Aged, 80 and over ,Crohn's disease ,biology ,Gastroenterology ,Anti–Saccharomyces cerevisiae antibody ,Middle Aged ,medicine.disease ,Ulcerative colitis ,digestive system diseases ,Celiac Disease ,Immunology ,biology.protein ,Colitis, Ulcerative ,Female ,Antibody ,Research Article - Abstract
Saccharomyces cerevisiae (baker's yeast) may play an important part in the pathogenesis of Crohn's disease. Because of this the levels of IgG and IgA antibodies against three S cerevisiae strains (NCYC 77, NCYC 79, and NCYC 1108) were assayed in 49 patients with Crohn's disease, 43 with ulcerative colitis, 14 with coeliac disease, and 21 healthy controls. Coded serum samples were tested by ELISA. Similar antibody patterns to all three strains were found. IgG and IgA antibody levels were significantly raised in patients with Crohn's disease compared with healthy controls (p < 0.001 and p < 0.0001 respectively) and with ulcerative colitis patients (p < 0.0001 and p < 0.0006 respectively). Raised IgA, but not IgG, yeast antibody levels were found in two patients with Crohn's disease who were intolerant to yeast, but these values were similar to those in other patients without yeast intolerance. In ulcerative colitis, both IgG and IgA levels were similar to normal controls. Patients with small bowel Crohn's disease had significantly higher IgG antibody levels than those with colonic disease (p < 0.01). High levels of IgG, but not IgA, antibody were present in patients with coeliac disease, the antibody responses being indistinguishable from those found in Crohn's disease. It is concluded that the presence of IgG antibody to S cerevisiae is characteristic but not specific to Crohn's disease. Although raised IgA antibody levels are more frequently found in Crohn's disease, their pathogenic importance remains to be established. more...
- Published
- 1992
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10. Virulence properties of Escherichia coli strains isolated from patients with inflammatory bowel disease
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C. D. Holdsworth, M. H. Giaffer, and B. I. Duerden
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Adult ,Male ,Bacterial Toxins ,Virulence ,Shiga Toxin 1 ,medicine.disease_cause ,Inflammatory bowel disease ,Bacterial Adhesion ,Microbiology ,Pathogenesis ,Enterotoxins ,Hemolysin Proteins ,Crohn Disease ,Escherichia coli ,medicine ,Humans ,Crohn's disease ,biology ,Gastroenterology ,Hemolysin ,Middle Aged ,medicine.disease ,biology.organism_classification ,Enterobacteriaceae ,Ulcerative colitis ,digestive system diseases ,Colitis, Ulcerative ,Female ,Research Article - Abstract
Escherichia coli strains cultured from 74 patients with inflammatory bowel disease at different stages of disease activity (Crohn's disease (40), ulcerative colitis (34)) and 18 healthy controls were studied in relation to haemolysin and verotoxin production and enteroadherence. Disease activity was assessed by standard clinical and laboratory tests. Haemolytic E coli were isolated from 18% of patients with Crohn's disease, 24% with ulcerative colitis, and 11% of healthy controls. None of these differences was significant. No verotoxin producing strains were detected among the 216 E coli isolates examined but the extract from five strains (Crohn's (4), ulcerative colitis (1) produced a distinctive cytopathic effort on Vero cell monolayers which was later shown not to be due to verotoxin. The adhesion indices of E coli isolates cultured were: mean (SEM) 42.2 (6.4) for Crohn's disease, 43.3 (6.2) for ulcerative colitis, and 11.3 (2.0) for normal controls (p less than or equal to 0.0001). Adhesive E coli were isolated from 62% of patients with Crohn's disease and 68% with ulcerative colitis but from only 6% of normal controls (p less than or equal to 0.0002). Neither haemolysin production nor enteroadherence was dependent upon disease activity, disease location, sulphasalazine treatment, or previous intestinal resection. These results indicate that only enteroadherent E coli were frequently associated with inflammatory bowel disease; their relation to the pathogenesis of these conditions, however, remains uncertain. more...
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- 1992
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11. 99 Tc m HMPAO-labelled leucocyte imaging in Crohn's disease: a subtraction technique for the quantification of disease activity
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W. B. Tindale, D C Barber, C. D. Holdsworth, S Senior, and M. H. Giaffer
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Crohn's disease ,Pathology ,medicine.medical_specialty ,business.industry ,Biophysics ,Subtraction ,Organotechnetium Compounds ,Disease ,medicine.disease ,Inflammatory bowel disease ,Disease activity ,Technetium Tc 99m Exametazime ,Crohn Disease ,Subtraction Technique ,Oximes ,Leukocytes ,Residual activity ,Humans ,Medicine ,In patient ,Radiology ,Radionuclide Imaging ,business ,Inactive disease - Abstract
A new technique for the quantitative analysis of labelled leucocyte images from patients with inflammatory bowel disease is described. The method involves the computer generation of a 'background' image which, after appropriate registration, is subtracted from the patient's image to leave a residue which represents abnormal uptake in the bowel. Quantification of the residual activity yields a scan score which can be related to the level of disease activity in patients with Crohn's disease. In 54 investigations on 33 patients the scan scores correctly agreed with a clinical assessment of disease activity in 16 of 20 cases with inactive disease and 32 out of 34 cases with active disease. Most of the discrepancies reflected inaccuracies in the clinical assessment of activity rather than shortcomings of the imaging technique. more...
- Published
- 1992
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12. Effects on an Elemental Diet on the Faecal Flora in Patients with Crohn's Disease
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M. H. Giaffer, C. D. Holdsworth, and B. I. Duerden
- Published
- 1991
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13. Challenges and Controversies in the Management of Hepatitis C Virus Infection (Part 2)
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M. H. Giaffer and N. B. Bel Haj
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medicine.medical_specialty ,Cirrhosis ,medicine.diagnostic_test ,business.industry ,Hepatitis C virus ,Antiviral therapy ,General Medicine ,medicine.disease ,Chronic liver disease ,medicine.disease_cause ,Virological response ,Internal medicine ,Liver biopsy ,medicine ,In patient ,High incidence ,business - Abstract
Patients with HCV-related cirrhosis are frequently seen in clinical practice when the diagnosis is established either clini-cally when signs of chronic liver disease are evident, or histo-logically when liver biopsy is performed as part of the assess-ment of patients with HCV infection. It continues to be debat-able whether cirrhotic patients should receive antiviral therapy. Those who propose treatment state that eradication of HCV is the main goal of antiviral therapy thus limiting the spread of HCV infection and stress that cirrhosis is not a permanent in-jury that cannot be reversed. Opponents of antiviral therapy in patients with cirrhosis state that such treatment produces very low virological response rates in the face of a reportedly high incidence of side effects. more...
- Published
- 2006
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14. Challenges and Controversies in the Management of Hepatitis C Virus Infection (Part 1)
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M. H. Giaffer and N. B. Bel Haj
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Hepatitis ,medicine.medical_specialty ,Cirrhosis ,business.industry ,Hepatitis C virus ,Public health ,Incidence (epidemiology) ,General Medicine ,medicine.disease ,medicine.disease_cause ,Chronic liver disease ,Virology ,digestive system diseases ,Liver disease ,Hepatocellular carcinoma ,Internal medicine ,Medicine ,business - Abstract
Hepatitis C virus (HCV) is emerging as a public health issue in most counties worldwide. The prevalence of HCV infection varies among different geographical areas from 0.5% to 40% with an overall global prevalence of 3%. The WHO estimates that around 170 million people are chronically infected with HCV world wide. Hepatitis CV infection causes a slowly progressive liver disease in over 60% of infected individuals culminating into cirrhosis and ultimately leading to liver failure and hepatocellular carcinoma (HCC). Chronic liver disease due to HCV infection is now the leading indication for livertransplantation both in Europe and the USA. Although the incidence of acute hepatitis C has decreased over the last decade, the number of individuals with HCV-related liver disease continues to rise and is projected to peak around year 2015. As such HCV infection imposes a significant burden on the already exhausted health resources, particularly in the developing counties where the infection is endemic and its incidence is increasing. more...
- Published
- 2005
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15. Helicobacter pylori eradication ameliorates symptoms and improves quality of life in patients on long-term acid suppression. A large prospective study in primary care
- Author
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S, Verma and M H, Giaffer
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Male ,Peptic Ulcer ,Helicobacter pylori ,Primary Health Care ,Middle Aged ,Anti-Ulcer Agents ,Helicobacter Infections ,Histamine H2 Antagonists ,Quality of Life ,Humans ,Female ,Prospective Studies ,Dyspepsia ,Practice Patterns, Physicians' - Abstract
Our objective was to determine prescribing patterns for H2 receptor antagonists (H2RA) in primary care and to establish the prevalence and impact of Helicobacter pylori (Hp) eradication in this population of patients. Patients on long-term (6 months or longer) H2RA were identified through a computerized database at the six primary care practices in North England. Hp status was identified by serology, and those positive received standard proton pump-based triple therapy followed by a urea breath test to confirm Hp eradication. The main outcome measures were the indications for prescribing long-term H2RA in primary care, the prevalence of patients with a positive Hp serology, and the impact of Hp eradication on the subsequent need for acid suppression, severity of dyspepsia, gastrointestinal symptom rating score (GSRS), quality of life (QOL), and overall feeling of well-being. One thousand seven (1.5%) patients were on long-term H2RA. Peptic ulcer disease (PUD) was the most common indication for prescribing (42%), followed by nonulcer dyspepsia (28%) and gastroesophageal reflux disease (23%). In 81% of the patients treatment with H2RA therapy followed a previous endoscopic or radiological investigation. Only 27 (2.5%) patients had had their Hp status checked within the last 6 months. Of the 471 patients who eventually had their Hp serology tested, 297 (63%) were Hp positive. Fifty-eight percent of the Hp-positive patients had PUD. Successful Hp eradication was achieved in 250 (84%) of the patients, of whom 247 (83%) finished the 1-year follow-up. This was associated with a significant reduction in the amount of H2RA being consumed (P0.00001). There was also a significant improvement in the symptom scores and the GSRS after successful Hp eradication (P0.00001). Overall 67% of the patients reported an improvement in the QOL and 77% noted a feeling of well-being 1 year after Hp eradication. A significant proportion of patients in primary care is still being maintained on long-term H2RA, imposing a considerable financial drain on the NHS resources. Approximately two-thirds of these patients will be Hp positive, and among them the largest group will comprise patients with PUD. Hp eradication in such patients results in a significant reduction in usage of acid suppression and an improvement in overall QOL and severity of dyspeptic symptoms. more...
- Published
- 2002
16. A double-blind comparison of balsalazide, 6.75 g, and sulfasalazine, 3 g, as sole therapy in the management of ulcerative colitis
- Author
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J C, Mansfield, M H, Giaffer, P A, Cann, D, McKenna, P C, Thornton, and C D, Holdsworth
- Subjects
Adult ,Aged, 80 and over ,Male ,Administration, Oral ,Middle Aged ,Anti-Ulcer Agents ,Severity of Illness Index ,Phenylhydrazines ,Sulfasalazine ,Aminosalicylic Acids ,Treatment Outcome ,Double-Blind Method ,Gastrointestinal Agents ,Humans ,Colitis, Ulcerative ,Female ,Mesalamine ,Sigmoidoscopy ,Aged - Abstract
Sulfasalazine is accepted therapy for active ulcerative colitis, but side-effects and intolerance are common. Balsalazide is an azo-bonded pro-drug which also releases 5-aminosalicylic acid into the colon, but uses an inert carrier molecule.To compare the safety and efficacy of sul- fasalazine, 3 g, with balsalazide, 6.75 g, in the initial daily treatment of mild to moderate ulcerative colitis.A randomized, multicentre, double-blind, parallel group study was performed, with a treatment duration of 8 weeks. Patients on previous maintenance treatment were excluded. The trial medication was the sole treatment for the colitis. Efficacy was assessed by patient diaries, symptom assessment, sigmoidoscopic appearance and histology.Fifty patients were recruited: 26 allocated to the balsalazide group and 24 to the sulfasalazine group. More patients withdrew due to adverse events in the sulfasalazine group (nine patients vs. one patient in the balsalazide group, P=0.004). Improvement occurred in both groups, with a tendency to a faster response with balsalazide. Of the patients taking balsalazide, 61% achieved clinical and sigmoidoscopic remission.Balsalazide, 6.75 g, is effective as the sole treatment for patients with mild to moderately active ulcerative colitis, with significantly fewer withdrawals due to side-effects than in a similar group of patients taking sulfasalazine, 3 g. more...
- Published
- 2002
17. Does better disease-related education improve quality of life? A survey of IBD patients
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S, Verma, H H, Tsai, and M H, Giaffer
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Adult ,Crohn Disease ,Patient Education as Topic ,Surveys and Questionnaires ,Quality of Life ,Humans ,Colitis, Ulcerative ,Middle Aged - Abstract
The importance of health-related quality of life (HRQOL) assessment in patients with chronic disorders such as inflammatory bowel disease (IBD) is now acknowledged by researchers. Of the many factors that may influence HRQOL, patient knowledge of the condition and disease-related information provision have hitherto not been studied. In all, 250 patients with inactive IBD (UC = 128, CD = 122) were randomly chosen from our IBD clinic. Two sets of questionnaires [initially a standard questionnaire to assess level of disease-related information by a patient information score (PIS), followed by a HRQOL questionnaire] were sent to each patient. In the PIS, a score of 7 or more indicated satisfactory disease-related knowledge and in the HRQOL, a score less than 51 suggested a normal QOL, and a score above 60 significantly impaired QOL. A total of 168 patients (66%) returned both the questionnaires (UC = 91, CD = 77). The mean QOL in patients with UC and CD was 62.2+/-8.3 and 63.9+/-9.5 respectively, (P = NS). 99 patients (59%) had significantly impaired QOL (mean score 65+/-7.6) with only 12 patients (8%), 6 in each group, having a normal QOL. Mean PIS score for the patients was 7.04+/-0.1; 53% of the UC patients and 75% of the CD patients (P = 0.006) were considered well informed (ie, PIS scores of 7 or more). The mean PIS for UC patients was 6.5+/-0.4 vs 7.5+/-0.2 for the CD group (P = 0.001). There was, however, no correlation seen between the QOL and PIS scores, both for UC and CD patients (R = 0.3). In conclusion, most patients with IBD have impaired QOL, despite of having inactive disease. The level of disease-related knowledge appears to be better in patients with CD, although that does not seem to affect QOL. more...
- Published
- 2001
18. Double blind trial of oral fluticasone propionate v prednisolone in the treatment of active ulcerative colitis
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C D Holdsworth, C J Hawkey, M H Giaffer, D A Burke, M L Keech, A. B. Hawthorne, and C O Record
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,medicine.medical_treatment ,Prednisolone ,Anti-Inflammatory Agents ,Gastroenterology ,Fluticasone propionate ,law.invention ,Randomized controlled trial ,Double-Blind Method ,law ,Internal medicine ,medicine ,Humans ,Colitis ,Fluticasone ,Aged ,Chemotherapy ,business.industry ,Middle Aged ,medicine.disease ,Ulcerative colitis ,Androstadienes ,Endocrinology ,Corticosteroid ,Colitis, Ulcerative ,Female ,business ,medicine.drug ,Research Article - Abstract
Fluticasone propionate is a corticosteroid with the potential for topical treatment of ulcerative colitis because of low systemic bioavailability. The drug was compared with prednisolone in the management of active left sided or total ulcerative colitis. Two hundred and five patients were studied in the multicentre four week double blind study. Prednisolone was given in a dose of 40 mg daily orally, reducing over four weeks to 10 or 20 mg. Fluticasone propionate was given in an oral daily dose of 20 mg. The primary end point was the investigator's overall assessment of response. Patient's assessment, sigmoidoscopic appearance, and histology were also studied. Patients improved more rapidly with prednisolone. Differences between the two groups were significant at two weeks. At four weeks differences were not significant, but there was a trend in favour of prednisolone. Corticosteroid side effects were minimal in the fluticasone propionate group, and there was minimal suppression of the hypothalamic pituitary adrenal axis. Fluticasone propionate 20 mg daily is not as effective in the treatment of active ulcerative colitis as prednisolone tapering from 40 mg daily to 10 or 20 mg. The complete absence of suppression of the corticoadrenal axis by fluticasone propionate was encouraging, however, and a higher dosage schedule should be assessed. more...
- Published
- 1993
19. Clinical tolerance to three 5-aminosalicylic acid releasing preparations in patients with inflammatory bowel disease intolerant or allergic to sulphasalazine
- Author
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C. D. Holdsworth, C. J. O'brien, and M. H. Giaffer
- Subjects
Male ,medicine.medical_specialty ,Allergy ,Aminosalicylic acid ,Gastroenterology ,Inflammatory bowel disease ,Drug Hypersensitivity ,chemistry.chemical_compound ,Mesalazine ,Sulfapyridine ,Oral administration ,Internal medicine ,Medicine ,Humans ,Pharmacology (medical) ,Mesalamine ,Olsalazine ,Hepatology ,business.industry ,Balsalazide ,medicine.disease ,Inflammatory Bowel Diseases ,Rash ,Phenylhydrazines ,Sulfasalazine ,Aminosalicylic Acids ,chemistry ,Immunology ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
The clinical tolerance to three 5-aminosalicylic acid (5-ASA) releasing preparations (mesalazine, olsalazine and balsalazide) was assessed in a consecutive series of 43 patients with inflammatory bowel disease who were intolerant to sulphasalazine. The relative contributions to the side-effects of sulphasalazine made by its two components, 5-ASA and sulphapyridine, were also assessed in these patients. Thirty-nine (91%) patients were able to tolerate at least one of the three 5-ASA preparations. Only four (9%) patients were intolerant to all preparations, having adverse reactions previously experienced with sulphasalazine and presumably related to 5-ASA rather than sulphapyridine. The clinical tolerance to mesalazine (63%), olsalazine (70%) and balsalazide (70%) was similar, and tolerance to one drug only was found in nine (18%) patients. The commonest adverse reactions associated with 5-ASA preparations were gastrointestinal. Diarrhoea was a problem in five patients during treatment with olsalazine and three each while on mesalazine and balsalazide. Allergic reactions from 5-ASA preparations were uncommon; of ten patients with rash following sulphasalazine only one developed a rash with mesalazine. The results of this study indicate that the vast majority of patients with inflammatory bowel disease can be managed with at least one of these four 5-ASA containing preparations and that the side-effects of sulphasalazine are multifactorial in aetiology, some being due to the parent molecule, and some to one of its two metabolites, 5-ASA and sulphapyridine. more...
- Published
- 1992
20. Effects on an Elemental Diet on the Faecal Flora in Patients with Crohn's Disease
- Author
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M. H. Giaffer, C. D. Holdsworth, and B. I. Duerden
- Subjects
medicine.medical_specialty ,Flora ,Crohn's disease ,biology ,Elemental diet ,digestive, oral, and skin physiology ,Therapeutic effect ,biology.organism_classification ,medicine.disease ,Gastroenterology ,digestive system diseases ,fluids and secretions ,Viable count ,Internal medicine ,medicine ,Bacteroides ,Anaerobic exercise ,Feces - Abstract
Alteration of faecal microbial flora has been suggested as a possible mechanism by which elemental diets exert their therapeutic effects in Crohn’s disease. Thirteen patients with active Crohn’s disease (mean CDAI 284 ± 34) were studied. Faecal samples were collected before and at weekly intervals after starting the elemental diet Vivonex for a period of 4 wk. The composition of the faecal microbial flora was assessed using a semi-quantitative method which has been calibrated against an established quantitative surface viable count technique. The only significant change in the faecal flora observed during the period of dietary treatment was a marked reduction in the scores of anaerobic lactobacilli (P ≤ 0.0001); these organisms disappeared from the stools of eight (62 per cent) patients. However, the change in lactobacilli scores was not related to changes in the clinical condition as assessed by the CDAI and established laboratory indicators of activity. The results of this study show that alteration of the faecal flora does not explain the therapeutic value of elemental diets in Crohn’s disease.Keywords: Crohn’s disease; Elemental diet; Faecal flora; Vivonex. more...
- Published
- 1991
- Full Text
- View/download PDF
21. The assessment of faecal flora in patients with inflammatory bowel disease by a simplified bacteriological technique
- Author
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M. H. Giaffer, C. D. Holdsworth, and B. I. Duerden
- Subjects
Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Microbiology ,Gastroenterology ,Inflammatory bowel disease ,Feces ,Crohn Disease ,Internal medicine ,Lactobacillus ,medicine ,Humans ,Colitis ,Bacteriological Techniques ,biology ,Bacteria ,business.industry ,General Medicine ,Middle Aged ,biology.organism_classification ,medicine.disease ,Isolation (microbiology) ,Inflammatory Bowel Diseases ,Ulcerative colitis ,digestive system diseases ,Diarrhea ,Colitis, Ulcerative ,Female ,Bacteroides ,medicine.symptom ,business - Abstract
A semi-quantitative bacteriological method was used to study faecal flora in 42 patients with Crohn's disease, 37 with ulcerative colitis and 21 healthy controls. Faecal homogenates were plated on primary isolation plates by a technique that allowed the growth of various microbial isolates to be assessed on a visual 1(+)-5+ score. This method was first calibrated against a standard quantitative bacteriological technique, which confirmed the reliability and reproducibility of the results obtained by the simpler method. Patients with clinically active Crohn's disease (22) had significantly higher total aerobe scores than patients with quiescent disease (20) (p less than or equal to 0.006) or ulcerative colitis (p less than or equal to 0.04) or normal controls (p less than or equal to 0.02). The scores of Escherichia coli were parallel to those of total aerobes. Lactobacillus and bifidobacteria scores were significantly reduced in patients with Crohn's disease compared to those with ulcerative colitis and controls. The anaerobic flora in both Crohn's disease and ulcerative colitis was indistinguishable from that of controls. Bacteroides vulgatus and B. fragilis were the predominant bacteroides in all groups. Patients with ulcerative colitis, regardless of disease activity, harboured faecal flora that did not differ from that of normal controls. The abnormal faecal flora in Crohn's disease did not correlate with established clinical and laboratory indicators of disease activity. more...
- Published
- 1991
22. Anaphylactoid reaction associated with the use of 99Tcm hexamethyl propylene amine oxime as a leukocyte labelling agent
- Author
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S Senior, C. D. Holdsworth, W. B. Tindale, and M. H. Giaffer
- Subjects
Adult ,Pathology ,medicine.medical_specialty ,Allergy ,Time Factors ,Granulocyte ,Pharmacology ,Inflammatory bowel disease ,chemistry.chemical_compound ,Technetium Tc 99m Exametazime ,Crohn Disease ,Labelling ,Oximes ,medicine ,Leukocytes ,Humans ,Radiology, Nuclear Medicine and imaging ,Radionuclide Imaging ,Anaphylaxis ,Crohn's disease ,business.industry ,General Medicine ,Organotechnetium Compounds ,medicine.disease ,Oxime ,medicine.anatomical_structure ,chemistry ,Toxicity ,Female ,business ,Technetium-99m - Abstract
99Tcm-HMPAO-labelled leukocyte bowel scanning is being increasingly used in the assessment of disease extent and activity in patients with inflammatory bowel disease, particularly Crohn's disease, when clinical and laboratory indices of activity can be unreliable. Initial experience with this compound has shown that it is safe. No reported adverse reactions have been associated with its use in white cell studies. This case report describes an anaphylactoid reaction related to the use of this new granulocyte labelling tracer. more...
- Published
- 1991
23. Long-term effects of elemental and exclusion diets for Crohn's disease
- Author
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P. A. Cann, C. D. Holdsworth, and M. H. Giaffer
- Subjects
Adult ,Male ,medicine.medical_specialty ,Normal diet ,Elemental diet ,Diet therapy ,Disease ,Gastroenterology ,Enteral administration ,Enteral Nutrition ,Crohn Disease ,Recurrence ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Food, Formulated ,Crohn's disease ,Hepatology ,business.industry ,medicine.disease ,Surgery ,Food intolerance ,Parenteral nutrition ,Female ,business - Abstract
Previous studies have confirmed the therapeutic value of elemental diets in promoting remission in active Crohn's disease, but their long-term benefit has not been established. Twenty-seven patients with established Crohn's disease who attained clinical remission after four weeks of enteral feeding were followed prospectively for up to 36 months. Twenty of these were willing to be tested for specific food intolerance using a pre-defined dietary elimination protocol; the others continued on a normal unrestricted diet. Eighteen patients (67%) have since relapsed; 89% of the relapse occurred within the first 6 months. Of the 15 patients with colonic involvement, 12 (80%) relapsed by 6 months. In contrast only 3 of 11 with isolated small bowel disease experienced early relapse. Of the 14 patients who completed the process of dietary testing, 5 could not identify any trigger foods; the remaining 9 were maintained on exclusion diets, 3 of whom relapsed early. Of the 11 taking a normal diet, 9 relapsed. Disease duration, previous intestinal resection or prior steroid therapy did not affect the relapse rate. Eight patients (31%) obtained a long-term remission, mean 23 months (range 12-36 months), without any medication. Long-lasting remissions can be obtained in about one-third of patients with Crohn's disease following treatment with a defined formula diet. Colonic involvement is associated with a high early relapse rate. more...
- Published
- 1991
24. Drug-induced oesophageal ulceration in a patient with acquired immunodeficiency syndrome
- Author
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M D Talbot, J. M. Craig, and M H Giaffer
- Subjects
Adult ,Male ,Drug ,Pathology ,medicine.medical_specialty ,media_common.quotation_subject ,medicine.medical_treatment ,Dermatology ,Esophageal Diseases ,Gastroenterology ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,Immunopathology ,medicine ,Humans ,Pharmacology (medical) ,Esophagus ,Ulcer ,media_common ,Antibacterial agent ,Acquired Immunodeficiency Syndrome ,Chemotherapy ,business.industry ,Esophageal disease ,Public Health, Environmental and Occupational Health ,medicine.disease ,Anti-Bacterial Agents ,Infectious Diseases ,medicine.anatomical_structure ,Doxycycline ,Viral disease ,business - Published
- 1996
- Full Text
- View/download PDF
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