A meta-analytic review of the implementation characteristics in parenting interventions to promote early child development

This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high-income (62%) and low-and-middle-income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community-based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta-analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low- and middle-income or high-income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale-up of effective interventions to improve child development.

Effects of armed conflict on maternal and infant health: a mixed-methods study of Armenia and the 2020 Nagorno-Karabakh war

INTRODUCTION

Armed conflict worldwide and across history has harmed the health of populations directly and indirectly, including generations beyond those immediately exposed to violence. The 2020 war between Armenia and Azerbaijan over Nagorno-Karabakh, inhabited by an ethnically Armenian population, provides an example of how conflict harmed health during COVID-19. We hypothesised that crises exposure would correspond to decreased healthcare utilisation rates and worse health outcomes for the maternal and infant population in Armenia, compounded during the pandemic.

METHODS

Following a mixed-methods approach, we used ecological data from 1980 to 2020 to evaluate health trends in conflict, measured as battle-related deaths (BRDs), COVID-19 cases, and maternal and infant health indicators during periods of conflict and peace in Armenia. We also interviewed 10 key informants about unmet needs, maternal health-seeking behaviours and priorities during the war, collecting recommendations to mitigate the effects of future crisis on maternal and infant health. We followed a deductive coding approach to analyse transcripts and harvest themes.

RESULTS

BRDs totalled more in the 2020 war compared with the previous Nagorno-Karabakh conflicts. Periods of active conflict between 1988-2020 were associated with increased rates of sick newborn mortality, neonatal mortality and pre-eclampsia or eclampsia. Weekly average COVID-19 cases increased sevenfold during the 2020 Nagorno-Karabakh war. Key informants expressed concerns about the effects of stress and grief on maternal health and pregnancy outcomes and recommended investing in healthcare system reform. Participants also stressed the synergistic effects of the war and COVID-19, noting healthcare capacity concerns and the importance of a strong primary care system.

CONCLUSIONS

Maternal and infant health measures showed adverse trends during the 2020 Nagorno-Karabakh war, potentially amplified by the concurrent COVID-19 pandemic. To mitigate effects of future crises on population health in Armenia, informants recommended investments in healthcare system reform focused on primary care and health promotion.

Risks to Child Development and School Readiness Among Children Under Six in Pakistan: Findings from a Nationally Representative Phone Survey

This paper analyzes the risks to child development and school readiness among children under age 6 in Pakistan. Drawing on a nationally representative telephone survey conducted in the midst of a global pandemic, between December 2021 and February 2022, we present the first nationally representative estimates of child development for children under 3 years of age and school readiness for children 3-6 years of age, using internationally validated instruments. The paper examines how risk factors that were exacerbated due to the COVID-19 pandemic, such as parental distress, lack of psychosocial stimulation, food insecurity, low maternal education, no enrollment in early childhood education, and living in a rural area, are associated with children's outcomes. The data indicate that more than half (57 percent) of parents with children under age 3 were distressed and that 61 percent of households reported cutting down on the size of or skipping meals since the start of the pandemic. The data reveal that over half of parents fail to engage in adequate psychosocial stimulation with their child and enrollment in early childhood education is very low (39 percent). The paper finds that child development outcomes decline rapidly as the number of risks increase. Specifically, for children under 3 years, lack of psychosocial stimulation at home and higher levels of parental distress were most significantly associated with lower child development levels. For a child aged 3-6 years, early childhood education enrollment and the amount of psychosocial stimulation the child received at home had the strongest association with school readiness scores.

Correction: Measurement tools and indicators for assessing nurturing care for early childhood development: A scoping review

[This corrects the article DOI: 10.1371/journal.pgph.0000373.].

Caregiver parenting practices, dietary diversity knowledge, and association with early childhood development outcomes among children aged 18-29 months in Zanzibar, Tanzania: a cross-sectional survey

Background

Many children in low- and middle-income countries fail to reach their cognitive potential, with experiences before age 3 critical in shaping long-term development. Zanzibar’s Jamii ni Afya program is the first national, digitally enabled community health volunteer (CHV) program promoting early childhood development (ECD) following the Nurturing Care Framework within an integrated maternal and child healthcare package. Using program baseline data, we explored home environment, caregivers’ parenting, health and nutrition knowledge and practices, and ECD outcomes in Zanzibar.

Methods

We conducted a national household survey among 499 children aged 18-29 months using two-stage cluster sampling in February 2019. The primary outcome was child development score measured using the Caregiver Reported Early Developmental Index (CREDI), with higher scores representing higher levels of child development. We analyzed CREDI scores, along with MICS questions on parenting knowledge, practices, and characteristics of the home environment. We developed multivariate regression models to assess associations between caregiver-child interactions, knowledge of dietary diversity, and ECD.

Results

Ten percent of children had overall CREDI z-scores 2 standard deviations [SD] or more below the global reference population mean, with 28% of children at risk of developmental delay with z-scores 1 SD or more below the mean. Cognitive and language domains were of highest concern (10.2 and 12.7% with z-score < − 2 SD). In 3-day recall, 75% of children engaged in ≥4 early stimulating activities with all caregivers averaging 3 total hours of play. CREDI scores were positively associated with greater frequency of caregivers’ engagement (β = 0.036, p = 0.002, 95%CI = [0.014, 0.058]), and dietary diversity knowledge (β = 0.564, p < 0.001, 95%CI = [0.281, 0.846]).

Conclusions

Our findings demonstrate a positive association between both the frequency of caregiver child interactions and knowledge of adequate dietary diversity, and ECD outcomes. This aligns with global evidence that promoting early stimulation, play and learning opportunities, and dietary diversity can improve developmental outcomes. Further study is needed to establish causal relationships and assess the impact of ECD programming in Zanzibar.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13009-y.

Practitioner Experiences Responding to Suicide Risk for Survivors of Human Trafficking in the Philippines

Human trafficking survivors experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. We conducted a focused ethnography exploring the experiences of non-mental health professionals working in the anti-human trafficking sector in the Philippines in responding to suicidality among survivors of human trafficking (n = 20). Themes included: emotional burden on service providers, manifestations of stigma regarding suicide, lack of clarity regarding risk assessment, lack of mental health services and support systems, transferring responsibility to other providers, and the need for training, supervision, and organizational systems. We discuss implications for training service providers in the anti-human trafficking sector, as well as cultural adaptation of suicide prevention interventions with human trafficking survivors in the Philippines.

Measurement tools and indicators for assessing nurturing care for early childhood development: A scoping review

Nurturing care encompasses five components that are crucial for supporting early childhood development: good health, adequate nutrition, opportunities for early learning, responsive caregiving, and safety and security. While there has been increasing attention in global public health towards designing and delivering programs, services, and policies to promote nurturing care, measurement has focused more on the components of health and nutrition, with less attention to early learning, responsive caregiving, and safety and security. We conducted a scoping review to identify articles that measured at least one nurturing care outcome in a sample of caregivers and/or children under-5 years of age in low- and middle-income countries (LMICs). We systematically searched five electronic bibliographic databases for peer-reviewed articles published from database inception until November 30, 2020. We first classified outcomes to their respective nurturing care component, and then applied an inductive approach to organize key constructs within each nurturing care component and the specific measures and indicators used across studies. We identified 239 total articles representing more than 50 LMICs for inclusion in the review. The majority of included studies reported a measure of nutrition (N = 166), early learning (N = 140), and health (N = 102), followed by responsive caregiving (N = 78) and lastly safety and security (N = 45). For each nurturing care component, we uncovered multiple constructs relevant to children under-5: nutrition (e.g., anthropometry, complementary feeding), early learning (e.g., stimulation practices, early childhood education), health (e.g., birth outcomes, morbidity), responsive caregiving (e.g., parental responsivity, parent-child interactions), and safety and security (e.g., discipline, inadequate supervision). Particularly for outcomes of early learning and responsive caregiving, there was greater variability with regards to the measures used, reported indicators, and analytic construction of variables than the other three nurturing care components. This study provides a comprehensive review of the current state of measurement of nurturing care. Additional research is needed in order to establish the most optimal measures and indicators for assessing nurturing care, especially for early learning and responsive caregiving.

[Treatment of Helicobacter pylori infections]

The treatment of Helicobacter pylori (H.p.) infection is based on the recommendations of the Maastricht consensus conference 1996. The main indications for eradication of H.p. are peptic ulcer disease, gastritis with severe histological abnormalities, low grade gastric MALT lymphoma and a history of resection for gastric cancer. The results of recent studies demonstrate that the symptoms of non-ulcer dyspepsia are not improved by H.p. eradication. A family history of gastric cancer and an earlier operation for peptic ulcer are considered advisable indications for the treatment of H.p. infection. Triple therapies consisting of a proton pump inhibitor (PPI) or ranitidine bismuth citrate plus 2 antibiotics are established as effective and well-tolerated first line regimens. The most important antibiotics are clarithromycin and amoxicillin. The efficacy of metronidazole is impaired by an increasing rate of resistant strains. Only few new antibiotics are currently tested in clinical trials. After the failure of a first anti-H.p. treatment it is advisable to change antibiotics according to the probability of resistance, to increase dosage and duration of treatment and to include bismuth compounds in the second line regimen. An alternative option after failed triple therapies may be a high dosage and prolonged dual regimen with a PPI and amoxicillin or quadruple therapy consisting of a PPI, bismuth subcitrate, tetracycline and metronidazole.

Famotidine versus omeprazole in combination with clarithromycin and metronidazole for eradication of Helicobacter pylori--a randomized, controlled trial

BACKGROUND

One-week low-dose triple therapy is currently considered the gold standard regimen for treatment of Helicobacter pylori infection. However, the mechanisms involved in the synergy between antibiotics and proton pump inhibitors are controversial.

AIMS

To test the hypothesis that acid suppression represents the crucial mechanism by which the antibacterial activity of antibiotics can be enhanced, and to assess the impact of primary resistance on treatment outcome.

METHODS

One hundred and twenty patients with H. pylori infection and duodenal ulcer, gastric ulcer or non-ulcer dyspepsia were randomly assigned to a 1 week course of either famotidine 80 mg b.d., clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. (FCM group; n = 60) or omeprazole 20 mg o.d., clarithromycin 250 mg b.d. and metronidazole 500 mg b.d. (OCM group; n = 60). Gastroscopy was performed at baseline and 5 weeks after completion of treatment. H. pylori status was assessed by biopsy urease test, histology and culture.

RESULTS

In the intention-to-treat analysis, eradication of H. pylori was achieved in 47 of 60 patients (78%; 95% CI: 66-88%) in the FCM group, compared to 44 of 60 patients (73%; 95% CI: 60-84%) in the OCM group (N.S.). Using per protocol analysis, eradication therapy was successful in 47 of 52 patients (90%; 95% CI: 79-97%) treated with FCM and 44 of 57 patients (77%; 95% CI: 64-87%) treated with OCM (N.S.). Primary metronidazole resistance was present in 27% and primary clarithromycin resistance in 8% of strains. Overall per protocol eradication rates in strains susceptible to both antibiotics and strains with isolated metronidazole resistance were 93% and 84%, respectively. No patient with clarithromycin resistance responded to treatment.

CONCLUSIONS

High-dose famotidine and omeprazole, combined with clarithromycin and metronidazole, are equally effective for eradication of H. pylori. In 1-week low-dose triple therapy, metronidazole resistance has no major impact on eradication rates whereas clarithromycin resistance is associated with a poor treatment outcome.

Effect of omeprazole and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the healing of duodenal ulcer: comparison with a historical control

BACKGROUND/AIMS

To test the hypothesis of equivalence of an omeprazole 7-day triple therapy without subsequent acid suppression and a historical ranitidine 12-day triple therapy (recruiting phase 1989-91) with subsequent acid suppression in their effect on the eradication of Helicobacter pylori (H. pylori) and the healing of duodenal ulcer.

METHODOLOGY

Seventy-seven patients with H. pylori-positive duodenal ulcers received a 7-day treatment with amoxicillin 750 mg tid and metronidazole 500 mg tid. Additional omeprazole 20 mg or 40 mg once daily was given to 39 and 38 of the patients, respectively. Endoscopy was performed before treatment and four weeks after cessation of therapy.

RESULTS

The cumulative intention-to-treat (ITT) H. pylori-eradication rate was 66% (51/77) as compared to 89% (46/52) for the historical control (p < 0.05). The corresponding ulcer healing rates were 90% (69/77) and 92% (48/52). Primary metronidazole resistance (PMR) had escalated from 10% to 27% within 6 years resulting in eradication rates of 84% for sensitive and 19% for resistant strains (p < 0.001). PMR could be demonstrated in 45% of all female, but only in 17% of the male patients (p < 0.05). In the patients with H. pylori eradication, the ulcers healed in 98% (50/51) as compared to 73% (19/26) in those with persistent infection (p < 0.005). Analysis based on the presence of PMR showed ulcer healing rates of 95% (53/56) for sensitive and 76% (16/21) for resistant strains (p < 0.05). Improvement of pain also showed a significant correlation with successful eradication. H. pylori-eradication, healing and symptom relief were similar in the omeprazole 20 mg and 40 mg groups.

CONCLUSIONS

The effect of amoxicillin plus metronidazole plus antisecretory agent on the eradication of H. pylori has decreased markedly during the past 6 years due to the escalation of PMR. Doubling of the omeprazole dose does not affect outcome. Cure of the infection as well as metronidazole susceptibility enhance duodenal ulcer healing and symptom relief. Acid suppression following a successful 1-week anti-HP therapy is not required for duodenal ulcer treatment.

Short-course therapy with amoxycillin-clarithromycin triple therapy for 10 days (ACT-10) eradicates Helicobacter pylori and heals duodenal ulcer. ACT-10 Study Group

BACKGROUND

Whilst the role of Helicobacter pylori eradication in managing duodenal ulcers has been established, consensus regarding the ideal regimen has not been achieved.

METHODS

Patients with H. pylori-positive active duodenal ulcer were randomly assigned to receive triple therapy with amoxycillin 1000 mg b.d. + clarithromycin 500 mg b.d. + omeprazole 20 mg daily for 10 days (ACT-10) or dual therapy with clarithromycin 500 mg t.d.s. + omeprazole 40 mg daily for 14 days (Dual). No additional acid suppression was provided following eradication therapy. Endoscopy, with biopsy for culture and histology, as well as 13C-urea breath testing (13C-UBT) were performed pre-treatment to assess H. pylori infection. H. pylori eradication was established at 4-6 weeks follow-up with culture (2 antral, 1 corpus biopsies), histology (2 antral biopsies), and 13C-UBT. Ulcer healing by endoscopy and change in clinical symptoms were also assessed at 4-6 weeks.

RESULTS

Two hundred and sixty-seven (267) patients were randomized to ACT-10 (n = 137) or Dual therapy (n = 130). By per-protocol and intention-to-treat analyses, H. pylori eradication at 4-6 weeks follow-up was 91% (115/127) and 88% (120/136), respectively, for ACT-10 patients and 59% (68/115) and 55% (72/130), respectively, for Dual therapy patients (P < 0.001 for both analyses). Ulcer healing was high in both treatment groups: ACT-10, 93% (118/127) and 90% (122/136), respectively; and Dual therapy, 91% (104/114) and 85% (111/130), respectively. Pre-treatment resistance to clarithromycin was low (4%, 8/214) as compared to metronidazole resistance which was over 40%. Emergence of resistance to clarithromycin was observed in 2% of patients receiving ACT-10 and in 25% of those receiving Dual therapy. ACT-10 and Dual therapy patients experienced similar rates of drug-related adverse events (33% vs. 32%, respectively) and discontinuation from therapy due to an adverse event (1.5% vs. 5%, respectively). More than 90% of patients were compliant with each prescribed medication.

CONCLUSION

In patients with active duodenal ulcer, a 10-day course of amoxycillin-clarithromycin-based triple therapy without additional acid suppression is highly effective in eradicating H. pylori and healing duodenal ulcer.

Comparison of two dosing regimens of cisapride in the treatment of reflux oesophagitis

AIM

In an international, multicentre, double-blind trial, to document the therapeutic equivalence of two dosing regimens of cisapride on endoscopic healing and symptom improvement in patients with proven reflux oesophagitis grade I or II (Savary-Miller).

METHODS

Four hundred and seven patients were randomly allocated to treatment with either cisapride 10 mg q.d.s. or cisapride 20 mg b.d. for 8-12 weeks depending on whether complete healing was found at endoscopy. The primary parameters of efficacy were cure of oesphagitis and improvement of the reflux symptom score.

RESULTS

The healing rates at endpoint were 73% in both treatment groups. The mean total reflux symptom score decreased from baseline to endpoint from 7.9-2.1 (cisapride 10 mg q.d.s) and 7.9-2.5 (cisapride 20 mg b.d.). Each of the two treatment regimens was well tolerated. The most frequently (6.9%) reported adverse event (diarrhoea) was mild or moderate in most cases and can be explained by pharmacological action of cisapride.

CONCLUSIONS

The results of the study demonstrate that cisapride 10 mg q.d.s. and 20 mg b.d. are equivalent in terms of efficacy and safety in the treatment of reflux oesophagitis.

Double-blind study of the effect of cisapride on constipation and abdominal discomfort as components of the irritable bowel syndrome

AIM

To study the effect of prokinetic treatment with cisapride in patients with constipation-predominant irritable bowel syndrome.

PATIENTS AND METHODS

Ninety-six patients were randomly assigned to treatment with either cisapride 5 mg three times daily or placebo three times daily for a period of 12 weeks. The dosage could be doubled after 4 weeks. Presence of the target symptoms abdominal pain, constipation and abdominal bloating was an obligatory criterion for inclusion in the study.

RESULTS

After 12 weeks of treatment, 31%, 56% and 27% of the cisapride treated patients were found to be without the three target symptoms (P < 0.05). The corresponding percentages for the placebo-treated patients were 31%, 58% and 19%, respectively, (P < 0.05). The visual analogue scale (VAS) symptom scores assessed by the patients for global rating of bowel disease, general well-being and frequency of stool passage improved significantly within each treatment group (P < 0.05). Evaluation of efficacy parameters using intention-to-treat analysis showed no statistically significant differences between the groups. Using efficacy analysis, the difficulty of stool passage showed a significantly higher improvement with cisapride (P < or = 0.05).

CONCLUSIONS

These results indicate that cisapride is not superior to placebo in the treatment of constipation and abdominal discomfort as components of irritable bowel syndrome. It may, however, be of use in improving the difficulty of stool passage.

Clarithromycin or amoxycillin plus high-dose ranitidine in the treatment of Helicobacter pylori-positive functional dyspepsia

OBJECTIVE

This study was intended to investigate the effect of ranitidine in dual anti-Helicobacter pylori therapy. Simultaneously, it was to evaluate the potential effect of H. pylori eradication on the symptomatology of H. pylori-positive dyspepsia.

PATIENTS AND METHODS

Fifty-four patients with H. pylori infection and symptoms of non-ulcer dyspepsia were randomly assigned to treatment with either amoxycillin 500 mg four times daily plus ranitidine 300 mg four times daily, clarithromycin 500 mg twice daily plus ranitidine 300 mg twice daily, clarithromycin 500 mg four times daily plus ranitidine 300 mg twice daily or clarithromycin 500 mg four times daily plus ranitidine 300 mg four times daily for a period of 12 days. In addition, ranitidine 150 mg twice daily was given for a further 16 days.

RESULTS

Eradication of H. pylori using the assigned treatments was achieved in 47% (seven out of 15), 50% (five out of 10), 70% (seven out of 10) and 77% (10 out of 13) of patients, respectively. Failure of therapy with clarithromycin was associated with primary or acquired resistance after treatment in 91% (10 out of 11). Symptom improvement was significant (P = 0.0001) and similar in all of the four treatment groups up to week 8. As regards H. pylori status, no differences in the mean symptom score improvement could be found between patients with eradication and those with persistent infection (12.3-7.0, P = 0.0001, n = 29 compared with 13.0-6.5, P = 0.004, n = 19). After 1 year the symptom score had increased both in patients with persistent H. pylori (9.1) and in those remaining free of infection (10.0). No reinfection could be found.

CONCLUSION

These results suggest that clarithromycin plus high-dose ranitidine is a combination which achieves reasonably high H. pylori eradication rates. However, treatment failure inevitably leads to clarithromycin resistance. The improvement of non-ulcer dyspepsia symptoms during acute therapy is independent of H. pylori eradication. Long-term benefit of H. pylori eradication with respect to the symptoms of functional dyspepsia was not observed.

Duodenal ulcer healing after 7-day treatment: a pilot study with lansoprazole, amoxicillin and clarithromycin

OBJECTIVE

To evaluate the efficacy and safety of a one-week triple therapy without bismuth and metronidazole in duodenal ulcer healing and symptom relief.

PATIENTS AND METHODS

Forty-five patients with duodenal ulcers and Helicobacter pylori (H. pylori) infections were given a 7-day treatment with lansoprazole 30 mg bid, amoxicillin 1.000 mg bid, and clarithromycin 500 mg bid. Endoscopies with urease tests and histologic examinations were performed before initiation and four weeks after cessation of therapy.

RESULTS

Using efficacy analysis, 41 of 42 duodenal ulcers (98%; 95% CI 0.87-1.00) were healed after one week of treatment. H. pylori was eradicated in 40 of 42 patients (95%; 95% CI 0.84-1.00). Two patients with healed ulcers showed a persistent infection, whereas H. pylori was eradicated in the one patient with persisting ulcer. Using intention-to-treat analysis, ulcer healing was achieved in 41 of 45 (91%; 95% CI 0.79-0.98) and H. pylori eradication in 40 of 45 patients (89%; 95% CI 0.76-0.96). After a mean of five days, 40 of 41 patients (98%; 95% CI 0.87-1.00) with ulcer healing became completely pain-free.

CONCLUSIONS

One-week therapy with lansoprazole, amoxicillin and clarithromycin is highly effective in duodenal ulcer healing and symptom improvement. Prolonged acid suppression does not seem to be essential for duodenal ulcer treatment.

Sucralfate effervescent tablet: treatment of peptic ulcer disease and change in serum aluminium concentration

In a single-centre randomised clinical trial, a new effervescent formulation of sucralfate was compared with the granular formulation of the drug in the treatment of peptic ulcer. The effervescent tablet had not been previously administered to human subjects. Fifty patients with endoscopically verified duodenal (40) and gastric (10) ulcers were treated with 2.0 g sucralfate twice daily, given either as a granular formulation or effervescent tablet. Control endoscopies were performed at weeks 4 and 8 and again at week 12 if gastric ulcers had not healed earlier. The healing rates in the effervescent tablet group were 71% (15/21) and 86% (18/21) after 4 and 8 weeks. In this group one gastric ulcer had to be treated for a further 4 weeks and had not healed at week 12. The corresponding rates in the sucralfate granulate group were 95% (18/19) after 4 and 8 weeks. Serum aluminium concentrations were measured simultaneously before and after treatment. The aluminium concentration almost doubled in both treatment groups during dosing with sucralfate. This effect has not been described previously in the course of therapy with sucralfate in patients with peptic ulcer disease and should be borne in mind when considering treatment with this drug.

Helicobacter pylori reinfection with identical organisms: transmission by the patients' spouses

Reinfection with Helicobacter pylori after eradication is responsible for the recurrence of duodenal ulcer disease. The mode of transmission has not yet been established. In this study, 18 patients with chronic duodenal ulcers in whom H pylori had been eradicated with amoxicillin and metronidazole were entered into a prospective follow up study. Control endoscopies were performed 4, 8, 14, 27, and 43 months after starting treatment and the results of direct tests were compared with the kinetics of H pylori specific IgG titres. After eradication there was a noticeable and consistent fall in anti-H pylori IgG, while reinfections were characterised by a significant increase in specific titres. Reinfection was detected in two patients after 14 and 43 months, respectively. The H pylori strains responsible for these reinfections, the corresponding pretreatment isolates, and the strains isolated from the spouses of these patients were examined by polymerase chain reaction based DNA fingerprinting. Analysis showed that reinfection had been caused by the same H pylori strain and identified the spouses of these patients as carriers of the identical strain. Considering the genomic diversity and the interpatient heterogeneity of H pylori these results suggest a person to person transmission of H pylori reinfection. By the end of the observation period reflux oesophagitis had developed in 10 of the 16 patients who had not been reinfected. This surprising finding may be explained by the changed eating habits of patients after healing of duodenal ulcer disease.

Double-blind dose-finding study of olsalazine versus sulphasalazine as maintenance therapy for ulcerative colitis

OBJECTIVE

To determine the therapeutic efficacy and safety of three doses of olsalazine compared with the standard dose of sulphasalazine.

DESIGN

Randomized double-blind multicentre 6-month study comparing three doses of olsalazine (0.5, 1.25 and 2.0 g daily) and sulphasalazine 2.0 g daily for maintaining remission in patients with ulcerative colitis.

SETTING

Public hospitals and private practices in Germany, Austria and Switzerland.

PATIENTS

A total of 162 patients with ulcerative colitis in remission.

RESULTS

According to intention-to-treat analysis, the failure rates of the different treatment groups were not significantly different (36, 49 and 24% for 0.5, 1.25 and 2.0 g olsalazine daily and 32% for 2.0 g sulphasalazine daily). Olsalazine and sulphasalazine showed a tendency towards lower failure rates in extended (28%) than in distal disease (44%). The withdrawal rate due to adverse effects was 4%, the most frequent single event being diarrhoea (2.5, 5.2 and 11.7% for 0.5, 1.25 and 2.0 g olsalazine daily and 0% for sulphasalazine daily).

CONCLUSION

This study found no significant differences between the therapeutic efficacy or safety of 0.5-2.0 g olsalazine daily. Because of its sulpha-free formulation olsalazine may, however, be preferred to sulphasalazine.

Kinetics of specific IgG antibodies for monitoring the effect of anti-Helicobacter pylori chemotherapy

A total of 104 patients with recurrent duodenal ulcer were treated with either ranitidine plus amoxicillin plus metronidazole or ranitidine plus placebo. To study the effect of the eradication of Helicobacter pylori on the systemic immune response in an IgG ELISA, sera were drawn from all patients before the onset of therapy and at 6, 16 +/- 2, 32 +/- 2, and 60 +/- 2 weeks after therapy. In patients with eradication of the organism, a significant (P < .001) reduction of the specific IgG titer occurred. This was not observed in patients without bacterial eradication. If a titer reduction of > 50% was taken as an indicator for eradication of H. pylori, the sensitivity of the serologic test was 97.6%-99.7%. Its specificity increased with the interval to the onset of chemotherapy from 56.3% to 97.6%. Serologic tests are simple to perform and cause very little discomfort to the patient.

The effect of Paxillus involutus Fr. on aluminum sensitivity of Norway spruce seedlings

Non-mycorrhizal Norway spruce seedlings (Picea abies Karst.) and Norway spruce seedlings colonized with Paxillus involutus Fr. were grown in an axenic silica sand culture system. After successful mycorrhizal colonization, the seedlings were exposed to 200 or 800 micro M AlCl(3) for 10 weeks. In both non-mycorrhizal and mycorrhizal seedlings, exposure to Al significantly reduced root growth and the uptake of Mg and Ca. After 5 weeks of exposure to 800 micro M Al, the mycorrhizal seedlings had significantly higher chlorophyll concentrations than the non-mycorrhizal seedlings, although no difference in Mg nutrition was apparent. After 10 weeks of exposure to Al, both non-mycorrhizal and mycorrhizal seedlings exhibited needle chlorosis and reduced photosynthetic activity. However, the aluminum-induced reduction in shoot growth was largely ameliorated by colonization with P. involutus. We conclude that mycorrhizal colonization modifies the phytotoxic effects of Al in Norway spruce seedlings. However, differences in physiological responses to Al between mycorrhizal and non-mycorrhizal seedlings may be largely reduced in the long term as a result of impaired mineral nutrient uptake.

Effect of cisapride on relapse of esophagitis. A multinational, placebo-controlled trial in patients healed with an antisecretory drug. The Italian Eurocis Trialists

The effect of a prokinetic agent, cisapride, on the relapse of reflux esophagitis was investigated in a randomized, double-blind trial conducted in 443 patients whose esophagitis had previously been healed with an acid antisecretory drug. Patients received cisapride, 20 mg at night, cisapride 10 mg twice daily, or placebo for 12 months or until endoscopic relapse was confirmed endoscopically. In 88% of all patients (respectively 133, 132, and 124), endoscopic data were available at discontinuation of treatment. In comparison with placebo, the two cisapride regimens prolonged both the time to endoscopically confirmed relapse (Kaplan-Meier analysis; P = 0.001) and the time to symptomatic relapse (P = 0.012). The life-table endoscopic relapse rates at 12 months were 51% for placebo, 32% for cisapride 20 mg at night (P = 0.005), and 34% for cisapride 10 mg twice daily (P = 0.02). Patients with more severe esophagitis before healing relapsed more rapidly during maintenance therapy, regardless of the treatment regimen. Adverse events were infrequent in all three groups. These findings indicate that maintenance treatment with the prokinetic drug cisapride prevents the relapse of esophagitis after it has been healed by acid antisecretory therapy.

Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer

BACKGROUND

Persistent infection with Helicobacter pylori is associated with the recurrence of duodenal ulcer. Whether the efficacy of bismuth therapy in reducing the rate of recurrence of duodenal ulcer is due to its antimicrobial effects on H. pylori or to a direct protective action on the mucosa is still a matter of debate.

METHODS

To study the effect of the eradication of H. pylori on the recurrence of duodenal ulcer, we treated 104 patients with H. pylori infection and recurrent duodenal ulcer with either amoxicillin (750 mg three times daily) plus metronidazole (500 mg three times daily) or identical-appearing placebos, given orally for 12 days. All patients also received ranitidine (300 mg each night) for 6 or 10 weeks. Endoscopy was performed before treatment and periodically during follow-up for up to 12 months after healing.

RESULTS

Among the 52 patients given antibiotics, H. pylori was eradicated in 46, as compared with 1 of the 52 given placebo (89 percent vs. 2 percent, P < 0.001). After six weeks, the ulcers were healed in 48 patients given antibiotics and 39 given placebo (92 percent vs. 75 percent, P = 0.011). Side effects, mainly diarrhea, occurred in 15 percent of the patients given antibiotics. Among the patients followed up for 12 months, duodenal ulcers recurred in 4 of 50 patients given antibiotics and 42 of 49 given placebo (8 percent vs. 86 percent, P < 0.001). Ulcers recurred in 1 of 46 patients in whom H. pylori had been eradicated, as compared with 45 of 53 in whom H. pylori persisted (2 percent vs. 85 percent, P < 0.001).

CONCLUSIONS

In patients with recurrent duodenal ulcer, eradication of H. pylori by a regimen that does not have any direct action on the mucosa is followed by a marked reduction in the rate of recurrence, suggesting a causal role for H. pylori in recurrent duodenal ulcer.

Treatment of patients with advanced colorectal cancer with cisplatin, 5-fluorouracil, and leucovorin

Based on in vitro studies that have demonstrated synergy between 5-fluorouracil (5-FU), leucovorin (LV), and cisplatin (CDDP) against human colon cancer cell lines, a clinical trial was initiated to determine the effects of this combination in patients with advanced unresectable colorectal carcinoma. Fifty-nine patients were enrolled in the study and 12 of them had received prior conventional 5-FU chemotherapy. Treatment consisted of 4 weekly courses of high-dose LV (200 mg/m2) administered by intravenous (IV) bolus, followed by 5-FU (550 mg/m2) and CDDP (20 mg/m2) each administered as a 2-hour infusion on 4 consecutive days. After a median of 5.5 treatment cycles, objective tumor response was seen in 20 of 59 patients (34%) (this included 3 complete remissions). The response rate in the 47 previously untreated patients was 38% (95% confidence limits, 26% to 53%). Stable disease occurred in 16 (27%) patients, whereas the tumor progressed in 23 (39%) patients. The median survival time was 11.5 months, with 15% of the patients alive at 2 years. The regimen was well tolerated and the primary side effects were mild and reversible gastrointestinal symptoms and myelosuppression. There was no episode of life-threatening toxicity. Eastern Cooperative Oncology Group (ECOG) Grade III adverse reactions that required 25% dose reductions occurred in only 14% of the patients. The results of this trial suggest that 5-FU, LV, and CDDP is an active, safe, and well-tolerated combination regimen in patients with advanced colorectal cancer.

A comparison of two doses of nizatidine versus placebo in the treatment of reflux oesophagitis

Three-hundred and twenty-five patients with endoscopically verified oesophagitis entered a double-blind, randomized multicentre study that compared 300 mg nizatidine b.d., 300 mg nocte and placebo. The 6- and 12-week treatment responses were studied. Healing was defined as complete epithelialization of all oesophageal lesions. The healing rates were 40% in the 300 mg nizatidine b.d. group, 30% in the 300 mg nocte group and 26% in the placebo group at 6 weeks. The corresponding figures after 12 weeks of treatment were 50%, 44% and 34%, respectively. The healing rates were significantly different (P less than 0.05) between the high-dose nizatidine group and placebo only, both at 6 and 12 weeks. Despite a trend at both 6 and 12 weeks in favour of 300 mg nizatidine nocte compared to placebo, this was not significantly different. The most important factor for the outcome, apart from the treatment group, was the pre-entry severity of oesophagitis. The differences observed between treatment groups in healing rates, symptomatic relief, and antacid consumption appear to result mainly from the patients with moderate and severe oesophagitis upon entry. Nizatidine (300 mg) b.d. appeared to be safe and effective in the treatment of reflux oesophagitis.

Diagnosis and tactical approach to surgery for early gastric carcinoma: a retrospective analysis of the past 16 years in an Austrian general hospital

In principle, many authors advocate a radical surgical approach for early gastric cancer (gastrectomy on principle). Our own experience with subtotal gastrectomy (including N1 + N2 lymphadenectomy; limited resection even without groups 11, 12) shows that this method yields comparable results. With an operative mortality of 2%, the survival rate was 84.3% after 5 years and 70.5% after 10 years, instead of the predicted values of 82.8% and 63.4%, respectively. Applied to the same age group without gastric carcinoma, this yields a 5-year survival rate of 101.8% and thus almost reaches Japanese standards.

Rioprostil in the short-term treatment of duodenal ulcer: a multicentre double-blind trial vs. cimetidine

The efficacy and safety of the new prostaglandin E1 (PGE1) synthetic analogue, rioprostil, 300 micrograms b.d. and cimetidine, 400 mg b.d., on duodenal ulcer healing are compared in an international, multicentre, double-blind study. A total of 257 patients have entered the study; 243 are considered eligible for efficacy analysis and 207 for safety analysis. After 4 and 6 weeks of treatment, the endoscopic healing rates do not significantly differ between the two groups, being 55% and 83% respectively with rioprostil vs. 60% and 78% respectively with cimetidine. The major adverse effect attributable to rioprostil is diarrhoea, which was documented in 11% of patients compared with 1% of patients taking cimetidine. However, central nervous system complaints are twice as frequent in the cimetidine group. Monitoring of clinical laboratory tests show no significant abnormalities when compared with the baseline values during the administration of either drug. This study documents that rioprostil, at the dosage of 300 micrograms b.d., is as effective and safe as cimetidine in the short-term therapy of duodenal ulcer.

Physiological and psychological response to a three-month mental strain period in students

Biochemical and immunological parameters, physical and mental performance, subjective complaints and behavioural characteristics were compared before and after 14 final examinations undertaken by 64 students during a three-month examination period. A decrease in cholesterol, triglycerides, HDL-cholesterol, physical performance and an increase in LDL/HDL cholesterol quotient, lactate level, mental performance were accompanied by a lower frequency of mental complaints and higher frequency of physical complaints. From the multidimensional variance and discriminant analysis 17 of the 44 variables discriminated between the state prior to and after the examination period. The results are interpreted in terms of the psychophysiological adaptation to adequate mental stress.

Combined therapy with cisapride and cimetidine in severe reflux oesophagitis: a double blind controlled trial

Combined treatment with cimetidine 1 g daily and cisapride 40 mg daily in patients with endoscopically diagnosed severe reflux oesophagitis was compared with single drug therapy (cimetidine and placebo). At the end of the six to 12 weeks treatment, 11 (46%) of the 24 patients under single drug therapy were endoscopically healed and three were improved. In contrast, 16 (70%) of the 23 patients under combined therapy were healed and all of the remainder were improved (p = 0.025). The severity of diurnal and nocturnal heartburn, decreased significantly more (p less than 0.05) on cimetidine + cisapride than on cimetidine + placebo. The combined treatment was well tolerated. These results suggest that combined therapy with cisapride and cimetidine may be useful in patients with severe reflux oesophagitis.

The efficacy of antimicrobial treatment in Campylobacter pylori-associated gastritis and duodenal ulcer

The efficacy of various antimicrobial and anti-ulcer agents on the elimination of Campylobacter pylori in duodenal ulcer patients was investigated. Ranitidine, cimetidine, pirenzepine, aluminium phosphate gel as well as combinations of H2-receptor antagonists or pirenzepine + penicillin V, ciprofloxacin, ofloxacin, phenyl-mercuryborate or rifampicin had no influence on C. pylori in vivo. Short term elimination of C. pylori was achieved in 3/15 patients treated with ranitidine + bacampicillin and in 1/5 treated with cimetidine + metronidazole. This elimination was accompanied by a significant reduction of polymorphonuclear infiltration of the antral mucosa. Development of bacterial resistance was observed in patients with additional quinolones, metronidazole and rifampicin but not in patients treated with betalactam antibiotics.

A comparison of roxatidine acetate 150 mg once daily and 75 mg twice daily in duodenal ulcer healing

A randomised multicentre, double-blind study of the efficacy and safety of roxatidine acetate 150 mg at bedtime or 75 mg twice a day was conducted in 300 outpatients with endoscopically confirmed duodenal ulcers. After 14 days' treatment with roxatidine acetate substantial reductions in ulcer sizes had been obtained, in addition to healing rates of 87 to 89%, with no significant differences between the dosage regimens. There were graded reductions in day and night-time assessment of epigastric pain for both treatment groups and no differences in the mean numbers of antacid tablets consumed. In addition, cigarette smoking did not influence the healing rates produced by either treatment schedule. 11 patients reported 12 mild adverse reactions, with gastrointestinal symptoms the most frequent, and no clinically significant alterations in laboratory values. The present data suggests that a single bedtime dose of roxatidine acetate 150 mg produces effective duodenal ulcer healing and pain relief equivalent to that produced by a twice daily dosage regimen.

[Treatment of duodenal ulcer with famotidine]

In a prospective double blind study the efficacy and safety of the new H2-receptor antagonist famotidine was compared with ranitidine. 48 patients with endoscopically proven duodenal ulcer were randomly allocated to receive famotidine 40 mg once at night, 20 mg bid, 40 mg bid or ranitidine 150 mg bid. After 4 weeks of treatment the ulcers of 7/12, 10/12, 9/12 and 6/12 patients were healed; the corresponding rates after 8 weeks were 9/12, 12/12, 11/12 and 10/12. Statistically there was no significant difference between the various groups. Adverse events of any clinical importance were not observed. These data indicate, that famotidine is as effective and as safe as ranitidine for the treatment of acute duodenal ulcer.

[Campylobacter pylori, gastritis and peptic ulcer]

In the course of routine gastroduodenoscopic examination of 218 patients bioptic mucosal specimens were examined bacteriologically for the presence of Campylobacter (C.) pylori. The organism was isolated from 52 out of 53 patients (98%) with duodenal ulcer, 7 out of 9 with gastric ulcer (78%), 24 out of 31 with mucosal erosions (77%), 10 out of 10 with duodenitis (100%), 16 out of 16 with chronic active gastritis (100%) and from 40 out of 73 patients (55%) with inactive chronic gastritis. By contrast, all specimens from 26 patients with endoscopically and histologically normal mucosa were negative for this bacterium. The rate of elimination of C. pylori from mucosal specimens was investigated as a first step towards studying the influence of antibiotic therapy upon healing of gastric and duodenal ulcers. For this purpose 30 patients with duodenal ulcers were treated either with ranitidine alone (15) or together with bacampicillin (15), which was shown to be highly active in studies with ampicillin in vitro. After 4 weeks the organism was still found in specimens from all patients treated with ranitidine alone, but also in 12 out of 15 patients given combined therapy. This result demonstrates that systemic antimicrobial chemotherapy with bacampicillin is insufficient to eradicate C. pylori from the stomach and the duodenum.

Effects of low and high dose oral cimetidine on hormone serum levels in patients with peptic ulcers

Luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (hPRL) and testosterone (T) were assayed in a total of 131 patients with peptic ulcer. Initial oral treatment was performed with 1000 mg cimetidine per day for 6 to 12 weeks. After healing was confirmed endoscopically, the patients were switched to a maintenance dose of 400 mg per day cimetidine for 3 years. Serum hormone levels before and during the two regimens were estimated in 48 male, 22 postmenopausal and 5 premenopausal subjects. Comparison between the two cimetidine doses was possible in 76 male, 44 postmenopausal and 6 premenopausal patients. In all patients hormone parameters assayed before therapy were within the normal ranges. FSH was noted to increase significantly in all but the premenopausal group but remained within the normal range. In contrast, hPRL declined significantly in all groups of subjects except for premenopausal females during cimetidine treatment. LH and T did not change during treatment and no differences of hormone serum levels were noted between the two regimens. Present data combine to suggest that an initial treatment with 1000 mg of cimetidine per day did not provoke hyperprolactinemia, and a switch from an initial high dose to a maintenance dose of 400 mg per day did not cause further changes in hormone serum levels. Changes of LH, FSH, hPRL and T recorded in the present study are too small to be considered responsible for possible endocrine disorders observed during cimetidine therapy.

[3-year long-term therapy of recurrent duodenal ulcer with 400 mg cimetidine nocte]

253 patients were treated for 3 years with 400 mg cimetidine at night to prevent relapses of recently healed duodenal ulcers. The efficacy of maintenance treatment was evaluated on a life table basis. In contrast to previous studies not the first but the third symptomatic relapse was taken as the major criterium of treatment failure, an assumption, that better represents the everyday practical situation. Further endpoints for the life table calculation were: the wish of the patient to stop treatment after the first or second recurrence, the failure of a first or second recurrence to heal within 12 weeks and side effects. At 1, 2 and 3 years 5 +/- 2.4%, 16 +/- 4.6% and 20 +/- 5.2% respectively had to be considered as treatment failures. 4 patients presented with a bleeding relapse, none of which necessitated emergency operation. There were no irreversible side effects. This study demonstrates that treatment of recurrent duodenal ulcers with 400 mg cimetidine at night for 3 years is safe and improves considerably the quality of life of the majority of patients. The authors suggest that drug maintenance treatment should be offered before surgery is recommended.

Maintenance treatment with cimetidine in peptic ulcer disease for up to 4 years

A multinational maintenance trial was conducted in 1842 peptic ulcer patients to investigate the efficacy and safety of continuous cimetidine maintenance therapy for up to 4 years. Patients with healed ulcers entered maintenance treatment with a 400-mg bedtime dose of cimetidine. Symptomatic ulcer relapse occurred in 17.2% of patients during the 1st year of treatment, in 9.6% during the 2nd year, and in 8.8% during the 3rd year. In addition to life-table analysis, the monthly prevalence of active ulceration over the 3-year period was examined. The average monthly prevalence rates were 2.1%, 1.8%, and 1.5% for the three successive yearly periods of continued cimetidine treatment. The adverse reactions observed in this study were not different from those previously reported with cimetidine. Moreover, there was a progressive decrease in the incidence of adverse events over the 4 years, thus establishing the long-term safety of continuous cimetidine treatment. It is concluded from this study that cimetidine maintenance treatment not only continues to be effective and safe beyond 1 year but also may reduce the risk of relapse over time.

Famotidine: proven once-a-day treatment for gastric ulcer

An 8-week, double-blind, randomized, placebo-controlled, multinational (n = 14), multicenter (n = 44) trial was conducted to determine whether famotidine speeds healing and relief of symptoms in patients with benign gastric ulcer. Of the 336 patients who entered the trial, 167 received 40 mg of famotidine in the evening, and 169 received placebo. At 4, 6, and 8 weeks after entry, ulcers had healed in a significantly (P less than 0.01) higher percentage of famotidine-treated patients than in those treated with placebo (47%, 65%, 80% versus 31%, 46%, 54%, respectively). Famotidine was also superior to placebo in relieving ulcer symptoms; the proportion of patients receiving additional antacid therapy was significantly lower in the famotidine group. The findings show that the new H2-receptor antagonist famotidine, administered as a single evening dose, significantly speeds the healing of benign gastric ulcers and that it is a safe and highly effective treatment of gastric ulceration. The convenient dosage regimen of famotidine (one tablet in the evening) should improve patient compliance, which, in turn, may result in faster healing of ulcers and a lower incidence of ulcer complications.

Nizatidine versus ranitidine in the prevention of duodenal ulcer relapse. Six-month interim results of a European multicentre study

Nizatidine, a new H2-receptor antagonist, was compared with ranitidine in a double-blind, randomized, multicentre trial for the prevention of duodenal ulcer relapse. This is the interim analysis of 197 patients admitted to the study by 1 September 1985, having finished a 6-month treatment period by 1 March 1986. At night, 96 and 101 patients received 150 mg nizatidine and 150 mg ranitidine, respectively. Both groups were well matched for demographic data, duration and severity of ulcer disease. Calculating cumulative relapse rates by the life-table method of Cutler and Ederer, 18% on nizatidine and 13% on ranitidine had experienced a symptomatic or asymptomatic recurrence. The difference is not statistically significant. The symptomatic response was identical in both groups, 3/4 of the patients in both groups being free of any symptom over all 6 months. During maintenance treatment, 24% of the patients on nizatidine and 32% of those on ranitidine reported new symptoms, listed as 'adverse events'. However, none of these events was likely to be drug related. There was no difference between the two groups concerning the percentage change of laboratory variables from baseline to endpoint.

300 mg nizatidine at night versus 300 mg ranitidine at night in patients with duodenal ulcer. A multicentre trial in Europe

Patients (859) from six countries were randomized into an endoscopically controlled double-blind trial. The objective of this study was to compare the efficacy and safety of nizatidine 300 mg nocte with ranitidine 300 mg nocte in the therapy of duodenal ulceration. Patients fulfilling the entry criteria and completing the protocol numbered 777 (388 nizatidine, 389 ranitidine). Endoscopy was performed on entry and at 4-week intervals (up to 8 weeks) until the ulcer healed, except in Germany where endoscopy was also performed after 14 days. Both groups appeared well matched for population demographics, duodenal ulcer history, previous therapy and pre-study symptomatology. Overall healing rates in the nizatidine group compared favourably with the ranitidine group at 4 weeks (nizatidine 81%, ranitidine 80%) and 8 weeks (nizatidine 92%, ranitidine 93%). Data from Germany alone showed similar ulcer healing rates after 2 weeks therapy (nizatidine 60%, ranitidine 64%). Although there were no differences between or within the treatment groups, overall ulcer healing was significantly impaired (p less than 0.05 or less) in patients with a large ulcer (greater than 15 mm), a family history of peptic ulcer disease, verified disease or greater than 5 years duration, or heavy smokers (greater than 20 cigarettes/day). Age did not influence healing. Overall healing rates were significantly influenced by country of patient origin, being higher in Germany, and lower in Belgium (p less than 0.001). After 2 weeks therapy, about 60% of the nizatidine and ranitidine treated patients were pain free, while 4 weeks therapy was associated with relief of all symptoms in 72% of patients and relief of night pain in more than 90%. Antacid consumption reduced at a similar rapid rate during the study. Events were reported equally in both treatment groups, events compatible with peptic ulcer disease predominating. Events associated with study termination appeared related to documented disease or protocol violations. Monitoring of laboratory data suggested no significant haematological or biochemical abnormalities in the nizatidine group. Nizatidine 300 mg nocte appears to be as effective as ranitidine 300 mg nocte in both ulcer healing and symptomatic response.

[Therapy of duodenal ulcer and pyloric ulcer with 800 mg cimetidine nightly]

The efficacy of cimetidine 400 mg b.i.d. as compared with a single evening dose 800 mg was evaluated in a single-blind multicentre trial involving 86 patients with endoscopically proven duodenal or pyloric ulcer. After four weeks of treatment the healing rates were 64.4% (29/45) with 400 mg cimetidine twice daily and 78% (32/41) with 800 mg nocte; after eight weeks the corresponding rates were 77.7% (35/45) and 85.3% (35/41). Administration of 800 mg cimetidine every evening is, consequently, at least as effective as a twice-daily regimen. In the second half of the treatment period it was significantly more effective in reducing pain and antacid consumption. The single noctural dose takes the pathogenetic importance of overnight gastric acidity into consideration, entails a simplification of therapy and may improve patient compliance. It should, therefore, take preference over the conventional twice-daily regimen.

[Parameters of acral vasomotor activity--sensory arousal variables in psychological stress]

By means of complex methods in 65 test persons from a large number of parameters the photopulse amplitude and the rheographic quotient at the finger apart from the heart rate and the blood pressure were established as very sensitive demand variables under psychic stress. The temporary and formal criteria of the volume pulse curves are less well suitable for this purpose. In the different reaction patterns the inclusion of sensitive biosignals of the acral vasomotricity is an information gain for the demand diagnostics under psychic stress.

[Famotidine versus placebo in prevention of the recurrence of duodenal ulcer disease. A multicenter study in Germany, Austria and Italy]

The aim of this study was to gain experience concerning efficacy and safety of famotidine, the new H2-receptor antagonist, for the maintenance of duodenal ulcer disease. 344 patients whose acute duodenal ulceration had recently been healed under famotidine or ranitidine were recruited for a year maintenance treatment with 20 mg bedtime dose of famotidine or placebo. 167 patients were treated with famotidine over 6 and 52 over 12 months. The corresponding numbers in the placebo control were 177 and 21. A life table method of analyses showed that the ulcer relapse rate was consistently and significantly (p less than 0.01) lower on famotidine than on placebo after 6 months (26% [43/167] versus 55% [98/177]). Of the 52 patients treated with 20 mg famotidine at night for further 6 months 7 (14%) developed an ulcer relapse. Of the 21 patients treated for further 6 months with placebo 5 (24%) showed an acute ulcer crater at endoscopy. Famotidine was well tolerated in the longterm therapy. The results confirm the efficacy and safety of famotidine in the prevention of duodenal ulcer relapse for at least 6 months.