The gastrointestinal tract in uremia

Gastrointestinal mucosal abnormalities ranging from edema to ulceration occur in two thirds of patients dying of uremia. Early studies suggested that uremic patients on maintenance dialysis treatment were at increased risk of peptic ulceration but more recent data indicate that this is not so. Other gastrointestinal problems reported for uremic subjects on maintenance dialysis treatment include bleeding from telangiectatic lesions, constipation, mucosal deposition of amyloid and acute pancreatitis. Nausea and vomiting are common in the uremic patient but gastric emptying studies have yielded conflicting results. Patients undergoing renal transplantation are at increased risk of development of esophagitis, complicated peptic ulcer, intestinal ulceration, and perforation as well as acute pancreatitis.     

Effectiveness of acupuncture for Parkinson's disease: A systematic review

The objective of this review is to assess the clinical evidence for or against acupuncture as a treatment for Parkinson's disease (PD). We searched the literature using 17 databases from their inception to September 2007 (searched again 3rd January 2008), without language restrictions. We included all randomized clinical trials (RCTs) regardless of their design. Methodological quality was assessed using the Jadad score. Eleven RCTs met all inclusion criteria. Three RCTs assessed the effectiveness of acupuncture on Unified Parkinson's Disease Rating Scale (UPDRS) compared with placebo acupuncture. A meta‐analysis of these studies showed no significant effect (n = 96, WMD, 5.7; 95% CI ?2.8 to 14.2, P = 0.19, heterogeneity: tau² = 0, χ² = 0.97, P = 0.62, I² = 0%). Another six RCTs compared acupuncture plus conventional drugs on improvement of symptoms of PD with drugs only. A meta‐analysis of two of these studies suggested a positive effect of scalp acupuncture (n = 106, RR, 1.46, 95% CI = 1.15 to 1.87, P = 0.002; heterogeneity: tau² = 0.00, χ² = 1.14, P = 0.29, I² = 12%). Two further RCTs tested acupuncture versus no treatment. The meta‐analysis of these studies also suggested beneficial effects of acupuncture. The results of the latter two types of RCTs fail to adequately control for nonspecific effects. In conclusion, the evidence for the effectiveness of acupuncture for treating PD is not convincing. The number and quality of trials as well as their total sample size are too low to draw any firm conclusion. Further rigorous trials are warranted. © 2008 Movement Disorder Society     

Metiamide in the Zollinger-Ellison syndrome

The histamine H₂-receptor antagonist metiamide is an inhibitor of endogenous and stimulated gastric-acid secretion. It appears to have therapeutic possibilities in duodenal-ulcer disease. Three patients exhibiting the Zollinger-Ellison syndrome have been treated with this drug for six months or more. Rapid symptomatic improvement occurred in each case, followed by ulcer healing. There were also reductions in gastric secretion and consistent changes in the fasting serum-gastrin concentration. One patient relapsed temporarily during therapy. There have been no side effects. It is concluded that, in the short term, metiamide is of benefit in the Zollinger-Ellison syndrome.     

Helicobacter pylori and gastric acid output in peptic ulcer disease

Helicobacter pylori is associated with peptic ulcer, and a causal relationship has been postulated. We investigated the association betweenHelicobacter pylori and gastric acid output. Two hundred forty-one patients were studied: 173 with duodenal ulcer, 51 with gastric ulcer (41 corpus, 10 prepyloric), and 17 with combined gastric and duodenal ulcer. In 194 patients (80%),Helicobacter pylori could be demonstrated histologically from gastric antral biopsies. The presence or absence ofHelicobacter pylori was not influenced by age, sex, or use of tobacco or analgesics. Patients with duodenal ulcer or combined gastric and duodenal ulcer had similar gastric acid outputs irrespective of the presence or absence ofHelicobacter pylori. However, gastric ulcer patients withHelicobacter had higher basal and maximal acid outputs when compared to patients withoutHelicobacter (mean basal output: 4.1 mmol/hr vs 2.4,P<0.05; mean maximal output 19.5 mmol/hr vs 14.4,P<0.05). AlthoughHelicobacter pylori is associated with both gastric ulcer and duodenal ulcer, its significance may be different in the two diseases.     

Anthroposophical medicine: A systematic review of randomised clinical trials

The aim of this systematic review was to summarise and critically evaluate all randomised clinical trials testing the effectiveness of the whole system of anthroposophical medicine either as a sole or as an adjunctive form of treatment. Seven independent literature searches were conducted to locate all such studies. Trials of single remedies within the wider anthroposophical approach were excluded. No language restrictions were applied. Unfortunately not a single study was located which met the inclusion/exclusion criteria. It was therefore concluded that, at present, the question whether the anthroposophical concept of healing generates more good than harm cannot be answered.