Combination of diet, exercise and intermittent treatment of cimetidine on body weight and maintenance of weight loss. A 42 months follow-up study.

INTRODUCTION: The aim of the study was to investigate the long term effect of diet, exercise and intermittent treatment of cimetidine on body weight and maintenance of weight lost during treatment. MATERIAL AND METHODS: Fifty women and five men who had completed a 8 week randomized double-blind, placebo-controlled trial of cimetidine for weight loss were invited to participate in an open, non-randomized follow-up study of 42 months. The study was designed to compare weight loss and/or weight gain in subjects who, dependent on their level of motivation, volunteered to participate in an intervention or non-intervention group. In the intervention group the subjects were treated with cimetidine for 8 weeks twice a year, followed a diet restriction and performed regular exercise. In the non-intervention group the subjects had no behavioral treatment. Twenty two subjects volunteered to participate in the intervention program whereas 33 subjects volunteered to participate in the non-intervention group. RESULTS: In the intervention group, non-significant reductions in body weight (1.9 +/- 5.5 kg), BMI (0.6 +/- 1.7 kg/m2), body fat% (1.7 +/- 2.9) and waist circumference (2.1 +/- 5.9 cm) were found. In the non-intervention group there was a significant increase in body weight (7.5 +/- 5.3 kg), BMI (2.6 +/- 1.8 kg/m2), body fat% (3.0 +/- 3.3) and waist circumference (6.7 +/- 5.1 cm). Among the group of subjects initially treated with cimetidine for 8 weeks and who followed a subsequent intervention of additional 42 months (n = 16), there was a 15.1% weight loss. Among the group initially treated with placebo for 8 weeks and who volunteered to participate in the non-intervention group (n = 22), there was a weight gain of 8.6%. In conclusion, the combination of diet restriction, regular exercise and intermittent treatment of cimetidine appears to have long term effects on body weight and maintenance of weight loss.

Non-ulcer dyspepsia and peptic ulcer: the distribution in a population and their relation to risk factors.

BACKGROUND: The aetiology of non-ulcer dyspepsia and a possible connection to peptic ulcer disease is debated. This paper discusses this problem in a population based study. AIMS: The relation between non-ulcer dyspepsia and peptic ulcer disease was explored by the distribution in the general population and their associations to demographic, lifestyle, and psychological factors. METHODS: All inhabitants of a community aged 20-69 years received a questionnaire concerning abdominal complaints, health, lifestyle, diet, and social conditions. Reports on peptic ulcer were verified with medical records. Dyspeptic subjects and matched healthy, non-dyspeptic controls were endoscoped in a blinded procedure. SUBJECTS: Of 2027 persons invited, 1802 (88.9%) returned the questionnaire from which dyspeptic subjects and controls were identified. Of 782 subjects invited to endoscopy, 309 dyspeptic and 310 control subjects (79.2%), participated. RESULTS: Men reported dyspepsia (30.4%) and peptic ulcer (8.7%) more often than women (24.1% and 5.2%, respectively). Non-ulcer dyspepsia was frequent (between 10.6% and 17.2%) in both sexes and age groups up to 60 years, with a lower frequency in both men and women above this age (3.0% and 6.8%). Non-ulcer dyspepsia was associated with having a family history of dyspepsia and of peptic ulcer and the use of tranquillisers. Nearly one third of dyspeptic persons above the age of 40 years had peptic ulcer, but peptic ulcer prevalence was low under this age. Peptic ulcer was associated with a family history of peptic ulcer, smoking, and daily life stress, and also with poor living conditions during childhood, frequent recurrence of herpes labialis, conditions that were associated with Helicobacter pylori infection. CONCLUSIONS: Non-ulcer dyspepsia and peptic ulcer have different patterns of relations to lifestyle, social, and psychological factors. The results perhaps support the hypothesis of peptic ulcer being an infectious disease in contrast with non-ulcer dyspepsia.

Is Helicobacter pylori the cause of dyspepsia?

OBJECTIVE: To determine the association between infection with Helicobacter pylori and dyspepsia. DESIGN: Cross sectional study of dyspeptic subjects and age and sex matched controls identified by a questionnaire survey of all inhabitants aged 20-69. (Endoscopy, histological examination, and microbiological examinations of biopsies from the gastric mucosa were performed blind.) SETTING: Population based survey in Sørreisa, Norway. SUBJECTS: All 782 dyspeptic subjects (excluding those with a previous history of peptic ulcer, gall stones or kidney stones, and coronary heart disease) and controls were offered an endoscopy, of whom 309 dyspeptic subjects and 310 controls attended. MAIN OUTCOME MEASURES: Prevalences of endoscopic and histological diagnoses and of cultures positive for H pylori. RESULTS: A high prevalence of positive cultures, increasing with age, was found in both dyspeptic subjects (48%) and non-dyspeptic controls (36%) (p = 0.004). Positive cultures in both dyspeptic subjects and controls were strongly associated with histological gastritis (70%, 95% confidence interval 65.5 to 85.3; 60%, 52.7 to 67.7, respectively) and peptic ulcer (92%, 61.5 to 99.8; 64.1, 9.4 to 99.2, respectively). Only 3% of subjects with a histologically non-inflamed gastric mucosa had this infection (dyspeptic subjects 2%, 0.2 to 7.0; controls 4%; 1.2 to 8.8). CONCLUSIONS: The relation between dyspeptic symptoms and H pylori is dubious; H pylori seems to have a pathogenetic role in gastritis and may be a contributing factor but not a cause of peptic ulcer.

Erosive prepyloric changes in dyspeptics and non-dyspeptics in a defined population. The Sørreisa Gastrointestinal Disorder Study.

In this population-based endoscopic survey we found erosive prepyloric changes (EPC) in 38.5% of dyspeptics and 35.1% of non-dyspeptics. EPC were observed more frequently in men than in women in both groups. Occurrence of Helicobacter pylori was not associated with EPC. No common gastrointestinal symptoms were found to be associated with EPC. Endoscopic duodenitis of the duodenal bulb was found more frequently in subjects with EPC of the two highest grades than in subjects without EPC. Only the highest grade of EPC was associated with chronic gastritis. EPC were associated with cigarette smoking and, among women, also use of alcohol. We conclude that EPC constitute an endoscopic finding without relation to specific symptoms. These changes therefore do not represent a clinical entity, and it is doubtful whether this finding will give the clinician a better understanding of dyspepsia.

Prevalences of endoscopic and histological findings in subjects with and without dyspepsia.

OBJECTIVE: To examine the association between dyspeptic symptoms and endoscopic and histological diagnoses. DESIGN: Cross sectional study of people with dyspepsia and controls matched for age and sex identified by questionnaire survey of all inhabitants aged 20 to 69. Endoscopy and histological examination was performed with the examiner blind to whether or not the patient had dyspepsia. SETTING: Population based survey in Sørreisa, Norway. SUBJECTS: All people with dyspepsia and age and sex matched people without dyspepsia were offered endoscopy. A total of 309 people with dyspepsia and 310 without dyspepsia underwent endoscopy, giving 273 matched pairs. MAIN OUTCOME MEASURES: Prevalences of endoscopic and histological diagnoses made according to internationally accepted standards. RESULTS: In all, 1802 of 2027 (88.9%) people returned the questionnaire. Of the 163 subjects who refused endoscopy, 114 were controls. Of five endoscopic and four histological diagnoses only peptic ulcer disease, endoscopic duodenitis, and active chronic gastritis were diagnosed significantly more often in people with dyspepsia. In all, 30% to 50% of the diagnoses of mucosal inflammation and peptic ulcer disease were made among subjects without dyspepsia, and only 10% of both those with and those without dyspepsia had normal endoscopic findings. CONCLUSIONS: The diagnostic findings, with possible exceptions of peptic ulcer disease and endoscopic duodenitis, showed no association of clinical value with dyspeptic symptoms. The small number of "normal" endoscopic findings in both those with and those without dyspepsia challenge well accepted endoscopic and histological diagnostic criteria with relation to the upper gastrointestinal tract.

Towards a true prevalence of peptic ulcer: the Sørreisa gastrointestinal disorder study.

This study, designed to overcome methodological problems inherent in earlier prevalence studies of peptic ulcer, was carried out in a municipality in northern Norway. It included the total population of 2027, aged 20-69 years, and comprised a questionnaire and search for previously diagnosed peptic ulcers in the local medical records for all subjects, and additional endoscopy of all subjects with dyspepsia and their matched healthy controls (n = 619). The overall prevalence was 10.5% in men and 9.5% in women, a sex ratio close to one and a higher duodenal:gastric ratio than previously reported from this region. A substantial 1% prevalence of asymptomatic ulcers was also observed.

Cimetidine, 800 mg at night, in the treatment of duodenal ulcers.

One hundred and eight patients with endoscopically proven duodenal ulcers were randomly allocated to treatment with cimetidine, either 400 mg twice daily or 800 mg at night for 4 to 8 weeks in a double-blind study. There was no significant difference between the healing rates of the two groups. Thus, 45 of 52 (87%) healed on cimetidine twice daily and 43 of 51 (84%) healed on 800 mg at night after 4 weeks' treatment. The corresponding healing rates after 8 weeks were 51 of 52 (98%) and 50 of 51 (98%). The intensity of pain decreased more rapidly in the group treated with 800 mg cimetidine at night. These results indicate that 800 mg cimetidine at night is as good as 400 mg given twice daily.