- Email: [email protected]
Omeprazole in ulcerative colitis
facilitate a rational choice of drug, given that the clinician now has qualitatively different alternatives to choose from. Our point is not so much that our meta-analysis is important but rather that clinicians should not use standard drugs merely because they are familiar or new drugs because they are newsworthy. Instead, they should make a deliberate clinical choice on the basis of an individual patient’s best interests. John M Davis, Philip G Janicak Illinois State Psychiatric Institute, University of Illinois at 1153 North Lavergne, Chicago, IL 60651, USA
Chicago,
previous experience, the patient asked for treatment with omeprazole. This was started 4 weeks later and again led to a full remission of colitis symptoms within 5 days. Omeprazole is effective in healing of peptic ulceration, and a few favourable reports exist for treatment of peptic ulcer in Crohn’s diseased To our knowledge, there are no reports of its use in ulcerative colitis. At present no pharmacological mechanism can be offered to explain our case; mechanisms may be speculatively proposed on the basis of the analogy of omeprazole interacting with Helicobacter pylori colonisation.2 Ute Heinzow, Tilman
1 Janicak PG, Davis JM, Preskorn SH, Ayd FJ Jr. Principles and practice of psychopharmacotherapy. Baltimore: Williams & Wilkins, 2
1993: 106-07. Kane J, Honigfeld
G, Singer J, Meltzer H. Clozaril collaborative study clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry
1
group:
1988; 45: 789-96. 3
Davis JM. Treatment of schizophrenia. Curr 28-33.
Opin Psychiatry 1991; 4:
Schlegelberger
Blücherplatz 11, D-24106 Kiel, Germany
2
Valori RM, Cockel R. Omeprazole for duodenal ulceration in Crohn’s disease. BMJ 1990; 300: 438-39. Bell GD, Powell KU, Bundge SM, et al. Omeprazole plus antibiotic combination for the eradication of metronidazole-resistant Helicobacter pylori. J Pharmacol Ther 1992; 6: 751-58.
Testing of blood donations for hepatitis C Aedes and dengue
virus
SiR-Freier (Nov 20, p 1281) mentions the recent spread of the efficient arboviral vector Aedes albopictus in North America. Introduced by international traffic in used tyres (Rogers and Packer, Nov 20, p 1282), A albopictus has reached other continents, including Europe, where most countries are within range of these cold-adapted strains from Japan.1-3 Current disturbances in the Balkans provide conditions similar to those that allowed a major European epidemic of dengue in 1926-27. The cold intolerance of the vector then involved, A aegypti, limited its spread. Cold-adapted strains of A albopictus would not be so limited. Severe cases of dengue (haemorrhagic fever; shock syndrome) can be fatal, and we have neither specific treatment nor a preventive vaccine.
SiR-The first commercial assay for hepatitis C virus (HCV) antibody available for screening donated blood in 1990 was based on a recombinant antigen from a single non-structural region of the genome, NS4.1 A second-generation assay, introduced in 1991, had recombinant antigens from the non-structural regions NS3 and NS4 and antigen from the core region. This much superior assay has dramatically reduced the incidence of post-transfusion hepatitis previously attributed to non-A, non-B hepatitis.3 Third-generation assays from Ortho and Abbott are now available in Europe additionally containing antigen from the NS5 region which codes an RNA polymerase. In theory, inclusion of antigens from further regions of the HCV genome should improve the ability of an assay to detect evidence of infection at any point in the time course of an HCV infection, but data are lacking on whether there is real benefit from these new assays. We report a donor whose HCV antibody detection required the presence of NS5 antigen in the test. An assay for HCV antibody already containing antigen from the NS5 region has been available from Murex Diagnostics for some years. In May, 1993, this test was adopted by the Edinburgh and South East Scotland blood transfusion service for HCV antibody screening. As part of our routine confirmatory procedure all repeat reactive samples were referred to the Scottish National Blood Transfusion Service (SNBTS) Microbiology Reference Unit for confirmation with Chiron third-generation recombinant immunoblot assay (RIBA) and, if positive or indeterminate, further referred to the SNBTS polymerase-chain-reaction (PCR) laboratory for PCR analysis and typing.4 In September, after 20 000 donations had been tested, a donation from a female was found to be repeat reactive on enzyme-linked immunosorbent assay (ELISA), RIBA-3 positive, PCR positive, and of HCV type 3a.4 This did not seem unusual. All samples referred to the Microbiology Reference Unit are screened by other ELISAs currently in use in the SNBTS as part of an investigation of the sensitivity of tests from different manufacturers. This sample was not detected on repeat testing by the Abbott 20, their
N R Grist, N R H Burgess Communicable Diseases and Environmental Health (Scotland) Unit, Ruchill Hospital, Glasgow G20 9NB, UK; and Department of Military Entomology, Royal Army Medical College, London
1 Grist NR. New mosquito in Africa. Lancet 1992; 339: 1363. 2 Grist NR. Aedes albopictus: the tyre-travelling tiger. J Infect 1993; 27: 1-4. 3 Ward MA. Burgess NRH. Aedes albopictus; a new disease Europe? J R Army Med Corps 1993; 139: 109-11.
vector
in
Omeprazole in ulcerative colitis SiR-We report an unexpected observation in a 34-year-old with biopsy-proven ulcerative colitis. He complained of flatulence since a teenager and, since 1983, had frequent bowel movements with bloody stools. In 1986 his symptoms became more serious and in 1991 active colitis localised to the rectum and sigmoid colon was diagnosed by sigmoidoscopy. He was initially treated with dietary exclusion of raw fruits and milk (the latter was found to be an irritant) and long-term sulphasalazine 500 mg twice daily. The severity of his bloody diarrhoea was reduced to three daily loose stools accompanied by mild abdominal cramps without full remission and symptom-free intervals during the past 2 years. In 1993 antrogastritis and oesophagitis were diagnosed by gastroscopy and treated with omeprazole 20 mg daily for 2 weeks. Within 4 days of commencing omeprazole, the colitis symptoms disappeared. Bowel movements became normal and milk products were again tolerated without bloody diarrhoea. 7 days after the successful omeprazole treatment of antrogastritis ended, his colitis symptoms recurred with several daily loose stools with blood. Because of the positive man
February 19, 1994
Manufacturer/type Abbott 2 0 Abbott 3 0 Ortho 2 5 Ortho 3 0 Murex VK48
Sample 1
Sample 2
OD/cut-offResult
OD/cut-off
0316 > 4 454 0 778 4 647 2 455
0278 > 5 076 0 942 4 752 > 3 324
*OD = optical density of sample; OD/cut-off Table: ELISA results
Negative Positive
Negative Positive Positive >
Result
Negative Positive
Negative Positive Positne
1 000 = pos!tivity.
477
Chicago,
previous experience, the patient asked for treatment with omeprazole. This was started 4 weeks later and again led to a full remission of colitis symptoms within 5 days. Omeprazole is effective in healing of peptic ulceration, and a few favourable reports exist for treatment of peptic ulcer in Crohn’s diseased To our knowledge, there are no reports of its use in ulcerative colitis. At present no pharmacological mechanism can be offered to explain our case; mechanisms may be speculatively proposed on the basis of the analogy of omeprazole interacting with Helicobacter pylori colonisation.2 Ute Heinzow, Tilman
1 Janicak PG, Davis JM, Preskorn SH, Ayd FJ Jr. Principles and practice of psychopharmacotherapy. Baltimore: Williams & Wilkins, 2
1993: 106-07. Kane J, Honigfeld
G, Singer J, Meltzer H. Clozaril collaborative study clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry
1
group:
1988; 45: 789-96. 3
Davis JM. Treatment of schizophrenia. Curr 28-33.
Opin Psychiatry 1991; 4:
Schlegelberger
Blücherplatz 11, D-24106 Kiel, Germany
2
Valori RM, Cockel R. Omeprazole for duodenal ulceration in Crohn’s disease. BMJ 1990; 300: 438-39. Bell GD, Powell KU, Bundge SM, et al. Omeprazole plus antibiotic combination for the eradication of metronidazole-resistant Helicobacter pylori. J Pharmacol Ther 1992; 6: 751-58.
Testing of blood donations for hepatitis C Aedes and dengue
virus
SiR-Freier (Nov 20, p 1281) mentions the recent spread of the efficient arboviral vector Aedes albopictus in North America. Introduced by international traffic in used tyres (Rogers and Packer, Nov 20, p 1282), A albopictus has reached other continents, including Europe, where most countries are within range of these cold-adapted strains from Japan.1-3 Current disturbances in the Balkans provide conditions similar to those that allowed a major European epidemic of dengue in 1926-27. The cold intolerance of the vector then involved, A aegypti, limited its spread. Cold-adapted strains of A albopictus would not be so limited. Severe cases of dengue (haemorrhagic fever; shock syndrome) can be fatal, and we have neither specific treatment nor a preventive vaccine.
SiR-The first commercial assay for hepatitis C virus (HCV) antibody available for screening donated blood in 1990 was based on a recombinant antigen from a single non-structural region of the genome, NS4.1 A second-generation assay, introduced in 1991, had recombinant antigens from the non-structural regions NS3 and NS4 and antigen from the core region. This much superior assay has dramatically reduced the incidence of post-transfusion hepatitis previously attributed to non-A, non-B hepatitis.3 Third-generation assays from Ortho and Abbott are now available in Europe additionally containing antigen from the NS5 region which codes an RNA polymerase. In theory, inclusion of antigens from further regions of the HCV genome should improve the ability of an assay to detect evidence of infection at any point in the time course of an HCV infection, but data are lacking on whether there is real benefit from these new assays. We report a donor whose HCV antibody detection required the presence of NS5 antigen in the test. An assay for HCV antibody already containing antigen from the NS5 region has been available from Murex Diagnostics for some years. In May, 1993, this test was adopted by the Edinburgh and South East Scotland blood transfusion service for HCV antibody screening. As part of our routine confirmatory procedure all repeat reactive samples were referred to the Scottish National Blood Transfusion Service (SNBTS) Microbiology Reference Unit for confirmation with Chiron third-generation recombinant immunoblot assay (RIBA) and, if positive or indeterminate, further referred to the SNBTS polymerase-chain-reaction (PCR) laboratory for PCR analysis and typing.4 In September, after 20 000 donations had been tested, a donation from a female was found to be repeat reactive on enzyme-linked immunosorbent assay (ELISA), RIBA-3 positive, PCR positive, and of HCV type 3a.4 This did not seem unusual. All samples referred to the Microbiology Reference Unit are screened by other ELISAs currently in use in the SNBTS as part of an investigation of the sensitivity of tests from different manufacturers. This sample was not detected on repeat testing by the Abbott 20, their
N R Grist, N R H Burgess Communicable Diseases and Environmental Health (Scotland) Unit, Ruchill Hospital, Glasgow G20 9NB, UK; and Department of Military Entomology, Royal Army Medical College, London
1 Grist NR. New mosquito in Africa. Lancet 1992; 339: 1363. 2 Grist NR. Aedes albopictus: the tyre-travelling tiger. J Infect 1993; 27: 1-4. 3 Ward MA. Burgess NRH. Aedes albopictus; a new disease Europe? J R Army Med Corps 1993; 139: 109-11.
vector
in
Omeprazole in ulcerative colitis SiR-We report an unexpected observation in a 34-year-old with biopsy-proven ulcerative colitis. He complained of flatulence since a teenager and, since 1983, had frequent bowel movements with bloody stools. In 1986 his symptoms became more serious and in 1991 active colitis localised to the rectum and sigmoid colon was diagnosed by sigmoidoscopy. He was initially treated with dietary exclusion of raw fruits and milk (the latter was found to be an irritant) and long-term sulphasalazine 500 mg twice daily. The severity of his bloody diarrhoea was reduced to three daily loose stools accompanied by mild abdominal cramps without full remission and symptom-free intervals during the past 2 years. In 1993 antrogastritis and oesophagitis were diagnosed by gastroscopy and treated with omeprazole 20 mg daily for 2 weeks. Within 4 days of commencing omeprazole, the colitis symptoms disappeared. Bowel movements became normal and milk products were again tolerated without bloody diarrhoea. 7 days after the successful omeprazole treatment of antrogastritis ended, his colitis symptoms recurred with several daily loose stools with blood. Because of the positive man
February 19, 1994
Manufacturer/type Abbott 2 0 Abbott 3 0 Ortho 2 5 Ortho 3 0 Murex VK48
Sample 1
Sample 2
OD/cut-offResult
OD/cut-off
0316 > 4 454 0 778 4 647 2 455
0278 > 5 076 0 942 4 752 > 3 324
*OD = optical density of sample; OD/cut-off Table: ELISA results
Negative Positive
Negative Positive Positive >
Result
Negative Positive
Negative Positive Positne
1 000 = pos!tivity.
477