Intravenous Omeprazole Research Articles

Rapid correction of metabolic alkalosis in hypertrophic pyloric stenosis with intravenous cimetidine: preliminary results

Pyloromyotomy has been the treatment of choice for hypertrophic pyloric stenosis (HPS) for the past century. In most HPS cases, there is mild metabolic alkalosis, which requires intravenous fluid resuscitation with 5% dextrose/normal saline for 1-2 days. However, in some cases, due to a delay in diagnosis, alkalosis becomes severe and a much longer resuscitation period (5-10 days) is required to normalize serum pH. Metabolic alkalosis of HPS results from excessive vomiting of hydrochloric acid; and therefore if its production is reduced, serum pH can be normalized faster. In this study, the use of intravenous cimetidine (CM) in a small number of infants with HPS is presented. Over a 28-month period, 32 HPS cases, including a sub-group of 17 infants (aged 7-9 weeks) with arterial pH >7.60, were admitted to a tertiary referral unit. Four infants in this sub-group were treated with standard resuscitation fluids for 4 days prior to intravenous CM, while 12 infants received CM immediately. Intravenous CM (10 mg/kg) was given at twice daily until arterial pH was less than 7.50. In one case, intravenous omeprazole at 0.1 mg/kg was given instead of CM. In all 17 cases, CM treatment or omeprazole therapy (for 12-48 h) reduced pH to less than 7.50, thus allowing for Ramstedt pyloromyotomy the same day. These patients were allowed oral feeding on the following day and were discharged at 1-3 post-operative days. No complications due to CM (or omperazole) treatment were observed. Intravenous CM administration can rapidly normalize severe metabolic alkalosis in HPS patients. As a result, pyloromyotomy can be performed sooner reducing both hospital stay and costs.

BET 2. USE OF INTRAVENOUS OMEPRAZOLE IN GASTROINTESTINAL PATIENTS BEFORE ENDOSCOPY

BET 2. USE OF INTRAVENOUS OMEPRAZOLE IN GASTROINTESTINAL PATIENTS BEFORE ENDOSCOPY

Oral or Intravenous Proton Pump Inhibitor in Patients with Peptic Ulcer Bleeding after Successful Endoscopic Epinephrine Injection – a Prospective Randomized Comparative Trial

Purpose: We aim to assess the outcomes of oral versus low-dose intravenous proton pump inhibitor after endoscopic injection of epinephrine in patients with peptic ulcer bleeding. Methods: This is a prospective randomized controlled trial conducted in a medical center in Taiwan. From January 2007 to December 2007, peptic ulcer patients with active bleeding, non-bleeding visible vessels or adherent clots were enrolled after successful endoscopic hemostasis achieved by injection with 10 ml diluted epinephrine (1:10,000). They were randomized to receive either oral rabeprazole (RAB group, 20 mg twice daily for 3 days, and then 20 mg orally once daily for 2 months) or omeprazole (OME group, 40 mg intravenous infusion every 12 hours for 3 days, and then 40 mg esomeprazole orally once daily for two months). The primary end point was the 14-day rebleeding rate. The hospital stay, volume of blood transfused, number of surgeries performed, and the mortality rates at day 14 were compared as well. Results: A total of 156 patients were enrolled, with 78 patients allocated in the OME group and 78 in the RAB group. Rebleeding occurred in 12 patients (15.4%) in the OME group and 13 patients (16.7%) in the RAB group within 14 days (P > 0.1). The two groups were not different statistically in the hospital stay (mean: 8.52 days in OME group versus 8.86 days in RAB group, P > 0.1), volume of blood transfusion (mean: 1231 ml in OME group versus 1156 ml in RAB group, P > 0.1), numbers of patients requiring urgent operation (one patient of each group), and mortality rate (1 patient in OME group and 2 patients in RAB group, P > 0.1). Conclusion: Oral rabeprazole and low-dose intravenous omeprazole are equally effective in preventing rebleeding in patients with high-risk bleeding peptic ulcers after successful endoscopic injection with epinephrine.Table: Clinical variables of patients at entry to the studyTable: Outcomes of patients received oral versus low-dose intravenous proton pump inhibitor

W1909 Effect of Intravenous Infusion Versus Intravenous Bolus OMEPRAZOLE in Patients with Bleeding Peptic Ulcer

W1909 Effect of Intravenous Infusion Versus Intravenous Bolus OMEPRAZOLE in Patients with Bleeding Peptic Ulcer

Changes in omeprazole pharmacokinetics in rats with diabetes induced by alloxan or streptozotocin: Faster clearance of omeprazole due to induction of hepatic CYP1A2 and 3A1

To investigate the effect of diabetes mellitus induced by alloxan (DMIA) or streptozotocin (DMIS) on the pharmacokinetics of omeprazole in rats. It has been reported that omeprazole is primarily metabolized via hepatic CYP1A2, 2D1, and 3A1 in rats. The expression and mRNA levels of hepatic CYP1A2 and 3A1 increases in DMIA and DMIS rats, but the expression of hepatic CYP2D1 does not change in DMIS rats. In addition, the metabolic activities of intestinal CYP3A1/2 decreases in DMIS rats. Thus, it could be expected that the pharmacokinetics of omeprazole would be affected by changes in both DMIA and DMIS. Omeprazole was administered intravenously (20 mg/kg) and orally (40 mg/kg) to DMIA and DMIS rats and their respective controls. After intravenous administration of omeprazole, the CLNR of the drug was significantly faster in DMIA (52.6 versus 67.4 mL/min/kg) and DMIS (50.2 versus 73.0 mL/min/kg) rats than the respective controls. However, after oral administration of omeprazole, the AUC was comparable between each type of diabetic rat and the respective controls. The significantly faster CLNR of intravenous omeprazole could be due to increased expression and mRNA levels of hepatic CYP1A2 and 3A1 in both types of diabetic rat. The comparable AUC of oral omeprazole could be due to a decrease in the intestinal first-pass effect of omeprazole caused by decreased intestinal CYP3A1/2 in diabetic rats. Following both intravenous and oral administration in DMIA and DMIS rats, the pharmacokinetics of omeprazole were similarly altered.

Suppression of gastric acid with intravenous esomeprazole and omeprazole: results of 3 studies in healthy subjects

To identify the optimal pharmacodynamic dosing regimen for esomeprazole administered intravenously (i.v.) and to compare acid suppression with various esomeprazole i.v. and omeprazole i.v. dosing regimens. A total of 90 healthy Helicobacter pylori-negative subjects participated in three randomized, crossover studies of esomeprazole i.v. Comparative acid output study: an open-label study that compared single 40 mg i.v. doses (administered over 30 min) of esomeprazole and omeprazole. Dose-ranging study: an open-label study that compared acid control with five different doses of esomeprazole i.v., administered over 24 h. Comparative pH study: a double-blind study that compared esomeprazole i.v. and omeprazole at doses of 80 mg (over 30 min) + 8 mg/h (for 23.5 h). In the comparative acid output study, estimated mean pentagastrin-stimulated acid output was reduced from 33.9 mmol/h at baseline to 5.4 mmol/h at 4 - 5.5 h with esomeprazole vs. 9.5 mmol/h with omeprazole (p < 0.001). In the dose-ranging study, the 80 + 8 mg/h regimen provided a greater mean time with pH > 6 (12.6 h) than the lower doses (11.0 and 10.7 h for 40 + 8 mg/h and 80 + 4 mg/h, respectively) and significantly more time with pH > 4 (21.5 vs. 19.7 and 19.2 h, respectively; p < 0.05). In the comparative pH study, the mean number of h with pH > 4 was similar between esomeprazole (21.4 h) and omeprazole (21.1 h). Esomeprazole was superior to omeprazole in reducing stimulated acid secretion. Control of intragastric pH was similar for esomeprazole and omeprazole at a dose of 80 + 8 mg/h. An esomeprazole i.v. dosage regimen of 80 + 8 mg/h appeared to be optimal for acid suppression in healthy subjects under study.

Thrombotic Microangiopathy in a Child With Acute Pancreatitis

Thrombotic Microangiopathy in a Child With Acute Pancreatitis

Effects of enzyme inducers and inhibitors on the pharmacokinetics of intravenous omeprazole in rats

A series of experiments using various inducers and inhibitors of the hepatic microsomal cytochrome P450 (CYP) isozymes were conducted to find CYP isozymes responsible for the metabolism of omeprazole in male Sprague-Dawley rats. Omeprazole, 20 mg/kg, was administered intravenously. In rats pretreated with SKF 525-A (a nonspecific CYP isozyme inhibitor in rats), the time-averaged nonrenal clearance (Cl(nr)) was significantly slower (77.1% decrease) than that in untreated rats. This indicated that omeprazole is metabolized via CYP isozymes in rats. Hence, rats were pretreated with various enzyme inducers and inhibitors. In rats pretreated with 3-methylcholanthrene and dexamethasone (main inducers of CYP1A1/2 and 3A1/2 in rats, respectively), the Cl(nr) values were significantly faster (43.8% and 26.3% increase, respectively). In rats pretreated with troleandomycin and quinine (main inhibitors of CYP3A1/2 and 2D1 in rats, respectively), the Cl(nr) values were significantly slower (20.9% and 12.9% decrease, respectively). However, the Cl(nr) values were not significantly different in rats pretreated with orphenadrine, isoniazid and sulfaphenazole (main inducers of CYP2B1/2 and 2E1, and a main inhibitor of 2C11, respectively, in rats) compared with those of respective control rats. The above data suggested that omeprazole could be mainly metabolized via CYP1A1/2, 3A1/2 and 2D1 in male rats.

Role of Intravenous Omeprazole in Patients with High-Risk Peptic Ulcer Bleeding After Successful Endoscopic Epinephrine Injection: A Prospective Randomized Comparative Trial

Background: Epinephrine injection is the most common endoscopic therapy for peptic ulcer bleeding. Controversy exists concerning the optimal dose of proton pump inhibitors for patients with bleeding peptic ulcers after successful endoscopic therapy. The objective of this study was to determine the optimal dose of proton pump inhibitor after successful endoscopic epinephrine injection in patients with bleeding peptic ulcers. Methods: A total of 200 peptic ulcer patients with active bleeding or non-bleeding visible vessels who had obtained initial hemostasis with endoscopic injection of epinephrine were randomized to receive omeprazole 40 mg infusion every 6 hours (N = 67), omeprazole 40 mg infusion every 12 hours (N = 66) or cimetidine 400 mg infusion every 12 hours (N = 67).

Role of Intravenous Omeprazole in Patients with High-Risk Peptic Ulcer Bleeding After Successful Endoscopic Epinephrine Injection: A Prospective Randomized Comparative Trial

Epinephrine injection is the most common endoscopic therapy for peptic ulcer bleeding. Controversy exists concerning the optimal dose of proton pump inhibitors (PPI) for patients with bleeding peptic ulcers after successful endoscopic therapy. The objective of this study was to determine the optimal dose of PPI after successful endoscopic epinephrine injection in patients with bleeding peptic ulcers. A total of 200 peptic ulcer patients with active bleeding or nonbleeding visible vessels (NBVV) who had obtained initial hemostasis with endoscopic injection of epinephrine were randomized to receive omeprazole 40 mg infusion every 6 h, omeprazole 40 mg infusion every 12 h or cimetidine (CIM) 400 mg infusion every 12 h. Outcomes were checked at 14 days after enrollment. Rebleeding episodes were fewer in the group with omeprazole 40 mg infusion every 6 h (6/67, 9%) as compared with that of the CIM infusion group (22/67, 32.8%, p < 0.01). The volume of blood transfusion was less in the group with omeprazole 40 mg every 6 h than in those groups with omepraole 40 mg infusion every 12 h (p= 0.001) and CIM 400 mg infusion every 12 h (p < 0.001). The hospital stay, number of patients requiring urgent operation, and death rate were not statistically different among the three groups. A combination of endoscopic epinephrine injection and a large dose of omeprazole infusion is superior to combined endoscopic epinephrine injection with CIM infusion for preventing recurrent bleeding from peptic ulcers with active bleeding or NBVV.

Glucagon-Like Peptide-2: Update of the Recent Clinical Trials

Although long-term parenteral nutrition is lifesaving in patients with intestinal failure, it is expensive and associated with serious complications such as catheter sepsis, venous occlusions, and liver failure and severely impairs the quality of life in the short bowel patients. Therefore, treatments that increase the absolute intestinal absorption, thereby eliminating or minimizing the need for parenteral support, are needed. In this respect, glucagon-like peptide 2 (GLP-2) has received attention. In this review, the nature of the short bowel syndrome is described, and the antisecretory, transit-modulating, but also intestinotrophic effects of GLP-2 are presented. As illustrated in 2 pilot studies, one using native GLP-2 and the other a degradation-resistant analogue, teduglutide, these new agents may prove important in optimizing remnant intestinal function, thereby eliminating the need for parenteral support and improving quality of life in short bowel patients with intestinal failure.

A comparison of oral omeprazole and intravenous cimetidine in reducing complications of duodenal peptic ulcer

BackgroundGastrointestinal bleeding is a common problem and its most common etiology is peptic ulcer disease. Ulcer rebleeding is considered a perilous complication for patients. To reduce the rate of rebleeding and to fasten the improvement of patients' general conditions, most emergency departments in Iran use H2-blockers before endoscopic procedures (i.e. intravenous omeprazole is not available in Iran). The aim of this study was to compare therapeutic effects of oral omeprazole and intravenous cimetidine on reducing rebleeding rates, duration of hospitalization, and the need for blood transfusion in duodenal ulcer patients.MethodsIn this clinical trial, 80 patients with upper gastrointestinal bleeding due to duodenal peptic ulcer and endoscopic evidence of rebleeding referring to emergency departments of Imam and Sina hospitals in Tabriz, Iran were randomly assigned to two equal groups; one was treated with intravenous cimetidine 800 mg per day and the other, with 40 mg oral omeprazole per day.ResultsNo statistically significant difference was found between cimetidine and omeprazole groups in regards to sex, age, alcohol consumption, cigarette smoking, NSAID consumption, endoscopic evidence of rebleeding, mean hemoglobin and mean BUN levels on admission, duration of hospitalization and the mean time of rebleeding. However, the need for blood transfusion was much lower in omeprazole than in cimetidine group (mean: 1.68 versus 3.58 units, respectively; p < 0.003). Moreover, rebleeding rate was significantly lower in omeprazole group (15%) than in cimetidine group (50%) (p < 0.001).ConclusionThis study demonstrated that oral omeprazole significantly excels intravenous cimetidine in reducing the need for blood transfusion and lowering rebleeding rates in patients with upper gastrointestinal bleeding. Though not statistically significant (p = 0.074), shorter periods of hospitalization were found for omeprazole group which merits consideration for cost minimization.

A head to head comparison of oralvsintravenous omeprazole for patients with bleeding peptic ulcers with a clean base, flat spots and adherent clots

To compare the effect of intravenous and oral omeprazole in patients with bleeding peptic ulcers without high-risk stigmata. This randomized study included 211 patients [112 receiving iv omeprazole protocol (Group 1), 99 receiving po omeprazole 40 mg every 12 h (Group 2)] with a mean age of 52.7. In 144 patients the ulcers showed a clean base, and in 46 the ulcers showed flat spots and in 21 old adherent clots. The endpoints were re-bleeding, surgery, hospital stay, blood transfusion and death. After discharge, re-bleeding and death were re-evaluated within 30 d. The study groups were similar with respect to baseline characteristics. Re-bleeding was recorded in 5 patients of Group 1 and in 4 patients of Group 2 (P = 0.879). Three patients in Group 1 and 2 in Group 2 underwent surgery (P = 0.773). The mean length of hospital stay was 4.6 +/- 1.6 d in Group 1 vs 4.5 +/- 2.6 d in Group 2 (P = 0.710); the mean amounts of blood transfusion were 1.9 +/- 1.1 units in Group 1 vs 2.1 +/- 1.7 units in Group 2 (P = 0.350). Four patients, two in each group died (P = 0.981). After discharge, a new bleeding occurred in 2 patients of Group 1 and in 1 patient of Group 2, and one patient from Group 1 died. We demonstrate that the effect of oral omeprazole is as effective as intravenous therapy in terms of re-bleeding, surgery, transfusion requirements, hospitalization and mortality in patients with bleeding ulcers with low risk stigmata. These patients can be treated effectively with oral omeprazole.

The effect of regular and high doses of omeprazole on the intragastric acidity in patients with bleeding peptic ulcer treated endoscopically: a clinical trial with continuous intragastric pH monitoring

In peptic ulcer bleeding (PUB), pH level >4 is considered necessary to prevent dissolving of a formed fibrin clot. The effect of regular or high doses of omeprazole on the intragastric pH in patients with acute PUB was studied. In our earlier study, after endoscopic therapy, PUB patients were randomized to receive a regular dose of intravenous omeprazole (20 mg; i.e. 60 mg/3 days) or a high dose of omeprazole (80 mg bolus + 8 mg/h; i.e. 652 mg/3 days). Of these 142 analysed and reported patients, 13 PUB patients also had intragastric pH monitoring for these 3 days; seven of these patients had a regular dose and six received a high dose of omeprazole. The mean 24-h intragastric pH (regular versus high dose) on day 1 was 4.9 +/- 1.6 versus 6.3 +/- 0.5 (P = 0.035), on day 2 was 4.9 +/- 1.8 versus 6.7 +/- 0.3 (P = 0.001), and on day 3 was 5.7 +/- 1.1 versus 6.7 +/- 0.5 (P = NS). The medians of the intragastric pH were 6 versus 6.5 (P = 0.082) on day 1, 5.8 versus 6.8 (P = 0.001) on day 2, and 6.2 versus 6.8 (P = 0.17) on day 3. The proportion of time when pH <4 on day 1 was 29.2 +/- 34.1 versus 5.4 +/- 5.7% (P = NS). A regular dose of omeprazole raises the mean and median 24-h intragastric pH >4 in patients with PUB. This reduction in the acidity together with endoscopic therapy is probably sufficient to maintain haemostasis. A high dose of omeprazole keeps the pH almost constantly >6.

A rare cause of massive pleural effusion

Pleural effusions commonly complicate pancreatitis and are usually reactive. Massive pleural effusions are a rare but recognised complication of pancreatitis, the management of which may require surgical intervention. Bishop et al. [1] reported massive pleural effusion secondary to pancreaticopleural fistula in a 4-year-old girl who, following failure of medical management, underwent surgery. Namazi and Mowla [2] also reported a patient with massive pleural effusion secondary to pancreatitis, who underwent drainage of a pancreatic cyst following failure of conservative management. Medical management of massive pleural effusion secondary to pancreatitis is reported to be successful in approximately 40% of adult cases [3]. We report successful resolution following medical management in a 12-year-old girl who presented with a massive right pleural effusion secondary to chronic pancreatitis. A 12-yearold girl presented with poor weight gain, and abdominal and retrosternal chest pain. She underwent a barium meal and an upper and lower gastrointestinal endoscopy. Apart from Enterobius vermicularis infestation resulting in a mild nonspecific proctitis, these investigations were normal. Empirical treatment with Gaviscon and mebendazole resulted in weight gain and symptom resolution. Six months later, she presented with a 2-month history of progressive shortness of breath and poor exercise tolerance. She was noted to be pyrexial and complained of right upper quadrant abdominal and chest pain. Clinical examination revealed no signs of respiratory distress, normal pulse oximetry and respiratory rate. However, there were absent breath sounds over the right lung and a chest X-ray film demonstrated a right pleural effusion (Fig. 1). An ultrasound scan and a chest CT scan confirmed a hyper-echoic fluid collection, total collapse of the right lung with no evidence of septation, mediastinal mass or lymphadenopathy. A Mantoux test was negative. Analysis of pleural fluid obtained after drainage revealed a white cell count of 1.05·10/l, raised amylase of 24777 U/l with a protein content of 32 g/l. Simultaneous serum analysis revealed a serum albumin of 31 g/l and an amylase of 304 U/l. The patient was treated conservatively with chest tube drainage, intravenous antibiotics, and intravenous octreotide (1 lg/kg/h), omeprazole and parentral nutrition. Within 2 weeks her pleural effusion resolved, her plasma amylase normalised and enteral nutrition was reintroduced. A magnetic resonance cholangiopancreatography delineated the pancreas and confirmed a dilated tortuous and beaded pancreatic duct with no evidence of pancreatopleural fistula or pseudocyst (Fig. 2). Further investigation confirmed that the patient and her father both carry the N291 mutation in the PRSS1 hereditary pancreatitis gene explaining her findings of chronic pancreatitis. The patient has remained symptom free with normal plasma amylase levels for 12 months following presentation, and her father has never had symptoms suggestive of pancreatitis. Pleural effusions commonly complicate acute pancreatitis and are usually small, left-sided and reactive. They arise from inflammation of the diaphragm and pleura, the amylase concentration of which may be moderately elevated. Pleural effusions arising from chronic pancreatitis are rare in children and result from either posterior disruption of the pancreatic duct into the retroperitoneal space leading to the formation of a fistulous tract between the pancreas and the pleural cavity through the aortic or oesophageal hiatus, or direct extension of a pancreatic pseudocyst [3]. These effusions tend to be large and recurrent with a dramatically elevated amylase content. M. Lawson (&) AE A. M. Dalzell Department of Paediatric Gastroenterology, Royal Liverpool Children’s Hospital NHS Trust Alder Hey, Eaton Road, L12 2AP Liverpool, UK E-mail: maureenlawson@doctors.org.uk Tel.: +44-151-2525373 Fax: +44-151-2525928

The Efficacy of High- and Low-Dose Intravenous Omeprazole in Preventing Rebleeding for Patients with Bleeding Peptic Ulcers and Comorbid Illnesses

This study sought to determine if high-dose omeprazole infusion could improve the control of rebleeding in patients with comorbid illnesses and bleeding peptic ulcers. After achieving hemostasis by endoscopy, 105 patients were randomized into high-dose (n = 52) and low-dose (n = 53) groups, receiving 200 and 80 mg/day omeprazole, respectively, as a continuous infusion for 3 days. Thereafter, oral omeprazole, 20 mg/day, was given. The cumulative rebleeding rates comparatively rose in both groups (high-dose vs. low-dose group), beginning on day 3 (15.4% vs. 11.3%), day 7 (19.6% vs. 20%), and day 14 (32.7% vs. 28.9%), until day 28 (35.4% vs. 33.3%), and were not significantly different between the two groups (P > 0.50). Multiple logistic regression confirmed that a serum albumin level <3 g/dL was an independent factor associated with rebleeding (P = 0.002). For patients with comorbidities, 3-day omeprazole infusion, despite increasing the daily dose from 80 to 200 mg, was not adequate to control peptic ulcer rebleeding.

Impact of Stress Ulcer Prophylaxis Algorithm Study

In the intensive care unit at Royal Victoria Hospital, we noted that drugs prescribed for stress ulcer prophylaxis were not always indicated or optimal. Accordingly, we implemented an algorithm for stress ulcer prophylaxis to guide the medical team in their decisions. The agents selected for the algorithm were intravenous famotidine and omeprazole suspension or tablets, depending on the available administration route. To evaluate the impact of a treatment algorithm on the appropriateness of prescriptions for stress ulcer prophylaxis. A quasi-experimental-type evaluative study was conducted based on a pre-/post-intervention design without a concurrent control group. A total of 555 complete admissions met the selection criteria; 303 patients formed the pre-intervention group, and 252 made up the post-intervention group (exposed to the treatment algorithm). After implementation of the algorithm, the proportion of inappropriate prophylaxis was decreased (95.7% vs 88.2%; p = 0.033). The number of days of inappropriate prophylaxis was also reduced significantly (p = 0.013), as was the cost per patient (p = 0.003) for all admissions. However, no difference was observed when the subgroup of patients who received prophylaxis alone was studied (p = 0.098 and p = 0.918). The presence of bleeding was similar in both groups. Introduction by pharmacists of a treatment algorithm for stress ulcer prophylaxis in intensive care units allows a reduction of inappropriate prescriptions and thus a reduction in the cost of drugs. The use of omeprazole suspension seems to be an alternative to intravenous histamine2-inhibitors; however, a large-scale study is necessary to confirm the efficacy and safety of proton-pump inhibitors administered by an enteral tube.

The Prediction of Recurrent Bleeding Leading to Surgery or Death After Therapeutic Endoscopy and Adjunctive Use of Intravenous High Dose Omeprazole Infusion for Bleeding Peptic Ulcers

Introduction: We previously showed that the adjunctive use of high dose omeprazole infusion after endoscopic hemostasis effectively reduced rebleeding and improved outcomes of patients with bleeding peptic ulcers [Lau NEJM 2000]. This study aimed to identify factors that predict rebleeding leading to surgery or death in high risk patients. Patients and Method: We selected patients at high risk of rebleeding basing on either: hemoglobin < 10 g/dl, SBP <100 mmHg, fresh blood in stomach, actively bleeding ulcers or large ulcer ≥2 cm [Wong GUT 2002].

Cyproterone acetate and ethinylestradiol-induced pill oesophagitis: a case report

Although there are many cases of oesophagitis related to pill in medical literature, there are only a few reports concerning oesophagitis related to oral contraceptives, and none about cyproterone acetate and ethinylestradiol combination (Diane-35). In this report, we describe a female patient who suffered from odynophagia and retrosternal pain after taking Diane-35 for hirsutism. The endoscopic examination revealed two well-demarcated circumferential ulcers of 1 cm diameter surrounded by relatively normal mucosa in mid-oesophagus. The patient had gone to bed immediately after taking the pill. Oral intake was stopped, and intravenous fluids and omeprazole were administered as part of treatment. The patient benefited from this approach very quickly and was discharged from hospital in 5 days. The oesophagus was completely normal in control endoscopy after 2 months. Diane-35 should be added to the list of drugs causing pill oesophagitis, and physicians should inform the patients that the pills should be taken with enough water and they should not lie down right after ingesting the pills.

Endoclipping for Gastric Perforation After Endoscopic Polypectomy: An Alternative Treatment to Avoid Surgery

A 47-year-old woman underwent endoscopic polypectomy of a villous adenoma in the lesser curvature of the gastric antrum. Shortly after the procedure, she complained of severe abdominal pain. An abdominal x-ray showed air under the diaphragm, suggestive of gastric perforation. On re-endoscopy, the cavity at the site of polypectomy was closed using endoscopically applied metallic clips. She was treated with intravenous hyperalimentation, omeprazole, and antibiotics for 10 days. Ingestion of food was started 10 days after admission, and she was discharged without any complaints. She is free of symptoms on follow-up after 8 months, and endoscopy showed complete healing of the perforation. The procedure is the third described for the stomach in the English literature and emphasizes the use of endoclipping in selected cases of small and well-defined perforations.