Oral Omeprazole Research Articles

Prescribing efficiency of proton pump inhibitors in China: influence and future directions.

BackgroundPharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables.MethodsObservational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China.ResultsAppreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (−34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (−19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral PPIs as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%.ConclusionsEncouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.

Pharmacokinetics of intravenous, plain oral and enteric-coated oral omeprazole in the horse.

The objectives were to document the pharmacokinetics of intravenous, enteric-coated oral and plain oral omeprazole in fasted horses and to investigate the impact of feeding on the bioavailability of an enteric-coated omeprazole. Twelve horses received four treatments: intravenous omeprazole (0.5mg/kg) in the fasted state (IV-Fasted), enteric-coated omeprazole (4mg/kg) orally in the fasted state (ECO-Fasted), enteric-coated omeprazole (4mg/kg) orally in the fed state (ECO-Fed) and plain omeprazole (4mg/kg) orally in the fasted state (PL-Fasted). Plasma omeprazole concentrations were determined by UHPLC-MS. Bioavailability was higher (P=0.038) in the ECO-Fasted group (21.5 [9.0-27.7]%) than the PL-Fasted group (10.1 [7.7-13.3]%). Similarly, AUC0-∞ was higher in the ECO-Fasted group than the PL-Fasted group (P=0.027). No significant differences were present between the ECO-Fasted and ECO-Fed groups with regards to bioavailability, Cmax , Tmax or AUC0-∞ . When the half-life data from the oral formulations was pooled, it was longer than that observed in the IV-Fasted group (100 [73-118] min) and 35 [34-39] min, respectively; P<0.0001). Bioavailability of enteric-coated omeprazole was higher than previously reported and feeding had minimal impact. Bioavailability of plain omeprazole was approximately half that of enteric-coated omeprazole. The longer half-life observed following oral administration was consistent with the flip-flop effect and has not previously been described for omeprazole in the horse.

Observation the clinical curative effect of children's laryngopharyngeal reflux and sleep apnea hypopnea syndrome

To observe the clinical curative effect of anti-reflux treatment for obstructive sleep apnea hypopnea syndrome (OSAHS) in children. Twenty children with sleep-disordered breathing were included in this study. There were 15 males and 5 females, aged 3-9 years old, median 6 years old. The electronic laryngoscope, polysomnography (PSG) monitoring, Reflux symptom index (RSI) questionnaire and Reflux finding score (RFS) were used to establish the initial diagnosis of OSAHS with LPRD, preclude adenoid hypertrophy and tonsil hypertrophy and nasal disorders. Oral Domperidone and Omeprazole were given for treatment. For children under 3-year-old, the dosage of Domperidone was 0.6 ml.kg⁻¹.day⁻¹.For children over 3-year-old, Domperidone combined with Omeprazole were given with the dosage of 0.3 mg.kg⁻¹.day⁻¹. After 4 weeks of treatment, 19 patients symptoms of OSAHS include disturbed sleep, dyspnoea and apneic attack improved. After 8 weeks of treatment, 20 cases with OSAHS symptoms improved than before treatment. Under the electronic laryngoscope, the decrease in pharyngeal lymphoid follicles, the epiglottis, aryepiglottic fold and scoop intergenic region erythema shallow, edema lessened. After treatment of 4 weeks and 8 weeks, there was statistically significant (P < 0.05). Before and after treatment, the difference of RFS was statistically significant (P < 0.05); PSG monitoring proved significant effect in 3 cases (15.0%), effective in 11 cases (55.0%) and 6 cases were ineffective (30.0%). Twenty patients with obstructive apnea index change was not obvious (P > 0.05), apnea hypopnea index and lowest artery oxygen saturation better, differences were statistically significant (Z of 2.819 and 2.733 respectively, P < 0.05). The treatment of LPRD can improve the symptoms of OSAHS, these two diseases may coexist in mutual relations.

Study on Effectiveness of Low Dose Theophylline as Add-on to Inhaled Corticosteroid for Patients with Sulfur Mustard Induced Bronchiolitis

Background: Theophylline may reverse steroid resistance and decrease inflammation in patients with chronic pulmonary disease and sulfur mustard (SM) induced bronchiolitis. This study was designed to assess the effects of low-dose theophylline on improvement of pulmonary function tests (PFTs) of SM exposed patients. Methods: In this comparative observational study, a group of SM-exposed victims during the Iraq-Iran war who were treated with oral slow releasing (SR) theophylline, salmetrol, fluxitide, omeprazole and NAC (study group) were compared to a group of age and gender matched SM-exposed patients who received same medications except oral SR theophylline (historical control group). PFTs were measured at the beginning of the study and after 8 weeks of the treatment. Results: In total, 33 subjects in the study group and 27 subjects in the control group were studied. Mean (SD) age of all subjects was 51 (14.1) years. In the study group, on the 8th week post-treatment, PFTs decreased, though the differences of tests between before and after treatment were not significant. In the control group, all the tests decreased in the same period and these reductions were not also significant. However, the changes in PFTs were significantly different between the two groups. The results of most PFTs in the controls decreased in greater extents compared to theophylline treated patients. This shows that despite theophylline was unable to improve the patients; it was partially able to decelerate the reductions in PFTs. Conclusion: Theophylline may not improve PFTs of SM exposed patients but it may decelerate the progress of the underlying respiratory disease. Further studies in this setting with higher doses of theophylline and longer term of evaluation are needed to better understand the pathophysiological mechanism of SM induced bronchiolitis and the effectiveness of the treatment with theophylline.

A comparison of two doses of omeprazole in the treatment of equine gastric ulcer syndrome: A blinded, randomised, clinical trial

Studies on omeprazole have reported that doses as low as 0.7 mg/kg bwt per os are potent suppressors of acid production. Yet, to date, no studies have compared treatment efficacy of different doses in clinical cases of equine gastric ulceration. Furthermore, no studies have been performed to compare the healing response of the squamous and glandular mucosa to acid suppression therapy. To compare: 1) the efficacy of 2 doses of omeprazole in the treatment of primary squamous and glandular gastric ulceration; and 2) the healing response of primary squamous and glandular gastric ulceration to acid suppression therapy. A blinded, randomised, dose-response clinical trial. Twenty Thoroughbred racehorses with grade ≥2/4 glandular ulceration were identified on gastroscopy. Seventeen horses also had grade ≥2/4 squamous ulceration. Horses were randomly assigned to one of 2 groups. Horses received either 2.0 g (high dose: 4.0 mg/kg bwt) or 0.8 g (low dose: 1.6 mg/kg bwt) of oral omeprazole per os once daily. Gastroscopy was repeated at 28-35 days. Time and dose significantly affected grades of squamous (P<0.0001, P = 0.02) and glandular (P = 0.006 and 0.005) ulceration. Data analysis did not support our hypothesis that the lower dose would have similar effects (i.e. be noninferior) to the higher dose when considering ulcer healing and ulcer improvement. Improvement was more likely with the high dose for the squamous (P = 0.05) but not glandular (P = 0.4) mucosa. The percentage of glandular ulcers that improved was less than squamous ulcers (P = 0.02). The results suggest that a dose-response exists for the treatment of both squamous and glandular ulcers. Improvement of glandular ulcers was not as complete as observed with squamous ulcers and current equine gastric ulcer syndrome treatment recommendations may not be appropriate for glandular disease.

Intravenous Albumin Shortens the Duration of Hospitalization for Patients with Hypoalbuminemia and Bleeding Peptic Ulcers: A Pilot Study

Patients with hypoalbuminemia have an increased risk of ulcer rebleeding and longer length of hospitalization. This study aimed to test whether intravenous albumin can decrease the incidence of rebleeding or shorten the duration of hospitalization in patients with bleeding peptic ulcers and hypoalbuminemia. Sixty-two patients with bleeding peptic ulcers and Rockall scores ≥ 6 were prospectively enrolled after having received endoscopic therapy. The enrolled patients were divided into a normal albumin group (serum albumin ≥ 3 g/dL, n = 39) or an intervention group (<3 g/dL, n = 23) to receive a 3-day course of omeprazole infusion and 25-day oral esomeprazole. Patients (n = 29) with bleeding ulcers and hypoalbuminemia who received the same dose of intravenous and oral omeprazole but did not receive albumin therapy were enrolled from a previous study as the control group. In the intervention group, patients received albumin infusion (10 g q8h) for 1 day (serum albumin levels 2.5-2.9 g/dL) and 2 days (<2.5 g/dL), respectively. The 28-day cumulative rebleeding rates were similar between the intervention group and the control group (39.1 vs. 42.3 %, p = 0.99). The intervention group had a shorter duration of hospitalization (9 vs. 15 days, p = 0.02) than cohort controls. The risk of rebleeding developed after discharge were similar (normal albumin group vs. intervention group vs. control group, 1/5 [20 %] vs. 2/9 [22.2 %] vs. 1/11 [9.1 %], p = 0.7). Albumin administration shortens the duration of hospitalization for patients with peptic ulcer bleeding and hypoalbuminemia, but does not decrease the incidence of rebleeding.

Cutaneous Nodule in a Young Man

A 21-YEAR-OLD MALE STUDENT PRESENTS WITH A NODULE ON HIS CHEST THAT has been progressively enlarging over 1 month. He also has a 1-month history of upper abdominal pain associated with diarrhea but without fever or chills. He was diagnosed with acute gastroenteritis and treated with oral omeprazole and ofloxacin without relief. He has lost 5 kg during the past half year. He denies any history of chronic illness or family history of cancer. Physical examination reveals left supraclavicular and cervical lymphadenopathy. A solitary asymptomatic, nontender, and indurated nodule is found on his chest (FIGURE 1). Gastrointestinal endoscopy shows multiple ulcers on the gastric fundus and gastric corpus. What Would You Do Next?

Isolated motor conduction block associated with infliximab

TNF-alpha antagonists have been associated with various types of peripheral neuropathies, including multifocal motor neuropathy with conduction block and mononeuropathies [1]. We present two patients treated with infliximab who developed unifocal motor neuropathy with conduction block. A 34-year-old female with Crohn’s disease developed painless weakness of right-hand pincer grip of insidious onset. She had previously received five courses of infliximab infusions (5 mg/kg) and a further dose 3 days after symptom onset. Infliximab partially controlled gastrointestinal symptoms and she was otherwise well. Regular medication included the oral contraceptive pill, levothyroxine, folate, omeprazole, B12 injections, and iron infusions. Examination revealed MRC grade 4 power of the right abductor pollicis brevis, flexor pollicis longus, flexor digitorum profundus (median), and opponens pollicis. Flexor carpi radialis was mildly weak (4?) but forearm pronation remained strong. There were no sensory signs and systemic examination was unremarkable. A detailed four-limb neurophysiological examination 6 weeks after symptom onset revealed isolated severe right median motor conduction block 2.5–6.5 cm proximal to the antecubital fossa skin crease (Fig. 1). Median and other sensory conduction responses were normal. EMG of median innervated forearm muscles including abductor pollicis brevis and flexor pollicis longus was consistent with conduction block, with reduced recruitment of motor units but no spontaneous activity or other evidence of motor axon loss. Right median sympathetic skin response, somatosensory evoked potentials, and thenar thermal threshold testing were all normal. There was evidence for systemic active inflammation with mild leukocytosis, thrombocytosis, and normocytic anemia; ESR 102 mm/h and CRP 51 mg/l. Anti-DNA antibodies, ANCA, ANA, RA latex, glycolipid and antiGAD antibodies, anti-GM1, and anti-GQ1b antibodies were either normal or negative. An MRI with gadolinium showed hyperintensity of the right median nerve in the lower third of the right arm on TIRM and T2-weighted images, with subtle enhancement but no enlargement. This corresponded to the site of conduction block. No specific treatment was given, but there was significant improvement of power in weak muscles within 4 weeks of presentation, and complete recovery at 1 year. Patient 2, a 41-year-old female with ankylosing spondylitis, had been treated with regular infliximab infusions since 2003. In April 2009, she awoke with painless weakness of left finger and wrist extension 3 days after an infliximab infusion (270 mg). Examination revealed MRC grade 0 finger extension and 4wrist extension with radial deviation and no sensory loss. Initial neurophysiological examination 1 week after symptom onset showed profound A. W. Michell (&) Department of Clinical Neurophysiology, Box 124 Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK e-mail: andrew.michell@addenbrookes.nhs.uk

Management of a Benign Oesophageal Stricture in a Dog using a Biodegradable Self- Expanding Stent

Summary A three-year-old female neutered Staffordshire bull terrier presented with a progressive two week history of regurgitation following surgery for septic peritonitis. Oesophagoscopy revealed a narrow stricture in the mid-oesophagus. Stricture reformation occurred following repeated endoscopic and fluoroscopic guided balloon dilations, with the addition of intralesional triamcinolone, on eleven occasions. Following the twelfth balloon dilation, a tubular self-expanding biodegradable polydioxanone stent was placed across the stricture under fluoroscopic guidance and sutured to the oesophageal wall. Initially, the dog made a good recovery, however seven days later, signs of regurgitation returned associated with marked oesophagitis. Regurgitation resolved over the next two weeks following intralesional triamcinolone injections and oral prednisolone, ranitidine, omeprazole and sucralfate. Fluoroscopy four months after placement revealed the stent was no longer present and there was no evidence of stricture. Oesophageal motility was subjectively delayed in this area. The dog was tolerating a soft food diet without regurgitation.

Esophageal Pseudodiverticulosis Presenting with Massive Gastrointestinal Bleed

Purpose: Introduction: Esophageal intramural pseudodiverticulosis (EIP) is a rare benign disease of uncertain significance. We report a case of EIP which presented with massive self-limiting gastrointestinal bleed. Case: A 63 year old male presented to the emergency department with hematemesis and postural dizziness. His medical history was significant for coronary artery disease, diabetes mellitus, hypertension, esophageal candidiasis, alcohol and tobacco abuse. His heart rate was 111 per minute and BP was 104/70 mmHg without orthostasis. Abdominal examination did not reveal any significant abnormality. His hemoglobin was 12.7 gm/dl and hematocrit 40.2% compared to baseline values of 13.7 gm/dl and 44% respectively. In the emergency department he had two bouts of hematemesis with clots and a significant decline in hematocrit. He was volume resuscitated, started on esomeprazole infusion and transfused two units of packed RBC. After stabilization EGD was performed which revealed extensive pseudodiverticulosis of the esophagus from about 25 cm down to the distal esophagus. Erosive non-bleeding reflux induced distal esophagitis was also seen (Los Angeles Grade B). He remained stable during hospital stay without any recurrence of bleeding and was subsequently discharged on oral omeprazole. Discussion: EIP is a rare disease characterized by small sac like out pouching of the esophageal wall. Men between the ages of 50-70 years are most commonly affected and reflux esophagitis, diabetes mellitus and chronic alcoholism are well known associations. This benign esophageal disease is also known to be associated with candidial, herpetic and eosinophilic esophagitis. Our patient had a history of esophageal candidiasis which along with multiple other risk factors may have contributed to the pathogenesis of pseudodiverticuli. The pathophysiology of EIP remains unclear. The most widely accepted hypothesis is based on chronic mucosal inflammation resulting in squamous metaplasia of glandular epithelium with ductal dilatation and formation of pseudodiverticuli. Although esophagitis is a very commonly observed endoscopic finding, pseudodiverticulosis is extremely rare and this paradox is difficult to explain. Most patients present with dysphagia, odynophagia or chest tightness, hematemesis is rare. There are only two reported cases of EIP presenting with gastrointestinal bleeding. Endoscopy is the diagnostic test of choice and these small diverticular openings can be missed in the absence of detailed examination with adequate air insufflation. Treatment is aimed at relieving obstructive symptoms when present or treating underlying causes such as esophagitis in our case.

Fixed drug eruption caused by three unrelated drugs: promethazine, pethidine and omeprazole

We report a case of fixed drug eruption (FDE) caused by three unrelated drugs. A 52-year-old woman presented with a diagnosis of FDE after taking a drug to treat a common cold. An oral provocation test and a patch test were carried out, and the patient reacted to promethazine, which is a derivative of phenothiazine. To determine the core structure of the antigen, we performed patch testing and/or an oral provocation testing with six drugs that are similar in structure to promethazine. The patient reacted to five of the six drugs, and the antigenic determinant was identified as a phenothiazine and a tricyclic structure. The patient had similar eruptions at the same sites 3 years later after taking pethidine. Seven months after that reaction, a more severe eruption was caused by oral omeprazole. This is an extremely rare case of FDE caused by three structurally unrelated drugs.

Aggressive Benign Gastric Ulcer

This 48 years old male patient presented with 2 months history of persistent vomiting and epigastric pain and unsatisfactory response to multiple courses of proton pump inhibitors. He had no chronic medical disease nor GIT bleeding. On examination he was pale with epigastric tenderness, otherwise free. Investigations showed mild microcytic hypochromic anemia. Diagnostic upper endoscopy was done and showed GERD with huge active gastric ulcer with marked mucosal congestion and inflammation, necrotic floor and edematous edge, for the first time it was suspected to be malignant (image 1), multiple biopsies were taken. Biopsy result showed moderately active chronic H Pylori with intestinal metaplasia. Treatment included two days of parentral PPI, then two weeks of triple therapy follwed by four weeks of oral omeprazole 40 mg/day. Follow up one month later showed marked improvement (image 2). Thus it could be concluded that apparently aggressive lesions are not always malignant, any suspicious lesion should be biopsied , treatment of H Pylori promotes healing of gastric ulcer and follow up of endoscopic healing is advised.

Russell Body Gastritis in a Patient with Recurrent Upper Gastrointestinal Bleeding

Purpose: 70-year-old male with a history of two episodes of massive recurrent upper gastrointestinal bleeding presented for follow up endoscopy 6 months later for a evaluation of abdominal discomfort. His prior endoscopy showed discrete ulcer in the antrum with raised edge, with a slight erythema at the periphery. By endoscopic ultrasound this was superficial. This was thought to be likely the site of the UGIB and two clips were placed at the site of the ulceration to prevent of future bleeding at that time. Biopsy from the antral mucosa showed evidence of chronic gastritis and Giemsa stain showed rare H. Pylori microorganisms. Follow up endoscopy showed persistence of the antral nodule noted on previous endoscopy and was thought to be the site of the first episode of the UGIB. No ulcer was noted at this time. The biopsy revealed localized accumulation numerous Russell bodies. Although acute and chronic inflammation of moderate severity was noted in the gastric mucosa, no H. pylori was identified on this follow up biopsy. However, there was a marked widespread stromal infiltration with plasma cells in the gastric antrum. These plasma cells contained numerous large eosinophilic inclusion bodies, which have been classified as ‘Russell’ bodies. Because of the Russell-body-containing plasma cells in the antrum, the gastritis has been classified as Russell body gastritis. Modified Giemsa stain of biopsy samples and stool test for H. pylori was negative. To further define the nature of the infiltrating and Russell-body-containing plasma cells and to exclude a lymphoproliferative disorder, immunohistologic analysis was carried out. Immunoreactivity against CD79a, CD20 was not increased, while anti-kappa light chain and anti-lambda light chain immunoreactivity showed strong signals, altogether suggesting no lympho-proliferative disorder. Further, routine laboratory studies including routine hematology and serum chemistry was unremarkable. Serum and urine protein electrophoresis was normal. Patient was prescribed with oral omeprazole 40 mg/day with good relief in his symptoms. At one year follow up in the outpatient clinic patient was doing well without any further episode of UGIB.

A Semi-Mechanistic Model to Predict the Effects of Liver Cirrhosis on Drug Clearance

Liver cirrhosis is characterized by a decrease in functional hepatocytes, lowered circulating levels of plasma proteins and alterations in blood flow due to the development of portacaval shunts. Depending on the interplay between these parameters and the characteristics of an administered drug, varying degrees of impaired systemic clearance and first-pass metabolism are anticipated. The Simcyp Population-based ADME Simulator has already been used successfully to incorporate genetic, physiological and demographic attributes of certain subgroups within healthy populations into in vitro-in vivo extrapolation (IVIVE) of xenobiotic clearance. The objective of this study was to extend population models to predict systemic and oral drug clearance in relation to the severity of liver cirrhosis. Information on demographics, changes in hepatic blood flow, cytochrome P450 enzymes, liver size, plasma protein binding and renal function was incorporated into three separate population libraries. The latter corresponded to Child-Pugh scores A (mild), B (moderate) and C (severe) liver cirrhosis. These libraries, together with mechanistic IVIVE within the Simcyp Simulator, were used to predict the clearance of intravenous and oral midazolam, oral caffeine, intravenous and oral theophylline, intravenous and oral metoprolol, oral nifedipine, oral quinidine, oral diclofenac, oral sildenafil, and intravenous and oral omeprazole. The simulated patients matched the clinical studies as closely as possible with regard to demographics and Child-Pugh scores. Predicted clearance values in both healthy control and liver cirrhosis populations were compared with observed values, as were the fold increases in clearance values between these populations. There was good agreement (lack of statistically significant difference, two-tailed paired t-test) between observed and predicted clearance ratios, with the exception of those for two studies of intravenous omeprazole. Predicted clearance ratios were within 0.8- to 1.25-fold of observed ratios in 65% of cases (range 0.34- to 2.5-fold). The various drugs that were studied showed different changes in clearance in relation to disease severity, and a 'one size fits all' solution does not exist without considering the multiple sources of the changes. Predictions of the effects of liver cirrhosis on drug clearance are of potential value in the design of clinical studies during drug development and, clinically, in the assessment of likely dosage adjustment.

A Biodegradable Esophageal Stent in the Treatment of a Corrosive Esophageal Stenosis in a Child

A Biodegradable Esophageal Stent in the Treatment of a Corrosive Esophageal Stenosis in a Child

M1885 Gastric Acid Suppression of a New Oral Powder Omeprazole Suspension for Infants with GERD. Pilot Study

M1885 Gastric Acid Suppression of a New Oral Powder Omeprazole Suspension for Infants with GERD. Pilot Study

Pantoprazole vs. Ranitidine for Prevention of Peptic Ulcer Rebleeding

Multiple studies and meta-analyses have shown that high-dose proton-pump inhibitor (PPI) therapy reduces rebleeding in patients with peptic ulcers and high-risk endoscopic stigmata. Investigators have evaluated either intravenous or oral omeprazole but have used pantoprazole when IV omeprazole was unavailable. Although it seems logical that pantoprazole would have a similar effect, confirming data are lacking. Now, investigators have performed a multicenter, international study randomizing 1256 patients with bleeding peptic …

Helicobacter pylori related dyspepsia: prevalence and treatment outcomes at University Kebangsaan Malaysia-Primary Care Centre

BackgroundOptimum management of dyspepsia in primary care is a debatable subject. Testing for Helicobacter pylori (HP) has been recommended in primary care as this strategy will cure most underlying peptic ulcer disease and prevent future gastro duodenal disease.MethodsA total of 98 patients completed Modified Glasgow Dyspepsia Severity Score Questionnaire (MGDSSQ) at initial presentation before undergoing the 13Carbon Urea Breath Test (UBT) for HP. Those with positive UBT received Eradication Therapy with oral Omeprazole 20 mg twice daily, Clarithromycin 500 mg daily and Amoxycillin 500 mg twice daily for one week followed by Omeprazole to be completed for another 4 to 6 weeks. Those with negative UBT received empirical treatment with oral Omeprazole 20 mg twice daily for 4 to 6 weeks. Patients were assessed again using the MGDSSQ at the completion of treatment and one month after stopping treatment.ResultsThe prevalence of dyspepsia at Universiti Kebangsaan Malaysia-Primary Care Centre was 1.12% (124/11037), out of which 23.5% (23/98) was due to HP. Post treatment assessment in both HP (95.7%, 22/23) and non HP-related dyspepsia (86.7%, 65/75) groups showed complete or almost complete resolution of dyspepsia. Only about 4.3% (1/23) in the HP related dyspepsia and 13.3% (10/75) in the non HP group required endoscopy.ConclusionThe prevalence of dyspepsia due to HP in this primary care centre was 23.5%. Detection of HP related dyspepsia yielded good treatment outcomes (95.7%).

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

The effect of omeprazole on asthmatic adolescents with gastroesophageal reflux disease

The prevalence of gastroesophageal reflux disease (GERD) is increasing in patients with asthma and the effect of proton pump inhibitor therapy on asthma outcome has shown variable results. The aim of this study was to determine the efficacy of omeprazole in the treatment of asthma and improvement of pulmonary function in adolescents with GERD. Thirty-six consecutive patients (range, 13-20 years old) with moderate persistent asthma and GERD were recruited on regular follow-up in Mashhad City. The case group included 18 patients who received oral omeprazole (20 mg twice a day for 6 weeks) and the control group included 18 patients who received placebo. A pulmonary function test was examined in two groups immediately before and 6 weeks after medication. The symptoms of GERD were significantly improved with omeprazole in the case group. After 6 weeks of study, the mean values of forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow rate were higher in patients treated with omeprazole (p<0.0001). Treatment by omeprazole is effective for treatment of asthmatic patients with GERD.