Prevention Of Duodenal Ulcer Relapse Research Articles

Efficacy of misoprostol and ranitidine in the prevention of duodenal ulcer relapse and its correlation with endogenous gastric prostanoid synthesis

We determined endogenous gastric prostaglandin synthesis and its correlation with the prevention of duodenal ulcer relapse by misoprostol and ranitidine. Sixty-one patients with recent endoscopically healed duodenal ulcer were randomly allocated in a double-blind fashion for one year of treatment with misoprostol 400 micrograms nocte, ranitidine 150 mg nocte or placebo. Patients were followed every two months. Endoscopy was repeated at six and 12 months or beforehand, if relapse was suspected. Antral and fundic biopsies, 3-4 from each region, were obtained at each endoscopy for determination of prostaglandin synthesis. During the one year of treatment, 11 out of the 12 placebo treated patients flared up, as opposed to 10 out of 25 and four out of 24 misoprostol and ranitidine treated patients, respectively. The difference between all treatment groups was significant (P less than 0.0001). In all subjects who flared up, pretrial endogenous antral and fundic prostaglandin E2 synthesis were not different from their respective synthesis in those who did not relapse.

Lansoprazole is superior to ranitidine as maintenance treatment for the prevention of duodenal ulcer relapse

To compare lansoprazole 30 mg once daily, lansoprazole 15 mg once daily and ranitidine 150 mg once nightly in the prevention of duodenal ulcer relapse in patients whose duodenal ulcers had been previously healed with lansoprazole 30 mg once daily or ranitidine 300 mg nightly. A double-blind, parallel group, randomized multicentre study conducted in 33 centres in the UK, Eire, Sweden and Australia. Two hundred and nineteen patients with a duodenal ulcer were randomized to receive lansoprazole 30 mg and 217 to receive ranitidine 300 mg for 8 weeks. Patients were then re-randomized to receive lansoprazole 30 mg (122 patients), lansoprazole 15 mg (121 patients) or ranitidine 150 mg (116 patients) for 12 months. All patients had an endoscopically-proven duodenal ulcer at baseline and were considered suitable for long-term maintenance therapy to prevent relapse. Significantly more patients were healed on lansoprazole (98%) compared to ranitidine (89%) (P < 0.001, Fisher's exact test). Lansoprazole provided more rapid symptom relief than ranitidine. Lansoprazole 30 mg and lansoprazole 15 mg increased the probability of not relapsing in comparison to ranitidine (P = 0.001 and 0.06, respectively, life-table analysis). Relapse rates over the 12 months were lower in the lansoprazole treatment groups (lansoprazole 30 mg, 5%; lansoprazole 15 mg, 12%; and ranitidine, 21%; lansoprazole 30 mg vs. ranitidine 150 mg, P = 0.002). Symptoms were well controlled in both groups during the maintenance phase. All treatments were well tolerated with no major differences seen in adverse event profiles between treatment groups. Both doses of lansoprazole (30 mg and 15 mg) were superior to ranitidine 150 mg in the prevention of duodenal ulcer relapse. Lansoprazole was superior to ranitidine in terms of symptom control and duodenal ulcer healing. Both treatments were well tolerated.

Ranitidine bismuth citrate plus clarithromycin is effective in the eradication of Helicobacter pylori and prevention of duodenal ulcer relapse: [formula omitted], SJ. Sontag, AA. Ciociola, DL. Sykes, DJ. McSorley, DD. Webb and the H. pylori Ulcer Group. Univ. of Texas VA Medical Center, Dallas TX, VA Medical Center, Hines IL, Glaxo Inc., RTP NC

Ranitidine bismuth citrate plus clarithromycin is effective in the eradication of Helicobacter pylori and prevention of duodenal ulcer relapse: [formula omitted], SJ. Sontag, AA. Ciociola, DL. Sykes, DJ. McSorley, DD. Webb and the H. pylori Ulcer Group. Univ. of Texas VA Medical Center, Dallas TX, VA Medical Center, Hines IL, Glaxo Inc., RTP NC

Prevention of duodenal ulcer relapse with amoxycillin and omeprazole [Reply

Prevention of duodenal ulcer relapse with amoxycillin and omeprazole [Reply

Prevention of duodenal ulcer relapse with amoxycillin and omeprazole

European Journal of Gastroenterology & Hepatology: November 1994 - Volume 6 - Issue 11 - p 1071

Prevention of duodenal ulcer relapse with amoxycillin and omeprazole

Objective: To evaluate, prospectively, whether omeprazole and amoxycillin eradicate Helicobacter pylori and prevent duodenal ulcer relapse. Patients and methods: This prospective multicentre trial included 53 patients. Twenty-nine H. pylori-positive patients were treated with omeprazole for 4 weeks (group A) and the remaining 24 received amoxycillin plus omeprazole for 2 weeks. Eradication of H. pylori was evaluated using the rapid urease test and histological examination. Results: Six months after the end of therapy, H. pylori was eradicated in two out of 23 patients (9%) from group A and 10 out of 21 (48%) from group B. The ulcer relapse rate was 68% (n = 15) for patients from group A and 1 7% (n = 3) for those from group B. Conclusions: Our regimen eradicated H. pylori in half of our patients and is effective in preventing ulcer relapse with few adverse events

Prevention of Duodenal Ulcer Relapse by Long-Term Treatment with Omeprazole

Duodenal ulcer is a chronic disease with a high risk of relapse--if left untreated, the relapse rate is 50-80% per year (1). However, the relapse rate can be effectively reduced by inhibition of gastric acid secretion. Although many patients can be managed with episodic therapy, controlled either by the patient or doctor, continuous maintenance treatment is often necessary for patients with severe forms of the disease and those at risk of complications (2). Maintenance therapy with single night-time doses of an H2-receptor antagonist reduces relapse rates from approximately 75% to 25% per year (3). As omeprazole is more effective than the H2-receptor antagonists in the acute treatment of duodenal ulcer, healing virtually all patients within 4 weeks (4), it may also be more effective in the maintenance treatment of duodenal ulcer disease. To date, three studies have reported the effect of omeprazole on relapse rates of duodenal ulcer. A Danish multicentre study involved 195 patients, who were treated with omeprazole, either 10 mg once daily, or 20 mg once daily on Friday, Saturday and Sunday (weekend therapy), or with placebo (5). After 6 months, the remission rates were 67% and 70%, respectively, for those patients receiving omeprazole--significantly higher than in those receiving placebo (17% after 6 months). An Italian multicentre study of 81 patients found that omeprazole, both 10 mg once daily, and 20 mg once daily at weekends (Friday, Saturday and Sunday), was equally effective in preventing relapse. The proportions of patients in remission were 81% and 70%, respectively, after 6 months (6).(ABSTRACT TRUNCATED AT 250 WORDS)

Acid, motility, and ulcers: a comparison of cisapride with placebo in the prevention of duodenal ulcer relapse.

In a single centre double blind study of 66 patients, the value of cisapride (10 mg twice daily) was compared with placebo in the prevention of duodenal ulcer relapse. Patients who remained ulcer free attended for clinical review every two months and had a mandatory endoscopy at 0, 4, 8, and 12 months or if symptoms suggestive of ulcer recurrence developed. The 12 month crude relapse rates (that underestimate the probability of ulcer recurrence) showed that cisapride was superior to placebo (34% (11/32) relapsed on cisapride v 68% (23/34) on placebo, p = 0.007). This finding was confirmed using lifetable analysis, with a 35% reduction (95% confidence intervals 10-59%, p < 0.05) in the proportion of ulcer relapses in patients who had received cisapride compared with those treated with placebo. These results are similar to those reported in maintenance trials of H2 receptor antagonists analysed by the same method. Drug related adverse clinical events were mainly trivial, but led to three patients on cisapride and one on placebo withdrawing from the trial.

Omeprazole for prevention of duodenal ulcer relapse

Source Citation Lauritsen K, Andersen BN, Laursen LS, et al. Omeprazole mg three days a week and 10 mg daily in prevention of duodenal ulcer relapse. Double-blind comparative trial. Gastroenterolog...

Omeprazole 20 mg three days a week and 10 mg daily in prevention of duodenal ulcer relapse: Double-blind comparative trial

In a double-blind, parallel-group clinical trial of 195 patients with duodenal ulcers who after a short-term study had relief of pain and healed ulcers proved endoscopically, 65 were randomized to receive 20 mg omeprazole 3 days a week (once in the morning from Friday to Sunday), 64 to receive 10 mg omeprazole once daily in the morning, and 66 to receive placebo for up to 6 months. The patients underwent repeat endoscopy with biopsy of the gastric fundic mucosa (qualitative assessment of argyrophilic cell population), assessment of symptoms, and laboratory screening with measurement of basal serum gastrin concentrations at 3 and 6 months or more often if indicated by recurrence of symptoms. At 3 months, endoscopically proved ulcer relapse occurred in 16% receiving 20 mg omeprazole 3 days a week; 21% receiving 10 mg omeprazole daily; and 50% receiving placebo. At 6 months, corresponding rates were 23%, 27%, and 67% with 95% confidence intervals of difference between the placebo group and omeprazole groups of 28%-60% and 24%-56% (P less than 0.00001), respectively, and between omeprazole groups of -19%-11% (NS). No major clinical or laboratory side effects were noted. Thus both omeprazole regimens are effective and safe in preventing duodenal ulcer relapse.

Oxygen-Derived Free Radicals and the Prevention of Duodenal Ulcer Relapse: A New Approach

This study investigated whether or not oxygen-derived free radicals are implicated in the mechanism of recurrence of duodenal ulceration. To this end, allopurinol (50 mg qds)--a hydroxyl scavenger and an inhibitor of xanthine oxidase which forms superoxide radicals--and dimethyl sulphoxide (DMSO, 500 mg qds)--a hydroxyl scavenger--were given orally. Three hundred and two consecutive patients with previous symptomatic, endoscopy-proven duodenal ulceration which had been shown endoscopically to have healed and who were smokers and social drinkers, were randomized to receive for one year either placebo, cimetidine 400 mg at bedtime, allopurinol, or DMSO. In two hundred and twenty patients evaluable for efficacy, the cumulative relapse at one year was: placebo 65%, cimetidine 30%, allopurinol 12% and DMSO 13%. Cimetidine was significantly effective (p less than 0.01); however, allopurinol and DMSO were equally efficacious and superior to cimetidine (p less than 0.05). In patients who relapsed, the ulcer recurrence tended to occur early on placebo and to be evenly distributed over the year on active therapy. In all the groups, the relative frequency of symptomatic to silent relapses was similar in the first and second halves of the year and was comparable among the groups. The results suggest that oxygen-derived free radicals are directly implicated in the mechanism of duodenal ulcer relapse and that removing the radicals reduces recurrence of this ulceration.

Rioprostil, a new Prostaglandin E1Analogue, in the Once-Daily Treatment for the Prevention of Duodenal Ulcer Recurrence: A Comparison with Ranitidine

The efficacy of Rioprostil (a new prostaglandin E1 analogue) is compared with that of ranitidine in the recurrence prevention of duodenal ulcer(s). Duration of treatment is 6 months. Ninety-seven patients received rioprostil, 600 micrograms once-daily orally, and 110 patients received ranitidine, 150 mg once-daily orally. On rioprostil, 14.9% of patients showed a relapse after 6 months compared to 10.1% on ranitidine. Diarrhoea occurred in 7 patients on rioprostil and 3 patients on ranitidine. Rioprostil given 600 micrograms daily in the evening is a highly effective treatment for the prevention of duodenal ulcer relapse, the efficacy not being significantly different from ranitidine 150 mg.

Rioprostil and Ranitidine in the Prevention of Duodenal Ulcer Relapse

One hundred and ninety duodenal ulcer patients who had relief of pain and endoscopically proven ulcer healing after a short treatment period are allocated at random to double-blind maintenance treatment with a synthetic dehydroprostaglandin-E1, rioprostil, 300 micrograms, or ranitidine, 150 mg, at bedtime for 6 months. Patients are monitored every two months and examined by endoscopy after six months of treatment, or more often if warranted. The cumulative relapse rate in the rioprostil group at six months is 32% (25/78) vs. 28% (20/72) in the ranitidine group. This difference is not significant. The percentage of side effects observed is 17% in the rioprostil group vs. 5% in the ranitidine group, but discontinuation of treatment is observed with the same frequency in the two groups.

Dietary fibre and peptic ulcer.

Until some years ago dietary regulations constituted the most important part of peptic ulcer treatment. The clinical value of the traditional, bland, low-fibre diet has never been documented. A survey is given of the influence of a high-fibre diet on peptic ulcer disease. Studies evaluating the effect of a high-fibre diet in the treatment of gastric and duodenal ulcer as well as the prophylactic effect on duodenal ulcer recurrence are reviewed. Experimental studies in vitro and in vivo have been performed to look at the possible mechanisms by which fibre could innfluence ulcer diathesis. The fibre components, guar gum (Guarem) and fibre-enriched wheat bran (Fiberform) effectively bind bile acids in gastric juice both in vitro and in vivo. The bile acid binding in vivo is effective not only in healthy subjects but also in patients with gastric ulcer. Fibre-enriched wheat bran prolongs the meal-induced pH elevation and reduces postprandial pepsin concentrations. The fibre-induced alterations of in-tragastric pH and pepsin are not due to alterations of gastric emptying as physiological doses of the fibre components mentioned do not influence the gastric emptying of a semi-solid meal in healthy subjects.The clinical studies revealed a prophylactic effect of a high-fibre diet in the prevention of duodenal ulcer relapse. However, in the treatment of acute gastric and duodenal ulcer, there seems to be no obvious advantage in the use of a high-fibre diet compared with the traditional bland diets.

H2-receptor antagonists: development and application.

The advent of H2-receptor antagonists has dramatically advanced the understanding and treatment of peptic ulcer disease. Ranitidine and cimetidine have been shown to be safe and effective in healing duodenal and gastric ulcers and in prevention of duodenal ulcer relapse. Due to differences in chemical structure, ranitidine is more potent and has a longer duration of action and fewer side effects than cimetidine. The current trend in therapy is toward less frequent dosing patterns with more attention toward controlling nocturnal acid secretion. Possibilities for other therapeutic uses of H2-receptor antagonists are suggested.

PREVENTION BY BEDTIME CIMETIDINE OF DUODENAL-ULCER RELAPSE

45 patients with healed duodenal ulcers completed a six-month double-blind trial to compare the effects of cimetidine and placebo on the prevention of duodenal-ulcer relapse. A single bedtime dose of cimetidine (800 mg) was given and ulcer relapse was assessed endoscopically at regular intervals. At the end of the six-month trial, 16 of the 21 (76%) cimetidine-treated patients remained ulcer-free compared with only 3 of the 24 (12·5%) placebo-treated patients. No untoward effects of this treatment were observed.