Short-term Treatment Of Duodenal Ulcer Research Articles

Morphologic and Ultrastructural Effects of Maalox TC on Human Gastric and Duodenal Mucosa

Prostaglandins (PGs) and aluminum-containing antacids (Al.AAs) are effective in preventing gastric and duodenal lesions induced by neutralizing agents. The efficacy of Al.AAs is thought to be due to neutralizing properties and to stimulation of endogenous PGs synthesis. Liquid Maalox has the same effect as cimetidine 400 mg on postprandial duodenal acid load. In numerous prospective studies, Al.AAs have been shown to be as effective as cimetidine in the short-term treatment of duodenal ulcer (DU). Maalox TC at a dosage of 3 tablets b.i.d. provides an effective method for preventing DU relapse. Its effect is similar to that of nighttime cimetidine. Meta-analysis of prospective trials suggests that Al.AAs prevent stress ulcers more effectively than does cimetidine. It has been suggested that Al.AA acts by inducing surface epithelial cell disruption. Al-induced mucosal protection could be caused by a stimulated release of endogenous PGs, induced by Al microcrystal penetration of cells. In a recent study, we showed that small amounts of Al were absorbed by human gastric mucosa and accumulated in lysosomes; however, we did not observe any histological or ultrastructural lesions of the gastric mucosa. Prostaglandins (enprostil, misoprostol, and rioprostil) are as effective as cimetidine, but less effective than ranitidine, in healing DU. Enprostil and rioprostil have been shown to be as effective as ranitidine in treating gastric ulcer (GU). Moreover, enprostil inhibits postprandial gastrin release, whereas H2-blockers increase gastrin levels. Coadministration of misoprostol with aspirin is highly effective in healing aspirin-induced gastroduodenal lesions. Moreover, cotreatment with misoprostol was associated with a marked decrease in GU in patients with osteoarthritis receiving NSAIDs chronically.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of Sucralfate and Ranitidine Twice Daily in Duodenal Ulcer Treatment

Sucralfate and ranitidine were compared in the treatment of duodenal ulcer in this multicenter, randomized, double-blind study. A total of 165 patients with endoscopically proven duodenal ulceration were included in the trial and randomized to treatment with sucralfate, 2 g b.i.d. (morning and evening with an empty stomach), or ranitidine, 150 mg twice daily. All patients were endoscopically examined after 4 and, if unhealed, 8 weeks. Of the patients considered suitable for analysis at 4 weeks, 73.5% (61 of 83) of the sucralfate group demonstrated healing of the ulcer in comparison with 63.3% (50 of 79) of the ranitidine group. At 8 weeks cumulative healing rates were 89% (74 of 83) and 84.8% (67 of 79), respectively. When smokers were considered separately, healing rates at 4 weeks were 69.2% (36 of 52) for sucralfate and 53.3% (24 of 45) for ranitidine. At 8 weeks cumulative healing rates were 92.3% (48 of 52) and 77.7% (35 of 45), respectively (p less than 0.05). Overall, there was no difference in the two groups regarding symptom relief and side effects. These results suggest that these drugs are equally effective in the short-term treatment of duodenal ulcer, although in smokers sucralfate appears to be more effective than ranitidine.

Comparative study of mifentidine and ranitidine in the short-term treatment of duodenal ulcer

The efficacy and safety of mifentidine 20 mg at night, a new, potent, long-acting H2-receptor antagonist, has been compared with ranitidine 300 mg at night in 60 patients with acute duodenal ulcer, in a randomized double-blind study. Antacid tablets were allowed as additional treatment for pain relief. The treatment lasted for 4 weeks. After 4 weeks of treatment the healing rate was similar; amongst the patients who completed the treatment, healing was 68% for mifentidine, 63% for ranitidine, and on intention-to-treat analysis, healing in both groups was 63%. Pain relief and antacid consumption were similar in both groups. Clinically significant adverse effects were not detected and any changes in laboratory values were minimal, clinically insignificant and reversible. Mifentidine appears to be an effective and safe once-a-day treatment for acute duodenal ulcer disease.

Combined Ranitidine and Pirenzepine in the Treatment of Duodenal Ulcer: A Multicentre Double-Blind Study Using Endoscopy

The efficacy of a combination of ranitidine and pirenzepine in the short-term treatment of duodenal ulcer was evaluated in a double-blind trial. In a multicentre study, 352 patients with active duodenal ulcers were randomly allocated to be treated with 300 mg/day ranitidine plus placebo (group I), 300 mg/day ranitidine plus 50 mg/day pirenzepine (group II), or 300 mg/day ranitidine plus 100 mg/day pirenzepine (group III) for 4 weeks. The respective healing rates assessed using endoscopic examination after 2 and 4 weeks' treatment were 40% and 70% in group 1, 44% and 82% in group II, and 37% and 77% in group III. The differences between the treatment groups were not significant, although 300 mg/day ranitidine plus 50 mg/day pirenzepine tended to be superior to the other treatments. Analgesic activity was the same in the three groups with 33%, 34% and 33% reductions, respectively, in the numbers of patients experiencing pain after 2 weeks. Side-effects (mainly dry mouth and blurred vision) were significantly more frequent in group III patients.

Single night‐time doses of 40 mg famotidine or 800 mg cimetidine in the treatment of duodenal ulcer

Famotidine (40 mg) and 800 mg cimetidine as single night-time doses were compared in a randomized, double-blind, multicentre study of acute treatment for duodenal ulceration. Fifteen centres recruited 304 patients into the study. Of these, 274 were included for analysis, with 136 receiving famotidine and 138 receiving cimetidine. After 4 weeks, 75% of the patients who received famotidine and 77% of the patients who received cimetidine were healed. At 6 weeks the cumulative healing rates were 91% with famotidine and 87% with cimetidine. Differences between the groups were not significant at 4 or 6 weeks. No significant difference in healing rates between smokers and non-smokers was found. Day and night pain resolved rapidly in both groups. Both treatments were well-tolerated; adverse events were reported in 17 patients on famotidine and 18 on cimetidine, with headache the most frequent event in both groups. Famotidine is effective and well-tolerated in the short-term treatment of duodenal ulcer.

Omeprazole in the Treatment of Duodenal Ulcer

Omeprazole is the most effective antisecretory agent available today. Open and dose-comparative studies have documented that at dosages of 20 mg/day or more, the drug produces duodenal ulcer healing rates of 90-100% after 4 weeks. Controlled trials show that omeprazole, 20-40 mg/day, is superior to cimetidine and ranitidine in healing duodenal ulcer, with a median therapeutic gain of 21% at 2 weeks and 15% at 4 weeks. Ulcer symptom relief is also more pronounced and faster with omeprazole than with H2-receptor antagonists. No significant side-effects attributable to treatment with omeprazole have appeared in any of these studies or in the accumulated experience from several thousand patients treated with omeprazole. No tendency to an increase in recurrence rate after discontinuation of treatment with omeprazole has been shown. In summary, omeprazole constitutes a major advance in the short-term treatment of duodenal ulcer, giving fast and pronounced healing and symptom relief.

Sucralfate in Duodenal Ulcer Disease: A Double-Blind Trial

ABSTRACT Seventy-five patients with endoscopically confirmed duodenal ulcer disease received either sucralfate (34 patients) or placebo (41 patients) for 6 weeks in a double-blind clinical trial. N...

An Open Trial of Omeprazole in Short-Term Treatment of Duodenal Ulcer

Omeprazole is a new, potent and long acting inhibitor of gastric acid secretion. This open, non-controlled trial has been carried out to assess the duodenal ulcer healing rate with omeprazole, 30 mg once daily.

Comparison of two sucralfate dosages (2 g twice a day versus 1 g four times a day) in duodenal ulcer healing

The effects of two dosage regimens of sucralfate, 2 g twice a day (one-half hour before breakfast and at night) and 1 g four times a day (one-half hour before meals and at night), on ulcer healing in 80 patients with endoscopically proved duodenal ulcer were compared. The study was single-blind and endoscopically controlled. Endoscopy was performed after four weeks and, if complete healing was not achieved, after an additional four weeks. Clinical assessment was carried out every two weeks. Seventy-four patients completed the study. After four weeks, the ulcer had healed in 28 of 36 patients (78 percent) who received 2 g of sucralfate twice a day and in 28 of 38 patients (74 percent) who received 1 g of sucralfate four times a day. The cumulative healing rates after eight weeks were 83 percent and 84 percent, respectively. The results suggest that sucralfate given in a dosage of 2 g twice a day is as effective as 1 g four times a day in the short-term treatment of duodenal ulcer.

A Double-Blind Endoscopic Study with De-Nol® Tablets and Cimetidine for Duodenal Ulcer

In a double-blind, double-dummy comparison of short-term ulcer healing, involving 50 patients treated with either De-Nol tablets (four times daily) or cimetidine tablets (400 mg, twice daily), no statistical difference in healing rates was observed after 8 weeks' treatment. There was, however, a numerical trend in favour of De-Nol (De-Nol, 100% healed; cimetidine, 88% healed). Statistical significance in favour of De-Nol was observed, however, in the reduction of antacid tablet consumption and relief of ulcer pain. No unwanted side effects were observed with either drug. This trial indicates that De-Nol and cimetidine are equally effective and useful in the short-term treatment of duodenal ulcer.

9 - Antacids and Anticholinergics in the Treatment of Duodenal Ulcer

Anticholinergic agents are most often divided into tertiary and quaternary ammonium compounds. Tertiary ammonium agents are fully and rapidly absorbed. Quaternary ammonium agents are slowly and incompletely absorbed, but do not cross the blood-brain barrier, or do so to a very limited degree, and have a very low rate of central nervous system side-effects. There are probably subclasses of cholinergic receptors, and anticholinergic agents have different affinities for these. Anticholinergics can decrease the basal acid secretion as well as secretion stimulated by histamine, pentagastrin, insulin or food. Combined therapy with antacids and anticholinergics will give a more long-lasting decrease in acidity than with either drug alone. The reported controlled studies with anticholinergic agents suggest that they can induce healing of duodenal ulcer to the same degree as cimetidine but at the cost of more frequent side-effects. Except for the studies on pirenzepine there are, however, too few studies in which anticholinergics have been compared with histamine H2-receptor antagonists; thus the place of anticholinergics in the treatment of an active duodenal ulcer is not clear. In doses of not less than 100 mg daily, pirenzepine is a candidate-drug for the short-term treatment of duodenal ulcer. At these doses, side-effects of dry mouth and visual disturbance are, however, rather frequent, and more serious side-effects such as urinary retention do also occur. More studies with both the conventional anticholinergics and pirenzepine, with emphasis not only on the desired effects but also on side-effects, are needed before anticholinergics can be taken into consideration as alternatives to histamine H2-receptor antagonists for healing and maintenance treatment. There is some evidence that long-term treatment with anticholinergic agents can decrease recurrences and complications of peptic ulcer disease. Even if there are some encouraging reports on the combination of anticholinergics and antacids, we need more such studies with lower doses of antacids and lower doses of anticholinergics before this combination therapy can be regarded as an equally good alternative to histamine H2-receptor antagonists for ulcer healing and symptom relief.

H2 antagonists: long-term ulcer therapy?

Accumulated worldwide experience with histamine receptor antagonists (H₂antagonists), presented at this year's World Congress of Gastroenterology in Stockholm, shows convincingly that these drugs are effective for more than short-term treatment of duodenal ulcer. Both cimetidine and the new, more specific H₂antagonist ranitidine heal 80% to 90% of both duodenal and gastric ulcers. More important, continuous administration of these agents keeps most ulcers—of both types—healed for at least 12 to 18 months, the longest study periods reported yet. As many as 10% of the population of industrialized countries may suffer either duodenal or gastric ulcer at some time during their lives. So it is not surprising that the first pharmacologically specific H₂antagonist approved for peptic ulcer, cimetidine, became one of the top two or three best-selling prescription agents in the United States within a few years of its introduction in 1977. It was equally inevitable

H2 antagonists: long-term ulcer therapy?

Accumulated worldwide experience with histamine receptor antagonists (H₂antagonists), presented at this year's World Congress of Gastroenterology in Stockholm, shows convincingly that these drugs are effective for more than short-term treatment of duodenal ulcer. Both cimetidine and the new, more specific H₂antagonist ranitidine heal 80% to 90% of both duodenal and gastric ulcers. More important, continuous administration of these agents keeps most ulcers—of both types—healed for at least 12 to 18 months, the longest study periods reported yet. As many as 10% of the population of industrialized countries may suffer either duodenal or gastric ulcer at some time during their lives. So it is not surprising that the first pharmacologically specific H₂antagonist approved for peptic ulcer, cimetidine, became one of the top two or three best-selling prescription agents in the United States within a few years of its introduction in 1977. It was equally inevitable

Pharmacology, clinical efficacy, and adverse effects of sucralfate, a nonsystemic agent for peptic ulcer.

Sucralfate, a complex salt of polyaluminum hydroxide with a sulfated disaccharide skeleton, has recently been approved by the Food and Drug Administration for the short-term treatment of duodenal ulcer. The drug is nonsystemic in action and apparently exerts its antiulcer effects by bonding with proteinaceous exudates in the ulcer crater, thereby protecting it from insult. In vitro and clinical studies have shown that the drug is not an antacid but does block the diffusion of acid. Inhibition of pepsin and bile acid activities have also been demonstrated. In double-blind clinical trials where patients used antacids as needed for pain, sucralfate 1 g 4 times a day was significantly more effective than placebo and as effective as cimetidine. No serious adverse effects have been caused by this locally-acting agent.

Comparison of the Healing Capacities of Sucralfate and Cimetidine in the Short-Term Treatment of Duodenal Ulcer: A Double-Blind Randomized Trial

Fifty-nine outpatients with endoscopically proven duodenal ulcer were evaluated for 4-8 wk in a randomized, double-blind trial comparing sucralfate, a sulfated disaccharide, (1 g, 0.5 h before each meal and at bedtime) with cimetidine (300 mg, 0.5 h before each meal and at bedtime). Ulcer symptoms and their relief were recorded by patients in a diary, along with data on cigarette, alcohol, coffee, and drug intake. Duodenoscopy was performed after 4 wk to assess healing, and was repeated after 8 wk if healing had not occurred by the 4-wk evaluation. Twenty-four of 30 patients taking sucralfate (80.0%) and 22 of 29 patients taking cimetidine (75.9%) had their ulcer completely healed after 4 wk. The overall healing rates after 8 wk for the sucralfate and cimetidine groups were 90.0% (27 of 30 patients) and 86.2% (25 of 29 patients), respectively. There were no significant differences between the two treatment groups in ulcer healing, symptom relief, and side effects. Symptoms were relieved equally with respect to time and efficacy. Minor adverse experiences were reported in each treatment group. None of these experiences were serious enough to warrant discontinuation of treatment. These results suggest tha sucralfate is as effective as cimetidine in the short-term treatment of duodenal ulcer.

How physicians use cimetidine: a survey of hospitalized patients and published cases.

WHEN the Food and Drug Administration released cimetidine for clinical use in 1977, only two indications were approved; short-term treatment of duodenal ulcer, and treatment of pathologic gastric acid hypersecretory conditions. Nevertheless, physicians presumably prescribe the drug for a much broader range of indications, since sales now amount to $500 million annually. Because little information is available about how cimetidine is actually used in clinical practice, we prospectively surveyed 200 consecutive patients who received cimetidine while hospitalized. We also reviewed published reports concerned with side effects of cimetidine and determined why the drug had been given to the 102 patients . . .

Comparison of sulglycotide with cimetidine in short-term treatment of duodenal ulcer: double-blind controlled trial.

Comparison of sulglycotide with cimetidine in short-term treatment of duodenal ulcer: double-blind controlled trial.