Therapy For Peptic Ulcer Disease Research Articles

Rational Drug Therapy of Peptic Ulcer Disease In Patients Admitted To Gastroenterology Ward of LRH Peshawar, Khyber Pakhtunkhwa, Pakistan

The present study was conducted from 12 Sep.2019 to 10 Nov. 2019 at the Gastroenterology ward, Lady Reading Hospital Peshawar Pakistan, aiming to accurately investigate the Peptic Ulcer Disease state, signs and symptoms, to ensure complete information about drug therapy and patients response. Peptic ulcer disease is defined as an upper gastric mucosal rupture due to acid hat results in the formation of ulcers that extend beyond the muscular mucosa to the submucosa. Peptic ulcer is characterized by abdominal pain, change in appetite, unexplained weight loss, nausea, vomiting, heart burn and dark, tarry stools. Spicy and acidic foods, Stress and restless lifestyle were considered to be the leading causes of peptic ulcer. However the Helicobacter pyloribacterium is responsible for up to 60% stomach ulcers. Frequent use of painkillers, old age, obesity Smoking, excessive alcohol use, too little sleep, type O blood and chronic stress, are the risk factors of peptic ulcers. Acute peptic ulcers results from taking aspirin or anti-inflammatory drugs. Chronic peptic ulcer represents a profound loss of substance. Data from a total of10 patients (6 female and 4 male)of all age, having various peptic ulcer diseases were involved in this study. It was concluded that most of the female patients (60%) were having peptic ulcers as compared to male patient (40%). It was found that 30-40 years old peptic ulcer patient percentage was 20%.Moreover it was observed that frequent use of Nonsteroidal Anti-inflammatory Drugs has been found to be the main causes of peptic ulcers

A129 CYP2C19 PHARMACOGENETIC TESTING IN PAEDIATRIC PATIENTS WITH EOSINOPHILIC ESOPHAGITIS INFLUENCES DOSING OF PROTON-PUMP-INHIBITORS AND RESPONSE TO THERAPY

BackgroundEosinophilic esophagitis (EoE) is a chronic inflammatory disorder that can be treated with a proton pump inhibitor (PPI). Pharmacogenetics (PGx) is the study of how variations in an individual’s genome influences drug response. Genetic variation in the metabolism gene CYP2C19 can produce differences in enzyme activity which is known to be a contributing factor for therapeutic failure with PPI treatment. Use of 2nd generation PPI (rabeprazole) can be beneficial in some as this PPI is less effected by CYP2C19 metabolism. PGx has been studied in PPI therapy for peptic ulcer disease but has not been demonstrated in patients with EoE.AimsTo describe the CYP2C19 metabolism in patients with EoE on PPI and to estimate the clinical utility of PGx testing in directing subsequent changes in therapy with improvement in remission rates.MethodsInterim analyses of a single centre, non-interventional, ongoing descriptive pilot study investigating CYP2C19 metabolism in patients with EoE, as part of a larger PGx pilot study and EoE- AHEAD Registry Study at SickKids. Patients with EoE that were newly diagnosed and started PPI or those not in remission on current non-PPI therapy or not in remission on dose PPI (2 mg/kg/day, max 30 mg lansoprazole BID) were included. Active disease was defined as a peak eosinophil count >15/hpf.Results37 patients met the inclusion criteria with completed PGx test; mean age was 13 years, 29(78%) were male, and 13(35%) had concurrent atopic disease. PGx testing showed that 12(32%) and 4(11%) were rapid (RM) and ultrarapid metabolizers (URM) respectively (Fig.1), which is significantly higher than the population average. Of this subgroup, 9 started rabeprazole, 3 had a lansoprazole dose increase, and 4 had no changes. Overall, changes in therapy based on PGx testing were made in 29(78%) patients, 8 are awaiting follow-up (Fig 2). Currently, the patients with available repeat biopsy results after PGx test-guided therapy changes is limited due COVID-19 related delays in endoscopies.ConclusionsThe preliminary findings of our study using PGx to guide PPI dosing in pediatric patients with EoE demonstrate that PGx test results lead to a change in clinical management in most patients. In RM and URM, PGx results trigger an adjustment of PPI dose or type could lead to earlier disease remission in PPI-responsive patients, thereby optimizing PPI efficacy. PGx may support dose reduction in poor metabolizers aiming to avoid long-term adverse events.Further correlation with endoscopy and histology findings of patients after PGx-guided therapy changes will follow. Furthermore, it is important to examine if CYP2C19 variant information available before PPI therapy further streamlines an initial phase of the treatment. Funding AgenciesDr. Marcon: J Garfield Campbell Fund, Dr. Hulst: Start-up Funds from the Department of Pediatrics at SickKids

SAT-497 Importance of OTC Medications in Hypercalcemia

Background: Calcium-alkali syndrome, formerly known as milk-alkali syndrome was a classic cause of hypercalcemia until newer therapies for peptic ulcer disease emerged is mostly seen today in osteoporosis prevention and secondary hyperparathyroid treatment in chronic kidney disease. Here we present the contemporary presentation as a result of the classic syndrome. Case: 57-year-old male, history of hypertension, type-2 diabetes, Hodgkin’s lymphoma in remission was admitted with lower abdominal pain and difficulty voiding. His vitals and physical exam were within normal limits. Medications included Janumet, Lipitor and Ramipril. Labs showed a white count of 15.3cells 103 /uL with a left shift and a normal hemoglobin level. Serum chemistry with BUN of 37mg/dl, creatinine at 3.86mg/dl, calcium at 15.3mg/dl, albumin level of 3.4g/dl, corrected to 15.5mg/dl, phosphorous was low at 1.6mg/dl with normal magnesium level of 1.7mg/dl. The patient had prior normal renal function and calcium levels. Lymphoma was highest on the differential for the hypercalcemia. Workup revealed intact PTH of 9.9pg/ml (Low), PTHrp at 12pg/ml (14-27), 1,25- dihydroxy vitamin D level of <8 pg/ml (Low), 25-hydroxy vitamin D at 14.9ng/ml (Low). Serum protein electrophoresis revealed elevated alpha-1 and alpha-2 proteins signifying an ongoing acute inflammation. ACE levels were low at 5U/L (9-67). TSH levels were normal. LDH levels were normal at 234U/L. Further questioning revealed that the patient took about 40 tablets of over the counter “Tums” for gastritis in the last 3 days. Tums contains 500 -1117mg elemental calcium/tablet. It has been noted that calcium absorption markedly increases in the gut with high intake of 10-15gms calcium/day despite suppressed calcitriol levels. Based on the above, the diagnosis of Milk-Alkali syndrome: modern presentation was made. The calcium was treated with aggressive hydration and counselling regarding excessive Tums usage. Removal of Tums restored normal calcium levels and renal function. The modern presentation differs from the classic in being an incidental discovery, as the patient is asymptomatic as in our case. Hypophosphatemia is common due to an absence of phosphate load unlike with milk. Hypomagnesemia could be present as the high calcium inhibits magnesium resorption. Treatment includes removal of the offending agent and isotonic saline infusion. Furosemide has been tried but it may cause hypocalcemia as the suppressed PTH is slow to respond. For the same reason bisphosphonates should be avoided. Conclusion: Calcium-Alkali-syndrome, a now uncommon classic cause of hypercalcemia presents with a reversible triad of non-PTH, noncalcitriol mediated hypercalcemia, metabolic alkalosis and renal insufficiency in the setting of excessive ingestion of calcium with an absorbable alkali. OTC medications should be included in the history to avoid missing this diagnosis.

The study of the antiulcer effect of the lyophilized extract of fireweed herb on the model of ethanol-prednisolone stomach damage in rats

Peptic ulcer disease therapy includes schemes for the use of a number of drugs; most of them are synthetic with many side effects and contraindications. Therefore, the search for alternative herbal medicines with the anti-inflammatory and reparative action in the treatment of peptic ulcer is pathogenetically justified and relevant since herbal medicinal products are characterized by a wide range of pharmacological properties and high safety with sufficient efficiency.Aim. To study the antiulcer activity of the lyophilized extract of the fireweed (Chamaenerion angustifolium) herb when gastric lesion in rats simulated with the ethanol-prednisolone mixture.Materials and methods. Gastroprotective properties of the lyophilized extract of fireweed herb were studied on the model of acute ulcer of the stomach in rats; it was simulated by intragastric administration of the mixture of prednisolone in the dose of 20 mg/kg and 80 % ethanol in the dose of 6 ml/kg. By the method generally used the blood serum was obtained for biochemical examination, the stomach was removed, cut along a low curvature, and the condition of the gastric mucosa was assessed using a loupe. The ulcerous index and the anti-ulcer activity were calculated, the content of TBA of active products, the activity of catalase, the content of reduced glutathione and succinate dehydrogenase were determined.Results. It was found that the lyophilized extract of fireweed herb in the dose of 20 mg/kg significantly stimulated reparative processes in the areas of the ulcer defect. The degree of lesion of the mucous membrane of the stomach in all animals with visible changes in the state of the mucous membrane corresponded to 1 point (only edema, the absence of folding and/or 1-2 small ulcerations were observed); the ulcerative index compared to animals of control pathology decreased by an average of 4.3 times. The antiulcer activity of the extract studied was 49 %. The lyophilized extract of fireweed herb normalized lipid peroxidation processes at the organ level.Conclusions. On the model of ethanol-prednisolone damage of the stomach in rats the fireweed herb showed the antiulcer effect, which was not inferior to the action of the reference drug – the herbal tea “Gastrofit” by its intensity.

Terapie peptického vředu

The modern therapy for peptic ulcer disease and other acid peptic diseases is based on administration of proton pump inhibitors (PPI) which have fully replaced anacids, parasympatholytics and histamine H2 receptor antagonists. The most effective way is to administer proton pump inhibitors in the morning on an empty stomach in a single daily dose. It is a very safe therapy, despite the fact that a potential adverse effect of long-term PPI treatment on the efficacy of other medications (clopidogrel), on bone metabolism and development of respiratory infections have been discussed recently. PPI also play an essential role in the eradication treatment of Helicobacter pylori infection, the prevention and treatment of gastropathy induced by nonsteroidal anti-inflammatory drugs and in relation to some rare hypersecretory conditions. The role of proton pump inhibitors in the therapy for functional dyspepsia is contradictory. Massive bleeding from the peptic ulcer is a relatively frequent complication of NSAID gastropathy. Endoscopic hemostasis and parenteral administration of PPI for at least 72 hours are used in therapy. Key words: acid peptic diseases - gastric secretion - peptic ulcer - proton pump inhibitors.

Do elevated blood calcium levels in patients with peptic ulcer facilitate perforation?

Aim: Calcium is primarily stored in bones in the body. The increase in blood calcium level due to primary or secondary causes leads to several impairments of the gastrointestinal system like anorexia, nausea-vomiting, peptic ulcer (PU), and abdominal pain. In this study, we want to compare and analyse the difference in blood calcium levels of patients who underwent surgery for peptic ulcer perforation (PUP) and those diagnosed with PU by endoscopy. Material and Methods: Between May 2012-January 2017, patientsÂ’ data for PU disease were recorded and our study was planned retrospectively Patients were sorted into two groups: Group1 included patients operated for PUP; and Group2 included the patients with administered medical therapy for PU disease. Blood calcium levels during admission, age, gender and drug history of patients were recorded. Study exclusion criteria were patients whose data were missing (113 patients), patients who had metabolic bone disease, patients who had been using calcium channel blockers and who were administered anti-ulcer drugs. Results: Twenty-eight patients had PUP and 176 patients had PU disease. Group 1 had a lower mean age (p=0.017), and higher male gender rate (p

Sa1420 Clinical Predictors for Technical Success and Complications of Ercp in Patients With Billroth II Anatomy: A Single Center, Eleven Year Experience

The frequency with which physicians that perform ERCP encounter Billroth II anatomy will decline as the incidence of gastric malignancy decreases, endoscopic resection techniques for early malignancy advance and with effective medical therapy for peptic ulcer disease. ERCP is challenging in Billroth II anatomy with increased risk for perforation(10-18%) and lower rates of success(70-80%). Consequently, factors that predict technical success and complications are important.

A Neglected Field of Peptic Ulcer Disease Therapy: Its Relation with Vitamin Supplements

Introduction: Market supply and consumer demand for vitamins have been growing worldwide over the last decade. Peptic ulcer disease (PUD) accounts for a large proportion of morbidity of gastrointestinal disorders. Interactions of over the counter (OTC) or prescribed vitamins with pharmacotherapeutic agents for PUD are often ignored by gastroenterologists and may have important therapeutic implications as the PUD patient population is vulnerable to harmful drug-vitamin interactions This is a systematic review to assess the negative clinical outcomes with concomitant use of vitamins and common pharmaceutical agents for PUD. Methods: Study Selection Criteria: Studies relevant to the negative outcomes after taking vitamins with Histamine H2-receptor antagonists (H2RA) and proton pump inhibitors (PPI) were selected. Data collection & extraction: Articles were searched in PubMed, Medline, and two other databases. Data analysis: Outcomes related to vitamin use with above PUD meds were retrieved and all relevant data was extracted to an Excel® spreadsheet with data abstraction checklists. Results: Data was extracted from 27 studies on the outcomes of concomitant use of vitamins with H2RA and PPI. 10 single vitamins, including vitamin A (retinol), thiamine, niacin, vitamin B6, folic acid, vitamin B12, vitamin c, vitamin D, vitamin E and vitamin K, were involved in more than 50 interactions with medications for peptic ulcer disease, which include H2RA (n=29, 46%): cimetidine (n=11), ranitidine (n=6), famotidine (n=8), nizatidine (n=4); PPI (n=34, 54%), including omeprazole, lansoprazole, esomeprazole, rabeprazole and pantoprazole. The majority (61.1%) of outcomes was attributed to pharmacokinetic-related mechanisms. 26.7% and 12.2 % were attributable to pharmacodynamics and combined mechanisms, respectively. Vitamin E appeared to bind with the nuclear receptor, pregnane X receptor, which results in increased expression of CYP3A4, therefore, increase metabolism of omeprazole. Conclusion: The significance of drug interactions of vitamins with commonly used anti-ulcer medications appears to be ill-appreciated by practicing gastroenterologists. To improve the treatment outcomes in PUD patients, gastroenterologist must be familiar with the consequences of combining vitamins with current pharmaceutical agents for PUD. However, clinical adverse outcomes such as slow or no ulcer healing, increased risk of ulcer-related bleeding or other complications, are rarely reported and merit further studies.

Antisecretory and antiulcerative effects of ethyl acetate fraction of &lt;i&gt;Nigella sativa &lt;/i&gt;(L.) Seed extract in rats

The present work was carried out to investigate the possible effects of ethyl acetate seed fraction of Nigella sativa on gastric ulcers and basal gastric secretions using the Non-Steroidal Anti-inflammatory Drug-induced (NSAID) model. Phytochemical screening according to Trease and Evans, 2002 and acute toxicity tests using the Lorke’s Method, 1983 were conducted. For the mucosal integrity study, ulcer and preventive indices were analysed, while volume of gastric juice, titratable acidity, acid output and pepsin concentration were assessed for basal gastric secretion parameters. Phytochemical screening revealed the presence of flavonoids, alkaloids, saponins, glucocinolates amongst others, while the acute toxicity studies revealed a median lethal dose above 5000mg/kg. The rats were grouped into 9 (n = 5), with the extract fraction administered at 50, 100 and 200mg/kg subcutaneously, followed by pyloric ligation with cimetidine used as the standard drug. Five rats received normal saline 1ml/kg/rat subcutaneously (S.C) as Negative Control, Five rats received indomethacin (20 mg/kg S.C), Ten rats for the study of the effect of two different doses of cimetidine 50 and 100 mg/kg S.C (5 rats for each dose). Ten rats for the study of effect of two different doses of cimetidine (50 mg and 100 mg/kg) S.C, given 30 minutes prior to indomethacin administration (5 rats for each dose). The three experimental doses of the extract at 50,100 and 200mg/kg showed a dosedependent decrease in both ulcer and preventive indices with the 200mg/kg dose at 0.6mm and 94% respectively. It also showed a significant (p<0.05) decrease in volume of gastric juice, titratable acidity, acid output and pepsin concentration in dose-dependent manner with the three experimental doses administered with the highest reduction at the 200mg/kg dose. The results obtained suggest that this fraction down-regulated all those parameters which might be attributed to the presence of the phytoconstituents present in this fraction, particularly the flavonoids. Therefore, the extract fraction of this plant possesses gastroprotective activity further explaining the folkloric use of this plant in the therapy of peptic ulcer disease. Keywords : Antiulcerative, Antisecretory, Nigella sativa, Phytochemicals, Rats, Seed Extracts.

Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive people.

Peptic ulcer disease is the cause of dyspepsia in about 10% of people. Ninety-five percent of duodenal and 70% of gastric ulcers are associated with Helicobacter pylori. Eradication of H. pylori reduces the relapse rate of ulcers but the magnitude of this effect is uncertain. This is an update of Ford AC, Delaney B, Forman D, Moayyedi P. Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive patients. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003840. DOI: 10.1002/14651858.CD003840.pub4. To assess the proportion of peptic ulcers healed and the proportion of participants who remained free from relapse with eradication therapy against placebo or other pharmacological therapies in H. pylori-positive people.To assess the proportion of participants that achieved complete relief of symptoms and improvement in quality of life scores.To compare the incidence of adverse effects/drop-outs (total number for each drug) associated with the different treatments.To assess the proportion of participants in whom successful eradication was achieved. In this update, we identified trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (1950 to March 2016) and Ovid EMBASE (1980 to March 2016). To identify further relevant trials, we handsearched reference lists from trials selected by electronic searching, and published abstracts from conference proceedings from the United European Gastroenterology Week (published in Gut) and Digestive Disease Week (published in Gastroenterology). The search was last updated in March 2016. We contacted members of Cochrane Upper GI and Pancreatic Diseases,and experts in the field and asked them to provide details of outstanding clinical trials and any relevant unpublished materials. We analysed randomised controlled trials of short- and long-term treatment of peptic ulcer disease in H. pylori-positive adults. Participants received at least one week of H. pylori eradication compared with ulcer healing drug, placebo or no treatment. Trials were included if they reported assessment from two weeks onwards. We collected data on ulcer healing, recurrence, relief of symptoms and adverse effects. We calculated the risk ratio (RR) with 95% confidence intervals (CI) using both fixed-effect and random-effects models with Review Manager software (RevMan 5.3) based on intention-to-treat analysis as far as possible. A total of 55 trials were included for one or more outcomes for this review.In duodenal ulcer healing, eradication therapy was superior to ulcer healing drug (UHD) (34 trials, 3910 participants, RR of ulcer persisting = 0.66, 95% confidence interval (CI) 0.58 to 0.76; 381/2286 (adjusted proportion: 12.4%) in eradication therapy plus UHD versus 304/1624 (18.7%) in UHD; low quality evidence) and no treatment (two trials, 207 participants, RR 0.37, 95% CI 0.26 to 0.53; 30/125 (adjusted proportion: 21.7%) in eradication therapy versus 48/82 (58.5%) in no treatment; low quality evidence).In gastric ulcer healing, the differences were imprecise between eradication therapy and UHD (15 trials, 1974 participants, RR 1.23, 95% CI 0.90 to 1.68; 220/1192 (adjusted proportion: 16.0%) in eradication therapy plus UHD versus 102/782 (13.0%) in UHD; very low quality evidence). In preventing duodenal ulcer recurrence the differences were imprecise between maintenance therapy with H.pylori eradication therapy and maintenance therapy with UHD (four trials, 319 participants, RR of ulcer recurring 0.73; 95% CI 0.42 to 1.25; 19/159 (adjusted proportion: 11.9%) in eradication therapy versus 26/160 (16.3%) in UHD; very low quality evidence), but eradication therapy was superior to no treatment (27 trials 2509 participants, RR 0.20, 95% CI 0.15 to 0.26; 215/1501 (adjusted proportion: 12.9%) in eradication therapy versus 649/1008 (64.4%) in no treatment; very low quality evidence).In preventing gastric ulcer recurrence, eradication therapy was superior to no treatment (12 trials, 1476 participants, RR 0.31, 95% CI 0.22 to 0.45; 116/697 (adjusted proportion: 16.3%) in eradication therapy versus 356/679 (52.4%) in no treatment; very low quality evidence). None of the trials reported proportion of people with gastric ulcer not healed after initial therapy between H.pylori eradication therapy and no active treatment or the proportion of people with recurrent gastric ulcer or peptic ulcers during maintenance therapy between H.pylori eradication therapy and ulcer healing drug therapy. Adding a one to two-week course of H. pylori eradication therapy is an effective treatment for people with H. pylori-positive duodenal ulcer when compared to ulcer healing drugs alone and no treatment. H. pylori eradication therapy is also effective in preventing recurrence of duodenal and gastric ulcer compared to no treatment. There is currently no evidence that H. pylori eradication therapy is an effective treatment in people with gastric ulcer or that it is effective in preventing recurrence of duodenal ulcer compared to ulcer healing drug. However, confidence intervals were wide and significant benefits or harms of H. pylori eradication therapy in acute ulcer healing of gastric ulcers compared to no treatment, and in preventing recurrence of duodenal ulcers compared to ulcer healing drugs cannot be ruled out.

69-Year-Old Woman With Confusion and Fatigue

Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN (H.M.K.); Advisor to resident and Consultant in Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN (A.E.K.). A 69-year-old woman presented to her primary care physicianwith a 4-day history of fatigue and dizziness. She was 45 minutes late for her appointment because she had trouble driving to the office. She reported no motor or sensory deficits but had difficulty with coordination. Review of systems was positive for dysuria and urinary frequency. She did not have fever, chills, weight or appetite changes, respiratory, cardiac, or gastrointestinal symptoms, or recent head trauma. The patient’s medical history was remarkable for hypertension, hyperlipidemia, type 2 diabetes mellitus, osteoporosis, and gastroesophageal reflux disease. Medications included metoprolol tartrate, lisinopril with hydrochlorothiazide, lovastatin, cholecalciferol, and as-needed calcium carbonate. She had smoked half a pack of cigarettes per day for 40 years but had quit smoking 6 years previously. She didnot use alcohol or illicit drugs. On examination, the patient was afebrile with a blood pressure of 104/67 mm Hg, heart rate of 76 beats/min, respiratory rate of 17 breaths/min, oxygen saturation of 94% while breathing room air, and body mass index (calculated as weight in kilograms divided by height inmeters squared) of 39 kg/m. Shewas alert and oriented to person, place, and time. Her speech was dysarthric, and she had difficulty following simple commands. Her coordination was impaired with symmetric dysmetria on finger-to-nose testing, heel-kneeshin testing, and rapid alternating movements. Cranial nerves II through XII were intact. Results of motor and sensory examinations were within normal limits. Reflexes were symmetric. Lymph node, thyroid, cardiac, respiratory, gastrointestinal, musculoskeletal, and skin examinations identified no abnormalities.

Pharmacological evaluation of cytoprotective potential of Phyllanthus Emblica (PE) and Asparagus Racemosus (AR) in preventing gastric erosions, ulcerations and inflammation induced in rats

Background: Most of the currently available therapies for peptic ulcer disease have their own limitations and an ideal therapeutic agent is not yet available in the market.Hence,we decided to explore the cytoprotective potential of Indian Medicinal Plants namely Phyllanthus emblica and Asparagus racemosus along with ranitidine as a positive control in various animal models. Aims & Objective: To evaluate the cytoprotective effect of the extracts of Phyllanthus emblica (PE) and Asparagus racemosus (AR) in preventing gastric erosions, ulcerations and inflammation induced in rats. Materials and Methods: Cold immobilization stress, ethanol (99.9%), aspirin were the experimental models selected for inducing gastric erosions and ulcerations. Ulcer index , erosions, oedema, congestion and inflammation were the parameters studied for assessing gastric damage whereas carrageenininduced rat paw oedema model was used to induce inflammation. Ranitidine was used as a positive control. Results : The two drugs chosen for the study namely Phyllanthus emblica and Asparagus racemosus prevented gastric damage significantly in the ethanol group (p<0.05) and cold stress group (p<0.05). In the aspirin group, erosions, oedema, congestion and inflammation were remarkably reduced by PE cold water extract (PECWE) and PE hot water extract (PEHWE) and in the AR treated groups when compared with the control group. PECWE and PEHWE showed significant anti-inflammatory activity (p<0.05) comparable to aspirin thereby proving their role in inflammatory disorders. In our study, AR also showed a significant protection (p<0.05) against ethanol, cold stress and aspirin group. Conclusion : The present study supports that ethanol, cold simmobilization stress and aspirin induce gastritis, gastric erosions and ulcerations and Phyllanthus emblica and Asparagus racemosus have significant potential as prominent cytoprotectants against these toxic effects.

Proton pump inhibitors in acute peptic ulcer bleeding

Proton pump inhibitors in acute peptic ulcer bleeding

Proton pump inhibitors in acute peptic ulcer bleeding

Proton pump inhibitors in acute peptic ulcer bleeding

Helicobacter pylori and nonmalignant diseases.

This paper reviews the new literature from the past year on the association between colonization with Helicobacter pylori and non-malignant disease of the upper gastrointestinal tract. This issue has, in the past year, remained a topic of wide research interest yielding many important new data. These data show that H. pylori eradication is the most effective therapy for peptic ulcer disease, but that a considerable proportion of ulcer patients remain to have dyspeptic symptoms. The discussion on the interaction between H. pylori and NSAID use in the etiology of ulcer disease has not yet been settled. Several studies, both from Asia and Europe, now reported that H. pylori eradication has a minimal effect on the primary prevention of ulcer disease in NSAID users, but eradication appears of relevance for the secondary prevention of ulcer disease in addition to proton pump inhibitor maintenance therapy. Various studies brought further support for the hypothesis that H. pylori eradication is of some benefit for patients with non-ulcer dyspepsia, although the effects are limited. The prevalence of H. pylori is lower among GERD patients than among controls, but H. pylori eradication has not been consistently shown to increase the risk for the newly development of GERD in an individual subject undergoing H. pylori eradication. The discussion on H. pylori and GERD should not preclude us from treating H. pylori-infected patients for accepted clinical indications. In patients using proton pump inhibitors for GERD, H. pylori eradication leads to a resolution of their corpus-predominant pangastritis, without impairing the efficacy of PPI therapy.

Current therapy for nonvariceal upper gastrointestinal bleeding.

Upper gastrointestinal bleeding continues to plague physicians despite the discovery of Helicobacter pylori and advances in medical therapy for peptic ulcer disease. Medical therapy with new nonsteroidal anti-inflammatory medications and somatostatin/octreotide and intravenous proton pump inhibitors provides hope for reducing the incidence of and treating bleeding peptic ulcer disease. Endoscopic therapy remains the mainstay for diagnosis and treatment of upper gastrointestinal bleeding. Many methods of endoscopic hemostasis have proven useful in upper gastrointestinal hemorrhage. Currently, combination therapy with epinephrine injection and bicap or heater probe therapy is most commonly employed in the United States. Angiography and embolization play a role primarily when endoscopic therapy is unsuccessful.

Use of Helicobacter pylori-specific antibodies in the evaluation of intestinal metaplasia and gastric dysplasia

It is believed that Helicobacter pylori acts mainly during the initial phases of gastric carcinogenesis. Therefore, this study aims to assess the usefulness of H. pylori diagnosis in patients with chronic gastritis (CG), intestinal metaplasia (IM) and dysplasia – conditions that are associated with gastric cancer. A cross-sectional study of 94 patients was performed, which involved endoscopic biopsy and determination of specific serum anti-H. pylori antibodies (IgA, IgG and IgM) by enzyme-linked immunosorbent assay (ELISA). Biopsies were taken from the gastric antrum and corpus, and from endoscopic lesions. Two specimens per patient were used for bacterial culture. H. pylori infection status, used as the gold standard, was based on culture results. Validity measures were determined and receiver operating curve (ROC) was used to determine the best cut-off for serum antibody levels. Histopathological evaluation (n=160) was performed independently by two pathologists. Lesions consistent with CG were found in 86 patients (91%), consistent with IM in 69 patients (73%) and with dysplasia in five patients (5%). In the 86 patients with CG, 38 (44%) were infected by H. pylori, as were 26 (38%) and one (20%) with IM and dysplasia, respectively (P=0.039). Area under the curve (AUC) was 0.40 (95% confidence interval [CI]: 0.28–0.51) for IgM, 0.69 (0.58–0.80) for IgA and 0.83 (0.74–0.92) for IgG for the diagnosis of H. pylori infection. Best cut-off was 41 u/mL for IgG, with a sensitivity (95% CI) of 90% (84–96%) and a negative predictive value (NPV) of 91% (85–97%). For IgA the results were 22 u/mL, 74% (65–83%) and 77% (68–86%), respectively. Prevalence of H. pylori appeared to decrease with increasing severity of the gastric lesion. In conclusion, it is suggested that non-invasive serological evaluation of anti-H. pylori (IgG) status after eradication therapy for peptic ulcer disease could be extended, after proper assessment of cut-off values and their validation, to the follow-up of patients with CG and IM.

Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients.

Peptic ulcer disease is the cause for dyspepsia in about 10% of patients. 95% of duodenal and 70% of gastric ulcers are associated with Helicobacter pylori. Eradication of H pylori reduces the relapse rate of ulcers but the magnitude of this effect is uncertain. The primary outcomes were the proportion of peptic ulcers healed initially and proportion of patients free from relapse following successful healing. Eradication therapy was compared to placebo or pharmacological therapies in H. pylori positive patients. Secondary aims included symptom relief and adverse effects. A search was undertaken according to the Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group module using CCTR, MEDLINE, EMBASE and CINAHL databases. Experts in the field and pharmaceutical companies were contacted. Abstract books between 1994 and 2002 were hand-searched. Randomised controlled trials of short and long-term treatment of peptic ulcer disease in H. pylori positive adults were analysed. Patients received at least one week of H pylori eradication compared with ulcer healing drug, placebo or not treatment. Trials were included if they reported assessment from 2 weeks onwards. Data were collected on ulcer healing, recurrence, relief of symptoms and adverse effects. 59 trials were eligible. Data extraction was not possible in 7 trials, and 52 trials were included. In duodenal ulcer healing, eradication therapy was superior to ulcer healing drug (UHD) (34 trials, 3910 patients, relative risk [RR] of ulcer persisting = 0.66; 95% confidence interval [CI] = 0.58, 0.76) and no treatment (2 trials, 207 patients, RR = 0.37; 95% CI 0.26, 0.53). In gastric ulcer healing, no significant differences were detected between eradication therapy and UHD (13 trials, 1469 patients, RR = 1.32; 95% CI = 0.92, 1.90). In preventing duodenal ulcer recurrence no significant differences were detected between eradication therapy and maintenance therapy with UHD (4 trials, 319 patients, relative risk [RR] of ulcer recurring = 0.73; 95% CI = 0.42, 1.25), but eradication therapy was superior to no treatment (26 trials 2434 patients, RR = 0.19; 95% CI = 0.15, 0.26). In preventing gastric ulcer recurrence, eradication therapy was superior to no treatment (9 trials, 774 patients, RR = 0.31; 95% CI 0.19, 0.48). A 1 to 2 weeks course of H. pylori eradication therapy is an effective treatment for H. pylori positive peptic ulcer disease.

Current Features of Peptic Ulcer Disease in Finland: Incidence of Surgery, Hospital Admissions and Mortality for the Disease During the Past Twenty-five Years

Background: Medical therapy of peptic ulcer disease (PUD) has improved dramatically during the past 20 years with the introduction of modern antisecretory drugs as well as eradication therapy of Helicobacter pylori. During the 1990s, there has been a 3-fold increase in the consumption of histamine2-receptor antagonists and proton-pump inhibitors, but also an 8-fold increase in the consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) in Finland. Methods: The incidence of surgery, hospital admissions and mortality for PUD was analysed between 1972 and 1999; the data were collected from the National Research and Development Centre for Welfare and Health and from the National Centre for Statistics. In the analysis, the codes of the International Statistical Classification of Diseases 8-10 were used. Results: In 1987, 11.9 elective operations (per 10 5 inhabitants) were performed (mean of 2 consecutive years), but only 1.3 in 1997, a reduction of 89%. In 1987, 5.2 emergency operations for ulcer perforation or bleeding were performed, whereas there were 7.5 in 1997, an increase of 44%. The annual hospital admission rate increased from 38.3 admissions (per 10 5 inhabitants) in 1972 (mean ± s (standard deviation) of 5 consecutive years) to 68.7 in 1992. This 79% increase was mainly due to bleeding from gastric ulcer in elderly women. The overall annual mortality rate increased between 1972 and 1992 from 6.4 to 8.4 deaths (per 10 5 inhabitants), i.e. by 31%. The mortality rate from ulcer perforation and haemorrhage increased from 4.2 deaths in 1972 to 7.3 deaths in 1992, i.e. by 74%. Conclusions: The increasing incidence rates of emergency surgery, hospital admissions and mortality for PUD in the 1980s and 1990s have started to decrease in the most recent years in Finland. This epidemiologic change probably reflects both the demographic change and an increased consumption of NSAIDs, among the elderly people, in particular. The most recent epidemiologic change may reflect an increased consciousness about the harmful effects of conventional NSAIDs. Regardless of the constantly occurring emergency surgery, elective surgery for PUD is hardly ever required today.

Lansoprazole: an update of its place in the management of acid-related disorders.

Lansoprazole is an inhibitor of gastric acid secretion and also exhibits antibacterial activity against Helicobacter pylori in vitro. Current therapy for peptic ulcer disease focuses on the eradication of H. pylori infection with maintenance therapy indicated in those patients who are not cured of H. pylori and those with ulcers resistant to healing. Lansoprazole 30 mg combined with amoxicillin 1g, clarithromycin 250 or 500mg, or metronidazole 400 mg twice daily was associated with eradication rates ranging from 71 to 94%, and ulcer healing rates were generally >80% in well designed studies. In addition, it was as effective as omeprazole- or rabeprazole-based regimens which included these antimicrobial agents. Maintenance therapy with lansoprazole 30 mg/day was significantly more effective than either placebo or ranitidine in preventing ulcer relapse. Importantly, preliminary data suggest that lansoprazole-based eradication therapy is effective in children and the elderly. In the short-term treatment of patients with gastro-oesophageal reflux disease (GORD), lansoprazole 15, 30 or 60 mg/day was significantly more effective than placebo, ranitidine 300 mg/day or cisapride 40 mg/day and similar in efficacy to pantoprazole 40 mg/day in terms of healing of oesophagitis. Lansoprazole 30 mg/day, omeprazole 20 mg/day and pantoprazole 40 mg/day all provided similar symptom relief in these patients. In patients with healed oesophagitis. 12-month maintenance therapy with lansoprazole 15 or 30 mg/day prevented recurrence and was similar to or more effective than omeprazole 10 or 20 mg/day. Available data in patients with NSAID-related disorders or acid-related dyspepsia suggest that lansoprazole is effective in these patients in terms of the prevention of NSAID-related gastrointestinal complications, ulcer healing and symptom relief. Meta-analytic data and postmarketing surveillance in >30,000 patients indicate that lansoprazole is well tolerated both as monotherapy and in combination with antimicrobial agents. After lansoprazole monotherapy commonly reported adverse events included dose-dependent diarrhoea, nausea/vomiting, headache and abdominal pain. After short-term treatment in patients with peptic ulcer, GORD, dyspepsia and gastritis the incidence of adverse events associated with lansoprazole was generally < or = 5%. Similar adverse events were seen in long-term trials, although the incidence was generally higher (< or = 10%). When lansoprazole was administered in combination with amoxicillin, clarithromycin or metronidazole adverse events included diarrhoea, headache and taste disturbance. In conclusion, lansoprazole-based triple therapy is an effective treatment option for the eradication of H. pylori infection in patients with peptic ulcer disease. Preliminary data suggest it may have an important role in the management of this infection in children and the elderly. In the short-term management of GORD, lansoprazole monotherapy offers a more effective alternative to histamine H2-receptor antagonists and initial data indicate that it is an effective short-term treatment option in children and adolescents. In adults lansoprazole maintenance therapy is also an established treatment option for the long-term management of this chronic disease. Lansoprazole has a role in the treatment and prevention of NSAID-related ulcers and the treatment of acid-related dyspepsia; however, further studies are needed to confirm its place in these indications. Lansoprazole has emerged as a useful and well tolerated treatment option in the management of acid-related disorders.