Treatment Of Peptic Ulcer Disease Research Articles

Study of the antiulcer activity of dry extract of garden cabbage on a model of subchronic gastric ulcer

Aim – to study the gastroprotective properties of dry cabbage garden extract on the model of experimental lesions of the gastric mucosa with acetylsalicylic acid.Materials and methods. Subchronic ulcerative lesions of the gastric mucosa of rats were simulated by intragastric administration of acetylsalicylic acid at a dose of 150 mg/kg for 3 days. Dry cabbage extract in a conditional therapeutic dose of 50 mg/kg and the comparison drugs omeprazole and altan were administered daily during the reproduction of the pathology and for another 2 days. The percentage of animals with ulcers in the group, the condition of the gastric mucosa were evaluated, the ulcer index and anti-ulcer activity were calculated. Histologically, the capacity of mucoid secretion by mucus-forming cells of the pathogenic epithelium outside the destruction zones by the severity of the PAS-reaction was investigated.Results. It was established that the dry extract of cabbage at a dose of 50 mg/kg leveled the ulcerogenic effect of acetylsalicylic acid at the level of omeprazole, which was reflected by a decrease in the ulcer index by 3,3 times, its antiulcer activity was 83 %. The maximum anti-ulcer effect was shown by the combination of dry cabbage extract with omeprazole, which significantly reduced the risk of developing damage to the gastric mucosa, ulcer index exceeded monotherapy with dry cabbage extract, omeprazole and altan, anti-ulcer activity was at the level of 94 %. The cabbage extract stabilized the processes of mucoid synthesis; when combined with omeprazole, the PAS-intensity of the gastric superficial-foveolar epithelium of the mucous membrane did not differ from the intact control in all the studied areas. The obtained data allow us to consider the dry extract of garden cabbage as a gastroprotector of acetylsalicylic ulcerogenesis.Conclusions. On the model of rats' gastric lesion with acetylsalicylic acid, a dry cabbage extract showed an anti-ulcer effect, by the severity of which it was not inferior to the comparator drug with the proton pump inhibitor omeprazole and significantly exceeded the phytopreparation of altan tablets. The combined use of cabbage extract and omeprazole showed a high prophylactic effect on the negative effect of nonsteroidal anti-inflammatory drugs on the gastric mucosa. One of the mechanisms of the gastroprotective effect of dry cabbage extract is its ability to enhance the formation of mucus by the cells of the integumentary-patchy epithelium of the stomach. The results indicate the promise of further research on the anti-ulcer properties of dry cabbage extract for the purpose of its use in the treatment of peptic ulcer disease and the prevention of gastropathy caused by nonsteroidal anti-inflammatory drugs.

Effectiveness of GastimunHp Plus in Supporting the Treatment of Peptic Ulcer Disease With Helicobacter Pylori Infection

Effectiveness of GastimunHp Plus in Supporting the Treatment of Peptic Ulcer Disease With Helicobacter Pylori Infection

Inhibitory pompy protonowej w opiece paliatywnej

The gold standard treatment for peptic ulcer disease, gastroesophageal reflux disease (GERD), and Zollinger-Ellison syndrome is the class of medications known as the proton pump inhibitors (PPIs). Omeprazole, the prototype of this group belongs to the chemical class of benzimidazoles; substitution of R groups account for the variation in properties and side-effect profile of the different members of this drug class. Highly potent blocker of gastric acid secretion, this class of medications exert their effects via a dose-dependent inhibitory action on hydrogen-potassium ATPase proton pump located on the luminal side of the gastric parietal cell. Proton pump inhibitors are mostly indicated in the treatment of chemotherapy induced gastroesophageal reflux disease (GERD), in addition, they are first line agents for the treatment of dyspepsia, Helicobacter Pylori eradication, and the prevention and treatment of NSAID and glucocorticosteroid-induced ulcers. There is evidence to support the use of PPIs for treatment of hemoptysis and to limit the incidence of rebleeding palliative patients with peptic ulceration, for metastatic esophageal and gastric carcinoma. The side effect profiles vary with each drug and there is potential for drug interactions especially in the setting of polypharmacy among palliative care patients.

Lansoprazole inhibits the cysteine protease legumain by binding to the active site.

Proton pump inhibitors (PPIs) are prodrugs used in the treatment of peptic ulcer diseases. Once activated by acidic pH, the PPIs subsequently inhibit the secretion of gastric acid by covalently forming disulphide bonds with the SH groups of the parietal proton pump, that is the H+ /K+ -ATPase. Long-term use of PPIs has been associated with numerous adverse effects, including bone fractures. Considering the mechanism of activation, PPIs could also be active in acidic micro-environments such as in lysosomes, tumours and bone resorption sites. We suggested that the SH group in the active site of cysteine proteases could be susceptible for inhibition by PPIs. In this study, the inhibition by lansoprazole was shown on the cysteine proteases legumain and cathepsin B by incubating purified proteases or cell lysates with lansoprazole at different concentrations and pH conditions. The mechanism of legumain inhibition was shown to be a direct interaction of lansoprazole with the SH group in the active site, and thus blocking binding of the legumain-selective activity-based probe MP-L01. Lansoprazole was also shown to inhibit both legumain and cathepsin B in various cell models like HEK293, monoclonal legumain over-expressing HEK293 cells (M38L) and RAW264.7 macrophages, but not in human bone marrow-derived skeletal (mesenchymal) stem cells (hBMSC-TERT). During hBMSC-TERT differentiation to osteoblasts, lansoprazole inhibited legumain secretion, alkaline phosphatase activity, but had no effects on in vitro mineralization capacity. In conclusion, lansoprazole acts as a direct covalent inhibitor of cysteine proteases via disulphide bonds with the SH group in the protease active site. Such inhibition of cysteine proteases could explain some of the off-target effects of PPIs.

The histaminergic control of the iridal vascular tone in rats and its influencing by topical administration of olopatadine and ranitidine

Objective. We evaluated the histamine's role in regulating the iris vasomotricity in rats, using as a research tool topical olopatadine, a selective H1 blocker, which is indicated for the treatment of allergic conjunctivitis and ranitidine, a selective H2 blocker mainly used for the treatment of peptic ulcer disease. Methods. Two groups of six Wistar rats anesthetized with ketamine 200 mg/kg body weight were used. They received distilled water in conjunctival instillations, initially and after 5 minutes, olopatadine 2.5 mmol/ l for the first group, respectively ranitidine 2.5 mmol/ l for the second group. The changes of the iris arteriolar and venular diameters were recorded. Results. Both olopatadine and ranitidine produced statistically significant iridal arteriolar vasoconstriction and ranitidine determined statistically significant venuloconstriction, while distilled water did not produce any statistically significant effect. Conclusions. There is a vasodilator histaminergic tone exerted through the histaminergic H1 and H2 receptors in the iris arterioles and, respectively, through the H2 receptors in the iridal venules. Olopatadine, a topical H1 antagonist used in the treatment of ocular allergies, may interfere with the humoral regulation of the iris arteriolar tone. Ranitidine, an H2 antagonist, decreased the diameter of the iris arterioles and venules, when administered topically in rats.

Efficacy and safety of Syferol-IHP for the treatment of peptic ulcer disease: a pilot, double-blind randomized trial.

BackgroundTo our knowledge, there is no prior randomized study on the utility of Syferol-IHP (blend of virgin coconut oil and Ocimum sanctum oil) when coadministered with a triple therapy schedule.AimThis study determined the efficacy and safety of Syferol-IHP as adjunct to conventional triple therapy for the treatment of peptic ulcer disease (PUD).MethodsA pilot double-blind randomized trial was conducted in patients with confirmed diagnosis (endoscopy-guided biopsy) of PUD. Eligible patients were randomized to Pylorest (a three-in-one tablet containing rabeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg) and Syferol-IHP for 2 weeks, followed by rabeprazole and Syferol-IHP for 2 weeks or Pylorest and placebo for 2 weeks, followed by rabeprazole and placebo for 2 weeks. Repeat endoscopy-guided biopsy and histology were done 4 weeks posttherapy. Primary outcome measures were the healing of ulcer and eradication of Helicobacter pylori. Secondary outcome measures were the disappearance of epigastric pain, gastritis, and duodenitis. Analysis was by intention-to-treat.ResultsOf the 63 patients enrolled, 60 patients had complete evaluation, with 37 patients receiving Pylorest and Syferol-IHP and 23 patients receiving Pylorest and Placebo. Healing of the PUD in favor of Pylorest and Syferol-IHP was significantly higher for gastric ulcer (RR=0.000, 95% CI=undefined, P=0.048) but not for duodenal ulcer (RR=0.400, 95% CI=0.07–2.37, P=0.241). H. pylori eradication was 100% with Syferol-IHP vs 50% with placebo (P=0.066). Epigastric pain (reduction to 16.2% vs 43.5%; P=0.021), gastritis (reduction to 13.5% vs 39.1%; P = 0.024), and duodenitis (reduction to 0% vs 8.7%; P=0.327) were observed in the Syferol-IHP and Pylorest vs placebo and Pylorest groups, respectively. Adverse events (RR=0.971, 95% CI=0.46–2.04, P=0.937) and laboratory parameters were not significantly different pre- and posttherapies (P>0.05, for both groups).ConclusionAlthough both treatment arms were equally safe, co-administration of Syferol-IHP and triple therapy is more efficacious than triple therapy alone for treating PUD. Pan African Clinical trial registry identifier number is PACTR201606001665364.

High prevalence of asymptomatic peptic ulcers diagnosed during screening endoscopy in patients with cirrhosis.

Background:Peptic ulcer disease (PUD) is more prevalent in cirrhotics and this may aggravate prognosis. We investigated the prevalence of PUD in cirrhotics and its potential association with Helicobacter pylori (H. pylori) infection, the underlying etiology and severity of liver disease, and other manifestations of portal hypertension (PH).Methods:We enrolled consecutive asymptomatic cirrhotic patients who underwent screening endoscopy in a tertiary hospital during a 12-month period. We recorded the presence of PUD and the endoscopic findings associated with PH. H. pylori infection was documented through either histology or CLO-test. The diagnosis of cirrhosis was based on elastography, liver biopsy or a combination of clinical, biochemical and imaging data.Results:One hundred patients (M/F: 54/46, mean age: 61±14 years) were included in the analysis. Viral hepatitis (37%) and alcohol (22%) were the most common causes of cirrhosis. Child-Pugh stage was A/B/C: 60/35/5. PUD was found in 19 patients (14 gastric, 5 duodenal). H. pylori infection was diagnosed in 54%. Varices were detected in 59% (39% needed treatment). PH gastropathy was present in 81% (severe in 33%). The presence of PUD was unrelated to the etiology and the severity of liver disease or to other endoscopic manifestations of PH. No correlation was found between PUD and H. pylori infection.Conclusions:A high prevalence of PUD was observed in our cirrhotic patients, although they were asymptomatic and had no known risk factors of ulcerogenicity. The value of screening endoscopy for the early diagnosis and treatment of PUD in cirrhotics deserves further investigation.

Role of Camphlobacter pylori and non steroidal anti-inflammatory drugs in the pathogenesis of peptic ulcer and pharmacological approaches for the treatment of peptic ulcer disease

Role of Camphlobacter pylori and non steroidal anti-inflammatory drugs in the pathogenesis of peptic ulcer and pharmacological approaches for the treatment of peptic ulcer disease

Recurrent Oral Ulcers: current and future therapeutic approaches

Recurrent Oral Ulcers: current and future therapeutic approaches

Diagnosis of Bezoar-induced small-bowel obstruction on sonography in emergency department

Bezoars are defined as indigestible foreign materials impacting in the gastrointestinal tract, which are classified according to what they are composed of. Small intestinal obstruction caused by bezoar impaction was a rare disease. However, it has become more and more recognized since gastrectomy with truncal vagotomy was introduced into the treatment of peptic ulcer disease. Computerized tomography (“CT”) is still the imaging modality of choice in preoperative diagnosis of small bowel obstruction caused by bezoars. Although ultrasound has less sensitivity and specificity in detecting bezoars as compared with CT, it still can reveal bezoars in 88% of patients. Some case reports have addressed the role of sonographic detection of small intestinal phytobezoar. Ultrasonography may be a more available and time saving tool when used as a “screening” modality at emergency department for patients with mild persistent nonspecific abdominal pain but without definite peritoneal signs, especially when presence of past history of gastrectomy with truncal vagotomy.

Pediatric Gastritis, Gastropathy, and Peptic Ulcer Disease.

1. Desiree Sierra, MD* 2. Mary Wood, MD* 3. Sneha Kolli, MD* 4. Lina Maria Felipez, MD† 1. *Department of Medical Education and 2. †Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children’s Hospital, Miami, FL * Abbreviations: H2RA: : histamine 2 receptor antagonist IBD: : inflammatory bowel disease NSAID: : nonsteroidal anti-inflammatory drug PPI: : proton pump inhibitor PUD: : peptic ulcer disease Providers should be able to identify the signs and symptoms of peptic ulcer disease in children, select the proper diagnostic tests needed to confirm the diagnosis, and describe adequate treatment regimens to start once the diagnosis is confirmed. After completing this article, readers should be able to: 1. Understand the mechanism and pathogenesis of gastritis, gastropathy, and peptic ulcer formation. 2. Recognize the symptoms of and risk factors for gastritis, gastropathy, and peptic ulcer disease. 3. Understand which patients warrant referral to a gastroenterologist for possible endoscopy. 4. Review the role of Helicobacter pylori in peptic ulcer disease. 5. Review the treatment of peptic ulcer disease with and without the presence of H pylori. Gastritis, gastropathy, and peptic ulcer disease (PUD), collectively known as acid peptic disease, are often described as a spectrum of the same disease. Although these conditions are more common in adults, their incidence in the pediatric population is clinically significant. Left untreated, gastritis can progress to PUD, which can result in serious complications such as perforation, bleeding, bowel strictures, and obstruction. Studies describing the role of Helicobacter pylori , nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and other causes have helped to further expand our understanding of gastritis and PUD in children. Direct visualization and the ability to biopsy with endoscopy have revolutionized the diagnosis and treatment of these diseases. The incidence of PUD in children is lower than that in adults. Based on several international studies, the incidence in children varies from 2% to 8%. (1)(2) The incidence of bleeding ulcers is lower and is estimated to be between 0.5 and 4.4 of 100,000 individuals. (3) These rates …

Disparities in peptic ulcer disease: A nationwide study

BackgroundWhile advances in diagnosis and treatment of peptic ulcer disease have led to a decrease in hospital admissions the socioeconomic distribution of these benefits is unknown. MethodsWe designed a retrospective cohort study using the National Inpatient Sample from 2012 to 2013 including all patients that were admitted for peptic ulcer disease. We compared the types of ulcer related complications, the rates of intervention and the outcomes based on race and insurance status. ResultsOf 42,046 patients admitted for peptic ulcer disease 80.25% had an ulcer related complication. Black patients had the lowest rates of bleeding and highest rates of perforation and were less likely to undergo surgery for their complication but mortality was not different from white patients. Uninsured patients also had lower rates of bleeding and higher rates of perforation and they were at increased risk for death. ConclusionsUnlike other surgical conditions insurance status, not race, predicts mortality in peptic ulcer disease.

EVALUATION OF GASTROPROTECTIVE EFFECT OF COENZYME Q 10 AND L - GLUTAMINE IN STRESS AND ETHANOL-INDUCED PEPTIC ULCER IN WISTAR RATS: A NOVEL PRECLINICAL STUDY

Objective: Coenzyme Q 10 (CoQ10) and L-glutamine have antioxidant property their role in peptic ulcer diseases is not well known. Hence, the aim of present study is to evaluate the gastroprotective role of CoQ10 and L-glutamine in stress and ethanol-induced peptic ulcers in Wistar albino rats.Methods: A total of 90 rats were used for the conduct of study in two experimental models, the stress- and the ethanol-induced ulcer model. Each model consists of eight groups with six rats in each group. Sucralfate and pantoprazole were used as standard drugs along with CoQ10 and L- glutamine as test drugs. Drugs were administered for 10 days in stress model and 7 days in case of ethanol model. Statistically analyzed using analysis of variance and post-hoc test with significance as p>0.05Results: CoQ10 and L- glutamine when used alone as well in combination with pantoprazole and sucralfate showed no ulcer formation. Test drugs showed decrease in gastric acid secretion, decreased total and free acidity levels, higher gastric pH, increased mucous secreting ability, higher levels of reduced glutathione levels in both tissue as well as blood and lower malondialdehyde levels when compared with pantoprazole and sucralfate suggestive of their antioxidative benefit, in both the models.Conclusion: Well-designed clinical trials can be done to evaluate the use of CoQ10 and L- glutamine in the treatment of peptic ulcer disease due to various etiology.

Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers.

With the advent of anti-Helicobacter pylori therapy, hospital admissions for peptic ulcer disease (PUD) have declined significantly since the 1990s. Despite this, operative treatment of PUD still is common. Although previous papers suggest that Candida in peritoneal fluid cultures may be associated with worse outcomes in patients with perforated peptic ulcers (PPUs), post-operative anti-fungal therapy has not been effective. We hypothesized that pre-operative anti-fungal drugs improve outcomes in patients with PPUs undergoing operative management. A prospectively maintained Acute and Critical Care Surgery (ACCS) database spanning 2008-2015 and including more than 7,000 patients was queried for patients with PPUs. Demographics and clinical outcomes were abstracted. Pre-operative anti-fungal use, intra-operative peritoneal fluid cultures, and infectious outcomes were abstracted manually. We compared outcomes and the presence of fungal infections in patients receiving peri-operative anti-fungal drugs in the entire cohort and in patients with intra-operative peritoneal fluid cultures. Frequencies were compared by the Fisher exact or χ2 test as appropriate. The Student's t-test was used for continuous variables. There were 107 patients with PPUs who received operative management; 27 (25.2%) received pre-operative anti-fungal therapy; 33 (30.8%) received peritoneal fluid culture, and 17 cultures (51.5%) were positive for fungus. The presence of fungus in the cultures did not affect the outcomes. There were no differences in length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, 30-day re-admission rates, or rates of intra-abdominal abscess formation or fungemia in patients who received pre-operative anti-fungal drugs regardless of the presence of fungi in the peritoneal fluid. Candida has been recovered in 29%-57% of peritoneal fluid cultures in patients with PPUs. However, no studies have evaluated pre-operative anti-fungal therapy in PPUs. Our data suggest that pre-operative anti-fungal drugs are unnecessary in patients undergoing operative management for PPU.

Novel Therapeutic Options for Prevention and Treatment of Peptic Ulcer Disease

Novel Therapeutic Options for Prevention and Treatment of Peptic Ulcer Disease

Nizatidine Based Floating Microspheres by Ionotropic Gelation Technique - Morphology and Release Characteristics

Nizatidine is a histamine H2-receptor antagonist that inhibits stomach acid production and used in the treatment of peptic ulcer disease and gastroesophageal reflux disease. The main aim of the present investigation was to develop gastro retentive floating microspheres for Nizatidine. These are prepared by ionotropic gelation method with an aim of increasing the gastric residence time and for controlled release. The polymeric mixture of Sodium alginate and HPMCK4, HPMC K15M and HPMC K 100M, was used as polymers. Calcium carbonate was used as the gas forming gent. Prepared Microspheres were characterized for the Micromeretic properties, incorporation efficiency, buoyancy test, SEM analysis, FTIR, and in vitro dissolution studies. The dissolution studies were carried out in 0.1N HCl and the results were applied to various kinetic models. Among the total 18 formulations F17 was optimized. The % yield of F17 formulation was found to be 95.47 ± 0.36%. Based on optical microscopy, the particle size was 50.67 ± 0.13μm. The % buoyancy, % entrapment efficiency and swelling index of F17 formulation was 94.23%, 93.62 ± 0.29% and 92.13 ± 0.17%, respectively. The Cumulative % drug release of F17 formulation was 98.23 ± 5.49% in 12 h when compared with marketed product 95.87 ± 0.31 in 12 h. SEM studies showed the particles were in spherical shape. Based on obtained results, Floating alginate Nizatidine microspheres were of good candidate for targeting to GIT.

Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials

SummaryBackgroundGastroprotectant drugs are used for the prevention and treatment of peptic ulcer disease and might reduce its associated complications, but reliable estimates of the effects of gastroprotectants in different clinical settings are scarce. We aimed to examine the effects of proton-pump inhibitors (PPIs), prostaglandin analogues, and histamine-2 receptor antagonists (H2RAs) in different clinical circumstances by doing meta-analyses of tabular data from all relevant unconfounded randomised trials of gastroprotectant drugs.MethodsWe searched MEDLINE and Embase from Jan 1, 1950, to Dec 31, 2015, to identify unconfounded, randomised trials of a gastroprotectant drug (defined as a PPI, prostaglandin analogue, or H2RA) versus control, or versus another gastroprotectant. Two independent researchers reviewed the search results and extracted the prespecified outcomes and key characteristics for each trial. We did meta-analyses of the effects of gastroprotectant drugs on ulcer development, bleeding, and mortality overall, according to the class of gastroprotectant, and according to the individual drug within a gastroprotectant class.FindingsWe identified comparisons of gastroprotectant versus control in 849 trials (142 485 participants): 580 prevention trials (110 626 participants), 233 healing trials (24 033 participants), and 36 trials for the treatment of acute upper gastrointestinal bleeding (7826 participants). Comparisons of one gastroprotectant drug versus another were available in 345 trials (64 905 participants), comprising 160 prevention trials (32 959 participants), 167 healing trials (28 306 participants), and 18 trials for treatment of acute upper gastrointestinal bleeding (3640 participants). The median number of patients in each trial was 78 (IQR 44·0–210·5) and the median duration was 1·4 months (0·9–2·8). In prevention trials, gastroprotectant drugs reduced development of endoscopic ulcers (odds ratio [OR] 0·27, 95% CI 0·25–0·29; p<0·0001), symptomatic ulcers (0·25, 0·22–0·29; p<0·0001), and upper gastrointestinal bleeding (0·40, 0·32–0·50; p<0·0001), but did not significantly reduce mortality (0·85, 0·69–1·04; p=0·11). Larger proportional reductions in upper gastrointestinal bleeding were observed for PPIs than for other gastroprotectant drugs (PPIs 0·21, 99% CI 0·12–0·36; prostaglandin analogues 0·63, 0·35–1·12; H2RAs 0·49, 0·30–0·80; phet=0·0005). Gastroprotectant drugs were effective in preventing bleeding irrespective of the use of non-steroidal anti-inflammatory drugs (phet=0·56). In healing trials, gastroprotectants increased endoscopic ulcer healing (3·49, 95% CI 3·28–3·72; p<0·0001), with PPIs more effective (5·22, 99% CI 4·00–6·80) than prostaglandin analogues (2·27, 1·91–2·70) and H2RAs (3·80, 3·44–4·20; phet<0·0001). In trials among patients with acute bleeding, gastroprotectants reduced further bleeding (OR 0·68, 95% CI 0·60–0·78; p<0·0001), blood transfusion (0·75, 0·65–0·88; p=0·0003), further endoscopic intervention (0·56, 0·45–0·70; p<0·0001), and surgery (0·72, 0·61–0·84; p<0·0001), but did not significantly reduce mortality (OR 0·90, 0·72–1·11; p=0·31). PPIs had larger protective effects than did H2RAs for further bleeding (phet=0·0107) and blood transfusion (phet=0·0130).InterpretationGastroprotectants, in particular PPIs, reduce the risk of peptic ulcer disease and its complications and promote healing of peptic ulcers in a wide range of clinical circumstances. However, this meta-analysis might have overestimated the benefits owing to small study bias.FundingUK Medical Research Council and the British Heart Foundation.

A study of CYP2C19*2, *3 and *7 in different Sudanese ethnic groups and their response to omeprazole based triple therapy in Khartoum, Sudan 2016-2017

Background: Peptic ulcer disease has a high burden worldwide and the commonest causative agent is H. pylori which are usually eradicated with omeprazole-based triple therapy. Pharmacogenetics is an important branch of pharmacology and should be applied to assist the clinical usage of medicines which has a strong relation with enzyme activity of certain genes and alleles known through the literature. CYP2C19 is known to affect the activity of omeprazole and this will result in different responses to treatment. The commonest alleles through the literature are CYP2C19*2, and CYP2C19*3 which vary according to different ethnicity of different populations. Aim: In Sudan, there are versatile ethnic groups which might affect the response to treatment by many drugs dependent genotypes for example CYP2C19 and Omeprazole interaction and hence studies in this area should be done as they are few. Methodology: A purposeful convenient sampling; in which patients with peptic ulcer disease and treated with omeprazole were reviewed and the PCR is used to differentiate the CYP2C19 different alleles in patients presenting from February 2016 to January 2017. Results: In the present study we investigated the distribution of three common gene variants affecting the omeprazole treatment of peptic ulcer disease and H. pylori eradication namely to CYP2C19*2, *3 and *7. The CYP2C19*2 mutation was found among all seven ethnic groups of Sudan, Arabs mostly 17 (139) followed by Darforians 9 (139), Beja 6 (139) and Nilotics 6 (139), Nuba 5 (139) then, Nubians 3 (139) and Fulani 1 (139), p=0.048 which is significant. Regarding CYP2C19*3 mutation of this allele is found in certain ethnic groups Arabs 6 (139), Nubians 6 (139) and Nuba 2 (139), p=0.043 significant. There is no mutation found among different Sudanese ethnic groups in CYP2C19*7. Arabs are normal homozygotes 6 (139) and Darforians 1 (139). Nuba 1 (139) were found to be heterozygotes in this allele p=0.038 significant. Treatment of H. pylori with omeprazole-based triple therapy was used in 110 (139) and no significant correlation found with the different ethnic groups of Sudan. Conclusion: These data indicate that Sudanese seven ethnic groups showed activity of CYP2C19*2, CYP2C19*3 were they took omeprazole based triple treatment and some of them showed activity to CYP2C19*7.

Milk-Alkali Syndrome: A Forgotten Cause of Metabolic Alkalosis

The milk-alkali syndrome is triad of hypercalcemia, metabolic alkalosis, and acute kidney injury associated with the ingestion of large amounts of calcium and alkali. The syndrome was originally described in association with the use of milk and sodium bicarbonate for the treatment of peptic ulcer disease. Once was a classic cause of hypercalcemia, milk-alkali syndrome is now the third leading cause after hyperparathyroidism and malignancy. This is attributed to the development of proton pump inhibitors, antihistamines, and other modalities of treatment for peptic ulcer disease. J Med Cases. 2018;9(5):145-146 doi: https://doi.org/10.14740/jmc3048e

Treatment of Peptic Ulcer Disease: Yesterday, today and tomorrow

Treatment of Peptic Ulcer Disease: Yesterday, today and tomorrow