Ulcer healing and serum pepsinogen I in cimetidine and glycopyrrolate treated duodenal ulcer patients

Cimetidine is effective in the treatment of acute duodenal ulcers. 26 endoscopically verified duodenal ulcer patients were treated for four weeks with either cimetidine 0.8 g/day or with the anticholinergic drug glycopyrrolate 4 mg/day on a double-blind basis. Gastroscopical healing was achieved in 10/13 (77%) of cimetidine treated patients and in 4/13 (31%) of glycopyrrolate treated patients (p less than 0.05). There were no major side-effects in either group. In this study cimetidine seemed to be more effective than glycopyrrolate in the treatment of acute duodenal ulcer. The pretreatment level of serum pepsinogen I was elevated (110.1 +/- 42.8 microgram/l; mean +/- SD) in these patients (normal range 20--100 microgram/l) and increased significantly after pentagastrin stimulation to 133.2 +/- 56.4 microgram/l (p less than 0.001). The post-treatment level measured 24 hours after termination of treatment had increased significantly in the cimetidine group but not in the glycopyrrolate group. In the cimetidine group the high pretreatment level of pepsinogen I tended to predict a poor response.     

Effect of antacids on intragastric pH in healthy subjects and duodenal ulcer patients. Influence of the size of the antacid dose and of anticholinergics

Summary. Different doses of two liquid antacids, alone and combined with an anti-cholinergic agent, were studied with respect to the duration of antacid action. The studies were performed in healthy subjects with MAO <30 mmol/h and in duodenal ulcer patients with MAO > 35 mmol/h. Gastric pH was recorded using radiotelemetric technique (Heidelberg capsule). In the healthy subjects, there was no significant difference in the duration of action with the different doses but in duodenal ulcer patients a tenfold increase of the antacid dose resulted in a doubling of the duration of action. Combined treatment with an anticholinergic and antacids enhanced the antacid effects in both groups. It is concluded that an antacid dose should be so great that it binds secreted acid before the dose leaves the stomach. Further increase of the dose will not increase the duration. Concomitant use of an anticholinergic agent increases the duration of antacid action.     

A Portrait History of Cardiology

Duodenal ulcer which occurs in childhood does not always respond satisfactorily to medical therapy.

A study of 109 patients at the Mayo Clinic showed that there is a 50 per cent chance that duodenal ulcer which begins in childhood will persist or recur in adolescence or adulthood if medical treatment alone is employed.

The authors present a study of 10 children who had surgical treatment for duodenal ulcer after medical measures had failed. Five patients had a posterior gastroenterostomy and five had a gastric resection. There were no surgical deaths, and eight traced patients developed normally without recurrence of ulcer.     

DOES SMOKING INFLUENCE THE ERADICATION OF HELICOBACTER PYLORI AND DUODENAL ULCER HEALING WITH DIFFERENT REGIMENS?

To determine the effect of smoking on Helicobacter pylori eradication and ulcer healing, we investigated 232 patients with H. pylori-positive duodenal ulcer. Patients were given one of seven different treatment protocols and divided into three groups according to smoking habits. Group 1 (n=128) consisted of non-smokers, group 2 (n=65) of mild smokers (5-20 cigarettes/day) and group 3 (n=39) of heavy smokers (>20/day). The eradication of H. pylori and ulcer healing rate was controlled eight weeks later after ceasing the therapy. The overall eradication rate was 66% in all patients and 68%, 66%, 59% in each group, respectively. The eradication rates showed no statistical difference between groups. Complete ulcer healing was achieved in 84% of all patients and ulcer healing rate between groups did not show any significance (85%, 83% and 82% respectively). These results suggest that smoking status does not influence the eradication of H. pylori and duodenal ulcer healing rates at eight weeks in patients on different treatment schedules.     

内镜下综合治疗十二指肠球部溃疡出血65例疗效分析

目的探讨经内镜下综合治疗十二指肠球部溃疡出血的临床价值。方法对2005年1月至2008年7月共65例经内镜综合治疗的十二指肠球部溃疡出血患者的临床资料进行回顾性分析。结果65例患者止血成功57例，初次治疗成功率为87．6％。再出血8例，再次内镜下止血4例成功，4例治疗无效转外科手术治疗，总有效率为95．3％。结论内镜下综合治疗十二指肠球部溃疡出血是一种安全、有效的方法，应该作为首选方法在临床上推广应用。     

Treatment of peptic ulcer with sucralfate]

Sucralfate made in Bulgaria (Farmaphim) and its Yugoslavian analogue venter have been tried in gastroduodenal ulcer. The drugs were given per os (1 g, 1 tablet) 4 times a day before meals for 20 days. Sucralfate treatment was assigned to 26 patients with gastric and 26 with duodenal ulcer. The other 20 gastric ulcer patients received venter. 10 patients with gastric and 20 with duodenal ulcer entered the control group receiving placebo. Attenuation of the symptoms was reported as early as on day 4 of the treatment in 85-100% of the patients both with gastric and duodenal ulcer. The 20-day course of sucralfate treatment brought about a complete epithelization on gastric ulcer in 54% while in venter treatment in 55% of those treated versus placebo group 10%. Duodenal ulcer epithelization occurred in sucralfate-treated group in 58% against placebo group 17%. The differences in treatment results between sucralfate and venter are immaterial, whereas against placebo they are significant (p less than 0.05). Side effects were not serious.     

Efficacy of sufficient operation view by ring-shaped thread counter traction for safer duodenal ESD

Abstract

Background: Duodenal ESD is considered especially difficult with perforation and bleeding. This study assessed safer duodenal ESD procedures, especially with regard to obtaining a good operation view using a ring-thread method and closure of a post-ESD artificial ulcer.

Methods: From 2013 to 2015, 17 patients who were diagnosed with duodenal adenoma or early duodenal cancer >20?mm in diameter underwent conventional ESD (C group). From 2016 to 2017, 12 patients underwent ring-shaped thread counter traction ESD with hemoclips and/or Over-The-Scope Clip (OTSC) (Ovesco Endoscopy GmbH, Tuebingen, Germany) closure of post ESD artificial ulcer (ring group). An observational study between the C group and Ring group was conducted. The primary outcome was perforation events during ESD (UMIN000026184).

Results: There was a significant difference in perforation during ESD with five cases vs. 0 case in C and ring groups (p?=?.038). For bleeding that needed to be coagulated by forceps during ESD, there was a significant difference with four cases in the C group (p?=?.07). The total procedure time was 96.6?±?28.2 and 72.8?±?24.2 (min) with a significant difference (p?=?.027).

Conclusions: Ring-shaped thread counter traction makes the most difficult duodenal ESD safer and easier without complications.     

Role of Helicobacter pylori in cirrhotic patients with dyspepsia: a 13C-urea breath test study

The role ofHelicobacter pylori in dyspeptic, cirrhotic patients remains unclear. This prospective outpatient study, conducted to assess the relationship of gastroduodenal disease andH. pylori as determined by the (¹³C) urea breath test, enrolled 109 consecutive cirrhotic patients with dyspepsia. All patients underwent upper-gastrointestinal endoscopy, which revealed respective prevalences of peptic ulcer, gastric ulcer, and duodenal ulcer of 41.3%, 23.9%, and 22.9%;H. pylori infection was found in 52.3%. The rate of peptic ulcer disease in theH. pylori-positive (45.6%) and -negative (36.5%) groups was not significantly different; neither was the prevalence ofH. pylori in patients with or without portal hypertensive gastropathy and with or without esophageal varices. The relationship between peptic ulcer disease andH. pylori in dyspeptic patients with cirrhosis appears to be weak. Likewise, no significant relationship was evident betweenH. pylori and portal hypertensive gastropathy or esophageal varices. This organism may not be a major pathogenetic factor in gastroduodenal diseases in dyspeptic patients with cirrhosis.     

Serum IL-8 as a possible marker for determining the status of<Emphasis Type="Italic">Helicobacter pylori</Emphasis> infection in patients with untreated and treated peptic ulcer

Failure to eradicateHelicobacter pylori can lead to peptic ulcer recurrence and gastric malignancy. Therefore, the objective of this study was to develop a noninvasive method for determining whetherH pylori infection was eradicated with antibiotic-based triple therapy. A total of 17 patients with duodenal ulcer (DU) and 17 with gastric ulcer (GU) were evaluated both before and after treatment. Outcomes included serum levels of interleukin-8 (IL-8), pepsinogen I, and gastrin, and the Wilcoxon signed rank test was used to test significance. Changes in these parameters were also correlated with disease status. In those patients where both GU and DU healing occurred as a result of treatment, most showed an increase in serum IL-8 and a decrease in serum pepsinogen. Serum gastrin levels were not significantly changed in either group. Posttreatment increases in serum IL-8 were seen in 15 of 17 (88%) recovered DU patients and 14 of 17 (82%) recovered GU patients (P < .05 for each). Posttreatment decreases in pepsinogen I were found in 15 of 17 DU and 15 of 17 GU patients (P < .05 for each). These preliminary findings suggest that an increase in serum IL-8 and possibly a decrease in pepsinogen I may be useful in identifying the successful eradication ofH pylori infection in patients with peptic ulcer treated with antibiotics. A more systematic analysis of these putative diagnostic markers is now warranted.     

Absence of tolerance in duodenal ulcer patients treated for 28 days with a bedtime dose of roxatidine or ranitidine

Summary— There is much experimental work on the occurrence of tolerance to the antisecretory effect of H₂-receptor antagonists in healthy subjects, while data on its development in patients with duodenal ulcer are poor and conflicting. Moreover, this phenomenon has not been studied previously with 24 h gastric pH-metry in patients with active duodenal ulcer. For these reasons, we carried out a prospective pharmacodynamic investigation in 48 patients with endoscopically proven duodenal ulcer using the well-established once daily dosing schedule of H₂ blockers. They were studied by means of 24 h continuous endoluminal pH-metry which was performed before, on d1 and d28 after receiving an oral bedtime dose (2200 hours) of either roxatidine 150 mg or ranitidine 300 mg, given in randomized and single-blind fashion. Eight patients did not complete the study for various reasons and 82% of ulcers healed after 4 weeks of therapy. Gastric pH was higher ( P < 0.001) on d1 and d28 than basal values during all time periods, but the evening, with both H₂ blockers. There was no significant difference between pH values of d1 and d28 in any time interval with both roxatidine and ranitidine. There was also no difference in pharmacodynamic data between the two active treatments. We conclude that tolerance does not develop after 1 month's treatment with a bedtime dose of H₂ antagonist in patients with active duodenal ulcer and therefore data gathered on this phenomenon in healthy subjects are not applicable to ulcer patients.     

雷贝拉唑治疗十二指肠球部溃疡的疗效观察

目的 观察雷贝拉唑治疗十二指肠球部溃疡的疗效。方法 十二指肠球部溃疡患者随机,开放式服用雷贝拉唑10 mg/d,2周,记录治疗前和用药期间的腹痛、腹胀、厌食、嗳气、反酸的变化情况。结果 十二指肠球部溃疡的治愈率92.50％,第7天上腹痛、腹胀、厌食、嗳气、反酸的缓解率分别为98.15％、93.33％、85.37％、88.00％、100.00％。结论 雷贝拉唑对十二指肠球部溃疡,能够很好控制症状,完全愈合溃疡。具有起效快、疗效稳定长久、药物相互作用小、副作用少等优点,是治疗消化性溃疡特别是十二指肠球部溃疡的一个理想的新一代质子泵抑制剂。     

Effect of dopamine-related drugs on duodenal ulcer induced by cysteamine or propionitrile: prevention and aggravation may not be mediated by gastrointestinal secretory changes in the rat

Dose- and time-response studies have been performed with dopamine agonists and antagonists using the cysteamine and propionitrile duodenal ulcer models in the rat. The experiments demonstrate that the chemically induced duodenal ulcer is prevented by bromocriptine, lergotrile and reduced by apomorphine or L-dopa. Aggravation of cysteamine-induced duodenal ulcer was seen especially after (-)-butaclamol, (-)-sulpiride, haloperidol and, less effectively, after other dopaminergic antagonists. The duodenal antiulcerogenic action of dopamine agonists was more prominent after chronic administration than after a single dose, whereas the opposite was found concerning the proulcerogenic effect of dopamine antagonists. In the chronic gastric fistula rat, both the antiulcerogens bromocriptine or lergotrile and the proulcerogens haloperidol, pimozide or (-)-N-(2-chlorethyl)-norapomorphine decreased the cysteamine- or propionitrile-induced gastric secretion. No correlation was apparent between the influence of these drugs on duodenal ulcer development and gastric and duodenal (pancreatic/biliary) secretions. In the chronic duodenal fistula rat, decreased acid content was measured in the proximal duodenum after haloperidol, and diminished duodenal pepsin exposure was recorded after bromocriptine. Furthermore, the aggravation by dopamine antagonists of experimental duodenal ulcer probably involves a peripheral component. The site of dopamine receptors and physiologic effects which modulate experimental duodenal ulcer remain to be identified, but their elucidation may prove to be an important element in the pathogenesis and treatment of duodenal ulcer.     

Acetaminophen/diphenhydramine overdose in profound hypothermia

Background. There are few reports of acetaminophen overdose in hypothermic patients and even fewer reports describing profound hypothermia. The kinetics, risk of hepatotoxicity, and the possible dose adjustments to N-acetylcysteine (NAC) therapy are not known in this setting. Case report. A 37-year-old female was found unconscious outside in December and was brought by ambulance to a tertiary care Emergency Department (ED) following a presumed overdose of acetaminophen and diphenhydramine. She later confirmed the ingestion and reported the ingestion had occurred approximately 18 hours prior to being found. On arrival, she was profoundly hypothermic, with a core rectal temperature of 17°C. Her initial serum acetaminophen concentration was 232 mcg/mL 19 hours post ingestion of a reported dose of approximately 50 grams of acetaminophen and 2.5 grams of diphenhydramine. Active rewarming was started immediately and IV NAC was initiated using the standard treatment protocol. The patient did not develop serious signs of hepatic injury or NAC toxicity. The patient's AST and ALT peaked 12 hours after admission at 84 IU/L (ref 10–37 U/L) and 104 IU/L (ref 12–78 U/L), respectively. Her INR peaked 2 hours after admission at 1.46 (ref < 1.2). Discussion. Despite the significant ingestion of acetaminophen, delayed presentation, prolonged period of decreased responsiveness, and profound hypothermia, the patient did not develop any signs/symptoms of liver injury. NAC was administered in a standard dose during her rewarming period without apparent toxicity. The patient's absorption and/or metabolism of acetaminophen were likely slowed by her hypothermia and possibly by the anticholinergic coingestant. Initiation of IV NAC at a standard dose was apparently safe and effective in preventing hepatotoxicity as the patient was rewarmed. Conclusions. Profound hypothermia may be protective of hepatic injury in acetaminophen overdose. Delayed absorption from the coingestant, diphenhydramine, may also have played a role. IV NAC was given in a standard dose without apparent toxicity in the setting of profound hypothermia. Lastly, IV NAC, in standard dosing, appeared to be effective in preventing hepatotoxicity during rewarming in a patient with a potentially hepatotoxic concentration of acetaminophen with a coingestion of the anticholinergic agent, diphenhydramine.     

Healing and recurrence of active duodenal ulcer with nizatidine

Nizatidine, a new H2-receptor antagonist for treatment of duodenal ulcer disease, was evaluated in a unique two-phase, placebo-controlled, randomized, double-blind, multicenter clinical trial. Patients received either 150 mg nizatidine twice daily or placebo for 4 weeks (phase I). If ulcer healing did not occur during phase I, patients were randomly reallocated to receive either 150 mg nizatidine twice daily or placebo for an additional 4 weeks (phase II). Patients with a healed ulcer continued on the same therapy. All patients were endoscoped at week 8. Healing rates at week 2 were 93 of 265 (35%) nizatidine-treated patients and 55 of 260 (21%) placebo-treated patients (p less than 0.001); at week 4, healing rates were 198 of 259 (76%) nizatidine-treated patients and 95 of 243 (39%) placebo-treated patients (p less than 0.001). In phase II, ulcer healing occurred in 46 of 86 (53%) nizatidine-treated patients and in 23 of 90 (26%) placebo-treated patients (p = 0.002). In patients who had a healed ulcer at previous endoscopies, 18 of 178 (10%) nizatidine-treated patients and 10 of 81 (12%) placebo-treated patients had a recurrence of duodenal ulcer. Smokers who had histories of previous ulcers were more likely to have an early recurrence.     

A method of increasing the effectiveness of anti-ulcer therapy

Forty-three patients with duodenal ulcer were treated with almagel and gastrocepin, had four meals a day. Twenty-one patients received the drugs according to the standard schedule before meals. The test group of 22 patients took meals and drugs in turn during 24 hours with the aim of a continuous moderate reduction of acidity and activity of proteolytic enzymes. Statistical analysis of the results showed a shorter duration of the ulcer healing in the test group. This conclusion permits recommending the above novel modification of the standard treatment for use in duodenal ulcer treatment as advantageous.     

Substituted benzimidazoles--a new dimension in ulcer therapy?

Substituted benzimidazoles represent a new class of gastric secretory inhibitors, which suppress acid secretion via direct inhibition of the parietal cell H+/K+-ATPase. The most potent derivative so far is omeprazole, which inhibits basal acid secretion and prevents the stimulatory effect of all classical acid secretory stimulants. In man, a single dose of 80 mg leads to almost complete achlorhydria over 24 hours. The results of the first duodenal ulcer trial with omeprazole are encouraging. No definite side effects have been attributed to the drug so far. Omeprazole may possibly initiate a new era in the medical treatment of peptic ulcer disease.     

奥美拉唑联合呋喃唑酮及阿莫西林治疗十二指肠溃疡疗效观察

目的 观察奥美拉唑联合呋喃唑酮及阿莫西林治疗十二指肠溃疡的疗效.方法 将十二指肠溃疡患者50例随机分为两组:治疗组26例,予以奥美拉唑每日清晨空腹口服20 mg,治疗4周,呋喃唑酮100 mg,3次/d,阿莫西林1000 mg,2次/d,治疗2周,治疗期间不加其他药物.对照组:奥美拉唑每日清晨空腹口服20 mg,治疗4周.结果 治疗组:治愈率53.85%,好转率42.31%,有效率98.16%;对照组:治愈率41.67%,好转率37.50%,有效率79.17%.治疗组和对照组总有效率经统计学处理有显著差异(P＜0.05).结论 奥美拉唑联合呋喃唑酮及阿莫西林治疗十二指肠溃疡能改善临床症状和促进溃疡愈合.     

Various new approaches to the treatment of patients with uncomplicated peptic ulcer

Basing on literature and his own experience, the author suggests the standard therapy of ulcer with spare diet to be revised. In noncomplicated duodenal ulcer soft diet is not obligatory for it has no advantages over unmeasured diet. The same is true for hospital treatment of duodenal ulcer, as the patients demonstrated the same mean duration of the ulcer healing in outpatient conditions. Healing of duodenal ulcer, compared in duration for monotherapy (histamine H2 blockers) and polychemotherapy (peritol plus antacids or cymetidine plus antacides) showed that neither therapy is preferable.