Clinical and endoscopic evaluation of gastroesophageal reflux disease in patients successfully treated with esomeprazole

BACKGROUND: Esomeprazole, an S-isomer of omeprazole, is the first proton pump inhibitor developed as an optical isomer, and it has shown high healing rates in erosive esophagitis. AIM: To evaluate the efficacy and tolerability of esomeprazole in subjects with erosive esophagitis, according to the Los Angeles classification study design: an open, multi-center clinical study. MATERIAL AND METHODS: Two hundred and eighteen subjects with reflux esophagitis confirmed by endoscopy were included in an open, multi-center study in Brazil. All of them received esomeprazole 40 mg, once daily, for a 4-week period. Subjects who had unhealed esophagitis by week 4 continued the treatment for another 4 weeks. The primary efficacy endpoint was the healing rates by weeks 4 and 8. The secondary endpoints were the number of patients with symptom resolution by week 4, the number of days to sustained symptom resolution, number of symptom-free days and nights and safety and tolerability of the drug. RESULTS: Healing rates by weeks 4 and 8 were 82% (confidence interval: 77.4%-87.6%) and 96.1% (confidence interval: 93.5% - 98.8%), respectively. Ninety-nine (99%) of the patients had heartburn resolution by week 2. The most common adverse events were headache (4%), diarrhea (2.6%) and epigastric pain (2.2%). CONCLUSION: For the studied period, esomeprazole was shown to be a safe and well-tolerated drug, providing significant healing rates of mucosal breaks, regardless of LA classification, in patients with erosive esophagitis. Esomeprazole was also shown to be effective in quickly relieving symptoms.     

Progressive systemic sclerosis: I. Gastric secretory pattern

Summary Twenty-four patients with progressive systemic sclerosis (19 female and 5 male) between the ages of 21 and 56, had their gastric secretory pattern under basal conditions and after Histalog stimulation (1.7 mg./kg. body weight) compared with those of 20 healthy, normal people (control group). No difference was observed in the gastric secretory pattern of both groups.Supported by a grant from the Instituto Brasileiro de Estudos e Pesquisas de Gastro-enterologia.The Histalog used in this study was kindly supplied by Eli Lilly and Company, Indianapolis, Ind.     

Helicobacter pylori infection in children of low and high socioeconomic status in northeastern Brazil

This survey was designed to evaluate the prevalence of Helicobacter pylori infection in asymptomatic children from families of low and high socioeconomic status living in two neighboring communities in Teresina in northeastern Brazil. The study included 303 children, 163 (53.8%) males and 140 (46.2%) females, ranging in age from 6 months to 12 years. Helicobacter pylori status was determined by the H. pylori stool antigens test, in which sensitivity and specificity values for Brazilian children were 96.9% and 100%, respectively. The prevalence rates were 55.0% (93 of 169) and 16.4% (22 of 134) for children of low and high socioeconomic status, respectively (P < 0.001). Infection with H. pylori occurred early in life (before 2 years of age) in both groups (22.9% versus 14.3%; P = 0.061) and increased as the children became older. The rate of infection in children 11-12 years of age living in the poor area was as high as the levels found in Brazilian adults. An improved standard of living is followed by a sharp decrease in the prevalence rates in children, even in a developing country such as Brazil.     

The electrolytes in gastric secretion after histamine and Histalog stimulation

Summary and conclusion Twenty-three subjects were subjected to histamine and Histalog stimulation, and the gastric secretions were collected over periods of 2 hours. In the 17 subjects whose data were considered acceptable, a rise in rate of gastric secretion was observed after both types of stimulation. The curve for sodium concentration follow an inverse relationship to that for acid; the curve for total chloride concentration was closely parallel to that for acid. After both types of stimulation, there was a rise in the K concentration.No correlation was observed between the curves for Cl or total acidity and the curve for K.The Histalog (3-beta-aminoethylpyrazole dihidrochloride) used in the study reported here was kindly provided by Eli Lilly & Co., Lndianapolis. Ind. The study was also supported by a grant from Laboratório Torres, São Paulo, Brasil.     

Giant gastric ulcer

Summary 1. The authors' experience in 27 cases of giant gastric ulcers (craters larger than 3 cm. in diameter) is presented.2. In 8 patients, the diagnosis of malignancy was made before treatment was begun. Four proved to have malignant ulcers, and the other 4 benign ones.3. Of the 18 patients submitted to the therapeutic test, 5 healed their lesions after 8 weeks and the remainder after 2 and a half, 5, and 13 months, respectively.4. The only serious complication was hemorrhage.5. Pulmonary chronic emphysema was found in 6 patients.6. The authors believe that the large size of these ulcers is not a criterion of malignancy, and that these giant lesions may heal as well as the smaller ones, although they show an increased tendency to recurrence.7. The authors emphasize the importance of the so-called pseudotumoral gastric ulcer, which roentgenologically and/or gastroscopically, as well as macroscopically, has the appearance of an ulcerated cancer. The benign nature of the lesion is revealed only by histologic study. Four patients were inadvertently submitted to extensive surgery, and 3 died as a result of their operations.The studies described in this article were supported by grants from Jayme Torres and the Jockey Club of São Paulo.     

Gastric ulcer cicatrization: A comparison of roentgenologic and histologic data

Summary It is the opinion of the authors that the only reliable clinical criterion assuring the benign nature of an ulcerated gastric lesion is its radiologic and/or gastroscopic healing after therapy.Six of 250 patients with gastric ulcer clinically diagnosed were operated upon after a therapeutic test of 4–6 weeks' duration: in all histologic study of the stomachs revealed healed or healing lesions. The scars were always lined by regenerated mucosa showing only slight distortion in its pattern.The work reported in this article was supported by grants from Jayme Torres and from the Jockey Club of São Paulo.     

Very-low dose antacid in treatment of duodenal ulcer

Antacid (AA) in a very low dose (88 mmol/day) was compared to the standard 800-mg dose of cimetidine in healing duodenal ulcers. The influence of sex, age, symptom duration at entry, night pain, smoking, coffee consumption, and alcohol on ulcer healing was studied. The antacid was given in two different schedules: group I--20 ml 1 hr after breakfast and at bedtime; group II--10 ml 1 hr after breakfast and lunch and 20 ml at bedtime. Cimetidine (group III) was given in two divided doses: 400 mg 1 hr after breakfast and 400 mg at bedtime. Endoscopic control was performed after four weeks and, if necessary, after eight weeks of treatment. The healing rate after four weeks of treatment was, respectively, for groups I, II, and III, 45.5%, 55.8%, and 69.4% (group I = group II, and group III different from groups I and II). After eight weeks of treatment the healing rate was 61.5%, 80.8%, and 88.0% for groups I, II, and III, respectively (group II = group III, and group I different from groups II and III). Except for group I, smoking did not influence healing rate. Age, sex, symptoms at entry, night pain, and coffee consumption did not influence the treatment results. The authors concluded that the very low dose of magaldrate (88 mmol/day), when administered in three divided doses (10 ml after breakfast and lunch and 20 ml at bedtime) for eight weeks was as effective as 800 mg of cimetidine (400 mg twice a day) in healing duodenal ulcer.