摘要:

SUMMARYNon‐steroidal anti‐inflammatory drugs (NSAIDs) induce gastric and duodenal damage in animals and humans. The possible protection afforded by cimetidine against acute and short‐term NSAID‐induced mucosal damage was evaluated in five studies. Cimetidine 200 mg once daily and 400 mg once daily was found to protect the gastric mucosa against damage induced by a single dose of aspirin 1300 mg; this protection was found to be independent of gastric acid secretion. Cimetidine 200 mg q.d.s. was found to protect the stomach and duodenum against damage induced by 14 days’treatment with aspirin 650 mg q.d.s. Duodenal and gastric damage induced during a 7‐day treatment period with naproxen 500 mg b.d. was prevented by cimetidine 400 mg b.d.; this dose of cimetidine also provided significant duodenal protection against damage induced by I week of therapy with indomethacin 50 mg t.d.s. There is no correlation between upper gastrointestinal symptoms, or between mucosal prostanoids, and the presence or absence of mucosal damage. Cimetidine is therefore effective in the prevention of mucosal damage induced by short‐term treatmen

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00766.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYIn a series of double‐blind randomized studies in normal volunteers using continuous intragastric pH monitoring, the effects of different dosage regimens of roxatidine, a new H2‐receptor antagonist, were compared with placebo and ranitidine. Roxatidine acetate, 75 mg twice daily, decreased median 24 h gastric acidity from pH 1.6 to 3.2 and median nocturnal acidity from 1.5 to 3.0. Roxatidine acetate, 150 mg at bedtime, raised median 24 pH of the same 17 subjects to 2.4 and nocturnal pH to 5.9. In another series of experiments, 150 mg roxatidine acetate at bedtime was as effective as ranitidine 300 mg nocte raising median nocturnal pH (14 volunteers) from 1.4 to 6.65 compared to 6.7, respectively. However, when drugs were taken after the evening meal (post cenam nocte, pcn) roxatidine acetate 150 mg was less potent than ranitidine 300 mg with median night‐time pH rising from 1.3 to 3.2 and 4.0, respectively, in 28 volunteers. Roxatidine acetate 300 mg pcn raised the pH to 4.9 suggesting that roxatidine is 1–2 times as potent as ranitidine, on a milligram‐for‐mill

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00674.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYIn this double‐blind multicentre trial, 127 patients on non‐steroidal anti‐inflammatory drugs (NSAIDs) who experienced gastrointestinal symptoms significant enough to warrant endoscopic evaluation, but without endoscopic evidence of mucosal damage, were randomized to receive cimetidine 400 mg b.d. or placebo for 4 weeks. Non‐steroidal anti‐inflammatory drug therapy was maintained at pre‐trial doses for the duration of the study. After 4 weeks, 72 % of cimetidine‐treated patients experienced complete symptom resolution, as defined by a global symptom score of zero, compared with 49% on placebo. Complete disappearance of upper abdominal pain was achieved in 72 % of the cimetidine‐treated patients as opposed to 47% on placebo. Relief of heartburn was experienced by 87 % of patients on cimetidine compared with 60 % on placebo. Throughout treatment, the proportion of cimetidine‐treated patients with nausea was consistently lower than in patients on placebo, while the two groups were similar with respect to disappearance of vomiting. At the completion of acute treatment, 27% of placebo‐treated patients but only 12% of those on cimetidine were ineligible to continue maintenance due to persisting gastrointestinal symptoms. Patients who were symptom‐free and required continuation of NSAID therapy were followed for 6 months during which they were re‐randomized to receive cimetidine 400 mg nocte or placebo. Of the 105 patients included in this maintenance treatment phase of the study, 11% of the cimetidine‐treated patients and 10% of those on placebo experienced relapse of symptoms. However, the mean time to relapse was 120 days with cimetidine compared with 35 days with placebo. The results of this study indicate that cimetidine is effective in the treatment of endoscopy‐negative NSAID‐induced GI symptoms, specifically pain and heartburn, in pati

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00767.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYOvernight gastric secretion was studied in 32 patients with acute duodenal ulcers before treatment and whilst taking cimetidine 400 mg b.d. After 6 weeks of treatment with cimetidine 400 mg b.d. 13 patients had healed ulcers, seven patients had healed ulcers but a persistent erosive duodenitis, and 12 patients had persisting ulceration. Inhibition of nocturnal gastric secretion by cimetidine 400 mg b.d. was most profound in patients who healed their ulcers completely; a less profound inhibition of nocturnal gastric secretion was seen in the non‐healing and duodentis groups. In patients with persisting ulcers and poor inhibition of nocturnal gastric secretion by cimetidine, gastric secretion could be suppressed by either cimetidine 400 mg b.d. in combination with pirenzepine 50 mg b.d., or by cimetidine 1600 mg nocte, but suppression of nocturnal gastric secretion was more effective with cimetidine 1600 mg than cimetidine with pirenzepin

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00675.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYThe efficacy of cimetidine 800 mg nocte in the treatment of erosions or ulcers induced by non‐steroidal anti‐inflammatory drugs (NSAIDs) was evaluated in an uncontrolled multicentre study of 187 patients requiring continuation of their NSAID therapy. After 4 weeks of treatment, endoscopic healing was achieved in 62 % of patients. After 8 weeks of therapy, 88% of patients were lesion‐free. Patients with ulcer had a healing rate of 49% at week 4, which increased to 81 % at the completion of 8 weeks. The majority of patients (82 %) with erosions healed in 4 weeks. By week 8, erosions were healed in 97 % of patients. Following endoscopically verified lesion healing, 113 patients entered a maintenance phase of the study, which assessed the efficacy of cimetidine 400 mg nocte in preventing recurrence of erosions or ulcers while continuing NSAID therapy. During a 6‐month observation period, the cumulative probability of endoscopically observed recurrence of lesions was 12 % (with a mean time to recurrence of 116 days), which is similar to the incidence of relapse achieved with cimetidine 400 mg nocte in patients with uncomplicated peptic ulcer. The results of this study suggest that cimetidine 800 mg nocte is effective in healing NSAlD‐induced lesions despite continued NSAID use, and that maintenance treatment with cimetidine 400 mg nocte can prevent lesions and reduce lesion recurrence during chronic NSAID admin

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00768.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYIt is now accepted that the administration of non‐steroidal anti‐inflammatory drugs (NSAIDs) can result in peptic ulceration. Not infrequently, the first presentation of the ulcer is as a life‐threatening complication such as a perforation or gastrointestinal bleed. Surgeons often become involved in management when one of these complications occurs. This paper discusses the ways in which NSAID‐induced peptic ulceration may present to the surgeon and the special features that distinguish patients with NSAID‐induced ulcers from the remainder of patients with peptic ulcer disease. It is pointed out how little has been written on the surgical management of this group of patients. The importance of the overall assessment of these patients, with the correction of nutritional deficiencies and the use of appropriate prophylactic therapeutic measures in their surgical management, is stressed. The criteria for determining what surgical procedure is used and results are

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00769.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYProbably all non‐steroidal anti‐inflammatory drugs (NSAIDs) increase the risk of gastrointestinal (GI) mucosal injury. The most frequent lesions are gastric erosions in the pre‐pyloric region. Non‐steroidal anti‐inflammatory drugs also increase the incidence of peptic ulcers, although it is not yet clear whether more gastric ulcers or more duodenal ulcers are produced. Gastrointestinal symptoms are prevalent during NSAID treatment, but there is no correlation between symptoms and lesions. Clinical presentation may therefore vary considerably: many symptomatic patients will have no lesions, whereas others will present with complications but no symptoms. Blood loss is the most frequent complication of NSAID‐induced GI lesions. Bleeding is usually 'silent’and occult. Overt haemorrhage, though rare, is more frequent in patients taking NSAIDs. Other complications, such as penetration and perforation, may also occur. Endoscopy is the diagnostic method of choice, as this method can detect even superficial mucosal lesions. However, because of the lack of correlation between symptoms and lesions, it is difficult to ascertain which patients are at risk and thus to avoid unnecessary diagnostic procedures. Future efforts should therefore be directed towards the prevention of NSAID‐ind

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00770.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYDespite the fact that non‐steroidal anti‐inflammatory drugs (NSAIDs) are among the most widely used drugs in medicine today, 2–10% of patients must discontinue their use primarily due to gastrointestinal (GI) side‐effects. While the development of non‐aspirin NSAIDs (NA‐NSAIDs) has significantly reduced GI side‐effects, major problems persist. A practical clinical approach to these problems includes informing the patient about the risks and benefits of NSAIDs, risk management during treatment with NSAIDs and investigation of symptomatic side‐effects during treatment. Prophylaxis of GI side‐effects is feasible in selected populations, but it has not been studied widely and may not be cost‐effective. At present, costs of prophylaxis in all but selected populations with multiple risks probably ou

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00771.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

SUMMARYNon‐steroidal anti‐inflammatory drugs (NSAIDs) are efficacious in the treatment of arthritis. However, side‐effects particularly gastrointestinal toxicity, have been well documented with their use. Thus, in assessing total direct medical costs in the treatment of arthritis, the expenses involved in treating these side‐effects must be taken into account. A retrospective analysis was undertaken of all direct medical costs related to care of a group of Medicaid recipients treated for arthritis during a 2‐year period. Data were obtained from the Medicaid Management Information System of Washington, D.C., USA. The actual expenditure of treating arthritis as well as the medical costs of associated NSAID‐induced gastrointestinal side‐effects were determined. Arthritis treatment costs per quarter were found to be $145 per patient. Approximately 25 % of the population experienced NSAID‐related gastrointestinal side‐effects requiring further medical care. Treatment of these adverse effects cost an additional $66 per quarter per patient, thus adding 45.5% to the cost of arthritis treatment. Pharmaceutical claims comprised 42.4% of total adverse drug reaction treatment costs, while the few hospital claims accounted for 37.9% and physician charges 19.7%. It has been estimated that in 1983 direct medical costs of arthritis treatment in the USA was $8.6 billion. By extrapolating the costs in this study, it can be estimated that a further $3.9 billion was spent on treating gastrointestinal side‐effects of NSAIDs, making a tot

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00772.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1988.tb00773.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY