ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00776.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYGastro‐oesophageal reflux disease (GERD) is generally considered to be the result of a motility disorder which permits the abnormal and prolonged exposure of the lumen of the oesophagus to the acidic gastric contents.This view is supported by experimental data, intraoesophageal pH measurement, and the dramatic results of symptom relief and healing seen with effective antisecretory treatment.Oesophageal mucosal injury is determined by the pH of the refluxate and duration of acid exposure. Most patients experience meal‐stimulated reflux during the day and the more severe cases experience 24‐h acid exposure. In contrast to the H2‐receptor antagonists (H2RAs), the proton pump inhibitors (PPIs) are more effective at controlling meal‐stimulated acid secretion when each is given in standard doses. Therefore, the degree and duration of acid suppression throughout 24 h is greater.Treatments which maintain intra‐oesophageal pH>4 for 96% or more of the 24 h normalize acid exposure and are associated with the highest healing rates. Peptic activity is minimized at or above pH 4. The time above pH 4 is significantly longer with the PPIs than with the H2RAs. Thus, the healing‐time curves for GERD (grades II‐IV) are shifted to the left for the PPIs which heal a significantly greater proportion of patients earlier than the H2RAs or sucralfate.Symptoms in GERD are related to the degree and duration of oesophageal acid exposure. Symptom relief is more rapid and complete with the PPIs than with the H2RAs or other treatments in

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00777.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYGastro‐oesophageal reflux disease (GERD) occurs in up to 44% of adults in the USA. Most individuals do not seek medical help, self‐medicating with antacids. Manifestations of GERD range from symptoms without oesophagitis, which constitute the bulk of patients who self‐medicate, to active oesophagitis and then to complications such as stricture and ulceration. It is the more severe cases who tend to come to the gastroenterologist, but it must be remembered that reflux symptoms are probably around 5–10 times more common than actual oesophagitis. Since acid in the refluxate is responsible for the bulk of the symptoms and mucosal damage, antacids are often used for quick relief—which of course may not be sustained. More prolonged suppression of acid secretion, such as by a histamine H2‐receptor antagonist (H2RA) or a proton pump inhibitor (PPI), is required to give long‐lasting symptomatic relief and heal any inflammatory change.H2‐receptor antagonists inhibit acid secretion with an effect that lasts for 4–8 h with a single dose, decreasing stimulated acid secretion by around 70%. When treating oesophagitis, the H2RAs suffer from the disadvantage of their relatively short duration of action (compared with PPIs), development of tolerance, and incomplete inhibition of acid secretion in response to a meal. Therefore, it is not easy for the H2RAs to achieve optimum conditions for healing the more severe forms of oesophagitis—even very high doses may fail.In mild GERD the H2RAs have been shown to be effective in relieving symptoms. In particular, when there is no oesophagitis, relief of reflux symptoms has been obtained after 4 weeks in almost all cases with a twice daily regimen: and it would seem that the sensitivity of the oesophageal mucosa may be reduced so that symptomatic remission is often obtained for a prolonged period after stopping therapy. In the milder forms of oesophagitis (grades I or II) healing can be achieved with all the H2RAs in 40–60% of cases in 8 weeks. This can be increased, by a substantial increase in dosage, to around 50–70%, but seldom higher than that. This higher dose has cost and compliance considerations. Proton pump inhibitors are required for higher percentage healing and especially

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00778.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYBackground: The effects of octreotide on small intestinal and gall‐bladder motility are well established. However, the influence of octreotide on the gastric emptying rate of both solids and liquids in normal healthy volunteers has never been studied.Methods: In nine healthy subjects, the gastric emptying rate of liquids and solids was studied in basal condition and 30 min after subcutaneous administration of 50 μg of octreotide, using the combined14C‐octanoic acid/13C‐glycine breath test. To determine if the results were entirely due to alterations in gastric emptying,14/13CO2excretion rates of intraduodenally administered14C‐octanoic acid and13C‐glycine were measured in basal condition and after subcutaneous injection of octreotide.Results: After subcutaneous injection of octreotide, the gastric emptying rate of solids was decreased in all but one subject, while the gastric emptying rate of fluids was decreased in all subjects. Nevertheless,14/13CO2excretion rates in the breath after intraduodenally administered14C‐octanoic acid and13C‐glycine, were similar in basal condition and after subcutaneous injection of octreotide.Conclusions: Subcutaneous injection of a single physiological dose of octreotide induces a marked delay in the gastric emptying of solids and liquids in young healthy volunteers. The combined14C‐octanoic acid/13C‐glycine breath test is very well suited to demonstrate this effect, since the absorption and metabolism of octanoic acid and glycine remains unaltered after administra

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00345.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYEfficacy (healing, symptom relief) and cost‐effectiveness are the principal reasons for the rapidly increasing use of proton pump inhibitors (PPIs) for the management of gastro‐oesophageal reflux disease.Efficacy: Mean healing rates pooled from clinical trials are as follows: on omeprazole (OME) 20 mg vs. H2‐receptor antagonist, H2RA (cimetidine (CIM) 1.6 g or ranitidine (RAN) 300 mg) (eight studies) at 4 weeks, 67% vs. 37%; at 8 weeks, 81% vs. 49%; on lansoprazole (LAN) 30 mg vs. H2RA (three studies), 83% vs. 47% and 91% vs. 63% at 4 and 8 weeks, respectively. The benefit is greatest in severe disease because the H2RAs are disproportionately less effective. Heartburn is more rapidly relieved and in a higher proportion: at 4 weeks, on OME 20 mg vs. H2RA, 77% vs. 47% and on LAN 30 mg vs. H2RA, 81% vs. 46%. Both PPIs are effective in H2RA‐refractory disease, approximately 80% healing occurring in 8 weeks.Relapse rates after healing vary from 2 5 % to 8 5 % at 6 months. Maintenance therapy sustains remissions: relapse at 1 year is, on OME 20 mg vs. RAN 300 mg (2 studies), 12% vs. 79% and 28% vs. 55% (and 38% on OME 10 mg); on LAN 30 mg vs. 10 mg vs. RAN 600 mg, 20% vs. 31% vs. 68%. The effectiveness of the lower dose allows for dose titration.Cost effectiveness: The higher drug costs for the PPIs are offset by their higher efficacy, making their use cost effective, particularly in severe disease.Efficacy and cost effectiveness are likely to further expand the use of PPIs at the expense of H2RAs as increasing numbers of patients with milder disease are

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00779.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYBackground: Pantoprazole is a new substituted benzimidazole which is a potent inhibitor of gastric acid secretion by its action upon H+,K+‐ATPase.Methods: The proton pump inhibitors pantoprazole and omeprazole were compared in a randomized, doubleblind study in 219 patients with benign gastric ulcers. Patients received either pantoprazole 40 mg (n= 146) or omeprazole 20 mg (n= 73), once daily before breakfast for 4 weeks. Treatment was extended for a further 4 weeks if the ulcer had not healed.Results: After 4 weeks, complete ulcer healing was seen in 88% of protocol‐correct patients given pantoprazole and in 77% given omeprazole (between‐group differenceP<0.05). At 8 weeks, the corresponding values were 97% and 96% (not significant). In the comparative intention‐to‐treat analysis there were no statistical differences between the treatment groups. Among the patients who had ulcer pain prior to treatment, 79% of the pantoprazole group and 68% of the omeprazole group were pain‐free after 2 weeks, and after 4 weeks 88% and 81%, respectively (not significant). Pronounced improvement in the other gastrointestinal symptoms was seen in both groups. Only 10% of patients in each group reported adverse events. There were moderate increases in fasting serum gastrin levels with both treatments at 4 and 8 weeks.Conclusion: Pantoprazole, 40 mg once daily in the morning, is a highly effective, well tolerated treatment for acute, benign gastric ulcer. Pantoprazole and omeprazole were equally safe in the therapy of ga

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00346.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYBackground: Lansoprazole is a new proton pump inhibitor which produces prolonged decrease of gastric acidity. The aim of this study was to compare lansoprazole to a standard dose of ranitidine in the treatment of patients with reflux oesophagitis.Methods: Two hundred and forty‐seven patients with erosive oesophagitis were randomly assigned to 8 weeks of treatment with either 30 mg lansoprazole once daily or 150 mg ranitidine twice daily.Results: Two hundred and forty‐two patients were included in the analysis. Lansoprazole (30 mg) daily, healed oesophagitis in 92.1% of patients after 8 weeks of treatment. This was significantly superior to 150 mg ranitidine b.d.s. which healed oesophagitis in 69.9% of patients (P<0.001). Relief of reflux symptoms was superior with lansoprazole to that with ranitidine. Both lansoprazole and ranitidine were well tolerated with no serious drug‐related adverse events noted.Conclusion: Lansoprazole, 30 mg once daily, is highly effective and safe in the short‐term treatment of erosive oesop

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00347.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYHelicobacter pyloriinfection is now recognized as the major cause of chronic gastritis throughout the world. A fraction of infected persons develop peptic ulcer disease or gastric cancer, accounting for its clinical significance. The pathophysiology of this infection can be better understood by considering five central concepts—heterogeneity of strains, persistence of infection, immunological down‐regulation, physiological consequences and variability in outcome. Microbial, host and environmental factors must each contribute to the outcome variat

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00780.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYThere is general agreement thatHelicobacter pylorieradication is indicated in all infected patients with duodenal ulcer disease and is probably indicated in all infected patients with gastric ulcer disease. However, translation of treatment recommendations into practice leads to some difficult clinical decisions. Three of the more perplexing questions are whether or not all patients with dyspepsia andH. pylorishould be treated, whether or not a definitive diagnosis of ulcer should be established by an invasive method, and whetherH. pylorieradication is sufficient to prevent recurrence of bleeding ulcers, especially in patient groups that have a high frequency of nonsteroidal anti‐inflammatory drug (NSAID) use. Another common problem is the question of whether or not to establish the success of an eradication regimen in an individual patient and the choice of method to obtain this information. There is also an obvious need to develop better antimicrobial regimens aimed specifically atHelicobacter pylori.At the basic level, almost nothing is known about the mechanisms by whichH. pyloriproduces peptic ulcer in 10–20% of infected patients while producing gastritis in all infected subjects. There is good evidence that host factors, including intrinsic rate of acid secretion, family history and smoking are independent additive risk factors for ulcer. Ingestion of NSAIDs appears to be an independent and separate risk factor. There is evidence that strains ofH. pylorithat lack certain genetic markers may have a reduced likelihood of causing ulcers, but the‘ulcer’ marker is present in the majority of infected subjects without ulcer. One goal of research inH. pylori‐infected subjects should be to identify those without ulcer who are at high risk of developing ulce

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00781.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARYBackground and aims: In a recent open trial we have shown the efficacy of long term intermittent administration of a poorly absorbable antibiotic (rifaximin) in obtaining symptomatic relief in uncomplicated diverticular disease of the colon. The aim of this double‐blind placebo‐controlled trial was to test our previous observations.Methods: One hundred and sixty‐eight outpatients with symptomatic uncomplicated diverticular disease were treated with fibre supplementation (glucomannan 2 g/day) plus rifaximin 400 mg b.d. for 7 days every month (84 patients), or with glucomannan 2 g/day plus placebo two tablets b.d. for 7 days every month (84 patients). Clinical evaluation was performed at admission and at three‐month intervals for 12 months.Results: After 12 months, 68.9 % of the patients treated with rifaximin were symptom‐free or mildly symptomatic, compared to 39.5% in the placebo group (P= 0.001). Symptoms such as bloating and abdominal pain or discomfort were primarily affected by antibiotic treatment when compared with placebo (P<0.001).Conclusion: Rifaximin appears to be of some advantage in obtaining symptomatic relief in diverticular disease of the colon when compared with fibre supplementat

ISSN:0269-2813    

DOI:10.1111/j.1365-2036.1995.tb00348.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY