Famotidine therapy for active duodenal ulcers: a multivariate analysis of factors affecting early healing

Article Abstract:

Factors that influence the rate of healing of ulcers in the duodenum were analyzed in 135 patients. The patients were taking famotidine, an anti-ulcer drug, for four to eight weeks. Treatment of duodenal ulcers with famotidine was effective and was well tolerated, with no detectable adverse side effects. Healing was determined by endoscopy at four to eight weeks. Approximately 80 percent of the patients after four weeks of treatment and 94 percent of the patients after eight weeks of treatment had ulcers that were healed. Five independent factors were identified which influenced healing of the ulcers. The risk factors were evaluated by multivariate analysis, which compensates for the interaction between variables. The most important risk factor against early healing of the ulcer was the use of alcohol. The odds of a ulcer persisting after four weeks of treatment were 6.5 times greater for patients who consumed alcohol daily. The second most important risk factor was the size of the ulcer. Other risk factors that affected healing were symptoms of bleeding and a history of previous duodenal ulcers. The use of salicylates, such as aspirin, or the use of nonsteroidal anti-inflammatory agents, such as ibuprofen, improved healing. The number of patients whose ulcers were healed after four weeks of taking famotidine decreased with increasing numbers of risk factors present. Fewer than half of the patients who had severe pain seven days after the treatment with famotidine had ulcers that healed at four weeks. A number of other factors, namely sex, race, age, smoking, and the existence of other medical conditions, did not affect ulcer healing with famotidine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Physiological aspects, Nonsteroidal anti-inflammatory drugs, Ulcers, Nonsteroidal anti-inflammatory agents, Alcohol, Ethanol, Sodium compounds, Famotidine, Sodium salicylate, Salicylates

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Bismuth absorption and myoclonic encephalopathy during bismuth subsalicylate therapy

Article Abstract:

Bismuth salts have been successfully used to treat diarrhea, and rarely cause toxicity or adverse reactions. When bismuth subsalicylate is administered, 90 percent of the subsalicylate and little if any of the bismuth is absorbed. However, increased levels of bismuth in the blood may be evident after large or repetitive ingestion of bismuth salts that are water soluble. Increased blood levels of bismuth have been associated with encephalopathy, or impaired brain function, which is characterized by altered mental status, impaired muscle coordination, muscle spasm, and abnormalities of the electrical activity in the brain. There is only one previous report of encephalopathy after the ingestion of bismuth subsalicylate (e.g. Pepto-Bismol). A case is described of a 45-year-old man with acquired immunodeficiency syndrome (AIDS), who developed diarrhea three weeks after being hospitalized for pneumocystis pneumonia. The diarrhea resolved after treatment with large doses of bismuth subsalicylate, but after seven days, he developed lethargy or sluggishness, difficulty with speech, and spasms of the muscles in the face. Excessive levels of bismuth were detected in his urine and blood, and despite treatment with D-penicillamine to lower bismuth levels, the patient died within 24 hours. Abnormalities of the gastrointestinal mucosa, which lines the stomach and intestinal tract, and the large repetitive doses of bismuth subsalicylate resulted in increased bismuth absorption and encephalopathy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diarrhea, AIDS (Disease), Bismuth subsalicylate, Pepto-Bismol (Medication)

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Effect of triple therapy (antibiotics plus bismuth) on duodenal ulcer healing: a randomized controlled trial

Article Abstract:

In recent years evidence has shown that infection of the gastrointestinal tract with the bacterium Helicobacter pylori is associated with a high incidence of chronic gastritis, a common predecessor of ulcers. A study was performed to determine if adding antibacterial agents to anti-ulcer agents might improve healing of ulcers. A total of 105 patients with duodenal ulcers was randomly divided into two groups; one group was given ranitidine, an anti-ulcer drug, and the other received ranitidine, bismuth and antibiotics (tetracycline and metronidazole). Bismuth and antibiotic treatment have been shown to eradicate H. pylori infection. Prior to treatment, nearly all of the patients were found to be infected with H. pylori. At the study's conclusion, all those assigned to receive ranitidine were still infected with H. pylori, while infections were eradicated in 43 of the 53 patients given ranitidine and antibiotics with bismuth (triple therapy). The rate of healing of the ulcers was shown to be faster in those taking the triple therapy than in those taking ranitidine alone. The long-term consequences of the three-drug combination are not yet clear, and other anti-ulcer regimens whose side effects are well-known are just as efficacious as this treatment. While ranitidine plus triple therapy may be effective, its use is not yet warranted in light of other more well-known anti-ulcer drugs that are widely available. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Dosage and administration, Metronidazole, Helicobacter infections, Drug therapy, Combination, Combination drug therapy, Tetracycline, Tetracyclines, Ranitidine

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