Ranitidine in the treatment of non-steroidal anti-inflammatory drug associated gastric and duodenal ulcers

Article Abstract:

Gastric and duodenal ulcers develop when there is an imbalance between the destructive effects of gastric acid on the gastrointestinal mucosa (inner lining of the stomach and intestines) and the protective ability of mucosal secretions. Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to cause gastrointestinal ulcers, perhaps through a direct destructive effect on the mucosa, or by interfering with mucosal protective mechanisms. Physicians commonly prescribe NSAIDs in combination with drugs that suppress gastric acid secretion in the belief that decreased acid will counterbalance the decreased mucosal integrity and alleviate ulceration. However, there is limited experimental or clinical evidence to support this notion. To determine the effects of a commonly used inhibitor of gastric acid (the histamine H2 receptor antagonist ranitidine), 190 patients who developed gastric or duodenal ulcers, or both, while taking NSAIDs for a variety of painful conditions (predominantly arthritis) were assessed. The patients randomly assigned either to a group that stopped taking NSAIDs and received daily doses of ranitidine, or a group that received daily doses of ranitidine and continued NSAID therapy. Due to ethical considerations, there was no group of patients that did not receive ranitidine. In patients who continued taking both medications, gastric ulcers had healed in 63 percent of the cases at 8 weeks, compared with 95 percent for patients who stopped taking NSAIDs. For duodenal ulcers, the healing rates at 8 weeks were 84 and 100 percent, respectively. At 12 weeks, 70 percent of gastric ulcers and 92 percent of duodenal ulcers were healed in patients who continued taking NSAIDs; all ulcers had healed in those who stopped NSAIDs. These results demonstrate that although healing of gastric and duodenal ulcers is greatest when NSAID therapy is discontinued, ranitidine (in 150 milligrams doses twice a day) successfully heals most NSAID-related ulcers . (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Nonsteroidal anti-inflammatory drugs, Nonsteroidal anti-inflammatory agents, Peptic ulcer, Gastric acid, Ranitidine

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Adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate

Article Abstract:

There is growing evidence that infection with the bacteria Helicobacter pylori is strongly correlated with development and recurrence of duodenal ulcer, an inflammatory condition of the initial segment of the intestine. Treating duodenal ulcers with colloidal bismuth subcitrate (CBS) has been reported to be more effective than the use of standard anti-ulcer therapy (e.g. cimetidine administration). It is thought that this may be due to the ability of the former medication to suppress H. pylori activity. However, CBS alone eradicates H. pylori in less than 50 percent of patients. To determine whether more complete suppression of H. pylori infection is associated with a better prognosis for duodenal ulcer, 141 patients with documented duodenal ulcer were assigned to one of four treatment groups: CBS alone, CBS plus the antibacterial agent amoxicillin, CBS plus one of two doses of the antibacterial agent metronidazole, and CBS plus both amoxicillin and metronidazole. The patients receiving either CBS plus the high dose of metronidazole or all three medications had a significantly higher rate of duodenal ulcer healing than those receiving CBS alone. These two treatment regimens were also more effective in eradicating H. pylori. This bacteria, when isolated from patients before and after treatment with metronidazole, showed greater resistance to the drug following treatment than before. This indicates that acquired resistance to metronidazole may be the reason H. pylori is not effectively eradicated by this drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Physiological aspects, Metronidazole, Helicobacter infections, Amoxicillin

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Effect of calcitonin on gastric emptying in patients with an active duodenal ulcer

Article Abstract:

Researchers searching for drugs that would have an effect on peptic ulcers have recently been investigating the properties of calcitonin, a hormone which lowers calcium and phosphate levels in the blood, and its effect on the process of emptying the stomach of food after a meal (gastric emptying). The concentrations in the blood of gastrin (a hormone which stimulates the production of stomach acid), insulin, glucose (sugar), calcium and phosphorus were measured in eight patients with duodenal ulcers after they consumed a mixed solid-liquid meal. Calcitonin markedly delayed gastric emptying in all the patients, but it did not significantly affect the release of gastrin after the meal. After the meal, the release of insulin was stopped by the hormone. At the same time, the amount of blood glucose increased as calcitonin was given, with the highest glucose concentration measured at the end of infusion of the hormone. Calcitonin did not significantly change the levels of calcium or phosphorus in the blood. In patients with duodenal ulcers, calcitonin treatment delays gastric emptying and inhibits gastric acid secretion. Because of these results, further studies of calcitonin in the treatment of duodenal ulcers are recommended.

Health aspects, Measurement, Blood sugar, Blood glucose, Insulin, Calcitonin

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