Weekend treatment with 20 and 40 mg omeprazole: effect on intragastric pH, fasting and postprandial serum gastrin, and serum pepsinogens

Article Abstract:

Peptic ulcer is a condition in which the lining of the stomach or intestines succumbs to the destructive actions of acid produced by the stomach, resulting in gnawing pain, nausea, vomiting and loss of appetite. An accepted treatment strategy for peptic ulcers is the administration of drugs that inhibit the secretion of gastric acid. A relatively new class of gastric acid inhibitory drugs acts by inhibiting the action of a key enzyme (sodium/potassium ATPase) involved in the secretion of gastric acid; omeprazole is the prototypic member of this class. Relatively low doses of omeprazole (20 milligrams, or mg) reduce the six-month ulcer relapse rate from 83 percent of placebo-treated patients to 29 percent; presumably, higher doses would reduce relapses even further. However, adverse effects have been reported with continuous high-dose administration of omeprazole. Administration of omeprazole to ulcer patients at periodic intervals (rather than every day) has been reported to be effective in preventing ulcer relapse. To determine the efficacy of suppressing gastric acid secretion with intermittent (weekend-only) administration of high and low doses of this drug, a study was carried out involving eight healthy subjects who received either low dose (20mg) or high dose (40mg) omeprazole on Friday, Saturday, and Sunday. Gastric acid secretion and hormone levels were measured for the remainder of the week. The following weekend, subjects were given whichever treatment they had not received during the first trial, and measurements were repeated. There was a dose-dependent decrease in gastric acid secretion, which returned to baseline levels within one day after the last dose of omeprazole; the high dose reduced gastric acid secretion significantly more than the low dose. Changes in gastrointestinal hormone levels were consistent with the alterations in gastric acid. Hence, weekend administration of omeprazole at higher doses may reduce gastric acidity sufficiently to decrease ulcer relapse rates without evoking the adverse effects seen with chronic suppression of gastric acid secretion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug therapy, Dosage and administration, Antiulcer agents, Peptic ulcer, Omeprazole, Gastric acid, Antiulcer drugs

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Mortality and causes of death in Crohn's disease: review of 50 years' experience in Leiden University Hospital

Article Abstract:

Crohn's disease is a disease of the small intestine characterized by inflammation, malabsorption of nutrients, diarrhea, malnutrition, and intestinal bleeding. Patients suffering from Crohn's disease are reported to be at greater risk for developing cancer of the colon and rectum. It has been suggested that these patients are also more prone to mortality from other causes, but this has not been well investigated. To evaluate the causes of death in Crohn's disease patients, the records of 671 patients seen at Leiden University Hospital between 1934 and 1984, all of whom were diagnosed with Crohn's disease, were analyzed. Follow-up was possible in 98.2 percent of the cases. About 10 percent of the patients died, and the cause of death was definitely or probably related to Crohn's disease in 61 percent of these cases; the remainder died of incidental causes unrelated to Crohn's disease. The incidence of disease-related deaths has declined precipitously since 1973. There are no longer any deaths from such Crohn's disease-related complications as malnutrition or amyloidosis (an immune system dysfunction), and postoperative deaths have decreased significantly in recent years. Crohn's disease-related mortality was higher in women than men, and higher in patients with early onset than in those with later onset. These results are consistent with the idea that the prognosis for Crohn's disease has improved dramatically in recent years, but that continuing high levels of medical care, especially for patients with early-onset disease, are necessary for this trend to persist. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Prognosis

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Rectal mucosal dysplasia in Crohn's disease

Article Abstract:

Crohn's disease is an inflammatory disorder of the small intestine characterized by malabsorption of nutrients, diarrhea, malnutrition, and intestinal bleeding. Patients with Crohn's disease are at higher risk for developing cancer of the large intestine, as are patients suffering from ulcerative colitis, a similar syndrome affecting the colon. Ulcerative colitis patients have an increased incidence of dysplasia (abnormal development) of the epithelial cells lining the colon. To determine if similar changes occur in the rectal epithelial cells of Crohn's disease patients, and what relationship these changes have on the onset of rectal cancer, 812 biopsy specimens were taken from 356 Crohn's disease patients and microscopically analyzed for evidence of dysplasia. In 18 cases (5 percent), dysplasia was observed; four of these patients showed similar dysplasia on repeat biopsy. Most dysplasia was mild, some moderate, and none severe. Three of these patients developed abnormal growths including cancer in two and an adenoma in one. Dysplasia was significantly more pronounced in patients who ultimately underwent removal of the colon than in those who did not. Four additional patients who did not have dysplasia during a single biopsy sampling developed rectal carcinoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

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