gelusil and Gastroesophageal-Reflux

The pathogenesis of patient dissatisfaction following involuntary therapeutic substitutions involving proton pump inhibitors (PPIs) is poorly understood. The aim of this study was to describe the patient population experiencing therapeutic failure and investigate whether failure was related to individual differences in response to the different PPIs. Treatment failures in a lansoprazole-rabeprazole therapeutic substitution program were compared to switch successes. A subgroup was randomized in a double-blind, double-dummy, crossover study to four 2-week periods of lansoprazole-rabeprazole-lansoprazole-rabeprazole or vice versa. Measures included overall rating of gastrointestinal reflux disease (GERD) symptoms for the past week as well as the frequency and distress scales of the GERD Symptom Assessment Scale. One hundred fifteen nonresponders were compared with 54 successful responders. Nonresponders consisted primarily of patients with GERD (74%, vs. 44% of responders; P = 0.005) who had undergone upper gastrointestinal endoscopy (50%, vs. 31% of responders; P = 0.02). Twelve patients completed the randomized treatment study. The interrater kappa coefficient for responder status was estimated to be 0.80 for lansoprazole and 0.21 for rabeprazole. The majority of PPI nonresponders had a clinical diagnosis of GERD and were receiving >/=40 mg of rabeprazole daily. This pilot study provides new insights into the design of subsequent studies of nonresponders in PPI therapeutic substitution programs.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Aged; Aluminum Hydroxide; Analysis of Variance; Cross-Over Studies; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Enzyme Inhibitors; Female; Follow-Up Studies; Gastroesophageal Reflux; Humans; Lansoprazole; Magnesium Hydroxide; Male; Middle Aged; Prospective Studies; Proton Pump Inhibitors; Proton-Translocating ATPases; Rabeprazole; Silicic Acid; Treatment Failure

We sought to evaluate safety and efficacy of IV pantoprazole when used as initial therapy in patients with gastroesophageal reflux disease (GERD) and a history of erosive esophagitis (EE) in a double-blind, placebo-controlled, randomized, parallel-group study. Patients were randomized to 7 days of once-daily IV or oral pantoprazole (40 mg) or placebo. Efficacy variables included maximal acid output, basal acid output, and changes from baseline in frequency/severity of GERD symptoms, and frequency of antacid usage. Seventy-eight patients were randomized (n=26/27/25 [IV/oral/placebo]). Mean maximal acid output was 8.4, 6.3, and 20.9 mEq/h for IV or oral pantoprazole, and placebo, respectively. For pantoprazole versus placebo, maximal and basal acid output were significantly lower (P<.001) and there was a numerical trend toward improved GERD and antacid usage. Both treatments were well tolerated. In conclusion, IV/oral pantoprazole were similarly effective in suppressing basal and pentagastrin-stimulated gastric acid secretion in GERD patients with a history of EE.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Administration, Oral; Adult; Aluminum Hydroxide; Analysis of Variance; Anti-Ulcer Agents; Benzimidazoles; Body Weights and Measures; Double-Blind Method; Drug Combinations; Esophagitis, Peptic; Female; Gastric Acid; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Infusions, Intravenous; Magnesium Hydroxide; Male; Middle Aged; Omeprazole; Pantoprazole; Placebo Effect; Severity of Illness Index; Silicic Acid; Sulfoxides; Treatment Outcome

Fifteen cases of intractable chronic esophagitis due to gastroesophageal reflux were treated with a continuous intraesophageal antacid drip. A proprietary antacid preparation, Gelusil or monalium hydrate (Riopan), in a concentration of one part of antacid to nine parts of water, was infused into the mid-esophagus through a polyethylene tube with an internal diameter which admits a No. 18 blunted needle. Patients are not confined to bed while the drip is in progress. If the flow is constant and the end of the tube is below the cricopharyngeal sphincter, patients do not experience discomfort even if the drip is administered continuously for several days.Results indicate that remission of symptoms can be achieved in almost every patient, even those who have previously failed to respond to oral antacid therapy.

Topics: Aluminum Hydroxide; Antacids; Anti-Ulcer Agents; Drug Combinations; Esophagitis, Peptic; Gastroesophageal Reflux; Geriatrics; Humans; Hydroxides; Magnesium Hydroxide; Silicic Acid