montelukast and Abdominal-Pain

Functional dyspepsia (FD) is common in children, with as many as 80% of those being evaluated for chronic abdominal pain reporting symptoms of epigastric discomfort, nausea, or fullness. It is known that patients with persistent complaints have increased comorbidities such as depression and anxiety. The interaction with psychopathologic variables has been found to mediate the association between upper abdominal pain and gastric hypersensitivity. These observations suggest that abnormal central nervous system processing of gastric stimuli may be a relevant pathophysiologic mechanism in FD. Despite increased understanding, no specific therapy has emerged; however, recent nonpharmacological-based options such as hypnosis may be effective. Novel approaches, including dietary manipulation and use of nutraceuticals such as ginger and Iberogast (Medical Futures Inc., Ontario, Canada), may also be considered.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Abdominal Pain; Acetates; Acupuncture Therapy; Adolescent; Animals; Child; Cognitive Behavioral Therapy; Cyclopropanes; Dyspepsia; Endoscopy, Gastrointestinal; Gastric Emptying; Gastrointestinal Motility; Helicobacter Infections; Helicobacter pylori; Humans; Hypnosis; Imagery, Psychotherapy; Lansoprazole; Leukotriene Antagonists; Phytotherapy; Plant Extracts; Proton Pump Inhibitors; Quinolines; Serotonin; Stomach; Sulfides; Viscera; Zingiber officinale

To date, no adequate data are available on direct comparison of the efficacy of levocetirizine, a recently approved histamine1-antihistamine, with that of a leukotriene antagonist in the treatment of seasonal allergic rhinitis (SAR) symptoms.. To compare the efficacy of therapeutic doses of 5 mg of levocetirizine and 10 mg of montelukast in ragweed sensitized patients.. A randomized, double-blind, placebo-controlled, parallel-group study was conducted between July and October 2006. Symptomatic patients with SAR were exposed to ragweed pollen under controlled conditions in an environmental exposure chamber for 4 to 5 hours after treatment with 5 mg of levocetirizine, 10 mg of montelukast, or matched placebo on 2 consecutive days. The mean change from baseline in pollen-induced rhinitis symptoms, expressed as a major symptoms complex (MSC) score (sum of scores for rhinorrhea, itchy nose, sniffles, nose blows, sneezes, and watery eyes), in period 1 (first 5 hours after first drug intake) was the primary efficacy outcome.. A total of 611 patients were screened, of whom 403 were randomized to receive treatment (102 placebo, 152 levocetirizine, and 149 montelukast). The MSC score in period 1 was progressively decreased to a significantly greater extent in the levocetirizine group compared with the montelukast and placebo groups (adjusted mean differences, -2.18 [95% confidence interval, -3.35 to -1.01; P < .001] and -2.22 [95% confidence interval, -3.51 to -0.92; P < .001] for levocetirizine vs montelukast and vs placebo, respectively). The effect of 10 mg of montelukast was not significantly different compared with placebo. Levocetirizine also achieved a significantly faster onset of action within 2.5 hours of administration. Both products were well tolerated.. This study in an environmental exposure chamber confirms the therapeutic efficacy of 5 mg of levocetirizine in improving symptoms of SAR, which was superior to 10 mg of montelukast.

Topics: Abdominal Pain; Acetates; Adolescent; Adult; Aged; Ambrosia; Cetirizine; Cyclopropanes; Double-Blind Method; Exanthema; Female; Histamine H1 Antagonists, Non-Sedating; Humans; Leukotriene Antagonists; Male; Middle Aged; Patient Satisfaction; Quinolines; Rhinitis, Allergic, Seasonal; Sulfides; Time Factors; Treatment Outcome

The epidemiology of eosinophilic gastroenteritis remains unclear. We aim to determine the prevalence of eosinophilic gastroenteritis in patients with lower abdominal symptoms.. In a prospective study, colonoscopy was performed on 2,469 consecutive patients. Biopsies were taken from the terminal ileum and ascending, transverse, descending and sigmoid colon in all patients.. Sixty-four of the 2,469 patients (2.6%) had eosinophilic gastroenteritis. Only five of the 64 patients (7.8%) with eosinophilic gastroenteritis had endoscopic mucosal abnormalities during colonoscopy. Six of these 64 patients (9.4%) had severe disease at presentation, and seven of these 64 patients (10.9%) required systemic steroid treatment. An elevated absolute peripheral eosinophil count was independently associated with severe disease at presentation (4/6 [66.7%] vs 3/58 [5.2%], p=0.005; odds ratio [OR], 25.320; 95% confidence interval [CI], 2.628 to 243.910), and severe disease at the time of presentation was independently associated with the use of systemic steroid treatment (6/7 [85.7%] vs 0/57 [0%], p=0.008; OR, 18.021; 95% CI, 2.163 to 150.152).. The prevalence of eosinophilic gastroenteritis is common, and patients usually present normal-appearing mucosa on colonoscopy. Those with severe disease at presentation usually have a raised absolute peripheral eosinophil count and should be commenced on systemic steroids as an initial therapy.

Topics: Abdominal Pain; Acetates; Adolescent; Adult; Anti-Inflammatory Agents; Colon, Descending; Colon, Sigmoid; Colonoscopy; Cyclopropanes; Drug Therapy, Combination; Enteritis; Eosinophilia; Female; Gastric Mucosa; Gastritis; Humans; Ketotifen; Male; Middle Aged; Prednisolone; Prevalence; Prospective Studies; Quinolines; Republic of Korea; Sulfides; Treatment Outcome; Young Adult

Topics: Abdominal Pain; Acetates; Angioplasty; Ascites; Budd-Chiari Syndrome; Child; Constriction, Pathologic; Cyclopropanes; Diagnosis, Differential; Humans; Hypereosinophilic Syndrome; Leukotriene Antagonists; Male; Quinolines; Sulfides; Treatment Outcome; Vena Cava, Inferior

Topics: Abdominal Pain; Acetates; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Budesonide; Capillary Permeability; Cough; Cyclopropanes; Diarrhea; Dyspnea; Female; Humans; Lung; Mast Cells; Mastocytosis, Systemic; Middle Aged; Nedocromil; Quinolines; Sulfides