riopan and Duodenal-Ulcer

A randomized, placebo-controlled trial was performed to assess the effect of magaldrate (800 mg every 4 h) in reducing the rate of upper gastrointestinal tract bleeding among 100 consecutive patients with severe diseases admitted to a general hospital ward. Upper gastrointestinal tract bleeding occurred in 11 of 48 placebo-treated patients and in only 1 of 52 magaldrate-treated patients (p less than 0.01). Endoscopic examination of these patients showed gastric ulcer (two cases), multiple gastric mucosa ulcerations (nine), and no lesions (one). In three patients who received placebo the hemorrhage was clinically relevant and required transfusion of two or more blood units. Patients with two or more risk factors showed a higher rate of gastrointestinal hemorrhage (p less than 0.05). Respiratory failure and treatment with a high dose of corticosteroids were associated with the highest incidence of bleeding (p less than 0.05 for both). The only adverse reaction associated with magaldrate was a mild and self-limiting diarrhea in two cases. We conclude that patients seriously ill admitted to a general hospital ward should be treated with a prophylactic agent against stress-induced ulcer bleeding. Magaldrate is an effective and safe antacid to prevent gastrointestinal tract bleeding in such patients.

Topics: Adult; Aged; Aged, 80 and over; Aluminum Hydroxide; Antacids; Chi-Square Distribution; Critical Illness; Duodenal Ulcer; Female; Hospitalization; Hospitals, General; Humans; Magnesium Hydroxide; Male; Middle Aged; Peptic Ulcer Hemorrhage; Single-Blind Method

Antacid (AA) in a very low dose (88 mmol/day) was compared to the standard 800-mg dose of cimetidine in healing duodenal ulcers. The influence of sex, age, symptom duration at entry, night pain, smoking, coffee consumption, and alcohol on ulcer healing was studied. The antacid was given in two different schedules: group I--20 ml 1 hr after breakfast and at bedtime; group II--10 ml 1 hr after breakfast and lunch and 20 ml at bedtime. Cimetidine (group III) was given in two divided doses: 400 mg 1 hr after breakfast and 400 mg at bedtime. Endoscopic control was performed after four weeks and, if necessary, after eight weeks of treatment. The healing rate after four weeks of treatment was, respectively, for groups I, II, and III, 45.5%, 55.8%, and 69.4% (group I = group II, and group III different from groups I and II). After eight weeks of treatment the healing rate was 61.5%, 80.8%, and 88.0% for groups I, II, and III, respectively (group II = group III, and group I different from groups II and III). Except for group I, smoking did not influence healing rate. Age, sex, symptoms at entry, night pain, and coffee consumption did not influence the treatment results. The authors concluded that the very low dose of magaldrate (88 mmol/day), when administered in three divided doses (10 ml after breakfast and lunch and 20 ml at bedtime) for eight weeks was as effective as 800 mg of cimetidine (400 mg twice a day) in healing duodenal ulcer.

Topics: Adult; Alcohol Drinking; Aluminum Hydroxide; Antacids; Cimetidine; Coffee; Drug Administration Schedule; Duodenal Ulcer; Duodenoscopy; Female; Humans; Magnesium Hydroxide; Male; Middle Aged; Patient Compliance; Prognosis; Risk Factors; Smoking

The antacid ES Riopan was acidified ex vivo to pH 2.5 to completely eliminate its buffering capacity and was then tested as a mucosal protective agent. The pH 2.5 acidified antacid solution was named activated aluminum complex. Activated aluminum complex was 8.2 times more potent than its parent antacid in protecting against acidified aspirin-induced gastric lesions in the rat. Activated aluminum complex had a duration of action greater than 10 h in the ethanol-induced gastric lesion model, while ES Riopan was active for 6 h. Activated aluminum complex was able to inhibit both acid- and nonacid-mediated ulcers in the stomach and intestine. Its mucosal protective activity was not blocked by pretreatment with indomethacin. These results demonstrate that the nonbuffering antacid activated aluminum complex exerted a more potent and longer-lasting mucosal protective activity than its parent antacid. The activity was probably due to the presence of a hexaaquoaluminum cation and supports the argument that antacids possess mucosal protective effects independent of their acid-neutralizing capacity.

Topics: Aluminum Hydroxide; Animals; Antacids; Aspirin; Cysteamine; Duodenal Ulcer; Ethanol; Gastric Mucosa; Hydrogen-Ion Concentration; Indomethacin; Intestinal Mucosa; Ligation; Magnesium Hydroxide; Male; Rats; Rats, Inbred Strains; Stomach Ulcer

In the last years the importance of the evaluation of antacid compounds according to their neutralizing capacity decreased. Clinical investigations have shown that antacid mixtures of aluminum-magnesium hydroxide healed gastric an duodenal ulcers (neutralizing capacity 100-150 mmol/day) as well as H2 receptor antagonists and better than a placebo. By this the necessary daily dosage could be reduced essentially. This paper presents studies showing that lattice like structured antacids (e.g. Magaldrate) healed gastric and duodenal ulcers (neutralizing capacity 100-350 mmol/day) as well as Ranitidine (150 mg b.d.). Maintenance therapy should be evaluated critically because sufficient data are not available and mineral metabolism is changed significantly by extremely small dosages of aluminium-magnesium hydroxide antacids even in patients with normal kidney function.

Topics: Aluminum Hydroxide; Antacids; Drug Administration Schedule; Duodenal Ulcer; Gastric Acidity Determination; Humans; Magnesium Hydroxide; Peptic Ulcer; Ranitidine; Recurrence; Structure-Activity Relationship; Wound Healing

Topics: Aluminum Hydroxide; Circadian Rhythm; Drug Administration Schedule; Duodenal Ulcer; Humans; Magnesium; Magnesium Hydroxide

It has been previously suggested that antral pH governs the density of antral G- and D-cells. Therefore, we investigated the effect of acid neutralization by an antacid (magaldrat; in vivo neutralization capacity of 144 mval/day) and the effect of suppression of gastric acid secretion by an H2-receptor blocker (oxmetidine, 400 mg/day) on the density of both cell types in healthy volunteers and duodenal ulcer patients. Four weeks after antacid treatment antral G-cell density decreased significantly in both groups, while antral D-cells decreased only in volunteers. Basal serum gastrin was not altered, whereas the integrated postprandial serum gastrin response and antral gastrin concentration was significantly reduced in volunteers but not in ulcer patients. None of the parameters investigated was changed by oxmetidine treatment. Considering the short-lasting effect on acid neutralization induced by the antacid dosage used in this study and the inability of oxmetidine treatment to influence volume densities and secretory activities of antral G- and D-cells it is concluded that mechanisms other than a change of antral pH may account for the results obtained during antacid treatment.

Topics: Adult; Aluminum Hydroxide; Antacids; Duodenal Ulcer; Female; Gastric Mucosa; Gastrins; Histamine H1 Antagonists; Humans; Imidazoles; Magnesium; Magnesium Hydroxide; Male; Middle Aged; Pyloric Antrum