riopan and Gastrointestinal-Hemorrhage

We studied the serum aluminum levels of 30 intensive care patients receiving six daily doses of magaldrate (Riopan) or aluminium hydroxide (Trigastril). In both groups we found a significant rise of the serum aluminium concentration (p less than 0.01) following administration of the antacid solutions. Examination on day 9 and 15 the magaldrate group showed significantly (p less than 0.05) lower aluminium levels than the aluminium hydroxide group. An increase up to the critical serum aluminium level of 100 ng/ml occurred in none of the patients that all had normal or slightly impaired renal function. Therefore routine measurements of serum aluminium levels in patients without renal impairment are not considered necessary following antacid therapy. However, we recommend the use of antacids with an aluminium absorption rate as low as possible.

Topics: Adult; Aged; Aluminum; Aluminum Hydroxide; Antacids; Brain; Female; Gastrointestinal Hemorrhage; Humans; Kidney Diseases; Magnesium; Magnesium Hydroxide; Male; Middle Aged; Random Allocation

We retrospectively investigated the efficacy of high dose omeprazole compared to a combined therapy of famotidine, pirenzepine and antacid for acute upper gastrointestinal hemorrhage (AUGIH) also adjuvant to endoscopic injection therapy if indicated. The clinical course of AUGIH was evaluated, if emergency endoscopy revealed lesions substantially dependent on intragastric acidity with respect to pathogenesis and/or healing (peptic ulcer, erosive gastroduodenitis, reflux-esophagitis, Mallory-Weiss tears) and patients either received a combined therapy of famotidine (20 mg i.v. every 12 hrs), pirenzepine (10 mg i.v. every 12 hrs) and antacid (control group: n = 96) or omeprazole (40 mg i.v. every 6 hrs; omeprazole group: n = 100). Rate of rebleeding was lower in the omeprazole group without reaching significance (12 vs. 21; p = 0.06). No difference was found for rates of operation (6 vs. 6; p = 0.94), death from bleeding (5 vs. 9; p = 0.22), transfusions ([mean +/- SD] 3.3 +/- 5.0 vs. 3.2 +/- 5.7; p = 0.51) and hospitalisation ([mean +/- SD] 26.8 +/- 12.1 vs. 27.8 +/- 16.0 days; p = 0.88). Considering prognostic risk factors (age > or = 65, actively bleeding lesion, initial state of shock) logistic regression showed that high dose omeprazole inhibited rebleeding (p = 0.01) but had no effect as regards surgery or mortality. Within two selected subgroups defined by additional criteria (no endoscopic treatment and anamnestic peptic lesion) omeprazole-treated cases showed lower rates of rebleeding (3/49 vs. 12/54, p " 0.02 and 3/44 vs. 13/48, p = 0.01 resp.) and death from bleeding (0/46 vs. 6/50, p = 0.03 and 0/43 vs. 5/45, p = 0.03 resp.).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Aluminum Hydroxide; Antacids; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Endoscopy, Digestive System; Famotidine; Gastrointestinal Hemorrhage; Humans; Magnesium Hydroxide; Omeprazole; Peptic Ulcer Hemorrhage; Pirenzepine; Recurrence; Retrospective Studies; Survival Rate