riopan and Peptic-Ulcer

Gastric stress ulceration and bleeding are common occurrences in the critically ill and prophylactic acid-suppression is used almost universally in this population. Evidence suggests that general medical patients hospitalized outside of the intensive care unit often receive similar therapy.. To determine how frequently general medical patients are prescribed stress ulcer prophylaxis and what evidence exists for doing so.. The MEDLINE database (1966 to October 2005), the Cochrane Central Register of Controlled Trials (4th Quarter 2005), and the bibliographies of selected articles.. Studies that contained significant data about either the frequency of use of stress ulcer prophylaxis in general medical patients or gastrointestinal bleeding outcomes in patients given prophylaxis.. The primary author extracted prevalence and outcome data.. Descriptive studies suggest that 20-25% of general medical patients receive acid suppression for stress ulcer prophylaxis in the absence of presumed (but not established) risk factors for bleeding. Only two randomized, controlled trials evaluated the effects of prophylaxis in this population. The first found a reduction in clinically significant gastrointestinal bleeding from 6% (3 of 48) with placebo to zero (n = 52) with magaldrate. The second found a reduction in clinically significant bleeding from 3% (2 of 70) with sucralfate to zero (n = 74) with cimetidine.. A significant number of general medical patients are prescribed acid-suppressive therapy for stress ulcer prophylaxis. The literature provides only sparse guidance on this issue with two randomized trials showing a possible benefit for prophylaxis. Further study is needed.

Topics: Aluminum Hydroxide; Antacids; Anti-Ulcer Agents; Cimetidine; Humans; Magnesium Hydroxide; Peptic Ulcer; Peptic Ulcer Hemorrhage; Stress, Physiological

Topics: Aluminum Compounds; Aluminum Hydroxide; Aluminum Silicates; Antacids; Dyspepsia; Humans; Magnesium; Magnesium Compounds; Magnesium Hydroxide; Peptic Ulcer; Silicates

In a multicentre study, 146 peptic ulcer patients who had recently healed with H2 antagonists (38 gastric, 108 duodenal ulcers) received randomly for a year one of the following mucosal protecting antiulcer drugs: aceglutamide aluminium salt (AAL), zinc acexamate (ZAC) and magaldrate (MAG). Forty six patients received AAL (700 mg bid), 50 patients received ZAC (300 mg at single nocturnal dose) and 50 patients received MAG (800 mg bid). An endoscopic examination was performed at the beginning of the study and 12 months later. Clinical examinations where performed on months 3, 6 and 9, advancing the endoscopical control in case of ulcer symptoms. ZAC showed to be superior to MAG (p less than 0.05, chi-square test) in preventing relapses, with a favourable tendence in front of AAL, but without reaching statistical significance. Its important to mention the high number of withdrawals and the good tolerance of the treatments.

Topics: Adult; Aluminum Hydroxide; Aminocaproates; Aminocaproic Acid; Antacids; Anti-Ulcer Agents; Female; Glutamine; Humans; Magnesium Hydroxide; Male; Middle Aged; Organometallic Compounds; Peptic Ulcer; Recurrence; Time Factors

Ligation of the pig bile duct (BDL) results in 100% incidence of pars esophageal ulceration within 48 hours of the procedure. Usually such ulceration is uniformly fatal unless a highly selective vagotomy is performed simultaneously with the BDL. The administration of sucralfate to pigs with BDL prolonged their survival for up to 7 days, with evidence of healing of the ulcer on macroscopic and histologic observations. An increase in cell proliferation in the squamous epithelium of the ulcerated area was also seen in this sucralfate group. These features were not seen in controls, pigs with BDL only, or pigs with BDL and with magaldrate (Riopone), colloidal bismuth subcitrate (DeNol), or carbenoxolone. Analysis by Sepharose 2B gel filtration showed that there was no significant difference in the amounts of polymeric mucin in any group, with a wide scatter of the data seen especially for pigs in the untreated BDL-only group. This study suggests that sucralfate may enhance healing in this experimental pig ulcer model via a mechanism independent of the stimulation of mucus secretion. We propose that coating the mucosa with sucralfate provides a temporary substitute barrier that creates a microenvironment conducive to wound repair by mucosal proliferation.

Topics: Aluminum Hydroxide; Animals; Antacids; Bile Ducts; Chromatography, Gel; Disease Models, Animal; Gastric Mucins; Incidence; Magnesium Hydroxide; Molecular Weight; Organometallic Compounds; Peptic Ulcer; Sucralfate; Survival Rate; Swine; Wound Healing

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; Aluminum Compounds; Aluminum Hydroxide; Antacids; Magnesium; Magnesium Compounds; Magnesium Hydroxide; North Carolina; Peptic Ulcer