salicylates and Peptic-Ulcer

As one of the most prevalent infections globally, Helicobacter pylori (H. pylori) continues to present diagnostic and therapeutic challenges for clinicians worldwide. Diagnostically, the "test-and-treat" strategy is the recommended approach for healthcare practitioners when managing this potentially curable disease. The choice of testing method should be based on several factors including patient age, presenting symptoms, and medication use, as well as test reliability, availability, and cost. With rising antibiotic resistance, particularly of macrolides, care must be taken to ensure that therapy is selected based on regional resistance patterns and prior antibiotic exposure. In the USA, macrolide antibiotic resistance rates in some areas have reached or exceeded a generally accepted threshold, such that clarithromycin triple therapy may no longer be an appropriate first-line empiric treatment. Instead, bismuth quadruple therapy should be considered, while levofloxacin-based or alternative macrolide-containing therapies are also options. Once treated, it is essential to test for eradication as untreated H. pylori is associated with serious complications including peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. This review article aims to consolidate current knowledge of H. pylori infection with a particular emphasis on diagnostic and treatment strategies.

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Antigens, Bacterial; Biopsy; Bismuth; Breath Tests; Clarithromycin; Culture Techniques; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Dyspepsia; Feces; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Levofloxacin; Lymphoma, B-Cell, Marginal Zone; Metronidazole; Nitro Compounds; Organometallic Compounds; Peptic Ulcer; Polymerase Chain Reaction; Proton Pump Inhibitors; Rifabutin; Salicylates; Salvage Therapy; Serologic Tests; Stomach Neoplasms; Tetracycline; Thiazoles; Treatment Outcome; Urea

National Danish guidelines for the diagnosis and treatment of Helicobacter pylori (Hp) infection have been approved by the Danish Society for Gastroenterology. All patients with peptic ulcer disease, gastric cancer, and MALT lymphoma should be tested for Hp. We also recommend testing in first degree relatives to patients with gastric cancer, in NSAID-naive patients, who need long-term NSAID therapy, and in patients presenting with dyspepsia and no alarm symptoms. Non-endoscoped patients can be tested with a urea-breath test or a faecal antigen test. Endoscoped patients can be tested with a rapid urease test. Proton pump inhibitor therapy should be stopped at least 1 week prior to Hp testing. All infected patients should be offered Hp eradication therapy. First-line treatment is 7-day triple therapy with a proton pump inhibitor and clarithromycine in combination with metronidazole or amoxicilline. Quadruple therapy for 2 weeks with bismuthsubsalicylate, tetracycline, metronidazole and a proton pump inhibitor is recommended in case of treatment failure. Hp testing should be offered to all patients after eradication therapy but is mandatory in patients with ulcer disease, noninvasive gastric cancer or MALT lymphoma. Testing after eradication should not be done before 4 weeks after treatment has ended.

Topics: Amoxicillin; Anti-Bacterial Agents; Antidiarrheals; Bismuth; Clarithromycin; Denmark; Drug Therapy, Combination; Dyspepsia; Helicobacter Infections; Helicobacter pylori; Humans; Lymphoma, B-Cell, Marginal Zone; Metronidazole; Organometallic Compounds; Peptic Ulcer; Proton Pump Inhibitors; Salicylates; Stomach Neoplasms; Tetracycline

Peptic ulcer disease is strongly associated with infection by Helicobacter pylori, a spiral-shaped, flagellated organism found predominantly in the gastric antrum. More than 90 percent of duodenal ulcers and adenocarcinomas of the distal stomach are associated with H. pylori infection. Eradication of the organism effectively prevents relapses of gastroduodenal ulcers associated with H. pylori. In patients undergoing endoscopy, the rapid urease test is highly sensitive and specific in diagnosing H. pylori infection. Noninvasive diagnostic methods include serologic antibody measurements and urea breath testing. Empiric therapy may be tried if the diagnosis is suspected on a clinical basis. Traditional 14-day "triple therapy" with bismuth, metronidazole and either amoxicillin or tetracycline has consistently produced eradication rates of approximately 90 percent. Newer combination regimens have shown promise in a smaller number of studies. No single agent given as monotherapy has proved to be acceptably effective in clinical studies.

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Clarithromycin; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Omeprazole; Organometallic Compounds; Penicillins; Peptic Ulcer; Protein Synthesis Inhibitors; Salicylates; Tetracycline

Topics: Antacids; Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Gastric Acid; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Metronidazole; Organometallic Compounds; Peptic Ulcer; Salicylates; Tetracycline

Topics: Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Organometallic Compounds; Peptic Ulcer; Salicylates; Tetracycline; United States

Now that Helicobacter pylori has been strongly implicated as a causative factor in peptic ulcer disease, the dictum "no acid--no ulcer" may no longer be valid. However, H pylori has proved difficult to eradicate, and the approach to treatment of peptic ulcer is undergoing changes. At present, a triple-drug combination of bismuth and antibiotics is advised, and cultures should be obtained before and after treatment to monitor its efficacy. Side effects include pseudomembranous colitis and drug resistance.

Topics: Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Peptic Ulcer; Salicylates

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Peptic Ulcer; Recurrence; Salicylates

Helicobacter pylori is a recently identified microorganisms which is thought to be the causing agent of the peptic acid disease in children as well as in adults. It is currently accepted that frequent relapses of this illness in spite of an adequate treatment can be associated to the faulty eradication of this bacteria. This article outlines the characteristics of H. pylori, its incidence, pathogenesis, as well as the current diagnostic methods used and the treatment applied.

Topics: Anti-Bacterial Agents; Bismuth; Child; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Peptic Ulcer; Salicylates

Topics: Adrenal Cortex Hormones; Duodenal Ulcer; Gastric Juice; Gastric Mucosa; Peptic Ulcer; Salicylates; Stomach; Stomach Ulcer

A review of the literature on the gastrointestinal side effects of the analgesic drugs has disclosed a disparity between generally held views and the scientific evidence. This is largely due to the paucity of large long term controlled trials since the cost of these is very high. The problems in mounting a large observational study with population controls are discussed against a backgrwound of exploratory work in Australia and New Zealand and the conclusion is reached that a comprehensive survey is needed. The difficulties in mounting such a survey are discussed.

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Female; Humans; Indomethacin; Male; Oxyphenbutazone; Peptic Ulcer; Phenylbutazone; Rheumatic Diseases; Salicylates; Stomach Diseases; Stomach Ulcer

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Arthritis, Rheumatoid; Atrophy; Betamethasone; Drug Interactions; Glucocorticoids; History, 20th Century; Humans; Hydrocortisone; Infections; Injections, Intra-Articular; Joint Diseases; Methylprednisolone; Necrosis; Osteoporosis; Peptic Ulcer; Prednisolone; Prednisone; Rheumatic Diseases; Salicylates; Skin Diseases; Substance Withdrawal Syndrome; Synovitis; Triamcinolone; Vascular Diseases

At present, the prevalence of Helicobacter pylori (H. pylori) in complicated peptic ulcer and the effect of H. pylori eradication on complicated peptic ulcer have not been fully established. In this study, we report the prevalence of H. pylori in peptic ulcer patients complicated with gastric outlet obstruction, effectiveness of oral eradication therapy on these patients, and their long-term follow up.. Ten consecutive patients presenting with clinically and endoscopically significant obstructed peptic ulcers were included in this study. During each endoscopy, seven gastric biopsy specimens were obtained and analyzed for H. pylori colonization.. The antral mucosal biopsy specimens were positive for H. pylori in nine patients. H. pylori infection was eradicated and complete ulcer healing was observed in all patients. The mean follow-up period was 14 (7-24) months. One patient had duodenal perforation and underwent surgical intervention following medical treatment, despite the eradication of H. pylori. Ulcer recurrence was noted in two (22.2%) of nine patients, and in one of them the recurrent ulcer was complicated with obstruction (11. 1%). The mean time to ulcer recurrence was 17 months (range, 10-24 months). The biopsies and CLOtests were H. pylori negative at the time of ulcer or erosion recurrence in two patients.. We suggest that H. pylori eradication may improve the resolution in obstructive ulcer cases with colonization.

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Female; Follow-Up Studies; Gastric Outlet Obstruction; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Peptic Ulcer; Salicylates; Tetracycline; Treatment Outcome

We evaluated the efficacy of lansoprazole, clarithromycin, and metronidazole (LCM) administered twice daily for 7 days. Because there is growing concern about the development of metronidazole-resistant H. pylori (HP) strains, we also tested a novel regimen consisting of lansoprazole, clarithromycin, and bismuth subsalicylate (LCB).. Patients with active HP infection and peptic ulcer, a history of peptic ulcer, or nonulcer dyspepsia were randomized to either lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and metronidazole 500 mg b.i.d. or lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and bismuth subsalicylate 524 mg b.i.d. (LCB) for 7 days. Compliance and side effects were recorded by using a diary.. "Per protocol" eradication with LCM was achieved in 41 of 47 (87%). By using "intention to treat" analysis, LCM eradicated HP infection in 43 of 53 patients (81%). By using "per protocol" analysis, LCB eradicated HP infection in 40 of 47 patients (85%). On an "intention to treat" basis, LCB led to HP eradication in 42 of 52 (81%). The most common significant side effects observed with LCM were altered taste (39%) and abdominal pain (19%). With LCB, the most common significant side effects were altered taste (23%) and dark stools (23%).. LCB for 7 days was as effective in eradicating HP infection as a 7-day course of LCM. Further studies evaluating the role of bismuth compounds in proton-pump inhibitor based triple therapy are warranted. Such therapy may have particular importance in areas where high metronidazole resistance is a concern.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Abdominal Pain; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Clarithromycin; Drug Administration Schedule; Drug Combinations; Drug Resistance, Microbial; Dyspepsia; Evaluation Studies as Topic; Feces; Helicobacter Infections; Helicobacter pylori; Humans; Lansoprazole; Medical Records; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Patient Compliance; Peptic Ulcer; Proton Pump Inhibitors; Salicylates; Taste Disorders

In an attempt to increase the efficacy and simplicity of FDA-approved regimens for Helicobacter pylori, we studied (1) addition of an inexpensive antibiotic (amoxicillin) to twice-daily ranitidine bismuth citrate (RBC)-clarithromycin dual therapy, and (2) substitution of RBC for bismuth subsalicylate + H2-receptor antagonist in bismuth-based triple therapy.. Subjects with previously untreated Helicobacter pylori infection documented by 13C-urea breath test plus either endoscopic biopsy or serology were randomly assigned to a 2-wk course of (1) RBC 400 mg b.i.d., amoxicillin 1 g b.i.d., and clarithromycin 500 mg b.i.d. (RAC), or (2) RBC 400 mg b.i.d., metronidazole 250 mg t.i.d., and tetracycline 500 mg t.i.d. (RMT). Repeat breath test was performed 4 wk after the completion of therapy.. Intent-to-treat and per-protocol cure rates for RAC were 46 of 50 patients (92%) and 45 of 47 patients (96%); for RMT they were 40 of 50 patients (80%) and 37 of 42 patients (88%). Study drugs were stopped due to side effects in three patients (6%) taking RAC and six patients (12%) taking RMT.. Twice-daily RBC-based triple therapy with clarithromycin and amoxicillin produces Helicobacter pylori eradication rates over 90%, which is comparable to rates seen with proton pump inhibitor-based triple therapies. RBC also may be substituted for bismuth subsalicylate and an + H2-receptor antagonist in standard bismuth-based triple therapy.

Topics: Adult; Amoxicillin; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Biopsy; Bismuth; Breath Tests; Carbon Isotopes; Clarithromycin; Drug Combinations; Female; Follow-Up Studies; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Male; Metronidazole; Organometallic Compounds; Penicillins; Peptic Ulcer; Proton Pump Inhibitors; Ranitidine; Salicylates; Tetracycline; Urea

To assess the effect of aluminum hydroxide/magnesium hydroxide antacid and bismuth subsalicylate on gastric pH in clinically normal horses and to develop guidelines on the use of these agents for treatment of peptic ulcer disease in horses.. Prospective, randomized, controlled trial.. 5 clinically normal adult horses with chronically implanted gastric cannulas.. Each horse received all 5 treatments (30 g of aluminum hydroxide/15 g of magnesium hydroxide, 12 g of aluminum hydroxide/6 g of magnesium hydroxide, 10.5 g of bismuth subsalicylate, 26.25 g of bismuth subsalicylate, and 5% methylcellulose control) with only 1 experiment performed each day. Gastric pH was measured via a glass electrode inserted through the gastric cannula for 1 hour before treatment and continued for 2 hours after treatment. Food or water was not given to the horses during the experiment. Measurements of gastric pH obtained during posttreatment hours were compared with pretreatment gastric pH values.. Only a dose of 30 g of aluminum hydroxide/ 15 g of magnesium hydroxide resulted in a significant increase in gastric pH over baseline or control values. Mean pH was 5.2 +/- 0.62 and 4.59 +/- 0.48 for posttreatment hours 1 and 2, respectively.. Oral administration of 30 g of aluminum hydroxide/15 g of magnesium hydroxide to adult horses should result in a mean hourly gastric pH > or = 4.0 for at least 2 hours.

Topics: Administration, Oral; Aluminum Hydroxide; Animals; Antacids; Bismuth; Drug Therapy, Combination; Female; Gastric Acidity Determination; Gastric Mucosa; Horse Diseases; Horses; Hydrogen-Ion Concentration; Magnesium Hydroxide; Male; Organometallic Compounds; Peptic Ulcer; Prospective Studies; Salicylates; Stomach

Omeprazole/amoxicillin regimen has proved elsewhere to be effective in the eradication of Helicobacter pylori (H. pylori). However, in the Chinese, its role in H. pylori is still unclear.. Between November 1993 and June 1994, 112 patients with active, H. pylori positive peptic ulcer were enrolled in this study. Five groups were arranged randomly to have 20 mg omeprazole q.d. for 28 days plus 750 mg amoxicillin b.i.d. for the first 10 days (omep-20-amox group, N = 22), 20 mg omeprazole b.i.d. for 28 days plus 750 mg amoxicillin b.i.d. for the first 10 days (omep-40-amox group, N = 22), 300 mg bismuth subsalicylate q.i.d. for 28 day, and 750 mg amoxicillin b.i.d., 500mg metronidazole t.i.d. for the first 7 days (triple therapy group, N = 25), 20 mg omeprazole q.d. for 28 days (omep-20 group, N = 22), or 150 mg ranitidine b.i.d. or 400 mg cimetidine b.i.d. for 28 days (H2-antagonist group, N = 21).. The eradication rate of H. pylori eight weeks after the entry of study was 38.1% in the omep-20-amox group, 66.7% in the omep-40-amox group, 77.3% in the triple therapy group, 4.7% in the omep-20 group and 0% in the H2 antagonist group (p < 0.05 between the triple therapy and the omep-20-amox, the omep-20, and the H2 antagonist groups). Eleven patients in the triple therapy group suffered from adverse effects (45.8%) (p < 0.05 as compared with other groups). The ulcer healing rates four weeks after the entry of study for the omep-20-amox, the omep-40-amox, the triple therapy, and the omep-20 groups were 80.9%, 80.9%, 68.2%, and 85.7% respectively (p > 0.05). For the H2 antagonist group, the ulcer healing rate eight weeks after the entry of study was 70%.. Both medium-dose omeprazole/amoxicillin and triple therapy can achieve good eradication rates. However, medium-dose omeprazole/amoxicillin had a much lower side effect. Therefore, we recommend medium-dose omeprazole/amoxicillin for the eradication of H. pylori.

Topics: Adult; Aged; Amoxicillin; Anti-Ulcer Agents; Drug Therapy, Combination; Female; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Penicillins; Peptic Ulcer; Salicylates; Salicylic Acid

Azithromycin is new acid-stable macrolide that achieves 10- to 40-fold higher tissue levels than erythromycin after oral dosing. Important to note, the tissue half-life of azithromycin is measured in days instead of hours.. We evaluated two new triple therapies for Helicobacter pylori infection in which azithromycin was substituted for metronidazole either as 250 mg b.i.d. or t.i.d. along with tetracycline 500 mg q.i.d. and bismuth subsalicylate 2 tablets q.i.d. for 14 days. H. pylori status was determined by histology before and 6 wk or more after therapy.. Thirty men with documented H. pylori peptic ulcers completed therapy. Twenty-one also received ranitidine (300 mg in the evening) along with the antimicrobial therapy. H. pylori infection was successfully treated in 15 (50%) (95% CI = 31-69%). The cure rate was significantly higher with the 250-mg-t.i.d.-azithromycin dosage regime (83%) (95% CI = 52-98%) compared to the 250-mg-b.i.d.-dosage regime (28%) (95% CI = 10-53%) (p < 0.01). Troublesome side effects were experienced by the majority of those receiving azithromycin t.i.d.. We conclude that although 750 mg or more of azithromycin might eventually be able to replace metronidazole or clarithromycin in standard triple therapy, additional studies are required to identify a regime that is both effective and tolerable.

Topics: Azithromycin; Bismuth; Drug Administration Schedule; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Peptic Ulcer; Ranitidine; Salicylates; Tetracycline

We evaluated whether therapy designed to eradicate Helicobacter pylori infection resulted in a reduction in rebleeding in patients with peptic ulcer disease. Patients presenting because of major upper gastrointestinal hemorrhage from peptic ulcer and whose ulcers healed in a study in which they were randomized to receive ranitidine alone or triple therapy plus ranitidine were followed up regularly with endoscopy. No maintenance anti-ulcer therapy was given after ulcer healing.. Patients received ranitidine, 300 mg, or ranitidine plus triple therapy. Triple therapy consisted of tetracycline, 2 g; metronidazole, 750 mg; and bismuth subsalicylate, 5 or 8 tablets (151 mg bismuth per tablet), and was administered for the first 2 weeks of treatment; ranitidine therapy was continued until the ulcer had healed or 16 weeks had elapsed. After ulcer healing, no maintenance antiulcer therapy was given. Development of ulcer recurrence with or without recurrent upper gastrointestinal bleeding was evaluated.. Thirty-one patients with major upper gastrointestinal bleeding from peptic ulcer were studied; 17 received triple therapy and 14 ranitidine alone. Major rebleeding occurred significantly (p = 0.031) more often in those in the ranitidine group (28.6%), compared with none (0%) in the triple therapy group.. Eradication of H. pylori infection reduces the rate of ulcer recurrence and rebleeding in complicated ulcer disease.

Topics: Adult; Aged; Bismuth; Drug Therapy, Combination; Follow-Up Studies; Gastrointestinal Hemorrhage; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Peptic Ulcer; Prospective Studies; Ranitidine; Recurrence; Salicylates; Tetracycline

The clinical efficacy and gastroduodenal tolerability of imidazole salicylate (imidazole 2-hydroxybenzoate, ITF 182), a new synthetic drug with an anti-inflammatory action, was evaluated endoscopically in comparison with those of piroxicam in elderly patients suffering from osteoarthrosis. Of the 41 patients entering the trial, only 38 completed the protocol (6 men and 32 women; mean age, 71; range, 65-80 years). After upper gastrointestinal endoscopy for the purpose of excluding gastric and duodenal mucosal lesions, the patients were allocated at random, according to a double-blind, double-dummy protocol, to treatment either with imidazole salicylate 750 mg three times daily or with piroxicam 20 mg once daily for a period of 4 weeks. Imidazole salicylate proved active in controlling a number of the pain symptoms caused by arthrosis, although its efficacy was inferior to that of piroxicam. Grade 2 gastric mucosal lesions were detected in 1 of 20 patients (5%) treated with imidazole salicylate; lesions corresponding to grades 2, 3, and 4 were found in 6 of 18 (33%) of those treated with piroxicam (P = .034). Painful dyspepsia was reported by 15% of the patients in the imidazole salicylate group and by 28% of those in the piroxicam group. On the basis of these results and under the experimental conditions adopted in this trial, the authors concluded that imidazole salicylate is characterized by good gastric tolerability and can thus be used in the treatment of rheumatic diseases in the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Activities of Daily Living; Aged; Anti-Inflammatory Agents, Non-Steroidal; Consumer Behavior; Double-Blind Method; Endoscopy; Female; Humans; Imidazoles; Male; Osteoarthritis; Peptic Ulcer; Piroxicam; Salicylates

Topics: Anniversaries and Special Events; Antacids; Anti-Bacterial Agents; Asthma; Bacterial Vaccines; Bismuth; Drug Resistance, Bacterial; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Nobel Prize; Organometallic Compounds; Peptic Ulcer; Probiotics; Salicylates; Stress, Psychological

We determined the in vitro susceptibility of clinical isolates of Helicobacter pylori to ZnCl, compared its sensitivity to bismuth subsalicylate (BSS) and clarithromycin (CLR) that are used for the treatment of H. pylori infection and its activity at different gastric pH. One hundred sixteen clinical isolates of H. pylori strains were chosen. Agar gel dilution method was used to determine the susceptibility of H. pylori isolates to ZnCl 40 μg/ml, BSS 20 μg/ml, and CLR 2 μg/ml. Suspension of 10(9) bacteria/μl was streaked on the blood agar plate. The control consisted of H. pylori incubated without ZnCl, BSS, and CLR. One hundred ten H. pylori strains (95%) were susceptible to ZnCl 40 μg/ml compared to 114 (98%) to BSS 20 μg/ml (p=0.002) and 92 (79%) to CLR 2 μg/ml (p=0.602). H. pylori isolates from patients with nonulcer dyspepsia and from peptic ulcer were equally susceptible to ZnCl 40 μg/ml (90/96 vs. 26/26, p=0.208). H. pylori associated with chronic gastritis and chronic active gastritis were equally susceptible to ZnCl. H. pylori demonstrated susceptibility to ZnCl in vitro. H. pylori susceptibility to ZnCl 40 μg/ml was greater than BSS and comparable to CLR. ZnCl may be used in the treatment of H. pylori infection.

Topics: Adult; Aged; Anti-Bacterial Agents; Bismuth; Chlorides; Chronic Disease; Clarithromycin; Drug Resistance, Bacterial; Dyspepsia; Female; Gastric Juice; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Hydrogen-Ion Concentration; Male; Microbial Sensitivity Tests; Middle Aged; Organometallic Compounds; Peptic Ulcer; Salicylates; Zinc Compounds

Topics: Bismuth; Drug Interactions; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Peptic Ulcer; Salicylates; Tetracycline

Among patients with peptic ulcer disease, the prevalence of Helicobacter pylori has been reported to range from 80% to 90%. Thus empirical cost-effective therapy has been suggested. We surveyed patients with peptic ulcer disease in Rochester, NY.. From two teaching hospitals all patients who had duodenal ulcers (DU) and/or gastric ulcers (GU) on esophagogastroduodenoscopy (EGD) with antral biopsy for histology for H. pylori and for rapid urease (CLO) test were included in the study. We examined a total of 160 patients with DU and 145 patients with GU, age range 18-92 yr, obtaining clinical data, race, medication profile, and history of use of nonsteroidal antiinflammatory drugs (NSAIDs). An ulcer was defined if the lesion with loss of mucosal integrity was > or = 0.5 cm, with apparent depth. H. pylori was considered present if CLO test and/or histology were positive for H. pylori. To confirm the reliability of nonuse of NSAIDs, we randomly checked blood samples of 90 such patients from the ambulatory clinic for the presence of salicylates. To identify the sensitivity of the CLO test, we performed a serology test for H. pylori antibody in 100 subjects to compare the CLO test results. Also, 500 CLO test results were compared to the histology results for H. pylori.. Among 160 DU patients, 16 were NSAID users with negative H. pylori and excluded from the prevalence study. Of the remaining 144 patients with DU, H. pylori was present in 88 patients (61%). When these data were analyzed according to race, H. pylori was present in 54 (52%) of 104 whites compared to 34 of 40 (85%) nonwhites (blacks, Hispanics, Asians) (p < 0.01). Among 145 GU patients 18 were NSAID users with negative H. pylori and excluded from the prevalence analysis. Of the remaining 127 patients with GU, H. pylori was present in 87 patients (61%). Among them, H. pylori was present in 46 of 87 (53%) whites, whereas 31 of 40 nonwhites (78%) were H. pylori-positive (p < 0.01). Antral histology and CLO test for H. pylori were in agreement in 92% of cases. Serology and CLO test for H. pylori were in agreement in 87% of cases. None of the randomly screened patients, including 16 ulcer patients with negative H. pylori, showed presence of salicylate in blood.. In greater Rochester, NY, where the majority of our patients with EGD were whites, the prevalence of H. pylori among ulcer patients was lower compared to other regions, particularly among whites. This suggests that an additional causative factor or factors for peptic ulcers may be present. Hence, empirical antibiotic therapy of ulcer patients without confirming the presence of H. pylori may not be justified.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Drug Therapy, Combination; Duodenal Ulcer; Endoscopy, Digestive System; Helicobacter Infections; Helicobacter pylori; Humans; Middle Aged; New York; Peptic Ulcer; Pyloric Antrum; Retrospective Studies; Salicylates; Stomach Ulcer; Urease; White People

To determine the pharmacoeconomic impact of antimicrobial treatment of peptic ulcer disease (PUD) in a large urban jail.. Retrospective comparison of PUD-related pharmacy and laboratory expenditures over a 2-year period before and after the institution of a PUD treatment protocol with the priority of Helicobacter pylori eradication for inmates in Rikers Island Correctional Facility.. After the protocol was adopted, total pharmacy-related and laboratory-related expenses for PUD care decreased by 40.2%, and expenditures for ranitidine declined by 52.2%. There was an increase in spending for antimicrobial agents and H. pylori antibody testing, but this was insignificant compared to the savings generated by decreased ranitidine usage. Annual savings in our facility as a result of this intervention were $123,449.. Modern therapeutic strategies for PUD aimed at eradicating H. pylori can result in significant savings in the institutional setting; these savings are largely attributable to the decreased usage of histamine-2 receptor antagonists.

Topics: Adult; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Male; Metronidazole; New York City; Organometallic Compounds; Peptic Ulcer; Prisons; Ranitidine; Retrospective Studies; Salicylates; Tetracycline; Urban Health

Topics: Amoxicillin; Antacids; Anti-Bacterial Agents; Anti-Ulcer Agents; Clarithromycin; Diarrhea; Drug Interactions; Drug Resistance, Microbial; Duodenal Ulcer; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Metronidazole; Misoprostol; Peptic Ulcer; Proton Pump Inhibitors; Salicylates; Salicylic Acid; Sucralfate; Tetracycline

This study had three goals: (1) Identify patients with Helicobacter pylori, treat their disease, monitor their progress, and determine that they are no longer infected. (2) Realize a cost savings for our health clinic. (3) Improve patient quality of life. These three goals have been met.

Topics: Amoxicillin; Bismuth; Cost Savings; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Histamine H2 Antagonists; Humans; Metronidazole; Military Personnel; Organometallic Compounds; Peptic Ulcer; Salicylates; Tetracycline; United States; Utah

Topics: Amoxicillin; Anti-Bacterial Agents; Antitrichomonal Agents; Bismuth; Cost of Illness; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Organometallic Compounds; Penicillins; Peptic Ulcer; Pilot Projects; Salicylates; Tetracycline

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Omeprazole; Organometallic Compounds; Penicillins; Peptic Ulcer; Ranitidine; Salicylates; Tetracycline

Mucus and bicarbonate secretions have been widely implicated as an important pre-epithelial protective barrier against autodigestion of the gastric mucosa by acid and pepsin. Evidence from several independent studies shows there is a continuous layer of resilient viscoelastic mucus gel adherent to the surface of the gastroduodenal mucosa. The median thickness of the adherent gastric mucus layer in humans is 180 microns, range 50-450 microns. The epithelial bicarbonate secretion permeates the unstirred matrix of mucus gel neutralizing luminal acid and establishing a pH gradient within the gel. In the duodenum, evidence supports the mucus bicarbonate barrier as a major protective mechanism against acid aggression. The adherent mucus gel, by acting as an effective 'permeability' barrier to pepsin, protects the underlying sensitive mucosa from digestion. However, pepsin slowly digests mucus gel at its luminal surface to produce soluble degraded mucin. In a rat gastric damage model in vivo, pepsin in excess digests the gastric mucus barrier sufficiently rapidly to outweigh new mucus secretion and lead to breaching of the mucus barrier with the formation of small punctate ulcers in the epithelium accompanied by mucosal haemorrhage. The mucus secretagogue 16,16 dimethyl prostaglandin E2 and the muco-adhesive carbopol-polyacrylate both fully protected the mucosa against pepsin damage by enhancing the protective properties of the mucus barrier. Sucralfate and bismuth subsalicylate were partially effective in protection against pepsin damage but this protection was mainly mediated at the level of the mucosa. In peptic ulcer disease, there is increased mucolytic (mucus degrading) activity in gastric juice and this is associated with an impaired mucin polymeric structure and a weaker mucus barrier.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: 16,16-Dimethylprostaglandin E2; Acrylic Resins; Animals; Bismuth; Duodenum; Gastric Mucosa; Intestinal Mucosa; Male; Mucus; Organometallic Compounds; Pepsin A; Peptic Ulcer; Rats; Rats, Wistar; Salicylates; Sucralfate

Fifty patients with relapsing or complicated Helicobacter pylori positive duodenal (n = 41) or gastric ulcer disease (n = 9) and failure of a combined treatment with omeprazole plus amoxycillin to eradicate H. pylori infection were re-treated with either oral triple therapy (bismuth subsalicylate, metronidazole, tetracycline) plus ranitidine [group I: n = 22] or high-dose omeprazole (40 mg b.d. to t.d.s.) plus amoxycillin (1 g t.d.s.) [group II: n = 28].. Patients of group I and II had similar demographic and clinical characteristics. The overall proportion of eradication of H. pylori infection was 81.8% in group I and 78.6% in group II (P = N.S.) as judged from negative bacterial findings by means of an urease test, specific culture and histology after modified Giemsa stain. Ulcer healing was observed in all patients after a maximum duration of 10 weeks. Ten patients on triple therapy and only one patient on omeprazole plus amoxycillin (45.5% vs. 3.6%; P < 0.001) complained of side effects without necessity of discontinuation of the study medication in either group. Twenty patients (group I: n = 10; group II: n = 10) with relapsing duodenal ulcer disease and successful cure were prospectively followed for one year without any evidence of ulcer relapse or H. pylori re-infection.. Oral triple therapy plus ranitidine or high-dose omeprazole plus amoxycillin remain highly effective in eradicating H. pylori infection in patients with peptic ulcer disease and treatment failure of omeprazole/amoxycillin, but the omeprazole enhanced antibiotic monotherapy seems to be superior with regard to side effects. Thus, high-dose omeprazole/amoxycillin is recommended as the treatment of first choice in these selected patients. Triple therapy should be reserved for patients intolerant of amoxycillin.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Amoxicillin; Bismuth; Drug Therapy, Combination; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Peptic Ulcer; Prospective Studies; Ranitidine; Recurrence; Salicylates; Tetracycline; Treatment Failure; Treatment Outcome

Metronidazole resistance has become an increasing problem that has limited the usefulness of the original triple therapy. Our objective was to evaluate clarithromycin, a new macrolide compound active against Helicobacter pylori.. We evaluated a new clarithromycin triple therapy for H. pylori infection consisting of the combination of clarithromycin (500 mg t.i.d.), tetracycline (500 mg q.i.d.), and bismuth subsalicylate tablets (2 q.i.d.) for 14 days. Patients with ulcer also received concomitant ranitidine, 300 mg after the evening meal, for 6 wk.. Thirty men with documented H. pylori infection were studied; 29 had peptic ulcer disease. Seven had previously failed antimicrobial therapy, including three with metronidazole-based triple therapy. H. pylori status was determined by histology. H. pylori status and ulcer status were evaluated 4 wk after the end of antimicrobial therapy. The ulcer was healed in 90%. The H. pylori infection was cured in 93%, including all three patients who previously failed metronidazole-based triple therapy.. We conclude that the combination of clarithromycin, tetracycline, and bismuth is an effective new therapy for treatment of H. pylori infection.

Topics: Adult; Aged; Bismuth; Clarithromycin; Drug Administration Schedule; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Organometallic Compounds; Peptic Ulcer; Ranitidine; Salicylates; Tetracycline; Time Factors

To study the relationship between Helicobacter pylori infection, gastric inflammatory scores, and fasting gastrin and pepsinogen A and C concentrations, and to evaluate the effect of treatment on these parameters.. Gastrin and pepsinogen A and C concentrations were measured in 36 patients with gastritis, 10 gastric ulcer patients, 12 duodenal ulcer patients, and in 15 subjects with normal gastric mucosa, by standard radioimmunoassay techniques. Fifteen patients with H. pylori infection underwent triple therapy (bismuth subsalicylate, amoxicillin, metronidazole) and were reassessed 1 month later.. Fasting gastrin and pepsinogen A and C concentrations were significantly higher in H. pylori-positive gastritis and peptic ulcer patients than in subjects with normal mucosa and in patients with H. pylori-negative gastritis. There was a significant correlation between inflammatory scores and serum gastrin (r = 0.45, p < 0.0001), and pepsinogen A (r = 0.33, p < 0.006) and pepsinogen C (r = 0.55, p < 0.0001) concentrations. Neither sex nor age affected basal gastrin and pepsinogen concentrations. Eradication of H. pylori infection was successful in 12 patients and resulted in a significant fall in serum gastrin and in pepsinogen A and C concentrations, and in a concomitant improvement of the inflammatory scores. Serum peptide levels and gastritis scores were unchanged in those patients in whom H. pylori infection persisted.. These findings suggest that hypergastrinemia and hyperpepsinogenemia are secondary to H. pylori infection and are related to mucosal inflammation.

Topics: Amoxicillin; Bismuth; Drug Therapy, Combination; Female; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Organometallic Compounds; Pepsinogens; Peptic Ulcer; Salicylates

Topics: Anti-Bacterial Agents; Bismuth; Drug Therapy, Combination; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Organometallic Compounds; Peptic Ulcer; Salicylates

The objective of the present work was to determine the effect of treating Helicobacter pylori infection on the recurrence of peptic ulcer bleeding. We prospectively followed 66 out of 70 consecutive H. pylori-positive (histology and/or culture) patients with conservatively and endoscopically managed peptic ulcer bleeding (duodenal ulcer; n = 39, gastric ulcer: n = 25, gastroduodenal double ulcer: n = 2) for a median period of 17 months (range 6-33 months). Patients were treated in seven different clinical protocols, each of which included the attempt to eradicate H. pylori infection. Patients with (n = 42) and without (n = 24) bacterial eradication had similar demographic and clinical characteristics. Eradication of H. pylori was associated with a statistically significant reduction of ulcer recurrences (2.4 vs. 62.5%; p < 0.001) and bleeding relapses (0 vs. 37.5%; p = 0.01). We conclude that H. pylori eradication markedly changes the natural history in patients with complicated duodenal and gastric ulcer disease. Thus, treatment aimed at bacterial eradication should be considered in all patients with conservatively managed bleeding from H. pylori-positive ulcers.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin; Bismuth; Drug Therapy, Combination; Duodenal Ulcer; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Middle Aged; Omeprazole; Organometallic Compounds; Peptic Ulcer; Peptic Ulcer Hemorrhage; Prospective Studies; Ranitidine; Recurrence; Salicylates; Stomach Ulcer

Helicobacter pylori infection is associated with exaggerated gastrin release. We investigated whether this abnormality was due to the bacteria or the immune response. Fasting and meal-stimulated 'total' and amidated gastrin were measured in 10 H. pylori-infected volunteers before eradication therapy, after 2 and 14 days of therapy, and 4 weeks after completion of therapy. The exaggerated meal-stimulated gastrin concentration remained unchanged after 2 days of therapy, although the polymorphonuclear cell infiltrate and H. pylori bacteria were no longer evident. The expected fall in gastrin concentration after 14 days of therapy was associated with a reduction in the density of mucosal mononuclear cells, suggesting exaggerated gastrin release was related to chronic inflammation or to H. pylori or its products. The effect of H. pylori on normal progastrin processing was also assessed; 2 control groups were included: 10 H. pylori-uninfected volunteers and 13 patients with H. pylori peptic ulcers. There was a significant difference in the proportion of circulating gastrins that were biologically active amidated gastrins between ulcer patients and uninfected controls (56.7 +/- 4% versus 33.8 +/- 4%, p < 0.001). The proportion of amidated to total gastrins did not increase after successful eradication.

Topics: Adult; Bismuth; Female; Food; Gastrins; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Organometallic Compounds; Peptic Ulcer; Protein Precursors; Protein Processing, Post-Translational; Salicylates; Tetracycline

Topics: Bismuth; Helicobacter Infections; Helicobacter pylori; Humans; Metronidazole; Organometallic Compounds; Peptic Ulcer; Ranitidine; Recurrence; Salicylates; Tetracycline

This study determines objectively the extent of nonsteroidal anti-inflammatory drug (NSAID) use in upper gastrointestinal (GI) mucosal acid-peptic diseases by supplementing the conventional interview with two tests of current aspirin (ASA) use--high-performance liquid chromatography (HPLC) for the presence of salicylates in serum and platelet cyclooxygenase activity, which detects ASA use within 5 days of testing. Of 186 consecutive patients undergoing upper endoscopy, 62% of 55 patients with esophagitis had evidence of current NSAID use, vs. 26% of 42 control patients with normal endoscopy (p less than 0.001), 12% of 17 patients with recently healed peptic ulcer (p less than 0.001), and 36% of 25 patients who had an active peptic ulcer (p less than 0.05), five of whom had concomitant esophagitis. Another 52 patients were ineligible for this analysis. Testing for platelet cyclooxygenase activity uncovered 26% more ASA users than history alone. In considering age, sex, smoking and drinking habits, arthritis, and ASA use by logistic regression, ASA use was the only factor contributing to esophagitis; ASA could not be further associated with severity, stricture or symptoms, however. In these patients, 95% of NSAID use was chronic, and 84% of that was ASA. These data show a previously unreported, strong association of ASA use with esophagitis, which suggests that ASA may be a significant factor in the resistance of esophagitis to current therapies as well as the frequently rapid relapse after therapy is withdrawn.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Blood Platelets; Chromatography, High Pressure Liquid; Drug Utilization; Endoscopy, Gastrointestinal; Esophagitis; Esophagoscopy; Humans; Medical History Taking; Peptic Ulcer; Prospective Studies; Prostaglandin-Endoperoxide Synthases; Salicylates

Numerous reports have established the association of Helicobacter pylori and peptic ulcer disease in adults. Recently, this association has also been demonstrated in children. We investigated 14 children and adolescents with recurrent abdominal pain. In six patients, endoscopy revealed gastritis and Helicobacter pylori was identified. Giemsa stain was more sensitive than culture or urease testing in identifying the bacteria. In four of the six, a nodular appearance of the antral mucosa was observed. The histological examination suggests lymphoid hyperplasia as the cause of the nodularity. All of the patients became symptomless after combined treatment with amoxicillin and bismuth subsalicylate. We conclude that nodular gastritis is a peculiar type of gastritis in children. It is frequently found in association with Helicobacter pylori infection.

Topics: Adolescent; Amoxicillin; Biopsy; Campylobacter; Campylobacter Infections; Child; Female; Gastric Mucosa; Gastritis; Gastroscopy; Humans; Male; Peptic Ulcer; Salicylates; Salicylic Acid

Topics: Amoxicillin; Bismuth; Campylobacter Infections; Drug Therapy, Combination; Gastric Mucosa; Gastritis; Humans; Metronidazole; Organometallic Compounds; Peptic Ulcer; Salicylates

The gastric and tracheal flora of 142 consecutive patients receiving stress ulcer prophylaxis were investigated, identifying identical isolates by typing. Furthermore, the growth pattern of normal respiratory bacteria and organisms causing ventilation pneumonia at different pH values and the in vitro effect of sucralfate and bismuth subsalicylate on these bacteria in simulated gastric fluid were studied. The results obtained were as follows: (1) with rising gastric pH bacterial counts in gastric aspirates, especially gram-negatives, increased significantly; (2) in 45 (31.7%) of the patients identical organisms were first isolated in gastric samples and one to two days later in tracheal secretions; (3) ventilation pneumonia was significantly more frequent in patients with high gastric pH; (4) pathogens causing ventilation pneumonia grew well in simulated gastric fluid at higher pH values, unlike normal respiratory organisms; and (5) sucralfate and bismuth subsalicylate showed antibacterial activity against frequent causative organisms of ventilation pneumonia.

Topics: Anti-Bacterial Agents; Anti-Ulcer Agents; Bismuth; Gastric Juice; Humans; Hydrogen-Ion Concentration; Organometallic Compounds; Peptic Ulcer; Pneumonia; Prospective Studies; Respiration, Artificial; Risk Factors; Salicylates; Stress, Physiological; Sucralfate; Trachea

We describe five patients who had chronic recurrent gastroduodenal ulcers and pain, intestinal obstruction, bleeding, or a combination of these symptoms. Four patients required surgical intervention because of a poor response to medical therapy. The ulcers recurred in all patients, despite evidence of achlorhydria in two of them. Although the patients denied the use of salicylates, all of them had therapeutic blood levels of salicylates. A salicylate level should be determined in patients with severe ulcer disease that is resistant to medical therapy or that is recurrent after appropriate surgical therapy when the presence of hypergastrinemia or hyperchlorhydria has been definitely excluded. A low serum level of uric acid can also be a clue to the abuse of salicylates.

Topics: Adult; Female; Humans; Male; Middle Aged; Peptic Ulcer; Personality Disorders; Recurrence; Salicylates; Substance-Related Disorders

Colloidal bismuth subcitrate (CBS) precipitates in an acid environment, adheres to mucus, blocks pepsin activity, retards hydrogen-ion back diffusion and stimulates prostaglandin synthesis. The average healing rate after 4 weeks' treatment with CBS is 78% in duodenal ulcer versus 67% with cimetidine. A direct comparison with ranitidine gives healing rates of 78% (CBS) as opposed to 78% with ranitidine. The corresponding figures in gastric ulcer are 68% (CBS) and 54% (cimetidine). The percentage of relapse-free patients is substantially higher after CBS ulcer healing than after H2-blockers. Bismuth subsalicylate eliminates Campylobacter pylori in 71% after 4-weeks' therapy. Parallel to this elimination a decrease and normalization of the acute inflammatory process can be seen in antral mucosa.

Topics: Anti-Ulcer Agents; Bismuth; Campylobacter Infections; Chronic Disease; Duodenal Ulcer; Gastritis; Humans; Organometallic Compounds; Peptic Ulcer; Salicylates; Stomach Ulcer

Topics: Anti-Inflammatory Agents; Drug Eruptions; Dyspepsia; Headache; Humans; Peptic Ulcer; Phenylacetates; Propionates; Salicylates; Vertigo

Ulcers of the small bowel are documented in a patient after intake of salsalate. Rapid clinical and endoscopic improvement occurred on discontinuation of administration of the drug. Endoscopic features suggested the direct effect of a tablet dissolving in the proximal part of the small bowel. To my knowledge, this is the first report of small-bowel ulcerations associated with the newer form of salicylates that bypass the stomach for their absorption.

Topics: Female; Humans; Intestinal Diseases; Intestine, Small; Middle Aged; Osteoarthritis; Peptic Ulcer; Salicylates; Ulcer

Topics: Animals; Anti-Inflammatory Agents; Benzoates; Female; Male; Peptic Ulcer; Rats; Salicylates

Topics: Adult; Female; Humans; Peptic Ulcer; Recurrence; Salicylates

The relative risks associated with anti-inflammatory drug prescription for patients with an earlier history of drug-associated gastro-intestinal disturbance have been investigated in a retrospective study. Under these circumstances ibuprofen was well tolerated. The risks associated with modified salicylates (principally aspirin in enteric-coated form) and indomethacin suppositories also appeared to be relatively slight. Retreatment with phenylbutazone, oral indomethacin, naproxen and combination therapy was hazardous.

Topics: Administration, Oral; Aged; Anti-Inflammatory Agents; Arthritis; Duodenal Ulcer; Female; Gastrointestinal Hemorrhage; Humans; Ibuprofen; Indomethacin; Male; Middle Aged; Osteoarthritis; Peptic Ulcer; Peptic Ulcer Hemorrhage; Recurrence; Retrospective Studies; Salicylates; Suppositories; Time Factors

This study examines the relationship between the pH within the middle third of antral mucosa (intramural pH [IMpH]) and the development of ulceration caused by salicylates. Luminal soldium salicylate does not significantly alter the IMpH or cause ulceration of mucosa maintained at luminal pH 7. Salicylate at pH 3.5 initially decrease IMpH (7.28 to 6.75), during which time ulceration occurs. IMpH subsequently increase, resulting in profound alkalinization (pH 7.67) associated with increased HCO3 secretion. Salicylate at pH 1 causes a sustained decrease in IMpH (6.57), which is associated with more severe ulceration. Neither sodium salicylate nor acetylsalicylic acid given intravenously affects. IMpH or causes ulceration at luminal pH 7 or 3.5. However, at pH 1 both salicylate compounds cause ulceration and subtle changes in net ion fluxes without altering IMpH. The data suggest that acidification of the midportion of the mucosa in general is not a prerequisite for the occurrence of gross damage, and the damaging effects of intravenous salicylates cannot be explained by thier metabolic actions alone. However, it appears that the metabolic effects of salicylate make the mucosa more susceptible to the deleterious effects of diffusing acid. Since intravenous sodium salicylate and acetylsalicylic acid both cause ulceration but only acetylsalicylic acid alters prostaglandin synthesis, interference with prostaglandin metabolism does not appear to be a prerequisite for the occurrence of ulceration.

Topics: Animals; Aspirin; Bicarbonates; Gastric Mucosa; Hydrogen-Ion Concentration; Peptic Ulcer; Pyloric Antrum; Rabbits; Salicylates; Sodium Salicylate

An analysis of 37 patients over the age of 65 years who underwent emergency surgery for complications of peptic ulcer is presented. A major predisposing factor to these complications was the use of ulcerogenic drugs that were prescribed for chronic musculo-skeletal ailments. The overall mortality was 23.5%, and was mainly related to pre-existing cardio-pulmonary disease.

Topics: Aged; Emergencies; Heart Failure; Humans; Indomethacin; Lung Diseases, Obstructive; Peptic Ulcer; Salicylates; Steroids

To evaluate the effect of anti-inflammatory drug therapy on ulcer healing, we studied retrospectively patient records listing the dual diagnoses of rheumatoid arthritis and peptic ulcer (1953-1975). Forty-three ulcers (23 gastric and 20 duodenal) occurred in 41 subjects. Evaluation of ulcer healing was possible in 35 patients, 27 of whom had continued on anti-inflammatory drug therapy while being treated for ulcer disease and eight who did not. In 21 of the 27 patients the ulcer healed; in six the ulcer failed to heal, including one who died from gastric carcinoma. Fourteen of the 21 patients whose ulcer healed were taking both aspirin and corticosteroids; in all eight patients who stopped taking anti-inflammatory drugs, the ulcers (eight gastric, one duodenal) healed. In six patients no evaluating was possible because the outcome of ulcer therapy was unknown. The numbers of patients not studied, unlisted or unretrieved are unknown, though probably small, and while no data are available on controls drawn from the same population or on the rates of spontaneous ulcer healing and recurrence in this population, our study nevertheless establishes that ulcer healing does occur in many patients with rheumatoid arthritis despite continued treatment with salicylate, corticosteroid, or other anti-inflammatory drugs.

Topics: Anti-Inflammatory Agents; Arthritis, Rheumatoid; Humans; Peptic Ulcer; Salicylates; Stomach Ulcer; Wound Healing

Analgesic nephropathy is recognized worldwide, but the differences in incidence in various countries, or regions, remain unexplained. Analgesic compounds may cause both functional and structural renal damage. This damage may be related to depletion of glutathione and renal vasoconstriction (probably mediated through prostaglandin depletion) and to the fact that the concentrations of glutathione and prostaglandins and their metabolites in the kidneys are manyfold their concentrations in plasma. Most patients with analgesic nephropathy are middle-aged women with histories of peptic ulcer, anemia, psychiatric disorders, headaches, and arthralgias. Investigations often show pyuria, some bacteriuria, and impaired concentrating ability, as well as other abnormalities of tubular function; caliceal abnormalities on intravenous pyelography are also frequent. It is important to discover these patients; evidence exists that with cessation of drug ingestion, renal function may stabilize and, in some cases, may improve.

Topics: Analgesics; Female; Glutathione; Humans; Hypokalemia; Kidney Diseases; Male; Middle Aged; Peptic Ulcer; Salicylates; Substance-Related Disorders

Topics: Analgesics; Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Experimental; Dogs; Edema; Female; Fluorobenzenes; Gastrointestinal Hemorrhage; Humans; In Vitro Techniques; Lethal Dose 50; Male; Mice; Peptic Ulcer; Platelet Aggregation; Rabbits; Rats; Salicylates; Time Factors

The in vitro inhibition of the glucosamine synthetase activity of rat gastric mucosal homogenates by sodium salicylate and phenylbutazone has been previously reported and has been adduced as a possible mechanism for the ulcerogenic effect of these drugs. This inhibition has been confirmed in human gastric and colonic mucosal homogenates and it is also shown by acetylsalicylic acid and by hydrocortisone hemisuccinate. However, paracetamol and gentamicin, neither of which is known to be ulcerogenic, also inhibited the enzyme to a similar degree to the ulcergenic drugs. This refutes glucosamine synthetase inhibition as the mechanism of the ulcerogenic action of anti-inflammatory drugs.

Topics: Acetaminophen; Aspirin; Carbohydrate Epimerases; Duodenal Ulcer; Gastric Mucosa; Gentamicins; Glutamine-Fructose-6-Phosphate Transaminase (Isomerizing); Humans; Hydrocortisone; In Vitro Techniques; Intestinal Mucosa; Peptic Ulcer; Salicylates; Sodium Salicylate

Topics: Alcoholic Beverages; Diet; Duodenal Ulcer; Gastric Juice; Gastrins; Gastrointestinal Hormones; Histamine Release; Humans; Indomethacin; Peptic Ulcer; Salicylates; Secretin; Smoking; Stomach Ulcer; Stress, Psychological; Vagus Nerve

Topics: Adult; Age Factors; Aged; California; Esophageal and Gastric Varices; Ethanol; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Hematemesis; Hematocrit; Hospitalization; Humans; Liver Cirrhosis; Melena; Middle Aged; Peptic Ulcer; Recurrence; Salicylates; Shock, Hemorrhagic

Topics: Alcohol Drinking; Barium Sulfate; Diagnosis, Differential; Esophageal and Gastric Varices; Esophagoscopy; Ethanol; Fiber Optic Technology; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Mallory-Weiss Syndrome; Peptic Ulcer; Radiography; Salicylates; Time Factors

Topics: Adult; Age Factors; Aged; Antacids; Female; Hospitalization; Humans; Male; Middle Aged; Peptic Ulcer; Radiography; Recurrence; Retrospective Studies; Salicylates; Sex Factors; Smoking; Wound Healing

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Aged; Cathartics; Chemical and Drug Induced Liver Injury; Cholestasis; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Iatrogenic Disease; Indomethacin; Insecticides; Pancreatitis; Peptic Ulcer; Phenylbutazone; Potassium Chloride; Reserpine; Salicylates; Thiazines

Topics: Animals; Body Weight; Diet; Dose-Response Relationship, Drug; Feeding Behavior; Humans; Hydrocortisone; Immobilization; Male; Peptic Ulcer; Rats; Salicylates; Stress, Psychological

Topics: Animals; Anti-Inflammatory Agents; Benzyl Compounds; Edema; Female; Fever; Flufenamic Acid; Indomethacin; Lethal Dose 50; Male; Mefenamic Acid; Methylamines; Mice; Naphthalenes; Pain; Peptic Ulcer; Phenylbutazone; Pyrazoles; Rats; Salicylates; Terpenes; Uricosuric Agents

Topics: Animals; Anti-Inflammatory Agents; Disease Models, Animal; Female; Male; ortho-Aminobenzoates; Peptic Ulcer; Phenylbutazone; Rats; Salicylates

Topics: Animals; Gastric Juice; Hydrogen-Ion Concentration; Ligation; Male; Mucoproteins; Neuraminic Acids; Peptic Ulcer; Pyloric Stenosis; Rats; Salicylates

Topics: Analgesics; Aniline Compounds; Anti-Inflammatory Agents; Aspirin; Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Gastrointestinal Diseases; Humans; Indomethacin; Inflammation; Lysosomes; ortho-Aminobenzoates; Peptic Ulcer; Pyrazoles; Salicylates

Topics: Adult; Age Factors; Anemia; Bone Diseases; Bone Resorption; Calcium; Fluorides; Glucocorticoids; Hepatomegaly; Histamine; Histamine Release; Humans; Hydroxyproline; Male; Mast Cells; Opium; Osteoporosis; Peptic Ulcer; Phosphorus; Protein-Losing Enteropathies; Radiography; Salicylates; Serotonin; Sex Factors; Splenomegaly; Urticaria Pigmentosa

Topics: Adrenocorticotropic Hormone; Caffeine; Drug-Related Side Effects and Adverse Reactions; Gastrointestinal Diseases; Histamine; Humans; Indomethacin; Nicotinic Acids; Peptic Ulcer; Phenylbutazone; Reserpine; Salicylates

Of a series of 130 patients undergoing operation for peptic ulcer disease at the Vancouver General Hospital, seven patients with personality defects had a disastrous outcome after operation.THE MAIN FEATURES OF THIS POSTGASTRECTOMY SYNDROME WERE REMARKABLY SIMILAR: persistent abdominal pain without demonstrable cause, intermittent and inexplicable nausea and vomiting, continued analgesic drug dependence and marked nutritional deficiencies. The high incidence was surprising and was not confined to any particular socioeconomic group. Such patients fall into three groups: those with true ulcer disease, those with salicylate addiction, and those without positive signs of ulcer but with chronic complaints. A history of a personality defect should warn the surgeon, and operation should be performed only for the complications of true ulcer disease. Though operation may cure the ulcer, the patient is worse off because the resulting physiologic derangements cannot be accepted or handled by him. These patients continue to haunt the surgeon, and the syndrome has been named the "albatross" syndrome.

Topics: Adult; Antisocial Personality Disorder; Female; Gastrectomy; Humans; Male; Middle Aged; Neurotic Disorders; Peptic Ulcer; Postoperative Complications; Psychosomatic Medicine; Salicylates

Topics: Adrenal Cortex Hormones; Antitubercular Agents; Duodenal Ulcer; Humans; Peptic Ulcer; Reserpine; Salicylates; Stomach Ulcer

Topics: Adrenal Cortex Hormones; Arthritis, Rheumatoid; Dyspepsia; Female; Humans; Male; Peptic Ulcer; Phenylbutazone; Salicylates

Topics: Adolescent; Adrenal Cortex Hormones; Child; Female; Humans; Male; Peptic Ulcer; Salicylates