simethicone and Peptic-Ulcer

The effects of the intravenous bolus administration of famotidine versus the administration of Mylanta II liquid every 2 hours on the pH of the gastric antrum, body, and fundus for 24 hours were compared in 10 critically ill patients admitted to the intensive care unit with isolated cranial trauma. Patients received 30 mL of Mylanta II every 2 hours via nasogastric tube for 24 hours, followed by administration of 20 mg of intravenous bolus famotidine every 12 hours for the subsequent 24-hour period. pH of the gastric antrum, body, and fundus was monitored continuously using a three antimony pH electrode/nasogastric tube assembly. Gastric pH data were analyzed for the percentage of time pH was less than 4 and median pH for the antrum, body, and fundus for each 24-hour period. The percentage of time pH was less than 4 was significantly less in the antrum and body of the stomach during famotidine therapy (8.9% +/- 3.6% and 24.9% +/- 6.9%, respectively) compared with Mylanta II (39.1% +/- 6.7% and 57.6% +/- 8.5%, respectively, both p < 0.005), but was not significantly different in the fundus (famotidine: 25.3% +/- 7.8%; Mylanta II: 28.3% +/- 6.5%). Median gastric pH for 24 hours was significantly greater in the antrum and body of the stomach during famotidine therapy (7.8 +/- 0.2 and 6.8 +/- 0.6, respectively) compared with Mylanta II (4.5 +/- 0.6 and 3.7 +/- 0.9, respectively, p < 0.005 and p < 0.01, respectively), but was not significantly different in the fundus (famotidine: 5.9 +/- 0.8; Mylanta II: 5.4 +/- 0.7). The data indicate that an intravenous bolus of famotidine every 12 hours is more effective than Mylanta II liquid every 2 hours administered via a nasogastric tube in maintaining gastric pH above 4 in critically ill patients. Famotidine produces a uniform increase in gastric pH throughout the stomach, whereas Mylanta II controls only proximal gastric pH, probably related to fundic pooling of antacid in the supine position.

Topics: Adult; Aluminum Hydroxide; Antacids; Critical Illness; Drug Combinations; Famotidine; Female; Gastric Acid; Gastric Acidity Determination; Gastric Fundus; Humans; Injections, Intravenous; Intubation, Gastrointestinal; Magnesium Hydroxide; Male; Middle Aged; Peptic Ulcer; Pyloric Antrum; Simethicone; Stomach; Stress, Physiological

To determine the comparative efficacy of several histamine (H2)-receptor antagonists (cimetidine, famotidine, and ranitidine) and the antacid Mylanta-II (Stuart Pharmaceuticals, Wilmington, DE) in gastric pH control and the prevention of postoperative stress ulceration, a prospective, randomized study was performed in a homogeneous population of patients with elective coronary artery bypass. None of the 57 patients in the study population had a documented history of ulcer disease. There were four treatment groups, each with similar demographics (age and sex). Cimetidine-treated group consisted of 15, famotidine-treated group of 18, ranitidine-treated group of 19, and antacid-treated group of 5 patients. There was no hemodynamically significant postoperative gastrointestinal bleeding in any of the patients. When the agents were compared for efficacy of gastric pH control, statistically better pH control was found in the famotidine- and ranitidine-treated groups (P less than 0.003) than in the cimetidine-treated group (pH less than or equal to 4.0) during the 20-hour observation period. Side effects (hematologic and neurological) were noted only in the cimetidine-treated group. The results of this study indicate that in patients in postoperative intensive care, better gastric pH control, and thus prevention of gastric stress ulcers, is achieved with either famotidine or ranitidine rather than cimetidine or antacid.

Topics: Aged; Aluminum Hydroxide; Antacids; Cimetidine; Coronary Artery Bypass; Drug Combinations; Famotidine; Female; Humans; Magnesium Hydroxide; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Prospective Studies; Ranitidine; Simethicone; Stress, Physiological

To assess the efficacy of cimetidine versus Mylanta II in the prevention of stress erosions, 44 patients at risk were randomized to receive cimetidine 300 mg/6 h intravenously to a maximum of 400 mg/4 h; or Mylanta II 30 ml/h through a nasogastric tube to a maximum of 90 ml/h. The minimum dose of medication was used to maintain hourly gastric pH greater than or equal to 4. All patients were to be endoscoped after 72 h and erosions graded by an endoscopist who had no knowledge of their treatment regime. Grade 3 or 4 erosions occurred in five of 21 cimetidine-treated patients and eight of 16 antacid-treated patients (p greater than 0.05). A gastric pH greater than or equal to 4 was maintained 79.5% of the time by cimetidine and 97.9% of the time by Mylanta II (p less than 0.001). Cimetidine and antacids are equal in the prevention of stress erosions although Mylanta II is superior in hourly pH control. Hourly pH control does not entirely explain the beneficial effect of cimetidine in the prevention of stress ulcers. There was no significant bleeding in this study. Fatalities in patients at risk of developing stress ulcers result from the underlying disease, not from hemorrhage from stress-induced mucosal lesions. In critically ill patients, endoscopic examination should be restricted to the rare case with manifest hemorrhage.

Topics: Adult; Aged; Aluminum Hydroxide; Antacids; Cimetidine; Critical Care; Drug Combinations; Female; Gastric Acid; Gastric Acidity Determination; Humans; Hydrogen-Ion Concentration; Intensive Care Units; Intubation, Gastrointestinal; Magnesium; Magnesium Hydroxide; Male; Middle Aged; Peptic Ulcer; Random Allocation; Risk; Silicones; Simethicone; Stress, Physiological

Four antacid preparations have been studied in a stratified, randomized, double-blind trial to evaluate criteria which determine patients' acceptance of this type of therapy. There was a considerable range of judgements about palatability, but preference was determined not only by factors such as the smell, taste, texture and after-taste of the preparation, but also by the order in which the antacids were tested and by the age and sex of the patient. The preparations also differed considerably in acid-neutralizing capacity and ability to bind bile salts, as well as cost. We conclude that individuals requiring antacid therapy should be allowed to chose from among a range of preparations, in order to maximize compliance.

Topics: Adult; Aged; Alginates; Aluminum Compounds; Aluminum Hydroxide; Aluminum Silicates; Antacids; Bicarbonates; Clinical Trials as Topic; Dimethylpolysiloxanes; Double-Blind Method; Drug Combinations; Esophagitis; Female; Humans; Magnesium; Magnesium Compounds; Magnesium Hydroxide; Magnesium Oxide; Male; Middle Aged; Patient Acceptance of Health Care; Peptic Ulcer; Random Allocation; Silicates; Silicic Acid; Silicon Dioxide; Silicones; Simethicone; Sodium Bicarbonate

Topics: Aluminum Hydroxide; Antacids; Cimetidine; Drug Combinations; Famotidine; Humans; Magnesium Hydroxide; Peptic Ulcer; Postoperative Complications; Ranitidine; Simethicone; Stress, Physiological

The effect of cimetidine (400 mg twice a day) on the short-term healing of chronic peptic ulcer is reported. In benign gastric ulcer, 17 of 25 patients (68%) healed in six weeks and 23 of 25 patients (92%) by 12 weeks. In duodenal ulcer, 33 of 42 patients (80%) healed in six weeks and 40 of 42 patients (95%) by 12 weeks. In stomal ulcer after a previous Polya gastrectomy, eight of 10 patients (80%) healed in six weeks and 10 of 10 patients (100%) by 12 weeks. In this study, the cimetidine regimen of 400 mg twice a day has produced healing rates in gastric, duodenal or stomal ulcer which compare favourably with those reported for the currently recommended regimen of 200 mg three times a day and 400 mg at night. Twice a day dosage is likely to improve patient compliance, costs less, and may reduce dose-related side effects. Perhaps 400 mg of cimetidine twice a day should become the recommended dosage for the initial treatment of peptic ulcer.

Topics: Adult; Aged; Aluminum Hydroxide; Antacids; Cimetidine; Drug Combinations; Duodenal Ulcer; Endoscopy; Female; Gastrectomy; Guanidines; Humans; Magnesium Hydroxide; Male; Middle Aged; Patient Compliance; Peptic Ulcer; Simethicone; Time Factors; Ulcer