sodium-bicarbonate and Esophagitis--Peptic

Morning dose or twice-daily proton pump inhibitor (PPI) use is often prescribed to heal severe reflux esophagitis.. Compare the effect of single dose morning (control arm) versus nighttime (experimental arm) omeprazole/sodium bicarbonate (Zegerid(®)) (IR-OME) on esophagitis and gastroesophageal reflux symptoms.. Adult outpatients with Los Angeles grade C or D esophagitis were allocated to open-label 40 mg IR-OME once a day for 8 weeks in a prospective, randomized, parallel design, single center study. Esophagogastroduodenoscopy (EGD) and validated self-report symptom questionnaires were completed at baseline and follow-up. Intention-to-treat and per-protocol analyses were performed.. Ninety-two of 128 (72 %) eligible subjects participated [64 (70 %) male, mean age 58 (range 19-86), median BMI 29 (range 21-51), 58 C:34 D]. Overall, 81 (88 %) subjects healed [n = 70 (76 %)] or improved [n = 11 (12 %)] erosions. There was no significant difference (morning vs. night) in mucosal healing [81 vs. 71 %, (p = 0.44)] or symptom resolution [heartburn (77 vs. 65 %, p = 0.12), acid regurgitation (82 vs. 73 %, p = 0.28)]. Prevalence of newly identified Barrett's esophagus was 14 % with half diagnosed only after treatment.. Once-daily IR-OME (taken morning or night) effectively heals severe reflux esophagitis and improves GERD symptoms. Results support the clinical practice recommendation to repeat EGD after 8 weeks PPI therapy in severe esophagitis patients to assure healing and exclude Barrett's esophagus.

Topics: Adult; Aged; Aged, 80 and over; Barrett Esophagus; Comorbidity; Drug Combinations; Endoscopy, Digestive System; Endoscopy, Gastrointestinal; Esophagitis, Peptic; Female; Humans; Intention to Treat Analysis; Male; Middle Aged; Mucous Membrane; Omeprazole; Prospective Studies; Proton Pump Inhibitors; Sodium Bicarbonate

Food and acid have been shown to be refluxed independently of each other in healthy volunteers, and anti-reflux agents decrease the reflux of both parameters. Until now this phenomenon had not been studied in patients with low-grade oesophagitis, who are the group most likely to use anti-reflux medication.. To assess patterns of gastro-oesophageal reflux of acid and food in 12 ambulant patients with endoscopically proven oesophagitis of between grades I and II, but who were otherwise healthy. Also to assess the effectiveness of a single dose of an alginate-containing anti-reflux agent in controlling food and acid reflux in this patient group.. Oesophageal pH monitoring and external ambulatory gamma detection were used to study food and acid reflux. A pH electrode was positioned 5 cm above the cardia and the gamma detector was positioned externally over the pH electrode. The patients then received a technetium-99m labelled meal designed to provoke reflux. Thirty minutes later the patients were given a 20 ml dose of alginate (Liquid Gaviscon), or 20 ml of tap water. Incidence of reflux was monitored for approximately 4 h from the end of the meal. Allocation to treatment group was randomized, with patients receiving the alternative treatment on the second study day after approximately a 7-day washout period.. The mean percentage time oesophageal pH remained below 4 was 16.3 min for the control group and 5.4 min for the treatment group (P = 0.03). Food reflux was detected 23.7% of the time in the control group compared to 12% of the time in the treatment group (P = 0.02). The anti-reflux agent was also successful in decreasing the number of events, but the duration of the reflux events was not significantly different.. Patients with grades I and II oesophagitis reflux food and acid independently, and are predominantly either food refluxers or acid refluxers, but not both. Liquid alginate decreases the number of both food and acid reflux events, but does not change their duration.

Topics: Adult; Aged; Alginates; Aluminum Hydroxide; Antacids; Drug Combinations; Eating; Esophagitis, Peptic; Female; Gastric Acid; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Silicic Acid; Sodium Bicarbonate

Fifty-three patients with symptomatic reflux oesophagitis were entered into a single centre randomized study comparing the effects of a dimethicone/antacid (Asilone Gel) and an alginate/antacid (Gaviscon liquid) on symptoms and endoscopic changes over an 8-week period. Both treatments significantly improved heartburn, acid regurgitation and flatulence. Dimethicone/antacid but not alginate/antacid, produced a significant improvement in oesophagitis, oesophageal ulceration and histological grade of inflammation over the 8-week treatment period so that 14 patients treated with dimethicone/antacid and 10 with alginate/antacid had normal endoscopic oesophageal appearances at the end of the study. The difference in improvement between the two patient groups did not reach significance however, except for dimethicone/antacid improving histological changes (P less than 0.05). These findings suggest that dimethicone/antacid and alginate/antacid are equally effective in treating symptomatic reflux oesophagitis although dimethicone/antacid may have an advantage in improving oesophageal histological appearances.

Topics: Adult; Alginates; Aluminum Hydroxide; Antacids; Bicarbonates; Dimethylpolysiloxanes; Double-Blind Method; Drug Combinations; Esophagitis, Peptic; Esophagus; Female; Humans; Magnesium Oxide; Male; Silicic Acid; Simethicone; Sodium Bicarbonate

Fifty patients in whom endoscopy revealed peptic esophagitis were included in a double-blind study in which either sucralfate (1 g four times a day) or an alginate/antacid compound (5 g four times a day) were randomly assigned. After six weeks of treatment, efficacy and clinical safety were evaluated in 23 patients in the sucralfate group and 22 patients in the alginate/antacid group. No significant difference between the two treatments was detected with regard to efficacy, evaluated on the basis of clinical and endoscopic criteria. Clinical safety was also good in both groups. Sucralfate was, therefore, found to be as effective and as well tolerated as the alginate/antacid compound in the treatment of peptic esophagitis.

Topics: Adult; Alginates; Aluminum Hydroxide; Antacids; Bicarbonates; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Endoscopy; Esophagitis, Peptic; Female; Humans; Male; Middle Aged; Random Allocation; Silicic Acid; Silicon Dioxide; Sodium Bicarbonate; Sucralfate

The efficacy of sucralfate and of an alginate/antacid compound was compared in a randomized, double-blind 6-week trial in patients with symptomatic, endoscopically confirmed macroscopic reflux esophagitis. Of the 68 patients who completed the study, 36 received sucralfate and 32 alginate/antacid. Significant symptomatic improvement occurred in both treatment groups: almost 70% of the patients became symptom-free or improved. Esophagitis healed completely in 53% of the patients receiving sucralfate and in 34% of the alginate/antacid patients, as measured with endoscopic criteria (p greater than 0.05). Our results indicate that sucralfate seems to be at least as effective as alginate/antacid in relieving symptoms and in healing macroscopic lesions. As a safe, locally active mucosal protecting agent, sucralfate is a promising new drug for the treatment of reflux esophagitis and deserves further trials over longer periods.

Topics: Adult; Aged; Alginates; Aluminum; Aluminum Hydroxide; Antacids; Anti-Ulcer Agents; Bicarbonates; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Esophagitis, Peptic; Female; Humans; Male; Middle Aged; Silicic Acid; Silicon Dioxide; Sodium Bicarbonate; Sucralfate

In a multi-centre placebo-controlled double-blind study, the therapeutic effectiveness of sucralfate (aluminium sucrose sulphate, four times 1 g daily) was tested on 66 out-patients with endoscopically confirmed reflux oesophagitis. After 12 weeks of treatment complete healing occurred in 72% of the sucralfate group, and in a further 14% there was improvement. In the placebo group the healing rate was 40%, with improvement in a further 20%. Serious side-effects did not occur. Sucralfate treatment was especially effective in patients with signs of high-grade inflammation (stage III of Savary and Miller) unsuccessfully treated with other drugs. Contrary to previously available drugs, sucralfate is effective also in lesions caused by alkaline reflux and is thus a useful addition to the hitherto unsatisfactory means of treatment.

Topics: Alginates; Aluminum; Aluminum Hydroxide; Bicarbonates; Clinical Trials as Topic; Constipation; Drug Combinations; Esophagitis, Peptic; Female; Humans; Male; Middle Aged; Placebos; Silicic Acid; Sodium Bicarbonate; Sucralfate

Topics: Alginates; Aluminum Hydroxide; Antacids; Drug Combinations; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Obesity; Silicic Acid; Sodium Bicarbonate

Topics: Alginates; Aluminum Hydroxide; Antacids; Drug Combinations; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Obesity; Silicic Acid; Sodium Bicarbonate

Topics: Alginates; Aluminum Hydroxide; Antacids; Bezoars; Diagnosis, Differential; Drug Combinations; Esophagitis, Peptic; Female; Humans; Infant, Newborn; Radiography, Thoracic; Silicic Acid; Sodium Bicarbonate; Stomach

To evaluate the efficacy of alginates in the treatment of postgastroresection reflux esophagitis.. Thirty-four post-Billroth II distal gastrectomy patients with reflux esophagitis and without erosive and ulcerative lesions of the gastric stump and anastomosis, who had received geviscon monotherapy for 6 weeks, were examined. Their symptoms and the data of esophagogastroduodenoscopy and impedance pH monitoring were assessed to control treatment results.. There was statistically significant relief of the subjective (heartburn and bitter taste in the mouth) and objective symptoms of the disease and the reflux esophagitis in geviscon-treated patients.. Geviscon is the drug of choice for treating reflux esophagitis in patients after partial distal gastrectomy provided that the acid-forming function of the gastric mucosa is minimally preserved.

Topics: Alginates; Aluminum Hydroxide; Drug Combinations; Endoscopy, Digestive System; Esophagitis, Peptic; Female; Gastrectomy; Gastroenterostomy; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Silicic Acid; Sodium Bicarbonate; Treatment Outcome

The medical therapy of reflux esophagitis consists of modifications of the patients's lifestyle and antacids, alginic acid or both (phase I). Phase II medications include drugs that suppress acid/peptic activity (antacid/alginate, H2-receptor blockers, cimetidine, ranitidine, famotidine), drugs that enhance motility (metoclopramide, domperidone) and drugs that coat and increase mucosal protection (sucralfate). Combinations of H2-receptor blockers and motility stimulating drugs have not been very effective. Overall the results of medical therapy of reflux esophagitis are suboptimal.

Topics: Alginates; Aluminum Hydroxide; Antacids; Bicarbonates; Combined Modality Therapy; Dilatation; Domperidone; Drug Combinations; Esophagitis, Peptic; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Metoclopramide; Peristalsis; Silicic Acid; Sodium Bicarbonate; Sucralfate

Topics: Adult; Aged; Alginates; Aluminum Hydroxide; Bicarbonates; Cimetidine; Dilatation; Drug Combinations; Esophageal Stenosis; Esophagitis, Peptic; Female; Humans; Male; Middle Aged; Silicic Acid; Sodium Bicarbonate

Topics: Alginates; Aluminum Hydroxide; Antacids; Bicarbonates; Carbenoxolone; Cimetidine; Drug Combinations; Esophagitis, Peptic; Humans; Metoclopramide; Silicates; Silicic Acid; Sodium Bicarbonate