sodium-bicarbonate and Stomach-Ulcer

Minute early gastric cancers can be removed with endoscopic mucosal resection techniques. However, early detection of these minute cancers with endoscopy is still difficult. For this purpose, use of a dye is helpful. To increase visibility further, gastric mucus should be removed before endoscopic examination. In this study, the effectiveness of premedication with pronase for improving visibility during gastroendoscopy was investigated.. From January through July 1996, outpatients scheduled for gastroendoscopy were randomly assigned to oral premedication with the antifoam agent dimethylpolysiloxane alone (n=34), with dimethylpolysiloxane plus sodium bicarbonate (n=32), or with dimethylpolysiloxane, sodium bicarbonate, and pronase (n=34). All were given about 10 minutes before the start of endoscopy. After inserting the endoscope, the endoscopist gave visibility scores at conventional endoscopy and after methylene blue spraying.. Premedication with pronase significantly improved visibility before and after methylene blue spraying as compared with the two other groups pretreated without pronase. Pronase also significantly shortened the times for chromoendoscopic examination. Pronase had no significant effect on the culture of Helicobacter pylori.. Premedication with pronase improved endoscopic visualization during conventional endoscopy and chromoendoscopy. Its routine use at gastroendoscopy is therefore recommended.

Topics: Adult; Diagnosis, Differential; Dimethylpolysiloxanes; Female; Gastritis; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Image Enhancement; Male; Methylene Blue; Middle Aged; Premedication; Pronase; Sensitivity and Specificity; Sodium Bicarbonate; Stomach Neoplasms; Stomach Ulcer

Ninety-five patients with healed gastric ulcers were treated with ranitidine 150 mg at night plus either Caved-S two tablets twice daily, or an identical placebo preparation. Treatment was continued for 2 years: the recurrence rate after 1 year was 12.5% for single therapy and 19% for combined therapy, and 30 and 40% respectively after 2 years (differences not significant). No serious side-effects were encountered, but patients found the combination therapy difficult to take, and it conferred no clinical advantage. In a 3 month follow-up after stopping maintenance therapy, 11% of the patients had a symptomatic ulcer recurrence. It is therefore recommended that elderly patients with gastric ulceration should remain on maintenance therapy for life.

Topics: Adult; Aluminum Hydroxide; Anti-Ulcer Agents; Bismuth; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Female; Glycyrrhiza; Humans; Magnesium Hydroxide; Male; Middle Aged; Plant Extracts; Ranitidine; Recurrence; Sodium Bicarbonate; Stomach Ulcer

In a double blind endoscopically controlled study, 100 patients with gastric ulcers were treated with either ranitidine or ranitidine plus Caved-S. On single therapy, 58% of ulcers were healed at four weeks, 92% at eight weeks and 96% at 12 weeks. Combination therapy did not alter the healing rate, nor improve on the control of dyspeptic symptoms. No difference in healing rate was found between good and poor drug compliance patients. This suggests that ranitidine may be equally effective at lower dosages. Thirty seven patients had developed their ulcer while taking non-steroidal anti-inflammatory drugs. These patients were mainly elderly women who had a higher risk of bleeding (p = 0.006) from a large ulcer (p = 0.009).

Topics: Aged; Aluminum Hydroxide; Anti-Ulcer Agents; Bismuth; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Dyspepsia; Female; Glycyrrhiza; Humans; Magnesium Hydroxide; Male; Middle Aged; Plant Extracts; Ranitidine; Sodium Bicarbonate; Stomach Ulcer

One hundred patients with benign gastric ulceration were treated in a single-blind, endoscopically controlled trial to assess the relative efficacy of cimetidine (1 g daily) and Caved-S (six tablets daily). Ulcer healing was assessed after six weeks' treatment, and, if incomplete, after a further six weeks. There was no significant difference between the two drug regimens (approximately 63% at six weeks and 91% at 12 weeks). If an ulcer remains unhealed after 10 weeks' treatment the patient should undergo surgery. There was no difference in the relief of day pain between the two drug regimens but cimetidine was more effective over the first two weeks of treatment relieving night pain, than was Caved-S (p less than 0 . 02). After ulcer healing, drug dosage was reduced (cimetidine to 400 mg at night and Caved-S to two tablets twice daily). So far, 56 patients, 28 in each group, have completed the first year's maintenance treatment, and there have been four ulcer recurrences in each group (14%).

Topics: Aged; Aluminum Hydroxide; Bismuth; Cimetidine; Clinical Trials as Topic; Drug Combinations; Female; Glycyrrhiza; Guanidines; Humans; Magnesium Hydroxide; Male; Middle Aged; Plant Extracts; Recurrence; Sodium Bicarbonate; Stomach Ulcer

Topics: Aluminum Hydroxide; Bismuth; Clinical Trials as Topic; Drug Combinations; Duodenal Ulcer; Glycyrrhiza; Humans; Magnesium Hydroxide; Peptic Ulcer; Plant Extracts; Plants, Medicinal; Sodium Bicarbonate; Stomach Ulcer

Topics: Antacids; Anti-Inflammatory Agents; Bicarbonates; Bismuth; Clinical Trials as Topic; Drug Combinations; Duodenal Ulcer; Evaluation Studies as Topic; Foeniculum; Humans; Magnesium; Plants, Medicinal; Plants, Toxic; Rhamnus; Sodium Bicarbonate; Stomach Diseases; Stomach Ulcer

Currently available anti-ulcer drugs suffer from serious side effects which limited their uses and prompted the need to search for a safe and efficient new anti-ulcer agent. Boswellia gum resin (BR) emerged as a safe, efficient, natural, and economic potential cytoprotective agent. Thus, it is of medical importance to develop gastroretentive (GR) formulations of BR to enhance its bioavailability and anti-ulcer efficacy. Early attempts involved the use of organic solvents and non-applicability to large-scale production. In this study, different tablet formulations were prepared by simple direct compression combining floating and bioadhesion mechanisms employing hydroxypropyl methylcellulose (HPMC), sodium carboxymethyl cellulose (SCMC), pectin (PC), and/or carbopol (CP) as bioadhesive polymers and sodium bicarbonate (SB) as a gas former. The prepared tablets were subjected for assessment of swelling, floating, bioadhesion, and drug release in 0.1 N HCl. The optimized GR formulation was examined for its protective effect on the gastric ulcer induced by indomethacin in albino rabbits compared with lactose tablets. The obtained results disclosed that swelling, floating, bioadhesion, and drug release of the GR tablets of BR depend mainly on the nature of the matrix and the ratio of polymer combinations. Moreover, a combination of SCMC-CP in a ratio of 2:1 (SCP21) exhibited desirable floating, bioadhesion, swelling, and extended drug release. Also, a 6-h pretreatment with SCP21 tablets decreased the severity of inflammation and number of bleeding spots among ulcer-induced rabbits in comparison to those treated with lactose tablets.

Topics: Acrylic Resins; Animals; Anti-Ulcer Agents; Biological Availability; Boswellia; Carboxymethylcellulose Sodium; Chemistry, Pharmaceutical; Drug Liberation; Excipients; Hypromellose Derivatives; Indomethacin; Male; Pectins; Polymers; Protective Agents; Rabbits; Resins, Plant; Sodium Bicarbonate; Stomach Ulcer; Tablets

Usual treatment for Helicobacter pylori-induced peptic ulcer includes a 'triple therapy' consisting of two antibiotics (amoxicillin and clarithromycin) and a proton pump inhibitor (omeprazole). The objective of this project work was defined with a view to retain the drug in stomach for better antiulcer activity and substituting one of the synthetic drugs in this therapy with a herbal alternative. Hence, aim of the present work was to design and develop a bilayer floating tablet of amoxicillin and Aloe vera gel powder for the treatment of peptic ulcer. A. vera gel powder is used for its cytoprotective action. Bilayer floating tablets were prepared by applying direct compression technique. The proportion of sodium bicarbonate and citric acid was adjusted to get the least possible lag time with good matrix integrity and total floating time. Polymer concentration was adjusted to get the maximum release in 8 h. The formulation was developed using hydroxypropyl methyl cellulose (HPMC) K4M and HPMC K100M in a ratio of 85:15 along with 1:4 ratio of effervescent agents was found to give floating lag time of less than 1 min with total floating time of more than 8 h and 97.0% drug release in 8 h. In vivo study in rats meets the requirement of antiulcer activity for bilayer tablet in comparison to single amoxicillin as standard.

Topics: Aloe; Amoxicillin; Animals; Chemistry, Pharmaceutical; Citric Acid; Drug Compounding; Gels; Hypromellose Derivatives; Male; Methylcellulose; Polymers; Powders; Rats; Rats, Wistar; Sodium Bicarbonate; Stomach Ulcer; Tablets

Maintenance of gastric pH above 4.0 aids the prevention of bile acid-mediated ulcerative damage to the pars esophageal tissue in pigs. One means of doing so is the addition of buffering compounds, such as sodium bicarbonate, to the water supply; however, any potential physiological effect of buffer consumption has yet to be determined. Experiment 1 tested the acute effects of buffer addition to the water supply on systemic acid-base and electrolyte balance in swine (BW 40.7 +/- 3.0 kg). Consumption of water calculated to a 200 mOsm solution with sodium bicarbonate for 24 h increased (P < 0.05) blood Na+, HCO3(-), and pCO2, although these effects were all within physiologically tolerable levels. Urine pH and Na+ excretion increased (P < 0.001) following the consumption of NaHCO3, with Na+ concentration almost threefold higher in treated pigs compared with controls. Experiment 2 determined the chronic systemic effects of buffer consumption by measuring blood and urine variables, with pigs consuming NaHCO3-treated water throughout. Water consumption increased (P < 0.001) during buffer consumption, although intake levels remained within normal ranges. Blood pH levels were not affected by long-term consumption of dietary buffer; however, blood HCO3(-) (P < 0.05), Na+, and pCO2 (P < 0.01) increased. Urine pH and urine Na+ concentration increased (P < 0.01) in buffer-treated compared with control animals. Results indicate that sodium bicarbonate can safely be added to the water supply for pigs, with no clinically relevant alterations in acid-base balance because the animals readily compensate for buffer intake.

Topics: Acid-Base Equilibrium; Adaptation, Physiological; Animals; Anti-Ulcer Agents; Drinking; Hydrogen-Ion Concentration; Male; Random Allocation; Sodium; Sodium Bicarbonate; Stomach; Stomach Ulcer; Swine; Swine Diseases

The effects of cimetidine and NaHCO3 on gastric acid back-diffusion (either the H+ loss or the Na+, K+ and CA++ gain in the gastric lumen) and mucosal ulceration were studied in rats with chronic feeding of betel quid chewing (BQC)- or its individual component-containing food. After 30 and 90 days of feeding, the animal was fasted for 24 hrs and vagotomized. An acid solution (100 mM HCl plus 54 mM NaCl) with or without drugs was irrigated in the rat stomach for 3 hrs. The results indicated that BQC and its individual component produced a variety of change in enhancement in acid solution-induced acid back-diffusion and mucosal hemorrhagic ulceration but in decrease of gastric mucus secretion. These parameters were dose-dependently reversed by intragastric cimetidine (50-300 mg/kg) in BQC-treated rats. Similar but lesser effect than cimetidine (300 mg/kg) was obtained by intragastric administration of NaHCO3 (52 mg/kg). It is concluded that in BQC- or its component-feeding rats, the enhancement in acid back-diffusion and the reduction in mucus secretion are at least in part responsible for the formation of hemorrhagic ulceration which can be inhibited by intragastric cimetidine or NaHCO3.

Topics: Animals; Areca; Calcium; Cimetidine; Dose-Response Relationship, Drug; Gastric Acid; Gastric Mucosa; Gastrointestinal Hemorrhage; Hydrogen; Male; Permeability; Plants, Medicinal; Rats; Rats, Wistar; Sodium; Sodium Bicarbonate; Stomach Ulcer

An experiment was conducted with growing-finishing pigs to evaluate the interactive effects of dietary sodium bicarbonate (1%) and excess dietary Cu (250 mg/kg diet) on growth, liver Cu accumulation and incidence of gastric ulceration. A 2 x 2 factorial arrangement of treatments was used and each treatment was replicated four (Trial 1) or three (Trial 2) times with four pigs per replicate. Initial weight of the pigs was 57 (Trial 1) and 32 kg (Trial 2). Growth rate and efficiency of feed utilization were not affected (P > .10) by treatment. Sodium bicarbonate increased (P < .06) the incidence of gastric ulceration and decreased (P < .01) dressing percentage. Dietary Cu (P < .01) increased liver Cu concentration but did not affect (P > .10) the incidence of gastric ulceration.

Topics: Animal Feed; Animals; Bicarbonates; Copper; Growth; Incidence; Liver; Sodium; Sodium Bicarbonate; Stomach Ulcer; Swine; Swine Diseases

The present study examines the involvement of acidosis in stress ulceration in rat stomachs. Cold restraint stress for 2 hr did not affect the blood lactate level; however, it produced respiratory acidosis, as reflected by the depressed respiratory rate which was associated with increased CO2 tension and a lowered blood pH. Severe hemorrhagic ulceration was found in the glandular mucosa. The effects of stress on blood pH and the stomach were reversed by IV infusion of NaHCO3. Infusion of HCl IV decreased the blood pH and HCO-3 level and produced gastric ulceration. It is concluded that respiratory acidosis could be involved in stress ulceration. The metabolic acidosis evoked by HCl also induced gastric damage, but the effect was much less.

Topics: Acidosis, Respiratory; Animals; Bicarbonates; Carbon Dioxide; Cold Temperature; Female; Hydrochloric Acid; Hydrogen-Ion Concentration; Lactates; Rats; Rats, Inbred Strains; Restraint, Physical; Sodium; Sodium Bicarbonate; Stomach Ulcer; Stress, Physiological

Topics: Acetates; Acetazolamide; Acetic Acid; Animals; Bicarbonates; Infusions, Parenteral; Male; Rats; Rats, Inbred Strains; Sodium; Sodium Bicarbonate; Stomach Ulcer

Gastric ulceration has been induced after stress, combining 24 h of fasting and 48 h of restraint in 9 groups of 20 rats with or without a pyloroplasty or a pylorojejunostomy combined with atropine and gastric infusion of NaHCO3 or taurocholic acid. After death or sacrifice at 48 h, ulcer index and blood in the jejunum were determined. Gastric mucosal blood flow was measured semi-continuously by a laser Doppler velocimeter. There were 45% deaths after 48 h of restraint alone, and 70% in the group combining pylorojejunostomy with taurocholic acid. Mortality was lower (p less than or equal to 0.01) pylorojejunostomy alone and more significantly so (p less than or equal to 0.001) when associated with NaHCO3. There was no death when NaHCO3 and atropine were combined with restraint. The mucosal blood flow increased significantly during the first 12 h of restraint in the taurocholic acid group. Both groups with NaHCO3 had mucosal blood flows similar to the controls. Gastric acid and gastric emptying, mucosal ischemia and bile reflux are joint factors inducing gastric stress ulcer. The 100% survival and the low ulcer index after a treatment by atropine and gastric infusion of NaHCO3 suggest that these well-known drugs should be used more frequently.

Topics: Animals; Atropine; Bicarbonates; Bile Reflux; Biliary Tract Diseases; Blood Flow Velocity; Disease Models, Animal; Gastric Mucosa; Jejunum; Male; Peptic Ulcer Hemorrhage; Pylorus; Rats; Rats, Inbred Strains; Restraint, Physical; Sodium; Sodium Bicarbonate; Stomach Ulcer; Stress, Physiological; Taurocholic Acid

It is suggested that carbonic anhydrase is implicated not only in gastric acid secretion, but in mucosal protection. It was reported that acetazolamide induced gastric mucosal lesions. But acetazolamide also caused concomitant metabolic acidosis by inhibiting H+ secretion from renal tubules. We investigated whether concomitant metabolic acidosis is implicated in gastric mucosal lesions induced by acetazolamide in vivo. We also evaluated the effect of acetazolamide on gastric H+ back diffusion in vivo. Correction of metabolic acidosis with sodium bicarbonate had no effect on the degree of the gastric mucosal lesions. Acetazolamide caused no change in gastric H+ and Na+ flux. These results suggest that metabolic acidosis induced by acetazolamide is not implicated in gastric mucosal lesions. Carbonic anhydrase has no effect on H+ back diffusion but may be implicated in mucosal protection by the disposition of back diffused H+ into the gastric mucosa.

Topics: Acetazolamide; Acidosis; Animals; Bicarbonates; Carbonic Anhydrases; Gastric Mucosa; Hydrogen-Ion Concentration; Male; Rats; Rats, Inbred Strains; Sodium; Sodium Bicarbonate; Stomach Ulcer

Histamine and serotonin levels in gastric secretion and the effects of pharmacological antagonists were studied in rats in which stomach ulceration was induced by electrical vagal stimulation. Electrical vagal stimulation (2 and 5 V) produced a graded increase in haemorrhagic glandular mucosal ulcers. NaHCO3 perfusion completely neutralised the increased acid output but failed to prevent ulceration. Atropine inhibited gastric mast cell degranulation as well as histamine and serotonin release. Diphenhydramine, atropine and sub-diaphragmatic vagotomy antagonised the increase in intragastric pressure. Diphenhydramine, cimetidine, atropine or vagotomy but not methysergide reduced ulcer severity. It is concluded that gastric acid and serotonin do not play an important role in glandular ulceration induced by electrical vagal stimulation. The lesions probably result from increased intragastric pressure and release of gastric histamine which stimulates H1 and H2 receptors in the stomach. The similarities between the aetiologies of glandular ulcers due to electrical vagal stimulation and to stress are also discussed.

Topics: Animals; Atropine; Bicarbonates; Electric Stimulation; Gastric Juice; Histamine Release; Male; Pressure; Rats; Rats, Inbred Strains; Serotonin; Sodium; Sodium Bicarbonate; Stomach; Stomach Ulcer; Vagotomy; Vagus Nerve

Topics: Aluminum; Aluminum Hydroxide; Anti-Ulcer Agents; Bismuth; Carbenoxolone; Chronic Disease; Cimetidine; Drug Combinations; Drug Evaluation; Gastric Mucosa; Glycyrrhiza; Humans; Magnesium Hydroxide; Plant Extracts; Plants, Medicinal; Recurrence; Sodium Bicarbonate; Stomach Ulcer; Sucralfate

Eighty two patients with an endoscopically healed gastric ulcer, were treated for two years with either Caved-S tablets, two twice daily or cimetidine 400 mg at night. During the first year, 12% (four out of 34) of the Caved-S group and 10% (four out of 41) of the cimetidine group had an ulcer recurrence. By the end of the second year, the recurrence rate was 29% (nine out of 31) in the Caved-S group, and 25% (eight out of 32) for the cimetidine group. Ulcer relapse occurred frequently in patients with either a dyspeptic history of over six months (p less than 0.05), or a past history of a gastric ulcer (p less than 0.001). Ulcers recurred rapidly after maintenance therapy; Caved-S two out of 22; cimetidine seven out of 23, within four months (NS). This study shows that long term maintenance therapy is safe and reasonably effective. The high recurrence rate after stopping treatment suggests that therapy in high risk or elderly patients should be for life.

Topics: Adult; Aluminum Hydroxide; Anti-Ulcer Agents; Bismuth; Cimetidine; Drug Combinations; Female; Glycyrrhiza; Humans; Magnesium Hydroxide; Male; Middle Aged; Plant Extracts; Recurrence; Sodium Bicarbonate; Stomach Ulcer

The present experiment demonstrated that relatively high doses of acetazolamide (100 and 200 mg/kg s.c.) induced severe gastric hemorrhagic ulceration in rats. This ulceration was aggravated by oral administration of HC1, but was inhibited by NaHCO3. Further, the severity of ulceration was also decreased by pretreatment with methysergide, chlorpheniramine, or cimetidine. These protective effects were affirmed by an increase in serotonin and histamine released from the stomach after acetazolamide treatment. Acetazolamide injection also increased the protein level, but reduced the sialic acid content in the gastric secretion, indicating that the gastric mucosal barrier may have been damaged. Prostaglandin E2 content of the gastric mucosa was not affected by the drug; however, carbonic anhydrase activity was markedly reduced in a dose-dependent manner. Thus, it is suggested that the ulceration induced by acetazolamide is mainly due to the inhibition of carbonic anhydrase activity and mucus secretion. The increases in serotonin and histamine released may also have been contributing factors for gastric ulcer formation.

Topics: Acetazolamide; Animals; Bicarbonates; Carbonic Anhydrase Inhibitors; Dinoprostone; Dose-Response Relationship, Drug; Gastric Acid; Gastric Mucosa; Histamine Antagonists; Male; Prostaglandins E; Rats; Rats, Inbred Strains; Serotonin Antagonists; Sodium Bicarbonate; Stomach Ulcer

The accidental or intentional ingestion of urine sugar reagent (Clinitest) tablets, a potent caustic, has been reported to cause severe esophageal mucosal damage and stricture formation. Gastric mucosal damage was reported once before in a man who intentionally ingested 26 Clinitest tablets. We encountered a case of accidental Clinitest tablet ingestion causing gastric and duodenal ulceration without esophageal damage, a previously undescribed complication of inadvertent Clinitest tablet ingestion. Our case reemphasizes the role of early fiberoptic endoscopy in the evaluation of caustic ingestions.

Topics: Accidents; Citrates; Citric Acid; Copper Sulfate; Diabetes Complications; Drug Combinations; Duodenal Ulcer; Duodenoscopy; Gastroscopy; Humans; Indicators and Reagents; Male; Middle Aged; Sodium Bicarbonate; Stomach Ulcer

Topics: Adult; Aluminum Hydroxide; Bismuth; Drug Combinations; Drug Evaluation; Gastric Acid; Glycyrrhiza; Humans; Magnesium Hydroxide; Middle Aged; Plant Extracts; Sodium Bicarbonate; Stomach Ulcer; Time Factors

Topics: Acetazolamide; Animals; Bicarbonates; Gastric Juice; Gastric Mucosa; Hydrogen-Ion Concentration; Rats; Rats, Inbred Strains; Sodium Bicarbonate; Stomach Ulcer

36 patients with a ventricular ulcer demonstrated by endoscopy and secured by histology, were given 2 tablets Caved-S 4 times a day for 4 weeks. Clinical parameters were subjective complaints, such as pain and heartburn, which after a relatively short time, many patients declared to have diminished or ceased completely. Objective parameters were endoscopic explorations before beginning of the treatment, i.e. gastroscopy and biopsy, examinations by gastro-camera and in some cases chromography to exclude a possible malignancy. The control examinations were performed almost exclusively by gastro-camera, and that after 2 and 4 weeks. The ulcer healing stage could be clearly defined after Ohmori and Miwa (1971), its localisation and size were also recorded. Altogether it can be said, that the preparation Caved-S, by a working-principle not as yet exactly defined in all details, effects rapid healing endoscopically provable, but that ulcers with a special localisation, e.g. in the angulus-area of the posterior wall, require a longer healing time according to expectation. Clinically relevant side effects were not observed. Thus it can be concluded that Caved-S is very suitable for the treatment of ventricular ulcers. The preparation has a spasmolytical component leading quickly to freedom from pain, and a protective component effecting a healing tendency which can be demonstrated by endoscopic methods. It must be said, however, that this protective healing-promoter factor has not yet been defined pharmacologically.

Topics: Aluminum Hydroxide; Bismuth; Carbonates; Drug Administration Schedule; Drug Combinations; Drug Evaluation; Female; Gastroscopy; Glycyrrhiza; Humans; Magnesium Hydroxide; Male; Photography; Plant Extracts; Plants, Medicinal; Sodium Bicarbonate; Stomach Ulcer