A Comparison of the Effect of High-dose Oral and Intravenous Proton Pump Inhibitor on the Prevention of Rebleeding after Endoscopic Treatment of Bleeding Peptic Ulcers / 대한소화기내시경학회지

BACKGROUND/AIMS: The use of proton pump inhibitor (PPI) prevents rebleeding by elevating the intragastric pH in patients with bleeding peptic ulcers after hemostasis has been achieved. We assessed if high-dose oral pantoprazole is as effective as high-dose intravenous pantoprazole for their ability to prevent rebleeding after having achieved initial hemostasis in patients with active bleeding or nonbleeding visible vessels. METHODS: Thirty eight patients with bleeding peptic ulcers who had achieved initial hemostasis were enrolled in this randomized controlled trial. In the high-dose oral pantoprazole group (n=19), 40 mg of pantoprazole was given orally twice daily for 5 days. In the high-dose intravenous pantoprazole group (n=19), an 80 mg intravenous bolus of pantoprazole was given; this was followed by 8 mg/hour of continuous infusion daily for 3 days. Thereafter, 40 mg of pantoprazole was given orally once daily for 8 weeks. RESULTS: The two groups were similar with respect to all the background variables. Rebleeding occurred in 2 patients (10.5%) in the intravenous group and in 1 patient in the oral group (5.3%) by day 30 after enrollment (p=1.000). There was no significant difference in terms of the number of therapeutic endoscopic sessions (1 vs. 1.13+/-0.52), the surgery (0% vs. 0%), the bleeding related mortality (0% vs. 0%), and the mean number of units of transfused blood. CONCLUSIONS: The high-dose oral pantoprazole is as effective as an intravenous administration in reducing rebleeding episodes in patients with bleeding peptic ulcers after successful endoscopic therapy.

Polymorphism of IL-1beta; IL-1Ra, TNF-alpha Cytokine Genes in Korean Patients with Glomerulonephritis / 대한신장학회잡지

BACKGOUND: Recently it has been reported that several cytokine gene polymorphisms regulate cytokine production and play an important role in immune and inflammatory response. We evaluated IL-1beta IL-1Ra, and TNF-alpha gene polymorphism in patients with primary glomerulonephritis to determine the association between cytokine polymorphism and disease susceptibility. METHODS: In this study, we enrolled 118 patients with primary glomerulonephritis and healthy 300 persons who had visited the health screening center. We analyzed -511C/T polymorphism of IL-1beta tandem repeats polymorphism in intron 2 of IL-1Ra and -308G/A polymorphism of TNF-alpha We classified primary glomerulonephritis according to pathologic finding and clinical diagnosis. RESULTS: There were no differences with IL-1betaand TNF-alpha gene polymorphism between patient and control group. The carriage of IL1RN*2 was significantly associated with an increased risk of primary glomerulonephritis (patients:control=12.75:5.4%, p<0.01). IL1RN*2 was significantly frequent in patients with membranous GN or minimal change disease (p<0.05). When we classified glomerulonephritis according to clinical diagnosis, IL1RN*2 carriage rate was higher in patients with nephrotic syndrome and RPGN or acute nephritic syndrome than patients with asymptomatic urinary abnormalities (p<0.05). IL-1beta(TT) genotype was more prevalent in acute glomerulonephritis (68.4%) than asymptomatic urinary abnormalities or other glomerulonephritis. TNF2 carriage rate showed a lower tendency in patients with asymptomatic urinary abnormalities. CONCLUSION: IL1RN*2 is significantly associated with an increased risk of development of primary glomerulonephritis. We suggest cytokine gene polymorphism is also related to clinical manifestations of glumerulonephritis.