Role of PPI and importance of anti-reflux agents in the treatment of NERD

Background: Esomeprazole, an S-isomer of omeprazole, is a much more potent acid inhibitor than most other currently available PPIs and gives excellent results. Therefore, it is a first-line drug for acid-related diseases like NonErosive Reflux Disease (NERD). Yet, patients demand faster onset and response. Aim : To establish the role of esomeprazole and the importance of anti-reflux agents like a combination of two antacids (calcium carbonate and sodium bicarbonate) and alginate in treating NERD. Conclusion: Esomeprazole therapy shows potential efficacy in the continuous maintenance treatment of the NERD. However, it is suggested that to improve the efficiency of esomeprazole for the treatment of NERD; we can supplement the drug with antacids (sodium bicarbonate and calcium carbonate) and alginates.

Henoch Schonlein purpura and antacids / 中国小儿急救医学

Henoch Schonlein purpura(HSP), also known as immunoglobulin A vasculitis, is the most common vasculitis in children, which involves skin, gastrointestinal tract, joints and kidney.Glucocorticoid is the conventional treatment for HSP patients with digestive system symptoms.Antacids, including H 2-receptor antagonists and proton pump inhibitors, are often used in combination with glucocorticoids in order to avoid the adverse reactions of glucocorticoids therapy.Antacids may play a role in the treatment of HSP patients by alleviating gastrointestinal symptoms, adjuvant treatment of secondary acute pancreatitis, inhibiting Helicobacter pylori and reducing the adverse reactions of glucocorticoids.However, there are few studies and more exploration is needed.

Perspectiva histórica do tratamento clínico da doença do refluxo gastroesofágico / Historical perspective of gastroesophageal reflux disease clinical treatment

ABSTRACT BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal diseases. GERD generates significant impairment in patients' quality of life and it is associated to relevant medical resources utilization. A better understanding of GERD pathophysiology in the past five decades has favored the evolution of therapeutic strategies from non-drug interventions and antacids to more efficacious and safer alternatives. OBJECTIVE: To summarize data about the historical evolution of GERD management in Brazil, focusing on medical therapy and addressing evidence on efficacy and safety of drug classes currently recommended. METHODS: A narrative review was conducted by systematizing information about discoveries on GERD pathophysiology. We also addressed efficacy and safety of medications currently used to reduce symptoms and improve endoscopic healing of esophageal lesions. A structured search on Pubmed was performed to identify systematic reviews and meta-analysis investigating GERD outcomes positively impacted by proton pump inhibitors (PPIs), the first choice of pharmacotherapy for the disease. RESULTS: The chronological development of therapeutic measures for GERD in Brazil evolved from lifestyle interventions with relative poor effect on symptoms related to esophageal acid exposure, particularly heartburn, to effective and safe pharmacological interventions such as histamine H2-receptor antagonists and PPIs. In the present days, some drug classes play a minor role in disease management, namely prokinetics and antacids, due to their reduced efficacy and relevant safety concerns (particularly with prokinetics). The main challenge for prescribers and researchers seems to be finding long-acting acid suppressants strategies able to ameliorate patients' symptoms and quality of life, thereafter, reducing medical resource consumption. The dual delayed-release PPI dexlansoprazole seems to respond for some of the limitations other PPIs have. CONCLUSION: Recognizing the historical evolution of GERD management can help care providers to better understand therapeutic options for their patients, as well as focus on unmet needs that deserve further attention. PPIs are still the first choice therapy, with good evidence in favor of their efficacy, despite some safety concerns. However, as with any medical intervention, it is recommended to prescribe PPIs for patients with clear indication, using adequate dosing and monitoring for adverse events.

RESUMO CONTEXTO: A doença do refluxo gastroesofágico (DRGE) é uma das doenças gastrointestinais mais prevalentes, resultando em limitações significativas na qualidade de vida dos pacientes e, também, relevante utilização de recursos médicos. Um melhor entendimento da fisiopatologia da doença nas últimas cinco décadas tem favorecido a evolução das estratégias de tratamento, desde intervenções não farmacológicas e antiácidos, a alternativas mais eficazes e seguras. OBJETIVO: Resumir os dados sobre a evolução histórica do manejo da DRGE no Brasil, focando na terapia medicamentosa e abordando evidências sobre a eficácia e segurança de classes medicamentosas atualmente recomendadas. MÉTODOS: Uma revisão narrativa foi conduzida para sistematizar informações sobre descobertas na fisiopatologia da DRGE e, também, sobre a eficácia e segurança de medicamentos utilizados atualmente para reduzir os sintomas e melhorar a cicatrização endoscópica de lesões esofágicas. Uma busca estruturada na base de dados Pubmed foi realizada para identificar revisões sistemáticas e metanálises que investigassem desfechos da doença impactados positivamente pelos inibidores da bomba de prótons (IBPs), a primeira escolha farmacológica para a doença. RESULTADOS: O desenvolvimento cronológico das medidas terapêuticas para a DRGE no Brasil evoluiu de modificações no estilo de vida que demonstraram relativamente pouco efeito sobre os sintomas relacionados à exposição esofágico ao ácido, particularmente a azia, a intervenções farmacológicas eficazes e seguras como os anti-histamínicos H2 e os IBPs. Atualmente, algumas classes de medicamentos exercem um papel menor no manejo da doença, procinéticos e antiácidos por exemplo, devido à sua eficácia reduzida e a preocupações relevantes quanto a segurança (particularmente com os procinéticos). O principal desafio para os prescritores e pesquisadores parece ser encontrar estratégias supressoras de ácidos de longa duração capazes de melhorar os sintomas e a qualidade de vida dos pacientes, reduzindo assim o consumo de recursos médicos. O dexlansoprazol, um IBP de liberação retardada dupla, parece responder a algumas limitações que outros IBPs têm. CONCLUSÃO: O reconhecimento da evolução histórica do manejo da DRGE pode auxiliar aos profissionais assistentes a melhor entender as opções terapêuticas para seus pacientes, assim como focar em necessidades não atendidas que necessitem de maior atenção. IBPs ainda são a terapia de escolha inicial, com boas evidências a favor de sua eficácia, apesar algumas questões acerca da segurança de seu uso. No entanto, assim como para qualquer intervenção medicamentosa, é recomendada a prescrição dos IBPs para pacientes com indicação clara, utilizando doses adequadas e monitorando a ocorrência de eventos adversos.

Manejo del paciente portador de sangrado digestivo alto en el servicio de urgencias / Upper digestive bleeding patient management in the emergency department

Introducción: el sangrado digestivo alto constituye uno de los síndromes más frecuentes en servicios de urgencias. La endoscopia oral y los medicamentos antiácidos y protectores de la mucosa gástrica, hacen menos frecuente el empleo de intervenciones quirúrgicas en el manejo del paciente con sangrado digestivo alto. La necesidad del tratamiento quirúrgico no siempre puede obviarse. Objetivo: describir las características clínicas de los pacientes con sangrado digestivo alto atendidos en el Hospital Militar Dr. Joaquín Castillo Duany. Métodos: estudio descriptivo transversal. Universo constituido por 92 pacientes con diagnóstico de sangrado digestivo alto. Variables caracterizadas: edad, sexo, tratamiento médico empleado, técnica quirúrgica utilizada, complicaciones posquirúrgicas y estadía hospitalaria. Resultados: el sangrado digestivo alto fue más frecuente en hombres, con más de 40 años de edad, se les aplicó tratamiento médico, la modalidad más frecuente fue la combinación de antiácidos. Se realizó tratamiento endoscópico al 3,2 por ciento de los pacientes, fueron intervenidos quirúrgicamente el 5,4 por ciento. La mitad de los operados padecía úlcera péptica gástrica. La técnica quirúrgica más empleada fue la gastrostomía y gastrorrafia. La estadía hospitalaria fue menor de 5 días. Conclusiones: se evidenció predominio del sangrado digestivo alto en el sexo masculino y en mayores de 40 años. El tratamiento endoscópico y las intervenciones quirúrgicas representaron un bajo porcentaje. La estadía hospitalaria fue más prolongada en pacientes con complicaciones. Los hallazgos en los que más difieren otras investigaciones radican en el incremento del empleo de la endoscopia oral, en combinación con el uso de antisecretores y en las variantes de técnicas quirúrgicas empleadas(AU)

Introduction: upper Digestive Bleeding is one of the most frequent syndromes in emergency services. Oral endoscopy, antacid and protective gastric mucosal medications make the use of surgical interventions less common in the management of upper digestive bleeding patients. However, the need for surgical treatment cannot always be overlooked. Objective: to describe the clinical characteristics of patients with upper digestive bleeding treated at the Military Hospital Dr. Joaquín Castillo Duany. Methods: cross-sectional descriptive study. A universe of 92 patients with a diagnosis of upper digestive bleeding. Variables characterized: Age, sex, medical treatment, surgical technique used, postoperative complications, and hospital stay. Results: upper digestive bleeding was more frequent in men and in patients over 40 years old. In patients in whom medical treatment was applied, the most frequent modality was the combination of anti-H2 antihistamines and proton pump inhibitors. Endoscopic treatment was performed in 3.2 percent of patients, and 5.4 pèrcent was operated on. Half of the patients underwent gastric peptic ulcer, and the most commonly used surgical technique was gastrostomy. The predominant hospital stay was less than 5 days(AU)

Influence of intensified acid suppression scheme on operation-related clinical parameters, re-bleeding rate and laboratory indexes of elderly patients with ANVUGIB underwent endoscopic hemostasis / 中国内镜杂志

Objective To investigate the influence of intensified acid suppression scheme on operation-related clinical parameters, re-bleeding rate and laboratory indexes of elderly patients with ANVUGIB underwent endoscopic hemostasis. Methods 150 elderly patients with ANVUGIB underwent endoscopic hemostasis were chosen from June 2015 to June 2017 and randomly divided into control group (75 patients) with conventional dose of pantoprazole and observation group (75 patients) with intensified dose of pantoprazole; and the clinical efficacy, the disappeared time of spitting blood and melena, hemostasis time, total blood transfusion volume, hospitalization time, re-bleeding rate, conversion to open surgery rate, the levels of laboratory index in 24 h and 72 h after treatment and adverse reaction incidence of both groups were compared. Results The clinical total effects of observation group were significantly higher than that in control group (P < 0.05). The disappeared time of spitting blood and melena, hemostasis time,total blood transfusion volume, hospitalization time of observation group were significantly better than that in control group (P < 0.05). The re-bleeding rate and conversion to open surgery rate of observation group were significantly lower than that in control group (P < 0.05). The levels of laboratory index in 24 h and 72 h after treatment of observation group were significantly better than that in control group (P < 0.05). There was no significant difference in the adverse reaction incidence between the two groups (P > 0.05). Conclusion Intensified acid suppression scheme in the treatment of elderly patients with ANVUGIB undergoing endoscopic hemostasis can efficiently achieve hemostasis in early stage, relieve symptoms and signs, decrease the blood loss amount in perioperative period, reduce the conversion to open operation risk and be helpful to improve the levels of PCV and BUN.

Application and Evaluation of Antacids and Acid Inhibitors in Acid-Related Disorders / 胃肠病学

Acid-related disorders are commonly seen diseases of upper digestive tract which are closely related to acid attack.Antacids and acid inhibitors are the main drugs in the therapy of acid-related disorders.There are complex interrelationships between antacids and acid inhibitors and other drugs.This article reviewed the application and evaluation of antacids and acid inhibitors in acid-related disorders.

Pathogenesis of portal hypertensive gastropathy in cirrhotic patients and the application of antacids in treatment / 临床肝胆病杂志

Portal hypertensive gastropathy (PHG) has a high incidence rate in cirrhotic patients,leading to a high risk of upper gastrointestinal bleeding.Gastric mucosal injury is the major pathological change of PHG.There are few studies focusing on the clinical application of antacids in the treatment of PHG in cirrhotic patients and there are still controversies over this issue.This article reviews the influencing factors for PHG,the mechanism of gastric mucosal injury,and the application of antacids.It is pointed out that during the treatment of PHG,besides the reduction in portal venous pressure,the application of antacids such as proton pump inhibitors can improve the cure rate of PHG.Prospective randomized control trials with a large sample size are needed to further demonstrate the clinical effect and safety of antacids in the treatment of PHG in cirrhotic patients.

Evaluación de la prescripción de medicamentos en consultas de Gastroenterología / Evaluation of drug prescription in Gastroenterology outpatient departments

Se realizó un estudio descriptivo y transversal, de tipo farmacoepidemiológico, de 426 pacientes atendidos en las consultas de Gastroenterología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" y del Policlínico Docente "Ramón López Peña" de Santiago de Cuba, de mayo del 2011 a igual mes del 2012, quienes consumían medicamentos bajo indicación facultativa (o se automedicaban), con vistas a evaluar dichas prescripciones. En la serie, el grupo farmacológico más prescrito fue el de los antiácidos, con un mayor consumo del Alusil® y el Silogel®, y entre las prescripciones inadecuadas predominaron las asociaciones medicamentosas para la cimetidina y la metoclopramida, así como la incorrecta individualización al recetar el Alusil®; de igual manera, la polimedicación resultó el factor más relacionado con la prescripción inadecuada.

A descriptive and cross-sectional study of pharmacoepidemiological type of 426 patients assisted in the Gastroenterology Department from "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital and in "Ramón López Peña" Teaching Polyclinic in Santiago de Cuba was carried out from May, 2011 to same month of 2012, who consumed drugs prescribed by doctors (or they self-medicated), with the aim of evaluating these prescriptions. In the series, the most prescribed pharmacological group was that of antacids, with a higher consumption of Alusil® and Silogel®, and among the inadequate prescriptions the medicamentous associations for cimetidina and metoclopramida, as well as the incorrect individualization when prescribing Alusil® prevailed; likewise, polymedication was the most related factor with inadequate prescription.

Effects of sucralfate and acid-suppressive drugs on preventing ventilator-associated pneumonia of mechanically ventilated patients: a meta-analysis / 中华内科杂志

Objective To evaluate the effect of sucralfate and acid-suppressive drugs on preventing ventilator-associated pneumonia (VAP) in mechanically ventilated patients.Methods All randomized controlled trials (RCTs),which studied the effect of sucralfate and acid-suppressive drugs on the incidence of VAP in mechanically ventilated patients,were searched from PubMed,Embase and the Cochrane Library during January 1966 to March 2013 via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.2 and the quality of the RCTs was strictly evaluated with the methods recommended by the Cochrane Collaboration.Results A total of 15 RCTs involving 1315 patients in the sucralfate group and 1568 patients in the acid-suppressive drug group were included in this study.The incidence of VAP was significantly reduced in the sucralfate group (RR =0.81,95％ CI 0.7-0.95,P =0.008),while no difference was found between the two groups in the incidence of stress-related gastrointestinal bleeding (RR =0.96,95％ CI 0.59-1.58,P =0.88).No statistical difference was found in the days on ventilator,duration of ICU stay and ICU mortality in the two groups (all P values ＞ 0.05).Conclusion In patients with mechanical ventilation,sucralfate could decrease the incidence of VAP,while has no such effect on the stress-related gastrointestinal bleeding,the days on ventilator,duration of ICU stay and ICU mortality.

Evaluation of cost effectiveness and efficacy of commonly used different antacid gel preparations.

Background: Gastroesophageal reflux disease (GERD) is a common clinical condition in Indian population. Antacids, which are available as over the counter (OTC) are the commonly prescribed drugs for treatment of GERD. Antacids manufactured and marketed by various multinational and local companies are available in the market. There is need for evaluating the cost effectiveness and efficacy of these antacids as a matter of public concern. Hence the present study was conducted to evaluate the cost effectiveness and efficacy of the commonly prescribed antacid gel preparations. Methods: Seven different gel formulations of antacids manufactured by different companies were evaluated. Cost effectiveness was done by calculating the cost per ml of antacid and also by palatability test. Efficacy was evaluated based on acid neutralizing capacity (ANC) of antacid preparations. Results: The highest cost was 0.305 Rs. per ml and lowest was 0.135 Rs per ml. Palatability score was high at 26.80 and low at 23.85. The antacid with lowest ANC was 20.5 mEq and the highest was 26.5 mEq. Conclusion: Cost effectiveness studies are beneficial in improving the prescribing pattern. It will be a benefit for both doctor as well as patient.

Clinical Characteristics of Gastroesophageal Reflux Disease with Esophageal Injury in Korean: Focusing on Risk Factors / 대한소화기학회지

BACKGROUND/AIMS: Recent studies suggest that the prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea. However, studies on risk factors for GERD have yielded inconsistent results. The aims of this study were to compare clinical features between symptomatic syndromes without esophageal injury (=non-erosive disease [NED]) and syndromes with esophageal injury (=erosive disease [ED]), and to determine risk factors associated ED. METHODS: A total of 450 subjects who visited gastroenterology clinics of six training hospitals in Daegu from March 2008 to April 2010 were consecutively enrolled. The subjects were asked to complete a questionnaire which inquired about gastroesophageal reflux symptoms. The questionnaire also included questions about smoking, alcohol drinking, consumption of coffee, use of drugs, exercise, and other medical history. The subjects were subdivided into NED and ED groups. RESULTS: The proportion of subjects in each NED and ED group was 172 (38.2%) and 278 (61.8%). Male gender, smoking, alcohol drinking, consumption of coffee, large waist circumference, infrequent medication of antacids, aspirin and NSAIDs, infrequent and mild GERD symptoms were all significantly associated with ED on univariate analysis. Age, hiatal hernia, diabetes mellitus, body mass index, change in weight during 1 year, and number of typical GERD symptoms were not independent risk factors for ED. However, the association between ED and alcohol drinking, infrequent medication of antacids, mild typical GERD symptoms remained as strong risk factors after adjustments on multivariate logistic analysis. CONCLUSIONS: Independent risk factors associated with ED were alcohol drinking, infrequent medication of antacids and mild typical GERD symptoms.

Long-term therapeutic results in patients with perforated gastroduodenal ulcer operated on by simple closure and pharmacal management / 中国基层医药

Objective To investigate the long-term follow up results of patients with gastroduodenal ulcer perforation managed by simple suture and pharmacal management.Methods 74 patients with perforated gastroduodenal ulcer operated with simple closure and pharmacal management in hospital from February 1990 to May 2005 were observed,after operation the patients underwent follow-up.According to follow-up data,the long-term therapeutic results of these patients were determined.Results The rate of symptomatic ulcer recurrence(Visick Ⅲ-Ⅳ)was14.9%(26.9% in patients with gastric ulcer and 8.3% in duodenal ulcer)in 74 patients with perforated gastroduo denal ulcer operated on with simple closure and pharmacal management after operation.Both of them showed significant difference(Fisher' s Exact Test:P = 0.043).The incidence of long-term complications was 10.8% and there was no statistical difference between the patients with gastric ulcer and those with duodenal ulcer(Fisher's Exact Test:P =0.440).56 patients were surveyed by endoscopy or upper gastrointestinal series within 6 months after operation.The rate of cure was 91.1% ,significant difference was not observed between the patients with gastric ulcer and those with duodenal ulcer(Fisher' s Exact Test:P = 0.336).But after a year ulcer recurrence rate of total 46 patients was 10.9% and the gastric ulcer recurrence rate significantly higher than that of duodenal ulcer(Fisher's Exact Test;P = 0.047).Conclusion Long-term effect of patients with perforated gastroduodenal ulcer operated by simple closure and pharmacal management was satisfactory.But the former was less effective than the latter.

Avaliação da resposta de pacientes asmáticos com refluxo gastroesofágico após terapia com pantoprazol: estudo prospectivo, randomizado, duplo cego e placebo-controlado / Evaluation of pantoprazol treatment response of patients with asthma and gastroesophageal reflux: a randomized prospective double-blind placebo-controlled study

OBJETIVOS: Determinar o efeito do tratamento da DRGE no controle clinico e funcional respiratório em indivíduos asmáticos e avaliar as características clinicas deste grupo de pacientes. MÉTODOS: Pacientes com asma portadores de DRGE patológico documentado por pHmetria de 24 h foram avaliados por meio de questionários sobre sintomas respiratórios, digestivos, de qualidade de vida além de manometria esofágica, espirometria e pico de fluxo expiratório antes e após o estudo. Quarenta e nove indivíduos que apresentavam DRGE patológico na pHmetria esofágica de 24 h foram selecionados e participaram de ensaio clínico terapêutico com pantoprazol (40 mg/dia) controlado com placebo, randomizado, duplo-cego, paralelo por 12 semanas consecutivas. RESULTADOS: Quarenta e quatro indivíduos completaram o estudo (n = 22 cada grupo). Houve melhora significativa no escore de sintomas respiratórios e na qualidade de vida somente no grupo que utilizou pantoprazol (p = 0,01 e p = 0,001, respectivamente). Os parâmetros funcionais respiratórios não se modificaram com os diferentes tratamentos. CONCLUSÕES: Neste estudo, o tratamento efetivo do RGE melhorou a qualidade de vida, determinou diminuição dos sintomas em asma de maneira significativa no grupo que utilizou medicamento, contudo sem alterar os parâmetros funcionais.

OBJECTIVES: To determine the effect that the treatment of GERD has on the clinical management, as well as the respiratory function, of patients with asthma and to evaluate the clinical characteristics of this group of patients. METHODS: Patients with asthma and concomitant GERD, documented using 24 h pH-metry, were evaluated by means of quality of life questionnaires, as well as questionnaires related to respiratory and digestive symptoms. In addition, esophageal manometry, spirometry and the determination of peak expiratory flow were also performed prior to and after the study. Forty-nine individuals who were diagnosed with GERD by means of 24 h esophageal pH-metry were selected and participated in a clinical randomized double-blind placebo-controlled study, involving the administration of 40 mg/day of pantoprazol for 12 consecutive weeks. RESULTS: Forty-four individuals completed the study (n = 22 per group). There was significant improvement in the scores for respiratory symptoms and quality of life only in the group that received pantoprazol (p = 0.01 and p = 0.001, respectively). No respiratory function parameters changed in either group. CONCLUSIONS: In this study, the effective treatment of GERD improved patient quality of life, and the symptoms of asthma significantly decreased in the group that received the medication. There were no changes in pulmonary function parameters.

Effects of a single low dose of ranitidine and effervescent antacids on intragastric acidity in healthy volunteers / Efectos de bajas dosis de ranitidina y antiácidos efervescentes sobre la acidez intragástrica en voluntarios sanos

Introduction/aims: We hypothesized that a combination of an effervescent antacid and ranitidine could allow immediate and long-lasting increase intragastric acidity. Our aim was to determine the effect of the combined intake of both, of a low dose ranitidine (OTC) and 5g of antacid on gastric pH. Material and methods: Twenty healthy Helicobacter pylori negative volunteers were enrolled. The study consisted in a fasting 6-hour gastric ph-metric procedure performed in two different periods: baseline (1-hour before drug) and post-drug (5-hours) after oral administration of a single dose of ranitidine (75 mg) plus 5 g of a commercial composed alkaline (sodium bicarbonate, citric acid, sodium carbonate). Results: While two subjects did not complete the pH-metry analysis due to technical reasons, 18 volunteers were finally assessed. Baseline intragastric pH (1.3±0.1) (mean±SD) rose significantly after administration of the drug (mean pH value for the whole period: 5.1±0.3; p<0.00001). The pH increased after administration of the study combination and values higher than pH 3 and pH 4 were reached immediately (median time: 27 sec, range: 0- 189 and 54 sec, range 27-3,600 sec, respectively). Gastric pH was initially maintained above 4 for 23.0±5 minutes. The mean time lapsed with pH<4 during the post-drug period was 96±17 min (32% of the total time). Conclusion: Our study confirms the fast and persistent effect produced by the administration of a combination of antacid salts plus low dose of ranitidine. We suggest that the given combination could be effeceffective, fast and safe for sporadic pyrosis or mild grastroesophageal reflux symptoms.

Introducción/objetivos: la combinación de un antiácido efervescente y ranitidina podría brindar un descenso inmediato y prolongado de la acidez intragástrica. Nuestro objetivo fue determinar el efecto de la ingesta conjunta de ambos (75 mg de ranitidina y 5 g de antiácidos) sobre el pH gástrico. Material y métodos: se incluyeron 20 voluntarios sanos, con anticuerpos anti- Helicobacter pylori negativos. Se realizó, en condiciones de ayuno, una pH-metría gástrica de 6 horas en dos períodos: basal (1 hora antes del medicamento) y post-droga (5 horas) luego de la administración oral de una dosis única de ranitidina (75 mg) + 5 g de antiácidos efervescentes (bicarbonato sódico, ácido cítrico, carbonato sódico). Resultados: dado que dos pacientes no completaron el estudio de pH por razones técnicas, se analizaron los resultados de 18 voluntarios. El pH intragástrico basal fue de 1.33±0.12 (promedio ± DS) y se elevó a 5.1±0.3 como promedio de todo el período post-droga (p<0.00001). El incremento de pH fue inmediato; así los valores de pH=3 y pH=4 fueron alcanzados en 27 seg, rango: 0-189 y 54 seg, rango 27- 3.600, respectivamente (mediana, rango). El pH se mantuvo inicialmente por encima de 4 durante 23.0±5 minutos. El tiempo con pH < 4 durante las 5 horas post-droga fue de 96± 17 minutos (32% del tiempo total). Conclusión: nuestro estudio confirma el efecto rápido y persistente determinado por la combinación de sales antiácidas y bajas dosis de ranitidina. De este modo esta asociación podría ser efectiva, rápida y segura frente a pirosis esporádica o síntomas de reflujo gastro-esofágico leve.

Two Cases of Gastric Mucosal Calcinosis / 대한소화기내시경학회지

Gastric mucosal calcinosis (GMC) is a very rare condition that is characterized by the nodular deposition of calcium salts in the gastric mucosa. It has been associated with renal failure, gastric cancer, ingestion of aluminum- containing antacids and the use of sucralfate in organ transplant patients. The etiology of this condition is uncertain, but several theories have been proposed; the condition is due secondarily to hyperparathyroidism in renal failure and to the alkalinization of the gastric mucosa. We report here on two patients who had long-term use of bismuth and/or aluminum-containing antacids to treat their gastro-esophageal reflux symptoms. The esophagogastroduodenoscopy revealed acute gastritis patterns, and GMC was confirmed histologically with biopsy. When one patient stopped ingesting bismuth-containing antacid solution, the follow-up esophagogastroduodenoscopy and the biopsy revealed a completely improved state. We report here on these interesting cases and we include a brief review of the literature.

A case of antacid-associated osteomalacia / 대한내과학회지

Chronic heavy use of phosphate-binding antacids has been known to cause osteomalacia. However, in spite of widespread use of antacids without prescription, there was no case report of osteomalacia associated with antacids in Korea. We report a case of osteomalacia diagnosed in a 36-year-old woman who had ingested large amounts of aluminum-containing antacids due to epigastric soreness. She had consumed about 4.2 kg of aluminum hydroxide over 10 years until she had withdrawn antacids 3 months before she was admitted with non-traumatic fractures of bilateral femur necks. Biochemical tests revealed normal levels of serum calcium and iPTH, increased level of serum alkaline phosphatase, and normal renal function. Bone mineral density (BMD) values of lumbar spines were decreased (T-score=-3.99~-3.11). Bone biopsy showed abundant unmineralized osteoid indicating osteomalacia. She was treated with bilateral total hip replacement arthroplasty and recommended not to restart the ingestion of antacids. After thirty months' withdrawal of antacids, BMD values of lumbar spines were found to be improved (T-score=-2.3~-1.4).

El ácido gástrico / Gastric acid

El ácido gástrico, producto de la secreción de las células gástricas parietales u oxínticas, cumple roles biológicos imprescindibles para la homeostasis corporal. La producción del ácido gástrico depende de un proceso celular efector constituido por histamina, acetilcolina y gastrina en el primer nivel, constituyendo primeros mensajeros de dicho proceso. Estos interaccionan con receptores específicos, lo que a su vez activa segundos mensajeros representados por AMPc y el sistema calciocalmodulín. Estos luego activan en cascada sucesiva a una proteinokinasa que fosforila una proteína específica, activándola, lo que inicia la síntesis de ácido. Una bomba de protones situada en el polo luminal de la célula parietal, extruye finalmente el ácido sintetizado hacia el lumen gástrico. El proceso secretor descrito es puesto en movimiento, secuencialmente en tres fases, dos de ellas estimuladoras -fase cefálica y fase gástrica- y una inhibidora o fase intestinal. Estas etapas son iniciadas por fenómenos sico-neurales -pensamiento, visión, olfación o recuerdo-; por alimentos y otras sustancias ingeridas; y por productos de la digestión de nutrientes. Alteraciones en la regulación de la secreción ácida; en la constitución de la barrera mucosa gastroduodenal, protectora frente a la acción potencialmente lesiva de alimentos y fármacos o drogas; y potenciación de su acción por la presencia de H. pylori, constituyen la base etiopatogénica de la enfermedad ácido-péptica, entidad nosográfica donde juega un rol fundamental. Desde el punto de vista terapéutico, tanto dentro del marco teórico como del práctico, se puede interferir con la secreción ácida neutralizando alguno de los pasos de su proceso celular efector. Un adecuado conocimiento de los aspectos básicos relacionados con la problemática del ácido gástrico, permite plantear estrategias para el manejo de la patología asociada con él, en forma particular en lo concerniente a la enfermedad ácido-péptica en todas...

Gastric acid, a product of parietal cells secretion, fullfills multiple biological roles which are absolutely necessary to keep corporal homeostasis. The production of the acid depends upon an effector cellular process represented in the first step by histamine, acetilcholine and gastrin, first messengers of the process. These interact with specific receptors than in sequence activate second messengers -cAMP and the calcium-calmodulin system- which afterwards activate a kinase. An specific protein is then phosphorilated by this enzyme, being the crucial factor that starts the production of acid. Finally, a proton bomb, extrudes the acid towards the gastric lumen. The secretion process mentioned above, is progressively activated in three steps, two of which are stimulators -cephalic and gastric phases- and the other one inhibitor or intestinal phase. These stages are started by mental and neurological phenomena -thought, sight, smell or memory-; by food, drugs or other ingested substances; and by products of digestion. Changes in regulation of acid secretion, in the structure of gastro-duodenal mucosal barrier by a wide spectrum of factors and agents including food, drugs and H. pylori, are the basis of acid-peptic disease, entity in which gastric acid plays a fundamental role. From the therapeutic point of view, so at the theoretical as at the practical levels, ¡t is possible to interfere with the secretion of acid by neutralization of some of the steps of the effector cellular process. An adequate knowledge of the basics related to gastric acid, allows to create strategies for the clinical handling of associated pathology, specifically in relation to peptic acid disease in all of the known clinical forms.