Study on the Effects of Xiaoruzeng Capsule on the Gastric Acid and Pepsase in Rats / 中国药房

OBJECTIVE:To study the effects of Xiaoruzeng capsule on the gastric acid and pepsin in rats. METHODS:Rats were randomized into a blank group (distilled water),a positive control group (3.6 mg/kg omeprazole ) and the groups of low, middle and high doses of Xiaoruzeng capsule [2.25,4.5,9.1 g(crude drug)/kg]. These groups were respectively marked as groups A,B,C,D and E,with 10 rats in each group. All the rats were given corresponding drugs,ig,for consecutive 10 d. Their suc-cus gastricus was collected 3 h after the last administration,and determined for pH value with precision pH test strip and for free acidity and total acidity by acid-base neutralization titration method. The content and activity of pepsin were determined and calculat-ed with the test kit and microplate reader. The pathological change of the stomach was observed under the electron microscope. RE-SULTS:Compared with group A,groups B,C and D had higher pH value of succus gastricus;groups C,D and E had lower free acidity;groups B,C and D had lower total acidity,group E had higher total acidity;groups B,D and E had lower activity of pep-sin;and group C had higher content of pepsin. Compared with group B,group D had lower pH value of succus gastricus;group C had lower total acidity;group E had higher acidity;and groups C,D and E had higher activity of pepsin. There was statistical sig-nificance(P<0.01 or P<0.05). Gastric mucosal erosive haemorrhage was noted in three rats in group E,and other groups demon-strated no obvious pathological change. CONCLUSIONS:Low dose of Xiaoruzeng capsule can slightly inhibit the gastric acid in rats,but will not effect the activity of pepsin.

Impact of prolonged 48-h wireless capsule esophageal pH monitoring on diagnosis of gastroesophageal reflux disease and evaluation of the relationship between symptoms and reflux episodes / Impacto da monitorização prolongada do refluxo por pHmetria sem cateter por 48 horas, no diagnóstico da doença do refluxo gastroesofágico e no estudo da relação entre os sintomas e o refluxo

CONTEXT: Gastroesophageal reflux disease is one of the most common digestive diseases and an important cause of distress to patients. Diagnosis of this condition can require ambulatory pH monitoring. OBJECTIVES: To determine the diagnostic yield of a wireless ambulatory pH monitoring system of 48-hours, recording to diagnose daily variability of abnormal esophageal acid exposure and its symptom association. METHODS: A total of 100 consecutive patients with persistent reflux symptoms underwent wireless pH capsule placement from 2004 to 2009. The wireless pH capsule was deployed 5 cm proximal to the squamocolumnar junction after lower esophageal sphincter was manometrically determined. The pH recordings over 48-h were obtained after uploading data to a computer from the receiver that recorded pH signals from the wireless pH capsule. The following parameters were analyzed: (1) percentual time of distal esophageal acid exposure; (2) symptom association probability related to acid reflux. The results between the first and the second day were compared, and the diagnostic yield reached when the second day monitoring was included. RESULTS: Successful pH data over 48-h was obtained in 95 percent of patients. Nearly one quarter of patients experienced symptoms ranging from a foreign body sensation to chest pain. Forty-eight hours pH data analysis was statistically significant when compared to isolated analysis of day 1 and day 2. Study on day 2 identified seven patients (30.4 percent) that would be missed if only day 1 was analyzed. Three patients (18.7 percent) out of 16 patients with normal esophageal acid exposure on both days, showed positive symptom association probability, which generated an increase in diagnostic yield of 43.4 percent. CONCLUSION: Esophageal pH monitoring with wireless capsule is safe, well tolerated, does not require sedation. The extended 48-h period of study poses an increased yield to diagnose gastroesophageal reflux disease patients.

CONTEXTO: A doença do refluxo gastroesofágico é uma das doenças digestivas mais comuns e importante causa de desconforto para os pacientes. O diagnóstico desta condição clínica pode requerer monitoramento ambulatorial do pH esofágico. OBJETIVOS: Determinar o espectro diagnóstico do sistema de monitoramento ambulatorial do pH esofágico com cápsula telemétrica por um período de 48 horas no diagnóstico da variabilidade diária da exposição ácida anormal e sua associação com sintomas. MÉTODOS: Foram incluídos 100 pacientes adultos, consecutivos, com sintomas relacionados com a doença do refluxo gastroesofágico, que realizaram pHmetria com cápsula telemétrica por 48 horas entre 2004 e 2009. A cápsula foi posicionada e implantada a 5 cm da borda superior do esfíncter esofágico inferior, definida pela manometria esofágica. Foram analisados os seguintes parâmetros: (1) tempos percentuais de exposição ácida no esôfago distal; (2) probabilidade de associação dos sintomas com o refluxo ácido. Foram comparados os resultados entre o 1º e o 2º dia de monitoramento, assim como o eventual ganho diagnóstico obtido após a inclusão do 2º dia no monitoramento. RESULTADOS: Sucesso na obtenção dos dados do pH esofágico durante 48 horas foi obtido em 95 por cento dos pacientes. Aproximadamente 25 por cento dos pacientes apresentaram sintomas relacionados à implantação da cápsula, variando entre sensação de presença de corpo estranho à dor torácica. A análise dos resultados do estudo de 48 horas mostrou-se estatisticamente significante quando comparada com as análises isoladas do dia 1 e do dia 2. O estudo do dia 2 identificou sete pacientes (30.4 por cento) que teriam sido perdidos se somente o dia 1 fosse analisado. Três pacientes (18.7 por cento) dos 16 pacientes com exposição ácida normal no esôfago distal em ambos os dias, apresentaram probabilidade de associação com o sintoma positivo, que gerou incremento no ganho diagnóstico com este método diagnóstico de 43.4 por cento. CONCLUSÕES: O monitoramento do pH esofágico com a cápsula telemétrica é seguro, bem tolerado e não requer sedação. A extensão do período de estudo para 48 horas representa significativo aumento no ganho diagnóstico em pacientes com doença do refluxo gastroesofágico.

Influencia da ranitidina e pantoprazol no pH gastrico em pacientes septicos / Ranitidine is unable to maintain gastric pH level above 4 in septic patients

Objetivo: Avaliar a capacidade da ranitidina e do pantoprazol em elevar e manter o pH gástrico = 4 em pacientes sépticos. Material e métodos: Foram estudados 20 pacientes internados na UTI, com diagnóstico de sepse/choque séptico, em ventilação mecânica. Dez receberam ranitidina (50 mg em bolo 8/8 horas) e outros 10 pacientes receberam pantoprazol 40 mg, em bolo de 12/12 horas. O pH gástrico foi medido de forma contínua por 48 horas. Foi realizada endoscopia digestiva alta antes e após o estudo e encaminhado para análise um fragmento obtido por biópsia e pesquisa de Helicobacter pylori. Resultados: O grupo ranitidina permaneceu por 46,27 ± 38,21 % e o grupo do pantoprazol 81,57 ± 19,65% do tempo estudado com pH gástrico = 4 (p=0,04). No subgrupo de ranitidina sem atrofia gástrica o pH esteve = 4 em 15,97 % e em cinco casos com atrofia em 79,44% do tempo estudado. No subgrupo do pantoprazol que realizou biópsia, quatro pacientes não apresentavam atrofia gástrica e o tempo de pH =4 foi de 81,17%. Em um paciente com atrofia da mucosa gástrica, o pH gástrico se manteve =4 durante todo o período do estudo. Conclusões: A ranitidina intravenosa, usada para profilaxia de úlcera de estresse, não foi capaz de manter o pH gástrico acima de quatro em pacientes sépticos. Todos os casos do grupo ranitidina, onde o pH foi mantido acima de quatro, apresentavam hipotrofia ou atrofia gástrica. O pantoprazol manteve o pH acima que quatro por período maior de tempo durante o estudo.

Purpose: To evaluate whether ranitidine and pantoprazole are able to maintain gastric pH = 4 in septic patients. Material and methods: Twenty intensive care unit (ICU) patients from a University teaching hospital, with sepsis. Ten patients received ranitidine (50 mg as an intermittent bolus t.i.d.) and ten received pantoprazole (40 mg as an intermittent bolus b.i.d.). Gastric pH was measured continuously for 48 hours. Endoscopy of the upper digestive tract, gastric biopsy and investigation for Helicobacter pylori were carried out prior to and at the end of the study. Results: pH values = 4 were maintained for 46.27 ± 38.21 % and 81.57 ± 19.65% of observation time in the ranitidine and pantoprazole groups, respectively (p=0.04). In the subgroup of ranitidine without atrophy gastric pH was = 4 at 15.97% and in five cases with atrophy in 79.44% of the time studied observation time. In the subgroup of pantoprazole who underwent biopsy, four patients did not have mucosal atrophy and gastric pH was = 4 for 81.17% of the time. In one patient with mucosal atrophy, gastric pH remained = 4 for the entire study period. Conclusions: Intravenous ranitidine was unable to maintain gastric pH above 4 in septic patients. All cases in the ranitidine group in whom pH remained above 4 were found to have mucosal gastric hypotrophy or atrophy. Pantoprazole successfully maintained pH above 4.

Clinical predictors of abnormal esophageal pH monitoring in preterm infants / Preditores clínicos para pHmetria esofágica anormal em prematuros

BACKGROUND: Risk factors for gastroesophageal reflux disease in preterm neonates have not been yet clearly defined. AIM: To identify factors associated with increased esophageal acid exposition in preterm infants during the stay in the neonatal unit. METHODS: A case-control study in preterm infants who had undergone prolonged monitoring of distal esophageal pH, following clinical indication. Eighty-seven preterms with reflux index (percentage of total time of esophageal pHmetry) >10 percent (cases) and 87 unpaired preterms were selected with reflux index <10 percent (controls). Demographic variables, signs and symptoms, main diagnoses and some aspects of treatment were studied. Simple and multiple logistic regression analysis adjusted for birthweight and postconceptional age at the pH study were used. RESULTS: The factors associated with a greater chance of reflux index >10 percent in preterms were: vomiting, regurgitation, Apnea, female gender. The variables that were associated with a lower frequency of increased reflux index were: volume of enteral intake at the onset of symptoms >147 mL/kg/day, and postnatal corticoid use. CONCLUSIONS: Vomiting, regurgitation, apnea, female gender and acute respiratory distress during the first week of life were variables predictive of increased esophageal acid exposition in preterm infants with birthweight <2000 g. Bronchopulmonary dysplasia and use of caffeine were not associated with reflux index >10 percent.

RACIONAL: Os fatores de risco para a doença pelo refluxo gastroesofágico em recém-nascidos prematuros não foram, até momento, claramente estabelecidos. OBJETIVO: Identificar fatores associados ao aumento da exposição ácida intra-esofágica em prematuros durante o período de internação em unidade neonatal. MÉTODOS: Realizou-se estudo de caso controle com prematuros que realizaram monitorização prolongada do pH esofágico por suspeita clínica de doença do refluxo. Foram selecionados 87 recém-nascidos com valor do índice de refluxo (percentual do tempo total do exame com pH abaixo de 4) >10 por cento (casos) e 87 recém-nascidos com índice de refluxo <10 por cento (controles). Casos e controles não foram emparelhados. As variáveis estudadas foram as demográficas, os sinais e sintomas clínicos, os principais diagnósticos e alguns aspectos da terapêutica. Foram utilizadas as análises de regressão logística uni e multivariada, ambas ajustadas pelo peso ao nascimento e pela idade pós-conceptual no momento do estudo de pH. RESULTADOS: Os fatores que se associaram a maior chance de índice de refluxo >10 por cento foram: vômitos, regurgitações, apnéia, sexo feminino e insuficiência respiratória na 1ª semana de vida. As variáveis que se associaram a menor freqüência de índice de refluxo <10 por cento foram: volume de mamada ao início dos sintomas >147mL/kg/d e uso de corticóide pós-natal. CONCLUSÕES: Vômitos, regurgitações, apnéia, sexo feminino e a insuficiência respiratória na primeira semana de vida foram variáveis preditoras para elevada exposição ácida do esôfago em prematuros com peso ao nascer <2000 g. A displasia broncopulmonar e o uso de cafeína não se associaram ao índice de refluxo >10 por cento.

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.

Influence of alveolar ventilation changes on gastric intramucosal pH in neurosurgical patients / 中华麻醉学杂志

Objective To assess the influence of changes in alveolar ventilation on gastro-intestinal perfusion measured via a nasogastric tonometer.Methods Sixteen ASA Ⅰ - Ⅱ patients ( 7 male, 9 female) aged 15-67 yr, undergoing elective intracranial operation were included in this study. The patients were premedicated with oral ranitidine 150 mg and intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Anesthesia was induced with midazolam 1-2 mg, fentanyl 2 ?g? kg-1 , propofol 1.5-2.0 mg ? kg-1 and vecuronium 0.1 mg ? kg-1 , and maintained with 0.5%-2.0% isoflurane inhalation and intermittent iv boluses of fentanyl and vecuronium. The patients were intubated and mechanically ventilated after induction of anesthesia. The ventilatory settings were : RR 10 bpm; FGF 1 L? min-1; I: E = 1:2; the initial VT was 7 ml? kg-1 (T1 ) which was gradually increased to 8 ml ?kg-1(T2), 9ml?kg-1(T3) and 10 ml?kg-1 (T4) and then returned to 7 ml ? kg-1 again. Each VT was maintained for 1 h. A nasogastric tonometer (Tonocap, Datex-Ohmeda, Finland) was inserted into stomach and automatically measured gastric intramucosal CO2 tension (PgCO2) every 10 min. Radial artery was cannulated for direct MAP monitoring and blood sampling. Blood gas analysis was performed every hour at various VT levels. Gastric-to-arterial pH gap and gastric-to-arterial PCO2 gap [P(g-a)CO2] were calculated.Results PgCO2 decreased during T2_4 (hyperventilation phase) (P