Omeprazole and adenocarcinoma in the stomach of rats submitted to duodenogastric reflux. Is there a protective effect?

Abstract Purpose: To investigate the role of omeprazole and nitrites on the gastric mucosa of rats submitted to specific techniques to induce duodenogastric reflux. Methods: One hundred and twenty Wistar rats were divided into three groups: Group I (n=40) -gastrotomy; Group II (n=40) - duodenogastric reflux after gastrojejunoanastomosis latero-lateral (DGR); Group III (n=40) - retrograde duodenogastric reflux through the pylorus (DGR-P). The groups were divided into 4 subgroups of 10 animals, respectively treated for 16 weeks with water, omeprazole 1.6 mg / rat / day, nitrite 600 mg / kg / day and omeprazole plus nitrite simultaneously. Results: The proliferative lesions found were: squamous hyperplasia - 69.1%, adenomatous hyperplasia in the anastomosis - 29.1% and prepyloric adenomatous hyperplasia - 42.5%. Adenocarcinomas were registered in 7 animals (5.8%): one in Group I (omeprazole plus nitrite), two in Group II (omeprazole and nitrite plus omeprazole) and four in Group III (water, nitrite, omeprazole and omeprazole plus nitrite). Conclusions: The occurrence of squamous hyperplasia, adenomatous hyperplasia and adenocarcinoma increased after gastrojejunal anastomoses, which cause duodenogastric reflux. The association of omeprazole did not protect the development of proliferative lesions and cancer induced by duodenogastric reflux in rats.

Effects of ischemia and omeprazole preconditioning on functional recovery of isolated rat heart / Efeitos da isquemia e pré-condicionamento com omeprazol na recuperação funcional do coração isolado de rato

Abstract Objective: The aim of this study was to compare protective effects of ischemic and potential protective effects of pharmacological preconditioning with omeprazole on isolated rat heart subjected to ischemia/reperfusion. Methods: The hearts of male Wistar albino rats were excised and perfused on a Langendorff apparatus. In control group (CG) after stabilization period, hearts were subjected to global ischemia (perfusion was totally stopped) for 20 minutes and 30 minutes of reperfusion. Hearts of group II (IPC) were submitted to ischemic preconditioning lasting 5 minutes before 20 minutes of ischemia and 30 minutes of reperfusion. In third group (OPC) hearts first underwent preconditioning lasting 5 minutes with 100μM omeprazole, and then submitted 20 minutes of ischemia and 30 minutes of reperfusion. Results: Administration of omeprazole before ischemia induction had protective effect on myocardium function recovery especially regarding to values of systolic left ventricular pressure and dp/dt max. Also our findings are that values of coronary flow did not change between OPC and IPC groups in last point of reperfusion. Conclusion: Based on our results it seems that ischemic preconditioning could be used as first window of protection after ischemic injury especially because all investigated parameters showed continuous trend of recovery of myocardial function. On the other hand, preconditioning with omeprazole induced sudden trend of recovery with positive myocardium protection, although less effective than results obtained with ischemic preconditioning not withstand, we must consider that omeprazole may be used in many clinical circumstances where direct coronary clamping for ischemic preconditioning is not possible. .

Resumo Objetivo: O objetivo deste estudo foi comparar os efeitos protetores de efeitos protetores isquêmicos e potenciais de précondicionamento farmacológico com omeprazol no coração isolado de rato submetido à isquemia/reperfusão. Métodos: Os corações de ratos albinos Wistar machos foram excisados e perfundidos em um aparelho de Langendorff. No grupo controle (grupo I), após o período de estabilização, os corações foram submetidos à isquemia global (a perfusão foi totalmente interrompida) por 20 minutos e 30 minutos de reperfusão. Corações do grupo II (IPC) foram submetidos a précondicionamento isquêmico com duração de 5 minutos antes de 20 minutos de isquemia e 30 minutos de reperfusão. No terceiro grupo (OPC), corações foram submetidos a pré-condicionamento com duração de 5 minutos com 100 μM de omeprazol, e, então, submetidos a 20 minutos de isquemia e 30 minutos de reperfusão. Resultados: A administração de omeprazol antes da indução da isquemia teve efeito protetor sobre a recuperação funcional do miocárdio especialmente em relação aos valores de pressão sistólica ventricular esquerda e dp/dt max. Também os nossos achados são de que os valores de fluxo coronário não se alteraram entre os grupos OPC e IPC no último ponto de reperfusão. Conclusão: Com base nos nossos resultados, o pré-condicionamento isquêmico poderia ser usado como primeira janela de proteção após a lesão isquêmica, especialmente porque todos os parâmetros analisados apresentam tendência contínua de recuperação da função do miocárdio. Por outro lado, o pré-condicionamento induzido com omeprazol apresenta tendência repentina de recuperação com proteção miocárdio positiva, embora menos efetiva da obtida com o pré-condicionamento isquêmico. Devemos considerar que o omeprazol pode ser usado em muitas circunstâncias clínicas em que o pinçamento coronariano direto para pré-condicionamento isquêmico não é possível. .

Effect evaluation of the feeding, and administration of omeprazole pelletsorally on gastric juice pH in adult horses / Evaluación del efecto de la alimentación y de la administración deomeprazol en pellets vía oral sobre el pH del jugo gástrico en equinosadultos / Avaliação do efeito da alimentação, e administração de omeprazole pelletspor via oral no pH do suco gástrico em cabalhos adultos

The aim of this study was to determine the omeprazol treatment effect on equine gastric fluid pH with food andwithout food administering for the duration of the experiment. To carry this project out, 7 animals were chosenbetween the ages of 3 and 10 (2 males and 5 females) from the Centro de Veterinaria y Zootecnia - CES. In thecontrolled treatment they received 200 ml of physiological saline and were treated using omeprazol pellets whichwere administered in a single dose of 4 mg/kg via a nasogastric insertion, and in two groups with or without foodduring the treatment. Gastric pHs were measured at 0 hour (fasting before treatment) and then at hours 3, 5, 7, 9,11 and 24 after treatment. In animals consuming food, both treatments showed post treatment gastric pH increases,which can be explained by the ad libitumn food management in both treatments, which may increasing post prandialpH. In fasting animals, we observed that in the controlled treatment the pH was maintained at very low levels atall measurement times, while in the omeprazol treatment the pH increased significantly. These results show thattreatment with omeprazol pellets at a dose of 4 mg/kg via nasogastric insertion increased gastric pH in healthyanimals that are not eating food and that this effect was similar to them being administered food.

El objetivo de este estudio fue determinar el efecto del tratamiento con omeprazol sobre el pH del fluido gástrico en equinos, con la administración del alimento y sin ella. Para llevar a cabo este proyecto se eligieron siete animalesentre los 3 y 10 años de edad (2 machos y 5 hembras) del Centro de Veterinaria y Zootecnia – CES. El tratamientocon omeprazol se administró en pellets a una dosis única de 4 mg/kg, por vía nasogástrica, para los grupos cono sin alimento. Para el tratamiento control, se administraron 200 ml de solución salina fisiológica. En todos lostratamientos se midieron los pHs gástricos a la hora 0 (ayunas antes del tratamiento) y luego a las horas 3, 5, 7, 9, 11 y 24, postratamiento. Los animales que consumieron alimento con y sin omeprazol presentaron aumentos de pHgástrico postratamiento, lo que se puede explicar por el sumistro de heno ad libitum en ambos tratamientos. En losanimales en ayuno se observó que en el tratamiento control, el pH se mantuvo en niveles muy bajos en todas las horasde medición, mientras que en el tratamiento con omeprazol, el pH aumentó notablemente. Los resultados muestran que el tratamiento con pellets de omeprazol a una dosis de 4 mg/kg vía nasogástrica aumentó el pH gástrico en animales sanos que no están consumiendo alimento y que este efecto fue similar que cuando se administró el mismo.

A resistência é o mecanismo pelo qual a bactéria pode diminuir a ação dos agentes antimicrobianos de formanatural ou adquirida; dentro das causas mais frequentes está a utilização indiscriminada destes agentes em pacienteshumanos e produções pecuárias. Desde 1990 tem identificado novas cepas resistentes de bactérias que originaramdoenças zoonóticas emergentes. Dentro destas a zoonose, a salmonelose é considerada a doença mais difundida anível mundial, a ampla distribuição na natureza entre animais silvestres, domésticos e o meio ambiente, produz umarápida propagação de seus mais de 2500 sorotipos no homem. Contudo, a grande preocupação pela infecção com esteinteiro patógeno é devido aos cada vez mais elevados fracassos nos tratamentos com antimicrobianos convencionais,ocasionados pela alta resistência bacteriana a estes fármacos. O presente artigo é uma revisão sobre a problemáticaque gerou a resistência de Salmonella no homem e os animais, contem também estratégias de prevenção e controledeste fenômeno, que está distante de terminar e permitem o fortalecimento da saúde pública.

Apical acidity decreases inhibitory effect of omeprazole on Mg2+ absorption and claudin-7 and -12 expression in Caco-2 monolayers

Clinical studies reported hypomagnesaemia in long-term omeprazole usage that was probably due to intestinal Mg2+ wasting. Our previous report demonstrated the inhibitory effect of omeprazole on passive Mg2+ transport across Caco-2 monolayers. The present study aimed to identify the underlying mechanism of omeprazole suppression of passive Mg2+ absorption. By using Caco-2 monolayers, we demonstrated a potent inhibitory effect of omeprazole on passive Mg2+, but not Ca2+, transport across Caco-2 monolayers. Omeprazole shifted the %maximum passive Mg2+ transport-Mg2+ concentration curves to the right, and increased the half maximal effective concentration of those dose-response curves, indicating a lower Mg2+ affinity of the paracellular channel. By continually monitoring the apical pH, we showed that omeprazole suppressed apical acid accumulation. Neomycin and spermine had no effect on passive Mg2+ transport of either control or omeprazole treated monolayers, indicating that omeprazole suppressed passive Mg2+ transport in a calcium sensing receptor (CaSR)-independent manner. The results of western blot analysis showed that omeprazole significantly suppressed claudin (Cldn)-7 and -12, but not Cldn-2, expression in Caco-2 cells. By using apical solution of pH 5.5, 6.0, 6.5, and 7.0, we found that apical acidity markedly increased passive Mg2+ transport, Mg2+ affinity of the paracellular channel, and Cldn-7 and -12 expression in Caco-2 monolayers. Apical acidity abolished the inhibitory effect of omeprazole on passive Mg2+ transport and Cldn-7 and -12 expression. Our results provided the evidence for the regulation of intestinal passive Mg2+ absorption by luminal acidity-induced increase in Cldn-7 and -12 expression.

Proteção da recuperação funcional do miocárdio pelo omeprazol após isquemia-reperfusão em corações isolados de ratos / Myocardium functional recovery protection by omeprazole after ischemia-reperfusion in isolated rat hearts

OBJETIVO: Analisar efeitos do omeprazol na proteção da recuperação funcional de corações isolados de ratos submetidos à lesão de isquemia-reperfusão. MÉTODOS: Foram estudados 12 ratos Wistar, peso corpóreo médio de 280g. Após anestesia com injeção intra-abdominal de 10mg de cetamina e 2mg de xilazina, os corações foram removidos e mantidos em perfusão com solução Krebs-Henseleit (95 por centoO2 e 5 por cento CO2, 37ºC, 110-120mmHg de pressão de perfusão e pressão diastólica de 8 mmHg) em sistema Langendorff, modificado, descartável, modelo FCSFA-ServCor (Comex Ltda.). Os seis corações do Grupo I (GI) e os seis do Grupo II (GII) foram submetidos a 20 minutos de isquemia e 30 minutos de reperfusão. Nos corações do Grupo II, imediatamente antes da isquemia, foram administrados via perfusão coronária 200mcg de omeprazol. Foram controlados frequência cardíaca (FC), fluxo coronário (FCo), pressão sistólica (PS), +dP/dt e -dP/dt, após estabilização (t0) e no final da reperfusão (t30). Empregou-se método não paramétrico de Kruskal-Wallis (P<0,05) para análise estatística dos dados. RESULTADOS: Não ocorreram diferenças (P>0,05) entre os valores de FCo e FC nos dois grupos. No final do período de reperfusão (t30), foram significantes (P<0,05) as variações da PS reduzida para 28,0±3,6 por cento do valor inicial (t0) no Grupo I e para 79.0±5,9 por cento no Grupo II; a +dP/dtmax declinou para 31,0±5,6 por cento no GI, mantendo-se em 99,4±11,2 por cento (P<0,05) no GII e a -dP/dtmax declinou para 26,0±7,3 por cento no GI, mantendo-se em 82,0±2, 2 por cento no GII (P<0,05). CONCLUSÃO: A administração do omeprazol antes da indução da isquemia coronária protegeu significantemente a recuperação funcional do miocárdio.

OBJECTIVE: To evaluate the myocardium contractility alterations of isolated hearts of rats, submitted to ischemia and reperfusion with and without administration of the omeprazole. METHODS: Twelve Wistar breed rats with 270g mean body weight was studied. After anesthesia by intraperitoneal injection of ketamine 10mg and xylazine 2mg, their hearts were removed and perfused with Krebs-Henseleit solution (95 percent of O2 and 5 percent of CO2, 37ºC, 110-120 mmHg perfusion pressure, 8 mmHg ventricular diastolic pressure) in the São Francisco de Assis disposable Langendorff system model Comex Ltda, MG. The six hearts of Group I (GI) and of the Group II (GII) were submitted to 20 min ischemia and 30 min reperfusion. In GII hearts, intracoronary injection of omeprazole 200 mcg was done immediately before the ischemia period induction. The following parameters were registered after the stabilization period (t0), and after the reperfusion period (t30): heart rate (HR), coronary flow (CoF), systolic pressure (SP), +dP/dt and -dP/dt. The Kruskal-Wallis test (P<0.05) was applied to statistical analysis. RESULTS: There were no significant differences (P>0.05) between groups among HR and CoF values. Differences (P<0.05) occurred between groups, I e II after the reperfusion period (t30) regarding systolic pressure reduced for 28.0±3.6 percent in the control group GI and for 79.0±5.9 percent in GII; The +dP/dtmax declined to be only 31.0±5.6 percent in GI, preserving 99.4±11.2 percent values in GII (P<0.05). The t30 -dP/dtmax values were GI 26.0±7.3 percent and GII 82.0±2.2 percent (P<0.05). CONCLUSION: The omeprazole administration before ischemia induction significantly protected the myocardium function recovery.

Effects of saffron and its active constituents, crocin and safranal, on prevention of indomethacin induced gastric ulcers in diabetic and nondiabetic rats

Saffron is the dried stigmata of the flowers of saffron [Crocus sativus L., Iridaceae]. Saffron is well known for the treatment of gastric disorders in traditional medicine. In the search for new potential antiulcer agents, the effects of the ethanol extract of saffron and its active constituents crocin and safranal as compared with omeprazole against gastric ulcer induced by indomethacin in non-diabetic and streptozocin diabetic rats were studied. The effects of pretreatment with saffron extract [25, 100 or 250 mg/kg, p.o.], crocin [2.5, 5 or 10 mg/kg, p.o.] and safranal [0.25, 2, 5 ml/kg, p.o.] and omeprazole [30 mg/kg, p.o.] 30 min before administration of indomethacin [40 mg/kg, p.o. in non-diabetic rats and 15 mg/kg, p.o. in diabetic rats] on gastric lesions, increase of lipid peroxidation and decrease of glutathione levels induced by indomethacin in non-diabetic and diabetic rats were evaluated. Saffron extract, crocin, safranal and omeprazol prevented the gastric lesions, increase of lipid peroxidation and decrease of glutathione levels induced by indomethacin in non-diabetic and diabetic rats as compared with the control group [P < 0.01]. The effects of saffron extract, crocin and safranal on the gastric ulcer index, lipid peroxidation and glutathione levels were comparable to omeprazole. Saffron, crocin and safranal may prevent the gastric mucosa damage due to their antioxidant properties by increasing the gluthatione levels and diminishing the lipid peroxidation in the rat gastric mucosa

El uso de inhibidores de bomba de protones y el hábito de fumar no modifican la tasa de sobrecrecimiento bacteriano intestinal en pacientes con patología digestiva funcional / Small intestinal bacterial overgrowth is not influenced by proton pump inhibitors and smoking habit in patient with funtional gastrointestinal disorders

Background: Drug induced inhibition of acid secretion has been associated to small intestinal bacterial overgrowth (SIBO). Smoking is followed by an increase of exhaled and orocecal transit time (OCTT). Aim: To investigate if the use of proton pump inhibitiors (PPI) and smoking can modifie the incidence of SIBO in patients with functional gastrointestinal disease. Patients and Methods: Questionnaires performed before a study for SIBO in patients with functional gastrointestinal disorders were analyzed. The use PPI and the smoking habit were recorded. The presence of SIBO and the OCTT was determined by means of the lactulose hydrogen breath test. Results: 437 patients, mean age 45 years (range: 14-93), 337 (77 percent) female, entered in the study SIBO was present in 356 patients, and 81 patients had normal H2 breath test. Both groups had a similar distribution of gender and age. The percentage of SIBO was no different in patients using PPI or presenting smoking habit Conclusions: Use of PPI and smoking habit are not risk factors for the development of SIBO in patients with functional disorders.

Los fármacos que inhiben la secreción gástrica favorecen el sobrecrecimiento bacteriano intestinal (SBI), mientras que el habito de fumar puede aumentar los niveles de H2 espirado y el tiempo de transito orocecal (TTOC). Objetivo: Investigar si el uso de inhibidores de la bomba de protones (IBP) y el habito de fumar modifican la incidencia de SBI en pacientes con trastornos digestivos funcionales. Pacientes y Métodos: Se analizaron encuestas de pacientes con patología digestiva funcional previas a un estudio de SBI Se consignaron el uso de IBP Y el hábito tabáquico en los 6 meses que precedieron al examen. La presencia de SBI y el tiempo de transito orocecal (TTOC) se determinaron con el test de hidrógeno en aire espirado con lactulosa. Resultados: 437 pacientes, con edad x 45 años (rango: 14-93),337 (77 por ciento) mujeres. Con SBI 356 pacientes, sin SBI 81 pacientes. Ambos grupos fueron comparables en cuanto a distribución por sexo y edad. El porcentaje de pacientes con SBI no fue diferente en pacientes con antecedente de uso de IBP o con hábito tabaquito. Conclusiones: El antecedente del uso de IBP y el tabaquismo no constituyen un factor de riesgo para SBI en pacientes con patología digestiva funcional.

Hernia hiatal gigante: reporte de un caso / Giant hiatal hernia: a case report

La hernia de hiato es una situación patológica que se da cuando parte del estómago se introduce hacia el tórax. El esófago entra en el abdomen desde el tórax a través de un agujero o hiato que se encuentra en el diafragma. El estómago protruye a través de este hiato debilitado y produce ardores (pirosis) y dolor torácico. La persistencia en el tiempo de esta hernia, puede provocar una metaplasia de la mucosa esofágica dando al lugar al esófago de Barret el cual puede malignizar produciéndose cáncer de esófago. (1) La hernia de hiato es relativamente frecuente, afectando hasta un 20 por ciento de la población. Del total de pacientes con el trastorno, cerca del 10 por ciento son asintomáticos, dependiendo del grado de protrución estomacal y de que tanto esté afectado el esfinter esofágico inferior (EEI). Un 40 por ciento de las hernias de hiato son hernias deslizantes, en las que el EEI protruye conjuntamente con una porción del estómago y solo un 5 por ciento son paraesofágicas, en la que solo una porción del estómago se hace intratorácica mientras tanto que el EEI permanece intraabdominal. Los síntomas más comunes de una hernia de hiato incluyen pirosis, dolor torácico, disfagia, palpitaciones y ocasionalmente regurgitación o reflujo gastroesofágico. El diagnóstico de una hernia hiatal comienza con el éxamen físico por razón de la sintomatología. Los estudios radiográficos y la endoscopia digestiva demuestran la hernia hiatal y ayudan a descartar otras causas de molestias digestivas altas. (2) Se recomienda un procedimiento quirúrgico conocida como fundoplicación de Nissen, (3) Cuando los síntomas causados por una hernia de hiato son tan severas que pueden resultar en lesiones al esófago o incluso cáncer del esófago. (6) Se trata de lactante mayor de seis meses de edad quien es natural de la localidad y procedente de Cordero, quien inicia enfermedad actual el día de hoy en la madrugada según refiere la madre, caracterizado por vómitos en número incontables.

Promotion of cutaneous wound healing by famotidine in Wistar rats.

BACKGROUND & OBJECTIVE: Drugs like famotidine, omeprazole and sucralfate which have been reported to promote the healing of gastric ulcers, may have the same effect on cutaneous wounds. Due to paucity of information in this regard, the present study was planned to investigate the effect of these drugs on resutured incision, excision and dead space wounds in Wistar rats. METHODS:Resutured incision, excision and dead space wounds were inflicted under light ether anaesthesia aseptically. Control animals received vehicle and other groups received famotidine, omeprazole and sucralfate orally for a period of 10 days in the incision and dead space wounds, whereas in excision wounds till complete closure. On the 11th day after estimating breaking strength of the resutured incision wounds, animals were sacrificed and granulation tissue removed from dead space wounds to estimate the breaking strength and hydroxyproline content. Quantification of granulation tissue and histological studies were also carried out. Wound closure rate, epithelization time and scar features were studied in the excision wound models from the day of famotidine till complete closure of the wound. RESULTS: Only famotidine significantly promoted the healing process in all the three wound models studied. Histopathological studies revealed increased collagen content and granulation tissue in famotidine treated group compared to control. INTERPRETATION & CONCLUSION: In all the three wound models studied famotidine promoted wound healing whereas omeprazole and sucralfate did not do so. The pro healing effect of famotidine needs to be explored clinically.

[ effect of omeprazole on the number and size of after-endoscopic band ligation ulcers of esophageal varices]

Endoscopic variceal ligation [EVL] is an effective option in treatment of esophageal varices bleeding or elective ablation. Although the after-EVL ulceration is well recognised, the effect of acid suppression on ulcer healing is not determined, definitely. In this study, we tried to evaluate the efficacy of Omeprazole as the most available protone pomp inhibitor [PPI] on the numbers and size of after-EVL esophageal ulcers in patients electively underwent this procedure. We performed a randomised placebo-controled trial of Omeprazol after elective EVL. Fifty consecutive cirrhotic patients who were cadidated for EVL randomly enrolleded in and were divided equally into case [25] and control [25] groups. After endoscopy and EVL, case subjects received Omeprazole [20 mg twice a day] for 2 weeks and control subjects received placebo for the same period as well. All the patients underwent a follow up endoscopy 13-15 days after EVL. Forty two patients [20 cases and 22 controls] completed the study. Numbers and size of ulcers were evaluated throughin the follow up endoscopy. Numbers of ulcers were significantly higher in control group [3.15 vs. 2.59, p=0.03]. The ulcers in Omeprazole group were on average half as large as in the placebo group [37.08 mm[2] vs.73.74 mm[2], p<0.0001]. After elective EVL, Omeprazol-treated Patients experienced a significant reduction in number and size of their post-banding ulcers. It seems that Omeprazole reduces the numbers and size of after-EVL ulcers

[Evaluation of co-administration of omperazole with H[2] blockers and antacids]

Omperazole as a very useful drug in peptic ulcer which needs to be converted to active form and its activation requires acidic environments. H[2] blockers and antacids can prevent this activation by elevation of pH in the gastrointestinal system thus diminishing omperazole effectiveness. In this study, cases of coadministration of omperazsole with H[2] blockers and antiacids has been evaluated. This descriptive study included 1200 prescriptions containing omperazole alone or in combination with other drugs at the Chamran Pharmaceutical Store of Yazd. In 599 cases, omeprazole was administered with other drugs of which 211 cases [35.3%] was with H[2] blockers and l 16 prescriptions with antiacids. Only in 55 cases [4.6%], both antiacids and H[2] blockers were administered in combination with omperazole. On the basis of previous studies and considering the physiology of acid secretion in parietal cells and pharmacological mechanism of drugs used in the treatment of peptic ulcer, coadministration of antacids and H[2] blockers with omperazole decrease its efficacy and must therefore be avoided

Profilaxis del sangrado de tubo digestivo en el paciente crítico UIC HALF enero-diciembre 2005 serie de casos / Prevention of the one bled of alimentary canal in the critical patient UIC HALF January-December 2005 series of cases

El estudio tuvo como propóstio determinar el fármaco más utilizado y poder identificar si existen o no diferencias entre los pacientes y permitir pautas a investigaciones posteriores con el fin de evaluar la eficacia de ambas drogas. Se realizó un estudio descriptivo a través de revisión de casos, con un total de 82 pacientes, se revisaron los expedientes clínicos para el llenado de una ficha previamente elaborada. El sexo predominante fue el masculino en un 67 porciento y el grupo etáreo predominante fue de 47-57 años. Las principales patologías o factores de riesgo ingresados en UCI del hospital fueron: sepsis, cirugia mayor, ventilación mecanica politrauma. Los fármacos utilizados para profilaxis de sangrado digestivo fueron ranitidina y omeprazol. El 20.7 porciento de los pacientes presentaron sangrado y correspondió a aquellos que se les administró ranitidina. A ningún paciente se le realizó diagnóstico por endoscopia. Los hallazgos encontrados no difieren de lo reportado de la literatura referente a factores de riesgo y aunque no se trate de un estudio analítico se demuestra que los inhibidores de bomba tiene un mejor efecto protector de la mucosa gástrica que los bloqueadores H2, por lo que se recomienda realizar estudios posteriores que evaluén la eficacia de los fármacos ranitidina e inhibdores de bomba, mientras tanto en los pocientes críticos con uno o múltiples factores de riesgo utilizar inhibidores de bomba como profilaxis...

Estudo comparativo do pH e do volume salivar em indivíduos com laringofaringite crônica por doença do refluxo gastroesofágica antes e após o tratamento / Comparative study of salivary pH and volume in adults with chronic laryngopharyngitis by gastroesophageal reflux disease before and after treatment

INTRODUÇÃO: A Doença do Refluxo Gastroesofágico (DRGE) é a doença digestiva mais prevalente da atualidade e, recentemente, tem sido implicada em uma gama de alterações do seguimento laringofaríngeo (RLF). No entanto, pouco se sabe dos mecanismos fisiopatológicos destas manifestações supraesofágicas da DRGE. Os achados clínicos contraditórios e recentes pesquisas sugerem haver deficiências na capacidade de defesa deste seguimento. Uma das principais responsáveis pela homeostase da mucosa oral e do trato digestivo é a saliva com seu conteúdo orgânico e inorgânico. Tanto alterações do pH quanto do volume salivar já foram correlacionados com os sintomas e sinais sugestivos da DRGE e RLF. Estudo recente de nossa autoria demonstra diminuição estatisticamente significante do pH salivar de indivíduos com RLF quando comparado a controles sem a doença. Outro estudo constatou correlação entre a redução do volume X pH da saliva em indivíduos com DRGE, estando esta redução diretamente relacionada aos níveis de pH esofágico constatados durante pH-metria esofágica de 24 horas. OBJETIVOS: Avaliar como se comportam o pH e volume da saliva em um mesmo indivíduo com DRGE e RLF antes e após o tratamento clínico. MATERIAL E MÉTODO: Vinte e três pacientes com RLF tiveram o pH e volume da saliva total testados antes e após receberem tratamento com droga bloqueadora de bomba de prótons durante 12 semanas. RESULTADOS: Houve uma diferença estatisticamente significante (p<0,001) entre o pH da saliva antes e após o tratamento, estando este maior após o controle clínico da doença. O volume de saliva no paciente tratado foi significativamente maior do que no paciente pré-tratamento (p=0.009). DISCUSSÃO: Os achados sugerem que o pH salivar é influenciado pela presença de refluxo gastroduodenal à região laringofaríngea. Caso estudos futuros com populações maiores realmente comprovem esta correlação, poderemos cogitar a possibilidade de usar a mensuração do pH salivar, que é feita de forma rápida e não invasiva, como um meio de diagnosticar e avaliar o comportamento e controle do Refluxo Laringofaríngeo.

INTRODUCTION: Gastroesophageal Reflux Disease (GERD) is the most prevalent digestive disease of the modern society and has been associated with abnormalities in the larynx and pharynx (LPR). Nonetheless, little is known about the mechanisms involved in this atypical form of the disease. Contradictory clinical data suggest a defense deficit at this segment. Saliva with its organic and inorganic components is responsible for the homeostasis of the oral mucosa and the digestive tract. Salivary pH and volume abnormalities have been linked to laryngopharyngeal symptoms of GERD and LPR. In a recent study we demonstrated significant salivary pH reduction in patients with LPR. Another study found correlation between reduced salivary pH and volume directly related to esophageal pH-metry results. AIM: To evaluate salivary pH and volume before and after clinical treatment of LPR. MATERIAL AND METHOD: Twenty-three adults with LPR had total fasting saliva tested before and after a 12-week course of oral proton pump inhibitor. RESULTS: A statistically significant difference was found in salivary pH before and after treatment with increase of pH values after control of the disease (p<0.001). Salivary volumes of treated patients were also significantly higher than in pre-treated patients (p=0.009). DISCUSSION: These findings suggest that salivary pH and volume are influenced by the presence of gastroesophageal contents and that salivary pH monitoring can potentially become a cost-effective method for diagnosing and controlling LPR.

Aspectos atuais da abordagem da esofagite de refluxo complicada em crianças e adolescentes / Management of severe reflux esophagitis in children: current aspects

A esofagite é uma das principais complicações da doença do refluxo gastroesofágico (DRGE) em crianças e adolescentes e, quanto maior sua gravidade, maior a dificuldade de tratamento. O relaxamento transitório e inadequado do esfíncter esofágico infe- rior é o principal mecanismo etiopatogênico da DRGE e a presença de ácido é fator essencial para a ocorrência das lesões esofágicas. O surgimento dos inibidores de bomba de prótons (IBP) revolucionou o tratamento das doenças cloridopépticas e a supressão farmacológica da secreção ácida gástrica com estas drogas passou a ser a terapêutica de escolha para a esofagite de refluxo. Os achados endoscópicos de erosões e/ou ulcerações na mucosa esofágica caracterizam esofagite de refluxo complicada, cujo tratamento torna-se mais complexo, em virtude da dificulda- de de cicatrização das lesões, maior risco de complicações, pequena resposta ao uso dos antagonistas dos receptores H2 da histamina e necessidade de manutenção a longo prazo para evitar recidiva da doença. Embora o omeprazol seja usado há mais de 15 anos na população pediátrica, ainda há escassez de dados na literatura quanto ao manejo ideal da esofagite péptica complicada e quanto à dose efetiva desta droga para uso nestes pacientes. Estudos pediátricos, até o momento, mostram ampla varia- ção da dose do omeprazol e sugerem monitoração mais precisa do tratamento clínico da esofagite de refluxo infantil, principal- mente através da pHmetria esofágica de 24 horas. A cirurgia anti- refluxo apresenta altas taxas de morbidade e insucesso após o procedimento e deve ser reservada somente para os casos refra- tários ao tratamento clínico otimizado.

Esophagitis is the main complication of gastroesophageal reflux disease (GERO) in children and the treatment is very difficult. Transient relaxations of lower esophageal sphincter are the princi- pal ethyopathogenic mechanism of GERO, with acid as one of the factors that takes to esophageal erosions. The blockage of gastric acid secretion by proton pump inhibitors (PPI) revolutionized the treatment of peptic esophagitis and becomes the therapy of choice. Endoscopic features of esophageal erosions and ulcerations characterize severe reflux esophagitis and the management may be more oriented because of severe grades of esophageal lesions, poor outcome, no response to H2-receptor antagonists and prolonged use of PPI. Oespite of omeprazole use for more than 15 years in pediatric population, there are few data about the ideal management for severe reflux esophagitis and about the effective omeprazole dosage in children. Pediatric studies show wide variation of the omeprazole dosage and recommend optimized medical therapy, including continuous esophageal pH monitoring. Antireflux surgery is attended by a high morbidity and failure rate and remain the treatment of choice only for refractory cases.

Toxoplasmose congênita: orientação prática sobre prevenção e tratamento / Congenital toxoplasmosis: treatment and prevention guideline

A toxoplasmose, parasitose prevalente em todo o mundo, quando adquirida durante a gestação pode ser transmitida ao feto e causar, dentre outros problemas, atraso no desenvolvimento neuropsicomotor, estrabismo, déficit visual e perdas auditivas. A prevenção da transmissão vertical deve ser iniciada antes da con- cepção ou o mais precocemente possível durante o pré-natal. A identificação de gestantes susceptíveis (soronegativas) deve ser acompanhada de orientações escritas e verbais sobre as formas de aquisição da infecção (profilaxia primária) e, se bem realizada, tem se mostrado eficaz. As mulheres com contato prévio com o parasito, antes da gestação, se imunocompetentes, apresentam muito baixo risco de infectar o concepto. Mas, as gestantes agudamente infectadas devem ser identificadas precocemente para instituição de terapêutica adequada (profilaxia secundária) com o objetivo de evitar a infecção ou diminuir as suas conseqüências para o feto. Considerando-se que a infecção adquirida, assim como a congênita, são geralmente assintomáticas, devemos utilizar a triagem sorológica da mãe e, posteriormente da criança suspeita, para diagnosticar e tratar esses casos. Os autores se pro- põem a apresentar uma orientação prática para abordagem do binômio mãe/filho suspeitos de toxoplasmose, com base nos conhecimentos disponíveis no momento e de acordo com o protocolo utilizado no Serviço de Doenças Infecciosas e Parasitárias, setor de Infectologia Pediátrica, do Hospital das Clínicas da Universidade Federal de Minas Gerais.

The toxoplasmosis, a prevalent parasitosis throughout the world, when acquired during pregnancy can be transmítted to the fetus and cause, among other problems, delay in the neuropsychomotor development, strabismus and visual and hearing impairment. The vertical transmission prevention must be initiated before conception or as early as possible in the prenatal assessment. The identification of susceptible pregnant woman (nega tive blood test) must be accompanied by written and verbal orientation about how the disease can be acquired (primary prophylaxis) and, if well per- formed, has showed good efficacy. Women with previous contact with the parasite, before pregnancy, if imunecompetents, show a very low risk of infecting the child. But, the pregnant women acutely infected must be identified early for the implementation of adequa te therapeutics (secondary prophylaxis) aiming to avoid infection ar at least decrease its consequence to the fetus. Considering that the acquired infection as well as the congenital are usually assymptomatic, we should use the mother's serological screening and, afterwards the child's to diagnose and treat these cases. The authors intend to show a public guideline in the assessment of the mother/child suspects of being infected with toxoplasmosis, based in the current available knowledge and according to the protocol used in the Serviço de Doenças Infecciosas e Parasitárias, Setor de Infectologia Pediátrica, Hospital das Clínicas da Universidade Federal de Minas Gerais.

Capacidad ácidosupresora del omeprazol 20 mg comprimidos versus pantoprazol 20 y 40 mg comprimidos en voluntarios / Acid-supressing capacity of omeprazole 20 mg tablets vs pantoprazole 20 and 40 mg tablets. A pilot study in volunteers

OBJECTIVE: To compare the acid-supressing capacity of omeprazole (OZ) 20 mg tablets vs pantoprazole (PZ) 20 and 40 mg tablets, in healthy volunteers, with 24-h intragastric pH-metry. MATERIAL AND METHODS: Open, randomized, cross-over trial in 10 healthy volunteers; on days 0.8 and 22, 24-h intragastric pH-metry. Day 0, basal, thereafter 7 days with OZ or PZ 20 mg/day; day 8, pH-metry, then "wash out" for 7 days and thereafter 7 more days' therapy with PZ or OZ. On day 22 a 24-h intragastric pH control was performed again. In the last treatment stage, all of them were administered pantoprazole 40 mg/day for 8 days again with a 24-h pH recording at the end. RESULTS: 24-h pH-metry expressed as the time (hours) in which the pH was < or = 4 and the values as mean +/- standard deviation. BASAL 22.12 +/- 1.54, POST-OZ 9.78 +/- 6.72, POST-PZ 20 15.65 +/- 5.65, POST-PZ 40 8.57 +/- 5.93. Statistical evaluation with two way repeated measures ANOVA p < 0.0001. Newman Keuls post-hoc test: (1) vs (2) p < 0.003; (1) vs (3) p < 0.03; (2) vs (4) 0.65. CONCLUSIONS: According to the results it might be stated that both proton pump inhibitors have acid-supressing capacity and omeprazole in equal dosis is more effective than pantoprazole as acid-supressor, with statistically significative differences. There was no difference between 20 mg omeprazole and 40 mg pantoprazole.

Effect of omeprazole on plasma zinc levels after oral zinc administration.

BACKGROUND: The intestines are the major site of zinc absorption and excretion. Reduced gastric acid secretion and elevated gastric pH is an important factor affecting intestinal mineral absorption. METHODS: Gastric pH and volume, and basal and maximal acid outputs were measured in 14 healthy volunteers. Plasma zinc levels were then measured at baseline and 1, 2, 3 and 4 hours after oral administration of 300 mg zinc sulfate. The experiment was repeated after omeprazole administration (60 mg/day orally) for 7 days. RESULTS: Omeprazole administration significantly increased fasting gastric pH (5.5 versus 2.4; p < 0.001). Mean basal gastric acid output (1.6 vs 8.0 mEq/h; p < 0.001) and maximal acid output (20.6 vs 106.6 mEq/h; p < 0.001) decreased after omeprazole administration. Zinc absorption decreased after omeprazole administration (141 [34] mg/dL/h) compared with pre-omeprazole values (245 [35]; p < 0.01). CONCLUSION: Suppression of gastric acid secretion by omeprazole reduces intestinal absorption of zinc.

Efeitos da ranitidina e do omeprazol sobre o pH gástrico em cäes / Effect of ranitidine and omeprazole on gastric pH in dogs

O objetivo deste trabalho foi investigar o efeito da ranitidina e omeprazol sobre o pH gástrico em 24 cães adultos, machos, sem raça definida, distribuídos em 3 grupos: grupo A - controle, grupo B - ranitidina e grupo C - omeprazol. O pH gástrico foi medido, após coleta do suco gástrico, com seringa, em cães submetidos a gastrotomia. Esta medida foi feita no grupo controle nos tempos zero, 30, 60, 90 e 120 minutos, no grupo ranitidina a medida foi feita no tempo zero, seguida de aplicação de 0,85 mg/kg de ranitidina por via endovenosa, sendo realizada nova medida nos tempos 30, 60, 90 e 120 minutos e, no grupo omeprazol a medida foi feita no tempo zero, seguida de aplicação de 0,68 mg/kg de omeprazol por via endovenosa, sendo realizada nova medida nos tempos 30,60, 90 e 120 minutos. A comparação entre os grupos mostrou um aumento significante do pH gástrico após o uso de ranitidina e omeprazol. Entretanto, os efeitos comparados da ranitidina e omeprazol não apresentaram diferenças significantes na variação do pH.