L-arginine-induced esophagitis, report of six cases / Reporte de seis casos de esofagitis inducida por L-arginina

Abstract Background: Drug-induced esophagitis is an uncommon diagnosis in the pediatric population. The following is a report of six adolescents with L-arginine-induced esophagitis. Case reports: All patients were under treatment with L-arginine for short stature. After using the prescribed medication for 1-3 months, all cases started with severe retrosternal pain, odynophagia, and dysphagia. The upper gastrointestinal endoscopies showed ulcers located in the mid esophageal mucosa. Conclusions: In the presence of acute severe odynophagia, dysphagia, and retrosternal pain, drug-induced esophagitis should be considered as a possible diagnosis. Treatment includes liquid diet, pain control, sucralfate, omeprazole, and interruption of L-arginine. In addition, the physician should explain preventive measures focused on patient and family education on the drug side effects and precise instructions on how to take medications, as well as a careful balance of risk and benefits of any medication. At present, there are no clinical trials that support the use of L-arginine in treatment of short stature.

Resumen Introducción: La esofagitis inducida por medicamentos es un diagnóstico poco frecuente en pacientes pediátricos. A continuación, se describe una serie de seis casos de pacientes menores de 15 años con esofagitis inducida por L-arginina. Casos clínicos: Los seis casos se encontraban en tratamiento con L-arginina por talla baja e iniciaron con dolor retroesternal, odinofagia y disfagia de rápida instalación. Cuatro de ellos acudieron al servicio de urgencias por la intensidad de los síntomas. Los hallazgos en la endoscopia del tubo digestivo alto fueron úlceras en la mucosa del esófago a la altura del tercio medio, zona de estrechez natural por la compresión del bronquio izquierdo. Conclusiones: En presencia de odinofagia, disfagia, dolor retroesternal y el antecedente de la ingesta de L-arginina, la esofagitis inducida por fármacos debe considerarse como una posibilidad diagnóstica. El tratamiento está basado en el manejo del dolor, sucralfato, omeprazol, así como la suspensión del medicamento y medidas preventivas centradas en la educación del paciente y los familiares sobre los riesgos y beneficios de un medicamento y la forma correcta de administrarlo.

Tissue content of sulfomucins and sialomucins in the colonic mucosa, without fecal stream, undergoing daily intervention with sucralfate

PURPOSE: To measure the content of acidic mucin, sialomucin, and sulfomucins in the colonic mucosa without fecal stream submit to intervention with sucralfate (SCF). METHODS: Thirty-six rats were submitted to a right colostomy and a distal mucous fistula and divided into two groups according to sacrifice to be performed two or four weeks. Each group was divided into three subgroups according daily application of enemas containing saline, SCF at 1.0 g/kg/day or 2.0 g/kg/day. Colitis was diagnosed by histological analysis. Acid mucins were determined with the Alcian-Blue and sulfomucin and sialomucin by high iron diamine-alcian blue (HID-AB) techniques. The mucins were quantified by computer-assisted image analysis. Mann-Whitney and ANOVA tests were used to analyze the results establishing the level of significance of 5% for both (p<0.05). RESULTS: SCF enemas decreased the inflammation score and was related to the concentration used and time of the intervention. SCF at both concentrations increased the content of acid mucin, which was related to the concentration used and to the improvement in the inflammatory score. There was an increase in the content of sulfomucins and sialomucins in SCF groups. SCF increased sulfomucins from 2 weeks of intervention, which was not related to the dose or time of application. The increase in sialomucin content was related to the time and dose used in the intervention. CONCLUSION: Sucralfate increased the content of acidic mucins, primarily at the expense of sialomucin, which was affected by the dose and time of intervention. .

Chronic Hemorrhagic Radiation Proctitis Treated by Sucralfate Enema / 대한소화기학회지

No abstract availble.

Predictors of duodenal ulcer healing in sucralfate treated patients.

The objective of the study was to assess the efficacy of sucralfate in promoting duodenal ulcer healing and to assess the value of some variables in predicting outcome of such therapy. Following variables were tested for predicting the outcome: age at onset, age at presentation, duration of symptoms, sex, periodicity, smoking, nocturnal pain, relief by food, relief by antacid, gastric stasis like symptoms, associated irritable bowel syndrome, site, size and number of ulcers and degree of deformity of bulb. Sixty patients with uncomplicated DU confirmed at endoscopy were treated with sucralfate one gram before three major meals and 1 g at bedtime for two months. Endoscopy was repeated at the end of the trial. There were four drop-outs. Complete, partial and no healing occurred in 45 (80.36)%, 3 (5.36%) and 8 (14.28%) subjects. Ulcer healing rate was higher in those without gross bulbar deformity (41/46) than in those with gross deformity (4/10), (Odd's ratio 12.3, 95% ci 1.98 to 78.44). Other variables were not found to be associated with ulcer healing.

Comparación de los efectos entre la ranitidina y el sucralfato sobre el pH gástrico y el desarrollo bacteriano intragástrico / Comparison of between ranitidine and sucralfate effects on gastric pH and intragastric colonization

Introducción. La profilaxis de las úlceras de estrés con antiácidos y bloqueadores H2 produce colonización gástrica en los pacientes en estado crítico. Objetivo Comparar los efectos entre ranitidina y sucralfato sobre el pH gástrico y colonización intragástrica. Pacientes y métodos. Estudiamos prospectivamente 64 pacientes que ingresaron a una UCI. Se compararon los efectos entre el tratamiento con ranitidina (32 pacientes, grupo A) y sucralfato (32 pacientes, grupo B) durante 72 horas. Resultados. El pH gástrico fue a las 0, 24, 48 y 72 horas después del tratamiento 2.9 ñ 0.68; 4.3 ñ 0.73, 4.1 ñ 0.68, 4.5 ñ 0.86 y 2.75 ñ 0.61, 6.16 ñ 0.97, 6.5 ñ 0.87, 6.56 ñ 0.79, respectivamente entre los grupos A y B (p < 0.05). La colonización gástrica fue más alta en el grupo B, once pacientes, que en el grupo A, tres pacientes (p= 0.034). Conclusión. La ranitidina incrementa el riesgo de colonización bacteriana del estómago en el paciente crítico

Natural honey exerts its protective effects against ethanol-induced gastric lesions in rats by preventing depletion of glandular nonprotein sulfhydryls.

The role of nonprotein sulfhydryls (NP-SH) in the protective effects of honey against absolute ethanol-induced gastric lesions was studied in rats. Sucralfate and ranitidine were used as known standard gastroprotective agents. Honey orally and drugs orally or subcutaneously were administered to 24 h fasted rats 30 or 90 min before oral administration of ethanol. Mucosal damage and the glandular NP-SH levels were measured 1 h after ethanol. Both honey and sucralfate dose-dependently afforded protection against gastric damage and reversed the changes in glandular NP-SH levels induced by ethanol. Ranitidine was ineffective in this model. Pretreatment with indomethacin (IND) did not alter the protective effects of honey or the NP-SH levels, but significantly reduced the protective effects of sucralfate. On the other hand, pretreatment with N-ethylmaleimide (NEM) significantly reduced the protective effects of both honey and sucralfate and lowered the NP-SH levels. Combined IND and NEM treatment caused a significant reduction of the protective effects of honey and the NP-SH levels, but the values were not significantly different from those obtained with NEM alone. In contrast, combined IND plus NEM treatment completely abolished the protective effects of sucralfate and significantly lowered the NP-SH levels. Although these results suggest the involvement of prostaglandins (PGs) -- sensitive process in the protective effects of sucralfate, but honey and sucralfate (partially) share a common mechanisms of action in mediating the gastroprotective effects through NP-SH sensitive processes.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluación de tratamientos en la prevención de las lesiones agudas gástricas en el stress, en ratas / Evaluation of the treatments in the prevention of acute gastric lesions in stress, in rats

Se estudiaron en grupos de ratas Wistar, en stress por inmovilización más inmersión en agua a 18C, las groseras lesiones agudas gástricas sangrantes y su prevención con drogas citoprotectoras gástricas como: sucralfato, HOAI y Mg, magaldrato, hidrotalcita y misoprostol; asimismo, drogas antisecretoras gástricas como misoprostol (dosis antisecretora), somatostatina (octeotride), ranitidina, omeprazol y lanzoprazol. En otra experiencia, se estudió la secreción gástrica ácida en ratas con ligadura de píloro, donde fueron tratadas con las mismas drogas y dosis que en la experiencia anterior. Se comprobó que el modelo de stress 6 hs. dió una zona lesional gástrica de un 80 por ciento; el sucralfato, como droga citoprotectora, dio una protección parcial de la mucosa gástrica; en cambio, los bloqueantes de la bomba de protones, omeprazol y lanzoprazol dieron una zona gástrica cercana al 0 por ciento y por ende, postulamos su uso en terapia intensiva en la profilaxis de las lesiones agudas gástricas sangrantes en el stress.

Ulcera peptica / Peptic ulcer

Neste artigo, procuramos resumir os conhecimentos atuais com relaçao a etiopatogenia e,principalmente, ao diagnostico e tratamento da ul-cera peptica.

A comparative therapeutic trial of sucralfate and ranitidine in initial healing and relapse rate of duodenal ulcer.

The present study was carried out to examine the comparative efficacy of sucralfate and ranitidine in the treatment of duodenal ulcer. Sixty-six patients with endoscopically diagnosed duodenal ulcer were studied in a 4-6 weeks randomised, single blind trial comparing sucralfate 1 gm T.D.S. one hour before meal and 1 gm nocte (34 pts) with ranitidine 300 mg nocte (32 pts). Six patients (four on sucralfate and 2 on ranitidine) failed to complete the study. Endoscopy after four weeks of treatment showed an ulcer healing rate of 57% in the sucralfate group compared with 73% in ranitidine group (p greater than 0.1). At six weeks these figures had risen to 87% and 90% respectively (p less than 0.5). After one year followup study 69% of sucralfate treated ulcers relapsed whereas the relapse rate was 82% in ranitidine treated ulcer group (p less than 0.1). It was observed that the relapse was earlier in the ranitidine group as compared to sucralfate group (p less than 0.01 at 3 months and p less than 0.05 at 6 months). Asymptomatic recurrence was seen in 15% (6/40) patients. Sucralfate was not only as effective as ranitidine in short term healing of duod. ulcer but also delayed the relapse of ulcer in long term followup after initial healing with the drug.

Prevencion del sangrado digestivo alto: estudio comparativo sucralfate vs. antiacido / Prevention of upper digestive bleeding: comparative study sucralfate vs. antiacid

Se realizo un estudio comparativo, aleatorio, entre sucralfate y antiacido para la prevencion de sangrado digestivo alto en pacientes criticamente enfermos. Cuarenta y nueve pacientes recibieron antiacido y 56 recibieron sucralfate. Presentaron sangrado digestivo cuatro pacientes del grupo sucralfate y tres del grupo antiacido. Se practico endoscopia a cinco de los pacientes que sangraron, encontrandose gastroduodenitis erosiva en cuatro y ulcera duodenal en uno. Todos los pacientes con sangrado digestivo tuvieron por lo menos dos guayacos positivos en jugo gastrico antes de sangrar en forma evidente, siendo esta prueba un indicador precoz y sensible de sangrado digestivo (p<0.001). La mortalidad no relacionada con el sangrado fue similar en los dos grupos (29% sucralfate y 24% antiacido). El promedio del pH fue mayor en el grupo antiacido (5.48 mas o menos 0.96) que el grupo sucralfate (3.62 mas o menos 0.72)(p<0.005). Estos resultados sugieren que el sucralfate es igualmente efectivo que el antiacido en la prevencion del sangrado disgestivo alto en pacientes criticamente enfermos

Sucralfate in the short-term treatment of duodenal ulcer. A double-blind comparison with cimetidine and placebo.

A phase III randomised, double-blind, placebo controlled study was conducted to compare the efficacy and adverse effects of sucralfate and cimetidine in the short-term management of active duodenal ulcer. Standard therapeutic doses were used. Antacids were permitted on an ad lib basis. Eighty patients with endoscopically proven DU were treated for 4 weeks with sucralfate (SUC) (n = 40), cimetidine (CIM) (n = 20) and placebo (PLA) (n = 20), of whom 60 patients--SUC (32), CIM (14) and PLA (14) completed the trial. Baseline clinical and endoscopic data were comparable amongst the 3 groups. The patients were reexamined clinically at 1, 2 and 4 weeks and endoscopically at 2 and 4 weeks. The data comprising pain and non-pain symptom scores, and ulcer size before and after the trial were analysed using the Mann-Whitney test. There were no significant differences in the rate of ulcer healing between SUC and CIM at 4 weeks. 71.8% of the SUC group had complete healing, as compared with 71.4% in the CIM group and 35% in the PLA group. Both SUC and CIM were superior to PLA. (p less than .05) Non-pain symptom scores at the end of 1 week were significantly lower with CIM (p less than 0.001), but levelled at 4 weeks when compared with SUC. Both SUC and CIM were superior to placebo (p less than .001). Day-time pain relief was significantly better with both SUC and CIM as compared to placebo (p less than 0.1). There was no significant difference in night-pain relief between the 3 groups.(ABSTRACT TRUNCATED AT 250 WORDS)