ABSTRACT
We entered 174 patients with healed duodenal ulcer and 77 with healed gastric ulcer into a double-blind, placebo-controlled, 6-month trial to investigate the efficacy of 1 g sucralfate twice daily in preventing ulcer recurrence. Endoscopy was performed after 6 months or earlier for symptoms compatible with ulcer disease. The relapse rate in the 126 patients with duodenal ulcer who could be evaluated for efficacy was 14/66 (21.2%) under sucralfate and 30/60 (50%) under placebo treatment (p less than 0.01). No significant difference in relapse rate was found in the 55 gastric ulcer patients who could be evaluated; 11 of 30 (37%) relapsed on sucralfate and 11 of 25 (44%) relapsed on placebo. Among the duodenal ulcer patients in the placebo group, those who had been treated initially with H2-receptor blockers for acute ulcer had significantly more relapses than patients who had been treated with other drugs. The recurrence rate was independent of prior treatment in the sucralfate group. Duodenal ulcer patients with a history of multiple episodes of active ulcer disease had a significantly higher rate of relapse than patients with only a few previous episodes. Both treatments were well tolerated. Two patients in each treatment group complained of nausea and epigastric pain immediately after drug intake. No other drug-related symptoms were observed. We conclude that sucralfate is effective in the prophylaxis of duodenal ulcer. No significant effect was found in the prevention of gastric ulcer recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Aluminum/therapeutic use , Anti-Ulcer Agents/therapeutic use , Peptic Ulcer/prevention & control , Aluminum/adverse effects , Antacids/therapeutic use , Anti-Ulcer Agents/adverse effects , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Male , Middle Aged , Recurrence , Smoking , Sucralfate , Time FactorsABSTRACT
5-Aminosalicylic acid (5-ASA, 0.5 g t.i.d. as suppository) was administered to 10 patients with ulcerative colitis and 4 patients with Crohn's disease. Both diseases were active despite out-patient pretreatment in 9 cases for at least 6 weeks with sulfasalazine (1.5-3.0 g/d) and corticosteroids. Prior to 5-ASA treatment the activity index according to Best was 241 +/- 85 for the ulcerative colitis patients and 263 +/- 83 for the Crohn's disease patients. After an admission of 4 to 6 weeks treatment with 5-ASA led to a significant decrease (P less than 0.0001) to 43 +/- 38 in the ulcerative colitis patients whereas the decrease in the Crohn group was markedly less to 165 +/- 129 (P less than 0.035). Apart from two patients with Crohn's disease the antiphlogistic effect of 5-ASA could be proven by endoscopy, histomorphology and (or) radiography with an 86% remission rate and by the improved faecal quality (n = 12). The results show that 5-ASA leads to improvement in part only of patients with Crohn's disease, however that all patients with ulcerative colitis respond to this biologically active metabolite. Particularly due to absence of undesirable side effects 5-ASA represents an advantageous possibility for treatment.
Subject(s)
Aminosalicylic Acids/therapeutic use , Colitis, Ulcerative/drug therapy , Crohn Disease/drug therapy , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aminosalicylic Acids/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Female , Humans , Male , Mesalamine , Middle Aged , Sulfasalazine/therapeutic use , SuppositoriesABSTRACT
The routine endoscopic examination by color television is possible be new technical developments. For routine color television - endoscopy an efficient three-tube-camera should be used, directly attached to the endoscope. For demonstration purposes or to control technical proceedings in the field of operative endoscopy the one-tube-color television camera can be sufficient, even if there are difficulties also for the experienced examiner to read findings from the television screen. This difficulty do not exist with the three-tube-camera. The resolution power of the endoscope in comparison to the television picture of the endoscopic color television picture is not different. The resolution power is limited by the endoscopes. An enlargement of the endoscopic picture by changing the focus of the objective gives no improvement. We have excellent experiences with the routine color television-endoscopy during colonoscopy. With a three-tube-camera the total examination can be controlled while the one-tube-camera is only valid to insert the coloscope. The color television endoscopy enables to produce a large archive of endoscopic findings for teaching purposes without secondary cost and with a description during the active examination. Our experiences with routine endoscopy with color television proves that this technique is an improvement.
Subject(s)
Endoscopes , Television , Colonoscopes , ColorABSTRACT
We studied the therapeutic efficacy of sulfasalazine and its metabolites sulfapyridine and 5-aminosalicylic acid in nine patients with Crohn's disease and in 23 patients with ulcerative colitis. In a randomized, controlled trial, we treated 11 patients for six weeks with 1 g of sulfasalazine three times a day, seven patients with 0.5 g of sulfapyridine three times a day, and 14 patients with 0.5 g of 5-aminosalicylic acid suppositories three times a day. The clinical state of the disease was characterized by an activity index, quality of stool, and remission rate. In addition, we monitored plasma levels of sulfapyridine, 5-aminosalicylic acid, and their acetylated metabolites. The initial activity index (mean +/- S.D.) was significantly reduced by sulfasalazine (from 245 +/- 129 to 100 +/- 71; P < 0.001) and by 5-aminosalicylic acid (from 251 +/- 65 to 90 +/- 93; P < 0.0001), but sulfapyridine was without benefit. Stool quality was also improved by sulfasalazine (82 per cent of the cases) and by 5-aminosalicylic acid (79 per cent). The highest remission rate was achieved with 5-aminosalicylic acid (86 per cent), followed by sulfasalazine (64 per cent) and sulfapyridine (14 per cent). Our investigations show that 5-aminosalicylic acid is the active moiety of sulfasalazine and that this effective metabolite may be an alternative to sulfasalazine in inflammatory bowel disease.
Subject(s)
Aminosalicylic Acids/therapeutic use , Colitis, Ulcerative/drug therapy , Crohn Disease/drug therapy , Sulfanilamides/therapeutic use , Sulfapyridine/therapeutic use , Sulfasalazine/therapeutic use , Adult , Aminosalicylic Acids/administration & dosage , Clinical Trials as Topic , Humans , Middle Aged , Remission, Spontaneous , Sulfapyridine/administration & dosage , Sulfasalazine/administration & dosageABSTRACT
Using a "quasi physiological" examination technique (Heidelberg capsule in free passage), the influence of Gastropulgit on the intragastral pH value was measured in comparison with 3 mEq/L sodium bicarbonate (NaHCO3), involving 147 patients. The following results were obtained. 1. Contrary to NaHCO3, Gastropulgit results in a very constant compensation of the gastric pH level to weakly acid values. 2. The return of acid gastric medium after administration of Gastropulgit is slower in the case of weaker neutralization. As opposed to NaHCO3, the initial pH value was not reached as an average. 3. Over and beyond the actual duration of its effect, Gastropulgit also has an effect on gastric function, whose total duration could not be evaluated using the present technique. A trial neutralization employing NaHCO3 after termination of the Gastropulgit reaction shows an absence of high alkalization. On average, only weakly acid values were obtained. The return to a less acid pH value constitutes the second effect. According to these results, Gastropulgit appears to balance out a physiologically stimulated gastric function. It is not yet possible to provide evidence of an adaptation to physiological conditions, as these are not yet sufficiently known. One may assume, however, that the compensation of acid stimulation after the neutralization phase is a part of the process. As a result of the effects over and beyond the actual effective period - an influence on subsequent neutralization attempts - one may surmise that the administration of a gastric therapeutic agent which also neutralizes acids, such as Gastropulgit, may also be justified prior to the intake of a meal, and that it promises a favourable therapeutic effect when used in a broad range.
Subject(s)
Antacids/administration & dosage , Gastric Acidity Determination/methods , Gastric Juice/metabolism , Bicarbonates/administration & dosage , Humans , Hydrogen-Ion Concentration , TelemetryABSTRACT
42 cases of acute hepatitis diagnosed from 1970 to 1974 were reviewed retrospectively. The effect of (+)-Cyanidanol-3 on the course of acute hepatitis was controlled on 35 patients in a double blind study. During acute hepatitis, bed rest had an essential influence on the time needed to normalize the transaminases. Based on these observations, we proved the effect, that during treatment with (+)-Cyanidanol-3 the patients showed a positive influence regarding the time for normalization of the transaminases in contrast to the placebo-group. During the first weeks the depression of the transaminase-activity in the blood was noticeable. Because of the small number of patients in that group, this effect could not yet been proved statistically. The stimulation of ATP synthesis as the main therapeutic principle can show a favourable result in the treatment of acute hepatitis.
