Very-low dose antacid in treatment of duodenal ulcer. Comparison with cimetidine.

Antacid (AA) in a very low dose (88 mmol/day) was compared to the standard 800-mg dose of cimetidine in healing duodenal ulcers. The influence of sex, age, symptom duration at entry, night pain, smoking, coffee consumption, and alcohol on ulcer healing was studied. The antacid was given in two different schedules: group I--20 ml 1 hr after breakfast and at bedtime; group II--10 ml 1 hr after breakfast and lunch and 20 ml at bedtime. Cimetidine (group III) was given in two divided doses: 400 mg 1 hr after breakfast and 400 mg at bedtime. Endoscopic control was performed after four weeks and, if necessary, after eight weeks of treatment. The healing rate after four weeks of treatment was, respectively, for groups I, II, and III, 45.5%, 55.8%, and 69.4% (group I = group II, and group III different from groups I and II). After eight weeks of treatment the healing rate was 61.5%, 80.8%, and 88.0% for groups I, II, and III, respectively (group II = group III, and group I different from groups II and III). Except for group I, smoking did not influence healing rate. Age, sex, symptoms at entry, night pain, and coffee consumption did not influence the treatment results. The authors concluded that the very low dose of magaldrate (88 mmol/day), when administered in three divided doses (10 ml after breakfast and lunch and 20 ml at bedtime) for eight weeks was as effective as 800 mg of cimetidine (400 mg twice a day) in healing duodenal ulcer.

[Single nocturnal dose of ranitidine in the treatment of duodenal ulcer: results of an open multicenter, comparative trial]. / Ranitidina em dose única noturna no tratamento da úlcera duodenal. Resultado de um estudo aberto, multicêntrico, comparativo.

This prospective multicentric randomized open trial was designed to evaluate the efficacy of ranitidine 150 mg bid vs 300 mg nocte in the short-term (4 weeks) treatment of duodenal ulcer in 15 Brazilian centers. On the basis of a randomization table 190 patients with endoscopically confirmed duodenal ulcer were allocated to receive either ranitidine 150 mg bid (94 pts) or 300 mg nocte (96 pts). The 2 treatment groups were well matched for age, sex, duration of ulcer disease, number and size of ulcers, duration of current episode, intensity of ulcer pain, alcohol and coffee intake and smoking habits. They were endoscopically controlled at the end of the 4 weeks. At 4 weeks 78 of 94 patients (83.0%) had their ulcers healed with the 150 mg bid regimen as opposed to 79 of 96 patients (82.3%) allocated to the 300 mg nocte dosage. This difference was not statistically significant. Ulcer symptoms diminished with treatment in both groups. The tolerability and compliance was excellent in both groups. The results show that ranitidine 300 mg nocte is as effective in the short-term treatment of duodenal ulcer as ranitidine 150 mg bid. Considering the greater simplicity of administration enhancing patient compliance, the treatment with 300 mg nocte is preferable.

Drenagem transpapilar do Wirsung em cirurgia sobre a papila de Vater. / Wirsung transpapilar drainage in surgery of Vater's papilla

Os autores apresentam 35 casos de drenagem do Wirsung, quando da realizacao da esfinfincteroplastia. Realizam, concomitantemente, o estudo bioquimico do suco pancreatico e suas relacoes com a alimentacao.Tecem comentarios sobre a possivel etiologia da pancreatite aguda pos-operatoria e propoem a drenagem do Wirsung como fator fundamental da prevencao desta complicacao Apresentam um caso de pancreatite aguda pos-operatoria laboratorial, que evoluiu satisfatoriamente, e um caso de pancreatite cronica que evoluiu com baixos niveis de enzimas pancreaticas. Analisam os dados bioquimicos do suco pancreatico e a resposta enzimatica sob a influencia da dieta zero, da aspiracao nasogastrica e de varias dietas orais. Enfocam mais particularmente os niveis de amilase e lipase do suco pancreatico

Chronic gastritis and peptic ulcer.

The relationship between chronic gastritis and peptic ulcer was studied in 97 patients, 51 with duodenal ulcer and 46 with gastric ulcer. Six biopsies (three from the antrum and three from the body) were obtained under direct vision by means of an Olympus panendoscope. Chronic gastritis was classified according to the grade of inflammation (slight or moderate and intense), and to its location (antritis or pangastritis). In gastric ulcer the relationship between frequency of chronic gastritis and the site of the ulcer (antrapyloric, at the angulus, body of the stomach) was also established. Antritis was just as frequently observed in duodenal ulcer (94%) as in gastric patients (96%), but severe inflammation of the antrum was higher in G.U. (43%) than in D.U. (17%). Chronic gastritis of the gastric body was always accompanied by antritis, both in G.U. and in D.U. and was observed in 63% of the former group and 37% of the latter. Severe inflammation of the glandular portion of the stomach occurred in only one patient with D.U (2%) and in 7 with G. U (15%). In the present investigation, no relationship between between the site of gastric ulcer and the frequency of chronic gastritis was observed.