Eradication of H. pylori with pantoprazole, clarithromycin, and metronidazole in duodenal ulcer patients: a head-to-head comparison between two regimens of different duration.

BACKGROUND: The study was conducted to compare the efficacy and tolerability of two pantoprazole-based triple therapies of different length in the eradication of H. pylori. METHODS: In this double-blind, multicenter parallel group comparison, H. pylori-positive patients were randomly assigned to either the PCM-7 group (7 days of pantoprazole 40 mg bid, clarithromycin 500 mg bid, metronidazole 500 mg bid) or the PCM-14 m group (modified 14 day therapy of the same regimen with metronidazole only given for 10 days due to labeling reasons). H. pylori status was determined by urease test, histology, culture, and 13C-urea breath test. Treatment outcome was assessed 6 weeks after intake of the last study medication. RESULTS: The following eradication rates were achieved: for PCM-7 in the MITT population 83% (89/107), in the PP population 84% (81/97); for PCM-14 m in MITT 87% (92/106), in PP 88% (91/104). Ulcer healing rates were: for PCM-7 in MITT population 99% (106/107), in the PP population 99% (96/97); for PCM-14 m in MITT 99% (105/106), in PP 99% (103/104). Gastrointestinal symptoms and gastritis scores decreased in both treatment groups. Equivalence of treatment regimens could be proven for all populations. In total, 64 patients reported adverse events. Five serious adverse events occurred, all unrelated to the study medication. CONCLUSION: The two pantoprazole-based triple therapies tested in this study are equally effective in H. pylori eradication, ulcer healing and relief from ulcer pain. It is concluded that 7 days of triple therapy are generally sufficient.

[Metoclopramide antagonizes dopamine-induced inhibition of lower esophageal sphincter pressure in the awake beagle]. / Metoclopramid (MCP) antagonisiert die Dopamin (DOP)-induzierte Hemmung des unteren Osophagussphinkterdruckes (UOSD) am wachen Beagle.

Different contradictory results, even in the same species of the DOP-effect on LESP have been reported. The aim of the present studies was to evaluate the effect of DOP on LES in purebread male beagles and whether in could be antagonised by the DOP-antagonist MCP. The LESP in beagles is sensitive to dopamine (DOP) and its "antagonist", metoclopramide (MCP). MCP raised the inhibited LESP after DOP-infusion in vivo, while it failed to change DOP-induced relaxation of opossum LES in vitro [1]. Data obtained after monotherapie with MCP did not exceed LESP-response to MCP after DOP-pretreatment. DOP applied as background counter-inhibition could be used to correct interdigestive phasic changements of LESP in order to reach a stable starting-point to investigate the action of LESP-stimulating compounds pharmacomanometrically. Due to DOP reflux-facilitating side effect via its decrease of LESP, large doses of DOP, as used in the intensiv care unit, should be administered together with sphincter-strengthening agents or antacid compounds.