[Gastrointestinal damage in osteoarthritis patients]. / Lesão gastroduodenal assintomática em portadores de osteoartrose.

Seventy-seven patients with symptomatic osteoarthritis of the hip and/or knee, with clinical indication for nonsteroidal anti-inflammatory drugs were studied. However, no patient was submitted to any anti-inflammatory medication seven days, prior the beginning of the study and did not complain of any gastrointestinal disease. Shortly before starting the anti-inflammatory drug therapy all patients were submitted to gastroduodenal endoscopy. This diagnostic procedure revealed that 54.6% of the patients presented at least one gastroduodenal damage, 22.1%, hyperemia, 3.9%, petechias, 23.4%, erosions and 5.2%, peptic ulcers. There results permitted to conclude that to identify and/or exclude damage of the gastrointestinal tract, data obtained in the anamnese are not sufficient. For these patients the endoscopic examination is a need. Anti-inflammatory therapy must be careful associated with dietetic orientation and the prescription of drugs to protect the gastrointestinal mucosa.

Impairment of nitrergic-mediated relaxation of rat isolated duodenum by experimental diabetes.

1. Diabetes mellitus is associated with changes in gastrointestinal motility. The effects of experimental diabetes, induced by streptozotocin administration to rats 3-4 weeks previously, on the nitric oxide (NO)-mediated (nitrergic) relaxation of the duodenum have now been investigated. 2. The non-adrenergic, non-cholinergic (NANC) relaxation of the isolated duodenum induced by nicotine (0.3-10 microM) or the nicotinic agonist, 1,1-dimethyl-4-phenylpiperazinium (DMPP; 10 microM) was inhibited by the NO synthase inhibitor, NG-nitro-L-arginine (3-100 microM). 3. This nitrergic relaxation induced by nicotine or DMPP of the duodenum from diabetic rats was substantially smaller than that of the tissue from control rats. 4. By contrast, the relaxation of the duodenum from diabetic rats to the NO donor, nitroprusside (0.3-10 microM) was similar to that of control tissue, whereas the relaxation to ATP (0.1-3 microM) was enhanced to a small but significant degree. 5. Incubation of duodenal tissue from control rats at 4 degrees C for 72 h, which leads to neuronal disruption, significantly attenuated the relaxation to nicotine or DMPP whereas the relaxation induced by nitroprusside or ATP was not affected. Comparable cold-storage did not affect the endothelium-dependent relaxation of rat aortic rings induced by acetylcholine (0.01-2 microM). 6. The calcium-dependent NO synthase activity in duodenal tissue, determined by the conversion of radiolabelled L-arginine to citrulline, was significantly reduced in cold-stored tissue and in tissue obtained from diabetic rats. 7. These findings in the rat duodenum indicate that a reduction in intestinal NO synthase activity is associated with an impairment of the NANC relaxation. A defect in the intestinal nitrergic innervation could thus contribute to the motility dysfunction observed in diabetes.

Treatment of duodenal ulcer with omeprazole or ranitidine in a Brazilian population: a multicenter double-blind, parallel group study.

Two hundred and forty-one patients with at least one ulcer at stage A1 or A2, measuring at least 5 mm in its larger diameter, were included in this Brazilian double-blind randomized study. Patients received omeprazole 20 mg in the morning (n = 120) or ranitidine 300 mg at night (n = 121) for 2 wk; unhealed ulcers were treated for an additional 2 wk. At the end of 4 wk, unhealed ulcers were treated openly with omeprazole 20 mg o.m. for 4 wk. Healing rates at 2 and 4 wk were 67.3% and 92.9% for omeprazole and 39.8% and 82.0% for ranitidine (per protocol analysis). Results were similar when analyzed as intention to treat (p significant in favor of omeprazole). Epigastric day-time pain was the most common of all symptoms (89.2%), but only heartburn at day 15 showed a significantly better response to omeprazole than to ranitidine. A multivariate analysis (logit analysis) showed that the odds in favor of healing were greater for small ulcers, nonsmokers, and omeprazole treatment.

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.

Coffee drinking in patients with duodenal ulcer and a control population.

The ingestion of plain coffee was compared in 150 duodenal ulcer patients (DU) and 100 control subjects without digestive complaints (C). The DU and C groups were registered in accordance with their daily consumption of coffee: none, 1-100 ml, 101-300 ml, 301-500 ml, and more than 500 ml. Fifty millilitres of coffee as prepared in Brazil contain around 50 mg of a caffeine, which is 2.8 times more than in an equal volume of coffee in the United States. Patients with DU stopped drinking coffee or reduced the volume significantly after symptoms started. There was a significant change in coffee intake at all volume levels except at 1-100 ml. The main reason for the reduction of coffee ingestion was the relationship observed by the patients between the consumption of coffee and dyspeptic complaints. Our results suggest a close correlation between the ulcer-like symptoms and the amount of coffee ingested by patients with duodenal ulcer.

[Treatment of gastric ulcer with ranitidine: comparison of a single 300 mg dose at night with 150 mg twice a day]. / Tratamento da úlcera gástrica com ranitidina: comparação da dose única noturna de 300 mg com a de 150 mg duas vezes ao dia.

Twenty five patients with endoscopically diagnosed gastric ulcer, were randomly allocated to treatment with ranitidine 300 mg at night or ranitidine 150 mg twice daily. After six weeks, ulcer healing was observed in 7 out of 14 patients (50%) treated with ranitidine 300 mg nocte and in 7 out of 11 (63.6%) receiving 150 mg bid. Cumulative healing rates at 12 weeks were 64.2% and 81.8%, respectively. There was no statistically significant difference between these two groups. No adverse events were reported by any patient. Ranitidine 300 mg administered at night was effective and a safe regimen for the treatment of gastric ulcer.

Is the inhibition of nocturnal gastric acid secretion the most important factor in duodenal ulcer treatment? A comparison between the effectiveness of single morning and nocte doses of ranitidine 300 mg.

Fifty-five patients with an endoscopically confirmed duodenal ulcer were randomly allocated to receive ranitidine 300 mg either in a single morning or a single nocte dose (26 and 29 patients respectively). They were endoscopically examined at the end of the second week and when the ulcer was still active, the patient was treated for another two weeks, when endoscopy was repeated. Patients with ulcers still active at four weeks were considered treatment failures. The healing rate observed when ranitidine 300 mg was given in the morning was 10/26 (38%) at the end of the second week and 17/26 (65%) at the end of the fourth week. The healing rates after the 300 mg nocte treatment was 12/29 (41%) at the end of the second week and 20/29 (68%) at the end of the fourth week. No side effects were observed in any of the 55 patients, although one patient in the morning regimen bled at the end of the second week and was withdrawn from the study. Our results showed that ranitidine 300 mg in a single morning dose is as effective as when given in a single night dose. This finding is suggestive that reduction of nocturnal gastric acid secretion is important, but not essential for the healing of duodenal ulcer.

Famotidine in the short and long-term treatment of duodenal ulcer.

Famotidine was compared to ranitidine in a short-term study on the treatment of duodenal ulcer. Famotidine 20 mg. b.i.d., 40 mg. b.i.d. and 40 mg. nocte heal as many ulcer as ranitidine (90.9%, 91.7%, 83.3% and 100% respectively). A single 20 mg. bedtime dose shows to be effective on preventing ulcer recurrence for as long as 48 weeks; the 38% recurrence rate observed with famotidine was statistically different from the 78% observed with placebo. Diarrhoea was the most common complain observed during the short-term trial, followed by sleepiness and headache. The few and small biochemical alterations during the long-term treatment (increase in transaminases, alkaline phosphatase, glucose, BUN) could in no instance be directly related to the substances on use.

Famotidine in the short and long-term treatment of duodenal ulcer.

Famotidine was compared to ranitidine in a short-term study on the treatment of duodenal ulcer. Famotidine 20 mg. b.i.d., 40 mg. b.i.d. and 40 mg. nocte heal as many ulcer as ranitidine (90.9

, 91.7

, 83.3

and 100

respectively). A single 20 mg. bedtime dose shows to be effective on preventing ulcer recurrence for as long as 48 weeks; the 38

recurrence rate observed with famotidine was statistically different from the 78

observed with placebo. Diarrhoea was the most common complain observed during the short-term trial, followed by sleepiness and headache. The few and small biochemical alterations during the long-term treatment (increase in transaminases, alkaline phosphatase, glucose, BUN) could in no instance be directly related to the substances on use.

[Nutritional evaluation in cirrhotic patients]. / Avaliação nutricional em cirróticos.

Great importance has been given to nutritional evaluation concerning either diagnosis or prognosis, and also involving nutritional support as therapeutic approach. Nutritional evaluation of 32 cirrhotic patients was performed using anthropometric measures as triceps skinfold and arm muscular circumference, and laboratory data: creatinine/height index, serum albumin transferrin; and lymphocyte number in peripheral blood. Non-caloric stores, evaluated by triceps skinfold were extremely low in 81% of the cases studied, while muscular stores, evaluated by arm muscular circumference and creatinine/height index were depleted in respectively 37.5% and 43.7%. Visceral stores evaluated by serum levels of albumin and transferrin, as well as immunological state, measured by peripheral lymphocytes counts, showed severe depletion in 10 to 15% of the patients. The increasing importance of nutrition in hepatic cirrhosis is stressed and interpretation of the different methods used for nutritional evaluation in chronic liver disease is discussed.