Pantoprazole versus ranitidine in the treatment of duodenal ulcer: a multicenter study in Brazil.

OBJECTIVE: The aim of this study was to compare the effectiveness and tolerance of pantoprazole versus ranitidine in the treatment of duodenal ulcers in the Brazilian population. METHODS: A total of 222 patients with active duodenal ulcers (DU) were randomly allocated to a double dummy blind treatment, either with ranitidine (RAN) 300 mg (111, aged from 20-68 yr old, 56 female) or with pantoprazole (PANT) 40 mg (111 patients, 18-70 yr old, 45 female). After a 2-wk course of treatment, each patient was clinically and endoscopically assessed for ulcer healing. Failure to heal required a further 2-wk course of treatment and a new evaluation thereafter. RESULTS: In all, 77 of the 103 patients in the PANT group (74.8%) and 42 of the 94 patients in the RAN group (44.7%) who completed the study had ulcer healing after one 2-wk treatment course, and an additional 23 in the PANT group (22.3%) and 28 in the RAN group (29.8%) after the second 2-wk treatment course, totaling 100 (97.1%) and 70 (74.5%), respectively. Therapeutic gain in favor of pantoprazole was significant both at the end of the first and the second 2-wk treatment course (p<0.001). At 2 wk, symptoms remission was significantly higher in the PANT group (97.6%) than with the RAN group (77.5%) (p<0.001). The Intention-to-treat analysis showed results statistically similar to those observed in the per-protocol analysis. Minor adverse events were reported by four patients in the PANT group and three in the RAN group. No relevant laboratory abnormalities were seen. No patient withdrew from the study due to adverse events. CONCLUSIONS: Our results show that pantoprazole is more effective than ranitidine in the treatment of duodenal ulcer providing faster ulcer healing in most patients (97.1%), in 4 wk. Adverse events were rare and were similar in both groups, and had no influence on the therapeutic outcome.

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.

[Effect of various therapeutic schedules of antacids on the pH of gastric contents in patients with duodenal ulcer]. / Efeitos de diferentes esquemas terapêuticos de antiácidos sobre o pH do conteúdo gástrico em pacientes com úlcera duodenal.

Ten patients with uncomplicated duodenal ulcer were given three different therapeutic regimens of antacid experiments II, III and IV, and a control regimen, without antacid, named experiment I. Experiment I consisted of a normal diet with three meals a day; experiment II, III and IV consisted of a diet as in experiment I plus 132,06 mEq, 265,92 mEq or 396,88 mEq respectively of antacid divided in six equal doses given one and three hours after breakfast, lunch and dinner. Having been carefully instructed, the patients were intubated with a gastric tube, which was kept in for five days, receiving in each day one of the aforementioned regimens, in a sequential order. The fifth day was reserved for the augmented Histalog test. Each hour from 8 a.m. to 10 p.m., in the first four days, a sample of the gastric juice was aspirated for pH measurement. The statistical evaluation of the acidity of the samples at different times showed that experiment III (265,92 mEq antacid/day) was able to keep the pH over 3 for longer periods of time when compared with experiments I and II and not different from experiment IV. The present investigation emphasize the necessity of clinical trials comparing therapeutic regimens of antacid with different neutralizing capacity, in order to find the most effective dose in the treatment of duodenal ulcer.

Efeitos de diferentes esquemas terapeuticos de antiacidos sobre o pH do conteudo gastrico em pacientes com ulcera duodenal. / Effets of different therapeutic schedules of antacids on the pH of gastric contents in patients with duodenal ulcer

Foram estudados os efeitos de diferentes esquemas terapeuticos de antiacido sobre o pH do conteudo gastrico em l0 pacientes com ulcera duodenal. Os pacientes foram internados durante cinco dias, entubados com sonda nasogastrica e submetidos a tres esquemas terapeuticos de antiacido e um controle, sem antiacido. O antiacido-teste utilizado, era administrado em seis doses diarias e iguais, uma e tres horas apos o desjejum, almoco e jantar e a diferenca entre os esquemas estava na sua potencia antiacida (PA). O esquema I (controle), sem antiacido, o esquema II tinha uma PA equivalente a 132,96 mEq de CH1 0,1 N, o esquema III de 265,92 mEq e o esquema IV de 398,88 mEq. A cada hora, de 8 as 22 horas, obtinha-se uma aliquota do conteudo gastrico para determinacao potenciometrica do pH. Considerou-se como sucesso terapeutico a ocorrencia de pH do conteudo gastrico igual ou superior a 3,0. Verificouse que o esquema II nao diferiu significativamente do esquema controle; que o esquema III, teve um desempenho altamente significativo, em relacao ao esquema controle e significativo, em relacao ao esquema II; e que o esquema IV teve um desempenho semelhante ao esquema III, nao havendo diferenca entre eles. Conclui-se que o sucesso maximo na manutencao do pH do conteudo gastrico igual ou superior a 3,0, no periodo de 8 as 22 horas, foi alcancado com dose unitaria correspondente a 44,32 mEq de antiacido, equivalente a dois comprimidos do antiacido-teste

Influencia do teor de fibra dietetica da alimentacao sobre alguns parametros fecais, no homem. / Effect of the content of dietary fibers in nutrition on some stool parameters, in man

Os autores estudaram o efeito produzido, em alguns parametros fecais, pela substituicao do pao de uma dieta normal por biscoito de farelo de trigo. Analisaram-se o peso fecal, a agua eliminada nas fezes, o peso das fezes secas, a gordura e o nitrogenio fecais, a frequencia das evacuacoes, pH, a cor, a forma e a consistencia das fezes. Utilizaram-se l0 individuos sadios durante dois periodos de seis dias cada um. No primeiro, estudou-se a dieta controle (dieta I) e, no segundo, a dieta experimental (dieta II), enriquecida com biscoito de farelo de trigo. Foram observados aumentos significativos do peso fecal, da agua eliminada nas fezes, do peso das fezes secas e da frequencia das evacuacoes. A gordura e o nitrogenio fecal nao foram alterados significativamente com o uso da dieta II. O pH, a cor, a forma e a consistencia das fezes nao apresentaram alteracoes substanciais quando os individuos passaram a utilizar a dieta II. Em vista dos resultados obtidos, concluiu-se que a utilizacao do biscoito de farelo de trigo e benefica como suplementacao de fibra dietetica, podendo ser de grande utilidade terapeutica, especialmente em individuos com constipacao intestinal essencial

Endoscopic findings after antacid, cimetidine and placebo for peptic ulcer: importance of staging the lesions.

Noventa e quatro pacientes ambulatoriais foram sorteados para tres diferentes esquemas terapeuticos da ulcera peptica, a saber: 30 foram tratados (em aberto) com antiacido a cada hora; 64 receberam cimetidina ou placebo (estudo duplamente-cego). Apos quatro semanas 66,3% dos pacientes no grupo antiacido, 56,2% no grupo cimetidina e 9,4% no grupo placebo tiveram cicatrizacao de suas ulceras. A diferenca entre cimetidina e antiacido nao foi estatisticamente significativa. A baixa incidencia de cicatrizacao no grupo placebo, menor do que a relatada em outros experimentos pode ser atribuida a nao ingestao suplementar de antiacidos naquele grupo e/ou ao criterio de estadiar endoscopicamente as lesoes, tanto para a admissao no estudo, quanto para avaliar os resultados

Effect of clebopride on lower esophageal sphincter pressure.

A metoclopramida e o clebopride produziram aumento significativo na pressao do esfincter inferior do esofago, quando estudados em 12 individuos normais. O aumento da pressao induzido pelo clebopride foi significativamente superior ao induzido pela metoclopramida. A tolerancia ao clebopride foi satisfatoria, causando na maioria dos individuos, apenas discreta sonolencia

Coeliac disease in identical twins.

Coeliac disease occurred at the same age in MZ twins. The diagnosis was confirmed by histology of the small intestine, rapid response to a gluten-free diet, and relapse after reintroduction of gluten.

Effect of normal and ulcer-type diet on the acidity of gastric contents in patients with duodenal ulcer.

Patients with uncomplicated duodenal ulcer were given two types of diet -a normal and a ulcer-type diet. The data obtained did not show any statistically significant difference between the action of the two diets. No evidence was then found to be in support of the still widely used restricted diet in the treatment of peptic ulcer.