Úlcera péptica / Peptic ulcer

La enfermedad ulcerosa péptica es una patología frecuente; aunque su incidencia ha disminuido en los últimos años, sigue siendo una causa importante de morbimortalidad asociada a un elevado gasto sanitario. Los factores de riesgo más importantes son la infección por Helicobacter pylori(H. pylori) y el uso de antiinflamatorios no esteroideos. La mayoría de los pacientes con enfermedad ulcerosa péptica permanecen asintomáticos, siendo la clínica más frecuente la dispepsia, a menudo característica (dispepsia ulcerosa). También puede comenzar con complicaciones como hemorragia digestiva alta, perforación o estenosis. La técnica diagnóstica de elección es la endoscopia digestiva alta. El tratamiento con inhibidores de la bomba de protones, la erradicación de H. pylori y evitar el consumo de antiinflamatorios no esteroideos son la base del tratamiento. Sin embargo, la prevención es la mejor estrategia, incluye una adecuada indicación de inhibidores de la bomba de protones, la investigación y tratamiento de H. pylori, evitar los antiinflamatorios no esteroideos o utilizar aquellos menos gastrolesivos (AU)

Peptic ulcer disease is a frequent pathology; although the incidence has decreased in recent years, it continues to be an important cause of morbidity and mortality associated with high healthcare costs. The most important risk factors are Helicobacter pylori(H. pylori) infection and the use of non-steroidal anti-inflammatory drugs. Most patients with peptic ulcer disease remain asymptomatic, with dyspepsia being the most frequent and often characteristic symptom. It can also debut with complications such as upper gastrointestinal bleeding, perforation or stenosis. The diagnostic technique of choice is upper gastrointestinal endoscopy. Treatment with proton pump inhibitors, eradication of H. pylori and avoiding the use of non-steroidal anti-inflammatory drugs are the basis of treatment. However, prevention is the best strategy, it includes an adequate indication of proton pump inhibitors, investigation and treatment of H. pylori, avoiding non-steroidal anti-inflammatory drugs or using those that are less gastrolesive (AU)

[Peptic ulcer]. / Úlcera péptica.

Peptic ulcer disease is a frequent pathology; although the incidence has decreased in recent years, it continues to be an important cause of morbidity and mortality associated with high healthcare costs. The most important risk factors are Helicobacter pylori(H. pylori) infection and the use of non-steroidal anti-inflammatory drugs. Most patients with peptic ulcer disease remain asymptomatic, with dyspepsia being the most frequent and often characteristic symptom. It can also debut with complications such as upper gastrointestinal bleeding, perforation or stenosis. The diagnostic technique of choice is upper gastrointestinal endoscopy. Treatment with proton pump inhibitors, eradication of H. pylori and avoiding the use of non-steroidal anti-inflammatory drugs are the basis of treatment. However, prevention is the best strategy, it includes an adequate indication of proton pump inhibitors, investigation and treatment of H. pylori, avoiding non-steroidal anti-inflammatory drugs or using those that are less gastrolesive.

Gastroprotective effect of the crude ethanolic extract from the stem barks of Piptadenia viridiflora (Kunth) Benth. (Fabaceae) / Efecto gastroprotector del extracto etanólico crudo de la corteza de Piptadenia viridiflora (Kunth) Benth. (Fabaceae)

The objective of this work was to evaluate the gastroprotective activity of the crude ethanolic extract (CEE) from the stem barks of Piptadenia viridiflora using the acute models of inducing gastric ulcers by ethanol, ethanol-acidified, and ischemia-reperfusion, and correlating this response with the antioxidant activity, as well as, analyze the chemical profile of the extract by high-performance liquid chromatography coupled to diode array detector (HPLC-DAD). For this purpose, mice and rats were used. The ethanol ulcer induction test showed that CEE at doses of 100 and 200 mg/kg promoted 70% and 80% of gastroprotection, respectively. In the gastric ulcer induction test by acidified-ethanol and ischemia-reperfusion, CEE (200 mg/kg) promoted 66% and 90% of gastroprotection in animals, respectively. In conclusion, this species has gastroprotective activity, and this response is possibly related to the antioxidant activity, as well as the presence of flavonoids detected in CEE of P. viridiflora.

El objetivo de este trabajo fue evaluar la actividad gastroprotectora del extracto etanólico crudo (CEE) de Piptadenia viridiflora, utilizando los métodos de inducción de úlceras gástricas agudas por etanol, etanol acidificado y de isquemia-reperfusión, y correlacionando esta respuesta, con la actividad antioxidante, así como, perfil químico de la muestra. Para ello se utilizaron ratones (Swiss) y ratas (Wistar). Como resultado, la prueba de inducción de úlceras por etanol mostró que la CEE a dosis de 100 y 200 mg/kg promovió 70% y 80% de gastroprotección, respectivamente. En la prueba de inducción de úlcera gástrica por etanol acidificado e isquemia-reperfusión, la CEE (200 mg/kg) promovió 66% y 90% de gastroprotección en animales, respectivamente. Concluimos que la especie tiene una acción gastroprotectora y que esta respuesta posiblemente esté relacionada con la actividad antioxidante, así como con la presencia de flavonoides detectados en la CEE de P. viridiflora.

[Updating in prescription of proton pump inhibitors. What to do and what not to do]. / Actualización en la prescripción de inhibidores de la bomba de protones. Qué hacer y qué no hacer.

INTRODUCTION: Proton pump inhibitors (PPIs) are the most prescribed pharmacological subgroup of the National Health System and their use has been related to possible potentially serious adverse effects. OBJECTIVE: To review the current indications for treatment with PPIs as well as the data related to their safety, in order to promote their adecuate use. MATERIAL AND METHODS: A review of the literature focused on the following topics has been carried out: a) molecules and mechanism of action; b) current indications for treatment and adherence to them; c) adverse effects related to its use; d) drug interactions; e) alternatives in deprescription. RESULTS: The current indications have not changed substantially in recent years and are well established, however, there is a high percentage of inappropriate prescription, mainly in individuals with low or no risk. CONCLUSIONS: PPIs are safe drugs and generally well tolerated and their benefits are higher than possible adverse effects. Adhering to evidence-based recommendations represents the only rational approach to safe and effective therapy.

Are the clinical guideline recommendations on gastroprotection being followed? A review in patients taking nonsteroidal anti-inflammatory drugs. / ¿Qué tanto se siguen las recomendaciones de las guías clínicas sobre gastroprotección? Una revisión en enfermos que consumen antiinflamatorios no esteroideos.

INTRODUCTION AND AIMS: The chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause complications in the gastrointestinal tract. The use of proton pump inhibitors (PPIs) is recommended in high-risk patients to prevent them. OBJECTIVE: The aim of this article was to evaluate the gastroprotection measures taken in persons with chronic NSAID use. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted. The clinical records were reviewed of patients seen as outpatients at the Rheumatology Department over a 4-month period, choosing those with chronic NSAID use, and intentionally looking for gastroprotection measures according to the recommendations published by the American College of Gastroenterology. RESULTS: A total of 417 patients (347 women; mean age: 48.12±14.2 years) were included. The most frequent diagnosis was rheumatoid arthritis (65%). Nine patients (2.1%) had a history of peptic ulcer, 48 (11.5%) patients were 65 years of age or older, 26 (6.2%) patients took NSAIDs and aspirin, and 130 (31.2%) took NSAIDs with steroids. Tests for Helicobacter pylori infection were done in just 53 cases, and there were positive results in only 9 (16%). Some risk for gastrointestinal toxicity was established in 211 cases and only 65 (30.8%) received gastroprotection. In contrast, 31 (15%) patients received gastroprotection when there was no indication for it. CONCLUSION: Prophylaxis with PPIs in chronic NSAID users was inadequately employed. It was not prescribed in the majority of patients (69.2%) and it was used with no justification in others (15%).

Efectos gastroprotectores del D-002 (alcoholes de cera de abejas) y el Lyprinol® sobre la úlcera gástrica experimental en ratas / Gastroprotective effects of D-002 (beeswax alcohols) and Lyprinol® on experimentally-induced gastric ulceration in rats

Introducción: el D‒002, una mezcla de alcoholes de la cera de abejas, efectivo en modelos de osteoartritis y para reducir los síntomas de la misma. A diferencia de los medicamentos antiinflamatorios clásicos el D‒002 produce efectos gastroprotectores más que efectos gastrotóxicos. El Lyprinol, usado para disminuir la inflamación y los síntomas artríticos, mejora los síntomas de disfunción gastrointestinal en sujetos con dicha enfermedad. D‒002 y Lyprinol inhiben las actividades de cyclooxigenasa y 5‒lipooxigenasa, y son similarmente efectivos para reducir la inflamación en modelos experimentales. Objetivo: comparar los efectos del D‒002 y el Lyprinol sobre la mucosa gástrica de ratas normales y de ratas con úlcera gástrica inducida experimentalmente. Métodos: se determinó el índice de úlcera en ratas normales y en ratas con úlceras gástricas inducidas por etanol e inducidas por ligadura de píloro, en las cuales se midió el volumen gástrico y la secreción de mucus. Las ratas normales se distribuyeron en un grupo control (vehículo), uno con ácido acetil salicílico (150 mg/kg), tres con D‒002 y tres con Lyprinol; las ratas con úlcera inducida por etanol en un grupo control (vehículo), tres con D‒002 y tres con Lyprinol; y el experimento con ligadura...(AU)

Introduction: D-002, a mixture of beeswax alcohols, has been effective in osteoarthritis models and for reducing osteoarthritis symptoms. Unlike the classic anti-inflammatory drugs, D-002 elicits gastroprotective rather than gastrotoxic effects. Lyprinol, used for ameliorating inflammation and arthritic symptoms, improves gastrointestinal dysfunction symptoms in osteoarthritis subjects. Both D-002 and Lyprinol inhibit cyclooxygenase and 5?lipoxygenase activities, and have been similarly effective for reducing inflammation experimentally. Objective: to compare the effects of D-002 and Lyprinol on gastric mucosa of normal and experimentally-induced ulcer rats. Methods: ulcer indexes were measured in normal rats and in rats with ethanol or pylorus ligation-induced ulcers, in which gastric volume and mucus secretion were also measured. Normal rats were randomized into a vehicle control, one acetic salicylic acid (150 mg/kg), three D-002, three Lyprinol groups; rats with ethanol-ulcers into a vehicle control, three D-002 and three Lyprinol-treated groups; and the experiment on pylorus ligation included a negative control and eight pylorus-ligated...(AU)

Gastroprotective effects of D-002 (beeswax alcohols) and Lyprinol® on experimentally-induced gastric ulceration in rats

Introduction: D-002, a mixture of beeswax alcohols, has been effective in osteoarthritis models and for reducing osteoarthritis symptoms. Unlike the classic anti-inflammatory drugs, D-002 elicits gastroprotective rather than gastrotoxic effects. Lyprinol, used for ameliorating inflammation and arthritic symptoms, improves gastrointestinal dysfunction symptoms in osteoarthritis subjects. Both D-002 and Lyprinol inhibit cyclooxygenase and 5?lipoxygenase activities, and have been similarly effective for reducing inflammation experimentally. Objective: to compare the effects of D-002 and Lyprinol on gastric mucosa of normal and experimentally-induced ulcer rats. Methods: ulcer indexes were measured in normal rats and in rats with ethanol or pylorus ligation-induced ulcers, in which gastric volume and mucus secretion were also measured. Normal rats were randomized into a vehicle control, one acetic salicylic acid (150 mg/kg), three D-002, three Lyprinol groups; rats with ethanol-ulcers into a vehicle control, three D-002 and three Lyprinol-treated groups; and the experiment on pylorus ligation included a negative control and eight pylorus-ligated groups: one vehicle control, three D-002, three Lyprinol, one omeprazole 10 mg/kg. In all cases, D-002 and Lyprinol (50, 200 and 400 mg/kg) were given orally. Results: unlike D-002 and Lyprinol (50-400 mg/kg), acetic salicylic acid increased ulcer indexes and the incidence of ulcers versus the vehicle control. Single oral doses of D-002 (50-400 mg/kg) or Lyprinol (200 and 400 mg/kg) decreased significantly (p<0.01) and in a similar way ulcer indexes versus the ethanol-positive control. D-002 and Lyprinol (50-400 mg/kg) lowered significantly (p<0.01) and comparably ulcer indexes in rats with pylorus ligation versus the positive controls. D-002 (200 and 400 mg/kg) decreased gastric volume and increased gastric mucus secretion versus the positive control whereas only Lyprinol 400 mg/kg increased the gastric mucus secretion but without modifying the gastric volume. Omeprazole significantly reduced ulcer index (p<0.05) and gastric volume (p< 0.01), with no change in mucus secretion. Conclusion: D-002 and Lyprinol did not show gastrotoxic effects and similar efficacy in protecting against ethanol and pylorus ligation-induced gastric ulceration in rats(AU)

Introducción: el D‒002, una mezcla de alcoholes de la cera de abejas, efectivo en modelos de osteoartritis y para reducir los síntomas de la misma. A diferencia de los medicamentos antiinflamatorios clásicos el D‒002 produce efectos gastroprotectores más que efectos gastrotóxicos. El Lyprinol, usado para disminuir la inflamación y los síntomas artríticos, mejora los síntomas de disfunción gastrointestinal en sujetos con dicha enfermedad. D‒002 y Lyprinol inhiben las actividades de cyclooxigenasa y 5‒lipooxigenasa, y son similarmente efectivos para reducir la inflamación en modelos experimentales. Objetivo: comparar los efectos del D‒002 y el Lyprinol sobre la mucosa gástrica de ratas normales y de ratas con úlcera gástrica inducida experimentalmente. Métodos: se determinó el índice de úlcera en ratas normales y en ratas con úlceras gástricas inducidas por etanol e inducidas por ligadura de píloro, en las cuales se midió el volumen gástrico y la secreción de mucus. Las ratas normales se distribuyeron en un grupo control (vehículo), uno con ácido acetil salicílico (150 mg/kg), tres con D‒002 y tres con Lyprinol; las ratas con úlcera inducida por etanol en un grupo control (vehículo), tres con D‒002 y tres con Lyprinol; y el experimento con ligadura de píloro en un grupo control (vehículo), tres D‒002, tres Lyprinol y uno con omeprazol (10 mg/kg). En todos los casos, el D‒002 y el Lyprinol (50, 200 y 400 mg/kg) se administraron por vía oral. Resultados: el ácido acetil salicílico, no el D‒002 ni el Lyprinol (50‒400 mg/kg), incrementó el índice de úlceras y la incidencia de úlceras comparadas con el grupo control. Dosis orales únicas de D‒002 (50‒400 mg/kg) o Lyprinol (200 y 400 mg/kg) redujeron significativa (p<0,01) y similarmente el índice de úlceras comparado con el grupo control positivo con úlceras por etanol. El D‒002 y el Lyprinol (50‒400 mg/kg) redujeron significativamente (p<0,01) y comparablemente el índice de úlceras en ratas con ligadura de píloro comparado con el grupo control positivo. El D‒002 (200 y 400 mg/kg) redujo el volumen gástrico e incrementó la secreción de mucus gástrico respecto al grupo control positivo; mientras solo el Lyprinol 400 mg/kg aumentó la secreción de mucus gástrico pero sin modificar el volumen gástrico. El omeprazol redujo significativamente el índice de úlcera (p<0,05) y el volumen gástrico (p<0,01), sin modificar la secreción de mucus. Conclusiones: el D‒002 y el Lyprinol no presentaron efectos gastrotóxicos, y protegieron con eficacia similar de las úlceras gástricas inducidas por etanol y por ligadura del píloro en ratas(AU)

Utilización de AINES y uso de IBP profilácticos en pacientes de medicina interna / The Use of NSAIDs Combined with Prophylactic Use of PPIs for Internal Medicine Patients

Introducción: los antiinflamatorios no esteroideos (AINES) son prescritos con frecuencia en la práctica médica y sus eventos adversos gastrointestinales aumentan la morbimortalidad, la cual puede disminuir utilizando profilácticamente inhibidores de la bomba de protones (IBP), misoprostol o anti H2. Objetivo: estimar la prevalencia de consumo de AINES en una población de consulta externa de Medicina Interna y, en ellos, determinar la frecuencia de prescripción profiláctica de IBP en pacientes con riesgo de sangrado gastrointestinal.Métodos: estudio prospectivo de prevalencia analítica con pacientes mayores de 18 años de la consulta externa de Medicina Interna de la Fundación Hospital San Carlos de Bogotá. Los pacientes consumidores de AINES fueron clasificados en tres grupos de riesgo de sangrado gastrointestinal con base en los factores de riesgo tradicionalmente descritos. Resultados: de 140 pacientes incluidos, el 30% tomaban AINES. El 47,6% (n=20) fueron clasificados en el grupo de bajo riesgo, el 28,5% (n=12) en el grupo de riesgo intermedio y el 23,8% (n=10) en el grupo de alto riesgo. El 47% (20 pacientes) de los que consumían AINES tomaban simultáneamente IBP. Con respecto a los grupos de riesgo, consumían IBP el 80% de alto riesgo, el 50% de riesgo intermedio y el 30% de bajo riesgo. Conclusión: en la población estudiada, la prescripción de IBP en pacientes de alto riesgo es superior a la informada en trabajos internacionales (80% versus menos del 50%). Hay formulación de IBP innecesaria en el 30% de los pacientes de bajo riesgo.

Introduction: Adverse gastrointestinal events related to non-steroid anti-inflammatory drugs (NSAIDs) which are frequently prescribed in medical practice increase morbidity and mortality. These can be reduced through prophylactic use of proton pump inhibitors proton pump (PPIs) or misoprostol anti H2. Objective: The objective of this study was to estimate the prevalence of NSAIDs use in a population of internal medicine outpatients and to determine the frequency of prophylactic prescriptions of PPIs for patients at risk of gastrointestinal bleeding. Methods: This was a prospective and analytical study of prevalence among patients over 18 years of age in the Internal Medicine outpatient service at the Hospital San Carlos in Bogota. Patients who consume NSAIDs were classified into three risk groups based on traditionally described risk factors for gastrointestinal bleeding. Results: Thirty percent of the 140 enrolled patients were taking NSAIDs. 47.6 % (n = 20) were classified in the low risk group, 28.5 % (n = 12) in the intermediate-risk group and 23.8 % (n = 10) in the high risk group. 47% (20 patients) of those taking NSAIDs were simultaneously taking PPIs. Eighty percent of the high risk group, 50% of the intermediate-risk group, and 30% of the low risk group were taking PPIs. Conclusion: PPIs were prescribed more frequently for high risk patients in this study population (80%) than has been that reported in international publications (less than 50%). The prescription of PPIs for 30% of the low risk patients is unnecessary.