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Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Triple therapy has been recommended as the most effective treatment for Helicobacter pylori eradication. Despite achieving a comparatively high eradication result, however, around 10% of patients still fail to be cured. Omeprazole can enhance efficacy of single and double antibiotic protocols and is particularly effective when combined with clarithromycin and a nitroimidazole. This study examined the effect of combining triple therapy with omeprazole. A prospective, randomised, unblinded, single centre trial was carried out on consecutive patients with symptoms of dyspepsia and H pylori infection confirmed by rapid urease test, microbiological culture, and histological assessment. Patients were given a five times/day, 12 day course of colloidal bismuth subcitrate chewable tablets (108 mg), tetracycline HCl (250 mg), and metronidazole (200 mg) with either 20 mg omeprazole twice daily (triple therapy+omeprazole) or 40 mg famotidine (triple therapy+famotidine) at night. Compliance and side effects were determined using a standard questionnaire form. One hundred and twenty five of 165 triple therapy+omeprazole patients and 124 of 171 triple therapy+famotidine patients returned for rebiopsy four weeks after completion of treatment. Significantly more triple therapy+omeprazole patients achieved eradication 122 of 125 (97.6%) as assessed by negative urease test, culture, and histological assessment, when compared with 110 of 124 (89%) triple therapy+famotidine patients (p = 0.006; chi 2). There were 30 triple therapy+omeprazole (24%) and 26 triple therapy+famotidine (21%) patients with de novo metronidazole resistant H pylori included in the study. Side effects were mild and infrequent and were comparable in both groups, although pain in duodenal ulcer, gastric ulcer, and oesophagitis patients seemed to subside earlier in those taking omeprazole. Compliance (>95% of drugs taken) was achieved by 98% of patients of both groups. A 12 days regimen of triple therapy with omeprazole is more effective in achieving H pylori eradication than is triple therapy plus famotidine. Use of 20 mg omeprazole twice daily rather than 40 mg famotidine with a 12 day, low dose triple therapy enhances eradication to over 97% whether the H pylori is metronidazole sensitive or resistant.
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PMID:Omeprazole enhances efficacy of triple therapy in eradicating Helicobacter pylori. 748 31

We have administered Isobutyramide as a suspension over a period of 3 months, from a starting dose of 50 mg/kg/day up to 150 mg/kg/day, to four adult sickle cell (SS) anemia patients. The maximum dose was maintained for 3 weeks. The blood counts remained stable and the Hb F levels decreased slightly. The G gamma levels increased at the end of the trial, suggesting activation of the G gamma gene at the highest dose of Isobutyramide. Three patients showed a stable rate of hemolysis, while in one patient, an increase of lactate dehydrogenase occurred. None of the patients experienced pain crisis or organ-specific crisis, but all four complained about mild epigastric burning and a bitter taste. After the first month of treatment one patient complained about intolerable epigastric discomfort which was relieved by Omeprazole. Another patient complained about increasing dyspepsia in the 12th week leading to the termination of the trial. Oral Isobutyramide administration does not qualify as an effective treatment of SS patients.
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PMID:Isobutyramide therapy in patients with sickle cell anemia. 754 4

With rare exception, peptic ulcers can now be classified as either Helicobacter pylori-related, induced by nonsteroidal anti-inflammatory drugs (NSAIDs), or related to Zollinger-Ellison syndrome. Helicobacter pylori-related ulcers can be treated by eradication of H pylori or by traditional therapies, including antisecretory drugs or sucralfate. Successful eradication of H pylori requires compliance with a multidrug regimen. Therefore, candidates should demonstrate substantial motivation. In general, the greater the degree of ulcer recurrence or resistance, the stronger the indication for H pylori eradication. Sucralfate is effective in healing H pylori-related duodenal ulcers, and H2 receptor antagonists heal H pylori-related duodenal and gastric ulcers. Omeprazole provides faster healing of H pylori-related ulcers, and is particularly useful in treating large gastric ulcers. Dyspepsia induced by NSAIDs and NSAID-related endoscopic erosions are managed by stopping NSAID use or reducing the dosage; administering NSAIDs with meals; and administering H2 receptor antagonists in full split-doses. NSAID-induced duodenal ulcers and small gastric ulcers can be healed with full split-doses of H2 receptor antagonists, even while the NSAID is continued. Large (> 5 mm) NSAID-induced gastric ulcers are most efficiently treated with omeprazole, particularly if the patient continues to take the NSAID.
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PMID:An etiologic approach to management of duodenal and gastric ulcers. 828 53

Gastrointestinal involvement occurs in most patients with systemic sclerosis and is subclinical in about one third. Early pathology is characterized by vasculopathy, resulting in tissue ischemia and progressive dysfunction. Noninvasive esophageal studies using semisolid bolus scintigraphy are sensitive but lack specificity. Long-term treatment of reflux with high-dose proton pump inhibitors appears safe and effective for symptom relief and may prevent recurrence of esophagitis and stricture. Dyspepsia may result from gastroparesis and antral distension. Gastric antral vascular ectasia is a vascular manifestation, and bleeding may be controlled endoscopically. Prokinetic agents effective in pseudoobstruction include metoclopramide, domperidone, cisapride, octreotide, and erythromycin. Patients with intestinal neuropathy or response to bolus octreotide are more probable long-term responders. The combination of octreotide and erythromycin may be particularly effective in systemic sclerosis. The combination of cisapride and erythromycin may cause serious cardiac arrhythmia and is contraindicated. Omeprazole may predispose to small intestinal bacterial overgrowth. Malabsorption not responding to antibiotic therapy should be investigated with small-bowel biopsy to rule out more unusual causes. Pneumatosis cystoides intestinalis may be due to excessive hydrogen production by intestinal bacteria altering the partial pressure of nitrogen in the intestinal wall. In selected cases, surgery for intestinal failure is an option with resection or bypass of affected segments or placement of enterostomy tubes for feeding or decompression. Careful preoperative characterization of intestinal segments is required.
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PMID:Gastrointestinal features of scleroderma. 901 61

Omeprazole triple therapy has been shown to produce Helicobacter pylori eradication rates of up to 96% in patients with current or recent peptic ulceration. Such therapy is also now being used without endoscopy in H. pylori-positive patients who may have an inactive ulcer or dyspepsia, and in whom their effectiveness has been less well documented. Compliance is an important variable affecting H. pylori eradication; with 1-week omeprazole triple therapy, however, compliance is uniformly high, and this allows more detailed analysis of other causes of treatment failure. The strains of H. pylori in patients with functional dyspepsia may be associated with a lower degree of inflammation. Two new, large studies (DU-MACH and GU-MACH) have therefore looked at the impact of inflammation on H. pylori eradication. Polymorph infiltration in the antrum of patients with inflammation of grades 2/3 was associated with a significantly higher eradication rate when compared with inflammation of grades 0/1. Inflammation may be important for a number of reasons, including degradation of the mucus and epithelial layers (which may allow better penetration of charged antibiotics from the gastric lumen) and altered vascular and epithelial permeability (which may allow better systemic delivery of drugs). Alternatively, inflammation may be a marker for more aggressive H. pylori subtypes, which are also more vulnerable to antibiotic therapy.
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PMID:Is there any difference in Helicobacter pylori eradication rates in patients with active peptic ulcer, inactive peptic ulcer and functional dyspepsia? 1050 19

Omeprazole combined with 2 antimicrobials has been suggested as a first-line option for Helicobacter pylori eradication in recent years. However, controversy exists regarding the efficacy of this protocol. This open-label, prospective clinical study investigated the efficacy of omeprazole-based triple therapy for H pylori eradication in 518 patients with H pylori-positive functional dyspepsia with or without duodenal ulcer. Amoxicillin, macrolides (clarithromycin or roxithromycin), and nitroimidazoles (metronidazole, ornidazole, or tinidazole) were the antibiotics used in the study. Nonulcer patients were randomly assigned to 1 of 8 different treatment protocols and duodenal ulcer patients were randomly assigned to 1 of 4 different treatment protocols consisting of omeprazole (20 mg once daily for nonulcer patients, 20 mg twice daily for ulcer patients for 14 days) with a combination of 2 of the above antimicrobials (for 10 days). H pylori infection was assessed by histologic findings and a rapid urease test before therapy and 4 weeks after therapy ended. Four hundred fifty-nine patients completed their regimens; 327 had functional dyspepsia (180 men, 147 women; median age, 39 years; range, 18 to 70 years) and 132 had ulcers (81 men, 51 women; median age, 40 years; range, 18 to 70 years). Eradication of H pylori was achieved in 58.8% (270 of 459) of all patients, 58.1% (190 of 327) of nonulcer dyspeptic patients, and 60.6% (80 of 132) of duodenal ulcer patients. The eradication rate varied from 47.2% to 69.4% in different treatment protocols. There were no statistically significant differences in eradication rates in any treatment group. All drugs were generally well tolerated in all groups, and no patient discontinued treatment because of side effects. Therapy with omeprazole and 2 antimicrobials for H pylori had limited efficacy in a Turkish population. The reason for these results, which conflict with those of other studies, is not clear. Further investigations of regimens for the eradication of H pylori in our population are necessary.
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PMID:Efficacy of omeprazole plus two antimicrobials for the eradication of Helicobacter pylori in a Turkish population. 1111 61

Use of low-dose aspirin is associated with gastroduodenal mucosal damage and increased risk of upper gastrointestinal (GI) bleeding. Many patients on low-dose aspirin should receive prophylactic treatment, because they often present several risk factors that may lead to upper GI complications in nonsteroidal anti-inflammatory drug (NSAID) users. It is reasonable to assume that effective therapy (e.g., omeprazole, misoprostol, and high-dose famotidine) in the prevention of NSAID-induced gastroduodenal ulcers will also be effective in this setting. However, the best therapeutic approach to reducing GI toxicity in low-dose aspirin users is not defined, because only a few studies have focused on this problem. Omeprazole seems very effective in reducing both acute gastroduodenal mucosal damage and upper GI bleeding in the high-risk patient taking low-dose aspirin, but data with other antiulcer agents are lacking (misoprostol) or inconsistent (ranitidine) at present. No data are available on the effect of these drugs on dyspepsia or chronic gastroduodenal ulcers in the long-term use of low-dose aspirin. The role of Helicobacter pylori is controversial, but it may increase mucosal damage and the risk of upper GI bleeding in these patients. More data are needed to define the best therapeutic regimen in patients taking low-dose aspirin.
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PMID:Current approaches to reducing gastrointestinal toxicity of low-dose aspirin. 1116 3

It is rather difficult to choose a drug to treat nonsteroidal anti-inflammatory drug (NSAID)-induced gastropathies in patients with rheumatic diseases, which primarily makes it necessary to use antiulcerous treatment as part of continuous NSAID therapy. Detecting upper gastric ulcers or erosions in many patients admitted to a rheumatology hospital for exacerbation of the underlying disease cannot cause NSAID to be discontinued even temporarily as this may lead to a significant deterioration and progression of the joint syndrome. The aim of the study was to evaluate the efficiency of 2-week treatment with misoprostol (Cytotec), 800 micrograms/day, and omeprasole (Omez), 40 mg/day, for NSAID-induced gastropathy in 63 patients with rheumatic diseases. The study has indicated that the use of Omez seems to be more advisable than that of Cytotec in the treatment of NSAID-induced gastropathy if it is necessary to continue to treat the patient with a whole range of antirheumatic drugs. Equally effective in healing ulcers and erosions, Omez is much better tolerated and able to rapidly relieve gastralgias and dyspepsia. It seems that the use of Cytotec for NSAID-induced gastropathy with a great deal of side effects and relatively less efficiency borne in mind may be limited because of cases of inefficiency of proton pump inhibitors.
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PMID:[Omeprazole and misoprostol for NSAID-induced gastropathies: comparative efficiency of their short-term treatment]. 1151 Jan 88

The results of two treatment types of the patients with chronic gastritis and with non-ulcerative functional dyspepsia (NFD) at reflux-similar variant are represented. The patients received Omeprasol (Losec) or Rabeprasol (Pariet) accordingly 20 mg once per day in the morning, 30-60 minutes before the breakfast. The treatment course was 7 days. The investigations have shown the following: the level of acidity has decreased in all the patients treated by Rabeprasol, normal acidity is detected in the all 15 patients, the level of gastric acidity has decreased in the patients, treated by Omeprasol. However the hyperacidity was preserved in 10 from 12 patients.
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PMID:[Inhibitors of proton pump in the treatment of non-ulcer functional dyspepsia of the reflux-like type]. 1204 84

Omeprazole (Prilosec) 20 mg is highly effective for the treatment of acid-related dyspepsia. There was no advantage to higher doses, and relapse following the initial 2-week treatment period was common.
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PMID:Omeprazole 20 mg equal to 40 mg for primary care acid-related dyspepsia. 1552 22


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