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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pharmacologic management of peptic ulcer disease continues to evolve with the introduction of diverse types of new therapeutic agents. The ideal aims of treatment of peptic ulcer disease are to relieve pain, heal the ulcer, and delay ulcer recurrence. This article provides a broad perspective on the pharmacology and therapeutic actions of antiulcer drugs. To date, no drug meets all goals of therapy. Drug treatment of peptic ulcers is targeted at either counteracting aggressive factors or stimulating the mucosal defense. Drugs that inhibit or neutralize gastric acid secretion include histamine H2-receptor antagonists, proton pump inhibitors, anticholinergics, prostaglandins, and antacids. H2-receptor antagonists have become first-line drugs for treatment of uncomplicated duodenal ulcers, gastric ulcers, prevention of ulcer relapse, and mild esophagitis. However, H2-receptor antagonists, like other gastric antisecretory/antiulcer drugs, have high rates of ulcer recurrence following discontinuation of therapy. They therefore need to be administered continuously in patients prone to such recurrences. Omeprazole has emerged as a major drug for the treatment of severe erosive esophagitis, refractory ulcers, and Zollinger-Ellison syndrome. The major disadvantage of proton pump inhibitors is the concern for their long-term safety. The roles of M1-antimuscarinic agents and antacids have not been fully defined. Misoprostol, effective for the treatment of gastric and duodenal ulcers, is now the only drug that prevents ulcers induced by nonsteroidal anti-inflammatory drugs. Mucosal protective drugs that do not inhibit gastric acid secretion include sucralfate and organic bismuth salts. Sucralfate is a nonsystemic, well-tolerated, effective drug for treatment of duodenal ulcers and prevention of duodenal ulcer relapse. The organic bismuth salt bismuth subcitrate is efficacious in the treatment of duodenal and gastric ulcers. Furthermore, it has also been established that it alters the course of ulcer recurrence. However, bismuth encephalopathy is a major toxicity concern that needs to be addressed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Drugs for treatment of peptic ulcers. 135 99

Omeprazole, a proton pump inhibitor, is a potent and long-acting gastric acid reducing agent. To assess its short-term efficacy and safety, 27 gastric ulcers (GU) and 40 duodenal ulcers (DU) in 64 patients were treated with 20 mg. Omeprazole was given once daily. At 2 weeks, the healing rate for gastric ulcers was 66% (18/27) and for duodenal ulcers, 78% (31/40). At 4 weeks, the healing rate was 85% and 95% for GU and DU, respectively. Pain relief was achieved after 2 weeks in 62% with GU and 61% in DU. There were no significant side effects noted during the treatment course. Omeprazole is effective and safe in the treatment of gastric and duodenal ulcers.
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PMID:An open trial on short-term omeprazole therapy for gastric and duodenal ulcers. 188 55

To assess the comparative efficacy of omeprazole 20 mg, a proton pump inhibitor, versus ranitidine 150 mg twice a day, an H2-receptor antagonist, in healing duodenal ulcers we performed a randomized, double-blind, multicenter trial in 309 patients with endoscopically diagnosed ulcers. Patients were treated for up to four weeks and were seen at week 2 and at week 4, if unhealed at week 2, for determination of ulcer status by endoscopy, review of daily self-assessment symptom diaries, and clinical laboratory including fasting serum gastrin. Gastrin levels were repeated two weeks after cessation of study medication. Evaluation of baseline demographic and laboratory parameters demonstrated no significant differences between the two groups at entry. At week 2, 42% of the omeprazole and 34% of the ranitidine-treated patients were healed (P = NS). At week 4, there was a 19% advantage in ulcer healing for the omeprazole-treated patients in comparison to those treated with ranitidine (82% vs 63%, respectively, P less than 0.05). Healing of ulcers greater than or equal to 1.0 cm occurred in 83% of those treated with omeprazole versus 37% treated with ranitidine (P less than 0.01). There were no significant differences in rate of pain relief or incidence of clinical laboratory abnormalities. Mean fasting serum gastrin value during treatment increased over the baseline in both groups, (P less than 0.05). The percent change was significantly greater with omeprazole but few patients had elevations above the upper limit of normal for the assay. Both drugs were well tolerated. Omeprazole 20 mg demonstrated superiority in healing duodenal ulcers at four weeks in comparison to ranitidine 150 mg twice daily and was more effective in healing ulcers greater than or equal to 1.0 cm.
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PMID:U.S. experience with omeprazole in duodenal ulcer. Multicenter double-blind comparative study with ranitidine. The Omeprazole DU Comparative Study Group. 203 18

Transient esophageal ulceration is a common finding after sclerotherapy of varices. A small proportion of these ulcers become chronic and resistant to conventional therapy. Such chronic ulcers have been associated with pain, stricture formation, and recurrent hemorrhage. The use of omeprazole, a proton pump inhibitor, was examined in the current study in the treatment of 10 patients (6 women, 4 men; age range, 27-86 years) with cirrhosis (PBC, 4; sclerosing cholangitis, 2; chronic active liver disease, 2; alcohol, 1; and cryptogenic, 1) who developed an esophageal ulcer after a mean of 13 (range, 8-21) sessions of sclerotherapy. The ulcers had been present for 3-54 months despite prolonged treatment with high-dose H2-receptor antagonists and sucralfate. In each case one or more complications had occurred: severe pain in 3, stricture formation in 4, and recurrent hemorrhage in 7 cases. After an 8-week course of omeprazole, 40 mg daily, endoscopy confirmed complete healing of the ulceration in all 10 cases with symptom resolution. In 2 cases the ulcer recurred, with associated bleeding within 6 weeks of discontinuing the treatment in 1 patient. Both cases responded to repeat therapy. These results confirm the efficacy of omeprazole for postsclerotherapy ulceration and imply that acid-pepsin has a role in perpetuating such ulcers.
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PMID:Omeprazole in the management of intractable esophageal ulceration following injection sclerotherapy. 222 99

The study objective was to study the ulcer healing effects and safety of the proton pump inhibitor, omeprazole, given in a dose of 20 mg once daily before breakfast. The study design was a randomized, double-blind, multicenter comparison of omeprazole and placebo using endoscopy to assess ulcer healing after two or four weeks of therapy. One hundred fifty-three patients with endoscopically documented active duodenal ulcer were studied. One hundred two patients received omeprazole and 51 received placebo. Patients in both groups were similar with regard to age, sex, duration of disease, initial ulcer size, smoking history, and alcohol use. A "per protocol" analysis of healing rates showed a significant advantage for omeprazole (P less than 0.01) at both week 2 (41% vs 13%) and week 4 (75% vs 27%). Concomitant factors (including smoking and ulcer size) did not alter the significance of the differences in healing rates between omeprazole and placebo. Complete relief of day and night pain was more often achieved (P less than 0.01) in the omeprazole group. "All-patients treated" analyses for healing and pain relief gave results similar to the respective "per protocol" analyses. Omeprazole was well tolerated; fewer patients had clinical and laboratory adverse experiences in the omeprazole group than in the placebo group. Fasting serum gastrin levels increased with omeprazole therapy (mean 34.9 to 73.5 pg/ml) but exceeded the normal range (greater than 150 pg/ml) in only 12.3% of patients. Two weeks after therapy was stopped, serum gastrin levels showed a decrease toward baseline but had not yet completely returned to pretreatment levels (mean 49.7 pg/ml).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Omeprazole versus placebo in duodenal ulcer healing. The United States experience. 240 8

We conducted a six week double blind randomised study of 176 patients with prepyloric gastric ulcer to determine whether the proton pump inhibitor, omeprazole 30 mg daily would accelerate healing and pain relief, as compared with cimetidine 1 g daily. At two, four, and six weeks after entry ulcers healed in a larger percentage of patients treated with omeprazole (54, 81, and 86%) than of those treated with cimetidine (39, 73, and 78%) ('intention to treat' cohort; p less than 0.05 at two weeks). A higher proportion of patients on omeprazole became free of pain during the first week of treatment (p less than 0.05). No major clinical or biochemical side effects were noted. Omeprazole is an efficient treatment for patients with prepyloric gastric ulcers.
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PMID:Effect of omeprazole and cimetidine on prepyloric gastric ulcer: double blind comparative trial. 327 55

Omeprazole is a proton pump inhibitor which induces a dose-dependent reduction of gastric acid secretion. To assess its efficacy in healing and alleviating the symptoms of duodenal ulcer, a randomized and double-blind study was conducted in 26 French centers comparing omeprazole 20 mg o.m. with cimetidine 400 mg b.i.d. After two weeks' treatment (285 cases), healing, assessed by endoscopy, was obtained in 64.5 p. 100 of omeprazole-treated patients, and in 44.3 p. 100 of cimetidine-treated patients (p = 0.0008). After 4 weeks treatment (232 cases), 90.1 p. 100 of omeprazole-treated patients healed, compared to 79.3 p. 100 of cimetidine-treated patients (p = 0.03). After 2 weeks treatment, there was no difference between the groups as far as nocturnal pain was concerned; however there was a significant difference in favor of omeprazole in the resolution of mild or moderate day-time pain (p = 0.01). There were no clinical or biochemical adverse events which could be ascribed to either of the treatments tested.
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PMID:[Comparative efficacy of omeprazole and cimetidine in the treatment of duodenal ulcer in the acute stage. A French multicenter, controlled therapeutic trial]. 332 22

To date, the primary therapeutic approach to peptic ulcer disease, either gastric or duodenal ulcer, remains the inhibition of gastric acid secretion. The major therapeutic goals in peptic ulcer disease are symptom relief, acceleration of crater healing, and the prevention of relapse or recurrence. Since the introduction of H2-receptor antagonists and proton pump inhibitors, the full control of acid secretion can be achieved. In the treatment of gastric ulcer, analysis of all studies that have compared lansoprazole, a newly developed proton pump inhibitor, and H2-receptor antagonists has shown a statistically significant difference for a higher healing rate with lansoprazole. In most of the comparative studies, the time to epigastric pain relief was shorter after receiving lansoprazole than after H2-receptor antagonists. In a single study comparing lansoprazole with omeprazole in 126 gastric ulcer patients, the healing rate at 8 weeks was significantly higher (P = 0.04) for lansoprazole than for omeprazole (93% vs 82%). In most studies comparing lansoprazole to H2-receptor antagonists in the treatment of duodenal ulcer, the healing rates at 4 weeks were significantly higher in the lansoprazole group. The time to achieve epigastric pain relief was significantly shorter with lansoprazole. In a single study comparing lansoprazole with omeprazole, ulcer healing rates at 2 weeks were significantly higher for lansoprazole (74% vs 58%) but not at 4 weeks (94% vs 94%). In conclusion, lansoprazole is more effective than H2-receptor antagonists in relieving ulcer pain and has a similar safety profile in the healing of gastric and duodenal ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Progress with proton pump inhibitors in acid peptic disease: treatment of duodenal and gastric ulcer. 791 99

Heartburn and epigastric pain are the leading symptoms of reflux disease. Next to other symptoms like pharyngeal burning, regurgitation and retrosternal pain, chronic hoarseness and coughing as well as angina pectoris symptoms may point towards a pathological reflux. In endoscopically verified reflux esophagitis proton pump inhibitors are the treatment of first choice. Aim of therapy is loss of symptoms, healing of epithelial defects and prevention of Barrett's esophagus. If a columnar epithelium-lined esophagus is seen, surveillance is recommended in one- or two-year intervals.
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PMID:[Reflux disease and Barrett esophagus--monitoring and therapy]. 802 95

Omeprazole, a proton pump inhibitor, was added to the treatment regimen of seven patients with biopsy proven inflammatory bowel disease. Six of the seven patients showed a marked clinical improvement in symptoms, especially pain and diarrhea after starting omeprazole. One of the six is using omeprazole as her sole medication for her colitis currently. Others have been able to decrease steroid doses. A possible mechanism of action relates the similar chemical structure of omeprazole to metronidazole which is efficacious in colitis.
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PMID:Is omeprazole helpful in inflammatory bowel disease? 807 18


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