Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038358 (gastric ulcer)
 5,179 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although the approved indications for long-term histamine (H2) receptor-antagonists are limited to the management of hypersecretory states and prophylaxis against recurrent duodenal ulcer, these agents are often prescribed indiscriminately. Definitive guidelines concerning proper patient selection for prophylaxis against duodenal ulcer recurrence are lacking. Persons likely to benefit from maintenance therapy include those who smoke and those with a long duration of symptoms or prior history of an ulcer complication. Although not an approved indication, maintenance therapy to prevent recurrent gastric ulcer is appropriate for elderly persons receiving nonsteroidal anti-inflammatory drugs or in patients with poor cardiopulmonary status who may not tolerate surgery for an ulcer-related complication. The role of long-term H2-antagonist therapy in reflux esophagitis is not defined but may be appropriate in scleroderma and Barrett's esophagus. Finally, several miscellaneous conditions, including cystic fibrosis, Menetrier's disease, and pancreatic exocrine insufficiency, may benefit from long-term H2-antagonist therapy. Currently, clinical trials document the efficacy of maintenance therapy in duodenal ulcer for up to a three-year period; however, for gastric ulcer and chronic reflux esophagitis, the duration and benefit of long-term therapy is not established, and treatment regimens need to be individualized. Therapy may be required indefinitely in the miscellaneous states mentioned previously.
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PMID:Rational approach to long-term use of H2-antagonists. 288 77

It is clear that CP is present in a higher or lower degree in different gastric-duodenum pathologies, especially in active superficial chronic gastritis, gastric ulcer and duodenum ulcer with gastric metaplasia. It is also found in atrophic chronic gastritis and, to a lesser extent, if it has intestinal metaplasia, as well as in some normal stomachs. It is not found in a histologically normal duodenum, nor in the oesophagus. As the fact that there was no publication on BE drew our attention, we set to make a retrospective research of CP of spinal metaplasia of distal oesophagus. Its presence proved to be high, 88% even in those cases with intestinal metaplasia and with ulcer of Barrett. We have used Gram coloration and Warthin Starry with Alcian-Blue and we have classified it within the degrees set by Marshall and Warren. We have also carried out a discussion on certain physiopathological facts, such as the presence of infiltrated PMN in all the cases, and its importance in keeping metaplasia, of ulcers of Barrett and its possible role in the development of adenocarcinoma.
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PMID:[Organisms of the Campylobacter type in Barrett esophagus]. 344 90

Bile reflux has been implicated in the pathogenesis of gastritis, gastric ulcer, and esophagitis. Radionuclide techniques provide the only non-invasive method to detect duodenogastric reflux. To analyze the problems that occur with attempts at quantitation, 55 patients were prospectively evaluated (45 patients with reflux esophagitis or Barrett's esophagus and ten patients with clinical symptoms of bile reflux, four of whom had Bilroth II surgery) with Tc-99m DISIDA, using a fasting technique with gallbladder stimulation by sincalide. Visual duodenogastric reflux occurred in 16 of 55 patients. Overlap of small bowel with the stomach is the major problem for accurate quantitation and occurred in 20 of 55 patients (36%). Overlap of left lobe of the liver occurred in 40 of 55 patients (73%), but its contribution to gastric activity was slight and could be easily subtracted. Reflux was intermittent in six of the 16 positive studies (38%), and continuous computer acquisition is needed to detect its maximum value. Primarily because of the problem of small bowel overlap, scintigraphic evaluation of duodenogastric reflux is only, at best, semi-quantitative. A review of the technical variables used in this examination, as well as potential problems that can occur, is provided.
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PMID:Scintigraphic evaluation of duodenogastric reflux. Problems, pitfalls, and technical review. 358 23

Lansoprazole is a proton pump inhibitor that reduces gastric acid secretion. It has proved effective in combination regimens for the eradication of Helicobacter pylori and as monotherapy to heal and relieve symptoms of gastric or duodenal ulcers and gastro-oesophageal reflux. After initial healing, it may be used to prevent recurrence of oesophageal erosions or peptic ulcers in patients in whom H. pylori is not the major cause of ulceration and to reduce basal acid output in patients with Zollinger-Ellison syndrome. Usual dosages are 15 to 60 mg/day, although dosages of < or = 180 mg/day have been used in patients with hypersecretory states. In patients with duodenal or gastric ulcer, short term lansoprazole monotherapy was similar to omeprazole and superior to histamine H2 receptor antagonists in achieving healing rates > 90%. Lansoprazole was as effective a component of H. pylori eradication regimens as omeprazole, tripotassium dicitrato bismuthate (colloidal bismuth subcitrate) or ranitidine. Lansoprazole was superior to ranitidine in symptom relief and healing of gastro-oesophageal reflux disease and tended to relieve symptoms more rapidly than omeprazole, although initial healing was similar. As maintenance treatment, lansoprazole was similar to omeprazole and superior to ranitidine in relieving symptoms and preventing relapse. Lansoprazole was also superior to ranitidine in healing and relieving symptoms of oesophageal erosions associated with Barrett's oesophagus; healing was maintained for a mean of 2.9 years in > or = 70% of patients. Lansoprazole was also superior to ranitidine in prophylaxis of redilatation of oesophageal strictures. After > or = 4 years of use in patients with Zollinger-Ellison syndrome, lansoprazole 60 to 180 mg/day effectively controlled basal acid output. Dosages may be reduced in some patients once healing and symptom relief has been achieved. Preliminary studies of lansoprazole in patients at risk of aspiration pneumonia or stress ulcers show promise. Although studies show lansoprazole is potentially effective in treating gastrointestinal bleeding, future studies should assess patients' H. pylori status. Lansoprazole has been well tolerated in clinical trials, with headache, diarrhoea, dizziness and nausea appearing to be the most common adverse effects. Tolerability of lansoprazole does not deteriorate with age and the drug is well tolerated in long term use (< or = 4 years) in patients with Zollinger-Ellison syndrome or reflux disease. Thus, lansoprazole is an important alternative to omeprazole and H2 receptor antagonists in acid-related disorders. In addition to its efficacy in healing or maintenance treatment, it may provide more effective symptom relief than other comparator agents.
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PMID:Lansoprazole. An update of its pharmacological properties and clinical efficacy in the management of acid-related disorders. 927 7

Proton pump inhibitors (PPIs) are drugs which irreversibly inhibit proton pump (H+/K+ ATPase) function and are the most potent gastric acid-suppressing agents in clinical use. There is now a substantial body of evidence showing improved efficacy of PPIs over the histamine H2 receptor antagonists and other drugs in acid-related disorders. Omeprazole 20 mg/day, lansoprazole 30 mg/day, pantoprazole 40 mg/day or rabeprazole 20 mg/day for 2 to 4 weeks are more effective than standard doses of H2-receptor antagonists in healing duodenal and gastric ulcers. Patients with gastric ulcers should receive standard doses of PPIs as for duodenal ulcers but for a longer time period (4 to 8 weeks). There is no conclusive evidence to support the use of a particular PPI over another for either duodenal or gastric ulcer healing. For Helicobacter pylori-positive duodenal ulceration, a combination of a PPI and 2 antibacterials will eradicate H. pylori in over 90% of cases and significantly reduce ulcer recurrence. Patients with H. pylori-positive gastric ulcers should be managed similarly. PPIs also have efficacy advantages over ranitidine and misoprostol and are better tolerated than misoprostol in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs). In endoscopically proven gastro-oesophageal reflux disease, standard daily doses of the PPIs are more effective than H2-receptor antagonists for healing, and patients should receive a 4 to 8 week course of treatment. For severe reflux, with ulceration and/or stricture formation, a higher dose regimen (omeprazole 40 mg, lansoprazole 60 mg, pantoprazole 80 mg or rabeprazole 40 mg daily) appears to yield better healing rates. There is little evidence that PPIs lead to resolution of Barrett's oesophagus or a reduction of subsequent adenocarcinoma development, but PPIs are indicated in healing of any associated ulceration. In Zollinger-Ellison syndrome, PPIs have become the treatment of choice for the management of gastric acid hypersecretion.
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PMID:Proton pump inhibitors. Pharmacology and rationale for use in gastrointestinal disorders. 977 9

In the MUSE classification of gastroesophageal reflux disease (GERD), esophagitis is assessed by the presence of metaplasia, ulcer, stricture, or erosion, each being graded as absent, mild or severe. Daily reflux symptoms affect about 4 to 7 percent of the population; erosive esophagitis occurs in about 2 percent; the prevalence rate of Barrett's metaplasia is 0.4 percent; and esophageal adenocarcinoma leads to two deaths per million living population. In persons with GERD symptoms, about 20 percent are found to have erosive esophagitis, while ulcers or strictures are found in less than 5 percent of all patients with erosive esophagitis. No clear-cut temporal progression exists between successive grades of disease severity, as the most severe grade of GERD is reached at the onset of the disease. Mild forms of GERD tend to be more common in women than men, while severe GERD characterized by erosive esophagitis, esophageal ulcer, stricture or Barrett's metaplasia are far more common in men than women. All forms of GERD affect Caucasians more often than African Americans or Native Americans. The prevalence of GERD is high among developed countries in North America and Europe and relatively low in developing countries in Africa and Asia. During the past three decades, hospital discharges and mortality rates of gastric cancer, gastric ulcer and duodenal ulcer have declined, while those of esophageal adenocarcinoma and GERD have markedly risen. These opposing time trends suggest that corpus gastritis secondary to Helicobacter pylori infection protects against GERD. This hypothesis is consistent with the geographic and ethnic distributions of GERD. Case-control studies also indicate that cases with erosive esophagitis are less likely to harbor active or chronic corpus gastritis than controls without esophagitis.
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PMID:Clinical epidemiology and natural history of gastroesophageal reflux disease. 1078 May 69

General practitioners may gain valuable information from the use of open access endoscopy. The benefit to the individual patient depends on the interpretation of the endoscopy findings and the subsequent action. The aim of the study was to determine GPs response to open access endoscopy findings of three conditions with possible malignant complications: Barrett's oesophagus, gastric ulcer and colonic adenomatous polyps. The study took place at Ninewells Hospital, Dundee. Using the endoscopy unit's records for the year, 1 January 1995 to 31 December 1995, all patients having had an open access upper gastro-intestinal endoscopy or sigmoidoscopy were identified. Case-notes were reviewed of patients who had Barrett's oesophagus, gastric ulcer or colonic polyps diagnosed. During the year, 1158 upper gastro-intestinal endoscopies and 293 sigmoidoscopies were performed by the open access service. The referral rates for the conditions were as follows: Barrett's oesophagus 56%; Gastric ulcers 56%; Adenomatous polyps 88%; Non adenomatous polyps 12.5%. The provision of guidelines does not ensure a high referral rate, education is a vital partner.
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PMID:Response to open access endoscopy findings by general practitioners guidelines need education for implementation. 1086 38

Gastroesophageal reflux disease (GERD) has a high prevalence of 40% in Western countries. A dysfunction of the lower esophageal sphincter of unknown origin is the main etiology. Less common pathophysiological reasons are disorders of esophageal motility, delayed gastric emptying, gastric acid hypersecretion and bile reflux. As causal surgical therapy for these disorders fundoplication has been developed 50 years ago. This technique uses a wrap of gastric fundus around the distal esophagus as reflux barrier. Because of severe postoperative complications (dysphagia, gas bloat syndrome, gastric ulcer) and recurrence after fundoplication, medical therapy became the treatment of choice with the development of H2-receptor antagonists and proton pump inhibitors in the 1970s. However, after improvement of surgical technique and introduction of laparoscopic fundoplication in 1991 surgery offers a secure and effective causal therapy. Randomized controlled trials proof the superiority of fundoplication versus medical therapy in regard of long term results, recurrence and cost effectiveness as well as the superiority of laparoscopic versus conventional open fundoplication in regard of recovery and cost effectiveness with equal long term results. Therefore, laparoscopic fundoplication by an experienced laparoscopic surgeon is the surgical therapy of choice. However the high prevalence of GERD requires careful selection of patients for surgery. A thorough preoperative evaluation including upper gastrointestinal endoscopy with biopsy, esophageal manometry and 24 h-pH monitoring as well as upper gastrointestinal contrast study is essential. Today the indication for fundoplication is seen in young symptomatic patients, requiring a long-term medical therapy, in hiatal hernia with threatening complications as well as in complications of severe GERD, especially Barrett-esophagus. At present the advantages of total (Nissen) or partial (Toupet) wrap as well as the benefit of dissection of the short gastric vessels for total fundoplication are still unclear, especially concerning long-term results. To answer these technical questions further randomized controlled trials with long-term follow-up have to be performed.
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PMID:[Surgery of reflux esophagitis--a renaissance]. 1130 53

Helicobacter pylori is the major cause of chronic gastritis. The predominant anatomic distribution of the gastritis is antral in the majority of individuals. In a small minority, the corpus is predominantly involved. The former pattern is associated with duodenal ulceration in some patients, but the majority of those infected never develop either symptoms or disease. The latter form is associated with the development of gastric ulcer and carcinoma and may be protective against the development of Barrett's esophagus. It is the physiological changes associated with the histological changes and the, as yet poorly, defined host response, which are of paramount importance in determining the evolution of a disease or whether the infected individual remains asymptomatic and disease free. This article addresses the various relationships between H. pylori infection, histology, gastric physiology, and disease.
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PMID:Chronic gastritis and Helicobacter pylori. 1147 52

In the recent years, the prevalence of adenocarcinomas of the esophagus has substantially increased. At present its prevalence in the USA is comparable to that of squamous carcinoma (5/100,000 a year). In 80-90% of cases esophageal adenocarcinoma is located in 1/3 of the lower esophagus and is mainly derived from Barrett's esophagus (BE). The role of Helicobacter pylori (Hp) infection in the pathogenesis of gastritis and gastric ulcer disease has been well known and documented. However, its role in the pathogenesis of esophageal reflux disease, its complications, particularly regarding the risk of Barrett's esophagus and adenocarcinoma is still being studied. The relation between Hp infection and BE has been discussed for many years. The importance of the problem is warranted by the wide prevalence of both Hp infection and reflux disease in the population. The above mentioned findings confirm the protective effects of Hp infection in BE. Despite numerous studies some doubts concerning the relations between Hp infection and BE are still to be explained.
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PMID:Helicobacter pylori infection and the risk of adenocarcinoma of the esophagus. 1614 24


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