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Query: UMLS:C0038358 (gastric ulcer)
 5,179 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a randomized, double-bind, parallel, multi-clinic study, the safety and efficacy of enprostil (35 micrograms twice daily) and ranitidine (150 mg twice daily) were compared in the treatment of active gastric ulcer in 93 outpatients (47 enprostil-treated patients and 46 ranitidine). The two treatment groups were well matched for demographic characteristics. The healing rates in the enprostil group were 22, 58, 80, and 86 percent at two, four, six, and eight weeks, respectively. The corresponding rates in the ranitidine group were 22, 66, 84, and 89 percent. None of these differences was statistically significant. The area of the ulcer at baseline and smoking status did not appear to influence healing rates. There were no significant differences between treatment groups in time to relief of ulcer symptoms, frequency of daytime or nighttime ulcer pain, or antacid use. Side effects attributable to enprostil treatment were diarrhea (10 percent versus 6 percent with ranitidine), gastrointestinal pain, and vomiting. These side effects, however, did not influence the patients' assessments of their overall response to enprostil and ranitidine therapy. Six enprostil-treated patients and one ranitidine-treated patient withdrew from the trial prematurely because of adverse experiences. Monitoring of clinical laboratory test results showed no significant changes in the two treatment groups. This study demonstrates that a prostaglandin E2 analogue, enprostil, in a dose of 35 micrograms twice daily, is similarly safe and effective as ranitidine in the treatment of active gastric ulcer.
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PMID:Comparative clinical trial of enprostil and ranitidine in the treatment of gastric ulcer. 309 61

Prostanoids decrease gastric acid secretion and exert cytoprotective properties. The effect of several synthetic prostanoids on gastric ulcer healing was evaluated. The first trials were performed on a small number of patients with PGE2 analogs and their results were inconclusive. Two huge multicenter trials tested the efficacy of misoprostol, a synthetic PGE1 analog, in comparison to placebo and cimetidine. In the placebo-controlled trial, following 8 weeks of therapy, misoprostol 100 micrograms q.i.d was significantly better than placebo. In the cimetidine controlled trial, 2 doses of misoprostol were tested, 50 micrograms and 200 micrograms q.i.d. Ulcer healing rates following 4 weeks were 39%, 51%, and 58% in the misoprostol 50 micrograms, 200 micrograms, and cimetidine treatment groups, respectively. There was no statistically significant difference in the healing rates at 4 weeks between the misoprostol 200 micrograms and cimetidine 300 mg q.i.d groups (P = 0.16). The healing rate with the misoprostol 200 micrograms dose was significantly better than with the 50 micrograms dose (P = 0.008). Cimetidine 300 mg relieved global pain significantly better than misoprostol 200 micrograms at 2 weeks (P = 0.047) but not at 4 weeks. The 200 micrograms dose of misoprostol relieved pain significantly better than the 50 micrograms dose at 4 weeks (P = 0.019), but not at 2 weeks. All 3 treatments were well tolerated. Severe adverse events were rare. The efficacy of enprostil, another PGE2 analog, on gastric ulcer healing was also found to be better than placebo and not significantly different from ranitidine. The synthetic prostanoids, misoprostol and enprostil, appear to be safe and effective in the treatment of gastric ulcer.
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PMID:Efficacy of prostanoids in the treatment of gastric ulcer. 311

Misoprostol, a synthetic prostaglandin E1 (PGE1) methyl ester analog has potent antisecretory and cytoprotective effects on the gastric and duodenal mucosa which should make it an effective drug in the treatment of gastric and duodenal ulcer. In two multicenter, randomised, double-blind, controlled studies involving over 900 patients with endoscopically proven benign gastric ulcer and in six similar studies involving over 2000 patients with active duodenal ulcers, differing doses of misoprostol have been compared with either placebo therapy or with conventional doses of cimetidine. In these studies misoprostol 800 mcg daily given as two or four divided doses has been shown to produce rates of complete ulcer healing and pain relief which were significantly superior to placebo therapy and comparable to those achieved with cimetidine. Drug related adverse effects were infrequent. A dose related diarrhea occurred in a small proportion of patients which seldom necessitated suspension of therapy. Because of the known uterotropic effect of prostaglandins the drug should not be used in pregnant women or women of child bearing age unless they are using adequate contraceptive measures. No clinically significant adverse, hematological or biochemical effects have been reported. Two studies suggested that misoprostol reduced the adverse effect of smoking on the healing of duodenal ulcer. In addition, misoprostol has been shown to protect the gastro-duodenal mucosa from the damaging effects of alcohol and non-steroidal anti-inflammatory drugs. This action may prove of value in the treatment of ulcer patients who are inveterate smokers, alcohol users or who are compelled to consume non-steroidal anti-inflammatory drugs for pain relief from rheumatic and allied diseases.
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PMID:Misoprostol in peptic ulcer disease. 312 78

Misoprostol, a synthetic methyl ester analogue of prostaglandin E1 (PGE1) is both a powerful inhibitor of gastric secretion and is able to protect the gastroduodenal mucosa from damage produced by alcohol, aspirin, naproxen and tolmetin. The results of 12 double-blind, randomized, placebo- and cimetidine-controlled trials involving 4000 patients have been reviewed here and show that misoprostol, given in a dosage of 800 micrograms daily in two or four divided doses, is able to produce rates of complete ulcer healing and pain relief in both gastric and duodenal ulcer which are significantly superior to placebo therapy and comparable to those achieved with high or conventional doses of cimetidine. One further large trial has shown that misoprostol is able to heal a significant proportion of duodenal ulcers refractory to treatment with H2 receptor antagonists. In the compromised patient, two trials have suggested that misoprostol is able to abolish the adverse effects of smoking on duodenal ulcer, although this effect was not apparent in the gastric ulcer trials or in other duodenal ulcer trials. Similarly, while in volunteers pretreatment with misoprostol is able to protect the gastric mucosa from alcohol damage, there is little clinical evidence to support improved ulcer healing in the patient who abuses alcohol. Further studies in these areas should be conducted. Misoprostol could well have an important role to play in the protection of the gastroduodenal mucosa from damage produced by non-steroidal anti-inflammatory drugs (NSAIDs) in arthritic patients compelled to take these drugs for long periods. A series of double-blind placebo-controlled trials in healthy volunteers have shown that pretreatment with, or simultaneous administration of, 800 micrograms daily of misoprostol, reduces significantly mucosal damage produced by aspirin, tolmetin and naproxen. Two controlled clinical trials in a large number of arthritic patients have shown firstly, that misoprostol 800 micrograms daily is able to reduce significantly aspirin-induced mucosal bleeding as compared with placebo and secondly, in an endoscopically, placebo-controlled trial that it reduced significantly the frequency and severity of aspirin-induced mucosal lesions, accelerated the healing of erosions and ulcers and in other patients was able to protect the undamaged mucosa from injury. Misoprostol is well tolerated--a dose related, usually self limiting, diarrhoea occurred in a small proportion of patients but only rarely enforced withdrawal. Because of its uterotropic effects misoprostol should not be given to women of child bearing age unless they are taking adequate contraceptive measures. It has no other systemic effects and no clinically significant adverse haematology or biochemical abnormalities, or drug interactions have been reported. It does not seem to induce hypergastrinaemia. Misoprostol is, therefore, a safe and effective drug in the treatment of chronic peptic ulcer and could have a beneficial action in duodenal ulcers refractory to treatment with H2-receptor antagonists. It could benefit compromised groups of ulcer patients who are smokers or alcohol users amd certainly has been shown to protect the gastroduodenal mucosa against damage induced by NSAIDs in healthy volunteers and arthritic patients.
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PMID:The therapeutic efficacy of misoprostol in peptic ulcer disease. 313 82

The efficacy and tolerability of the prostaglandin E1 derivative rioprostil (Bay o 6893) was studied in a randomized, double-blind, placebo-controlled trial in 40 patients affected by acute gastric ulcer. At the end of the eight weeks period ulcer healing was achieved in 85% of the rioprostil-treated patients and in 60% of the placebo-treated ones (p less than 0.05). Rioprostil produced a significant reduction of pain and also improved the clinical status. This positive outcome was noted both in smokers and in non-smoking patients, while only this last group improved during the placebo treatment.
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PMID:Rioprostil: a clinical experience in gastric ulcer treatment. 314 50

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

The current therapeutic approach to peptic ulcer disease includes agents that reduce gastric acidity and hence peptic activity, inactivate or adsorb pepsin, create a physical barrier against the effects of acid and pepsin, or enhance mucosal defence. Profound gastric acid reduction may predispose to infection, and it has been suggested that carcinogenesis is possible, although a cause-effect relationship has never been established. The side-effects of therapy are well-described, and may limit the therapeutic approach. Healing rates correlate closely with acid suppression in duodenal ulcer, but not entirely in gastric ulcer. Maintenance therapy lowers the relapse rate, but does not alter the ulcer diathesis. The optimal strategy for long-term management remains unclear, but in the future one should consider outcome measures which include a decrease in pain, improvement in the quality of life, reduction work loss, and a reduction of complications, in addition to ulcer healing. The ideal therapy should be efficacious, safe, and convenient--with no side-effects--and cost-effective. New agents should suppress acid and peptic activity, while enhancing the gastric mucosal defence mechanisms (such as mucosal blood flow, mucus, and bicarbonate secretion) and stimulating gastric cellular regeneration and restitution.
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PMID:The limitations of current therapy in peptic ulcer disease. 330 47

Pain is commonly the initial symptom in peptic ulcer, but the mechanism is controversial. Chemical irritation by hydrochloric acid (HCl) and disordered motor activity have been implicated. Questions have been raised as to whether pain is a good indicator of an active ulcer. We have studied the mechanism of ulcer pain, using intragastric administration of 0.1 N HCl, study of X-ray alterations, measurement of intraluminal pressures, and measurement of gastric acidity along with fluorocinematography. Ulcer pain was accompanied by a synchronous increase in motor activity; gastric emptying was rapid with duodenal ulcer and delayed with gastric ulcer; relief of pain occurred with emptying. Ulcer pain is not a good indicator of activity. Relief of ulcer pain before endoscopic healing with famotidine is due to the inhibition of HCl below the threshold required to initiate disturbances of motor activity. Recurrent 'silent' ulcer with complications occurs in 40% of patients.
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PMID:Ulcer pain mechanisms. The clinical features of active peptic ulcer disease and implications for therapy. 331 Jan 99

One hundred and fifty patients with various rheumatic complaints who were taking nonsteroidal anti-inflammatory drugs (NSAIDs) and required upper gastrointestinal endoscopy were compared with 150 patients, matched for age and sex, who were also referred for gastroscopy but who did not have rheumatic complaints and were not taking these drugs. A comparison was made between the indications for endoscopy and the endoscopic findings in the two groups. Significant differences were found. Fewer patients with rheumatic complaints had normal findings, more had chronic gastric ulcer, duodenal ulcer, gastritis or mucosal erosions. Patients with rheumatic complaints were referred more frequently for anaemia and less frequently for dysphagia or abdominal symptoms. The increased severity of gastric morbidity in patients with rheumatism is probably due to damage caused by NSAIDs. The frequency and severity of upper gastrointestinal lesions in patients with rheumatic complaints taking NSAIDs cannot be estimated from the patient's complaint rate, anaemia rather than pain being the most frequent finding. Upper gastrointestinal tract endoscopy is required to make a definitive diagnosis. This has important implications for the licensing policies of regulatory authorities when considering the licensing of new nonsteroidal anti-inflammatory drugs.
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PMID:Contrasting presentation and findings between patients with rheumatic complaints taking nonsteroidal anti-inflammatory drugs and a general population referred for endoscopy. 348 49

A randomized, multicenter, double-blind, placebo-controlled study was conducted to determine whether ranitidine 150 mg b.i.d. for 6 weeks would expedite endoscopic healing or relief of symptoms in patients with benign gastric ulcer. Of 203 patients enrolled, 101 received ranitidine and 102 received placebo. Endoscopic evaluations were conducted at baseline and at 2 and 6 weeks. At 6 weeks 68% of the patients treated with ranitidine had healed compared with 53% in the placebo group (p = 0.02). In those patients who had not healed by 6 weeks, ranitidine provided greater relief from pain than placebo. More patients in the placebo group dropped out of the study because of worsening symptoms (13 versus 4, p = 0.04). No differences in laboratory abnormalities or incidence of adverse events were detected between the two study groups. These results indicate that ranitidine 150 mg b.i.d. is superior to placebo in the treatment of benign gastric ulcer.
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PMID:Treatment of benign chronic gastric ulcer with ranitidine. A randomized, double-blind, and placebo-controlled six week trial. 353 10


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