Long-term treatment of gastro-oesophageal reflux disease patients with frequent symptomatic relapses using rabeprazole: on-demand treatment compared with continuous treatment.

BACKGROUND: On-demand treatment may be an alternative in the long-term treatment of non-severe gastro-oesophageal reflux disease in patients with frequent symptomatic relapses. AIM: To compare the efficacy of on-demand treatment with rabeprazole 10 mg versus continuous treatment in the long-term treatment of patients with frequent symptomatic relapses of mild to moderate gastro-oesophageal reflux disease. METHODS: This randomized, open-label study enrolled patients diagnosed with non-erosive reflux disease or oesophagitis grade 1 or 2 (Savary-Miller classification) reporting frequent symptomatic relapses (requiring > or =2 courses of antisecretory therapy during the previous year), whose intensity is rated at least moderate (>2 on a 5-point Likert scale). After a 4-week selection phase with rabeprazole 10 mg once daily, patients reporting symptom relief (Likert score < or =2) were randomized to receive either rabeprazole 10 mg continuous treatment or on-demand treatment for 6 months. The main evaluation criterion was the rate of symptom relief (scored on the Likert scale) after 6 months. RESULTS: One hundred and seventy-six patients were enrolled in the 4-week selection phase (men, 53%; mean age, 49 years; non-erosive reflux disease, 36.4%; gastro-oesophageal reflux disease 1, 53.4%; gastro-oesophageal reflux disease 2, 10.2%). Rabeprazole relieved symptoms in 88.6% of patients. Of this group, 152 were randomized to the comparative phase to receive rabeprazole 10 mg continuous treatment (once daily) or on-demand treatment (continuous treatment, n = 81; on-demand treatment, n = 71). At month 6 (end point), the symptom relief rate was slightly higher for patients in the continuous treatment group compared with those in the on-demand treatment group: 86.4% versus 74.6%, respectively. This difference was not statistically significant (P = 0.065). For the overall quality of life score, there was no difference between the continuous treatment and on-demand treatment groups (86.25 and 84.94). Mean daily consumption of rabeprazole was significantly lower in the on-demand treatment group versus the continuous treatment group (0.31 tablets versus 0.96 tablets; P < 0.0001). CONCLUSION: On-demand therapy with rabeprazole 10 mg provides an alternative to continuous therapy in patients with mild to moderate gastro-oesophageal reflux disease suffering from frequent symptomatic relapses.

Effect of low-dose rabeprazole and omeprazole on gastric acidity: results of a double blind, randomized, placebo-controlled, three-way crossover study in healthy subjects.

BACKGROUND: The treatment of acid-related symptoms requires rapid and consistent acid suppression, especially with on-demand regimens. AIM: To compare the antisecretory activity of low-dose rabeprazole and omeprazole in healthy, Helicobacter pylori-negative subjects. METHODS: In this randomized, double-blind, placebo-controlled, three-way crossover study, 27 volunteers were given rabeprazole 10 mg, omeprazole 10 mg, or placebo once daily for 7 days with a 10-14-day washout between treatments. Intragastric pH was monitored for 24-h on days 1 and 7 of each treatment. RESULTS: Median gastric pH was significantly higher with rabeprazole than with omeprazole or placebo: day 1: 2.3, 1.4 and 1.3, respectively (P = 0.0056, rabeprazole vs. omeprazole; P < 0.0001, rabeprazole vs. placebo); day 7: 3.7, 2.2 and 1.3, respectively (P = 0.0016 rabeprazole vs. omeprazole; P < 0.0001, rabeprazole vs. placebo). Time with gastric pH above 4 was significantly higher with rabeprazole than with omeprazole: day 1, 5.8 h vs. 3.7 h, respectively (P < 0.02); day 7, 10.5 h vs. 4.6 h, respectively (P = 0.0008). CONCLUSIONS: Rabeprazole 10 mg provides more rapid acid inhibition compared with omeprazole 10 mg. After 7 days, the time with pH above 4 is more than doubled with rabeprazole 10 mg vs. omeprazole 10 mg.

[Pheochromocytoma revealed by cerebral hematomas. Significance of the abolition of a cutaneous abdominal reflex ipsilateral to the adrenal tumor]. / Hématomes intra-cérébraux révélant un phéochromocytome. Abolition d'un réflexe cutané abdominal ipsilatéral à la tumeur surrénalienne.

Cerebro-vascular complications of pheochromocytoma are now rare. The case reported here is a 47-year-old woman who presented with two cerebral hematomas and a pheochromocytoma. Abolition of a cutaneous abdominal reflex abolition can help the clinician to locate the adrenal tumor side.

[Thyrotoxic periodic paralysis. Discussion of the role of Na-K-ATPase, apropos of a case]. / La paralysie périodique thyréotoxique. Discussion du rôle de la Na-K- ATPase, à propos d'une observation.

We report a case of thyrotoxicosis periodic paralysis (TPP), occurring as a complication of a Grave's disease in a 31 year-old Caucasian male. It has been suggested that the membrane Na-K pump was involved in the pathogenesis of this complication. In our patient, before treatment, the activity of erythrocyte Na-K-ATPase was significantly decreased, as compared with healthy subjects (228nmol Pi/mg prot/h versus 298 + 60 nmol Pi/mg prot/h) and went back to normal levels post treatment. The activity of this enzyme seems to be prone to genetics factors as well as environmental ones. This would explain the higher incidence of TPP in male and in asiatic people. However, other reports emphasize the role of Na-K-pump-independent potassium influx, which would be more specific of TPP.

[Bone marrow aplasia related to ticlopidine]. / Aplasie médullaire associée à la ticlopidine.

The authors report two cases of bone marrow aplasia observed 2 months after initiation of a treatment with ticlopidine. The outcome was favorable after discontinuation of therapy. The frequency of this severe drug-induced complication seems to have been underestimated. The absolute necessity of a careful haematological survey during the first 3 months of therapy is pointed out.

[Inflammatory rheumatism and celiac disease in adults. Coincidence or pathogenic relationship?]. / Rhumatisme inflammatoire et maladie coeliaque de l'adulte. Coïncidence ou lien pathogénique?

Five adults had inflammatory rheumatic disorders 6 to 20 years before the diagnosis of coeliac disease. It is known that joint inflammation occurs in certain patients with adult coeliac sprue who develop either a specific inflammatory rheumatic disease or an atypical progressive polyarthropathy, sometimes as the first manifestation of the intestinal disorder. The diagnosis of adult coeliac sprue should be entertained in these cases even in absence of major digestive disorders or malabsorption. IgA anti-reticulin antibodies and atrophy of the duodenojejunal villosities are the best indicators for diagnosis. There are two important reasons for making the diagnosis of "asymptomatic adult coeliac sprue". First a gluten-free diet can improve or even cure the inflammatory joint disease, a rare situation which emphasizes the causal relationship between these two diseases. Second, the risk of developing lymphoma (especially in the small bowel) is apparently lower in patients on gluten-free diet. Pathogenesis is unclear. Frequently the two autoimmune disorders simply appear to coincide in the same patient; more rarely, arthritis is a symptom of coeliac disease. The immunological mechanisms probably begin when antigens cross an excessively permeable intestinal mucosa.

[Superior vena cava syndromes of benign etiology]. / Les syndromes caves supérieurs d'étiologie bénigne.

Superior vena cava syndromes are uncommon and usually caused by malignant diseases. In about 20% of the cases however, the cause is benign. Besides chronic mediastinitis, a growing number of cases are reported of thrombosis resulting from endovenous devices (central catheters, pacemaker leads...). Onset is often slow and insidious, good tolerance in the early stages being explained by the development of an effective collateral circulation. Bibrachial phlebography is still the reference exploration, but computed tomography and magnetic resonance imaging are contributive to diagnosis. Symptoms usually regress after medical treatment, sometimes requiring thrombolysis, however, in 10% of the patients, major functional impairment may require bypass surgery (autologous graft or endoprosthesis) or transluminal angioplasty. There is still some debate as to the precise indications for each method, but angioplasty, used recently, appears to be the most interesting technique for a disease in which prognosis is almost always favorable.

[Polyarthralgia disclosing hyperthyroidism. Two case reports]. / Polyarthralgies révélatrices d'hyperthyroïdie. Deux observations.

BACKGROUND: We report two cases of rheumatism associated with hyperthyroidism. In both cases, arthralgia totally regressed after thyroid treatment. CASE REPORTS: Two 79-year-old and 59-year-old women developed manifestations of polymyalgia rheumatica and psoriasis arthritis respectively. Corticosteroid therapy was ineffective and followed by manifestations of hyperthyroidism. The first patient was treated with carbimazole and the second with thyroidectomy. Once the hyperthyroidism was controlled, both patients experienced a dramatically rapid cure of their arthralgias. DISCUSSION: Scalpulo-humeral periarthritis is the main articular complication of hyperthyroidism. True manifestations of "thyrotoxicosis rheumatism" are unusual and may be linked with a direct toxicity of the thyroid hormones on joint cartilage or with an autoimmune manifestation of hyperthyroidism.

[Panniculitis-fasciitis syndrome disclosing systemic erythematous lupus]. / Syndrome panniculite-fasciite révélant un lupus érythémateux systémique.

INTRODUCTION: Panniculitis is a common manifestation of lupus, but is rarely the first manifestation in systemic lupus erythematosus. We report a case associated with fasciitis. CASE REPORT: A 67-year-old man was hospitalized for fever, pleuropericarditis, subcutaneous diffuse infiltration of the two thighs and the abdomen due to panniculitis and lupic fasciitis. Antiphospholipid antibody test was positive. There was non antiphospholipid syndrome. COMMENTS: Panniculitis can occur simultaneously or a few months or years before systemic lupus erythematosus. An association with fasciitis should be entertained whenever the cutaneous involvement is extensive and firm. In such a situation, deep biopsies are indicated. Observations of further cases will help identify the role of general steroid therapy in fasciitis-panniculitis and systemic lupus erythematosus.

[Leishmaniasis and human immunodeficiency virus: an emerging co-infection?]. / Leishmaniose et virus de l'immunodéficience humaine: une co-infection en émergence?

Although not considered as indicative of AIDS, leishmaniasis presents a number of epidemiologic and clinical features that promote opportunistic infection in HIV patients. Accurate assessment of the incidence of this type of co-infection is difficult due to underestimation in endemic areas such as Africa and Asia. In these areas the WHO estimates that 2 to 9 p. 100 of HIV patients will develop leishmaniasis/HIV co-infection which could become a major concern. The characteristics of this co-infection have been documented. It is observed in adults between 20 and 40 years of age with a strong male sex bias. The visceral form is most frequent. Manifestations are similar to those observed in immunocompetent subjects but with the possibility of asymptomatic and low-grade forms (10 p. 100) and unusual locations suggesting multiorgan spreading in absence of host immune response. In addition to the time-tested standard procedures for diagnosis of parasitic disease, new serologic tests and genomic amplification are now available. Pentavalent antimonials have long been considered as the treatment of choice but they are not always effective and can have untoward effects. Amphotericine B especially in the liposomal form is a good alternative. The particularly high incidence of recurrence suggests that follow-up may be indicated but the modalities of prophylaxis have yet to be defined.