A review of treatment of duodenal and gastric ulcers--pantoprazole vs. omeprazole.

The efficacy and safety of pantoprazole in the treatment of duodenal and gastric ulcers has been compared with that of the first proton pump inhibitor omeprazole in two (previously reported) clinical studies. Pantoprazole (40 mg/day) administered orally was an effective and well-tolerated treatment for both indications. Pantoprazole was as effective as omeprazole (20 mg/day) and had a similar safety profile. For gastric ulcers, the healing rate with pantoprazole was superior to that with omeprazole at 4 weeks.

Comparison of pantoprazole versus omeprazole in the treatment of acute duodenal ulceration--a multicentre study.

METHODS: In this randomized, double-blind, multicentre study, the proton pump inhibitors pantoprazole and omeprazole were compared in patients with active duodenal ulcers. Two hundred and seventy-six protocol-correct patients received either pantoprazole 40 mg (n = 185) or omeprazole 20 mg (n = 91), once daily for 2 or 4 weeks, depending on the progress of ulcer healing. RESULTS: Rates of complete ulcer healing after 2 weeks were 71% in patients given pantoprazole and 74% in patients given omeprazole. After 4 weeks the figures were 96% and 91%, respectively. These differences were not significant. There was no significant difference in ulcer pain prior to treatment, and 85% of the pantoprazole group and 86% on omeprazole were pain-free after 2 weeks (not significant). The time until complete pain relief with pantoprazole or omeprazole, based on data from diary cards, was not significantly different (P > 0.05, Uleman's U-test). Both treatments were equally well tolerated. Changes in routine laboratory parameters were minimal in both groups. CONCLUSION: Pantoprazole was shown to be a highly-effective and well-tolerated treatment for acute duodenal ulcer. Pantoprazole 40 mg and omeprazole 20 mg were equally effective with respect to ulcer healing and pain relief, and have similar adverse event profiles.

[Radiological and clinical aspects of resection of the cardia]. / Radiologische und klinische Aspekte nach Kardiaresektion

Following resection of the cardia, problems may arise during two phases; in these, clinical and radiological examination may be required. Immediately after the operation one is concerned particularly with checking the incision or the extent and localisation of suture abnormalities. In the late post-operative period the problems are different. In addition to a description of the anatomy at the proximal and distal ends of the stomach, it is necessary to estimate functional conditions, such as passage through the anastomosis and the pylorus, the reservoir function of the gastric remnant and gastro-oesophageal reflux. An important task is to demonstrate tumour recurrence. For this purpose endoscopic, biopsy and cytological examinations are required.

Omeprazole heals duodenal, but not gastric ulcers more rapidly than ranitidine. Results of two German multicentre trials.

In two double-blind, randomized German multicentre trials the effects of omeprazole 20 mg mane and ranitidine 150 mg b.i.d. were compared for the first time in 334 outpatients with duodenal ulcer and 184 outpatients with gastric ulcer. In patients with duodenal ulcer endoscopically controlled healing rates after two weeks were 72% with omeprazole and 59% with ranitidine (p = 0.012); after 4 weeks 96 and 92%, resp. were healed (n.s.). In patients with gastric ulcer the healing rates after two, four, and eight weeks were 43, 81, and 95%, respectively, with omeprazole and 45, 80, and 90%, respectively, with ranitidine (n.s.). Smoking impaired healing in duodenal, but not in gastric ulcer. Symptom relief was comparable with both drugs. Serious side effects or clinically relevant changes in laboratory screening results were not detected. - Our results demonstrate for the first time that omeprazole 20 mg mane is superior to ranitidine 150 mg b.i.d. in the short-term treatment of duodenal, but not gastric ulcer.

[Morphology and physiopathology of Billroth I gastroduodenostomy]. / Morfologia e fisiopatologia della gastroduodenostomia secondo Billroth I

97 patients subjected from 1 to 7 years previously to partial gastric resection by gastroduodenostomy (Billroth I) have been studied endoscopically and radiologically. Acid secretion after pentagastrin injection has also been determined. The most frequent mucous alterations identified by endoscopy were erosions in the stomach residue with inflammatory granulation in the anastomosis region. Recurrent ulcers were observed in 3% of cases. Acid secretion was reduced in 87% by comparison with the preoperative picture. The quantity of residual recretion depended on the greater curvature of the residual stomach. Radiological studies highlighted functional modifications indicative of organized motility in the residual stomach and pseudopyloric function at anastomosis level making coordinated draining possible.

[Differential after care for early detection of recurrence--from the general practice viewpoint]. / Differenzierte Nachsorge zur Rezidivfrüherkennung--aus allgemeinärztlicher Sicht.

A field-research on follow-up of GI-Carcinoma in 1989 with contributions of 159 general practitioners and physicians of Hamburg city area revealed some specific problems in performance and quality: lack of communications by and insufficient and inconstant qualifications of involved hospital staff as well as high rate of deficits in knowledge of necessary systematic examinations in symptom free patients.

[Cancer surgery--palliative surgery?]. / Krebschirurgie--palliative Chirurgie?

Results of surgical treatments in carcinomas of solid organs are presenting a constant pour level of success. Radical treatment as final intention of tumor management cannot be performed in the majorities of cases. We suppose that advances can be expected only by new structural approaches to surgical performance. Cooperation with clinical pathologists, oncologists and immunologists must be organized on a new level. This means also increased work concerning typing, grading, staging, documentation and follow-up. Surgeons should develop as competent partners for this cooperation to regain their central position in oncologic network of the future.

[Occlusive jaundiced caused by liver metastases. Results of endoscopic surgical treatment]. / Verschlussikterus durch Lebermetastasen: Ergebnisse der endoskopisch-chirurgischen Behandlung.

The results of endoscopic drainage treatment in 69 patients with metastases of the liver have been analyzed for the period from 1982 to 1992. Fifty-five patients had follow-up. Criteria for inclusion were: positive diagnosis of liver metastases, jaundice, and primary origin of tumors distant from the pancreaticobiliary system ("distant" primary). Localisations of metastic obstructions were: hilum of the liver (n = 24), commonbile duct (n = 16), and prepapillary region (n = 15). Treatment was performed by transpapillary applications of one or more (n = 3) pig-tail or Tannenbaum stents. Concentrations of mean serum bilirubin could be reduced from 14.5% to 8.8 mg%, 16 patients reached a normal level (less than 1.0 mg%). The median survival time was 76 days ranging vom 4 to 299 days. The most frequent complication was cholangitis in 29% of the cases with mortality in 6 patients. Patients less than 60 years of age and with obstructions in the mid commonbile duct gained most by this kind of treatment. Results were poor in elderly patients with hilar stenosis. Selected patients with known liver metastases may benefit from endoscopic treatment of jaundice.

[The significance of laboratory chemical parameters for the diagnosis of mesenteric infarction (author's transl)]. / Zur Bedeutung laborchemischer Parameter für die Diagnostik des Mesenterialinfarktes.

A laparotomy was performed on 23 dogs with and without ligation of the mesenteric artery. Twenty-eight laboratory parameters of blood samples taken immediately and then every two hours after the operations were checked for systematic trends. The analysis of variance showed some differences between both groups. It was impossible to use the individual results of this investigation for a general diagnostic approach. Difficult and long-lasting biochemical investigations are of dubious value since time loss is one of the most important problems in mesenteric occlusion. Indications for invasive diagnostic procedures and for laparotomy should not be postponed; they should depend on the different aspects of clinical symptoms, as it is practised now.

[Endoscopy of postoperative hemorrhage in the upper gastrointestinal tract]. / Endoskopie der postoperativen Blutung aus dem oberen Gastrointestinaltrakt

In hemorrhages from the upper gastrointestinal tract, emergency endoscopy is becoming more and more significant. Hemorrhages during the early postoperative stage, particularly in abdominal surgery, require particular attention due to the generally difficult postoperative situation. In most instances, intragastral hemorrhages are due to erosions and anastomotic bleeding. A detailed knowledge of the surgery performed may contribute to a quick and successful examination. Among the most important premises for a high rate of correct diagnoses are the experience of the examining physician as well as an early or immediate identification of the indications. In addition to the diagnostic significance, under favorable circumstances endoscopy makes possible definitive or temporary staunching of the bleeding by means of diathermy, laser beam or sclerotization.