Effect of intravenous esomeprazole 40 mg and pantoprazole 40 mg on intragastric pH in healthy subjects. A prospective, open, randomised, two-way cross-over comparative study.

OBJECTIVE: The aim of this study was to compare the effect on intragastric acidity over 24 h on days 1 and 3 following treatment with intravenous (i.v.) esomeprazole 40 mg (CAS for esomeprazole sodium: 161796-78-7) and pantoprazole 40 mg (CAS for pantoprazole sodium: 138786-67-1). METHODS: In an open, randomised, two-way cross-over study, 36 healthy volunteers received esomeprazole (Nexium) 40 mg or pantoprazole 40 mg, both administered once daily as an i.v. bolus injection for 3 consecutive days. Continuous 24-h pH recordings were made under standardised conditions at baseline and on days 1 and 3 of each treatment period. The primary variable was the percentage of time with intragastric pH > 4 during a 24-h period. RESULTS: Time with intragastric pH > 4 was significantly greater with esomeprazole than with pantoprazole during the first 4 h (47.8% vs. 18.9%), as well as for the 24-h period of day 1 and day 3 (day 1: 38.8% vs. 23.7%; day 3:55.0% vs. 35.2%, p < 0.0001 for all times examined). Mean of median intragastric pH with esomeprazole was significantly higher than with pantoprazole during the 24-h period (day 1:3.2 vs. 2.2, p < 0.0001; day 3: 4.3 vs. 3.1, p < 0.00001). CONCLUSION: Esomeprazole administered as a 40 mg i.v. bolus injection provided faster and more effective control of intragastric acidity than a 40 mg i.v. bolus injection of pantoprazole, and also maintained pH > 4 longer both during the first 4 h on day 1 and during the 24-h period of day 1 and day 3 of dosing.

Diagnosis and grading of gastritis by non-invasive optical analysis.

OBJECTIVES: The precise identification of many diseases of the gastrointestinal tract requires the histological analysis of multiple biopsies of the lining mucosae, thus preventing an immediate diagnosis and the safe screening of the entire organ. To address these limitations, we developed a novel spectroscopic procedure for a real-time, non-invasive optical analysis of mucosae. METHODS: We have used a fibre-optic probe that monitors light propagation through small tissue volumes to evaluate the antral and fundic mucosa of 51 patients that underwent gastroscopy for symptoms of dyspepsia. Several optical coefficients were computed from the recorded light reflectance, and confronted to the diagnosis made by an expert gastroscopist at the time of the clinical examination. Both evaluations were then validated by comparison with the histological diagnosis of a pathologist who screened biopsies taken at the sites of the optical measurements. RESULTS: We report that the optical procedure discriminated normal and pathological gastric mucosae with a higher sensitivity and specificity than endoscopic diagnosis. We also show that the changes in light-scattering coefficient, which permitted the optical diagnosis of gastritis alterations, were indirectly correlated with the extent of inflammatory infiltration of the mucosa and detected mucosal alterations mild enough to escape endoscopic detection. CONCLUSIONS: The results show that, in a normal clinical setting, the optical in vivo analysis provided by our system detects alterations typical of gastritis, and allow for their graded scoring with a specificity and sensitivity that compare well with those of standard histology, while avoiding the invasiveness of the latter procedure. The method is adaptable to the screening of other types of lesions and mucosae and, hence, should prove useful in improving available diagnostic approaches.

Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial.

BACKGROUND & AIMS: Emergency endoscopy may be difficult in upper gastrointestinal bleeding when blood obscures the visibility. Erythromycin, a motilin agonist, induces gastric emptying. We investigated whether an intravenous bolus infusion of erythromycin would improve the yield of endoscopy in these patients. METHODS: Patients admitted within 12 hours after hematemesis were randomly assigned to erythromycin (250 mg) or placebo, 20 minutes before endoscopy. The primary end point was endoscopic yield, as assessed by objective and subjective scoring systems and endoscopic duration. Secondary end points were the need for a second look, endoscopy-related complications, blood units transfused, and length of hospital stay. RESULTS: Fifty-one patients received erythromycin and 54 received placebo. A clear stomach was found more often in the erythromycin group (82% vs. 33%; P < 0.001). This difference remained significant in patients with cirrhosis. Erythromycin shortened the endoscopic duration (13.7 vs. 16.4 minutes in the placebo group; P = 0.036) and reduced the need for second-look endoscopy (6 vs. 17 cases; P = 0.018). Length of hospital stay and blood units transfused did not significantly differ between the 2 groups. No complications were noted. CONCLUSIONS: Erythromycin infusion before endoscopy in patients with recent hematemesis makes endoscopy shorter and easier, thereby reducing the need for a repeat procedure.