Effect and tolerability of omeprazole in the treatment of duodenal ulcer disease.

In an open clinical trial, 16 hospital outpatients with endoscopically proven duodenal ulcer were given 30 mg omeprazole once daily for four weeks. After two weeks' treatment 14 of the 16 patients had healed and after four weeks all patients were healed. Reduction of pain was rapid and occurred during the first part of the trial. No serious adverse events or clinically significant deviations from normal laboratory values were reported. Serum gastrin levels significantly increased during treatment but returned to normal levels after the treatment was discontinued.

Omeprazole vs. ranitidine in the short-term treatment of duodenal ulcer: an Italian multicenter study.

A double-blind, double-dummy, randomized Italian multicenter trial was carried out to compare the efficacy and safety of omeprazole 20 mg in the morning and ranitidine 150 mg b.i.d. in short-term treatment of acute duodenal ulcer. One hundred and twenty-one patients (61 in the omeprazole and 60 in the ranitidine group) with endoscopically proven active duodenal ulcer, completed the study. The healing rates after 2, 4 and 6 weeks were 66, 97 and 100%, respectively, with omeprazole and 53, 85 and 92%, respectively, with ranitidine. The difference was statistically significant (p less than 0.05) at weeks 4 and 6. Night and day pain were markedly reduced during both treatments, as also antacid consumption. Both drugs were well tolerated, and the adverse events were infrequent and moderate. In our experience, omeprazole 20 mg once daily seems to be superior to ranitidine 150 mg b.i.d. in the short-term treatment of duodenal ulcer.

A pharmacokinetic study on midazolam in compensated liver cirrhosis.

The authors studied the pharmacokinetic behaviour of a new benzodiazepine, midazolam, after a single oral administration in a group of five patients of both sexes, suffering from compensated alcoholic cirrhosis. In this clinical situation both absorption and metabolism rates of the compound were similar to those observed in healthy subjects. The only notable effect, occurring in one severely affected cirrhotic, consisting of prolonged pharmacological activity of the drug.

Pharmacokinetics in the elderly.

The article discusses how and why drug responses are altered in elderly patients. It describes how the mutation of body composition and decay of physiological functions in the aged alters the pharmacokinetic parameters and consequently the drug responses. It also provides guidelines on which to base estimates of an accurate drug schedule.

Antimuscarinic compounds and gastric kinetics: a study with pirenzepine on healthy subjects.

A study has been made on the modifications that appear after acute dosage of pirenzepine in a series of eight healthy subjects of both sexes who had shown, by radioisotopic evaluation, a physiological pattern of gastric kinetics. The acute dosage of the drug was continued for three days at therapeutic doses and, a few hours after the last administration, the same study was repeated. As a test meal, a whole fried egg containing 99mTc-labelled serum albumin was used. The kinetics of the gastric content was scanned by a gamma-camera. The difference in gastric kinetics between the baseline situation and that after administration of the drug is reported and discussed.

Cellular ageing.

Ageing is characterized by several modifications at the molecular and cellular levels. Although none of the functional or structural changes can be regarded as peculiar to old age, some relevant features can be found in the cells. Cell organization becomes structurally uneven and functionally disharmonious. The onset of ageing, however, cannot be accounted for simply in terms of structural and physiological deterioration. Attempts have therefore been made to work out a comprehensive approach which might be able to provide a sensible solution to the problem.

Duodenogastric reflux and gastric damage from non-steroidal antiinflammatory drugs.

The authors describe cases urgently admitted for iatrogenic gastric lesions due to non-steroid antiinflammatory treatment during the past year. Nine patients were affected by peptic ulcer (bleeding in five cases), while in the remaining 11 an erosive acute gastritis could be observed. Among them, ten patients had been taking acetylsalicylic acid, one indomethacin and the others ketoprofen, indoprofen or similar drugs. In 11 patients, five presenting gastric ulcer and six affected by haemorrhagic gastric damage, an evident duodenogastric reflux was demonstrated. Fifteen patients were treated pharmacologically and complete healing of the lesions was obtained, while in five patients surgical treatment was necessary. The authors conclude by pointing out the high incidence (over 50%) and the pathogenetic role of duodenogastric reflux in gastric lesions appearing in patients treated with non-steroidal antiinflammatory drugs.

[Infective food poisoning. Physiopathology, clinical aspects, therapy]. / Tossinfezioni alimentari. Fisiopatologia, clinica, terapia.

The nosographic classification of infective food poisoning is still the subject of controversy. At any rate, by and large the pathophysiological mechanisms and their manifestations appear to be clear. After discussing the etiopathogenetic features of the most frequently observed forms, the authors describe ways of transmission, clinical manifestations, diagnostic possibilities and consequent therapeutic management.

Pharmacokinetics of omeprazole in cirrhotic patients.

Omeprazole (CAS 73590-58-6), an H+, K+ ATPase inhibitor, is a potent suppressor of gastric acid secretion and a very active substance in the treatment of duodenal and gastric ulcers. The kinetic profile of omeprazole is well defined for healthy volunteers and for some high-risk population, but not so far for patients with liver disease. As the substance is mainly metabolized in the liver, changes in liver circulation and/or function might lead to changes in the pharmacokinetics of omeprazole. Aim of the study was to evaluate the kinetic profile in patients with liver disease and compare the results obtained in healthy volunteers, 16 subjects were included in the study: 8 patients with liver cirrhosis and 8 healthy volunteers. A single oral dose of omeprazole 20 mg was administered: plasma samples were collected for 24 h since omeprazole administration. The principal pharmacokinetic parameters were estimated for the two studied populations.

Antiinflammatory drugs and gastric emptying. A comparison between acetylsalicylic acid and carprofen.

Continuing their studies of gastric emptying modifications induced by nonsteroid anti-inflammatory drugs, the authors investigated the effects of 6-chloro-a-methylcarbazole-2-acetic acid (carprofen, Imadyl) versus those of acteylsalicylic acid (ASA) in an open crossover study of 10 healthy volunteers with normal gastric motility. The subjects received a standard meal labeled with 99Tc DTPA and were monitored for gastric emptying over time by scintiscanning with a gamma ray camera wired to a computer. Each subject was examined in basal conditions and after dosing with carprofen and ASA in random sequence with a 10-day washout period between tests. With the ASA treatment, all subjects showed considerable prolongation of gastric transit compared to pretreatment values, both in terms of first discharge of labeled bolus into the duodenum and of percent gastric radioactivity dissipated at 20 min. With carprofen, both parameters were influenced in the same direction to a significantly lower degree, to the point where the difference from pretreatment values was statistically improbable.

A study of gastric kinetics (comparison between different isotope carriers).

From the various investigations of gastric emptying described in the literature, radionuclide labelling of meals appears to provide the most suitable technique. The emptying patterns of different 99mTc-DTPA carriers were studied in healthy volunteers, compared with patterns found after ingestion of a fried egg incorporating 99mTc-serum albumin. The results are described and discussed. They seen to suggest that there are different modalities of gastric emptying when different meals and markers are used.

Enzyme dissolution of a phytobezoar in a gastrectomized subject.

A case of phytobezoar in a gastrectomized patient with liver disorders is reported. Owing to the difficulty of establishing the diagnosis, the need for gastroscopy and biopsy is emphasized. Apart from the cases in which surgical removal is urgent, attention is drawn to the effectiveness of enzyme dissolution in connection with the experience described.