الملخص
BACKGROUND/AIMS: Proton pump inhibitors (PPI) and H2-receptor antagonists (H2RA) are commonly prescribed for the treatment of mild to moderate reflux esophagitis (MMRE). There remains great controversy in their usefulness as the first choice and the appropriateness. We prospectively compared the efficacy and safety of the 8-week low-dose PPI vs. standard-dose H2RA in MMRE. METHODS: One hundred patients with MMRE were randomized to receive either low-dose of omeprazole (L-OMP: 10 mg, q.d.) or standard-dose of ranitidine (S-H2RA: 150 mg, b.i.d.) for 8 weeks. The H. pylori status using rapid urease test, histological examination and culture, reflux esophagitis (RE) grading, gastrointestinal symptoms using 4-point scale, adverse event and the standard laboratory examination were assessed at baseline and 8-week end point of therapy. RESULTS: Improvement rate of RE [intention to treat (n=82)/per protocol (n=72)] were shown in 69.1%/63.9% for L-OMP and 65.0%/63.9% for S-H2RA group (p=0.697, p=1.000). Complete healing rates of RE were 54.7%/50.0% for L-OMP and 42.5%/41.7% for S-H2RA. No significant difference in healing rate, the rapidity of symptom resolution, adverse events, and laboratory monitoring was found between the two groups. CONCLUSIONS: The low-dose omeprazole therapy produced similar healing rates and safety in the treatment of MMRE. In addition, L-OMP is advantageous in its once-a-day dosing and might be an alternative to S-H2RA, especially in Korean patients with MMRE.
الموضوعات
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Anti-Ulcer Agents/administration & dosage , Comparative Study , English Abstract , Esophagitis, Peptic/drug therapy , Histamine H2 Antagonists/administration & dosage , Omeprazole/administration & dosage , Ranitidine/administration & dosageالملخص
The present study was designed to delineate the role of H1- and H2-histamine receptors in the neuro-immune regulation in rats. The effects of H1- and H2-receptor antagonists on humoral and cell-mediated immune (HI and CMI) responses were investigated after intraperitoneal (i.p.) and intra-cerebroventricular (i.c.v.) administration. HI response was assayed by anti-sheep red blood cell (SRBC) antibody titre in presence and absence of 2-mercaptoethanol (2-ME). The CMI responses were evaluated by delayed type hypersensitivity (DTH) reaction (in vivo), i.e., measurement of footpad thickness, and lymphokine activity such as leucocyte migration inhibition (LMI) test (in vitro). On i.p. administration, both H1- (pheniramine and astemizole) and H2-receptor antagonists (ranitidine and cimetidine) were observed to produce significant enhancement of anti-SRBC antibody response. However, only H2- and not H1-receptor blockers were observed to stimulate CMI response significantly. When administered by icv route, only H2-receptor antagonists caused a statistically significant increase in both HI and CMI responses, while the H1-receptor blockers failed to modify the same. Thus, H2-receptors appear to play a major role in the histaminergic mechanisms involved in immunomodulation both at the level of immunocompetent cells active in the peripheral tissues as well as through the central nervous system structures involved in the central regulation of neuro-immune interaction.
الموضوعات
Animals , Antibody Formation/drug effects , Cell Migration Inhibition , Central Nervous System/physiology , Erythrocytes/immunology , Histamine/pharmacology , Histamine H1 Antagonists/administration & dosage , Histamine H2 Antagonists/administration & dosage , Immunity, Cellular/drug effects , Injections, Intraventricular , Male , Neuroimmunomodulation/physiology , Peripheral Nervous System/drug effects , Rats , Rats, Wistar , Receptors, Histamine H1/drug effects , Receptors, Histamine H2/drug effectsالملخص
Objetivo. El objetivo de nuestro estudio fue evaluar la eficacia del tratamiento con ranitidina asociada a tres antibióticos para la erradicación del Helicobacter pylori (Hp) contra el tratamiento de mantenimiento con ranitidina en la prevención de la recidiva de la úlcera duodenal (UD) durante un seguimiento de 12 meses. Antecedentes. Se han efectuado numerosos estudios sobre la erradicación del Hp en la mucosa gástrica y la prevención de la UD recidivante, sin embargo, no se ha establecido aún un tratamiento óptimo. Métodos. Nosotros efectuamos un estudio prospectivo y comparativo con 51 pacientes portadores de UD activa diagnosticada por endoscopía y que fueron distribuidos al azar en dos grupos. El grupo A (26 pacientes) recibió ranitidina 300 mg/día + metronidazol 1.5 g/día + furoxona 300 mg/día por cinco días durante 12 meses. En ambos grupos efectuamos endoscopía de control a las ocho semanas de iniciado el tratamiento, así como a los seis y 12 meses de su inclusión en el protocolo o antes en caso de presentar manifestaciones clínicas de recidiva de la UD. En cada endoscopía se tomaron dos biopsias del antro gástrico para la detección histológica del Hp mediante tinción de Giemsa así como de hematoxilina y eosina. Todos los pacientes dieron su consentimiento para participar en la investigación ésta fue aprobada por el Comité de Etica de nuestro hospital. El análisis estadístico se efectuó mediante X2. Resultados. Después de ocho semanas, las ulceras de todos los pacientes se encontraban cicatrizadas. El porcentaje de erradicación del Hp fue de 24/26 (92 por ciento) en el grupo A y ninguno en el grupo B(p<0.001). La reubfeccuñib por Hp ocurrió en 9/24 (37.5) durante el periodo control de 12 meses (grupo A) y de éstos un paciente tuvo recidiva de la UD. Por el contrario, los 25 pacientes del grupo B fueron persistentes positivos para el Hp y siete sufrieron recidiva de la UD (p<0.05). Ambos tratamientos fueron bien tolerados. Conclusiones. La terapia combinada de amoxicilina, metronizadol, furoxona y ranitidina es altamente efectiva para la erradicación del Hp y la prevención de la recidiva de la UD. Nuestros resultados son similares a los reportados con otros esquemas terapéuticos
الموضوعات
Humans , Male , Female , Adolescent , Adult , Middle Aged , Drug Therapy, Combination , Furazolidone/administration & dosage , Helicobacter Infections/drug therapy , Helicobacter pylori , Histamine H2 Antagonists/administration & dosage , Longitudinal Studies , Metronidazole/administration & dosage , Ranitidine/administration & dosage , Peptic Ulcer/prevention & control , Recurrence , Time Factorsالملخص
Objetivo. Comparar y contrastar la eficacia y tolerabilidad de un inhibidor de bomba de protones, pantoprazol, con un antagonista de los receptores H2, ranitidina, en el tratamiento de pacientes con esofagitis por reflujo moderada y severa. Antecedentes. La esofagitis por reflujo es una enfermedad común que afecta del 5 al 10 por ciento de la población mundial. El reflujo ácido juega un papel importante en el desarrollo de la enfermedad, así como las alteraciones en la motilidad del esófago y estómago. Pacientes y métodos. 315 pacientes (intento de tratamiento) con esofagitis por reflujo (Savary-Miller (SM) grados II y III) confirmada endoscópicamente fueron reclutados en este estudio por 46 investigadores mexicanos en nueve centros. Los pacientes recibieron ya sea pantoprazol 40 mg una vez al día o 150 mg de ranitidina dos veces al día en este estudio doble ciego, aleatorizado, con comparación de grupos paralelos. Los pacientes que no alcanzaron una cicatrización endoscópica completa después de cuatro semanas de tratamiento recibieron cuatro semanas adicionales. La tolerabilidad a los medicamentos fue valorada a través del informe de eventos adversos durante el estudio. Resultados. Después de cuatro semanas de tratamiento con pantoprazol el 81 por ciento de los pacientes con SMII y 67 por ciento de los pacientes con SM III habían cicatrizado; en contraste en el grupo tratado con ranitidina cicatrizaron solamente 67 y 30 por ciento respectivamente, todos los resultados están expresados en pacientes protocolo correcto. Después de ocho semanas de tratamiento los índices de cicatrización para el grupo pantoprazol se incrementaron a 94 por ciento y en el grupo de ranitidina 74 por ciento (p=0.001). La incidencia de eventos adversos fue menor del 2 por ciento en ambos grupos de tratamiento, por lo tanto encontramos que ambas terapias fueron bien toleradas. Conclusiones. El pantoprazol es superior a la ranitidina en el tratamiento de esofagitis por reflujo moderada y severa y ambos tratamientos son igualmente bien tolerados
الموضوعات
Humans , Male , Female , Adolescent , Adult , Middle Aged , Anti-Ulcer Agents/administration & dosage , Anti-Ulcer Agents/therapeutic use , Benzimidazoles/administration & dosage , Benzimidazoles/therapeutic use , Data Interpretation, Statistical , Double-Blind Method , Esophagitis, Peptic/classification , Esophagitis, Peptic/drug therapy , Histamine H2 Antagonists/administration & dosage , Histamine H2 Antagonists/therapeutic use , Enzyme Inhibitors/administration & dosage , Enzyme Inhibitors/therapeutic use , Placebos , Prospective Studies , Ranitidine/administration & dosage , Ranitidine/therapeutic use , Sulfoxides/administration & dosage , Sulfoxides/therapeutic use , Time Factorsالملخص
Antecedentes. El helicobacter pylori (Hp) se presenta en más del 80 por ciento de los casos con enfermedad ácido péptica. Su erradicación requiere antimicrobianos cuya efectividad puede alcanzar 90 por ciento o más, según el esquema utilizado. Objetivo. Comparar la eficacia de erradicación del Hp en úlcera péptica y gastritis crónica con dos esquemas de tratamiento. Material y métodos. Se incluyeron pacientes mayores de 20 años, con enfermedad ácido péptica y biopsia positiva con Hp. Se investigaron antecedentes de úlcera y hemorragia, ingestión de AINE's, tabaco y alcohol. Fueron sometidos a endoscopia superior con biopsia de antro inicial y postratamiento para documentar erradicación. Se administraron dos esquemas de tratamiento: GI: subsalicilato de bismuto-tetraciclina-metronidazol-ranitidina, GII subsalicilato de bismuto amoxicilina-metronidazol-ranitidina. Análisis estadístico. Chi2 y análisis multivariado. Resultados. Se incluyeron 118 pacientes, 52 por ciento del sexo femenino, 48 por ciento del masculino con edad promedio de 47 ñ 16 años. El 79 por ciento de los casos tuvieron historia previa de úlcera y hemorragia, 62 por ciento, ingestión de AINE's 49 por ciento y tabaquismo 30 por ciento al momento de su diagnóstico. El 90 por ciento presentó dolor, melena 47 por ciento y 24 por ciento hematemesis. La erradicación de Hp fue de 70 por ciento para ambos esquemas (pNS), persistió la ulcera gástrica y duodenal en 23 por ciento y la ingestión de AINE's se asoció a pobre cicatrización ulcerosa y falla de erradicación (p<0.05). Conclusiones. Se obtuvo erradicación del Hp en 70 por ciento sin diferencia entre ambos grupos. Falla en cicatrización ulcerosa en 23 por ciento de los casos y los AINE's se asociaron a probre cicatrización y erradicación de Hp (p<0.05)
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Anti-Infective Agents/administration & dosage , Bismuth/administration & dosage , Chi-Square Distribution , Drug Therapy, Combination , Follow-Up Studies , Gastritis/drug therapy , Helicobacter Infections/drug therapy , Helicobacter pylori , Histamine H2 Antagonists/administration & dosage , Metronidazole/administration & dosage , Penicillins/administration & dosage , Tetracycline/administration & dosage , Duodenal Ulcer/drug therapy , Stomach Ulcer/drug therapy , Peptic Ulcer/drug therapyالملخص
The effect of pre-operative intake of oral water and ranitidine on gastric fluid volume and pH was studied in 75 children of American Society of Anesthetists (ASA) grade I and grade II undergoing elective surgery. Group I patients fasted from midnight and acted as control. Group II patients received 5 ml/kg plain water orally 3 hours before surgery. Group III children received 5 ml/kg of plain water and 2 mg/kg of ranitidine orally 3 hours before surgery. Mean volume of gastric aspirate was comparable in all 3 groups (p > 0.05). Mean pH was significantly higher in ranitidine treated patients (5.12 +/- 1.73) as compared to non-ranitidine treated patients (2.26 +/- 0.57 and 2.53 +/ 0.79 in group I and group II respectively). Number of patients at risk (pH < or = 2.5 and volume > or = 0.4 ml/kg) was not significantly different in group I and group II. Mean thirst and behaviour scores were significantly higher in fluid treated patients (groups II and III) as compared to control (p < 0.01). To conclude, administration of pre-operative water (5 ml/kg) along with ranitidine (2 mg/kg) favourably modifies gastric fluid volume and pH, improves patient behaviour and minimises the number of patients at risk of aspiration pneumonitis, should the child aspirate.
الموضوعات
Administration, Oral , Body Water/drug effects , Child , Child, Preschool , Fasting , Female , Gastric Acid/metabolism , Histamine H2 Antagonists/administration & dosage , Humans , Male , Preoperative Care/methods , Ranitidine/administration & dosage , Reference Values , Stomach/drug effects , Elective Surgical Procedures , Water/administration & dosageالملخص
INTRODUCTION: Definitive surgery at the time of primary laparotomy for perforated duodenal ulcer is often deferred because of its increased morbidity. However simple closure alone is associated with a high rate of recurrence. In view of this H2 blockers have been administered along with simple closure to promote ulcer healing. Only 4 series have been published so far, all lacking either a control group or endoscopic follow up. The results are contradictory. AIMS: This study was done to assess the effect of administration of H2 blockers after simple closure on ulcer healing in a randomised, controlled, double blind fashion. METHODS: One hundred patients were entered in the study. Fifty patients randomly selected either received ranitidine or a placebo after simple closure. Follow up endoscopy was done at 1, 2 and 6 months. If persistence of ulcer was seen at 4 weeks, patients on placebo were converted to ranitidine and those on ranitidine were continued on the drug. RESULTS: Endoscopically assessed rate of persistent or recurrent ulcer at 4 weeks was 39% in the ranitidine group and 29% in the placebo group. At 6 months the corresponding figures were 33% and 30% respectively. The differences between the two groups were not significant. CONCLUSIONS: Ranitidine, therefore, does not appear to promote healing of a perforated duodenal ulcer after simple closure.
الموضوعات
Administration, Oral , Adolescent , Adult , Child , Combined Modality Therapy , Double-Blind Method , Duodenal Ulcer/complications , Endoscopy, Digestive System , Female , Follow-Up Studies , Histamine H2 Antagonists/administration & dosage , Humans , Laparotomy , Male , Middle Aged , Peptic Ulcer Perforation/diagnosis , Prospective Studies , Ranitidine/administration & dosage , Treatment Outcomeالملخص
BACKGROUND: Roxatidine acetate is a novel H2-receptor antagonist and several studies have shown that it is effective in healing duodenal ulcers. We evaluated the efficacy of roxatidine in a non-western society with particular different features and its healing of duodenal ulcers was compared in Thailand with that of ranitidine. METHOD: The design was controlled, randomized, double-blind, and multicenter. The study recruited a total of 215 patients who were endoscoped at the start of the trial and then randomized to receive a single capsule of roxatidine acetate, 150 mg, or an identical capsule containing ranitidine, 300 mg, both to be taken at night. Patients were evaluated at 1, 2, and 4 weeks, including endoscopy at the last session, as well as at 6 weeks with repeat endoscopy if the ulcer had not healed. RESULT: Both drugs relieved pain rapidly, usually within a week, and at repeat endoscopy at 4 weeks most ulcers (78%) were healed, 77.0 and 79.5 per cent in ranitidine and roxatidine, and in those patients in whom healing was not completed the healing rate had risen appreciably to 89.8 and 93.8 per cent respectively at 6 weeks. Small ulcers tended to heal quicker than larger ones, but smoking and alcohol intake had no negative effects on the results. CONCLUSION: The study was valid proof that roxatidine, in a single evening dose of 150 mg, was found to be both safe and effective in the rapid healing of duodenal ulcers when compared with 300 mg ranitidine.
الموضوعات
Adult , Aged , Aged, 80 and over , Double-Blind Method , Drug Administration Schedule , Duodenal Ulcer/diagnosis , Female , Histamine H2 Antagonists/administration & dosage , Humans , Male , Middle Aged , Pain Measurement , Piperidines/administration & dosage , Ranitidine/administration & dosage , Risk Factors , Thailand , Treatment Outcomeالملخص
Most controlled studies in humans indicate that ranitidine does not alter theophylline metabolism, even at high doses. However, there have been several case reports published recently which demostrate the development of theophylline toxicity mostly in older patients receiving stable oral doses of this drug when ranitidine was administered simultaneously. We studied eleven elderly (mean age, 69,0 + or - 6.2 years) patients with chronic obstructive pulmonary disease (COPD). During one week the patients took slow-release theophylline, 200 mg every 12 h, followed by one week intake of the same dose of theophylline plus ranitidine tables, 150 mg every 12h. At the end of each period, blood samples were obtained 0,1,2,3,4,6,7,8 and 12h after the morning dose for the determination of serum theophylline levels. the peak theophylline concentration was achieved after 4.1 + or - 0.9 h while the patients were taking theophylline, and after 2.9 + or - 1.4 h with the combined regimen. This difference was statistically significant. These results suggest that the reported increases in serum theophylline levels in older patients receiving theophylline and ranitidine cannot be ascribed to slower theophylline metabolism in the geriatric patient with COPD who is also given ranitidine.
الموضوعات
Humans , Middle Aged , Histamine H2 Antagonists/administration & dosage , Lung Diseases, Obstructive/metabolism , Ranitidine/administration & dosage , Theophylline/administration & dosage , Age Factors , Chromatography, High Pressure Liquid , Drug Interactions , Drug Therapy, Combination , Ranitidine/blood , Ranitidine/metabolism , Theophylline/blood , Theophylline/metabolismالملخص
Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid) while 27 patients received ranitidine (150 mg bid) for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates (22/25 vs 22/26); roxatidine, however, resulted in greater reduction in the number and severity of night time pain episodes (p < 0.05). No adverse event was reported during 4 weeks of treatment with roxatidine. Thus roxatidine achieves the primary therapeutic goal of relief of pain better than ranitidine.
الموضوعات
Adult , Double-Blind Method , Drug Administration Schedule , Duodenal Ulcer/diagnosis , Female , Follow-Up Studies , Histamine H2 Antagonists/administration & dosage , Humans , Male , Pain Measurement , Piperidines/administration & dosage , Ranitidine/administration & dosage , Treatment Outcomeالموضوعات
Humans , Male , Female , Peptic Ulcer/epidemiology , Antacids/administration & dosage , Gastric Acidity Determination , Histamine H2 Antagonists/administration & dosage , Omeprazole/administration & dosage , Ranitidine/administration & dosage , Peptic Ulcer/diagnosis , Peptic Ulcer/physiopathology , Peptic Ulcer/drug therapyالملخص
Se estudió en forma prospectiva, pacientes pediátricos con diagnóstico de asma bronquial en el Hospital I Ramón Castilla-IPSS, Lima-Perú, quienes recibieron tratamiento con inhalador asociado a Beclametasona mas Salbutamol. La evolución del cuadro clínico, los valores de flujo pico, los efectos colaterales y standard de vida con la asociación medicamentosa fue superior cuando fue comparada al tratamiento antiasmático llamado de primera linea
الموضوعات
Humans , Male , Female , Child, Preschool , Adolescent , Asthma/therapy , Histamine H2 Antagonists/therapeutic use , Beclomethasone/administration & dosage , Beclomethasone/therapeutic use , Albuterol/administration & dosage , Albuterol/therapeutic use , Histamine H2 Antagonists/administration & dosageالملخص
Verificar se a cimetifdina, ranitidina e a famotidina, quando injetadas por via ip em camundongo, promovem ativaçäo macrofágica e se esta é alterada com o uso prévio de tioglicolato sódico. Tipo de estudo - Experimental. Animais - Camundongos isogênicos, Balb/c, 19-21g. Intervençiao - Utilizados oito grupos com 10 animais cada. Os animais foram tratados, por via ip, com cimetidina (100mg/Kg), ranitidina (62,5mg/Kg) e famotidina (50mg/Kg), sendo comparados com um grupo controle (salina). Vinte e quatro horas após a inoculaçäo, foi aplicada a técnica do espraiamento de macrófagos. Em etapa posterior, o mesmo procedimento foi realizado, porém em grupos tratados previamente com tioglicolato sódico (15mg/Kg). Análise estatística - Através dos testes de KrusKal-Wallis e Mann-Whitney. Resultados e conclusäo - A inoculaçäo dos anti-H2 em cavidade peritoneal de camundongos aumenta significantemente o espraiamento macrofágico, independentemente do uso prévio de um irritante peritoneal
الموضوعات
Animals , Male , Female , Mice , Histamine H2 Antagonists/pharmacology , Macrophage Activation/drug effects , Ranitidine/administration & dosage , Ranitidine/pharmacology , Famotidine/administration & dosage , Famotidine/pharmacology , Cimetidine/administration & dosage , Cimetidine/pharmacology , Histamine H2 Antagonists/administration & dosage , Mice, Inbred BALB C , Injections, Intraperitonealالملخص
La mayoría de las úlceras clorhidropéptica cicatriza cuando se reduce adecuadamente la acción agresora ácida durante una fracción de las 24 horas del día: (a) neutralizando en el lumen de la secreción; (b) actuando sobre receptores en las membranas de las células parietales. Los antagonistas del receptor-2 de la histmina en dosis nocturna única reducen el tiempo total de cicatrización de 90 por ciento de las úlceras duodenales y gástricas a 6 y 8 semanas promediales, respectivamente. La vida media de eliminación es corta, no se acumulan y los efectos colaterales, cuya incidencia real con dosis habituales es muy baja, son reversibles. Los antiácidos ( hidróxido de aluminio ) y bloquedores del receptor-1 de la muscarina ( pirenzepina ) son alternativas de segunda línea en la estrategia terapeútica general. Omeprazol, un bloqueador de la bomba de protones, se acumula intracelularmente y alcanza niveles de inhibición casi total; por ello mismo se restrige su uso a determinados problemas clínicos graves y sólo durante lapsos breves. Bismuto coloidal y sucralfato se adhieren a la base de la úlcera y promueven su curación eficazmente. Prostaglandina E2 y sus análogos combinan la acción antisecretora con la " citoprotección " directa: su indicación principal es la prevención de recurrencias de lesiones gástricas en pacientes bajo tratamiento obligado con anti-inflamatorios no esteroideos. Dosis moderadas de bloqueadores del receptor H2 durante periodos hasta de 2 años disminuyen apreciablemente las recurrencias de la enfermedad ulcerosa común. El tratamiento quirúrgico es apreciable a casos precisos