ABSTRACT
No disponible
Subject(s)
Humans , Heartburn/drug therapy , Heartburn/etiology , Proton Pumps/antagonists & inhibitors , Baclofen/therapeutic use , GABA Agonists/therapeutic use , Histamine H2 Antagonists/therapeutic use , Anti-Ulcer Agents/therapeutic use , Endoscopy , Hydrogen-Ion Concentration , Electric Impedance , ManometryABSTRACT
Raltegravir es el primer inhibidor de la integrasa aprobado para tratar la infección por el virus de la inmunodeficiencia humana de tipo 1 en pacientes adultos con evidencia de replicación viral a pesar de estar recibiendo terapia antirretroviral. Se administra por vía oral a una dosis de 400 mg cada 12 h, con o sin alimentos. Se elimina mayoritariamente por glucuronidación mediante la UGT1A1 y no tiene efecto inhibidor ni inductor en las principales isoenzimas del citocromo P450 hepático, por lo que presenta escaso riesgo de interacciones farmacológicas con la mayoría de los fármacos de uso habitual, como metadona, antifúngicos azólicos o fármacos para tratar la disfunción eréctil. Los estudios de interacción con otros antirretrovirales demuestran que raltegravir puede emplearse en combinación con tenofovir, efavirenz, atazanavir, ritonavir o tipranavir/ritonavir sin que se requiera ajuste de dosis. En combinación con rifampicina se recomienda valorar el aumento de dosis de raltegravir a 800 mg/12 h. Los inhibidores de la bomba de protones aumentan las concentraciones plasmáticas de raltegravir (exposición o área bajo la curva 3 veces mayor), por lo que se recomienda evitar, en lo posible, su uso combinado. Raltegravir es un fármaco bien tolerado y no requiere ajuste de dosis en pacientes con insuficiencia renal grave ni en pacientes con insuficiencia hepática leve a moderada. No hay estudios en pacientes con insuficiencia hepática grave
Raltegravir is the first integrase inhibitor approved for the treatment of HIV-1 infection in pretreated adults with evidence of viral replication despite receiving antiretroviral therapy. Raltegravir is administered orally at a dose of 400 mg every 12 hours, with or without food. This drug is mainly eliminated through UGT1A1-mediated glucuronidation and is not an inhibitor or inducer of the main liver cytochrome P450 isoenzymes; consequently there is virtually no risk of pharmacological interactions with most commonly used drugs such as methadone, azole antifungal agents or drugs used to treat erectile dysfunction. Studies of interaction with other antiretroviral agents show that raltegravir can be used in combination with tenofovir, efavirenz, atazanavir, ritonavir or tipranavir/ritonavir without the need for dose adjustments. When combined with rifampicin, the dose of raltegravir should be increased to 800 mg/12 h. Proton pump inhibitors increase plasma levels of raltegravir (a 3- fold increase in exposure or AUC levels), and consequently their combined use should be avoided as far as posible. Raltegravir is well tolerated and does not require dose adjustments in patients with severe renal impairment or mild-to-moderate liver impairment. There are no studies in patients with severe liver impairment (AU)
Subject(s)
Humans , HIV Integrase Inhibitors/pharmacokinetics , HIV , HIV Infections/drug therapy , Anti-HIV Agents/pharmacokinetics , Drug Interactions , Anti-Retroviral Agents/pharmacokinetics , Proton Pumps/antagonists & inhibitorsABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Esophagitis/diagnosis , Eosinophilia/diagnosis , Gastroesophageal Reflux/diagnosis , Diagnosis, Differential , Proton Pumps/antagonists & inhibitorsABSTRACT
Background: Drug induced inhibition of acid secretion has been associated to small intestinal bacterial overgrowth (SIBO). Smoking is followed by an increase of exhaled and orocecal transit time (OCTT). Aim: To investigate if the use of proton pump inhibitiors (PPI) and smoking can modifie the incidence of SIBO in patients with functional gastrointestinal disease. Patients and Methods: Questionnaires performed before a study for SIBO in patients with functional gastrointestinal disorders were analyzed. The use PPI and the smoking habit were recorded. The presence of SIBO and the OCTT was determined by means of the lactulose hydrogen breath test. Results: 437 patients, mean age 45 years (range: 14-93), 337 (77 percent) female, entered in the study SIBO was present in 356 patients, and 81 patients had normal H2 breath test. Both groups had a similar distribution of gender and age. The percentage of SIBO was no different in patients using PPI or presenting smoking habit Conclusions: Use of PPI and smoking habit are not risk factors for the development of SIBO in patients with functional disorders.
Los fármacos que inhiben la secreción gástrica favorecen el sobrecrecimiento bacteriano intestinal (SBI), mientras que el habito de fumar puede aumentar los niveles de H2 espirado y el tiempo de transito orocecal (TTOC). Objetivo: Investigar si el uso de inhibidores de la bomba de protones (IBP) y el habito de fumar modifican la incidencia de SBI en pacientes con trastornos digestivos funcionales. Pacientes y Métodos: Se analizaron encuestas de pacientes con patología digestiva funcional previas a un estudio de SBI Se consignaron el uso de IBP Y el hábito tabáquico en los 6 meses que precedieron al examen. La presencia de SBI y el tiempo de transito orocecal (TTOC) se determinaron con el test de hidrógeno en aire espirado con lactulosa. Resultados: 437 pacientes, con edad x 45 años (rango: 14-93),337 (77 por ciento) mujeres. Con SBI 356 pacientes, sin SBI 81 pacientes. Ambos grupos fueron comparables en cuanto a distribución por sexo y edad. El porcentaje de pacientes con SBI no fue diferente en pacientes con antecedente de uso de IBP o con hábito tabaquito. Conclusiones: El antecedente del uso de IBP y el tabaquismo no constituyen un factor de riesgo para SBI en pacientes con patología digestiva funcional.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , Anti-Ulcer Agents/pharmacology , Bacteria/growth & development , Bacteria , Nicotine/pharmacology , Proton Pumps/antagonists & inhibitors , Chile/epidemiology , Time Factors , Hydrogen/analysis , Intestines , Lactulose/administration & dosage , Omeprazole/pharmacology , Breath Tests , Gastrointestinal Transit/physiologyABSTRACT
No disponible
Subject(s)
Humans , Proton Pumps/antagonists & inhibitors , Peptic Ulcer/drug therapy , Clarithromycin/therapeutic use , Amoxicillin/therapeutic use , Metronidazole/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Helicobacter Infections/drug therapy , Helicobacter pylori/pathogenicity , Proton Pumps/antagonists & inhibitors , Clarithromycin/therapeutic use , Amoxicillin/therapeutic use , Bismuth/therapeutic use , Ranitidine/therapeutic use , Anti-Bacterial Agents/therapeutic use , Ofloxacin/therapeutic use , Metronidazole/therapeutic use , Rifabutin/therapeutic useABSTRACT
Introducción: los inhibidores de la bomba de protones (IBP)bloquean la enzima H+/K+ ATPasa en las células parietales gástricas,logrando la inhibición de la secreción de ácido clorhídrico deforma basal como tras estimulación. Las indicaciones apropiadaspara su uso son: enfermedad por reflujo gastroesofágico, hemorragiadigestiva aguda, úlceras activas, gastritis o esofagitis erosiva,dispepsia, gastropatía por AINE, profilaxis de úlcera de estrésen pacientes de riesgo.El objetivo del estudio fue la revisión de las indicaciones de losIBP en nuestro medio y la evaluación de su utilización en el HospitalUniversitario de Guadalajara.Material y métodos: se realizó un estudio de corte transversalanalítico con selección aleatoria de los pacientes atendidos enel Servicio de Medicina Interna durante todo el año 2003. Se revisaronun total de 208 historias de 832 pacientes (un 25%) a losque se administraron IBP. La edad media fue de 67 años (rango16-92), el 46,2% fueron mujeres y las enfermedades subyacentesmás frecuentes fueron: HTA, EPOC y DM.Resultados: un 34,6% de los pacientes tomaban IBP antesdel ingreso. De estos, el 68,1% no tenía indicación. Durante el ingresose prescribió de forma inadecuada el IBP al 73,07% y alalta, se mantenía el IBP sin indicación correcta.Conclusiones: los resultados están en concordancia con losanteriormente publicados, manteniéndose una alta frecuencia deuso incorrecto de los IBP y siendo recomendable una utilizaciónmás racional para evitar los efectos secundarios, las interaccionescon otros fármacos y aportar una atención médica más eficiente
Introduction: proton pump inhibitors (PPIs) block the H+/K+ ATPase enzyme in gastric wall cells, leading to an inhibition of both baseline and stimulated acid secretion. Appropriate indications include: Gastroesophageal reflux, acute upper gastrointestinalbleeding, erosive gastritis or esophagitis, dyspepsia,NSAID-related gastropathy, and stress ulcer prophylaxis in high risk patients. The aims of this study were to review the current indications of PPIs, and to evaluate their use in Guadalajaras University Hospital.Material and methods: a transversal, analytic, randomizedstudy was carried out during 2003 in our internal medicine department. A total of 208 medical records for 832 patients receiving PPIs were reviewed (25%). Mean age was 67 years (range: 16-92), 46.2% were females, and most frequent conditions were HBP, COPD, and DM. Results: 34.6% of patients took PPIs before admission, theiruse being inappropriate in 68.1% of them. Among hospitalized patients 73.03% used PPIs inappropriately, and most of them had no such indication at discharge.Conclusions: results are in accordance with the literature, with a high frequency of incorrect PPI use; a more accurate use of PPIs is to be recommended to avoid side effects and drug interactions, and to provide a more efficient medical care (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Drug Utilization , Proton Pumps/antagonists & inhibitors , Cross-Sectional Studies , Hospitalization , Patient DischargeABSTRACT
Medication of gastrointestinal disorders in the pregnancy, as well as of other pathological conditions, represent an important challenge for gastroenterologist and obstetrician. Several new medications has been developed in the last year and an adequate knowledge about the risks and benefits of different drugs involved in the treatment of these patients is very important. Classification of the drugs used in gastrointestinal diseases as well the available evidence of the effects these drugs during pregnancy is analyzed.
El tratamiento de las enfermedades gastrointestinales en el embarazo, así como otras condiciones patológicas, representa un importante desafió para los gastroenterólogos y obstetras. Nuevos medicamentos han sido desarrollados en el último tiempo y un adecuado conocimiento sobre los riesgos y beneficios de las diferentes drogas involucradas en el tratamiento de estas pacientes es muy importante. La clasificación de las drogas usadas en las enfermedades gastrointestinales, así como la evidencia disponible de los efectos de estos medicamentos durante el embarazo es analizada.
Subject(s)
Humans , Histamine H2 Antagonists , Immunosuppressive Agents/therapeutic use , Antiemetics/therapeutic use , Pregnancy Complications/drug therapy , Gastrointestinal Diseases/drug therapy , Enzyme Inhibitors/therapeutic use , Anti-Bacterial Agents/adverse effects , Antidiarrheals/therapeutic use , Proton Pumps/antagonists & inhibitors , Cathartics/therapeutic use , Pregnancy Complications/chemically induced , Inflammatory Bowel Diseases/drug therapy , Irritable Bowel Syndrome/drug therapy , Peptic Ulcer/drug therapyABSTRACT
La prescripción de fármacos antiulcerosos en medio hospitalario, y su influencia posterior en atención primaria, se incrementó en los últimos años y con ello el gasto farmacéutico. El objetivo del presente estudio es analizar la prevalencia de prescripción de antiulcerosos en nuestro centro hospitalario y la adecuación a las indicaciones establecidas. Se realizó un estudio observacional de prescripción-indicación con 2 cortes transversales separados en 6 meses para evitar sesgos de selección. Se constata el uso elevado de gastroprotectores, principalmente inhibidores de bomba de protones, sobre todo en profilaxis de gastropatía por antiinflamatorios no esteroideos (AINE) (17,1%), con una tasa de prescripciones incorrectas del 77,6% a pesar de la existencia de un protocolo específico elaborado por el comité de farmacia y terapéutica de nuestro centro. Destaca el número elevado de prescripciones en pacientes con corticoterapia sin asociación con AINE (25,7%). Se requieren nuevas herramientas que impliquen al facultativo y a los gestores clínicos en el uso racional de medicamentos
Prescription rates of anti-ulcer drugs in hospitals and their spill-over to general practice have risen over the last few years, increasing pharmaceutical expenses. The aim of this study was to analyze gastroprotective drug prescription habits in our hospital by assessing both prevalence and adherence to approved indications. An observational study of prescription-indication was performed with 2 cross sections separated by 6 months to avoid selection bias. We found overprescription of gastroprotective drugs, mainly proton pump inhibitors for the prevention of non-steroidal antiinflammatory drug-induced ulcer (17.1%). Overall, 77.6% of prescriptions had no acceptable indication, despite the availability of a specific protocol produced by the Pharmacy and Therapeutics Committee in our center. There was a high prevalence of prescriptions for non-approved indications such as prophylaxis in patients administered corticosteroids without non-steroidal anti-inflammatory agents (25.7%). New programs to train clinicians and clinical managers in rational drug use are required
Subject(s)
Humans , Primary Health Care/statistics & numerical data , Drug Utilization/statistics & numerical data , Anti-Ulcer Agents/therapeutic use , Enzyme Inhibitors/therapeutic use , Proton Pumps/antagonists & inhibitors , Omeprazole/therapeutic use , Drug Prescriptions/statistics & numerical data , Drug Costs/statistics & numerical data , Anti-Inflammatory Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic useABSTRACT
Los inhibidores de la bomba de protones (IBP) son fármacos útiles para el control de la patología asociada con la acidez gástrica, patología con una alta prevalencia dentro de la población general. En las Unidades de dolor tratamos pacientes con pluripatología y polimedicados, entre ellas patologías asociadas con la acidez gástrica. Así como también utilizamos fármacos como AINES, glucocorticoides, bifosfonatos... que pueden reactivar, empeorar la patología ligada a la acidez. El conocimiento de los aspectos farmacológicos de los IBP, tanto farmacocinéticos como farmacodinámicos, es necesario y preciso para poder elegir el más adecuado para nuestros pacientes con pluripatologia y polimedicados evitando las posibles interacciones farmacológicas que podrían afectar al estado de salud de nuestros pacientes (AU)
Protón Pump Inhibitors (PPIs) have shown their usefulness in the treatment of acid-related disorders, highly prevalent in normal population. Pain units are used to treating patients with a wide range of diseases, including acid related-disorders, who are also being prescribed many different drugs, like NSAIDs, corticosteroids or biphosponates, which may reactívate or even worsen acid-related disorders. Knowledge of the pharmacological aspects of PPIs, both their pharmacokinetics and pharmacodynamics, is needed to properly choose the one which fits most to our multi-pathologic, multi-treated patients, in order to avoid possible pharmacological interactions than could endanger their health condition (AU)
Subject(s)
Humans , Gastric Acid/metabolism , Proton Pumps/antagonists & inhibitors , Omeprazole/pharmacokinetics , Anti-Ulcer Agents/pharmacokinetics , Drug Interactions , Liver/metabolism , Pain ClinicsABSTRACT
Presentamos el caso clínico de un niño de 22 meses de edad enviado a nuestro departamento por sufrir episodios recurrentes de diseña alta y tos perruna desde los tres meses. Por Pediatría se sospecha estenosis laríngea o laringomalacia y solicitan su confirmación. La exploración ORL incluida la nasofibrolaringoscopia resultó ser normal. Se realizó tomografía axial computarizada (TAC) y resonancia magnética del cuello (RM) descartándose en ambas patología. Después de haberse agotados múltiples terapéuticas, pautamos tratamiento empírico con inhibidores de la bomba de protones (IBP) y para sorpresa nuestra la mejoría fue espectacular
We detail here the clinical case of a 22 month old child who was referred to our department because of recurring episodes of upper dyspnea and barking cough since he was 3 months old. The Pediatric Department suspected laryngeal stenosis or laryngomalacia and asked for confirmation of this. The ENT examination including nasofibrolaryngoscopy was normal. A computerised axial tomography (CAT) was carried out, as well as a magnetic resonance of the neck, both eliminating possible pathologies. Having tried several treatments, we prescribed empirical treatment with proton pump inhibitors, and to our surprise the improvement was spectacular. We have carried out a review of literature about gastroesophageal reflux, its manifestations, diagnosis and treatment
Subject(s)
Humans , Male , Infant , Dyspnea/diagnosis , Dyspnea/etiology , Proton Pumps/antagonists & inhibitors , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/drug therapy , Laryngoscopy/methods , Tomography, Emission-Computed/methods , Time Factors , Follow-Up Studies , Gastroesophageal Reflux/pathology , Gastroesophageal Reflux , Magnetic Resonance Imaging/methodsABSTRACT
No disponible
Subject(s)
Female , Adolescent , Humans , Anaphylaxis/etiology , Proton Pumps/antagonists & inhibitors , Omeprazole/adverse effects , Drug HypersensitivityABSTRACT
The effect of proton pump inhibitors and Helicobacter pylori infection on the bioavailability of antibiotics is poorly understood. We determined the effects of 5-day oral administration of 60 mg lansoprazole on the bioavailability of clarithromycin in individuals with and without H. pylori infection. Thirteen H. pylori-infected and 10 non-infected healthy volunteers were enrolled in a study with an open-randomized two-period crossover design and a 21-day washout period between phases. Plasma concentrations of clarithromycin in subjects with and without lansoprazole pre-treatment were measured by liquid chromatography coupled to a tandem mass spectrometer. Clarithromycin Cmax and AUC0-10 h were significantly reduced after lansoprazole administration. In addition, lansoprazole treatment of the H. pylori-positive group resulted in a statistically significant greater reduction in Cmax (40 vs 15 percent) and AUC0-10 h (30 vs 10 percent) compared to lansoprazole-treated H. pylori-negative subjects. Thus, treatment with lansoprazole for 5 days reduced bioavailability of clarithromycin, irrespective of H. pylori status. This reduction, however, was even more pronounced in H. pylori-infected individuals.
Subject(s)
Humans , Adult , Anti-Bacterial Agents/pharmacokinetics , Anti-Ulcer Agents/administration & dosage , Clarithromycin/pharmacokinetics , Helicobacter pylori , Helicobacter Infections/drug therapy , /administration & dosage , Anti-Bacterial Agents/therapeutic use , Biological Availability , Case-Control Studies , Chromatography, High Pressure Liquid , Cross-Over Studies , Clarithromycin/therapeutic use , Drug Synergism , Proton Pumps/antagonists & inhibitors , Time FactorsABSTRACT
No disponible
Subject(s)
Male , Aged , Humans , Abdomen, Acute/etiology , Stomach Diseases/diagnosis , Gastroscopy , Proton Pumps/antagonists & inhibitors , Radiography, Thoracic , Stomach Diseases/radiotherapy , Stomach Diseases/therapy , Torsion AbnormalityABSTRACT
Objetivo: determinar la eficacia del rabeprazol (RPZ), amoxicilina (Am) y claritromicina (Cla) (7 vs. 14 días) en la erradicación de H. pylori y determinar el efecto de la resistencia a los antibióticos y el genotipo de CYP2C19. Material y métodos: inicialmente, se determinó el genotipo de CYP2C19 a 100 sujetos sanos para determinar el tamaño de muestra del ensayo clínico. Posteriormente, 59 pacientes H. pylori+ recibieron al azar RPZ (20 mg diarios), Cla (500 mg cada 12 horas) y Am (1.000 mg cada 12 horas) (7 vs. 14 días). Se determinó la CMI para Am y Cla por el método de dilución en agar. El genotipo CYP2C19 fue determinado por PCR-RFLP. Resultados: en el análisis por protocolo (PP), las tasas de erradicación fueron del 89,7 y 72% para los grupos de 7 y 14 días respectivamente (p = 0,159). En el análisis de intención de tratamiento (IT), las tasas de erradicación fueron del 86,7 y 62,1% en los grupos de 7 y 14 días respectivamente (p = 0,06). Ninguna cepa presentó resistencia a Am y 4 cepas fueron resistentes a Cla: 3 (11,1%) en el grupo de 14 días y 1 (4%) en el grupo de 7 días. Las tasas de erradicación no fueron afectadas por la resistencia de la cepa o el genotipo de CYP2C19. Conclusiones: las terapias de 7 y 14 días fueron eficaces para la erradicación de H. pylori. Al parecer, la resistencia de la cepa y el genotipo de CYP2C19, no influenciaron las tasas de erradicación de H. pylori en la población estudiada
Objective: to assess the efficacy of rabeprazole (RPZ), amoxicillin (Am), and clarithromycin (Cla) (7 vs. 14 days) in the eradication of H. pylori, and to determine the effect of strain-specific antibiotic resistance and host CYP2C19 status. Material and methods: first, we determined the CYP2C19 status of 100 healthy subjects to establish a sample size for the clinical trial. Then, 59 H. pylori-infected patients were randomized to receive RPZ (20 mg daily) plus Cla (500 mg b.d.) and Am (1,000 mg b.d.) for 7 vs. 14 days. The MIC for Am and Cla were determined using the agar dilution method. The CYP2C19 genotype was determined by the PCR-RFLP method. Results: in the per-protocol analysis (PP) eradication rates were 89.7 and 72% for the 7- and 14-day groups (p = 0.159). In the intention to-treat analysis (ITT) eradication rates were 86.7 and 62.1% in the 7- and 14-day groups, respectively (p = 0.06). None of the strains was resistant to Am, and 4 strains were resistant to Cla: 3 (11.1%) in the 14-day group and 1 (4%) in the 7- day group. Neither strain-specific antibiotic resistance nor host CYP2C19 status influenced eradication rates. Conclusions: both 7- and 14-day therapies were effective for H. pylori eradication. Strain resistance and CYP2C19 status do not seem to influence eradication rates in the studied population
Subject(s)
Humans , Helicobacter pylori/pathogenicity , Helicobacter Infections/drug therapy , Anti-Bacterial Agents/pharmacokinetics , Drug Resistance, Microbial/immunology , Antacids/pharmacokinetics , Proton Pumps/antagonists & inhibitors , Amoxicillin/pharmacokinetics , Clarithromycin/pharmacokinetics , Enzyme Inhibitors/pharmacokinetics , Benzimidazoles/pharmacokinetics , GenotypeABSTRACT
Objetivo. Determinar si resulta coste-efectivo prolongar el tratamiento de 7 a 10 días en pacientes dispépticos y diferenciar entre dispepsia funcional, dispepsia no investigada y enfermedad ulcerosa. Diseño. Estudio de coste-efectividad mediante árbol de decisión con la comparación de los costes directos por paciente curado con ambas estrategias. Horizonte temporal: 2 años; perspectiva: Sistema Nacional de Salud. Emplazamiento. Atención primaria. Participantes. Simulación de 100 pacientes con úlcera péptica, dispepsia funcional o dispepsia no investigada que reciben tratamiento para la infección por Helicobacter pylori. Intervenciones. Tratamiento erradicador de H. pylori con un inhibidor de la bomba de protones, claritromicina y amoxicilina durante 7 o 10 días. Se midió el coste incremental por paciente curado. Resultados. En pacientes con úlcera péptica, el coste incremental por paciente curado al prolongar el tratamiento erradicador de 7 a 10 días es de 147 (intervalo de confianza [IC] del 95%, 121,3-162,7), mientras que en los pacientes con dispepsia funcional o dispepsia no investigada, es de 39,8 (IC del 95%, 28,5 a 60,7) y 27,3 (IC del 95%, 14,92 a 52,72), respectivamente. El análisis de sensibilidad demostró que la eficacia del tratamiento erradicador (7 frente a 10) fue la variable que más influyó en la estabilidad de los resultados. Conclusiones. Siete días es la duración más coste-efectiva de las terapias triples para realizar tratamiento erradicador en pacientes ulcerosos. Sin embargo, las pautas de 10 días son más coste-efectivas en pacientes con dispepsia funcional o para el tratamiento de pacientes sin diagnóstico endoscópico previo
Objective. To determine through an economic evaluation study whether it is cost-effective to extend treatment of dyspeptic patients from 7 to 10 days, distinguishing between functional dyspepsia, unexamined dyspepsia, and ulcer disease. Design. Cost-effectiveness study by means of a decision 3 comparing direct costs per patient cured with 2 strategies: a) 7 days treatment versus b) 10 days. Two-year study in the National Health System. Setting. Primary care. Participants. One-hundred patients with peptic ulcer, functional dyspepsia, or unexamined dyspepsia who received treatment for H pylori infection. Interventions. H pylori eradication treatment with a proton pump inhibitor, clarithromycin, and amoxycillin for 7 or 10 days. Measurement variable: incremental cost per patient cured. Results. In peptic ulcer patients, the incremental cost per patient cured on extending the eradication treatment from 7 to 10 days was 147 (95% CI, 121.3-162.7), whereas in patients with functional or unexamined dyspepsia, it was 39.8 (95% CI, -28.5 to -60.7) and 27.3 (95% CI, -14.92 to -52.72), respectively. The sensitivity analysis showed that the efficacy of eradication treatment (7 vs 10) was the factor that most affected the stability of the results. Conclusions. Seven days is the most cost-effective duration of the triple therapy for eradicating H pylori in ulcer patients. However, 10 days is more cost-effective in functional dyspepsia patients or those with no prior endoscope diagnosis
Subject(s)
Humans , Helicobacter Infections/drug therapy , Drug Administration Schedule , Cost Efficiency Analysis , Helicobacter pylori/pathogenicity , Dyspepsia/drug therapy , Cost of Illness , Amoxicillin/administration & dosage , Proton Pumps/antagonists & inhibitors , Clarithromycin/administration & dosage , Peptic Ulcer/drug therapyABSTRACT
OBJETIVO: Rever a literatura sobre tratamento da doença do refluxo gastroesofágico (DRGE) com ênfase nos aspectos farmacológicos. Identificar particularidades do tratamento farmacológico nas manifestações esofágicas e extra-esofágicas da doença. FONTES DE DADOS: Busca eletrônica na base de dados PubMed/MEDLINE e Cochrane Collaboration. Procurou-se identificar estudos controlados e randomizados publicados a partir de 2000, bem como revisões que representassem consensos e diretrizes publicados nos últimos 10 anos. SíNTESE DOS DADOS: Nenhuma das drogas atualmente usadas no tratamento da DRGE altera comprovadamente o mecanismo principal da doença, ou seja, os relaxamentos transitórios do esfíncter esofágico inferior. O tratamento farmacológico da DRGE com sintomas ou com lesões esofágicas é baseado na inibição da secreção ácida, em particular pelos inibidores da bomba de prótons (IBP). Nas situações em que a hiper-reatividade das vias aéreas inferiores coexiste com sintomas esofágicos da DRGE, a inibição da secreção ácida deve trazer benefícios na condução da doença respiratória se houver uma relação causal; contudo, essa situação não é comum. Quando não coexistem sintomas esofágicos, a pHmetria esofágica de 24 h deve ser realizada previamente ao tratamento farmacológico da DRGE. A melhora dos sintomas respiratórios pode ser tardia em relação aos sintomas esofágicos. A DRGE freqüentemente recorre, e o tratamento farmacológico deve ser repetido ou mantido indefinidamente, conforme a apresentação clínica da doença. CONCLUSÃO: As condutas propostas para o tratamento farmacológico da DRGE na criança são oriundas principalmente de estudos de séries de casos ou de estudos em adultos. Existem poucos estudos controlados e randomizados em crianças. A realização de um número maior desses estudos poderá reafirmar ou introduzir novos aspectos nas condutas propostas.
OBJECTIVE: To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease. SOURCES: Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. SUMMARY OF THE FINDINGS: The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e., transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. CONCLUSIONS: The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Adult , Anti-Ulcer Agents/therapeutic use , Gastroesophageal Reflux/drug therapy , Omeprazole/therapeutic use , /therapeutic use , Abdominal Pain/pathology , Barrett Esophagus/drug therapy , Barrett Esophagus/etiology , Esophageal Stenosis/drug therapy , Esophageal Stenosis/etiology , Esophagitis/drug therapy , Esophagitis/etiology , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnosis , Hydrogen-Ion Concentration , /pharmacology , Life Style , Proton Pumps/antagonists & inhibitors , Proton Pumps/pharmacology , Syndrome , Vomiting/pathologyABSTRACT
La importante capacidad inhibitoria de la secreción ácida gástrica de los inhibidores de la bomba de protones (IBP) los convierte en los fármacos de elección en las enfermedades relacionadas con el ácido. La elevada prevalencia de esas enfermedades y la necesidad de mantener la administración del fármaco durante períodos muy prolongados determinan que este grupo terapéutico sea uno de los de mayor volumen de gasto para el sistema sanitario. Sin embargo, con la enorme generalización de su uso, aún siguen aflorando periódicamente reservas sobre su potencial toxicidad, una opinión basada en una cierta desconfianza sobre la especificidad de su mecanismo de acción y en la sensación consiguiente de que algo tan potente debe conllevar una contrapartida lesiva. Los IBP actúan selectivamente en el eslabón final del proceso de secreción del ácido gástrico, la H+/K+-ATPasa o bomba de protones. Esta enzima representa un paso obligado en el proceso de secreción de H+, y los IBP son muy específicos de la célula parietal, porque para actuar necesitan de un ambiente con unos valores de pH muy bajos, que sólo se dan en el canalículo secretor de esa célula. En el presente artículo se revisa los efectos adversos de los IBP, haciendo especial énfasis en los relacionados con su administración continuada y en ciertas circunstancias relacionadas con situaciones especiales de los pacientes, como la ancianidad, la insuficiencia hepática, la gestación y la lactancia materna y la infancia. Todos los IBP comercializados comparten una base química común y no hay grandes diferencias en sus potenciales efectos adversos, la posibilidad de favorecer infecciones oportunistas o su capacidad de generar interacciones farmacocinéticas con otros fármacos que, en general y cuando se las refiere, son de poca entidad. Tras 2 décadas de uso, se confirma que los IBP son fármacos muy eficaces y seguros
The significant inhibitory capacity of gastric acid secretion of PPIs makes them the drugs of choice for treating acid-related diseases. The considerable prevalence of these diseases and the need for maintaining the administration of the drug during considerably long periods results in this therapeutic group being one of the most widely used. However, in spite of their extensive use, there continue to emerge concerns about their potential toxicity; concerns surrounding the specificity of their mechanism of action and a consequential suspicion that something so potent must involve harmful effects. PPIs act selectively on the final stage of the process of gastric acid secretion, namely the H+/K+-ATPase or proton pump. This enzyme represents an essential step in the process of secretion of H+, and PPIs exert a very specific action on the parietal cell, as they need an environment with very low pH levels, which only exist in this cell. In the present article, the adverse effects of PPIs are reviewed, with special emphasis on those related to their continued administration and on the special circumstances of patients, as in the case of the elderly, those with liver failure, pregnant and breastfeeding mothers and children. All the PPIs on the market share a common chemical basis and there are no great differences in their potential adverse effects, the possibility of them promoting opportunist infections or their capacity to generate pharmacokinetic interactions with other drugs, which, if occur, are generally insignificant. After two decades of use, PPIs have proved to be very effective and safe drugs
Subject(s)
Humans , Proton Pumps/antagonists & inhibitors , Gastroesophageal Reflux/drug therapy , Antacids/adverse effects , Gastric Acid , Gastric Acidity Determination , Risk FactorsABSTRACT
PURPOSE: To evaluate models of gastric material collection from Wistar rats with and without using proton pump inhibitors(PPIs). METHODS: Twenty-four rats underwent intraperitoneal omeprazol treatment, and other 12 received similar treatment with 0.9 percent saline. All animals underwent collection of gastric material samples, after stomach removal, by either biopsies, or aspirates, or swabs. Samples were bacteriologically processed in order to identify species and strains. Values are described as natural logarithm of colony former units per mL [Ln(CFU/mL)]. Kruskal-Wallis and Mann-Whitney non-parametric tests were used, and p<0.05 was set as statistically significant. RESULTS: Significant difference was not seen for Ln (UFC/mL) values among the three methods of collection irrespective of using or not omeprazol. Also, significant difference was not seen in Ln (UFC/mL) values when comparing a method with each others, either using omeprazol or placebo. A significant increase of bacteria strains occurred when PPI was used, and this was seen on the three ways of collection, mainly in biopsy and swab. CONCLUSION: No difference occurred among the three methods of collecting bacteria samples from stomachs of rats, either when using placebo or omeprazol. A remarkable change is seen on animals bacterial microflora when PPIs are used, and bacteria are better identified when swab and biopsy are used.
OBJETIVO: Avaliar modelos de coleta de material gástrico de ratos da linhagem Wistar, com e sem o uso de inibidores de bomba de próton (IBPs). MÉTODOS: 24 ratos foram submetidos a tratamento com omeprazol intraperitoneal e 12 outros ratos receberam tratamento semelhante com solução salina a 0,9 por cento. Os animais foram submetidos a coleta de amostras de material gástrico, após retirada do estômago, utilizando-se de biópsias, aspirados ou swabs. Os materiais obtidos foram processados bacteriologicamente para identificação de espécimes quanto ao gênero. Os valores são descritos em logaritmo natural das unidades formadoras de colônias por mL [Ln(UFC/mL)]. Utilizou-se os testes não-paramétricos de Kruskal-Wallis e Mann-Whitney, considerando-se p<0,05 como estatisticamente significativo. RESULTADOS: Não se observou diferença significativa da quantidade de Ln(UFC/mL) entre os três métodos de coleta, independente do uso de omeprazol. Também não se observou diferença significativa de Ln(UFC/mL) ao comparar-se os métodos individualmente entre si nas condições de uso de omeprazol ou placebo. Houve aumento significativo da variedade de gêneros de bactérias com o uso de IBP, nos 3 métodos de coleta, sendo isto mais perceptível na biópsia e swab. CONCLUSÃO: Não houve diferença entre os três métodos de coleta de amostras bacterianas de estômago de ratos, tanto em uso de placebo quanto em uso de omeprazol. Nota-se uma mudança evidente da microflora bacteriana nos animais em uso de IBPs, sendo melhor identificado pelos métodos de swab e biópsia.