Gastrointestinal prophylaxis in critically ill patients.

Physiologic stress associated with illness and hospitalization is known to result in gastrointestinal ulceration, especially among the critically ill. The complication of this stress-related mucosal disease could be prevented with appropriate application of pharmacologic prophylaxis. Vigilance by the nursing staff is required to properly detect and manage the condition.

Impact of the reclassification of omeprazole on the prescribing and sales of ulcer healing drugs.

OBJECTIVES: To investigate if the reclassification of omeprazole from a prescription only medicine to pharmacy sale status had an impact on the prescribing and sales of ulcer-healing drugs and whether deprivation had any influence on this. SETTING: Primary care, Wales, UK. METHOD: Retrospective analysis (March 2002 to February 2005) of prescription data and pharmacy sales data. MAIN OUTCOME MEASURE: Number of items per 1,000 population. RESULTS: The number of prescription items for ulcer-healing drugs across Wales increased in each year of the study. The number of items per 1,000 population for proton pump inhibitors increased by 12.4% (473.3 to 531.8 items) in 2003/04 and 13.8% (531.8 to 605.1 items) in 2004/05, whereas the number of items per 1,000 population for H2 antagonists fell by 6.2% (149.1 to 139.9 items), and 5.7% (139.9 to 131.9 items) during 2003/04 and 2004/05, respectively. The sale of items per 1,000 population of H(2) antagonists increased by 34.3% (19.8 to 26.6 items) in 2003/04, but fell by 8.6% (26.6 to 24.3 items) in 2004/05. In February 2005, 12 months after reclassification, omeprazole accounted for 7.6% (2.0 items per 1,000 population) of the total sales (26.3 items per 1,000 population) of ulcer-healing drugs from pharmacies in Wales. Areas with high multiple deprivation and unemployment were significantly associated with the prescribing of ulcer-healing drugs, H2 antagonists and proton pump inhibitors. Multiple deprivation, unemployment and low income explained 21% of the variation in prescribing of ulcer-healing drugs. The sale of omeprazole through pharmacies was not related to these deprivation characteristics. CONCLUSION: Twelve months after the reclassification of omeprazole the market growth of H2 antagonists sold from pharmacies was halted although there was no apparent impact on the prescription of ulcer-healing drugs. As a consequence there was no saving to the health service drug budget associated with the reclassification of omeprazole.

[Side effects of current anti-Helicobacter therapy]. / Pobochnye deistviia sovremennoi antikhelikobakternoi terapii.

The article deals with side effects of present-day antihelicobacter therapy including side effects of some drugs with antisecretory and antibacterial action and complications observed in using combined treatment of helicobacteriosis (triple and quadrotherapy).

Empleo de medicamentos para el tratamiento de la enfermedad ulcerosa péptica / Use of drugs for the treatment of peptic ulcer

El artículo proporciona información farmacológica sobre los medicamentos utilizados en el tratamiento de la úlcera péptica. Detalla también las características de los principios activos de las drogas utilizadas (AU)

Antiácidos y antiulcerosos por vía oral / Oral antacids and anti-ulcer medications

Puesto que el modo de administración de un medicamento tiene que ser siempre absolutamente eficaz y no puede condicionar la eficacia terapéutica, se analizan las posibilidades de la administración de medicamentos por vía oral, en este caso de antiácidos y antiulcerosos. Ambos se prescriben mucho, tanto en el hospital como en atención primaria, por lo que es conveniente que enfermería conozca bien sus características y cómo administrar cada uno de ellos (AU)

Pharmacotherapy of acid-peptic disorders.

In the past two decades, there have been tremendous changes in the understanding and therapy of acid-peptic diseases. Currently there are many new and effective approaches to the treatment of dyspeptic symptoms and the ulcerative and erosive diseases of the upper gastrointestinal tract. Application of an appropriate therapeutic strategy requires understanding of the pathophysiology of the disease process as well as the pharmacology of the available medications. In general, medications to neutralize gastric acid or suppress acid secretion are selected relative to the severity of the acid-mediated injury. Antacids are ideal for suppression of sporadic symptoms. H2-receptor antagonists are useful for the treatment of dyspepsia or uncomplicated ulcers. For the most severe injuries, proton pump inhibitors provide both relief of symptoms and healing of damaged mucosa.

Drug therapy and peptic ulceration.

Peptic ulceration can be treated by various types of drugs including antacids, protectors, antimicrobials and acid-secretion reducers. Nurses have a role to play in administering medicines, educating patients and, in future, prescribing drugs.

Famotidina en el tratamiento de la úlcera péptica / Famotidine in peptic duodenal ulcer treatment

Este estudio abierto, multicéntrico, estuvo destinado a evaluar la eficacia, tolerancia y seguridad del nuevo antagonista de los receptores H2, Famotidina, en el tratamiento de la úlcera péptica duodenal. Treinticuatro pacientes con úlcera péptica duodenal, demostrada endoscópicamente, recibieron una tableta de Famotidina, 40mg. noche, hasta por seis semanas. Se mantuvo el tratamiento hasta documentar cicatrización de la lesión, mediante endoscopía realizada a la segunda, cuarta y sexta semana. Un paciente fue excluído por desviación del protocolo. La curación acumulativa en los 33 pacientes evaluables fue de 48.5 por ciento, 91 por ciento y 97 por ciento a la segunda, cuarta y sexta semana de tratamiento, respectivamente. El 52 por ciento de los pacientes se tornó asintomático a las 72 horas y el 79 por ciento al finalizar la primera semana. La droga fue bien tolerada y no se registraron reacciones adversas clínicas, ni de laboratorio en los treinticuatro pacientes estudiados. Se concluye que Famotidina es eficaz y bien tolerada en el tratamiento de la mayoría de pacientes con úlcera péptica duodenal

Alternatives to the acid-oriented approach to ulcer disease: does 'cytoprotection' exist in man? A new classification of antiulcer agents.

This review summarizes the historical contradictions and inconsistencies that form the labile arguments advocating neutralization or inhibition of secretion of gastric acid for the prevention or treatment of gastroduodenal ulcers. Re-evaluation of old concepts is needed in the wake of recognition that even the most potent antisecretory agents do not change the natural history of ulcer disease; that is, the recurrence is high after termination of treatment. New biochemical, functional, and structural targets are listed for pharmacologic intervention in ulcer disease. As a supplement or alternative to the antisecretory agents, we should now consider prosecretory agents (for example, for bicarbonate and mucus secretion) and antioxidants (for example, free radical scavengers). Gastroduodenal motility, smooth muscle, the vascular endothelial cell, and the basement membrane seem to represent additional pharmacologic targets toward which new gastroprotective drugs can be directed even though the biochemical mechanism of action of these new agents may not be fully understood. New results suggest that these elements have a role in the pathogenesis of ulcer disease, and their modulations seem to exert a beneficial effect without inhibiting gastric secretion in rodents. In man, the acid antisecretory and cytoprotective doses seem to overlap, but arguments are presented to shift defining gastric 'cytoprotection' by the dose of drugs to the characterization of the phenomenon (for example, events such as the ethanol-induced hemorrhagic erosions which cannot be decreased by antisecretory agents). Furthermore, non-prostaglandin and non-H2-receptor antagonist drugs are available that exert acid-independent gastroprotection both in animals and humans. The future is thus bright for the development of new antiulcer agents.