ABSTRACT
Esophagitis dissecans (ESD) is an uncommon disease that is associated with eosinophilic esophagitis (EoE), candidiasis and/or drugs. We aim to characterize the clinical, endoscopic and histological damage of the mucosal in subjects with dysphagia, its relation to concomitant entities and the treatment response. This is a retrospective observational study in patients with dysphagia and esophageal mucosal damage We included 23 patients (mean age = 55 years) who had GERD symptoms, dysphagia and/or odynophagia. There were 10, 9 and 4 cases of esophagitis dissecans, desquamative/esfacelante (ESD/ES) and fibrostenotic, respectively. ESD/SE is a rare entity with variable clinical, endoscopic and histological spectrum. The association with GERD was frequent.
La esofagitis disecante (ESD) es una enfermedad rara que puede asociarse a esofagitis eosinofílica, candidiásica o medicamentos. Se analizaron las características clinico-endoscópicas e histopatológicas en sujetos con disfagia de corta evolución asociada a afecciones concurrentes. Estudio observacional de cohorte retrospectiva con disfagia y daño mucoso. Se ingresaron 23 pacientes con edad media de 55 años. Todos tuvieron síntomas de reflujo gastroesofágico (ERGE), disfagia y odinofagia. Fueron 10, 9 y 4 casos de ESD, descamativa/esfacelante (ESD/ES) y fibroestenosis, respectivamente. La ESD/SE es una afección rara, con un espectro clínico, endoscópico e histológico variable.
Subject(s)
Deglutition Disorders/etiology , Esophagitis/complications , Acute Disease , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Candidiasis, Oral/complications , Eosinophilic Esophagitis/complications , Esophageal Stenosis/etiology , Esophagitis/diagnosis , Esophagitis/pathology , Esophagitis/therapy , Esophagoscopy , Female , Gastroesophageal Reflux/complications , Humans , Male , Middle Aged , Mucous Membrane/pathology , Proton Pump Inhibitors/therapeutic use , Retrospective Studies , Young AdultABSTRACT
BACKGROUND/AIMS: To evaluate the effectiveness of pantoprazole magnesium (pantoprazole-Mg) 40 mg in the relief of esophageal and extra-esophageal symptoms of gastroesophageal reflux disease (GERD), particularly night-time symptoms. METHODS: Patients (aged 18-50 years) with 3-month history of heartburn and/or acid regurgitation plus at least one other symptom in the last week were enrolled in a nationwide, prospective and observational study in Mexico. Patients received pantoprazole-Mg 40 mg once daily during 4 weeks. Symptoms were assessed through a physician-administered structured interview and the patient-completed ReQuest in Practice™ questionnaire. Night-time GERD was defined as arousal from sleep during the night due to GERD-associated symptoms. RESULTS: Out of 4,343 patients included at basal visit, 3,665 were considered for the effectiveness per protocol analysis. At baseline, patients had a median of 8 GERD related symptoms. Patients with night-time GERD symptoms (42.7%) were more likely to have extra-esophageal symptoms (P < 0.001) than other GERD patients. Pantoprazole-Mg 40 mg once daily for 4 weeks improved a broad range of GERD-associated symptoms from baseline (80% reduction on physicians assessments; 68-77% reduction on ReQuest in Practice™ dimensions), including both day- and night-time GERD symptoms; improvements were the greatest for extra-esophageal symptoms in patients with night-time symptoms. Pantoprazole-Mg was well tolerated. CONCLUSIONS: Pantoprazole-Mg 40 mg significantly improved a broad range of esophageal and extra-esophageal GERD related symptoms including sleep disturbances, as well as well-being, in patients with daytime or night-time GERD, making it a good option for patients with GERD, especially when extra-esophageal and night-time symptoms are present.
ABSTRACT
BACKGROUND: To improve proton pump inhibitor effects, pharmacological modifications have been developed such as the use of enantiomer molecules (e.g., S-omeprazole, S-pantoprazole, or dexlansoprazole), or addition of NaHCO3 (for an immediate release) or magnesium (with a lower absorption for a more sustained effect). OBJECTIVE: The objective of this study was to assess the efficacy, safety, and tolerability of pantoprazole magnesium 40 mg once daily for 4 weeks, on the relief of reflux symptoms in gastroesophageal reflux disease (GERD) patients. METHODS: A phase IV, open-label, prospective, multicenter study was designed. Patients included were prescribed pantoprazole magnesium 40 mg orally once daily for 28±2 days. All patients had a history of persistent or recurrent heartburn and/or acid regurgitation for at least 3 months. Effectiveness and tolerability data obtained from patients who completed a minimum of 4 weeks of pantoprazole magnesium treatment were considered for analysis. RESULTS: The account of baseline characteristics and demographics of GERD symptom intensity was made by analyzing the group of 4,343 patients that fulfilled all inclusion criteria; 54% were females (n=2,345) and 46% (n=1,998) males, with a mean age of 36.2±7.5 years. Severity of symptoms, assessed by the physician using the 4-point Likert scale, reduced by at least 80% from baseline intensity after treatment in the per protocol population. In the case of the intention-to-treat population, the improvement in symptom intensity was 73%. The number of patients that experienced any adverse events was 175/5,027 (3.48%). CONCLUSIONS: Pantoprazole magnesium is a safe, effective, and well-tolerated drug that significantly improves GERD symptoms.
Subject(s)
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use , Anti-Ulcer Agents/therapeutic use , Gastroesophageal Reflux/drug therapy , Proton Pump Inhibitors/therapeutic use , 2-Pyridinylmethylsulfinylbenzimidazoles/adverse effects , 2-Pyridinylmethylsulfinylbenzimidazoles/chemistry , Adult , Anti-Ulcer Agents/adverse effects , Anti-Ulcer Agents/chemistry , Female , Gastroesophageal Reflux/physiopathology , Heartburn/drug therapy , Humans , Male , Pantoprazole , Prospective Studies , Proton Pump Inhibitors/adverse effects , Proton Pump Inhibitors/chemistry , Salts , Treatment OutcomeABSTRACT
The Montreal Definition and Classification divides Gastroesophageal Reflux Disease (GERD) into esophageal symptomatic syndromes (and with mucosal damage) and extraesophageal syndromes (with acid established association and proposed association). In typical GERD symptoms, an 8-week treatment with PPIs is satisfactory in most cases (> 90%). Response rates to PPIs in GERD are highly variable, as they also rely on an appropriate clinical diagnosis of the disease; endoscopy differentiates the macroscopic GERD phenotype. The non-erosive variety (50-70% prevalence) has a different symptomatic response rate, as gastric acid is not the sole etiology of symptoms. The possible explanations of treatment failure include treatment adherence, PPI metabolism alterations and characteristics, and inadequate diagnosis. Refractory symptoms are related to gastric content neutralization by the chronic use of PPIs.Extraesophageal manifestations are associated with other pathophysiological mechanisms where an autonomic nervous system disturbance gives rise to symptoms. In these clinical entities, the relationship between symptoms and acid needs to be established in order to determine the use of PPIs, or consider other drugs. In other words, so as to "custom-tailor the best-fitting therapy" we need to answer the questions for whom, for what, how and for how long. Finally, PPI safety and tolerability are factors to be considered in elderly patients requiring chronic PPI use, who usually have chronic concomitant illnesses.
Subject(s)
Gastroesophageal Reflux/drug therapy , Precision Medicine , Proton Pump Inhibitors/therapeutic use , Aryl Hydrocarbon Hydroxylases/genetics , Cost-Benefit Analysis , Cytochrome P-450 CYP2C19 , Drug Interactions , Gastric Acid , Gastric Juice/drug effects , Gastroesophageal Reflux/economics , Gastroesophageal Reflux/genetics , Genetic Markers , Humans , Polymorphism, Genetic , Proton Pump Inhibitors/economics , Proton Pump Inhibitors/pharmacokinetics , Proton Pump Inhibitors/pharmacology , Treatment OutcomeABSTRACT
La Clasificación de Montreal divide la enfermedad por reflujo gastro-esofágico (ERGE) en síndromes esofágicos sintomáticos y con daño a la mucosa y en síndromes extraesofágicos con asociación establecida al ácido y asociación propuesta. En síntomas ERGE típicos el tratamiento con inhibidores de la bomba de protones (IBP) es satisfactorio (> 90%) a 8 semanas en la mayoría de los casos. Las tasas de respuesta a los IBP en la ERGE son muy variables; ya que también dependen de un adecuado diagnóstico clínico de la enfermedad; la endoscopia diferencia el fenotipo macroscópico de la ERGE. La variedad no erosiva (prevalencia 50-70%) tiene una tasa de respuesta sintomática diferente ya que el ácido no es causa suficiente para explicar los síntomas. Las posibles explicaciones a la falla al tratamiento son el apego al tratamiento, alteraciones en el metabolismo y características de IBP y diagnóstico inadecuado. Los síntomas refractarios se relacionan con neutralización del contenido por el uso crónico de IBP. Las manifestaciones extraesofágicas se asocian con otros mecanismos fisiopatológicos como la disfunción del sistema nervioso autónomo. En estas entidades es necesario establecer la relación o no con el ácido para determinar el uso con IBP o considerar otros fármacos. Es decir, necesitamos responder a las preguntas en quien, para qué, cómo y por cuánto tiempo, para diseñar un "traje a la medida". Por último, la seguridad y la tolerabilidad a IBP son factores a considerar en pacientes de edad avanzada que requieren su uso crónico y que generalmente tienen enfermedades crónicas concomitantes (AU)
The Montreal Definition and Classification divides Gastroesophageal Reflux Disease (GERD) into esophageal symptomatic syndromes (and with mucosal damage) and extraesophageal syndromes (with acid established association and proposed association). In typical GERD symptoms, an 8-week treatment with PPIs is satisfactory in most cases (> 90%). Response rates to PPIs in GERD are highly variable, as they also rely on an appropriate clinical diagnosis of the disease; endoscopy differentiates the macroscopic GERD phenotype. The non-erosive variety (50-70% prevalence) has a different symptomatic response rate, as gastric acid is not the sole etiology of symptoms. The possible explanations of treatment failure include treatment adherence, PPI metabolism alterations and characteristics, and inadequate diagnosis. Refractory symptoms are related to gastric content neutralization by the chronic use of PPIs. Extraesophageal manifestations are associated with other pathophysiological mechanisms where an autonomic nervous system disturbance gives rise to symptoms. In these clinical entities, the relationship between symptoms and acid needs to be established in order to determine the use of PPIs, or consider other drugs. In other words, so as to "custom-tailor the best-fitting therapy" we need to answer the questions for whom, for what, how and for how long. Finally, PPI safety and tolerability are factors to be considered in elderly patients requiring chronic PPI use, who usually have chronic concomitant illnesses (AU)
Subject(s)
Humans , Male , Female , Proton Pump Inhibitors/therapeutic use , Gastroesophageal Reflux/drug therapy , Endoscopy, Digestive System/methods , Endoscopy, Gastrointestinal/methods , Proton Pump Inhibitors/pharmacokinetics , Esophagitis/diagnosis , Esophagitis/drug therapy , Omeprazole/therapeutic use , Proton Pump Inhibitors/administration & dosage , Proton Pump Inhibitors/metabolism , Proton Pump Inhibitors/pharmacology , Gastroesophageal Reflux/metabolism , Gastroesophageal Reflux/physiopathologyABSTRACT
BACKGROUND: Because of the increasing resistance to clarithromycin and metronidazole, two of the antibiotics used for the eradication of Helicobacter pylori, new therapeutic alternatives are needed. The aim of this study was to determine the efficacy of a randomized, comparative trial of 7 vs. 14-day triple treatment with rabeprazole, ofloxacin and amoxicillin for H. pylori eradication. MATERIAL AND METHODS: The present authors studied 76 dyspeptic patients infected with H. pylori diagnosed by both histology and a rapid urease test. Patients were randomized to receive rabeprazole (20 mg b.i.d.), plus ofloxacin (400 mg b.i.d.) and amoxicillin (1000 mg b.i.d.) for 7 days (group 1) vs. 14 days (group 2) and were followed by 6 weeks. Eradication was assessed 4 weeks after completing the course of study treatment by the (14)C-urea breath test. Per protocol and intention-to-treat eradication rates were determined. RESULTS: For the intention to treat analysis, the eradication rate was 62.2% for group 1 and 92.3% for group 2 (p =.004). For the per protocol analysis, eradication rate for group 1 was 63.9% and for group 2 was 97.3% (p =.001). CONCLUSIONS: Triple therapy with rabeprazole, amoxicillin and ofloxacin by 14 days was efficient for H. pylori eradication and therefore deserves further study. The same regimen prescribed for 7 days had a significantly lower and unacceptable cure rate and should not be used.