Efficacy of omeprazole, famotidine, mosapride and teprenone in patients with upper gastrointestinal symptoms: an omeprazole-controlled randomized study (J-FOCUS).

BACKGROUND: In Japan, treatment guidelines are lacking for patients with upper gastrointestinal symptoms. We aimed to compare the efficacy of different drugs for the treatment of uninvestigated upper gastrointestinal symptoms. METHODS: This was a randomized, open-label, parallel-group multicenter study. Helicobacter pylori-negative, endoscopically uninvestigated patients ≥ 20 years of age with upper gastrointestinal symptoms of at least moderate severity (Global Overall Symptom score [GOS] ≥ 4 on a 7-point Likert scale) were randomized to treatment with omeprazole (10 mg once daily), famotidine (10 mg twice daily), mosapride (5 mg three times daily) or teprenone (50 mg three times daily). The primary endpoint was sufficient relief of upper gastrointestinal symptoms after 4 weeks of treatment (GOS ≤ 2). UMIN clinical trial registration number: UMIN000005399. RESULTS: Of 471 randomized patients, 454 were included in the full analysis set. After 4 weeks of treatment, sufficient symptom relief was achieved by 66.9% of patients in the omeprazole group, compared with 41.0%, 36.3% and 32.3% in the famotidine, mosapride and teprenone groups, respectively (all, p < 0.001 vs omeprazole). There were no treatment-related adverse events. CONCLUSIONS: The favorable efficacy and safety profiles of omeprazole in relieving uninvestigated upper gastrointestinal symptoms support its use as first-line treatment in this patient group in Japan. Patients who show no improvement in symptoms despite PPI use, and those with alarm symptoms (such as vomiting, GI bleeding or acute weight loss) should receive further investigation, including prompt referral for endoscopy. TRIAL REGISTRATION: UMIN000005399.

A Case of Portal Venous Stenting for Metastatic Hilar Stricture After the Radical Resection of Colon Cancer.

Like standard stenting in an unresectable malignant stricture of the biliary or digestive tract, minimally invasive modality for portal stenosis is indispensable for palliation. We describe here a safe and practical procedure of portal stenting in a case of metastatic hilar strictures developed nine years after the radical resection of sigmoid colon cancer. After urgent delivery of the biliary tract stenting for the relief of jaundice, the patient received palliative stenting for the stricture of the portal trunk. Transhepatic approach, via the anterior branch, of the portal vein intervention may fit into the standard aspects for portal stenting.

Additional effect of low iron diet on iron reduction therapy by phlebotomy for chronic hepatitis C.

BACKGROUND/AIMS: Iron-induced oxidative stress plays an important role in the pathogenesis of chronic hepatitis C. Both phlebotomy for removing body iron stores and low iron diet for minimizing portal iron supply to the liver have been shown to improve serum transaminase levels in patients with the disease. However, the cooperative effects of phlebotomy and low iron diet have not yet been elucidated in detail. METHODOLOGY: A pilot study was undertaken to investigate whether a low iron diet could improve the efficacy of phlebotomy in iron reduction therapy. Of 21 patients diagnosed with chronic hepatitis C, 10 patients were treated with phlebotomy alone (group A) while 11 patients were treated with a low iron plus phlebotomy (group B). Phlebotomy was repeated biweekly until serum ferritin levels reached 10 ng/mL in both A and B groups. In addition, a low iron diet (iron intake of 8 mg/day or less) was recommended for group B, followed by estimation of iron intake from daily diet records. RESULTS: Serum alanine aminotransferase levels were significantly improved from 106+/-30 to 68+/-22 IU/L (p<0.005, paired t-test) in group A and from 100+/-33 to 46+/-10 IU/L (p<0.002, paired t-test) in group B. The enzyme levels after treatment were significantly higher in group A (p<0.02, non-paired t-test), which showed a higher upward distribution of the enzyme activity. The estimated dietary iron intake in group B was reduced from 17.6+/-6.1 to 8.2+/-3.7 mg/day. CONCLUSIONS: These findings suggest that phlebotomy alone does not completely remove iron-induced oxidative stress and a low iron diet induces an additional effect in iron reduction therapy for chronic hepatitis C.

[Eradication of Helicobacter pylori for idiopathic thrombocytopenic purpura].

We investigated the prevalence of Helicobacter pylori infection and the effect of its eradication in a series of 61 chronic ITP patients. H. pylori infection was found in 53 (86.9%) of 61 ITP patients. H. pylori eradication were performed in 44 infected ITP patients and succeeded in 28 (63.6%) patients. 20 (71.4%) of those 28 patients had platelet recovery and 15 (53.6%) patients achieved a remission, and that effect continue (about 2 years). And we investigated relation with ITP and upper gastrointestinal disease. 2 (3.8%) of 53 H. pylori infected cases were gastric ulcer, 1 (1.9%) was duodenal ulcer and 1 (1.9%) was gastric cancer. All cases were chronic atrophic gastritis, and localized atrophic cases achieved a remission after eradication of H. pylori.