BACKGROUND/AIMS: It is not clear whether the anti-secretory therapy should be continued for symptomatic relief and ulcer healing before or after the eradication of H. pylori in patients with peptic ulcer disease. The aim of this study was to evaluate the effectiveness of additional anti-secretory therapy before or after H. pylori eradication in peptic ulcer disease. METHODS: Thirty eight patients with H. pylori-positive active peptic ulcer were included. Patients were randomly allocated into 3 groups; standard 1-week triple therapy followed by omeprazole (20 mg, qd) for 3 weeks (group A), standard 1-week triple therapy only (group B), and omeprazole (20 mg, qd) for 3 weeks followed by 1-week triple therapy (group C). Endoscopy with the rapid urease test and histology for H. pylori was performed 4-8 weeks after the completion of treatment. The symptom was scored by a visual analog scale. RESULTS: Of the 38 patients, 10 were excluded from the per-protocol analysis of this study. The H. pylori eradication rates were 87.5% (group A), 80.0% (group B) and 90.0% (group C) respectively. The peptic ulcer healing rates were 100% in group A, 70.0% in group B, and 90.0% in group C. There was no difference in H. pylori eradication rates and ulcer healing rates among three groups (p>0.05). Symptom score differences between pre-treatment and post-treatment group were not significantly different (p>0.05). CONCLUSIONS: The standard one week triple therapy with or without 3-weeks anti-secretory treatment with omeprazole before or after the therapy does not affect H. pylori eradication rates, peptic ulcer healing rates, and symptom score improvement.
Adult ; Anti-Bacterial Agents/administration & dosage/therapeutic use ; Anti-Ulcer Agents/administration & dosage/*therapeutic use ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Omeprazole/administration & dosage/therapeutic use ; Peptic Ulcer/*drug therapy/microbiology

AIM: To study the gastroprotective effect and in vivo antioxidant potential of a standardized iridoid fraction from B. prionitis leaves (BPE) against different gastric ulcer models in rats. METHOD: The standardized iridoid fraction from BPE at 50, 100, and 200 mg/kg body weight was administered orally, twice daily for 5 days for prevention from aspirin, ethanol, cold-restraint stress (CRS), and pylorus ligation (PL)-induced ulcers. Estimation of the antioxidant enzyme activity was carried out in a CRS-induced ulcer model, and various gastric secretion parameters including volume of gastric juice, acid output, and pH value were estimated in the PL-induced ulcer model. RESULTS: BPE showed a dose-dependent ulcer protective effect in PL (18.67%-66.26% protection), aspirin (24.65%-63.25% protection), CRS (20.77%-59.42% protection), and EtOH (16.93%-77.04% protection)-induced ulcers. BPE treatment in PL-rats showed a decrease in acid-pepsin secretion, and enhanced mucin and mucosal glycoproteins. However, BPE reduced the ulcer index with significant decrease in LPO (P < 0.01-0.001), SOD (P < 0.01-0.001), and an increase in CAT (P < 0.01-0.001), activity in the CRS-induced model. CONCLUSION The data shows that the iridoid fraction from BPE possesses anti-ulcerogenic and antioxidant potential.
Acanthaceae ; chemistry ; Animals ; Anti-Ulcer Agents ; administration & dosage ; Disease Models, Animal ; Humans ; Iridoids ; administration & dosage ; Male ; Plant Extracts ; administration & dosage ; Protective Agents ; administration & dosage ; Rats ; Rats, Wistar ; Stomach Ulcer ; drug therapy

OBJECTIVETo study the efficacy of esomeprazole-based 1 week or 2 weeks triple therapy for Helicobactor pylori (H. pylori) infection in children.

METHODSOne hundred and five children with H. pylori infection identified by 13C-UBT were randomly assigned into Group A (n=60) and Group B (n=45). The patients of the two groups were administered with 1 week or 2 weeks triple therapy consisting of esomeprazole, clarithromycin and amoxillin, respectively. They were followed up four weeks after drug withdrawal.

RESULTSRecurrent abdominal pain was relieved in all of patients. Fifty-five patients (91.7%) showed 13C-UBT negative in Group A and 42 (93.3%) presented negative in Group B. There was no significant difference in the eradication rate of H. pylori.

CONCLUSIONSEsomeprazole-based triple therapy for H. pylori infection is effective in children. The efficacy of esomeprazole-based 1 week or 2 weeks triple therapy for this disorder does not appear to be different.

Adolescent ; Amoxicillin ; administration & dosage ; Anti-Bacterial Agents ; adverse effects ; Anti-Ulcer Agents ; administration & dosage ; Child ; Child, Preschool ; Clarithromycin ; administration & dosage ; Drug Therapy, Combination ; Esomeprazole ; administration & dosage ; Female ; Helicobacter Infections ; drug therapy ; Helicobacter pylori ; Humans ; Male

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) treatments fail at least in 10-20% of patients. However, retreatment strategies after failure of initial treatment have not been established. This study was conducted to evaluate the eradication rate of retreatment choices. METHODS: Twenty-seven peptic ulcer patients who were retreated with OAC (omeprazole + amoxicillin + clarithromycin) or BMT (bismuth + metronidazole + tetracycline) after failure of BMT or OAC were included. Quadruple therapy (omeprazole + BMT) was also tried after failure of two successive triple therapies. Furthermore, the effect of resistance of metronidazole or clarithromycin on the eradication of H. pylori was evaluated. RESULTS: Among 13 patients who were retreated with OAC after failure of BMT regimen, H. pylori was eradicated in 10 patients (76.9%). Among 14 patients retreated with BMT after failure of OAC regimen, H. pylori was eradicated in 11 patients (78.6%). Resistance of H. pylori to metronidazole or clarithromycin decreased the efficacy of BMT or OAC, respectively. CONCLUSIONS: Eradication regimen should be decided considering the resistance to H. pylori. However, in case of unknown state of resistance, OAC can be chosen if BMT fails. Similarly, BMT can be tried in cases that OAC therapy failed. After failures of both triple therapies, quadruple therapy can be tried as the next step.
Adult ; Anti-Bacterial Agents/*administration & dosage ; Anti-Ulcer Agents/*administration & dosage ; Drug Therapy, Combination ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Peptic Ulcer/*drug therapy/microbiology ; Retreatment

OBJECTIVE: To evaluate the efficacy and safety of 4 kinds of triple strategy of Helicobacter pylori (Hp) eradication. METHODS: A total of 307 patients who suffered from Hp infection, confirmed by rapid urease test (RUT) and 14C-urea breath test (UBT),were randomly divided into 4 groups. Each group had 80, 76, 77, and 74 patients respectively. Group A was treated with rabeprazole, clarithromycin, and furazolidone (RCF); Group B with ranitidine bismuth citrate, clarithromycin, and furazolidone (BCF); Group C with rabeprazole, amoxicillin, and furazolidone (RAF); while Group D with ranitidine bismuth citrate, amoxicillin, and furazolidone (BAF). Hp was detected by RUT and UBT at 4 weeks after later treatment. RESULTS: Hp eradication rates of group A,B,C, and D were 90.0%,67.1%,62.3%,and 45.9%,respectively. The difference between Group A and Group B, Group A and Group C was significant (P<0.05). Eradication rate of Group B and C was higher than that of Group D (P<0.05). There was no statistical difference between the eradication rate of Group B and C, and among the side effects of the 4 groups. CONCLUSION The strategy of RCF was the best among the 4 triple strategy of Hp eradication, which can be used clinically.
2-Pyridinylmethylsulfinylbenzimidazoles ; administration & dosage ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; administration & dosage ; Anti-Ulcer Agents ; administration & dosage ; Clarithromycin ; administration & dosage ; Drug Therapy, Combination ; Duodenal Ulcer ; microbiology ; Female ; Furazolidone ; administration & dosage ; Helicobacter Infections ; drug therapy ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Rabeprazole ; Stomach Ulcer ; microbiology ; Young Adult

BACKGROUND/AIMS: At present, triple therapy schemes are recommended by national and international consensus conferences for the treatment of Helicobacter pylori (H. pylori) infection. However, even with the most effective current treatment regimens, about 10-20% of patients fail to eradicate H. pylori, necessitating alternative strategy to eradicate H. pylori in primary treatment failure. Therefore, we performed this study to evaluate the efficacy of quadruple therapy and to compare 1 and 2-week quadruple regimen as a second-line therapy. METHODS: The hospital records of 155 patients who failed to the standard triple therapy (proton pump inhibitor, amoxicillin, clarithromycin) were reviewed retrospectively, and divided the 1 or 2 weeks OBMT regimen (omeprazole 20 mg bid, bismuth salt 120 mg qid, metronidazole 500 mg tid, tetracycline 500 mg qid). Presence of H. pylori infection and side-effects of the treatment regimen were assessed 4 weeks after the cessation of treatment. CONCLUSIONS: One hundred and eight male and 47 female (mean age, 52.2+/-15.4) patients were enrolled. The overall eradication rate of H. pylori with quadruple therapy was 83.9% and the eradication rate was similar between 1 and 2 weeks of OBMT regimen (76.8% in OBMT 1 week, 87.9% in OBMT 2 weeks, respectively p=0.110). CONCLUSIONS: Quadruple therapy is an effective salvage regimen for H. pylori eradication after the failure of standard triple therapy. One week quadruple therapy is not significantly different from 2-weeks regimen as the second-line option for H. pylori eradication.
Adult ; Aged ; Anti-Bacterial Agents/administration & dosage ; Anti-Ulcer Agents/administration & dosage ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Proton Pumps/antagonists & inhibitors

OBJECTIVE: To observe the effect of birid triple viable on peptic ulcer patients with Helicobacter pylori(H.pylori) infection. METHODS: A total of 120 peptic ulcer patients with H.pylori infection was randomly divided into 2 groups. The control group was treated with the triple therapy including Esomeprazole, Amoxicillin, and Furazolidone. The treatment group was treated with the same triple therapy plus birid triple viable. The pH values of the gastric juice, bacterial culture of the gastric juice, the therapy-related side effects and the healing rate of ulcer and erosive were observed before the treatment and after a 14-day-treatment respectively. The (14)C-urea breath test((14)C-UBT) was used to evaluate the H.pylori eradication rates 4 weeks after the treatment. RESULTS: After the treatment, pH values of the gastric juice in both groups were significantly higher than those before the treatment (P<0.05). When pH values of the gastric juice ≥4, the positive rate of bacterial culture in the treatment group was lower than that of the control group (80.0% and 97.4% respectively, P<0.05). The rate of adverse effects in the treatment group was lower than that in the control group (11.7% and 30% respectively, P<0.05).After a 2-week treatment, the healing rate of ulcer and erosion was 80% and 68.7% in the treatment group, and 73.3% and 40.7% in the control group. The healing rate of ulcer had no significant difference in the 2 groups (P>0.05),while the healing rate of erosion in the treatment group was higher than that of the control group (P<0.05).The H.pylori eradication rates evaluated by per-protocol (PP) analysis in the treatment group was significantly higher than that of the control group (80.4% and 62.4% respectively, P<0.05). CONCLUSION The combined use of birid triple viable and the triple therapy of H.pylori in peptic ulcer patients with H.pylori infection can reduce the bacteria of the gastric juice and therapy-related side effects. It can increase the H.pylori eradication rate and promote the healing of erosion.
Adult ; Amoxicillin ; administration & dosage ; Anti-Bacterial Agents ; administration & dosage ; Anti-Ulcer Agents ; administration & dosage ; Drug Administration Schedule ; Drug Therapy, Combination ; Esomeprazole ; administration & dosage ; Female ; Furazolidone ; administration & dosage ; Helicobacter Infections ; drug therapy ; Helicobacter pylori ; drug effects ; isolation & purification ; Humans ; Lactobacillus acidophilus ; physiology ; Male ; Peptic Ulcer ; drug therapy ; microbiology

OBJECTIVETo research the pharmacological action of curcumin solid dispersions (SDs, curcumin and polyvinylpyrrolidone (PVP) k30 in the ratio of 1:8) was investigated on experimental gastric ulcer in rats and mice.

METHODAnimals were randomly divided into several experimental groups. Each group consisted of 10 animals. The control group received PVP vehicle (720 mg x kg(-1), po) throughout the course of the experiments. The treatment groups received different doses of curcumin SDs (equivalent to curcumin 10, 30 and 90 mg x kg(-1), po), and ranitidine (27 mg x kg(-1), po) was used as the positive control. In acetic acid-induced gastric ulcers model, serum NO, plasma ET and gastric ulcer indexes of rats were measured after oral administration for 14 d. In rat ulcer model induced by pylorus-ligature, gastric volume pepsin and gastric ulcer indexes of rats were measured after oral administration for 3 d and pylorus-ligature inducement for 16 h. Gastric ulcer indexes of mice were measurement after oral administration for 3 d and subcutaneous injection reserpine 10 mg x kg(-1).

RESULTThe results showed that curcumin SDs (equivalent to curcumin 30, and 90 mg x kg(-1), po) could reduce the ulcer indexes 4.59 +/- 0.96 and 3.33 +/- 0.93 (P < 0.01), and increase serum NO level (29.75 +/- 5.90) mmol x L(-1) (P < 0.05) and (39.63 +/- 12.73) mmol x L(-1) (P < 0.01), compared to gastric index 5.87 +/- 0.48 and NO level (23.63 +/- 5.73) mmol x L(-1) in control group. Compared to plasma ET (163.65 +/- 63.84) ng x L(-1) in control group, curcumin SDs (equivalent to 90 mg x kg(-1), po) could decrease plasma ET level (104.22 +/- 63.84) ng x L(-1) (P < 0.05). Compared to gastric ulcer indexes 4.25 +/- 0.71 of control group in rat pylorus-ligature model, curcumin SDs (equivalent to curcumin 90 mg x kg(-1)) could reduce gastric ulcer to 2.38 +/- 0.74 (P < 0.01). Compared to gastric volume (14.61 +/- 1.80) mL, acidity of gastric juice (87.70 +/- 9.84) mmol x L(-1), and the activity of pepsin (408.63 +/- 41.75) U x mL(-1), curcumin SDs (equivalent to curcumin 30, 90 mg x kg(-1)) could reduce gastric volume to (12.68 +/- 1.46) mL (P < 0.05) and (9.99 +/- 0.79) mL (P < 0.01), reduce acidity of gastric juice to (77.62 +/- 8.34) mmol x L(-1) (P < 0.05) and (65.77 +/- 8.19) mmol x L(-1) (P < 0.01), inhibit the activity of pepsin to (358.13 +/- 37.44) U x mL(-1) (P < 0.05) and (292.13 +/- 41.93) U x mL(-1) (P < 0.01). In reserpine-induce gastric ulcer model, curcumin SDs (equivalent to curcumin 30, 90 mg x kg(-1)) could reduce gastric ulcer indexes to 3.88 +/- 0.40 and 3.03 +/- 0.64 (P < 0.01), compared to that of control group 5.13 +/- 0.59.

CONCLUSIONSeveral animal gastric ulcer models prove that curcumin SDs has anti-gastric ulcer effects by inhibiting gastric acid secretion, reducing gastric juice acidity, inhibiting the activity of pepsin and promoting healing of ulcer. These findings show a potential application of curcumin SDs as an anti-ulcerogenic drug.

Animals ; Anti-Ulcer Agents ; administration & dosage ; chemistry ; Curcumin ; administration & dosage ; chemistry ; Disease Models, Animal ; Female ; Humans ; Male ; Plant Extracts ; administration & dosage ; chemistry ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Stomach Ulcer ; drug therapy

BACKGROUND/AIMS: As a second-line treatment for H. pylori eradication in the case of first-line OAC (omeprazole, amoxicillin, clarithromycin) treatment failure, a minimum of one-week OBMT quadruple therapy composed of omeprazole, bismuth, metronidazole, tetracycline has been recommended in European countries and one or two weeks in USA. In Korea, one-week OBMT quadruple therapy is recommended for the case of first-line OAC treatment failure. Because H. pylori eradication rate of one-week OBMT therapy in Korea is about 80%, the eradication rate of one week therapy is not satisfactory. We analyzed the effect of two-week second-line OBMT therapy. METHODS: Between June 2002 and June 2003, 107 patients who were H. pylori positive (44 males and 63 females: mean age 51.8 years) after primary eradication therapy received two-week OBMT therapy. Four weeks after completion of therapy, 13C-urea breath test was performed to detect H. pylori. RESULTS: After two weeks of OBMT therapy, eradication was achieved in 103 of 107 patients (96.3%) and in 68 of 71 peptic ulcer patients (95.8%). CONCLUSIONS: Two-week OBMT therapy should be considered as a retreatment regimen with the eradication rate more than 90%.
Adult ; Antacids/administration & dosage ; Anti-Bacterial Agents/administration & dosage ; Anti-Ulcer Agents/administration & dosage ; Bismuth/administration & dosage ; Drug Therapy, Combination ; English Abstract ; Female ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Metronidazole/administration & dosage ; Middle Aged ; Omeprazole/administration & dosage ; Retreatment ; Tetracycline/administration & dosage

This prospective, randomized, double-blinded study was performed to evaluate the effects of intravenous metoclopramide and ranitidine on preoperative gastric contents in outpatients receiving intravenous anesthesia for laparoscopic gynecologic surgery. Fifteen minutes before the induction of anesthesia, the Z-M group (n=20) received 50mg ranitidine and 10mg metoclopramide intravenously and the control group (n=20) received the same volume of normal saline. Before the surgery, a 14-F multiorifice nasogastric tube was inserted to aspirate the gastric contents of patients under sedation with propofol and midazolam. The mean pH values of the gastric fluid were 2.7+/-2.0 (SD) [median 1.6 (range: 1.2-7.2)] in the control group, and 6.1+/-1.9 [median 6.8 (range 1.4-7.8)] in the Z-M group. The mean aspirated volumes (mL) were 15.3+/-10.4 (SD) [median 11.0 (range: 5.0-44.0)] in the control group, and 6.9+/-10.0 (SD) [median 4.5 (range: 0-38.0)] in the Z-M group. There were significantly more high-risk (gastric fluid volumes > 25mL and pH < 2.5) patients in the control group (4/20, 20%) than in the Z-M group (1/20, 5%). In conclusion, intravenous prophylactic ranitidine and metoclopramide may be an easy and useful method to decrease the volume while increasing the pH of gastric contents, and therefore may reduce the number of patients at risk for aspiration pneumonitis in ambulatory laparoscopic procedures who receive an anesthesia.
Stomach/*drug effects ; Risk Factors ; Ranitidine/*administration & dosage ; Preoperative Care ; Pneumonia, Aspiration/epidemiology/*prevention & control ; Metoclopramide/*administration & dosage ; Injections, Intravenous ; Humans ; Antiemetics/*administration & dosage ; Anti-Ulcer Agents/*administration & dosage ; Ambulatory Surgical Procedures ; Adult