Clinical Study Of The Efficacy And Tolerability Of Lansoprazole In The Management Of Duodenal Ulcer [estudo Clinico Sobre A Eficacia E A Tolerabilidade De Lansoprazol No Tratamento Da Ulcera Duodenal]

The present study aimed to evaluate the efficacy and tolerability of lansoprazole 30 mg once daily in healing duodenal ulcer in two Brazilian centers. Patients were evaluated on the basis of clinical and endoscopic criteria before treatment and two weeks after the beginning of treatment. The patients who were not healed (red or white scar: S1 or S2 according Sakitas's classification) were reevaluated 4 weeks after the beginning of treatment. Fifthy-eight patients completed the study. Endoscopic examination revealed that duodenal ulcer was healed (S1 or S2 according Sakitas's classification) 2 weeks after the beginning of treatment in 51 patients (87,9%). In the remaining seven patients (12,1%) the ulcer was healed at the end of treatment (4 weeks). Clinical symptoms (daytime epigastric pain, nocturnal epigastric pain, daytime heartburn, nocturnal heartburn, nausea, vomiting, post-prandial distention, anorexia, and dysphagia) were dramatically reduced two weeks after the beginning of treatment in terms of the number of patients presenting the symptom and the severity. The present study confirms the efficacy of lansoprazole in the treatment of duodenal ulcer. All patients who completed the study were healed. The adverse events reported were mild nature and were not considered related to the medication under study, not requiring discontinuation of treatment. With a marked efficacy lansoprazole is also safe.553156160Black, J.W., Duncan, W.A.M., Durant, C.J., Definition and antagonism of histamine H2-receptors (1972) Nature, 236, pp. 385-390Brimblecombe, R.W., Duncan, W.A.M., Durant, C.J., Cimetidine - A non-thiourea H-receptors antagonist (1975) J Int Med Res, 3, pp. 86-92Andersen, B.N., Medical treatment of peptic ulcer disease (1988) Acta Chir Scand Suppl, 547, pp. 88-92Dammann, H.G., Dreyer, M., Kangah, R., First-choice treatment in uncomplicated ulcer disease: A case for acid inhibitors (1988) Scand J Gastroenterol, 23 (153 SUPPL.), pp. 62-70Burland, W.L., Hawkins, B.W., Beresford, J., Cimetidine treatment for the prevention of duodenal ulcer: An international collaborative study (1980) Postgr Med J, 56, pp. 173-176Lindberg, P., Brändström, A., Wallmark, B., Structure-activity relationships of omeprazole analogues and their mechanism of action (1987) Trends in Pharmacol Sci, 8, pp. 399-402Lindberg, P., Brändström, A., Wallmark, B., Omeprazole: The first proton pump inhibitor (1990) Med Res Rev, 10 (1), pp. 1-54Dahlgren, S., Domellöf, L., Hradsky, M., The effects of omeprazole and cimetidine on duodenal ulcer healing and the relief of symptoms (1988) Aliment Pharmacol Ther, 2 (6), pp. 483-492Walan, A., Bader, J.P., Classen, M., Effect of omeprazole and ranitidine on ulcer healing and relapse rates in patients with benign gastric ulcer (1989) N Engl J Med, 320 (2), pp. 69-75Maton, P.N., Omeprazole (1991) N Engl J Med, 324 (14), pp. 965-975Lauritsen, K., Andersen, B.N., Laursen, L.S., Omeprazole 20 mg three days a week and 10 mg daily in prevention of duodenal ulcer relapse. Double-blind comparative trial (1991) Gastroenterology, 100 (3), pp. 663-669Bianchi Porro, G., Corinaldesi, R., Lazzaroni, M., Long term treatment with omeprazole 20mg three days a week or 10mg daily in the prevention of duodenal ulcer relapse (1994) Aliment Pharmacol Ther, 8 (5), pp. 541-548Goh, K.L., Boonyapisit, S., Lai, K.H., Prevention of duodenal ulcer relapse with omeprazole 20mg daily, a randomized double-blind, placebo-controlled study (1995) J Gastroenterol Hepatol, 10 (1), pp. 92-97Pilotto, A., Di Mario, F., Battaglia, G., The efficacy of two doses of omeprazole for short- and long-term peptic ulcer treatment in the elderly (1994) Clin Ther, 16 (6), pp. 935-941Festen, H.P., Prevention of duodenal ulcer relapse by long-term treatment with omeprazole (1994) Scand J Gastroenterol, 29 (201 SUPPL.), pp. 39-41Licht, H., Andrieu, J., Bognel, J.C., Lansoprazole versus ranitidine dans le traitement des ulcères duodenaux: Resultats d'un essai multicentrique controlé, randomisé en double insu sur groupes paralleles (1990) MCD, 19, pp. 251-255Petite, J.P., Slama, J.L., Licht, H., Comparaison du lansoprazole (30mg) et de l'oméprazole (20mg) dans le traitement de l'ulcère duodenaux. Essai thérapeutique multicentrique comparatif en double aveugle (1993) Gastroenterol Clin Biol, 17 (5), pp. 334-340Bader, J.P., Delchier, J.C., Clinical efficacy of pantoprazole compared with ranitidine (1994) Aliment Pharmacol Ther, 8 (1 SUPPL.), pp. 47-52Judmater, G., Koeltz, H.R., Comparison of pantoprazole and ranitidine in the treatment of acute duodenal ulcer (1994) Aliment Pharmacol Ther, 8 (1), pp. 81-86. , Pantoprazole-Duodenal Ulcer-Study GroupZaterka, S., Massuda, H., Chinzon, D., Treatment of duodenal ulcer with omeprazole or ranitidine in a Brazilian population: A multicenter double-blind, parallel group study (1993) Am J Gastroenterol, 88 (3), pp. 397-401Meneghelli, U.G., Zaterka, S., Castro, L.P., (1998) Pantoprazole Versus Ranitidine in the Treatment of Duodenal Ulcer. A Multicenter Study in Brazil, , Enviado para publica̧ãoMarks, I.N., Winter, T.A., Lucke, W., Omeprazole and ranitidine in duodenal ulcer healing (1988) S Afr Med J, 74 (SUPPL.), pp. 54-5

Estudo da hiper-responsividade brônquica em pacientes portadores de refluxo gastroesofágico Bronchial hyperreactivity in patients with gastroesophageal reflux disease

OBJETIVO: O intuito deste trabalho foi evidenciar a existência desse reflexo vagal, através de uma broncoprovocação, em pacientes portadores de refluxo gastroesofágico. MÉTODOS: Onze pacientes com endoscopia sem evidências de refluxo gastroesofágico ou hérnia hiatal (grupo controle) e dez pacientes com hérnia hiatal ou refluxo gastroesofágico foram submetidos à broncoprovocação com carbacol. RESULTADOS: O teste foi positivo em 5 dos pacientes com hérnia hiatal ou refluxo gastroesofágico (50%), e em 3 do grupo controle (27%) (p = 0,64). CONCLUSÃO: A hipótese de que as vias aéreas de pacientes com refluxo gastroesofágico sem sintomas asmatiformes anteriores possam ser mais responsivas do que as de pacientes sem refluxo gastroesofágico permanece não comprovada.<br>OBJECTIVE: To identify this vagal reflex using bronchial provocation tests in patients with gastroesophageal reflux disease. METHODS: The study group was composed of 10 patients presenting endoscopic evidence of hiatal hernia or gastroesophageal reflux disease, and the control group consisted of 11 patients presenting no evidence of either condition. All subjects were submitted to bronchial provocation with carbachol. RESULTS: The provocation test was positive in 5 (50%) of the study group patients and 3 (27%) of the control group patients (p = 0.64). CONCLUSION: The hypothesis that the airways of patients with gastroesophageal reflux disease (and no history of asthma-like respiratory symptoms) might be more responsive than those of individuals without the disease remains unproven

Esofagomanometria e pHmetria esofágica de 24 h em uma ampla amostra de pacientes com manifestações respiratórias Esophageal manometry and 24-h esophageal pH-metry in a large sample of patients with respiratory symptoms

OBJETIVO: Determinar a prevalência da doença do refluxo gastroesofágico (DRGE) e avaliar o perfil motor esofágico de portadores de manifestações respiratórias encaminhados para avaliação funcional esofágica em um serviço de referência em motilidade digestiva. MÉTODOS: Foram analisados os resultados de esofagomanometria e de pHmetria esofágica de 24 h. O critério de inclusão foi a presença de sintomas respiratórios, acompanhados ou não de sintomas digestivos. RESULTADOS: Dos 1.170 pacientes incluídos no estudo, 602 (51,5%) relataram manifestações digestivas associadas às respiratórias (grupo MRD) e 568 (48,5%), apenas respiratórias (grupo MR). A asma foi diagnosticada em 142 indivíduos no grupo MR (subgrupo MR-A) e em 201 no grupo MRD (subgrupo MRD-A). Dentre os 346 casos de dismotilidade do corpo esofágico, a hipomotilidade esteve presente em 175 (14,3% e 15,6%, respectivamente, no grupos MRD e MR) e hipotonia do esfíncter esofágico inferior (EEI) em 411 (40.3% e 30,2% nos mesmos grupos, respectivamente). A hipotonia se correlacionou com DRGE. A exposição do esôfago distal ao ácido foi marcadamente anormal no período de decúbito. A prevalência de DRGE na amostra total, nos subgrupos MR-A/MRD-A e somente no subgrupo MR-A foi de 39,8%, 44,0% e 35,2%, respectivamente. CONCLUSÕES: A hipotonia do EEI foi a alteração manométrica preponderante, correlacionando-se com DRGE. Embora a DRGE foi mais evidente no grupo MRD, aproximadamente um terço dos pacientes do grupo MR apresentou DRGE (DRGE silencioso). Os achados sugerem a DRGE como possível causa extrapulmonar de sintomas respiratórios crônicos não responsivos à terapêutica convencional.<br>OBJECTIVE: To determine the prevalence of gastroesophageal reflux disease (GERD) and to evaluate the esophageal motor profile of patients with respiratory symptoms referred to a digestive motility referral center for esophageal function testing. METHODS: The results of esophageal manometry and 24-h esophageal pH-metry were analyzed.The inclusion criterion was presenting respiratory symptoms, with or without accompanying digestive symptoms. RESULTS: Of the 1,170 patients included in the study, 602 (51.5%) reported having digestive and respiratory symptoms (DRS group), and 568 (48.5%) reported having only respiratory symptoms (RS group). Asthma was diagnosed in 142 patients in the RS group (RS-A subgroup) and in 201 of those in the DRS group (DRS-A). Of the 346 cases of esophageal dysmotility, hypomotility was found in 175 (14.3% and 15.6% in the DRS and RS groups, respectively), and lower esophageal sphincter (LES) hypotonia was found in 411 (40.3% and 30.2%, respectively). Hypotonia correlated with GERD. Exposure of the distal esophagus to acid was markedly abnormal in the supine position. The prevalence of GERD in the sample as a whole, the RS-A/DRS-A subgroups and the RS-A subgroup alone was 39.8%, 44.0% and 35.2%, respectively CONCLUSIONS: Hypotonic LES was the most common abnormality and correlated with GERD. Although GERD was more evident in the DRS group, approximately one third of the patients in the RS group also presented GERD (silent GERD). The findings suggest that GERD can be an extrapulmonary cause of chronic respiratory symptoms unresponsive to conventional therapy

Dor torácica não-cardiogênica Non-cardiac chest pain

CONTEXTO: Dor torácica não-cardiogênica ou dor torácica funcional é síndrome clínica com elevada prevalência no mundo ocidental, podendo estar presente entre 15% a 30% dos pacientes com coronariografias normais. Tem importante impacto na qualidade de vida dos pacientes e associa-se com considerável aumento da utilização dos serviços de saúde. FONTES DE INFORMAÇÃO: Para esta revisão, foram utilizadas as seguintes bases de dados: Medline, the Cochrane Library, LILACS e livros nacionais. Das publicações dos últimos 5 anos foram selecionadas fontes relevantes como artigos originais, artigos de revisão, consensos, diretrizes e revisões sistemáticas de literatura com meta-análise. Publicações relevantes anteriores ao período de tempo analisado, foram também incluídas. RESULTADOS: Foram incluídas 44 publicações, sendo 28 artigos originais, 12 trabalhos de revisão, 2 diretrizes, 1 meta-análise e 1 consenso. CONCLUSÕES: A dor torácica não-cardiogênica abrange a investigação do trato digestório, do aparelho musculoesquelético, do aparelho respiratório e de distúrbios psicológicos. O objetivo do tratamento é o alívio ou eliminação do sintoma e deve estar voltado para o principal mecanismo gerador. A base do tratamento é medicamentosa, entretanto, pode ser necessária intervenção de natureza psicológica e, nos pacientes com acalásia a terapia endoscópica ou cirúrgica. Considerando-se que a maioria dos pacientes apresentarão causas relacionadas ao esôfago, sendo as principais, a doença do refluxo gastroesofágico e distúrbios motores, as principais medicações utilizadas no controle da dor torácica não-cardiogênica são os inibidores da bomba de prótons e os antidepressivos tricíclicos. Recentemente, novas modalidades diagnósticas e também formas de tratamento, tais como, a injeção por endoscopia de toxina botulínica no esôfago e a hipnose, estão em investigação e algumas poderão ocupar lugar no cenário do tratamento destes pacientes.<br>CONTEXT: Non-cardiac chest pain or functional chest pain is a syndrome with high prevalence in ocidental world. Findings on 15%-30% of coronary angiograms performed in patients with chest pain are normal. Causes significant impact in quality of life of patients and is associated with increased use of the health care facilities. DATA SOURCES: To this review the following data base were accessed: Medline, the Cochrane Library, LILACS. The limit was the last 5 years publications and were selected relevant original articles, reviews, consensus, guidelines and meta-analysis. RESULTS: Forty-four papers were selected, 28 original articles, 12 reviews, 2 guidelines, 1 consensus and 1 meta-analysis. CONCLUSIONS: Exclusion of cardiac disease is of crucial importance. On the other hand non-cardiac chest pain could be related to gastrointestinal, muscular and respiratory causes and/or psychological disturbances. Treatment aims to attack mechanism generator in order to relieve or to eliminate symptoms. Drugs are the cornerstone of treatment, exception to achalasia patients because those have better response to dilation of the esophagus or surgery, and to those who need intensive pyschological therapy. The most important drugs used are proton pump inhibitors and triciclic antidepressants, the latter, to modulate central signal process (visceral hypersensitivity) and autonomic response. Recently, new diagnostic facilities, and also therapeutic modalities, such as esophageal botulin toxin injection and hypnosis are under investigations. In the near future, maybe some of them would take a place in the therapeutic scenario of these patients