Hanns-Gerd Dammann

First-Choice Treatment in Uncomplicated Ulcer Disease: A Case for Acid Inhibitors

First-choice treatment in uncomplicated ulcer disease is determined by the main therapeutic aims, namely pain relief, prompt healing, simple administration form, and safety. Today these goals can be best achieved with H2-receptor antagonists, which, among the antisecretory substances currently available, show a prominent and well-defined clinical efficacy and safety profile. The major disadvantage of antimuscarinics such as pirenzepine and prostaglandin analogs such as misoprostol is their narrow therapeutic range; the effective antiulcer dose is very close to the dose that produces relevant side effects. Omeprazole, although providing the best clinical results in acid-related diseases carries at least theoretically some potential risks, such as ECL-cell hyperplasia. With H2-receptor antagonists, today the question continually arises as to how the therapeutic results could be improved through a substantial reduction of both day- and night-time acidity. A single early evening administration versus bedtime ...

Acid Secretion During and After Omeprazole Treatment in Healthy Volunteers

The effect of omeprazole, 30 mg daily, on gastric acid secretion has been assessed, together with effects on basal levels of hormones, including fasting gastrin, thyroid stimulating hormone (TSH), tri-iodothyronine (T3), thyroxine (T4), thyroxine binding globulin (TBG), insulin, glucagon, C-peptide, prolactin, testosterone, 17β-oestradiol, cortisol and parathyroid hormone (PTH), in eight healthy volunteers before and after a 28-day treatment.

Famotidine: Proven Once-a-Day Treatment for Gastric Ulcer

An 8-week, double-blind, randomized, placebo-controlled, multinational (n = 14), multicenter (n = 44) trial was conducted to determine whether famotidine speeds healing and relief of symptoms in patients with benign gastric ulcer. Of the 336 patients who entered the trial, 167 received 40 mg of famotidine in the evening, and 169 received placebo. At 4, 6, and 8 weeks after entry, ulcers had healed in a significantly (P less than 0.01) higher percentage of famotidine-treated patients than in those treated with placebo (47%, 65%, 80% versus 31%, 46%, 54%, respectively). Famotidine was also superior to placebo in relieving ulcer symptoms; the proportion of patients receiving additional antacid therapy was significantly lower in the famotidine group. The findings show that the new H2-receptor antagonist famotidine, administered as a single evening dose, significantly speeds the healing of benign gastric ulcers and that it is a safe and highly effective treatment of gastric ulceration. The convenient dosage regimen of famotidine (one tablet in the evening) should improve patient compliance, which, in turn, may result in faster healing of ulcers and a lower incidence of ulcer complications.

Sucralfate in the Treatment of Reflux Esophagitis in Adults: An Update

Sucralfate was evaluated in several clinical studies on reflux esophagitis, a total of over 400 patients were studied worldwide. In this study 49 patients with reflux esophagitis of stage I-III acc. to Savary and Miller were included. The evaluation was based on 41 patients, 22 received sucralfate suspension 1 g in 5 ml qid, 19 ranitidine 150 mg bid. The patients were treated for 8 weeks, endoscopic controls were performed before treatment and after 8 weeks. The healing rates were 64% in the sucralfate group and 68% in the ranitidine group and exhibited no significant difference (p greater than 0.05). Antacid consumption and symptomatic improvement were comparable in both groups. Sucralfate seems to be a valid alternative to H2-blockers in the treatment of reflux esophagitis.

Antisecretory and protective properties of prostaglandin analogs in man

: Several prostaglandins inhibit gastric acid secretion and prevent ulcer formation in animals by mechanisms that are independent from each other. Little is known about these properties in humans. The effects of 16,16-dimethyl-prostaglandin E2 and the thiaprostaglandin E2 EMD 33 290 were tested on basal acid secretion as well as on the aspirin- and bile salt-induced fall of gastric transmucosal potential difference in man. 16,16-dm PGE2 and EMD 33 290 prevented the drop in gastric potential difference caused by 1000 mg aspirin or 50 ml of 4 mmol/l Na-taurocholate. The protective doses against aspirin were 0.1 microgram and 50 micrograms for 16,16-dm PGE, and EMD 33 290 respectively. Against Na-taurocholate, doses of 1.0 microgram and 250 micrograms were effective. By contrast, 20-100 times higher doses of both prostaglandin analogues were necessary to inhibit gastric acid secretion. Half maximal inhibition of basal acid output was achieved by 0.1 microgram/kg b.w. of 16,16-dm PGE2 and by 28 micrograms/kg b.w. EMD 33 290. In analogy to animal findings, antisecretory prostaglandins protect the human stomach against aspirin and bile salts in doses which are much smaller than the threshold antisecretory ones.

Rioprostil in the acute and long-term treatment of peptic ulcers: a review.

The new prostaglandin E1 analogue, rioprostil, significantly accelerates healing and the elimination of pain in cases of peptic ulcer. The anti-ulcerous potency of this prostaglandin is equivalent to that of cimetidine. In comparison with ranitidine, there is a positive trend in favour of the H2-receptor antagonist, ranitidine, which has a more pronounced antisecretory effect than rioprostil. The differences in the healing rates during treatment with rioprostil and ranitidine are statistically significant in some cases, whereas those relating to pain alleviation are not. In contrast, the therapeutic efficacy of the two substances is almost identical in cases of Ulcus ventriculi. Rioprostil can be used with much the same success as ranitidine for preventing the recurrence of duodenal ulcers. The frequency of diarrhoea during rioprostil treatment, 300 micrograms b.d. and 600 micrograms nocte, is approximately 10%. In only about 1% of the patients does the rioprostil treatment have to be discontinued because of this adverse reaction.

Prevention of taurocholate-induced drop in gastric potential difference with ranitidine in man.

To The Editor: An increased amylase--creatinine clearance ratio has been demonstrated in patients with diabetic ketoacidosis (DKA) (1, 2). A number of hypotheses have been advanced to explain the phenomenon. On a technical note, the influence of the amylase assay technique on the calculation of this ratio has received considerable attention (3). However, spurious elevations of serum creatinine due to acetoacetate interference may also contribute to this increased ratio. I recently had the opportunity of investigating a 36-year-old male diabetic who had DKA and hyperamylasemia. Relevant serum laboratory parameters were: sodium 126 mEq/liter (normal 135-145), potassium 5.2 mEq/liter (normal 3.55.0), chloride 85 mEq/liter (normal 95-105), total carbon dioxide 8 mEq/liter (normal 23-34), anion gap 35.2 mEq/liter (normal 12.0-18.6), amylase 216 IU/liter (normal 5-80), urea nitrogen 39 mg/dl (normal 5-23), Urine amylase was 653 IU/liter (normal 40-450). Serum and urine creatinine were measured by both an endpoint method in which acetoacetate interference occurs (Abbott VP analyzer; Abbott Diagnostics, Dallas, Texas 75247) and a kinetic method free of ketone interference (ACA analyzer, Dupont Co. Wilmington, Delaware 19898). The results are summarized in Table I. The spurious increase in serum creatinine by the endpoint method is consistent with the degree of elevation of the anion gap (5). Both studies reporting the increased ratio in DKA (1, 2) used standard Autoanalyzer methodology for measurement of serum creatinine. This is subject to the same degree of ketone interference as other endpoint methodologies.

A Single Evening Dose of Rioprostil, 600 μg, in the Treatment of Acute Duodenal Ulcers

Dammann HG, Dreyer M, Muller P, Simon B, Demol P. A single evening dose of rioprostil, 600 μg, in the treatment of acute duodenal ulcers. Scand J Gastroenterol 1989, 24(suppl 164), 215-218When administered as 300 μg b.d. or as 600 μg once in the evening, the new prostaglandin E, analogue, rioprostil, is capable of reducing nocturnal H+ activity (1200 h to 0800 h) by 52% and 74%, respectively (p<0.01). Diurnal acidity (0900 h to 1800 h), on the other hand, is only reduced by 33% and 15% (not significant). A single evening dose of rioprostil, 600 μg, is used successfully on 208 patients suffering from acute duodenal ulcer. After 2 weeks and 4 weeks of treatment, the healing rates are comparable to the high values obtained with ranitidine, 300 mg nocte (rioprostil, 600ug nocte: 54.1% and 84.1%; ranitidine, 300mg nocte: 54.4% and 89.9%). There are also no significant differences between the groups as regards symptomatic improvement. Severe diarrhoea and abdominal complaints do not occur with rioprostil, 600 μ...

INHIBITION OF NOCTURNAL ACID SECRETION BY H2-RECEPTOR-ANTAGONIST SKF 93479

which, in our experience with more than 400 strains of Aeromonas, does not relate to enterotoxicity.3 3 We find biochemical characteristics, including haemolysin assay, very useful in epidemiological studies of diarrhoea, and these methods may be applicable in investigations of outbreaks of infection with Aeromonas such as that reported by Dr Cookson and colleagues (Nov. 28, p. 1232) especially in patients in whom diarrhoea is unexplained and may be due to Aeromonas.