[Effectiveness and safety of lansoprazole in the treatment of peptic ulcer]

BACKGROUND

Lansoprazole, a new proton pump inhibitor, is now available in Mexico. It has been tested elsewhere with excellent results.

AIM

To study its safety and efficacy in Mexican patients.

METHOD

40 patients with gastric or duodenal ulcer larger than 0.5 cm, from 4 hospitals in central Mexico, were included. All were subjected to a complete medical history and upper GI endoscopy. symptoms (epigastric pain, heartburn, regurgitation, nausea, vomiting) were graded 1 to 4 according to severity. Lansoprazole (one 30 mg capsule/ day) was prescribed for 4 weeks in duodenal ulcer 8 weeks in gastric ulcer. Each patient was seen once a week at the office for compliance, symptom evaluation and side effects. A second endoscopy was performed at the end of the respective treatment period. Blood (CBC, chemistries) and urine tests were performed at the beginning and end of the study.

RESULTS

23 men and 17 women were included, Mean age: 53.8 yr. (19-95). 11 gastric ulcers and 29 duodenal ulcers. 27 measured 0.6-1.5 cm; 6 ulcers measured 1.6-2.5 cm; 6 ulcers were larger than 2.5 cm. 8 patients were bleeding at admission and 4 had multiple ulcers. 2 patients were lost to follow up. symptom grading: 18 patients had 10 points or less, 21 had more than 10 points, one bleeding patient was otherwise asymptomatic. After the first week of treatment, 42% were asymptomatic, after the 2nd. week, 75% were asymptomatic and 95% at the end of the study. The second endoscopy documented complete ulcer healing in 92% out of 37 remaining patients; further lansoprazole treatment healed 2 out of three unhealed ulcers. One patient underwent surgery for duodenal bulb stenosis. Side effects were reported by 2 patients. Treatment had to be discontinued in one patient because of headache. There was no effect of lansoprazole over the laboratory tests.

CONCLUSIONS

Lansoprazole was effective for prompt symptom relief in most patients and was able to heal more than 90% of gastric and duodenal ulcers with minimal side effects.

[Sodium benzoate in portal-systemic-encephalopathy-induced blood ammonia normalization and clinical improvement. Interim report of a double-blind multicenter trial]

To investigate the therapeutic efficacy of sodium benzoate (SB) in a cirrotic population with chronic portal systemic encepalopathy (PSE), we performed a double blind, randomised, multicentric, clinical trial, comparing SB versus a standard therapy of lactitol (LA). To perform the study blind, syrups containing the two drugs were prepared. To date 27 patients have been studied. Of these, 12 received SB (5.6 g/day) and 15 received LA (29 g/day). Standard PSE parameters were assessed and hippurate urinary excretion was measured before and after the trial. For the SB group, basal and final PSE index were 0.39 +/- 0.16 and 0.17 +/- 0.1 respectively (p < 0.001). The Group on LA had a PSE index of 0.40 + 0.1 and 0.23 +/- 0.18 (basal and final respectively) (p < 0.001). The final hippurate excretion for SB group was 2498.9 mg/24 h. The hippurate excretion for the LA group suffer no changes (traces). No serious side effects were observed with either therapy. We suggested that SB is a safe, efficacious and comfortable alternate treatment for PSE.

[A 10-year prolective study on cancer of the digestive system]

OBJECTIVE

A ten year prolective and multicentre study of cancer of the Digestive Tract aims to evaluate the variations on frequency and to identify risk factors.

METHODS

Ten hospitals are participating five in Mexico City and five in other states. Data were obtained through the hospitals files and specially designed questionnaires, the latter mainly diet and habits oriented.

RESULTS

Through this ten years in the 4,715 cases studied we can appreciate a decreasing tendency of the carcinoma of the stomach (GC) that has been the most frequent until 1984 in the general group General Hospital and Instituto Nacional de la Nutrición. Since then and up to date, first place in frequency in shared between the stomach and colorectal carcinoma (CRC). CRC has been increasing even in the General Hospital in which GC was very high. Eighth years ago we found that people in those hospitals in which GC was high the diet was poor in proteins, fat A and C vitamin. People in those hospitals with high frequency of CRC had diet high in protein, fat and low in fiber. A new study on diet is ongoing. Gallbladder and biliary tract carcinoma has been increasing in all the hospitals. A high O blood group was found in the Juarez Hospital in which gallbladder carcinoma was the highest. O group is highest in the indian people. Cancer of the gallbladder is very high in Pimas and Navajos indians. A plan to study litogenic index and culture of salmonella is going to be practiced in bile from normal and gallbladder carcinoma. Concerning habits, tobacco and alcohol consumption are most frequent in cancer of the esophagus and pancreas. Also coffee consumption is high in the latter.

CONCLUSIONS

Along this 10-year study, the frequency of gastric cancer has been decreasing. Instead, the frequencies of colo rectal and biliary tract cancers have been increasing. Variations in frequencies correlated with the composition of the diet, fiber consumption habits and racial characteristics of the different groups.

[Prophylactic effect of Misoprostol on gastric lesions induced by aspirin (ASA) in healthy subjects]

Aspirin (ASA) and other nonsteroidal anti-inflammatory drugs (NSAIDs), are extensively used for treating rheumatic diseases, inflammatory problems, and pain of different etiologies. However, their use is limited by the damage they may produce to the gastroduodenal mucosa. The purpose of this double-blind, multicenter, randomized, placebo-controlled study was to assess and corroborate the protective effect of misoprostol on the gastric mucosa against ASA injury. Following endoscopic screening, 60 healthy male and female subjects were assigned, at random, to one of two treatment groups. One group was treated with ASA (3.0 g/day, in three divided doses) and misoprostol (600 mcg/day, co-administered with ASA); the other with ASA and placebo. After six days of treatment, endoscopy was repeated and the gastric mucosa was graded on a 5 point endoscopic score. Protection was defined as mucosa having an endoscopic score of 2 or less (10 or fewer hemorrhages or erosions). Misoprostol produced a significant (p = 0.005) and profound protection of the gastric mucosa against ASA injury and was well tolerated. These results suggest that misoprostol should have significant therapeutic utility in the treatment and prevention of gastropathy due to NSAIDs.