A comparison of omeprazole, lansoprazole and pantoprazole in the maintenance treatment of severe reflux oesophagitis

BACKGROUND

Proton pump inhibitors are effective for the healing of oesophagitis. Standard doses of omeprazole, lansoprazole or pantoprazole are sufficient for healing in mild to moderate cases of oesophagitis.

AIM

To compare the efficacy of double the standard doses of omeprazole, lansoprazole or pantoprazole for maintenance treatment of severe oesophagitis complicated by a stricture.

METHODS

Thirty-six patients with reflux oesophagitis and stricture confirmed by endoscopy were included in a prospective study comparing three maintenance therapies. In all cases weekly dilatation of the stenosis was performed and patients were treated with omeprazole 20 mg b.d. until healing of oesophagitis and dysphagia relief were achieved. Thirty participants responded to therapy and were then randomly assigned to 4 weeks of maintenance treatment with omeprazole (20 mg b.d.; n = 10), lansoprazole (30 mg b.d.; n = 10) or pantoprazole (40 mg b.d.; n = 10). Subsequently, endoscopies were performed-the endoscopists were blinded to the therapy assignment. The endpoints were defined as the absence of oesophagitis, oesophageal stricture and complaints.

RESULTS

After 4 weeks of treatment, the number of patients remaining in remission (no oesophagitis or stricture and no symptoms) was nine out of 10 (90%) in the omeprazole group, two out of 10 (20%) in the lansoprazole group (P < 0.01) and three out of 10 (30%) in the pantoprazole group (P < 0.01).

CONCLUSIONS

In our study omeprazole was superior to either lansoprazole or pantoprazole in the maintenance treatment of complicated gastro-oesophageal reflux disease.

Effect of pyritinol on EEG and SSEP in comatose patients in the acute phase of intensive care therapy

The extent and duration of acute disturbances of consciousness depend on the severity and localization of the underlying cerebral dysfunction. The Glasgow Coma Scale (GCS) permits a relevant statement to be made on the course and recovery tendency of functional damage patterns in cerebral, mesencephalic, and brain stem structures. Therapy is directed at exerting a beneficial effect on the disturbed cerebral metabolism by administration of centrally active substances and at utilizing the available reserve plasticity of the brain for any possible recovery of mental performance. The bioavailability and profile of action of pyritinol have been well documented in animal experiments. We have studied the question as to the extent to which the substance influences the depth of coma in patients receiving acute intensive care therapy, and how this can be objectified electrophysiologically in the form of a specific central effect on basal brain structures. In a phase-II pilot study over five days the acute effect of intravenous 60-min. administration of 1,000 mg pyritinol on the depth of coma, the central conduction time (CCT) and the primary complex amplitude (N20/P25) of the SSEP, and on vigilance behavior (spectral edge frequencies and power) was investigated for 90 minutes in each case under intensive-medical steady-state conditions in 10 comatose patients. Because of the differences in the underlying brain damage, the primary depth of coma, age (30-89 years), sex (two female, eight male), as well as previous treatment (surgery, conservative), the significance of the results could not be evaluated by confirmatory statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of EEG monitoring in operations of the supra-aortic arteries]

Experiences with 207 patients operated under EEG monitoring have shown changes of EEG in 20% which made the application of an intraluminal shunt necessary. The majority of these patients had multimorbidity of supraaortic branches. Earliest changes could be seen after seven seconds of clamping time. In these cases an operation of the carotic artery should be avoided and an extra-intracranial bypass is recommended.

[Brain function and artificial respiration]

Haemodynamic changes (cerebral perfusion pressure, cerebral blood flow) and variations of blood gases (especially paCO2) induced by mechanical ventilation, can influence cerebral function. The cerebral response to these changes is modified by the individual pathophysiology of the cranial contents. The cerebral mechanisms of adaptation allow a safe ventilation of a patient without cerebral disorders, provided ventilation is within normal clinical limits. In patients, however, whose mechanisms of adaption are impaired locally or globally, the pathophysiological situation may become grossly changed by variations in the ventilatory pattern. A therapeutical application of this interaction is controlled hyperventilation to lower intracranial pressure. On the other hand, changes in the ventilatory pattern (variation of PEEP-level, variation of minute volume, bronchial toilet) can impair cerebral function critically. As the individual reactions cannot be predicted in this group of patients, monitoring of haemodynamic parameters (MAP, CVP, CO), blood gases, intracranial pressure, and EEG is of utmost importance.

[Hematuria due to foreign bodies in a woman-patient with the Munchhausen syndrome]

It is reported on a female patient with Münchhausen syndrome who was referred by the family doctor for the clarification of a haematuria. As cause of the haematuria two stones of about 1 cm in diameter each were found which were artificially brought into the bladder.