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  • 1
    ISSN: 1573-2568
    Keywords: acidity ; duodenal ulcer ; healthy subjects ; pH monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The circadian pattern of intragastric acidity was assessed in 19 healthy subjects and 37 patients with active, endoscopically proven duodenal ulcer using 24-hr continuous intraluminal pH-metry. The median pH 24-hr profiles showed that ulcer patients had lower postprandial pH elevations and a smaller decline in acidity during the early morning hours when compared with controls. The after-lunch and -dinner area under the curve and maximum pH values were significantly higher in controls compared to ulcer patients. In the nighttime, the median pH values in controls were significantly higher during 9 pm to 12 pm (P=0.02), 12 pm to 4 am P=0.01), and 4 am to 8 am (P=0.0008) compared to the ulcer patients. We conclude that the 24-hr acidity is higher in ulcer patients compared to healthy subjects and that the differences are particularly evident in the postprandial and nocturnal periods.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-2568
    Keywords: gastric acidity ; pH monitoring ; low doses ; H2 antagonists
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Twenty-four-hour intragastric acidity was measured continuously over five separate occasions in 15 patients with healed duodenal ulcers. They were randomized to receive either placebo, cimetidine 800 mg, ranitidine 150 mg, famotidine 20 mg, or nizatidine 150 mg, given at 2200 hr in doubleblind fashion. All H2-receptor blockers were more effective than placebo in suppressing both circadian (P〈0.05–P〈0.01) and nocturnal (P〈0.002) gastric acidity, while there was no significant difference between the effects of the four active drugs in the same time periods. The percentage of nocturnal acid inhibition (2300–0800 hr) over placebo in terms of H+ values was virtually 100% with all active treatments. The effect on daytime (0800–1700 hr) and evening (1700–2300 hr) acidity of both placebo and the four H2-receptor antagonists was similar. Therefore, in the above doses, H2-receptor blockers guarantee overnight anacidity to a similar degree and cause the physiological buffering of daily meals on gastric acidity to be fully exploited. Furthermore, the reducing effect of daily meals on drug action can be prevented. Since strong acid suppression strictly confined to the nocturnal period has been shown to be closely correlated with the highest ulcer healing rates, it is suggested that single low bedtime doses of H2-receptor antagonists should be evaluated in the acute treatment of duodenal ulcer.
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  • 3
    ISSN: 1573-2568
    Keywords: bedtime dose ; gastric acidity ; mealtime doses ; pH monitoring ; ranitidine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was carried out in order to compare the effects of mealtime and bedtime regimens of ranitidine on gastric acidity. Fifteen duodenal ulcer pateints in clinical remission were randomized to receive in single-blind fashion either placebo, ranitidine 300 mg at night (2200 hr) or ranitidine 150 mg three times a day given before each of the three daily meals (1800, 0800 and 1200 hr). Over 24 hr, the two active treatments produced a significantly greater acid inhibition than placebo, while the single daily regimen was superior to the three times a day regimen of ranitidine in terms of both rise in pH values (P〈0.001) and duration of action expressed as time spent obove 3.0 pH units (P〈0.05). The analysis of these two parameters during fractioned periods of the circadian cycle showed that the three divided doses of ranitidine were more effective during the daytime (P〈0.01) and the evening (P〈0.001), whereas the bedtime dose of ranitidine was superior during the night (P〈0.0001). Thus a short-lasting antisecretory action, which is, however, capable of fully controlling the hihg acidity of postprandial periods, might be the key to understanding the results of several recent clinical trials in which the suppression of daytime gastric acidity has been shown to promote similar or even faster duodenal ulcer healing rates than the suppression of nocturnal acidity.
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  • 4
    ISSN: 1573-2568
    Keywords: duodenal ulcer ; omeprazole ; pH monitoring ; ulcer healing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was carried out in order to perform a combined prospective assessment of the individual pharmacodynamic response and of duodenal ulcer healing in patients treated with three different doses of omeprazole. Ninety-nine patients with endoscopically proven duodenal ulcers were subdivided into three parallel groups of 33 cases, who were randomly assigned to receive orally at 0800 hr, in single blind fashion, either 10 mg, 20 mg, or 40 mg of omeprazole. All of them underwent continuous intragastric pH monitoring both in basal conditions and on the fifth day of each dose regimen; ulcer healing was then assessed endoscopically after four weeks of treatment. All three doses of omeprazole caused pH values to increase significantly (P〈0.001) over the whole 24-hr period. In patients treated with omeprazole 10 mg, the individual responses showed the highest variability: the acid inhibition, expressed in terms of time spent above pH 3.0, lasted for more than 16 hr in 42% of cases, for more than 8 hr in 28%, and for less than 6 hr in 30%. In patients treated with omeprazole 20 mg, the pharmacological response was more marked and uniform and lasted for more than 16 hr in 79% of cases; however, it is worth noting it lasted for less than 6 hr in three patients (10%). In patients treated with omeprazole 40 mg, the individual response was excellent (more than 16 hr) in 94% of cases, and it lasted for less than 6 hr in only one patient (3%). The mean durations of antisecretory effect of 10, 20 and 40 mg of omeprazole were 13.21, 19.10, and 21.45 hr, and the respective four-week healing rates were 68%, 87%, and 98%. Thus, the longer-lasting the acid inhibition, the higher the healing rate (P〈0.05). A dose of omeprazole as low as 10 mg produces a consistent acid inhibition in 70% of cases, and this can be associated with frequent, but unpredictable, clinical benefit. The acid suppression obtained with omeprazole 20 mg is remarkable in the majority of patients, but is poor in 10% of cases, and this finding may result in clinical nonresponse. The 40-mg dose of omeprazole produces the most uniform response and is only occasionally unsuccessful in the clinical setting.
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  • 5
    ISSN: 1573-2568
    Keywords: gastric acidity ; Barrett's esophagus ; pH monitoring ; reflux esophagitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Increased gastroesophageal acid reflux is frequently found in patients with Barrett's esophagus, and it has been hypothesized that gastric acid hypersecretion could be an important factor aggravating the exposure of esophageal mucosa to acid and then contributing to the development of this disorder. The aim of the present study was to assess whether the circadian pattern of gastric acidity differs between refluxer patients with and without Barrett's esophagus and normal subjects. Continuous 24-hr gastric pH monitoring was performed in 119 healthy volunteers, 20 patients with Barrett's esophagus, 37 patients with moderate and 10 patients with severe reflux esophagitis without Barrett's esophagus. In all these diseases the final diagnosis was ascertained by means of endoscopy plus biopsy. There was no difference in the 24-hr and daytime patterns of gastric pH between healthy subjects and patients with Barrett's esophagus, while nocturnal acidity was significantly lower (P〈0.05) in the latter population. Gastric acidity, in contrast, was higher (P〈0.05) in controls than in patients with both moderate and severe reflux esophagitis without Barrett's esophagus during the whole 24-hr period. There was no difference between refluxer patients with and without Barrett's esophagus in any of the three time intervals we analyzed. Because normal subjects had lower gastric pH than patients with Barrett's esophagus during the night and than patients with reflux esophagitis during the whole 24-hr period, gastric hyperacidity is not a relevant factor in the development of both metaplastic columnar epithelium and inflammatory changes in the distal esophagus, and other pathophysiological mechanisms are involved in these histological alterations.
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  • 6
    ISSN: 1573-2568
    Keywords: misoprostol ; ranitidine ; intragastric acidity ; pH monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of the new synthetic prostaglandin E 1 analog, misoprostol, on intragastric acidity was evaluated by means of 24-hr intraluminal pH monitoring of 16 duodenal ulcer patients. They were randomly allocated into two groups: eight received no medication and misoprostol 400 Μg bid and eight received ranitidine 150 mg and misoprostol 400 Μg bid not less than one week apart. The comparison of the 24-hr areas under the curve related to the median pH values showed that no difference existed between misoprostol and untreated patients in the first group, while ranitidine was significantly more effective (P= 0.00003) than misoprostol in the second group. The analysis of arithmetic differences between the 24-hr median pH values showed that misoprostol increased pH values by at least one unit compared to the untreated subgroup for about 3.5 hr, while the antisecretory action of ranitidine was far superior to that of misoprostol throughout the whole 24-hr period. It can be concluded that the effect of twice daily doses of misoprostol 400 Μg on 24-hr intragastric pH is small and not at all comparable to that of the well-known potent H 2 blocker ranitidine.
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  • 7
    ISSN: 1573-2568
    Keywords: duodenal ulcer ; maintenance therapy ; omeprazole ; pH monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was carried out to assess the antisecretory effects and their possible changes over time of three different dose regimens of omeprazole that could be proposed for maintenance treatment in duodenal ulcer. Forty-five patients with endoscopically proven duodenal ulcer were studied by means of 24-hr gastric pH-metry both in basal conditions and on the fifth day of acute treatment with omeprazole 20 mg in the morning. Ulcers healed after four weeks (in three cases after eight weeks) and afterwards, 15 patients were randomized to receive orally at 0800 hr in single-blind fashion omeprazole 10 mg daily (group A), 15 to receive omeprazole 40 mg on Saturday and Sunday followed by a five-day period without medication (group B), and 15 to receive omeprazole 20 mg every other day (group C) for up to three months. On the 20th and 80th days of these maintenance treatments 24-hr gastric pH-metry was repeated to assess the antisecretory effectiveness of each regimen over a two-month period. In patients of group B these tests began at 1700 hr on Friday, the last of five days off treatment, and in those of group C at 1700 hr of the day off medication. All three dose regimens of omeprazole were able to raise pH values significantly (P〈0.01–0.001) compared to basal levels. Omeprazole 20 mg every other day was more effective (P〈0.01) than omeprazole 40 mg weekend, but did not differ significantly from omeprazole 10 mg daily. The durations of acid inhibition (pH〉3.0 units/24 hr) were 12.44, 10.00, and 17.38 hr with groups A, B, and C, respectively. There was no significant difference between the pH profiles of the 20th and 80th days with every dose regimen. It is concluded that all three dose regimens of omeprazole are effective in reducing gastric acidity and their pharmacodynamic action does not change with time. Therefore they are suitable to be assessed in large clinical trials aimed at verifying the prevention of duodenal ulcer recurrence for longer periods.
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  • 8
    ISSN: 1432-1041
    Keywords: famotidine ; gastric acid ; duodenal ulcer ; administration time ; pH monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary In order to assess whether dinnertime administration of a once daily dose of famotidine is more advantageous than a bedtime dose in suppressing evening and nocturnal gastric acidity, we gave nine patients with a past history of duodenal ulcer in double-blind, randomized fashion either (1) placebo at 6 p.m. and 10 p.m., (2) famotidine 40 mg at 6 p.m. (Fam 6) + placebo at 10 p.m. or (3) placebo at 6 p.m. + famotidine at 10 p.m. (Fam 10) on three separate occasions. Comparison of the 24-h median pH values showed that the two administrations of famotidine were superior to placebo, while Fam 6 was significantly more effective than Fam 10. The gain in acid suppression of Fam 6 with respect to Fam 10 was particularly evident from 6 p.m. to midnight. Although the antisecretory effectiveness of Fam 6 was lower than that of Fam 10 from 4 a.m. to 8 a.m., it remained clearly higher than that of placebo and ensured virtual anacidity (median pH=6.7) even in this time segment. We conclude that a once daily dose of famotidine at 6 p.m. is better than bedtime administration at covering the long period of continuous unbuffered intragastric acidity which extends from after the evening meal to breakfast.
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