Combined treatment of gastric ulcers induced by nonsteroid anti-inflammatory drugs. Results of 4-week population-based controlled trial of efficacy of proton pump inhibitor combination with tripotassium bismuth dicitrate
- Authors: Karateev AE, Uspenskiy Y.P, Pakhomova IG, Nasonov EL, Karateev AE, Uspensky Y.P, Pakhomova IG, Nasonov EL
- Issue: Vol 81, No 6 (2009)
- Pages: 62-66
- Section: Editorial
- URL: https://journals.rcsi.science/0040-3660/article/view/30392
- ID: 30392
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Abstract
Material and methods. Fifty rheumatic patients entered the study (5 males and 45 females, mean age 63.5 ± 6.2 years) with NSAD-induced GU. Criteria of participation in the study: ulcer size > 1.0 cm, 2 and more ulcers, administration of glucocorticoids (GC) and/or cytotoxic drugs. The patients were divided into two groups. Group 1 patients received omeprasol 20 mg twice a day + BTD 240 mg twice a day; group 2 patients received omeprasol alone 20 mg twice a day. The groups were matched by demographic and clinical parameters, consisted mainly of women with rheumatoid arthritis, most of the patients took GC, methotrexate or leflunamid. The result of the treatment was evaluated by the findings of endoscopic examination 4 and 8 weeks after treatment.
Results. Three patients from group 1 and 2 patients from group 2 were withdrawn from the study. For 4 weeks ulcer heeling was achieved in 15 patients of group 1 (68.2%) and 8 patients of group 2 (34.8%), p = 0.038. On week 8 ulcers healed in 86.3 and 78.3% patients, respectively. Severe side effects were absent.
Conclusion. Combination of omeprasol with BTD stimulated heeling of NSAD-induced gastric ulcer.
About the authors
A E Karateev
Yu P Uspenskiy
I G Pakhomova
E L Nasonov
A E Karateev
Yu P Uspensky
I G Pakhomova
E L Nasonov
References
- Лазебник Л. Б., Дроздов В. Н. Заболевания органов пищеварения у пожилых. М.: Анахарсис; 2003.
- Parfitt J., Drimab D. Pathological effects of drugs on the gastrointestinal tract: a review. Hum. Pathol. 2007; 38: 527-536.
- Применение нестероидных противовоспалительных препаратов: Клинические рекомендации / Насонов Е. Л., Лазебник Л. Б., Беленков Ю. Н. и др. М.: Алмаз; 2006.
- Kean W., Buchanan W. The use of NSAIDs in rheumatic disorders 2005: a global perspective. Inflammopharmacology 2005; 13 (4): 343-370.
- Lain L. Approaches to nonsteroidal antiinflammatory drug use in high-risk patient. Gastroenterology 2001; 120: 594-606.
- Fosbцl E., Gislason G., Jacobsen S. et al. The pattern of use of non-steroidal antiinflammatory drugs (NSAIDs) from 1997 to 2005: a nationwide study on 4,6 million people. Pharmacoepidemiol. Drug Saf. 2008; Mar 28. 17 (8): 822-833.
- Каратеев А. Е., Насонова В. А. Развитие и рецидивирование язв желудка и двенадцатиперстной кишки у больных, принимающих нестероидные противовоспалительные препараты: влияние стандартных факторов риска. Тер. арх. 2008; 5: 62-66.
- Насонов Е. Л., Каратеев А. Е. Гастроинтестинальные осложнения НПВП: нерешенные проблемы. Мнение эксперта-ревматолога. Экспер. и клин. гастроэнтерол. 2006; 2: 6-9.
- Singh G., Triadafilopoulos S. Appropriative choice of proton pump inhibitor therapy in the prevention and management of NSAID-related gastrointestinal damage. Int. J. Clin. Pract. 2005; 59; 1210-1215.
- Yeomans N. D., Tulassay Z., Juhasz L. et al. A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. N. Engl. J. Med. 1998; 338: 719-726.
- Hawkey C. J., Karrascch J. A., Szczepanski L. et al. Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. N. Engl. J. Med. 1998; 338: 727-734.
- Goldstein J., Johanson J., Hawkey C. et al. Clinical trial: healing of NSAID-associated gastric ulcers in patients continuing NSAID therapy - a randomized study comparing ranitidine with esomeprazole. Aliment. Pharmacol. Ther. 2007; 26 (8): 1101-1111.
- Hawkey C. et al. Relative contributions of mucosal injury and Helicobacter pylori in the development of gastroduodenal lesions in patients taking non-steroidal anti-inflammatory drugs. Gut 2002; 51: 336-343.
- Каратеев А. Е., Дюков И. В. Факторы, влияющие на эффективность ингибиторов протонной помпы при НПВП-индуцированных язвах желудка. Тер. арх. 2007; 5: 66-70.
- Wallace J. Recent advances in gastric ulcer therapeutics. Curr. Opin. Pharmacol. 2005; 5 (6): 573-577.
- Wallace J. Prostaglandins, NSAIDs, and gastric mucosal protection: why doesn't the stomach digest itself? Physiol. Rev. 2008; 88 (4): 1547-1565.
- Okuyama M., Tominaga K., Tanigawa T. et al. The role of mucoprotective drugs in a treatment and prevention for NSAID-induced gastric ulcer. Nippon Rinsho 2007; 65 (10): 1850-1855.
- Исаков В. А. Коллоидный субцитрат висмута: его свойства как основа для применения в гастроэнтерологии. Рос. журн. гастроэнтерол., гепатол., колопроктол. 2003; прил. 19 (3): 30-35.
- Park K., Hahm J., Kim H. Pharmacological effects of metronidazole + tetracycline + bismuth subcitrate versus omeprazole + amoxycillin + bismuth subcitrate in Helicobacter pylori-related gastritis and peptic ulcer disease. Eur. J. Gastroenterol. Hepatol. 1994; 6 (suppl. 1): 103-107.
- Goenka M., Das K., Vaiphei K. et al. Helicobacter pylori eradication-evaluation of triple therapy containing omeprazole. Indian J. Gastroenterol. 1996; 15 (1): 1-3.
- Gisbert J., Gonzalez L., Calvet X. Systematic review and meta-analysis: proton pump inhibitor vs. ranitidine bismuth citrate plus two antibiotics in Helicobacter pylori eradication. Helicobacter 2005; 10 (3): 157-171.
- Stables R., Campbell C., Clayton N. et al. Gastric anti-secretory, mucosal protective, antipepsin and anti-Helicobacter properties of ranitidine bismuth citrate. Aliment. Pharmacol. Ther. 1993; 7 (3): 237-246.
- Abuznaid M., Sallam A., Hamdan I. et al. Diclofenac-bismuth complex: synthesis, physico-chemical, and biological evaluation. Drug Dev. Ind Pharm. 2008; 34 (4): 434-444.
- Wagstaff A., Benfield P., Monk J. Colloidal bismuth subcitrate. A review of its pharmacodynamic and pharmacokinetic properties, and its therapeutic use in peptic ulcer disease. Drugs. 1988; 36 (2): 132-157.
- Konturek S., Kwiecien N., Obtulowicz W. et al. Effect of colloidal bismuth subcitrate on aspirin-induced microbleeding, DNA loss, and prostaglandin formation in humans. Scand. J. Gastroenterol. 1988; 23; 861-866.
- Cataldo M., D'Aiuto A., Bongiorno A. De-nol in NSAID-induced gastroduodenal lesions. Minerva Dietol. Gastroenterol. 1990; 36: 27-30.
- Bianchi Porro G., Lazzaroni M., Petriollo M. et al. Peptic ulcer therapy with cimetidine versus tripotassium dicitraio bismuthate in rheumatoid arthritis patients undergoing chronic NSAID treatment. Aliment. Pharmacol. Ther. 1998; 12: 343-347.
- Jablonskб M. Healing of gastric body ulcer with gastroprotective versus antisecretory treatment. Dig. Dis. Sci. 1995; 40 (9): 2016-2018.
- Каратеев А. Н., Насонов Е. Л., Раденска-Лоповок С. Г. Эффективность коллоидного субцитрата висмута при гастропатиях, индуцированных НПВП. Тер. арх. 2005; 2: 46-49.
- Маев И. В., Вьючнова Е. С., Стасева И. В. Сравнительная оценка различных схем терапии НПВП-гастропатии. Рос. журн. гастроэнтерол. и гепатол. 2003; 3: 73.
- de Leest H., Steen K., Lems W. et al. Eradication of Helicobacter pylori does not reduce the incidence of gastroduodenal ulcers in patients on long-term NSAID treatment: double-blind, randomized, placebo-controlled trial. Helicobacter 2007; 12 (5): 477-485.
- Chan F., Sung J., Suen R. et al. Does eradication of helicobacter pylori impair healing of non-steroidal anti-inflammatory drug associated bleeding peptic ulcers? A prospective randomized study. Aliment. Pharmacol. Ther. 1998; 12: 1201-1205.
- Hawkey C. J., Tullasay Z., Szczepanski L. et al. Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAID study. Lancet 1998; 352: 1016-1021.
- Suzuki M., Suzuki H., Hibi T. Proton pump inhibitors and gastritis. J. Clin. Biochem. Nutr. 2008; 42 (2): 71-75.
- Лазебник Л. Б., Васильев Ю. В. VIII съезд научного общества гастроэнтерологов России. Стандарты "Диагностика и терапия кислотозависимых заболеваний, в том числе ассоциированных с Helicobacter pylory". Экспер. клин. и гастроэнтерол. 2008; 3: 130-134.
- Malfertheiner P., Megraud F., O'Morain C. et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007; 56 (6): 772-781.
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