The modern therapy for peptic ulcer disease and other acid peptic diseases is based on administration of proton pump inhibitors (PPI) which have fully replaced anacids, parasympatholytics and histamine H2 receptor antagonists. The most effective way is to administer proton pump inhibitors in the morning on an empty stomach in a single daily dose. It is a very safe therapy, despite the fact that a potential adverse effect of long-term PPI treatment on the efficacy of other medications (clopidogrel), on bone metabolism and development of respiratory infections have been discussed recently. PPI also play an essential role in the eradication treatment of Helicobacter pylori infection, the prevention and treatment of gastropathy induced by nonsteroidal anti-inflammatory drugs and in relation to some rare hypersecretory conditions. The role of proton pump inhibitors in the therapy for functional dyspepsia is contradictory. Massive bleeding from the peptic ulcer is a relatively frequent complication of NSAID gastropathy. Endoscopic hemostasis and parenteral administration of PPI for at least 72 hours are used in therapy. Key words: acid peptic diseases - gastric secretion - peptic ulcer - proton pump inhibitors.
- MeSH
- antiflogistika nesteroidní terapeutické užití MeSH
- Helicobacter pylori * MeSH
- histamin H2 - antagonisté terapeutické užití MeSH
- infekce vyvolané Helicobacter pylori * komplikace farmakoterapie MeSH
- inhibitory protonové pumpy terapeutické užití MeSH
- lidé MeSH
- peptický vřed * farmakoterapie mikrobiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antiflogistika nesteroidní MeSH
- histamin H2 - antagonisté MeSH
- inhibitory protonové pumpy MeSH
Effective eradication regimes of Helicobacter pylori infections are nowadays based on administration of a substance with a strong suppressive effect on production of gastric HCl combined with two antibiotics. As suppressor of gastric HCl production unequivocally some drug from the group of proton pump blockers is used. As to antibiotics, in first line therapy the following are recommended: clarithromycin, amoxicillin, metronidazole. A problem in the eradication therapy of Helicobacter pylori infection in recent years is the increasing resistance to clarithromycin and apparently also metronidazole. In the Czech Republic the resistance to clarithromycin in relation to Helicobacter pylori is stabilized at a level lower than 3.0 %. Resistance to metronidazole was reported in 1992 within the range of 24 % - 26 %, however in 2001 it was already 36.0 %. Therefore the question arises whether it is possible under our conditions to check the increasing metronidazole resistance by a drug which by its spectrum of action resembles metronidazole while it differs from it as to its chemical structure. This is the reason why the authors implemented a trial where metronidazole was replaced by tinodazole (Avrazor, Léciva Co.). The results revealed that in the group treated with tinidazole eradication was achieved after 7-day administration of ornidazole in 93.0 %, in the group where part of the eradication regime was metronidazole eradication was 82.6 %. The tolerance of both drugs was very good. The authors recommend to include the pattern omeprazole 2 x 20 mg, clarithromycin 2 x 500 mg and tinidazole 2 x 500 mg among first line therapeutic regimes.
- MeSH
- antibakteriální látky aplikace a dávkování MeSH
- bakteriální léková rezistence MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- Helicobacter pylori * účinky léků MeSH
- infekce vyvolané Helicobacter pylori farmakoterapie mikrobiologie MeSH
- inhibitory protonové pumpy MeSH
- klarithromycin aplikace a dávkování MeSH
- kombinovaná farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metronidazol aplikace a dávkování MeSH
- mladiství MeSH
- omeprazol aplikace a dávkování MeSH
- ornidazol aplikace a dávkování MeSH
- peptický vřed farmakoterapie mikrobiologie MeSH
- protivředové látky aplikace a dávkování MeSH
- rozvrh dávkování léků MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Názvy látek
- antibakteriální látky MeSH
- inhibitory protonové pumpy MeSH
- klarithromycin MeSH
- metronidazol MeSH
- omeprazol MeSH
- ornidazol MeSH
- protivředové látky MeSH
The great prevalence and chronic nature of peptic ulcers traditionally represent a great economic load for the system of health care. The exponentially growing therapeutic and diagnostic possibilities of the treatment of peptic diseases are under a strong economic pressure from health-insurance companies. The use of an economic model for the management of peptic diseases aims to maximize health benefit from limited sources of the health services. It can be said already now that the detection of the Helicobacter pylori infection ranks among the most important discoveries of the 20th century. Elimination of the Helicobacter pylori infection can produce a dramatic reduction in relapses of peptic ulcers, which is reflected not only in the improved quality of life but also in a subsequent economic contribution. The present authors paid attention to the financial costs of the combined therapy for eradication of the Helicobacter pylori infection in the course of the years 1998-2001.
- MeSH
- analýza nákladů a výnosů MeSH
- Helicobacter pylori * MeSH
- histamin H2 - antagonisté ekonomika terapeutické užití MeSH
- infekce vyvolané Helicobacter pylori komplikace farmakoterapie ekonomika MeSH
- inhibitory protonové pumpy MeSH
- lidé MeSH
- náklady na léky * MeSH
- peptický vřed farmakoterapie ekonomika mikrobiologie MeSH
- recidiva MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Slovenská republika MeSH
- Názvy látek
- histamin H2 - antagonisté MeSH
- inhibitory protonové pumpy MeSH
The aim of our study is to give a survey of the most efficient methods for treatment and prevention of non-steroidal anti-inflammatory drug (NSAID)-induced gastrointestinal adverse in cases when antiphlogistic treatment cannot be discontinued due to active and progressive joint disease. Analysis of published studies shows that, the proton pump inhibitors (omeprazole) are the most efficient agents in treatment of gastric and duodenal ulcers induced by NSAIDs. The analysis shows a reliable effect of prostaglandin analogues (misoprostol) as well. Prostaglandin analogues (misoprostol) proved the most effective in treatment of gastric erosions. Prophylaxis of adverse gastrointestinal mucosal abnormalities can be primary or secondary. Secondary prevention is intended for patients with gastrointestinal symptoms or those treated for mucosal defects (ulcer, erosions). The standard prevention using H2-antagonists or sucralphate does not provide sufficient protection against NSAID in these patients, but omeprazole reduces the chance of a peptic lesion relapse. Primary prevention is intended for patients with a higher risk of gastrointestinal complications (age above 60, history of peptic ulcer, a higher dose of NSAID, simultaneous treatment with glucocorticoids or anticoagulants). Diclofenac with misoprostol and nabumetone reduce the incidence of gastroduodenal ulcers and their complications in short-term as well long-term studies. Meloxicam reduces the incidence of gastroduodenal mucosal abnormalities is short-term studies. Nimesulide is associated with a lower incidence of adverse gastrointestinal events, but the fact is that, reliable data on gastroduodenal ulcer incidence reduction or their complications are not available.
- MeSH
- antiflogistika nesteroidní škodlivé účinky MeSH
- lidé MeSH
- peptický vřed chemicky indukované farmakoterapie prevence a kontrola MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antiflogistika nesteroidní MeSH
The diagnosis of peptic ulcer must be precise and based on both endoscopic examination (in the case of gastric ulcer to differentiate between benign or malign ulcers), and on bioptic examination. Peptic ulcer is pathogenetically associated with H. pylori. A small group of patients with duodenal ulcers and without H. pylori or without an other known cause (NSAID, etc.) is a poorly defined sub-group of patients. H. pylori has an important role in the pathogenesis of gastritis and bulbitis. Both states are involved in the pathogenesis of peptic ulcer. If H. pylori is eradicated, inflammatory changes of the gastric and duodenal mucosa recede and the recurrence of peptic ulcer decreases to a minimal size. For estimation of H. pylori, several invasive and non-invasive techniques are used. Among invasive methods most used in peptic ulcers, a combination of the rapid urease test and histology seems to be the most important. Among non-invasive methods, the breath tests are the most reliable. The treatment is focused on the eradication of H. pylori (no H. pylori is found one month or more after completed therapy). Of the eradication regimens, the triple therapy with proton pump inhibitors, claritromycin and metronidazole or amoxicillin are most effective. If this therapy fails, quadrutherapy (triple therapy combined with colloid bismuth subcitrate) may be successful. The precise diagnosis of peptic ulcer and H. pylori infection is a basic prerequisite for rational therapy of peptic ulcer disease and its relapses.
- MeSH
- gastrointestinální látky terapeutické užití MeSH
- gastrointestinální motilita účinky léků MeSH
- lidé MeSH
- peptický vřed farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- gastrointestinální látky MeSH
In an open clinical endoscopically controlled study in 30 consecutive patients with rheumatic diseases complicated by the ulcerative and erosive form of gastroduodenopathy induced by non-steroidal antiinflammatory drugs and oesophagitis, after four weeks treatment with oral famotidine (one dose of 40 mg/day) confirmed a significant improvement of the mean oesophageal (0.67 +/- 1.06 vs. 0.03 +/- 0.18, p rrr 0.01) gastric 2.10 +/- 1.49 vs. 0.63 +/- 0.85, p rrr 0.001) and duodenal mucosal score (1.80 +/- 1.52 vs. 0.43 +/- 0.82, p rrr 0.001). After four weeks treatment 71% lesions (5/7) in the oesophagus were cured, 77% gastric lesions (10/13) and 75% duodenal lesions (9/12). Treatment with non-steroid antirheumatics proceeded.
- MeSH
- antiflogistika nesteroidní škodlivé účinky MeSH
- ezofagitida chemicky indukované farmakoterapie MeSH
- famotidin terapeutické užití MeSH
- histamin H2 - antagonisté terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- peptický vřed chemicky indukované farmakoterapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- antiflogistika nesteroidní MeSH
- famotidin MeSH
- histamin H2 - antagonisté MeSH
- MeSH
- dospělí MeSH
- famotidin terapeutické užití MeSH
- lidé MeSH
- peptický vřed farmakoterapie MeSH
- prospektivní studie MeSH
- protivředové látky terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- famotidin MeSH
- protivředové látky MeSH
Extremely effective drugs used in the therapy of diseases etiologically associated with excessive HCl secretion by the gastric mucosa include proton pump blockers. Their obvious advantage, as compared with commonly used drugs, is that they cause a marked drop of HCl production by the gastric mucosa regardless of the type of stimulus, i.e. whether parietal cell receptors are influenced. Their therapeutic action is extremely effective, while side-effects are minimal. The publication gives the basic indications of administration of proton pump blockers, compares their therapeutic efficiency with H2 blockers and draws attention to possible pitfalls of therapy.
- MeSH
- 2-pyridinyl methylsulfinyl benzimidazoly MeSH
- benzimidazoly terapeutické užití MeSH
- gastrointestinální nemoci farmakoterapie MeSH
- inhibitory protonové pumpy * MeSH
- lanzoprazol MeSH
- lidé MeSH
- omeprazol analogy a deriváty terapeutické užití MeSH
- pantoprazol MeSH
- peptická ezofagitida farmakoterapie MeSH
- peptický vřed farmakoterapie MeSH
- protivředové látky terapeutické užití MeSH
- sulfoxidy terapeutické užití MeSH
- Zollingerův-Ellisonův syndrom farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- 2-pyridinyl methylsulfinyl benzimidazoly MeSH
- benzimidazoly MeSH
- inhibitory protonové pumpy * MeSH
- lanzoprazol MeSH
- omeprazol MeSH
- pantoprazol MeSH
- protivředové látky MeSH
- sulfoxidy MeSH
The most substantial factor in the pathogenesis of peptic ulcers of the gastroduodenum is a preserved HCl secretion (frequently hypersecretion) and the presence of Helicobacter pylori. In some of the ulcers a part is played by non-steroid antirheumatic drugs. In the treatment inhibition of acid secretion by antagonists of H2 receptors proved useful as they heal approximately 80% ulcers in the course of four weeks. Drugs of this group however, do not resolve the main problem of anti-ulcerous treatment, i.e. the liability of ulcers to relapse. 70-80% of the patients develop a relapse within one to two years. Moreover, in 5-10% of the patients the ulcers are resistant to treatment with H2 receptor antagonists. An obvious advance in treatment are inhibitors of the proton pump which intensely inhibit HCl secretion independently on the type of stimulation. At present in clinical practice omeprazole, lansoprazole and pantoprazole are used, all being derivates of benzimidazole. They are the drugs of choice in ulcers resistant to H2 receptor antagonists, in severe forms of reflux oesophagitis in Zollinger-Ellison's syndrome, in ulcers induced by non-steroid antirheumatics. The most substantial fact is that in combination with amoxacillin (or another suitable antibiotic) in 70-80% of cases they eradicate also Helicobacter pylori and heal in a large percentage (70-80%) the ulcerous defect within two weeks.
- MeSH
- histamin H2 - antagonisté terapeutické užití MeSH
- lidé MeSH
- peptický vřed farmakoterapie patofyziologie MeSH
- protivředové látky terapeutické užití MeSH
- žaludeční kyselina metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- histamin H2 - antagonisté MeSH
- protivředové látky MeSH
