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Biomedical subjects

D W Piper

Publications and source records attributed to D W Piper.

At least 73 records · Page 4Linked to original sources
PubMed1983

Comparison of ranitidine and cimetidine in the treatment of chronic gastric ulcer. A double-blind trial.

The aim of the study was to compare the effectiveness of ranitidine and cimetidine in accelerating the healing of chronic gastric ulcer. 44 outpatients with endoscopically proven gastric ulcer whose duration of symptoms was greater than 4 weeks and who were without major systemic disease were studied. Patients were randomly allocated to receive either ranitidine, 150 mg twice a day or cimetidine, 200 mg three times a day and 400 mg at night for 4 weeks. If the ulcer had not healed, treatment was continued for a further 4 weeks, when patient assessment and endoscopy were repeated. By 4 weeks, 13 of 22 patients taking ranitidine (59%) and 14 of 22 patients taking cimetidine (64%) had healed (p2 = 1.0, 95% confidence interval - 20%, 38%). At 8 weeks, 91% on ranitidine and 91% on cimetidine had healed (p2 = 1.0, 95% confidence interval - 18%, 18%). Symptomatic improvement was similar with both drugs. Smoking did not influence healing rates. There were no major side effects with either medication. It is concluded that ranitidine and cimetidine are of similar efficacy in accelerating the healing of chronic gastric ulcer.

Adolescent↗
PubMed1983

Social aspects of chronic duodenal ulcer. A case control study.

A case-control study of 80 patients with duodenal ulcer and 80 community controls was undertaken to compare these two groups regarding social and environmental factors including socio-economic status, marital status, country of birth, childhood and family factors. An increased risk of duodenal ulcer was associated with status incongruity in males; the male patients, when matched on suburb of residence, having lower status occupations than controls, and when matched on occupational status, tending to have lower educational levels than controls. Being unmarried was associated with an increased risk of duodenal ulcer in females. The number of siblings was also a risk factor in the male patients, those with more than 5 siblings being at an increased risk. Factors not associated with duodenal ulcer included country of birth, childhood happiness, sibling sequence and family stability. In conclusion, the factors associated with chronic duodenal ulcer were found predominantly in adult life and could produce their adverse effects by causing chronic stress which may be more relevant than acute stress as produced by major life events.

Chronic Disease↗
PubMed1983

Drugs for the prevention of peptic ulcer recurrence.

The treatment of chronic peptic ulcer involves the treatment of acute exacerbations and the complications, and the prevention of ulcer recurrence. Several drugs accelerate the initial healing of ulcer and include the H2-receptor antagonists (cimetidine and ranitidine), colloidal bismuth, sucralfate, pirenzepine, carbenoxolone sodium, prostaglandins, high dose antacids and trimipramine. The long term management of ulcer involves the use of drugs and, in selected patients, surgery. Drugs used in this context include H2-receptor antagonists, pirenzepine, sucralfate and probably prostaglandins when further trial evidence is available. Regimens of long term drug treatment include intermittent treatment and maintenance treatment. The former consists of no active treatment after the ulcer is healed and the treatment of each acute exacerbation when it occurs, this treatment involving any one of the several drug routines mentioned above. If exacerbations are frequent (i.e. more than 2 to 3 years), maintenance therapy with H2-receptor antagonists, pirenzepine or sucralfate is advised. If the ulcer recurs despite long term treatment, it may be healed again using the healing dose of the above agents, and maintenance therapy recommenced if the remission induced by maintenance therapy was several years. If the remission was short, surgery should be advised.

Aluminum↗
PubMed1983

The personality pattern of patients with chronic peptic ulcer. A case-control study.

The personality assessment of 96 patients with gastric ulcer (GU) and 70 patients with duodenal ulcer (DU) was carried out using the Cattell Sixteen Personality Factor Questionnaire (16 PF). Two control groups were used; one group comprised community controls and the other patient controls--that is, patients with cholelithiasis. Three of the four personality characteristics that distinguished female GU and/or DU patients from controls--emotional instability, tension, and anxiety--and the two characteristics that distinguished male GU patients--low enthusiasm and low self-control--are components of neuroticism. Female GU patients in exacerbation resembled those in remission, and GU and DU patients had similar personality profiles. Although a distinct personality pattern has yet to be identified in peptic ulcer, the results of this study and others suggest that both GU and DU are associated with the personality abnormalities of anxiety and neuroticism.

Adult↗
PubMed1983

A two-year prospective controlled study of maintenance cimetidine and gastric ulcer.

The aim of the study was to determine the effectiveness of cimetidine in a dose of 400 mg twice daily in the prevention of gastric ulcer recurrence over a 2-yr period. The trial was double-blind and placebo-controlled; 24 patients received cimetidine and 25 received placebo. All had had a gastric ulcer within the prior 6 wk, and healing was demonstrated by endoscopy or by barium meal. The patients were contacted at monthly intervals, and if symptoms were present, investigations were performed. Annual barium meal examinations or endoscopy were also performed in all except 7 patients. In the placebo group, there was rapid recurrence within the first 12 mo; 12 of the 13 recurrences that occurred in this group over the 2-yr period took place within the first 12 mo. In the cimetidine-treated group, there were eight recurrences over the 2-yr period, five of which occurred in the first year. Log rank comparison showed a significant benefit due to cimetidine at 1 yr, but not over the 2-yr period.

Adult↗
PubMed1983

Effect of human colonic microsomes and cell-free extracts of Bacteroides fragilis on the mutagenicity of 2-aminoanthracene.

It has been previously demonstrated that whereas the microsomal fraction of rat colonic tissue and cell-free extract of Bacteroides fragilis alone do not convert 2-aminoanthracene into a mutagen, both together have this capacity in a model using the Ames technique. The aim of the present study was to extend these observations to human colonic tissue and to compare colonic mucosa with other tissues. It was found that whereas colonic microsomal fraction and cell-free extract of Bacteroides fragilis alone possessed little activating capacity with regard to 2-aminoanthracene, both together activated 2-aminoanthracene into a mutagen in this model. The microsomal fraction of other tissues, such as kidney, brain, muscle, and gastric and ileal mucosae, possessed activities similar to colonic mucosa.

Anthracenes↗
PubMed1982

Comparison of ranitidine and cimetidine in duodenal ulcer healing.

A single-blind trial in 50 outpatients was aimed at comparing the effectiveness of ranitidine (150 mg twice a day) and cimetidine (200 mg three times a day and 400 mg at night) in the healing of endoscopically proven duodenal ulcer. Patients were reassessed after two weeks of therapy, and then after four weeks immediately before repeat endoscopy. If the ulcer had not healed, treatment was continued for a further two weeks when patient assessment and endoscopy were repeated. By four weeks, ulcers had healed in 72% of patients receiving ranitidine and in 64% of those receiving cimetidine (P = 0.76). At six weeks, the healing rate was 92% in both groups. Symptomatic improvement was similar with both drugs. It is concluded that ranitidine and cimetidine are equally effective in healing duodenal ulcer.

Adult↗
PubMed1982

Cimetidine and colloidal bismuth in treatment of chronic duodenal ulcer. Comparison of initial healing and recurrence after healing.

The aim of the study was to compare the use of cimetidine and colloidal bismuth in the initial healing of chronic duodenal ulcer and to note the recurrence rate over 1 year after healing induced by both forms of treatment. Cimetidine was administered in the dose of 200 mg three times daily and 400 mg at night and the dose of colloidal bismuth was 5 ml four times each day. 51 outpatients with chronic duodenal ulcers proven on endoscopy completed the initial study. At 3 weeks, healing was observed in 83% of the cimetidine group and 70% of the colloidal bismuth group (p greater than 0.10); at 6 weeks, 96% of patients in both groups had healed. 33 patients were followed up over 1 year, 16 having initially been treated with cimetidine and 17 with colloidal bismuth. 2 other patients originally treated with cimetidine were followed up for 6 months only. No further treatment was given. Endoscopy was performed at 6 and 12 months, or earlier if symptoms developed. At 6 months, 44% of patients in the cimetidine group had recurred compared to 47% in the colloidal bismuth group (p greater than 0.5). At 1 year, 75% of patients in the cimetidine group and 76% in the colloidal bismuth group had recurred (p greater than 0.5). It is concluded that both agents are equally effective in healing duodenal ulcers and the incidence of recurrence over 1 year is similar irrespective of whether the initial healing is induced with colloidal bismuth or cimetidine.

Bismuth↗
PubMed1982

Environmental factors and chronic gastric ulcer. A case control study of the association of smoking, alcohol, and heavy analgesic ingestion with the exacerbation of chronic gastric ulcer.

The aim of this case control study was to define the strength of the associations of smoking, alcohol, and heavy analgesic ingestion with chronic gastric ulcer (GU). Ninety-nine patients were interviewed about smoking, alcohol, and analgesic ingestion for the 6 months before exacerbation of their chronic GU. The 180 non-ulcer community control subjects were frequency-matched with the patients for the characteristics of age, sex, and social status. Smoking, alcohol, and heavy analgesic ingestion were studied when present as sole factors and in combinations. Their associations with GU were measured by the odds ratio (OR) and the adjusted odds ratio (AOR). Smoking in male patients (OR 15.4) and heavy analgesic ingestion in female patients (OR 23.4) were significant as sole factors. Smoking plus heavy analgesic ingestion was significant in female patients (OR 10.0), and the combination of all three factors was significant in male patients (OR 13.0) and in female patients (OR 6.3). Smoking had significantly increased AORs of 3.3 in male patients and 3.5 in female patients; alcohol had a significantly decreased AOR of 0.4 in female patients; and heavy analgesic ingestion was significantly increased in female patients (AOR 7.2). It is concluded that smoking in all patients and heavy analgesic ingestion in female patients are risk factors for chronic GU. Alcohol, however, does not appear to be a risk factor.

Adult↗
PubMed1981

Possible ranitidine hepatitis.

A 63-year-old woman developed anicteric hepatitis after two weeks of therapy with ranitidine. Despite continuation of therapy, her symptoms resolved within five days and transaminase levels returned to normal in the next four weeks, at which time use of the drug ceased. The gamma-glutamyl transpeptidase level returned to normal two weeks later. Although liver biopsy and drug rechallenge were not performed, no other cause for the reaction could be found.

Chemical and Drug Induced Liver Injury↗
PubMed1981

Life events and chronic duodenal ulcer: a case control study.

The frequency of life events during the two years before an exacerbation of ulcer in a duodenal ulcer population was compared with the frequency of these events over the same time period in an age-sex matched probability sample of the community population. The mean number of events and the associated distress and life change scores were similar for both groups. When events were categorised into areas of activity, such as health, bereavement, family and social life, change of residence, etc. and were further classified on the basis of desirability, separation from persons, and problem chronicity, only one significant difference was found between patients and controls-more patients changed residence (p=0.0005). Frequency distributions of the number of events and the distress and life change scores were similar for both groups. Concerning individual events, the only significant differences in frequency were that more patients changed residence in Sydney (p=0.006) and more controls had a child leave home for reasons other than marriage (p=0.03). Patients and controls experienced the same four most frequent events. Among patients, no correlation existed between age and either the number of events experienced or distress and life change scores. Among controls, age was negatively correlated with the number of events experienced (p=0.0004) and the life change scores (p<0.003). It is concluded, therefore, that an excess of stress, as measured by the number of life events experienced and by distress and life change scores associated with these events, does not appear to be a risk factor for the exacerbation of chronic duodenal ulcer.

Adult↗
PubMed1981

Analgesic ingestion and chronic peptic ulcer.

The patterns of analgesic ingestion in gastric and duodenal ulcer patients were compared with those of matched community controls in order to ascertain differences that may exist between ulcer and nonulcer subjects of comparable age and sex. The differences sought concerned amounts and types of analgesics ingested. The types of analgesics studied were aspirin and acetaminophen, ingested either alone or together. Analgesics such as dextropropoxyphene and codeine were disregarded. It was found that there was a strong positive association between heavy analgesic intake and chronic gastric ulcer with a relative risk of 29.5. The association was most marked in female patients (relative risk = 51.8). The involvement of aspirin-containing and acetaminophen-containing drugs was of similar significance with relative risk of 17.3 and 24.4, respectively. Aspirin alone was the least frequently ingested. The association was only partly related to painful nonulcer health problems and to ulcer pain. No association was found between chronic duodenal ulcer and analgesic intake. The strong association found between gastric ulcer and heavy analgesic intake does not, per se, necessarily indicate a causal relationship.

Acetaminophen↗
PubMed1980

Improvement in mortality rates in bleeding peptic ulcer disease: Royal North Shore Hospital of Sydney, 1947-1977.

A series of patients with upper gastrointestinal haemorrhage treated at the Royal North Shore Hospital from 1976 to 1977 was compared to a similar series treated from 1947 to 1949. Although over-all mortality rates were similar, a clear improvement emerged when variceal, carcinoma and stress ulcer patients were excluded, and when the effect of age was taken into account (the mortality rate in the non-variceal, non-cancer, non-stress patients being 2% over-all, and 1.5% in those under 60 years of age). A review of the English literature on upper gastrointestinal haemorrhage from 1930 to 1977 showed no improvement in over-all mortality over this period. When these same factors were taken into account, however, the survival in the non-stress, chronic peptic ulcer group aged over 60 years was found to have significantly improved over this time.

Australia↗