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Biomedical subjects

M G Moshal

Publications and source records attributed to M G Moshal.

At least 19 recordsLinked to original sources
PubMed1983

The pharmacokinetics of ranitidine in patients with chronic duodenal ulceration: a comparison of responders and non-responders.

The pharmacokinetics of orally administered ranitidine were studied in 17 male patients with chronic duodenal ulceration. The patients were divided into 2 groups, 10 responders and 7 nonresponders, on the basis of their endoscopic response to ranitidine treatment. The 10 responders were studied both after a single 150 mg dose (SD) and after multiple dosing (MD) with ranitidine 150 mg twice daily for 4 weeks. The area under the curve (AUC) and maximum concentration (Cmax) were significantly higher (p less than 0.01 and p less than 0.05, respectively) after MD than after SD, but the half-life (t1/2) and minimum concentration (Cmin) 12 h postdosing did not differ. The non-responders were studied after MD only and their pharmacokinetic characteristics were compared with those of responders. No differences between the 2 groups were found. However, 2 non-responders had particularly low plasma ranitidine levels and high acid output. Such patients may need larger doses of ranitidine for adequate suppression of gastric acid. Five patients (4 responders and 1 non-responder) received ranitidine 20 mg i.v. The drug followed a two-compartment model, with mean values for t1/2 beta, volume of distribution steady-state and total plasma clearance of 80 min, 701 and 680 ml/min, respectively. The oral bioavailability of ranitidine in these 5 patients showed wide variation (27-76%; mean 51%).

Administration, Oral↗
PubMed1983

Double-blind placebo-controlled evaluation of one year therapy with sucralfate in healed duodenal ulcer.

Forty patients with duodenal ulcer, considered healed at endoscopy, were entered in a double-blind trial and treated for up to one year with sucralfate, 500 mg before breakfast, lunch, supper and 1000 mg on retiring, or with placebo. The subjects were interviewed and endoscopy was performed at 0, 3, 6, 9 and 12 months or at any time if pain recurred and they returned to the clinic. On relapse, the patients were withdrawn from trial. The remission rate maintained by sucralfate was superior to that achieved by placebo. The difference was significant (p less than 0.05) at 6 months (64% vs. 27%) and at 12 months (56% vs. 18%). No important side effects were noted.

Adult↗
PubMed1982

The effect of tri-potassium di-citrato bismuthate on the duodenal mucosa during ulceration. An ultrastructural study.

The manner in which tri-potassium di-citrato bismuthate (TDB) promotes duodenal ulcer healing is not known. Endoscopic biopsy specimens were taken from the edges of duodenal ulcers from 5 patients before and after treatment with TDB. Using the bismuth contained within this drug as an electron-dense marker, the mode of action of TDB was determined by transmission electron microscopy. TDB was found to promote ulcer healing by adhering to the ulcerative mucosa, thereby providing an effective barrier to the substances which cause and maintain ulceration.

Anti-Ulcer Agents↗
PubMed1982

Pirenzepine, cimetidine and placebo in the long-term treatment of duodenal ulceration. A comparative study.

Sixty patients with endoscopically proven healed duodenal ulcers were treated for a year with either pirenzepine (Gastrozepin; Boehringer Ingelheim) 100 mg daily, cimetidine 400 mg at night, or placebo, The monthly relapse rate (patients per month) in the first 3 months (pirenzepine 2,3, cimetidine 2,3, placebo 3,0) and in the next 9 months (pirenzepine 0,33, cimetidine 0,44, placebo 0,56) is lower for pirenzepine and cimetidine than for placebo. This trend is in favour of pirenzepine and cimetidine as effective means of keeping duodenal ulcers in remission. Asymptomatic relapses were also less common with pirenzepine (50%) and cimetidine (45%) than with placebo (64%). No serious side-effects of pirenzepine were observed during the trail.

Adult↗
PubMed1982

Effect of metoclopramide given before atropine sulphate on lower oesophageal sphincter tone.

The effects on lower oesophageal sphincter (LOS) tone of sequential intravenous injections of metoclopramide 10 mg/atropine 0,6 mg and atropine 0,6 mg/metoclopramide 10 mg, given randomly on separate occasions to 8 healthy volunteers, were studied. The administration of metoclopramide increased mean LOS pressure by 13,6 cm H2O (P less than 0,001). Subsequent injection of atropine failed to lower LOS pressure significantly, LOS pressure being sustained at a mean of 11,2 cm H2O above basal control levels (P less than 0,01). In contrast, injection of atropine at a later date in the same subjects lowered the average LOS pressure by 10,5 cm H2O (P less than 0,001), and subsequent intravenous injections of metoclopramide restored LOS pressure to basal levels. The results of this study suggest that metoclopramide should be given prior to atropine before induction of general anaesthesia to counteract the deleterious effects of atropine on LOS tone, thereby helping to reduce the chances of regurgitation and pulmonary aspiration of acid gastric contents.

Adult↗
PubMed1982

Bicitropeptide powder and placebo in the treatment of duodenal ulcers. A double-blind endoscopically controlled clinical trial.

In a double-blind study comprising 50 patients with endoscopically proven uncomplicated duodenal ulcers a powder formulation of bicitropeptide (BCP-Compound) was found to be superior to placebo. On endoscopic examination 19 patients (76%) treated with bicitropeptide powder had healed, while 3 (12%) showed some degree of healing, a total success rate of 88%. Only 5 patients (20%) on placebo had healed completely while 3 (12%) showed some degree of healing (chi 2 = 17,9667; P less than 0,0005). Blood and urine bismuth levels were measured before and after 6 and 12 weeks of therapy, and showed an increase after the first 6 weeks. By 12 weeks the levels had decreased, although they were still higher than the initial values. The blood levels were, however, significantly lower than postulated toxic levels.

Adult↗
PubMed1982

Factors affecting duodenal ulcer healing. Four double-blind trials in 193 patients.

An analysis of four double-blind endoscopically controlled trials carried out in 1978 -1980 is presented. Drugs utilized were (patient numbers in brackets): a new histamine H2-receptor antagonist ranitidine (25) v. placebo (22), the colloidal bismuth ulcer-coating preparation bicitropeptide (24) v. cimetidine (26), the tricyclic antidepressant trimipramine (20) v. placebo (19), and the disaccharide coating preparation sucralfate (29) v. placebo (28). Factors analysed were smoking, alcohol consumption, age, length of history, sex and race. The prevalence of smoking and alcohol use, age and length of history varied in the four trials. Pronouncements regarding these factors based on small trials are therefore unreliable. There were no overall diffeences in healing rates whether the patient smoked, consumed alcohol, was above or below 40 years of age, or had a history shorter or longer than 1 year. Comparison of drug and placebo responses revealed that the differences between these were most significant in: non-smokers (P=0,0010) compared with smokers (P=0,0288); teetotallers (P<0,005) compared with alcohol consumers (NS); history under 1 year (P<0,005) compared with over 1 year (P<0,025); males (<0,01) compared with females (NS); and Indians (P<0,005) compared with Blacks (NS).

Adult↗
PubMed1982

Acid secretion and duodenal ulcer healing in patients on medical treatment.

The relationship between gastric acid secretion and ulcer healing was analysed in 168 patients with endoscopically proven duodenal ulceration. One hundred and three patients received active treatment with various therapeutic agents and 65 received placebo. The mean maximal acid output in patients with unhealed ulcers was significantly higher than that in patients with endoscopically confirmed ulcer healing in both the actively treated and the placebo groups (P less than 0,001). In patients with normosecretory acid status the rate of ulcer healing on active treatment was significantly higher than that achieved with placebo (P less than 0,001). However, no significant difference in ulcer healing was evident following active treatment or placebo administration in patients with hypersecretion of acid. Acid secretory profiles warrant consideration when the results of clinical trials are interpreted.

Double-Blind Method↗
PubMed1982

Changes in the morphology of villar epithelial cells adjacent to duodenal ulcers during the process of healing.

Fifteen patients with active duodenal ulcers were treated for 6 weeks with ulcerone, aluminium sucrose sulphate, or bromazepam to promote healing. Biopsies taken from the edge of ulcers before treatment showed an epithelium exclusively populated with cells of a mucus-secreting type which resembled those normally found in the gastric antrum. Biopsies taken at endoscopy from the edge of ulcers or scars at time intervals during treatment to endoscopic healing showed, irrespective of the drug used, a sequence of ultrastructural changes in villar epithelial cells, from a gastric secretory to a duodenal absorptive cell type. We suggest that the gastric cells in the duodenum are derived from stem cells in the crypts of Lieberkühn surrounding an ulcer and are produced in response to luminal fluids of abnormally low pH. Their function is probably protective, in that they isolate regions of ulceration from the healthy mucosa and, by the continuous secretion of gastric mucin, protect the ulcer from the harmful effects of luminal acids. Their transformation to absorptive cells during ulcer healing is part of a natural sequence that is aided by, but not dependent on, drug therapy.

Bismuth↗
PubMed1981

The effect of stressful life situations on the healing of duodenal ulceration.

Ninety-five duodenal ulcer patients were assessed by a gastro-enterologist as being either difficult or easy healers. Difficult healers were defined as those taking longer than 6 weeks to heal or those who relapsed within 6 months of healing, as assessed by endoscopy. Easy healers were defined as being healed within 6 weeks of treatment and remaining healed. The detailed psychosocial questionnaires compiled for patients were analysed in terms of stressful life situations experienced at the time of treatment. Significantly more stressful life situations occurred in patients with a difficult healing period than in those who experienced easy healing. Of the stressful life situations which were considered the area of family stress appeared most crucial in retarding easy recovery.

Duodenal Ulcer↗
PubMed1981

The role of intelligence and depression in Indian and black duodenal ulcer patients in South Africa.

In a comparison of South African Indian and Black duodenal ulcer patients and a control group of hospital patients, intelligence and depression were not found to be relevant to the incidence of duodenal ulceration. This finding emerges as part of an ongoing study on the apparent increase of duodenal ulceration in South African Indians and Blacks. The role of psychological medicine in a consultation/liaison service is discussed.

Adolescent↗
PubMed1981

Tri-potassium di citrato bismuthate chewing tablets and cimetidine tablets in the treatment of duodenal ulcers. A double-blind double-dummy comparative study.

A randomized, double-blind, double-dummy comparative 6-week study of tri-potassium di-citrato bismuthate (TDB) (Ulcerone; De-Nol) chewing tables and cimetidine was carried out in 60 patients suffering from duodenal ulceration. The data on 51 patients (27 on TDB and 24 on cimetidine) were analysed (9 patients absconded). Both treatments appeared to be highly effective in ulcer healing at the 6-week endoscopic assessment. The healing rate for TDB chewing tablets was 89% and that for cimetidine tablets 92%. Both forms of therapy were comparable in respect of improvement of pain and effect on all other observed symptoms. Neither drug had a statistically significant effect on any of the haematological or clinical chemical parameters tested during the trial, except that the cimetidine-treated group showed a significant linear reduction in white blood cell count. No side-effects were reported. It is suggested that TDB chewing tablets are a safe, effective and cheaper alternative to cimetidine in the treatment of patients with duodenal ulceration.

Adult↗
PubMed1981

Ranitidine in uncomplicated duodenal ulceration. A double-blind endoscopically controlled trial.

Fifty patients with endoscopically proven uncomplicated duodenal ulcers were given either ranitidine 150 mg twice daily or placebo for 4 weeks in a randomized double-blind study. After 4 weeks 76% of patients on ranitidine showed healing. Fifteen (60%) were completely healed, 5 (20%) were partly healed, and 5 had active unchanged ulcers. Of the patients on placebo 6 (27%) were completely healed, 6 (27%) were partly healed, 10 had active unchanged ulcers and 3 had absconded. Grouping partly healed with active ulcers, a Z value of 2,23 was obtained in the Mantel-Haenszel test (P = 0.013 in favour of ranitidine over placebo). Of 10 patients who were partly healed or had active ulcers after being given ranitidine in the first stage of the study, 7 healed on one further course in an open study and 3 still had active ulcers after two further courses. Of 16 patients who were partly healed or had active ulcers after 4 weeks on the placebo, 3 healed on one course of ranitidine, 6 healed on two courses, 6 still had active ulcers after two courses, and 1 absconded. No side-effects were noted. Ranitidine is a safe and effective drug for the treatment of active duodenal ulceration.

Adult↗
PubMed1981

Psychosituational factors and duodenal ulceration in South African blacks and Indians.

Forty-one patients with endoscopically confirmed recent duodenal ulceration and 38 controls were studied by a multidisciplinary team. Results indicated that the development of duodenal ulceration may be promoted by stressful situations (71%), especially those which are work-related, avoidance-avoidance conflict (56%), and a compliant personality (51%). Denial was employed by 32%. On the basis of these psychosituational findings a hypothesis for the pathogenesis of duodenal ulceration has been postulated.

Black or African American↗
PubMed1981

Peritoneoscopy in the diagnosis of tuberculous peritonitis.

Seventy-four patients with tuberculous peritonitis were examined by peritoneoscopy (laparoscopy). The characteristic features were uniform miliary tubercles studding the visceral and parietal peritoneum together with numerous adhesions between bowel loops, liver capsule, and abdominal walls. Guided biopsy yielded a definitive diagnosis in 56 cases. Special precautions are urged to avoid an increased risk of complications by peritoneoscopy and biopsy in tuberculous peritonitis.

Humans↗