PubMed · 11979873
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Shigeji Ito, Takeshi Azuma, Yukinao Yamazaki. 2002. [Plaunotol].. https://pubmed.ncbi.nlm.nih.gov/11979873/
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BACKGROUND AND AIMS: After partial gastrectomy, the mucosa of the residual stomach usually undergoes severe changes, and these lesions are known to be pre-cancerous. Recently, Helicobacter pylori has been highlighted as an agent that induces such mucosal alterations. In the present study, we evaluated whether eradication of H. pylori reduced the risk of carcinogenesis. PATIENTS AND METHODS: The subjects were 12 patients who underwent distal gastrectomy with Billroth I anastomosis for early gastric cancer and were positive for H. pylori. We performed endoscopy and biopsy both before and after H. pylori eradication therapy to assess changes in the gastric mucosa. RESULTS: After eradication therapy, no mucosal edema or erythema was detected. On histological examination, mononuclear cell infiltration had decreased and there was complete absence of neutrophil infiltration. The Ki-67 labeling index and the tissue IL-8 level had also decreased significantly, compared with before eradication. CONCLUSION: Before H. pylori eradication, the mucosa of the residual stomach may be at high risk of carcinogenesis due to induction of mucosal damage and active gastritis by H. pylori. Such changes were almost completely normalized by eradication therapy, so the eradication of H. pylori may reduce the risk of H. pylori-associated carcinogenesis in patients who have undergone gastrectomy for early gastric cancer.
BACKGROUND: Insufficient acid suppression is one of the main causes of proton pump inhibitor-refractory gastro-oesophageal reflux disease. AIM: To achieve more potent and long-lasting acid suppression, different dosage regimens of rabeprazole were compared in relation to the CYP2C19 genotype status. METHODS: In a cross-over study, 18 healthy Helicobacter pylori-negative males (six homozygous extensive metabolizers, six heterozygous extensive metabolizers and six poor metabolizers) were given rabeprazole 10 mg once daily, 20 mg once daily or 10 mg twice daily, or water only (baseline data), for 7 days each. On day 7 of each regimen, 24-h intragastric pH-metry was performed. RESULTS: No significant differences were observed in median pH values and pH>4 holding time ratios between rabeprazole 10 mg once daily and 20 mg once daily. However, with rabeprazole 10 mg twice daily, these parameters were significantly higher than those with 20 mg once daily. The potency of acid suppression by rabeprazole was influenced by the CYP2C19 genotype status. The differences were somewhat significant but not large. The incidence of nocturnal acid breakthrough was lowest with rabeprazole 10 mg twice daily. CONCLUSIONS: Rabeprazole 10 mg twice daily, not 20 mg once daily, should be administered to achieve more potent and long-lasting acid suppression.
Gastroesophageal reflux disease (GERD), is a common disorder. The most effective medical treatment for GERD is a proton pump inhibitor (PPI). The aim of this study was to specify the most inexpensive PPI therapy for GERD, and to examine the implications of varying outcome measure, holding time, on the conclusions about the cost-effectiveness of the treatments. Proton pump inhibitors that have holding time of intragastric pH>4 for at least 11h in 24h period (esomeprazole, lansoprazole, omeprazole and rabeprazole), were included. In this cost-minimization analysis (CMA), data on holding times were gathered from scientific publications listed in MEDLINE, prices of proton pump inhibitors from the Finnish database of drug prices and the treatment dosages were taken from the official guide of drug therapies in Finland. A decision tree was applied and the probabilities utilized were acquired from three expert physicians. The cost-minimization analysis was performed in three settings. At first, drugs that had a holding time (pH>4) of 11h or more were included. Secondly, drugs that had a holding time of 12h or more were included, and thirdly, a holding time of 13h or more was required. In the first analysis, the least expensive PPI treatment was lansoprazole (average cost of 138.89 per patient). In the second analysis, least expensive treatment was rabeprazole (193.81 per patient), and in the third, rabeprazole again (193.81 per patient). Esomeprazole and omeprazole were not among two of the least expensive alternatives in any of the settings. Which proton pump therapy turns out to be the least expensive for GERD, depends on the length of the holding time desired. Varying the holding time of the drug had a profound effect on the conclusions about the cost-effectiveness of the alternative treatments.