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At least 289 records · Page 16Linked to original sources
PubMed1982

[Treatment of jejunal peptic ulcer with cimetidine or an antacid? Results of a long-term study].

The effectiveness of cimetidine or antacid in healing recurrent jejunal peptic ulcers after Billroth II gastric resection without vagotomy was tested in a randomized study of 18 in-patients. Mean stimulated acid secretion of the cimetidine group was 11.2 +/- 4.3 mmol/h, in the antacid group 12.6 +/- 5.6 mmol/h. Serum gastrin levels were within the normal range in all patients. Within four weeks the ulcers had healed completely in eight of the nine patients on cimetidine (1,000 mg/d), but in only three of the nine patients on antacids (magnesium-aluminiumhydroxide, neutralization capacity 564 mmol/d). The difference is statistically significant (P less than 0.025). All 11 patients with healed ulcers were given prophylactically either 800 mg cimetidine daily or magnesium-aluminiumhydroxide (neutralization capacity 564 mmol/d). During a follow-up period of one year recurrences occurred in two of the five patients on antacids, but in none of the six treated with cimetidine. The results indicate that cimetidine also accelerates the healing of recurrent jejunal peptic ulcers. But further studies are required to elucidate whether long-term treatment with histamine-H2-receptor antagonists is as good as surgery in the long-term prevention of ulcer recurrences.

Adult↗
PubMed1975

Decreased serum salicylate concentrations in children with rheumatic fever treated with antacid.

To determine if the common practice of giving antacids to patients on salicylate therapy has an effect on serum salicylate concentrations, we gave a widely used antacid, aluminum and magnesium hydroxide, and aspirin concomitantly to three children with rheumatic fever. Urinary pH increased appreciably, and serum salicylate concentrations decreased by 30 to 70 per cent. In five healthy adult volunteers concomitant administration of antacid had no effect on the bioavailability of aspirin. Pharmacokinetic analysis revealed that the antacid-induced decrease of serum salicylate concentrations was due to increased renal clearance of salicylate caused by the rise in urinalry pH.

Adult↗
PubMed1980

Antacid versus cimetidine in preventing acute gastrointestinal bleeding. A randomized trial in 75 critically ill patients.

Over a 15-month period, 75 critically ill patients at risk of acute gastrointestinal bleeding were randomized into two groups: one group (38 patients) received the H2-blocker cimetidine intravenously at an initial dosage of 300 mg every six hours, and the other group (37 patients) received antacid (Mylanta II) through a nasogastric tube at an intial dosage of 30 ml every hour. Gastric pH was measured hourly and titrated above 3.5. Upper-gastrointestinal-tract bleeding occurred in seven of 38 cimetidine-treated patients but in none of 37 antacid-treated patients (P less than 0.01). When antacid titration was added to the cimetidine regimen in four of seven patients with bleeding, all four stopped bleeding. Renal failure, sepsis, peritonitis, hypotension, respiratory failure, jaundice, multiple trauma, and major operative procedures were associated with an increased incidence of bleeding. Cimetidine does not adequately protect seriously ill patients from acute upper-gastrointestinal-tract bleeding. Antacid is better for this purpose.

Acute Disease↗
PubMed1983

Healing of benign gastric ulcer with low-dose antacid or cimetidine. A double-blind, randomized, placebo-controlled trial.

We conducted a 12-week, double-blind, randomized, placebo-controlled trial to determine whether cimetidine (300 mg with meals and at bedtime) or a convenient, liquid aluminum-magnesium antacid regimen (15 ml one hour after meals and at bedtime) would expedite healing or relief of symptoms in patients with benign gastric ulcer. Of the 101 patients who completed the trial according to protocol, 32 received the antacid, 36 cimetidine, and 33 placebo. At 4, 8, and 12 weeks after entry, ulcers had healed in a larger percentage of patients treated with cimetidine than of those treated with placebo: 53, 86, and 89 per cent of the cimetidine group versus 26, 58, and 70 per cent of the placebo group (P = 0.02, 0.01, 0.05), respectively. Healing at the three intervals had occurred in 38, 70, and 84 per cent, respectively, of the antacid-treated patients. Neither cimetidine nor antacid was more effective than placebo in relieving symptoms. The presence or absence of symptoms during the fourth and eighth treatment weeks was a poor predictor of the presence of absence of an ulcer crater. We conclude that cimetidine significantly hastens the healing of benign gastric ulcer.

Adult↗
PubMed2000

Influence of pharmacotechnical design on the interaction and availability of norfloxacin in directly compressed tablets with certain antacids.

Norfloxacin is a fluorquinolone that can interfere with antacids that contain aluminum and magnesium salts by complexation and modification of its solubility, which reduces its absorption and may lead to therapeutic failures. The purpose of this work was to evaluate the effect of the pharmaceutical design on this interaction and to develop a formulation of norfloxacin tablets in which this process could be avoided. Norfloxacin tablets were designed in 28 formulations. The interaction was studied in terms of in vitro dissolution behavior (USP 23, apparatus 2) in simulated gastric fluid with different doses of four commercially available antacid preparations. It was observed that dissolution rates were markedly reduced in the presence of all antacids studied. This phenomenon was practically avoided with some formulations of norfloxacin tablets in which a disintegrant (sodium starch glycolate or crospovidone) was included. These results indicated that the chelation among metal ions and norfloxacin could be affected by the delivering ability of the drug in the tablet. It was demonstrated that the pharmacotechnical design could modify an interaction process. Some formulations of tablets, in which the reduced dissolution rates in the presence of nonsystemic antacids in vitro was practically avoided, were developed by direct compression.

Antacids↗
PubMed1983

Effect of antacids on the plasma concentration of phenoperidine.

The effect of antacids on the plasma concentration of phenoperidine was studied in six volunteers. All subjects received the same dose of phenoperidine (15 micrograms kg-1) on different occasions in the presence, and absence of, an antacid preparation. In control studies, secondary peaks in the plasma concentration of phenoperidine were invariably observed; these were entirely eliminated, or modified substantially, by the concurrent administration of antacids. In the latter conditions, plasma concentrations of phenoperidine were greater during the first 20 min, and the area under the plasma concentration--time curve between 0 and 20 min was significantly greater than in control studies. In contrast, the plasma clearance of the drug was almost identical in control conditions and during treatment with antacids. After the oral administration of phenoperidine to two subjects, the systemic bioavailability of the drug was 9.9% and 13.9% respectively.

Administration, Oral↗
PubMed1980

Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill.

One hundred forty-four critically ill patients admitted to an intensive care setting were randomly assigned to cimetidine or antacid treatament groups. Gastric pH was monitored hourly. One hundred twenty-three (85%) patients demonstrated a fall in pH to less than 4 and were considered to require prophylaxis. Prophylaxis was considered adequate if the measured pH could then be maintained at greater than or equal to 4. Fifty-eight patients received antacids alone, the average requirement being 41 cc/hour. Sixty-five patients received cimetidine. Seventeen (26%) of the cimetidine prophylaxis patients failed to raise their pH and were than placed on hourly administration of antacid with successful elevations of pH to greater than or equal to 4 in all cases on an average supplementary dose of 53 cc/hour. Risk factors, including sepsis, hypotension, head injury, respiratory failure, degree of trauma, and age, were not statistically different in the two treated groups. Using these same criteria, responders to cimetidine could not be differentiated from nonresponders. All patients were protected from significant stress bleeding while on this study. Significant complications of either treatment were minimal. Antacids offered consistent protection against gastric acidity and were 100% effective. A routine schedule of 300 mg every six hours of cimetidine was effective in only 47% of patients, and the maximum dose of cimetidine was effective in only 74% of patients. Hourly measurement of intragastric pH is required for monitoring the response to prophylaxis of stress bleeding in severely ill patients.

Adult↗
PubMed1989

Misoprostol versus antacid titration for preventing stress ulcers in postoperative surgical ICU patients.

Bleeding from gastroduodenal lesions is a potentially life-threatening complication in patients subjected to overwhelming physiologic stress. Titration of gastric contents with antacid was the first prophylactic treatment regimen proved to decrease the incidence of bleeding and remains the standard by which other methods are compared. We designed a prospective double-blind, double-placebo study comparing the effectiveness of antacid titration with fixed doses of a synthetic prostaglandin E1 analog (misoprostol) for preventing stress gastritis and bleeding. To assess the success of each treatment regimen, we did endoscopic examinations before operation, 72 hours after operation, and after the patient had completed the study. A total of 281 patients entered the study (140 misoprostol, 141 antacid). The two groups were comparable with respect to preoperative parameters and type of operation. We found no statistically significant differences between the two treatment groups concerning upper gastrointestinal tract lesions or serious adverse effects. No clinically evident upper gastrointestinal hemorrhage occurred in either group. Mean gastric pH, measured at two-hour intervals during the initial 72 hours, was maintained at 4.0 or higher in both groups. We conclude that fixed-dose misoprostol is as effective as intensive antacid titration in preventing stress ulcers and bleeding in surgical ICU patients.

Adult↗
PubMed1985

Does antacid prophylaxis prevent upper gastrointestinal bleeding in critically ill patients?

Sixty-five surgical ICU patients at high risk of developing acute erosive gastritis and bleeding received prophylactic antacid treatment to maintain a gastric pH of at least 5.0. A similar control group of 61 patients received no specific prophylaxis. All patients in both groups developed microscopic bleeding; however, microscopic bleeding did not influence outcome. In the control group, eight (13.1%) patients developed moderate visible bleeding, as compared to seven (10.8%) patients in the antacid group, an insignificant difference. A single patient in the control group developed severe GI bleeding due to acute erosive gastritis. Antacid prophylaxis did not prevent macroscopic bleeding and there was no correlation between the number of risk factors in individual patients and the rate of upper GI bleeding. We conclude that antacid is not required to prevent upper GI bleeding in high-risk critically ill patients.

Adolescent↗
PubMed1989

Occult gastrointestinal bleeding in high-risk intensive care unit patients receiving antacid prophylaxis: frequency and significance.

Gastroccult reagent was used every 4 h to detect blood in gastric juice in 41 ICU patients at risk of GI bleeding (GB) and receiving antacid prophylaxis (gastric pH greater than 3.5). Of the present patients, 27% (11/41) had at least one episode of occult GB (three consecutive positive determinations; a total of 14 episodes). Endoscopy identified acute gastroduodenal mucosal lesions (stress ulcers) as the most frequent lesion in this group (eight patients). Sepsis was the most frequent underlying condition associated with occult GB due to stress ulcer. Hematemesis occurred in 36% (4/11) of patients with occult GB and was due to stress ulcer in three patients and to benign gastric tumor in one. No overt GB occurred in the absence of previous occult GB. We conclude that: a) risk of GB persists in critically ill ICU patients in spite of antacid prophylaxis (gastric pH greater than 3.5); b) high-risk patients can be identified through periodic testing for the presence of blood in gastric juice using the reagent; c) when occult GB occurs, treatment should be based on the endoscopy results. In the absence of acute gastroduodenal mucosal lesions, antacid prophylaxis should not be modified, and specific treatment of the identified lesion(s) should be initiated. In the presence of stress lesions, antacid prophylaxis should be reinforced if the pH of the gastric content is less than 3.5 and a septic complication should be actively sought if the pH is greater than 3.5.

Adult↗
PubMed1991

Efficacy of low-dose antacids in the treatment of peptic ulcers: pharmacological explanation?

Antacids have been used as remedies for benign gastroduodenal disorders for centuries. They were regarded to be effective in relieving gastric pain and symptoms of hyperacidity and in promoting ulcer healing. The effectiveness was based on empiric observations and was not derived from the controlled clinical trials data. Until the introduction of histamine H2-receptor antagonists into peptic ulcer therapy, they dominated that field together with carbenoxolone. The enthusiasm for and euphoric attitude of gastroenterologists all over the world to H2-receptor antagonists resulted in a life of shadow for antacids. This changed when Peterson et al. published the first controlled clinical trial on Maalox (N Engl J Med 1977;267:341-5). (The use of trade names for antacids is justified as most of the antacids in use are composed of at least two if not more constituents).

Aluminum Oxide↗
PubMed1999

Does acid suppression by antacids and H2 receptor antagonists increase the incidence of atrophic gastritis in patients with or without H. pylori gastritis?

Currently there is controversial evidence that suggests that the accepted incidence of atrophic gastritis of 1.2 to 3.3% in patients with Helicobacter pylori gastritis may be increased by the long-term suppression of acid by a proton pump inhibitor (omeprazole). The purpose of this study is to show whether lesser forms of acid suppression by antacids or H2 receptor antagonists may have an influence on the development of atrophic gastritis. The authors recently reported a study in which a cohort of 36 patients with symptoms of dyspepsia were followed clinically for a period of 7 to 19 years. In that report all subjects underwent upper endoscopy with two biopsy specimens each from the antrum and fundus, on at least two occasions, 7 to 19 years apart. A diagnosis of atrophic gastritis was based on the interpretation of these biopsies by two gastrointestinal pathologists. The presence of H. pylori colonization was determined by tissue sampling and by a campylobacter-like organisms test of the antrum. Of the 36 patients in the authors' previous report, 33 had adequate baseline and follow-up data on medications consumed throughout the period of the study. In their current report they now present the findings of a retrospective review in which they correlate the presence of atrophic gastritis with the sole use of antacids and H2 receptor antagonists throughout the period of the study. In the cohort of 33 patients evaluated from the previous report, the authors found that atrophic gastritis had developed in all 28 patients positive for H. pylori, and in none of the 5 patients negative for H. pylori (p < 0.0001). A retrospective analysis of this previously studied cohort of 33 patients revealed that the use of antacids and H2 receptor antagonists did not predict the development of atrophic gastritis in either H. pylori-negative or -positive subjects. In a retrospective analysis of a cohort of 33 patients followed for an average of 11.7 years, atrophic gastritis developed in H. pylori-positive but not in H. pylori-negative subjects, irrespective of the use and duration of antacids or H2 receptor antagonists.

Aged↗
PubMed1989

Acute damage of gastroduodenal mucosa by acetylsalicylic acid: no prolonged protection by antacids.

Twenty healthy volunteers participated in a double-blind, crossover study to evaluate endoscopically whether low-dose antacids have any prolonged and pH-independent protective capacity against gastroduodenal mucosal damage induced by acetylsalicylic acid. Antacid or placebo one tablet q.d.s. was given for 1.5 days. Acetylsalicylic acid (1.5 g) was administered 3 h after the last dose of antacid/placebo, and gastroscopy was performed 1 h thereafter. Thirteen of 20 subjects showed a decrease in total damage with antacids as compared with placebo, but the difference did not reach statistical significance. Thus, protection by antacids against acetylsalicylic acid-induced gastric mucosal lesions could not be documented at a time when intragastric pH presumably had returned to normal.

Adult↗
PubMed1994

Short report: a comparative study of the interaction between antacid and H2-receptor antagonists.

The influence of concomitant antacid administration on the relative bioavailability of the H2-receptor antagonists cimetidine, famotidine, nizatidine and ranitidine, was investigated in a panel of 21 healthy, adult male volunteers in an eight-way crossover trial. Administration with antacid reduced the bioavailability of all agents tested. The reduction in area under the serum concentration-time curve (AUC) was greatest for cimetidine (23%) and ranitidine (26%) and least for nizatidine (12%) and famotidine (19%). Reductions in peak serum concentration (Cmax) followed a similar pattern. The times of peak serum concentrations were not affected by antacid. Comparison of the relative bioavailability among all drugs tested showed no statistically significant differences in the effect of antacid administration on these agents. However, a high degree of intersubject variability was observed.

Adult↗
PubMed1984

The use of radiotelemetry techniques for the in vivo assessment of antacids.

The use of the pH radio pill for the assessment of antacid effect has been evaluated. The correlation between the pH pill and a conventional pH electrode system was high (r2 = 0.997). The records of in vivo pH against time allow unique measurements of antacid efficacy (defined as the integrated area under the pH against time curve) and duration of action to be obtained. Using a free pill, antacid assessments were performed in 13 subjects in the left lateral position. The effects of repeated antacid administrations were studied in five subjects using a pH pill which was prevented from leaving the stomach by tethering it to the teeth. These longer studies were performed in the sitting position. The efficacy (p less than 0.02) and duration of action (p less than 0.02) of sodium citrate 0.3 M were less in those subjects in whom the pill was tethered. The differences between the results of the studies using either a free or a tethered pill can be attributed to posture. The overall duration of action of sodium citrate 15 ml was short, the mean (SEM) value being 42.4 (4.5) minutes in the left lateral position and 21.2 (4.0) minutes in the upright position.

Aluminum Hydroxide↗
PubMed1991

Hyperaluminaemia in critically ill patients: role of antacid therapy and impaired renal function.

A significant rise in serum concentrations of aluminum was demonstrated in 23 patients prophylactically treated with the antacid magaldrate, whereas no increase in serum aluminium was observed in another 26 critically ill patients, in whom the use of antacids was avoided. In parallel, urinary excretion rates of aluminum rose to values close to maximum 72 h after antacid therapy had been started. Hyperaluminaemia was most marked in patients with acute renal failure undergoing continuous haemofiltration, but a significant increment in serum aluminium was also noted in patients with impaired renal function in the predialytic state. In the latter group and in patients with normal renal function there was a significant negative correlation between urinary excretion rates of aluminium and creatinine clearance after 48 h of treatment suggesting an enhancement of gastrointestinal absorption of aluminium in the presence of chronic renal failure. Maximum serum concentrations of aluminium did attain critical values in some patients with acute renal failure, but no overt signs of aluminium toxicity were noted. However, in light of both, possible subtle toxicity and enhanced absorption of aluminium in critically ill patients with renal failure, the prophylactic use of antacids in this setting should be re-evaluated cautiously.

Acute Kidney Injury↗
PubMed2004

Effect of proton pump inhibitors and antacid therapy on 13C urea breath tests and stool test for Helicobacter pylori infection.

OBJECTIVE: There is uncertainty about the best method of testing patients for Helicobacter pylori (H. pylori) infection while they are taking proton pump inhibitors. The aim of this study was to determine: (i) if the decreased sensitivity of the urea breath test during proton pump inhibitor is corrected by different techniques for breath testing and (ii) if the sensitivity of stool test is decreased with the administration of proton pump inhibitors. METHODS: Prospective randomized single-blind study was performed in a tertiary care university hospital. Out of 72 H. pylori infected patients endoscoped for upper abdominal symptoms 48 were randomized to proton pump inhibitors (omeprazole 20 mg each day or esomeprazole 40 mg each day) and 24 to antacid (aluminum hydroxide 800 mg each day) for 14 days. Several breath tests (standard 75 mg (13)C-UBT with citric acid, with orange juice, a tablet breath test with 100 and 50 mg of (13)C), and a stool test were carried out. Baseline samples were collected before and after treatment. RESULTS: The baseline sensitivity for all breath tests was 100% in both groups; for stool test it was 97.8% (95% CI: 88.7-96.6) and 90% (95% CI: 69.9-97.2) in the proton pump inhibitor and antacid group, respectively. After treatment, the sensitivity of tests was significantly low (UBTs range: 77.1%-85.4%; stool test: 83%; 95% CI: 63.9-91.1), while it was unchanged in the antacid group. CONCLUSIONS: False negative breath and stool tests are equally common in patients taking proton pump inhibitors. Antacids do not impair the sensitivity of the breath tests or the stool test.

Administration, Oral↗
PubMed1976

Influence of a liquid antacid on the absorption of different iron salts.

The influence of a liquid antacid on the absorption of iron from iron tablets was studied in healthy volunteers using a serum iron technique. Tablets containing ferrous salts (carbonate, fumarate, sulphate) with different in-vitro dissolution properties were studied. Co-administration of the antacid and the iron tablets resulted in a marked reduction of the absorption of iron from all preparations studied. The lowest absorption was found when ferrous carbonate was given with the antacid. This was ascribed to the fact that ferrous carbonate is almost completely insoluble at pH-levels near neutral. This was confirmed in a series of patients with achlorhydria in which the absorption from ferrous carbonate was virtually nil. It was concluded that iron tablets and antacid preparations should not be administered at the same time and that ferrous carbonate tablets should not be used in patients with achlorhydria.

Achlorhydria↗