Stomach Ulcers Research Today is a free monthly online journal that collates and summarizes the latest research about Stomach Ulcers, including details on symptoms, treatment, causes, bleeding, medication.

Intragastric pH with oral vs intravenous bolus plus infusion proton-pump inhibitor therapy in patients with bleeding ulcers.

Laine L, Shah A, Bemanian S

Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. llaine@usc.edu

BACKGROUND & AIMS: Intravenous bolus plus infusion proton pump inhibitor (PPI) therapy is recommended for patients with bleeding ulcers and higher risk stigmata. If frequent oral dosing of PPIs provided similar antisecretory effect, this might be preferred based on ease and cost. METHODS: Patients presenting with overt bleeding due to ulcers had intragastric pH probes placed after endoscopy and baseline pH recorded. They were randomly assigned to intravenous lansoprazole (90-mg bolus followed by 9-mg/h infusion) or oral lansoprazole (120-mg bolus followed by 30 mg every 3 hours). pH was recorded for 24 hours. RESULTS: Intragastric pH was > 6 for 67.8% of the study period with intravenous PPI (n = 32) and 64.8% with oral PPI (n = 34): difference, 3.0%; 95% confidence interval (CI): -9.2% to 15.2%. Intragastric pH was > 6 for > 60% of the study period in 22 (68.8%) patients receiving intravenous and 22 (64.7%) patients receiving oral PPI: difference, 4.0%; 95% CI: -18.7% to 26.8%. At 1 hour, mean pHs for intravenous vs oral were 5.3 +/- 0.4 vs 3.3 +/- 0.4, respectively (difference, 2.0; 95% CI: 0.8-3.1; P = .001). At > or = 1.5 hours, 95% CIs of the differences for all hourly mean pHs included zero. Mean pH rose above 6 after 2-3 hours of intravenous PPI and 3-4 hours of oral PPI. CONCLUSIONS: Frequent oral PPI may be able to replace the currently recommended intravenous bolus plus infusion PPI therapy in patients with bleeding ulcers, although the possibility that intravenous PPIs are superior cannot be definitively excluded given our relatively wide confidence intervals. Intravenous PPI provides more rapid increase in pH, reaching mean pH of 6 approximately 1 hour sooner than oral PPI.

Published 13 June 2008 in Gastroenterology, 134(7): 1836-41.
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Articles on Stomach Ulcers published 21 May 2008:

MDCT for differentiation of category T1 and T2 malignant lesions from benign gastric ulcers.   AJR Am J Roentgenol, 190(6): 1505-11.

OBJECTIVE: The purpose of this study was to evaluate MDCT parameters for differentiating malignant (category T1 and T2) from benign gastric ulcers and to evaluate the performance characteristics of these predictors with optimal cutoff points determined in receiver operator characteristic analysis. SUBJECTS AND METHODS: The subjects were 26 patients with gastric cancer (11 with T1 lesions, 15 with T2 lesions) and 26 patients with benign gastric ulcer. MDCT and virtual gastroscopic findings were ... [Abstract] [Full-text]

Articles on Stomach Ulcers published 2 May 2008:

Helicobacter pylori eradication prevents progression of gastric cancer in hypergastrinemic INS-GAS mice.   Cancer Res, 68(9): 3540-8.

Helicobacter pylori infection results in chronic gastritis, which may progress to gastric cancer. In this study, we investigated the efficacy of H. pylori eradication in preventing the progression of gastritis to gastric cancer in H. pylori-infected transgenic INS-GAS mice. H. pylori infection induced severe dysplasia and gastric cancer classified as high-grade and low-grade gastrointestinal intraepithelial neoplasia (GIN) in INS-GAS mice at 28 weeks postinfection (WPI). H. pylori eradication ... [Abstract] [Full-text]

Articles on Stomach Ulcers published 16 April 2008:

Degos' disease with delayed involvement of the gastrointestinal tract.   Australas J Dermatol, 49(2): 86-90.

A 75-year-old woman presented with pink papules over the trunk and limbs. Over the next few weeks, the papules became umbilicated and then developed into porcelain-white lesions with a rose or violaceous rim. A biopsy of one of these lesions revealed superficial and deep dermal lymphohistiocytic inflammation, mainly perivascular with a central zone of infarction consistent with Degos' disease. Three years later, she presented with increasing abdominal pain, anaemia, raised inflammatory markers ... [Abstract] [Full-text]

Articles on Stomach Ulcers published 16 January 2008:

Hydrogen sulphide-induced hypothermia attenuates stress-related ulceration in rats.   Clin Exp Pharmacol Physiol, 35(2): 223-8.

1. Hydrogen sulphide (H(2)S) acts as a gaseous cellular messenger and has recently been reported to induce a suspended animation-like state in mice. The aim of the present study was to investigate the protective role of H(2)S exposure in stress gastric ulcer. 2. In the present study, we used a rat model of water immersion and restraint stress (WRS) to induce the typical stress disease, namely stress gastric ulcer. Rats were treated with WRS for 4 h, with or without pre-exposure to H(2)S (160 ... [Abstract] [Full-text]

Articles on Stomach Ulcers published 14 January 2008:

Decreasing incidence of symptomatic gastrointestinal ulcers and ulcer complications in patients with rheumatoid arthritis.   Ann Rheum Dis, 67(2): 256-9.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) frequently cause gastrointestinal (GI) ulcers and complications of ulcers. In 1997 in Amsterdam, the incidence of symptomatic GI events was 2.1% (95% CI 1.0-3.1) in patients with rheumatoid arthritis (RA). We conducted a new prospective, observational study on the symptomatic GI events in our outpatient clinics, and compared the data to a previous study conducted by our group. Over the same time period, a decline of GI events over the ... [Abstract] [Full-text]

Articles on Stomach Ulcers published 7 January 2008:

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BACKGROUND: While the clinical presentation of cutaneous stomal metastases after percutaneous endoscopic gastrostomy (PEG) placed for pharyngoesophageal malignancy is well described, the clinicoendoscopic findings with gastric stomal metastases is insufficiently characterized. A novel clinicoendoscopic presentation is reported of significant gastrointestinal bleeding caused by an ulcerated gastric stomal metastasis. METHODS: A male patient was admitted for melena with a growing abdominal wall ... [Abstract] [Full-text]

Articles on Stomach Ulcers published 30 November 2007:

Hydrogen sulfide enhances ulcer healing in rats.   FASEB J, 21(14): 4070-6.

Hydrogen sulfide is an endogenous mediator that relaxes vascular smooth muscle, exhibits several antiinflammatory activities, and contributes to gastric mucosal defense. This study was performed to examine the role of hydrogen sulfide in the resolution of injury; specifically, the healing of gastric ulcers. Ulcers were induced in rats by serosal application of acetic acid. This elicited a marked increase in gastric expression of the two key enzymes in hydrogen sulfide synthesis ... [Abstract] [Full-text]

Articles on Stomach Ulcers published 8 November 2007:

Oral proton pump inhibitors are as effective as endoscopic treatment for bleeding peptic ulcer: a prospective, randomized, controlled trial.   Dig Dis Sci, 52(12): 3371-6.

In managing patients with bleeding peptic ulcers, it has been reported that pharmacologic treatment can be an alternative to endoscopic treatment. We compared the hemostasis rates of the endoscopic treatment, hemoclipping, and the pharmacologic treatment, oral proton pump inhibitors (PPIs), in bleeding peptic ulcer. A randomized prospective study was performed on 129 bleeding peptic ulcer patients with hematemesis or melena. Sixty-two patients were treated by endoscopic hemoclipping and ... [Abstract] [Full-text]

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