01:07,17,Feb,2009 | (766/0/0) | Original

treatment of a bleeding ulcer


Of: Yao Jianfeng Yu Xiaofeng Wang Gensheng
Unit: 200040 Huadong Hospital
Keywords:
Shanghai Medical 990,813 Lansoprazole (Lansoprazole, trade name: Takepron) is a new generation of H-K ATP inhibitor, is an ideal drug for treatment of peptic ulcer. To observe the drug on peptic ulcer complicated by hemorrhage, in our hospital from March 1994 to May 1998, 30 cases of complicated peptic ulcer bleeding in patients with oral lansoprazole treatment, and with omeprazole injection compared. Also observed after treatment intragastric pH. The results now reported as follows.
Materials and methods
First, the study
60 patients were hospitalized because of hematemesis or melena, 44 patients had dizziness, fainting, cold sweats, low blood pressure, pulse rate and rapid increase in the symptoms of low blood volume, within 24 hours of admission by endoscopy diagnosed as peptic ulcer complicated bleeding. Were randomly divided into two groups: lansoprazole group of 30 patients, 24 males and 6 females, mean age 44 ± 14 years. Of which 24 cases of duodenal ulcer, gastric ulcer in 6 cases. See endoscopic bleeding ulcers in 6 cases, blood crust attached to the 4 cases, vascular revealed 4 cases, more than 16 cases of bleeding ulcers has been stopped. Omeprazole injection group of 30 patients, 26 males and 4 females, mean age 43 ± 28 years. Including 26 cases of duodenal ulcer, gastric ulcer in 4 cases. Endoscopic ulcer bleeding in 5 cases, 3 cases of adhesion of blood scab, blood vessels revealed in 5 cases, the ulcer bleeding has stopped in 17 cases. The two groups were age, gender, endoscopic signs of bleeding were comparable with (by χ2 test, P> 0.05).
Second, the research methods
(A) Endoscopic treatment of active bleeding when he saw that local injection of epinephrine in the endoscopic or spray thrombin, until active bleeding stopped, and then oral lansoprazole or omeprazole intravenous injection. Lansoprazole Group: Daily morning oral 30mg. Omeprazole injection group: 40mg intravenous injection, morning and evening, use 3 days, then switched to the oral omeprazole daily 20mg. Transfusion or blood transfusion as the condition needs. Continued bleeding during treatment or re-bleeding, use of other therapeutic measures or surgery. Hospitalized for observation for 10 to 14 days.
Medication in all cases to disable all other anti-ulcer drugs are, and hemostatic. Were measured before and after treatment of blood, urine, stool, and liver and kidney function, blood electrolytes.
6, the percentage of time to calculate the average 24-hour pH, median pH.
(C) of the efficacy criterion [1] hemostasis: 1, clinical symptoms improved after treatment, faeces from black to yellow; 2, fecal occult blood test was negative; 3, the endoscope has only confirmed bleeding, ulcers without signs of recent hemorrhage . Item 3 above may be considered with any bleeding has ended and no further hospitalization signs of bleeding.
He
mostatic failure: 1, still bleeding from the treatment 3 days signs such as black stools or vomiting blood, bowel sounds hyperthyroidism, or blood transfusion required to maintain normal blood circulation; or endoscopy confirmed that there continued to hemorrhage, need to switch to other measures or surgery to stop bleeding treatment. 2, the treatment of signs is no longer bleeding, but the hospital for observation, there are signs of bleeding or endoscopic ulcers have confirmed the original hemorrhage.
Results
First, the medication 24 hours after the pH of the stomach
0.05).
Table 1, two 24-hour intragastric pH monitoring compared groups
4 (%)
5 (%)
6 (%)
The average pH
Median pH
Lansoprazole group
98.43 ± 2.98
96.90 ± 4.40
84.42 ± 12.97
6.92 ± 0.35
7.05 ± 0.36
Omeprazole injection group
97.13 ± 3.80
95.23 ± 5.86
88.37 ± 2.94
7.07 ± 0.15
7.33 ± 0.35
Second, observation of clinical bleeding
Two groups of 60 patients were hemostasis, recurrent bleeding during hospitalization was not found, bleeding was 100% effective.
Third, the adverse reaction
Two groups of patients in the treatment of no obvious side effects.
Discussion
Peptic ulcer bleeding is a common emergency complicated one, dealing not in time can be life threatening. Medical treatment, including transfusion, blood transfusion, hemostatic, and the application of acid-suppressing drugs. Documents introduced in recent years, including direct spraying of local endoscopic hemostatic drugs such as Monteggia solution, thrombin, legislation to stop bleeding, as well as coagulation, microwave and laser to stop bleeding, have a good effect, but some patients still inevitable surgery. Since the advent of omeprazole after injection, Brunner has been reported [2] effect on bleeding peptic ulcer bleeding more than 80%, much higher than ranitidine or famotidine is superior. We observed lansoprazole, its hemostatic effect is obvious, the total effective rate was 100%, compared with the similar efficacy of omeprazole injection, higher than Brunner reported that this may be related to our patients with active bleeding within the first on endoscopic hemostasis.
4 time percentage of 98.43%, it can be suppressed effectively and within a short pepsin activity, and promote ulcer healing [3,4], low-acid environment conducive to platelet aggregation and accelerate the coagulation process to achieve the purpose of bleeding [5]. Some scholars believe that, even if active bleeding gastric endoscopic therapy has ceased, should maintain the intragastric pH 3 to 5 days in 6 above, to avoid dissolution of the formed clot and prevent further bleeding. Daily oral lansoprazole 30mg, one can maintain the intragastric pH of more than 6 hours in 84%, or up to 20 hours. To create favorable conditions for gastric bleeding.
References
1 Gu with the progress, Zheng Songbai. Omeprazole and ranitidine treatment of acute peptic ulcer bleeding in comparison. New Drugs and clinical ,1994,13:41-42.
2 Brunner G. Intravenous therapy with high dose of ranitidine and omeprazole in critically ill patients with bleeding peptic ulceration of the upper intestinal tract: an open randomized controlled trial. Digestion, 1990, 45:217-225.
3 Burget DW, Male G. Is there an optimal degress of acid supression for healing of duodenal ulcer? A model of the relationship between ulcer healing and acid s upression. Gastroenterology, 1990, 99:345-352.
4 Ye Ping, Guo-Ming Xu, Zhao-Shen Li. Lansoprazole duodenal ulcer 24-hour intragastric pH monitoring. Chinese Journal of Digestion ,1996,16:210-212.
5 Brunner G. modern treatment of peptic ulcer. Chinese Journal of Digestion ,1996,16:284-286.
(Received :1998-09-21 Revised :1998-12-21) (Article Source: Shanghai Medical 1999 Volume 8, 0)
treatment of a bleeding ulcer

Your position: World Manager> Medicine> cutting edge> Research News COX-2 inhibitors class of drugs to prevent bleeding ulcers has been questioned Date :2003-01-02 09:54:38.0 Source: Author: 【ICXO.com Editor's Note】
World Executive Intelligence-bi.icxo.com newsletter
One study showed that well-known arthritis drugs Celebrex and not as expected, effectively prevent arthritis patients with recurrent gastric ulcer bleeding. COX-2 inhibitor, Celebrex is a typical representative of drugs, other drugs including Merck's Vioxx and Pfizer's Bextra.
"New England Journal of Medicine" (New England Journal of Medicine) on Thursday published a study showed that people with ulcers taking Celebrex in arthritis patients during the six months in patients with gastric ulcer bleeding was 4.9%. The combined treatment of a standard non-steroidal analgesics diclofenac and Prilosec ulcer drug combination therapy group, the incidence of gastric ulcer bleeding was 6.4%. There were no significant compared to the two significant differences.
Celebrex and two similar anti-inflammatory drugs has claimed these drugs safer for arthritis patients. It is based on earlier studies have shown that compared with traditional anti-inflammatory drugs, these three drugs caused fewer ulcers and other gastrointestinal complications. These three new drugs with annual sales totaling more than 60 million.
But recently, the safety of these drugs has been questioned. The new study found, were more likely to occur in the recurrence of ulcers in arthritis patients, nearly 10% per year will develop into another bleeding ulcer. The findings led to the debate about Celebrex upgrade.
The study found that the traditional anti-inflammatory drugs plus a combination of ulcer drug Prilosec also the same phenomenon - Doctors often use this combination in patients with arthritis, gastrointestinal protection. In addition, the researchers said the results of previous studies and compared the two treatments have not been able to better prevent the risk of renal complications in patients.
Researchers in Hong Kong and some experts say, although the results showed that the two treatments have the same effect, but also indicated the need for further research in order to prevent those years of use of non-steroidal anti-inflammatory drugs (NSAIDs) to relieve joint pain in older Guanjie Yan patients with bleeding gastric ulcer.
Arthritis Foundation (Arthritis Foundation) John H. Klippel, MD, believes that because of possible gastrointestinal bleeding and renal toxicity, physicians should closely monitor those patients at high risk.
Celebrex is Pharmacia's products. The company spokesman Paul Fitzhenry said the company believes that these findings Celebrex reduced the risk of complications in patients with gastrointestinal risk. He said Wednesday that these results should be within the field of future research guidelines. The spokesman also said a drug treatment course than the two drugs to cure. "If you are a doctor, you want your patients a more convenient, you will choose to give him a drug rather than the two drugs." She said. Prilosec's manufacturer AstraZeneca (AstraZeneca) did not comment Wednesday.
The study published in last Thursday's "New England Journal of Medicine" on. Acceptance of test after all the 287 patients with bleeding ulcers, and into another possible higher risk of fatal ulcers.
Research trials in patients receiving half the use of anti-inflammatory drugs diclofenac and Prilosec, the other half use Celebrex. This is the three new non-steroidal anti-inflammatory drugs into a brand, also known as cyclooxygenase 2 (cox-2) inhibitors. The drug can produce prostaglandins chemical substances, the substances in the body repair process will lead to gastrointestinal pain and cause inflammation.
These drugs include Merck's Vioxx and Pfizer's Bextra. They will not protect the stomach lining of inhibiting COX-1 play a role. Diclofenac and other traditional non-steroidal anti-inflammatory drugs on oxidative enzyme oxidase 1 and 2 are produced inhibition, which can cause stomach irritation and makes the ulcer worse.
Each year taking traditional anti-inflammatory drug-induced complications cause about 107,000 Americans are hospitalized and an estimated 16,500 people die each year ulcer complications.
In a 6-month study period, patients using Celebrex approximately 4.9% of people with recurrent bleeding, and in the receiving diclofenac and Prilosec treated patients, this ratio was about 6.4%.
Houston Veterans Affairs Medical Center (Veterans Affairs Medical Center) doctor David Y. Graham wrote in a paper, test results were unprecedented, two treatment methods are not effective in preventing recurrent bleeding.
In a 6-month trial, both treatments can effectively relieve pain in patients and enable them to carry out daily activities.
But the Celebrex group had about 25% of patients, diclofenac / Prilosec group of about 31% of patients, including high blood pressure and ankle swelling complications including kidney; two groups had about 6% of patients renal failure occurred.
Klippel, these results indicate that physicians must pay close attention to taking these anti-inflammatory drugs in patients at high risk, such as pain increased and accompanied by blood in the stool, which indicates a ulcer. Limb joints also should be concerned about whether the swelling, elevated blood pressure - these are signs of renal dysfunction.
The study leader Francis KL Chan, said doctors should avoid known to suffer from kidney disease, hypertension and heart failure in patients with open these prescriptions. Previous studies have reported fewer side effects these prescriptions kidneys, because the study did not include seriously ill patients.
Medicine and Dentistry of New Jersey (University of Medicine and Dentistry of New Jersey) of Dr. Todd Stitik, said the research strongly supports the American College of Rheumatology (American College of Rheumatology) existing arthritis treatment guidelines, and to the doctors the choice.
He said, for those with expensive prescription COX-2 inhibitors in patients, should reduce the amount of reagent, and so also reduce the opportunity to interact with other drugs. Other patients, there are many anti-inflammatory drugs and ulcers generic drugs available.
Stitik noted that through the use of stretching and other training methods to lose weight, heat or cold, post or plywood, and other treatment, some patients with arthritis can limit or avoid taking painkillers. World Executive Intelligence-bi.icxo.com
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Home> Experts> Content Document Name: Endoscopic injection therapy follow-up examination in 85 patients with bleeding ulcers Observation Introduction: Objective: endoscopy follow-up examination and repeated injection of patients with bleeding ulcer patients. Methods: Emergency endoscopy diagnosed 85 patients with bleeding peptic ulcer were randomly divided into treatment group, 43 patients in the control group of 42 patients. Diluted epinephrine treatment group, the organization in the endoscopic sclerotherapy ulcers guided injection into the base, due to the role of local pressure to stop the bleeding. Endoscopic treatment group follow-up appointment, and then given repeated injection of bleeding. Control group, no follow-up endoscopic examination. Results: The patients with bleeding ulcers after endoscopic injection therapy 10 to 30% longer bleeding, ulcers no local feature improved to achieve better therapeutic effect. Two groups of patients receiving endoscopic follow-up examination, whether or not, no difference in rebleeding rate (p> 0. 5), blood transfusion among patients, hospital stay time, the number of transfer operations and the numbers of deaths was not statistically significant. Conclusion: Endoscopic bleeding ulcer patients with repeated treatments significantly reduced the incidence of rebleeding and mortality. According to standard diagnostic Forrset patients with peptic ulcer bleeding after successful endoscopic therapy the first time, not recommended follow-up endoscopic procedures
Objective: To study the efficacy of endoscope follow-up examination and duplicated injection treatment in bleeing ulcer patients.Method: The 85 cases of bleeding peptic ulcer diagnosed by emergency endoscope examination randomely divided into treatment group including 43 cases and control group including 42 cases. In the treatment gr
oup we injected attrnuant adrenalin and tissue uulcanizer to the basilar part of the ulcer by guidance of the endoscope, which can stop bleeding by the effect of local compression . the name of endoscopic follow-up examination of the literature treatment of bleeding ulcers, 85 injection Cases Article Name
English (English) translation Endoscope follow-up examination to observe the efficacy of injection treatment in 85 cases of bleeding ulcer patients; of Lize Ling; Zhao Min; AuthorLI Ze-ling; ZHAO Yu-min (Dangshan People s Hospital; Anhui Dangshan 235300; China ); Author
Author Agencies Dangshan County of Anhui Province People's Hospital; Dangshan County, Anhui Province, Anhui Province People's Hospital Dangshan; Anhui Dangshan; Document Source
Article From Shanghai Institute of Metallurgy; Materials Physics and Chemistry (Professional) PhD thesis in 2000 Keywords bleeding ulcer; injection; endoscopic follow-up; KeywordsBleeding ulcer; Injection treatment; Endoscope follow-up;
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