Document Detail


Use of proton-pump inhibitors in complicated ulcer disease and upper gastrointestinal tract bleeding.
MedLine Citation:
PMID:  10597118     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The use of proton-pump inhibitors in the management of complicated peptic ulcer disease and upper gastrointestinal bleeding is described. Treatment of peptic ulcers in patients who are Helicobacter pylori positive should include antimicrobial therapy to eradicate the infection; based on considerations of primary antimicrobial resistance and safety, one recommended regimen is the combination of a proton-pump inhibitor (lansoprazole 30 mg or omeprazole 20 mg), clarithromycin 500 mg, and amoxicillin 1 g, each twice daily for 14 days. The proportion of H. pylori-negative ulcers has increased in the United States, now accounting for 39% of patients with ulcers who report no intake of nonsteroidal anti-inflammatory drugs (NSAIDs). Compared with H. pylori-positive ulcers, H. pylori-negative ulcers are more aggressive, characterized by high recurrence rates and increased risk of bleeding and perforation. Long-term therapy with a proton-pump inhibitor may be useful in these patients. Acid suppressants may also have a role in the initial treatment of patients who have a bleeding ulcer, including those associated with NSAID use. For patients who require continuous NSAID therapy, proton-pump inhibitors have been shown to heal a significantly higher percentage of peptic ulcers in eight weeks than histamine H2-receptor antagonists, and maintenance therapy with either lansoprazole or omeprazole reduces ulcer recurrence. Preliminary data suggest a role for proton-pump inhibitors in the prevention of stress ulcers among critically ill patients. Proton-pump inhibitors play an important role in the treatment of both H. pylori-negative and H. pylori-positive peptic ulcers, as well as in upper gastrointestinal tract bleeding. Further study is needed regarding their role in preventing stress ulcers in critically ill patients.
Authors:
C W Howden
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists     Volume:  56     ISSN:  1079-2082     ISO Abbreviation:  Am J Health Syst Pharm     Publication Date:  1999 Dec 
Date Detail:
Created Date:  1999-12-29     Completed Date:  1999-12-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9503023     Medline TA:  Am J Health Syst Pharm     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  S5-11     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology and Hepatology, Northwestern University Medical School, Chicago, IL 60611, USA. chowden@nwu.edu
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MeSH Terms
Descriptor/Qualifier:
2-Pyridinylmethylsulfinylbenzimidazoles
Anti-Bacterial Agents / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / adverse effects
Anti-Ulcer Agents / pharmacology,  therapeutic use*
Drug Therapy, Combination
Gastrointestinal Hemorrhage / chemically induced,  drug therapy*,  microbiology*
H(+)-K(+)-Exchanging ATPase / antagonists & inhibitors*
Helicobacter Infections / complications*,  drug therapy
Helicobacter pylori*
Humans
Intensive Care
Omeprazole / analogs & derivatives,  pharmacology,  therapeutic use
Peptic Ulcer / chemically induced,  drug therapy*,  microbiology*
Proton Pumps / antagonists & inhibitors*
Treatment Outcome
Chemical
Reg. No./Substance:
0/2-Pyridinylmethylsulfinylbenzimidazoles; 0/Anti-Bacterial Agents; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Anti-Ulcer Agents; 0/Proton Pumps; 103577-45-3/lansoprazole; 73590-58-6/Omeprazole; EC 3.6.1.10/H(+)-K(+)-Exchanging ATPase
Comments/Corrections
Erratum In:
Am J Health Syst Pharm 2000 Apr 1;57(7):699

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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