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Gastropathy induced by nonsteroidal anti-inflammatory drugs: prescribing patterns among geriatric practitioners.

The objective of this study was to determine patterns among geriatric practitioners in prescribing agents that protect the gastrointestinal tract when nonsteroidal anti-inflammatory drug (NSAID) treatment is started for elderly patients. A questionnaire describing five scenarios of elderly patients requiring NSAID therapy asked respondents to choose gastrointestinal-protective agents for each scenario. Respondents were then asked to what extent four established risk factors for NSAID gastropathy (age, previous peptic ulcer, previous gastrointestinal bleeding, and heart disease) affected their

Eradication of Helicobacter pylori restores the inhibitory effect of cholecystokinin on gastric motility in duodenal ulcer patients.

BACKGROUND: Increased gastric emptying and defective action of endogenous cholecystokinin (CCK), that is known to inhibit this emptying, have been implicated in the pathogenesis of duodenal ulcer (DU). The aim of this double blind study was to assess whether CCK and somatostatin participate in the impairment of gastric motility in active DU patients before and after Helicobacter pylori eradication. METHODS: Tests were undertaken in 10 DU patients without or with elimination of the action of endogenous CCK using loxiglumide, a selective CCK-A receptor antagonist, before and 4 weeks after eradi

[NSAID-induced gastrointestinal diseases: recent data on pathogenesis and prevention].

Our knowledge of the mechanism by which aspirin and traditional NSAIDs work and damage the gastrointestinal mucosa, recently markedly improved, has suggested a number of measures for the prevention of the NSAID-induced GI lesions. Among these, perhaps the most innovative approach seems to be the nitric oxide-releasing NSAIDs or compounds, like amtolmetin guacyl, that work by increasing the endogenous biosynthesis of NO selectively at gastric mucosa level. Further data, stemming from large RCTs and confirming the results of experimental studies and the initial clinical experiences, are needed t

Radiation induced oral mucositis.

PATIENTS RECEIVING RADIOTHERAPY OR CHEMOTHERAPY WILL RECEIVE SOME DEGREE OF ORAL MUCOSITIS THE INCIDENCE OF ORAL MUCOSITIS WAS ESPECIALLY HIGH IN PATIENTS: (i) With primary tumors in the oral cavity, oropharynx, or nasopharynx; (ii) who also received concomitant chemotherapy; (iii) who received a total dose over 5,000 cGy; and (iv) who were treated with altered fractionation radiation schedules. Radiation-induced oral mucositis affects the quality of life of the patients and the family concerned. The present day management of oral mucositis is mostly palliative and or supportive care. The newe

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… THERAPEUTIC INTERVENTIONS Sucralfate Sucralfate, a cytoprotective agent used for gastro intestinal ulcerations, is a basic aluminum salt of sucrose octasulfate, and may be useful in palliation of established mucositis by its coating and protective actions. … Radiation-induced mucositis: A randomized clinical trial of micronized sucralfate versus salt and soda mouthwashes. Cancer Invest. 2003;21:21–33. doi: 10.1081/cnv-120016400. 15. Nottage M, McLachlan SA, Brittain MA, Oza A, Hedley D, Feld R, et al. …

Pharmacological interventions for non-ulcer dyspepsia.

BACKGROUND: The commonest cause of upper gastrointestinal symptoms is non-ulcer dyspepsia (NUD) and yet the pathophysiology of this conditio … cal significance. Antacids (one trial generating 109 patients; RRR = -2%; 95% CI = -36% to 24%) and sucralfate (two trials generating 246 patients; RRR = 29%; 95% CI = -40% to 64%) were not statistically significantly superior to placebo. A funnel plot suggested that the prokinetic and H2RA results could be due to publication bias. REVIEWERS' CONCLUSIONS: T …

Recommendations for Stress Ulcer Prophylaxis in Critically Ill Adults: A Contextualized Clinical Practice Guideline From the Saudi Critical Care Society and the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Endorsed by the Kuwait Anesthesia and Critical Care Society.

BACKGROUND: Critically ill adults are at risk for stress-related upper gastrointestinal bleeding (UGIB). Regional variations in gastrointest … uggests using a proton pump inhibitor (PPI) or a histamine-2 receptor antagonist (H2RA) rather than sucralfate (conditional recommendation; low to moderate certainty) and suggests enteral or intravenous administration based on clinical feasibility (conditional recommendation; very low to low certainty). In critically ill adults receiving SUP, low-dose PPI or …

Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer.

BACKGROUND: The number of patients with chronic gastrointestinal (GI) symptoms after cancer therapies which have a moderate or severe impact … chaemia. The best current evidence for effective treatment of radiation-induced GI bleeding is with sucralfate enemas and hyperbaric oxygen therapy. CONCLUSIONS: All cancer units must develop simple methods to identify the many patients who need help and establish routine referral pathways to specialist gastroenterologists where patients can receive safe an …

Treatment-induced mucositis: an old problem with new remedies.

Mucositis may be a painful, debilitating, dose-limiting side-effect of both chemotherapy and radiotherapy for which there is no widely accepted prophylaxis or effective treatment. The basis of management is pain relief, prevention of dehydration and adequate nutrition. When tested vigorously, most antiseptic mouthwashes and anti-ulcer agents are ineffective. Simple mechanical cleansing by saline is the most effective traditional measure. A variety of new agents are effective. Granulocyte macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) act outwith

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… The effects of sucralfate suspension and diphenhydramine syrup plus kaolin-pectin on radiotherapy-induced mucositis. 71 3 3 1991 288 293 Oral Surg Oral Med Oral Pathol 1707149 10.1016/0030-4220(91)90301-r Barkvoll P. Attramadal A. … The efficacy of sucralfate suspension in the prevention of oral mucositis due to radiation therapy. 28 3 1 2 1994 693 698 Int J Radiat Oncol Biol Phys 8113113 10.1016/0360-3016(94)90195-3 Eriksson G. Johansson C. Aly A. …

Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric operation in the United States. Although r … ulcers were managed with chronic acid suppressive therapy consisting of proton pump inhibitors and sucralfate. Revisional surgery was performed in 5 (33.3%) of 15 patients because of the combination of constant pain and ulceration refractory to optimal medical treatment and in 1 patient (7%) because of refractory pain unresponsive to medical therapy and wei …

Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee.

This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelin … al lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care--associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legio …

Ranitidine bismuth citrate-based triple therapy for seven days, with or without further anti-secretory therapy, is highly effective in patients with duodenal ulcer and Helicobacter pylori infection.

OBJECTIVE: To compare the efficacy of two protocols for the eradication of Helicobacter pylori infection and the healing of active duodenal ulcer: (i) ranitidine bismuth citrate (RBC) plus two antibiotics for 7 days, and (ii) the same triple therapy followed by 3 weeks of anti-secretory drug treatment. METHODS: The study comprised 102 patients with active duodenal ulcer and H. pylori infection; the patients were randomized to open treatment with either RBC 400 mg b.d. plus amoxycillin 1 g b.d. and clarithromycin 500 mg b.d. for 7 days, or the same treatment followed by 3 weeks of RBC 400 mg b

WITHDRAWN: Pharmacological interventions for non-ulcer dyspepsia.

BACKGROUND: The commonest cause of upper gastrointestinal symptoms is non-ulcer dyspepsia (NUD) and yet the pathophysiology of this conditio … cal significance. Antacids (one trial evaluating 109 participants; RRR -2%; 95% CI -36% to 24%) and sucralfate (two trials evaluating 246 participants; RRR 29%; 95% CI -40% to 64%) were not statistically significantly superior to placebo. A funnel plot suggested that the prokinetic results could be due to publication bias or other small study effects. AUTHO …

Pharmacological interventions for non-ulcer dyspepsia.

BACKGROUND: The commonest cause of upper gastrointestinal symptoms is non-ulcer dyspepsia (NUD) and yet the pathophysiology of this conditio … cal significance. Antacids (one trial evaluating 109 participants; RRR -2%; 95% CI -36% to 24%) and sucralfate (two trials evaluating 246 participants; RRR 29%; 95% CI -40% to 64%) were not statistically significantly superior to placebo. A funnel plot suggested that the prokinetic results could be due to publication bias or other small study effects. AUTHO …

Risk factors for nosocomial pneumonia in critically ill trauma patients.

OBJECTIVE: To determine risk factors for nosocomial pneumonia in critically ill trauma patients. DESIGN: Prospective cohort study. SETTING … ntinuous enteral feeding; prolonged mechanical ventilation (>1 day); use of H2-receptor antagonist, sucralfate, muscle relaxants, corticosteroids, barbiturates, and inotropic agents; positive end-expiratory pressure; intense sedation; re-intubation; tracheotomy; urgent brain computed tomography (CT) scan; craniotomy; iatrogenic event; and hyperventilation. T …

Interventions for treating oral mucositis for patients with cancer receiving treatment.

BACKGROUND: Treatment of cancer is increasingly effective but associated with short and long term side effects. Oral side effects, including … parisons for mucositis treatment including two or more trials were: benzydamine HCl versus placebo, sucralfate versus placebo and low level laser versus sham procedure. Only the low level laser showed a reduction in severe mucositis when compared with the sham procedure, RR 5.28 (95% confidence interval (CI) 2.30 to 12.13).Only 3 comparisons included more th …

Radiation-Induced Oral Mucositis.

Radiation-induced oral mucositis (RIOM) is a major dose-limiting toxicity in head and neck cancer patients. It is a normal tissue injury caused by radiation/radiotherapy (RT), which has marked adverse effects on patient quality of life and cancer therapy continuity. It is a challenge for radiation oncologists since it leads to cancer therapy interruption, poor local tumor control, and changes in dose fractionation. RIOM occurs in 100% of altered fractionation radiotherapy head and neck cancer patients. In the United Sates, its economic cost was estimated to reach 17,000.00 USD per patient with

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… vs. placebo | Significant lower incidence of severe mucositis RT | Makkonen et al. ( 147 ) | Yes/yes/yes | P | Sucralfate vs. placebo | Only slight protective effect of sucralfate RT | Epstein et al. ( 148 ) | Yes/yes/yes | P + T | Sucralfate vs. placebo | Non-significant reduction of oral discomfort … RT | Meredith et al. ( 144 ) | Yes/yes/yes | T | Antacid, diphenhydramine, lidocaine ± sucralfate | Non-significant reduction of severity RT | Cengiz et al. ( 142 ) | Yes/yes/yes | P + T | Sucralfate vs. placebo | Decreased severity RT | Carter et al. ( 244 ) | Yes/yes/yes | P | Sucralfate vs. placebo …

MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy.

BACKGROUND: Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for mucositis. METHODS: A literature search was conducted to identify eligible published articles, based on predefined inclusion/exclusion criteria. Each article was independently reviewed by 2 reviewers. Studies were rated according to the presence of major and minor flaws as per previously published

Does smoking predispose to peptic ulcer relapse after eradication of Helicobacter pylori?

OBJECTIVES: To investigate whether smoking would increase ulcer recurrence after eradication of Helicobacter pylori (H. pylori) without maintenance acid-suppression therapy. METHODS: A total of 287 patients, 256 patients with duodenal ulcers and 31 patients with gastric ulcers, were followed-up for up to 18 months after ulcer healing and successful eradication of H. pylori. There were 83 smokers (defined as smoking > or = 10 cigarettes/day) and 204 patients who never smoked or stopped smoking after the diagnosis of peptic ulcer disease. None were taking nonsteroidal anti-inflammatory drugs or

Pharmacological interventions for non-ulcer dyspepsia.

BACKGROUND: The commonest cause of upper gastrointestinal symptoms is non-ulcer dyspepsia (NUD) and yet the pathophysiology of this conditio … cal significance. Antacids (one trial generating 109 patients; RRR = -2%; 95% CI = -36% to 24%) and sucralfate (two trials generating 246 patients; RRR = 29%; 95% CI = -40% to 64%) were not statistically significantly superior to placebo. A funnel plot suggested that the prokinetic result could be due to publication bias. The funnel plot of H2RAs did not sho …