RESUMEN
Patients with reflux esophagitis (grade II or III, Savary-Miller, intention-to-treat, n=256, age range 19-82 years) were randomly assigned to a double-blind, double-dummy treatment with either pantoprazole 40 mg once daily or ranitidine 150 mg twice daily. After 4 weeks, each patient was clinically and endoscopically assessed. Failure to heal required a further 4 weeks of treatment and a new evaluation thereafter. After 4 weeks, healing of lesions was confirmed in 63% (69 out of 109) of patients receiving pantoprazole and in 22% (25 out of 113) receiving ranitidine (P < 0.001, per protocol population). After 8 weeks, the cumulative healing rates were 88% and 46%, respectively (P < 0.001). Complete freedom from esophagitis-related symptoms (acid eructation, heartburn, pain while swallowing) was greater in the pantoprazole than in ranitidine group after 2 and 4 weeks (74% vs. 47%; 87% vs. 52%, respectively, P < 0.001). After 4 weeks, the healing rate was 76% in Helicobacter pylori (Hp)-positive vs. 45% in Hp-negative patients treated with pantoprazole (P < 0.01). The Hp status did not influence healing rates in patients treated with ranitidine. The most frequent adverse events in the pantoprazole group were diarrhea and somnolence (2-3% of patients), and in the ranitidine group, headache, diarrhea, dizziness, increase of liver enzymes and pruritus (2-4% of patients). In conclusion, pantoprazole was more effective than ranitidine in the healing rate and relief from reflux esophagitis-associated symptoms, and Hp infection was associated with higher healing rate during therapy with pantoprazole but not with ranitidine.
Asunto(s)
Bencimidazoles/administración & dosificación , Esofagitis Péptica/tratamiento farmacológico , Infecciones por Helicobacter/complicaciones , Helicobacter pylori/aislamiento & purificación , Ranitidina/administración & dosificación , Sulfóxidos/administración & dosificación , 2-Piridinilmetilsulfinilbencimidazoles , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Bencimidazoles/efectos adversos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Esofagitis Péptica/complicaciones , Esofagitis Péptica/diagnóstico , Femenino , Estudios de Seguimiento , Infecciones por Helicobacter/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Omeprazol/análogos & derivados , Pantoprazol , Probabilidad , Ranitidina/efectos adversos , Medición de Riesgo , Sulfóxidos/efectos adversos , Resultado del Tratamiento , Cicatrización de Heridas/efectos de los fármacos , Cicatrización de Heridas/fisiologíaRESUMEN
Over a 5-year period (1985 to 1990), 25 patients (11 men and 14 women, median age 68) with adenomatous tumors of the papilla of Vater judged to be benign by endoscopic appearance and forceps biopsy were included in this study. All patients had de novo tumors except for two patients who had recurrent adenomas after local surgical excision. Presenting symptoms included pain (19 patients), jaundice (9 patients), and pancreatitis (4 patients). ERCP showed bile and pancreatic duct dilation in 20 patients (6 with stones) and 2 patients, respectively. The adenoma and the papilla of Vater were excised using a standard polypectomy snare (snare papillectomy). Procedure-related complications included bleeding in two patients and acute pancreatitis in three patients. No deaths occurred. Histologic analysis showed benign adenoma with mild to moderate dysplasia in 18 patients and severe dysplasia in 1 patient. Two patients with evidence for intraductal tumor extension on ERCP were referred for surgery. Six patients had recurrences at a median follow-up of 37 months (range, 7 to 79 months), of whom one had intraductal tumor spread and underwent pancreatoduodenectomy. Five patients were re-treated endoscopically; one ultimately required surgery.
Asunto(s)
Adenoma/cirugía , Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco/cirugía , Endoscopía , Adenoma/diagnóstico por imagen , Adenoma/patología , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática/diagnóstico por imagen , Ampolla Hepatopancreática/patología , Colangiopancreatografia Retrógrada Endoscópica , Neoplasias del Conducto Colédoco/diagnóstico por imagen , Neoplasias del Conducto Colédoco/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de NeoplasiaRESUMEN
Ninety-seven patients with bleeding esophageal varices due to mansonic schistosomiasis were treated with endoscopic sclerotherapy. Seventy-five patients (Group I) had previously undergone surgery for portal hypertension and presented with bleeding recurrence. Twenty-two patients (Group II) had not undergone surgical treatment. The sclerotherapy technique employed was intravascular (IV) injections of ethanolamine in 40 patients and paravascular (PV) in 57 patients. Of a total of 38 (39%) patients who had bleeding recurrence, 27 (36%) were from Group I and 11 (50%) from Group II (p less than 0.005). Over a follow-up period of 48 to 132 months, 367 sessions of sclerotherapy were carried out in the 72 remaining patients from Group I (4.93 +/- 2.05). The remaining 16 patients from Group II needed 121 (7.56 +/- 2.70) sessions of sclerotherapy (p less than 0.001). Thus, sclerotherapy was effective in the control of rebleeding in 73 (97.3%) patients from Group I and 16 (72.7%) from Group II (p less than 0.05). We conclude that previous surgical treatment for portal hypertension in patients with mansonic schistosomiasis, greatly benefits treatment of rebleeding esophageal varices by endoscopic sclerotherapy. This is probably due to the lower portal pressure after splenectomy.
Asunto(s)
Várices Esofágicas y Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Esquistosomiasis mansoni/complicaciones , Escleroterapia , Adolescente , Adulto , Anciano , Várices Esofágicas y Gástricas/etiología , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/cirugía , Masculino , Persona de Mediana EdadRESUMEN
Endoscopic sclerotherapy for bleeding esophageal varices was carried out in 78 patients with schistosomiasis (Group I) and 71 cirrhotic patients (Group II). All Group I patients had uniformly good liver function. According to Child's classification 25 patients (35%) of Group II were Child A, 16 (23%) Child B and 30 (42%) Child C. The sclerotherapy was performed by intravascular injections of 3% ethanolamine. Throughout a follow-up period of at least 24 months, hemorrhage recurred in 13% of the Group I patients, with one death (1%). The Child A category had a 24% recurrence with a 4% death rate, Child B a 38% recurrence with a 50% death rate, and Child C group a 73% recurrence with no survivals. A comparison of patients with schistosomiasis and cirrhosis type A revealed no differences with respect to rebleeding or survival (p greater than 0.05). Differences were significant for bleeding recurrence and survival in Child B patients as compared with schistosomiasis patients (p less than 0.025). This difference was highly remarkable when patients with schistosomiasis were compared with Child C cases, both for recurrence and survival (p less than 0.001). On the basis of these observations it is concluded that results of sclerotherapy depend fundamentally on liver function, and thus this procedure is justified in the early phases of liver cirrhosis.