Comparative study of therapeutic effects of PPI and H2RA on ulcers during continuous aspirin therapy

AIM:To compare the therapeutic effects of proton pump inhibitors(PPI) and histamine 2 receptor antagonists(H2RA) on gastroduodenal ulcers under continuous use of low-dose aspirin.METHODS:Sixty patients who had a gastroduodenal ulcer on screening endoscopy but required continuous use of low-dose aspirin were randomly assigned to receive PPI(lansoprazole 30 mg,n = 30) or H2RA(famotidine 40 mg or if famotidine had been administered before assignment,ranitidine 300 mg,n = 30).The therapeutic effects were evaluated by endoscopy after 8-wk treatment.The presence or absence of Helicobacter pylori(H.pylori) was determined by urea breath test before treatment.Abdominal symptoms were compared with the gastrointestinal symptom rating scale(GSRS) questionnaire before and after treatment.RESULTS:Twenty-six patients in the PPI group and 26 patients in the H2RA group,excluding dropouts,were analyzed.There were no significant differences in median age,sex,underlying disease,smoking status,H.pylori infection,prevalence of ulcers before treatment,and lesion site between the two groups.The therapeutic effects were endoscopically evaluated as healed in 23 patients(88.5%) and not healed in 3 patients in the PPI group and as healed in 22 patients(84.6%) and not healed in 4 patients in the H2RA group.Abdominal symptoms before treatment were uncommon in both groups;the GSRS scores were not significantly reduced after treatment as compared with before treatment.CONCLUSION:The healing rate of gastroduodenal ulcers during continuous use of low-dose aspirin was greater than 80% in both the PPI group and the H2RA group,with no significant difference between the two groups.

Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis

AIM: To investigate the effect of gastric acid suppressants and prokinetics on peritonitis development in peritoneal dialysis(PD) patients.METHODS: This was a single-center, retrospective study. The medical records of 398 PD patients were collected from January 2000 to September 2012 and analyzed to compare patients with at least one episode of peritonitis(peritonitis group, group A) to patients who never had peritonitis(no peritonitis group, group B). All peritonitis episodes were analyzed to compare peritonitis caused by enteric organisms and peritonitis caused by non-enteric organisms.RESULTS: Among the 120 patients who met the inclusion criteria, 61 patients had at least one episode ofperitonitis and 59 patients never experienced peritonitis. Twenty-four of 61 patients(39.3%) in group A and 15 of 59 patients(25.4%) in group B used gastric acid suppressants. Only the use of H2-blocker(H2B) was associated with an increased risk of PD-related peritonitis; the use of proton pump inhibitors, other antacids, and prokinetics was not found to be a significant risk factor for PD-related peritonitis. A total of 81 episodes of peritonitis were divided into enteric peritonitis(EP) or non-enteric peritonitis, depending on the causative organism, and gastric acid suppressants and prokinetics did not increase the risk of EP in PD patients.CONCLUSION: The use of H2B showed a trend for an increased risk of overall PD-related peritonitis, although further studies are required to clarify the effects of drugs on PD-related peritonitis.