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A variety of gastrointestinal diseases involve an imbalance between the protective actions of the gastrointestinal mucosa and the destructive actions of hydrochloric acid, which is secreted by the stomach. Many forms of treatment involve pharmacological agents that suppress gastric acid. Gastric acid is secreted from the parietal cells of the stomach through a process critically dependent on the enzyme hydrogen/potassium-ATPase, which exchanges intracellular hydrogen ions for extracellular potassium ions, thus increasing the acidity of the extracellular environment. As a novel drug for the suppression of gastric acid secretion, omeprazole is a specific inhibitor of this enzyme. Omeprazole is not stable in an acidic environment like the stomach, so it is administered as enteric-coated capsules, which do not dissolve until they reach the duodenum. The onset of action of omeprazole is approximately one hour, with a peak activity six hours after administration. As a result of omeprazole's suppression of gastric acid secretion, it also has the effect of causing a counter-regulatory increase in the release of gastrin (a hormone that induces acid secretion) from the cells of the stomach, and in the long-term, the number of gastrin-secreting cells is increased. This does not appear to enhance the likelihood of either ulcer recurrence following drug termination or neoplastic alterations in the cells of the stomach. Omeprazole has recently been approved by the FDA for use in the treatment of duodenal ulcer and gastric ulcer. It is also used in the treatment of both refractory ulcerative conditions that do not respond to more conventional forms of therapy and gastroesophageal reflux esophagitis (inflammation of the esophagus caused by regurgitated gastric acid). An extremely low incidence of side effects and a favorable safety profile make this drug very promising for treatment of a wide variety of gastric acid-related disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Histamine is a hormone that stimulates the secretion of acid from certain stomach cells. Drugs that block histamine action in the stomach, histamine H2 blockers, have been widely and successfully used to treat stomach ulcers, with healing occurring at a rate of 80 percent after four weeks of ranitidine (an H2 blocker). Omeprazole is a drug which decreases acid secretion by a different method, and was more effective in treating ulcers than ranitidine in preliminary studies. A more extensive study of the two drugs has been completed. The proportion of healed ulcers after treatment with each drug was studied in 194 patients (51 women) with duodenal (junction between stomach and small intestine) or gastric (stomach) ulcers. Omeprazole provided better healing, especially during the first two weeks. At two and at four weeks, the percent of ulcers healed by omeprazole was 68 and 99, respectively. After two and after four weeks of ranitidine treatment, the percent of ulcers healed was 48 and 88, respectively. This is probably related to the greater effectiveness of omeprazole in suppressing acid secretion. Patients reported less pain with omeprazole, as well. The ulcer recurrence rates were similar for each drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

V.K. Sharma [1] C.W.Howden [2] (1.) University of Arkansas for Medical Sciences, Little Rock, AR; (2.) Northwestern University, Chicago, IL, USA Recent interest has focused on a possible preventive role [...]

V.K. Sharma [1] G.I. Leontiadis [2] C.W. Howden [3] (1.) University of Arkansas for Medical Sciences, Little Rock, AR, USA; (2.) 'G. Papanikolaou' Hospital, Thessaloniki, Greece; (3.) Northwestern University, Chicago, [...]

Objective: To compare the effectiveness of lansoprazole 30mg once daily and esomeprazole 40mg once daily on healing and symptom relief in patients with erosive oesophagitis. Design: Phase IV, randomised, double-blind, active-controlled, multicentre study. Patients and participants: 284 patients with endoscopically confirmed erosive oesophagitis (grade ≥2). Methods: Patients were randomised to treatment with lansoprazole or esomeprazole. The primary efficacy endpoint was the healing of erosive oesophagitis (defined as grade 0 or 1) at week 8. Healing rates at week 4 and the percentages of patients reporting no daytime or night-time heartburn after 1 day, 3 days and 1 week of treatment, as well as the rate of healing or improvement of oesophagitis by two grades, were also analysed. Results: Healing rates and 95% confidence intervals (CIs) at week 8 were 91.4% (85.4, 95.5%) for lansoprazole 30mg once daily and 89.1% (82.7, 93.8%) for esomeprazole 40mg once daily, respectively. For any baseline grade, greater than 90% of lansoprazole-treated and 81% of esomeprazole-treated patients exhibited healing or improvement of erosive oesophagitis by two grades from baseline to week 8. Healing rates at week 4 were also comparable: 77.0% (95% CI 69.1, 83.7%) for lansoprazole 30mg and 78.3% (95% CI 70.4, 84.8%) for esomeprazole 40mg. The percentages of heartburn-free patients after 1 day, 3 days and 1 week of treatment were slightly higher for lansoprazole compared with esomeprazole, although the differences did not reach statistical significance (p > 0.05). Both treatments were well tolerated. Conclusions: In erosive oesophagitis, lansoprazole 30mg once daily and esomeprazole 40mg once daily are equally effective in healing erosions and relieving heartburn. [ABSTRACT FROM AUTHOR]

Presents reactions to the medical issues of the 'British Medical Journal' in Great Britain. Restrictions on blood donors; Safety of Acyclovir in pregnancy; Treatment of analgesics.

Examines the maintenance treatment with hydrogen receptor antagonists in patients with peptic ulcer disease in terms of cost or patient benefit. Effectiveness of hydrogen receptor antagonists in keeping ulcer in remission; Treatment of patients with ulcer disease; Importance of treatment to be effective and safe.

Discusses the efficacy and safety of analgesics used for the treatment of common minor disorders occurring in pregnancy in Great Britain. Use of analgesics in early stages of pregnancy; Effect of analgesics on the fetus; Treatment of constipation by a bulking agent.

Examines the association of idiopathic hypoparathyroidism with stable untreated myelofibrosis. Effect of chemotherapy to neoplasms predisposing to hypoparathyroidism; Case report on a 77 year old woman with myelofibrosis; Convulsions associated with hypocalcemia; Significance of magnesium concentrations in parathyroid secretion.