Sucralfate in the prevention of duodenal ulcer relapse and factors influencing the relapse rate

Forty three subjects with DU confirmed at endoscopy and healed after eight weeks of sucralfate therapy were subjected to a randomized double-blind controlled trial for six months. Twenty one subjects received sucralfate (1 g one hour before breakfast and dinner). Twenty two subjects received placebo. Symptoms were evaluated every month. The subjects were endoscoped at the end of the trial or earlier in case symptoms recurred. Sucralfate was found to be significantly more effective than placebo (6/21 vs. 17/22, p < 0.005) in preventing DU relapse. Age at presentation, age at onset, duration of illness, sex, periodicity, smoking, gastric stasis like symptoms, associated irritable bowel syndrome, degree of deformity of the bulb and initial presence of duodenitis were the factors examined for their effect upon the relapse. In the placebo group relapsers had significantly shorter mean duration of illness indicating that DU may relapse more frequently in earlier part of its natural course. Other factors did not influence the relapse rate. In the sucralfate group, higher ages at onset and at presentation were associated with significantly higher relapse rate. Sucralfate may be less effective in preventing relapse in elderly and late onset DU patients.

Factors influencing development of bulbar deformity in duodenal ulcer disease

Sixty subjects were carefully interrogated and repeatedly endoscoped with a view to studying the effect of sucralfate on healing and recurrence of duodenal ulcer disease. Degree of bulbar deformity was noted during each endoscopy. During the trial it appeared that deformity progressed more rapidly in late onset subjects (onset at or above 30 years of age). In eight subjects deformity became gross over a period of three years. Seven of them belonged to the late onset subgroup. Two subject had large ulcers and both belonged to the late onset subgroup, one had rapidly progressive disease. Out of six subjects with multiple ulcers four belonged to the late onset subgroup, two of the later had rapidly progressive disease.

Complementary and Alternative Medicine in Cardiovascular Care

Complementary and alternative medicine (CAM) refers to a broad set of health care practices that are not part of a country’s own tradition and are not integrated into the dominant health care system. Herbal remedies, dietary supplements, acupuncture, homeopathy, ayurveda, unani, traditional Chinese medicine, prayer, yoga and meditation are the common examples. CAM therapies often represent an enormous area of unregulated and widely practised therapeutics with an inadequate scientific literature. However, there is emerging evidence that some of the CAM therapies are effective in certain clinical conditions. Presently, throughout the world, there is rampant growth of CAM industries, and increasing number of reputed pharmaceutical companies are producing herbals and dietary supplements. Herbal products used for cardiovascular purposes include garlic, hawthorn, ginkgo, horse chestnut and arjun. These substances are often popularly believed to be ‘natural’, hence safe. But adverse reactions including deaths have been reported with some of the CAM products. There is also growing concern for significant drug interaction among commonly used herbals, dietary supplements and cardiovascular drugs. At present, CAM therapies may best be regarded as an adjunct to standard medical care. More scientific research and strict regulation by standard national and international authorities are needed to ensure their efficacy and safety in cardiovascular care. Key words: Complementary and alternative medicine, Herbals, Cardiovascular care. DOI: http://dx.doi.org/10.3329/cardio.v1i1.8211 Cardiovasc. j. 2008; 1(1) : 84-96