Current approaches in the medical treatment of oesophageal reflux

Gastro-oesophageal reflux and its complications are a common clinical management problem. Medical treatment revolves around the use of physical and mechanical methods in prevent reflux, dieting and drug restriction, acid reduction, mechanical foam barriers, and drugs to increase lower oesophageal sphincter (LES) pressure and improve acid clearance. It is recommended that patients elevate the head of their bed at night, eliminate alcohol and smoking, and avoid food known to decrease LES pressure or irritate the oesophageal mucosa. Antacids are effective in the control of reflux symptoms in most patients with mild to moderate reflux oesophagitis. 'Gaviscon' is also effective but no better than antacids. The histamine H2 receptor blocker, cimetidine, alleviates symptoms and may also improve endoscopic and histological oesophagitis. Cimetidine and drugs which augment sphincter pressure (bethanechol, metoclopramide, domperidone and prostaglandins) may be helpful in treating patients with severe reflux oesophagitis.

Bismuth subsalicylate therapy of viral gastroenteritis

The therapeutic efficacy of bismuth subsalicylate was examined in a randomized double-blind fashion in 59 volunteers who were inoculated with Norwalk agent. Sixty-eight percent of the volunteers demonstrated seroconversion; 57% became ill. The severity and duration of the illness in 32 volunteers in the treatment and placebo groups were compared. Significant reduction in the severity and duration of abdominal cramps (P less than 0.01) and in the median duration of GI symptoms (P less than 0.05) was noted in the treatment group. There was no difference in the number, weight, or water content of stools, or in the rate of viral excretion between the two groups. The median duration of illness was 20 hr in the treatment group and 27 hr in the placebo group (0.1 greater than P greater than 0.05).

A three-part controlled study of trimebutine in the treatment of irritable colon syndrome

Three controlled trials were carried out in patients with irritable bowel syndrome to assess the effectiveness of trimebutine in controlling the symptoms of abdominal distension, pain, flatulence, constipation, diarrhoea and dyspepsia. In the first two trials, it was shown that 200 mg trimebutine 3-times daily for 3 days produced rapid relief of symptoms and was significantly (p less than 0.001) more effective than placebo, but not significantly so when the dosage level was halved. In the third trial, the results showed that 200 mg trimebutine 3-times daily for 2 weeks was as effective as 100 mg mebeverine 4-times daily in relieving the major symptoms and in improving motility. No serious side-effects were reported with trimebutine at the dosage used.

The symptomatic treatment of heartburn and dyspepsia with Liquid Gaviscon: a multicentre general practitioner study

In a multicentre open study, Liquid Gaviscon was shown to give effective relief of heartburn and dyspepsia in over 82% of patients. Symptomatic relief was obtained during the day and at night-time and the treatment was as effective whether the patients had a short (0-4 weeks) or long (more than 1 year) history of problems.

Drug therapy of patients treated in hospitals for duodenal ulcers

Drug therapy in hospitalized patients treated for duodenal ulcer disease was reviewed retrospectively. The information was obtained by the means of a medical audit of patient records indexed by the discharge diagnosis of duodenal ulcers. A total of 485 cases were abstracted. Antacids were found to be the cornerstone of duodenal ulcer drug therapy. Anticholinergic drugs occupied a central role throughout the medical treatment of duodenal ulcers. The investigators identified a need for the dissemination of information concerning the use of anticholinergics in duodenal ulcer patients experiencing the complications of hemorrhage and obstruction.

Acute severe mastitis in cows of the Dutch-Friesian Breed (author's transl)

One hundred cases of severe acute mastitis are reported. Bacteriological examination of the milk was negative in 23% of the cases. E. coli was most frequently found to be the causative organism (23%), followed by St. aureus (19%), C. pyogenes (10%), Str. dysgalactiae (9%), Str. agalactiae (5%) and a number of other pathogenic agents such as atypical streptococci, Str. uberis, haemolytic streptococci, Aerobacter aerogenes, Kl. pneumoniae, a clostridium and P. multocida. In several cases, a tentative diagnosis may be based on the clinical symptoms, which is then found to be correct on bacteriological examination of the milk. The prognosis will vary with the causative organism. Treatment was life-saving in more than 90% of the cases, the milk-producing capacity of the affected quarter being completely preserved in 36% and partly preserved in 27% of the cases.

Increased formation of ursodeoxycholic acid in patients treated with chenodeoxycholic acid

The formation of ursodeoxycholic acid, the 7 beta-hydroxy epimer of chenodeoxycholic acid, was investigated in three subjects with cerebrotendinous xanthomatosis and in four subjects with gallstones. Total biliary bile acid composition was analyzed by gas-liquid chromatography before and after 4 months of treatment with 0.75 g/day of chenodeoxycholic acid. Individual bile acids were identified by mass spectrometry. Before treatment, bile from cerebrotendinous xanthomatosis (CTX) subjects contained cholic acid, 85%; chenodeoxycholic acid, 7%; deoxycholic acid, 3%; allocholic acid, 3%; and unidentified steroids, 2%; while bile from gallstone subjects contained cholic acid, 45%; chenodeoxycholic acid, 43%; deoxycholic acid, 11%, and lithocholic acid, 1%. In all subjects, 4 months of chenodeoxycholic acid therapy increased the proportion of this bile acid to approximately 80% and decreased cholic acid to 3% of the total biliary bile acids, the remaining 17% of bile acids were identified as ursodeoxycholic acid. After the intravenous injection of [3H]chenodeoxycholic acid, the specific activity of biliary ursodeoxycholic acid exceeded the specific activity of chenodeoxycholic acid, and the resulting specific activity decay curves suggested precursor-product relationships. When [3H]7-ketolithocholic acid was administrated to another patient treated with chenodeoxycholic acid, radioactivity was detected in both the ursodeoxycholic acid and chenodeoxycholic acid fractions. These results indicate that substantial amounts of ursodeoxycholic acid are formed in patients treated with chenodeoxycholic acid. The ursodeoxycholic acid was synthesized from chenodeoxycholic acid presumably via 7-ketolithocholic acid.