Wine stimulates gastric acid secretion in isolated rabbit gastric glands via two different pathways

Randomized trial comparing rabeprazole- versus lansoprazole-based Helicobacter pylori eradication regimens

Different types of proton pump inhibitor (PPI)-based triple therapies could result in different Helicobacter pylori eradication rates. This study aimed to compare the efficacy and safety of rabeprazole- and lansoprazole-based triple therapies in primary treatment of H. pylori infection. From September 2005 to July 2008, 426 H. pylori-infected patients were randomly assigned to receive a 7-day eradication therapy with either rabeprazole 20mgbid (RAC group, n=222) or lansoprazole 30mgbid (LAC group, n=228) in combination with amoxicillin 1gbid and clarithromycin 500mgbid. The patients received follow-up esophagogastroduodenoscopy (EGD) and/or (13)C-urea breath test 12-16 weeks later to define H. pylori status. Their personal and medical history, compliance and side effects were obtained by using a standardized questionnaire. Intention-to-treat analysis revealed that the eradication rate was 87.84% in the RAC group and 85.96% in the LAC group (p=0.56). All patients returned for assessment of compliance (100% in the LAC group vs. 99.50% in the RAC group; p=0.32) and adverse events (7.20% in the RAC group vs. 5.70% in the LAC group, p=0.51). Univariate analysis suggested that patients with nonsteroid anti-inflammatory agent (NSAID) use had lower eradication rates than those without (76.71% vs. 88.74%; p=0.006). Our results showed that efficacy and safety were similar in rabeprazole- and lansoprazole-based primary therapies. The influence of NSAID usage on H. pylori eradication needs to be further investigated.

Identification of organic acids in wine that stimulate mechanisms of gastric acid secretion

Wine may cause stomach irritation due to its stimulatory effect on gastric acid secretion, although the mechanisms by which wine or components thereof activate pathways of gastric acid secretion are poorly understood. Gastric pH was measured with a noninvasive intragastric probe, demonstrating that administration of 125 mL of white or red wine to healthy volunteers stimulated gastric acid secretion more potently than the administration of equivalent amounts of ethanol. Between both beverages, red wine showed a clear trend for being more active in stimulating gastric acid secretion than white wine (p = 0.054). Quantification of the intracellular proton concentration in human gastric tumor cells (HGT-1), a well-established indicator of proton secretion and, in turn, stomach acid formation in vivo, confirmed the stronger effect of red wine as compared to white wine. RT-qPCR experiments on cells exposed to red wine also revealed a more pronounced effect than white wine on the fold change expression of genes associated with gastric acid secretion. Of the quantitatively abundant organic acids in wine, malic acid and succinic acid most actively stimulated proton secretion in vitro. However, addition of ethanol to individual organic acids attenuated the secretory effect of tartaric acid, but not that of the other organic acids. It was concluded that malic acid for white wine and succinic acid for red wine are key organic acids that contribute to gastric acid stimulation.

Less irritative action of wine and Japanese sake in rat stomachs: a comparative study with ethanol

The ingestion of alcohol, especially in excess, causes acute gastric lesions and gastritis in humans, yet the mucosal irritative action of alcoholic beverages remains largely unknown. We examined the mucosal irritative action of whiskey, wine and Japanese sake in the rat stomach both ex vivo and in vitro, in comparison with ethanol. Under urethane anesthesia, a rat stomach was mounted in an ex vivo chamber, then superfused with saline, and the transmucosal potential difference (PD) was measured. After the basal PD had stabilized, the mucosa was exposed for 30 min to 2 ml of 15% ethanol, whiskey (containing 15% ethanol), white wine, or Japanese sake (the ethanol concentration of the latter two is 12-15%). In the in vitro study, rat epithelial cells (RGM1) were treated with the alcoholic beverages for 5 min, and the cell viability was determined with crystal violet. Ethanol or whiskey applied to the chamber caused a decrease in PD, while wine or Japanese sake did not. Histologically, surface epithelial damage was observed after exposure to both ethanol and whiskey, yet no damage was induced by white wine and Japanese sake. Likewise, both ethanol and whiskey markedly reduced the viability of RGM1 cells after 5 min of incubation, while neither white wine nor Japanese sake had any effect. In addition, supplementation of glucose significantly prevented the reduction in both PD and cell viability caused by ethanol. These results suggest that the mucosal irritative action of Japanese sake and white wine is much less pronounced than that of ethanol or whiskey and that the less damaging action of Japanese sake and white wine may be, at least partly, accounted for by the glucose contained in these alcoholic beverages.

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A prospective randomized trial of esomeprazole- versus pantoprazole-based triple therapy for Helicobacter pylori eradication

OBJECTIVE

This prospective, randomized, controlled, head-to-head study was conducted to compare the efficacies of esomeprazole- and pantoprazole-based triple therapies for Helicobacter pylori eradication.

METHODS

From January 2002 to October 2003, 200 H. pylori-infected patients were randomly assigned to undergo twice daily treatment with esomeprazole 40 mg (n = 100) or pantoprazole 40 mg (n = 100) combined with clarithromycin 500 mg and amoxicillin 1 g for 1 wk (ECA and PCA groups, respectively). Follow-up endoscopy was performed at 8 wks after the end of treatment to assess the treatment response.

RESULTS

Intention-to-treat analysis demonstrated a significantly higher eradication rate for the ECA group than for the PCA group (94%vs 82%, respectively, p= 0.009). Per-protocol analysis also showed similar results (97%vs 84%, p= 0.003). Both groups had similar frequencies of adverse events (15%vs 24%) and drug compliance (97%vs 96%). Multivariate analysis disclosed that the use of esomeprazole (OR: 1.56, 95% CI, 1.11-2.19) and good compliance 7.39 (95% CI, 1.27-42.95) were independent predictors of treatment success. Alcohol drinking was an independent predictor of eradication failure (OR: 0.18; 95% CI, 0.06-0.54).

CONCLUSION

Esomeprazole-based triple therapy demonstrated a higher eradication rate than pantoprazole-based regimen. The differences in eradiation efficacies between the two study groups may be related to the more powerful acid inhibition effect and stronger anti-H. pylori activity of esomeprazole compared to pantoprazole.

Effects of whisky on plasma gastrin and cholecystokinin in young adult men

Whisky (1 g/kg, 21.5% alcohol) was administered orally to healthy young adult male volunteers, and changes in the plasma concentrations of alcohol, acetaldehyde, gastrin, cholecystokinin (CCK) and serum amylase were measured over time. Values for alcohol and acetaldehyde rapidly reached a peak at 30-45 min after alcohol intake, followed by a gradual decline. The plasma gastrin concentration showed a rapid elevation, while the plasma CCK concentration did not exhibit any significant changes in the early phase after alcohol intake. Elevation of CCK was observed after 75 min, however. These results show that intake of whisky stimulates the secretion of gastrin and is associated with a later increase in CCK.