Five-year cimetidine maintenance trial for peptic ulcer disease. A clinical and endocrinologic approach

Prolactin Induces IL-2 Associated TRAIL Expression on Natural Killer Cells from Chronic Hepatitis C Patients In vivo and In vitro

BACKGROUND

Natural killer cells (NKC) are a major component of the innate immune response to HCV, mediating their effects through TRAIL and IFN-γ. However, their function is diminished in chronic HCV patients (HCVp). Prolactin is an immunomodulatory hormone capable of activating NKC.

OBJECTIVE

The study aims to explore if hyperprolactinemia can activate NKC in HCVp.

METHODS

We treated twelve chronic HCVp (confidence level =95%, power =80%) for 15 days with Levosulpiride plus Cimetidine to induce mild hyperprolactinemia. Before and after treatment, we determined TRAIL and NKG2D expression on peripheral blood NKC, along with cytokine profiles, viral loads and liver function. We also evaluated in vitro effects of prolactin and/or IL-2 on NKC TRAIL or NKG2D expression and IFN-γ levels on cultured blood mononuclear cells from 8 HCVp and 7 healthy controls.

RESULTS

The treatment induced mild hyperprolactinemia and increased TRAIL expression on NKC as well as the secretion of IL-1ra, IL-2, PDGF and IFN-γ. Viral loads decreased in six HCVp. IL-2 and TRAIL together explained the viral load decrease. In vitro, prolactin plus IL-2 synergized to increase TRAIL and NKG2D expression on NKC from HCVp but not in controls.

CONCLUSION

Levosulpiride/Cimetidine treatment induced mild hyperprolactinaemia that was associated with NKC activation and Th1-type cytokine profile. Also, an increase in TRAIL and IL-2 was associated with viral load decrease. This treatment could potentially be used to reactivate NKC in HCVp.

Cimetidine use and the risk for prostate cancer: results from the VITAL cohort study

PURPOSE

The histamine-2 (H(2)) blocker cimetidine may alter androgen, zinc, and prolactin levels, which could alter prostate cancer risk. Increased risk for men filling more than 20 cimetidine prescriptions was reported previously. We examined the association between cimetidine use and prostate cancer risk in a cohort in western Washington State.

METHODS

Participants were 33,506 men, 50 to 76 years old, enrolled in the VITamins And Lifestyle cohort (VITAL). H(2)-blocker use during the prior 10 years was self-reported through baseline questionnaire between October 2000 and December 2002. Men were followed up for subsequent prostate cancer by linkage to the Surveillance, Epidemiology and End Results cancer registry. We identified 548 incident invasive prostate cancer cases diagnosed from baseline to December 31, 2003.

RESULTS

Overall, no association between ever use of cimetidine or years of cimetidine use and prostate cancer risk was observed. However, daily cimetidine use for 10 years was associated with increased risk (relative risk, 2.35; 95% confidence interval, 1.05-5.26) compared with nonuse of any H(2) blockers. Use of other H(2) blockers was not associated with prostate cancer.

CONCLUSIONS

Additional studies are needed to determine whether long-term daily cimetidine use is associated with increased prostate cancer risk in other populations, and if so, the reason for this association.

The prescribing of acid suppressants prior to the endoscopic diagnosis of Barrett's oesophagus and oesophagitis

BACKGROUND

There has been a dramatic rise in incidences of Barrett's oesophagus and oesophageal adenocarcinoma. It has been suggested that the introduction and use of acid suppression therapy may be a factor in the rising incidences of Barrett's oesophagus and oesophageal adenocarcinoma.

METHODS

This was a record linkage study, using a prescribing database and an endoscopy database. Patients who had undergone their first endoscopy during the period 1992-1995 and received the diagnosis of Barrett's oesophagus or oesophagitis were identified. The prescribing of acid suppressants was compared for the 3 years prior to endoscopy, between those with Barrett's oesophagus and those with oesophagitis.

RESULTS

There was no significant difference between the Barrett's patients and the oesophagitis patients in the proportion that had been exposed to acid suppression therapy (53.4% vs. 51.7%, P=0.704). The mean number of days of prescribing among those who had been exposed to acid suppression therapy was higher in the Barrett's group (340.5 vs. 237.0 days, P=0.001).

CONCLUSIONS

Patients with Barrett's oesophagus have received more acid suppressant therapy prior to diagnosis. The reasons for this are not clear. However, 46.6% of Barrett's patients have not been exposed to acid suppressant therapy.

The natural course of peptic ulcer disease and its predictors

BACKGROUND

Little is known about today's natural course of peptic ulcer disease (PUD).

METHODS

A follow-up study based on a structured telephone interview was attempted in 728 patients with an endoscopic diagnosis of peptic ulcer in 1980-84.

RESULTS

Seven patients (1%) died because of PUD during the 8- to 10-year follow-up period. Of the 441 interviewed patients 15.2% had experienced no further clinical manifestations of PUD, 10.9% had had bleeding and 0.7% perforation, and 17.5% had been operated on. The operated patients reported fewer symptoms (p < 0.01) during the last 2 weeks before the interview than those not operated on. On an average the unoperated patients had had symptoms and had used histamine-2-receptor antagonists (H2RA) 12 and 10 weeks per year, respectively. Long-term treatment with H2RA was reported by 18%. More than one-third (36%) of the unoperated patients stated that the symptoms had had a significant negative impact on their lives. Age at onset of disease and index ulcer, family history, use of anti-inflammatory drugs and alcohol, bleeding, and another chronic disease were found to be significant predictors of the course.

CONCLUSION

In more than one-third of the patients with PUD the course is still burdened with many symptoms and complications.

Tolerance during dosing with H2-receptor antagonists. An overview

Diminution of antisecretory effect of H2-receptor antagonists with repeated oral dosing, termed tolerance, has been established in healthy volunteers. Anecdotal evidence indicates the development of tolerance with intravenous dosing. These findings demonstrate that tolerance may be clinically relevant in diseases where tight control of acidity is required. Patients with duodenal ulcer disease, however, do not develop significant tolerance, according to the sparse investigations available. Tolerance will, at most, only be of minor clinical significance in failures of DU to heal. The mechanisms implicated in the development of tolerance remain unclear.