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Biomedical subjects

F Parente

Publications and source records attributed to F Parente.

At least 91 records · Page 5Linked to original sources
PubMed1993

Short and long term outcome of Helicobacter pylori positive resistant duodenal ulcers treated with colloidal bismuth subcitrate plus antibiotics or sucralfate alone.

Thirty two patients with Helicobacter pylori positive duodenal ulcers resistant to treatment were randomly assigned to 4 weeks' treatment with sucralphate 4 g/day or colloidal bismuth subcitrate 480 mg/day plus amoxycillin from days 1 to 7 and tinidazole from days 8 to 14. After 4 weeks, patients with unhealed ulcers were crossed over to the other form of treatment for a further 4 week period. Patients with healed ulcers were followed up for 1 year without maintenance therapy with clinical and endoscopic investigations 3, 6, and 12 months after healing. Complete healing rates at 4 weeks were 88% (15 of 17) in the colloidal bismuth subcitrate plus antibiotics group and 40% (six of 15) in the sucralphate group (p < 0.05). After cross over, overall healing rates were 88% (22 of 25) and 47% (eight of 17), respectively (p < 0.05). H pylori eradication occurred in 83% of patients treated with the triple therapy. Cumulative relapse rates at 12 months were 12% (two of 17) in patients in whom H pylori had been eradicated and 100% (10 of 10) in those with persistent infection after short term therapy (p < 0.05). These results show that a colloidal bismuth subcitrate plus antibiotics regimen is highly effective in the short term treatment of resistant duodenal ulcers and that H pylori eradication can change the natural tendency to early recurrence of these ulcers.

Adult↗
PubMed1993

Non-Hodgkin's lymphoma and AIDS: frequency of gastrointestinal involvement in a large Italian series.

Even though the close association between AIDS and non-Hodgkin's lymphoma (NHL) is widely known, few studies have evaluated the frequency of gastrointestinal involvement in a large series of AIDS patients with heterogeneous risk factors. We therefore reviewed the demographic and clinical features of patients with AIDS and NHL seen at our institution over a period of 5 years. NHLs complicated AIDS in 70 of 786 (9%) cases in our study. All but one of the tumours were of high- or intermediate-grade histologic subtype, and 80% of 56 patients with diagnosis made during lifetime had disease stages III or IV, most with extranodal localization. The gastrointestinal tract was involved in 23 cases (33%), 13 of whom had an antemortem diagnosis. All these patients complained of significant symptoms, the most frequent being GI bleeding followed by recurrent abdominal pain with or without masses. Three patients had evidence of lymphomatous disease along both the upper and lower GI tract, but more often a single localization was present. Prognosis of patients with NHLs was very poor, and there was no significant difference in survival between patients with and without GI localization at the time of initial diagnosis.

Adolescent↗
PubMed1992

Topically active drugs in the treatment of peptic ulcers. Focus on colloidal bismuth subcitrate and sucralfate.

Topically active agents (i.e., colloidal bismuth subcitrate and sucralfate) have proved to be effective in promoting the healing of both gastric and duodenal ulcers and in relieving ulcer symptoms. Sucralfate alone has also been shown to maintain peptic ulcers in remission when taken continuously for a long period of time, whereas successful short-term therapy with bismuth subcitrate is associated with a more prolonged remission of duodenal ulcer disease when compared to H2 blockers. The antiulcer efficacy of these agents is partially counteracted by the need for multiple daily administrations, which requires greater patient compliance than with H2 antagonists. A specific subgroup of patients who might particularly benefit from these drugs are those with duodenal ulcer resistant to H2 blockers, whereas chronic nonsteroidal antiinflammatory drug users with peptic ulcer respond to therapy with site-protective agents as well as to antisecretory drugs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

Diagnosing and treating opportunistic infections of the oesophagus in AIDS patients.

The acquired immunodeficiency syndrome (AIDS) has created new problems in many areas of medicine. One of the most frequent gastrointestinal clinical manifestations of the disease is dysphagia/odynophagia which occurs in over 50% of patients at any stage of the illness and may severely compromise, if untreated, the nutritional status of the patient. In most cases it is due to an infection of the oesophagus by opportunistic pathogens (fungi or viruses or both) and may be successfully treated, at least temporarily, by specific drugs. This article reviews the most recent acquisitions in terms of diagnosis and treatment of such common problems in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Diazemuls versus diazepam as premedication in upper gastrointestinal endoscopy: a randomised cross-over study.

The efficacy and tolerability of Diazemuls versus conventional diazepam as endoscopic premedication was evaluated in a study with a cross-over design performed in 26 patients undergoing upper gastrointestinal tract endoscopy. No statistically significant differences were found between the two forms of premedication with regard to degree of sedation, patient compliance or recovery of psychomotor function. With respect to short-term amnesic effects, efficacy and tolerability Diazemuls was comparable to the conventional formulation of diazepam. Diazemuls may therefore be proposed as an alternative premedication for endoscopy.

Adult↗
PubMed1991

Acute upper gastrointestinal bleeding in patients with AIDS: a relatively uncommon condition associated with reduced survival.

To determine the cumulative incidence of acute upper gastrointestinal bleeding and its effect upon survival in patients with AIDS, 453 consecutive AIDS patients diagnosed in our hospital between June 1985 and March 1989 were followed for a median period of six months (maximum 42 months). The cumulative probability of acute gastrointestinal bleeding was 3% at six months and 6% at 14 months. This event was associated with significantly reduced survival. Independent risk factors for bleeding were: severe thrombocytopenia at the time of diagnosis and non-Hodgkin's lymphoma as the first clinical manifestation of AIDS. The potential causes of bleeding were investigated in all cases by emergency endoscopy or by necropsy examination in those patients whose clinical condition precluded the procedure. In nine of 15 patients, bleeding was due to lesions specifically associated with AIDS, but in the remainder the source of bleeding was not a direct consequence of HIV infection. We conclude that acute upper gastrointestinal bleeding rarely complicates the course of AIDS, but its occurrence is associated with decreased survival. As many of the causes are potentially treatable, a complete diagnostic approach is indicated in these patients, except those who are terminally ill.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Long term treatment of duodenal ulcer. A review of management options.

Duodenal ulcer is a chronic disease characterised by remission and relapses. The duration of this relapsing tendency is unpredictable for the individual patient, but in most cases it lasts for many years and perhaps the entire lifetime. Various therapeutic strategies have been suggested to maintain the disease in remission: continuous, intermittent and on-demand treatment with H2-antagonists, or surgery. Continuous maintenance treatment with the currently available H2-blockers has proved to be superior to all the other strategies in terms of efficacy, and should therefore be regarded as the long term treatment of choice for duodenal ulcer patients. The duration of maintenance treatment is still uncertain, but probably it should not be less than a few years. Intermittent treatment or surgery could be proposed to patients unsuitable for continuous maintenance, depending on whether they have mild or aggressive disease, respectively.

Anti-Ulcer Agents↗
PubMed1991

Kaposi's sarcoma and AIDS: frequency of gastrointestinal involvement and its effect on survival. A prospective study in a heterogeneous population.

The frequency and distribution of gastrointestinal Kaposi's sarcoma were prospectively investigated in 33 consecutive AIDS patients with heterogeneous risk factors and established skin or lymph-node disease. The influence of visceral involvement and degree of immunosuppression at the time of diagnosis on patient survival was also evaluated. Gastrointestinal lesions were found in 17 cases (51%): 5 patients (15%) had both upper and lower GI tract involvement, 8 patients (24%) had only gastroduodenal lesions, and 4 (12%) only lower tract disease. No difference in the frequency of visceral involvement was found between the two major risk groups (homosexuals and intravenous drug abusers). The degree of immunosuppression at diagnosis was the major determinant of survival, whereas gastrointestinal involvement did not in itself significantly influence patient survival. Morbidity from enteric Kaposi's sarcoma was quite low, 80% of these lesions being clinically silent during the follow-up period.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Opportunistic infections of the esophagus not responding to oral systemic antifungals in patients with AIDS: their frequency and treatment.

To determine the spectrum of esophageal disease responsible for dysphagia/odynophagia in AIDS patients not responding to current oral antifungals, we studied 49 consecutive patients whose esophageal symptoms failed to improve after a minimum of 3 wk of therapy with oral ketoconazole or fluconazole. An esophageal candidiasis resistant to oral antifungals was the most frequent disease found (22 single infections and four mixed with viruses). Viral esophagitis was identified in 13 cases (eight herpes simplex virus and five cytomegalovirus), and an esophagitis of unknown origin was documented in two patients. Other causes of symptoms included peptic esophagitis (four cases), esophageal stenosis (two cases), and Kaposi's sarcoma of the esophagus (one patient). Most patients with esophageal opportunistic infection experienced prompt relief of symptoms and complete endoscopic resolution on the specific antifungal (amphotericin B or fluconazole iv) or antiviral (acyclovir or gancyclovir iv) therapy, with the exception of those with concomitant fungal and viral infection who responded poorly to treatment. We conclude that most AIDS patients with dysphagia/odynophagia who do not respond to oral antifungals have an opportunistic infection of the esophagus. Nevertheless, specific antifungal or antiviral therapy is worthwhile, because it will eradicate, at least temporarily, the causative pathogens in most such patients.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Inhibition of nocturnal acidity is important but not essential for duodenal ulcer healing.

We have determined the relative importance of day and night time gastric acid inhibition for duodenal ulcer healing by comparing the anti-ulcer efficacy of a single morning with that of a single bedtime dose of ranitidine. One hundred and thirty patients with active duodenal ulcer were randomly assigned to a double-blind therapy with ranitidine 300 mg at 8 am or the same dose at 10 pm for up to eight weeks. The antisecretory effects of these regimens were also assessed by 24 h intragastric pH monitoring in 18 of these patients. At four weeks ulcers had healed in 41/61 (67%) of patients taking the morning dose and in 47/63 (75%) of those receiving the nocturnal dose (95% CI for the difference -0.09 +0.25; p ns). At eight weeks, the corresponding healing rates were 82% and 85.5%, respectively (95% CI for the difference -0.11 +0.17; p ns). Both treatments were significantly superior to placebo in raising 24 h intragastric pH, although the effects of the morning dose were of shorter duration than those of the nocturnal dose. These findings suggest that suppression of nocturnal acidity is important but not essential to promote healing of duodenal ulcers; a prolonged period of acid inhibition during the day (as obtained with a single large morning dose of H2-blockers) may be equally effective.

Adult↗
PubMed1990

Antacids for duodenal ulcer: current role.

Recent years have witnessed significant progress in antacid therapy of duodenal ulcer disease, consisting in the demonstration that the doses required for ulcer healing are much smaller and less frequent that those regarded as necessary or optimal in the past. Antacids at these dosages proved to be as effective as H2-blockers both in terms of healing capacity and in relieving ulcer symptoms and are associated with negligible gastrointestinal side-effects. In addition, there has been a renewed interest in the tablet formulation, which now appears more acceptable to the patient. All these characteristics make antacids competitive with other anti-ulcer agents, especially in terms of the cost/benefit ratio.

Antacids↗
PubMed1990

Site-and cytoprotective drugs in the short-term treatment of peptic ulcer. What is their current role?

Many endoscopically controlled comparisons with H2-blockers have widely documented that site- and cytoprotective drugs constitute effective and safe agents for the short-term treatment of gastric and duodenal ulcer. Their efficacy however, is counter-acted by the need for multiple daily administration which requires greater patient compliance. Due to its ability to eradicate Helicobacter pylori (HP) from the gastric antrum and retard relapses, colloidal bismuth may be the first choice anti-ulcer drug for those HP positive patients who do not accept continuous maintenance treatment after healing. A specific subgroup of duodenal ulcer patients who may particularly benefit from a short-term treatment with such agents (namely colloidal bismuth) are the non-responders to an 8-week course of H2-antagonists; conversely, actual evidence does not support the hypothetical superiority of such agents over H2-blockers in the treatment of cigarette smokers or chronic consumers of NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

Rioprostil in the short-term treatment of duodenal ulcer: a multicentre double-blind trial vs. cimetidine.

The efficacy and safety of the new prostaglandin E1 (PGE1) synthetic analogue, rioprostil, 300 micrograms b.d. and cimetidine, 400 mg b.d., on duodenal ulcer healing are compared in an international, multicentre, double-blind study. A total of 257 patients have entered the study; 243 are considered eligible for efficacy analysis and 207 for safety analysis. After 4 and 6 weeks of treatment, the endoscopic healing rates do not significantly differ between the two groups, being 55% and 83% respectively with rioprostil vs. 60% and 78% respectively with cimetidine. The major adverse effect attributable to rioprostil is diarrhoea, which was documented in 11% of patients compared with 1% of patients taking cimetidine. However, central nervous system complaints are twice as frequent in the cimetidine group. Monitoring of clinical laboratory tests show no significant abnormalities when compared with the baseline values during the administration of either drug. This study documents that rioprostil, at the dosage of 300 micrograms b.d., is as effective and safe as cimetidine in the short-term therapy of duodenal ulcer.

Anti-Ulcer Agents↗
PubMed1989

Side effects of anti-ulcer prostaglandins: an overview of the worldwide clinical experience.

Anti-ulcer prostaglandins (PG)--misoprostol, enprostil and rioprostil--have been given to more than 5000 patients in short-term studies on gastric and duodenal ulcer. Analysis of these studies shows the drugs to be safe. Their side effects appear to be dose-dependent and mainly restricted to the gastrointestinal system, the major syndromes being diarrhoea and abdominal pain. The clinical relevance of PG-related unwanted effects, though in average exceeding that of H2-blockers, seems to be sufficiently low. In terms of safety efficacy, however, they appear inferior to H2-antagonists, so their routine use in preference to the latter compounds is still premature.

Alprostadil↗
PubMed1989

Omeprazole in the treatment of duodenal ulcer.

Omeprazole is the most effective antisecretory agent available today. Open and dose-comparative studies have documented that at dosages of 20 mg/day or more, the drug produces duodenal ulcer healing rates of 90-100% after 4 weeks. Controlled trials show that omeprazole, 20-40 mg/day, is superior to cimetidine and ranitidine in healing duodenal ulcer, with a median therapeutic gain of 21% at 2 weeks and 15% at 4 weeks. Ulcer symptom relief is also more pronounced and faster with omeprazole than with H2-receptor antagonists. No significant side-effects attributable to treatment with omeprazole have appeared in any of these studies or in the accumulated experience from several thousand patients treated with omeprazole. No tendency to an increase in recurrence rate after discontinuation of treatment with omeprazole has been shown. In summary, omeprazole constitutes a major advance in the short-term treatment of duodenal ulcer, giving fast and pronounced healing and symptom relief.

Adenosine Triphosphatases↗