Biomedical subjects

Japie A Louw

Publications and source records attributed to Japie A Louw.

4 recordsLinked to original sources

PubMed2006

Peptic ulcer disease.

PURPOSE OF REVIEW: This review attempts to contextualize some of the clinically important publications of the last 2 years as they relate to the broad topic of dyspepsia and peptic ulcer disease, both Helicobacter pylori and nonsteroidal anti-inflammatory drug-related. RECENT FINDINGS: This review includes findings which provide insight with regard to the triaging of dyspeptic subjects, information on new proton pump inhibitor drugs and H. pylori eradication 'rescue regimens'. The 'COX-2 debacle' is discussed and new data relating to the efficacy of co-therapy strategies for the prevention of nonsteroidal anti-inflammatory drug gastropathy are presented, while the use of antiplatelet agents as 'safe' substitutes for aspirin cardioprophylaxis is questioned. The important issue of proton pump inhibitor safety and nonsteroidal anti-inflammatory drug enteropathy are addressed. SUMMARY: The review provides a summary and interpretation of literature pertaining to the above issues, and should provide a point of departure for clinical decision-making relevant to these issues.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2004

Peptic ulcer disease.

PURPOSE OF REVIEW: This review reports and attempts to place in some context current key observations in the literature, as they relate to peptic ulcer disease. RECENT FINDINGS: Focus areas in this review are general, the usefulness of symptom-based triage in management decision making and critical review of current practice as it relates to foregut malignancy; Helicobacter pylori, important observations regarding gastric cancer prevention are presented, the role of the organism in "acid rebound" is discussed, and further evidence to support the role of H. pylori eradication in peptic ulcer disease is provided; medication, a number of studies comparing steady state and onset of action efficacy of current proton pump inhibitors at a gastric pH level are reviewed and a new agent is introduced. Problems with and strategies for the safe use of antithrombotic agents are reviewed, and exciting data with regard to a new class of nonsteroidal antiinflammatory drug are provided, now at the "proof of concept" stage. SUMMARY: The review period's main "new" information relates to the nonsteroidal antiinflammatory drugs in which a number of exciting agents are being developed. Although inconclusive, the observations with regard to the effect of H. pylori eradication on gastric carcinogenesis is likely to lead to more work in this field.

Journal Article↗

PubMed2003

The management of peptic ulcer disease.

PURPOSE OF REVIEW: The period under review has seen little evolution in our understanding of the empiric management of dyspepsia. The role of Helicobacter pylori in this setting remains controversial, and a policy of risk stratification with the prudent use of test and treat and symptomatic therapy, with endoscopy for nonresponsive cases, seems to have some support from the literature in this period. RECENT FINDINGS: The management of nonsteroidal antiinflammatory drug-associated and aspirin-associated complications has received a lot of attention in the period under review. The COX-2 selective agents have maintained their reputation as safer (but not "safe") options, although some of the original work with one of these agents has been rigorously interrogated and found wanting. Studies in the review period have focused our attention on the less than satisfactory protection of proton pump inhibitor cotherapy, the site-specific nature of ulcer recurrences (which may have therapeutic implications), lower gastroenterology complications associated with NSAID use, and the beneficial effect of proton pump inhibitor cotherapy for patients receiving low-dose aspirin. One should also expect a lot more information in the future with regard to the use of the nitric oxide donating class of nonsteroidal antiinflammatory drugs and aspirin. SUMMARY: Findings are presented that suggest that the H.pylori stool antigen test is not as reliable as the urea breath test, while the most promising "new therapy" for H. pylori is not new, but rather an amalgam of some older drugs combined in a new "quadruple" therapy strategy, which shows some promise.

Journal Article↗

PubMed2002

Peptic ulcer disease.

The introduction of the "Maastricht 2-2000" document provides some guidance with regard to the management of Helicobacter pylori infection in both primary and specialist practice settings, albeit primarily in the European setting. The putative role of H. pylori in gastric carcinogenesis was supported by a further study. Studies on the natural history of peptic ulcer disease (PUD) highlight the particular vulnerability of the elderly patient to PUD and its complications, and focus attention on targeted intervention in this group, particularly the avoidance of nonsteroidal antiinflammatory drugs (NSAID). Little has evolved with regard to the introduction of new NSAID, but reports indicate the potential association of cyclooxygenase-2 (COX 2)-selective agent use with an increased risk of cardiovascular events. The role of H. pylori and NSAID as risk factors for peptic ulcer disease and its complications is again explored, and both meta-analysis and clinical studies provide some evidence of their synergistic effect. The introduction of esomeprazole, the S-isomer of omeprazole, has widened the clinician's therapeutic choice; the true value of this agent remains to be determined.

Journal Article↗