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Biomedical subjects

L Carling

Publications and source records attributed to L Carling.

At least 37 records · Page 2Linked to original sources
PubMed1987

Recurrent ulcer after treatment with cimetidine or sucralfate.

The recurrence of peptic ulcer disease after successful treatment with 400 mg cimetidine twice daily or 1 g sucralfate four times daily was investigated in a double-blind, 1-year follow-up study. Endoscopy was performed if ulcer symptoms recurred and 2-4 and 9-11 months after endoscopically confirmed healing of the initial ulcer. No anti-ulcer medication was permitted during the follow-up period. The recurrence rates were 71% in the cimetidine group (n = 143) and 68% in the sucralfate group (n = 115) (p greater than 0.3). The rate of asymptomatic ulcer relapse was 26% in the cimetidine and 23% in the sucralfate group (p greater than 0.4). The time to relapse did not differ between the treatment groups (p greater than 0.3). In the cimetidine group smokers had a higher 12-month recurrence rate than non-smokers, 83% compared with 58% (p less than 0.01). The corresponding figures in the sucralfate group were 76% and 57% (p = 0.057). The median time to recurrence in the cimetidine-treated group was 17 weeks among smokers, compared to 43 weeks among non-smokers (p less than 0.001). In the sucralfate-treated group the median time to recurrence was 23 weeks among smokers and 32 weeks among non-smokers (p greater than 0.3). Pre-study use of non-steroidal anti-inflammatory drugs and the time to healing of the initial ulcer did not influence the relapse rates in either of the treatment groups.

Adult↗
PubMed1987

Enprostil and cimetidine: comparative efficacy and safety in patients with duodenal ulcer.

The safety and efficacy of enprostil, 35 micrograms twice daily, and of cimetidine, 400 mg twice daily, in the treatment of duodenal ulcers were compared in a randomized, double-blind, parallel, multiclinic study. Endoscopy was performed before treatment and at 2-week intervals for 6 weeks or until the ulcer healed. Patients recorded their drug compliance, antacid use, ulcer symptoms, and adverse experiences daily. One hundred and six patients entered the trial, of which 104 were eligible for the initial endoscopy analysis. Base-line characteristics were similar in the two treatment groups. The cumulative healing rates in the enprostil group were 56%, 86%, and 92% at 2, 4, and 6 weeks, respectively, and those in the cimetidine group were 53%, 84%, and 90% (NS). The healing rates for nonsmokers at 6 weeks were 96% in the enprostil group and 97% in the cimetidine group, which were significantly greater than those for smokers--88% and 81%, respectively. There were no significant differences in the duration, severity, or frequency of daytime or nighttime pain between the groups. Seventeen of the enprostil patients (32%) reported 21 adverse experiences during the trial, and 20 of the cimetidine patients (39%) reported 23 adverse experiences. No patients withdrew because of adverse experiences. The two drugs were similarly safe and effective in the treatment of duodenal ulcer.

Adolescent↗
PubMed1987

Swedish multicenter study on prepyloric and gastric ulcer.

A double-blind, randomized, multicenter study was performed to compare the effects of sucralfate and cimetidine for the short-term treatment of gastric and prepyloric ulcers. Ulcer healing was evaluated endoscopically at 4-week intervals up to 8 weeks in the PPU study and up to 12 weeks in the GU study. A total of 142 PPU and 134 GU patients completed the study. The overall healing rates after 8 weeks in the PPU study were 83% for the sucralfate group and 90% for the cimetidine group (NS), while the cumulative healing rates after 12 weeks in the GU study were 98% for the sucralfate group and 94% for the cimetidine group (NS). The confidence interval means that the 95% confidence limit ranges from 11% in favour of sucralfate to 2% in favour of cimetidine in the GU study and corresponding figures of 4% 19% in the PPU study. There were significantly more patients in the cimetidine group taking antacid tablets after 3 weeks in the GU study. Symptomatic relief did not differ significantly. Reported side effects and symptoms, pooled together with our duodenal ulcer study, were mostly non-specific and in some part related to the ulcer disease. In conclusion, sucralfate and cimetidine are both excellent healing agents for the short-term treatment of PPU and GU. Both give rapid and good symptomatic relief with no side effects of any importance.

Adolescent↗
PubMed1987

Treatment of acute duodenal ulcer--a Swedish multicenter study.

Medical ulcer therapy focuses on enhancing mucosal defence mechanisms or reducing intraluminal acidity. In this Swedish multicenter, randomized double-blind study these two principles were compared in the treatment of acute duodenal ulcerations. Sucralfate (Andapsin 1g X 4) or cimetidine (Tagamet 400mg X 2), together with antacid tablets (Novalucol), were supplied to patients with acute ulcerations in the pyloric ring or duodenal bulb. Endoscopy was performed at inclusion, after four weeks and in some patients also after eight weeks. Besides healing rate, symptoms and antacid intake, smoking and side effects were recorded on a special protocol. 371 patients from 15 centers completed the trial. At inclusion the patient groups did not differ in any essential aspect. At four weeks 71% of 177 patients on sucralfate and 77% of 194 on cimetidine were healed. The corresponding figures for eight weeks were 86% (suc) and 92% (cim). The difference is not significant, the 95% confidence interval for the difference in ulcer healing efficacy of sucralfate compared with cimetidine at eight weeks was -12% to +5%. Antacid intake and symptoms decreased rapidly and equally in both groups. Side effects related to the treatments were uncommon. It is concluded that sucralfate and cimetidine, representing two different principles in medical ulcer treatment, are both very effective and compare well in the short term treatment of acute duodenal ulcer.

Acute Disease↗
PubMed1987

Treatment of peptic ulcers--acid reduction or cytoprotection?

In a Swedish multicenter double blind trial cimetidine was compared to sucralfate in the treatment of peptic ulcer. Patients with endoscopically verified gastric, prepyloric and duodenal ulcers were treated with cimetidine 400 mg x 2 or sucralfate 1 g x 4 for four to eight weeks. Gastric ulcers were treated up to 12 weeks. Patients with healed ulcers were followed for up to 12 months. During follow-up without any anti ulcer treatment control endoscopy was performed 2-4 and 9-11 months after endoscopic healing and at symptomatic recurrence. 647 patients were studied (334 cimetidine and 313 sucralfate). 258 patients were included in the 12 months' follow up: of these 143 were previously treated with cimetidine and 115 with sucralfate. Healing rates were 92% in patients treated with cimetidine and 87% in those given sucralfate (ns). Symptomatic relief and ulcer recurrence did not differ between the treatments. Smoking significantly increased recurrence rate and shortened the time to recurrence in the cimetidine treated patients, but not in the sucralfate group. Cimetidine and sucralfate compared well in all aspects of acute peptic ulcer treatment and recurrence during one year of follow up.

Adult↗
PubMed1987

Ulcer recurrences following initial ulcer healing with sucralfate or cimetidine.

Ulcer relapses after short-term treatment of duodenal, prepyloric and gastric ulcers with Cimetidine 400 mg b.d. or Sucralfate 1 g q.i.d. were studied in 270 patients over one year. Endoscopic examinations were carried out 2-4 and 9-11 months after ulcer healing or when symptoms occurred. Ulcer relapses were found in 59% of the Cimetidine-treated patients and 51% of those treated with Sucralfate, and a further 21% and 16% respectively had endoscopically verified erosive gastroduodenitis. The cumulative recurrence rate in smokers was 82% and that in non-smokers 51% (p less than 0.001). Relapses among the Cimetidine patients occurred more often in those who smoked or had irregular working hours. The onset of the relapse was not related ulcer healing time. The ulcer relapses appeared in the same region as the initial ulcer in 88% of cases and exactly at the original site in 33%. These results suggest that cytoprotection by Sucralfate did not result in fewer or later relapses than acid reduction by Cimetidine. Cigarette smoking obviously increases the risk of relapse in patients with healed peptic ulcers.

Cimetidine↗
PubMed1986

Short term treatment of gastric ulcer: a comparison of sucralfate and cimetidine.

A double blind randomised study was undertaken to compare sucralfate and cimetidine in short term treatment of gastric ulcer. The study included 149 patients with endoscopically confirmed gastric ulcerations. Patients with prepyloric ulcers 2 cm or less from the pyloric ring were not accepted for participation in the trial. Ulcer healing was assessed endoscopically at four week intervals. A total of 134 patients completed the study. The cumulative healing rates after 12 weeks were 98% for sucralfate and 94% for cimetidine treated patients. After four and eight weeks, the healing rates were 61% and 94% for sucralfate and 69% and 94% for the cimetidine-treated group respectively. No statistically significant differences in healing rates were seen. The 95% confidence interval was calculated for the difference between the ulcer healing rates of sucralfate and cimetidine. This interval was found to range between +11% and -2% after 12 weeks of treatment - that is, the healing efficacy of sucralfate was calculated to be at most 11% better or 2% worse than that of cimetidine. No significant differences in symptom relief, side effects or antacid intake were found.

Aluminum↗
PubMed1986

Short-term treatment of duodenal ulcer. A comparison of sucralfate and cimetidine.

A multicenter randomized double-blind study was performed to compare a cytoprotective agent (sucralfate) and an acid-reducing agent (cimetidine) in the treatment of duodenal ulcer. Patients with acute ulcerations in the pyloric ring and duodenal bulb confirmed by endoscopy were included in the trial. All patients were examined after 4 and, if not cured, after 8 weeks. A total of 371 patients from 15 centers completed the trial. The patient groups were comparable. At 8 weeks 86% of 177 patients receiving sucralfate treatment were cured, compared with 92% of 194 receiving cimetidine (NS). The corresponding figures at 4 weeks were 71% (sucralfate) and 77% (cimetidine) (NS). The 95% confidence interval for the difference in ulcer healing efficacy of sucralfate compared with cimetidine at 8 weeks was -12% to +5%. Antacid intake and symptoms decreased rapidly in both groups. Three patients were withdrawn owing to side effects. It is concluded that sucralfate and cimetidine. representing two different approaches to ulcer therapy, are both very effective and compare well with regard to ulcer healing, symptom relief, and side effects in the short-term treatment of acute duodenal ulcer.

Adult↗
PubMed1982

Coexistent hereditary haemorrhagic telangiectasia and primary thrombocythaemia--coincidence or syndrome?

Two patients with coexistent hereditary haemorrhagic telangiectasia (HHT) and primary thrombocythaemia (PT) are presented. In one of them, both diseases were detected at the same time. In the other, signs of HHT were present 20 years prior to the diagnosis of PT. Both patients had recurrent gastrointestinal haemorrhage with consequent anaemia, and multiple gastric telangiectases were demonstrated endoscopically. Persistent and severe haemorrhage from gastric telangiectases in one of the patients was successfully controlled by endoscopic monopolar electrocoagulation. The very high platelet counts were reduced with melphalan in one patient and with busulfan in the other. The degree of severity of both disorders was parallel in both cases. We suggest that the coexistence of these two rare disorders in one and the same patient may represent a syndrome that could be more common than hitherto known.

Aged↗
PubMed1981

Endoscopic polypectomy in the gastrointestinal tract.

The results of 160 consecutive fibre-optic endoscopic polypectomies in the gastrointestinal tract are reviewed. Of 22 polyps snared in the upper digestive tract, 16 could be retrieved. One gastric polyp showed early intramucosal carcinoma. Biopsies from a pedunculated duodenal polyp, which was lost after snaring, revealed adenoma with moderate atypia. Of 138 resected colonic polyps, 132 were retrieved. Of these, 104 (79%) were adenomas. Of 49 colonic adenomas smaller than 10 mm, 4 (8%) showed severe atypia (carcinoma in situ) but not invasive carcinoma. Of 36 adenomas sized 10--19 mm 8 (22%) showed severe atypia and one (3%) invasive carcinoma. Of 19 adenomas larger than 60 mm, 6 (32%) showed severe atypia and one (5%) invasive carcinoma. Of the colonic polyp patients, 87% had only one or two polyps. Synchronous adenomas and non-neoplastic polyps were found in 6 of 11 cases with 3 or more colonic polyps. It is concluded that endoscopic polypectomy, carefully and properly performed, is a valuable and promising procedure in the diagnosis and treatment of polyps in the gastrointestinal tract, especially in the large bowel.

Adenoma↗
PubMed1978

Oesophageal disease revealed by endoscopy in 1,000 patients referred primarily for gastroscopy.

Of 1000 patients referred primarily for gastroscopy, almost 18% had endoscopic signs of clinically important oesophageal disease. Erosive oesophagitis, a disease that is notoriously difficult to diagnose on X-ray, was demonstrated in alsmot 10% and oesophageal varices in 3.6% of the patients. It is concluded that a thorough examination of the oesophagus should be included in every routine upper gastrointestinal endoscopy.

Diverticulum, Esophageal↗
PubMed1976

Diagnosis and treatment of acute gastrointestinal haemorrhage in a small district hospital.

Ninety-eight consecutive patients admitted to a small district hospital because of acute gastrointestinal haemorrhage have been studied. Patients with haematemesis and/or melaena were treated with antacids and tranexamic acid from the very beginning and were examined with early panendscopy. All patients were closely observed in an ordinary medical ward by a staff especially trained to handle acute gastrointestinal bleeding. Seven patients required acute surgery. The overall mortality was 4.1%. It is concluded that acute gastrointestinal haemorrhage can be successfully handled with modern diagnosis and treatment in a small hospital.

Adult↗