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Proximal pharyngolaryngeal reflux now appears to be strictly related to symptoms and clinical patterns frequently encountered in clinical ORL practice and which are, more often than not, differentiated from classical gastro-oesophageal reflux disease. The aim of the study was to evaluate the incidence of the symptoms and clinical signs of gastro-oesophageal reflux disease, together with the symptomatologic response to a cycle of acid suppression treatment with proton pump inhibitors in a non-selected population comprising consecutive patients coming to the outpatient unit of the Laryngology Clinic of Universita Cattolica of Rome between June and December 2001, all of whom had been examined by the same practitioner. Of the 1300 patients evaluated, 52 presented a clinical history and chronic pharyngolaryngeal symptoms strongly indicative of gastro-oesophageal reflux disease. All selected patients were prescribed a two-month regimen of acid suppression therapy (20 mg Omeprazole twice daily, sufficient to confirm the clinical suspicion of pharyngolaryngeal reflux ex adiuvantibus (Omeprazole test), at the same time obtaining a satisfactory response in the symptomatology, as laid out in the guidelines emerging from the 1997 Consensus Conference Report on pharyngolaryngeal reflux. The same patients were later interviewed by telephone to evaluate the effectiveness of treatment, exclusively in terms of improvement in the symptoms. Analysis of the data from the 33 who answered the telephone questionnaire revealed a complete symptomatological response in 24 (72.7%), partial response in 4 (12.1%) and no response in 5. The Authors stress that, despite the known limits of this treatment, linked to proton pump inhibitors resistance, the "Omeprazole test", on account of excellent tolerability, lack of adverse effects and, above all, non-invasive nature, is feasible in the preliminary evaluation to confirm clinical suspicion of gastro-oesophageal reflux disease in outpatients, especially when a large-scale pH-metric multielectrode investigation is not possible. Furthermore, despite the many epidemiological, aetiopathogenetic, clinico-diagnostic and therapeutic aspects which remain to be clarified, there is no doubt that gastro-oesophageal reflux disease on account of the particular clinical features, directly involves the ORL specialist not only in the diagnostic, but also in the therapeutic phase.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12812134&dopt=Abstract
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STUDY OBJECTIVE: To determine the in vitro stability of esomeprazole pellets from an opened capsule after suspension in various common soft foods and beverages. DESIGN: In vitro study. SETTING: Pharmaceutical company research laboratory. MEASUREMENTS AND MAIN RESULTS: Pellets from opened esomeprazole 20-mg capsules were suspended in 100 ml of tap water, milk (1.5% fat), orange juice, apple juice, yogurt, or cultured milk for 30 minutes, then added to 500 ml of hydrochloric acid to simulate gastric acid exposure. After a 2-hour incubation, the mixture was filtered through a sieve, and the collected pellets were dissolved in an alkaline solution. Esomeprazole concentrations were measured using reverse-phase liquid chromatography The stability of the esomeprazole pellets exceeded 98% in all beverages and soft foods except milk. CONCLUSION: Administration of the pellets from an opened esomeprazole capsule shortly after suspending them in tap water, yogurt, cultured milk, orange juice, or apple juice may be a practical alternative for patients who cannot swallow an intact capsule. Bioavailability studies comparing esomeprazole administered as an intact capsule to that of the pellets from an opened capsule suspended in these beverages or soft foods are recommended to confirm these findings.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12820815&dopt=Abstract
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Antimicrob Agents Chemother. 2003 Jul;47(7):2249-55.
Gastric transitional zones, areas where Helicobacter treatment fails: results of a treatment trial using the Sydney strain mouse model.
van Zanten SJ, Kolesnikow T, Leung V, O'Rourke JL, Lee A.
Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Nova Scotia, Canada.
Current combination therapies cure Helicobacter pylori infection in 75 to 85% of cases. However, many treatment failures are not explained by antibiotic resistance. Our goal was to explore treatment failures under in vivo conditions by using the H. pylori Sydney strain (SS1) mouse model. Mice infected with H. pylori (SS1) were treated with monotherapies or combination therapies used in human trials. Bacterial levels and distribution of organisms within the stomach were assessed 24 h after treatment to determine clearance and location of treatment failures and 29 days after treatment to determine cure rates. Except for treatment with metronidazole, mono- and dual therapies did not cure infection but resulted in decreases in bacterial levels and differences in distribution within the stomach. In cases of treatment failure when clarithromycin was used, omeprazole and dual therapy with omeprazole and amoxicillin resulted in organisms being cleared from the antrum, but organisms remained in the antrum-body transitional zone. The triple therapies of OMC and bismuth subcitrate, metronidazole, and tetracycline were successful in eradicating infection. Except for metronidazole monotherapy and triple therapy with OAC, there was good correlation between the Sydney strain mouse model and humans with respect to the success of antimicrobial therapy. The antrum-body transitional zone was identified as a sanctuary site in treatment failure. This could result from antimicrobial agents not functioning effectively at this site or bacteria in this location expressing products that protect them against antimicrobial agents. This is the first demonstration of a possible sanctuary site as a reason for failure of therapy.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12821476&dopt=Abstract
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