Despite the scant evidence, anti-secretory agents are frequently recommended in the treatment of patients with a predominant complaint of pain while prokinetic agents are frequently used for bloating and early satiety [ 4 ]. Such therapy should be individualized and directed toward the predominant symptom [ 5 ]. For patients with predominant dyspepsia discomfort centered in the epigastrium, nausea, early satiety, postprandial fullness, recurrent emesis , a short course of empiric therapy with an H 2 -histamine receptor antagonists or proton pump inhibitors is acceptable.
There are currently no pediatric data to support the long-term benefit of anti-secretory therapy in patients with FGIDs [ 5 ]. The aim of this study is to compare the effectiveness of the commonly four most used drugs for treatment of dyspepsia in children, including Omeprazole, Ranitidine, Cimetidine, and Famotidine in a period of 4 weeks of treatment.
In this clinical trial study, children between 2 and 16 years old were enrolled with the diagnosis of FD which was made by a history of recurrent or persistent abdominal pain and discomfort which was typically centered in the upper abdomen for at least a week duration without any evidence of organic disorder. The other symptoms were early satiety, postprandial abdominal floating or distention, nausea and vomiting.
Then, for each patient, one of the acid suppressant medications, Omeprazole, Famotidine, Ranitidine, or Cimetidine, was administered, for a period of 4 weeks. All the results, consisting of any probable side effects during the therapy and the effectiveness of the medication being used in treatment of the patients, were collected and analyzed. Collected data and results were analyzed by SPSS 15 software.
Standard deviation, mean, and distribution of the results were also analyzed. There were children with various dyspeptic symptoms who participated in this study. The mean age of the patients was 7. The mean duration of the disease among the patients was 1 5. Ninety-nine patients In patients In 61 patients Symptoms distributions are mentioned in Table 1.
None of the patients had all the symptoms simultaneously. Of these children, 37 The most common symptoms relieved regardless of type of medication were nausea Abdominal pain was relieved in The distribution and percentage of symptoms being relieved regardless of the specific medication being administered are shown in Table 2. When different medications were compared, abdominal pain was improved in The distribution and percentage of symptoms being relieved in relation to the specific medication being used are mentioned in Table 3.
The least influenced symptoms followed by medical therapy in relation with specific medication was halitosis in all groups, When different medications compared 8 of 37 patients who took Cimetidine cured completely In the followups during 2 and 6 weeks after medical therapy, no side effects due to medical therapy were seen. Children with abdominal pain were found to miss more school than their peers, and their parents frequently missed work to take care of their children [ 6 ].
Some studies in children have shown an association between chronic or recurrent abdominal pain and higher depression and anxiety scores and poor quality of life [ 6 ]. Despite its high frequency and significant impact on quality of life of children, there is only limited evidence to support most treatments that are commonly used to treat childhood FAP.
Dietary recommendations may be helpful for some patients with functional recurrent abdominal pain of childhood [ 7 ]. There are different medical therapies with different medications for treatment of this disorder in children. Such therapy should be individualized and directed toward the predominant symptom [ 8 ].
Treatment modalities include medications, diet modification, herbal preparations, and behaviorally psychologic interventions [ 9 ]. Enteric-coated peppermint-oil capsules, believed to exert calcium channel blockade in smooth muscle, were shown in a randomized, placebo-controlled study to decrease the severity of abdominal pain, but not other symptoms in pediatric patients with irritable bowel syndrome [ 9 ].
Pharmacotherapy for treatment of FGIDs consists of anticholinergic agents, tricyclic antidepressants, serotonergic agents, selective serotonin reuptake inhibitors, 5-HT 3 receptor antagonists, 5-HT4 receptor agonists, and acid suppressive therapy [ 5 ]. For patients with predominant dyspepsia discomfort centered in the epigastrium, nausea, early satiety, postprandial fullness, recurrent emesis , a short course of empiric therapy with H 2 -receptor antagonists or proton pump inhibitors is acceptable [ 5 ].
Some meta-analysis studies showed that H 2 -receptor antagonists did or did not have a significant therapeutic effect in FD [ 10 , 11 ]. A meta-analysis of randomized controlled clinical trials has shown that there may be a benefit in the use of H 2 -receptor antagonists in patients suffering from FD [ 12 ].
In another study, it was found that Famotidine was equally effective as placebo [ 6 ]. In a double-blind randomized placebo-controlled study of 4 weeks of Lansoprazole a proton pump inhibitor for the treatment of FD in Chinese patients, findings implicated that proton pump inhibitors treatment was not superior to placebo for the management of FD in Chinese patients [ 15 ].
Proton pump inhibitors especially improved the symptoms of epigastric pain and heart burn [ 1 ]. Several studies in the primary care setting have concluded that proton pump inhibitors are more effective than H 2 -receptor antagonists or antacids in treating heart burn and dyspeptic symptoms [ 16 ].
Therefore, empiric acid suppression would seem to be the favored management approach for the treatment of FD [ 17 ]. Since the various proton pump inhibitors are of equivalent efficacy and safety, the cost and acceptability of a particular proton pump inhibitor preparation may be more important when selecting among them than comparable efficacy [ 18 ].
You can reduce the possibility of heartburn by making some lifestyle changes. Wear clothing that is loose around the waist to reduce pressure on the stomach. Eat smaller meals, and eat more slowly. Since reflux is common at night, make your last meal small and be sure to finish eating as long as 5 to 6 hours before bedtime.
Heartburn also occurs more frequently in those who are overweight or pregnant. Fatty foods worsen reflux, so you should avoid them as much as possible.
The long list of high-fat foods includes chocolate, bacon, potato chips, margarine, butter, and fried foods. You may find that other foods cause problems, such as orange juice, pizza, or tomato-based sauces.
When you have identified such an irritant, avoid it in the future. Nicotine and alcohol both worsen reflux, so you should avoid cigarettes, cigars, chewing tobacco, and all forms of alcohol. When you first recognize possible reflux, your pharmacy is a good place to go for advice on when to see a physician. Your pharmacist will need to know your age, your status regarding pregnancy or breastfeeding, and a list of all of your symptoms.
There are many dangerous symptoms that will require a physician visit to ensure that you do not have a serious condition such as an ulcer or stomach cancer. If the pharmacist believes your problem to be nothing more than reflux, he or she may recommend nonprescription products. Whichever you choose, be sure to read every set of warnings, precautions, and instructions on the label. Failure to understand and follow all of these guidelines can have drastic consequences.
Some heartburn products are simple antacids, such as Tums and Alka-Seltzer. They are usually inexpensive and act rapidly, although they do not reduce the amount of acid produced. Other OTC products are effective at reducing the amount of stomach acid produced, although they may not give relief as quickly and tend to cost more. These stronger products fall into two groups. They can be used by those age 12 years or older. They can only be used by those age 18 years or older. Gastroesophageal reflux disease.
Accessed October 18, Gastroesophageal reflux—discharge. Taking antacids. Tums Ultra product details. Tagamet HB Original Strength Pepcid AC. McNeil Consumer Pharmaceuticals. Maximum Strength Pepcid AC. Zantac Further studies are required that compare the efficacy of famotidine with cimetidine and ranitidine in the treatment of gastric ulcers and in the prevention of recurrent duodenal ulcers.
The overall incidence of adverse effects observed with famotidine appears to be similar to that reported for cimetidine and ranitidine. Like ranitidine, famotidine does not have antiandrogenic effects or substantially inhibit the hepatic metabolism of drugs. Because of its increased antisecretory potency and lack of antiandrogenic effects at higher doses, famotidine may be the H2-receptor antagonist of choice in treating Zollinger-Ellison syndrome.
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