PMID- 15086153
OWN - NLM
STAT- MEDLINE
DCOM- 20040713
LR  - 20131121
IS  - 0172-6390 (Print)
IS  - 0172-6390 (Linking)
VI  - 51
IP  - 56
DP  - 2004 Mar-Apr
TI  - Usefulness of proton pump inhibitor (PPI) maintenance therapy for patients with 
      H. pylori-negative recurrent peptic ulcer after eradication therapy for H. 
      pylori: pathophysiological characteristics of H. pylori-negative recurrent ulcer 
      scars and beyond acid suppression by PPI.
PG  - 338-42
AB  - BACKGROUND/AIMS: Problems after Helicobacter pylori (Hp) eradication therapy 
      include recurrence of Hp-negative peptic ulcers. We investigated the 
      pathophysiological characteristics of Hp-negative recurrent ulcer scars, and 
      performed proton pump inhibitor (PPI) maintenance therapy as a new therapy for 
      prevention of recurrence in patients with Hp-negative recurrence after Hp 
      eradication and investigated its usefulness. METHODOLOGY: The subjects were 21 
      patients with Hp-negative recurrent peptic ulcers after Hp eradication (gastric 
      ulcer: 19, duodenal ulcer: 2) and 25 patients with non-recurrent ulcers (gastric 
      ulcer: 20, duodenal ulcer: 5). The mucosa from the ulcer scar lesion was 
      endoscopically obtained from patients, and HE staining, CD68 immunohistochemical 
      staining, and investigation of the mucosal expression levels of TNF-alpha and 
      IFN-gamma were performed by ELISA. Patients with recurrence after eradication 
      were divided into two groups at the time of ulcer scar after the first treatment, 
      and received maintenance therapy: the intermittent treatment group that received 
      lansoprazole (LPZ), 30 mg/day, on two days on weekends (gastric ulcer: 9, 
      duodenal ulcer: 1) and the ranitidine (RAN) 150 mg/day daily treatment group 
      (gastric ulcer: 8, duodenal ulcer: 1). RESULTS: Infiltration of CD68-positive 
      inflammatory cells was observed in the lamina propria mucosae over the epithelial 
      layer in ulcer scars of the Hp-negative recurrent ulcer group compared with the 
      non-recurrent ulcer group, and TNF-alpha and IFN-gamma significantly increased 
      (27.22+/-6.23 pg/mg, 52.12+/-5.41 pg/mg vs. 4.23+/-2.14 pg/mg, 7.11+/-3.06 pg/mg, 
      P<0.001). In the RAN maintenance therapy group, the ulcer recurred within 10 
      months in all patients, while the ulcer recurred in only one patient in the 
      intermittent LPZ treatment group. CONCLUSIONS: These results suggested that the 
      pathophysiological characteristic of Hp-negative recurrent ulcer scar lesions 
      after eradication was infiltration of inflammatory cells, mainly 
      monocytes/macrophages, in the lamina propria mucosae over the epithelial layer, 
      and this may be a key factor in ulcer recurrence. Furthermore, intermittent PPI 
      therapy using LPZ may be a useful maintenance therapy for prevention of 
      recurrence in these cases.
FAU - Ohara, Tadashi
AU  - Ohara T
AD  - Department of Internal Medicine, Tokyo Dental College, Chiba Hospital, Chiba, 
      Japan. tohara@tdc.ac.jp
FAU - Morishita, Tetsuo
AU  - Morishita T
FAU - Suzuki, Hidekazu
AU  - Suzuki H
FAU - Masaoka, Tatsuhiro
AU  - Masaoka T
FAU - Ishii, Hiromasa
AU  - Ishii H
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Greece
TA  - Hepatogastroenterology
JT  - Hepato-gastroenterology
JID - 8007849
RN  - 0 (2-Pyridinylmethylsulfinylbenzimidazoles)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - 0K5C5T2QPG (Lansoprazole)
RN  - 82115-62-6 (Interferon-gamma)
RN  - 884KT10YB7 (Ranitidine)
RN  - KG60484QX9 (Omeprazole)
SB  - IM
MH  - 2-Pyridinylmethylsulfinylbenzimidazoles
MH  - Anti-Ulcer Agents/therapeutic use
MH  - Gastric Mucosa/pathology
MH  - Helicobacter Infections/*drug therapy
MH  - *Helicobacter pylori
MH  - Humans
MH  - Interferon-gamma/metabolism
MH  - Lansoprazole
MH  - Omeprazole/*analogs & derivatives/*therapeutic use
MH  - Peptic Ulcer/*drug therapy/microbiology/physiopathology
MH  - *Proton Pump Inhibitors
MH  - Ranitidine/therapeutic use
MH  - Recurrence
MH  - Tumor Necrosis Factor-alpha/metabolism
EDAT- 2004/04/17 05:00
MHDA- 2004/07/14 05:00
CRDT- 2004/04/17 05:00
PHST- 2004/04/17 05:00 [pubmed]
PHST- 2004/07/14 05:00 [medline]
PHST- 2004/04/17 05:00 [entrez]
PST - ppublish
SO  - Hepatogastroenterology. 2004 Mar-Apr;51(56):338-42.