Famotidine protects against aspirin GI damage

Medical Tribune September 2009 P6
David Brill

Histamine H2-receptor antagonists can limit the gastrointestinal side effects of low-dose aspirin and could offer a viable alternative to proton-pump inhibitors (PPIs), a recent study suggests.

The randomized, phase III FAMOUS* trial found that 12 weeks of treatment with famotidine significantly reduced the incidence of gastric ulcers, duodenal ulcers and erosive esophagitis compared to placebo.

The study, published in The Lancet, included 404 adults who were taking low-dose aspirin and had no ulcers or esophagitis at baseline. [2009;374:119-25]

Aspirin use continues to soar worldwide, yet there are few options for prevention of associated gastrointestinal complications. PPIs are known to be effective but have faced safety concerns – particularly over the risk of adverse interactions with clopidogrel.

“There is little doubt that aspirin and other anti-clotting drugs are very useful in the prevention of heart, brain, and other vascular diseases, hence their increasing use worldwide. Patients on such drugs should continue using them as advised by their family doctors or hospital specialists,” said the study’s lead author Dr. Ali Taha, of the University of Glasgow, UK.

“However, everybody should be aware that aspirin use can also be associated with a variety of gastrointestinal or digestive system problems, which sometimes can be serious. The results of this research widen the options for the prevention of such problems, particularly when more than one clotting drug is required,” he said.

Twelve weeks after randomization, 7 of 204 patients on famotidine had developed gastric ulcers, compared to 30 of 200 taking placebo (3.4 percent versus 15 percent; odds ratio 0.2; P=0.0002).

Just one patient developed a duodenal ulcer on famotidine, compared to 17 on placebo (0.5 percent versus 8.5 percent; OR 0.05; P=0.0045). Nine and 38 patients developed erosive esophagitis in the famotidine and placebo groups, respectively (4.4 percent versus 19 percent; OR 0.2; P<0.0001).>

A sympathetic ear: The best medicine for irritable bowels

Medical Tribune November 2008 SFIX
David Brill

Listening to your patients could be an effective treatment for irritable bowel syndrome (IBS), a recent study has suggested.

Researchers from the US and UK found that 62 percent of patients reported adequate symptom relief when their doctor spent more time with them and asked questions in a warm and friendly manner, in addition to providing placebo acupuncture.

Forty four percent of patients showed the same improvement when acupuncture was given without the extra attention, and just 28 percent when no placebo therapy was given at all.

Professor Ted Kaptchuk, who led the study, said that it was one of the most important demonstrations of the placebo effect in the literature and the first to look at long-term outcomes in the clinical setting.

“The important implication is that the power of the placebo effect, and specifically the patient-doctor component of the placebo effect, was huge. The magnitude of that effect is comparable to any drug that’s ever been tested for irritable bowel,” said Kaptchuk, who is based at Harvard Medical School, US.

He added that the same principles could apply to situations such as chronic pain and depression, which also have a strong “subjective component” whereby the context of the healthcare situation can influence a patient’s interpretation of their condition.

“We’re not treating something that is defined biologically, say a tumor or a blood assay or something you find on an X-ray. We’re treating a complaint that’s very real, and the interactions of that complaint with the person’s sense of well-being and health is probably where the placebo effect is very important,” he said.

The study involved 262 patients who were randomized to receive one of the two placebo interventions or simply to remain on a waiting list. The effects were recorded at 3 weeks and remained similar after 6. [BMJ 336(7651):999-1003]

Dr. Gwee Kok Ann, a Singapore-based IBS specialist and president of the IBS Support Group, was not surprised by the study’s findings.

“I’ve always felt that IBS patients respond very well to treatment if you just make the effort to talk with them and explain things to them,” he said.

“A lot of times it’s just helping the patient first of all to understand what’s going on because I think that’s the main worry in a lot of them. They worry is it cancer, is it colitis, and that in itself reinforces the symptoms because anxiety drives the symptoms too,” said Gwee, an adjunct associate professor at the National University of Singapore and a consultant gastroenterologist at Gleneagles Hospital.

Addressing the diagnosis of IBS in a tactful way can also improve outcomes, he said, noting that doctors should take time to explain the condition thoroughly and convincingly so that the patient is comfortable with the diagnosis.

Patients view pain as a warning that something is wrong, he explained, so if their doctor can’t find an explanation for it then adrenaline and anxiety can rise, prompting the patient to demand more and more tests in the expectation that something has been missed. This situation can be avoided by introducing the diagnosis of IBS early rather than leaving it as a last resort for when everything else has been ruled out, he said.

Chewing gum speeds recovery from bowel cancer op

Medical Tribune October 2008 P3

Chewing gum could help patients to recover after colectomy, a recent meta-analysis has shown.

The study, including five randomized controlled trials totaling 158 patients, found that gum significantly reduced the time to first flatus and first bowel movement following the operation. Postoperative hospital stay was also reduced, but this result did not reach statistical significance.

The researchers, from Imperial College London, UK, suggest that gum could serve as a form of “sham feeding” which stimulates the production of saliva, gastrointestinal hormones and pancreatic secretions.The potential for substantial cost savings means that larger placebocontrolled trials into the effects of chewing gum are warranted, they conclude. [Arch Surg 2008 143(8):788-93]