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      The Comparative Study of the Effectiveness of Cimetidine, Ranitidine, Famotidine, and Omeprazole in Treatment of Children with Dyspepsia

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          Abstract

          Background. Functional dyspepsia is a common chronic disorder with non specific upper abdominal pain or discomfort. Different approaches with anti-secretory, spasmolytic, prokinetic and anti-inflammatory effects and most preferably reduction of visceral hypersensitivity seem logical. In this study, we compared the effectiveness of the four most drugs used for treatment of dyspepsia in children. Methods. 169 patients between 2 to 16 years old that 47.3% was male and 52.7% was female were enrolled in this clinical trial study by the diagnosis of functional dyspepsia. Then for each patient one of the drugs; Omeprazole, Famotidine, Ranitidine or Cimetidine was administered, for a period of 4 weeks. Patients were followed after 2 and 6 weeks from the beginning of the treatment. Results. The distribution of drugs between these patients were including; 21.9% with Cimetidine, 21.3% with Famotidine, 30.8% with Omeperazole and 26% with Ranitidine that the proportion of patients with all symptoms relief were: 21.6% for Cimetidine, 44.4% for Famotidine, 53.8% for Omeprazole and 43.2% for Cimetidine ( P = .024). In followups within 2 and 6 weeks after beginning medical therapy, no side effects due to drugs were seen. Conclusion. If a cure is defined as all symptoms relief after a period of 4 weeks treatment, our findings showed that Omeperazole are superior to Ranitidine, Famotidine, and Cimetidine for management of functional dyspepsia.

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          The influence of cisapride on gastric tone and the perception of gastric distension.

          Delayed gastric emptying, impaired gastric accommodation to a meal and hypersensitivity to gastric distension have been implied in the pathophysiology of functional dyspepsia. Dyspeptic patients are often treated with the prokinetic drug cisapride. To assess the effects of cisapride on perception of gastric distension and gastric accommodation to a meal. Eighteen healthy volunteers underwent a gastric barostat study on two occasions, after pretreatment with placebo or cisapride 10 mg q.d.s. Graded isobaric and isovolumetric distensions were performed until the subjects reported discomfort. Volume and pressure changes were recorded and perception was scored by a questionnaire. In 10 volunteers, the amplitude of the gastric accommodation to a mixed liquid meal was also measured. Pre-treatment with cisapride significantly lowered thresholds for perception and for discomfort, both during isobaric (4.3 +/- 0.7 vs. 3.2 +/- 0.7 and 12.2 +/- 1.2 vs. 9.2 +/- 0.9 mmHg above minimal distending pressure (MDP), respectively, P < 0.05) and isovolumetric (256 +/- 46 vs. 200 +/- 35 and 644 +/- 36 vs. 511 +/- 40 mL, respectively, P < 0.05) distensions. Cisapride significantly enhanced the size of the meal-induced fundus relaxation (143 +/- 37 vs. 270 +/- 50 mL, P < 0.05). Cisapride enhances both the perception of gastric distension and the gastric accommodation to a meal. These data suggest that cisapride may provide benefit to patients with impaired postprandial relaxation of the fundus.
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            Implications of placebo theory for clinical research and practice in pain management.

            We review three possible theoretical mechanisms for the placebo effect: conditioning, expectancy and endogenous opiates and consider the implications of the first two for clinical research and practice in the area of pain management. Methodological issues in the use of placebos as controls are discussed and include subtractive versus additive expectancy effects, no treatment controls, active placebo controls, the balanced placebo design, between- versus within-group designs, triple blind methodology and the double expectancy design. Therapeutically, the possibility of shaping negative placebo responses through placebo sag, overservicing and the use of placebos on their own are explored. Suggestions for using conditioned placebos strategically in conjunction with nonplacebos are made and ways of maximizing the placebo component of nonplacebo treatments are examined. Finally, the importance of investigating the placebo effect in its own right is advocated in order to better understand the long-neglected psychological aspects of the therapeutic transaction.
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              Double blind, randomised, placebo controlled study of four weeks of lansoprazole for the treatment of functional dyspepsia in Chinese patients.

              The use of proton pump inhibitors for the treatment of functional dyspepsia is controversial and the role of Helicobacter pylori infection in functional dyspepsia is uncertain. To evaluate the efficacy of different doses of lansoprazole for the treatment of functional dyspepsia in Chinese patients. Patients with a clinical diagnosis of functional dyspepsia according to the Rome II criteria and normal upper gastrointestinal endoscopy were recruited and randomised to receive: (1) lansoprazole 30 mg, (2) lansoprazole 15 mg, or (3) placebo, all given daily for four weeks. Dyspepsia symptom scores and quality of life (SF-36 score) were evaluated before and four weeks after treatment. A total of 453 patients were randomised. There was no difference in the proportion of patients with complete symptom relief in the lansoprazole 30 mg (23%) and lansoprazole 15 mg (23%) groups compared with the placebo group (30%). The proportion of H pylori positive patients with a complete response was similar with lansoprazole 30 mg (34%) and lansoprazole 15 mg (20%) versus placebo (22%). All symptom subgroups (ulcer-like, dysmotility-like, reflux-like, and unspecified dyspepsia) had similar proportions of patients with complete symptom relief after treatment. Proton pump inhibitor treatment is not superior to placebo for the management of functional dyspepsia in Chinese patients.
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                Author and article information

                Journal
                ISRN Pediatr
                PEDIATRICS
                ISRN Pediatrics
                International Scholarly Research Network
                2090-469X
                2090-4703
                2011
                5 April 2011
                : 2011
                : 219287
                Affiliations
                Gastroenterohepatology Research Center, Pediatric Gastroenterology Department, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran
                Author notes
                *Seyed Mohsen Dehghani: dehghanism@ 123456sums.ac.ir

                Academic Editor: A. Maheshwari

                Article
                10.5402/2011/219287
                3263570
                22389770
                d6c919f6-e722-40b1-a941-b972522f3933
                Copyright © 2011 Seyed Mohsen Dehghani et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 January 2011
                : 1 March 2011
                Categories
                Research Article

                Pediatrics
                Pediatrics

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