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Volume 1, No 3 - Summer 2001

Volume 1, No 3 - Summer 2001

Table of Contents

One Hundred Years of NSAID Gastropathy: Are Coxibs the Answer? Treatment Update
One hundred years after the introduction of aspirin, greater understanding of the mechanism of action of NSAIDs has led to the development of selective COX-2 inhibitors. These have been shown to reduce pain and inflammation with reduced risk of GI complications. However, questions remain regarding such issues as restriction of their use to patients at high risk for complications, cost-effectiveness, effectiveness compared with prostaglandin replacement or acid reduction therapy, and safety in patients also taking aspirin for platelet inhibition. [Rev Gastroenterol Disord. 2001;1(3):121–127]
Gastroesophageal Reflux Disease—State of the Art Gastrointestinal Disorders
Gastroesophageal reflux disease (GERD) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus; heartburn, its most common manifestation, occurs in 7% to 10% of the U.S. population on a daily basis. In addition, many so-called extraesophageal or atypical symptoms, including chronic cough, laryngitis and other otolaryngologic conditions, asthma, and unexplained chest pain, can be associated with GERD, but these patients appear to have a decreased frequency of heartburn, making the diagnosis of GERD difficult. All patients can be successfully managed with appropriate, titrated use of pharmacologic therapy. Antireflux surgery should thus be considered as an option only for patients who cannot afford or choose not to continue long-term medical therapy and for the rare patient with side effects or resistance to proton pump inhibitors. Endoscopic therapy for reflux should be considered as an experimental technology needing continuing evaluation. [Rev Gastroenterol Disord. 2001;1(3):128–138]
Dyspepsia, Non–Ulcer Dyspepsia, and Helicobacter pylori Treatment Update
Since the discovery of Helicobacter pylori and its role in peptic ulcer disease, two strategies for low-cost treatment of uninvestigated dyspepsia have emerged: “test and treat" and “test and scope." The efficacy of these strategies is examined, with a review of several recent studies. Controversy exists as to the usefulness of eradication of H. pylori in the treatment of non-ulcer dyspepsia. Results of four large trials are presented as an illustration of this controversy. Guidelines for the management of dyspepsia and non-ulcer dyspepsia are reviewed. [Rev Gastroenterol Disord. 2001;1(3):139–146]
Budesonide Modified-Release Capsules New Drug Review
Budesonide modified-release capsule is an effective form of therapy for the treatment of Crohn’s disease located in the distal ileum, ileocecal region, and ascending colon. Because some of the benefit of budesonide therapy results from local effects, this agent will not be very effective in the treatment of patients with extensive colitis or left-side colitis. Budesonide is equal to less effective than prednisolone or prednisone therapy in the treatment of active Crohn’s disease, but is associated with fewer glucocorticoids adverse reactions. [Rev Gastroenterol Disord. 2001;1(3):147–155]