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Vol. 84, No. 1, 2011
Issue release date: July 2011
Digestion 2011;84:46–53

Proton Pump Inhibitor Dose-Related Healing Rate of Artificial Ulcers after Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

Kawano S. · Okada H. · Kawahara Y. · Hori K. · Tanioka D. · Tsuzuki T. · Inoue M. · Yagi S. · Takenaka R. · Yamamoto K.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

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Background/Aims: Two studies have reported on the superiority of a proton pump inhibitor (PPI) compared with a histamine-2-receptor antagonist for the treatment of artificial ulcers after endoscopic submucosal dissection (ESD), but the optimal dose of PPI remains to be defined. The aim of this study was to evaluate the possibility of reducing the dose of PPI. The authors thus compared 30 mg (standard-dose) and 15 mg (half-dose) lansoprazole in terms of ulcer healing, prevention of bleeding and quality of life. Methods: 91 patients with gastric mucosal neoplasm were enrolled. All patients who underwent ESD were administered lansoprazole 30 mg daily during the first week, after which they were randomly assigned to either the standard-dose or half-dose group. Results: One patient in each group developed hematemesis. The stage of ulcers, ulcer reduction ratios and scores on the Gastrointestinal Symptom Rating Scale did not differ at 28 and 56 days. The costs of PPI for the half-dose group and standard-dose group were 7,326.5 and 11,698.4 JPY, respectively, i.e. a difference of 471.9 JPY. Conclusions: A reduced dose of PPI after 1 week of ESD was equivalent in treatment performance to the standard dose and cheaper.

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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  1. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S: Endoscopic mucosal dissection for treatment of early gastric cancer. Gut 2001;48:225–229.
  2. Oyama T, Kikuchi Y: Aggressive endoscopic mucosal resection in the upper GI tract-hook knife EMR method. Minim Inv Ther Allied Technol 2002;11:291–295.

    External Resources

  3. Yahagi N, Fujishiro M, Kakushima N, Kobayashi K, Hashimoto T, Oka M, Iguchi M, Enomoto S, Ichinose M, Niwa H, Omata M: Endoscopic submucosal dissection for early gastric cancer using the tip of an electrosurgical snare (thin type). Dig Endosc 2004;16:34–38.

    External Resources

  4. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y: Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000;3:219–225.
  5. Ye BD, Cheon JH, Cho KD, Kim SG, Kim JS, Jung HC, Song IS: Omeprazole may be superior to famotidine in the management of iatrogenic ulcer after endoscopic mucosal resection: a prospective randomized controlled trial. Aliment Pharmacol Ther 2006;24:837–843.
  6. Uedo N, Takeuchi Y, Yamada T, Ishihara R, Ogiyama H, Yamamoto S, Kato M, Tatsumi K, Masuda E, Tamai C, Yamamoto S, Higashino K, Ishii H, Tatsuta M: Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial. Am J Gastroenterol 2007;102:1–7.

    External Resources

  7. Kawahara Y, Takenaka R, Okada H: Risk management in endoscopic submucosal dissection in upper gastrointestinal endoscopy.Dig Endosc 2007;19:S9–S13.

    External Resources

  8. Kakushima N, Yahagi N, Fujishiro M, Iguchi M, Oka M, Kobayashi K, Hashimoto T, Omata M: The healing rate of gastric artificial ulcers after endoscopic submucosal dissection. Dig Endosc 2004;16:327–331.

    External Resources

  9. Sakita T, Fukutomi H: Endoscopic diagnosis; in Yoshitoshi Y (ed): Ulcer of Stomach and Duodenum (in Japanese). Tokyo, Nankodo, 1971, pp 198–208.
  10. Svedlund J, Sjodin I, Dotevall G: GSRS – a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 1988;33:129–134.
  11. Suzuki H, Masaoka T, Sakai G, Ishii H, Hibi T: Improvement of gastrointestinal quality of life scores in cases of Helicobacter pylori-positive functional dyspepsia after successful eradication therapy.J Gastroenterol Hepatol 2005;20:1652–1660.
  12. Lee SY, Kim JJ, Lee JH, Kim YH, Rhee PL, Paik SW, Rhee JC: Healing rate of EMR-induced ulcer in relation to the duration of treatment with omeprazole. Gastroint Endosc 2004;60:213–217.
  13. Steven MF, Richard WM: The role of prolonged esophageal pH monitoring in the diagnosis of gastroesophageal reflux. JAMA 1984;252:1160–1164.

    External Resources

  14. Gotoda T, Yamamoto H, Roy M: Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006;41:929–942.
  15. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K: Advantage of endoscopic submucosal dissection compared with EMR for gastric cancer. Gastrointest Endosc 2006;64:877–883.
  16. Shimura T, Sasaki M, Kataoka H, Tanida S, Oshima T, Ogasawara N, Wada T, Kubota E, Yamada T, Mori Y, Fujita F, Nakao H, Ohara H, Inukai M, Kasugi K, Joh T: Advantages of endoscopic submucosal dissection over conventional endoscopic mucosal resection. J Gastroenterol Hepatol 2007;22:821–826.
  17. Imagawa A, Okada H, Kawahara Y, Takenaka R, Kato J, Kawamoto H, Fujiki S, Takata R, Yoshino T, Shiratori Y: Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success. Endoscopy 2006;38:987–990.
  18. Green FW, Kaplan MM, Curtis LE, Curtis LE, Levine PH: Effect of acid and pepsin on blood coagulation and platelet aggregation: a possible contributor to prolonged gastroduodenal mucosal hemorrhage. Gastroenterology 1978;74:38–43.
  19. Berstad A: Management of acute upper gastrointestinal bleeding. Scand J Gastroenterol 1982;75:103–108.
  20. Yamaguchi Y, Katsumi N, Tauchi M, Toki M, Nakamura K, Aoki K, Morita Y, Miura M, Morozumi K, Ishida H, Takahashi S: A prospective randomized trial of either famotidine or omeprazole for the prevention of bleeding after endoscopic mucosal resection and the healing of endoscopic mucosal resection-induced ulceration. Aliment Pharmacol Ther 2005;21(suppl 2):111–115.
  21. Hashimoto T, Adachi K: Changes in gastric mucosal blood flow during healing of EMR-induced ulcer. Dig Endosc 1997;9:127–131.

    External Resources

  22. Campbell DR, Haber MM, Sheldon E, Collis C, Lukasik N, Huang B, Goldstein JL: Effect of H. pylori status on gastric ulcer healing in patients continuing nonsteroidal anti- inflammatory therapy and receiving treatment with lansoprazole or ranitidine. Am J Gastroenterol 2002;97:2208–2214.
  23. Okano A, Hajiro K, Takakuwa H, Nishio A, Matsushita M: Predictors of bleeding after endoscopic mucosal resection of gastric tumors. Gastrointest Endosc 2003;57:687–690.
  24. Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, Saito D, Ono H: Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection – an analysis of risk factors. Endoscopy 2008;40:179–183.

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