Zeitschrift für Gastroenterologie
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Kava extracts are obtained from the rhizoma of the kava shrub (Piper methysticum) and contain various pyrones which are used as herbal anxiolytic remedies for generalized anxiety syndromes of low and intermediate grades. The commonly recommended daily dose of 60-120 mg kavapyrones and the duration of the therapy of up to 3 months should not be increased without consultation of a physician and were not followed by most patients, since herbal drugs are considered by the population not only as effective but also as safe. Whereas kava extracts are well tolerated by most patients and rare side effects are rapidly reversible upon drug discontinuation, there are suspected hepatotoxic reactions reported during the last years in temporal and not necessarily causal association with a therapy with kava extracts. ⋯ Preventive measures should therefore include a dose of 120, maximally 210 mg kavapyrones per day for 1 month, maximally 2 months, as well as a prescription by a physician. Laboratory test (ALT and gamma-GT) should be done before and during the therapy, and co-medication and alcohol consumption should be avoided. With these measures the hepatotoxic risks under the treatment with kavapyrones might be minimized which are also available via internet and from abroad with possible severe consequences when taken without medical supervision.
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the treatment of arthritis and pain. These drugs tend to cause significant side effects, however, including gastric and intestinal toxicity. The mechanism of action of NSAIDs is through their inhibition of the key enzyme of prostaglandin biosynthesis, the cyclooxygenase. ⋯ The COX-2 selectivity of these novel NSAIDs relate well to their favorable gastrointestinal tolerability profile. Clinical trials have shown meloxicam and celecoxib to be as effective as currently available NSAIDs, but with an improved gastrointestinal tolerability profile. Further clinical trials and large-scale postmarketing surveillance programs are needed, however, to confirm the potential therapeutic benefits of these novel preferential or specific COX-2 inhibitors.
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Review Clinical Trial
Randomised controlled trials for variceal bleeding.
The variceal bleeding episode represents several days of high risk of bleeding, thus therapy should be evaluated not only in terms of immediate cessation of bleeding but also in terms of providing a bleed-free interval of a few days. As the risk of continued bleeding or very early rebleeding from varices diminishes rapidly following admission, time is an important confounding variable when comparing therapies within and between trials. Cirrhotics with better liver function are more likely to stop bleeding with simple measures than those with worse liver function. ⋯ Firstly improvement of existing therapies or new therapies. Secondly, investigation of therapies not related to bleeding, eg prophylaxis against infection, improvement in renal support. Lastly evaluation of predictive factors which may a priori determine a high risk of continued bleeding or early rebleeding thus justifying immediate sclerotherapy or surgery in a sub-group of patients.
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Review
[Cytotoxicity of bile acids and lysolecithin--a factor in the pathogenesis of stomach ulcer?].
The role of bile acids and lysolecithin in the pathogenesis of peptic ulcer is as yet not unequivocally defined. Based on the physiochemical properties of bile acids and animal experiments they have damaging potential on the mucosal cell. ⋯ Based on the damaging potential in animal experiments and the few reported patient studies a role in pathogenesis is more probable than for bile acids. Studies on concentrations and effects of both, bile acids and lysolecithin over prolonged periods of time in patients with ulcer disease are necessary to further clarify their role in pathogenesis of ulcer disease.