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Absence of therapeutic benefit from antacids or cimetidine in non-ulcer dyspepsia
Abstracts in this issue were prepared by residents in the University of Arizona Emergency Medicine ResidencyProgram, Steven Seifert, MD, FACEP,on-site co-editor.
ABSTRACTS Harvey W Meislin, MD, FACEP Co-Editor Section of Emergency Medicine University of Arizona College of Medicine
Vincent J Markovchick, MD, FACEP Co-Editor Emergency Medical Services Denver General Hospital
antacids, cimetidine, gastritis
A b s e n c e of t h e r a p e u t i c benefit from antaci ds or c i m e t i d i n e in non-ulcer dyspepsia Nyren O, Adami HO, Bates S, et al N Engl J Med 314:339-343
Feb 1986
This prospective, double-blind, randomized study was designed to test the efficacy of antacids and cimetidme in the treatment of dyspepsia that is not secondary to peptic ulcer disease. One hundred fifty-nine patients with epigastric pain of at least two months duration were endoscoped. None had peptic ulcer disease. Eighty-two of the 159 patients had no evidence on endoscopy of organic lesions of the upper gastrointestinal tract, 73 had superficial gastritis, two had duodenitis, and two had both gastritis and duodeuitis. Patients were randomized into three groups receiving either an antacid containing aluminum hydroxide, magnesium hydroxide, and magnesium carbonate taken one and three hours after meals and at bedtime; cimetidine 400 mg twice a day; or placebo tablets. The treatment course was three weeks long and patients recorded their pain intensity on a scale of 0 to 6. All groups had an improvement in pain intensity after two weeks, and there was no statistical difference between any of the three groups. There was no difference in the group of patients who had endoscopically proven gastritis. [Editor's n o t e : This paper is another testi-
monial to the power of the placebo effect. The placebo effect is a powerful ally in the management of painful conditions.] Alan Goldner, MD abdominal trauma, handlebar injuries
Bicycle h a n d l e b a r injuries in children Sparnon AL, Ford WDA J Pediatr Surg 21:118-119
Feb 1986
The authors report on a retrospective ten-year review on injuries in children sustained from bicycle handlebars. Accidents involving a motor vehicle were excluded. Thirty children required admission. All of the riders fell forward onto the handlebars. With one exception, the falls initially were considered trivial, no ambulance was called, and 21 patients went directly home. There were no immediate signs of se-
162/973
vere i n j u ~ and nine patients were sent home after evaluation by a physician. Only when pain increased, or vomiting or collapse occurred, were the children admitted, resulting in a mean delay from time of accident to time of admission of 23 hours. The mean hospital stay was 22 days. The injuries included ten cases of traumatic pancreatitis (four with associated duodenal hematomas), five renal injuries, five ruptured spleens, two liver injuries, three small bowel perforations, and five abdominal wall hematomas. Eighteen operative procedures were necessary. The authors emphasize that these seemingly trivial accidents must be considered potentially serious despite minimal initial findings.
Steven M Chernow, MD headache, lumbar puncture
Is obligatory bed rest after lumbar punc t ur e obsolete? Dieterick M, Brandt Th Eur Arch Psych Neurol Sci 235:71-75
Spring 1985
Because postlumbar puncture headache (PLPH) is a common complication of spinal taps and prophylactic bed rest after lumbar puncture (LP) is often prescribed despite conflicting data on mode and efficacy, the authors designed a study to determine the prophylactic value of a specific posture taken by the patient after LP Eighty women and girls, and 80 men and boys 12 to 82 years of age (average age, 46), who were neurological patients, were randomly assigned to one of two groups. Seventy-eight patients lay prone with the head tilted down at a 10° angle for 30 minutes; 82 patients rose immediately after LP Exclusion criteria were patients with LP in the previous four weeks; those with increased intracranial pressure; those who could not be mobilized or who were taking analgesics; patients with psychoorganic disease, disturbance of consciousness, or pre-LP headache; or patients who required multiple needle introductions for a successful tap. LP was performed in a sitting position with a 20- or 22-gauge needle through the I_3/4 or L4/5 interspace, and 8 mL to 10 mL cerebrospinal fluid was removed. Alter LP the patients were told to drink 3 L fluid per day for five days. PLPH affected 44% of the patients who stayed in bed; 30% had minor complaints and 14% had major complaints. Of the patients who were mobilized immediately, 41% developed PLPH, 23% to a minor degree and 18% to a major degree. The authors conclude that there is no longer any justification for requiring patients to remain in bed after LP
Annals of EmergencyMedicine
Sidney Starkman, MD 15:8 August 1986
ABSTRACTS Harvey W Meislin, MD, FACEP Co-Editor Section of Emergency Medicine University of Arizona College of Medicine
Vincent J Markovchick, MD, FACEP Co-Editor Emergency Medical Services Denver General Hospital
antacids, cimetidine, gastritis
A b s e n c e of t h e r a p e u t i c benefit from antaci ds or c i m e t i d i n e in non-ulcer dyspepsia Nyren O, Adami HO, Bates S, et al N Engl J Med 314:339-343
Feb 1986
This prospective, double-blind, randomized study was designed to test the efficacy of antacids and cimetidme in the treatment of dyspepsia that is not secondary to peptic ulcer disease. One hundred fifty-nine patients with epigastric pain of at least two months duration were endoscoped. None had peptic ulcer disease. Eighty-two of the 159 patients had no evidence on endoscopy of organic lesions of the upper gastrointestinal tract, 73 had superficial gastritis, two had duodenitis, and two had both gastritis and duodeuitis. Patients were randomized into three groups receiving either an antacid containing aluminum hydroxide, magnesium hydroxide, and magnesium carbonate taken one and three hours after meals and at bedtime; cimetidine 400 mg twice a day; or placebo tablets. The treatment course was three weeks long and patients recorded their pain intensity on a scale of 0 to 6. All groups had an improvement in pain intensity after two weeks, and there was no statistical difference between any of the three groups. There was no difference in the group of patients who had endoscopically proven gastritis. [Editor's n o t e : This paper is another testi-
monial to the power of the placebo effect. The placebo effect is a powerful ally in the management of painful conditions.] Alan Goldner, MD abdominal trauma, handlebar injuries
Bicycle h a n d l e b a r injuries in children Sparnon AL, Ford WDA J Pediatr Surg 21:118-119
Feb 1986
The authors report on a retrospective ten-year review on injuries in children sustained from bicycle handlebars. Accidents involving a motor vehicle were excluded. Thirty children required admission. All of the riders fell forward onto the handlebars. With one exception, the falls initially were considered trivial, no ambulance was called, and 21 patients went directly home. There were no immediate signs of se-
162/973
vere i n j u ~ and nine patients were sent home after evaluation by a physician. Only when pain increased, or vomiting or collapse occurred, were the children admitted, resulting in a mean delay from time of accident to time of admission of 23 hours. The mean hospital stay was 22 days. The injuries included ten cases of traumatic pancreatitis (four with associated duodenal hematomas), five renal injuries, five ruptured spleens, two liver injuries, three small bowel perforations, and five abdominal wall hematomas. Eighteen operative procedures were necessary. The authors emphasize that these seemingly trivial accidents must be considered potentially serious despite minimal initial findings.
Steven M Chernow, MD headache, lumbar puncture
Is obligatory bed rest after lumbar punc t ur e obsolete? Dieterick M, Brandt Th Eur Arch Psych Neurol Sci 235:71-75
Spring 1985
Because postlumbar puncture headache (PLPH) is a common complication of spinal taps and prophylactic bed rest after lumbar puncture (LP) is often prescribed despite conflicting data on mode and efficacy, the authors designed a study to determine the prophylactic value of a specific posture taken by the patient after LP Eighty women and girls, and 80 men and boys 12 to 82 years of age (average age, 46), who were neurological patients, were randomly assigned to one of two groups. Seventy-eight patients lay prone with the head tilted down at a 10° angle for 30 minutes; 82 patients rose immediately after LP Exclusion criteria were patients with LP in the previous four weeks; those with increased intracranial pressure; those who could not be mobilized or who were taking analgesics; patients with psychoorganic disease, disturbance of consciousness, or pre-LP headache; or patients who required multiple needle introductions for a successful tap. LP was performed in a sitting position with a 20- or 22-gauge needle through the I_3/4 or L4/5 interspace, and 8 mL to 10 mL cerebrospinal fluid was removed. Alter LP the patients were told to drink 3 L fluid per day for five days. PLPH affected 44% of the patients who stayed in bed; 30% had minor complaints and 14% had major complaints. Of the patients who were mobilized immediately, 41% developed PLPH, 23% to a minor degree and 18% to a major degree. The authors conclude that there is no longer any justification for requiring patients to remain in bed after LP
Annals of EmergencyMedicine
Sidney Starkman, MD 15:8 August 1986