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The symptom relleving effect of omeprazole 40 mg daily is not significantly better than 20 mg in patients with acid related disease from general practice
of anesthesia, and the intragastric position of the pH probe was confirmed by a drop in pH gradient as the tube is advanced from the distal esophagus into the gastric lumen. All pts were premedicatedwith atropine 0.5 mg and hydroxyzine 50 mg intramuscularly 30 rain before induction. Anesthesia was induced with intravenous vecuronium/propofol and maintained with the inhalation of nitrous oxide, oxygen and sevoflurane. Intravenous cimetidine 300 mg was given 30 min after the initiation of surgery. RESULTS: There were no significant differences in age, gender, height, or weight between the 2 groups. During anesthesia induction mean gastric pH was not significantly different in RAB and CIM pts (5.4 vs 4.3; p>O.05). During general anesthesia, mean gastric pH in CIM pts decreased from 4.3 to 3.8. Mean gastric pl.I during general anesthesia was significantly elevated in RAB compared to CIM pts (5.5 vs 3.8; p 1 minute) of esophageal pH less than 3. However, HP - pts had significantly lower mean gastric and esophageal pl-I than HP + pts (gastric pH: 4.5_+0.6 vs 5.9-+0.9; p0.1; esophagealpH: 6.4_+1.0vs 6.6-+0.8, p>O.1). CONCLUSION:Oraladministration of 2 doses of RA8 20 mg was similarly effective in peri-operative gastric acid suppression as 4 doses (1 oral and 3 IV) of FAM 20 rag,. In addition, RAB was more effective in gastric acid suppression in H. pylori negative pts, who had lower gastric and esophageal pH values than H. pylori positive pts. 3928 Intravenous Acid Suppression - AppropriatenessOl Use in A Tertiary Care Setting F Douglas Bair, David Armstrong, Pengfei Zhou, McMaster Univ, Hamilton Canada Background: Intravenous acid suppressants (IVAS) are used extensively for prophylaxis in ICIJ and for the management of upper GI bleeds (UGIB); the appropriateness of IVAS use is controversial. Aim: To assess the effect of introducing IV pantoprazole (P) on the appropriateness of IVAS at 3 sites of a tertiary care hospital. Materials and Methods: Patients who started intravenous ranitidine (R) or P for comparable periods before (1999) and afer (2000) the introduction of IV P (Jan 7-13th incl. at sites 1 & 2; Jan 7-20th incl. at site 3) were identified from a pharmacy database; charts were reviewed and data extracted using an electronic standardized data collection form; the appropriateness of medication use was assessed using published criteria (AmJ HealthSystPharm1999;56:347-79).Drug costs (SCan)were assessed at $10 (R: range $6-$10) and $75 (P: range $60-125). Results: The number of patients receiving IVAS was similar in 1999 (R = 82) and 2000 (86: R = 72, P= 14) but the number of days of IVAS was greater in 2000 (477: R = 411, P = 66) than in 1999 (398 days; p<0.025). Overall, (72/167 = 43.1%) of orders were appropriate; more P orders (10/14 = 71%) than R orders (62/153=40.5%: p
the introduction of =ntravenouspantoprazole. Cost savings may be achieved by prompt review and appropriate cessat=onof IVAS. 3929 Cost Savings Following Intervention with a "Test-and-Treat" Strategy for H. pylori infection in Veterans on Chronic AntisecroforyTherapy Karen Rozenberg-Ben-dror, Lakeside VA liosp, Chicago, IL; Howard Chang, Patrick Okolo, Colin W. Howden, David H. 8arch, Northwestern Univ Medical Sch, Chicago, IL Objective: To determine the cost savings from reducing or stopping antisecretory medicines in veterans with H. pylort-associated peptic ulcer disease (PUD) after treatment for H. pylori infection. Methods: 350 veterans with PUD and H. pylori infection were enrolled in a GI clinic from 6/95 to 10/99 and followed until October 2000. After treatment for H. pylori, antisecretory medicines were reduced or stopped. Pharmaceuticalcost-savings per patient-year were calculated by subtracting the actual costs of antisecretory agents per year from the presumed costs of maintaining antisecretory agents. These cost savings were compared to the expense accrued by clinical outcomes for 1999, as determined by the Medicare Physician Fee Schedule. In addition, computerized records of 255 consecutive patients who tested negative for H. pylort by serology from 10/95 to 8/99 were reviewed to find 41 with PUD. Clinical expenses accrued in 1999 for these 41 were calculated for comparison purposes. Results: Of the 350 patients enrolled, 104 were excluded from analysis because of concomitant GERD, noncompliance with anti-H, pylori treatment, use of a maintenance antisecretory medicine for NSAID prophylaxis or use of an agent other than an H2-receptor antagonists (H2RA) or proton pump inhibitor (PPI). In the remaining 246 patients, $200,775 was saved over 6 years by reducing or stopping antisecretory medicines. Pharmaceuticalexpensedecreasedby $169,861 ($541/patient-year) for 105 patients previously on a PPI and by $30,914 ($69/patient-year) for 141 patients previously on an H2RA. In comparison, the 1999 clinical expensesfor patients previously on a PPI or an H2RA totaled $33246 ($320/patient-year) and $21,015 ($151/ patient-year), respectively. Of the 41 with H. pylori-negative PUD, 12 were on a PPI, 17 on an H2RA and 12 were not on an antisecretory. The 1999 clinical expenses totaled $9,004 ($750/patient-year) for those on a PPI, $10,463 ($615/patient-year) for those on an II2RA, and $8,085 ($674/patient-year) for those not on an antisecretory. Conclusions: Reducing or stopping antisecretory medicines after treatment for H. pylori infection produced large pharmaceutical cost savings without increasing overall clinical expenses in this VA setting. Savings were most notable in PUD patients who had been on a PPI to control symptoms. An attempt should be made to discontinue antisecretory medicines after treating H. pylori infection in patients with H. pylori-associated PUD. 3930 The Symptom Relieving Effect of Omeprazofe 40 m90aily Is Not Significantly Better than 20 mg in Patients with Acid Related Disease from General Practice. Villy Meineche-Schmidt, gen practice, Kokkedal Denmark Background: Acid related symptoms in patients in general practice are often treated with PPIs. The effect of higher doses of PPI has not been tested in such patients. Aim: To compare the symptom relieving effect of omeprazole 40 mg, 20 mg and placebo for two weeks in patients diagnosed by the general practitioner as having acid related abdominal symptoms. Methods: Consequtive patients consulting in general practice because of symptoms, that according to the G.P.s daily routine would be treated with a PPI or a H2-blocker were eligible for the study, Any alarm symptom, symptoms indicating IBS, treatment with PPIs during the last two weeks were reasons for exclusion. The abdominal symptoms and Hp serology status were recorded. The patients were randomised to treatment with Omeprazole40 mg, 20 mg or placebo in the morning for two weeks. The number of patients with complete relief of the predominant symptom and the number of patients with sufficient control of dyspeptic symptoms after treatment was calculated. Results: A total of 829 patients were randomised. 58% were females, 80% were aged less than 65 years and 57% had a dyspepsia history of more than twelve months. Six per cent were excessive alcohol users and 40% were Hp positive. Percentage of patients with complete relief of predominant symptom (and 95%C.1.) were: Omeprazole 40 mg 66.4 (60.6-71.9), Omeprazole20 mg 63.0 (57.0-68.7) and placebo 34.9 (29.3-40.9). Percentage of patients with sufficient control of all dyspeptic symptoms were: Omeprazole 40 mg 71.0 (65.4-76.2), Omeprazole20 mg 69.6 (63.8- 75.0), placebo 43.0 (37.1-49.1). No differences were found comparing Hp positive and negative patients. Conclusion: Omeprazole 40 mg and 20 mg were significantly better than placebo (p
Hpinfection is primarily managed by PCPs in most countries, liowever, knowledge about the management of Hpinfection varies from region to region. AIMs: To survey worldwide PCPs basic knowledge of Hpinfection. METHODS: 11 key questions were generated, covering the pathological role of Hp, testing for and treating Hp infection, management of dyspepsia, bacterial resistance, treatment failure, and the availability of such information to PCPs. RESULTS: 470 PCPs participated, representing 29 countries and regions including: Asia 168, Oceania27, Europe 138, Africa 16, North (NA) 81 and South America (SA) 40. The pathological role of Hpis of less concerned in Africa than elsewhere (63% vs. 93%). More than 80% of the total respondents (TRs) accepted causality between Hpinfection and DU and GU. 63% considered Hpto be related to gastric cancer. Hp infection is considered less relevant to dyspepsia in SA than elsewhere (43% vs. 65%), although 50% of the respondents test for
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the introduction of =ntravenouspantoprazole. Cost savings may be achieved by prompt review and appropriate cessat=onof IVAS. 3929 Cost Savings Following Intervention with a "Test-and-Treat" Strategy for H. pylori infection in Veterans on Chronic AntisecroforyTherapy Karen Rozenberg-Ben-dror, Lakeside VA liosp, Chicago, IL; Howard Chang, Patrick Okolo, Colin W. Howden, David H. 8arch, Northwestern Univ Medical Sch, Chicago, IL Objective: To determine the cost savings from reducing or stopping antisecretory medicines in veterans with H. pylort-associated peptic ulcer disease (PUD) after treatment for H. pylori infection. Methods: 350 veterans with PUD and H. pylori infection were enrolled in a GI clinic from 6/95 to 10/99 and followed until October 2000. After treatment for H. pylori, antisecretory medicines were reduced or stopped. Pharmaceuticalcost-savings per patient-year were calculated by subtracting the actual costs of antisecretory agents per year from the presumed costs of maintaining antisecretory agents. These cost savings were compared to the expense accrued by clinical outcomes for 1999, as determined by the Medicare Physician Fee Schedule. In addition, computerized records of 255 consecutive patients who tested negative for H. pylort by serology from 10/95 to 8/99 were reviewed to find 41 with PUD. Clinical expenses accrued in 1999 for these 41 were calculated for comparison purposes. Results: Of the 350 patients enrolled, 104 were excluded from analysis because of concomitant GERD, noncompliance with anti-H, pylori treatment, use of a maintenance antisecretory medicine for NSAID prophylaxis or use of an agent other than an H2-receptor antagonists (H2RA) or proton pump inhibitor (PPI). In the remaining 246 patients, $200,775 was saved over 6 years by reducing or stopping antisecretory medicines. Pharmaceuticalexpensedecreasedby $169,861 ($541/patient-year) for 105 patients previously on a PPI and by $30,914 ($69/patient-year) for 141 patients previously on an H2RA. In comparison, the 1999 clinical expensesfor patients previously on a PPI or an H2RA totaled $33246 ($320/patient-year) and $21,015 ($151/ patient-year), respectively. Of the 41 with H. pylori-negative PUD, 12 were on a PPI, 17 on an H2RA and 12 were not on an antisecretory. The 1999 clinical expenses totaled $9,004 ($750/patient-year) for those on a PPI, $10,463 ($615/patient-year) for those on an II2RA, and $8,085 ($674/patient-year) for those not on an antisecretory. Conclusions: Reducing or stopping antisecretory medicines after treatment for H. pylori infection produced large pharmaceutical cost savings without increasing overall clinical expenses in this VA setting. Savings were most notable in PUD patients who had been on a PPI to control symptoms. An attempt should be made to discontinue antisecretory medicines after treating H. pylori infection in patients with H. pylori-associated PUD. 3930 The Symptom Relieving Effect of Omeprazofe 40 m90aily Is Not Significantly Better than 20 mg in Patients with Acid Related Disease from General Practice. Villy Meineche-Schmidt, gen practice, Kokkedal Denmark Background: Acid related symptoms in patients in general practice are often treated with PPIs. The effect of higher doses of PPI has not been tested in such patients. Aim: To compare the symptom relieving effect of omeprazole 40 mg, 20 mg and placebo for two weeks in patients diagnosed by the general practitioner as having acid related abdominal symptoms. Methods: Consequtive patients consulting in general practice because of symptoms, that according to the G.P.s daily routine would be treated with a PPI or a H2-blocker were eligible for the study, Any alarm symptom, symptoms indicating IBS, treatment with PPIs during the last two weeks were reasons for exclusion. The abdominal symptoms and Hp serology status were recorded. The patients were randomised to treatment with Omeprazole40 mg, 20 mg or placebo in the morning for two weeks. The number of patients with complete relief of the predominant symptom and the number of patients with sufficient control of dyspeptic symptoms after treatment was calculated. Results: A total of 829 patients were randomised. 58% were females, 80% were aged less than 65 years and 57% had a dyspepsia history of more than twelve months. Six per cent were excessive alcohol users and 40% were Hp positive. Percentage of patients with complete relief of predominant symptom (and 95%C.1.) were: Omeprazole 40 mg 66.4 (60.6-71.9), Omeprazole20 mg 63.0 (57.0-68.7) and placebo 34.9 (29.3-40.9). Percentage of patients with sufficient control of all dyspeptic symptoms were: Omeprazole 40 mg 71.0 (65.4-76.2), Omeprazole20 mg 69.6 (63.8- 75.0), placebo 43.0 (37.1-49.1). No differences were found comparing Hp positive and negative patients. Conclusion: Omeprazole 40 mg and 20 mg were significantly better than placebo (p
Hpinfection is primarily managed by PCPs in most countries, liowever, knowledge about the management of Hpinfection varies from region to region. AIMs: To survey worldwide PCPs basic knowledge of Hpinfection. METHODS: 11 key questions were generated, covering the pathological role of Hp, testing for and treating Hp infection, management of dyspepsia, bacterial resistance, treatment failure, and the availability of such information to PCPs. RESULTS: 470 PCPs participated, representing 29 countries and regions including: Asia 168, Oceania27, Europe 138, Africa 16, North (NA) 81 and South America (SA) 40. The pathological role of Hpis of less concerned in Africa than elsewhere (63% vs. 93%). More than 80% of the total respondents (TRs) accepted causality between Hpinfection and DU and GU. 63% considered Hpto be related to gastric cancer. Hp infection is considered less relevant to dyspepsia in SA than elsewhere (43% vs. 65%), although 50% of the respondents test for
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