Helicobacter lesions and Omeprazole working times

RE: Helicobacter lesions and Omeprazole working times

Martin Atkinson — Tue, 27 Oct 2015 10:34:46 GMT

[quote user="Aine Seavers"]NICE is however controversial here since it dropped the level at which healthy folks should go on statins- and 2/3rd of UK GPs declinced to follow the guidelines esp on the back of statins only giving healthy folks 3 days extra of life but with a whole heap of side effects[/quote]I'm rather sceptical on this point I'm afraid. There is plenty of evidence that the L carnitine in red meat, not saturated fats is the main factor in the build up of cholesterol in blood vessels leading to coronary heart disease and that unsaturated fat products contain trans fats which are more harmful. Yet a friend of mine who has severe coronary heart disease has not been told this by his doctor and continues to eat red meat with a low saturated fat diet with unsaturated fats and pops statins like sweeties. Is his GP guilty of ignorance or something a bit more cynical?: he is making too much money from continuing to prescribe statins!

RE: Helicobacter lesions and Omeprazole working times

Andrew Kent — Tue, 27 Oct 2015 10:25:58 GMT

I think NICE guidelines can be useful in some situations but I agree they often have many more factors included than just evidence - cost being the major one.

Clearly the evidence they look at is also primarily human which doesn't mean that the conclusions are always as reliable or useful in our patients.

Andy

RE: Helicobacter lesions and Omeprazole working times

Aine Seavers — Tue, 27 Oct 2015 09:54:02 GMT

NICE is however controversial here since it dropped the level at which healthy folks should go on statins- and 2/3rd of UK GPs declinced to follow the guidelines esp on the back of statins only giving healthy folks 3 days extra of life but with a whole heap of side effects in the interim- so can one trust NICE not to have a conflict on interest given recent disclosures? Maybe one can but I wont be taking statins any time soon on what I have read for healthy folks and now I see PPIs for humans again in the news for not appropriate for reflux, yet we do it for pets.

RE: Helicobacter lesions and Omeprazole working times

Aine Seavers — Mon, 26 Oct 2015 21:35:33 GMT

They are used here for the triad with proven helicobacter presence- for 2 weeks average and no longer than 6 max after the antibiotics have stopped. In vet medicine they are used without such guide lines and often way beyone 8 weeks with this constant mis information that they take a week to work which is simply incorrect given anything I have been ever able to find to read on these meds.

RE: Helicobacter lesions and Omeprazole working times

Michael Woodhouse — Mon, 26 Oct 2015 19:33:23 GMT

[quote user="Aine Seavers"]medical profession 2012 advised: PPIs should not be used in advance of H₂RAs, an argument against 'step-down' therapy and other popular practices.^[2[/quote]

In the UK you would be prescribed a PPI alongside antibiotics if you had an ulcer. It's in the NICE guide.

RE: Helicobacter lesions and Omeprazole working times

Anthony Dennison — Thu, 22 Oct 2015 11:54:55 GMT

[quote user="Hannah Wynne Richards"]

What's the connection between mis-sold insurence policies and gastritis?

Wynne

[/quote]

PPI = Proton Pump Inhibitor

RE: Helicobacter lesions and Omeprazole working times

Aine Seavers — Thu, 22 Oct 2015 11:39:31 GMT

yes- agree with your findings in its use for CKD totally.

I was of the impression that atrophic gastritis and dysplasia have been noted with H.pylori both in vivi and in vitro studies for some time now and and that would tie in with my experience with some cats.

RE: Helicobacter lesions and Omeprazole working times

Aine Seavers — Thu, 22 Oct 2015 11:33:44 GMT

thanks Andy-I will have an in-depth read of them tomorrrow but note that in non geriatric cats they used a very low dose 2mg/kg d when we usually are up around the 4mg/kg dose in younger cats but yes its pro-kinetic effect is probably what we most benefit from in cats. My issue with the omeprazole wash out time is that here in Oz some specialists about 5 yrs ago were saying only bad vets used cimetedine in the dogs and so risked sever hypergastric rebound and hence advised omeprazole-without knowing that it has a a more tricky hypergastric rebound .Where did that leave UK vets who under the cascade had to use cimetidine first and yet the UK was not awash with cases of hypergasrtic rebound in pet coming off tagamet.

RE: Helicobacter lesions and Omeprazole working times

Hannah Wynne Richards — Thu, 22 Oct 2015 11:25:33 GMT

What's the connection between mis-sold insurence policies and gastritis?

Wynne

RE: Helicobacter lesions and Omeprazole working times

Andrew Kent — Thu, 22 Oct 2015 10:36:04 GMT

There are a couple of studies looking at antacids in our patients, there was a recent JVIM one in cats, which is now open access so you can see it here: http://onlinelibrary.wiley.com/doi/10.1111/jvim.12580/epdf

It found that ranitidine was no better than placebo at suppressing gastric acidity, omeprazole required twice daily administration (which we likely already knew).

However I do think ranitidine can be useful in cats but perhaps more for its pro-kinetic activity than antacid?

The study that is always quoted for dogs is older, see: http://avmajournals.avma.org/doi/abs/10.2460/ajvr.2005.66.425

Again, this suggested than ranitidine was no better than placebo.

In terms of your other points - I agree that there is little evidence that omeprazole takes a week to work - even on day 1 it is more effective than anything else and probably reaches a maximum effect by day 2-3.

And I also agree there is a reflex increase in acidity when omeprazole is stopped and there are some studies looking into this - whether this is a clinically significant problem remains to be seen!

Andy

RE: Helicobacter lesions and Omeprazole working times

Martin Atkinson — Thu, 22 Oct 2015 08:47:38 GMT

My understanding is that helicobactor is not pathogenic in cats and that treatment of gastric ulceration has been wrongly extrapolated from human medicine. Certainly in my experience Rantidine alone seems to be effective in controlling vomiting in feline CKD cases where gastric inflammation has been suspected as a cause of vomiting/anorexia.