Treatment of biliary colic with diclofenac: A randomized, double-blind, placebo-controlled study

Akriviadis, Evangelos; Hatzigavriel, Michael; Kapnias, Dimitrios; Kirimlidis, John; Markantas, Apostolos; Garyfallos, Alexandros

doi:10.1016/s0016-5085(97)70099-4

Cited by 91 publications

(53 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Also, we did not treat our symptomatic patients with other drugs, such as nonsteroidal anti-inflammatory drugs that inhibit the development of complication. 45 Furthermore, classification bias as well as placebo effects are also not likely to be involved, because we used strict criteria for the diagnosis of biliary pain and cholecystitis, excluding borderline or mild signs and symptoms. Finally, selection bias, the possibility that the patients who are not likely to develop pain and complications somehow have chosen the UDCA therapy must be considered, which is common in observational studies.…”

Section: Fig 2 Cumulative Probability Of Clinically Indicated Cholementioning

confidence: 99%

Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: A cohort analysis

et al. 1999

View full text Add to dashboard Cite

Whether ursodeoxycholic acid (UDCA) therapy alters the long-term clinical course of gallstones (GS) without stone dissolution remains unknown. We aimed to clarify the relationship between long-term UDCA therapy and risks of biliary pain or acute cholecystitis in GS patients. We also aimed to identify factors affecting the natural course, and to explore a simple patient selection criteria for UDCA therapy. A cohort of 527 uncomplicated GS patients with or without UDCA (600 mg/d) followed for up to 18 years was analyzed. Patients who had frequent attacks or were complicated with cholecystitis were converted to cholecystectomy. History and UDCA therapy were identified on Cox analysis as 2 factors affecting the long-term clinical course. In patients without therapy, history was the only predictor of biliary pain among various patient or stone characteristics; biliary pain was rare in asymptomatic patients, while frequent in symptomatic patients (P F .001). UDCA therapy was associated with reduced risk for biliary pain in both symptomatic (62% vs. 92% in untreated patients at 10 years; P F .001; relative risk, 0.19; 95% CI, 0.10-0.34) and asymptomatic patients (6% vs. 12% in untreated patients at 10 years; P ‫؍‬ .037; relative risk, 0.19; 95% CI, 0.04-0.91). Risk for the conversion was also reduced in UDCA-treated symptomatic patients (26% vs. 88% in untreated patients at 10 years, P F .001; relative risk, 0.08; 95% CI, 0.03-0.22). These effects were independent of stone dissolution. Three factors were identified on Cox analysis as affecting GS dissolution: radiolucency, small size (F10 mm) of stones, and visualized gallbladder (GB) on cholecystogram. A selection criteria based on these appears to exhibit high sensitivity (74%) and specificity (95%) for dissolution. UDCA therapy might be considered in symptomatic patients fulfilling these criteria, and also in patients who have significant surgical risk, because the longterm therapy is clearly associated with reduced risk of biliary pain and acute cholecystitis. (HEPATOLOGY 1999;30:6-13.)

show abstract

Section: Fig 2 Cumulative Probability Of Clinically Indicated Cholementioning

confidence: 99%

Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: A cohort analysis

et al. 1999

View full text Add to dashboard Cite

show abstract

“…However, the fi eld of application also includes pain and swelling at other sites. More recent indications are biliary colic [2] and the prevention of post-ERCP pancreatitis [3] . In future, these substances, which, of course, include acetylsalicylic acid (ASA), might also play a signifi cant role in the prevention of benign and malignant tumors [4][5][6][7] .…”

mentioning

confidence: 99%

NSAID-Associated Dyspepsia and Ulcers: A Prospective Cohort Study in Primary Care

Hollenz

Stolte²,

Leodolter³

et al. 2006

Dig Dis

View full text Add to dashboard Cite

Background and Aim: Nonsteroidal anti-inflammatory drugs (NSAIDs) cause dyspeptic complaints and lesions in the upper gastrointestinal tract. The true incidence of these side effects in the everyday situation remains uncertain. We therefore investigated as to how often patients on NSAIDs in the primary care setting must be expected to develop troublesome dyspepsia and/or ulcers in the upper gastrointestinal tract. Patients and Methods: Admitted to the study were consecutive patients requiring NSAID treatment for at least 2 weeks, who were free of treatment-requiring dyspeptic symptoms, and who were not receiving any prophylactic co-medication. After a minimum of 2 weeks of treatment with a NSAID, a standardized questionnaire and endoscopy of the upper gastrointestinal tract were obtained. Results: 104 patients (median age 53 years, 91 women) were recruited to the study. Four patients had to be excluded for protocol violations. NSAID treatment was applied mainly with diclofenac (n = 67), followed by ibuprofen (n = 22) and rofecoxib (n = 9). The main indication was degenerative complaints affecting the vertebral column and joints. Under treatment, 35% of the patients developed troublesome dyspepsia that required treatment. The frequency of dyspepsia was independent of the duration of NSAID use. Ulcer prevalence was 16% (duodenal ulcer: n = 5; gastric ulcer: n = 11; cardiac ulcer: n = 1). Relevant epigastric pain was experienced more frequently by ulcer patients than those with no ulcer (35 vs. 18%, p = n.s.), but their overall symptom frequency was no higher than in the latter. Predictors for the development of ulcer were smoking (odds ratio 5.11 [1.59–16.48]), regular use of alcohol (odds ratio 4.49 [1.34–15.07]) and duration of treatment less than 1 month (odds ratio 4.95 [1.06–23.09]). No ulcer complications occurred during the period under observation. Overall, 44% of the patients developed troublesome dyspepsia and/or ulcer. Conclusion: Primary care patients with an average risk profile frequently develop dyspeptic symptoms requiring treatment, and ulcers while on NSAIDs. Patients who developed an ulcer were not identifiable on the basis of symptoms or risk factors.

show abstract

“…Also, the frequency of administration of NSAIDs was significantly higher in patients with gallbladder drainage or supportive care than in those without these procedures. A previous report suggested that NSAIDs relieved pain and prevented the progression of acute cholecystitis (Akriviadis et al 1997). Therefore, it is also plausible that patients who required gallbladder drainage or supportive care had received NSAIDs more frequently.…”

Section: Discussionmentioning

confidence: 99%

The Care Processes for Acute Cholecystitis According to Clinical Practice Guidelines Based on the Japanese Administrative Database

Murata

Okamoto

Matsuda

et al. 2012

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

Acute cholecystitis is one of the most frequently encountered conditions in daily practice in Japan. However, there is a shortage of detailed data about treatments that have been performed according to the clinical practice guidelines (CPGs) for acute cholecystitis. We therefore examined the management of acute cholecystitis for adherence to the appropriate CPGs using the Japanese administrative database associated with the Diagnosis Procedure Combination (DPC) system. We collected data from 6,070 patients with acute cholecystitis, examining for the application of four recommended treatments (administration of antimicrobial drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) and performance of early and laparoscopic cholecystectomy). The patients were classified according to the procedures documented for each case: no gallbladder drainage (n = 4,333), gallbladder drainage without supportive care (ventilation or hemodiafiltration or the use of vasopressor) (n = 1,591) and gallbladder drainage and supportive care (n = 146). Multiple logistic regression models revealed that patients with gallbladder drainage without supportive care and those with gallbladder drainage and supportive care significantly higher received administration of antimicrobial drugs and NSAIDs, while these patients underwent less early or laparoscopic cholecystectomy than did patients without gallbladder drainage, after adjusting for potential confounding effects of the clinical variables. This study demonstrated that there were various differences with regard to the performance of recommended treatments between the levels of procedures required for acute cholecystitis. In addition, this administrative database was a feasible tool for the evaluation of care processes and will provide useful information contributing to improved quality of medical care.

show abstract

Treatment of biliary colic with diclofenac: A randomized, double-blind, placebo-controlled study

Cited by 91 publications

References 2 publications

Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: A cohort analysis

Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: A cohort analysis

NSAID-Associated Dyspepsia and Ulcers: A Prospective Cohort Study in Primary Care

The Care Processes for Acute Cholecystitis According to Clinical Practice Guidelines Based on the Japanese Administrative Database

Contact Info

Product

Resources

About