Hypothyroidism in polymyalgia rheumatica and giant cell arteritis.

Abstract

two), fatigue (two), insomnia (one), back pain (two).In one omeprazole treated patient the serum aspartate aminotransferase activity rose from 20 to 82 U/i (reference range 20-40 U/I) and the alkaline phosphatase activity from 368 to 808 U/I (reference range 82-224 U/1).The patient had no symptoms and the values were almost normal one month after the end of treatment.Two cimetidine treated patients also had raised aspartate aminotransferase activities.Some patients in both groups had abnormal liver function values at entry, which continued unchanged during the trial.In several patients single laboratory values fell outside the normal range, but these abnormalities occurred at random in both groups.The mean change in laboratory values in the two treatment groups from day 1 to day 43 was compared by using the two sample t test.No significant differences were found (p>O0 15), apart from the difference caused by a slight increase in the serum creatinine concentration in the cimetidine group (p = 0 00004). DiscussionPrevious controlled studies have provided little information on the effect of omeprazole on the healing of ulcers of the body of the stomach.A German multicentre trial in patients with gastric ulcer found no appreciable difference between the effects of omeprazole 20 mg and ranitidine 300 mg daily.6The ulcer was located in the body of the stomach in 53 patients, and the authors mentioned that the healing rate in this subgroup was lower than among the remaining patients, regardless of treatment.In two other trials in patients with gastric ulcer omeprazole was found to be superior to ranitidine but the available abstracts provide no information on sites of the ulcers."6In one study, which comprised solely patients with prepyloric ulcers, treatment with omeprazole 30 mg was found to be slightly superior to treatment with cimetidine 1 g.3We conclude that omeprazole 30 mg daily accelerates the healing of ulcers of the body of the stomach as compared with cimetidine 1 g daily.The results suggest that this effect may be more pronounced in larger ulcers than in smaller ulcers.A trial in patients with mixed gastric ulcers showed that omeprazole 40 mg daily provides higher healing rates than omeprazole 20 mg daily.7 Possibly, therefore, our results could be improved by using a higher dose.Our findings also support the conclusion from studies of duodenal ulcers, prepyloric ulcers, and mixed gastric ulcers that short term treatment of peptic ulcers with omeprazole is safe.The safety and efficacy of longer term use of omeprazole have yet to be assessed.Omeprazole and placebo capsules were kindly provided by A B Hassle, Molndal, Sweden.