Treatment of reflux esophagitis using dimethylpolysiloxane

Abstract

Dimethylpolysiloxane of the general formula ##STR1## is used for the treatment of inflammatory disorders of the oesophagus and of inflammatory and ulcerous disorders of the gastrointestinal tract.

Description

The defoaming effect of dimethylpolysiloxane is well investigated and is already used therapeutically as antiflatulent or ill preparation for sonography.

It has been found, surprisingly, that dimethylpolysiloxane can be employed with a particularly advantageous effect for the treatment of ulcerous disorders of the gastrointestinal tract. The defoaming effect of dimethylpolysiloxane is correlated with the other physicochemical properties film-formation and adhesion to walls. It has emerged, surprisingly, that dimethylpolysiloxane can also be administered orally over extended periods without disadvantageous effects in order to form and maintain in the oesophagus and in the gastrointestinal tract of humans a protective layer which assists the healing process when disorders of the type described are present.

The agent according to the invention is particularly employed for the treatment of ulcerous disorders of the gastrointestinal tract, generally of disorders of the oesophagus, of the stomach and upper small intestine, such as oesophagitis, ulcers (gastric and duodenal). It is used in the form of an orally administerable composition with a pharmaceutically acceptable diluent or carrier, e.g. in the form of chewable tablets.

The use according to the invention of dimethylpolysiloxane experiences an increase in its effectiveness when the agent is taken in conjunction with silica gel.

This results in the coating which is generated by the agent in the oesophagus and gastrointestinal tract having a gel-like structure. This layer comes very close to the physiological mucus (e.g. gastric mucus) which protects the mucous membranes of the oesophagus and gastrointestinal tract.

It is possible with the agent employed according to the invention specifically to coat the mucous membranes of oesophagus and gastrointestinal tract over a prolonged period by appropriate intake even for days, weeks or months, and thus protect them against the aggressive constituents of the gastrointestinal tract, such as hydrochloric acid and digestive enzymes. The protection brought about by the agent employed according to the invention effects, on the one hand, a reduction in the activity of tissue-damaging mechanisms and, on the other hand, a comparatively unimpaired regeneration of the walls associated with the cell regeneration and with the ulcer cleansing. The agent employed according to the invention additionally brings about an increase in the pH (buffering of raised acid values) in the stomach. The subjective feeling of the patient improves due to intake of the agent, the `heartburn` of the frequently hyperacid patients disappears.

Investigations

The following were investigated as a function of the dose and time:

1. Distribution and film-formation of dimethylpolysiloxane in the stomach. 2. Distribution and film-formation of dimethylpolysiloxane in the duodenum.

8 healthy men aged 25 and 40 years were employed as volunteer subjects (Table 1). The study was carried out as a controlled, randomized phase I study in crossover design. For the crossover design, the 8 subjects were randomized and assigned to the two dosage forms. The investigations were carried out at an interval of 7 days.

Two dosages were used per subject in the crossover design:

Dosage 1: 80 mg of dimethylpolysiloxane: (2.times.40 mg dimethylpolysiloxane chewable tablets) Dosage 2: 160 mg of dimethylpolysiloxane: (4.times.40 mg dimethylpolysiloxane chewable tablets)

The composition of the dimethylpolysiloxane chewable tablets is shown in Table 8.

No other drugs were allowed to be taken immediately before and during the study. Furthermore, smoking was not permitted on the day of the investigation.

Control Investigations

A comprehensive history was taken at the initial investigation; in addition the basic physical and neurological investigations. Laboratory tests were also carried out.

The following gastroenterological progress investigations were carried out on all the subjects on both investigation days:

1. Gastroscopy with documentation of oesophagus, stomach and duodenum immediately before chewing the dimethylpolysiloxane tablets. 2. The same investigations, including the documentation, 30 minutes after taking the chewable tablets. 3. The same investigations, including the documentation, 2 hours after chewing the dimethylpolysiloxane chewable tablets.

The investigations were carried out twice for each subject, with each alternative dosage, at an interval of 7 days. At a second progress investigation, in addition the pH of the stomach contents was measured at each gastroscopy.

The subjects were not allowed to take any food or drink for at least 6 hours before each drug intake and gastroscopy.

To prepare for the endoscopy, each subject received 0.5 mg of atropine in 1 ml of NACL solution administered subcutaneously. The local anaesthetic given for the mouth and pharyngeal space was Wander Novescine 1% solution (oxybuprocaine-HCL).

The gastroscopic investigations were carried out with an Olympus type P.sub.10 instrument. Documentation was effected by the visual findings and photography.

Results

1. Change in the stomach pH

Table 2 summarizes the changes in pH based on the pH at the investigation immediately before medication and 2 hours after medication.

The dimethylpolysiloxane administration leads to a distinct increase in the pH, i.e. a distinct shift from strongly acid in the direction of the alkaline range, irrespective of the number of chewable tablets administered. Despite the small number of subjects, this difference is significant at the 5% level.

Subject 7 was removed from the calculation because he had a duodenal cap greatly deformed by scarring and, moreover, the pH was already near the alkaline range (pH 6.05 or 6.83).

2. Film formation

Table 3 summarizes the individual results in Tables 4 to 7. The aim of the study was to demonstrate that the dimethylpolysiloxane remained in the stomach or duodenum in the observed period of 2 hours after administration of chewable tablets. The results are unambiguous. Administration of only 2 tablets of dimethylpolysiloxane (80 mg) leads to a reaction in all the subjects. This is even more evident due to administration of 4 tablets of dimethylpolysiloxane (160 mg).

At 360 mg, a relatively large amount of milky secretion was evident as observation parameter on the gastric mucous membrane in 7 of 8 subjects.

The individual findings (and the summary findings) are set out in Tables 4 to 7.

Evaluation of the visual findings and of the photographic documentation allows the summary assessment to be made that dimethylpolysiloxane chewable tablets and dimethylpolysiloxane are able to form an adhesive film on the gastric mucous membrane and in the proximal part of the duodenum.

TABLE 1______________________________________Anamnestic data on the subjects in the dimethylpolysiloxane study Mean SD Min Max Median______________________________________Age 32.15 4.51 25 40 31.5 yearsHeight 179.75 7.31 170 191 181 cmWeight 78 7.68 63 90 77 kgSystol. blood 116 9.99 101 130 114.5 mmHgpressureDiast. blood 78.62 8.44 62 90 81 mmHgpressurePulse 63.5 10.94 53 88 60.5 min______________________________________ TABLE 8______________________________________40 mg dimethylpolysiloxane chewable tablets______________________________________Composition per tablet:I. 1) Dimethylpolysiloxane DAB9 40.000 mg 2) Highly disperse silica DAB9 12.555 mg 3) Peppermint oil DAB9 0.300 mg Aniseed oil DAB9 0.033 mg 4) Microcrystalline cellulose DAB9 200.000 mgII. 5) Mannitol DAB9 338.111 mg 6) Saccharin sodium DAB9 0.667 mg 7) Carboxymethylcellulose sodium DAB9 1.667 mgIII. 9) Magnesium stearate DAB9 3.333 mg 10) Maize starch DAB9 3.333 mg______________________________________ DAB9 is the abbreviation for Deutches Arznel Buch (German Pharmaceutical Handbook) 9th Edition. TABLE 2______________________________________Change in the pH values in the stomach onmedication with dimethylpolysiloxane Sub;. No. 1 2 3 4 5 6 7 8______________________________________Before med. 1.80 1.96 1.92 1.98 1.51 2.11 6.03 1.6930 min after 2.06 -- -- -- -- -- -- --med.2 hours after 2.15 2.04 4.48 7.49 3.84 2.32 6.83 2.67med.No. of Tab. 2 4 4 2 2 2 4 2______________________________________

A positive influence on the pH by the medication is confirmed by the sign test (p<0.05, two-sided). However, no influence of the number of tablets on the increase in the pH can be established.

Subject 7 had a deformed duodenal cap due to scarring, without stenosis, was not included in the calculation because of the high pH values.

TABLE 3______________________________________Positive reaction on administration of dimethyl-polysiloxane chewable tablets______________________________________2 dimethylpolysiloxane tabletsSubjects withpositive reaction* no reaction n______________________________________8 0 8______________________________________4 dimethylpolysiloxane tabletsSubjects withpositive reaction** no reaction n______________________________________8 0 8______________________________________ *The reaction was minimal milky secretion in 5 of 8 subjects **The reaction was minimal milky secretion in 1 of 8 subjects, otherwise always a relatively large amount of milky secretion TABLE 4______________________________________Findings at the first investigation No. of Time* tabl. Finding______________________________________Subject No. 1 1 4 Signs of antral gastritis. Other- wise duodenum, stomach and oesophagus macroscopically normal.Subject No. 1 2 4 Gastric juice in the fundus; milky, cloudy and flocculent.Subject No. 1 3 4 Only minimal residues in the fundus. Otherwise empty as far as the deep duodenum.Subject No. 2 1 2 Signs of slight antral gastritis. Otherwise duodenum, stomach and oesophagus macroscopically normal.Subject No. 2 2 2 Gastric juice in the fundus; milky, cloudy and flocculentSubject No. 2 3 2 Still milky substance in the fundus. Duodenum and antrum empty.Subject No. 3 1 2 Small hiatus hernia with reflux of grade 0-1. Otherwise duodenum, stomach and oesophagus macroscopically normal.Subject No. 3 2 2 Gastric juice in the fundus; milky, cloudy and flocculentSubject No. 3 3 2 Minute residues of milky, flocculent deposits. Fundus with a film-like coating over large areas. Duodenum empty.Subject No. 4 1 4 Duodenum, stomach and oesophagus macroscopically normal.Subject No. 4 2 4 Gastric juice in the fundus; milky, cloudy and flocculentSubject No. 4 3 4 Slightly cloudy, milky gastric juice. Otherwise duodenum, stomach, oesophagus normal.Subject No. 5 1 4 Small hiatus hernia with reflux oesophagitis (grade 0-1). Other- wise duodenum, stomach and oesophagus macroscopically normal.Subject No. 5 2 4 Antrum with scabby-milky coating in the fundus. Very cloudy, milky fluid.Subject No. 5 3 4 Residues of milky flakes in the fundus. A few plaques in the antrum. Duodenum empty.Subject No. 6 1 4 Duodenum, stomach and oesophagus normal.Subject No. 6 2 4 A few whitish, milky spots in the antrum. Otherwise cloudy, milky coating in the fundus.Subject No. 6 3 4 Very cloudy, milky fluid deposited on the fundus. A few plaques in the antrum. Duodenum empty.Subject No. 7 1 2 Deformed duodenal cap due to scarring, without stenosis. Stomach and oesophagus normal.Subject No. 7 2 2 Low-viscosity, milky deposits in the fundus. Antrum, duodenum empty.Subject No. 7 3 2 Minimal spots of milky deposits in the stomach fundus. Other- wise duodenum and antrum empty.Subject No. 8 1 2 Duodenum, stomach and oesophagus normal.Subject No. 8 2 2 Low-viscosity but cloudy, milky secretion in the fundus, film-like coating. Antrum, duodenum empty.Subject No. 8 3 2 Low-viscosity milky secretion as film-like coating. Secretion cloudy. Antrum, duodenum empty.______________________________________ *Time 1 = immediately before medication Time 2 = 1/2 hour after medication Time 3 = 2 hours after medication TABLE 5______________________________________Findings at the second investigation(after 7 days) No. of Time* Tabl. Finding______________________________________Subject No. 1 1 2 Duodenum, stomach, oesophagus normal, distinct macroscopic improvement in antral gastritis. pH 1.80Subject No. 1 2 2 Distinctly less milky secretion and film coating. Otherwise finding unchanged. pH 2.06Subject No. 1 3 2 Minimal milky secretion in the fundus. Duodenum, stomach normal. pH 2.15Subject No. 2 1 4 Continuing signs of slight antral gastritis. Otherwise duodenum, stomach and oesophagus normal. pH 1.96Subject No. 2 2 4 Large amount of high-viscosity milky secretion in the fundus. Otherwise antrum empty.Subject No. 2 3 4 Large amount of high-viscosity milky secretion in the fundus. Antrum, duodenum empty. pH 2.04Subject No. 3 1 4 Small hiatus hernia with reflux of grade 0-1. Otherwise duodenum, stomach and oesophagus macroscopically normal. pH 1.92Subject No. 3 2 4 Large amount of high-viscosity milky secretion in the antrum and fundus, duodenum empty.Subject No. 3 3 4 Large amount of residues of milky coating and secretion in the antrum and fundus. Duodenum empty. pH 4.48Subject No. 4 1 2 Duodenum, stomach and oesophagus macroscopically normal. pH 1.98Subject No. 4 2 2 Minimal milky secretion in the fundus. Duodenum, antrum empty.Subject No. 4 3 2 Only residues of cloudy, milky secretion in fundus. Duodenum and antrum otherwise empty. pH 7.49Subject No. 5 1 2 Small hiatus hernia with reflux oesophagitis (grade 0-1). pH 1.51Subject No. 5 2 2 Minimal milky secretion in the corpus and in the antrum. Duodenum empty.Subject No. 5 3 2 Little cloudy secretion in the fundus. Antrum, duodenum empty. pH 3.84Subject No. 6 1 2 Duodenum, stomach and oesophagus normal. pH 2.11Subject No. 6 2 2 Little milky, cloudy secretion in the fundus and corpus.Subject No. 6 3 2 Minimal secretion in the duodenum and in the stomach. pH 2.32Subject No. 7 1 4 Deformed duodenal cap due to scarring, without stenosis. Stomach and oesophagus normal. pH 6.03Subject No. 7 2 4 Little milky cloudy secretion in the fundus. Antrum duodenum empty.Subject No. 7 3 4 Minimal secretion in the fundus without the milky cloudiness. Duodenum, antrum empty. pH 6.83Subject No. 8 1 4 Duodenum, stomach and oesophagus normal. pH 1.69Subject No. 8 2 4 Minimal, milky secretion as film-like coating. Tablets unchewed in the corpus. Duodenum empty.Subject No. 8 3 4 Now large amount of cloudy, milky secretion as film-like coating in the fundus. Corpus, duodenum, antrum empty. pH 2.67______________________________________ *Time 1 = immediately before medication Time 2 = 1/2 hour after medication Time 3 = 2 hours after medication TABLE 6______________________________________Summary of the findings in the dimethylpolysiloxane study No. of Frequency of occurrence subj. 2T 4T t2 t3 t 2 + 3______________________________________Signs of antral gastritis 2Antral gastritis macroscop. 1improvedDuodenum and antrum 6 6 4 4 6emptyDuodenum empty 3 3 1 2Corpus empty 1 1 1Minimal/little milky 6 5 1 2 2 2secretionMinimal/residues of spots 4 2 2 1 3of milky depositsA few plaques in the antrum 2 0 2 0 2Milky, cloudy, flocculent 4 2 2 2 2gastric juiceMilky deposits 5 3 2 2 1 2Large amount of high- 3 0 3 1 1 1viscosity milky secretionLarge amount of residues of 1 0 1 1milky coating and secretion______________________________________ Abbreviations: No. of subj. = number of subjects; T = tablets; t = time TABLE 7______________________________________Findings in the dimethylpolysiloxane study Subj. No. of Investigation No. Date tabl. time______________________________________Signs of antral gastritis 1 March 15 1Antral gastritis macro- 1 March 22 1scop. improvedSigns of antral gastritis 2 March 15 1 2 March 22 1Small hiatus hernia 3 March 15 1 3 March 22 1 5 March 15 1 5 March 22 1Deformed duodenal cap 7 March 15 1due to scarring, without 7 March 22 1stenosis.Duodenum and antrum 2 March 15 2 3empty 3 March 15 2 3 4 March 22 2 2 and 3 5 March 22 2 2 and 3 7 March 15 2 2 and 3 8 March 15 2 2 and 3 2 March 22 4 2 and 3 4 March 15 4 3 7 March 22 4 2 and 3 8 March 22 4 3Duodenum empty 5 March 15 4 3 6 March 15 4 3 8 March 22 4 2Corpus empty 8 March 22 4 3Minimal milky secretion 8 March 22 4 2(tablets unchewed in thecorpus)Minimal milky secretion 1 March 22 2 2 and 3in the fundus 4 March 22 2 2 and 3 5 March 22 2 3 6 March 22 2 2Minimal milky secretion 5 March 22 2 2in the corpus and antrum 6 March 22 2 2Fundus with minimal 7 March 15 2 3spots of milky deposits 1 March 15 4 3Little milky secretion in 7 March 22 4 2the fundusStomach with minimal 7 March 15 2 3spots of milky depositsMinimal secretion in the 6 March 22 2 3duodenum and antrumMinimal secretion in the 7 March 22 4 3fundus without milkycloudinessA few whitish spots in 6 March 15 4 2the antrumMinute residues of 3 March 15 2 3milky, flocculentdepositsResidues of milky flakes 5 March 15 4 3in the fundusA few plaques in the 5 March 15 4 3antrum 6 March 15 4 3Milky, cloudy, floccu- 2 March 15 2 2 and 3lent gastric juice in the 3 March 15 2 2fundus 1 March 15 4 2 4 March 15 4 2 and 3Low-viscosity, milky 7 March 15 2 2deposits in the fundus 8 March 15 2 2 and 3Fundus with film-like 3 March 15 2 3coating over large areaAntrum and fundus with 5 March 15 4 2scabby-milky coatingFundus with cloudy, 6 March 15 4 2 and 3milky coatingLarge amount of high- 2 March 22 4 2 and 3viscosity milky secretion 3 March 22 4 2in the fundusLarge amount of high- 3 March 22 4 2viscosity milky secretionin the antrumLarge amount of cloudy, 8 March 22 4 3milky secretion as film-like coating in thefundusLarge amount of 3 March 22 4 3residues of milky coatingand secretion in thefundus.Large amount of 3 March 22 4 3residues of milky coatingand secretion in theantrum______________________________________

Dimethylpolysiloxane is obtained by hydrolysis and polycondensation of dichlorodimethylsilane and chlorotrimethylsilane. The various types differ in the nominal viscosity which is expressed by the number with the substance name.

The degree of polymerization (n=20 to 400) is such that the kinematic viscosity ranges from 20 to 1,000 mm.sup.2.s.sup.-1 (20 to 1,000 cSt).

The structural formula of dimethylpolysiloxane is: ##STR2##

S 184 silicone antifoam agent from Wacker Chemie was used to prepare the chewable tablets in the tests described hereinbefore. Equivalent results are also achieved with dimethylpolysiloxane or silicone oils with a kinematic viscosity in the range from 10.0 to 10,000 mm.sup.2.s.sup.-1, in particular 300 to 3,000 mm.sup.2.s.sup.-1.

Aerosil 2000 was employed as highly disperse silica.

Claims

1. A method for treating reflux esophagitis in a patient in need of such treatment, which comprises orally administering to the patient a composition consisting essentially of a reflux esophagitis-treating effective amount of dimethylpolysiloxane.

2. The method according to claim 1 wherein the dimethylpolysiloxane has a kinematic viscosity in the range of 100 to 10,000 mm.sup.2.s.sup.-1.

3. A method for treating reflux esophagitis in a patient in need of such treatment, which comprises orally administering to the patient a composition consisting essentially of a silica gel and a reflux esophagitis-treating effective amount of dimethylpolysiloxane.

4. The method according to claim 3 wherein the dimethylpolysiloxane has a kinematic viscosity in the range of 100 to 10,000 mm.sup.2.s.sup.-1.