European Journal of Gastroenterology Hepatology, Aug 1, 1999
Bismuth triple therapy (bismuth compound, metronidazole and tetracycline) is the oldest effective... more Bismuth triple therapy (bismuth compound, metronidazole and tetracycline) is the oldest effective regimen to cure Helicobacter pylori infection. When tetracycline is replaced by amoxycillin the cure rate decreases. In 1990, it was the first-line regimen. However, the great number of pills in the rather complicated regimen, together with a relative high rate of side-effects, have stimulated the search for other regimens. In developed countries, it has now mainly been surpassed by the simpler, but much more expensive proton-pump inhibitor-based triple therapies. In many developing countries however, bismuth-based therapy is the only effective therapy patients can afford. Worldwide, this drug combination is therefore probably one of the most widely used regimens. The efficacy of bismuth triple therapy can be improved by adding acid suppressants (quadruple therapy), increasing treatment duration or increasing the total daily dose of metronidazole. The choice of the bismuth compound and the total daily dose of tetracycline seem less important. Treatment can be shorter (7 days) in areas with a low rate of metronidazole resistance or when acid inhibition is added. Bismuth is usually given four times daily; tetracycline is usually given 500 mg q.i.d. in a 7- or 10-day treatment, but this can probably be reduced to 250 mg q.i.d. in a 14-day regimen. A higher total daily dose of metronidazole increases the cure rate but also gives more side-effects. A daily dose of 1000-1200 mg metronidazole in three or four divided doses for one week suffices in areas with a low rate of metronidazole resistance. In areas with a higher rate of resistance one can either increase the treatment duration to 10-14 days or increase the daily dose of metronidazole to 1500-1600 mg and leave the treatment duration at 7 days.
Many patients treated for H. pylori infection have been taking a proton pump inhibitor beforehand... more Many patients treated for H. pylori infection have been taking a proton pump inhibitor beforehand. There is conflicting evidence whether pretreatment influences the efficacy of H. pylori eradication. The aim of this study was to investigate the influence of pretreatment on cure rates of H. pylori eradication. Patients with H. pylori positive peptic ulcer disease or functional dyspepsia were treated with two-day quadruple therapy (lansoprazole 30 mg twice daily, and colloidal bismuth subcitrate 120 mg, tetracycline 250 mg and metronidazole 250 mg, all eight times a day). Patients were randomised to receive either three-day pretreatment with lansoprazole 30 mg twice daily or no pretreatment. H. pylori was diagnosed using CLO, histology and culture. Twenty-five (66%) of 38 patients with pretreatment and 32 (84%) of 38 patients without pretreatment were cured (p=0.06). After adjustment for diagnosis, smoking status and metronidazole resistance the influence of pretreatment became slightly less pronounced (OR 0.44, 95% CI 0.1-1.7). Nonsmokers and patients with peptic ulcer disease were more likely to achieve H. pylori eradication than smokers and patients with functional dyspepsia, respectively (adjusted odds ratios: 4.79 (1.2-19) and 4.32 (1.0-18)). This two-day quadruple therapy reached an overall cure rate of 75%. Nonsmokers and patients with peptic ulcer disease were more likely to achieve H. pylori eradication. Three-day pretreatment with a proton pump inhibitor may decrease cure rates of this two-day quadruple therapy.
Background: A high level of gastric acid secretion is considered to be a risk factor for reflux o... more Background: A high level of gastric acid secretion is considered to be a risk factor for reflux oesophagitis or Barrett's oesophagus. Corpus gastritis may have a protective effect on the oesophagus, because of decreased gastric acid output. Aim: To determine if corpus gastritis is associated with reflux oesophagitis or Barrett's oesophagus. Methods: Three antral and two corpus biopsies were taken from consecutive patients in whom Helicobacter pylori testing was requested during endoscopy at a single centre between January 1995 and May 1997. Antral and corpus gastritis was studied by histology; H. pylori was studied by histology, culture and CLO test. A regression model was used to test for correlation between reflux oesophagitis, Barrett's oesophagus and risk factors. Results: During the study period, 676 patients had biopsies taken during upper gastrointestinal endoscopy. Endoscopic signs of reflux oesophagitis and Barrett's oesophagus were observed in 125 and 23 patients, respectively. Corpus gastritis was found in 59% of patients without reflux oesophagitis or Barrett's oesophagus, 45% of patients with reflux oesophagitis and 30% of patients with Barrett's oesophagus. Two hundred and fifty-seven patients underwent follow-up endoscopy after H. pylori therapy. During a mean follow-up of 3 months, the incidence of reflux oesophagitis was not statistically different for patients with healing of corpus gastritis (10/98; 10%) and patients with persistent gastritis (8/97; 8%). Conclusions: Corpus gastritis was less common in patients with an endoscopic diagnosis of reflux oesophagitis or Barrett's oesophagus.
H. pylori eradication is usually performed with three or four drugs for at least seven days. Rece... more H. pylori eradication is usually performed with three or four drugs for at least seven days. Recently four reports have shown a cure rate of approximately 90% using a four-day quadruple therapy. The objectives of this prospective study were: 1) to evaluate the efficacy of pantoprazole-based quadruple therapy, and 2) to compare the efficacy and tolerability of four-day with seven-day quadruple therapy. The study was performed in a single centre. The first 56 consecutive patients with nonulcer dyspepsia or peptic ulcer disease and proven H. pylori infection received seven days of quadruple therapy (pantoprazole, bismuth, tetracycline and metronidazole). At least six weeks after treatment, endoscopy was repeated with six biopsies of the antrum and corpus for histology, urease test and culture. The next 59 consecutive patients followed the same protocol but received four-day quadruple therapy. Using an intention-to-treat analysis, the cure rate in the seven-day treatment group was 54/56...
In an adult patient with untreated celiac sprue, mesenteric lymphadenopathy was detected by compu... more In an adult patient with untreated celiac sprue, mesenteric lymphadenopathy was detected by computerized tomography (CT). Although malignant lymphoma was suspected, the nodes disappeared after treatment with a gluten-free diet, as was documented by CT follow-up. This report demonstrates that mesenteric lymphadenopathy in celiac sprue might be benign. With the increased use of CT investigation, findings like these may be encountered more often.
European Journal of Gastroenterology Hepatology, Aug 1, 1999
Bismuth triple therapy (bismuth compound, metronidazole and tetracycline) is the oldest effective... more Bismuth triple therapy (bismuth compound, metronidazole and tetracycline) is the oldest effective regimen to cure Helicobacter pylori infection. When tetracycline is replaced by amoxycillin the cure rate decreases. In 1990, it was the first-line regimen. However, the great number of pills in the rather complicated regimen, together with a relative high rate of side-effects, have stimulated the search for other regimens. In developed countries, it has now mainly been surpassed by the simpler, but much more expensive proton-pump inhibitor-based triple therapies. In many developing countries however, bismuth-based therapy is the only effective therapy patients can afford. Worldwide, this drug combination is therefore probably one of the most widely used regimens. The efficacy of bismuth triple therapy can be improved by adding acid suppressants (quadruple therapy), increasing treatment duration or increasing the total daily dose of metronidazole. The choice of the bismuth compound and the total daily dose of tetracycline seem less important. Treatment can be shorter (7 days) in areas with a low rate of metronidazole resistance or when acid inhibition is added. Bismuth is usually given four times daily; tetracycline is usually given 500 mg q.i.d. in a 7- or 10-day treatment, but this can probably be reduced to 250 mg q.i.d. in a 14-day regimen. A higher total daily dose of metronidazole increases the cure rate but also gives more side-effects. A daily dose of 1000-1200 mg metronidazole in three or four divided doses for one week suffices in areas with a low rate of metronidazole resistance. In areas with a higher rate of resistance one can either increase the treatment duration to 10-14 days or increase the daily dose of metronidazole to 1500-1600 mg and leave the treatment duration at 7 days.
Many patients treated for H. pylori infection have been taking a proton pump inhibitor beforehand... more Many patients treated for H. pylori infection have been taking a proton pump inhibitor beforehand. There is conflicting evidence whether pretreatment influences the efficacy of H. pylori eradication. The aim of this study was to investigate the influence of pretreatment on cure rates of H. pylori eradication. Patients with H. pylori positive peptic ulcer disease or functional dyspepsia were treated with two-day quadruple therapy (lansoprazole 30 mg twice daily, and colloidal bismuth subcitrate 120 mg, tetracycline 250 mg and metronidazole 250 mg, all eight times a day). Patients were randomised to receive either three-day pretreatment with lansoprazole 30 mg twice daily or no pretreatment. H. pylori was diagnosed using CLO, histology and culture. Twenty-five (66%) of 38 patients with pretreatment and 32 (84%) of 38 patients without pretreatment were cured (p=0.06). After adjustment for diagnosis, smoking status and metronidazole resistance the influence of pretreatment became slightly less pronounced (OR 0.44, 95% CI 0.1-1.7). Nonsmokers and patients with peptic ulcer disease were more likely to achieve H. pylori eradication than smokers and patients with functional dyspepsia, respectively (adjusted odds ratios: 4.79 (1.2-19) and 4.32 (1.0-18)). This two-day quadruple therapy reached an overall cure rate of 75%. Nonsmokers and patients with peptic ulcer disease were more likely to achieve H. pylori eradication. Three-day pretreatment with a proton pump inhibitor may decrease cure rates of this two-day quadruple therapy.
Background: A high level of gastric acid secretion is considered to be a risk factor for reflux o... more Background: A high level of gastric acid secretion is considered to be a risk factor for reflux oesophagitis or Barrett's oesophagus. Corpus gastritis may have a protective effect on the oesophagus, because of decreased gastric acid output. Aim: To determine if corpus gastritis is associated with reflux oesophagitis or Barrett's oesophagus. Methods: Three antral and two corpus biopsies were taken from consecutive patients in whom Helicobacter pylori testing was requested during endoscopy at a single centre between January 1995 and May 1997. Antral and corpus gastritis was studied by histology; H. pylori was studied by histology, culture and CLO test. A regression model was used to test for correlation between reflux oesophagitis, Barrett's oesophagus and risk factors. Results: During the study period, 676 patients had biopsies taken during upper gastrointestinal endoscopy. Endoscopic signs of reflux oesophagitis and Barrett's oesophagus were observed in 125 and 23 patients, respectively. Corpus gastritis was found in 59% of patients without reflux oesophagitis or Barrett's oesophagus, 45% of patients with reflux oesophagitis and 30% of patients with Barrett's oesophagus. Two hundred and fifty-seven patients underwent follow-up endoscopy after H. pylori therapy. During a mean follow-up of 3 months, the incidence of reflux oesophagitis was not statistically different for patients with healing of corpus gastritis (10/98; 10%) and patients with persistent gastritis (8/97; 8%). Conclusions: Corpus gastritis was less common in patients with an endoscopic diagnosis of reflux oesophagitis or Barrett's oesophagus.
H. pylori eradication is usually performed with three or four drugs for at least seven days. Rece... more H. pylori eradication is usually performed with three or four drugs for at least seven days. Recently four reports have shown a cure rate of approximately 90% using a four-day quadruple therapy. The objectives of this prospective study were: 1) to evaluate the efficacy of pantoprazole-based quadruple therapy, and 2) to compare the efficacy and tolerability of four-day with seven-day quadruple therapy. The study was performed in a single centre. The first 56 consecutive patients with nonulcer dyspepsia or peptic ulcer disease and proven H. pylori infection received seven days of quadruple therapy (pantoprazole, bismuth, tetracycline and metronidazole). At least six weeks after treatment, endoscopy was repeated with six biopsies of the antrum and corpus for histology, urease test and culture. The next 59 consecutive patients followed the same protocol but received four-day quadruple therapy. Using an intention-to-treat analysis, the cure rate in the seven-day treatment group was 54/56...
In an adult patient with untreated celiac sprue, mesenteric lymphadenopathy was detected by compu... more In an adult patient with untreated celiac sprue, mesenteric lymphadenopathy was detected by computerized tomography (CT). Although malignant lymphoma was suspected, the nodes disappeared after treatment with a gluten-free diet, as was documented by CT follow-up. This report demonstrates that mesenteric lymphadenopathy in celiac sprue might be benign. With the increased use of CT investigation, findings like these may be encountered more often.
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