ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00025.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.Eradication ofHelicobacter pylorileads to faster ulcer healing and a significant decrease in ulcer recurrence. Clarithromycin is the most effective monotherapy for eradicatingH. pylorifrom the gastric mucosa, and omeprazole frequently is used for the treatment of duodenal ulcer disease, prompting the interest to investigate rigorously the combination of clarithromycin and omeprazole for eradicatingH. pylori.Materials and Methods.The aim of this double‐blind, randomized, multicenter (n=30), multinational (n=10) study was to compare clarithromycin and omeprazole with omeprazole monotherapy for the eradication ofH. pylorifrom the gastric mucosa, endoscopic healing, and reduction of symptoms and ulcer recurrence in patients with active duodenal ulcer. Patients with active duodenal ulcer associated withH. pyloriinfection were randomized to receive omeprazole, 40 mg every morning for 14 days, with either clarithromycin, 500 mg, or placebo three times daily, which was followed by omeprazole, 20 mg every morning for 14 days. Patients underwent endoscopy before enrolling in the study, immediately after finishing treatment, and at 4‐ to 6‐week and 6‐month follow‐up evaluations or at the recurrence of symptoms.Results.Two hundred and eight patients with active duodenal ulcer associated with confirmedH. pyloriinfection were randomized to treatment with either clarithromycin and omeprazole (n=102) or omeprazole and placebo (n=106). Four to six weeks after treatment was completed,H. pyloriwas eradicated in 74% (95% confidence interval, 63.0%–82.4%) of patients receiving clarithromycin and omeprazole, compared with 1% (0.0%–6.2%) of patients receiving omeprazole monotherapy (p<.001). Clarithromycin resistance developed in eight patients treated with clarithromycin and omeprazole and in none given omeprazole and placebo. Ulcers, which were healed following treatment in more than 95% of study patients, recurred by the 6‐month follow‐up visit in 10% (5%–19%) of dual therapy recipients, compared with 50% (39%–61%) of those who took omeprazole alone (p<.001).Conclusion.Clarithromycin and omeprazole dual therapy is simple and well‐tolerated and leads to consistently high eradication rates for patients with duodenal ulcer associated

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00026.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.Eradication ofHelicobacter pyloriprovides potential cure in the majority of patients with peptic ulcer disease, and eradication rates of more than 90% have been reported, using omeprazole in combination with two antimicrobials. The choice of antimicrobials, dose regimen and duration of treatment have varied between studies, however, and an optimal treatment still has to be established.Materials and Methods.We conducted an international, randomized, double‐blind, placebo‐controlled study involving more than 100 patients in each of six treatment groups in 43 hospital gastrointestinal units in Canada, Germany, Ireland, Sweden, and the United Kingdom. Patients (n=787) with proved duodenal ulcer disease were randomized to treatment twice daily for 1 week with omeprazole, 20 mg (O), plus either placebo (P) or combinations of two of the following anti‐microbials: amoxicillin, 1 gm (A), clarithromycin, 250 or 500 mg (C250, C500), or metronidazole, 400 mg (M). Eradication ofH. pyloriwas evaluated by13C‐UBT, performed before and 4 weeks after treatment cessation.Results.The eradication rates for the all‐patients‐treated analysis were 96%. OAC500; 95%, OMC250; 90%, OMC500; 84%, OAC250; 79%, OAM; and 1%, OP. OAC500 and OMC250 achieved eradication rates with lower 95% confidence interval limits exceeding 90%. All regimens were well‐tolerated, 96% of patients complied with their dose regimen, and 2.3% of the patients discontinued treatment owing to adverse events.Conclusions.Omeprazole triple therapies given twice daily for 1 week produce high eradication rates, are well‐tolerated, and are associated with high patient compliance. The two most effective therapies were those combining omeprazole, 20 mg, with either amoxicillin, 1 gm, plus clarithromycin, 500 mg, or metronidazole, 400 mg, plus clarithromycin, 250 mg, all gi

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00027.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.Omeprazole enhances the efficacy of bismuth‐based triple therapy. It is unknown whether the same is true for other proton pump inhibitors. Lansoprazole has superior anti‐Helicobacteractivity in vitro and possibly also in vivo; therefore we investigated quadruple therapy with lansoprazole.Materials and Methods.In two studies performed in separate hospitals, a total of 67Helicobacter pylori–positive patients were treated with 7‐day quadruple therapy (lansoprazole, colloidal bismuth subcitrate, tetracycline, and metronidazole) after 3 days of lansoprazole pretreatment. Testing for cure was done by endoscopy in study 1 and by breath test in study 2.Results.Cure rates per protocol were 31 of 31 (100%) in study 1 and 30 of 32 (94%) in study 2. Intention‐to‐treat cure rates were 31 of 35 (89%) in study 1 and 30 of 32 (94%) in study 2. Cured overall were 32 of 34 with a metronidazole sensitive strain and 3 of 3 with a metronidazole‐resistant strain. Data on side effects were collected from 51 patients. Twelve (21%) had no side effects, 27 (53%) had mild side effects, 10 (20%) had moderate side effects, but only 2 (4%) had severe side effects. Side effects, never were the reason that a patient stopped taking the medication.Conclusions.The results with lansoprazole‐quadruple therapy are comparable to the historic control group treated with omeprazole‐quadruple therapy. The cure rate is very high, and although mild to moderate side effects occured in many patients, everybody finished the

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00028.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.The NIH Consensus Conference in 1994 (1) concluded that all patients with peptic ulcr disease should be tested and treated forHelicobacter pyloriand that further evaluation was needed for patients in remission.Materials and Methods.We evaluated in a double blind randomization 30 patients whose duodenal ulcers had been healed with H2‐receptor antagonists and who remained in remission on maintenance therapy. After ulcer healing and the presence ofH. pylorihad been confirmed, these patients were randomized to receive eradication therapy or placebo and were followed for a mean period of 23 months.Results.Almost all patients receiving placebo had ulcer recurrence, whereas the patients treated with antibiotics demonstrate a low recurrence rate.Conclusion.These data suggest, for the first time to our knowledge, the importance of treating with antibiotics duodenal ulcer patients whose disease is in remissio

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00029.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.Helicobacter pyloriis associated with chronic active gastritis and peptic ulceration (PU). Omeprazole is a proton pump inhibitor that is effective in healing PU and reducing gastritis. Previously it has been found that omeprazole has some bacteriostatic activity againstH. pyloriboth in vitro and in vivo and in inhibiting urease activity in vitro. Our aim was to evaluate the effect of omeprazole onH. pyloricolonization of the gastric mucosa, urease activity in vivo, and the presence of associated gastritis in patients with duodenal ulcer (DU).Materials and Methods.We studied 12 patients (7 men and 5 women, ages 22–68 yr) with Du larger than 5 mm in diameter with a positive CLOtest (Delta West Ltd., Australia). Omeprazole, 20 mg bid, was given for 8 weeks to each patient, patients were endoscoped at the end of this period to check for healing of DU, and repeat biopsies were obtained from the gastric antrum for histologyical analysis, CLOtest, and culture.Results.DU healed completely in all patients. Likewise in all patients there was significant reduction in the urease activity, from 22.1=4.17 to 1.58 ± 0.92 units/ml (p<.001; 95% confidence interval of the difference between means, 32.7–14.1), and reducedH. pyloridensity, from 1,403.46 ± 128.23 to 422.5 ± 172.39 colony‐forming units (CFU) per milligram of tissue biopsy (p<.001; 95% confidence interval of the difference between means, 1,486.1–590.5). The numbers ofH. pyloriwere reduced on the gastric mucosa after omeprazole therapy and disappeared in six patients, a result that correlated with a negative CLOtest reading after 24 hours.Conclusion.Omeprazole, 20 mg bid, is capable of reducingH. pylorinumbers and urease activity in vivo. There was no significant reduction in the severity of antral gastritis in DU patien

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00030.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.Infection fromHelicobacter pyloriplays a role in several gastroduodenal diseases. The recent availability of molecular techniques, particularly the polymerase chain reaction (PCR), allows us to detect small amounts of this bacterium. The aims of this study were to compare PCR and histological findings and to ascertain the clinical usefulness ofH. pyloriPCR identification in different biological samples.Materials and Methods.We studied 94 consecutive patients. Saliva, gastric juice, and four antral and four body biopsies were obtained from each patients.H. pyloriwas evaluated histologically in two antral and two body biopsies (Giemsa or Warthin‐Starry stain). After extraction, DNA was submitted for PCR amplification using the two primers HPU1 and HPU2, which amplified a 411‐bp product from the urease gene A.Results.Forty‐nine patients wereH. pylori‐positive at histological workup. The sensitivity of PCR was 92% for gastric juice, 73% for antral biopsies, 61% for body biopsies, and 13% for saliva. Of the 45H. pylori‐negative patients at histological assessment, 7 (16%) had positive findings on PCR, mainly when gastric juice was examined.Conclusions.These results indicate that PCR is as sensitive as histological assessment. We suggest that PCRH. pyloridetection in gastric juice is a sensitive method for diagnosing this

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00031.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.In large‐scale multi‐center clinical trials, the US13C‐urea breath test (UBT) has proven to have a sensitivity and specificity of approximately 95%. Ingestion of a meal to delay gastric emptying has advantages of increasing the level of signal as well as prolonging the duration of significantly increased13C excretion, at the expense of requiring 40 to 60 minutes to complete the test. Our aim was to explore the utility of the13C‐UBT with a total duration of 30 minutes or less.Methods.After a baseline breath sample was obtained, 125 mg of13C‐urea was given in 100 ml of water, and additional breath samples were taken after 20 and 30 minutes. The results of the UBT were compared to histological assessment, culture, and the rapid urease test.13C‐UBTs were carried out on normal volunteers who underwent gastroscopy during which six mucosal biopsies were taken. Three biopsies were for histological evaluation (Genta stain), two for culture, and one was for agar gel rapid urease testing. The UBT was conducted 2 to 3 days either before or after the endoscopic procedure.Results.The cutoff value for a positive UBT was enrichment of 2.4Δ%0(delta over baseline). Of the 66 tests, 51%0wereHelicobacter pylori‐positive. There were no false positive UBTs and only two false negative UBTs at 20 minutes (sensitivity, 96%; specificity, 100%). At 30 minutes, one other UBT was false negative (gray zone of 2.36%0.) (sensitivity, 94%; specificity, 100%).Conclusion.These results suggest that omission of the meal and shortening the duration of the US13C‐UBT to 20 minutes still may maintain excellent specificity and sensiti

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00032.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.This study determines the prevalence and significance ofHelicobacter pyloriinfection in portal hypertensive patients.Materials and Methods.Patients numbered 118 and consisted of 90 patients with portal hypertension (66 men; 24 women; mean age, 49.1 ± 2.1 years) and 28 noncirrhotic patients with nonucler dyspepsia, (12 men; 16 women; mean age, 47.6 ± 2.8 years), who made up the control group. In all patients, diagnostic upper endoscopy was performed, and gastric biopsies were taken for histological examination and diagnosis ofH. pylori.Results.Of the portal hypertensive patients, 42 (47%) had congestive gastropathy, 11 (26%) of whom were positive forH. pylori.and 48 (53%) did not have gastropathy, 12 (25%) of whom were positive forH. pylori.In the control group, 15 of 28 (54%) were positive forH. pylori. H. Pyloriwas found less frequently in congestive gastropathy patients than in the control group. We found also that the presence and severity of congestive gastropathy is independent ofH. pyloristatus.Conclusions.We conclude that the role ofH. pyloriin the pathogenesis of congestive gastropathy is unlikely, and we suggest that there is no need for its routine eradication in cirrhotic patient

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00033.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.The role of the temperature of the diet as a potential etiological factor for gastritis or peptic ulcer disease has been postulated since the beginning of the century. Animal studies have demonstrated damage to gastric mucosa caused by hot water at 60 to 80°C. In the pre‐Helicobacter pyloriera it was reported that the majority of ulcer patients preferred hot drinks. It also was reported that the temperature of choice for drinks increased with severity of histological grade of gastritis. We evaluated the association between the preferred temperature of hot drinks and the presence ofH. pyloriinfection.Methods.We tested the temperature of choice for hot drinking liquids among 12H. pylori‐negative and 43H. pylori‐positive volunteers. We also compared the effect ofH. pyloritherapy on hot drink temperature preference and, in 32 individuals, whether there was a relation between temperature and the degree of gastric atrophy.Results.There was no difference in the preferred temperature for hot drinks between those volunteers with and withoutH. pyloriinfection (63.4°± 6°C compared to 61.3°± 7°C, respectively) (mean ± 1 SD,p=.3) There was no change in preferred temperature after successful therapy of theH. pyloriinfection compared to unsuccessfulH. pyloritherapy, nor was there a correlation between the preferred temperature and the presence, absence, or degree of gastric atrophy (r2<0.001).Conclusion.The temperature of preference for hot drinks was not influenced byH. pyloriinfection or by the presence of atrop

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00034.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY