Altuğ Şenol

Triple or Quadruple Tetracycline-Based Therapies Versus Standard Triple Treatment for Helicobacter pylori Treatment

Background:Our aim was to compare lansoprazole-tetracycline-metranidazole (LTM) as first-line treatment with the classical lansoprazole-amoxicillin-clarithromycin (LAC) and bismuth-containing quadruple treatments. Patients and Methods:This prospective, single-center, randomized study included 464 consecutive Helicobacter pylori–positive patients with dyspeptic symptoms. A total of 415 patients completed the study. The patients were allocated into 4 study groups using random sampling numbers as follows—LAC group: lansoprazole 30 mg twice daily, amoxicillin 1000 mg twice daily, and clarithromycin 500 mg twice daily for 14 days; BLTM group: bismuth subcitrate 300 mg 4 times a day, lansoprazole 30 mg twice daily, tetracycline 500 mg 4 times a day, and metronidazole 500 mg twice daily for 10 days; RBLTM group: ranitidine bismuth citrate 400 mg twice daily, lansoprazole 30 mg twice daily, tetracycline 500 mg 4 times a day, and metronidazole 500 mg twice daily for 10 days; and LTM group: lansoprazole 30 mg twice daily, tetracycline 500 mg 4 times a day, and metronidazole 500 mg twice daily for 10 days. Results:The per protocol H. pylori eradication rate in LAC, BLTM, RBLTM, and LTM groups were 37 of 104 (35.6%), 56 of 102 (54.9%), 67 of 104 (64.4%), and 63 of 105 (60%), respectively. The intention-to-treat eradication rate was 37 of 113 (32.7%) in LAC, 56 of 119 (47.1%) in BLTM, 67 of 117 (57.3%) in RBLTM, and 63 of 115 (54.8%) in LTM group. The BLTM, RBLTM, and LTM treatment groups achieved a significantly better eradication rate than the LAC treatment group (P < 0.001). There was not any significant statistical difference between the groups of BLTM, RBLTM, and LTM. Conclusion:LTM treatment group achieved a significantly better eradication rate than the LAC treatment group. The success ratio of LTM therapy is comparable with quadruple bismuth-based treatments.

Comparison of infusion or low-dose proton pump inhibitor treatments in upper gastrointestinal system bleeding

BACKGROUND The most effective schedule of proton pump inhibitor (PPI) administration following endoscopic hemostasis of bleeding ulcers remains uncertain. AIM To compare the treatment effects of continuous infusion and low-dose esomeprazole therapies in patients with non-variceal upper gastrointestinal (GI) bleeding. METHODS This prospective clinical study compared continuous infusion of esomeprazole (80 mg bolus followed by 8 mg∕h continuous infusion for 72 h) and low-dose esomeprazole (40 mg twice daily IV) treatments in GI bleeding patients with peptic ulcer presenting a high risk of re-bleeding, who were administered a successful endoscopic homeostasis. The primary end point was the occurrence of re-bleeding during hospitalization and within one month of discharge. Secondary outcomes were defined as duration of hospitalization, need of transfusion, surgical treatment, and mortality rate. After 72 h, both groups were switched to oral esomeprazole therapy for one-month. RESULTS A hundred thirty-two subjects were enrolled. Re-bleeding occurred in 11 (16.7%) patients in the infusion therapy group and in 12 (18.2%) patients in the low-dose group (P=0.819) within the first 72 h. No patient experienced re-bleeding in the first month following discharge. There was no statistical significant difference between the two groups in terms of transfusion need, durations of hospitalization, need for surgery and mortality rate. CONCLUSION PPI infusion therapy following endoscopic hemostasis treatment was not found superior to low-dose PPI therapy in the terms of re-bleeding, need of surgery and mortality.

Gastroesophageal scintigraphy in the evaluation of adult patients with chronic cough due to gastroesophageal reflux disease.

ObjectiveThe aim of this study was to evaluate the findings of gastroesophageal scintigraphy (GES) with late lung imaging in adult patients with chronic cough due to gastroesophageal reflux disease and a group of healthy participants. MethodsFifty-five patients with chronic cough with reflux symptoms, and a control group of 12 healthy participants were examined. All patients had reflux esophagitis documented by upper gastrointestinal endoscopy and histology. All participants underwent laryngoscopic examination and GES. The correlation between gastroesophageal reflux and several related variables was evaluated. ResultsOverall, 51 patients (92.7%) had positive GES findings for pathologic reflux; 19 (37.2%) of these patients had proximal reflux; and the remaining 32 (62.7%) had distal reflux. The frequency, duration, and percentage volume of gastric content of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P<0.0001). No statistically significant differences were seen between proximal reflux and distal reflux patients in terms of pulmonary function parameters, duration of cough, and reflux symptoms scores. However, severe grade (B and C) of esophagitis and the posterior laryngitis were more common in the patients with proximal reflux. Late lung imaging demonstrated evidence of pulmonary aspiration in only three of 51 (6%) patients. ConclusionOur study suggests that GES with late lung imaging objectively showed the presence of pathologic distal and/or proximal reflux, but rarely pulmonary aspiration, in the majority of chronic cough patients with gastroesophageal reflux disease. As the chronic cough patients with proximal reflux have more severe reflux characteristics, this examination may be effective in screening and following up these patients.

Serial Changes in Alpha-Fetoprotein Levels During Therapy for Chronic Hepatitis C

1 Altuğ Şenol1, Mete Akın2, Yıldıran Songür3, Mehmet İşler4, M.Cem Koçkar1 1Süleyman Demirel University School of Medicine, Department of Gastroenterology, Isparta, 2Akdeniz University School of Medicine, Department of Gastroenterology, Antalya, 3Memorial Şişli Hospital, Department of Gastroenterology, İstanbul, 4Şifa Hospital, Department of Gastroenterology, Isparta, Turkey Alpha-Fetoprotein Levels in Chronic Hepatitis C Serial Changes in Alpha-Fetoprotein Levels During Therapy for Chronic Hepatitis C