L. De Rafael

Basal and stimulated gastrin levels and gastric acid output five months after therapy for Helicobacter pylori eradication in duodenal ulcer patients

The aim of our study was to demonstrate the effect of Helicobacter pylori eradication on basal and stimulated serum gastrin levels and gastric acid output 5 months after therapy of patients with duodenal ulcer. Thirty-two patients (24 men and eight women with a mean age of 45 years) who had had endoscopy and were diagnosed as having duodenal ulcer entered the study. In all patients three biopsy specimens were taken from the duodenal bulb, gastric antrum, body, and fundus. These specimens were then sent for microbiological and histological examination. Triple therapy consisting of bismuth, metronidazole, and tetracycline was administered. Endoscopy was repeated 1 and 5 months after therapy, and biopsy specimens were again taken from the gastric antrum and body. Before treatment, serum samples were taken to measure basal and stimulated (90 min) gastrin levels after ingestion of two beef cubes, and basal and stimulated acid outputs (after pentagastrin) were studied. Measurements of gastrin and gastric acid output were repeated 5 months after therapy. H. pylori was eradicated in 26 patients (81.3%). Basal gastrin levels (mean +/- SD) at diagnosis and after eradication were 44 +/- 12 and 35.8 +/- 2 pg/ml, respectively (p < 0.05). Similarly, stimulated gastrin levels (integrated values) decreased from 5,303 +/- 1,526 pg/ml/min before therapy to 3,779 +/- 1,204 pg/ml/min after eradication (p < 0.001). However, basal (4.9 +/- 4mEq/h) and stimulated (28.5 +/- 10mEq/h) acid output did not vary after eradication (3.9 +/- 4 mEq/h and 26.2 +/- 12 mEq/h, respectively). We conclude that basal and stimulated gastric acid output are not changed by H. pylori eradication in duodenal ulcer patients 5 months after therapy, in spite of its association with a significant decrease in basal and stimulated gastrin levels.

Verification of decreased basal and stimulated serum pepsinogen-I levels is a useful non-invasive method for determining the success of eradication therapy for Helicobacter pylori.

BACKGROUND We wanted to demonstrate the effect of Helicobacter pylori eradication on basal and stimulated pepsinogen-I levels in duodenal ulcer patients and to verify whether modification of such levels is a useful method for determining the success of eradication therapy. METHODS Thirty-two patients (24 men; mean age, 45 years) with active duodenal ulcer were studied. In all patients three biopsy specimens were taken from the duodenal bulb, gastric antrum, body and fundus for microbiologic and histologic examination. Triple therapy consisting of bismuth, metronidazole, and tetracycline was administered. Endoscopy was repeated 1 month after completing therapy, and biopsy specimens were again taken from the gastric antrum and body. Serum samples were taken at initial and repeat endoscopies, to measure basal and stimulated (120 min) pepsinogen-I levels after injection of pentagastrin. RESULTS H. pylori was eradicated in 26 patients (81%). Significant histologic improvement, in both the antrum and body, was observed (p < 0.001). Basal pepsinogen-I levels (mean and 95% confidence interval) at diagnosis and after eradication were 106 (92-119) and 87 (74-100) ng/ml, respectively (P < 0.001). Similarly, stimulated pepsinogen-I levels (integrated values) decreased from 4790 (4199-5381) before therapy to 3970 (3383-4557) ng/ml.min after eradication (P < 0.001). Pepsinogen I levels did not change in patients in whom H. pylori was not eradicated. The area under the receiver operating characteristic curve for decreased basal and stimulated pepsinogen-I levels was 0.77 (SE, 0.09) and 0.79 (SE, 0.1), respectively. CONCLUSION H. pylori eradication in duodenal ulcer patients was associated with a significant decrease in basal and stimulated pepsinogen-I levels. Measurement of these levels could determine how successful response to therapy has been in both the eradication and resolution of associated gastritis. Other advantages of this procedure are that it has low cost and results are evident at an early stage.

Galenical formulations of amoxicillin/clavulanate and eradication of Helicobacter pylori in peptic ulcer patients: Preliminary report.

Objective: To determine the efficiency of two amoxicillin/clavulanate galenical formulations (suspension and capsules) in the eradication of Helicobacter pylori in peptic ulcer patients. Design: Two groups of patients suffering from peptic ulcer and with positive antrum and corpus culture for H. pylori were treated with: (1) amoxicillin/clavulanate capsules and (2) amoxicillin/clavulanate suspension. The dosage in both groups was 500/125 mg orally every 8 h for 21 days. Omeprazole was also administered (40 mg/day for 30 days) in both groups. Follow-up visits were scheduled 8 days after antibiotic therapy and 3 months later. Methods: Thirty-nine adult patients with peptic ulcer disease diagnosed by endoscopy and with positive H. pylori culture in the biopsy specimens of gastric antrum and corpus were studied. Results: Eight days after conclusion of antibiotic treatment, seven out of 21 (33%) patients in the capsule group had H. pylori eradicated from both antrum and corpus and five out of 21 (24%) patients had H. pylori eradicated from the antrum but not from the corpus. H. pylori was eradicated from both antrum and corpus in 10 out of 15 patients (66%) in the suspension group. Three months later all six patients in the suspension group examined were still free from H. pylori. In contrast, all patients in the capsule group had positive culture biopsies again. Conclusions: The suspension form achieved better results than the capsule form in the eradication of H. pylori from the stomach.

Estudio de prevalencia de Helicobacter pylori y Chlamydia pneumoniae en placas de ateroma de pacientes diabéticos y no diabéticos con arteriosclerosis

Fundamento La arteriosclerosis se comporta como un proceso inflamatorio cronico. Algunos estudios han sugerido que Chlamydia pneumoniae y Helicobacter pylori pueden representar un papel en la patogenia de la arteriosclerosis en pacientes diabeticos y no diabeticos. EL objetivo del estudio fue determinar mediante cultivo y reaccion en cadena de la polimerasa (PCR), la presencia de C. pneumoniae y H. pylori en arterias de pacientes con arteriosclerosis. Metodos y resultados El estudio presenta un diseno transversal, con 40 pacientes (22 diabeticos y 18 no diabeticos) sometidos a una intervencion de revascularizacion. Se recogieron muestras de ateroma y se utilizaron los siguientes metodos de deteccion de la infeccion: PCR y cultivo de las placas de ateroma para detectar C. pneumoniae y H. pylori. Se utilizo la serologia para determinar el contacto previo del paciente con el germen. En el grupo total, 29 pacientes (72,5%) presentaban serologia positiva a H. pylori y 20 (50%) a C. pneumoniae (p Conclusion En este estudio se demuestra la nula presencia de H. pylori y escasa de C. pneumoniae en placas de ateroma. La relacion entre arteriosclerosis e infeccion por C. pneumoniae, pero no por H. pylori, podria explicarse por infeccion directa de la pared arterial.

Increased Incidence of Helicobacter pylori in Gastric Cancer, as Shown by the Rapid Urease Test

Nowadays it is widely accepted that Helicobacter pylori infection is the main etiologic factor in chronic gastritis type B (CGB). However, its contribution to the developement of gastric ulcer remains controversial. In vivo studies on gnotobiotic piglets [1,2] and healthy humans [3, 4] have shown that a typical CGB picture can be reproduced by the ingestion of this microorganism. A further point supporting a relationship between H. pylori and CGB is the possibility of inducing a partial or complete histologic recovery of the disease after the clearance of bacteria by bismuth salts or antibiotics [5–8].

Helicobacter pylori in Subtotal Gastrectomies

Surgery has long been the cornerstone in the management of peptic ulcer disease (PUD) refractory to medical treatment. Although the number of elective interventions has substantially decreased after the marketing of H2 receptor antagonists, the surgical approach maintains its full validity in the management of complicated PUD.