Mahmoud M. Yousfi

Metronidazole, omeprazole and clarithromycin: An effective combination therapy for Helicobacter pylori infection

Background: Successful treatment of Helicobacter pylori infection results in cure of peptic ulcer disease. Multidrug regimens are needed to cure this infection. We studied the effectiveness and side effect profile of two antibiotics active against Helicobacter pylori, metronidazole and clarithromycin, combined with omeprazole.

The best gastric site for obtaining a positive rapid urease test

BackgroundRapid urease tests (RUTs) provide a simple, sensitive method of detecting Helicobacter pylori infection.

Detection of Helicobacter pylori by rapid urease tests: is biopsy size a critical variable?☆☆☆★★★

BACKGROUND The variables responsible for false-positive and false-negative rapid urease tests are largely unexplored. OBJECTIVES We compared the results of rapid urease testing with jumbo cup forceps (3.3 mm diameter) and tiny cup forceps (1.8 mm diameter) with two rapid urease tests. METHODS Antral biopsies were obtained. The order of forceps and rapid urease tests was randomized. Biopsies were also taken for Genta staining. RESULTS One hundred and two patients were studied; 59 had Helicobacter pylori infection. There were 22 false-negative tests (8 CLOtest, 16 hpfast) and 5 false-positive tests (3 CLOtest, 2 hpfast). All 5 false-positive tests were among those positive only in the second 12 hours. There was no difference in results with the jumbo and tiny cup forceps. Five percent to nine percent (average, 6.6%; 95% confidence interval, 4.4% to 9.6%) of tests with any of the combinations gave an erroneous categorization of H. pylori status. There were no clinical or statistical differences in H. pylori categorizations by CLOtest or hpfast. CONCLUSION The diagnostic yield for detecting H. pylori infection by rapid urease tests is not adversely affected by small biopsy size, possibly because tiny biopsies obtain superficial tissue where H. pylori reside.

Evaluation of a new reagent strip rapid urease test for detection of Helicobacter pylori infection

BACKGROUND Rapid urease tests are commonly used as a convenient method to detect Helicobacter pylori infection. Our previous experiments demonstrated enhanced efficacy of agar gel rapid urease test compared with reagent strip rapid urease tests. We evaluated the efficacy of PyloriTek, a new reagent strip rapid test for detecting H. pylori infection. METHODS Gastric antral mucosal biopsy specimens were obtained for comparison between agar gel rapid urease tests and PyloriTek (200 specimens). The rapid urease test to be used first was selected randomly. H. pylori status was determined using the Genta stain. Culture was performed to confirm H. pylori status when false rapid urease tests were suspected. RESULTS One hundred patients were studied; 68 had H. pylori infection. There were two false-negative and one false-positive PyloriTek when scored at 1 hour, compared with only one false-positive and no false-negative tests at 2 hours. With the agar gel rapid urease tests, there were no false-positive tests and 5 false-negative tests when scored at 1 hour, 2 false-negative tests at 12 hours and 1 at 24 hours; there were no false-positive tests. At 1 hour, 3% (95% CI = 1% to 9%) of PyloriTek tests had an erroneous categorization of H. pylori status compared with 5% for the agar gel rapid urease tests (95% CI = 1.6% to 11%) (p > 0.7). CONCLUSION The new reagent strip rapid urease test, PyloriTek, is rapid and comparable in accuracy to agar gel rapid urease tests for detecting H. pylori Infection.

One-week triple therapy with omeprazole, amoxycillin and clarithromycin for treatment of Helicobacter pylori infection.

Background: Multi‐drug regimens are generally required to reliably cure H. pylori infection. We previously demonstrated that a 2‐week three‐times‐a‐day regimen of amoxycillin and clarithromycin was effective against H. pylori infection.

Metronidazole, ranitidine and clarithromycin combination for treatment of Helicobacter pylori infection (modified Bazzoli's triple therapy).

Background: Multi‐drug regimens are generally required to reliably cure Helicobarter pylori infection. Metronidazole, clarithromycin and omeprazole has proven to be an effective combination therapy with a cure rate of 90% or greater.

Is Antrum or Corpus the Best Site for Culture of Helicobacter pylori

BackgroundIsolating Helicobacter pylori on culture media and performing antibiotic susceptibility testing is potentially the most useful tool for guiding antibiotic therapy, especially when antimicrobial resistance is suspected. The aim of this study was to determine whether the yield of H. pylori culture was related to the site from which the gastric specimen was obtained either before or after therapy.

Culture of Helicobacter pylori: Effect of Preimmersion of Biopsy Forceps in Formalin

Background.Treatment of antibiotic‐resistant Helicobacter pylori should be based on bacterial sensitivity testing that requires the ability to isolate the bacterium from gastric mucosal biopsies. The aim of this study was to determine whether the yield for detecting H. pylori infection by culture is reduced by immersion of biopsy forceps in formalin prior to obtaining the specimen.

Resolution of a metaplastic duodenal polyp after cure of Helicobacter pylori infection

Although there have been several reports of hyperplastic gastric polyps associated with persistent Helicobacter pylori gastritis, the association of H. pylori infection with metaplastic polyps in the duodenum has not hitherto been described. After a 52-year-old man had a single episode of hematemesis, endoscopy showed a smooth polyp 1 cm in greatest dimension formed by a proliferation of gastric epithelial cells of fundic and antral type found in the duodenal bulb. The outer surface was entirely covered with a single layer of hyperplastic columnar epithelium with many H. pylori organisms. After administration of metronidazole 500 mg, omeprazole 20 mg for 4 weeks, and clarithromycin 250 mg twice a day for 2 weeks, endoscopy showed a decrease in size of the duodenal polyp. At 12 weeks there was complete regression of the polyp. This report documents a new and unusual finding: resolution of a gastric metaplastic polyp in the duodenum associated with cure of H. pylori.