N. Dal Bò

Use of bovine lactoferrin for Helicobacter pylori eradication

BACKGROUND One-week triple therapy is the most frequently recommended treatment for Helicobacter pylori infection. Eradication rate is satisfactory, nevertheless is advisable to look for more effective therapies. AIM To test the efficacy of a standard triple therapy plus bovine lactoferrin in the eradication of H. pylori infection. PATIENTS AND METHODS One hundred and fifty consecutive H. pylori positive patients, suffering from dyspeptic symptoms were recruited in a 7-day triple therapy open randomised single centre study with rabeprazole, clarithromycin, tinidazole, bovine lactoferrin (group A) or rabeprazole, clarithromycin, tinidazole (group B), or a 10-day therapy with rabeprazole, clarithromycin, tinidazole (group C). H. pylori status was assessed 8 weeks after the end of the treatment by means of a 13C-urea breath test or a H. pylori stool antigen-test. RESULTS Eradication rates (intention to treat/per protocol) were: group A (92.2/95.9%), group B (71.2/72.5%) and group C (70.2/75%). The efficacy of triple therapy added with lactoferrin was significantly higher than other two regimens (p=0.01, intention to treat analysis; p=0.005, per protocol analysis). CONCLUSION These results suggest that lactoferrin tested in the present study was effective in curing H. pylori and could be a new agent to assist the antimicrobials in the eradication of the bacterium.

Bovine lactoferrin for Helicobacter pylori eradication: an open, randomized, multicentre study.

Background  Cure rates for eradication of Helicobacter pylori appear to be decreasing, thus more effective therapies must be identified.

'Serological biopsy' in first-degree relatives of patients with gastric cancer affected by Helicobacter pylori infection.

Background: Relatives of patients with gastric cancer are at increased risk of developing this disease, especially if they are infected by Helicobacter pylori. Moreover, H. pylori‐related atrophic gastritis and hypochlorhydria are well‐documented risk factors for noncardia gastric cancer. Serum pepsinogen I (sPGI) and II (sPGII) levels are low in this condition. The aim of our study was to assess by means of a ‘Gastropanel’ blood test, including sPGI, sPGII, gastrin‐17 (G‐17) and antibodies anti‐H. pylori (IgG‐Hp), both functional and morphological features of gastric mucosa in Hp + ve subjects with a family history of gastric cancer. Materials and Methods: Twenty‐five Hp + ve subjects consecutively referred to our department for gastrointestinal complaints, selected as first‐degree relatives of patients suffering from gastric cancer, were enrolled in the study and then matched for sex and age with 25 dyspeptic and Hp + ve subjects with no family history of gastric neoplasia. Blood samples were taken for determination of gastropanel in all patients; in addition, antibodies against CagA were analysed. Results: No statistically significant differences were detected zbetween the two groups as regards alcohol consumption, coffee intake and smoking habits. Mean sPGI levels in Group A (83.4 ± 58.4 μg/L) were significantly lower than those in Group B (sPGI 159.5 ± 80.6 μg/L; P < 0.0001) as well as sPGII (12.5 μg/L ± 6.24 versus 20.6 ± 58 μg/L; P < 0.006). No statistical difference was found between the two groups in relation to G‐17 levels, IgG‐Hp titres and antibodies against CagA. Conclusion: First‐degree relatives of patients with noncardia gastric cancer affected by H. pylori infection present lower sPGI and sPGII levels, possibly due to the increased frequency of atrophic lesions in these patients.

Low dose of clarithromycin in triple therapy for the eradication of Helicobacter pylori: One or two weeks?

The aims of this pilot study were: (i) to compare the efficacy of low‐dose clarithromycin (250 mg twice daily) for 1 or 2 weeks; and (ii) to evaluate possible therapeutic advantages in associating the low‐dose clarithromycin with an anti‐secretory agent or tripotassium dicitrate bismuthate (De Nol; Yamanouchi Pharm, Corugate Milano, Italy). A prospective, randomized, open trial was carried out on consecutive outpatients with dyspeptic symptoms and Helicobacter pylori infection. We enrolled 129 patients in one of the following schedules: (A) De Nol 120 mg q.i.d., clarithromycin 250 mg b.i.d. and metronidazole 250 mg q.i.d. for 2 weeks; (B) omeprazole 20 mg b.i.d., clarithromycin 250 mg b.i.d. and metronidazole 250 mg q.i.d. for 2 weeks; or (C) omeprazole 20 mg b.i.d., clarithromycin 250 mg b.i.d. and metronidazole 250 mg q.i.d. for 1 week. Results were evaluated by Per Protocol (PP) and Intention‐To‐Treat analysis (ITT). Eradication rate was 100% after treatment A, 92.6% after treatment B and 86.5% after treatment C by PP and 83.3, 75.7, and 68.1%, respectively by ITT. Side effects were reported by 16 subjects: 26.6% in group A; 9.1% in group B; and 7.5% in group C; in two cases side effects led to the withdrawal of the treatment. In conclusion, 500 mg clarithromycin per day in association with omeprazole and metronidazole, for 1 week gave comparable results to the same schedule for a 2 week period. The use of clarithromycin with bismuth and metronidazole produced a therapeutic gain compared with both of the anti‐secretory schedules, although this was not statistically significant.

Cure of Helicobacter pylori-positive active duodenal ulcer patients: double-blind, multicentre, 12-month study comparing a two-week dual vs a one-week triple therapy

Aims. To compare a two-week dual therapy to a one-week triple therapy for the healing of duodenal ulcer and the eradication of the Helicobacter pylori infection. Patients and Methods. A total of 165 patients with active duodenal ulcer were enrolled in the study. At entry, endoscopy, clinical examination and laboratory tests were performed. Histology and the rapid urease test were used to diagnose Helicobacter pylori infection. Patients received either lansoprazole 30 mg plus amoxycillin 1 g bid for two weeks (two-week, dual therapy) or lansoprazole 30 mg plus amoxycillin 1 g plus tinidazole 500 mg bid for one week plus lansoprazole qd for an additional week (one-week, triple therapy). Two and twelve months after cessation of therapy, endoscopy and clinical assessments were repeated. Results. Duodenal ulcer healing and Helicobacter pylori eradication were both significantly greater (p<0. 0001) in the triple therapy group (healing: 98.6%; Helicobacter pylori cure rate: 72.6%) than in the dual therapy group (healing: 77.3%; Helicobacter pylori cure rate: 33.3%). Ulcers healed more frequently in Helicobacter pylori-cured than in Helicobacter pylori-not cured patients (94.9% vs. 77.2%; p<0.0022). After one year, Helicobacter pylori eradication was re-confirmed in 4658 patients previously treated with the triple therapy and in 1040 patients treated with the dual therapy (p<0.0001). Only three duodenal ulcer relapses were observed throughout follow-up: all were in Helicobacter pylori-not cured patients. Conclusions. Triple therapy was more effective than dual both in curing Helicobacter pylori infection and healing active duodenal ulcers. The speed of ulcer healing obtained after only 7 days of antibiotics and 14 days of proton pump inhibitors confirmed that longer periods of anti ulcer therapy were not necessary. Helicobacter pylori -not cured patients had more slowly healing ulcers which were more apt to relapse when left untreated.

Helicobacter pylori eradication and serum pepsinogens.

3 Chapman MAS, Grahn MF, Boyle MA, Hutton M, Rogers J, Williams NS. Butyrate oxidation is impaired in the colonic mucosa of sufferers of quiescent ulcerative colitis. Gut 1994; 35: 73-6. 4 Finnie IA, Taylor BA, Rhodes JM. Ileal and colonic epithelial metabolism in quiescent ulcerative colitis: increased glutamine metabolism in distal colon but no defect in butyrate metabolism. Gut 1993; 34: 1552-8.

A PRELIMINARY REPORT ON HELICOBACTER PYLORI AND ANTRAL GASTRIN CONCENTRATION IN PATIENTS WITH DUODENAL ULCER

This study analyzed the relationship between Helicobacter pylori infection, mucosal gastrin concentration, and basal serum gastrin levels in duodenal ulcer patients with dyspepsia. Patients with duodenal ulcers who were H pylori positive showed higher antral gastrin concentrations than either H pylori-positive patients with dyspepsia or H pylori-negative patients with duodenal ulcers. No correlation was found between serum gastrin and antral gastrin concentrations. The increased antral gastrin concentrations were not correlated with an inhibition of acid-gastrin feedback. These preliminary data confirm that H pylori infection impairs gastrin physiology.

H2 antagonists and gastric ulcer: A multicenter, randomized, double-blind, controlled study comparing nizatidine with ranitidine*

An 8-week, multicenter, randomized, double-blind study was performed with the aim of comparing nizatidine 300 mg at bedtime with nizatidine 150 mg twice daily (BID) and with ranitidine 150 mg twice daily in 114 patients with benign acute gastric ulcer. Healing rates did not significantly differ among groups at 4 weeks, but they were lower in the once-daily group (53%) than in the BID groups (approximately 69%). At 8 weeks, healing rates with nizatidine 150 mg BID (97%) were significantly higher than those observed in the groups that received nizatidine 300 mg at bedtime (78%) or ranitidine 150 mg BID (83%). Smoking was found to affect the therapeutic efficacy of the bedtime dosing. The results of this study show that nizatidine is an efficacious and safe drug in the treatment of benign acute gastric ulcer when given twice daily, especially in smokers.

HEMORRHAGIC DUODENAL ULCER DISEASE: CLINICAL AND BIOCHEMICAL FINDINGS IN A CASE-CONTROL PILOT STUDY

Abstract A retrospective study of 31 consecutive bleeding duodenal ulcer (DU) patients and, as controls, 62 active DU subjects without bleeding episodes was conducted in order to ascertain whether bleeding DU patients have particular clinical or functional characteristics. The patients were followed for 15.6 and 17.4 months, respectively, after diagnosis. The following parameters were taken into account: sex, age, family history of ulcer, blood group (ABO system), ulcer pain, nonsteroidal anti-inflammatory drug (NSAID) consumption, cigarette smoking, alcohol and coffee consumption, ulcer site, fasting serum gastrin and pepsinogen group A, basal acid output (BAO), and maximal acid output (MAO). Statistics were gathered using the Students t test and Fishers exact test. Bleeding DU patients had less ulcer pain ( P P

P.04.10 LOW LEVELS OF GASTRIN-17 AS A NON-INVASIVE MARKER OF GERD

LOW LEVELS OF GASTRIN-17 AS A NON-INVASIVEMARKER OF GERD F. Di Mario ∗ ,1, F. Ferrara1, N. Dal Bo1, T. Slongo1, F. Murer 1, R. Marcello1 , H. Heras Salvat 1 , S. Loperfido1, A. Schiavinato1 , V. Savarino2 , C. Scarpignato3 1Department of Internal Medicine, Gastroenterology Unit, Treviso General Hospital, Treviso, Italy; 2Department of Internal Medicine, Gastroenterology Unit, Genoa University, Genova, Italy; 3Department of Clinical Sciences, Laboratory of Clinical Pharmacology, University of Parma, Parma, Italy