P. Pozzato

Short-term low-dose triple therapy for the eradication of Helicobacter pylori

Background: Helicobacter pylori infection causes antral gastritis and is strongly associated with duodenal ulcer relapse. Eradication of H. pylori infection may be difficult to achieve due to antimicrobial resistance, side effects and poor patient compliance. Objective: To evaluate the efficacy, tolerability and patient compliance of short-term triple therapy with clarithromycin, omeprazole and tinidazole. Methods: Triple therapy, comprising clarithromycin 250 mg twice daily, omeprazole 20 mg once daily and tinidazole 500 mg twice daily, was administered to 65 patients with H. pylori gastritis for 1 week. H. pylori infection before and after treatment was determined by histology, the urease test and the 13C-urea breath test. Upper gastrointestinal endoscopy, during which four antral biopsy specimens were taken, and the 13C-urea breath test were performed in all patients before treatment and at 1 and 6 months after treatment. Drug tolerance was evaluated by patient interviews and compliance by counting returned pills at the end of treatment. Results: Sixty-three patients with H. pylori infection were studied. One month after treatment, on intent-to-treat analysis, H. pylori infection had been eradicated in 62 out of 65 patients (95.4%), confirmed by a negative urease test, 13C-urea breath test and histological examination of antral biopsy specimens. All patients were free of infection 6 months after treatment ended. All but one patient completed treatment and took more than 90% of the prescribed medication. There were no side effects except for one case of mild nausea (not severe enough to stop treatment) and one case of urticaria, following which treatment was withdrawn. Conclusions: Short-term, low-dose triple therapy with clarithromycin, omeprazole and tinidazole is highly effective for the eradication of H. pylori infection. The lack of side effects and good compliance are important for successful eradication.

Validation of the 13C-urea breath test for the diagnosis of Helicobacter pylori infection in children: a multicenter study.

OBJECTIVE:The 13C-urea breath test (13C-UBT) is a safe, noninvasive, and accurate test for the detection of Helicobacter pylori (H. pylori) infection in adults. The aim of this study was to evaluate sensitivity and specificity of 13C-UBT in children using different types of test meal, doses of 13C-urea and breath sampling intervals. As yet, a validated, standardized 13C-UBT protocol for children has not been formulated.METHODS:13C-UBT was performed in 115 children and repeated within 3 days, modifying the test meal or the dose of 13C-urea. H. pylori status was assessed by histology and rapid urease test. 13C-UBT was performed using 100 mg or 50 mg of 13C-urea and a fatty test meal (100 FA; 50 FA), 50 mg of 13C-urea, and a carbohydrate test meal (50 CA). Breath samples were collected every 10 min for 60 min.RESULTS:The 13C-UBT in children was highly sensitive and specific with all three protocols used. The best combination of sensitivity (97.92%) and specificity (97.96%) was obtained with Protocol 50 FA at 30 min with a cut-off of 3.5 per mil.CONCLUSIONS:The 13C-UBT is an accurate test for the detection of H. pylori infection also in children. Administration of 50 mg of 13C-urea, a fatty test meal, and breath sampling at 30 min appears to be the most convenient protocol.

The risk of adenomatous polyps in asymptomatic first-degree relatives of persons with colon cancer

BACKGROUND & AIMS Increasing evidence indicates that inherited susceptibility is important in the pathogenesis of colorectal neoplasia. The aim of this study was to clarify whether having only one first-degree relative with colorectal cancer increases the risk of developing adenomatous polyps and whether total colonoscopy is an appropriate screening measure in these patients. METHODS The frequency of such a history was evaluated in 397 asymptomatic patients who underwent total colonoscopy. Of these patients, 155 had colorectal polyps and the remaining 242 did not have polyps. RESULTS Among polyp cases, 27 of 155 (17.4%) had a positive history; among those without polyps, 12 of 242 (5.0%) had a positive history. Alternatively expressed, 27 of 39 patients (69%) with family history and 128 of 358 patients (36%) without family history had adenomas. The estimated risk for polyps associated with family history was 1.9. Among polyp cases, 14 of 27 patients (51.9%) with family history and 32 of 128 patients (25.0%) without family history had only proximal polyps (chi 2 test; P = 0.006; odds ratio, 3.2), In the same groups, frequency of high-grade dysplasia was 8 of 27 patients (29.6%) and 16 of 128 patients (12.5%), respectively (chi 2 test; P = 0.04; odds ratio, 2.9). CONCLUSIONS Relative to subjects with no family history, asymptomatic patients with one first-degree relative with colorectal cancer had nearly double the risk of developing adenomatous polyps, greater frequency of severely dysplastic lesions, and significantly higher frequency of proximal polyp location. This suggests that total colonoscopy screening is indicated in these subjects.

Urea Breath Tests for the Detection of Helicobacter pylori Infection

Helicobacter pylori is recognized as an important human pathogen. The urea breath test, using either 13C or 14C, provides a noninvasive diagnostic method for the detection of active H. pylori infection.

Dyspeptic Symptoms and Endoscopic Findings in the Community: The Loiano–Monghidoro Study

OBJECTIVES:We aimed to evaluate the prevalence of endoscopic findings and their association with dyspeptic symptoms in the community.METHODS:A total of 1,533 inhabitants of two villages were invited to participate in a cross-sectional survey, and 1,033 were recruited. Participants underwent a validated dyspepsia questionnaire, upper gastrointestinal endoscopy, and a 13C-urea breath test.RESULTS:Endoscopic findings were present in 17.6% of asymptomatic subjects and in 27.4% of those with dyspeptic symptoms. The prevalence of esophagitis and Barretts esophagus in subjects with dyspeptic symptoms and without prominent reflux symptoms was 8.1 and 1.5%, respectively, and was similar to that of asymptomatic subjects (8.5 and 0.7%, respectively). Esophagitis was significantly associated with dyspeptic symptoms only in subjects with concomitant prominent reflux symptoms. Peptic ulcer (PU) was present in 8.8% of subjects with dyspeptic symptoms without reflux symptoms and similarly in 9.4% of those with prominent reflux symptoms. Subjects with dyspeptic symptoms and concomitant prominent reflux symptoms had an increased risk of having an underlying PU (odds ratio 2.74, 95% confidence interval 1.30–5.78).CONCLUSIONS:Almost three-quarters of subjects with dyspeptic symptoms do not have endoscopic findings and, in addition, esophagitis may not be the cause of dyspeptic symptoms in subjects without prominent reflux symptoms. PU may be the cause of dyspeptic symptoms in a subgroup of subjects with prominent reflux symptoms.

Helicobacter pylori: the challenge in therapy.

For the therapeutic management of Helicobacter pylori infection, the Maastricht 2–2000 Consensus Report have introduced the concept of the ‘treatment package’ that considers first‐ and second‐line eradication therapies together. According to this consensus statement, the first‐line therapy for H. pylori eradication is a combination of the proton pump inhibitors (PPI) or ranitidine bismuth citrate (RBC) and claritromycin plus either amoxicillin or metronidazole. The second‐line treatment is suggested to be PPI‐quadruple therapy for a minimum of 7 days. If bismuth compounds are not available, PPI‐based triple therapy will have to be used as a second‐line treatment only after susceptibility testing. Since no considerable progress has been made during the past year in treatment regimens, there is still a need for new compounds that are specific for H. pylori, which could constitute future therapies.

The Loiano‐Monghidoro population‐based study of Helicobacter pylori infection: prevalence by 13C‐urea breath test and associated factors

As part of a cross‐sectional study on cholelithiasis, 1533 out of 1840 residents in Loiano/Monghidoro, a rural area in Northern Italy (792 men, 741 women, age range 28–80 years), agreed to be further evaluated in relation to their Helicobacter pylori status.

Treatment of Helicobacter pylori infection. Indications and regimens: an update.

The management of Helicobacter pylori infection is still surrounded by controversy and uncertainties. Indications and correct application of current regimens for Helicobacter pylori infection are still considered a matter of debate. Regarding indications, only peptic ulcer and mucosa associated lymphoid tissue lymphoma are considered clear indications for treatment. In other conditions, such as atrophic gastritis, post gastric cancer resection, first-degree relatives of gastric cancer patients, dyspeptic patients, patients with gastro-oesophageal reflux disease and non-steroidal anti-inflammatory drug users, the value of Helicobacter pylori eradication is still controversial. The regimens for first-line and second-line treatment of Helicobacter pylori infection have been recommended by the Maastricht 2 Consensus Report. Although all the treatments are considered to be effective, physicians still do not agree on what first-line regimen should be used. Furthermore, a consensus on the duration of the antibiotic treatment is still lacking, although Maastricht guidelines for treatment of Helicobacter pylori infection recommend a one-week therapy. Also regimens, as a third-line treatment, and methods to improve compliance and clinical outcome are still a matter of debate. All these points will be considered in the present review

Incidence and recurrence rates of colorectal adenomas in first-degree asymptomatic relatives of patients with colon cancer.

Incidence and recurrence rates of colorectal adenomas in first-degree asymptomatic relatives of patients with colon cancer

Efficacy of Lansoprazole in Eradicating Helicobacter pylori: A Meta‐Analysis

The combination of lansoprazole with antibiotics either as double or triple therapy has demonstrated an H. pylori eradication rate of between 80 and 90%. With the aim of providing a complete revision of the results of these clinical studies and a quantification of the efficacy of lansoprazole in eradicating H. pylori and healing peptic ulcers, we have undertaken a meta‐analysis of all the controlled studies published in the literature.