Ramona McLoughlin

Therapy of Helicobacter pylori

This represents an overview of the main data published over the last year on the therapy of Helicobacter pylori. The problem of increasing failure of H. pylori eradication has been the main focus, with increasing resistance and poor patient compliance being the main culprits. Simple regimens are necessary to improve patient compliance. New antibiotics and novel agents are appraised with mixed results.

Eradication of Helicobacter pylori: recent advances in treatment.

Helicobacter pylori plays a key role in dyspepsia, peptic ulcer disease, and gastric neoplasia and eradication of the infection has become an important treatment goal in clinical practice. Seven‐day proton‐pump inhibitor–amoxicillin–clarithromycin triple therapy is the current first‐line therapy for H. pylori but eradication rates are compromised by poor compliance and antibiotic resistance. Ten‐day sequential treatment may emerge as an alternative first‐line therapy. Bismuth‐based quadruple therapy is the second‐line regimen of choice. Antimicrobial sensitivity testing is not recommended in the routine management of H. pylori infection. Novel triple‐therapy regimens containing rifabutin, levofloxacin, or furazolidone may be useful alternatives as second‐ or third‐line therapy.

Efficacy and safety of 6-thioguanine in the management of inflammatory bowel disease

Objective. 6-thioguanine has been used as an alternative immunomodulator in the treatment of inflammatory bowel disease but data on its efficacy and safety are limited. The aim of this study was to analyse our experience of the efficacy and safety of 6-thioguanine in inflammatory bowel disease. Material and methods. Patients attending the inflammatory bowel disease clinic who were started on 6-thioguanine therapy were included in this prospective observational study. Indications for initiating 6-thioguanine therapy and other related clinical, pharmacological and laboratory parameters prior to and during therapy were recorded to determine the efficacy and safety of 6-thioguanine. Results. A total of 40 patients were treated with 6-thioguanine, 28 with Crohns disease, 10 with ulcerative colitis and 2 with indeterminate colitis, at a fixed daily dose of 40 mg and continued for a median duration of 34 weeks (range 2–90 weeks). The indications for 6-thioguanine therapy included previous clinical resistance to thiopurine analogues (n=21), intolerance to thiopurine analogues (n=8) and de novo 6-thioguanine use in steroid refractory disease (n=11). Disease remission was reached in 44%, 73% and 89% of these patient groups at 3, 6 and 12 months, respectively. Inflammatory markers and steroid use were significantly lower during 6-thioguanine therapy compared with in the period before therapy. Therapy was discontinued in 13 patients (33%), mainly because of thrombocytopenia and associated hepatotoxicity. Conclusions. 6-thioguanine is a useful addition to treatment in inflammatory bowel disease but the frequent occurrence of hepatotoxicity limits its routine use.

Effectiveness of Antiinfectives

Background:Helicobacter pylori is one of the most common infections of mankind, with persistent colonization causing significant morbidity and mortality. Treatment: First-line therapy, consisting of 7-day treatment with a proton pump inhibitor or ranitidine bismuth citrate, amoxicillin and clarithromycin, with second-line therapy, consisting of a proton pump inhibitor, bismuth, metronidazole, and tetracycline, in the case of failure, is chosen as the most cost-effective method of H. pylori eradication. Conclusion: The effectiveness of these antiinfectives is limited by lack of compliance with treatment regimens, and increasing antibiotic resistance.

Re: Herrlinger et al. —pulmonary function abnormalities in inflammatory bowel disease

TO THE EDITOR: We read with interest the recent article by Herrlinger et al. (1). The authors have demonstrated significant alterations in forced expiratory volume in 1 second (FEV1), inspiratory vital capacity, Tiffeneau value, and lung carbon monoxide transfer capacity in patients with inflammatory bowel disease compared with healthy controls. Variability of the results both in favor (2, 3) and against (4, 5) such association reported in previous trials may be related to the presence of multiple confounding factors. Nutritional status has been shown to have significant influence on the overall pulmonary function in otherwise healthy individuals and in patients with inflammatory bowel disease (6–8). In a previous study, Christie and Hill (7) demonstrated a 35% loss of body protein stores and associated 20–40% physiological impairment in patients with acute exacerbations of Crohn’s disease compared with controls. The associated reduction reported for FEV1, vital capacity, and maximal voluntary ventilation was in the range of 25–40%. There was significant immediate and delayed improvement of these parameters after 2 wk of nutritional supplementation and further improvement on restoration of body proteins during convalescence. In our opinion, the significant alterations in FEV1 and inspiratory vital capacity reported by Herrlinger et al. (1) cannot be entirely ascribed to disease process or activity alone. Additional information on the nutritional status of the study population should have been included to fully clarify the reported association. Similarly, previous controversial results showing lung carbon monoxide transfer capacity alteration in inflammatory bowel disease patients demand carefully designed future prospective studies, considering all possible confounding factors including nutritional status of the study population.