S Salandin

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.

Serum pepsinogens as markers of Helicobacter pylori eradication

Abstract Various methods, both invasive and noninvasive, are used to verify Helicobacter pylori eradication, with varying degrees of accuracy. The purpose of this study was to verify the relationship between H pylori eradication and serum levels of pepsinogen A (PGA) and pepsinogen C (PGC). The study involved 79 patients who tested positive for H pylori infection after histologic examination and the urease test. Patients were treated with various drug regimens for 7 to 25 days. Two months after discontinuing treatment, endoscopy was performed to verify H pylori eradication; 33 of 79 patients were found to be free of infection. Venous blood samples were taken to measure PGA and PGC levels before and after treatment. Patients in whom H pylori infection was eradicated had a significant drop in PGA and PGC levels, whereas in patients with persisting H pylori infection, there was a trend in which pepsinogen levels coincided with the quantity of bacteria detected. These preliminary data suggest that it may be possible to evaluate H pylori eradication by means of serum pepsinogen levels, sparing patients a follow-up endoscopy.

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.

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

CYTOPROTECTIVE EFFECTS OF COLLOIDAL BISMUTH SUBCITRATE IN PATIENTS WITH ULCER DISEASE

Abstract Helicobacter pylori is capable of altering the structure of the mucus gel adhering to the surface of the gastric antral wall. Thirty patients (22 men and 8 women) with endoscopic evidence of active duodenal ulcer and histologically confirmed H pylori antral gastritis participated in this prospective study. The study objective was to evaluate the effects of 6 weeks of treatment with colloidal bismuth subcitrate (two 120-mg tablets twice daily) on peptic secretion and the gastric mucosal barrier. Samples of gastric juice were collected during endoscopy to measure pepsin levels. Also during endoscopy, four biopsies were taken (two antral and two from the body/fundus) for histological examination, H pylori detection, and the quantification of pepsinogen group A (PGA), gastrin, and pepsin in the tissues. All of the above parameters were repeated with endoscopy after 6 weeks of treatment. Ulcer healing was obtained in 26 (87%) of 30 patients after treatment. H pylori infection was cleared in 15 (50%) patients. No significant changes were detected in concentrations of pepsin in the gastric juice or concentrations of PGA, gastrin, or pepsin in the tissues. Mucus depletion was visibly lower after treatment, suggesting that colloidal bismuth subcitrate may alter the bacterial microenvironment, regenerating the quantity of mucus.