Prevalence,incidence and risk factors for Helicobacter pylori infection in a cohort of Portuguese adolescents (EpiTeen)

BackgroundHelicobacter pylori infection is acquired mainly during childhood, but it may occur throughout life. Understanding the determinants of infection at different ages is essential to clarify dynamics of H. pylori related diseases and to design preventive strategies.AimTo estimate the prevalence of H. pylori infection at the age of 13 and the incidence after a 3-year follow-up and to identify risk factors for infection.Subjects and methodsAdolescents born in 1990 were recruited in schools from Porto. Whole-cell anti-H. pylori IgG antibodies were quantified by ELISA. Prevalence ratios (PR) and incidence rate ratios (RR) adjusted for parental education were computed at baseline (n = 1312) and at follow-up (n = 280).ResultsThe prevalence was 66.2%, lower in subjects with more educated parents (PR = 0.72, 95%CI: 0.63–0.82), and higher for those having more than one sibling (PR = 1.10, 95%CI: 1.02–1.19) and for smokers (PR = 1.11, 95%CI: 1.02–1.20). The incidence was 4.1/100 person-years. Smoking (RR = 2.35, 95%CI: 1.16–4.75) and type of school (RR = 0.38, 95%CI: 0.16–0.95) were associated with the incidence of infection.ConclusionsPrevalence and incidence of H. pylori infection were high, suggesting that gastric cancer will remain an important public health problem in this generation of Portuguese. We identified smoking as a modifiable risk factor for infection.     

Second-line levofloxacin-based triple schemes for Helicobacter pylori eradication

BackgroundThe recommended second-line therapy for Helicobacter pylori (H. pylori) eradication is a quadruple regimen that fails in up to 30% of patients. Several recent studies suggest levofloxacin-based triple therapies as an alternative rescue treatment. However, dosage and length of levofloxacin-based regimens have not been established.AimTo compare the efficacy and tolerability of four second-line levofloxacin-based schemes for H. pylori eradication.MethodsOne hundred and sixty patients (aged 18–70 years, 72 male patients) who were H. pylori positive after standard triple therapies were randomised to receive esomeprazole 20 mg b.d. and amoxicillin 1 g b.d. plus levofloxacin 500 mg o.d., for 7 or 10 days (Groups A and B) or levofloxacin 500 mg b.d. for 7 days or 10 days (Groups C and D). H. pylori status was assessed by 13-C Urea Breath Test or rapid urease test, before and 6 weeks after therapy. Incidence of side effects was evaluated by a questionnaire.ResultsNo dropouts were observed. Eradication of H. pylori infection was successful in: 65% of patients in Group A; 90% in Group B; 70% in Group C; 85% in Group D. Based upon duration of treatment, eradication rates were: 67.5% in 7 days groups and 87.5% in 10 days groups (p = 0.004). Dosage of levofloxacin did not affect the eradication rates (77.5% both in the once daily and twice daily groups).Mild adverse events were reported overall in 16% of patients (22.5% in 7 days groups; 27.5% in 10 days groups; p = 0.58; 12% in the once daily group; 32.5% in the twice daily group; p = 0.04).Conclusions10 days levofloxacin-based second-line regimens were effective in curing H. pylori infection in more than 85% of patients with a lower incidence of adverse effects in levofloxacin single-dosage scheme. The 10 days levofloxacin-based regimens were more effective than 7 days course of treatment showing that duration of therapy is the crucial factor affecting eradication rate.     

The efficacy of Helicobacter pylori eradication regimen with and without vitamin C supplementation

BackgroundVitamin C in gastric juice and in vitro has been shown to inhibit the growth of Helicobacter pylori (H. pylori).AimsThe purpose of this study was to investigate the effect of addition of vitamin C to eradication regimen on H. pylori eradication rate.PatientsThis randomised controlled clinical trial was conducted on 312 patients with H. pylori infection who had referred to the Taleghani Research Center of Gastroenterology and Liver Disease.MethodsPatients were randomly divided into two groups. Group A patients (162 patients) received amoxicillin 1 g and metronidazole 500 mg b.i.d., bismuth 240 mg b.i.d. and omeprazole 40 mg q.i.d. in two divided doses. Patients in group B (150 patients) received the same regimen plus 500 mg vitamin C per day. All patients received therapy for 2 weeks. Four weeks later all patients underwent urea breath test and results were compared.ResultsA total of 140 patients in group A and 141 in group B completed the study. On intention-to-treat analysis 48.8% of patients in group A in comparison to 78% in group B responded to eradication therapy and had negative urea breath test (p < 0.0001).ConclusionAddition of vitamin C to H. pylori treatment regimen of amoxicillin, metronidazole and bismuth can significantly increases H. pylori eradication rate.     

Efficacy of H. pylori eradication with a sequential regimen followed by rescue therapy in clinical practice

BackgroundCurrent Italian guidelines suggest sequential therapy as first-line therapy and a levofloxacin-based rescue therapy for Helicobacter pylori eradication. We evaluated the efficacy of these therapies in clinical practice.Methods84 consecutive patients with dyspeptic symptoms and proven H. pylori infection by either UBT or upper endoscopy with biopsies were enrolled. Patients received a 10-day sequential therapy with lansoprazole 30 mg plus amoxycillin 1 g (all twice daily) for the first 5 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg (all twice daily) for the remaining 5 days. Eradication failure patients received triple therapy with lansoprazole 30 mg, levofloxacin 250 mg, and amoxycillin 1 g (all twice daily) for 10 days.ResultsFollowing the sequential therapy H. pylori eradication was achieved in 70/84 (83.3%; 95% CI = 75.4–91.3) patients, and in 70/77 (90.9%; 95% CI = 84.5–97.3) patients at ITT and PP analyses, respectively. The infection was cured in all 7 eradication failure patients by using second-line therapy.ConclusionsA sequential regimen as first-line therapy and a 10-day levofloxacin-based triple regimen in those patients who failed to clear the infection, appear to be a valid therapeutic strategy for management of H. pylori infection in clinical practice.     

Comparison of Helicobacter pylori eradication rates of standard 14-day quadruple treatment and novel modified 10-day, 12-day and 14-day sequential treatments

Background & aimThis study aimed to compare the efficacy and safety of bismuth-included standard regimen and modified sequential treatments in Turkey, where the success rate of standard triple therapy is very low.MethodsOne-hundred and sixty patients with dyspeptic complaints and naïve Helicobacter pylori infection were randomized into four groups: 41 patients received standard 14-day quadruple treatment (STD) (Rabeprazole 20 mg-bid, bismuth subcitrate (120 mg-qid), Tetracycline 500 mg-qid, Metronidazole 500 mg-tid) for 2 weeks. The modified sequential therapy groups received 20 mg rabeprazole and 1 g amoxicillin, twice daily for the first 5 days, followed by Rabeprazole 20 mg-bid, bismuth subcitrate (120 mg-qid), Tetracycline 500 mg-qid, Metronidazole 500 mg-tid for the remaining 5 (10 day sequential therapy group-10S) (42 patients), 7 (12 day sequential therapy group-12S) (42 patients) and 9 (14 day sequential therapy group-14S) (41 patients) days.ResultsThe overall compliance and H. pylori eradication rate among the 160 patients who completed the H. pylori eradication regimens were 86.9% (139/160) and 78.1% (125/160), respectively. The results were not statistically different between groups in the eradication rates. Per-protocol eradication rates were 76.5% in STD, 71.4% in 10S, 82.4% in 12S and 83.3% in 14S groups (p = 0.7). Intention-to-treatment rates were 77.5% in STD, 72.5% in 10S, 82.5% in 12S and 80.0% in 14S groups (p = 0.5).ConclusionThe eradication rates of standard 14-day and different sequential quadruple treatment regimens are comparable and much more higher than with standard 14-day triple H. pylori eradication treatment that has been reported previously in Turkey.     

Prevalence of lesions detected at upper endoscopy: An Italian survey

BackgroundPrevalence of gastroduodenal lesions is changing in the last decades. Prevalence of Helicobacter pylori infection, non-steroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitor (PPI) therapy may be involved in such a phenomenon. We assessed gastroduodenal lesions prevalence in a nationwide study.Materials and methodsConsecutive patients who underwent upper endoscopy for the first time in 24 Italian centres between January 2012 and 31 March 2012 were enrolled. Prevalence of gastric ulcer (GU), duodenal ulcer (DU), gastric erosions (GE), duodenal erosions (DE), gastric polyp (GP), Barrett's oesophagus (BE), and neoplasia was assessed.ResultsOverall, 1054 (M/F: 388/666; Mean age: 57.5 ± 5 years) patients were enrolled. H. pylori infection was detected in 356 (33.9%) patients, 358 (34%) were taking NSAIDs, and 532 (50.5%) PPIs. PPI therapy was associated with a significantly lower H. pylori detection rate (27.8% vs 39.8%; OR: 0.6, 95% CI 0.45–0.77; P < 0.001). GU, DU, GE, DE, GP and BE were detected in 17 (1.6%), 13 (1.2%), 150 (14.2%), 50 (4.7%), 51 (4.8%) and 17 (1.6%), respectively. Moreover, 3 (0.3%) distal gastric cancers were observed. H. pylori infection remained the most prevalent factor for all gastroduodenal lesions, but gastric polyp. One third of patients with GU and GE were taking only NSAIDs therapy.ConclusionsThe prevalence of peptic ulcer was very low (< 3%), with a similar rate between DU and GU. As many as half patients were on ongoing PPI therapy. Such a therapy could affect both the detection rate of H. pylori infection and the real prevalence of gastroduodenal lesions.     

Serum vitamin B12 and folate status in patients with inflammatory bowel diseases

BackgroundThe aims of this study were to investigate the prevalence of serum vitamin B₁₂ and folate abnormalities in patients with inflammatory bowel diseases (IBD) and to identify risk factors associated with B₁₂ and folate abnormalities in this entity.Methods138 patients with IBD (45 Crohn's disease and 93 ulcerative colitis) and 53 healthy subjects were enrolled into the study. Fasting serum B₁₂ and folic acid levels were measured and clinical data regarding inflammatory bowel diseases were gathered.ResultsWhile the mean serum B₁₂ concentration in CD patients was 281 ± 166 pg/ml, the mean serum vitamin B₁₂ concentration in UC patients was 348 ± 218 pg/ml (p = 0.224). The number of patients with vitamin B₁₂ deficiency in the CD group was greater than the number of patients with UC [n = 10 (22%) vs. n = 4 (7.5%), p = 0.014]. The number of patients (n = 10, 22%) with B₁₂ deficiency in the CD group was also greater than controls (n = 4, 7.5%) (p = 0.039). With regard to folate levels, the median serum folate level was 7.7 ± 5.3 ng/ml in CD patients, 8.6 ± 8.3 ng/ml in UC patients and 9.9 ± 3.3 ng/ml in the control group (p = n.s.). Patients with a prior ileocolonic resection had an abnormal B₁₂ concentration compared to patients without surgery (p = 0.008). In CD patients, ileal involvement was the only independent risk factor for having a low folate level.ConclusionSerum vitamin B₁₂ and folate deficiencies are common in patients with CD compared to UC patients and controls. In CD patients, prior small intestinal surgery is an independent risk factor for having a low serum vitamin B₁₂ level.     

Efficacy and safety of Levofloxacin,Clarithromycin and Esomeprazol as first line triple therapy for Helicobacter pylori eradication in Middle East. Prospective,randomized, blind,comparative, multicenter study

Background/aimsAntibiotic resistance and poor compliance are the main causes of Helicobacter pylori (H. pylori ) eradication failure. This study evaluated the eradication rate, tolerability, and compliance of Levofloxacin, Clarithromycin and Esomeprazol combined triple therapy for H. pylori eradication.Patients and methodsFour hundred-fifty patients from 3 centres who were diagnosed to have Helicobacter pylori infection by ¹³C-urea breath test were randomized into 3 equal groups; group 1 (CAE) received Clarithromycin 500 mg twice daily, Amoxicillin 1000 mg twice daily, plus Esomeprazol 20 mg twice daily for 7 days, group 2 (LAE) received Levofloxacin 500 mg once daily, Amoxicillin 1000 mg twice daily, plus Esomeprazol 20 mg twice daily for 7 days, group 3 (CLE) received Levofloxacin 500 mg once daily, Clarithromycin 500 mg twice daily, plus Esomeprazol 20 mg twice daily for 7 days. 436 patients were re-evaluated by ¹³C-urea breath test after 6 weeks from completion of treatment.ResultsH. pylori eradication (intention to treat) was successful in 136/150 (90.6%) with CLE, 127/150 (84.7%) with LAE and 118/150 (78.6%) with CAE. There was a significant difference (p < 0.001) regarding treatment success between CLE and LAE when compared with CAE. There was no difference among the treatment groups with regard to the incidence and severity of adverse events reported.ConclusionThe combined Levofloxacin, and Clarithromycin and Esomeprazol based regimen as first line triple therapy for H. pylori eradication can give more significant eradication rate with same safety when compared with classic triple therapy.     

Anti-mutated citrullinated vimentin antibodies in rheumatoid arthritis patients: Relation to disease activity and manifestations

Aim of the workTo evaluate the frequency of anti-mutated citrullinated vimentin antibodies (MCV) in rheumatoid arthritis (RA) patients and to correlate it with disease activity and various disease manifestations.Patients and methodsFifty RA patients were recruited from the rheumatology and rehabilitation outpatient clinic, Kasr Al-Aini. Thirty healthy subjects served as controls. All patients were subjected to full history taking and clinical examination including general and joint assessment. Disease activity was assessed by the disease activity score (DAS-28) and functional ability was evaluated by the Modified Health Assessment Questionnaire (MHAQ). Anti-MCV and anti-cyclic citrullinated peptide (anti-CCP) were assayed by ELISA in patients and controls. Plain X-ray was performed on the hands and wrists and Sharp score was used to assess the erosions and joint space narrowing.ResultsA highly significant elevation of serum anti-MCV in RA patients (135.82 ± 126.81 U/ml) compared to controls (13.63 ± 8.48 U/ml) (p < 0.0001) was found. Anti-MCV showed a sensitivity of 84% and specificity of 80%. There was a significant difference between anti-MCV positive and anti-MCV negative patients as regards MHAQ (1.07 ± 0.74 vs. 0.52 ± 0.37, p = 0.005) and Sharp erosion score (12.93 ± 23.55 vs. 4 ± 2.2, p = 0.02). Anti-CCP showed a sensitivity of 70% and specificity of 100%. There was a significant difference between the specificities of both markers (p = 0.03). There was no significant correlation of the anti-MCV with the clinical manifestations, MHAQ, DAS28 or Sharp score. Anti-MCV significantly correlated with anti-CCP (p < 0.0001).ConclusionAnti-MCV test has a significant association with the functional disability and radiologic progression in RA and could be considered as a promising biomarker.     

Sex-differences in the prevalence of Helicobacter pylori infection in pediatric and adult populations: Systematic review and meta-analysis of 244 studies

BackgroundThe main outcome of Helicobacter pylori infection, i.e. gastric cancer, is more frequent in men, but there is no comprehensive synthesis of the evidence on a potential role of sex in the acquisition and/or persistence of infection.AimsTo quantify the association between sex and H. pylori infection in pediatric and adult populations, through systematic review and meta-analysis.MethodsPubMed^® was searched, from inception to September 2015, to identify population-based studies reporting the prevalence and/or incidence of H. pylori infection in both sexes. Odds ratios (OR) or data to compute them were extracted; adjusted estimates were preferred, whenever available. The DerSimonian and Laird method was used to compute summary estimates and respective 95% confidence intervals (95%CI), separately for children and adults.ResultsAmong a total of 244 studies, mostly cross-sectional, male sex was associated with a greater prevalence of H. pylori infection, both in children (102 studies, OR = 1.06, 95%CI: 1.01, 1.12, I² = 43.7%) and adults (169 studies, OR = 1.12, 95%CI: 1.09, 1.15, I² = 68.5%). An underrepresentation of studies showing a negative association between male sex and infection was observed (Egger’s test: p = 0.006).ConclusionsAlthough further research is needed to understand the mechanisms by which sex may influence the acquisition and/or persistence of infection, our results support a small contribution of sex differences in the prevalence of infection to the male predominance of H. pylori-related outcomes, including gastric cancer.     

Effect of Helicobacter pylori eradication on glycaemia control in patients with type 2 diabetes mellitus and comparison of two therapeutic regimens

Background and study aimsThe eradication rate of Helicobacter pylori (H. pylori) has been reported as being lower in patients with type 2 diabetes mellitus (DM) than in those without DM. The aim of the study was to assess the efficacy of the two H. pylori eradication regimens in patients without and with type 2 DM and to study the effect of H. pylori treatment on glycaemia control.Patients and MethodsA total of 93 consecutive type 2 DM (non-insulin users) and 98 non-diabetic age- and sex-matched patients were enrolled. Patients were randomly assigned to one of the two treatment protocols all given twice daily: (a) a 14-day quadruple therapy comprising of omeprazole 20 mg, metronidazole 500 mg, amoxicillin 1 g and bismuth subcitrate 240 mg (OMAB) and (b) a 14-day triple regimen comprising of omeprazole 20 mg plus clarithromycin 500 mg and amoxicillin 1 g (OCA). Cure was defined as a negative ¹³C-urea breath test at least 6 weeks after treatment.ResultsThe H. pylori eradication rate with the OCA regimen was 63% in patients with type 2 DM (non-insulin users) and 87.7% in the control group (p = 0.017). The H. pylori eradication rate with the OMAB regimen was 38.2% in patients with type 2 DM and 55.1% in the control group (p < 0.001). Mean decrease of fasting plasma glucose and HbA1c level shows no statistically significant difference after H. pylori eradication.ConclusionThis study suggests that the eradication rate of H. pylori with OCA or OMAB treatment is lower in patients with type 2 diabetes than in non-diabetics and H. pylori treatment in patients with type 2 DM has no role in the control of the glycaemia. The triple therapy (OCA) is superior to the quadruple protocol (OMAB) in H. pylori eradication of both DM and non-DM cases.     

Endothelial nitric oxide synthase (eNOS) is not upregulated in gastric mucosa of Helicobacter pylori (H. pylori)-positive patients with type 2 diabetes mellitus

AimTo evaluate the expression of eNOS and CD34 in gastric mucosa of Helicobacter pylori (H. pylori) positive diabetic patients, in correlation with glycaemic control and diabetic autonomic neuropathy (DAN).MethodsWe prospectively studied 49 diabetic type 2 patients (29 women, mean age 65.32 ± 8.56 years) and 30 control subjects (15 women, mean age 58.47 ± 12.40) that underwent endoscopy. Biopsies from the body and antrum were evaluated for H. pylori-gastritis, eNOS and angiogenic marker CD34 expression. Statistical analysis in correlation with mean glycosylated haemoglobin (HbA1c) of the last 3 years, and DAN was performed.ResultsThe two groups were matched for age (p = 0.144), sex (p = 0.335), H. pylori-infection (p = 0.617) and degree of gastritis (p = 0.78). eNOS and CD34 attenuated expression correlated with diabetes mellitus (DM) in the corpus (p = 0.009 and 0.02, respectively). eNOS and CD34 expression was upregulated in H. pylori-positive controls but not in H. pylori-positive diabetic patients (p = 0.010 and 0.007 for the corpus and p = 0.036 and 0.047 for the antrum, respectively). eNOS expression correlated with good glycaemic control (GGC) in the gastric corpus (p < 0.001) and antrum (p = 0.0037) and with absence of DAN (p = 0.009 and 0.036, respectively for the corpus and antrum).ConclusionChronic glycaemic control affects eNOS expression and angiogenesis in the gastric mucosa of patients with type 2 DM. eNOS expression is not upregulated in H. pylori-positive diabetic patients.     

The relationship between plasma homocysteine levels and bone mineral density in post-menopausal women

BackgroundWhether or not mild hyperhomocysteinemia and low serum levels of folates or vitamin B12 are risk factors for osteoporosis in the elderly is controversial.Aims and methodsTo investigate whether or not plasma levels of total homocysteine (tHcy) and serum levels of folates and vitamin B12 are associated with bone mineral density (BMD), we carried out a cross-sectional study on 446 post-menopausal women (mean age: 65.1 ± 9.4 years), consecutively seen at the Siena Unit (Tuscany region, Central Italy) for BMD evaluation over a two-year period. BMD of the total femur, femoral neck and lumbar spine was detected by dual-energy X-ray absorptiometry.ResultsThe age-adjusted geometric mean of plasma tHcy levels (µmol/L) was 9.96 ± 1.29 in women with normal BMD, 11.06 ± 1.32 in those with osteopenia and 11.88 ± 1.35 in those with osteoporosis (p < 0.0001). On multiple linear regression analysis, adjusting for age, body mass index, folates, vitamin B12, creatinine clearance, smoking habit and alcohol intake, tHcy was negatively related to BMD of the total femur [β estimate for log-homocysteine: ? 0.050 (95% CI: ? 0.100 to ? 0.001, p = 0.048; R² = 0.02)], but not of femoral neck or lumbar spine. There was no significant association between BMD and serum levels of folates and vitamin B12.ConclusionstHcy is negatively associated with BMD of the total femur. The contribution of tHcy to explain the variance of BMD is small (2% of the total variance) but clinically relevant, considering the high prevalence of osteoporosis among post-menopausal women and the possibility to lower tHcy by vitamin supplementation.     

Eradication of Helicobacter pylori can facilitate immune reconstitution in HIV-1-infected immunological non-responders

ObjectiveA significant number of HIV-1 patients experience poor immune reconstitution despite long-term viral suppression with highly active antiretroviral therapy (immunological non-responders). The aims of the present study were to determine whether eradication of Helicobacter pylori could facilitate a better immune reconstitution in these patients.MethodsForty-nine immunological non-responder HIV-1 patients were evaluated by ¹³C-urea breath test (UBT) for the presence of active H. pylori infection. They were all asymptomatic. The UBT was positive in 26 (53%) of them. Eleven patients (group 1) were treated with a combination of omeprazole 20 mg bid, amoxicillin 1 g bid and clarithromycin 500 mg bid for 14 consecutive days. Eight weeks later, successful eradication was proven by a repeat negative UBT in all 11 patients. The remaining 15 (group 2) refused the H. pylori eradication treatment. All 26 patients were followed for 24 months and evaluated for blood CD4 and CD8 cell counts and percentages and for plasma HIV-1 viral load.ResultsAt the time of H. pylori diagnosis and eradication (baseline), CD4 and CD8 cell counts were similar in both study groups. All 11 H. pylori eradicated patients (group 1) had a significant increase in CD4 cell count starting 3 months and peaking 12–18 months after H. pylori eradication. Thereafter, CD4 levels gradually declined. Nevertheless, 24 months after triple therapy it was significantly higher than prior to H. pylori eradication. Parallel reciprocal changes were observed in CD8 cell counts. There were no significant changes in either CD4 or CD8 cell counts in group 2 patients. None of the patients of group 1 demonstrated virological failure, while four (26.7%) group 2 patients experienced virological failure requiring change of highly active antiretroviral therapy (HAART) regimen.ConclusionTriple therapy for H. pylori eradication is associated with a significant, although possibly transient immune reconstitution in HAART-treated HIV-1 patients with viral suppression without immunological response.     

Long-term follow-up of pepsinogen I/II ratio after eradication of Helicobacter pylori in patients who underwent endoscopic mucosal resection for gastric cancer

BackgroundAlthough the pepsinogen I/II (PGI/II) ratio after Helicobacter pylori eradication is recovered at short-term follow-up, long-term follow-up studies of PGI/II are rare.MethodsA total of 773 patients with gastric cancer who underwent endoscopic resection and pepsinogen and H. pylori tests were enrolled. H. pylori was eradicated in these patients. Endoscopic and pepsinogen tests were performed every year. A low PGI/II ratio was defined as ≤3.ResultsThe PGI/II ratio was higher in non-infected patients (n = 275, 4.99) than infected patients (n = 498, 3.53). After H. pylori eradication, the PGI/II ratio increased to 5.81 and 5.63 after 1 and 2 years (each p < 0.05). The PGI/II ratio in the non-eradication group decreased to 3.94 and 2.75 after 1 and 2 years. The PGI/II ratio in the H. pylori eradication group became similar to that of the H. pylori-negative group at 3 (4.48 vs. 4.34), 4 (4.88 vs. 4.34), and 5 years (4.89 vs. 4.23). The adjusted odds ratios for a lower PG I/II ratio in the non-eradication group compared to the eradication group were 4.78 (95% CI 2.15–10.67) after 1 year and 8.13 (95% CI 2.56–25.83) after 2 years.ConclusionsAfter H. pylori eradication, the PGI/II ratio increased and was similar to that of H. pylori-negative controls for up to 5 years of follow-up.     

Quadruple,sequential, and concomitant first-line therapies for H. pylori eradication: a prospective,randomized study

BackgroundCurrent Italian guidelines recommend 10-day bismuth-based or bismuth-free (sequential and concomitant) regimens for first-line H. pylori eradication. However, comparison among these regimens is lacking in our country.AimTo perform a ‘head-to-head’ comparison among these three therapies as first-line treatment for H. pylori eradication in clinical practice.MethodsThis was a prospective, open-label randomized study enrolling consecutive patients diagnosed with H. pylori infection never previously treated. Patients were randomized to receive one of the following 10-day therapies: (a) Bismuth-based therapy: esomeprazole 20 mg b.i.d and Pylera 3 tablets q.i.d; (b) Concomitant therapy: esomeprazole 20 mg plus amoxicyllin 1,000 mg, clarithromycin 500 mg and tinidazole 500 mg (all b.i.d.), and (c) Sequential therapy: esomeprazole 20 mg plus amoxicyllin 1,000 mg for 5 days followed by esomeprazole 20 mg plus clarithromycin 500 mg and tinidazole 500 mg for 5 days (all b.i.d). H. pylori eradication was assessed by using UBT 4-6 weeks after the end of therapy.ResultsOverall, 187 patients were enrolled. The eradication rates achieved with Pylera, concomitant and sequential were 85.2%, 95.2%, and 93.6%, respectively, at intention to treat, and 94.5%, 96.7%, and 95.1% at per protocol analyses, without a statistically significant difference. The incidence of severe side-effects was higher with the bismuth-based therapy than with the two bismuth-free regimens (9.8% vs 1.6%; p = 0.046).ConclusionsBismuth-based and bismuth-free therapies are equally effective for first-line H. pylori eradication. However, bismuth therapy was more frequently interrupted for side-effects than bismuth-free therapies.     

Malnutrition in elderly patients with renal failure: Importance of pre-dialysis period

Background and aimsIn elderly, renal failure is one of the major comorbidities. Malnutrition is another clinical problem in these patients’ follow-up. In this study, we compared nutritional states of elderly patients with different renal functions.MethodsEighty-three predialysis and 121 hemodialysis (HD) patients of 65 years and older and as control group, 46 elderly patients with no renal failure were compared. Blood urea nitrogen, creatinine, thyroid stimulating hormone, vitamin B12 and folic acid levels were measured in every patient. Nutritional status of all patients was evaluated with Mini Nutritional Assessment Short Form (MNA-SF). One-way ANOVA, post-hoc Tukey and Pearson correlation analysis were used for statistics.ResultsThe mean MNA-SF of pre-dialysis patients was 8.67 ± 3.00. In HD patients, it was 11.44 ± 2.43 and in control, it was 11.48 ± 2.27. In HD patients, a weak correlation was detected between higher BUN, creatinine and higher MNA-SF (r = 0.181, P = 0.047), (r  =  0.181, P = 0.046). In HD patients, vitamin B12 levels were higher than pre-dialysis and control group (P < 0.001).ConclusionIn elderly patients with renal failure, malnutrition starts in pre-dialysis period and MNA-SF can be a reliable technic for these patients’ nutritional evaluation.     

The effect of Helicobacter pylori eradication on dyspeptic symptoms,acid reflux and quality of life in patients with functional dyspepsia

BackgroundThe aims of this study were to investigate the effect of Helicobacter pylori eradication on gastroesophageal reflux, gastrointestinal symptoms and quality of life in patients with functional dyspepsia.Methods20 H. pylori positive patients diagnosed as having functional dyspepsia according to Roma-II criteria completed the study period. Esophageal motility testing and pH recordings were obtained from each patient before and at the end of the study period. Each patient's gastrointestinal symptoms were evaluated according to Glasgow dyspepsia score. 36-Item short-form health survey (SF-36) and EDQ5 health survey were obtained form each patient.ResultsH. pylori eradication was accomplished in 13 patients (65%). Glasgow dyspepsia symptom score improved in H. pylori eradicated patients (10.3 vs 7.5, p < 0.05) compared to baseline. Fasting lower esophageal sphincter pressures increased (21.6 vs 25.4 mmHg, p < 0.05) after H. pylori eradication Neither the amplitude of peristaltic contractions in the esophageal body (59.4 vs 57.7 mmHg, p = ns) nor the velocity of peristaltic contractions changed before and after eradication. The percent time of esophageal pH < 4 (0.7 vs 2.6, p < 0.001), reflux events longer than 5 min (0 vs 0.7, p < 0.005) and total reflux number (10.3 vs 19.3, p < 0.005) significantly increased after eradication therapy. In the SF-36 health-related quality of life survey, general health score was 3.5 vs. 3.4, physical activity 25.2 vs. 26.4, physical role 5.9 vs. 6.3, emotional pain 4.6 vs. 4.5, social activity 2.0 vs. 1.9, physical pain 3.4 vs. 3.0, vitality 32.3 vs. 34.6, and mental health 11.9 vs. 11.5, before and at the end of treatment (p = ns), respectively.ConclusionsH. pylori eradication did not influence quality of life in patients with functional dyspepsia. Majority of the patients experienced a significant change in esophageal acid exposure after H. pylori eradication. H. pylori eradication significantly decreases gastrointestinal symptoms, however has no effect on quality of life in patients with functional dyspepsia.     

Diagnostic value of rapid urease test and urea breath test for Helicobacter pylori detection in patients with Billroth II gastrectomy: A prospective controlled trial

AimThe aim of this work was to assess the reliability of rapid urease test (RUT) and urea breath test (UBT) for detecting Helicobacter pylori (H. pylori) in patients with Billroth II (BII) gastrectomy, using histology as reference.MethodsIn this prospective controlled study, 31 consecutive patients with BII gastrectomy and 73 controls who had an indication for endoscopy were included. Their H. pylori status was assessed with biopsies for histology, RUT and UBT. Histology served as the gold standard. Only the biopsies from the gastric fundus were evaluated. Specificity, sensitivity, positive and negative predictive value, degree of agreement and k-statistics were used.ResultsRUT and UBT for detecting H. pylori in the control group had excellent agreement [97%, kappa (k) = 0.94 and 99%, k = 0.97 respectively] with biopsies. In BII patients, RUT from fundic biopsies had very good agreement (87%, k = 0.74) compared to histology from fundic biopsies, whereas the UBT was unreliable (agreement: 71%, k = 0.41) compared to histology.ConclusionThe RUT from fundic biopsies in BII patients is a reliable test for H. pylori detection, whereas the UBT is unreliable.