Cure of Helicobacter pylori infection in the elderly: effects of eradication on gastritis and serological markers

Background: Specific data on anti-H. pylori treatments in elderly people are very scarce. The aim of the study was to evaluate in the elderly the efficacy of different anti-H. pylori therapies and the behaviour of serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio induced by the anti-H. pylori treatment. Methods: One hundred and twenty-one dyspeptic patients aged >60 years (mean age, 73 years; range, 61–89 years) with H. pylori-positive gastric ulcers (17 patients), duodenal ulcers (33 patients) or chronic gastritis (71 patients) were treated with one of the following anti-H. pylori treatments: (A) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days; (B) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 mg q.d.s. for 7 days; (C) omeprazole 40 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 q.d.s. for 7 days; (D) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days; (E) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days plus metronidazole 250 q.d.s. for 7 days; and (F) omeprazole 40 mg/day plus clarithromycin 250 mg b.d. for 7 days plus metronidazole 250 mg q.d.s. for 7 days. At the baseline and 2 months after therapy, endoscopy and serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio were measured. Results: Ten patients (8.2%) dropped out of the study. Six patients (4.9%) reported side-effects. The eradication rates of the six regimens, expressed using intention-to-treat and per protocol analysis, were, respectively: (A) 39% and 44%; (B) 50% and 56%; (C) 65% and 77%; (D) 47% and 50%; (E) 85% and 90%; and (F) 83% and 87%. The triple therapy for regimens E and F was significantly more effective than dual therapies (regimens A and D; intention-to-treat=P<0.007, per protocol=P<0.001) or the triple therapy for regimens B and C (intention-to-treat=P<0.009, per protocol=P<0.03). Patients cured of H. pylori infection showed a significant decrease in the activity of gastritis (P<0.0001), a significant drop in IgG anti-H. pylori (P=0.0004) and pepsinogen C (P<0.0001), and an increase in PGA/PGC ratio (P<0.001), while patients remaining H. pylori-positive showed no changes in the serum parameters. Conclusions: In the elderly, triple therapy with omeprazole +metronidazole+clarithromycin for 1 week is well tolerated and highly effective; anti-H. pylori antibody and PGC serum levels decrease soon after anti-H. pylori therapy only in patients cured of H. pylori infection.     

Opioid pathways exert a tonic restraint in the guinea-pig isolated colon: changes after chronic sympathetic denervation

Abstract— We have studied the effects of naloxone on acetylcholine and noradrenaline release in the guinea-pig isolated distal colon, and have assessed the effect of naloxone on electrically-induced contractions of the longitudinal muscle and non-adrenergic, non-cholinergic (NANC) relaxations of the circular muscle coat. Naloxone dose-dependently increased resting and electrically-evoked acetylcholine release and electrically-evoked noradrenaline release. Naloxone was more potent in increasing resting acetylcholine release in colonic specimens obtained after chronic sympathetic denervation. Naloxone (1 μm ) did not affect electrically-induced contractions of the longitudinal muscle, while it enhanced NANC relaxations of the circular muscle. The effects observed with naloxone in the present experiments suggest that opioid pathways exert a tonic restraint on neurotransmission in the guinea-pig colon. After suppression of the adrenergic inhibitory tone, the functional relevance of opioid pathways seems to be increased.     

The long-term efficacy of interferon alfa in chronic hepatitis C patients: A critical review

With current therapeutic regimens, sustained responses occur in no more than 25% of patients with chronic hepatitis C who are treated with interferon. Relapses occur usually within 6 months from therapy suspension, but clinical and virologic recurrencies can be observed as late as after 3 years of follow up. The rate of long-term responses seems to depend on the dosage and the period of administration of interferon, but the best therapeutic protocol remains unknown. As a direct marker of permanent recovery is not available, indirect signs of disease resolution are: (i) continuously normal alanine aminotransferase levels; (ii) clearance of HCV-RNA; (iii) disappearance of anti-C100/NS4; and (iv) significant histological improvements assessed at least 2 years after therapy withdrawal. Known baseline predictive features of long-term response are the absence of cirrhosis, low viraemic levels and infection with HCV of type III or IV genotype (Okamoto's classification). According to recent reports, the lower the heterogeneity of the hypervariable region of the envelope 2 gene of HCV, the higher the chance of a sustained remission. There is not yet any consensus on the efficacy of a second therapeutic course of interferon in inducing a permanent response, and controlled trials are needed to clarify this issue.     

Reversal of chlorpromazine-induced avoidance depression by the N-methyl-d-aspartate antagonist,dizocilpine, in mice

Abstract— The non-competitive N-methyl-d -aspartate (NMDA) antagonist MK-801 (dizocilpine) was tested, alone or in combination with chlorpromazine, in mice previously trained in the shuttle-box. The lowest doses of dizocilpine (0·02 and 0·04 mg kg^?1) attenuated the disrupting action of the neuroleptic (1·5 mg kg^?1) on avoidance-performance, while avoidance depression induced by 1·5 and 2 mg kg^?1 chlorpromazine was completely or almost completely reversed by 0·08 mg kg^?1 NMDA antagonist. The highest dose (0·16 mg kg^?1) of dizocilpine did not ameliorate avoidance-performance of mice receiving 2 mg kg^?1 chlorpromazine, perhaps because of ataxic effects produced by the drug combination, at these doses. The results support suggestions for a potential use of NMDA antagonists in the treatment of extrapyramidal side-effects of neuroleptics.     

Modulation of all-trans retinoid acid pharmacokinetics in acute promyelocytic leukaemia by prolonged interferon-α therapy

Summary. Continuous treatment with all-trans retinoid acid (ATRA) induces accelerated drag catabolism which is considered responsible for acquired resistance to ATRA. We studied the effect of interferon-o:2a (IFN) on ATRA pharmacokinetics in two patients with acute promyelocytic leukaemia (APL) in complete remission maintained by alternating 15d of IFN and 15 d of ATRA. Day 15 ATRA levels obtained during IFN + ATRA treatment were significantly higher than those observed in patients maintained on ATRA alone. In one patient IFN was discontinued and day 15 ATRA levels decreased to those observed in patients scheduled for maintenance with ATRA alone. In our two patients IFN substantially reduced the induction of ATRA catabolism, indicating a potential role for IFN in modulating ATRA pharmacokinetics.     

Endoscopic Resection of Squamous Papilloma of the Esophagus

Squamous papilloma is a rare, benign esophageal tumor which may be confused with verrucous carcinoma of the esophagus. The case of a 45-year old male who was found to have an esophageal squamous papilloma is presented. This case serves to demonstrate the important role of fiberoptic endoscopy for the transendoscopic resection of this tumor.     

Computed Tomography During Experimental Balloon Dilatation For Calcific Aortic Stenosis. A Look into the Mechanism of Valvuloplasty

Thin-slice contiguous computed tomographic scanning was performed in four postmortem hearts with calcific aortic valve stenosis (mean weight: 583 ± 78 g; mean age: 65 ± 10 years) before, during, and after balloon valvuloplasty. Balloons of increasing diameter (15–19 mm single balloons, and 3 × 12-mm trefoil-shaped balloon) were positioned across the aortic valve and manually inflated to pressures of 3 to 4 atmospheres. During inflation of the 3 × 12-mm balloon a larger residual orifice, potentially free for blood passage, was observed in the two cases with bicuspid valves and in one case with a fused tricuspid valve, while the reverse was noted in one case with a tricuspid valve without fusion. In most cases valvular orifice enlargement only occurred with larger diameter balloons. After valvuloplasty aortic valve area increased from 0.72 (range 0.20–0.95) cm² to 2.36 (range 0.95–3.14) cm². The smallest orifice enlargement after dilatation occurred in case 1, where valvular calcified deposits had the largest volume and the highest computed tomographic attenuation value. In each patient macroscopic changes (fracture of nodular calcifications, commissural splitting, tearing of the central raphe) were noted. No calcium dislodgement or aortic ring damage was observed. In autopsy specimens computed tomography provided accurate evaluation of aortic valve morphology, extent of valve calcification, balloon-leaflet relationship during inflation, and effects of the dilatation on valve leaflets and commissures. Advances in computed tomographic cardiovascular imaging may achieve similar results in the clinical setting, and allow a more rational, individualized approach to the valvuloplasty procedure. (J Interven Cardiol 1988:1:2)