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Shehryar M, Ahmad RU, Kareem HK, Khan L, Ashraf MF, Hassan A, Saeed S, Tareen HK, Nazir DA, Ashraf MA. Efficacy, safety and cost-effectiveness of vonoprazan vs Proton Pump Inhibitors in reflux disorders and H. pylori eradication: A literature review. Ann Med Surg (Lond) 2022; 82:104760. [PMID: 36268393 PMCID: PMC9577871 DOI: 10.1016/j.amsu.2022.104760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 02/07/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is one of the most prevalent conditions worldwide and is conventionally treated by proton pump inhibitor therapy. However, around 40% of people have reported some form of resistance to this therapy. Vonoprazan has recently been approved for the treatment of GERD. Literature was searched on PubMed, Google Scholar, Embase and Medline. Inclusion criteria were 1) Human subjects; 2) papers published in English language; 3) study types that are RCTs. In pre-clinical studies, VPZ was unaffected by changes in pH, making it 1.2-2 times more potent than PPI, both in-vivo and in-vitro. In studies involving GERD, several RCTs proved higher efficacy of VPZ than conventional PPI. RCTs on patients affected by H. Pylori showed a higher efficacy than VPZ (95.8%) as compared to PPI (69.6%). In another RCT, adverse effects including diarrhea, nausea and body rash were observed in 32.7% of the people taking VPZ as compared to 40.5% of the people taking PPI. VPZ was shown to be much more cost effective as compared to PPI. This article concludes that VPZ is superior to PPI in terms of efficacy, safety and cost-effectiveness in reflux disorders and H. pylori eradication. Hence, use of vonoprazan should be preferred over conventional PPIs in these disorders. As most of the research was conducted in Japan, studies should be carried out in different regions of the world to explore if these results are extrapolated in those regions. Research is also needed to explore the efficiency of VPZ in scenarios of PPI resistance.
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Affiliation(s)
| | | | | | - Laiba Khan
- HIT Hospital, Taxila Cantt, Rawalpindi, Punjab, Pakistan
| | | | - Ahtizaz Hassan
- HIT Hospital, Taxila Cantt, Rawalpindi, Punjab, Pakistan
| | - Sabeena Saeed
- HIT Hospital, Taxila Cantt, Rawalpindi, Punjab, Pakistan
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Congedi J, Williams C, Baldock KL. Epidemiology of Helicobacter pylori in Australia: a scoping review. PeerJ 2022; 10:e13430. [PMID: 35669956 PMCID: PMC9165601 DOI: 10.7717/peerj.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/21/2022] [Indexed: 01/14/2023] Open
Abstract
Background Helicobacter pylori (H. pylori), a bacterium implicated in the development of peptic ulcer and gastric cancer, is estimated to infect around half the world's population. Its prevalence in Australia is unclear. This scoping review aimed to evaluate all Australian literature providing estimates of the prevalence of H. pylori. Methods Australian studies examining H. pylori prevalence from 1982 onwards were eligible for inclusion. Medline, Embase and Scopus databases, and grey literature sources, were searched. Two independent reviewers undertook a two-stage screening process. Data were extracted by two independent reviewers using a pre-specified template. Results Of 444 identified studies, 75 were included in the review. H. pylori prevalence in Australian population-based studies (n = 8) ranged from 38.0% in 1991 to 15.1% in 2002; however, estimated prevalence across all non-clinical population studies in diverse sub-groups (n = 29) has varied dramatically. Decreased prevalence has been more marked in populations with gastrointestinal symptoms and conditions compared to non-clinical populations. Data on H. pyloriprevalence in vulnerable populations are lacking. Conclusions This is the first scoping review of Australian studies reporting H. pylori prevalence. A wide range of study designs, population groups, geographic regions, and diagnostic methods was included, involving data collected over a 50-year period (1969 to 2018). The summary of H. pylori prevalence estimates over time in this review points to a decrease in prevalence in Australia, particularly among populations with gastrointestinal symptoms and illnesses; however, it is unknown whether there is inequity in prevalence trends across vulnerable sub-groups of the Australian population. Future research and interventions supporting the health and wellbeing of vulnerable populations is required to ensure equitable health gains are made for all.
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Affiliation(s)
- Jillian Congedi
- UniSA Allied Health and Human Performance, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Craig Williams
- UniSA Clinical and Health Sciences, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Katherine L. Baldock
- UniSA Allied Health and Human Performance, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
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Maev IV, Andreev DN, Samsonov AA, Cheryomushkina AS. Peptic ulcer: the current state of the problem. MEDITSINSKIY SOVET = MEDICAL COUNCIL 2022:100-108. [DOI: 10.21518/2079-701x-2022-16-6-100-108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Peptic ulcer disease (PUD) is a chronic polyetiological recurrent disease of gastroduodenal region. In most cases, the pathogenesis of PU is caused by imbalance between the aggressive factors and protective factors of the gastric or duodenal mucosa. Helicobacter pylori (H. pylori) infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, are the major causative factors leading to PUD development. 65% of gastric ulcers and 80% of duodenal ulcers were found to be associated with H. pylori infection. In turn, NSAIDs account for 30% of gastric ulcers and 15% of duodenal ulcers. About 0.1–1% of all PUs are caused by Zollinger-Ellison syndrome. Abdominal pain is the leading symptom in the clinical findings of patients with exacerbation of PUD. Dyspeptic syndrome (vomiting, nausea, belching, abnormal bowel pattern) is much less common in patients with PUD. Endoscopic examination of the upper gastrointestinal tract is currently the gold standard test used in the diagnosis of PUD and is recommended for all patients suspected of having this disease (unless contraindicated). Antisecretory therapy including proton pump inhibitors is the main approach to the treatment of PUD, as well as the prevention of its complications. Integral to the treatment of patients with H. pylori-associated PU is the eradication therapy of the infection. It is reasonable to use a cytoprotector rebamipide, which accelerates ulcer healing and improves the resulting scar quality, as part of the pharmacotherapy of PUD. In addition, the use of rebamipide in H. pylori eradication therapy regimens contributes to increased efficiency of elimination of the microorganisms.
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Affiliation(s)
- I. V. Maev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - D. N. Andreev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - A. A. Samsonov
- Yevdokimov Moscow State University of Medicine and Dentistry
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Schneider A, Fasshauer E, Scheiderbauer J, Warnke C, Köpke S, Kasper J, Toussaint M, Temmes H, Hemmer B, Schiffmann I, Rahn A, Heesen C. Development and evaluation of evidence-based patient information handbooks about multiple sclerosis immunotherapies. Mult Scler Relat Disord 2022; 60:103728. [DOI: 10.1016/j.msard.2022.103728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
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[Upper abdominal pain: a frequent and multifaceted leading symptom in primary care internal medicine]. Internist (Berl) 2020; 62:3-16. [PMID: 33331949 DOI: 10.1007/s00108-020-00917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Upper gastrointestinal symptoms are among the most common reasons for medical consultation and represent a challenge for general practitioners in the outpatient care setting. History taking, symptom evaluation and physical examination are the crucial steps toward establishing an initial working diagnosis. The subsequent abdominal ultrasound and laboratory analyses are essential tools for the differential diagnosis.
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Kato S, Shimizu T, Toyoda S, Gold BD, Ida S, Ishige T, Fujimura S, Kamiya S, Konno M, Kuwabara K, Ushijima K, Yoshimura N, Nakayama Y. The updated JSPGHAN guidelines for the management of Helicobacter pylori infection in childhood. Pediatr Int 2020; 62:1315-1331. [PMID: 32657507 PMCID: PMC7839701 DOI: 10.1111/ped.14388] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
The Japan Pediatric Helicobacter pylori Study Group published the first guidelines on childhood H. pylori infection in 1997. They were later revised by the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (JSPGHAN). The H. pylori eradication rates, when employing triple therapy with amoxicillin and clarithromycin, currently recommended as the first-line therapy of H. pylori infection in Japan, have substantially decreased, creating an important clinical problem worldwide. In Japanese adults, the "test-and-treat" strategy for H. pylori infection is under consideration as an approach for gastric cancer prevention. However, the combined North American and European pediatric guidelines have rejected such a strategy for asymptomatic children. As risk for gastric cancer development is high in Japan, determining whether the "test-and-treat" strategy can be recommended in children has become an urgent matter. Accordingly, the JSPGHAN has produced a second revision of the H. pylori guidelines, which includes discussion about the issues mentioned above. They consist of 19 clinical questions and 34 statements. An H. pylori culture from gastric biopsies is recommended, not only as a diagnostic test for active infection but for antimicrobial susceptibility testing to optimize eradication therapy. Based upon antimicrobial susceptibility testing of H. pylori strains (especially involving clarithromycin), an eradication regimen including use of the antibiotics to which H. pylori is susceptible is recommended as the first-line therapy against H. pylori-associated diseases. The guidelines recommend against a "test-and-treat" strategy for H. pylori infection for asymptomatic children to protect against the development of gastric cancer because there has been no evidence supporting this strategy.
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Affiliation(s)
- Seiichi Kato
- Kato Children’s ClinicNatoriJapan
- Department of Infectious diseasesKyorin University School of MedicineTokyoJapan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | | | | | - Shinobu Ida
- Department of Pediatric Gastroenterology and EndocrinologyOsaka Women’s and Children’s HospitalOsakaJapan
| | - Takashi Ishige
- Department of PediatricsGunma University Graduate School of MedicineMaebashiJapan
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases & ChemotherapyTohoku Medical and Pharmaceutical University Graduate School of Pharmaceutical SciencesSendaiJapan
| | - Shigeru Kamiya
- Department of Infectious diseasesKyorin University School of MedicineTokyoJapan
| | - Mutsuko Konno
- Department of PediatricsSapporo Kosei General HospitalSapporoJapan
| | - Kentaro Kuwabara
- Department of PediatricsHiroshima City Hiroshima Citizens HospitalHiroshimaJapan
| | - Kosuke Ushijima
- Department of Pediatrics and Child HealthKurume University School of MedicineKurumeJapan
| | | | - Yoshiko Nakayama
- Department of PediatricsShinshu University School of MedicineMatsumotoJapan
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Pérez Romero S, Alberca de Las Parras F, Sánchez Del Río A, López-Picazo J, Júdez Gutiérrez J, León Molina J. Quality indicators in gastroscopy. Gastroscopy procedure. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:699-709. [PMID: 31190549 DOI: 10.17235/reed.2019.6023/2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the project "Quality indicators in digestive endoscopy", pioneered by the Spanish Society for Digestive Diseases (SEPD), the objective of this research is to suggest the structure, process, and results procedures and indicators necessary to implement and assess quality in the gastroscopy setting. First, a chart was designed with the steps to be followed during a gastroscopy procedure. Secondly, a team of experts in care quality and/or endoscopy performed a qualitative review of the literature searching for quality indicators for endoscopic procedures, including gastroscopies. Finally, using a paired analysis approach, a selection of the literature obtained was undertaken. For gastroscopy, a total of nine process indicators were identified (one preprocedure, eight intraprocedure). Evidence quality was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification scale.
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Alcaraz Serrat JA, Córdova H, Moreira L, Pocurull A, Ureña R, Delgado-Guillena PG, Garcés-Durán R, Sendino O, García-Rodríguez A, González-Suárez B, Araujo IK, Ginès À, Llach J, Fernández-Esparrach G. Evaluation of long-term adherence to oesophagogastroduodenoscopy quality indicators. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:589-597. [PMID: 32674879 DOI: 10.1016/j.gastrohep.2020.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In a previous study we demonstrated that a simple training programme improved quality indicators of Oesophagogastroduodenoscopy (OGD) achieving the recommended benchmarks. However, the long-term effect of this intervention is unknown. The aim of this study was to assess the quality of OGDs performed 3 years after of having completed a training programme. MATERIAL AND METHODS A comparative study of 2 cohorts was designed as follows: Group A included OGDs performed in 2016 promptly after a training programme and Group B with OGDs performed from January to March 2019, this group was also divided into 2 subgroups: subgroup B1 of Endoscopists who had participated in the previous training programme and subgroup B2 of Endoscopists who had not. The intra-procedure quality indicators proposed by ASGE-ACG were used. RESULTS A total of 1236 OGDs were analysed, 600 from Group A and 636 from Group B (439 subgroup B1 and 197 subgroup B2). The number of complete examinations was lower in Group B (566 [94.3%] vs. 551 [86.6%]; p<0.001). A significant decrease was observed in nearly all quality indicators and they did not reach the recommended benchmarks: retroflexion in the stomach (96% vs. 81%; p<0.001); Seattle biopsy protocol (86% vs. 50%; p=0.03), description of the upper GI bleeding lesion (100% vs. 62%; p<0.01), sufficient intestinal biopsy specimens (at least 4) in suspected coeliac disease (92.5% vs. 18%; p<0.001), photo documentation of the lesion (94% vs. 90%; p<0.05). Regarding the overall assessment of the procedure (including correct performance and adequate photo documentation), a significant decrease was also observed (90.5% vs. 62%; p<0.001). There were no differences between subgroups B1 and B2. CONCLUSIONS The improvement observed in 2016 after a training programme did not prevail after 3 years. In order to keep the quality of OGDs above the recommended benchmarks, it is necessary to implement continuous training programmes.
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Affiliation(s)
- José Andrés Alcaraz Serrat
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Leticia Moreira
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Anna Pocurull
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Romina Ureña
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | | | - Rodrigo Garcés-Durán
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Oriol Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Ana García-Rodríguez
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Begoña González-Suárez
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Isis K Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Àngels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España.
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Ivashkin VT, Maev IV, Tsar’kov PV, Korolev MP, Andreev DN, Baranskaya EK, Burkov SG, Derinov AA, Efetov SK, Lapina TL, Pavlov PV, Pirogov SS, Tkachev AV, Trukhmanov AS, Fedorov ED, Sheptulin AA. Diagnosis and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, Russian Society of Colorectal Surgeons and the Russian Endoscopic Society). RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2020; 30:49-70. [DOI: 10.22416/1382-4376-2020-30-1-49-70] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
| | - I. V. Maev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | | | - D. N. Andreev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | - S. G. Burkov
- Polyclinic No. 3 of the Administrative Department of the President of the Russian Federation
| | | | - S. K. Efetov
- I.M. Sechenov First Moscow State Medical University
| | - T. L. Lapina
- I.M. Sechenov First Moscow State Medical University
| | - P. V. Pavlov
- I.M. Sechenov First Moscow State Medical University
| | - S. S. Pirogov
- P.A. Gertsen National Medical Research Centre for Radiology, branch of the Moscow Research Institute of Oncology
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10
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Sakata Y, Yasudo H, Uchida M, Saito M, Azuma Y, Hasegawa S. Diagnostic Utility of Ultrasonography for Duodenal Ulcers in Pediatric Cases in Japan. Front Pediatr 2020; 7:547. [PMID: 32039112 PMCID: PMC6984193 DOI: 10.3389/fped.2019.00547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/13/2019] [Indexed: 12/17/2022] Open
Abstract
Objective: To evaluate the diagnostic utility of wall hypertrophy of the duodenal bulb with a hyperechoic lumen, designated as the "HH sign," using ultrasound sonography (US) in pediatric duodenal ulcer (DU) patients. Study design: We performed a US for five pediatric subjects diagnosed with DU by upper gastroscopy to determine the presence of the potentially diagnostic HH sign. The sonographic images were analyzed before and after DU treatment. Computed tomography was performed in three cases and fecal occult blood test (FOBT) in all five cases. Results: Upper gastroscopy confirmed DU in all patients. While the HH sign was observed using US in four cases, with the DU located in the anterior bulb, the FOBT was positive in only one case. In these four cases, the HH sign diminished in response to treatment, as visualized by US. This was observed for both the initial as well as recurrent episodes. A mass-like region was observed in only one case, with the ulcer located in the proximity of the inferior duodenal wall. Conclusion: The HH sign is useful for the follow-up of DU, and US may be a suitable modality for the follow-up. We believe that this diagnostic marker can aid in following up a greater number of DU cases.
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Affiliation(s)
- Yasufumi Sakata
- Department of Pediatrics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Hiroki Yasudo
- Department of Pediatrics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Masashi Uchida
- Division of Pediatrics, Tokuyama Central Hospital, Yamaguchi, Japan
| | - Mitsuru Saito
- Division of Gastroenterology, Tokuyama Central Hospital, Yamaguchi, Japan
| | - Yoshihiro Azuma
- Department of Pediatrics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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Affiliation(s)
- Emma Sverdén
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Upper Gastrointestinal Surgery, South Hospital, Stockholm, Sweden
| | - Lars Agréus
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- The University of Newcastle, Australia
| | - Jason M Dunn
- School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas' NHS Foundation Trust, UK
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas' NHS Foundation Trust, UK
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12
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Helicobacter pylori Infection: Challenges in India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2019. [DOI: 10.22207/jpam.13.2.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tsutsumi K, Kusano C, Suzuki S, Gotoda T, Murakami K. Diagnostic Accuracy of Latex Agglutination Turbidimetric Immunoassay in Screening Adolescents for Helicobacter pylori Infection in Japan. Digestion 2018; 98:75-80. [PMID: 29698942 DOI: 10.1159/000487184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/22/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Serologic tests are commonly used for screening Helicobacter pylori infection because they not only provide quick results but also are inexpensive. A new latex agglutination serum antibody assay (LZ test) has been developed and it is expected to be as effective as conventional assays. This study aimed to calculate a reliable cutoff value for the LZ test and to estimate the sensitivity and specificity of the cutoff value in screening adolescents for H. pylori infection in Japan. METHODS We screened junior high school students in Akita Prefecture, Japan, for H. pylori infection. We used the data of 213 such students who underwent H. pylori stool antigen (HpSA) tests in 2016. The students who had positive results with HpSA tests were diagnosed with H. pylori infection. Of the 213 students, 209 underwent the LZ test. RESULTS The prevalence rate of H. pylori infection was 3.8% (8/209). The area under the curve for the LZ test was 0.88. The cutoff value of the LZ test was determined to be 3.1 U/mL. At this value, the sensitivity and specificity were 87.5 and 91.5%, respectively. CONCLUSION The accuracy of the LZ test in adolescents was well balanced for sensitivity and specificity as well as for tolerable results.
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Affiliation(s)
- Koshiro Tsutsumi
- Department of Gastroenterology, Faculty of Medicine, Oita, Japan.,Department of Gastroenterology, Yuri Kumiai General Hospital, Akita, Japan
| | - Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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14
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Pre-treatment with proton pump inhibitors decreases the success of primary Helicobacter pylori eradication using a vonoprazan-based regimen. Kaohsiung J Med Sci 2018; 34:456-460. [PMID: 30041763 DOI: 10.1016/j.kjms.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/25/2018] [Accepted: 03/26/2018] [Indexed: 12/12/2022] Open
Abstract
Vonoprazan-based regimens have improved the rate of successful Helicobacter pylori (H. pylori) eradication, but it has not reached 100%. The aim of this study is to clarify significant predictors of successful H. pylori eradication using a vonoprazan-based regimen. In this retrospective cohort study, 174 patients who underwent primary H. pylori eradication therapy were included. All patients underwent esophagogastroduodenoscopy before treatment. The vonoprazan-based regimen includes amoxicillin 750 mg, clarithromycin 200 mg and vonoprazan 20 mg twice daily for one week. Pre-treatment with a proton pump inhibitor (PPI) was defined as continued PPI use for more than four weeks prior to eradication therapy. The rates of successful eradication were 83% (145/174) in intention-to-treat analysis and 85% (145/171) in per-protocol analysis. Predictors of successful eradication among 171 patients were evaluated in per-protocol analysis. In univariate analysis, male gender was a significant positive predictor of successful eradication (odds ratio [OR] 3.813, 95% confidence interval [CI] 1.363-10.663, p = 0.010) and pre-treatment with PPIs was a negative predictor (OR 0.193, 95%CI 0.076-0.485, p < 0.001). In multivariate analysis, male gender remained a positive predictor (OR 3.826, 95%CI 1.317-11.116, p = 0.013), and pre-treatment with PPIs (OR 0.232, 95%CI 0.087-0.615, p = 0.003) remained a negative predictor. In conclusion, pre-treatment with PPIs before eradication therapy decreases the rate of successful eradication. Therefore, it may be desirable to discontinue pre-treatment with PPIs prior to eradication therapy, because of the potential to improve the rate of successful eradication.
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Mahachai V, Vilaichone RK, Pittayanon R, Rojborwonwitaya J, Leelakusolvong S, Maneerattanaporn M, Chotivitayatarakorn P, Treeprasertsuk S, Kositchaiwat C, Pisespongsa P, Mairiang P, Rani A, Leow A, Mya SM, Lee YC, Vannarath S, Rasachak B, Chakravuth O, Aung MM, Ang TL, Sollano JD, Trong Quach D, Sansak I, Wiwattanachang O, Harnsomburana P, Syam AF, Yamaoka Y, Fock KM, Goh KL, Sugano K, Graham D. Helicobacter pylori management in ASEAN: The Bangkok consensus report. J Gastroenterol Hepatol 2018; 33:37-56. [PMID: 28762251 DOI: 10.1111/jgh.13911] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 12/13/2022]
Abstract
Helicobacter pylori (H. pylori) infection remains to be the major cause of important upper gastrointestinal diseases such as chronic gastritis, peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. H. pylori management in ASEAN: the Bangkok consensus report gathered key opinion leaders for the region to review and evaluate clinical aspects of H. pylori infection and to develop consensus statements, rationales, and grades of recommendation for the management of H. pylori infection in clinical practice in ASEAN countries. This ASEAN Consensus consisted of 34 international experts from 10 ASEAN countries, Japan, Taiwan, and the United States. The meeting mainly focused on four issues: (i) epidemiology and disease association; (ii) diagnostic tests; (iii) management; and (iv) follow-up after eradication. The final results of each workshop were presented for consensus voting by all participants. Statements, rationale, and recommendations were developed from the available current evidence to help clinicians in the diagnosis and treatment of H. pylori and its clinical diseases.
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Affiliation(s)
- Varocha Mahachai
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Ratha-Korn Vilaichone
- Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Rapat Pittayanon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | | | | | - Monthira Maneerattanaporn
- Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Peranart Chotivitayatarakorn
- Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Sombat Treeprasertsuk
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chomsri Kositchaiwat
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pisaln Mairiang
- Department of Medicine, Faculty of Medicine, KhonKaen University, Khon Kaen, Thailand
| | - Aziz Rani
- Department of Gastroenterology and Hepatology, University of Jakarta, Jakarta, Indonesia
| | - Alex Leow
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Swe Mon Mya
- Department of Gastroenterology, Yangon General Hospital, Yangon, Myanmar
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Oung Chakravuth
- Calmette Hospital, University of Health Science, Phnom Penh, Cambodia
| | - Moe Myint Aung
- Department of Gastroenterology, Yangon General Hospital, Yangon, Myanmar
| | - Tiing-Leong Ang
- Department of Gastroentrology and Hepatology, Changi General Hospital, Singapore
| | - Jose D Sollano
- Section of Gastroenterology, University of Santo Tomas Hospital, Manila, Philippines
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | | | | | | | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Depok, Indonesia
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kwong-Ming Fock
- Faculty of Medicine, National University of Singapore, Singapore
| | - Khean-Lee Goh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kentaro Sugano
- Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - David Graham
- Department of Medicine, Gastroenterology Section, Baylor College of Medicine and Michael E. DeBakey VA Medicine Center, Houston, Texas, USA
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Abstract
Helicobacter pylori infects about 50 % of the world's population, causing at a minimum chronic gastritis. A subset of infected patients will ultimately develop gastric or duodenal ulcer disease, gastric adenocarcinoma, or MALT (mucosa-associated lymphoid tissue) lymphoma. Eradication of H. pylori requires complex regimens that include acid suppression and multiple antibiotics. The efficacy of treatment using what were once considered standard regimens have declined in recent years, mainly due to widespread development of antibiotic resistance. Addition of bismuth to standard triple therapy regimens, use of alternate antibiotics, or development of alternative regimens using known therapies in novel combinations have improved treatment efficacy in specific populations, but overall success of eradication remains less than ideal. Novel regimens under investigation either in vivo or in vitro, involving increased acid suppression ideally with fewer antibiotics or development of non-antibiotic treatment targets, show promise for future therapy.
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Affiliation(s)
- Elizabeth A Marcus
- Department of Pediatrics, DGSOM at UCLA, Los Angeles, CA, USA.
- VA GLAHS, 11301 Wilshire Blvd. Bldg 113 Rm 324, Los Angeles, CA, 90073, USA.
| | - George Sachs
- Department of Physiology, DGSOM at UCLA, Los Angeles, CA, USA
- Department of Medicine, DGSOM at UCLA, Los Angeles, CA, USA
- VA GLAHS, 11301 Wilshire Blvd. Bldg 113 Rm 324, Los Angeles, CA, 90073, USA
| | - David R Scott
- Department of Physiology, DGSOM at UCLA, Los Angeles, CA, USA
- VA GLAHS, 11301 Wilshire Blvd. Bldg 113 Rm 324, Los Angeles, CA, 90073, USA
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Kim JW, Park HJ, Jang JY, Oh CH, Shim JJ, Lee CK, Chang YW. When Should Antiplatelet Agents Be Resumed After Successful Endoscopic Hemostasis in Patients with Peptic Ulcer Bleeding? Dig Dis Sci 2016; 61:1611-21. [PMID: 26846117 DOI: 10.1007/s10620-016-4052-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/21/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND During treatment for peptic ulcer bleeding (PUB), it is imperative to determine the effect of antiplatelet agents on recurrent bleeding in order to balance risks and benefits. AIMS We compared the rate of recurrent bleeding in antiplatelet users and non-users. METHODS This retrospective study analyzed prospectively collected data from PUB patients treated by endoscopic modalities between August 2007 and December 2014. We evaluated and compared the rate of recurrent bleeding within 30 days in antiplatelet users and non-users; we also categorized antiplatelet users into continuation (≤3 days) and withdrawal (>3 days) groups. RESULTS A total of 490 patients were enrolled in the study, 302 (61.6 %) and 188 (38.4 %) in the non-user and antiplatelet user groups, respectively. The recurrent bleeding rate among antiplatelet users (10.1 %) was significantly higher than that among non-users (5.0 %; p = 0.029). Among 188 antiplatelet users, 51 (27.1 %) and 137 (72.9 %) were assigned to the continuation and withdrawal groups, respectively. The rate of recurrent bleeding did not differ significantly between groups (11.7 vs. 5.9 %, p = 0.241). Multivariate analysis revealed chronic kidney disease as a risk factor [odds ratio (OR) 2.890, 95 % confidence interval (CI) 1.079-7.742, p = 0.035]. However, antiplatelet use (OR 1.691, 95 % CI 0.813-3.517, p = 0.160) was not. CONCLUSIONS This study highlights the need for clinicians to consider underlying diseases in antiplatelet users under the appropriate antiplatelet therapy during the post-hemostasis period. Furthermore, the optimal time to resume antiplatelet agents may be 3 days after successful endoscopic hemostasis in patients with PUB.
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Affiliation(s)
- Jung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea
| | - Hyun Jin Park
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea
| | - Jae-Young Jang
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea.
| | - Chi Hyuk Oh
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Jun Shim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea
| | - Chang Kyun Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea
| | - Young Woon Chang
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemoongu, Seoul, 130-702, Republic of Korea
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Ford AC, Gurusamy KS, Delaney B, Forman D, Moayyedi P. Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive people. Cochrane Database Syst Rev 2016; 4:CD003840. [PMID: 27092708 PMCID: PMC7163278 DOI: 10.1002/14651858.cd003840.pub5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peptic ulcer disease is the cause of dyspepsia in about 10% of people. Ninety-five percent of duodenal and 70% of gastric ulcers are associated with Helicobacter pylori. Eradication of H. pylori reduces the relapse rate of ulcers but the magnitude of this effect is uncertain. This is an update of Ford AC, Delaney B, Forman D, Moayyedi P. Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive patients. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003840. DOI: 10.1002/14651858.CD003840.pub4. OBJECTIVES To assess the proportion of peptic ulcers healed and the proportion of participants who remained free from relapse with eradication therapy against placebo or other pharmacological therapies in H. pylori-positive people.To assess the proportion of participants that achieved complete relief of symptoms and improvement in quality of life scores.To compare the incidence of adverse effects/drop-outs (total number for each drug) associated with the different treatments.To assess the proportion of participants in whom successful eradication was achieved. SEARCH METHODS In this update, we identified trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (1950 to March 2016) and Ovid EMBASE (1980 to March 2016). To identify further relevant trials, we handsearched reference lists from trials selected by electronic searching, and published abstracts from conference proceedings from the United European Gastroenterology Week (published in Gut) and Digestive Disease Week (published in Gastroenterology). The search was last updated in March 2016. We contacted members of Cochrane Upper GI and Pancreatic Diseases, and experts in the field and asked them to provide details of outstanding clinical trials and any relevant unpublished materials. SELECTION CRITERIA We analysed randomised controlled trials of short- and long-term treatment of peptic ulcer disease in H. pylori-positive adults. Participants received at least one week of H. pylori eradication compared with ulcer healing drug, placebo or no treatment. Trials were included if they reported assessment from two weeks onwards. DATA COLLECTION AND ANALYSIS We collected data on ulcer healing, recurrence, relief of symptoms and adverse effects. We calculated the risk ratio (RR) with 95% confidence intervals (CI) using both fixed-effect and random-effects models with Review Manager software (RevMan 5.3) based on intention-to-treat analysis as far as possible. MAIN RESULTS A total of 55 trials were included for one or more outcomes for this review.In duodenal ulcer healing, eradication therapy was superior to ulcer healing drug (UHD) (34 trials, 3910 participants, RR of ulcer persisting = 0.66, 95% confidence interval (CI) 0.58 to 0.76; 381/2286 (adjusted proportion: 12.4%) in eradication therapy plus UHD versus 304/1624 (18.7%) in UHD; low quality evidence) and no treatment (two trials, 207 participants, RR 0.37, 95% CI 0.26 to 0.53; 30/125 (adjusted proportion: 21.7%) in eradication therapy versus 48/82 (58.5%) in no treatment; low quality evidence).In gastric ulcer healing, the differences were imprecise between eradication therapy and UHD (15 trials, 1974 participants, RR 1.23, 95% CI 0.90 to 1.68; 220/1192 (adjusted proportion: 16.0%) in eradication therapy plus UHD versus 102/782 (13.0%) in UHD; very low quality evidence). In preventing duodenal ulcer recurrence the differences were imprecise between maintenance therapy with H.pylori eradication therapy and maintenance therapy with UHD (four trials, 319 participants, RR of ulcer recurring 0.73; 95% CI 0.42 to 1.25; 19/159 (adjusted proportion: 11.9%) in eradication therapy versus 26/160 (16.3%) in UHD; very low quality evidence), but eradication therapy was superior to no treatment (27 trials 2509 participants, RR 0.20, 95% CI 0.15 to 0.26; 215/1501 (adjusted proportion: 12.9%) in eradication therapy versus 649/1008 (64.4%) in no treatment; very low quality evidence).In preventing gastric ulcer recurrence, eradication therapy was superior to no treatment (12 trials, 1476 participants, RR 0.31, 95% CI 0.22 to 0.45; 116/697 (adjusted proportion: 16.3%) in eradication therapy versus 356/679 (52.4%) in no treatment; very low quality evidence). None of the trials reported proportion of people with gastric ulcer not healed after initial therapy between H.pylori eradication therapy and no active treatment or the proportion of people with recurrent gastric ulcer or peptic ulcers during maintenance therapy between H.pylori eradication therapy and ulcer healing drug therapy. AUTHORS' CONCLUSIONS Adding a one to two-week course of H. pylori eradication therapy is an effective treatment for people with H. pylori-positive duodenal ulcer when compared to ulcer healing drugs alone and no treatment. H. pylori eradication therapy is also effective in preventing recurrence of duodenal and gastric ulcer compared to no treatment. There is currently no evidence that H. pylori eradication therapy is an effective treatment in people with gastric ulcer or that it is effective in preventing recurrence of duodenal ulcer compared to ulcer healing drug. However, confidence intervals were wide and significant benefits or harms of H. pylori eradication therapy in acute ulcer healing of gastric ulcers compared to no treatment, and in preventing recurrence of duodenal ulcers compared to ulcer healing drugs cannot be ruled out.
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Affiliation(s)
- Alexander C Ford
- St. James's University HospitalLeeds Gastroenterology UnitBeckett StreetLeedsUKLS9 7TF
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Brendan Delaney
- King's College LondonDivision of Health and Social Care Research7th Floor Capital House42 Weston StreetLondonUKSE1 3QD
| | - David Forman
- International Agency for Research on Cancer150 cours Albert‐ThomasLyonFrance69372
| | - Paul Moayyedi
- McMaster UniversityDepartment of Medicine, Division of Gastroenterology1200 Main Street WestRoom 4W8EHamiltonONCanadaL8N 3Z5
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Senay E, Eken C, Yildiz M, Yilmaz D, Alkan E, Akin M, Serinken M. Comparison of intravenous pantoprazole and ranitidine in patients with dyspepsia presented to the emergency department: a randomized, double blind, controlled trial. World J Emerg Med 2016; 7:30-4. [PMID: 27006735 DOI: 10.5847/wjem.j.1920-8642.2016.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aimed to compare pantoprazole, a proton-pomp inhibitors (PPIs), and ranitidine, a H2 receptor antagonists (H2RA), in ceasing dyspeptic symptoms in the emergency department (ED). METHODS This randomized, double-blinded study compared the effectiveness of 50 mg ranitidine (Ulcuran(®)) and 40 mg pantoprazole (Pantpas(®)), given in a 100 mL saline solution by an intravenous rapid infusion within 2-4 minutes in patients with dyspepsia presented to the ED. Pain intensity was measured at baseline, 30 and 60 minutes after the drug administration. RESULTS A total of 72 patients were eligible for the study. Of these patients, 2 were excluded from the study because the initial visual analogue scale (VAS) scores were under 20 mm and 4 were excluded from the statistical analysis because of being diagnosed as having other causes of epigastric pain despite being allocated to one of the study groups. Thirty-three patients in the pantoprazole group and 33 patients in the ranitidine group were analyzed ultimately. The mean age of the patients was 36.6±15 years, and 26 (39.4%) patients were male. Both of the groups reduced pain effectively at 30 [27.6±28 (18 to 37) vs. 28.3±23 (20 to 37), respectively] and 60 minutes [39.6±39 (26 to 53) vs. 42.3±25 (33 to 51), respectively]. There were 13 (39.4%) patients in the pantoprazole group and 8 (24.2%) patients in the ranitidine group who required additional drug at the end of the study (P=0.186). CONCLUSION Intravenous pantoprazole and ranitidine are not superior to each other in ceasing dyspeptic symptoms at 30 and 60 minutes in the ED.
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Affiliation(s)
- Engin Senay
- Department of Emergency Medicine, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Cenker Eken
- Department of Emergency Medicine, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Murat Yildiz
- Department of Emergency Medicine, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Derya Yilmaz
- Department of Emergency Medicine, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Erhan Alkan
- Department of Gastroenterology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Mete Akin
- Department of Gastroenterology, Burdur Government Hospital, Antalya, Turkey
| | - Mustafa Serinken
- Pamukkale University Hospital, Department of Emergency Medicine, Denizli, Turkey
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Ren Q, Yan X, Zhou Y, Li WX. Periodontal therapy as adjunctive treatment for gastric Helicobacter pylori infection. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [PMID: 26852297 DOI: 10.1002/14651858.cd009477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Helicobacter pylori is estimated to affect about half the world's population and is considered as the main cause of chronic gastritis and peptic ulcer disease. Eradication of H. pylori infection accelerates ulcer healing and prevents relapse, reducing incidence of H. pylori-related gastric diseases. Numerous studies have provided evidence that the oral cavity could be a potential reservoir for H. pylori. The presence of oralH. pylori might affect the efficiency of eradication therapy and act as a causal force for its recurrence. Conversely, other investigators have indicated that the colonization and growth of H. pylori differs between the oral cavity and the stomach. Considering the open debate on the topic, it's necessary to clarify whether periodontal therapy is an effective adjunctive treatment for gastric H. pylori infection. OBJECTIVES To assess the effects of periodontal therapy plus eradication therapy versus eradication therapy alone for gastric H. pylori infection. The secondary objective is to compare the non-recurrence rate at long-term follow up in different treatment groups. SEARCH METHODS We identified randomized controlled trials (RCTs) by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 8), MEDLINE (1946 to August 2015), EMBASE (1980 to August 2015), and the Chinese Biomedical Database (1978 to August 2015). We also searched both ClinicalTrials.gov and the WHO ICTRP portal in October 2015. We handsearched the reference lists of included studies to identify relevant trials. SELECTION CRITERIA RCTs comparing periodontal therapy plus eradication treatment with eradication treatment alone, regardless of language of publication. DATA COLLECTION AND ANALYSIS Two reviewers selected the trials that met the inclusion criteria and extracted the details of each study independently. The data were pooled using both fixed-effect and random-effects models and results calculated as odds ratios (OR) with their 95% confidence intervals (CIs) based on an intention-to-treat analysis. However, because there was little difference in the results from these two models, we only reported the results from the fixed-effect model. MAIN RESULTS We included seven small RCTs involving 691 participants aged 17 to 78 years in our meta analyses. The primary result showed that periodontal therapy combined with H. pylori eradication treatment increased the eradication rate of gastric H. pylori compared with eradication treatment alone (OR 2.15; 95% CI 1.47 to 3.14; P < 0.0001) in people with H. pylori infection. In addition, periodontal therapy also had benefits on long-term gastric H. pylori eradication. After eradication of H. pylori, the non-recurrence rate of gastric H. pylori infection increased in participants treated with periodontal therapy compared with those who received eradication therapy alone (OR 3.60; 95% CI 2.11 to 6.15; P < 0.00001). According to the GRADE approach, the overall quality of the evidence was 'moderate' for eradication rate of gastric H.pylori and 'low' for non-recurrence rate of gastric H. pylori. AUTHORS' CONCLUSIONS Overall, periodontal therapy could increase the efficiency of H. pylori eradication and the non-recurrence rate of gastricH. pylori. In view of the limited number and quality of included studies, it will be necessary to conduct more well-designed, multicenter, and large-scale RCTs to determine the effects of periodontal therapy in eradicating gastric H. pylori and suppressing the recurrence of this bacterium in the stomach.
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Affiliation(s)
- Qian Ren
- Department of Gastroenterology, First Hospital of Lanzhou University, No. 1, Donggang West Road, Lanzhou City, Gansu, China, 730000
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21
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Ren Q, Yan X, Zhou Y, Li WX. Periodontal therapy as adjunctive treatment for gastric Helicobacter pylori infection. Cochrane Database Syst Rev 2016; 2:CD009477. [PMID: 26852297 PMCID: PMC8255095 DOI: 10.1002/14651858.cd009477.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Helicobacter pylori is estimated to affect about half the world's population and is considered as the main cause of chronic gastritis and peptic ulcer disease. Eradication of H. pylori infection accelerates ulcer healing and prevents relapse, reducing incidence of H. pylori-related gastric diseases. Numerous studies have provided evidence that the oral cavity could be a potential reservoir for H. pylori. The presence of oralH. pylori might affect the efficiency of eradication therapy and act as a causal force for its recurrence. Conversely, other investigators have indicated that the colonization and growth of H. pylori differs between the oral cavity and the stomach. Considering the open debate on the topic, it's necessary to clarify whether periodontal therapy is an effective adjunctive treatment for gastric H. pylori infection. OBJECTIVES To assess the effects of periodontal therapy plus eradication therapy versus eradication therapy alone for gastric H. pylori infection. The secondary objective is to compare the non-recurrence rate at long-term follow up in different treatment groups. SEARCH METHODS We identified randomized controlled trials (RCTs) by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 8), MEDLINE (1946 to August 2015), EMBASE (1980 to August 2015), and the Chinese Biomedical Database (1978 to August 2015). We also searched both ClinicalTrials.gov and the WHO ICTRP portal in October 2015. We handsearched the reference lists of included studies to identify relevant trials. SELECTION CRITERIA RCTs comparing periodontal therapy plus eradication treatment with eradication treatment alone, regardless of language of publication. DATA COLLECTION AND ANALYSIS Two reviewers selected the trials that met the inclusion criteria and extracted the details of each study independently. The data were pooled using both fixed-effect and random-effects models and results calculated as odds ratios (OR) with their 95% confidence intervals (CIs) based on an intention-to-treat analysis. However, because there was little difference in the results from these two models, we only reported the results from the fixed-effect model. MAIN RESULTS We included seven small RCTs involving 691 participants aged 17 to 78 years in our meta analyses. The primary result showed that periodontal therapy combined with H. pylori eradication treatment increased the eradication rate of gastric H. pylori compared with eradication treatment alone (OR 2.15; 95% CI 1.47 to 3.14; P < 0.0001) in people with H. pylori infection. In addition, periodontal therapy also had benefits on long-term gastric H. pylori eradication. After eradication of H. pylori, the non-recurrence rate of gastric H. pylori infection increased in participants treated with periodontal therapy compared with those who received eradication therapy alone (OR 3.60; 95% CI 2.11 to 6.15; P < 0.00001). According to the GRADE approach, the overall quality of the evidence was 'moderate' for eradication rate of gastric H.pylori and 'low' for non-recurrence rate of gastric H. pylori. AUTHORS' CONCLUSIONS Overall, periodontal therapy could increase the efficiency of H. pylori eradication and the non-recurrence rate of gastricH. pylori. In view of the limited number and quality of included studies, it will be necessary to conduct more well-designed, multicenter, and large-scale RCTs to determine the effects of periodontal therapy in eradicating gastric H. pylori and suppressing the recurrence of this bacterium in the stomach.
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Affiliation(s)
- Qian Ren
- First Hospital of Lanzhou UniversityDepartment of GastroenterologyNo. 1, Donggang West RoadLanzhou CityGansuChina730000
| | - Xiang Yan
- First Hospital of Lanzhou UniversityNo. 1, Donggang West RoadLanzhou CityGansuChina730000
| | - YongNing Zhou
- First Hospital of Lanzhou UniversityDepartment of GastroenterologyNo. 1, Donggang West RoadLanzhou CityGansuChina730000
| | - Wei Xin Li
- First Hospital of Lanzhou UniversityDivision of GeriatricsNo. 1, Donggang West RoadLanzhou CityGansuChina730000
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McMAHON BJ, BRUCE MG, KOCH A, GOODMAN KJ, TSUKANOV V, MULVAD G, BORRESEN ML, SACCO F, BARRETT D, WESTBY S, PARKINSON AJ. The diagnosis and treatment of Helicobacter pylori infection in Arctic regions with a high prevalence of infection: Expert Commentary. Epidemiol Infect 2016; 144:225-233. [PMID: 26094936 PMCID: PMC4697284 DOI: 10.1017/s0950268815001181] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 05/07/2015] [Accepted: 05/13/2015] [Indexed: 12/02/2022] Open
Abstract
Helicobacter pylori infection is a major cause of peptic ulcer and is also associated with chronic gastritis, mucosa-associated lymphoid tissue (MALT) lymphoma, and adenocarcinoma of the stomach. Guidelines have been developed in the United States and Europe (areas with low prevalence) for the diagnosis and management of this infection, including the recommendation to 'test and treat' those with dyspepsia. A group of international experts performed a targeted literature review and formulated an expert opinion for evidenced-based benefits and harms for screening and treatment of H. pylori in high-prevalence countries. They concluded that in Arctic countries where H. pylori prevalence exceeds 60%, treatment of persons with H. pylori infection should be limited only to instances where there is strong evidence of direct benefit in reduction of morbidity and mortality, associated peptic ulcer disease and MALT lymphoma and that the test-and-treat strategy may not be beneficial for those with dyspepsia.
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Affiliation(s)
- B. J. McMAHON
- Departments of Internal Medicine and Surgery, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - M. G. BRUCE
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - A. KOCH
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
| | - K. J. GOODMAN
- Canadian North Helicobacter pylori Working Group, University of Alberta, Edmonton, Alberta, Canada
| | - V. TSUKANOV
- Department of State Medical Research Institute for Northern Problems, Siberian Division of Russian Academy of Medical Sciences, Krasnoyarsk, Russia
| | - G. MULVAD
- Primary Health Care Clinic, Nuuk, Greenland
| | - M. L. BORRESEN
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
| | - F. SACCO
- Departments of Internal Medicine and Surgery, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - D. BARRETT
- Departments of Internal Medicine and Surgery, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - S. WESTBY
- Departments of Internal Medicine and Surgery, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - A. J. PARKINSON
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
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Teoh AYB, Chiu PWY, Kok ASY, Wong SKH, Ng EKW. The selective use of laparoscopic repair is safe in high-risk patients suffering from perforated peptic ulcer. World J Surg 2015; 39:740-5. [PMID: 25371298 DOI: 10.1007/s00268-014-2851-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of laparoscopic repair for perforated peptic ulcer (PPU) was shown to be safe and recommended in low-risk patients. However, whether the approach is safe to apply to high-risk patients is uncertain. STUDY DESIGN This was a retrospective study of all patients with PPU admitted between January 2002 and December 2012. The laparoscopy-first approach (LFA) was adopted as a routine for all patients. The outcomes of LFA for PPU were reviewed and assessed to determine if the approach was safe in high-risk patients. RESULTS Three hundred and seventy three patients that suffered from PPU were included into the study and 50.9% received laparoscopic repair. There was a significant increase in the number of operations performed yearly by the LFA (P < 0.001). 25.2% of the patients had a Boey score of ≥2. High-risk patients that received LFA suffered from larger ulcers (P < 0.001) with more severe contamination (P = 0.006) that required conversion (P = 0.002) when compared to the low-risk patients. When compared to open surgery, more high-risk patients in the open group had ASA grade ≥3 (P = 0.007) and suffered from mortality (P = 0.001). The only significant predictor to mortality in high-risk patients was ASA grade ≥3 (P = 0.014). CONCLUSIONS The adoption of LFA in patients suffering from PPU was associated with acceptable rates of mortality and morbidity. The approach could also be selectively adopted in patients with Boey score ≥2 provided their ASA grading is low and hemodynamically stable.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32, Ngan Shing Street, Shatin, New Territories, Hong Kong,
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Sakai K, Fujita K, Sozu T, Nakayama T, Furukawa TA. Eradication of Helicobacter pylorifor iron deficiency. Hippokratia 2015. [DOI: 10.1002/14651858.cd011480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kyoko Sakai
- Suita Saiseikai Hospital; Department of Laboratory Medicine; Kawazono town Suita Osaka Japan 564-0013
| | - Koichi Fujita
- Yodogawa Christian Hospital; Division of Gastroenterology and Hepatology; Osaka Japan 533-0024
| | - Takashi Sozu
- Kyoto University School of Public Health; Department of Biostatistics; Yoshida Konoe-cho, Sakyo-ku Kyoto Kyoto Japan 606-8501
| | - Takeo Nakayama
- Kyoto University School of Public Health; Department of Health Informatics; Yoshida-Konoe Sakyo Kyoto Japan 606-8501
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine / School of Public Health; Department of Health Promotion and Human Behavior; Yoshida Konoe-cho, Sakyo-ku, Kyoto Japan 606-8501
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Schulz TR, McBryde ES, Leder K, Biggs BA. Using stool antigen to screen for Helicobacter pylori in immigrants and refugees from high prevalence countries is relatively cost effective in reducing the burden of gastric cancer and peptic ulceration. PLoS One 2014; 9:e108610. [PMID: 25268809 PMCID: PMC4182532 DOI: 10.1371/journal.pone.0108610] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 08/21/2014] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Refugees and immigrants from developing countries settling in industrialised countries have a high prevalence of Helicobacter pylori (H. pylori). Screening these groups for H. pylori and use of eradication therapy to reduce the future burden of gastric cancer and peptic ulcer disease is not currently recommended in most countries. We investigated whether a screening and eradication approach would be cost effective in high prevalence populations. METHODS Nine different screening and follow-up strategies for asymptomatic immigrants from high H. pylori prevalence areas were compared with the current approach of no screening. Cost effectiveness comparisons assumed population prevalence's of H. pylori of 25%, 50% or 75%. The main outcome measure was the net cost for each cancer prevented for each strategy. Total costs of each strategy and net costs including savings from reductions in ulcers and gastric cancer were also calculated. RESULTS Stool antigen testing with repeat testing after treatment was the most cost effective approach relative to others, for each prevalence value. The net cost per cancer prevented with this strategy was US$111,800 (assuming 75% prevalence), $132,300 (50%) and $193,900 (25%). A test and treat strategy using stool antigen remained relatively cost effective, even when the prevalence was 25%. CONCLUSIONS H. pylori screening and eradication can be an effective strategy for reducing rates of gastric cancer and peptic ulcers in high prevalence populations and our data suggest that use of stool antigen testing is the most cost effective approach.
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Affiliation(s)
- Thomas R. Schulz
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, at the Doherty Institute, Melbourne, Victoria, Australia
| | - Emma S. McBryde
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, at the Doherty Institute, Melbourne, Victoria, Australia
- Centre for Population Health, Burnet Institute Prahran, Victoria, Australia
| | - Karin Leder
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Beverley-Ann Biggs
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, at the Doherty Institute, Melbourne, Victoria, Australia
- * E-mail:
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Rollan A, Arab JP, Camargo MC, Candia R, Harris P, Ferreccio C, Rabkin CS, Gana JC, Cortés P, Herrero R, Durán L, García A, Toledo C, Espino A, Lustig N, Sarfatis A, Figueroa C, Torres J, Riquelme A. Management of Helicobacter pylori infection in Latin America: a Delphi technique-based consensus. World J Gastroenterol 2014; 20:10969-83. [PMID: 25152601 PMCID: PMC4138478 DOI: 10.3748/wjg.v20.i31.10969] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/21/2014] [Accepted: 05/23/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature. METHODS Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria. RESULTS A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing. CONCLUSION These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.
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Robertson CG, Kumar B, Bright T, Watson DI. Beware of NSAID abuse: think twice before operating! ANZ J Surg 2014; 84:495-6. [DOI: 10.1111/ans.12567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Cameron G. Robertson
- Department of Surgery; Flinders Medical Centre; Adelaide South Australia Australia
| | - Bhaskar Kumar
- Department of Surgery; Flinders Medical Centre; Adelaide South Australia Australia
| | - Tim Bright
- Department of Surgery; Flinders Medical Centre; Adelaide South Australia Australia
| | - David I. Watson
- Department of Surgery; Flinders Medical Centre; Adelaide South Australia Australia
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Bhattacharyya A, Chattopadhyay R, Mitra S, Crowe SE. Oxidative stress: an essential factor in the pathogenesis of gastrointestinal mucosal diseases. Physiol Rev 2014; 94:329-54. [PMID: 24692350 DOI: 10.1152/physrev.00040.2012] [Citation(s) in RCA: 1364] [Impact Index Per Article: 136.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reactive oxygen species (ROS) are generated as by-products of normal cellular metabolic activities. Superoxide dismutase, glutathione peroxidase, and catalase are the enzymes involved in protecting cells from the damaging effects of ROS. ROS are produced in response to ultraviolet radiation, cigarette smoking, alcohol, nonsteroidal anti-inflammatory drugs, ischemia-reperfusion injury, chronic infections, and inflammatory disorders. Disruption of normal cellular homeostasis by redox signaling may result in cardiovascular, neurodegenerative diseases and cancer. ROS are produced within the gastrointestinal (GI) tract, but their roles in pathophysiology and disease pathogenesis have not been well studied. Despite the protective barrier provided by the mucosa, ingested materials and microbial pathogens can induce oxidative injury and GI inflammatory responses involving the epithelium and immune/inflammatory cells. The pathogenesis of various GI diseases including peptic ulcers, gastrointestinal cancers, and inflammatory bowel disease is in part due to oxidative stress. Unraveling the signaling events initiated at the cellular level by oxidative free radicals as well as the physiological responses to such stress is important to better understand disease pathogenesis and to develop new therapies to manage a variety of conditions for which current therapies are not always sufficient.
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Watari J, Chen N, Amenta PS, Fukui H, Oshima T, Tomita T, Miwa H, Lim KJ, Das KM. Helicobacter pylori associated chronic gastritis, clinical syndromes, precancerous lesions, and pathogenesis of gastric cancer development. World J Gastroenterol 2014; 20:5461-73. [PMID: 24833876 PMCID: PMC4017061 DOI: 10.3748/wjg.v20.i18.5461] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 12/12/2013] [Accepted: 03/07/2014] [Indexed: 02/07/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is well known to be associated with the development of precancerous lesions such as chronic atrophic gastritis (AG), or gastric intestinal metaplasia (GIM), and cancer. Various molecular alterations are identified not only in gastric cancer (GC) but also in precancerous lesions. H. pylori treatment seems to improve AG and GIM, but still remains controversial. In contrast, many studies, including meta-analysis, show that H. pylori eradication reduces GC. Molecular markers detected by genetic and epigenetic alterations related to carcinogenesis reverse following H. pylori eradication. This indicates that these changes may be an important factor in the identification of high risk patients for cancer development. Patients who underwent endoscopic treatment of GC are at high risk for development of metachronous GC. A randomized controlled trial from Japan concluded that prophylactic eradication of H. pylori after endoscopic resection should be used to prevent the development of metachronous GC, but recent retrospective studies did not show the tendency. Patients with precancerous lesions (molecular alterations) that do not reverse after H. pylori treatment, represent the "point of no return" and may be at high risk for the development of GC. Therefore, earlier H. pylori eradication should be considered for preventing GC development prior to the appearance of precancerous lesions.
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Kim NY, Bangdiwala SI, Thaler K, Gartlehner G. SAMURAI: Sensitivity analysis of a meta-analysis with unpublished but registered analytical investigations (software). Syst Rev 2014; 3:27. [PMID: 24641974 PMCID: PMC4021727 DOI: 10.1186/2046-4053-3-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/03/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The non-availability of clinical trial results contributes to publication bias, diminishing the validity of systematic reviews and meta-analyses. Although clinical trial registries have been established to reduce non-publication, the results from over half of all trials registered in ClinicalTrials.gov remain unpublished even 30 months after completion. Our goals were i) to utilize information available in registries (specifically, the number and sample sizes of registered unpublished studies) to gauge the sensitivity of a meta-analysis estimate of the effect size and its confidence interval to the non-publication of studies and ii) to develop user-friendly open-source software to perform this quantitative sensitivity analysis. METHODS The open-source software, the R package SAMURAI, was developed using R functions available in the R package metafor. The utility of SAMURAI is illustrated with two worked examples. RESULTS Our open-source software SAMURAI, can handle meta-analytic datasets of clinical trials with two independent treatment arms. Both binary and continuous outcomes are supported. For each unpublished study, the dataset requires only the sample sizes of each treatment arm and the user predicted 'outlook' for the studies. The user can specify five outlooks ranging from 'very positive' (i.e., very favorable towards intervention) to 'very negative' (i.e., very favorable towards control).SAMURAI assumes that control arms of unpublished studies have effects similar to the effect across control arms of published studies. For each experimental arm of an unpublished study, utilizing the user-provided outlook, SAMURAI randomly generates an effect estimate using a probability distribution, which may be based on a summary effect across published trials. SAMURAI then calculates the estimated summary treatment effect with a random effects model (DerSimonian & Laird method), and outputs the result as a forest plot. CONCLUSIONS To our knowledge, SAMURAI is currently the only tool that allows systematic reviewers to incorporate information about sample sizes of treatment groups in registered but unpublished clinical trials in their assessment of the potential impact of publication bias on meta-analyses. SAMURAI produces forest plots for visualizing how inclusion of registered unpublished studies might change the results of a meta-analysis. We hope systematic reviewers will find SAMURAI to be a useful addition to their toolkit.
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Affiliation(s)
| | - Shrikant I Bangdiwala
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, 27599, USA.
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Yuan Y, Ford AC, Khan KJ, Gisbert JP, Forman D, Leontiadis GI, Tse F, Calvet X, Fallone C, Fischbach L, Oderda G, Bazzoli F, Moayyedi P. Optimum duration of regimens for Helicobacter pylori eradication. Cochrane Database Syst Rev 2013:CD008337. [PMID: 24338763 DOI: 10.1002/14651858.cd008337.pub2] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The optimal duration for Helicobacter pylori (H. pylori) eradication therapy is controversial, with recommendations ranging from 7 to 14 days. Several systematic reviews have attempted to address this issue but have given conflicting results and limited their analysis to proton pump inhibitor (PPI), two antibiotics (PPI triple) therapy. We performed a systematic review and meta-analysis to investigate the optimal duration of multiple H. pylori eradication regimens. OBJECTIVES The primary objective was to assess the relative effectiveness of different durations (7, 10 or 14 days) of a variety of regimens for eradicating H. pylori. The primary outcome was H. pylori persistence. The secondary outcome was adverse events. SEARCH METHODS The Cochrane Library, MEDLINE, EMBASE, and CINAHL were searched up to December 2011 to identify eligible randomised controlled trials (RCTs). We also searched the proceedings of six conferences from 1995 to 2011, dissertations and theses, and grey literature. There were no language restrictions applied to any search. SELECTION CRITERIA Only parallel group RCTs assessing the efficacy of one to two weeks duration of first line H. pylori eradication regimens in adults were eligible. Within each regimen, the same combinations of drugs at the same dose were compared over different durations. Studies with at least two arms comparing 7, 10, or 14 days were eligible. Enrolled participants needed to be diagnosed with at least one positive test for H. pylori on the basis of a rapid urease test (RUT), histology, culture, urea breath test (UBT), or a stool antigen test (HpSA) before treatment. Eligible trials needed to confirm eradication of H. pylori as their primary outcome at least 28 days after completion of eradication treatment. Trials using only serology or a polymerase chain reaction (PCR) to determine H. pylori infection or eradication were excluded. DATA COLLECTION AND ANALYSIS Study eligibility and data extraction were performed by two independent review authors. Data analyses were performed within each type of intervention, for both primary and secondary outcomes. The relative risk (RR) and number needed to treat (NNT)/number needed to harm (NNTH) according to duration of therapy were calculated using the outcomes of H. pylori persistence and adverse events. A random-effects model was used. Subgroup analyses and sensitivity analyses were planned a priori. MAIN RESULTS In total, 75 studies met the inclusion criteria. Eight types of regimens were reported with at least two comparative eligible durations. They included: PPI + two antibiotics triple therapy (n = 59), PPI bismuth-based quadruple therapy (n = 6), PPI + three antibiotics quadruple therapy (n = 1), PPI dual therapy (n = 2), histamine H2-receptor antagonist (H₂RA) bismuth quadruple therapy (n = 3), H₂RA bismuth-based triple therapy (n = 2), H₂RA + two antibiotics triple therapy (n = 3), and bismuth + two antibiotics triple therapy (n = 2). Some studies provided data for more than one regimen or more than two durations.For the PPI triple therapy, 59 studies with five regimens were reported: PPI + clarithromycin + amoxicillin (PCA); PPI + clarithromycin + a nitroimidazole (PCN); PPI + amoxicillin + nitroimidazole (PAN); PPI + amoxicillin + a quinolone (PAQ); and PPI + amoxicillin + a nitrofuran (PANi). Regardless of type and dose of antibiotics, increased duration of PPI triple therapy from 7 to 14 days significantly increased the H. pylori eradication rate (45 studies, 72.9% versus 81.9%), the RR for H. pylori persistence was 0.66 (95% CI 0.60 to 0.74), NNT was 11 (95% CI 9 to 14). Significant effects were seen in the subgroup of PCA (34 studies, RR 0.65, 95% CI 0.57 to 0.75; NNT 12, 95% CI 9 to 16); PAN (10 studies, RR 0.67, 95% CI 0.52 to 0.86; NNT = 11, 95% CI 8 to 25); and in PAQ (2 studies, RR 0.37, 95% CI 0.16 to 0.83; NNT 3, 95% CI 2 to 10); but not in PCN triple therapy (4 studies, RR 0.87, 95% CI 0.71 to 1.07). Significantly increased eradication rates were also seen for PPI triple therapy with 10 versus 7 days (24 studies, 79.9% versus 75.7%; RR 0.80, 95% CI 0.72 to 0.89; NNT 21, 95% CI 15 to 38) and 14 versus 10 days (12 studies, 84.4% versus 78.5%; RR 0.72, 95% CI 0.58 to 0.90; NNT 17, 95% CI 11 to 46); especially in the subgroup of PAC for 10 versus 7 days (17 studies, RR 0.80, 95% CI 0.70 to 0.91) and for 14 versus 10 days (10 studies, RR 0.69, 95% CI 0.52 to 0.91). A trend towards increased H. pylori eradication rates was seen with increased duration of PCN for 10 versus 7 days, and of PAN for 10 versus 7 days and 14 versus 10 days, though this was not statistical significant. The proportion of patients with adverse events, defined by authors, was marginally significantly increased only between 7 days and 14 days (15.5% versus 19.4%; RR 1.21, 95% CI 1.06 to 1.37; NNTH 31, 95% CI 18 to 104) but not for other duration comparisons. The proportion of patients discontinuing treatment due to adverse events was not significantly different between treatment durations.Only limited data were reported for different durations of regimens other than PPI triple therapy. No significant difference of the eradication rate was seen for all regimens according to different durations except for H₂RA bismuth quadruple therapy, where a significantly higher eradication rate was seen for 14 days versus 7 days, however only one study reported outcome data. AUTHORS' CONCLUSIONS Increasing the duration of PPI-based triple therapy increases H. pylori eradication rates. For PCA, prolonging treatment duration from 7 to 10 or from 10 to 14 days is associated with a significantly higher eradication rate. The optimal duration of therapy for PCA and PAN is at least 14 days. More data are needed to confirm if there is any benefit of increasing the duration of therapy for PCN therapy. Information is limited for regimens other than PPI triple therapy; more studies are needed to draw meaningful conclusions for optimal duration of other H. pylori eradication regimens.
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Affiliation(s)
- Yuhong Yuan
- Department of Medicine, Division of Gastroenterology, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4K1
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Modak JK, Roujeinikova A. Cloning, purification and preliminary crystallographic analysis of the Helicobacter pylori leucyl aminopeptidase-bestatin complex. Acta Crystallogr Sect F Struct Biol Cryst Commun 2013; 69:1011-4. [PMID: 23989151 PMCID: PMC3758151 DOI: 10.1107/s174430911302054x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 07/24/2013] [Indexed: 11/10/2022]
Abstract
Helicobacter pylori is an important human pathogenic bacterium associated with numerous severe gastroduodenal diseases, including ulcers and gastric cancer. Cytosolic leucyl aminopeptidase (LAP) is an important housekeeping protein that is involved in peptide and protein turnover, catabolism of proteins and modulation of gene expression. LAP is upregulated in metronidazole-resistant H. pylori, which suggests that, in addition to having an important housekeeping role, LAP contributes to the mechanism of drug resistance. Crystals of H. pylori LAP have been grown by the hanging-drop vapour-diffusion method using polyethylene glycol as a precipitating agent. The crystals belonged to the primitive triclinic space group P1, with unit-cell parameters a = 97.5, b = 100.2, c = 100.4 Å, α = 75.4, β = 60.9, γ = 81.8°. An X-ray diffraction data set was collected to 2.8 Å resolution from a single crystal. Molecular-replacement results using these data indicate that H. pylori LAP is a hexamer with 32 symmetry.
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Affiliation(s)
- Joyanta K. Modak
- Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Anna Roujeinikova
- Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
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Meltzer AC, Pierce R, Cummings DAT, Pines JM, May L, Smith MA, Marcotte J, McCarthy ML. Rapid (13)C Urea Breath Test to Identify Helicobacter pylori Infection in Emergency Department Patients with Upper Abdominal Pain. West J Emerg Med 2013; 14:278-82. [PMID: 23687549 PMCID: PMC3656711 DOI: 10.5811/westjem.2012.12.15173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/10/2012] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In emergency department (ED) patients with upper abdominal pain, management includes ruling out serious diseases and providing symptomatic relief. One of the major causes of upper abdominal pain is an ulcer caused by Helicobacter pylori (H. pylori), which can be treated and cured with antibiotics. We sought to estimate the prevalence of H. pylori infection in symptomatic patients using a convenience sample at a single urban academic ED and demonstrate the feasibility of ED-based testing. METHODS We prospectively enrolled patients with a chief complaint of pain or discomfort in the upper abdomen for 1 year from February 2011 until February 2012 at a single academic urban ED. Enrolled subjects were tested for H. pylori using a rapid point of care (13)C Urea Breath Test (UBT) [Exalenz Bioscience]. We compared patient characteristics between those who tested positive versus negative for the disease. RESULTS A total of 205 patients with upper abdominal pain were tested over 12 months, and 24% (95% confidence interval: 19% to 30%) tested positive for H. pylori. Black subjects were more likely to test positive than white subjects (28% v. 6%, P < 0.001). Other factors, such as age and sex, were not different between the 2 groups. CONCLUSION In our ED, H. pylori infection was present in 1 in 4 patients with epigastric pain, and testing with a UBT was feasible. Further study is needed to determine the risk factors associated with infection, the prevalence of H. pylori in other EDs, the effect of the test on ED length of stay and the costeffectiveness of an ED-based test-and-treat strategy.
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Affiliation(s)
- Andrew C Meltzer
- George Washington University School of Medicine, Department of Emergency Medicine, Washington, DC
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Zullo A, Hassan C, Repici A, Bruzzese V. Helicobacter pylori eradication and reflux disease onset: Did gastric acid get "crazy"? World J Gastroenterol 2013; 19:786-9. [PMID: 23429673 PMCID: PMC3574874 DOI: 10.3748/wjg.v19.i6.786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GORD) is highly prevalent in the general population. In the last decade, a potential relationship between Helicobacter pylori (H. pylori) eradication and GORD onset has been claimed. The main putative mechanism is the gastric acid hypersecretion that develops after bacterial cure in those patients with corpus-predominant gastritis. We performed a critical reappraisal of the intricate pathogenesis and clinical data available in this field. Oesophagitis onset after H. pylori eradication in duodenal ulcer patients has been ascribed to a gastric acid hypersecretion, which could develop following body gastritis healing. However, the absence of an acid hypersecretive status in these patients is documented by both pathophysiology and clinical studies. Indeed, duodenal ulcer recurrence is virtually abolished following H. pylori eradication. In addition, intra-oesophageal pH recording studies failed to demonstrated increased acid reflux following bacterial eradication. Moreover, oesophageal manometric studies suggest that H. pylori eradication would reduce - rather than favor - acid reflux into the oesophagus. Finally, data of clinical studies would suggest that H. pylori eradication is not significantly associated with either reflux symptoms or erosive oesophagitis onset, some data suggesting also an advantage in curing the infection when oesophagitis is already present. Therefore, the legend of “crazy acid” remains - as all the others - a fascinating, but imaginary tale.
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Sereni G, Azzolini F, Camellini L, Formisano D, Decembrino F, Iori V, Tioli C, Cavina M, Di Mario F, Bedogni G, Sassatelli R. Efficacy of a therapeutic strategy for eradication of Helicobacter pylori infection. World J Gastroenterol 2012; 18:4542-8. [PMID: 22969227 PMCID: PMC3435779 DOI: 10.3748/wjg.v18.i33.4542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/16/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication.
METHODS: From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test (UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d.
RESULTS: Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. “Per protocol” eradication rates for first, second and third-line therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate.
CONCLUSION: First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and second-line treatment can still be triple therapy with amoxicillin and tinidazole.
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Kim Y, Yokoyama S, Watari J, Hori K, Yamasaki T, Okugawa T, Toyoshima F, Kondo T, Sakurai J, Tanaka J, Tomita T, Oshima T, Fukui H, Abe T, Matsumoto T, Miwa H. Endoscopic and clinical features of gastric ulcers in Japanese patients with or without Helicobacter pylori infection who were using NSAIDs or low-dose aspirin. J Gastroenterol 2012; 47:904-11. [PMID: 22350702 DOI: 10.1007/s00535-012-0553-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 01/31/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The endoscopic characteristics of gastric ulcers in patients who were using non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin (LDA) and were infected with Helicobacter pylori remain unclear. We elucidated the endoscopic characteristics of gastric ulcers that occurred in the presence or absence of H. pylori infection and were associated with the use of these drugs. METHODS A total of 379 patients with active-stage gastric ulcer were divided into three groups: H. pylori-positive patients using neither NSAIDs nor LDA (control group, n = 216), H. pylori-positive or -negative patients using NSAIDs (NSAIDs group, n = 100), and H. pylori-positive or -negative patients using LDA (LDA group, n = 63). The differences among these groups in endoscopic characteristics of the ulcers (site, multiplicity, and morphology) were determined. The influence of an antacid drug, i.e., a proton pump inhibitor (PPI) or a histamine H(2) receptor antagonist (H(2)RA), was also investigated. RESULTS The NSAIDs group, regardless of H. pylori infection status, had higher incidences of antral, multiple, and irregularly shaped ulcers. The LDA group had a higher incidence of antral ulcers in H. pylori-negative patients and, regardless of H. pylori infection status, a higher incidence of multiple ulcers. However, the incidence of irregularly shaped ulcers in the LDA group did not differ from that in the control group. Neither the concomitant use of an antacid nor the dosing period of NSAIDs affected the results. CONCLUSIONS Our study elucidated the morphological characteristics of gastric ulcers in persons taking NSAIDs or LDA in the presence and absence of H. pylori infection. Our results may be clinically useful for inferring the causes of ulcers from their morphological characteristics.
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Affiliation(s)
- Yongmin Kim
- Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Park WG, Cohen J. Quality measurement and improvement in upper endoscopy. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2012. [DOI: 10.1016/j.tgie.2011.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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How well is Helicobacter pylori treated in usual practice? CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 25:543-6. [PMID: 22059158 DOI: 10.1155/2011/647904] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Helicobacter pylori is a WHO class I carcinogen also associated with nonmalignant gastrointestinal diseases. Effective treatment exists, and all persons infected with H pylori should receive treatment. However, data regarding the rates of treatment prescription in clinical practice are lacking. OBJECTIVE To determine the rates of H pylori treatment in usual practice. METHODS Patients with histological evidence of H pylori infection between January 1, 2007, and December 31, 2007, at Sunnybrook Health Sciences Centre (Toronto, Ontario) were identified. Charts were reviewed to determine the rates of H pylori treatment and confirmation of eradication, when indicated. Questionnaires were subsequently sent to endoscopists of patients identified as not having received treatment to determine the reasons for lack of treatment. RESULTS A total of 102 patients were H pylori positive and were appropriate candidates for treatment, of whom 58 (57%) were male and 78 (76%) were outpatients, with 92 (90%) receiving eradication therapy. When indicated, 15 of 22 (68%) patients received confirmation of eradication, 13 of 18 (72%) patients underwent repeat endoscopy and 86% received complete therapy. Outpatients were more likely to receive eradication therapy (OR 10.3 [95% CI 2.6 to 40.4]; P=0.001) and complete therapy (OR 13.2 [95% CI 3.8 to 45.7]; P=0.0001) compared with inpatients. Having a follow-up appointment resulted in higher treatment rates (OR 12.0 [95% CI 3.0 to 47.5]; P=0.001). CONCLUSION During the time period studied, adequate rates of H pylori treatment were achieved in outpatients and patients who had formal follow-up at Sunnybrook Health Sciences Centre. However, some aspects of care remain suboptimal including treatment of inpatients and care following treatment. Additional studies are required to identify strategies to improve the care of patients infected with H pylori.
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Dahlerup S, Andersen RC, Nielsen BSW, Schjødt I, Christensen LA, Gerdes LU, Dahlerup JF. First-time urea breath tests performed at home by 36,629 patients: a study of Helicobacter pylori prevalence in primary care. Helicobacter 2011; 16:468-74. [PMID: 22059398 DOI: 10.1111/j.1523-5378.2011.00872.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of the current study was (1) to describe the use of a (13) C-urea breath test (UBT) that was performed by patients at their homes as a part of a test-and-treat strategy in primary care and (2) to investigate the prevalence of Helicobacter pylori in patients taking a first-time UBT. MATERIAL AND METHODS The patients performed UBTs at home based on the discretion of the general practitioner and mailed the breath bags to a central laboratory for analysis. Each patient was identified by a unique civil registration number. The study was population-based, and the background population was approximately 700,000 people. RESULTS From 2003 to 2009, 44,487 UBTs were performed. Of these, 36,629 were first-time UBTs. In total, 726 of 45,213 breath bags received (1.6%) were unable to be analyzed because of errors with the bags. For both women and men who were ≤ 45 years of age, positive H. pylori declined over the time course of the study (women: 19.6% in 2003 to 17.6% in 2009, p < .01; men: 20.7% in 2003 to 16.9% in 2009, p < .001). Patients who were older than 45 years had significantly higher positive H. pylori results than younger patients. CONCLUSIONS A test-and-treat system was possible to implement that allowed patients to perform UBTs at their homes. The results of the first-time UBTs demonstrated that approximately one of five patients who presented with dyspepsia in the clinical setting of Danish primary care was infected with H. pylori.
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Affiliation(s)
- Søren Dahlerup
- Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Aarhus C, Denmark.
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Wang AY, Peura DA. The prevalence and incidence of Helicobacter pylori-associated peptic ulcer disease and upper gastrointestinal bleeding throughout the world. Gastrointest Endosc Clin N Am 2011; 21:613-35. [PMID: 21944414 DOI: 10.1016/j.giec.2011.07.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Due to heightened awareness regarding testing for and eradication of infection, the prevalence and incidence of H pylori infection (and by extension the prevalence and incidence of peptic ulcer disease) appear to have declined in recent years. However, antimicrobial resistance is mounting and traditional clarithromycin- or metronidazole-containing triple therapies may no longer be highly effective at eradicating the infection. Combined bismuth- and metronidazole-containing quadruple therapy or sequential 4-drug therapy may be better choices for first-line treatment against this unique pathogen that is ideally suited to survive in the human stomach.
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Affiliation(s)
- Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Mishra J, Panigrahi S. A study of changes in stomach wall at sites other than the ulcer in chronic duodenal ulcer patients. Indian J Surg 2011; 73:262-3. [PMID: 22851838 DOI: 10.1007/s12262-011-0298-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 01/13/2011] [Indexed: 11/24/2022] Open
Abstract
It is known that at least 90% of duodenal ulcers are caused by infection with the bacterium Helicobacter pylori. Eradicating this organism usually results in complete resolution of the disease (Rosengren, Br J Gen Pract 46(409):491-492, 1996). To study the different changes if any in stomach wall at sites other than the ulcer in chronic duodenal ulcer patients by upper Gastro-Intenstinal Endoscopy followed by histopathological examination of different parts of stomach. This study was a retrospective study conducted in the Department of General surgery, V.S.S. Medical College, Burla, Sambalpur, odisha during the period of June 2007 to May 2009. Subjects were patients with chronic duodenal ulcer who underwent endoscopic examination, gastric biopsy and rapid urease test. Chronic gastritis of antrum, followed by erythematous pangastritis was the prominent feature both in endoscopy and histopathological examination. The Inflammatory change affected the mucosa and submucosa of the stomach wall. The prevalence rate of Helicobacter pylori was 84%, the antrum being the most common affected part (84%) followed by gastric fundus (41%). Chronic superficial atrophic gastritis of antrum, followed by pangastritis is the most common pathological abnormality in stomach wall in CDU cases. Gastric antrum is the most common site for H. pylori colonization followed by fundus. Presence of H. pylori in stomach wall is associated with active on chronic gastritis.
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Affiliation(s)
- Jagmohan Mishra
- Department of General surgery, V.S.S. Medical College, Qr. No.-4r/2, doctors colony, V.S.S. medical college, Burla, Sambalpur, 768017 Odisha India
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Lopez N, Kobayashi L, Coimbra R. A Comprehensive review of abdominal infections. World J Emerg Surg 2011; 6:7. [PMID: 21345232 PMCID: PMC3049134 DOI: 10.1186/1749-7922-6-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/23/2011] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nicole Lopez
- Assistant Professor of Surgery, University of California, San Diego, 200 W, Arbor Dr, #8896, San Diego, CA 92103-8896, USA.
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Asaka M, Kato M, Takahashi SI, Fukuda Y, Sugiyama T, Ota H, Uemura N, Murakami K, Satoh K, Sugano K. Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter 2010; 15:1-20. [PMID: 20302585 DOI: 10.1111/j.1523-5378.2009.00738.x] [Citation(s) in RCA: 286] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Over the past few years, the profile of Helicobacter pylori infection has changed in Japan. In particular, the relationship between H. pylori and gastric cancer has been demonstrated more clearly. Accordingly, the committee of the Japanese Society for Helicobacter Research has revised the guidelines for diagnosis and treatment of H. pylori infection in Japan. MATERIALS AND METHODS Four meetings of guidelines preparation committee were held from July 2007 to December 2008. In the new guidelines, recommendations for treatment have been classified into five grades according to the Minds Recommendation Grades, while the level of evidence has been classified into six grades. The Japanese national health insurance system was not taken into consideration when preparing these guidelines. RESULTS Helicobacter pylori eradication therapy achieved a Grade A recommendation, being useful for the treatment of gastric or duodenal ulcer, for the treatment and prevention of H. pylori-associated diseases such as gastric cancer, and for inhibiting the spread of H. pylori infection. Levels of evidence were determined for each disease associated with H. pylori infection. For the diagnosis of H. pylori infection, measurement of H. pylori antigen in the feces was added to the tests not requiring biopsy. One week of proton-pump inhibitor-based triple therapy (including amoxicillin and metronidazole) was recommended as second-line therapy after failure of first-line eradication therapy. CONCLUSION The revised Japanese guidelines for H. pylori are based on scientific evidence and avoid the administrative restraints that applied to earlier versions.
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Affiliation(s)
- Masahiro Asaka
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Fischbach W, Malfertheiner P, Hoffmann JC, Bolten W, Kist M, Koletzko S. Helicobacter pylori and gastroduodenal ulcer disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:801-8. [PMID: 20038978 DOI: 10.3238/arztebl.2009.0801] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 10/27/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND Helicobacter pylori-associated diseases and gastroduodenal ulcer disease are common conditions of major clinical and economic importance. There is thus a need for a guideline that incorporates the scientific knowledge gained in recent years and that takes specific aspects of the situation in Germany into account with regard to epidemiology, resistance status, diagnostic evaluation, and treatment. METHODS This level-S3 consensus guideline was developed in accordance with the recommendations of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). It was commissioned by the German Association for Digestive and Metabolic Diseases (Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, DGVS) and prepared in cooperation with other scientific societies. After search terms were compiled, a systematic, IT-supported literature search was performed in the PubMed and Cochrane databases. The search was restricted to articles that appeared in German or English from 2000 onward. RESULTS H. pylori infection can be accurately diagnosed either non-invasively (with a (13)C-urea breath test or a stool antigen test) or invasively (with a rapid urease test, by histology, or by culture). Gastric and duodenal ulcer and gastric MALT lymphoma are absolute indications for eradication therapy; relative indications include functional dyspepsia, the prevention of gastric cancer in persons at risk, the initiation of long-term treatment with non-steroidal anti-inflammatory drugs (NSAID), and the prior occurrence of gastroduodenal complications with the use of either NSAID or acetylsalicylic acid (ASA). First-line therapy consists of a proton-pump inhibitor (PPI) and clarithromycin combined with either metronidazole or amoxicillin, given for at least one week. CONCLUSION This guideline enables the structured, evidence-based diagnosis and treatment of H. pylori infection and associated conditions, as well as of gastroduodenal ulcer disease.
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Affiliation(s)
- Wolfgang Fischbach
- Medizinische Klinik II und Klinik für Palliativmedizin, Klinikum Aschaffenburg, Germany.
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van Rensburg C, Barkun AN, Racz I, Fedorak R, Bornman PC, Beglinger C, Balanzó J, Devière J, Kupcinskas L, Luehmann R, Doerfler H, Schäfer-Preuss S. Clinical trial: intravenous pantoprazole vs. ranitidine for the prevention of peptic ulcer rebleeding: a multicentre, multinational, randomized trial. Aliment Pharmacol Ther 2009; 29:497-507. [PMID: 19053987 DOI: 10.1111/j.1365-2036.2008.03904.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Controlled pantoprazole data in peptic ulcer bleeding are few. AIM To compare intravenous (IV) pantoprazole with IV ranitidine for bleeding ulcers. METHODS After endoscopic haemostasis, 1256 patients were randomized to pantoprazole 80 mg+8 mg/h or ranitidine 50 mg+13 mg/h, both for 72 h. Patients underwent second-look endoscopy on day 3 or earlier, if clinically indicated. The primary endpoint was an overall outcome ordinal score: no rebleeding, rebleeding without/with subsequent haemostasis, surgery and mortality. The latter three events were also assessed separately and together. RESULTS There were no between-group differences in overall outcome scores (pantoprazole vs. ranitidine: S0: 91.2 vs. 89.3%, S1: 1.5 vs. 2.5%, S2: 5.4 vs. 5.7%, S3: 1.7 vs. 2.1%, S4: 0.19 vs. 0.38%, P = 0.083), 72-h clinically detected rebleeding (2.9% [95% CI 1.7, 4.6] vs. 3.2% [95% CI 2.0, 4.9]), surgery (1.9% [95% CI 1.0, 3.4] vs. 2.1% [95% CI 1.1, 3.5]) or day-3 mortality (0.2% [95% CI 0, 0.09] vs. 0.3% [95% CI 0, 1.1]). Pantoprazole significantly decreased cumulative frequencies of events comprising the ordinal score in spurting lesions (13.9% [95% CI 6.6, 24.7] vs. 33.9% [95% CI 22.1, 47.4]; P = 0.01) and gastric ulcers (6.7% [95% CI 4, 10.4] vs. 14.3% [95% CI 10.3, 19.2], P = 0.006). CONCLUSIONS Outcomes amongst pantoprazole and ranitidine-treated patients were similar; pantoprazole provided benefits in patients with arterial spurting and gastric ulcers.
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Affiliation(s)
- C van Rensburg
- Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.
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Lee YC, Liou JM, Wu MS, Wu CY, Lin JT. Eradication of helicobacter pylori to prevent gastroduodenal diseases: hitting more than one bird with the same stone. Therap Adv Gastroenterol 2008; 1:111-20. [PMID: 21180520 PMCID: PMC3002494 DOI: 10.1177/1756283x08094880] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Helicobacter pylori (H. pylori) are gram-negative bacteria that selectively colonizes the gastric mucosa. The prevalence of H. pylori infection varies from 20 to 50% in industrialized countries to over 80% in developing countries. The infection may persist lifelong without specific treatment. Prolonged infection and inflammation due to bacterial virulence and host genetic factors will lead to chronic gastritis. A certain portion of infected patients then develop more severe pathologies such as peptic ulcer (10-15%), gastric cancer (1%), and mucosa-associated lymphoid tissue lymphoma (50.01%). Although the majority of infected patients remain asymptomatic, much of the evidence has shown that eradication of H. pylori infection can reduce the recurrence of peptic ulcer and benefit a substantial portion of patients with nonulcer dyspepsia. Though controversial in population-based clinical trials, several cost-effectiveness analyses also reveal that H. pylori eradication is cost effective in the primary prevention of gastric cancer. Therefore, the discovery of H. pylori offers the chance to prevent several gastroduodenal diseases by means of their eradication. In other words, gastroenterologists could hit more than one bird with one stone. However, there are concerns regarding application of a 'test and treat' strategy in the general population. In this review, we will focus on current evidence of H. pylori eradication in the primary and secondary prophylaxis of gastric cancer and peptic ulcer disease.
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Affiliation(s)
- Yi-Chia Lee
- Departments of Internal Medicine, College of Medicine, National Taiwan
University, Taipei, Taiwan and Division of Biostatistics, Graduate Institute
of Epidemiology, College of Public Health, National Taiwan University,
Taipei, Taiwan
| | - Jyh-Ming Liou
- Departments of Internal Medicine, College of Medicine, National Taiwan
University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Departments of Internal Medicine, College of Medicine, National Taiwan
University, Taipei, Taiwan
| | - Chun-Ying Wu
- Department of Internal Medicine, Veteran General Hospital, Taichung,
Taiwan
| | - Jaw-Town Lin
- Department of Internal Medicine, College of Medicine, National Taiwan
University, Taipei, Taiwan and Department of Internal Medicine, E-DA
Hospital/Kaohsiung County I-Shou University No. 7, Chung-Shan South Road,
Taipei, Taiwan
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Zambon CF, Fasolo M, Basso D, D'Odorico A, Stranges A, Navaglia F, Fogar P, Greco E, Schiavon S, Padoan A, Fadi E, Sturniolo GC, Plebani M, Pedrazzoli S. Clarithromycin resistance, tumor necrosis factor alpha gene polymorphism and mucosal inflammation affect H. pylori eradication success. J Gastrointest Surg 2007; 11:1506-14; discussion 1514. [PMID: 17846855 DOI: 10.1007/s11605-007-0246-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 07/12/2007] [Indexed: 01/31/2023]
Abstract
Several bacterial and host-related factors concur in causing Helicobacter pylori eradication failure. We ascertained the role of bacterial virulence genes (cagA, vacA), clarithromycin resistance [Cla(R), 23S ribosomal RNA (rRNA) mutations], host polymorphism of CYP2C19 (polyphosphoinositide, PPI, metabolism) and of the cytokines IL-1B-31C>T, IL-1RN VNTR, IFN-gamma+874A>T, TNF-alpha-1031T>C, TNF-alpha-857C>T, TNF-alpha-376G>A, TNF-alpha-308G>A, TNF-alpha-238G>A, IL-10-1082A>G, IL-10-819C>T, IL-10-592C>A, IL-12A+6686G>A, IL-12B+15485A>C. Two groups of H. pylori-infected and H. pylori-treated patients were retrospectively identified: 45 not eradicated and 57 eradicated. Treatment failure was significantly correlated with Cla(R) (all resistant strains in non-eradicated patients); with TNF-alpha-238, IL10-819, IL10-592, IL-12B+15485 single nucleotide polymorphism (SNP); with IL10 ATA/ATA haplotype; and with antral inflammatory grade. On considering Cla(S)-infected patients only, logistic regression analysis (eradication = dependent; TNF-alpha-238, IL12B + 15485 genotypes, IL10 ATA/ATA as present or absent, antral gastritis grade = covariates) confirmed as significantly correlated with eradication antral gastritis grade only (Exp(B) = 6.48; 95% CI, 1.2-35.01). In conclusion, the bacterial determinant causing triple therapy failure is clarithromycin resistant, being virulence genes not involved. The host related factors that favor eradication are those linked to inflammation: a higher inflammatory infiltrate in the mucosa, possibly favored by genotypes able to down regulate the anti-inflammatory cytokine response, enhance the chance of eradication success.
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Abstract
Eradication therapy for Helicobacter pylori is recommended in a number of clinical conditions. In this article, we discuss the epidemiology and cellular mechanisms that result in antimicrobial resistance, the results of current eradication therapies, and new approaches to the management of Helicobacter pylori infection.
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Affiliation(s)
- Nimish Vakil
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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