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Popa DG, Obleagă CV, Socea B, Serban D, Ciurea ME, Diaconescu M, Vîlcea ID, Meșină C, Mirea C, Florescu DN, Baleanu VD, Comandasu M, Tudosie MS, Tribus LC, Niculescu B. Role of Helicobacter pylori in the triggering and evolution of hemorrhagic gastro-duodenal lesions. Exp Ther Med 2021; 22:1147. [PMID: 34504592 PMCID: PMC8392874 DOI: 10.3892/etm.2021.10582] [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: 06/08/2021] [Accepted: 07/08/2021] [Indexed: 11/06/2022] Open
Abstract
The majority of studies concerning Helicobacter pylori (H. pylori) are oriented towards the implication of infection with H. pylori in processes that end in the formation of neoplasia, without assessing the impact of the bacterium in triggering acute gastroduodenal hemorrhagic episodes. The present study includes 166 patients with upper digestive hemorrhage, admitted to the ATI Clinic, the Gastroenterology Clinic or to the Surgery II Clinic of the County Emergency Clinical Hospital in Craiova, Romania between 2017 and 2019. All patients were monitored for evolution and received treatment according to current guidelines, and hemorrhagic lesions were biopsied. In the study group, 56.8% of the patients with upper gastrointestinal bleeding (UGIB) were positive for H. pylori and 43.2% were negative. In patients less than 50 years of age, non-steroidal anti-inflammatory drug (NSAID) use and H. pylori infection had a cumulative effect in causing bleeding lesions, but in patients older than 50 years of age, the use of NSAIDs was replaced by therapies with oral antiplatelet or anticoagulant agents. The need for hemostasis surgery was more common in patients who exhibited H. pylori-positive UGIB compared to H. pylori-negative (16 vs. 9.7%). In patients with H. pylori-positive hemorrhagic lesions, gastric resection was frequently required to obtain hemostasis. Persistence of H. pylori infection in patients with a history of gastric resection (4.1%) still predisposes to a hemorrhagic or neoplastic complication.
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Affiliation(s)
- Dragos George Popa
- Department of Plastic and Reconstructive Surgery, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Cosmin Vasile Obleagă
- Department of Surgery, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Bogdan Socea
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania.,Department of General Surgery, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania.,Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Marius Eugen Ciurea
- Department of Plastic and Reconstructive Surgery, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Marian Diaconescu
- Department of Surgery, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Ionică Daniel Vîlcea
- Department of Surgery, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Cristian Meșină
- Department of Surgery, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Cecil Mirea
- Department of Surgery, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Dan Nicolae Florescu
- Department of Gastroenterology, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Vlad Dumitru Baleanu
- Department of Gastroenterology, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Meda Comandasu
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Mihai Silviu Tudosie
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
| | - Laura Carina Tribus
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania.,Gastroenterology Department, Emergency University Hospital Bucharest, 210152 Targu Jiu, Romania
| | - Bogdan Niculescu
- Department of Sports and Health, 'Constantin Brancusi' University, 210152 Targu Jiu, Romania
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Chung WC, Jeon EJ, Oh JH, Park JM, Kim TH, Cheung DY, Kim BW, Kim SS, Kim JI. Dual-priming oligonucleotide-based multiplex PCR using tissue samples from the rapid urease test kit for the detection of Helicobacter pylori in bleeding peptic ulcers. Dig Liver Dis 2016; 48:899-903. [PMID: 27211882 DOI: 10.1016/j.dld.2016.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND In patients with peptic ulcer bleeding (PUB), diagnostic tests for Helicobacter pylori (H. pylori) infection have low sensitivity. The aim of our study was to investigate the diagnostic yield of dual-priming oligonucleotide-based multiplex (DPO)-PCR using tissue samples from the rapid urease test (RUT, CLO(®)test) kit in patients with PUB. METHODS We prospectively enrolled patients with PUB. During second-look endoscopy, gastric biopsy specimens for histology and RUT were obtained from a total of 170 patients. DPO-PCR tests were performed on tissue samples obtained from the CLO(®)test kit. If testing for H. pylori was negative, endoscopy with re-biopsy was performed 8 weeks after the bleeding episode. RESULTS H. pylori-associated bleeding was confirmed in 64.1% (109/170) of the patients. At the bleeding episode, the diagnostic sensitivities of RUT, histology, and DPO-PCR test were 47.7% (52/109), 71.6% (78/109) and 97.2% (106/109), respectively (p<0.01). The specificity of the DPO-PCR test was 91.8% (56/61). The positive predictive value (PPV) of the DPO-PCR test was 95.5% (106/111), and its negative predictive value (NPV) was 94.9% (56/59). CONCLUSIONS In patients with PUB, the DPO-PCR test could be a useful diagnostic tool for H. pylori infection. Particularly given a negative RUT result, subsequent DPO-PCR testing of tissue samples from the CLO(®)test kit could be of considerable benefit.
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Affiliation(s)
- Woo Chul Chung
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea, Republic of Korea
| | - Eun Jung Jeon
- Division of Gastroenterology, Department of Internal Medicine, St. Paul Hospital, The Catholic University of Korea, Republic of Korea.
| | - Jung Hwan Oh
- Division of Gastroenterology, Department of Internal Medicine, St. Paul Hospital, The Catholic University of Korea, Republic of Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, St. Mary Hospital, The Catholic University of Korea, Republic of Korea
| | - Tae Ho Kim
- Division of Gastroenterology, Department of Internal Medicine, St. Mary Hospital, The Catholic University of Korea, Republic of Korea
| | - Dae Young Cheung
- Division of Gastroenterology, Department of Internal Medicine, St. Mary Hospital, The Catholic University of Korea, Republic of Korea
| | - Byung Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, St. Mary Hospital, The Catholic University of Korea, Republic of Korea
| | - Sung Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, St. Mary Hospital, The Catholic University of Korea, Republic of Korea
| | - Jin Il Kim
- Division of Gastroenterology, Department of Internal Medicine, St. Mary Hospital, The Catholic University of Korea, Republic of Korea
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Diagnosis, treatment, and outcome in patients with bleeding peptic ulcers and Helicobacter pylori infections. BIOMED RESEARCH INTERNATIONAL 2014; 2014:658108. [PMID: 25101293 PMCID: PMC4101224 DOI: 10.1155/2014/658108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/10/2014] [Indexed: 12/13/2022]
Abstract
Upper gastrointestinal (UGI) bleeding is the most frequently encountered complication of peptic ulcer disease. Helicobacter pylori (Hp) infection and nonsteroidal anti-inflammatory drug (NSAID) administration are two independent risk factors for UGI bleeding. Therefore, testing for and diagnosing Hp infection are essential for every patient with UGI hemorrhage. The presence of the infection is usually underestimated in cases of bleeding peptic ulcers. A rapid urease test (RUT), with or without histology, is usually the first test performed during endoscopy. If the initial diagnostic test is negative, a delayed 13C-urea breath test (UBT) or serology should be performed. Once an infection is diagnosed, antibiotic treatment is advocated. Sufficient evidence supports the concept that Hp infection eradication can heal the ulcer and reduce the likelihood of rebleeding. With increased awareness of the effects of Hp infection, the etiologies of bleeding peptic ulcers have shifted to NSAID use, old age, and disease comorbidity.
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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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Gisbert JP. Prevención de la recidiva hemorrágica por úlcera péptica mediante la erradicación de Helicobacter pylori. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:567-75. [PMID: 16277966 DOI: 10.1157/13080605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- J P Gisbert
- Servicio de Aparato Digestivo, Hospital Universitario de la Princesa, Madrid, Spain.
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Lo CC, Lai KH, Peng NJ, Lo GH, Tseng HH, Lin CK, Shie CB, Wu CM, Chen YS, Huang WK, Chen A, Hsu PI. Polymerase chain reaction: A sensitive method for detecting Helicobacter pylori infection in bleeding peptic ulcers. World J Gastroenterol 2005; 11:3909-14. [PMID: 15991292 PMCID: PMC4504895 DOI: 10.3748/wjg.v11.i25.3909] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the sensitivity and specificity of polymerase chain reaction (PCR) in detecting Helicobacter pylori (H pylori) infection in patients with bleeding peptic ulcers, and to compare its diagnostic efficacy with other invasive and non-invasive tests.
METHODS: From April to September 2002, H pylori status in 60 patients who consecutively presented with gastroduodenal ulcer bleeding was examined by rapid urease tests (RUT), histology, culture, PCR, serology and urea breath tests (UBT).
RESULTS: The sensitivity of PCR was significantly higher than that of RUT, histology and culture (91% vs 66%, 43% and 37%, respectively; P = 0.01, < 0.001, < 0.001, respectively), but similar to that of serology (94%) and UBT (94%). Additionally, PCR exhibited a greater specificity than serology (100% vs 65%, P < 0.01). However, the specificity of PCR did not differ from that of other tests. Further analysis revealed significant differences in the sensitivities of RUT, culture, histology and PCR between the patients with and those without blood in the stomach (P < 0.01, P = 0.09, P < 0.05, and P < 0.05, respectively).
CONCLUSION: PCR is the most accurate method among the biopsy-based tests to detect H pylori infection in patients with bleeding peptic ulcers. Blood may reduce the sensitivities of all biopsy-based tests.
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Affiliation(s)
- Ching-Chu Lo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan, China
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Gisbert JP, Khorrami S, Carballo F, Calvet X, Gene E, Dominguez-Muñoz E. Meta-analysis: Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer. Aliment Pharmacol Ther 2004; 19:617-29. [PMID: 15023164 DOI: 10.1111/j.1365-2036.2004.01898.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM To perform a meta-analysis comparing the efficacy of Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer. METHODS A search was made of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and several congresses for controlled clinical trials comparing the efficacy of H. pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of peptic ulcer re-bleeding. Studies with all patients taking non-steroidal anti-inflammatory drugs were excluded. Extraction and quality assessment of the studies were performed by two reviewers. RESULTS In the first meta-analysis, the mean percentage of re-bleeding in the H. pylori eradication therapy group was 4.5%, compared with 23.7% in the non-eradication therapy group without long-term antisecretory therapy [odds ratio, 0.18; 95% confidence interval (CI), 0.09-0.37; 'number needed to treat' (NNT), 5; 95% CI, 4-8]. In the second meta-analysis, the re-bleeding rate in the H. pylori eradication therapy group was 1.6%, compared with 5.6% in the non-eradication therapy group with maintenance antisecretory therapy (odds ratio, 0.25; 95% CI, 0.08-0.76; NNT, 20; 95% CI, 12-100). When only patients with successful H. pylori eradication were included, the re-bleeding rate was 1%. CONCLUSIONS The treatment of H. pylori infection is more effective than antisecretory non-eradication therapy (with or without long-term maintenance antisecretory treatment) in the prevention of recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori, and eradication therapy should be prescribed to infected patients.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain.
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8
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Gisbert JP, Khorrami S, Carballo F, Calvet X, Gené E, Dominguez-Muñoz JE. H. pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer. Cochrane Database Syst Rev 2003:CD004062. [PMID: 14584003 DOI: 10.1002/14651858.cd004062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Peptic ulcer is the main cause for upper gastrointestinal haemorrhage, and Helicobacter pylori infection is the main etiologic factor for peptic ulcer disease. Maintenance antisecretory therapy has been the standard long-term treatment for patients with bleeding ulcers to prevent recurrent bleeding. On the other hand, the precise efficacy of H. pylori eradication for the prevention of rebleeding from peptic ulcer is unknown. OBJECTIVES To compare the efficacy of H. pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003), EMBASE (January 1988 to March 2003), CINAHL (January 1982 to March 2003), and reference lists of articles. We also conducted a manual search from several congresses. SELECTION CRITERIA Controlled clinical trials comparing the efficacy of H. pylori eradication therapy vs. antisecretory non-eradication therapy (with or without long-term maintenance antisecretory therapy) for the prevention of recurrent bleeding from peptic ulcer. DATA COLLECTION AND ANALYSIS Extraction and quality assessment of studies were done by two reviewers. Study authors were contacted for additional information. MAIN RESULTS Six studies with a total of 355 patients were included in the first meta-analysis: mean percentage of rebleeding in H. pylori eradication therapy group was 4.5%, and in the non-eradication therapy group without subsequent long-term maintenance antisecretory therapy it was 23.7% (OR 0.18, 95% CI 0.09 to 0.37; there was no statistical evidence of heterogeneity; NNT was 5, 95% CI 4 to 8). Three studies with a total of 470 patients were included in the second meta-analysis: mean percentage of rebleeding in H. pylori eradication therapy group was 1.6%, and in non-eradication therapy group with long-term maintenance antisecretory therapy it was 5.6% (OR 0.25, 95% CI 0.08 to 0.76; heterogeneity was not demonstrated; NNT was 20, 95% CI 12 to 100). Subanalysis. Excluding patients taking non-steroidal anti-inflammatory drugs (NSAIDs) at the time of recurrent bleeding resulted in a rebleeding rate of 4% (first meta-analysis) or 0.78% (second meta-analysis) in the group receiving H. pylori eradication therapy. When only patients with H. pylori eradication success were included, rebleeding rate was 1% in H. pylori eradication therapy group, and NNT decreased from 5 to 4. In some cases, recurrence of H. pylori infection seemed to be responsible for recurrence of bleeding. REVIEWER'S CONCLUSIONS Treatment of H. pylori infection is more effective than antisecretory non-eradicating therapy (with or without long-term maintenance antisecretory therapy) in preventing recurrent bleeding from peptic ulcer. Consequently, all patients with peptic ulcer bleeding should be tested for H. pylori infection, and eradication therapy should be prescribed to H. pylori-positive patients.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Hospital Universitario de la Princesa. Universidad Autónoma de Madrid, Diego de Leon, 62, Madrid, Spain, 28006.
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Pascual S, Griñó P, Casellas JA, Niveiro M, Such J, Palazon JM, Carnicer F, Pérez-Mateo M. Etiología de la hemorragia digestiva alta de origen péptico: papel de Helicobacter pylori y los antiinflamatorios no esteroideos. GASTROENTEROLOGIA Y HEPATOLOGIA 2003; 26:630-4. [PMID: 14670236 DOI: 10.1016/s0210-5705(03)70422-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Upper gastrointestinal bleeding continues to be a severe and frequent complication in ulcerative disease. Etiologic diagnosis in these patients is highly important in order to initiate appropriate treatment and prevent bleeding recurrence. OBJECTIVE 1. To investigate the prevalence of Helicobacter pylori infection and use of NSAIDs in patients with upper gastrointestinal hemorrhage of peptic origin. 2. To analyze the strategy used for the diagnosis of H. pylori in our previous work. PATIENTS AND MEHTODS: Seventy-three patients with endoscopically-diagnosed upper gastrointestinal bleeding of peptic origin were included in the study. The use of NSAIDs was investigated. H. pylori infection was diagnosed if one of the following tests was positive: urease test, histology, breath test. RESULTS H. pylori infection was found in 92% of duodenal ulcers and in 88% of gastric ulcers. Fifty-six percent of the patients had taken NSAIDs. Excluding these patients resulted in an H. pylori infection rate of 96.7%. The diagnosis was based on urease test in 46%. In the remaining patients, breath test and histology were required. CONCLUSIONS The main etiology in patients with upper gastrointestinal bleeding of peptic origin is H. pylori infection followed by the use of NSAIDs, and these two factors frequently coexist. The strategy of performing a urease test and, when this is negative, performing histological study and a breath test, is valid and allows a diagnosis of H. pylori infection to be made even if patients are receiving treatment that could make diagnosis difficult.
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Affiliation(s)
- S Pascual
- Unidad Hepática. Servicio de Medicina Interna. Hospital General Universitario. Alicante. Spain.
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Silva FM, Eisig JN, Chehter EZ, Silva JJD, Laudanna AA. Omeprazole, furazolidone, and tetracycline: an eradication treatment for resistant H. pylori in Brazilian patients with peptic ulcer disease. REVISTA DO HOSPITAL DAS CLINICAS 2002; 57:205-8. [PMID: 12436176 DOI: 10.1590/s0041-87812002000500003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To determine the efficacy of a simple, short-term and low-cost eradication treatment for Helicobacter pylori (H. pylori) using omeprazole, tetracycline, and furazolidone in a Brazilian peptic ulcer population, divided into 2 subgroups: untreated and previously treated for the infection. PATIENTS AND METHODS Patients with peptic ulcer disease diagnosed by endoscopic examination and infected by H. pylori diagnosed by the rapid urease test (RUT) and histological examination, untreated and previously unsuccessfully treated by macrolides and nitroimidazole, were medicated with omeprazole 20 mg daily dose and tetracycline 500 mg and furazolidone 200 mg given 3 times a day for 7 days. Another endoscopy or a breath test was performed 12 weeks after the end of treatment. Patients were considered cured of the infection if a RUT and histologic examination proved negative or a breath test was negative for the bacterium. RESULTS Sixty-four patients were included in the study. The women were the predominant sex (58%); the mean age was 46 years. Thirty-three percent of the patients were tobacco users, and duodenal ulcer was identified in 80% of patients. For the 59 patients that underwent follow-up examinations, eradication was verified in 44 (75%). The eradication rate for the intention-to-treat group was 69%. The incidence of severe adverse effects was 15%. CONCLUSION The treatment provides good efficacy for H. pylori eradication in patients who were previously treated without success, but it causes severe adverse effects that prevented adequate use of the medications in 15% of the patients.
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11
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Gisbert JP, Pajares JM. Review article: Helicobacter pylori infection and gastric outlet obstruction - prevalence of the infection and role of antimicrobial treatment. Aliment Pharmacol Ther 2002; 16:1203-8. [PMID: 12144568 DOI: 10.1046/j.1365-2036.2002.01275.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of Helicobacter pylori infection in peptic ulcer disease complicated by gastric outlet obstruction seems to be, overall, lower than that reported in non-complicated ulcer disease, with a mean value of 69%. However, H. pylori infection rates in various studies range from 33% to 91%, suggesting that differences in variables, such as the number and type of diagnostic methods used or the frequency of non-steroidal anti-inflammatory drug intake, may be responsible for the low prevalence reported in some studies. The resolution of gastric outlet obstruction after the eradication of H. pylori has been demonstrated by several studies. It seems that the beneficial effect of H. pylori eradication on gastric outlet obstruction is observed early, just a few weeks after the administration of antimicrobial treatment. Furthermore, this favourable effect seems to remain during long-term follow-up. Nevertheless, gastric outlet obstruction does not always resolve after H. pylori eradication treatment and an explanation for the failures is not completely clear, non-steroidal anti-inflammatory drug intake perhaps playing a major role in these cases. Treatment should start pharmacologically with the eradication of H. pylori even when stenosis is considered to be fibrotic, or when there is some gastric stasis. In summary, H. pylori eradication therapy should be considered as the first step in the treatment of duodenal or pyloric H. pylori-positive stenosis, whereas dilation or surgery should be reserved for patients who do not respond to such medical therapy.
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Affiliation(s)
- J P Gisbert
- Department of Gastroenterology, University Hospital of La Princesa, Madrid, Spain.
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12
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Chiba N, Van Zanten SJOV, Sinclair P, Ferguson RA, Escobedo S, Grace E. Treating Helicobacter pylori infection in primary care patients with uninvestigated dyspepsia: the Canadian adult dyspepsia empiric treatment-Helicobacter pylori positive (CADET-Hp) randomised controlled trial. BMJ 2002; 324:1012-6. [PMID: 11976244 PMCID: PMC102778 DOI: 10.1136/bmj.324.7344.1012] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether a "test for Helicobacter pylori and treat" strategy improves symptoms in patients with uninvestigated dyspepsia in primary care. DESIGN Randomised placebo controlled trial. SETTING 36 family practices in Canada. PARTICIPANTS 294 patients positive for H pylori ((13)C- urea breath test) with symptoms of dyspepsia of at least moderate severity in the preceding month. INTERVENTION PARTICIPANTS were randomised to twice daily treatment for 7 days with omeprazole 20 mg, metronidazole 500 mg, and clarithromycin 250 mg or omeprazole 20 mg, placebo metronidazole, and placebo clarithromycin. Patients were then managed by their family physicians according to their usual care. MAIN OUTCOME MEASURES Treatment success defined as no symptoms or minimal symptoms of dyspepsia at the end of one year. Societal healthcare costs collected prospectively for a secondary evaluation of actual mean costs. RESULTS In the intention to treat population (n=294), eradication treatment was significantly more effective than placebo in achieving treatment success (50% v 36%; P=0.02; absolute risk reduction=14%; number needed to treat=7, 95% confidence interval 4 to 63). Eradication treatment cured H pylori infection in 80% of evaluable patients. Treatment success at one year was greater in patients negative for H pylori than in those positive for H pylori (54% v 39%; P=0.02). Eradication treatment reduced mean annual cost by $C53 (-86 to 180) per patient. CONCLUSIONS A "test for H pylori with (13)C-urea breath test and eradicate" strategy shows significant symptomatic benefit at 12 months in the management of primary care patients with uninvestigated dyspepsia.
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Affiliation(s)
- Naoki Chiba
- Division of Gastroenterology, McMaster University, Hamilton, ON, Canada L8N 3Z5.
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14
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Chung IK, Hong SJ, Kim EJ, Cho JY, Kim HS, Park SH, Lee MH, Kim SJ, Shim CS. What is the best method to diagnose Helicobacter infection in bleeding peptic ulcers?: a prospective trial. Korean J Intern Med 2001; 16:147-52. [PMID: 11769572 PMCID: PMC4531724 DOI: 10.3904/kjim.2001.16.3.147] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND It has been debated which diagnostic test should be preferred for the diagnosis of Helicobacter pylori (HP) in patients with peptic ulcer diseases. Several limitations are reported in bleeding peptic ulcers because of intragastric blood and possibility of changed numbers of organisms by medication. This study was designed to find out the best method for diagnosis of HP infection, in aspect of deciding the times of detection and the specific tests in bleeding peptic ulcers. METHODS We prospectively examined histology, rapid urease test (CLO test), urea breath test (13C-UBT) and serology in HP diagnostics in 32 patients with bleeding peptic ulcers to detect HP infection. Each test was performed two times (four methods at first 24 hours and former three methods at 7th day after initial therapeutic endoscopy). We evaluated the sensitivity of each test, compared the two-times results and evaluated the effect of these tests to an outcome of endoscopic hemostasis. RESULTS Diagnostic sensitivities of histology, CLO test, 13C-UBT and serology are 75%, 67.8%, 100% and 100% at first endoscopy, and 71.4%, 78.5%, 89.3% at 7th day endoscopy, respectively. Histologic study and CLO test had diagnostic limitation at emergent first endoscopy contrary to UBT (p < 0.01). Histologic study, CLO test and UBT have limitations at 7th day endoscopy. Only 3 patients (9.4%) rebled with subsequent complete endoscopic hemostasis and all diagnostic tests at initial endoscopy did not influence the outcome of hemostasis. CONCLUSION First day histologic and CLO tests are inadequate methods in detecting HP infection in patients with bleeding peptic ulcers. 7-day histologic, CLO test and UBT have a low sensitivity. First-day UBT can be a standard test to diagnose HP infection in patients with bleeding peptic ulcers.
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Affiliation(s)
- I K Chung
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Chonan Hospital, Institute of Digestive Disease Research, Korea
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15
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Eisen GM, Dominitz JA, Faigel DO, Goldstein JL, Kalloo AN, Petersen BT, Raddawi HM, Ryan ME, Vargo JJ, Young HS, Fanelli RD, Hyman NH, Wheeler-Harbaugh J. An annotated algorithmic approach to upper gastrointestinal bleeding. Gastrointest Endosc 2001; 53:853-8. [PMID: 11375617 DOI: 10.1016/s0016-5107(01)70305-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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16
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Harris A. Treatment of Helicobacter pylori. World J Gastroenterol 2001; 7:303-7. [PMID: 11819780 PMCID: PMC4688712 DOI: 10.3748/wjg.v7.i3.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2001] [Revised: 04/03/2001] [Accepted: 04/15/2001] [Indexed: 02/06/2023] Open
Affiliation(s)
- A Harris
- Kent and Sussex Hospital, Tunbridge Wells, Kent TN4 8AT, England
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17
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Rota CA, Pereira-Lima JC, Blaya C, Nardi NB. Consensus and variable region PCR analysis of Helicobacter pylori 3' region of cagA gene in isolates from individuals with or without peptic ulcer. J Clin Microbiol 2001; 39:606-12. [PMID: 11158115 PMCID: PMC87784 DOI: 10.1128/jcm.39.2.606-612.2001] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2000] [Accepted: 12/06/2000] [Indexed: 01/01/2023] Open
Abstract
The clinical outcome of Helicobacter pylori infection may be associated with the cagA bacterial genotype. To investigate the cagA status of H. pylori-infected patients and the relationship between cagA and peptic ulcer disease, gastric biopsy specimens from 103 Caucasian patients in Brazil were analyzed by PCR. Since allelic variation in cagA exists and distinct H. pylori subgenotypes may circulate in different regions, PCR using primers for a variable 3' region of the cagA gene according to a Japanese methodology and for a consensus cagA 3' region used in Western methods was used for cagA detection. cagA was present in 53 (71%) of 75 H. pylori-positive cases when analyzed by the consensus region method and was associated with duodenal ulcer disease (P = 0.02), but not with gastric ulcer (P = 0.26), when compared to patients with duodenitis or gastritis. The variable region PCR method was able to detect 43 (57%) cagA-positive cases within the same group of H. pylori-positive patients and showed three subtypes of cagA (A, B/D, and C) that were not associated with clinical outcome. However, in 8 (18%) of the cases, more than one subtype was present, and an association between patients with multiple subtypes and disease outcome was observed when compared to patients with isolated subtypes (P = 0.048). cagA was a marker of H. pylori strains for duodenal ulcer disease in our population, and in spite of the differences in the 3' region of the cagA gene, the Japanese methodology was able to detect the cagA status in most cases. The presence of multiple subgenotypes of cagA was associated with gastric ulcer.
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Affiliation(s)
- C A Rota
- Laboratory of Molecular and Cellular Biology, NETLAB-Laboratório Bioclínico, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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18
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Abstract
Serologic testing is a useful noninvasive testing strategy for H. pylori. It is particularly useful in areas where the prevalence of H. pylori is high and inexpensive point-of-contact fingerprick tests are used. Sensitive tests are valuable ways of excluding H. pylori infection and can be used in conjunction with a direct test (urease histology culture or breath test) to confirm absence of H. pylori if the two methods are concordant. Serologic testing is more definitive and differentiating if the antigenic epitopes of H. pylori can be differentiated based on the antigenic epitopes that specifically associate with gastric cancer, peptic ulcer, and nonulcer dyspepsia. A study by Kawahara's group reported that Hsp 60 may be involved in the development of mucosa-associated lymphoid tissue based on ELISA. The idea of differentiating antigens for H. pylori may open a new area for use of serologic testing in the diagnostic approach of H. pylori infections.
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Affiliation(s)
- B Ho
- Department of Microbiology, National University of Singapore, Singapore.
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Andersen IB, Jørgensen T, Bonnevie O, Grønbaek M, Sørensen TI. Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study. Epidemiology 2000; 11:434-9. [PMID: 10874551 DOI: 10.1097/00001648-200007000-00012] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Both the incidence of and mortality from bleeding and perforated peptic ulcers are increasing. We assessed the association between smoking, intake of alcohol (including type of alcoholic beverage), and risk of a complicated peptic ulcer in a population-based study of 26,518 Danish subjects followed up for an average of 13.4 years. There were 214 cases of incident bleeding and 107 cases with perforated ulcers. We estimated relative risks (RRs) for incident bleeding and perforated peptic ulcers using Poisson regression analysis. Smoking more than 15 cigarettes per day compared with never smoking increased the risk of a perforated ulcer more than threefold [RR = 3.5; 95% confidence interval (CI) = 1.7-7.1)]. Drinking more than 42 drinks per week increased the risk of a bleeding ulcer fourfold (RR = 4.4; 95% CI = 2.3-8.3) compared with drinking less than one drink per week. Using the same comparison group, subjects who drank more than 21 drinks per week but no wine were at a higher risk of a bleeding ulcer (RR = 8.8; 95% CI = 2.2-35) than drinkers of the same amount of alcohol, but with more than 25% of their intake as wine (RR = 2.4; 95% CI = 1.0-6.0).
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Affiliation(s)
- I B Andersen
- Copenhagen Centre for Prospective Population Studies, Danish Epidemiology Science Centre, Copenhagen University Hospital, Denmark
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20
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Hsu PI, Lai KH, Tseng HH, Lin CK, Lo GH, Cheng JS, Chan HH, Chen GC, Jou HS, Peng NJ, Ger LP, Chen W, Hsu PN. Risk factors for presentation with bleeding in patients with Helicobacter pylori-related peptic ulcer diseases. J Clin Gastroenterol 2000; 30:386-91. [PMID: 10875466 DOI: 10.1097/00004836-200006000-00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
At present, there is no study that simultaneously addresses the apparent differences between bacterial and host factors in patients with bleeding and nonbleeding Helicobacter pylori-related ulcer diseases. Therefore, we designed this prospective study to evaluate whether there are identifiable differences between the two groups of patients whose H. pylori-related peptic ulcer diseases present with bleeding or dyspepsia. From July 1996 to November 1996, consecutive patients presenting with upper gastrointestinal bleeding or dyspepsia were enrolled if H. pylori-related ulcer diseases were confirmed. Fifteen clinical, endoscopic, histologic, and serologic factors were tested for association with ulcer bleeding by a logistic regression analysis. In the study period, bleeding occurred in 39 out of 119 patients with H. pylori-related peptic ulcer diseases. Multivariate analysis showed that ingestion of nonsteroidal antiinflammatory drugs (NSAIDs; p = 0.0156; odds ratio = 5:4), ulcer size > or = 1 cm (p = 0.0033; odds ratio = 4:2), and low bacterial density (p = 0.0030; odds ratio = 4:1) were independent factors associated with the risk of bleeding. There were no associations between ulcer bleeding and age, sex, smoking, alcohol consumption, the histologic grade of gastritis, location and number of ulcers, and the cytotoxin-associated gene (CagA) status of H. pylori strain. Therefore, we concluded that H. pylori-related ulcer patients who use NSAIDs or have large ulcers are more likely to present with upper gastrointestinal bleeding; that the CagA-bearing strains are not associated with the development of bleeding complication in patients with peptic ulcer diseases; and that the exact reason concerning the association between low bacterial density and ulcer bleeding merits further investigation.
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Affiliation(s)
- P I Hsu
- Division of Gastroenterology, Veterans General Hospital-Kaohsiung, National Yang-Ming University, Taiwan, ROC
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21
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Abstract
Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function of the acid or peptic activity in gastric juice. Twenty years ago, most ulcers were considered idiopathic; but a revolution in knowledge has occurred, so that it is now understood that the great majority of ulcers results from infection with Helicobacter pylori (HP) or use of nonsteroidal anti-inflammatory drugs (NSAIDs). Before this revolution, peptic ulcer disease was a common public health problem, responsible for considerable morbidity, some mortality, and high economic cost. Today, the overall prevalence of ulcers is falling, but complication rates remain relatively stable. These complex trends primarily reflect 3 factors: the rapid decline in the prevalence of HP in the population of developed countries, an increase in consumption of NSAIDs, and change in rates of smoking. Peptic ulcer prevalence is falling in younger individuals because of decreased prevalence of HP, whereas complications are rising in older subjects, largely as the result of increased NSAID use.
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Affiliation(s)
- A H Soll
- CURE-UCLA Digestive Disease Center, USA
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22
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Lee JM, Breslin NP, Gopaul M, Koh CW, Kong TY, Soong MM, O'Morain CA. The effects of blood on rapid urease testing for Helicobacter pylori in mucosal biopsies from the gastric antrum. Ir J Med Sci 2000; 169:60-2. [PMID: 10846863 DOI: 10.1007/bf03170489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND While the eradication of Helicobacter pylori in patients with bleeding peptic ulcer disease (PUD) decreases the rate of ulcer re-bleeding, the sensitivity of the rapid urease test (RUT) for H. pylori diagnosis is lower in this setting. The aim of this study was therefore to determine if exposing a gastric biopsy specimen to blood before its use in the RUT (CLOtest) could account for these findings. METHODS In patients undergoing endoscopy for the evaluation of dyspepsia gastric mucosal biopsies were obtained for H. pylori diagnosis (RUT, microbiology, and histology). Mucosal biopsies from each patient were also exposed to blood for 15, 30 and 45 minutes before use in the RUT. RESULTS Using a combination of diagnostic tests (histology, microbiology and routine CLOtest) as the 'gold standard', the sensitivity, specificity, positive predictive value and negative predictive value of the CLOtest remained above 90% despite prior exposure of the gastric biopsy specimen to blood, and these values were not significantly different from the performance characteristics of the CLOtest processed in a routine manner. CONCLUSION The exposure of gastric mucosal biopsy specimens to blood alone is not the explanation for the reduced sensitivity of the RUT in patients with bleeding peptic ulcers.
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Affiliation(s)
- J M Lee
- Department of Gastroenterology, Meath Hospital, Trinity College, Dublin
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23
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Laine L, Harper S, Simon T, Bath R, Johanson J, Schwartz H, Stern S, Quan H, Bolognese J. A randomized trial comparing the effect of rofecoxib, a cyclooxygenase 2-specific inhibitor, with that of ibuprofen on the gastroduodenal mucosa of patients with osteoarthritis. Rofecoxib Osteoarthritis Endoscopy Study Group. Gastroenterology 1999; 117:776-83. [PMID: 10500058 DOI: 10.1016/s0016-5085(99)70334-3] [Citation(s) in RCA: 345] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Prostaglandin production in the normal gastrointestinal tract, believed to be critical for mucosal integrity, is mediated by cyclooxygenase (COX)-1, whereas prostaglandin production at inflammatory sites seems to occur via induction of COX-2. We hypothesized that COX-2-specific inhibition with rofecoxib (25 mg once daily) in the treatment of patients with osteoarthritis would cause fewer gastroduodenal ulcers than an equally effective dose of ibuprofen (800 mg 3 times a day), a nonspecific COX inhibitor. METHODS A total of 742 osteoarthritis patients without ulcers on baseline endoscopy were randomly assigned to receive rofecoxib (25 or 50 mg once daily), ibuprofen (800 mg 3 times daily), or placebo. Endoscopy was repeated at 6, 12, and 24 weeks. At 16 weeks, by study design, 95% of the placebo group and 5% of the other groups were discontinued. RESULTS The cumulative incidence of gastroduodenal ulcers >/=3 mm with rofecoxib (25 or 50 mg once daily) was significantly (P < 0.001) lower than with ibuprofen and was statistically equivalent to placebo at week 12 (placebo, 9.9%; 25 mg rofecoxib, 4.1%; 50 mg rofecoxib, 7.3%; and ibuprofen, 27.7%). At 24 weeks, ulcer rates were 25 mg rofecoxib, 9. 6%; 50 mg rofecoxib, 14.7%; and ibuprofen, 45.8% (P < 0.001, ibuprofen vs. 25 and 50 mg rofecoxib). CONCLUSIONS Rofecoxib, at doses 2-4 times the dose demonstrated to relieve symptoms of osteoarthritis, caused significantly less gastroduodenal ulceration than ibuprofen, with ulcer rates comparable to placebo.
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Affiliation(s)
- L Laine
- Division of Gastrointestinal Diseases, University of Southern California, Los Angeles, California, USA.
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24
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Tu TC, Lee CL, Wu CH, Chen TK, Chan CC, Huang SH, Lee MS SC. Comparison of invasive and noninvasive tests for detecting Helicobacter pylori infection in bleeding peptic ulcers. Gastrointest Endosc 1999; 49:302-6. [PMID: 10049412 DOI: 10.1016/s0016-5107(99)70005-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Eradication of Helicobacter pylori infection has been shown to prevent recurrent bleeding from peptic ulcers. However, the detection rate for H pylori infection seems to be underestimated in this group of patients and has been scarcely investigated. METHODS Eighty patients with bleeding peptic ulcer were studied for evidence of H pylori infection. Seventy-seven of these patients were enrolled as having H pylori infection after any one of the following 3 tests were positive: culture, histologic study, or any 2 of rapid urease test (CLO test), carbon 13-labeled urea breath test (UBT), and serologic examination. Fresh blood or blood-containing material in the gastric antrum was noted by panendoscopy in 22 patients (group A). In the remaining 55 cases there was no blood in the antrum (group B). RESULTS The sensitivities of the CLO test, bacterial culture, histologic study, 13C-labeled UBT, and immunoglobulin G serologic test were 45.5%, 36.4%, 77.2%, 95.4%, and 100% in group A, respectively, and 70.9%, 40.0%, 70.9%, 92.7%, and 96.4%, respectively, in group B. There was a statistically significant difference between the sensitivities found for CLO test and 13C-labeled UBT (p < 0.05). Of these 5 tests, only the sensitivity of the CLO test showed a statistically significant difference between groups A and B (p < 0.05). A delayed positive CLO test result was recorded in 13 patients (3 in group A, 10 in group B). CONCLUSION Noninvasive tests seemed to be more sensitive than invasive tests in detecting H pylori infection in patients with bleeding peptic ulcers. Blood in the antrum might reduce the sensitivity of the CLO test but have no effect on the other tests. The CLO test should be observed for more than 24 hours because of the possibility of a delayed positive result in some patients with bleeding peptic ulcers.
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Affiliation(s)
- T C Tu
- Division of Gastroenterology, Department of Internal Medicine, and the Department of Pathology, Cathay General Hospital, Taipei, Taiwan
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Macri G, Milani S, Surrenti E, Passaleva MT, Salvadori G, Surrenti C. Eradication of Helicobacter pylori reduces the rate of duodenal ulcer rebleeding: a long-term follow-up study. Am J Gastroenterol 1998; 93:925-7. [PMID: 9647020 DOI: 10.1111/j.1572-0241.1998.00278.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The long-term efficacy of Helicobacter pylori eradication to reduce the rate of recurrence of peptic ulcer bleeding is still uncertain. We evaluated the rate of duodenal ulcer rebleeding for 48 months after H. pylori eradication. METHODS Thirty-two male patients with H. pylori infection and duodenal ulcer bleeding were treated with omeprazole (40 mg/day for 4 wk), colloidal bismuth (480 mg/day for 2 wk), amoxicillin (2 g/day for 1 wk), and metronidazole (750 mg/day for 1 wk), and followed up for 48 months. Endoscopy and tests for H. pylori infection were repeated every year. RESULTS Ulcer healed in all patients, but H. pylori infection persisted or recurred in 11 patients. Within 48 months, rebleeding occurred in nine (81.8%) of these patients, whereas the 21 patients who were persistently negative for H. pylori infection remained asymptomatic without rebleeding (0/ 21 = 0%, p < 0.002) during the whole follow-up. CONCLUSIONS Eradication of H. pylori can reduce the rate of duodenal ulcer rebleeding for at least 4 yr, thus potentially modifying the natural history of the disease.
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Affiliation(s)
- G Macri
- Department of Clinical Pathophysiology, University of Florence, Italy
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27
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Laine L, Sidhom O, Emami S, Estrada R, Cohen H. Effect of blood on rapid urease testing of gastric mucosal biopsy specimens. Gastrointest Endosc 1998; 47:141-3. [PMID: 9512278 DOI: 10.1016/s0016-5107(98)70346-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effect of blood on rapid urease tests is uncertain. We assessed the effect of soaking gastric biopsy specimens in blood on the results of both agar gel (CLOtest) and strip (Pyloritek) rapid urease tests. METHODS One hundred patients undergoing endoscopy had four adjacent biopsy specimens taken from normal appearing mucosa in the antrum. Two biopsies were soaked in blood for 1 minute; one specimen was placed on a CLOtest and one on a Pyloritek. The other two biopsy specimens were placed on CLOtest and Pyloritek without soaking in blood. The same process was performed with four adjacent biopsy specimens from the gastric body. CLOtests were read at 1, 4, and 24 hours; Pyloritek results were read at 1 hour. RESULTS The number of positive tests for the blood-soaked and standard biopsy specimens were comparable at all times for both rapid urease tests. Discordant results between the blood-soaked and standard specimens were seen in 17 of 400 test comparisons (4%): in 8 of these only the blood-soaked specimen was positive, and in 9 only the standard specimen was positive. CONCLUSIONS "Contamination" of biopsy specimens with blood does not alter rapid urease test results.
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Affiliation(s)
- L Laine
- USC School of Medicine, Los Angeles, California 90033, USA
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Abstract
The role of Helicobacter pylori in the pathogenesis of duodenal and gastric ulcer and ulcer recurrence is widely known. Bleeding, perforation, and obstruction represent the most serious, potentially life-threatening manifestations of ulcer disease (hemorrhage in 15%-20%). The lifetime prevalence of perforation and obstruction is much lower (approximately 5% and 2%, respectively). Despite improved diagnostic and therapeutic options, bleeding-related mortality rates remain at 6%-7% in the United States and between 4% and 14% in Europe. H. pylori and nonsteroidal anti-inflammatory drugs are now recognized as the two primary causes of ulcer disease. Eradication of H. pylori in patients with uncomplicated ulcers results in recurrence rates of < 10%, suggesting that eradication of H. pylori in patients with bleeding ulcers may virtually prevent recurrence of both the disease and its complications. Although the prevalence of H. pylori infection is almost 100% in duodenal and 80%-90% in gastric ulcer patients not using nonsteroidal anti-inflammatory drugs, the prevalence of the organism in bleeding duodenal and gastric ulcers does not reach 70% and 60%, respectively, which may be due to false-negative test results.
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Affiliation(s)
- D Vaira
- First Medical Clinic, University of Bologna, Italy
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