RESUMO
Successive Negative Contrast (SNC) occurs when there is a reduction in the quantity or quality of a reward that is expected according to the presence of contextual cues. This induces an emotional response of frustration that is similar to stress. While this phenomenon has been observed in several mammal species, findings in domestic dogs have been inconsistent, although this issue has strong relevance in dog training. The aim of this study was to assess the effects of Successive Negative Contrast in two responses that had already been studied in this species, but with an increase in the methodological rigor and variations in the experimental conditions to examine the generalizability of the phenomenon. To this end, experimental dogs experienced a pre-shift phase in which they received a high-value reward (liver), followed by a post-shift phase in which they obtained a low-value reward (dry dog food), and then a re-shift phase in which the high-value reward was available again. Control dogs received dry food in all phases. The results show a contrast effect on the behavior of following human pointing to obtain food (Study 1). On the contrary, there were no differences in problem solving behavior after the de- and re-evaluation of the reward during a non-social task (Study 2). The results support that Successive Negative Contrast is not a consistent phenomenon in pet dogs. It is possible that certain characteristics of dogs such as the great availability of high-value rewards in their daily lives could attenuate the effects of a reduction in incentive value.
RESUMO
A dog's behavior can indicate the location of hidden food to a human who is unaware of its position. These behavioral patterns are known as showing behavior, which comprise gazing towards the target location and gaze alternation between the human and the target (i.e., hidden food). Although this ability has been extensively studied in pet dogs, research has not yet focused on dogs with other kinds of life experiences, such as dogs working in Animal Assisted Interventions (AAI). These dogs are exposed to novel environments under the guidance of their handlers and previous studies have highlighted the importance of gazing behavior in this population. Therefore, we evaluated AAI and pet dogs on a showing task. Results indicate that dogs overall engaged in showing behavior as they gazed more towards the baited pot and alternated their gaze more on showing trials than control ones. Contrary to our expectations, differences between AAI and pet dogs were minimal. However, owners of AAI dogs were more successful than owners of pet dogs in finding the hidden food in showing trials. This suggests they may be more skillful in reading their dogs' behavior, which can be crucial to ensure their welfare during AAI sessions.
Assuntos
Comunicação Animal , Comportamento Animal , Vínculo Humano-Animal , Animais , Cães , AlimentosRESUMO
Dogs tend to gaze at humans when they are confronted with inaccessible food during an unsolvable task, which is often interpreted as a help requesting behavior. Dogs who participate in animal-assisted interventions (AAI) interact with many people during their lives and prior studies have emphasized the importance of gazing in their communication. We compared the behavior of AAI (n = 15) and pet (n = 16) dogs during an unsolvable task, using a container fixed to a wooden board with inaccessible food inside, while the owner and an unfamiliar woman stood facing each other at the sides of the board ignoring the dog. Results showed that AAI dogs spent significantly more time gazing and alternated their gaze more frequently between the container and the people than pet dogs. In addition, they spent more time in contact with the unfamiliar person. However, no significant differences were found in the time dogs of either group gazed towards the owner compared to the unfamiliar person, in the frequency of gaze alternation or in the time spent interacting with the apparatus. In line with prior studies, these results suggest that gazing may be a significant communicative response in AAI dogs, which could probably contribute to having a better coordination with their handler. A greater understanding of the characteristics of this population may aid the selection and training of AAI dogs, which is particularly relevant given the increased popularity of AAI nowadays.
Assuntos
Comunicação , Alimentos , Animais , Cães , Feminino , HumanosRESUMO
In the published article, the following information was missing.
RESUMO
Colorectal cancer (CRC) is one of the tumours with the highest incidence and mortality in the Spanish population. Nevertheless, the advances in prevention and treatment have contributed to an increased number of patients who survive for prolonged periods of time. In addition, despite recurrences, improved survival following metastasis resection is likewise on the rise. This underscores the importance of carrying out follow-up programmes even in low-risk patients for the early detection of recurrence. The main objective of this article is to provide a set of recommendations for optimising the follow-up of CRC survivors as well as for managing the sequelae that result from either pharmacological or surgical treatment.
Assuntos
Sobreviventes de Câncer , Neoplasias do Colo/diagnóstico , Continuidade da Assistência ao Paciente , Recidiva Local de Neoplasia/diagnóstico , Vigilância da População , Neoplasias Retais/diagnóstico , Antineoplásicos/efeitos adversos , Antígeno Carcinoembrionário/análise , Neoplasias do Colo/patologia , Neoplasias do Colo/terapia , Colonoscopia , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Oxaliplatina/efeitos adversos , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias , Prevenção Primária , Radioterapia/efeitos adversos , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Prevenção Secundária , Disfunções Sexuais Fisiológicas/etiologia , Fatores de TempoRESUMO
This study compares the performance of two groups of dogs with different levels of social interaction with humans, shelter and pet dogs, in two inhibitory control tasks. (1) In the A-not-B task, dogs were required to resist searching for food in a previously rewarded location, and (2) in the cylinder task, dogs were required to resist approaching visible food directly in favor of a detour reaching response. Our first aim was to evaluate the importance of learning and ontogeny in performing inhibitory tasks. Also, we assessed whether there is a correlation between the two tasks by comparing performance in the same subjects. Results showed significant differences between shelter and pet dogs in the A-not-B task, with poorer performance in shelter dogs. However, no differences were found in the cylinder task. The poorer performance of shelter dogs might be related to their infrequent interaction with humans, which reduces the chances to learn to inhibit certain behaviors. This result would highlight the importance of ontogeny in developing that ability. On the other hand, no correlations were found between the two tasks, which contributes information to the debate about the context specificity of inhibitory control in dogs.
Assuntos
Comportamento Animal , Aprendizagem , Animais , Cães , Humanos , RecompensaRESUMO
Domestic dogs have demonstrated striking social skills towards humans, however, there are few studies investigating impulsivity with delay-choice tasks in communicative contexts. In Study 1 we introduced a novel social delay-choice task in which subjects had to choose between one human cueing an immediate, low quality reward and another human signaling a delayed, high quality reward. In Study 2 we evaluated the tolerance to increasing delays using social and non-social cues. We also explored if more self-controlled dogs show any distinct behaviours during delays. Finally, we correlated all results with the Dog Impulsivity Assessment Scale (Wright et al., 2011). In Study 1 dogs reached an average maximum delay of 11.55s. In Study 2 that average was 52.14s with social cues and 40.2s with non-social, but differences were not significant. Tolerance to delays showed high interindividual variation. Dogs remained mostly standing and near the delayed experimenter in the social tasks although we could not to find any distinct coping strategies. No significant correlations were found between the delay reached and behaviours, neither with the scale. These results show the relevance of the parameters and methods used to investigate tolerance to delay of reinforcements. More investigations are required, especially an assessment of the same subjects performing the same tasks using different contexts.
Assuntos
Comportamento de Escolha , Cães/psicologia , Comportamento Impulsivo , Recompensa , Meio Social , Animais , Aprendizagem por Discriminação , Feminino , Masculino , Fatores de TempoRESUMO
Anti-inflammatory cytokines have an important role in disease, tumour and transplant processes. Alterations in the regulation of several cytokines have been implicated in a variety of inflammatory disorders, including IBD (inflammatory bowel disease) [Crohn's disease (CD) and ulcerative colitis (UC)]. Cytokine polymorphisms are also known to affect the level of gene expression. Thus, the aim of this study was to determine the relationship between cytokine polymorphisms and the IBD pathologies in a Spanish population. Polymorphisms analysis was performed using PCR-SSOP using a microbeads luminex assay. The following polymorphisms were determined: TNFα [-238G/A (rs361525) and -308G/A (rs1800629)], IFNγ [+874A/T (rs62559044)], TGFß [+869C/T (rs1982073) and +915G/C (rs1800471)], IL10 [-1082A/A (rs1800896), -592A/C (rs1800872), -819C/T (rs1800871)], IL6 [-174C/G (rs1800795)], IL12p40 [3'UTR -1188A/C (rs3212227)], IL1α [-889C/T (rs1800587)], IL1ß [-511C/T (rs1143634) and +3962C/T (rs1143633)], IL1R [Pst-1 1970C/T] and IL1RA [Mspa-1 11100C/T]. No statistical differences in TNFα, IFNγ, TGFß, IL10, IL6, IL1α, IL1ß, IL1R and IL1Ra genotypes and allele distributions between the IBD groups and healthy controls were found. However, we observed significant differences in the 3'UTR -1188A/C polymorphism of IL12p40. So -1188A allele was increased in patients with UC and the -1188C allele (high IL12p40 production) was increased in patients with CD with respect to controls. These data are in concordance with the fact that CD has been shown to be associated with a Th1 T-cell-mediated inflammation model and high IL12/IFNγ production at histological affected sites. These data suggest that cytokine polymorphisms in TNFα, IFNγ, TGFß, IL10, IL6 and IL1α, IL1ß, IL1R and IL1Ra cytokine gene do not seem to be relevant in IBD susceptibility and IL12p40 3'UTR -1188A/C polymorphism seems to be associated with a differential IBD development.
Assuntos
Colite Ulcerativa/genética , Doença de Crohn/genética , Citocinas/genética , Inflamação/genética , Adolescente , Adulto , Feminino , Genótipo , Humanos , Inflamação/imunologia , Masculino , Polimorfismo de Nucleotídeo Único , Adulto JovemRESUMO
BACKGROUND: We aimed to evaluate whether oral anticoagulants (OACs) alter faecal immunochemical test (FIT) performance in average-risk colorectal cancer (CRC) screening. METHODS: Individuals aged 50-69 years were invited to receive one FIT sample (cutoff 75 ng ml(-1)) between November 2008 and June 2011. RESULTS: Faecal immunochemical test was positive in 9.3% (21 out of 224) of users of OAC and 6.2% (365 out of 5821) of non-users (P-trend=0.07). The positive predictive value (PPV) for advanced neoplasia (AN) in non-users was 50.4% vs 47.6% in users (odds ratio, 0.70; 95% CI, 0.3-1.8; P=0.5). The PPV for AN in OAC more antiplatelets (aspirin or clopidogrel) was 75% (odds ratio, 2; 95% CI, 0.4-10.8; P=0.4). CONCLUSIONS: Oral anticoagulant did not significantly modify the PPV for AN in this population-based colorectal screening program. The detection rate of advanced adenoma was higher in the combination OAC more antiplatelets.
Assuntos
Anticoagulantes/administração & dosagem , Neoplasias Colorretais/diagnóstico , Sangue Oculto , Colonoscopia/métodos , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Imunoquímica/métodos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-IdadeRESUMO
Tumour necrosis factor alpha (TNF-α) has an important role in inflammatory response. Alterations in the regulation of TNF-α have been implicated in a variety of inflammatory disorders, including Inflammatory bowel disease (IBD). Indeed, a common treatment for IBD is the use of TNF-α inhibitors. Polymorphisms in the TNF-α promoter region are known to affect the level of gene expression. Our aim was to investigate the influence of these single nucleotide polymorphisms (SNPs) in TNF-α promoter gene play in the risk of IBD in a Spanish population and their individual response to anti-TNF-α treatment. DNA samples from patients with IBD and controls were screened for TNF-α -238G/A (rs361525) and -308G/A (rs1800629) SNPs by PCR-SSOP using a microbeads luminex assay and compared with response to TNF-α inhibitors. There were not statistical differences in -238G/A and -308G/A allele and genotype frequencies between patients. However, we found an increased frequency of -308A allele and -308GA genotype in these nonresponders patients to TNF-α inhibitors with respect to responders patients (Pc < 0.05). This -308GA genotype has been classified as high producer of this cytokine. This fact could actually be interesting to explain the different response of patients with IBD with respect to TNF-α inhibitors. TNF-α promoter gene polymorphism does not seem to play a role in IBD susceptibility, but particular TNF-α genotypes may be involved in the different responses to TNF-α inhibitor treatment in Spanish patients with IBD.
Assuntos
Doenças Inflamatórias Intestinais/genética , Polimorfismo Genético , Regiões Promotoras Genéticas , Fator de Necrose Tumoral alfa/genética , População Branca/genética , Adolescente , Adulto , Alelos , Criança , Feminino , Frequência do Gene , Genótipo , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Espanha , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto JovemRESUMO
Colorectal cancer is a serious health problem in which screening is capable of reducing both the mortality and the incidence of the disorder. Colonoscopy, the mainstay of this type of screening, allows to establish an early diagnosis and also to eliminate malignant precursor lesions. The screening test which is performed in Spanish programs is the determination of fecal occult blood using the immunochemical method which gives around 70% of positive values for colonoscopy for any type of neoplasia. As a result, in 2009 the National Health System set as an objective that these programs cover 50% of the population by 2015. It is well known that colon screening is highly cost effective with a ratio of around 2500 per QALY, much lower than ratios of other programs. Only the direct costs of colon and rectal cancer in Spain can be estimated at more than one thousand million euros per year. Early diagnosis and the cancers avoided thanks to screening can reduce these costs by 40%. The impact that the introduction of this screening has on health services can be lessened if the indications for colonoscopy are followed adequately. In conclusion, there is no justification for not acting to prevent CRC and this is especially so in times of crisis as there is no better social cost invested than that which saves suffering, deathsand even money.
Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/prevenção & controle , Colonoscopia/economia , Neoplasias Colorretais/diagnóstico , Análise Custo-Benefício , Humanos , Programas de Rastreamento/economia , Sangue Oculto , Anos de Vida Ajustados por Qualidade de Vida , EspanhaRESUMO
It is difficult to insert a flexible endoscope deep into the small intestine. A new method, double-balloon enteroscopy, has been developed to improve access to the small intestine, and the aim of this study was to evaluate its usefulness for examination of the small intestine of dogs. The method uses two balloons, one attached to the tip of the endoscope and another attached to the tip of an overtube. The double-balloon endoscope is advanced through the intestine by being held alternately by the balloon on the endoscope and the balloon on the overtube. The technique was applied in two dogs of medium size, using both oral and anal approaches, and it was possible to examine the whole surface of the mucosa of their small intestines.
Assuntos
Cateterismo/veterinária , Doenças do Cão/diagnóstico , Endoscópios Gastrointestinais/veterinária , Endoscopia Gastrointestinal/veterinária , Enteropatias/veterinária , Intestino Delgado , Animais , Cateterismo/métodos , Doenças do Cão/patologia , Cães , Endoscopia Gastrointestinal/métodos , Desenho de Equipamento , Enteropatias/diagnósticoRESUMO
The enteric-coated mycophenolate sodium (EC-MPS) is a new formulation of mycophenolic acid with a gastro-resistant enteric coating, which releases the drug in the intestine, reducing the incidence of the gastrointestinal (GI) adverse effects. The present work provided a summary of 20 patients with liver transplantation and more than a 1 year of treatment with mycophenolate mofetil (MMF) who, after presentation of GI complications, were converted to EC-MPS. The patients were followed over a 3-month period after beginning EC-MPS treatment. The mean age of the cohort was 53 +/- 10 years and included 75% men. The reasons for transplantation were ethanol cirrhosis (70%), hepatitis C cirrhosis (30%), hepatocarcinoma (5%), and Wilson's disease (5%). At baseline, all patients were being treated with cyclosporine (CsA). CsA doses and levels were reduced during follow-up: baseline dose 179 mg/day versus 143 mg/day at 3 months; levels: 90.4 ng/mL versus 85.8 ng/mL, respectively (P = .017). The administered dose of EC-MPS was 720 mg/day in all cases. The GI complications at baseline were: diarrhea 60% (92% moderate-severe), abdominal discomfort 60% (58% moderate), abdominal pain 45% (44% moderate-severe), gas 40% (38% moderate-severe), nausea 20% (25% moderate), and dyspepsia 20% (mild). After 3 months of EC-MPS treatment, only two patients (10%) displayed moderate diarrhea. The renal evolution was favorable, serum creatinine was reduced, and 24-hour creatinine clearance significantly increased (creatinine: 1.78 +/- 1.6 mg/dL at baseline versus 1.30 +/- 0.3 mg/dL at 3 months, P = .002; creatinine clearance: 72.8 +/- 18 mL/min versus 79.6 +/- 13 mL/min, P = .001). Conversion of MMF to EC-MPS in liver transplant recipients solved the GI tolerability problems and improved renal function during the first 3 months, probably due to the concomitant reduction of anticalcineurinic dose.
Assuntos
Gastroenteropatias/induzido quimicamente , Imunossupressores/uso terapêutico , Transplante de Fígado/efeitos adversos , Transplante de Fígado/imunologia , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Complicações Pós-Operatórias/induzido quimicamente , Adulto , Idoso , Ciclosporina/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Sobrevivência de Enxerto/fisiologia , Humanos , Imunossupressores/efeitos adversos , Rim/efeitos dos fármacos , Hepatopatias/classificação , Hepatopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The small bowel leiomyosarcoma is a infrequent tumour in the clinical practice. We report the case of a 50 year old male admitted to the hospital on two occasions for gastrointestinal bleeding. On the second occasion a push enteroscopy located in jejunum a tumour. The pathologic diagnosis was a low grade jejunal leiomyosarcoma. The patient required a surgical intervention with resection of the affected portion of the jejunum.
Assuntos
Hemorragia Gastrointestinal/etiologia , Neoplasias do Jejuno/complicações , Leiomiossarcoma/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
AIM: To evaluate the utility of double-balloon enteroscopy for small-bowel disease. DESIGN: A prospective study of 50 consecutive enteroscopies performed from December 2004 to July 2005 to analyze diagnoses and treatments. PATIENTS: 44 patients (33 had undergone a previous capsule endoscopy) with indications for obscure digestive hemorrhage, angiodysplasia, Peutz-Jeghers syndrome, ulcer, suspected Crohn's disease, tumors, and refractory celiac disease. RESULTS: We carried out enteroscopy studies in 44 patients by the oral route and, in 6 additional patients, by both the oral and anal routes. We reached the ileon with the oral route in all cases but one (jejunal stenosis), and in 4 cases out of 7 with the anal route, with an average duration of 73 minutes. We found angiodysplasia in 19 cases, as well as NSAID-related enteropathy, Crohn's disease, diverticulosis, and Waldenström's disease. We performed biopsies in 31% of cases with diagnoses of adenocarcinoma, lymphangiectasia secondary to tumor in celiac disease, and Whipple's disease. We treated 19 patients with angiodysplasia (1 to 20 synchronous lesions) with argon, and 4 patients with polyps using polipectomy (sporadic polyps or Peutz-Jeghers syndrome). A retained capsule in one patient with stenosis was removed. CONCLUSIONS: Double-balloon enteroscopy is a useful and effective technique in the diagnosis and treatment of small intestine diseases, thus complementing capsule endoscopy. More studies are needed to analyze its impact on the management of this condition.
Assuntos
Endoscópios Gastrointestinais , Endoscopia Gastrointestinal/métodos , Enteropatias/diagnóstico , Intestino Delgado/patologia , Cápsulas , Cateterismo , Humanos , Enteropatias/terapia , Gravação em VídeoRESUMO
INTRODUCTION: Diagnosis of Gilbert's disease often involves unnecessary testing and patient anxiety. Rifampin test can support the diagnosis; it has been described in short series and lacks standardization in dose, collection times, result presentation and interpretation. Our objective was to compare the response to oral rifampin in a series of patients with Gilbert's disease, 2 and 4 h after drug administration. PATIENTS AND METHODS: Eighty-nine patients with Gilbert's disease (elevated total bilirubin with no hepatopathy or hemolysis) were recruited. After a basal blood collection, 900 mg rifampin were administered per os and new samples were drawn 2 and 4 h later. Total and esterified bilirubin were measured in every sample. Haptoglobin concentration was also analyzed. RESULTS: When expressed as relative increase with respect to basal values, variations observed 2 h after rifampin intake were all above 15%. A significant correlation (r = 0.902; p = 0.000) was found between relative increases 2 and 4 h after drug administration. No significant variations were found in haptoglobin concentrations. CONCLUSION: Rifampin test is useful in diagnosing Gilbert's disease, but variations in total bilirubin concentrations (basal and post-rifampin) make that no absolute cut-off value can be used. Correlation between 2- and 4-h relative increases suggests that a shortened version could simplify the test.
Assuntos
Inibidores Enzimáticos , Doença de Gilbert/diagnóstico , Rifampina , Adulto , Bilirrubina/sangue , Humanos , Pessoa de Meia-IdadeAssuntos
Bezoares/complicações , Ruptura Espontânea/etiologia , Úlcera Gástrica/complicações , Bezoares/diagnóstico , Bezoares/cirurgia , Criança , Feminino , Gastroscopia , Humanos , Laparotomia , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/cirurgia , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/cirurgia , Resultado do TratamentoRESUMO
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 4, 2003), MEDLINE (January 1966 to January 2004), EMBASE (January 1988 to January 2004), CINAHL (January 1982 to January 2004), 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: Seven studies with a total of 578 patients were included in the first meta-analysis: mean percentage of rebleeding in H. pylori eradication therapy group was 2.9%, and in the non-eradication therapy group without subsequent long-term maintenance antisecretory therapy it was 20% (OR 0.17, 95% CI 0.10 to 0.32; there was no statistical evidence of heterogeneity; NNT was 7, 95% CI 5 to 11). 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 2.7% (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 1.1% in H. pylori eradication therapy group, and NNT decreased from 7 to 6. In some cases, recurrence of H. pylori infection seemed to be responsible for recurrence of bleeding. REVIEWERS' 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.
Assuntos
Antiulcerosos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Úlcera Péptica Hemorrágica/prevenção & controle , Úlcera Péptica/tratamento farmacológico , Humanos , Úlcera Péptica/microbiologia , Prevenção SecundáriaRESUMO
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.