RESUMEN
BACKGROUND & AIMS: Due to the poor eradication rates of standard triple therapy, the addition of bismuth salts has been proposed for first-line eradication of Helicobacter pylori. We assessed the effectiveness and safety of the combination of bismuth and the standard, clarithromycin-containing triple therapy in eradication of H pylori infection, using data from a large multi-center registry. METHODS: We performed an interim analysis of data from the European Registry on H pylori Management, a prospective trial registering clinical data and outcomes from infected patients from 27 countries in Europe since 2013. We extracted data on 1141 treatment-naïve patients who received first-line treatment with bismuth salts (240 mg) and a proton pump inhibitor (57% received esomeprazole, 18% received omeprazole, 11% received pantoprazole, and 14% received rabeprazole), amoxicillin (1 g), and clarithromycin (500 mg), all taken twice daily. RESULTS: Intention to treat and per-protocol rates of eradication were 88% and 94%, respectively. Intention to treat eradication increased to 93% in patients who received 14-day treatments. Adverse events occurred in 36% of patients; 76% of these events were mild, with a mean duration of 6 days. In multivariate analysis, eradication was associated with treatment compliance (odds ratio [OR], 13.0), a double dose (equivalent to 40 mg omeprazole) of proton pump inhibitor (OR, 4.7), and 14-day duration of treatment (OR, 2.0). CONCLUSIONS: In an analysis of data from a large multi-center registry, we found the addition of bismuth to 14-day standard triple therapy with clarithromycin and amoxicillin to eradicate H pylori infection in more than 90% of patients, based on intention to treat analysis, with an acceptable safety profile and level of adherence. ClinicalTrials.gov no: NCT02328131.
Asunto(s)
Amoxicilina/administración & dosificación , Antiinfecciosos/administración & dosificación , Bismuto/administración & dosificación , Claritromicina/administración & dosificación , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Farmacorresistencia Bacteriana Múltiple , Quimioterapia Combinada , Europa (Continente) , Femenino , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/virología , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de la Bomba de Protones/administración & dosificación , Sistema de Registros , Resultado del Tratamiento , Adulto JovenRESUMEN
We present a pancreatic plastic stent migration case and the difficulty of an endoscopic approach to remove it, this time resolved with a hand-made loop catheter using a straight cannula and a NovaGold guide.
Asunto(s)
Migración de Cuerpo Extraño , Catéteres , Colangiopancreatografia Retrógrada Endoscópica , Remoción de Dispositivos , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Humanos , Páncreas , StentsAsunto(s)
Adenocarcinoma/secundario , Carcinoma de Células Grandes/secundario , Neoplasias Duodenales/secundario , Hemorragia Gastrointestinal/etiología , Neoplasias Pulmonares/diagnóstico , Neoplasias Gástricas/secundario , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico , Anciano , Carcinoma de Células Grandes/complicaciones , Carcinoma de Células Grandes/diagnóstico , Neoplasias Duodenales/complicaciones , Neoplasias Duodenales/diagnóstico , Resultado Fatal , Humanos , Masculino , Melena/etiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Fumar/efectos adversos , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/diagnósticoRESUMEN
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