[Efficacy of the dosing regimen of pantoprazole 40 mg, amoxicillin 1000 mg and clarithromycin 500 mg, twice daily for 7 days, in the eradication of Helicobacter pylori in patients with peptic ulcer]. / Eficácia do regime terapêutico empregando a associação de pantoprazol, claritromicina e amoxicilina, durante uma semana, na erradicação do Helicobacter pylori em pacientes com úlcera péptica.

AIM: This is an open label, multicenter trial to determine the efficacy of the association of pantoprazole, clarithromycin and amoxicillin to eradicate Helicobacter pylori in patients with peptic ulcer. MATERIAL AND METHODS: Seventy-one patients (36 females, 35 males, average age 41.9 years) from three Brazilian university centers (located in the cities of Belo Horizonte and Porto Alegre), with peptic ulcers confirmed by endoscopy, and infections by H. pylori proven by at least two diagnostic testings were admitted in the trial. An association of pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1.0 g was administered to patients twice daily for 7 days. RESULTS: By the end of treatment all patients were examined for digestive symptoms, presence of adverse events, and treatment adherence. Sixty days after the end of the treatment a new endoscopy with biopsies and respiratory function testing with 13C-urea breath test was performed in order to determine the eradication rates of that microorganism. Patients showing negative results at least in the 13C-urea breath test and in one other test (urease or histology) were considered H. pylori-negative. By the end of the trial, 60/69 (87%, CI 95% = 78.9-94.8) patients had the H. pylori eradicated in the per protocol analysis and 60/71 (84.5%, CI 95% = 76-92.9) in the intention-to-treat analysis. One patient was withdrawn from the trial due to a diarrhea. Twelve (16.9%) patients showed adverse symptoms that were deemed as mild symptoms. CONCLUSION: Our conclusion is that the association of pantoprazole, amoxicillin and clarithromycin administered during 7 days is an effective and well-tolerated alternative as regards the eradication of H. pylori in patients with peptic ulcer in Brazil.

The impact of Helicobacter pylori resistance on the efficacy of a short course pantoprazole based triple therapy.

BACKGROUND: Many of the currently used Helicobacter pylori eradication regimens fail to cure the infection due to either antimicrobial resistance or poor patient compliance. Those patients will remain at risk of developing potentially severe complications of peptic ulcer disease. AIM: We studied the impact of the antimicrobial resistance on the efficacy of a short course pantoprazole based triple therapy in a single-center pilot study. METHODS: Forty previously untreated adult patients (age range 20 to 75 years, 14 males) infected with Helicobacter pylori and with inactive or healing duodenal ulcer disease were assigned in this open cohort study to 1 week twice daily treatment with pantoprazole 40 mg, plus clarithromycin 250 mg and metronidazole 400 mg. Helicobacter pylori was assessed at entry and 50 3 days after the end of treatment by rapid urease test, culture and histology of gastric biopsies. The criteria for eradication was a negative result in the tests. Susceptibility of Helicobacter pylori to clarithromycin and metronidazole was determined before treatment with the disk diffusion test. RESULTS: One week treatment and follow up were complete in all patients. Eradication of Helicobacter pylori was achieved in 35/40 patients (87.5%) and was higher in patients with nitroimidazole-susceptible strains [susceptible: 20/20 (100%), resistant: 10/15 (67%)]. There were six (15%) mild adverse events reports. CONCLUSIONS: A short course of pantoprazole-based triple therapy is well tolerated and effective in eradicating Helicobacter pylori. The baseline metronidazole resistance may be a significant limiting factor in treatment success.

The impact of Helicobacter pylori resistance on the efficacy of a short course pantoprazole based triple therapy

BACKGROUND: Many of the currently used Helicobacter pylori eradication regimens fail to cure the infection due to either antimicrobial resistance or poor patient compliance. Those patients will remain at risk of developing potentially severe complications of peptic ulcer disease. AIM: We studied the impact of the antimicrobial resistance on the efficacy of a short course pantoprazole based triple therapy in a single-center pilot study. METHODS: Forty previously untreated adult patients (age range 20 to 75 years, 14 males) infected with Helicobacter pylori and with inactive or healing duodenal ulcer disease were assigned in this open cohort study to 1 week twice daily treatment with pantoprazole 40 mg, plus clarithromycin 250 mg and metronidazole 400 mg. Helicobacter pylori was assessed at entry and 50 ± 3 days after the end of treatment by rapid urease test, culture and histology of gastric biopsies. The criteria for eradication was a negative result in the tests. Susceptibility of Helicobacter pylori to clarithromycin and metronidazole was determined before treatment with the disk diffusion test. RESULTS: One week treatment and follow up were complete in all patients. Eradication of Helicobacter pylori was achieved in 35/40 patients (87.5 percent) and was higher in patients with nitroimidazole-susceptible strains [susceptible: 20/20 (100 percent), resistant: 10/15 (67 percent)]. There were six (15 percent) mild adverse events reports. CONCLUSIONS: A short course of pantoprazole-based triple therapy is well tolerated and effective in eradicating Helicobacter pylori. The baseline metronidazole resistance may be a significant limiting factor in treatment success.

Eficácia do regime terapêutico empregando a associação de pantoprazol, claritromicina e amoxicilina, durante uma semana, na erradicação do Helicobacter pylori em pacientes com úlcera péptica / Efficacy of the dosing regimen of pantoprazole 40 mg, amoxicillin 1000 mg and clarithromycin 500 mg, twice daily for 7 days, in the eradication of Helicobacter pylori in patients with peptic ulcer

OBJETIVO: Estudo multicêntrico, aberto, delineado para determinar a eficácia da associação de pantoprazol, claritromicina e amoxicilina, na erradicação do Helicobacter pylori em pacientes portadores de úlcera péptica. MATERIAL E MÉTODOS: Setenta e um pacientes (36 mulheres, 35 homens, idade média 41,9 anos) provenientes de três centros universitários brasileiros (Belo Horizonte e Porto Alegre) com úlcera péptica confirmada à endoscopia e infecção por H. pylori comprovada por, no mínimo, dois testes diagnósticos. Os pacientes foram tratados com a associação de pantoprazol 40 mg, claritromicina 500 mg e amoxicilina 1,0 g, administrada duas vezes ao dia, durante 7 dias. RESULTADOS: Ao final do tratamento, os pacientes foram reexaminados para avaliação dos sintomas gastrointestinais, presença de eventos adversos e aderência ao tratamento. Nova endoscopia com biopsias e teste respiratório com 13C-uréia foram repetidos 60 dias após o término do tratamento para determinação das taxas de erradicação do microrganismo. Foram considerados H. pylori negativos os pacientes com, pelo menos, o teste respiratório com 13C-uréia e mais um teste (teste da urease ou histologia) negativos. Ao final do estudo 60/69 (87 por cento, 95 por cento = 78,9-94,8) pacientes erradicaram o H. pylori na análise por protocolo e 60/71 (84,5 por cento, 95 por cento = 76-92,9) na análise por intenção de tratamento. Um paciente interrompeu o tratamento devido à diarréia. Doze pacientes (16,9 por cento) apresentaram sintomas adversos e considerados de leve intensidade. CONCLUSAO: A associação de pantoprazol, amoxicilina e claritromicina por 7 dias constitui alternativa eficaz e bem tolerada para a erradicação do H. pylori em portadores de úlcera péptica no Brasil.

Papel do pantoprazol em baixa dose no tratamento ambulatorial da dispepsia funcional, das gastrites e da esofagite de refluxo leve / Role of low-dose pantoprazole in outpatient treatment of functional dyspepsia, gastritis, and mild gastroesophageal reflux disease

Sintomas dispépticos säo queixas comuns na prática clínica diária. Apenas uma minoria destes pacientes tem alguma alteraçäo estrutural que explique os sintomas. A maioria nlo apresenta lesöes estruturais, sendo, portanto, rotulada como portadora de dispepsia funcional ou DRGE sem esofagite. Muitos säo inadequadamente rotulados como portadores de gastrite A inibiçäo da secreçäo ácida é um elo comum na abordagem terapêutica destas afecçöes. O objetivo do presente estudo foi a avaliaçäo do papel do pantoprazol 20 mg no alívio sintomático da dispepsia funcional, das gastrites e no tratamento da doença do refluxo gastroesofágico sem esofagite ou da esofagite de refluxo leve. Num estudo aberto e multicêntrico foram incluídos 5.105 pacientes ambulatoriais, divididos em quatro grupos: Grupo 1:DRGE com 641 pacientes (12,6 porcento), Grupo 2:DF com 1709 pacientes(33,5 porcento), Grupo 3:gastrites com 2.105 pacientes(41,2 porcento), Grupo 4: outros(diagnósticos mistos: DRGE e DF, DRGE e gastrites, DF e gastrites) com 650 pacientes (12,7 porcento). Todos os sintomas gastrointestinais avaliados apresentaram melhora estatísticamente significante no pós-tratamento quanto comparados ao quadro inicial. Com o término do tratamento, a ausencia dos sintomas foi observada em cerca de 80 porcento a 95 porcento dos pacientes. Reaçöes adversas foram descritas em 1 porcento dos pacientes durante o tratamento com pantoprazol, sendo as mais observadas cefaléias, constipaçlo intestinal e diarréia. O presente estudo demonstrou uma eficácia significativa näo apenas em relaçäo a remissäo dos sintomas da dispepsia do tipo úlcera, mas também de sintomas característicamente descritos como motores, como a sensaçäo de plenitude gástrica ou empachamento, saciedade precoce, retardo do esvaziamento gástrico, náuseas e vômitos com o uso diário de 20 mg de pantoprazol durante uma média de três semanas. O alívio sintomático da dispepsia funcional, das gastrites e no tratamento da doença de refluxo gastroesofágico sem esofagite ou da esofagite de refluxo leve foi significativo com excelente tolerabilidade e segurança.

Constipaçäo intestinal funcional / Functional intestinal constipation

The intestinal constipation is not a disease but a clinical manifestation and one of the most frequent gastrointestinal problem. It is a functional disorder very frequent particulary amongst womwn. The etiology cam be a metabolic disturbance, an organic disturbance, a problem with the colon innervation or can be related with the drugs use. The treatment is composed by behavioural measures and a therapeutic approach. The former may be divided in substances that increase the fecal bolus, lubricants, osmotic agents and laxatives. The treatment should be individualized in a case per case basis (au)

Secretory, endoscopic and histophatologic changes and prevalence of Helicobacter pylori in the gastroduodenal mucosa in patients with chronic alcoholic pancreatitis

Com o intuito de determinar, em nosso meio, a prevalência de ulcera péptica em pancreatopatas crônicos de etiologia alcoólica, e sua eventual relaçäo com alteraçöes histopatológicas, endoscópicas e da produçäo ácida, bem como a ocorrência de colonizaçäo pelo Helibacter pylori na mucosa gastroduodenal desses pacientes, foram investigados prospectivamente 30 pancreatopatas crônicos (Grupo I) e dez controles (Grupo II). Todos os pacientes foram submetidos a avaliaçäo clinica, teste de secreçäo ácida, basal e estimulada por pentagastrina, dosagem de gastrinemia basal, esofagogastroduodenoscopia com biopsia de fundo, corpo e antro gastricos e de bulbo duodenal, para identificaçäo e gradaçäo da inflamaçäo e ocorrência do Helicobacter pylori

Primary extranodal non-Hodgkin lymphoma of the extrahepatic bile duct mimmicking Klatskin tumor

Relatamos um caso de linfoma nao-Hodgkin primário das vias biliares extra-hepaticas, cujo sintoma inicial foi ictericia. A colangiografia demonstrou estenose do ducto biliar, de aspecto semelhante a um tumor de Klatskin tipo II. O tratamento cirurgico permitiu completa ressecçäo do tumor e a análise histopatologica mostrou tratar-se de um linfoma näo-Hodgkin folicular centrocitico-centroblastico. No seguimento pos-operatório de 48 meses, a paciente permaneceu assintomatica. O diagnóstico e as operaçöes terapeuticas säo discutidos