Efficacy of two different dosage regimens of omeprazole, amoxycillin and metronidazole for the cure of Helicobacter pylori infection.

BACKGROUND: While addition of metronidazole to the omeprazole-amoxycillin combination has been shown to be advantageous, the optimal dosage and drug distribution of the antimicrobials has not been sufficiently evaluated. AIM: To investigate the efficacy of two different regimens of omeprazole, amoxycillin and metronidazole for the cure of Helicobacter pylori infection. METHODS: Two hundred and fifty-five patients with H. pylori associated duodenal ulcers were randomly treated with either a 1-week regimen of omeprazole 20 mg b.d., amoxycillin 1000 mg b.d. and metronidazole 800 mg b.d. (OAM b.d.) or a combination of omeprazole 40 mg o.d., amoxycillin 500 mg t.d.s. and metronidazole 400 mg t.d.s. (OAM t.d.s.). All patients subsequently received omeprazole 20 mg o.d. for an additional 3 weeks. H. pylori status was assessed by histology and 13C-UBT prior to treatment and 8 weeks after randomization. Additional biopsies were obtained for H. pylori culture to determine primary and secondary resistance to metronidazole by agar dilution. RESULTS: Two hundred and thirty-seven patients were included in the intention-to-treat analysis and 198 patients in the per protocol analysis. With intention-to-treat analysis, the cure rate was 77% after treatment with OAM b.d. (95% CI, 69%-85%) and 76% after OAM t. d.s. therapy (95% CI, 67%-83%). Ulcer healing (intention-to-treat analysis) was documented in 95% of patients in the OAM b.d. group (n=122) and in 97% of patients in the OAM t.d.s. group (n=115). Adverse events were reported in 26 (20%) and in 18 (14%) patients in the OAM b.d. and OAM t.d.s. groups, respectively. None resulted in discontinuation of treatment. Overall primary resistance of H. pylori against metronidazole was found in 22 of 116 strains (19%). CONCLUSIONS: The combination of omeprazole, amoxycillin and metronidazole achieves about an 80% cure rate of H. pylori infection even in active ulcers. The total daily dose, and the choice of twice or three times daily dosing does not seem critical with this regimen.

Alkaline reflux esophagitis in gastroresected patients. Objective detection with a simple isotope method.

The incidence and severity of alkaline reflux esophagitis occurring in 1129 gastroresected patients were evaluated. As far as the incidence of esophagitis are concerned, no significant difference was found after Billroth I or Billroth II type resection. Severe esophagitis developed in 62.6 per cent of patients with total gastrectomy, but never occurred when a long limb Roux-en-Y anastomosis was also performed. The majority of esophagitis was recognized within the first year after resection, so it might be supposed that not only operative procedure itself but the postoperative care period might be responsible for the development of esophagitis. It can be avoided and treated by Roux-en-Y anastomosis. Scintigraphy is a simple rapid method in the detection of gastroesophageal reflux, thus patients can be selected by it for further invasive investigation.

[Management of complications from endoscopic sphincterotomy]. / Az endoscopos sphincterotomia szövödményeinek kezeléséröl.

Endoscopic sphincterotomy can replace operation. It was to be chosen in case of recurrence common bile duct calculi. The authors describe 11 complicated cases (2.01%) (9 women, 2 men) which demanded surgical management out of the 546 endoscopic sphincterotomy performed during 10 years (1982-1991). Operations were performed on 6 patients and 3 of them died (0.55%). Operation was necessary because of perforation and bleeding (2 perforations, 2 bleedings, 2 bleedings and perforations at the same time).

[Detection of Helicobacter pylori in biopsy specimens, methodical studies]. / Helicobacter pylori kimutatása biopsiás mintákból, metodikai vizsgálat.

Demonstration of Helicobacter pylori infection receives more and more importance in nowadays gastroenterological practice. The authors have compared culture and histology from 69 antral biopsy specimens for their ability to document Helicobacter pylori infection. Infection ratios in the context of clinical and histological diagnoses resulted in a distribution pattern similar to that described by others: 85-69% of duodenal ulcer patients, 67-67% of gastric ulcer patients, 62-54% of patients with gastritis and/or erosion(s) and 33-60% of endoscopically negative patients were found to be Helicobacter pylori positive with culture and histology respectively. Normal or atrophic mucosa showed no bacteria with either methods, but one must also consider the small number of such cases in this study. Chronic gastritis with no signs of activity proved to be infected only in a minority of cases, while chronic active gastritis cases were Helicobacter pylori positive in 72 and 61% histologically and with culture respectively. The modified Giemsa stain used in this study grave a relative specificity of 0.74 and sensitivity of 0.79 as compared with culture. There was a good association between the two methods tested, and this could be further improved by doing the two tests simultaneously. The association was weaker when the tests were done asynchronously, this is why it is not recommended to use such a diagnostic schedule. Comparison of the traditional haematoxylin-eosin stain with the modified Giemsa stain resulted in a very strong association between the two.(ABSTRACT TRUNCATED AT 250 WORDS)

[Percutaneous transhepatic cholecysto-lithotripsy]. / Percutan transhepatikus cholecysto-lithotripsia.

Authors were the first in Hungary to perform the percutaneous transhepatic cholecystolithotripsy for the removing of gallbladder stones. The method can be performed easily with the necessary skill and it is not too troublesome for the patients. They present their beginning experience.

[Double pylorus (author's transl)]. / Doppelpylorus

Two cases of double pylorus are reported which had been diagnosed gastroscopically. In 1 case, the ulcerative origin could be demonstrated by autopsy and histological examination.

A simple method for measuring lateral flexion of the dorsolumbar spine.

A simple method for measurement of spinal dorsolumbar lateral flexion is described. Measurements performed on 200 healthy 19-year-old men showed that normal lateral flexion was about 10% of body height. The method which requires only a measuring tape correlates well with that recorded by the more sophisticated inclinometer.

[Gardner syndrome]. / Gardner-Syndrom.

A case of Gardner syndrome associated with alterations of the skin and bones and precancerous gastrointestinal polyposis is presented. Particular interest attached to the extension of polyposis to the entire digestive tract, the early appearance of abdominal signs attributable to the polyposis, and - as new symptoms - polycystic lung and widespread superficial naevus lipomatosus.

Punched-card aid in rheumatological diagnosis.

A punched-card diagnostic system is described for use in rheumatological practice. The system is based on pattern recognition and provides a list of both common and rare possible diseases. The system is simple and can be manufactured cheaply, and may be of particular use to family doctors in remote areas of practice. The system has also potential as an educational tool for both undergraduate and postgraduate students of medicine.