RESUMO
BACKGROUND & AIMS: After a first Helicobacter pylori eradication attempt, approximately 20% of patients will remain infected. The aim of the current study was to assess the effectiveness and safety of second-line empiric treatment in Europe. METHODS: This international, multicenter, prospective, non-interventional registry aimed to evaluate the decisions and outcomes of H pylori management by European gastroenterologists. All infected adult cases with a previous eradication treatment attempt were registered with the Spanish Association of Gastroenterology-Research Electronic Data Capture until February 2021. Patients allergic to penicillin and those who received susceptibility-guided therapy were excluded. Data monitoring was performed to ensure data quality. RESULTS: Overall, 5055 patients received empiric second-line treatment. Triple therapy with amoxicillin and levofloxacin was prescribed most commonly (33%). The overall effectiveness was 82% by modified intention-to-treat analysis and 83% in the per-protocol population. After failure of first-line clarithromycin-containing treatment, optimal eradication (>90%) was obtained with moxifloxacin-containing triple therapy or levofloxacin-containing quadruple therapy (with bismuth). In patients receiving triple therapy containing levofloxacin or moxifloxacin, and levofloxacin-bismuth quadruple treatment, cure rates were optimized with 14-day regimens using high doses of proton pump inhibitors. However, 3-in-1 single capsule or levofloxacin-bismuth quadruple therapy produced reliable eradication rates regardless of proton pump inhibitor dose, duration of therapy, or previous first-line treatment. The overall incidence of adverse events was 28%, and most (85%) were mild. Three patients developed serious adverse events (0.3%) requiring hospitalization. CONCLUSIONS: Empiric second-line regimens including 14-day quinolone triple therapies, 14-day levofloxacin-bismuth quadruple therapy, 14-day tetracycline-bismuth classic quadruple therapy, and 10-day bismuth quadruple therapy (as a single capsule) provided optimal effectiveness. However, many other second-line treatments evaluated reported low eradication rates. ClincialTrials.gov number: NCT02328131.
Assuntos
Infecções por Helicobacter , Helicobacter pylori , Quinolonas , Adulto , Amoxicilina , Antibacterianos/uso terapêutico , Bismuto , Claritromicina/uso terapêutico , Quimioterapia Combinada , Infecções por Helicobacter/tratamento farmacológico , Humanos , Levofloxacino , Moxifloxacina/uso terapêutico , Penicilinas/efeitos adversos , Estudos Prospectivos , Inibidores da Bomba de Prótons , Quinolonas/uso terapêutico , Sistema de Registros , Tetraciclina/uso terapêuticoRESUMO
INTRODUCTION: The safety of Helicobacter pylori eradication treatments and to what extent adverse events (AEs) influence therapeutic compliance in clinical practice are hardly known. Our aim was to assess the frequency, type, intensity, and duration of AEs, and their impact on compliance, for the most frequently used treatments in the "European Registry on Helicobacter pylori management." METHODS: Systematic prospective noninterventional registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H. pylori infection in routine clinical practice. All prescribed eradication treatments and their corresponding safety profile were recorded. AEs were classified depending on the intensity of symptoms as mild/moderate/severe and as serious AEs. All data were subject to quality control. RESULTS: The different treatments prescribed to 22,492 patients caused at least 1 AE in 23% of the cases; the classic bismuth-based quadruple therapy was the worst tolerated (37% of AEs). Taste disturbance (7%), diarrhea (7%), nausea (6%), and abdominal pain (3%) were the most frequent AEs. The majority of AEs were mild (57%), 6% were severe, and only 0.08% were serious, with an average duration of 7 days. The treatment compliance rate was 97%. Only 1.3% of the patients discontinued treatment due to AEs. Longer treatment durations were significantly associated with a higher incidence of AEs in standard triple, concomitant, bismuth quadruple, and levofloxacin triple or quadruple therapies. DISCUSSION: Helicobacter pylori eradication treatment frequently induces AEs, although they are usually mild and of limited duration. Their appearance does not interfere significantly with treatment compliance.
Assuntos
Antibacterianos/efeitos adversos , Bismuto/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Infecções por Helicobacter/tratamento farmacológico , Inibidores da Bomba de Prótons/efeitos adversos , Antibacterianos/uso terapêutico , Bismuto/uso terapêutico , Quimioterapia Combinada , Europa (Continente)/epidemiologia , Feminino , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Sistema de RegistrosRESUMO
BACKGROUND: Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. AIM: To evaluate the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin in the "European Registry of H pylori management" (Hp-EuReg). METHODS: A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e-CRF was created on AEG-REDCap. Patients with penicillin allergy were analyzed until June 2019. RESULTS: One-thousand eighty-four patients allergic to penicillin were analyzed. The most frequently prescribed first-line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera® ; n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% (P < .001). In second line, after the failure of PPI + C + M, two rescue options showed similar efficacy: PPI + B + T + M (78%) and PPI + C + levofloxacin (L) (71%) (P > .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. CONCLUSION: In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first-line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (<80%) results.
Assuntos
Hipersensibilidade a Drogas , Quimioterapia Combinada , Infecções por Helicobacter/tratamento farmacológico , Penicilinas/efeitos adversos , Antibacterianos/uso terapêutico , Bismuto/uso terapêutico , Claritromicina/uso terapêutico , Helicobacter pylori/efeitos dos fármacos , Humanos , Levofloxacino/uso terapêutico , Metronidazol/uso terapêutico , Penicilinas/uso terapêutico , Estudos Prospectivos , Inibidores da Bomba de Prótons/uso terapêutico , Sistema de Registros/estatística & dados numéricos , Tetraciclina/uso terapêuticoRESUMO
Irritable bowel syndrome is one of several highly prevalent functional gastrointestinal disorders (FGID) displaying symptoms of gastrointestinal dysmotility and visceral hypersensitivity. Substantial overlap of symptoms and comorbidities occur not only between irritable bowel syndrome and other FGID but also with gastrointestinal disorders that are not related to motility (eg, celiac disease and lactose intolerance) and to somatic conditions (eg, fibromyalgia and chronic fatigue syndrome). Pathogenic mechanisms common among FGIDs may include alternations in intestinal and colonic microflora. Evidence is also emerging of an interplay between gut immune cells/activity and alternations in motility, secretion, and sensation. The role of cytokine activity and inflammation is important in this regard. As recommended by Rome III, diagnostic testing should be guided by the patient's age, primary symptom characteristics, and other clinical and laboratory features. The high prevalence of coexisting conditions suggests the need to routinely assess patients for related disorders. Treatment should be based on an individualized evaluation, explanation, and reassurance.
Assuntos
Gastroenteropatias , Síndrome do Intestino Irritável , Intolerância à Lactose/diagnóstico , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Doença Celíaca/fisiopatologia , Comorbidade , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/epidemiologia , Doenças do Esôfago/fisiopatologia , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/epidemiologia , Síndrome de Fadiga Crônica/fisiopatologia , Fibromialgia/diagnóstico , Fibromialgia/epidemiologia , Fibromialgia/fisiopatologia , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/epidemiologia , Síndrome do Intestino Irritável/fisiopatologia , Intolerância à Lactose/epidemiologia , Intolerância à Lactose/fisiopatologia , PrevalênciaRESUMO
Helicobacter pylori can colonize the gastric mucosa and is considered as a risk factor for chronic active gastritis, peptic ulcer, gastric adenocarcinoma and primary gastric lymphoma. Among its various virulence factors, vacuolating cytotoxin encoded by vacA and cytotoxin-associated toxin encoded by cagA gene play an important role. The aims of this study were the detection of H.pylori vacA s and m genotypes, investigation of the association between vacA genotypes and cagA gene presence, and evaluation of the correlation between those factors and the clinical diagnosis. Gastric tissue specimens of patients who were clinically diagnosed as peptic ulcer disease (PUD) and non-ulcer dyspepsia (NUD) were included in the study. A total of 29 patients (age range: 18-74 years, mean age: 47.8 ± 13.6 years; 19 were female) without any familial relationship were evaluated. Thirteen (44.8%) of the patients were diagnosed clinically as PUD, while 16 (55.2%) as NUD. All of the patients' gastric tissue samples obtained by endoscopy were urease positive. H.pylori DNA was extracted from the tissue specimens by proteinase-K, phenol-chloroform-isoamyl alcohol method and vacA s, m1, m2 and cagA regions were identified by polymerase chain reaction (PCR) using four different primer sets. In addition, DNA sequencing was performed for the protected 785 base-pairs region of vacA m gene in all of the samples, and the sequences were aligned with Gene-Bank sequences, creating a phylogenetic tree. The distribution of vacA genotypes between 29 H.pylori positive patients were found as; s1m1 (n= 16), s1m2 (n= 6) and s2m2 (n= 7), while 19 patients yielded positive results for cagA gene. CagA positivity was detected in all of the 16 patients harboring s1m1 genotype, and 13 of those were the patients diagnosed as PUD (p= 0.008). Genotyping data achieved by phylogenetic analysis of the vacA m region were compatible with m genotypes identified by PCR. In conclusion, we detected a significant relationship between PUD and vacA s1m1 and cagA positivity. It was also determined that PCR would be a reliable, simpler and cheaper alternative to nucleotide sequencing for the identification of H.pylori vacA m genotypes.
Assuntos
Antígenos de Bactérias/genética , Proteínas de Bactérias/genética , Dispepsia/microbiologia , Mucosa Gástrica/microbiologia , Helicobacter pylori/genética , Úlcera Péptica/microbiologia , Adolescente , Adulto , Idoso , Antígenos de Bactérias/isolamento & purificação , Proteínas de Bactérias/isolamento & purificação , Feminino , Genótipo , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/classificação , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Reação em Cadeia da Polimerase , Alinhamento de Sequência , Análise de Sequência de DNA , Adulto JovemRESUMO
Monitoring therapy in chronic hepatitis B patients receiving lamivudine therapy, is done by two different assays; determination of viral load and genotypic resistance. These methods are labor intensive and time consuming. It was aimed to develop an assay to quantitate hepatitis B virus (HBV) DNA in serum and detect YMDD (thyrosine, methionine, aspartate, aspartate) motif mutations in the same run. The assay was based on real-time polymerase chain reaction (Rt-PCR) with YMDD-specific hybridization probes. Determination of YMDD motif was done by melting temperature analysis. External standard curve was used for quantifying viral DNA, which was generated by standard sera (VQC S2220) including HBV-DNA between concentrations of 1000 to 3 million copies/ml. The assay was compared with commercial quantitative kit (Artus HBV RG PCR; Qiagen, Germany), commercial line prob assay (INNO-LiPA HBV DR v1.0; Innogenetics, Belgium) and direct DNA sequencing method. Thirty-eight serum samples obtained from 20 chronic hepatitis B patients (7 female, 13 male; age range: 27-70 years) treated with only lamivudine and were negative for HIV and HCV antigen and antibodies were tested in the study. The analytical sensitivity of the assay was found as 200 copies/ml, with a dynamic range of 1 x 103 to 3 x 107 copies/ml. PCR efficiency of the in-house assay was found to be 1.98. Comparison of log10 HBV-DNA concentrations determined by the in-house and commercial quantitative kits showed a significant correlation (r= 0.681). Melting temperature (Tm) analysis was used for the YMDD motif determination and found to be 59.86°C for YMDD, 56.34°C for YVDD and 55.10°C for YIDD. The results of the in-house assay, DNA sequencing and LiPA were concordant in samples with homogeneous virus population, and in-house assay could also detect the major type of YMDD motif in mixed viral populations The Rt-PCR method which was developed in this study is a rapid, accurate and reproducible method for quantifying HBV-DNA and detecting the predominant YMDD motif in the same run in two hours duration. It was concluded that this method may be a convenient tool for monitoring HBV-infected patients receiving lamivudine treatment.
Assuntos
Antivirais/uso terapêutico , DNA Viral/análise , Vírus da Hepatite B/genética , Hepatite B Crônica/tratamento farmacológico , Lamivudina/uso terapêutico , Reação em Cadeia da Polimerase em Tempo Real/normas , Adulto , Idoso , DNA Viral/química , DNA Viral/isolamento & purificação , Monitoramento de Medicamentos/métodos , Feminino , Hepatite B Crônica/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Motivos de Nucleotídeos/genética , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: It is known that clarithromycin resistance has increased over the years (success rate 60%). The aim of the study was to investigate the importance of regional antimicrobial resistance rates for full accuracy of both diagnosis and treatment of Helicobacter pylori infection. METHODS: This study was carried out in the University Hospital Department of Gastroenterology. A total of 116 patients were evaluated with upper gastrointestinal endoscopy. Gastric antrum and corpus biopsy samples were taken for the rapid urease test (RUT), culture, and antimicrobial susceptibility testing for the presence of H. pylori. Antimicrobial susceptibilities of isolated H. pylori strains for clarithromycin and levofloxacin were determined by the epsilometer test (E-test). Minimal inhibitory concentration values for clarithromycin and levofloxacin were ≥1 and >1 µg/mL, respectively. RESULTS: H. pylori infection was considered clinically positive in 93 (80.2%) patients with either the RUT, culture, or histopathological examination. Seventy (60.3%) of the patients had RUT positivity. Sixty (85.7%) of these 70 patients had RUT positivity within the first 20 min. Among the 90 patients, who had a histopathological examination, HLO was positive in 76 (84.4%) patients. Fifty-two (44.8%) out of 116 patients were culture positive. Resistance rates for both clarithromycin and levofloxacin were high. In these 52 culture-positive patients, resistance rates determined for clarithromycin and levofloxacin were 26.9% and 25.5%, respectively. CONCLUSION: Clarithromycin or levofloxacin-based treatment regimen may not be an ideal alternative therapy for Turkish patients regardless of culture.
Assuntos
Antibacterianos , Resistência Microbiana a Medicamentos , Infecções por Helicobacter , Helicobacter pylori , Antibacterianos/farmacologia , Claritromicina/farmacologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/isolamento & purificação , Humanos , Levofloxacino/farmacologia , Turquia , Urease/análiseRESUMO
BACKGROUND: It has been shown that standard endoscopic features often labeled as gastritis has a poor correlation with histopathology. Recently, high resolution magnifying endoscopy has been reported to be an effective method to diagnose gastritis. The aim of the present study was to compare standard endoscopy with magnifying endoscopy for the diagnosis of Helicobacter pylori gastritis, and to determine whether gastritis can be diagnosed based on findings at magnification endoscopy. MATERIALS AND METHODS: A total of 129 patients were enrolled into the study. Erythema, erosions, prominent area gastrica, nodularity, and regular arrangement of collecting venules (RAC) were investigated by standard endoscopy. Standard endoscopy was followed by magnifying endoscopy in all patients, and repeated in 55 patients after indigo carmine spraying. RESULTS: None of the standard endoscopic features showed a sensitivity of more than 70% for H. pylori gastritis, except RAC pattern analysis. Absence of a corporal RAC pattern had 85.7% sensitivity and 82.8% specificity for predicting H. pylori infection. Under magnification, the sensitivity and specificity of regular corporal pattern (regular collecting and capillary vascular structures with gastric pits resembling pinholes) for predicting normal histology were 90.3% and 93.9%, respectively. Loss of collecting venules, or both collecting and capillary structures was correlated with chronic inflammation and activity. With the progression of mucosal atrophy, irregular collecting venules became visible. The values for irregularly arranged antral ridge pattern for the prediction of antral gastritis were 89.3% and 65.2%, respectively. Indigo carmine staining increased sensitivity and specificity up to 97.6% and 100% for corporal gastritis, and up to 88.4% and 75.0% for antral gastritis, respectively. Indigo carmine staining significantly increases the detection of intestinal metaplasia. CONCLUSIONS: High resolution magnifying is superior to standard endoscopy for the diagnosis of H. pylori gastritis, and identification of specific histopathologic features such as atrophy and intestinal metaplasia seems possible.
Assuntos
Endoscopia do Sistema Digestório/métodos , Gastrite/diagnóstico , Infecções por Helicobacter/diagnóstico , Adulto , Idoso , Feminino , Gastrite/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVE: Hepatocellular cancer (HCC) is one of the important health problems in Turkey. We aimed to determine the clinical and demographic features of HCC in the Turkish population and to evaluate the prognostic and survival features. METHOD: Two hundred and twenty-one patients with HCC from five hospitals in Turkey are included in this study. RESULTS: In 44.4% of the 221 patients with hepatitis B virus and in 21.3% of the 221 patients with hepatitis C virus were found to be responsible for HCC etiology. It has been shown that HCC developed on cirrhosis basis in 74.2% of the patients. HCC was presented with single solitary nodule in 69.2% of the patients. Non-liver metastasis was present in 12.5% of the patients. In 21.7% of the patients, alpha-fetoprotein (AFP) levels were above the diagnostics level of 400 ng/ml. The median overall survival (OS) of 221 patients was 14 months. The median OS of the patients with Child-Pugh A class was significantly longer than that with Child-Pugh B and C classes. The OS of the individuals with normal AFP levels was also longer than that with high AFP levels. The OS of the patients with Stage I HCC according to tumor node metastasis (TNM) classification, the female patients and the treated patients group was found to be significantly good. CONCLUSIONS: In conclusion, the viral etiology (hepatitis B and C infections) in Turkish population is found to be an important factor in HCC development. The Child-Pugh classification, AFP levels, TNM classification, being female and treatment were determined to be important prognostic factors in HCC patients.
Assuntos
Carcinoma Hepatocelular/mortalidade , Hepatite B Crônica/mortalidade , Hepatite C Crônica/mortalidade , Neoplasias Hepáticas/mortalidade , Adolescente , Adulto , Idoso , Biomarcadores Tumorais/metabolismo , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/virologia , Feminino , Seguimentos , Hepacivirus/patogenicidade , Vírus da Hepatite B/patogenicidade , Hepatite B Crônica/metabolismo , Hepatite B Crônica/virologia , Hepatite C Crônica/metabolismo , Hepatite C Crônica/virologia , Humanos , Incidência , Cirrose Hepática/metabolismo , Cirrose Hepática/mortalidade , Cirrose Hepática/virologia , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Turquia/epidemiologia , alfa-Fetoproteínas/metabolismoRESUMO
INTRODUCTION: The aim of this study was to assess the efficacy and safety of esomeprazole 40 mg once daily (q.d.) in healing reflux oesophagitis at 4 and 8 weeks, and the efficacy of esomeprazole 20 mg q.d. for 12 weeks in the maintenance of remission. METHODS: A total of 235 patients with endoscopically proven reflux oesophagitis were enrolled in this study, which consisted of two phases (healing and maintenance therapy). Patients who showed complete endoscopic and symptomatic healing at the end of 4 or 8 weeks were switched to maintenance treatment with esomeprazole 20 mg q.d. for 12 weeks. The primary efficacy endpoint was healing of reflux oesophagitis at week 8. Secondary assessments included the proportion of patients with symptomatic relapse in the maintenance phase. RESULTS: At the end of week 8, 88% (95% life-table confidence intervals [CI]: 84%, 92%) of patients were healed endoscopically and 90.6% of the patients were asymptomatic. Patient age, gender and Helicobacter pylori status had no effect on the efficacy of treatment. During the 12-week maintenance treatment phase, symptomatic relapse ratios were 0.5%, 2.2%, and 0%, for the first, second, and third 4-week periods, respectively. The proportions of patients satisfied with treatment were 95% and 99.4% at the end of acute and maintenance treatment, respectively. The most common adverse effects were headache, upper respiratory tract infection and abdominal pain. CONCLUSIONS: Esomeprazole is effective in the healing of reflux oesophagitis, the resolution of heartburn, and in maintaining symptomatic remission. The effectiveness of esomeprazole in patients with gastroesophageal reflux disease is not affected by the presence of H. pylori.
Assuntos
Antiulcerosos/uso terapêutico , Esomeprazol/uso terapêutico , Esofagite Péptica/tratamento farmacológico , Adolescente , Adulto , Idoso , Esquema de Medicação , Endoscopia do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVE: The role of routine endoscopic duodenal biopsies obtained during the evaluation of iron deficiency anaemia is being increasingly emphasized, but insufficiently applied. Diagnostic yield of this practice, mainly identification of coeliac disease, differs in different populations and geographic regions. The aim of this study is to assess the usefulness of routine duodenal biopsies during upper endoscopy in patients presenting with iron deficiency anaemia in Western Anatolia. METHODS: Routine duodenal biopsies were evaluated over a 12-month period in 100 consecutive adult patients with iron deficiency anaemia undergoing upper endoscopy. All potential bleeding lesions were identified and gastric as well as duodenal biopsies were taken for histopathologic investigation. RESULTS: A bleeding lesion is identified in 44% of cases. Duodenal biopsy gives an additional 5% diagnostic yield and revealed three patients with coeliac disease and two patients with giardiasis. One of the patients diagnosed with coeliac disease had a second bleeding lesion at the upper endoscopic examination. Appearance of the duodenal mucosa was normal in all patients including those with diagnostic duodenal biopsy. CONCLUSIONS: Routine duodenal sampling during the upper endoscopic examination gives an additional 5% diagnostic benefit and this practice should be included in the diagnostic work-up of patients with iron deficiency anaemia. As one of the patients who was found to have coeliac disease had a second bleeding lesion that may otherwise explain iron deficiency anaemia, finding a source for bleeding at the upper endoscopy should not preclude duodenal biopsy. Moreover, performing duodenal biopsy is still necessary even though the endoscopic appearance of the mucosa is normal. Aside from coeliac disease, Giardia infestation could be identified as a contributory factor for iron deficiency anaemia, in endemic regions.
Assuntos
Anemia Ferropriva/etiologia , Duodeno/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/patologia , Biópsia , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Colonoscopia , Testes Diagnósticos de Rotina/métodos , Duodenoscopia , Feminino , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/diagnóstico , Giardíase/complicações , Giardíase/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Helicobacter pylori remains one of the most common bacterial infections worldwide. Clarithromycin resistance is the most important cause of H. pylori eradication failures. Effective antibiotic therapies in H. pylori infection must be rapidly adapted to local resistance patterns. We investigated the prevalence of clarithromycin resistance due to mutations in positions 2142 and 2143 of 23SrRNA gene of H. pylori by fluorescence in situ hybridisation (FISH), and compared with culture and antimicrobial susceptibility testing in 234 adult patients with dyspepsia who were enrolled. Antrum and corpus biopsy specimens were obtained for rapid urease test, histopathology and culture. Epsilometer test was used to assess clarithromycin susceptibility. H. pylori presence and clarithromycin susceptibility were determined by FISH in paraffin-embedded biopsy specimens. We found that 164 (70.1%) patients were positive for H. pylori based on clinical criteria, 114 (69.5% CI 62.5-76.6%) were culture positive, and 137 (83.5% CI 77.8-89.2%) were FISH positive. Thus the sensitivity of FISH was significantly superior to that of culture. However specificity was not significantly different (91.4 versus 100.0%, respectively). The resistance rate to clarithromycin for both antrum and corpus was detected in H. pylori-positive patients; 20.2% by FISH and 28.0% by E-test.The concordance between E-test and FISH was only 89.5% due to the presence of point mutations different from A2143G, A2142G or A2142C. We conclude that FISH is significantly more sensitive than culture and the E-test for the detection of H. pylori and for rapid determinination of claritromycin susceptibility. The superior hybridisation efficiency of FISH is becoming an emerging molecular tool as a reliable, rapid and sensitive method for the detection and visualisation of H. pylori, especially when the management of H. pylori eradication therapy is necessary. This is particularly important for the treatment of patients with H. pylori eradication failure.
RESUMO
BACKGROUND: There is increasing concern about the efficacy of current regimens for the eradication of Helicobacter pylori. OBJECTIVES: This study examined rates of H. pylori eradication with a commonly used triple-therapy regimen consisting of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin in trials performed in Turkey from 1996 to 2005. It also investigated the relationship between eradication rates and the duration of treatment (7, 10, or 14 days), choice of PPI, and indication for treatment (dyspepsia or peptic ulcer). METHODS: This was a retrospective epidemiologic analysis. Articles concerning H. pylori eradication in Turkey that were published in peer-reviewed national and international journals were identified through searches of MEDLINE using the terms Helicobacter, eradication, and Turkey, and of the Turkish Medical Index using the terms Helicobacter and eradication. Abstracts from the Turkish Gastroenterology Congress from 1996 through 2005 were searched manually. Open-label trials, controlled trials, treatment arms, and case series that included a triple-therapy regimen consisting of standard doses of any PPI (omeprazole 20 mg BID, lansoprazole 30 mg BID, pantoprazole 40 mg BID, or esomeprazole 40 mg BID) with clarithromycin 500 mg BID and amoxicillin 1 g BID for 7 to 14 days were selected for analysis. Trials including patients who had undergone a previous attempt at eradication of H. pylori were excluded. RESULTS: Of 138 trials or treatment arms identified, 94 met the criteria for inclusion (3637 subjects). The pooled eradication rate was 68.8% (95% CI, 67.3-70.3). A marked decrease in eradication was noted after 2000. Pooled eradication rates each year from 1996 through 2005 were 79.4%, 83.7%, 81.8%, 81.8%, 75.1%, 61.3%, 65.6%, 65.1%, 55.3%, and 61.1%, respectively. Eradication rates were not affected by the duration of treatment, choice of PPI, or indication for treatment. CONCLUSIONS: Rates of H. pylori eradication with the triple-therapy regimen decreased in Turkey over the 10-year period studied. In an era of increasing clarithromycin use, the effectiveness of this regimen for H. pylori eradication appears to require reassessment.
Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Claritromicina/administração & dosagem , Inibidores Enzimáticos/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Ensaios Clínicos como Assunto , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Inibidores da Bomba de Prótons , Estudos Retrospectivos , Resultado do Tratamento , Turquia/epidemiologiaRESUMO
AIM: To detect H pylori infection and to evaluate the anti CagA seropositivity in adult Turkish dyspeptic patients. METHODS: We evaluated anti-H pylori IgA, IgG and anti-CagA antibodies using commercial enzyme-linked immunoassay (ELISA) and Western blot in dyspeptic Turkish patients. H pylori status was determined by histology and rapid urease testing. RESULTS: Fifty-six patients were entered. Forty-eight (85.7%) out of the 56 patients were positive for H pylori. H pylori IgG seropositivity was 82.1%, IgA seropositivity 48.2%. CagA ELISA showed that IgG was positive in 50% and IgA in 30.4% of those with H pylori infections. Western blot showed that IgG seropositivity was 80.4% and IgA seropositivity 33.9%. Western blot detected IgG antibodies with reactivity to CagA in 50%, VacA in 62.5%, UreB in 87.5%, UreA in 80.4%, and OMP in 57.1%. None of the tests had a sensitivity and specificity above 80%. CONCLUSION: None of these commercial tests seems clinically useful for H pylori detection in adult dyspeptic patients, while Western blot can give seropositivity and determine anti-CagA, VacA virulence factor status of Turkish dyspeptic patients in the Izmir region.
Assuntos
Antígenos de Bactérias/sangue , Antígenos de Bactérias/genética , Proteínas de Bactérias/sangue , Proteínas de Bactérias/genética , Western Blotting/métodos , Dispepsia/sangue , Dispepsia/microbiologia , Ensaio de Imunoadsorção Enzimática/métodos , Infecções por Helicobacter/sangue , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Adulto , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Turquia , Fatores de VirulênciaRESUMO
AIM: To compare two different H pylori stool antigen tests as noninvasive diagnostic methods. METHODS: The study population consisted of 22 upper gastrointestinal system bleeding patients. Urea breath test (UBT), rapid urease test (RUT) and histopathological examination were applied to all patients. Stool specimens from these patients were examined by rapid STRIP!HpSA and one step simple H pylori antigen cassette test for the detection of H pylori antigens. RESULTS: For these 22 patients, 15 (68.2%) were diagnosed as positive and seven (31.8%) were diagnosed negative for H pylori infection by the gold standard methods. Whereas 10 (45.5%) were positive and 12 (54.5%) were diagnosed negative by the rapid STRIP!HpSA test. The sensitivity, specificity, positive and negative predictive values were 60%, 86%, 90% and 50%, respectively. When compared to the gold standard methods, these differences were not significant. However, six patients (27.3%) were positive, and 16 (72.7%) were negative by the simple H pylori stool antigen cassette test. The sensitivity, specificity, positive and negative predictive values were 33%, 86%, 83% and 38%, respectively. Compared to the gold standard methods, the simple H pylori stool antigen cassette test results were significantly different (P = 0.012). CONCLUSION: Rapid STRIP!HpSA test could be used as a routine diagnostic tool in the microbiology laboratory for assessing clinical significance and eradication control of H pylori in upper gastrointestinal system bleeding patients.
Assuntos
Testes Diagnósticos de Rotina/métodos , Hemorragia Gastrointestinal/etiologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos de Bactérias/análise , Testes Respiratórios , Fezes/microbiologia , Feminino , Infecções por Helicobacter/imunologia , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Ureia/análise , Urease/análiseRESUMO
BACKGROUND AND AIM: Antibiotic-associated diarrhoea may develop during or following Helicobacter pylori eradication. We aimed to evaluate the efficacy and safety of Saccharomyces boulardii in preventing antibiotic-associated diarrhoea in patients receiving antibiotics for H. pylori eradication. METHODS: In a multicentre prospective clinical trial, patients with peptic ulcer disease or non-ulcer dyspepsia were enrolled to receive clarithromycin, amoxicillin and omeprazole for H. pylori eradication for 14 days. These patients were then randomized to receive either S. boulardii 500 mg twice daily (treatment group) or no treatment (control group). The primary outcome measure was the development of diarrhoea during (treatment period) or within 4 weeks after treatment (follow-up period). RESULTS: Of the 389 patients that were enrolled, 376 completed the study. Within the treatment period, diarrhoea developed in 5.9% of patients in the treatment group and in 11.5% of patients in the control group (P = 0.049); and in the follow-up period, diarrhoea developed in 1.0% of patients in the treatment group and in 3.8% of patients in the control group (P = 0.09). Overall diarrhoea rates throughout the whole study period were 6.9% in the treatment group and 15.6% in the control group (P = 0.007). No significant difference was observed between the treatment and control groups in terms of adverse events. CONCLUSION: S. boulardii is an effective and safe treatment for prevention of antibiotic-associated diarrhoea when given concomitantly to patients receiving H. pylori eradication.
Assuntos
Antibacterianos/efeitos adversos , Diarreia/prevenção & controle , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Probióticos/uso terapêutico , Saccharomyces , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Diarreia/induzido quimicamente , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
Foramen of Morgagni hernias are rare diaphragmatic hernias, usually occurring on the right and located in the anterior mediastinum. Adult patients diagnosed with a foramen of Morgagni hernia are usually asymptomatic and associated with obesity, trauma or other causes of increased intraabdominal pressure. Plain pulmonary roentgenogram, radiological studies of the gastrointestinal system with contrast material, computerized tomography and magnetic resonance imaging studies are helpful in diagnosis. In this article, a 78-year-old female case with a Morgagni hernia incidentally diagnosed on chest X-ray is presented.
Assuntos
Hérnia Diafragmática/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Radiografia Abdominal , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Helicobacter pylori (H. pylori) occurs throughout the world and causes gastroduodenal diseases. There is data indicating a change in the prevalence of H. pylori infection worldwide. The prevalence of H. pylori is 80% in Turkey, while it is higher in many developing countries, and the rate of infection varies throughout the world. In many developing countries, the prevalence of infection exceeds 90% by adulthood. AIM: To determine the change in the rate of H. pylori infection in gastric ulcers and duodenal ulcers for a 10-year period in a single centre. MATERIAL AND METHODS: The study population included 550 patients (342 in 2004, 208 in 1994) with gastric and duodenal ulcers. RESULTS: In 2004 there were 125 (36.5%) patients with gastric ulcer and 217 patients with duodenal ulcer (64.5%). CLO test positivity was 39.2% in patients with gastric ulcers and 60% in patients with duodenal ulcers. In 1994 there were 208 patients (159 duodenal ulcers, 49 gastric ulcers). Urease test was positive in 74.2% of patients with duodenal ulcer and in 65.2% of patients with gastric ulcer. The decrease in the rate of urease positivity in patients with gastric ulcer was statistically significant (p = 0.01) during this 10-year period. CONCLUSIONS: In the present study we found that the urease positivity decreased significantly in patients with gastric ulcer between 1994 and 2004.
RESUMO
OBJECTIVE: Recently, proton pump inhibitor (PPI)-based triple therapy has been recommended as a first line treatment in the eradication of Helicobacter pylori. The aim of this open, multicentre trial was to investigate the efficacy, safety, tolerability and the ulcer healing rate of a triple regimen consisting of pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1000 mg twice daily for 7 days, in the eradication of H. pylori in patients with duodenal ulcer in Turkey. RESEARCH DESIGN AND METHODS: H. pylori infection was assessed by histological examination and rapid urease test at baseline and 4 weeks after the completion of the therapy. Seventy-seven patients were enrolled, 5 were excluded due to various reasons and 72 completed the entire course of the trial. RESULTS: H. pylori eradication was confirmed in 49 of these patients; the eradication rate was 68% by per-protocol analysis and 63.6% by intention-to-treat analysis. The ulcers were completely healed in 61 patients (85%) at the second endoscopic examination. Drug compliance was excellent (97.3%) and there were no serious adverse events. CONCLUSION: Pantoprazole-based 1-week triple therapy was well tolerated and the ulcer healing rate was high (85%). Relatively low H. pylori eradication rates may be attributed to rising antibiotic resistance over recent years. A large scale, comparative study with other PPI-based regimens is warranted based on the results of this open study with the pantoprazole-based regimen.
Assuntos
Antiulcerosos/uso terapêutico , Benzimidazóis/uso terapêutico , Úlcera Duodenal/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Omeprazol/análogos & derivados , Omeprazol/uso terapêutico , Sulfóxidos/uso terapêutico , 2-Piridinilmetilsulfinilbenzimidazóis , Adulto , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Úlcera Duodenal/diagnóstico , Úlcera Duodenal/microbiologia , Úlcera Duodenal/fisiopatologia , Duodenoscopia , Feminino , Infecções por Helicobacter/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pantoprazol , Resultado do Tratamento , Cicatrização/efeitos dos fármacosRESUMO
BACKGROUND/AIMS: Leptin has recently been suggested to play a role in the pathogenesis of hepatic steatosis and steatohepatitis in the absence of viral infection. The aim of this study was to evaluate whether leptin levels are associated with hepatic steatosis in chronic hepatitis C. METHODOLOGY: Thirty-one patients (22 female, 9 male, mean age: 51 +/- 9) with histologically proven chronic hepatitis C were included in this prospective, controlled, observational, clinical study with blind outcome assessment. Patients with and without steatosis in liver biopsy served as each others' controls. RESULTS: Chronic hepatitis C patients with (n=23) and without steatosis (n=8) were similar with respect to their serum glucose, lipid and leptin levels (p>0.05). Serum leptin levels were correlated with both patient factors, such as obesity and with liver enzymes, such as ALT, AST only in patients with steatosis. Chronic hepatitis C patients with or without steatosis had similar leptin levels of 6.3 +/- 2.5 and 4.9 +/- 2.5, respectively. CONCLUSION: Leptin levels were well correlated with antropometrical parameters in chronic hepatitis C patients. Leptin levels were associated with evidence of impaired hepatic function in patients with chronic HCV related steatosis. Serum leptin may be a prognostic marker for patients with chronic HCV infection with steatosis.