Correlation between creatinine clearance and Helicobacter pylori infection eradication with sequential and triple therapeutic regimens: A randomised clinical trial.

BACKGROUND AND STUDY AIMS: Uraemic patients show susceptibility to gastrointestinal mucosal lesions and colonisation by Helicobacter pylori (HP). Antibiotic resistance constitutes a problem in treatment and bismuth preparations are toxic in uraemic patients. This study aimed to assess the correlation between creatinine clearance (CrCl) and eradication of HP infection with new sequential and standard triple therapeutic regimens. PATIENTS AND METHODS: A total of 120 HP-positive patients with renal function impairment and 60 control patients with HP infection were enrolled in this study. Patients were divided into four groups on the basis of CrCl and were randomly assigned to one of the two different regimens: A 14-day standard triple therapy with 20mg omeprazole bid, 1000mg amoxicillin bid and 500mg clarithromycin bid and a new sequential regimen with 20mg omeprazole bid and 1000mg amoxicillin bid both for 14 days, 500mg ciprofloxacin bid for the first 7 days and 200mg furazolidone bid for the last 7 days. Doses of amoxicillin, clarithromycin and ciprofloxacin were reduced to 50% in the cases of CrCl <30mgdl(-1). RESULTS: One hundred and sixty two out of 180 HP-positive patients (54.3% male, 51.6±12.1 years) completed treatment in the four groups and were studied. According to renal function they were classified into group A (n=39), haemodialysis (HD) patients; group B (n=37), CrCl <30mgdl(-1) without HD; group C (n=36), CrCl between 30 and 60mgdl(-1); and group D (n=50), control subjects with CrCl >90mgdl(-1). HP was successfully eradicated in 77.7% of patients with standard triple therapy and in 81.4% of patients with the sequential therapy. There was no significant difference among the study groups in the rate of HP-infection eradication with both regimens. CONCLUSION: HP eradication rates did not differ with both sequential and standard therapeutic regimens in uraemic and non-uraemic patients. We, therefore, prefer the standard triple therapy due to its simplicity and reported.

Noninvasive stool antigen assay for screening of Helicobacter pylori infection and assessing success of eradication therapy in patients on hemodialysis.

INTRODUCTION. Helicobacter pylori infection can be diagnosed by biopsy-based or noninvasive methods. Our aim was to identify H pylori-positive patients on hemodialysis by the noninvasive method of H pylori stool antigen (HPSA) and investigate its diagnostic accuracy for assessment of the eradication of infection after treatment in comparison with urea breath test (UBT). MATERIALS AND METHODS. Serology, HPSA, and UBT were performed on 87 hemodialysis patients. Infection with H pylori was confirmed if at least 2 tests were positive. Patients with H pylori infection received a 2-week course of triple therapy. To evaluate success of eradication HPSA and UBT were done after 8 weeks. RESULTS. Eighty-seven patients were enrolled in the study, of whom 39 (44.8%) were proved to have H pylori infection. The HPSA was positive in the stool specimens of 37 patients (42.5%) and the serology test was positive in 39 (44.8%). The HPSA had a 87.1% sensitivity and a 93.7% specificity for detection of H pylori infection. Thirty-seven patients completed the treatment period. Success of H pylori eradication was documented in 30 of the 37 patients (81.1%) based on UBT. After the treatment, the HPSA was negative in 32 of 37 of the stool specimens (86.4%), showing a 42.8% sensitivity and a 93.3% specificity to detect the failure of eradication of H pylori. CONCLUSIONS. Helicobacter pylori stool antigen assay is a noninvasive reliable tool to screen H pylori infection before therapy and assess the success of eradication in patients on hemodialysis.

Frequency, risk factors, and outcome of acute kidney injury following bone marrow transplantation at Dr Shariati Hospital in Tehran.

INTRODUCTION: Bone marrow transplantation (BMT) is a major modality for malignant and hematologic disorders. This procedure is associated with a high morbidity and mortality such as acute kidney injury (AKI). Many factors, such as therapeutic agents, irradiation, and graft versus host disease (GVHD) can cause AKI. Bone marrow transplantation conditioning therapy in Iran is based on drugs such as busulfan and cyclophosphamide and without irradiation therapy. The aim of this study was to evaluate the frequency, risk factors, and mortality of AKI among patients who underwent BMT. MATERIALS AND METHODS: Acute kidney injury was defined as doubling serum creatinine from baseline at any time during the first 180 days posttransplant. The risk of AKI in relation to non-total-body-irradiation-based conditioning regimen, type of graft (allograft and autograft), comorbidities, GVHD, drug toxicity, and veno-occlusive disease were examined in 375 patients with BMT. RESULTS: One hundred and forty-two patients (37.6%) developed AKI at a median of 18 days after transplant. A higher frequency of AKI was observed in patients who received cyclosporine A (40%), patients with allograft BMT (42.1%), and those who developed gastrointestinal GVHD (47.3%) .The remainder AKI cases were associated with amphotericin B, veno-occlusive disease, and hemolytic-uremic syndrome. CONCLUSIONS: The frequency of AKI in our patients with BMT remained high. Cyclosporine A and amphotericin B and the presence of GVHD and veno-occlusive disease increased the risk of AKI within the first 180 days after BMT.