Does delayed gastric emptying shorten the H pylori eradication period? A double blind clinical trial.

AIM: To evaluate the gastric emptying inhibitory effects of sugar and levodopa on H pylori eradication period. METHODS: A total of 139 consecutive patients were randomized into 6 groups. The participants with peptic ulcer disease or non-ulcer dyspepsia non-responding to other medications who were also H pylori-positive patients either with positive rapid urease test (RUT) or positive histology were included. All groups were pretreated with omeprazole for 2 d and then treated with quadruple therapy regimen (omeprazole, bismuth, tetracycline and metronidazole); all drugs were given twice daily. Groups 1 and 2 were treated for 3 d, groups 3, 4 and 5 for 7 d, and group 6 for 14 d. Groups 1 to 4 received sugar in the form of 10% sucrose syrup. Levodopa was prescribed for groups 1 and 3. Patients in groups 2 and 4 were given placebo for levodopa and groups 5 and 6 received placebos for both sugar and levodopa. Upper endoscopy and biopsies were carried out before treatment and two months after treatment. Eradication of H pylori was assessed by RUT and histology 8 wk later. RESULTS: Thirty patients were excluded. Per-protocol analysis showed successful eradication in 53% in group 1, 56% in group 2, 58% in group 3, 33.3% in group 4, 28% in group 5, and 53% in group 6. Eradication rate, patient compliance and satisfaction were not significantly different between the groups. CONCLUSION: It seems that adding sugar or levodopa or both to anti H pylori eradication regimens may lead to shorter duration of treatment.

Analysis of patients listed for liver transplantation in Shiraz, Iran.

AIM: To analyze records of patients listed for liver transplantation (LT) at our hospital, the first and the largest LT center in Iran. METHODS: We analyzed medical records of patients aged 14 years or older, who were listed for LT for chronic liver disease between 1994 and 2004. Outcome was determined from records or follow-up data. RESULTS: Among the 480 patients (mean age 39 [SD 13] years; 327 [68.1%] men) listed for LT, common causes of cirrhosis were cryptogenic (143; 29.9%) and hepatitis B (127; 26.5%). Child-Turcott-Pugh (CTP) class distribution of these patients was: A - 37 (7.7%), B - 258 (53.7%) and C - 185 (38.6%). Mean (SD) follow-up duration was 11.4 (11.8) months (range 1-108). One hundred and four (21.7%) patients received LT and 173 (36%) died while awaiting LT. CTP class influenced 1-year (90%, 73% and 55% in class A, B and C, respectively) and 2-year (84%, 48% and 25%, respectively) survival rates. MELD score also influenced survival. Survival was better in patients who underwent LT than in those who continued on the waiting list (p< 0.01). CONCLUSION: Only about one-fifth of patients listed for LT in Iran received LT and a large proportion died without LT.

Efficacy of saccharomyces boulardii with antibiotics in acute amoebiasis.

AIM: To compare the efficacy of antibiotics therapy alone with antibiotics and saccharomyces boulardii in treatment of acute amebiasis. METHODS: In a double blind, random clinical trial on patients with acute intestinal amoebiasis, 57 adult patients with acute amoebiasis, diagnosed with clinical manifestations (acute mucous bloody diarrhea) and amebic trophozoites engulfing RBCs found in stool were enrolled in the study. Regimen 1 included metronidazole (750 mg Tid) and iodoquinol (630 mg Tid) for 10 days. Regimen 2 contained capsules of lyophilized saccharomyces boulardii (250 mg Tid) orally in addition to regimen 1. Patients were re-examined at two and four weeks after the treatment, and stool examination was performed at the end of week 4. Student's t-test, chi(2) and McNemar's tests were used for statistical analysis. RESULTS: Three patients refused to participate. The other 54 patients were randomized to receive either regimen 1 or regimen 2 (Groups 1 and 2 respectively, each with 27 patients). The two groups were similar regarding their age, sex and clinical manifestations. In Group 1, diarrhea lasted 48.0+/-18.5 hours and in Group 2, 12.0+/-3.7 hours (P<0.0001). In Group 1, the durations of fever and abdominal pain were 24.0+/-8.8 and 24.0+/-7.3 hours and in Group 2 they were 12.0+/-5.3 and 12.0+/-3.2 hours, respectively (P<0.001). Duration of headache was similar in both groups. At week 4, amebic cysts were detected in 5 cases (18.5 %) of Group 1 but in none of the Group 2 (P<0.02). CONCLUSION: Adding saccharomyces boulardii to antibiotics in the treatment of acute amebiasis seems to decrease the duration of clinical symptoms and cyst passage.