Azithromycin, furazolidone and omeprazole: a promising low-dose, short-term, anti-H. pylori triple therapy

Aim: Tocompare four anti-H. pylori regimes using omeprazole and azithromycin associated to different antimicrobials in peptic ulcer H. pylori positive patients. Patients and methodos: afterinformed consent, 136 endoscopically proven peptic ulcer patients(74 male, 62 female) were randomly assigned to one of thefollowing therapy groups: Group 1: Om 20mg mane for 7 ays + Az 500mgmane for 3 days + tinidazole (Ti) 500mg bid for 7 ays. Group 2: Om 20 mg mane for 7 days + Az 500mane for 3 days + amoxycilin (Am) 500mg tid for 7 days. Group 3 Om 20 mg mane for 7 days + Az 500mg mane for 3 days + furazolidone (F) 200 mg tid for 7 days. Group 4: Om 20 mg mane for 7 days +Az 500mg mane for 3 days + colloidal bismuth subcitrate (CBS) 120 mg tid ( double dose at bedtime) for7 days. The H. Pylori status was assessed before treatment and 94 (63-214) days post treatment using urease test, and 14C-urea breath test. Statistical analysis was performed by Kruskal-Wallis test, chi-square test, Fisher's exact test, and Lancaster & Irvin method. Results: The four groups had similar demographic and clinical characteristics. 120/136 patients completed the study. One patient discontinued treatment due to side effects and 15 were lost to follow-up.32/136 (23.5por cento) hed side effect during treatment, mainly nause. H.pylori eradication in group 3 was statistically different from the other groups ( p=0.000). Group 3 & 4 (statistically non-different) presented significantly more side effects than group 1 and 2 (p=0.002). Conclusion: 1)Om + Associated to F (the cheapest ant- H.Pylori drug) for one week represents an efficient reasonaaable well-tolerates alternatiaaaaaave to H.pylori eradication. 2) Future studies testing F with other macrolides or Az during 7 days can enhance H. Pylori eradication rates

One-week triple therapy with omeprazole plus azithromycin and secnidazole is ineffective in eradicating "helicobacter pylori"

Background: There is not yet consensus on the most effective treatment for the helicobacter pylori infection, particularly in most developing countries. Azithromycin is a new macrolide and relatively novel agent for H. pylori eradication with an in vitro MIC90 lower than 1 mg/ml.Secnidazole, a nitromidazole that causes fewer side effects than metronidazole, was recenty reported to be used, for the firt time, in the treatment of H. pylori infection. Aim: To evaluate, in a prospective, randomized, single-center study, the association of twodifferent doses of omeprazole, azithromycin and secnidazole in H. pylori eradication. Patients and methods: After informed consent, 55 patients (36m,19F) with duodenal ulcer associated with H. pylori infection were randomized to receive omeprazole 20mg uid (Group A) or 20mg bid (Group B) for sevem days plus azithromycin 500mg uid for six days and secnidazole 2,000mg uid in the first, fourth and seventh day. The H. pylori status was assessed before and 60-90 days posttreatment using urease test, histology and 13C-urea breath test. Statistical analysis was performed by X² test. Results: The two groups had similar demographic characteristics. Fifty-five patients (36M, 19F) were enrolled. Six patients did not show-up for the second visit posttreatment. So, of the 49 evaluable patients, 25por cento (6/24) in Group A and 44por cento(11/25) in Group B wereeradicated, in a per protocol (PP) analysis. Intetion-to-treat (ITT) eradication rates were 21,4por cento (6/28) in Group A and 40.7por cento (11/27) im Group B. The differences betweem ITT and PP analysis from the two groups were not statistically significant. Conclusions: This study shows a very low eradication rate with the two regimens comprising of omeprazole, azithromycin and secnidazole and therefore, should not be recommended for thetreatment of H. pylori infection

Application of isotope-selective non-dispersive infrared spectrometry for the evaluation of the 13C-urea breath test: comparison with three concordant methods

The aim of this work was to compare the performance of isotope-selective non-dispersive infrared spectrometry (IRIS) for the 13C-urea breath test with the combination of the 14C-urea breath test (14C-UBT), urease test and histologic examination for the diagnosis of H. pylori (HP) infection. Fifty-three duodenal ulcer patients were studied. All patients were submitted to gastroscopy to detect HP by the urease test, histologic examination and 14C-UBT. To be included in the study the results of the 3 tests had to be concordant. Within one month after admission to the study the patients were submitted to IRIS with breath samples collected before and 30 min after the ingestion of 75 mg 13C-urea dissolved in 200 ml of orange juice. The samples were mailed and analyzed 11.5 (4-21) days after collection. Data were analyzed statistically by the chi-square and Mann-Whitney test and by the Spearman correlation coefficient. Twenty-six patients were HP positive and 27 negative. There was 100 per cent agreement between the IRIS results and the HP status determined by the other three methods. Using a cutoff value of delta-over-baseline (DOB) above 4.0 the IRIS showed a mean value of 19.38 (minimum = 4.2, maximum = 41.3, SD = 10.9) for HP-positive patients and a mean value of 0.88 (minimum = 0.10, maximum = 2.5, SD = 0.71) for negative patients. Using a cutoff value corresponding to 0.800 per cent CO2/weight (kg), the 14C-UBT showed a mean value of 2.78 (minimum = 0.89, maximum = 5.22, SD = 1.18) in HP-positive patients. HP-negative patients showed a mean value of 0.37 (minimum = 0.13, maximum = 0.77, SD = 0.17). IRIS is a low-cost, easy to manage, highly sensitive and specific test for H. pylori detection. Storing and mailing the samples did not interfere with the performance of the test.

Associação timoma e estrongiloidíase intestinal grave / Association of thymoma and severe intestinal strongyloidiasis

A 59-years-old man with thymoma and severe intestinal strongyloidiasis is reported. The authors pointed out a possible influence of immunological response related with thymoma in the development of hyperinfection by Strongyloides stercoralis.

Os autores relatam o caso de um homem de 59 anos de idade com timoma e estrongiloidíase intestinal grave. São revistos aspectos da resposta imunitária relacionados ao tumor e, possivelmente, implicados no desenvolvimento da hiperinfecção pelo Strongyloides stercoralis.

Histology of the mucosa of gastric antrum and body before and after eradication of Helicobacter pylori

1. Helicobacter pylori status and the histology of the antral and oxyntic mucosa were evaluated in 25 patients with duodenal ulcer treated with a triple schedule of furazolidone, metronidazole and amoxicillin, and in 16 patients treated only with cimetidine. 2. Before treatment, H. pylori was detected in all patients. One month after treatment with the antimicrobial agents, H. pylori was not found in 18 (72.0 per cent ) of 25 patients treated with the triple schedule. In the patients treated with cimetidine (N = 16) the H. pylori tests continued to be positive after treatment. 3. Inflammatory activity and intensity of gastritis were significantly reduced in patients treated with the antimicrobial agents but not in cimetidine-treated patients. Three patients who had negative cultures and improvement of gastritis 1 month after treatment became H. pylori positive again within 2 months, with concomitant reappearance of gastritis. 4. This study provides additional evidence that histological gastritis observed in H. pylori-positive patients with duodenal ulcer is due to the presence of the microorganism

The effect of chronic ingestion of ethanol on modulation of granulomatous inflammation in experimental schistosomiasis in mice

We studied the role of ethanol on the modulation of liver granulomata around Schistosoma mansoni eggs in mice. Albino mice, receiving 7 ethanol as the sole drinking liquid, at 60 and 90 days post-infection, presented smaller granulomata than controls did, when sacrificed at 120 days post-infection. No differences in diameters could be observed, when ethanol was given 4 months before up to 120 days after infection. The results suggested that modulation of schistosome granulomata by ethanol ingestion varies with time and duration of drug consumption.

Antiácido de alta potência versus cimetidina no tratamento da úlcera duodenal: comodidade posológica / High potency antacid versus cometidine in the treatment of duodenal ulcer: commodus psosology

Foram estudados 98 pacientes com úlcera péptica duodenal distribuídos de forma randômica em dois grupos. Um grupo recebeu antiácido liquido de alta potência (282,4mEq/dia) dividido em 4 tomadas durante 4 semanas e outro recebeu cimetidina (800 mg/dia) dividida em 2 tomadas por igual período. A potência antiácida da associaçäo líquida utilizada é de 7,06 mEq/ml. Todos os pacientes foram avaliados clinicamente no pré-tratamento e duas e quatro semanas após, com exames endoscópicos realizados na admissäo e após quatro semanas. A eficácia, considerada como cicatrizaçäo da úlcera duodenal associada a melhora da sintomatologia foi equivalente para ambos os tratamentos, näo havendo diferença estatisticamente significante. A tolerabilidade de ambas as drogas foi considerada boa

Comparison of the urease test and of direct smear examination in the control of treatment of Helicobacter pylori-induced infection

The sensitivity and specificity of the preformed urease test and of carbolfuchsin-stained smears for the diagnosis of the presence of Helicobacter pylori in gastric mucosa were evaluated before and after antimicrobial treatment. The results obtained by culture were used as the reference point. We studied 41 patients with endoscopically diagnosed duodenal ulcer. Twenty-five of these were treated with furazolidone (100 mg t.i.d.), amoxicillin (500 mg t.i.d.) and metronidazole (250 mg t.i.d.) for 5 days and then with only furazolidone (100 mg t.i.d.) for an additional 25 days. The 16 control patients were treated with cimetidine (800 mg, 4 times a day). The sensitivity of the urease test and of direct smear examination was 100 per cent before treatment and 84.6 per cent and 92.3 per cent , respectively, after treatment. We conclude that the urease test and carbolfuchsin-stained smears, which are highly sensitive for H. pylori diagnosis, present reduced sensitivity when they are employed for the follow-up of patients treated with antimicrobials

Relationship between Sakita endoscopic stage and duration of treatment for duodenal ulcer healing

Endoscopic staging of peptic ulcer lesions according to Sakita will be a methodological improvement in therapeutic trials provided that the correlation between stages and the time spent in treatments is proved valid. We describe a double-blind controlled randomized trial carried out to determine the efficacy of cimentidine in patients with duodenal ulcer in the H stage of Sakita endoscopic staging. Fifty-two patients with duodenal ulcer (H stage) were randomly allocated to receive either 400 mg cimetidine twice daily (N = 26), or placebo (N = 26) for two weeks; patients with unhealed ulcers continued the same treatment for an additional week. Of the cimetidine-treated patients, 19 (73%) were healed after two weeks and 23 (88.5%) after three weeks of treatment, and of the placebo-treated patients, 8 (31%) were healed after two and 13 (50%) after three weeks. These differences indicate a natural tendency of the H stage lesions to heal faster than reported for the active (stage A) lesions and still faster if treated with cimetidine. These findings, by establishing a relationship between the ulcer stage and the time spent in treatment, may help the physician to treat duodenal ulcer patients and will enable the adoption of an important, uniform criterion for selection of duodenal ulcer patients for therapeutic trials, especially in multicenter trials

Efeitos da pirenzepina sobre o pH do conteudo gastrico e sobre a secrecao acida basal e a estimulada pelo betazol, em pacientes com ulcera duodenal. / Effects of pirenzepin on pH of the gastric content and on the basal acid secretion and the stimulated by betazole, in patients with duodenal ulcer

O efeito da pirenzepina sobre o pH do conteudo gastrico e sobre a secrecao basal de acido e a estimulada pelo betazol foi estudado em pacientes com ulcera duodenal.Os resultados demonstraram que a pirenzepina, duas horas apos uma dose de 50 mg, por via oral, reduziu significativamente a acidez gastrica basal, mas nao modificou a secrecao estimulada pelo betazol. Verificou-se, tambem, que a pirenzepina, na dose de 150 mg, em tres tomadas diarias de 50mg nao alterou significativamente o pH do conteudo gastrico, durante as 24 horas do dia

Efeito de diferentes esquemas terapeuticos de antiacido sobre a acidez do conteudo gastrico, variando a dose e o horario de administracao, em pacientes com ulcera duodenal. / Effect of different therapeutic schedules of antacids on the pH of gastric content, varying dosage and time of administration, in patients with duodenal ulcer

Foram comparados os efeitos de tres diferentes esquemas terapeuticas de antiacido sobre o pH do conteudo gastrico, em 10 pacientes portadores de ulcera peptica duodenal: esquema I (periodo/controle), sem antiacido; esquema II, com 6 doses de antiacido com uma potencia antiacida de 49mEq por dose, ministradas 1 e 3 horas apos as tres principais refeicoes; esquema III, com 3 doses de antiacido de 98mEq, 2 horas apos as refeicoes e, finalmente, esquema IV, com 3 doses com potencia antiacida de 147mEq de antiacido, tambem, ministradas 2 horas apos as refeicoes. A cada hora, de 8 as 22 horas, colhia-se uma aliquota do conteudo gastrico para determinacao potenciometrica do pH. Considerouse sucesso terapeutico a ocorrencia de pH igual ou superior a 3,0. Os tres esquemas com antiacido (II, III e IV) foram superiores ao esquema I (controle), do qual diferiram de forma altamente significativa. Os esquemas II e IV foram iguais entre si e superiores ao esquema III

Efeito de antiacido contendo calcio sobre a secrecao gastrica de acido em pacientes com ulcera duodenal. / Effect of antacid containing calcium of gastric acid secretion, in patients with duodenal ulcer

O efeito de um antiacido contendo calcio, sobre a secrecao gastrica de acido, foi estudado em oito pacientes com ulcera duodenal. Os resultados demonstram que o antiacido contendo calcio na dose de 15 ml, correspondente a uma potencia antiacida de 49,5 mEq, nao provoca a estimulacao da secrecao gastrica acida, nas condicoes do teste, quando comparado com a dose equivalente de bicarbonato de sodio

Alteracoes da mucosa gastrica provocadas pelo teste aumentado do Histalog: estudo endoscopico e histopatologico. / Gastric mucosal changes induced by augmented Histalog test: endoscopic and histopathological study

Avaliou-se endoscopica e histologicamente, em 11 voluntarios, os efeitos sobre a mucosa gastrica, de doses maximas do cloridrato de betazol (Histalog).Gastroscopicamente, nao foram constatadas alteracoes em tres pacientes, enquanto seis mostraram congestao de ligeira a moderada da mucosa gastrica e em dois foram vistos sangramentos petequiais esparsos. No estudo das alteracoes histologicas verificadas na mucosa do corpo e antro gastricos, antes e apos a administracao do Histalog, nao se constatou diferenca estatisticamente significante na ocorrencia de erosoes, hemorragia e adenoma. Concluiu-se que doses maximas de Histalog nao causam hemorragia significante na mucosa gastrica e que a cor amarronzada do suco gastrico, aspirado nas ultimas porcoes de um teste aumentado de Histalog deve-se mais ao traumatismo da succao pela sonda nasogastrica, numa mucosa gastrica congesta pela acao do Histalo

Antiacidos: estudo da potencia, da cinetica de neutralizacao e do custo financeiro. / Antacids: study of potentiation, neutralization kinetics and financial cost

Foram estudados 45 preparados antiacidos comercializados em farmacias de Belo Horizonte, Minas Gerais, com o objetivo de obter dados para escolha racional destes medicamentos no tratamento de doencas acido-pepticas. Utilizou-se, para a determinacao da potencia antiacida total e da cinetica de neutralizacao, o metodo proposto por Fordtran e cols. (1973), ligeiramente modificado por Ribeiro (1980), que consiste na titulacao, pelo acido cloridrico 0,1 N, de solucao-teste do antiacido ate pH 3,0. Constatou-se: 1) variacao de ate 17 vezes da potencia antiacida total dos antiacidos liquidos; 2) variacao de ate 19,5 vezes da potencia antiacida total dos antiacidos solidos; 3) que os antiacidos liquidos, geralmente, foram mais potentes que seus correspondentes solidos, proporcionando uma posologia unitaria mais adequada ao uso clinico; 4) variacao de zero a 230 min no tempo final para liberacao da potencia antiacida total; e, 5) variacao de ate 84 vezes do custo financeiro de uma dose padrao, convencionada em 100mEq

Efeitos da cimetidina, do antiacido e da dieta livre sobre o pH do conteudo gastrico em pacientes com ulcera peptica. / Effects of cimetidine, antacids and free diet on pH of the gastric content in patients with peptic ulcer

Foi estudado o efeito da cimetidina, do antiacido e da dieta livre sobre o pH do conteudo gastrico em 28 pacientes portadores de ulcera peptica. Os resultados demonstraram que a cimetidina, na dose de 300 mg intramuscular de 6 em 6 horas, e o antiacido, na dose de 10 ml de suspensao ministrada de hora em hora, no intervalo das refeicoes, tem o mesmo poder de manter o pH do conteudo gastrico igual ou superior a 3,0