Реферат
Eradication of Helicobacter pylori using first-line therapy is becoming less effective. Subjects who had been treated for H. pylori infection were prospectively enrolled through an on-line database registry from October 2010 to December 2012. Demographic data, detection methods, treatment indication, regimens, durations, compliance, adverse events, and eradication results for H. pylori infection were collected. Data of 3,700 patients from 34 hospitals were analyzed. The overall eradication rate of the first-line therapy was 73.0%. Eradication failure was significantly associated with old age, concomitant medication, and comorbidity. Regional differences in eradication rates were observed. The most common first-line therapy was proton pump inhibitor-based triple therapy (standard triple therapy, STT) for 7 days (86.8%). The eradication rates varied with regimens, being 73% in STT, 81.8% in bismuth-based quadruple therapy, 100% in sequential therapy, and 90.3% in concomitant therapy. The eradication rate in treatment-naïve patients was higher than that in patients previously treated for H. pylori infection (73.8% vs. 58.5%, P < 0.001). The overall eradication rate for second-line therapy was 84.3%. There was no statistical difference in eradication rates among various regimens. H. pylori eradication rate using STT is decreasing in Korea and has become sub-optimal, suggesting the need for alternative regimens to improve the efficacy of first-line therapy for H. pylori infection.
Тема - темы
Adult , Aged , Female , Humans , Male , Middle Aged , Age Factors , Anti-Bacterial Agents/therapeutic use , Databases, Factual , Drug Therapy, Combination , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Internet , Logistic Models , Prospective Studies , Proton Pump Inhibitors/therapeutic use , Registries , Republic of Korea , Treatment OutcomeРеферат
Eradication of Helicobacter pylori using first-line therapy is becoming less effective. Subjects who had been treated for H. pylori infection were prospectively enrolled through an on-line database registry from October 2010 to December 2012. Demographic data, detection methods, treatment indication, regimens, durations, compliance, adverse events, and eradication results for H. pylori infection were collected. Data of 3,700 patients from 34 hospitals were analyzed. The overall eradication rate of the first-line therapy was 73.0%. Eradication failure was significantly associated with old age, concomitant medication, and comorbidity. Regional differences in eradication rates were observed. The most common first-line therapy was proton pump inhibitor-based triple therapy (standard triple therapy, STT) for 7 days (86.8%). The eradication rates varied with regimens, being 73% in STT, 81.8% in bismuth-based quadruple therapy, 100% in sequential therapy, and 90.3% in concomitant therapy. The eradication rate in treatment-naïve patients was higher than that in patients previously treated for H. pylori infection (73.8% vs. 58.5%, P < 0.001). The overall eradication rate for second-line therapy was 84.3%. There was no statistical difference in eradication rates among various regimens. H. pylori eradication rate using STT is decreasing in Korea and has become sub-optimal, suggesting the need for alternative regimens to improve the efficacy of first-line therapy for H. pylori infection.
Тема - темы
Adult , Aged , Female , Humans , Male , Middle Aged , Age Factors , Anti-Bacterial Agents/therapeutic use , Databases, Factual , Drug Therapy, Combination , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Internet , Logistic Models , Prospective Studies , Proton Pump Inhibitors/therapeutic use , Registries , Republic of Korea , Treatment OutcomeРеферат
Although gastric cancer is quite common in Korea, the treatment outcome is relatively favorable compared to those in western countries. However, there are currently no Korean multidisciplinary guidelines for gastric cancer. Experts from related societies developed guidelines de novo to meet Korean circumstances and requirements, including 23 recommendation statements for diagnosis (n=9) and treatment (n=14) based on relevant key questions. The quality of the evidence was rated according to the GRADE evidence evaluation framework: the evidence levels were based on a systematic review of the literature, and the recommendation grades were classified as either strong or weak. The applicability of the guidelines was considered to meet patients' view and preferences in the context of Korea. The topics of the guidelines cover diagnostic modalities (endoscopy, endoscopic ultrasound, and radiologic diagnosis), treatment modalities (surgery, therapeutic endoscopy, chemotherapy, and radiotherapy), and pathologic evaluation. An external review of the guidelines was conducted during the finalization phase.
Тема - темы
Diagnosis , Drug Therapy , Endoscopy , Korea , Stomach Neoplasms , Treatment Outcome , UltrasonographyРеферат
Although, gastric cancer is quite common in Korea, the treatment outcome is relatively favorable compared to that of Western countries. However, there is no Korean multidisciplinary guideline for gastric cancer and thus, a guideline adequate for domestic circumstances is required. Experts from related societies developed 22 recommendation statements for the diagnosis (n=9) and treatment (n=13) based on relevant key questions. Evidence levels based on systematic review of literatures were classified as five levels from A to E, and recommendation grades were classified as either strong or weak. The topics of this guideline cover diagnostic modalities (endoscopy, endoscopic ultrasound, radiologic diagnosis), treatment modalities (surgery, therapeutic endoscopy, chemotherapy, radiotherapy) and pathologic evaluation. External review of the guideline was conducted at the finalization phase.
Тема - темы
Humans , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemoradiotherapy, Adjuvant , Endoscopy, Gastrointestinal , Endosonography , Evidence-Based Medicine , Follow-Up Studies , Gastrectomy , Magnetic Resonance Imaging , Positron-Emission Tomography , Republic of Korea , Stomach Neoplasms/diagnosis , Tomography, X-Ray ComputedРеферат
BACKGROUND/AIMS: A worldwide increase in amoxicillin resistance in Helicobacter pylori is having an adverse effect on eradication therapy. In this study, we investigated the mechanism of the amoxicillin resistance of H. pylori in terms of amino acid substitutions in penicillin-binding protein 1 (PBP1). METHODS: In total, 150 H. pylori strains were isolated from 144 patients with chronic gastritis, peptic ulcers, or stomach cancer. The minimum inhibitory concentrations (MICs) of the strains were determined with a serial 2-fold agar dilution method. The resistance breakpoint for amoxicillin was defined as >0.5 microg/mL. RESULTS: Nine of 150 H. pylori strains showed amoxicillin resistance (6%). The MIC values of the resistant strains ranged from 1 to 4 microg/mL. A PBP1 sequence analysis of the resistant strains revealed multiple amino acid substitutions: Val16-->Ile, Val45-->Ile, Ser414-->Arg, Asn562-->Tyr, Thr593-->Ala, Gly595-->Ser, and Ala599-->Thr. The natural transformation of these mutated genes into amoxicillin-sensitive strains was performed in two separate pbp1 gene segments. A moderate increase in the amoxicillin MIC was observed in the segment that contained the penicillin-binding motif of the C-terminal portion, the transpeptidase domain. CONCLUSIONS: pbp1 mutation affects the amoxicillin resistance of H. pylori through the transfer of the penicillin-binding motif.
Тема - темы
Adult , Female , Humans , Male , Middle Aged , Amino Acid Sequence , Amino Acid Substitution , Amoxicillin/pharmacology , Anti-Bacterial Agents/pharmacology , Helicobacter Infections/drug therapy , Helicobacter pylori/chemistry , Microbial Sensitivity Tests , Penicillin Resistance/genetics , Penicillin-Binding Proteins/chemistry , Republic of Korea , Sequence Analysis, Protein , Transformation, GeneticРеферат
Helicobacter pylori (H. pylori) causes chronic gastritis, peptic ulcer disease, primary B-cell gastric lymphoma, and adenocarcinoma of the stomach. The eradication of H. pylori infection requires combination of antibiotics including proton pump inhibitors. However, development of antibiotic resistance is a major cause of treatment failure. To select an appropriate regimen, systemic information on the antibiotic resistance is mandatory. H. pylori acquires resistance essentially via point mutations, and this phenomenon is found with most antibacterials. The prevalence of primary antibiotic resistance in H. pylori strains isolated from Korean patients has been increasing along with the shift to high minimum inhibitory concentrations from 1987 to 2009. Moreover, MIC values of secondary isolates were higher than those of primary isolates. In addition, there is an increasing tendency for the emergence of strains with multi-drug resistance. Resistance rates of H. pylori to amoxicillin, clarithromycin, metronidazole, tetracycline, ciprofloxacin, levofloxacin, and moxifloxacin have been reported up to 18.5%, 38.5%, 66.2%, 34.6%, 34.6%, 29.5%, and 23.2%, respectively. Especially, antibiotic resistance to metronidazole or clarithromycin affects undermining the efficacy of eradication treatment. Further nation-wide surveillance regarding the effect of antibiotic resistance on the eradication rate is necessary to establish the appropriate treatment for H. pylori infection.
Тема - темы
Humans , Adenocarcinoma , Amoxicillin , Anti-Bacterial Agents , Aza Compounds , B-Lymphocytes , Ciprofloxacin , Clarithromycin , Drug Resistance, Microbial , Drug Resistance, Multiple , Gastritis , Helicobacter , Helicobacter pylori , Lymphoma , Lymphoma, Non-Hodgkin , Metronidazole , Microbial Sensitivity Tests , Ofloxacin , Peptic Ulcer , Point Mutation , Prevalence , Proton Pump Inhibitors , Quinolines , Stomach , Stomach Neoplasms , Tetracycline , Treatment FailureРеферат
Prevalence of erosive esophagitis (EE) has been increasing in Korea. The purpose of this study was to estimate prevalence of EE among low socioeconomic population in Korea and to investigate risk factors for EE. We reviewed the medical records of 7,278 subjects who were examined by upper endoscopy in the Korean National Cancer Screening Program at Chung-Ang University Yong-san Hospital from March 2003 to March 2008. The study population included subjects > or = 40 yr of age who were Medicaid recipients and beneficiaries in the National Health Insurance Corporation. Multivariate analysis was used to determine risk factors for EE. Prevalence of EE was 6.7% (486/7,278). According to the LA classification system, LA-A in 344 subjects, LA-B in 135 subjects, and LA-C and D in 7 subjects. In multivariate analysis, age > or = 60 yr, male sex, BMI > or = 25, current smoking, alcohol consumption, fasting glucose level > or = 126 mg/dL, and endoscopic hiatal hernia were significant risk factors for EE. The prevalence of EE in low socioeconomic Korean population is similar to that in personal annual medical check-ups. Risk factors for EE among them include old age, male sex, BMI > or = 25, current smoking, alcohol consumption, fasting glucose level > or = 126 mg/dL, and hiatal hernia.