Effects of anti-H. pylori triple therapy and a probiotic complex on intestinal microbiota in duodenal ulcer.

This study aimed to investigate the intestinal microbiota in duodenal ulcer (DU) patients, effects of proton pump inhibitors,clarithromycin and amoxicillin, PCA) for Helicobacter pylori (H. pylori) and Bacillus subtilis and Enterococcus faecium (BSEF) on intestinal microbiota. DU patients were randomly assigned to receive either PCA (group TT) or PCA plus BSEF(group TP). The fecal microbiome was conducted using high throughput 16S rDNA gene and internal transcribed spacer sequencings. The diversity and abundance of intestinal bacteria in the DU were significantly lower than health check control (HC) group. In the TT group, the abundance and diversity of both intestinal bacteria and fungi decreased after PCA treatment, compared with those before treatment, whereas in the TP group no obvious changes were observed. In the TT group at all the time points, both the intestinal bacteria and fungi were different from those in the HC group. However, in the TP group, at 10w the bacterial flora abundance was close to that in the HC group. The results indicate that anti- H. pylori treatment induced significant decrease in the diversity of intestinal microbiota, while the combined therapy supplemented with BSEF could protect and restore the intestinal microbiota.

Efficacy and Tolerability of Two Quadruple Regimens: Bismuth, Omeprazole, Metronidazole with Amoxicillin or Tetracycline as First-Line Treatment for Eradication of Helicobacter Pylori in Patients with Duodenal Ulcer: A Randomized Clinical Trial.

AIM: To evaluate the efficacy and tolerability of tetracycline vs. high-dose amoxicillin in bismuth-based quadruple therapy for Helicobacter pylori(H. pylori) eradication. METHODS: This randomized, open-label clinical trial included 228 patients with H.pylori infection and duodenal ulcer without a history of H.pylori treatment. Patients were randomly divided into two groups. The amoxicillin group received metronidazole 500mg, bismuth subcitrate 240mg, and amoxicillin 1000mg, all three times a day, plus omeprazole 20 mg twice a day, for 14 days. The tetracycline group received metronidazole 500mg three times a day; bismuth subcitrate240mg and tetracycline HCl 500mg, both four times a day; and omeprazole 20 mg twice a day, for 14 days. Evaluation for compliance and drug-relatedadverse effects were evaluated at the end of two weeks. Eight weeks after the end of treatment, the rate of H.pylori eradication was assessed by the C13urease breath test. RESULTS: There were no significant demographic differences between the two groups. Eradication rate was higher with the amoxicillin-containing regimen than the tetracycline-containing regimen: 105/110 (95.51%; 95% confidence interval, 91.5%-99.3%) vs. 88/105 (83.8%; 95%CI, 76.7%-90.8%) by per-protocol analysis (p = 0.005) and 92.9% (95%CI, 88.1%-97.6%) vs. 76.5% (95%CI, 68.7%-84.2%) by intention-to-treat analysis (ITT, p = 0.001). Adverse effects were significant higher in the tetracycline groupthan in the amoxicillin group (65.2% vs. 43.4%; p = 0.001). CONCLUSION: Bismuth-based quadruple therapy including high-dose amoxicillin and metronidazole achieved an acceptable rate of H.pylori infection eradication with good tolerance in patients with duodenal ulcer. This regimen can overcome treatment resistance in areas with high prevalence of metronidazole and clarithromycin resistance. TRIAL REGISTRATION: The Thai Clinical Trial Registry (TCTR) 20170623004.

Higher dietary cholesterol and ω-3 fatty acid intakes are associated with a lower success rate of Helicobacter pylori eradication therapy in Japan.

Background:Helicobacter pylori infection is a known risk factor for duodenal ulcers, gastritis, and gastric cancer. The eradication of H. pylori is successful in treating these disorders; however, the success rate of eradication therapy is declining. There may be an interaction with nutrient intake to account for this decline.Objective: We investigated the influence of food and nutrient intake on H. pylori eradication therapy.Design: In this study, 4014 subjects underwent endoscopy, were tested for serum antibodies to H. pylori (2046 positive; 51.0%), and had their food intake assessed with the use of a food-frequency questionnaire (FFQ). Of the positive subjects, endoscopies showed that 389 (19.0%) had gastritis and/or duodenal ulcers and were also positive for a 13C-urea breath test (UBT). These 389 subjects received 1-wk H. pylori eradication therapy with lansoprazole, amoxicillin, and clarithromycin and a second UBT 8 wk after treatment. Complete demographic characteristics, serum lipid, insulin, glycated hemoglobin, C-reactive protein (CRP), and creatinine concentrations as well as complete FFQs were available for 352 subjects. Multivariate logistic regression analyses were performed to determine factors that were associated with successful H. pylori eradication therapy.Results: The success rate of eradication therapy was 60.4% (235 of 389). Factors associated with the failure of eradication therapy included increased age (P = 0.02), higher CRP concentrations (P < 0.01), higher dietary cholesterol (P < 0.01) or egg intake (P < 0.01), higher ω-3 (n-3) fatty acid (P = 0.02) or fish intake (P = 0.01), and higher vitamin D intake (P = 0.02). Moreover, the higher vitamin D intake was strongly linked to higher fish intake. A limitation of the study is that we did not assess the antibiotic resistance of H. pyloriConclusions: Our results indicate that higher egg and fish intake may be negatively correlated with successful H. pylori eradication therapy in H. pylori-positive subjects with gastritis and/or duodenal ulcers.

Efficacy and safety of Jianzhong decoction in treating peptic ulcers: a meta-analysis of 58 randomised controlled trials with 5192 patients.

BACKGROUND: Jianzhong decoction is widely used to treat peptic ulcers; however, due to lack of systematic evaluations, its clinical efficacy remains controversial. We performed meta-analysis to evaluate the efficacy and safety of Jianzhong decoction in treating peptic ulcers. METHODS: Studies were systematically retrieved from PubMed, Embase, Cochrane library, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP, China Biology Medicine disc (CBMdisc), and references cited in related studies/reviews. Extracted data included the total effective rate, helicobacter pylori eradication rates, recurrence rate, and adverse reaction rate. Fifty-eight randomised controlled trials involving 5192 patients were included in the final analysis. RESULTS: Results showed that Jianzhong decoction therapy was more effective than conventional Western medicine therapy (total effective rate, odds ratio [OR] = 4.29, 95% confidence interval [CI]: 3.51-5.23, P = 0.000; helicobacter pylori eradication rates, OR =2.10, 95% CI: 1.69-2.61, P = 0.000; recurrence rate, OR =0.23, 95% CI: 0.18-0.29, P = 0.000; and adverse reaction rate, OR =0.20, 95% CI: 0.12-0.33, P = 0.000). CONCLUSIONS: Jianzhong decoction increased the total effective rate and helicobacter pylori eradication rate, and lowered the recurrence and adverse reaction rates. The results of this study can be used as a guide for clinical treatment of peptic ulcers.

Helicobacter pylori and gastric or duodenal ulcer.

In patients with gastric or duodenal ulcer associated with Helicobacter pylori, treatment of the infection improves healing and prevents complications and recurrences. The drug regimen generally consists of a high-dose proton-pump inhibitor (PPI) such as omeprazole plus antibiotics. Using the standard Prescrire methodology, we conducted a review of the literature in order to determine the standard empirical antibiotic regimen for H. pylori infection in adults with gastric or duodenal ulcer in France. In 2015, due to an increase in H. pylori resistance to clarithromycin, a 7-day course of the PPI + clarithromycin + amoxicillin combination is effective in only about 70% of cases. A Cochrane systematic review and meta-analysis of trials involving thousands of patients suggests that prolonging treatment with a PPI + amoxicillin + clarithromycin or a PPI + amoxicillin + metronidazole to 10 or 14 days improves the rate of H. pylori eradication by 5% to 10%. A metanalysis of seven trials including a total of about 1000 patients showed that combination therapy with a PPI + amoxicillin + clarithromycin + metronidazole for 5 days eradicates H. pylori in about 90% of cases, compared to about 80% of cases with a PPI + amoxicillin + clarithromycin given for 7 days. Sequential treatment with amoxicillin for 5 days, followed by clarithromycin + metronidazole for 5 days, has also been tested in thousands of patients. Efficacy and adverse effects were similar to those observed when the same antibiotics were taken simultaneously for 5 days. In randomised trials, replacing clarithromycin or amoxicillin with a fluoroquinolone yielded conflicting results. In 2009, nearly 20% of H. pylori isolates were resistant to levofloxacin in France. Tetracycline has only been evaluated in combination with bismuth. The few available data on doxycycline suggest that its efficacy is similar to that of tetracycline. A fixed-dose combination of bismuth subcitrate potassium + metronidazole + tetracycline is authorised in the European Union for use in combination with omeprazole for 10 days. It seems effective, even in case of clarithromycin resistance. However, bismuth can cause encephalopathy, and its value when added to antibiotics and a PPI is poorly documented. We found no robust comparative data on second-line empirical treatments. In patients with gastric or duodenal ulcer associated with H. pylori, eradication of the bacterium reduces the risk of complications and recurrence. In mid-2015, the choice of antibiotics is based on trials in which the primary endpoint was a negative urea breath test, which is an acceptable surrogate criterion. In previously untreated patients, the first-choice empirical treatment consists of three antibiotics: amoxicillin (2 g daily), clarithromycin (1 g daily) and metronidazole (1 g daily), plus a PPI (in practice, omeprazole 40 mg daily), with each drug taken in two divided doses per day. The antibiotics may be taken either simultaneously for five days, or sequentially (amoxicillin for 5 days, followed by clarithromycin + metronidazole for 5 days). The adverse effects of these antibiotic combinations correspond to those of their component drugs, which mainly consist of gastrointestinal disorders and the disulfiram-like reaction of metronidazole. Amoxicillin can be replaced by a fluoroquinolone in patients allergic to beta-lactam antibiotics, but there is a higher risk of resistance. Tetracycline and doxycycline appear effective, as few H. pylori strains are resistant in vitro. Bismuth can cause encephalopathy and should only be used in special cases.

EVIDENCE BASE OF LACTOBACILLUS REUTERI EFFICACY IN THE TREATMENT OF DISEASES ASSOCIATED WITH HELICOBACTER PYLORI.

Helicobocterpylori (HP) - the human infection that persists for a long time in the stomach and can cause chronic gastritis, gastric and duodenal ulcer, MALT-lymphoma, gastric adenocarcinoma. There is a well-adapted niche-specific microbial community in the stomach represented by Lactobocillus, Streptococcus ahd other bacteria. Use of probiotics is considered to be an alternative or supplement to eradication therapy Among the Lactobacillus the most promising is Loctobocillus reutert who are able to have the anti-HP activity L. reureri produces powerful antimicrobial compounds such as reuterin, reuteritsin 6, reutetsiklin and metabolites that inhibit the growth of I-/P (volatile fatty acids, lactic acid, hydrogen peroxide, etc.). These compounds could reduce the adhesion of HP to gastric epithelial cells, inhibit growth HP, which leads to a significant reduction in the degree of contamination of HP and the severity of gastric mucosal inflammation. The data on the effectiveness of L. re uteri as monotherapy in patients with HP without absolute indications for eradication, and as an additional component, which increase the effectiveness of eradication are presented.

Development of bacterial transglycosylase inhibitors as new antibiotics: moenomycin A treatment for drug-resistant Helicobacter pylori.

The problem of multidrug-resistant Helicobacter pylori requires new antibiotics development. We have evaluated a potential antibiotics, moenomycin A, which is classified as a phosphoglycolipid antibiotics that targets transglycosylase and is previously thought to be limited in Gram-positive bacteria. Herein, we report the activity of moenomycin A against multidrug-resistant H. pylori and the isolates from patients with different gastrointestinal diseases.

[The Parkinson puzzle]. / A Parkinson-puzzle.

Parkinson's disease is one of the most frequent progressive degenerative disorders with unknown origin of the nervous system. The commutation of the disease on Guam led to the discovery of a neurotoxin which was also found in other continents. This neurotoxin was identified in the common cyanobacteria (blue-green algae). Early clinical observations suggested some loose correlations with gastric and duodenal ulcer and Parkinson's disease, while recent studies revealed a toxin, almost identical to that found in cyanobacteria in one strain of Helicobacter pylori, which proved to cause Parkinson like symptoms in animals. Therefore, it cannot be ruled out that there is a slowly progressive poisoning in Parkinson's disease. The disease specific alpha-sinuclein inclusions can be found in nerve cells of the intestinal mucosa far before the appearance of clinical symptoms indicating that the disease may start in the intestines. These results are strengthened by the results of Borody's fecal transplants, after which in Parkinson patients showed a symptomatic improvement. Based on these observations the Parkinson puzzle is getting complete. Although these observations are not evidence based, they may indicate a new way for basic clinical research, as well as a new way of thinking for clinicians. These new observations in psycho-neuro-immunology strengthen the fact that immunological factors may also play a critical factor facilitating local cell necrosis which may be influenced easily.

[Jinghuaweikang capsules combined with triple therapy in the treatment of Helicobacter pylori associated gastritis and duodenal ulcer and analysis of antibiotic resistance: a multicenter, randomized, controlled, clinical study].

OBJECTIVE: To explore the efficacy of Jinghuaweikang capsules plus triple therapy (LACJ) in treatment of Helicobacter pylori (H. pylori) associated gastritis or duodenal ulcer, compare it with bismuth-containing quadruple therapy (LACB) and standard triple therapy (LAC) and analyze the antibiotic sensitivity of gastric mucosal H. pylori strains from the failed patients. METHODS: A total of 565 patients with H. pylori infection were recruited from 11 hospitals from January 2010 to June 2011. There were 336 males and 229 females. They underwent gastroendoscopy examination due to upper gastrointestinal symptoms and had never received H. pylori eradication therapies. Duodenal ulcer patients were divided randomly into LACJ therapy group, LACB therapy group and LAC therapy group while gastritis patients LACJ therapy group and LACB therapy group. Group LAC received lansoprazole 30 mg + amoxicillin 1000 mg + clarithromycin 500 mg, twice a day, for 7 d (d1-7). Group LACJ: LAC therapy plus Jinghuaweikang, 3 capsules, twice a day, for 7 d (d1-7) then Jinghuaweikang, 3 capsules, twice a day, for 14 d (d8-21). Group LACB: LAC plus bismuth potassium citrate 220 mg, twice a day, for 7 d (d1-7) and then bismuth potassium citrate 220 mg, twice a day, for 14 d (d8-21). All duodenal ulcer patients received lansoprazole (30 mg, once a day) for 14 days after the first 7-day of treatment (d 8-21). At least 28 days after the end of treatment, all patients underwent (13)C urea breath test. Gastric mucosa was collected under endoscopy from the failed patients. The detection technique of gene chip was employed to detect antibiotics resistant gene from mucosa. RESULTS: The eradication rates of duodenal ulcer patients in groups LACJ, LACB and LAC were as follows: per-protocol (PP), 80.2% (77/96), 89.9% (89/99) and 72.2% (70/97) (P = 0.007), intention-to-treat (ITT), 78.6% (77/98), 88.1% (89/101) and 70.0% (70/100) (P = 0.007). No statistical differences existed between groups LACJ and LACB or LAC (all P > 0.05). But there were statistical differences between groups LACB and LAC (both P = 0.002). The eradication rates of PP and ITT of chronic gastritis patients in groups LACJ and LACB were as follows: 75.8% (97/128), 74.6% (97/130) vs 83.8% (109/130), 80.1% (109/136) (both P > 0.05). The symptomatic improvements of abdominal pain, burning and acid reflux of duodenal ulcer patients in group LACJ were higher than those in groups LACB and LAC. There were statistical differences between groups LACJ and LAC (all P < 0.05). The symptomatic improvements of bloating and belching for chronic gastritis patients in group LACJ were higher than those of group LACB. But no significant difference existed between two groups (all P > 0.05). Sixty samples of gastric mucosa were collected from the failed patients. The detection rates of antibiotic-resistant gene to clarithromycin and amoxicillin were 60.0% (36/36) and 18.3% (11/60) respectively. CONCLUSIONS: The efficacy of LACJ for the treatment of H. pylori infection patients is similar to LACB and superior to LAC. And the symptomatic improvement of patients is better than the other two regimens. The main cause of treatment failure is antibiotic resistance of H. pylori strains.

[Use of the immunopotentiator N-acetyl-glucosamine-N-acetylmuramyl dipeptide during triple anti-Helicobacter pylori therapy].

AIM: To evaluate the efficiency of first-line Helicobacter pylori eradication therapy with glucosaminylmuramyldipeptide (Licopid JSC "Peptek", Russia). SUBJECTS AND METHODS: Eradication therapy was performed in 128 patients (84 men and 34 women; mean age 44.1 +/- 13.5 years) with duodenal bulb ulcer associated with H. pylori. The latter was detected in the gastroduodenal mucosa by a morphological study and rapid urease test before and 6-8 weeks after treatment and discontinuation of all drugs. Gastric metaplasia areas in the duodenum were revealed by periodic acid-Schiff and Alcian blue staining. The patients were divided into 4 groups according to the treatment protocol: 1) omeprazole (O) 0.04 g/day, clarithromycin (C) 1 g/day, amoxicillin (A) 2 g/day for 7 days (OCA7; n = 33); 2) the above drugs for 14 days (OCA14; n = 34); 3) O 0.04 g/day, C 1 g/day, A 2.0 g/day for 7 days, and glucosaminylmuramyldipeptide (Licopid) (L) 0.001 g/day for a day (OCA7L1; n = 34) and 4) the above drugs and L 0.01 g/day for 10 (OCA7L10; n = 27). RESULTS: According to the data of intention-to-treat analysis and per protocol, the H. pylori eradication rate was 81.8 and 87.1% for OCA7; 82.4 and 93.3% for OCA14; 88.2 and 93.8% for OCA7L1; 88.9 and 96% for OCA7L10 after PT and RRT, respectively. The rate of side effects was as follows: 6.1% for OCA7; 17.6% for OCA14 (5.9% stopped treatment); 5.9% for OCA7L1; 7.4% for OCA7L10. The cost of the treatment protocols was $ 32 for OCA7; $ 64 for OCA14; $ 40 for OCA7L1; $ 67 for OCA7L10. The intake of glucosaminylmuramyldipeptide (licopid) 0.001 g/day during 7-day triple anti-Helicobacter pylori therapy increased eradication by 6.4% (ITT) and 6.7% (PP), without raising the rate of side effects. CONCLUSION: H. pylori-positive patients with duodenal bulb ulcer should be given glucosaminylmuramyldipeptide (Licopid) 0.001 g/day during 7-day first-line eradication therapy as alternative to the 14-day treatment regimen.

Adjuvant effect of vitamin C on omeprazole-amoxicillin-clarithromycin triple therapy for Helicobacter pylori eradication.

BACKGROUND/AIMS: To test the impact of vitamin C supplementation on triple therapy for H. pylori eradication. METHODOLOGY: A total of 171 H. pylori-infected patients were randomized to receive different one-week triple therapies, including 20 mg omeprazole, 1 g amoxicillin, plus the following twice daily: (1) 250 mg clarithromycin (C250 group, n=55); (2) 250 mg clarithromycin and 500 mg vitamin C (V-C250 group, n=61); (3) 500 mg clarithromycin (C500 group, n=55). Six weeks after treatment, the success of H. pylori eradication was assessed by a 13C-urea breath test. Each collected H. pylori strain was defined as either clarithromycin susceptible or resistant by E-test. RESULTS: The demographic background, clarithromycin susceptibility of H. pylori, and drug compliance were similar among the three groups (p=NS). For clarithromycin susceptible infection, the V-C250 group had a higher eradication rate than the C250 group (ITT: 85% vs. 68% and PP: 90% vs. 73%, p = 0.03), but had an equivalent rate to the C500 group (p=NS). For clarithromycin resistant infection, all three groups had a similarly poor eradication rate of less than 34%. CONCLUSIONS: Adding vitamin C to one-week triple therapy can reduce the dosage of clarithromycin, but preserve the high eradication efficacy for clarithromycin susceptible H. pylori infection.

[Comparative study on Jinghua Weikang Capsule and famotidine in treating duodenal ulcer].

OBJECTIVE: To compare the effect and security of Jinghua Weikang Capsule (JWC) and famotidine in treating duodenal ulcer. METHODS: Two hundred patients with duodenal ulcer were randomly divided into the treated group treated with JWC, 160 mg 3 times per day and the control group treated with famotidine 20 mg twice per day, both by orally taking before meal for 4 weeks, 100 cases in each group. Changes of symptom score, adverse reaction, helicobacter pylori (Hp) infection and endoscopic figure before and after treatment were observed. RESULTS: The general remission rate and the ulcer healing rate in the treated group were equal to those in the control group respectively (both P > 0.05). Symptoms including belly ache, sour regurgitation and abdominal distension were ameliorated after therapy in both groups (all P < 0.05). The effect in relieving anorexia and eructation and Hp eradication rate were significantly higher in the treated group than those in the control group (all P< 0.05), while the incidence rate of adverse reaction in the treated group was remarkably lower than that in the control group (P < 0.05). CONCLUSION: JWC is an effective and safe remedy in treating duodenal ulcer, especially for symptom amelioration and Hp eradication, so it is worthy of expanding clinically.

[Clinical and immunological aspects of low-intensity laser irradiation in patients with gastroduodenal ulcers]. / Kliniko-immunologicheskie aspekty nizkointensivnogo lazernogo izlucheniia u bol'nykh iazvennoi bolezn'iu gastroduodenal'noi zony.

Laser iridotherapy was carried out simultaneously with irradiation of immuno-competent zones on the integument of the human body in patients with stomach and duodenal ulcers. As a result of such treatment, it was discovered that laser therapy has immunomodulating action leading to the reduction of the ulcer cicatrisation period.

Effect of Helicobacter pylori eradicated therapy on water gastric emptying in patients with active duodenal ulcer.

BACKGROUND AND AIMS: It remains debatable if duodenal ulcer (DU) or Helicobacter pylori infection has a definite impact on human gastric emptying (GE). We explored the nature of water GE in active DU patients before and after ulcer healing and the influence of H. pylori eradication on GE. METHODS: A home made applied potential tomography (APT) was used to measure liquid GE. Twelve electrodes were placed in a circular array around the upper abdomen of studied subjects. After drinking 500 mL of ion-free water, paired electrodes injected electrical current and the remaining 10 electrodes recorded signals, one-by-one in a rotating order. Based on tomographical calculation, the serial changes of averaged signals from altered resistivities were constructed to display GE. Initially, 64 H. pylori infected active DU patients were enrolled. After APT measurement, one-week triple therapy (omeprazole, amoxicillin and clarithromycin) was dispensed. Patients were asked back to determine ulcer/H. pylori status and GE on a scheduled date 3 months later. Finally, 58 patients finished the trial with valid and readable GE data obtained. RESULTS: The ulcer healing and H. pylori eradicated rates were 91.4% and 82.8%, respectively. In general, liquid GE was prolonged in all DU patients at follow up. Of 48 eradicated patients, 35.4% manifested either enhanced or delayed GE before treatment, whereas only five (10.4%) had abnormal GE after treatment (P < 0.0001). In contrast, this characteristically normalized GE was not found in non-eradicated patients. CONCLUSIONS: Water GE of active DU patients ranges from enhanced to delayed, while an effective H. pylori triple therapy is useful not only for healing ulcers, but also for restoring abnormal GE.

Sequential treatment for Helicobacter pylori eradication in duodenal ulcer patients: improving the cost of pharmacotherapy.

BACKGROUND: Several studies have shown that Helicobacter pylori eradication rates with standard 7-day triple therapy are unsatisfactory. A novel 10-day sequential treatment regimen recently achieved a significantly higher eradication rate. To improve the pharmacotherapeutic cost, we evaluated whether an acceptable eradication rate could be achieved in peptic ulcer patients by halving the dose of clarithromycin. METHODS: In a prospective, open-label study, 152 duodenal ulcer patients with H. pylori infection, assessed by rapid urease test and histology, were enrolled. Patients were randomized to receive either a 10-day sequential treatment comprising rabeprazole 20 mg b.d. plus amoxicillin 1 g b.d. for the first 5 days, followed by rabeprazole 20 mg b.d., clarithromycin 500 mg b.d. and tinidazole 500 mg b.d. for the remaining 5 days (high-dose therapy), or a similar schedule with the clarithromycin doses halved to 250 mg b.d. (low-dose therapy). No further antisecretory drugs were offered. Four to six weeks after therapy, H. pylori eradication and ulcer healing rates were assessed by endoscopy. RESULTS: Similar H. pylori eradication rates were observed following high- and low-dose regimens for both per protocol (97.3% vs. 95.9%; P = N.S.) and intention-to-treat (94.7% vs. 92.2%; P = N.S.) analyses. No major side-effects were reported. At repeat endoscopy, peptic ulcer healing was observed in 93% and 93% of patients following high- and low-dose therapy, respectively. CONCLUSION: The cheaper low-dose sequential regimen may be suggested for H. pylori eradication in duodenal ulcer patients, even without continued proton pump inhibitor therapy after eradication treatment.

Characterization of Helicobacter pylori strainsisolated before and after therapy.

BACKGROUND: Genotypic analysis has been performed in Helicobacter pylori strains isolated before and after antibiotic therapy from patients for whom no eradication of the microbes could be achieved. MATERIAL/METHODS: The Helicobacter pylori strains were isolated from 10 patients with duodenal ulcer, who were treated by the triple therapy (Controloc with amoxicillin and metronidazole). Biopsies of gastric mucosa were inoculated on the Columbia agar with antibiotics and on the medium without antibiotics. The cultures were kept in microaerophilic conditions at 37 degrees C for 4 to 10 days. Genotype analysis was performed using PCR-based RAPD fingerprinting. The sensitivity of the strains to metronidazole, clarithromycin, amoxicillin and tetracycline was tested using RESULTS: In five patients, identical strains of the bacteria were noted both before and after the therapy while distinct patterns of pre- and post-treatment isolates were found in three patients. One patient demonstrated identical strains before and after the therapy but upon later control testing was found to be infected with a genotypically distinct strain. In 2 patients (a married couple) the infection was caused by genotypically distinct strains. A high proportion (46%) of metronidazole-resistant strains was detected. CONCLUSIONS: Therapeutic failures in treatment of Helicobacter pylori infections may either be the result of ineffective eradication of the strain from the stomach or of a re-infection. When applying treatment with antibiotics, high frequency of metronidazole resistance should be taken into

Kang wei granules in treatment of gastropathy related to Helicobacter pylori infection.

Kang Wei Granules, a granular preparation for strengthening the spleen and replenishing Qi and for clearing away heat and resolving dampness, was used in the treatment of 288 cases of gastropathy related to Helicobacter pylori infection. The effects were compared with De Nol triple therapy in the control group of 74 cases. The therapeutic results showed that Kang Wei Granules was superior to the western drugs in improving the principal symptoms of deficiency of the spleen and stomach, and retention of damp-heat in the interior (P < 0.05).

[The state of immune system and effects of current therapy and immunomodulators]. / Sostoianie immunnoi sistemy u bol'nykh iazvennoi bolezni'iu dvenadtsatiperstnoi kishki i vliianie na nee sovremennoi terapii i immunomoduliruiushchikh sredstv.

To test the conception about a pathogenetic role of correlation between gastric comtamination with Helicobacter pylori (Hp) and immune system disorders in duodenal ulcer (DU), immune status and its response to current pharmacotherapy were studied in 84 patients in an acute recurrence phase. The patients were divided into 4 representative groups to receive monotherapy with omeprasol (group 1), combination denol + amoxicillin + tinidasol (group 2), quadrotherapy with drugs of group 1 and 2 (group 3), the above quadrotherapy plus immunomodulating drugs (imunofan + tactivin + oligovit) (group 4). In recurrent DU all the components of the immune system are affected especially cellular immunity. The response to the treatment was highest in group 1 and 4 (90% healing for 3 weeks), the worst in group 2 (68%). The complex of antibacterial drugs produces a moderate immunosuppressive action. The addition of immunomodulating drugs to the quadrotherapy promotes correction of secondary immunodeficiency and secondary Hp resistance to antibacterial drugs. This leads to a rise in eradication effect from 33-55 to 84% and a decrease in the number of early recurrences (during the first 6-12 months) from 42.1-33.6 to 12.5%.

[Microflora of the peri-ulcer zone in patients with ulcer disease and its sensitivity to antibacterial agents]. / Mikroflora periul'tseroznoi zony u bol'nykh iazvennoi bolezn'iu i ee chuvstvitel'nost' k antibakterial'nym preparatam.

The investigations carried out on 126 patients with ulcer disease has shown that from bioptates of periulcer mucosa it is possible to elicit 21 kinds of microorganisms including H. pylori, in quantity 2.8-5.76 lg KOE in 1 gr of bioptate in a combination from 2 to 6 various microbial cultures. They have hemocatheretic, lecithin, urease, gelatinous, DRNA, RNA, katalase activity and cytotoxic properties, what makes the microbiological characteristics of ulcer defect close to parameters of contaminated wound. The given circumstance allows to conclude that in treatment of ulcer relapse it is necessary to suppress the activity not only H. pylori, but also another high pathogenic microbial flora. The testing of various antibacterial medications to microorganisms of periulcer zone has shown, that Ampicillin had the greatest effect in a combination with Gentamicin or Ofloxacin.

Furazolidone-based triple 'rescue therapy' vs. quadruple 'rescue therapy' for the eradication of Helicobacter pylori resistant to metronidazole.

BACKGROUND: The optimal treatment of patients with Helicobacter pylori resistant to metronidazole has not been established. AIM: To compare the efficacy of quadruple and furazolidone-based triple therapy in the eradication of H. pylori resistant to metronidazole. METHODS: Duodenal ulcer patients (n = 70) in whom initial eradication therapy failed and who harboured H. pylori strains resistant to metronidazole were randomized to receive one of the following 7-day regimens: colloidal bismuth subcitrate, 240 mg, tetracycline, 750 mg, and furazolidone, 200 mg, each given twice daily (BTF), or omeprazole, 20 mg b.d., colloidal bismuth subcitrate, 240 mg b.d., tetracycline, 500 mg q.d.s., and metronidazole, 500 mg b.d. (OBTM). H.pylori status was assessed by culture, histology and rapid urease test before treatment and 4-6 weeks after therapy. Susceptibility to metronidazole was assessed by the agar dilution method. RESULTS: H. pylori eradication rates with intention-to-treat/per protocol analyses were: BTF, 85.7%/90.9%; OBTM, 74.2%/89.6%. Duodenal ulcers were healed in nine of 10 (90%) patients in the BTF group and in all patients (12/12) (100%) in the OBTM group (P = N.S.). A significantly lower rate of adverse events was observed in the BTF group than in the OBTM group (31.4% vs. 60%, P = 0.03), but there was no difference in terms of discontinuation of treatment (2/35 vs. 6/35, P = N.S.). CONCLUSIONS: The 1-week BTF regimen was as effective as the OBTM regimen, and produced less adverse events. Thus, it may be used in patients in whom resistance of H. pylori to metronidazole is suspected.