RESUMEN
Up to 20% of patients, or even more, will fail to obtain eradication after a standard triple therapy. The aim of this study is to evaluate the efficacy of moxifloxacine-containing regimens in the first-line treatment of Helicobacter pylori. One hundred and twenty H. pylori-positive patients were randomized into four groups to receive one of the following 14-day treatments: ranitidine bismuth citrate (RBC) 400 mg b.d. plus amoxicillin 1 g b.d. and clarithromycin 500 mg b.d. (RAC group, n = 30); RBC 400 mg b.d. plus moxifloxacine 400 mg o.d. and amoxicillin 1,000 mg b.d. (RAM group, n = 30); esomeprazole 40 mg b.d. plus amoxicillin 1,000 mg b.d. plus clarithromycin 500 mg b.d. (EAC group, n = 30); and esomeprazole 40 mg b.d. plus amoxicillin 1,000 mg b.d. plus moxifloxacine 400 mg o.d. (EAM group, n = 30). Eradication was assessed by (13)C urea breath test 8 weeks after therapy. Per-protocol and intention-to-treat eradication was achieved in 23 out of 30 patients (76.7%, 95% confidence interval [CI]: 61-92) in the RAC group, in 20 patients (66.7%, 95% CI: 49-84) in the RAM group, in 16 patients in the EAM group (53.3%, 95% CI: 34-71), and in 19 patients in the EAC group (63.3%, 95% CI: 54-72). Mild or moderate side-effects were significantly more common in the EAM group (70%) compared to the RAC (36.6%), RAM (43.3%), and EAC (56.6%) groups (P = 0.03). From our results, we conclude that moxifloxacine-containing triple therapies have neither eradication nor compliance advantages over standard triple therapies. Further studies with new antibiotic associations are needed for the better eradication of H. pylori in developing regions of the world.
Asunto(s)
Amoxicilina/uso terapéutico , Antiinfecciosos/uso terapéutico , Antiulcerosos/uso terapéutico , Compuestos Aza/uso terapéutico , Bismuto/uso terapéutico , Esomeprazol/uso terapéutico , Infecciones por Helicobacter/tratamiento farmacológico , Quinolinas/uso terapéutico , Ranitidina/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Amoxicilina/efectos adversos , Antiinfecciosos/efectos adversos , Antiulcerosos/efectos adversos , Compuestos Aza/efectos adversos , Bismuto/efectos adversos , Pruebas Respiratorias , Claritromicina/efectos adversos , Claritromicina/uso terapéutico , Quimioterapia Combinada , Esomeprazol/efectos adversos , Femenino , Fluoroquinolonas , Humanos , Masculino , Persona de Mediana Edad , Moxifloxacino , Proyectos Piloto , Estudios Prospectivos , Quinolinas/efectos adversos , Ranitidina/efectos adversos , Ranitidina/uso terapéutico , Resultado del Tratamiento , Adulto JovenRESUMEN
We present a 78-yr-old man with appendicular metastases from pancreatic adenocarcinoma. Barium enema X-ray showed incomplete filling of a distended appendix in a patient with abdominal discomfort. Colonoscopic evaluation revealed firm nodules in appendicular orifice. Histopathological examination of the nodule in the appendix revealed a metastatic adenocarcinoma. Abdominal computed tomography showed a low-density mass in the body of the pancreas. Endoscopic ultrasonography disclosed a hypoechoic mass in the body of the pancreas. Appendicular metastasis is extremely rare. To our knowledge, this is the second case of adenocarcinoma of the pancreas metastatic to the appendix in English language literature. A brief review of relevant literature is presented.