Eradication rate and adherence with high-dose amoxicillin and proton pump inhibitor as first-line treatment for Helicobacter pylori infection: Experience from University Hospital in Chile.

INTRODUCTION: In Chile, more than 70% of adults are infected by Helicobacter pylori. Clarithromycin should not be used in any regimen if there is >15% resistance to this antibiotic, being greater than 26% in our population. In this scenario, the effectiveness of triple therapy (proton pump inhibitor [PPI], clarithromycin, amoxicillin) was only 63.8%. AIM: To evaluate the eradication rate and safety of dual therapy (esomeprazole and amoxicillin) in high doses, through a prospective, observational, and descriptive study. METHODS: Patients with a positive urease test obtained in an upper digestive endoscopy were included. Any other previous H. pylori eradication regimen were excluded. All patients were treated with esomeprazole 40 mg three times a day and amoxicillin 750 mg four times a day for 14 days. The eradication rate of the dual therapy was evaluated with the H. pylori stool antigen test (the Pylori-Strip® test used) 6 weeks after completing the eradication treatment and with at least 14 days without PPI, being a negative result, confirmation of the effectiveness of this regimen. RESULTS: Of 122 patients, 106 had a negative H. pylori antigen in stool; The intention-to-treat and per protocol analysis, the eradication rates were 91.8% [95% CI: 87%-97%] and 94% [95% CI: 90%-98%], respectively. Four patients discontinued treatment due to adverse effects. Smoking and adherence to treatment were associated with eradication rate. CONCLUSIONS: In this cohort of patients with H. pylori infection, high-dose dual therapy has a high eradication rate and good adherence, raising the possibility that it could be used as first-line therapy in our country. Studies with a larger number of patients should confirm these results.

Fístula duodeno-cólica benigna: reporte de un caso y revisión del tema / Benign duodenal-colic fistula: a case report and subject review

La fístula duodeno-cólica es una entidad de presentación inusual, descrita en la literatura sólo como reportes de casos aislados. Las FDC benignas son una rara complicación de numerosas enfermedades gastro-intestinales, siendo la causa más frecuente la secundaria a la enfermedad de Crohn. Dolor abdominal, signos de malabsorción (diarrea, baja de peso), asociados eventualmente a náuseas y vómitos son la forma de presentación más frecuentes. El enema baritado es el mejor método diagnosticado. El manejo debe ser integral, considerando tanto el manejo de la enfermedad de base, como el soporte nutricional y la resolución quirúrgica de la fístula. Se presenta un caso clínico de esta patología.