Usefulness of antimicrobial susceptibility in the eradication of Helicobacter pylori.

The rate of eradication of Helicobacter pylori with standard triple therapy using omeprazole, amoxicillin and clarithromycin (OAC) is unacceptable in populations with high rates of clarithromycin resistance (15-20%). The aim of this study was to compare the efficacy of 10-day OAC therapy as the first-line treatment in patients diagnosed by culture with antimicrobial susceptibility or diagnosed by a (13) C-labelled urea breath test (UBT) without antimicrobial susceptibility in an area where the clarithromycin resistance rate was 15-20%. This was a retrospective cohort study of 266 patients, recruited consecutively throughout 2008. A total of 247 H. pylori-infected patients received antibiotic therapy (221 received the 10-day OAC therapy and 26 received other regimens) of which 134 patients were diagnosed by culture of gastric samples followed by antimicrobial susceptibility testing and 113 were diagnosed by UBT. In all patients, the eradication of H. pylori was checked by UBT. The cost of eradication by 10-day OAC treatment was assessed in each patient. The success rate of 10-day OAC therapy in patients diagnosed by culture and by UBT was 88% (103/117) and 49% (51/104), respectively (p <0.0005). The treatment was also more cost-effective in the former of these two groups (€571 versus €666). To perform culture and antimicrobial susceptibility of the H. pylori isolates was a more successful and cost effective strategy than empirical 10-day OAC treatment in populations with high rates of resistance to clarithromycin.

[Seroprevalence of delta virus and hepatitis C virus in patients with chronic infection with hepatitis B virus]. / Seroprevalencia del virus delta y de la hepatitis C en pacientes con infección crónica por el virus de la hepatitis B.

OBJECTIVE: To study the prevalence of hepatitis delta and hepatitis C viruses (HDV and HCV) in patients infected with hepatitis B virus (HBV) with and without risk behaviors for the infection by these viruses and by the human immunodeficiency virus (HIV). MATERIALS AND METHODS: Clinical and serological study (January 1990-December 1992) at Medicine Service at Galdacano Hospital of 109 patients with positive hepatitis B surface antigen and without clinical or serological evidence of acute hepatitis, 60 without risk behaviors for the infection, 45 parenteral drug abusers (PDA) and 4 homosexual males. RESULTS: Chronic HDV infection was observed in 60% of PDA and more frequently among HIV-positive patients (p < 0.05). In six of these patients the serological determination of HDV-Ag was positive. Chronic HDV and HCV infection rates in patients without risk behaviors were 1.6% and 16%, respectively. Eighty-eight percent of PDA had anti-HCV; no differences were observed between HIV-positive and HIV-negative patients (p = 0.64). CONCLUSIONS: HDV was particularly associated with parenteral drug abuse, with a similar prevalence to other surveys conducted in Spain. The higher frequency of HDV and HDV-Ag among HIV-positive patients could indicate a greater susceptibility to HDV in clinical conditions associated with immunosuppression. HCV infection occurs at early stages and is common among PDA infected with HBV, with no apparent association with patient's age, years of drug abuse or HIV infection.

[Percutaneous endoscopic feeding gastrostomy. Initial experience with 6 cases]. / Gastrostomía endoscópica percutánea de alimentación. Experiencia inicial en seis casos.

Over the past two years we have performed percutaneous endoscopic feeding gastrostomy (PEFG) in 5 patients, 4 males and 1 female, aged 42 to 89. All of them suffered from either incurable or severe illness which prevented their oral feeding. PEFG was performed following the method described by Gauderer and Ponsky or traction method. Only in one case it was difficult to perform and in another case a second PEFG was needed because of unintentional catheter extraction. PEFG allowed an adequate feeding in all of the patients until their death due to underlying disorder or to other causes during the follow-up period. The complications found included ascites infection in a patient with cirrhosis and pneumoperitoneum which resolved spontaneously in another case. No mortality was observed related to the procedure.

Clinical value of the determination of fasting glycocholic acid serum levels in patients with liver diseases. A comparison with standard liver tests.

Fasting serum levels of glycocholic acid were measured in 142 patients with benign diffuse liver diseases. A total of 63.4% of the whole group of patients, 86.6% of the cirrhotic patients and 31.7% of the noncirrhotic patients had increased serum levels of glycocholic acid. There were significant correlations with blood liver tests associated with liver disease severity such as prothrombin activity and albumin. There were highly significant differences in glycocholic acid levels according to the histological severity of the liver disease, especially when patients with cirrhosis or chronic active hepatitis were compared to the remaining patients and controls. However, discriminant analysis showed that prothrombin activity and albumin were better than glycocholic acid in predicting the histological severity of liver disease. Glycocholic acid serum levels were relatively independent of cholestasis and cytolysis and appeared to be more linked to liver dysfunction. In conclusion, fasting glycocholic acid measurement can be useful in the evaluation and follow-up of liver diseases as a marker of histological severity, and used in addition to other liver tests.