Comparison of 1-week vs. 2- or 4-week therapy regimens with ranitidine bismuth citrate plus two antibiotics for Helicobacter pylori eradication.

BACKGROUND: Helicobacter pylori eradication therapies based on ranitidine bismuth citrate have recently been introduced in clinical practice. AIM: To compare the efficacy of three regimens containing ranitidine bismuth citrate given for 1, 2 and 4 weeks, combined with two antibiotics for the first week, in the eradication of H. pylori. METHODS: Eighty-six consecutive patients (50 duodenal ulcer disease, 36 non-ulcer dyspepsia) with H. pylori infection were offered three eradication regimens: (a) 1-week group (n=28), ranitidine bismuth citrate 400 mg b.d. for 7 days; (b) 2-week group (n=29), ranitidine bismuth citrate 400 mg b.d. for 14 days; and (c) 4-week group (n=29), ranitidine bismuth citrate 400 mg b.d. for 28 days. In all patients, clarithromycin 500 mg b.d. and metronidazole 500 mg b.d. were given for the first week. Endoscopy was repeated 1 month after the end of treatment and eradication was considered to be successful if both rapid urease test and histology were negative. RESULTS: Overall, H. pylori was eradicated in 84% (72/86) patients on intention-to-treat analysis, whereas the per protocol cure rate was 89% (72/81). Eradication rates were 23/27 (85%) (95% confidence interval (CI): 66-96%), 25/27 (92%) (95% CI: 76-99%) and 24/27 (89%) (95% CI: 71-98%) in the 1-, 2- and 4-week groups, respectively, on per protocol analysis, and 25/28 (82%) (95% CI: 63-94%), 25/29 (86%) (95% CI: 68-96%) and 24/29 (83%) (95% CI: 64-94%), respectively, on intention-to-treat analysis (P > 0.05, N.S.). No significant differences were observed between groups concerning duodenal ulcer healing, resolution of symptoms and adverse effects. CONCLUSIONS: The 1-week regimen with ranitidine bismuth citrate, clarithromycin and metronidazole is effective in H. pylori eradication. Prolongation of treatment with ranitidine bismuth citrate for 2 or 4 weeks does not achieve a statistically significant more favourable outcome.

Prevalence and risk factors associated with specialized intestinal metaplasia at the esophagogastric junction.

BACKGROUND/AIMS: Specialized intestinal metaplasia around the esophagogastric junction is considered to be premalignant. The aim of this study was to examine prospectively the prevalence of metaplasia and to correlate its presence with clinical, endoscopic and histological findings. METHODOLOGY: In 101 symptomatic patients (40 women, 61 men; mean age: 55 yr, range: 20-79 yr), biopsies were taken from gastric type mucosa just distal to the esophagogastric junction. They were stained with hematoxylin and eosin and alcian blue-periodic acid Schiff for the detection of specialized intestinal metaplasia and inflammation of the cardiac mucosa (carditis) and with Warthin-Starry for H. pylori presence. RESULTS: Metaplasia was detected in 27 patients (26.7%). Multiple logistic regression analysis revealed that metaplasia was associated significantly with age (odds ratio, 2.8; 95% confidence interval, 1.2-6.6), endoscopic suspicion of short segment Barrett's esophagus (odds ratio, 3.6; 95% confidence interval 2.2-6.9), detection of H. pylori (odds ratio, 2.8; 95% confidence interval, 1.1-7) and presence of carditis (odds ratio, 6.4; 95% confidence interval, 2.8-16.8). CONCLUSIONS: The prevalence of specialized intestinal metaplasia around the esophagogastric junction is high in symptomatic patients. Age, endoscopic evidence of short segment Barrett's esophagus and histological presence of H. pylori and carditis are independent risk factors associated with its presence.

Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment.

BACKGROUND: Gastric phytobezoars represent the most common bezoars in patients with poor gastric motility. A variety of dissolution therapies and endoscopic fragmentation techniques have been evaluated as conservative treatment so as to avoid surgery. AIM: To investigate the effectiveness of Coca-Cola for gastric phytobezoars dissolution. METHODS: We performed a systematic search to identify publications on gastric phytobezoars to assess the efficacy of Coca-Cola as a dissolution therapy. Diospyrobezoars, formed after persimmon ingestion, are a distinct type of phytobezoars characterized by their hard consistency. Thus, these two subgroups of bezoars were compared in terms of successful dissolution. RESULTS: Over a 10-year period (2002-2012), 24 papers including 46 patients have been published. In 91.3% of the cases, phytobezoar resolution with Coca-Cola administration was successful, either as a single treatment (50%) or combined with further endoscopic techniques, whereas only 4 patients underwent surgery. Phytobezoars were more likely to dissolve after initial attempt with Coca-Cola compared with diospyrobezoars (60.6% vs. 23%, P = 0.022). CONCLUSIONS: Coca-Cola alone is effective in gastric phytobezoar dissolution in half of the cases and, combined with additional endoscopic methods, is successful in more than 90% of them.

Correlation between esophageal contraction amplitude and lower esophageal sphincter pressure in patients with nutcracker esophagus.

Nutcracker esophagus (NE) is a primary esophageal motility disorder characterized by high-wave amplitude at the distal esophagus. The aim of this study was to analyze patients with NE and determine the relationship between distal esophageal contraction amplitude and lower esophageal sphincter (LES) pressure. Esophageal manometry tracings of patients with NE, defined as the presence of distal contraction amplitude of more than 182 mmHg after wet swallow, were analyzed. LES pressure was measured as the mean end-expiratory value. Spearman's correlation coefficient analysis was used to compare esophageal contraction amplitude with LES pressure. This comparison was also performed in patients with isolated hypertensive LES (HLES) and in subjects with normal manometry. Forty patients (25 female, 15 male; mean age 54 years) with NE were included in the study. Mean (SD) distal esophageal contraction amplitude was 230 (35.7) mmHg and mean LES pressure was 27.3 (5.7) mmHg. Esophageal contraction amplitude showed a positive correlation with LES pressure (r = 0.49, P < 0.01). In contrast, no correlation was found in patients with HLES (r = 0.21, P > 0.05) and in those with a normal manometric study (r = 0.18, P > 0.05). It is concluded that in patients with nutcracker esophagus a positive correlation exists between distal esophageal contraction amplitude and LES pressure, suggesting a diffuse hypertensive pattern involving smooth muscle at the distal esophagus and adjacent LES.