Quadruple therapies show a higher eradication rate compared to standard triple therapy for Helicobacter pylori infection within the LEGACy consortium. A multicenter observational study in European and Latin American countries.

INTRODUCTION: Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations. OBJECTIVE: To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America. METHODS: A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms. RESULTS: 772 patients were incorporated (64.64% females; mean age of 52.93 years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success. CONCLUSIONS: Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents.

Prucaloprida: enterocinético selectivo como una nueva alternativa en el tratamiento del estreñimiento crónico / Prucalopride: selective enterokinetic as a new alternative in the treatment of chronic constipation

El estreñimiento crónico es un problema de salud frecuente que afecta a todos los grupos de edad, genera pobre calidad de vida en quienes lo padecen, e impacta de manera negativa en los sistemas de salud de países desarrollados como en aquellos en vías de desarrollo. La definición de estreñimiento se basa en la objetividad de la frecuencia de las deposiciones como también en lo subjetivo de los síntomas asociados a este trastorno como son pujo, sensación de evacuación incompleta o heces duras. El tratamiento incluye modificaciones en el estilo de vida, ejercicio aeróbico, mayor ingesta de agua y fibra, laxantes y el uso de estimulantes de la motilidad o procinéticos. Una novedosa alternativa es prucaloprida, un enterocinético selectivo agonista de los receptores 5HT4 de serotonina, que incrementa el reflejo peristáltico y desencadena las contracciones musculares de alta amplitud sobre el intestino grueso promoviendo la deposición. La prucaloprida, ha demostrado ser eficaz y seguro en pacientes adultos y adultos mayores con estreñimiento crónico.

Chronic constipation is a common health problem that affects all ages, generates poor quality of life, and impacts negatively on the health systems of developed and developing countries. The definition of constipation is based on the objectivity of stool frequency as well as in the subjective symptoms associated with this disorder like straining, sensation of incomplete evacuation or hard stools. The treatment includes changes in lifestyle, aerobic exercise, increased intake of water and fiber, laxatives and the use of motility stimulants or prokinetics. A novel alternative is the enterokinetic prucalopride, a selective 5HT4 serotonin agonist, which increases the peristaltic reflex and triggers high amplitude muscle contractions of the colon promoting intestinal deposition. Prucalopride has proven efficacy and safety in adults including elderly patients with chronic constipation.

Validación de método simplificado de la prueba en aliento con urea-13C para diagnóstico de infección por Helicobacter pylori / Validation of a simplified method of the 13C urea breath test for diagnosis

Objetivo: validar un método simplificado de la prueba enaliento con urea-13C (PAU-13Cs) para el diagnóstico de infecciónpor Helicobacter pylori (H. pylori), con administración simultáneade 50 mg de urea-13C y 2 g de ácido cítrico.Material y métodos: se estudiaron 88 pacientes (49 mujeresy 39 hombres); con promedio de edad 45 ± 15 años, referidospara endoscopia gastrointestinal y toma de biopsias. La PAU-13Csse realizó en ayuno. Se recolectaron las muestras de aire espiradoen tubos de cristal de 10 ml, antes y 30 minutos después de administrarsimultáneamente 50 mg de urea-13C y 2 g de ácido cítricodisueltos en 200 ml de agua. Las muestras se analizaron por espectrometríade masas. El diagnóstico de infección se considerócuando el cultivo y/o la biopsia y serología fueron positivas paraH. pylori.Resultados: cincuenta y un pacientes (57,95%) fueron positivos,30 (34,10%) negativos para H. pylori y 7 (7,95%) casos seconsideraron indeterminados. La sensibilidad, especificidad, valorpredictivo positivo y negativo de PAU-13Cs fue de 90,2, 93,3,95,8 y 84,8%, respectivamente. Con exactitud de 91,4%.Conclusión: la administración simultánea de 50 mg de urea-13C y 2 g de ácido cítrico, representa una alternativa para el diagnósticono invasivo de infección por H. pylori, debido a que conservala certeza diagnóstica de la PAU-13C

Objective: to validate a simplified 13C-urea breath test (13CUBT)method for the diagnosis of H. pylori infection.Material and methods: patients referred for gastrointestinalendoscopy and biopsy were included, and a 13C-UBT was performedafter a 6-hour fast. Breath samples were collected in 10ml glass tubes before and 30 min after the simultaneous administrationof 50 mg of 13C-urea and 2 g of citric acid in 200 ml ofwater. All breath samples were analyzed using isotope ratio massspectrometry. The diagnosis of H. pylori infection was establishedwith a positive culture and/or positive histology and serology.Results: eighty-eight patients were included, 49 female and39 male with a mean age of 45 ± 15 yrs. Fifty-one patients(57.95%) were positive and 30 (34.1%) negative for H. pylori.Seven cases (7.95%) were considered undetermined. The sensitivity,specificity, positive predictive value, and negative predictivevalue for 13C-UBT were 90.2, 93.3, 95.83, and 84.8%, respectively.Accuracy was 91.4%.Conclusions: the simultaneous administration of 50 mg of13C-urea and 2 g of citric acid represents an alternative for thenon-invasive diagnosis of H. pylori infection