ABSTRACT
BACKGROUND: Since the discovery, several decades ago, of the infection of the gastric mucosa with Helicobacter pylori and its association with chronic antral gastritis and peptic ulcer, the treatment of ulcer illness has recently been revolutionized. METHODS: In this study, the clinical effectiveness of three schemes of treatment with colloidal bismuth subcitrate (CBS) were compared. Fifty-three patients suffering from gastroduodenal peptic ulcer with Helicobacter pylori were distributed randomly into three groups. Group I (n = 17) received 240 mg CBS every 12 h for 6 weeks. Group II (n = 17) received 240 mg CBS every 12 h for 6 weeks, pus metronidazole 500 mg every 8 h plus tetracycline 500 mg every 8 h for 10 days. Group III (n = 19) received 240 mg CBS every 12 h for 6 weeks, plus metronidazole 500 mg every 8 h plus amoxicillin 750 mg every 12 h for 10 days. A duodenoscopy investigation with antrum biopsy for a morphologic study and detection of the germ was carried out by means of urease test and histological study (Warthin-Sarry and hematoxylin-eosin). RESULTS: The three schemes of treatment were effective for ulcerous healing with 70.5%, 82.3%, and 78.2%, respectively, without significant differences. The highest clearing index (52.6%) was obtained in group III. CONCLUSIONS: With these treatments, the Helicobacter pylori eradication was only observed in 47.3% of the patients studied.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Anti-Ulcer Agents/therapeutic use , Gastritis/drug therapy , Helicobacter Infections/drug therapy , Helicobacter pylori/drug effects , Organometallic Compounds/therapeutic use , Peptic Ulcer/drug therapy , Amoxicillin/administration & dosage , Amoxicillin/therapeutic use , Anti-Bacterial Agents/administration & dosage , Anti-Ulcer Agents/administration & dosage , Colloids , Drug Administration Schedule , Drug Resistance, Microbial , Drug Therapy, Combination/administration & dosage , Drug Therapy, Combination/therapeutic use , Duodenal Ulcer/drug therapy , Duodenal Ulcer/etiology , Duodenoscopy , Female , Gastritis/complications , Gastroscopy , Helicobacter Infections/complications , Helicobacter pylori/isolation & purification , Humans , Male , Metronidazole/administration & dosage , Metronidazole/therapeutic use , Organometallic Compounds/administration & dosage , Peptic Ulcer/etiology , Peptic Ulcer/microbiology , Stomach Ulcer/drug therapy , Stomach Ulcer/etiology , Tetracycline/administration & dosage , Tetracycline/therapeutic use , Treatment OutcomeABSTRACT
Duodenal diverticuli has been associated with biliary stones, specially in the common bile duct. Its presence alters the anatomy of the region of the papilla difficulting its identification and cannulation. ERCP was performed in 800 patients with suspicion of bilio-pancreatic disease, 60 (7.5%) of these patients (39 male and 21 female) had juxtapapillary diverticuli (single diverticuli in 52, 2 in 7 and 3 in 1 patient). In these patient cannulation of the common bile duct was possible in 43 (72%), only the pancreatic duct in 5 (8%) and no cannulation in 12 (20%). Common bile duct stones were found in 22 patients, papillotomy was indicated in 14 patients and was performed in 12, in 2 patients it was not possible to position the papillotomy.