Helicobacter pylori in South America.

Helicobacter pylori is the most common chronic bacterial infection in humans. In less developed nations, e.g., most South American countries, the prevalence of H pylori infection ranges from 70% to 90% of the population. In these countries there is rapid acquisition of the infection in early life, due to poor sanitation, low standards of living conditions and an increased rate of H pylori infection. The management of H pylori infection in South America is outlined.

Five-day bismuth-free triple therapy for the eradication of Helicobacter pylori and reduction of duodenal ulcer relapse.

Previous studies have demonstrated that the eradication of Helicobacter pylori (H. pylori) is associated with a significant reduction of the rate of duodenal ulcer (DU) relapse. The aim of this study was to assess the long-term effect of a bismuth-free triple therapy on the eradication of H. pylori and reduction of DU relapse. After informed consent, 61 patients with endoscopically proven DU and H. pylori infection detected on 14C-urea breath test (BT) were included in the study. All patients received a combination of furazolidone, amoxicillin, and metronidazole, three times a day, for 5 days, in addition to eventual classical antiulcer agents prescribed by their attending physicians. BT was repeated after an interval of at least 60 days to evaluate H. pylori eradication. Endoscopy and another BT were performed again at 6.5 months after therapy to detect possible recurrences. Forty-eight patients completed the trial: 26 (54%) patients were negative for H. pylori at 6.5 months after the end of treatment, and 22 (46%) persisted H. pylori positive. Ninety-two percent of the patients in whom the bacteria were eradicated showed endoscopically healed ulcers and were asymptomatic, and two that were symptomatic presented only occasional pain not requiring therapy. Among the 22 patients who persisted H. pylori positive, six (27%) showed endoscopically active ulcers (p = 0.012) and eight (36%) patients continued to be symptomatic (p less than 0.01), and were still using antiulcer drugs (p = 0.002) 6.5 months after treatment. It is concluded that combined treatment with furazolidone, amoxicillin, and metronidazole for 5 days represents a well-tolerated, inexpensive, and effective therapeutic regime for the eradication of H. pylori and abolition of DU relapse in more than 50% of the patients during a follow-up period of 6.5 months.

[Furazolidone and cimetidine in patients with active duodenal ulcer and Helicobacter pylori in the gastric antrum]. / Furazolidona x cimetidina em pacientes portadores de úlcera duodenal ativa e Helicobacter pylori no antro gástrico.

In order to assess the effect of furazolidone on duodenal ulcer disease and Helicobacter pylori (Hp), a double-blind, double-dummy, randomized, prospective pilot study comparing furazolidone and cimetidine was carried out in 31 antral Hp positive patients with endoscopically proven active duodenal ulcer. Clinical, endoscopical, bacteriological and histological studies were done before and at four weeks of the study in all patients. If the ulcer was not healed, the treatment was extended for a further four weeks and all the procedures repeated. The healed ulcer patients were followed-up and re-endoscoped, regardless the presence of symptomatology, at least at 3 and 6mo after the end of treatment. It was observed that furazolidone cleared Hp (18% x 0%), healed the ulcer (91% x 87%) and reduced the relapse rate (30% x 92%; p < 0.025).

[Single nocturnal dose of ranitidine in the treatment of duodenal ulcer: results of an open multicenter, comparative trial]. / Ranitidina em dose única noturna no tratamento da úlcera duodenal. Resultado de um estudo aberto, multicêntrico, comparativo.

This prospective multicentric randomized open trial was designed to evaluate the efficacy of ranitidine 150 mg bid vs 300 mg nocte in the short-term (4 weeks) treatment of duodenal ulcer in 15 Brazilian centers. On the basis of a randomization table 190 patients with endoscopically confirmed duodenal ulcer were allocated to receive either ranitidine 150 mg bid (94 pts) or 300 mg nocte (96 pts). The 2 treatment groups were well matched for age, sex, duration of ulcer disease, number and size of ulcers, duration of current episode, intensity of ulcer pain, alcohol and coffee intake and smoking habits. They were endoscopically controlled at the end of the 4 weeks. At 4 weeks 78 of 94 patients (83.0%) had their ulcers healed with the 150 mg bid regimen as opposed to 79 of 96 patients (82.3%) allocated to the 300 mg nocte dosage. This difference was not statistically significant. Ulcer symptoms diminished with treatment in both groups. The tolerability and compliance was excellent in both groups. The results show that ranitidine 300 mg nocte is as effective in the short-term treatment of duodenal ulcer as ranitidine 150 mg bid. Considering the greater simplicity of administration enhancing patient compliance, the treatment with 300 mg nocte is preferable.

Campylobacter pyloridis in the upper gastrointestinal tract: a Brazilian study.

The successful isolation of C. pyloridis from human gastric mucosa has renewed interest in these bacteria and their role as a causative agent for gastritis, and possible causal relationship between chronic gastritis and peptic ulceration. To determine the incidence of C. pyloridis in gastric biopsies we studied 51 consecutive Brazilian patients with a wide range of alimentary disorders presenting for endoscopy. At least three biopsies were taken from each site: antrum, any ulcer or cancer. Microbiological and histological studies were performed to identify the bacteria. The organism was found in 40/51 (78%) of patients. These was a close correlation between culture (100%), Gram (90%) and Gimenez staining (80%) in identifying the bacteria. All C. pyloridis positive patients had histological evidence of antral chronic gastritis (active or quiescent) even if the endoscopic appearance looked normal. All peptic ulcer patients (n = 17) showed C. pyloridis in the antrum. In the duodenum the bacteria were mainly seen in gastric type of mucosa. Our findings support the hypothesis that C. pyloridis is etiologically related to gastritis and possibly peptic ulceration.

[Effect of an antacid containing calcium on gastric acid secretion, in patients with duodenal ulcer]. / Efeito de antiácido contendo cálcio sobre a secrecão gástrica de ácido, em pacientes com úlcera duodenal.

In eight fasting men with duodenal ulcer disease, oral administration of therapeutic dose of 49,5 mEq of neutralizing potency of either sodium bicarbonate or a preparation of calcium hidroxogluconaluminate did not produce significant increase in gastric acid secretion above basal levels for 90 minutes. This data support the conclusion that this specific antacid-containing calcium preparation does not stimulate the gastric secretion of acid.

[Gastric mucosal changes induced by the augmented Histalog test: endoscopic and histopathological study]. / Alteracões da mucosa gástrica provocadas pelo teste aumentado do Histalog: estudo endoscópico e histopatológico.

A prospective study of the effects of maximal doses of betazol hydrochloride ( Histalog ) on the endoscopic and histologic findings of the gastric mucosa of volunteers was made. Of the 11 patients examined, no alteration was seen on gastroscopic examination after Histalog in three, slight to moderate congestion of the mucosa in six and scattered oozing bleeding points in two. The study of the histologic findings revealed no statistical significant difference in the recurrence of erosion, hemorrhage and edema in the antrum and body gastric mucosa, before and after the administration of Histalog . It was concluded that maximal doses of Histalog cause no significant hemorrhage in the mucosa of the stomach and that the brown colour frequently seen in the gastric secretions of the final portions of a Histalog test is to be attributed to trauma to the mucosa by the nasogastric tube and to Histalog induced congestion of the mucosa.

[Effect of the dietary fiber content in nutrition on various stool parameters, in man]. / Influencia do teor de fibra dietética da alimentação sobre alguns parâmetros feciais, no homem.

Ten subjects were studied for two periods of six days each during which they were fed respectively a regular diet (control diet) followed by a fiber-supplemented diet (experimental diet). The experimental diet consisted of a regular diet in which some foods where substracted and some bran biscuits, specially produced for this investigation, were added. The experimental diet produced a significant increase in daily stool weight, dried stool weight, water contents of the stools and intestinal transit time. The study has shown that special bran biscuits is effective in promoting a increase in bowel transit time, and therefore should be submitted to therapeutic trial in patients with constipation.

Endoscopic findings after antacid, cimetidine and placebo for peptic ulcer--importance of staging the lesions.

Ninety four adult outpatients entered a randomized trial in which 30 patients were treated openly with antacid hourly and 64 patients with a double-blind regimen of either cimetidine (1 g/day) or placebo. After 4 weeks, 66.3% of the antacid-treated patients, 56.2% of the cimetidine-treated patients and 9.4% of the placebo patients showed ulcer healing. The difference between cimetidine and antacid was not statistically significant. The low percentage in the placebo group as compared to other trials may be attributed to the avoidance of supplementary antacid in this group and or to the criterion of staging the lesions both for entry into study and for evaluating the results.

Effect of clebopride on lower esophageal sphincter pressure.

In 12 individuals without gastrointestinal symptoms, the IV administration of metoclopramide and of clebopride produced both a significant increase on the lower esophageal sphincter pressure. The increase induced by clebopride was significantly higher than that induced by metoclopramide. The tolerability of clebopride was satisfactory with just mild drowsiness being noted in most cases.