Evaluation of various laboratory techniques to diagnose Helicobacter pylori in patients with upper gastro-intestinal tract symptoms.

Helicobacter (Campylobacter) pylori is strongly associated with type B gastritis. The detection of H. pylori, which entails histological examination and culture of gastric biopsy specimens, takes several days. There has been much interest in developing more rapid tests, including non-invasive ones. Using histology and/or culture as the 'gold standard', several methods to detect H. pylori were compared and evaluated. The organism was detected in 84 of 100 consecutive patients attending the Gastrointestinal Unit of King Edward VIII Hospital for upper gastrointestinal tract endoscopy. Histological examination was the most sensitive (98%) and specific (100%) method used in detecting H. pylori in gastric biopsy specimens. An enzyme-linked immunosorbent assay to detect specific IgG antibodies to whole H. pylori organisms is a moderately sensitive (82%), non-invasive method but it is nonspecific (38%). Although culture was specific (100%), it was less sensitive (68%) than histological examination. The 'conventional' urease assays must be performed under controlled conditions (37 degrees C) for optimal results (sensitivity, 71%).

Incidence of Campylobacter pylori in patients with upper gastro-intestinal symptoms.

Antral mucosal biopsy specimens were examined microbiologically and histologically for the presence of Campylobacter pylori in 224 patients with upper gastrointestinal symptoms. The gastric mucosa of 183 patients (82%) were found to harbour C. pylori. C. pylori was strongly associated with the presence of histological gastritis (93%) and was detected in only 10% of 30 patients in whom histological examination of gastric biopsy specimens was negative. Endoscopically diagnosed duodenal lesions were more strongly associated with the presence of C. pylori than gastric lesions (P less than 0.001). The histological demonstration of spiral bacteria in biopsy specimens was a more sensitive method for the diagnosis of C. pylori than culture (80% v. 65%).

Pirenzepine and cimetidine for duodenal ulcers. A comparative randomised double-blind controlled study.

A double-blind controlled trial was undertaken to compare the relative effectiveness of pirenzepine (Gastrozepin; Boehringer Ingelheim) and cimetidine (Tagamet; SK & F) in healing endoscopically proven duodenal ulcers. Thirty patients with duodenal ulcers were treated with pirenzepine 50 mg twice daily and 30 patients with cimetidine 400 mg twice daily. Endoscopy was repeated after 4 weeks. Ulcers healed completely in 15 patients on pirenzepine and 21 patients on cimetidine (chi-square test 3.05; P less than 0.1); this difference was not significant. Treatment resulted in endoscopic improvement in 25 patients on pirenzepine and in 26 patients on cimetidine; this difference was also not statistically significant (chi-square test 1.18; P less than 0.5). No adverse effects were seen with cimetidine. Mild and reversible side-effects were seen in 4 patients on pirenzepine. The efficacy of pirenzepine appears similar to that of cimetidine in the healing of duodenal ulcers.

A comparative study of misoprostol and ranitidine in the healing of duodenal ulcers. A double-blind controlled trial.

This study was undertaken to evaluate the safety and therapeutic efficacy of the prostaglandin E1 analogue, misoprostol, when compared with ranitidine in the healing of duodenal ulcers. Sixty patients with endoscopically proven duodenal ulcers participated in a double-blind controlled randomised trial comparing misoprostol 400 microgram and ranitidine 150 mg, both given twice daily orally for up to 8 weeks. Patient characteristics at entry into the trial were similar in the two treatment groups, except that there were 6 women in the ranitidine-treated group and none in the misoprostol-treated group. Ulcers were 0.3 - 2.0 cm in length. Healing was determined by endoscopy at 4 weeks; if ulcers were not healed, endoscopy was repeated at 8 weeks. All patients were given antacid tablets to be used as needed for pain up to a maximum of 8 tablets per day. Healing rates at 4 weeks for a total of 58 evaluate patients in the two treatment groups were: misoprostol (15/29; 51.7%) and ranitidine (20/29; 69.0%). Healing rates at 8 weeks for a total of 55 evaluable patients in the two treatment groups were: misoprostol (21/27; 77.8%) and ranitidine (24/28; 85.7%). The healing rate for misoprostol did not differ significantly from that for ranitidine at both the 4-week (P = 0.28) and the 8-week assessment (P = 0.68). Diarrhoea was the most common side-effect but was usually mild. It occurred in 11 patients on misoprostol and 1 patient on ranitidine. These results indicate that misoprostol 400 micrograms was taken twice daily orally for up to 8 weeks is effective and safe for the treatment of duodenal ulcer.

Double-blind placebo-controlled evaluation of one year therapy with sucralfate in healed duodenal ulcer.

Forty patients with duodenal ulcer, considered healed at endoscopy, were entered in a double-blind trial and treated for up to one year with sucralfate, 500 mg before breakfast, lunch, supper and 1000 mg on retiring, or with placebo. The subjects were interviewed and endoscopy was performed at 0, 3, 6, 9 and 12 months or at any time if pain recurred and they returned to the clinic. On relapse, the patients were withdrawn from trial. The remission rate maintained by sucralfate was superior to that achieved by placebo. The difference was significant (p less than 0.05) at 6 months (64% vs. 27%) and at 12 months (56% vs. 18%). No important side effects were noted.

Pirenzepine, cimetidine and placebo in the long-term treatment of duodenal ulceration. A comparative study.

Sixty patients with endoscopically proven healed duodenal ulcers were treated for a year with either pirenzepine (Gastrozepin; Boehringer Ingelheim) 100 mg daily, cimetidine 400 mg at night, or placebo, The monthly relapse rate (patients per month) in the first 3 months (pirenzepine 2,3, cimetidine 2,3, placebo 3,0) and in the next 9 months (pirenzepine 0,33, cimetidine 0,44, placebo 0,56) is lower for pirenzepine and cimetidine than for placebo. This trend is in favour of pirenzepine and cimetidine as effective means of keeping duodenal ulcers in remission. Asymptomatic relapses were also less common with pirenzepine (50%) and cimetidine (45%) than with placebo (64%). No serious side-effects of pirenzepine were observed during the trail.

Bone-pointing: a modern entity.

This article seeks to create an awareness of the manner in which our society in general, albeit unconsciously, negatively influences the disease by an erroneous and unnecessarily pessimistic attitude to cancer. It is a plea for a change in our irrational beliefs about cancer, which form a striking analogy to the phenomenon of the tribal aboriginal's custom of bone-pointing.