Ranitidine bismuth citrate plus clarithromycin 7-day regimen is effective in eradicating Helicobacter pylori in patients with duodenal ulcer.

BACKGROUND: No clinical study has been performed to-date to evaluate the efficacy of the dual therapy of ranitidine bismuth citrate (RBC) plus clarithromycin (C) 500 mg b.d. given for 7 days for the eradication of H. pylori. AIM: To assess the eradication rates achieved by treatment with RBC 400 mg b.d. for 28 days combined with clarithromycin 500 mg b.d. for 7 days in H. pylori-positive duodenal ulcer patients. METHODS: One hundred and twelve H. pylori-positive patients with endoscopically proven active duodenal ulcer were included in a multicentre, open, randomized trial. H. pylori infection was initially detected by CLO-test and histology on antral and corpus biopsies, and by 13C-urea breath test (UBT). Patients were included if at least two of the tests were positive for H. pylori infection. Patients were randomized to receive RBC 400 mg b.d. for 4 weeks combined with clarithromycin 500 mg b.d. for the first 7 days (Group A) or 14 days (Group B). A second endoscopy was performed at least 28 days after the end of therapy for the assessment of ulcer healing and H. pylori infection. Eradication was assumed if all the tests (CLO-test, histology and UBT) were negative for H. pylori. RESULTS: Fifty patients in Group A and 55 in Group B were assessed for H. pylori eradication and ulcer healing. The eradication rates according to intention-to-treat analysis were 75% in Group A and 80% in Group B. Considering only those patients with evaluable data at least 28 days after the end of therapy, H. pylori eradication was achieved in 84% and 82% in Group A and B, respectively. No statistically significant difference in eradication was found between the two groups by Mantel-Haenszel test. Only one patient, in Group A, was withdrawn because of adverse events (epigastric pain and pruritus).

Gastric mucosal infiltration by Helicobacter pylori favours bacterial survival after treatment.

BACKGROUND: Although a number of patient and bacterial factors have been identified as predictors of treatment failure in Helicobacter pylori-associated gastritis, the causes of lack of response to treatment have not been fully elucidated. We hypothesized that bacterial infiltration of the gastric mucosa might be one of the factors responsible for treatment failure in patients harbouring the bacterium. METHODS: We studied 182 patients with gastritis who underwent anti-H. pylori treatment with different drugs. Gastric biopsies obtained at endoscopy, were examined for electron microscopic features of infiltration and damage. Patients were assigned to different treatment groups, and endoscopy, evaluation of H. pylori status and electron microscopy were repeated at least 4 weeks after the end of treatment. RESULTS: The overall H. pylori eradication rate was 65%. Eradication was achieved more frequently in patients without electron microscopic features of infiltration (85%), than in those patients with the bacteria deeply embedded into the gastric mucosa (45%; P < 0.0001). No treatment appeared to be clearly superior for patients with the highest degree of mucosal infiltration. CONCLUSIONS: Bacterial mucosal infiltration may facilitate the survival of H. pylori during antibacterial treatment; moreover, electron microscopy may be helpful to identify patients potentially unresponsive to anti-H. pylori treatment.

Bacterial mucosal infiltration in Helicobacter pylori-associated gastritis: histological and clinical consequences.

OBJECTIVES: We wished to demonstrate that gastric epithelial cells infiltration by HP is associated with the active inflammatory response and the severity of gastritis in the gastric antrum of patients harboring the bacterium. METHODS: We studied 129 patients with HP-associated gastritis and 60 HP-negative controls with gastritis of different origin. Gastric mucosal biopsies were obtained from all subjects at endoscopy and were examined for histological features of active inflammation and type of gastritis, as well as for electronmicroscopical features of invasion and damage, according to a four-degree classification (range 0-3). RESULTS: At entry, the presence of acute inflammatory activity, defined according to the presence of a polymorphonuclear cell infiltrate, was significantly greater in HP-positive patients than in controls (p < 0.00001) and was well related to the depth of mucosal invasion (p < 0.001). Accordingly, the prevalence of chronic atrophic gastritis was higher in HP-positive patients (p < 0.02 vs. controls) and at grade 3 of invasion (p < 0.04 vs. grade 1 and 2). Peptic ulcers were more frequent in grade 3 patients (p < 0.04). CONCLUSION: Gastric epithelial cell infiltration and damage by HP, as assessed by electron microscopy, is an important feature of HP-associated gastritis due to its histological and clinical correlates.

Omeprazole, bismuth and clarithromycin in the sequential treatment of Helicobacter pylori infection.

AIMS: To assess the therapeutic potential of clarithromycin, a new macrolide with high anti-Helicobacter pylori activity, given with bismuth salts and omeprazole in different regimens aimed at simplifying the treatment of H. pylori-related gastritis. METHODS: Eighty-eight patients with proven H. pylori infection and gastritis were treated with one of the following four regimens: omeprazole 40 mg/day for one week (group A, n = 14); omeprazole 40 mg/day for one week followed by clarithromycin 1 g/day for 2 weeks (group B, n = 26); omeprazole 40 mg/day for one week followed by tripotassium dicitrato bismuthate 480 mg/day and clarithromycin 1 g/day, both for two weeks (group C, n = 26); and tripotassium dicitrato bismuthate 480 mg/day and clarithromycin 1 g/day for two weeks (group D, n = 22). Presence of H. pylori, histology and electron microscopy were assessed at entry and four weeks after the end of each treatment. RESULTS: Omeprazole alone had no effect on H. pylori status. The highest eradication rate was obtained in group C patients (81%), a proportion significantly greater than that observed in group B (50%, P < 0.03) or group D patients (55%, P < 0.05). CONCLUSION: Sequential treatment may be a useful option in the treatment of H. pylori-related gastritis.

Five-year maintenance treatment with ranitidine: effects on the natural history of duodenal ulcer disease.

In this study, we assessed the effect of a 5-yr maintenance program with ranitidine on the natural history of duodenal ulcer disease both during treatment and after drug withdrawal. Two groups of patients with duodenal ulcer were studied. In group A patients (n = 40), ranitidine (150 mg/day) was given continuously for 5 yr; group B patients (n = 40), received seasonal, 8-wk prophylactic treatment with ranitidine (300 mg/day), in spring and fall. Routine endoscopy was performed every year and whenever ulcer symptoms recurred. After the 5-yr study, the drug was discontinued in both groups, and patients underwent endoscopy after 3, 6, 12, and 18 months. The probability of duodenal ulcer recurrence was significantly lower in patients continuously receiving ranitidine (p < 0.001), and ulcer complications were significantly lesser in group A patients (p < 0.03). In the 18 months of follow-up after drug discontinuation, only 15% (4/26) of patients of group A relapsed, whereas ulcer recurrence was diagnosed in 84% (26/32) of group B patients (p < 0.001). We conclude that low-dose continuous treatment with ranitidine is preferable to seasonal prophylaxis for its ability to modify the natural history of duodenal ulcer disease.

La rubéola y complicaciones neurológicas agudas en el pre-escolar y escolar. / Rubella and acute neurologic complications in preschoolers and schoolboys.

A raíz de una epidemia de rubéola, se estudia en el Servicio de Neuropediatría del Instituto Nacional de Salud del Niño de Lima, una casuística de 36 pacientes pre-escolares y escolares con manifestaciones neurológicas severas. Las formas clínicas más frecuentes fueron meningoenecefalitis y encefalitis con transtornos de conciencia y crisis convulsivas generalizadas. En forma poco frecuente o aislada se presentaron casos de cerebelitis, de meningitis, de meningo-panencefalitis sub-aguda y de poliradiculoneuritis. En el 94% de los casos las manifestaciones neurológicas se instalaron en forma rápida, el curso de la enfermedad fue agudo, la evolución corta y el pronóstico inmediato bueno.En un paciente con manengoencefalitis subaguda, la afección inicialmente aguda progresó durante 6 semanas para luego remitir en el lapso de 3 meses y medio, y en un niño con poliradiculoneuritis la mejoría fue discreta en el curso de un mes de observación. Los examenes auxiliares mostraron en el 78% de los pacientes una elevación de 4 veces el título basal de anticuerpos; en los líquidos cefalo-raquídeos de las meningoencefalitis y meningitis un aumento de proteínas y de células generalmente a predominio de linfocitos; en los hemogramas en la etapa aguda, leucocitos con neutrofilia y desviación izquierda y los electroencefalogramas de 8 pacientes registros anormales que no guardaron correlación con la evolución clínica. El diagnóstico se basó en el antecedente epidemiológico de rubéola, en el cuadro clínico y/o en la determinación de anticuerpos específicos por el método de inhibición de la hemaglutinación.

Meningitis meningococica en Lima Metropolitana: aspectos epidemiológicos y clínicos / Meningococcal Meningitis in Lima city: A clinical and epidemiological approach

En Lima Metropolitana la meningitis meningocócica era endémica, presentándose casos en forma aislada y muy esporádica. Desde el año 1982 se nota un incremento persistente, cuyo riesgo hemos considerado importante analizar mediante un estudio epidemiológico y clínico de los 50 casos de meningitis meningocócica, atendido en el quinquenio de 1§ de octubre de 1978 a 30 de setiembre de 1983 en 10 hospitales de Lima y Callao. Para determinar el riesgo epidemiológico se estudiaron la presentación de los casos por meses y períodos anuales y distritos de procedencia. Para conocer la población más afectada se realizaron los análisis estadísticos por grupos etáreos y se calcularon las tasas de incidencia, mortalidad y razón de letalidad. En el aspecto clínico se estudiaron las manifestaciones más importantes, enfatizándose en el aspecto neurológico y purpúrico. Se llegó a la conclusión que existe una epidemia con elevada letalidad en lactantes y un incremento muy significativo de morbilidad en escolares, adolescentes y adultos